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Geiger Y, van Oppen P, Visser H, Eikelenboom M, van den Heuvel OA, Anholt GE. Long-term remission rates and trajectory predictors in obsessive-compulsive disorder: Findings from a six-year naturalistic longitudinal cohort study. J Affect Disord 2024; 350:877-886. [PMID: 38266929 DOI: 10.1016/j.jad.2024.01.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 11/29/2023] [Accepted: 01/14/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND This naturalistic study, utilizing data from the Netherlands Obsessive-Compulsive Disorder Association (NOCDA) cohort, investigated the long-term remission rates and predictors of different trajectories of obsessive-compulsive disorder (OCD) within a clinical population. METHODS A sample of 213 participants was classified into three illness trajectories: "Chronic," "Episodic, "and "Remitted-OCD." Long-term remission rates were calculated based on three follow-up measurements over a 6-year period. A multinomial logistic regression model, incorporating five selected predictors with high explanatory power and one covariate, was employed to analyze OCD trajectory outcomes. RESULTS The long-term full remission rates, calculated from all the measurements combined (14%), were significantly lower than what was observed in earlier studies and when compared to assessments at each individual follow-up (∼30%). Moreover, high baseline symptom severity and early age of onset were identified as significant risk factors for a chronic course of OCD, while male sex and younger age predicted a more favorable trajectory. Notably, the likelihood of an episodic course remained high even without identified risk factors. LIMITATIONS The bi-annual data collection process is unable to capture participants' clinical conditions between assessments. Additionally, no data was collected regarding the specific type and duration of psychological treatment received. Regarding the type of treatment participants received. CONCLUSIONS Results suggest that long-term remission rates may be lower than previously reported. Consequently, employing multiple assessment points in longitudinal studies is necessary for valid estimation of long-term full remission rates. The results emphasize the importance of personalized clinical care and ongoing monitoring and maintenance for most OCD cases.
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Affiliation(s)
- Yuval Geiger
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Patricia van Oppen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health research institute and GGZ inGeest Specialized Mental Health Care, the Netherlands.
| | - Henny Visser
- Innova Research Centre, Mental Health Care Institute GGZ Centraal, Ermelo, the Netherlands.
| | - Merijn Eikelenboom
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health research institute and GGZ inGeest Specialized Mental Health Care, the Netherlands.
| | - Odile A van den Heuvel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy and Neurosciences, Amsterdam Neuroscience, the Netherlands.
| | - Gideon E Anholt
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Tibi L, van Oppen P, van Balkom AJ, Eikelenboom M, Visser H, Anholt GE. Predictors of the 6-year outcome of obsessive-compulsive disorder: Findings from the Netherlands Obsessive-Compulsive Disorder Association study. Aust N Z J Psychiatry 2023; 57:1443-1452. [PMID: 37183408 DOI: 10.1177/00048674231173342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Obsessive-compulsive disorder is characterized by a chronic course that can vary between patients. The knowledge on the naturalistic long-term outcome of obsessive-compulsive disorder and its predictors is surprisingly limited. The present research was designed to identify clinical and psychosocial predictors of the long-term outcome of obsessive-compulsive disorder. METHODS We included 377 individuals with a current diagnosis of obsessive-compulsive disorder, who participated in the Netherlands Obsessive Compulsive Disorder Association study, a multicenter naturalistic cohort study. Predictors were measured at baseline using self-report questionnaires and clinical interviews. Outcome was assessed using the Yale-Brown Obsessive Compulsive Scale at 2-, 4- and 6-year follow-up. RESULTS The overall course of obsessive-compulsive disorder was characterized by two prominent trends: the first reflected an improvement in symptom severity, which was mitigated by the second, worsening trend in the long term. Several determinants affected the course variations of obsessive-compulsive disorder, namely, increased baseline symptom severity, late age of onset, history of childhood trauma and autism traits. CONCLUSION The long-term outcome of obsessive-compulsive disorder in naturalistic settings was characterized by an overall improvement in symptom severity, which was gradually halted to the point of increased worsening. However, after 6 years, the severity of symptoms remained below the baseline level. While certain determinants predicted a more favorable course, their effect diminished over time in correspondence to the general worsening trend. The results highlight the importance of a regular and continuous monitoring for symptom exacerbations as part of the management of the obsessive-compulsive disorder, regardless of the presence of putative predictors.
