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Christ C, van Schaik DJF, Kikkert MJ, de Waal MM, Dozeman E, Hulstijn HL, Koomen LM, Krah IM, Schut DM, Beekman ATF, Dekker JJM. Internet-based emotion regulation training aimed at reducing violent revictimization and depressive symptoms in victimized depressed patients: Results of a randomized controlled trial. J Affect Disord 2024; 355:95-103. [PMID: 38521137 DOI: 10.1016/j.jad.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/26/2024] [Accepted: 03/09/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Depressed patients who have become victim of violence are prone to revictimization. However, no evidence-based interventions aimed at reducing revictimization in this group exist. METHODS This multicenter randomized controlled trial evaluated the effectiveness of an internet-based emotion regulation training (iERT) added to TAU in reducing revictimization, emotion dysregulation, and depressive symptoms in recently victimized, depressed patients compared to TAU alone. Adult outpatients (N = 153) with a depressive disorder who had experienced threat, physical assault, or sexual assault within the previous three years were randomly allocated to TAU+iERT (n = 74) or TAU (n = 79). TAU involved psychotherapy (mainly cognitive behavioral therapy [77.8 %]). iERT comprised six guided online sessions focused on the acquisition of adaptive emotion regulation skills. The primary outcome measure was the number of revictimization incidents at 12 months after baseline, measured with the Safety Monitor. Analyses were performed according to the intention-to-treat principle. RESULTS Both groups showed a large decrease in victimization incidents. Mixed-model negative binomial regression analyses showed that TAU+iERT was not effective in reducing revictimization compared to TAU (IRR = 0.97; 95%CI = 0.64,1.46; p = .886). Linear mixed-model analyses demonstrated that TAU+iERT yielded a larger reduction of emotion dysregulation (B = -7.217; p = .046; Cohens d = 0.33), but not depressive symptoms (B = -1.041; p = .607) than TAU. LIMITATIONS The study was underpowered to detect small treatment effects. Additionally, uptake of iERT was quite low. CONCLUSIONS Although TAU+iERT resulted in a larger decrease of emotion dysregulation than TAU alone, it was not effective in reducing revictimization and depressive symptoms. Patients' revictimization risk substantially decreased during psychotherapy.
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Affiliation(s)
- C Christ
- Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Medical Center, Department of Psychiatry, Amsterdam, the Netherlands; GGZ inGeest Specialized Mental Health Care, Department of Research and Innovation, Amsterdam, the Netherlands; Arkin Mental Health Care, Department of Research, Amsterdam, the Netherlands.
| | - D J F van Schaik
- Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Medical Center, Department of Psychiatry, Amsterdam, the Netherlands; GGZ inGeest Specialized Mental Health Care, Department of Research and Innovation, Amsterdam, the Netherlands
| | - M J Kikkert
- Arkin Mental Health Care, Department of Research, Amsterdam, the Netherlands
| | - M M de Waal
- Arkin Mental Health Care, Department of Research, Amsterdam, the Netherlands
| | - E Dozeman
- Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Medical Center, Department of Psychiatry, Amsterdam, the Netherlands; GGZ inGeest Specialized Mental Health Care, Department of Research and Innovation, Amsterdam, the Netherlands
| | - H L Hulstijn
- PuntP, Department of Affective Disorders, Arkin Mental Health Care, Amsterdam, the Netherlands
| | - L M Koomen
- Arkin BasisGGZ, Department of Primary Mental Health Care, Arkin Mental Health Care, Amsterdam, the Netherlands
| | - I M Krah
- GGZ Breburg, Department of Anxiety and Depressive Disorders, Breda, the Netherlands
| | - D M Schut
- Altrecht Mental Health Institute, Department of Anxiety and Depressive Disorders, Zeist, the Netherlands
| | - A T F Beekman
- Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Medical Center, Department of Psychiatry, Amsterdam, the Netherlands; GGZ inGeest Specialized Mental Health Care, Department of Research and Innovation, Amsterdam, the Netherlands
| | - J J M Dekker
- Arkin Mental Health Care, Department of Research, Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, Department of Clinical Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health research institute, Amsterdam, Netherlands
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Eysenbach G, Schuurmans J, Aouizerate B, Atipei Craggs M, Batterham P, Bührmann L, Calear A, Cerga Pashoja A, Christensen H, Dozeman E, Duedal Pedersen C, Ebert DD, Etzelmueller A, Fanaj N, Finch TL, Hanssen D, Hegerl U, Hoogendoorn A, Mathiasen K, May C, Meksi A, Mustafa S, O'Dea B, Oehler C, Piera-Jiménez J, Potthoff S, Qirjako G, Rapley T, Rosmalen J, Sacco Y, Samalin L, Skjoth MM, Tarp K, Titzler I, Van der Eycken E, van Genugten CR, Whitton A, Zanalda E, Smit JH, Riper H. Effectiveness of Self-guided Tailored Implementation Strategies in Integrating and Embedding Internet-Based Cognitive Behavioral Therapy in Routine Mental Health Care: Results of a Multicenter Stepped-Wedge Cluster Randomized Trial. J Med Internet Res 2023; 25:e41532. [PMID: 36735287 PMCID: PMC9938445 DOI: 10.2196/41532] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/18/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Internet-based cognitive behavioral therapy (iCBT) services for common mental health disorders have been found to be effective. There is a need for strategies that improve implementation in routine practice. One-size-fits-all strategies are likely to be ineffective. Tailored