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Affiliation(s)
- Lee Tibi
- Cognetica: The Israeli Center for Cognitive Behavioral Therapy, Tel-Aviv, Israel
| | - Patricia van Oppen
- Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center/GGZ InGeest, Amsterdam, The Netherlands
| | - Anton Jlm van Balkom
- Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center/GGZ InGeest, Amsterdam, The Netherlands
| | - Merijn Eikelenboom
- Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center/GGZ InGeest, Amsterdam, The Netherlands
| | - Henny Visser
- Mental Health Care Institute GGZ Centraal, Amsterdam, The Netherlands
| | - Gideon E Anholt
- Department of Psychology, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Elsman EBM, van Munster EPJ, van Nassau F, Verstraten P, van Nispen RMA, van der Aa HPA. Perspectives on Implementing the Patient Health Questionnaire-4 in Low-Vision Service Organizations to Screen for Depression and Anxiety. Transl Vis Sci Technol 2022; 11:16. [PMID: 35024786 PMCID: PMC8762693 DOI: 10.1167/tvst.11.1.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To describe the process of implementing a screening questionnaire for depression and anxiety, the Patient Health Questionnaire-4 (PHQ-4), in low-vision service (LVS) organizations. Methods This study consisted of three parts: (1) a usability study combined with semistructured interviews, in which clients (n = 10) of LVS organizations expressed their preference for using the PHQ-4; (2) a feasibility study, in which the PHQ-4 was implemented on a small scale and its use was evaluated, involving health care providers (n = 6) and clients (n = 9); and (3) semistructured interviews to identify barriers and facilitators for implementing the PHQ-4 according to health care providers (n = 6) and managers (n = 4) of LVS organizations. Results were integrated into themes and linked to constructs of the Consolidated Framework for Implementation Research (CFIR). Results Six themes were derived from the substudies: (1) quality of the intervention, (2) applicability for clients of LVS organizations, (3) attitude and needs of clients, (4) attitude of health care providers, (5) support within LVS organizations, and (6) embedment in current practice. Results could be linked to 12 CFIR constructs. The constructs "relative advantage," "patient needs and resources," and "available resources" emerged most prominently in our themes as either barrier or facilitator. Conclusions The PHQ-4 seems an appropriate screening instrument for use in LVS organizations because of its quality and adaptable use. It might provide opportunities to timely detect depression and anxiety, but challenges in implementing the PHQ-4 should be considered. Translational Relevance Barriers and facilitators for implementing the PHQ-4 may also apply to implementing other questionnaires in LVS organizations.
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Affiliation(s)
- Ellen B M Elsman
- Department of Ophthalmology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Edine P J van Munster
- Department of Ophthalmology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Expertise Innovation Knowledge, Robert Coppes Foundation, Vught, The Netherlands
| | - Femke van Nassau
- Department of Public and Occupational Health, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Peter Verstraten
- Expertise Innovation Knowledge, Robert Coppes Foundation, Vught, The Netherlands
| | - Ruth M A van Nispen
- Department of Ophthalmology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Hilde P A van der Aa
- Department of Ophthalmology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Expertise Innovation Knowledge, Robert Coppes Foundation, Vught, The Netherlands
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Ha KM. Conceptualization of Major Stakeholders in Emergency Management of Childcare Facilities. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2020; 17:514-526. [PMID: 32573377 DOI: 10.1080/26408066.2020.1768192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study aims to conceptualize the key stakeholders in emergency management of childcare facilities for applicable nations by referring to the Korean case. Qualitative content analysis is the main methodology used. Unique features are gathered from the Korean literature on childcare facilities and then summarized; however, universal principles from the English language literature on international childcare facilities are emphasized. The analysis of five major stakeholders in Korean childcare facilities, namely, governments, community personnel, parents, childcare providers, and children, shows that their current efforts are directed only at general safety management. Multi-hazard management or an integrated approach in terms of social work is thus provided as an alternative for not only Korea but also other nations.