implementation is considered as a promising approach. The self-guided integrated theory-based Framework for intervention tailoring strategies toolkit (ItFits-toolkit) supports local implementers in developing tailored implementation strategies. Tailoring involves identifying local barriers; matching selected barriers to implementation strategies; developing an actionable work plan; and applying, monitoring, and adapting where necessary. OBJECTIVE This study aimed to compare the effectiveness of the ItFits-toolkit with implementation-as-usual (IAU) in implementing iCBT services in 12 routine mental health care organizations in 9 countries in Europe and Australia. METHODS A stepped-wedge cluster randomized trial design with repeated measures was applied. The trial period lasted 30 months. The primary outcome was the normalization of iCBT delivery by service providers (therapists, referrers, IT developers, and administrators), which was measured with the Normalization Measure Development as a proxy for implementation success. A 3-level linear mixed-effects modeling was applied to estimate the effects. iCBT service uptake (referral and treatment completion rates) and implementation effort (hours) were used as secondary outcomes. The perceived satisfaction (Client Satisfaction Questionnaire), usability (System Usability Scale), and impact of the ItFits-toolkit by implementers were used to assess the acceptability of the ItFits-toolkit. RESULTS In total, 456 mental health service providers were included in this study. Compared with IAU, the ItFits-toolkit had a small positive statistically significant effect on normalization levels in service providers (mean 0.09, SD 0.04; P=.02; Cohen d=0.12). The uptake of iCBT by patients was similar to that of IAU. Implementers did not spend more time on implementation work when using the ItFits-toolkit and generally regarded the ItFits-toolkit as usable and were satisfied with it. CONCLUSIONS The ItFits-toolkit performed better than the usual implementation activities in implementing iCBT services in routine practice. There is practical utility in the ItFits-toolkit for supporting implementers in developing and applying effective tailored implementation strategies. However, the effect on normalization levels among mental health service providers was small. These findings warrant modesty regarding the effectiveness of self-guided tailored implementation of iCBT services in routine practice. TRIAL REGISTRATION ClinicalTrials.gov NCT03652883; https://clinicaltrials.gov/ct2/show/NCT03652883. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-020-04686-4.
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Affiliation(s)
| | | | - Bruno Aouizerate
- Regional Reference Center for the Management and Treatment of Anxiety and Depressive Disorders, FondaMental Advanced Centre of Expertise in Resistant Depression, Deparment of General and Academic Psychiatry, Charles Perrens Hospital, Bordeaux, France
| | - Mette Atipei Craggs
- Research Unit for Digital Psychiatry, Deptartment of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Philip Batterham
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Leah Bührmann
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - Alison Calear
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | | | - Helen Christensen
- Department of Medicine, University of New South Wales, Sydney, Australia
| | | | | | - David Daniel Ebert
- Professorship Psychology & Digital Mental Health, Technical University of Munich, Munich, Germany.,HelloBetter, GET.ON Institut für Online Gesundheitstrainings GmbH, Berlin, Germany
| | - Anne Etzelmueller
- Professorship Psychology & Digital Mental Health, Technical University of Munich, Munich, Germany.,HelloBetter, GET.ON Institut für Online Gesundheitstrainings GmbH, Berlin, Germany
| | - Naim Fanaj
- Mental Health Center Prizren, Prizren, Kosovo
| | - Tracy L Finch
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - Denise Hanssen
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ulrich Hegerl
- German Depression Foundation, Leipzig, Germany.,Department of Psychiatry, Psychosomatics, and Psychotherapy, Goethe Universität, Frankfurt am Main, Germany
| | - Adriaan Hoogendoorn
- Amsterdam Public Health research institute, Amsterdam, Netherlands.,GGZ InGeest, Amsterdam, Netherlands.,Psychiatry, Amsterdam University Medical Center - location VUmc, Amsterdam, Netherlands
| | - Kim Mathiasen
- Research Unit for Digital Psychiatry, Deptartment of Clinical Research, University of Southern Denmark, Odense, Denmark.,Centre for Digital Psychiatry, Mental Health Services of Southern Denmark, Odense, Denmark
| | - Carl May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Bridianne O'Dea
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | | | - Jordi Piera-Jiménez
- Catalan Health Service, Barcelona, Spain.,Digitalization for the Sustainability of the Healthcare System DS3-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Faculty of Informatics, Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Sebastian Potthoff
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - Gentiana Qirjako
- Department of Public Health, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - Judith Rosmalen
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ylenia Sacco
- Department of Mental Health, Local Health Authority Torino 3, ASLTO3, Torino, Italy
| | - Ludovic Samalin
- Department of psychiatry, Centre Hospitalier Universitaire de Clermont-Ferrand, Expert center for bipolar disorder (Foundation FondaMental), University of Clermont Auvergne, Clermont-Ferrand, France.,Centre national de la recherche scientifique, Clermont-Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Mette Maria Skjoth