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Affiliation(s)
- Kyoo-Man Ha
- Department of Public Policy and Management, Pusan National University , Busan, Korea
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van der Aa HPA, van Rens GHMB, Bosmans JE, Comijs HC, van Nispen RMA. Economic evaluation of stepped-care versus usual care for depression and anxiety in older adults with vision impairment: randomized controlled trial. BMC Psychiatry 2017; 17:280. [PMID: 28764679 PMCID: PMC5539614 DOI: 10.1186/s12888-017-1437-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 07/20/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A stepped-care program was found effective in preventing depressive and anxiety disorders in older adults with vision impairment. However, before a decision can be made about implementation, the cost-effectiveness of this program should be investigated. Therefore, we aimed to compare the cost-effectiveness of stepped-care versus usual care within low vision rehabilitation. METHODS An economic evaluation from a societal perspective was performed alongside a multicenter randomized controlled trial. Data were collected by masked assessors during 24 months. Included were 265 older adults with vision impairment and subthreshold depression and/or anxiety. They were randomly assigned to stepped-care plus usual care (n = 131) or usual care alone (n = 134). Stepped-care comprised 1) watchful waiting, 2) guided self-help based on cognitive behavioral therapy, 3) problem solving treatment, and 4) referral to a general practitioner. Costs were based on direct healthcare costs and indirect non-healthcare costs. Main outcome measures were quality-adjusted life years (QALYs) and the cumulative incidence of major depressive, dysthymic and/or anxiety disorders. Secondary outcomes were symptoms of depression and anxiety. RESULTS Based on intention-to-treat, significant differences were found in the incidence of depressive/anxiety disorders (mean difference 0.17; 95% CI 0.06 to 0.29) and symptoms of anxiety (mean difference 1.43, 95% CI 0.10 to 2.77) in favor of stepped-care versus usual care; no significant difference was found for QALYs and symptoms of depression. Societal costs were non-significantly lower in the stepped-care group compared with the usual care group (mean difference: -€877; 95% confidence interval (CI): -8039 to 5489). Cost-effectiveness acceptability curves showed that the probability of cost-effectiveness was 95% or more at a willingness-to-pay of €33,000 per disorder prevented. The probability that stepped-care was cost-effective compared to usual care was 59% or more for a ceiling ratio of 0 €/QALY and increased to 65% at 20000 €/QALY. CONCLUSIONS This economic evaluation shows that stepped-care is dominant to usual care, with a probability of around 60%, due to its clinical superiority and its modest cost savings. However, it depends on the willingness-to-pay of decision makers whether or not stepped-care is considered cost-effective compared with usual care. TRIAL REGISTRATION identifier: NTR3296 , date: 13-02-2012.