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - Kristine Tarp
- Research Unit for Digital Psychiatry, Deptartment of Clinical Research, University of Southern Denmark, Odense, Denmark.,Centre for Digital Psychiatry, Mental Health Services of Southern Denmark, Odense, Denmark
| | - Ingrid Titzler
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Claire Rosalie van Genugten
- Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health research institute, Amsterdam, Netherlands
| | - Alexis Whitton
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Enrico Zanalda
- Department of Mental Health, Local Health Authority Torino 3, ASLTO3, Torino, Italy
| | - Jan H Smit
- Amsterdam Public Health research institute, Amsterdam, Netherlands.,Psychiatry, Amsterdam University Medical Center - location VUmc, Amsterdam, Netherlands
| | - Heleen Riper
- Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health research institute, Amsterdam, Netherlands.,Psychiatry, Amsterdam University Medical Center - location VUmc, Amsterdam, Netherlands
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Schotanus AY, Dozeman E, Ikelaar SLC, van Straten A, Beekman ATF, van Nassau F, Bosmans JE, van Schaik A. Internet-delivered cognitive behavioural therapy for insomnia disorder in depressed patients treated at an outpatient clinic for mood disorders: protocol of a randomised controlled trial. BMC Psychiatry 2023; 23:75. [PMID: 36707843 PMCID: PMC9880372 DOI: 10.1186/s12888-022-04492-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/22/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Major depression is a highly prevalent disorder causing severe personal distress, and high societal costs. Patients with depression often have comorbid insomnia disorder (ID) leading to even worse personal distress and worse treatment outcomes. Recent results from a non-randomised pilot study with internet-delivered Cognitive Behavioural Therapy (CBTi) for Insomnia (I-Sleep) added to regular depression care were promising regarding feasibility and initial effects on insomnia complaints and depression. However, no randomised controlled trial (RCT) has been performed yet to access the (cost-) effectiveness of I-Sleep for depression. Therefore, this protocol article presents the design of an RCT aimed to assess the (cost-) effectiveness of I-Sleep in addition to usual care for depression compared to usual care alone in depressed patients with a comorbid Insomnia Disorder (ID) treated at outpatient clinics for mood disorders. METHODS /DESIGN: This is a multi-centre RCT with measurements at baseline and at 3, 6, 9, and 12 months of follow-up. Patients with depression and an ID are randomised to either I-Sleep treatment followed by regular depression care or to regular depression care alone. Our aim is to recruit one hundred and seventy-five patients from multiple outpatient clinics for mood disorders. The primary outcome is the change in depressive symptoms over 12 months of follow-up measured with the Patient Health Questionnaire (PHQ-9). Secondary outcomes are recovery from depression (PHQ-9), insomnia severity (Insomnia Severity Index, ISI), daily functioning (Work and Social Adjustment Scale, WSAS), general quality of life (EuroQol 5-level version, EQ-5D-5L), and societal costs (Adapted versions of the iMTA Productivity Cost Questionnaire, iPCQ and iMTA Medical Cost Questionnaire, iMCQ). DISCUSSION We hypothesize that the addition of I-Sleep to usual care will result in a significant improvement in depression treatment outcomes and quality of life as well as a decrease in healthcare and societal costs compared to usual care alone. This study is the first pragmatic RCT evaluating the effectiveness and cost-effectiveness of adding CBTi to usual care for depression. TRIAL REGISTRATION Netherlands Trial Register (NL8955). Registered on October 6th2020. https://trialsearch.who.int/Trial2.aspx?TrialID=NL8955.
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Affiliation(s)
- A. Y. Schotanus
- grid.420193.d0000 0004 0546 0540GGZ inGeest, Specialized Mental Health Care, Amsterdam, The Netherlands ,grid.12380.380000 0004 1754 9227Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands ,Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XDepartment of Health Sciences, Faculty of Science, VU University Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
| | - E. Dozeman
- grid.420193.d0000 0004 0546 0540GGZ inGeest, Specialized Mental Health Care, Amsterdam, The Netherlands ,grid.12380.380000 0004 1754 9227Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands ,Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands
| | - S. L. C. Ikelaar
- grid.420193.d0000 0004 0546 0540GGZ inGeest, Specialized Mental Health Care, Amsterdam, The Netherlands
| | - A. van Straten
- grid.12380.380000 0004 1754 9227Department of Clinical-, Neuro- and Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - A. T. F. Beekman
- grid.420193.d0000 0004 0546 0540GGZ inGeest, Specialized Mental Health Care, Amsterdam, The Netherlands ,grid.12380.380000 0004 1754 9227Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands ,Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands
| | - F. van Nassau
- grid.16872.3a0000 0004 0435 165XDepartment of Public and Occupational Health, Amsterdam UMC, VU University Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - J. E. Bosmans
- grid.420193.d0000 0004 0546 0540GGZ inGeest, Specialized Mental Health Care, Amsterdam, The Netherlands ,Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XDepartment of Health Sciences, Faculty of Science, VU University Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
| | - A. van Schaik
- grid.420193.d0000 0004 0546 0540GGZ inGeest, Specialized Mental Health Care, Amsterdam, The Netherlands ,grid.12380.380000 0004 1754 9227Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands ,Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands
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van Schaik DJF, Schotanus AY, Dozeman E, Huibers MJH, Cuijpers P, Donker T. Pilot Study of Blended-Format Interpersonal Psychotherapy for Major Depressive Disorder. Am J Psychother 2022:appipsychotherapy20210061. [DOI: 10.1176/appi.psychotherapy.20210061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Digna J. F. van Schaik
- Mental Health Program, Amsterdam Public Health, Amsterdam (all authors); GGZ inGeest Mental Health Care, Amsterdam (van Schaik, Schotanus, Dozeman); Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Huibers, Cuijpers, Donker)
| | - Amrah Y. Schotanus
- Mental Health Program, Amsterdam Public Health, Amsterdam (all authors); GGZ inGeest Mental Health Care, Amsterdam (van Schaik, Schotanus, Dozeman); Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Huibers, Cuijpers, Donker)
| | - Els Dozeman
- Mental Health Program, Amsterdam Public Health, Amsterdam (all authors); GGZ inGeest Mental Health Care, Amsterdam (van Schaik, Schotanus, Dozeman); Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Huibers, Cuijpers, Donker)
| | - Marcus J. H. Huibers
- Mental Health Program, Amsterdam Public Health, Amsterdam (all authors); GGZ inGeest Mental Health Care, Amsterdam (van Schaik, Schotanus, Dozeman); Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Huibers, Cuijpers, Donker)
| | - Pim Cuijpers
- Mental Health Program, Amsterdam Public Health, Amsterdam (all authors); GGZ inGeest Mental Health Care, Amsterdam (van Schaik, Schotanus, Dozeman); Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Huibers, Cuijpers, Donker)
| | - Tara Donker
- Mental Health Program, Amsterdam Public Health, Amsterdam (all authors); GGZ inGeest Mental Health Care, Amsterdam (van Schaik, Schotanus, Dozeman); Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Huibers, Cuijpers, Donker)
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Dozeman E, van der Lande HJ, Bet PM, Fransen K, Jager I, Jonker J, Philippo E, Reisman-Dolman J, van Schaik DJF, Scholten W, van de Velde I, Verheijen V, van der Wart M, van Zon M, Batelaan N, Vinkers CH. [Guided discontinuation of antidepressants: approach and first results of a Dutch multidisciplinary outpatient clinic]. Tijdschr Psychiatr 2022; 64:574-579. [PMID: 36349853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Discontinuation of antidepressant medication can be difficult due to withdrawal symptoms and relapse risk. Scientific evidence on the questions of who, when, and how to stop antidepressants is limited. In Amsterdam a multidisciplinary outpatient clinic was started to provide advice and guidance. AIM To substantiate the design of the clinic. Central questions relate to knowing which patients are referred, the background of their request, and their experiences with the outpatient clinic. METHOD The first 51 patients of the clinic were described on the basis of file research, in addition a survey was conducted into patient experiences. RESULTS Half of the patients <a id="_idTextAnchor005"></a>(55%) actually started discontinuation, 39% were advised not to do so (yet). Patients at the clinic had used antidepressants for an average of 10 years, and 76% had previously attempted to stop. 21% had now successfully stopped and 25% were satisfied with a lower dose. One patient relapsed during tapering. CONCLUSION So far, patients with long-term antidepressant use and multiple quit attempts have been referred. Our experiences are aimed at helping individual patients but can also result in more knowledge about who can stop at what moment, and how this should be done.
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Mol M, van Genugten C, Dozeman E, van Schaik DJF, Draisma S, Riper H, Smit JH. Why Uptake of Blended Internet-Based Interventions for Depression Is Challenging: A Qualitative Study on Therapists' Perspectives. J Clin Med 2019; 9:E91. [PMID: 31905834 PMCID: PMC7019532 DOI: 10.3390/jcm9010091] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 12/10/2019] [Accepted: 12/20/2019] [Indexed: 02/06/2023] Open
Abstract
(1) Background: Blended cognitive behavioral therapy (bCBT; online and face-to-face sessions) seems a promising alternative alongside regular face-to-face CBT depression treatment in specialized mental health care organizations. Therapists are key in the uptake of bCBT. This study focuses on therapists' perspectives on usability, satisfaction, and factors that promote or hinder the use of bCBT in routine practice; (2) Methods: Three focus groups (n = 8, n = 7, n = 6) and semi-structured in-depth interviews (n = 15) were held throughout the Netherlands. Beforehand, the participating therapists (n = 36) completed online questionnaires on usability and satisfaction. Interviews were analyzed by thematic analysis; (3) Results: Therapists found the usability sufficient and were generally satisfied with providing bCBT. The thematic analysis showed three main themes on promoting and hindering factors: (1) therapists' needs regarding bCBT uptake, (2) therapists' role in motivating patients for bCBT, and (3) therapists' experiences with bCBT; (4) Conclusions: Overall, therapists were positive; bCBT can be offered by all CBT-trained therapists and future higher uptake is expected. Especially the pre-set structure of bCBT was found beneficial for both therapists and patients. Nevertheless, therapists did not experience promised time-savings-rather, the opposite. Besides, there are still teething problems and therapeutic shortcomings that need improvement in order to motivate therapists to use bCBT.