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Affiliation(s)
- Hilde P. A. van der Aa
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Ophthalmology and the Amsterdam Public Health Research Institute, VU University Medical Centre, De Boelelaan 1117, 1081 Amsterdam, HV The Netherlands
| | - Ger H. M. B. van Rens
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Ophthalmology and the Amsterdam Public Health Research Institute, VU University Medical Centre, De Boelelaan 1117, 1081 Amsterdam, HV The Netherlands ,0000 0004 0409 6003grid.414480.dDepartment of Ophthalmology, Elkerliek Hospital, Wesselmanlaan 25, 5707 Helmond, HA The Netherlands
| | - Judith E. Bosmans
- 0000 0004 1754 9227grid.12380.38Department of Health Sciences and the Amsterdam Public Health Research Institute, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1105, 1081 Amsterdam, HV The Netherlands
| | - Hannie C. Comijs
- Department of Psychiatry VUmc/GGZinGeest, A.J.Ernststraat 1187, 1081 Amsterdam, HL The Netherlands
| | - Ruth M. A. van Nispen
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Ophthalmology and the Amsterdam Public Health Research Institute, VU University Medical Centre, De Boelelaan 1117, 1081 Amsterdam, HV The Netherlands
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van der Aa HPA, van Rens GHMB, Comijs HC, Margrain TH, Gallindo-Garre F, Twisk JWR, van Nispen RMA. Stepped care for depression and anxiety in visually impaired older adults: multicentre randomised controlled trial. BMJ 2015; 351:h6127. [PMID: 26597263 PMCID: PMC4655616 DOI: 10.1136/bmj.h6127] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
STUDY QUESTION Is stepped care compared with usual care effective in preventing the onset of major depressive, dysthymic, and anxiety disorders in older people with visual impairment (caused mainly by age related eye disease) and subthreshold depression and/or anxiety? METHODS 265 people aged ≥50 were randomly assigned to a stepped care programme plus usual care (n=131) or usual care only (n=134). Supervised occupational therapists, social workers, and psychologists from low vision rehabilitation organisations delivered the stepped care programme, which comprised watchful waiting, guided self help based on cognitive behavioural therapy, problem solving treatment, and referral to a general practitioner. The primary outcome was the 24 month cumulative incidence (seven measurements) of major depressive dysthymic and/or anxiety disorders (panic disorder, agoraphobia, social phobia, and generalised anxiety disorder). Secondary outcomes were change in symptoms of depression and anxiety, vision related quality of life, health related quality of life, and adaptation to vision loss over time up to 24 months' follow-up. STUDY ANSWER AND LIMITATIONS 62 participants (46%) in the usual care group and 38 participants (29%) from the stepped care group developed a disorder. The intervention was associated with a significantly reduced incidence (relative risk 0.63, 95% confidence interval 0.45 to 0.87; P=0.01), even if time to the event was taken into account (adjusted hazard ratio 0.57, 0.35 to 0.93; P=0.02). The number needed to treat was 5.8 (3.5 to 17.3). The dropout rate was fairly high (34.3%), but rates were not significantly different for the two groups, indicating that the intervention was as acceptable as usual care. Participants who volunteered and were selected for this study might not be representative of visually impaired older adults in general (responders were significantly younger than non-responders), thereby reducing the generalisability of the outcomes. WHAT THIS STUDY ADDS Stepped care seems to be a promising way to deal with depression and anxiety in visually impaired older adults. This approach could lead to standardised strategies for the screening, monitoring, treatment, and referral of visually impaired older adults with depression and anxiety. FUNDING, COMPETING INTERESTS, DATA SHARING Funded by ZonMw InZicht, the Dutch Organisation for Health Research and Development-InSight Society. There are no competing interests. Full dataset and statistical code are available from the corresponding author.Study registration www.trialregister.nl NTR3296.