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Affiliation(s)
- Mayke Mol
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, 1081 Amsterdam, The Netherlands; (C.v.G.); (E.D.); (D.J.F.v.S.); (S.D.); (H.R.); (J.H.S.)
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, 1081 Amsterdam, The Netherlands
| | - Claire van Genugten
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, 1081 Amsterdam, The Netherlands; (C.v.G.); (E.D.); (D.J.F.v.S.); (S.D.); (H.R.); (J.H.S.)
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, 1081 Amsterdam, The Netherlands
| | - Els Dozeman
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, 1081 Amsterdam, The Netherlands; (C.v.G.); (E.D.); (D.J.F.v.S.); (S.D.); (H.R.); (J.H.S.)
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, 1081 Amsterdam, The Netherlands
| | - Digna J. F. van Schaik
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, 1081 Amsterdam, The Netherlands; (C.v.G.); (E.D.); (D.J.F.v.S.); (S.D.); (H.R.); (J.H.S.)
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, 1081 Amsterdam, The Netherlands
| | - Stasja Draisma
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, 1081 Amsterdam, The Netherlands; (C.v.G.); (E.D.); (D.J.F.v.S.); (S.D.); (H.R.); (J.H.S.)
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, 1081 Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, 1081 Amsterdam, The Netherlands; (C.v.G.); (E.D.); (D.J.F.v.S.); (S.D.); (H.R.); (J.H.S.)
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, 1081 Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Clinical Psychology Section, Vrije Universiteit Amsterdam and the Amsterdam Public Health Research Institute, 1081 Amsterdam, The Netherlands
- Telepsychiatry and E-Mental Health, Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Jan H. Smit
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, 1081 Amsterdam, The Netherlands; (C.v.G.); (E.D.); (D.J.F.v.S.); (S.D.); (H.R.); (J.H.S.)
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, 1081 Amsterdam, The Netherlands
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Dozeman E, van Straten A, van Genugten CR, van Schaik DJF. [Guided web-based intervention for sleeping problems (I-Sleep) in depressed patients within outpatient specialist mental health care: a pilot study]. Tijdschr Psychiatr 2019; 61:683-691. [PMID: 31907912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Insomnia in depressed patients is usually targeted by medication, while cognitive behavioural treatment for insomnia (CBT-I) is the treatment of first choice. Effective online CBT-I is available but is not frequently offered in regular care.<br/> AIM: To determine the feasibility and indications for effectiveness of I-Sleep, an online CBT-I module, for uni- and bipolar depressed patients in specialised mental health care settings.<br/> METHOD: In a pilot study I-Sleep (5 sessions) was offered to all 31 patients. Patients who did not (yet) want to participate in the online intervention, and patients who were included after the intended sample size was reached, participated in the control-group. Feasibility was assessed by compliance rates and satisfaction of patients and therapists (CSQ). Effectiveness was assessed within and between groups by the Insomnia Severity Index (ISI) and the Patient Health Questionnaire (PHQ-9) at baseline and after 6 and 12 weeks.<br/> RESULTS: In the intervention group 41% completed all treatment sessions and 77% completed 3 or more sessions. Patients rated the intervention positively (CSQ 23.6, range 4-32). Sleep improved in the intervention group (Cohen's d = 1.93), as well as depression (Cohen's d=1.05). In the control group there was no significant improvement. The difference between the two groups was high and significant for sleep problems (Cohen's d = 0.99) but not for depressive symptoms.<br/> CONCLUSION: Online CBT-I is a feasible treatment option for depressed patients in mental health care settings. There are indications that CBT-I is also effective in reducing sleep problems in more severely depressed patients.
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Mol M, Dozeman E, Provoost S, van Schaik A, Riper H, Smit JH. Behind the Scenes of Online Therapeutic Feedback in Blended Therapy for Depression: Mixed-Methods Observational Study. J Med Internet Res 2018; 20:e174. [PMID: 29724708 PMCID: PMC5958280 DOI: 10.2196/jmir.9890] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In Internet-delivered cognitive behavioral therapies (iCBT), written feedback by therapists is a substantial part of therapy. However, it is not yet known how this feedback should be given best and which specific therapist behaviors and content are most beneficial for patients. General instructions for written feedback are available, but the uptake and effectiveness of these instructions in iCBT have not been studied yet. OBJECTIVE This study aimed to identify therapist behaviors in written online communication with patients in blended CBT for adult depression in routine secondary mental health care, to identify the extent to which the therapists adhere to feedback instructions, and to explore whether therapist behaviors and adherence to feedback instructions are associated with patient outcome. METHODS Adults receiving blended CBT (10 online sessions in combination with 5 face-to-face sessions) for depression in routine mental health care were recruited in the context of the European implementation project MasterMind. A qualitative content analysis was used to identify therapist behaviors in online written feedback messages, and a checklist for the feedback instruction adherence of the therapists was developed. Correlations were explored between the therapist behaviors, therapist instruction adherence, and patient outcomes (number of completed online sessions and symptom change scores). RESULTS A total of 45 patients (73%, 33/45 female, mean age 35.9 years) received 219 feedback messages given by 19 therapists (84%, 16/19 female). The most frequently used therapist behaviors were informing, encouraging, and affirming. However, these were not related to patient outcomes. Although infrequently used, confronting was positively correlated with session completion (ρ=.342, P=.02). Therapists adhered to most of the feedback instructions. Only 2 feedback aspects were correlated with session completion: the more therapists adhere to instructions containing structure (limiting to 2 subjects and sending feedback within 3 working days) and readability (short sentences and short paragraphs), the less online sessions were completed (ρ=-.340, P=.02 and ρ=-.361, P=.02, respectively). No associations were found with depression symptom change scores. CONCLUSIONS The therapist behaviors found in this study are comparable to previous research. The findings suggest that online feedback instructions for therapists provide sufficient guidance to communicate in a supportive and positive manner with patients. However, the instructions might be improved by adding more therapeutic techniques besides the focus on style and form.
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Affiliation(s)
- Mayke Mol
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Els Dozeman
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Simon Provoost
- Department of Clinical, Neuro and Developmental Psychology, Clinical Psychology Section, Vrije Universiteit Amsterdam and the Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Anneke van Schaik
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Heleen Riper
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, Amsterdam, Netherlands.,Department of Clinical, Neuro and Developmental Psychology, Clinical Psychology Section, Vrije Universiteit Amsterdam and the Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Institute of Telepsychiatry, University of Southern Denmark, Odense, Denmark
| | - Johannes H Smit
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
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Folker AP, Mathiasen K, Lauridsen SM, Stenderup E, Dozeman E, Folker MP. Implementing internet-delivered cognitive behavior therapy for common mental health disorders: A comparative case study of implementation challenges perceived by therapists and managers in five European internet services. Internet Interv 2018; 11:60-70. [PMID: 30135761 PMCID: PMC6084870 DOI: 10.1016/j.invent.2018.02.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Internet-delivered cognitive behavior therapy programs have been developed and evaluated in randomized controlled trials during the past two decades to alleviate the rising demand for effective treatment of common mental health disorders such as anxiety and depression. While most of the research on internet-based cognitive behavior therapy (iCBT) has focused on efficacy and effectiveness only little attention has been devoted to the implementation of iCBT. The aim of this study was to identify the main implementation challenges perceived by therapists and managers involved in the practical operation of iCBT services in routine care settings in five European countries. METHOD The study was designed as a multiple comparative case study to explore differences and similarities between five different iCBT services in Sweden, Norway, Denmark, The Netherlands and Scotland. Field visits were carried out to each of the five services including interviews with the management of the service (n = 9), focus group interviews with key staff (n = 15) and demonstration of online programs. The data material was processed through thematic, comparative analysis. RESULTS The analysis generated four transversal themes: 1) integration in the mental health care system; 2) recruitment of patients; 3) working practice of therapists; and 4) long-term sustainability of service. The main results concerned the need to address the informal integration in the health care systems related to the perceived skepticism towards iCBT from GPs and face-to-face therapists, the role of referral models and communication strategies for the stable recruitment of patients, the need for knowledge, standards and material for the training of therapists in the provision of online feedback, the need to improve the possibilities to tailor programs to individual patients, and the need for considerate long-term sustainability planning of the transitions from local projects to permanent regional or national services. CONCLUSION The present study gives an overview of the main implementation challenges regarding the practical operation of iCBT services perceived by the therapists and managers of the iCBT services. Future studies into specific details of each challenge will be important to strengthen the evidence base of iCBT and to improve uptake and implementation of iCBT in routine care.
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Affiliation(s)
- Anna Paldam Folker
- University of Southern Denmark, National Institute of Public Health, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Kim Mathiasen
- University of Southern Denmark, Department of Psychology, Campusvej 55, 5230 Odense M, Denmark
- Mental Health Services of Southern Denmark, Centre for Telepsychiatry, Heden 11, 5000 Odense C, Denmark
| | - Sigurd Mørk Lauridsen
- University of Southern Denmark, National Institute of Public Health, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Ellen Stenderup
- Mental Health Services of Southern Denmark, Centre for Telepsychiatry, Heden 11, 5000 Odense C, Denmark
| | - Els Dozeman
- GGZ inGeest, onderzoek en innovatie, Locatie Oldenaller, Oldenaller 1, Postbus 74077, 1070 BB Amsterdam, Netherlands
| | - Marie Paldam Folker
- Mental Health Services of Southern Denmark, Centre for Telepsychiatry, Heden 11, 5000 Odense C, Denmark
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Dozeman E, Verdonck-de Leeuw IM, Savard J, van Straten A. Guided web-based intervention for insomnia targeting breast cancer patients: Feasibility and effect. Internet Interv 2017; 9:1-6. [PMID: 30135831 PMCID: PMC6096207 DOI: 10.1016/j.invent.2017.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/17/2017] [Accepted: 03/21/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Insomnia is highly prevalent in breast cancer (BRC) patients, but non-pharmacological treatment is not widely available. The aim of this preliminary study was to investigate whether guided cognitive behavioral therapy via the Internet (I-CBT) is a feasible and effective solution for this undertreated condition in BRC patients, and to investigate who benefits most. METHODS An existing evidence based I-CBT sleep intervention (I-Sleep) was adapted for BRC patients. An open mixed methods design was used including qualitative interviews and pre- and post-test questionnaires measuring sleep, fatigue, daily functioning, and psychological distress. RESULTS 100 of the 171 participants (59%) completed the intervention fully and participants highly valued the intervention (7.5 out of 10). Large to small pre-post effect sizes were found on insomnia severity (d = 1.33) fatigue (d = 0.24), and daytime functioning (d = 0.30). Younger patients and patients with more severe insomnia at baseline benefited most from the intervention. CONCLUSION The I-CBT intervention I-Sleep is feasible, well-accepted, and effective for BRC patients who suffer from insomnia, especially for younger patients and those with more severe insomnia.