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Affiliation(s)
- Hilde P A van der Aa
- Department of Ophthalmology and EMGO+ Institute for Health and Care Research (EMGO+), VU University Medical Centre, 1081 HV, Amsterdam, Netherlands
| | - Ger H M B van Rens
- Department of Ophthalmology and EMGO+ Institute for Health and Care Research (EMGO+), VU University Medical Centre, 1081 HV, Amsterdam, Netherlands
| | - Hannie C Comijs
- Department of Psychiatry VUmc/GGZinGeest, 1081HL Amsterdam, Netherlands
| | - Tom H Margrain
- School of Optometry and Vision Sciences, Cardiff University, Cardiff CF24 4HQ, United Kingdom
| | - Francisca Gallindo-Garre
- Department of Epidemiology and Biostatistics, VU University Medical Centre, 1081 HV, Amsterdam, Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Centre, 1081 HV, Amsterdam, Netherlands
| | - Ruth M A van Nispen
- Department of Ophthalmology and EMGO+ Institute for Health and Care Research (EMGO+), VU University Medical Centre, 1081 HV, Amsterdam, Netherlands
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van der Aa HPA, Krijnen-de Bruin E, van Rens GHMB, Twisk JWR, van Nispen RMA. Watchful waiting for subthreshold depression and anxiety in visually impaired older adults. Qual Life Res 2015; 24:2885-93. [PMID: 26085328 PMCID: PMC4615663 DOI: 10.1007/s11136-015-1032-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2015] [Indexed: 12/21/2022]
Abstract
Purpose Immediate treatment of depression and anxiety may not always be necessary in resilient patients. This study aimed to determine remission rates of subthreshold depression and anxiety, incidence rates of major depressive and anxiety disorders, and predictors of these remission and incidence rates in visually impaired older adults after a three-month ‘watchful waiting’ period. Methods A pretest–posttest study in 265 visually impaired older adults (mean age 74 years), from outpatient low-vision rehabilitation services, with subthreshold depression and/or anxiety was performed as part of a randomised controlled trial on the cost-effectiveness of a stepped-care intervention. An ordinal logistic regression analysis was conducted. Main outcome measures were: (1) subthreshold depression and anxiety measured with the Centre for Epidemiologic Studies Depression Scale (CES-D) and the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), and (2) depressive and anxiety disorders measured with the Mini International Neuropsychiatric Interview. Results After a three-month watchful waiting period, depression and anxiety decreased significantly by 3.8 (CES-D) and 1.4 points (HADS-A) (p < 0.001). Of all participants, 34 % recovered from subthreshold depression and/or anxiety and 18 % developed a depressive and/or anxiety disorder. Female gender [odds ratio (OR) 0.49, 95 % confidence interval (CI) 0.28–0.86], more problems with adjustment to vision loss at baseline (OR 1.02, 95 % CI 1.00–1.03), more symptoms of depression and anxiety at baseline (OR 1.06, 95 % CI 1.02–1.10), and a history of major depressive, dysthymic, and/or panic disorder (OR 2.28, 95 % CI 1.28–4.07) were associated with lower odds of remitting from subthreshold depression and/or anxiety and higher odds of developing a disorder after watchful waiting. Conclusions Watchful waiting can be an appropriate step in managing depression and anxiety in visually impaired older adults. However, female gender, problems with adjustment to vision loss, higher depression and anxiety symptoms, and a history of a depressive or anxiety disorder confer a disadvantage. Screening tools may be used to identify patients with these characteristics, who may benefit more from higher intensity treatment or a shorter period of watchful waiting.
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Affiliation(s)
- Hilde P A van der Aa
- Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- EMGO+Institute for Health and Care Research (EMGO+), VU University Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Esther Krijnen-de Bruin
- Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Ger H M B van Rens
- Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- EMGO+Institute for Health and Care Research (EMGO+), VU University Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
- Department of Ophthalmology, Elkerliek Hospital, Wesselmanlaan 25, 5707 HA, Helmond, The Netherlands.
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Ruth M A van Nispen
- Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- EMGO+Institute for Health and Care Research (EMGO+), VU University Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
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de Beurs DP, de Groot MH, de Keijser J, Mokkenstorm J, van Duijn E, de Winter RFP, Kerkhof AJFM. The effect of an e-learning supported Train-the-Trainer programme on implementation of suicide guidelines in mental health care. J Affect Disord 2015; 175:446-53. [PMID: 25679199 DOI: 10.1016/j.jad.2015.01.046] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/16/2015] [Accepted: 01/16/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Randomized studies examining the effect of training of mental health professionals in suicide prevention guidelines are scarce. We assessed whether professionals benefited from an e-learning supported Train-the-Trainer programme aimed at the application of the Dutch multidisciplinary suicide prevention guideline. METHODS 45 psychiatric departments from all over the Netherlands were clustered in pairs and randomized. In the experimental condition, all of the staff of psychiatric departments was trained by peers with an e-learning supported Train-the-Trainer programme. Guideline adherence of individual professionals was measured by means of the response to on-line video fragments. Multilevel analyses were used to establish whether variation between conditions was due to differences between individual professionals or departments. RESULTS Multilevel analysis showed that the intervention resulted in an improvement of individual professionals. At the 3 month follow-up, professionals who received the intervention showed greater guideline adherence, improved self-perceived knowledge and improved confidence as providers of care than professionals who were only exposed to traditional guideline dissemination. Subgroup analyses showed that improved guideline adherence was found among nurses but not among psychiatrists and psychologists. No significant effect of the intervention on team performance was found. LIMITATIONS The ICT environment in departments was often technically inadequate when displaying the video clips clip of the survey. This may have caused considerable drop-out and possibly introduced selection bias, as professionals who were strongly affiliated to the theme of the study might have been more likely to finish the study. CONCLUSIONS Our results support the idea that an e-learning supported Train-the-Trainer programme is an effective strategy for implementing clinical guidelines and improving care for suicidal patients. TRIAL REGISTRATION Netherlands Trial Register (NTR3092 www.trialregister.nl).
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Affiliation(s)
- Derek P de Beurs
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
| | - Marieke H de Groot
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
| | | | - Jan Mokkenstorm
- GGZ Foundation for Mental Health Care GGZ inGeest, The Netherlands.
| | - Erik van Duijn
- GGZ Foundation for Mental Health Care Delfland, The Netherlands.
| | - Remco F P de Winter
- GGZ Foundation for Mental Health Care, Parnassia, The Hague, The Netherlands.
| | - Ad J F M Kerkhof
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
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Hutschemaekers GJM, Tiemens BG, de Winter M. Effects and side-effects of integrating care: the case of mental health care in the Netherlands. Int J Integr Care 2007; 7:e31. [PMID: 17786180 PMCID: PMC1963472 DOI: 10.5334/ijic.198] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2005] [Revised: 12/21/2006] [Accepted: 06/04/2007] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Description and analysis of the effects and side-effects of integrated mental health care in the Netherlands. CONTEXT OF CASE Due to a number of large-scale mergers, Dutch mental health care has become an illustration of integration and coherence of care services. This process of integration, however, has not only brought a better organisation of care but apparently has also resulted in a number of serious side-effects. This has raised the question whether integration is still the best way of reorganising mental health care. DATA SOURCES Literature, data books, patients and professionals, the advice of the Dutch Commission for Mental Health Care, and policy papers. CASE DESCRIPTION Despite its organisational and patient-centred integration, the problems in the Dutch mental health care system have not diminished: long waiting lists, insufficient fine tuning of care, public order problems with chronic psychiatric patients, etc. These problems are related to a sharp rise in the number of mental health care registrations in contrast with a decrease of registered patients in first-level services. This indicates that care for people with mental health problems has become solely a task for the mental health care services (monopolisation). At the same time, integrated institutions have developed in the direction of specialised medical care (homogenisation). Monopolisation and homogenisation together have put the integrated institutions into an impossible divided position. CONCLUSIONS AND DISCUSSION Integration of care within the institutions in the Netherlands has resulted in withdrawal of other care providers. These side-effects lead to a new discussion on the real nature and benefits of an integrated mental health care system. Integration requires also a broadly shared vision on good care for the various target groups. This would require a radicalisation of the distinction between care providers as well as a recognition of the different goals of mental health care.
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Hutschemaekers GJM, van Kalmthout M. The New Integral Multidisciplinary Guidelines in the Netherlands: The perspective of person-centered psychotherapy / Die neuen integralen multidisziplinären Richtlinien in den Niederlanden: Die Perspektive der Personzentrierten Psychotherapie / Las Nuevas Guías Multidisciplinarias Integrales en los Paises Bajos. La Perspectiva de la Psicoterapia Centrada en la Persona / De nieuwe Nederlandse integrale multidisciplinaire richtlijnen in de ggz. Het perspectief van de cliëntgerichte psychotherapie. PERSON-CENTERED & EXPERIENTIAL PSYCHOTHERAPIES 2006. [DOI: 10.1080/14779757.2006.9688399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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