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Affiliation(s)
- Els Dozeman
- Faculty of Behavioral and Movement Sciences, Department of Clinical- developmental- and neuro Psychology, Vrije Universiteit Amsterdam, The Netherlands
- EMGO Institute for Health Care and Research, VU University Medical Centre, Amsterdam, The Netherlands
- Department of psychiatry, GZ inGeest, Amsterdam, The Netherlands
| | - Irma M. Verdonck-de Leeuw
- Faculty of Behavioral and Movement Sciences, Department of Clinical- developmental- and neuro Psychology, Vrije Universiteit Amsterdam, The Netherlands
- EMGO Institute for Health Care and Research, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
- Vumc Cancer Center Amsterdam, The Netherlands
| | - Josée Savard
- School of Psychology, Université Laval, Quebec, Quebec, Canada
- Laval University Cancer Research Center, Quebec, Quebec, Canada
| | - Annemieke van Straten
- Faculty of Behavioral and Movement Sciences, Department of Clinical- developmental- and neuro Psychology, Vrije Universiteit Amsterdam, The Netherlands
- EMGO Institute for Health Care and Research, VU University Medical Centre, Amsterdam, The Netherlands
- Corresponding author at: A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands
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11
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Mol M, Dozeman E, van Schaik DJF, Vis CPCD, Riper H, Smit JH. The therapist's role in the implementation of internet-based cognitive behavioural therapy for patients with depression: study protocol. BMC Psychiatry 2016; 16:338. [PMID: 27716108 PMCID: PMC5045637 DOI: 10.1186/s12888-016-1045-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 09/20/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Internet-based Cognitive Behavioural Therapy (iCBT) for the treatment of depressive disorders is innovative and promising. Various studies have demonstrated large effect sizes up to 2.27, but implementation in routine practice lags behind. Mental health therapists play a significant role in the uptake of internet-based interventions. Therefore, it is interesting to study factors that influence the therapists in whether they apply internet-based therapy or not. This study, as part of the European implementation project MasterMind, aims to identity the factors that promote or hinder therapists in the use of iCBT in depression care. METHODS/DESIGN The uptake of iCBT by therapists in routine mental health care practice for the treatment of depression will be evaluated by a mixed method approach, to provide an understanding of the implementation factors (quantitative), and to ascertain the facilitating and hindering factors in the involvement of therapists in the implementation of iCBT (qualitative). The involvement of therapists in the implementation of iCBT is analysed following the RE-AIM framework on the five dimensions Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance. This enables us to evaluate the reach of therapists, the impact of iCBT on depression care, the extent to which therapists adopt iCBT, the extent to which iCBT is delivered as intended, and how iCBT can be maintained over time. DISCUSSION The results will provide valuable insight into the role of therapists in the implementation of iCBT for depression in secondary mental health care settings. They will result in concrete recommendations for how therapists can be facilitated in implementing and up-scaling iCBT for depression.
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Affiliation(s)
- Mayke Mol
- Department of Research & Innovation, GGZ inGeest, A.J. Ernststraat 1187, 1081 HL, Amsterdam, The Netherlands. .,EMGO Institute for Health Care and Research and Department of Psychiatry, VU University Medical Centre, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
| | - Els Dozeman
- Department of Research & Innovation, GGZ inGeest, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands ,EMGO Institute for Health Care and Research and Department of Psychiatry, VU University Medical Centre, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Digna J. F. van Schaik
- Department of Research & Innovation, GGZ inGeest, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands ,EMGO Institute for Health Care and Research and Department of Psychiatry, VU University Medical Centre, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Christiaan P. C. D. Vis
- EMGO Institute for Health Care and Research and Department of Psychiatry, VU University Medical Centre, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands ,Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Research & Innovation, GGZ inGeest, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands ,EMGO Institute for Health Care and Research and Department of Psychiatry, VU University Medical Centre, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands ,Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Jan H Smit
- Department of Research & Innovation, GGZ inGeest, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands ,EMGO Institute for Health Care and Research and Department of Psychiatry, VU University Medical Centre, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
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12
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van Schaik DJF, Dozeman E, van Marwijk HWJ, Stek ML, Smit F, Beekman ATF, van der Horst HE. Preventing depression in homes for older adults: are effects sustained over 2 years? Int J Geriatr Psychiatry 2014; 29:191-7. [PMID: 23737075 DOI: 10.1002/gps.3989] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 05/02/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the 2-year effects of a stepped-care programme to prevent the onset of a major depressive disorder (MDD) in older people living in residential homes. METHODS A 2-year follow-up study of a pragmatic randomised controlled trial was conducted in 14 residential homes in the Netherlands. A total of 185 residents (Center for Epidemiologic Studies Depression Scale score >7), who did not meet the diagnostic criteria for MDD, were randomised to a stepped-care programme (n = 93) or to usual care (n = 92). Stepped-care participants sequentially underwent watchful waiting, a self-help intervention, life review and a consultation with the general practitioner. The primary outcome measure was the incidence of MDD during a period of 2 years, according to the Mini International Neuropsychiatric Interview. RESULTS After 2 years, the incidence of MDD was not significantly reduced in the intervention group compared with the control group (incidence rate ratio: 0.98; 95% confidence interval (CI) [0.54, 1.81]). However, in the completer analysis, on the basis of 79 residents who completed the 2-year measurements, there was a significant difference in favour of the intervention group (incidence rate ratio: 0.53; 95% CI [0.32, 0.87]). Dropout percentages were high (44%), mostly accounted for by illness and death (68%). CONCLUSION A minority of residents had benefit from the intervention that sustained after 2 years in the completer group. Yet, these findings cannot be generalised as the majority of the residents did not opt for participation in the project and many dropped out. Ways should be sought to motivate residents with depressive symptoms to engage in preventive interventions.
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Affiliation(s)
- Digna J F van Schaik
- Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
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13
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Bosmans JE, Dozeman E, van Marwijk HWJ, van Schaik DJF, Stek ML, Beekman ATF, van der Horst HE. Cost-effectiveness of a stepped care programme to prevent depression and anxiety in residents in homes for the older people: a randomised controlled trial. Int J Geriatr Psychiatry 2014; 29:182-90. [PMID: 23765874 DOI: 10.1002/gps.3987] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 04/24/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Depression and anxiety are common in residents of elderly homes. Both disorders have negative effects on functioning, well-being and health-care utilisation. Besides treatment, prevention can be an option to reduce the burden of mental disorders. The objective of this study was to evaluate the cost-effectiveness of a stepped care programme to prevent the onset of depression and anxiety disorders in residents of elderly homes compared with usual care from a societal perspective. METHODS Outcomes were incidence of depression and/or anxiety, severity of depressive and anxiety symptoms and quality-adjusted life years. Health-care utilisation was measured during interviews. Multiple imputation was used to impute missing cost and effect data. Uncertainty around cost differences and incremental cost-effectiveness ratios was estimated using bootstrapping. Cost-effectiveness planes and acceptability curves were created. RESULTS The incidence of depression and anxiety combined in the intervention group was not reduced in comparison with the usual care group. There was also no effect on the other outcomes. Mean total costs in the intervention group were €838 higher than in the usual care group, but this difference was not statistically significant (95% confidence interval, -593 to 2420). Cost-effectiveness planes showed that there was considerable uncertainty. Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective in comparison with usual care was 0.46 for reducing the incidence of depression and anxiety combined. CONCLUSION A stepped care programme to prevent depression and anxiety in older people living in elderly homes was not considered cost-effective in comparison with usual care.
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Affiliation(s)
- J E Bosmans
- Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
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14
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Dozeman E, van Schaik DJF, van Marwijk HWJ, Stek ML, van der Horst HE, Beekman ATF. The center for epidemiological studies depression scale (CES-D) is an adequate screening instrument for depressive and anxiety disorders in a very old population living in residential homes. Int J Geriatr Psychiatry 2011; 26:239-46. [PMID: 20623777 DOI: 10.1002/gps.2519] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The CES-D is an instrument that is commonly used to screen for depression in community-based studies of the elderly, but the characteristics of the CES-D in a residential home population have not yet been studied. The aim of this study was to investigate the criterion validity and the predictive power of the CES-D for both depressive and anxiety disorders in a vulnerable, very old population living in residential homes. METHODS Two hundred seventy seven residents were screened with the CES-D, and subsequently interviewed with a diagnostic instrument, the Mini International Neuropsychiatric Instrument (MINI). The sensitivity, specificity, and positive and negative predictive value of the CES-D were calculated by cross-tabulation at different cut-off scores. Receiver Operating Characteristics (ROC) curves were used to assess the optimal cut-off point for each disorder and to asses the predictive power of the instrument. RESULTS In a residential home population the CES-D had satisfactory criterion validity for depressive disorders and for any combination of depressive and/or anxiety disorders. With a desired sensitivity of at least 80%, the optimal cut-off scores varied between 18 and 22. The predictive power of the CES-D in this population was best for major depression and dysthymia (Area Under the Curve, AUC 0.87), closely followed by the score for any combination of depressive and/or anxiety disorder (AUC 0.86). CONCLUSION The use of one single instrument to screen for both depression and anxiety disorders at the same time has obvious advantages in this very old population. The CES-D seems to be a suitable instrument for this purpose.
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Affiliation(s)
- Els Dozeman
- Department of General Practice, VU University Medical Center, Amsterdam, the Netherlands.
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Dozeman E, van Marwijk HWJ, van Schaik DJF, Stek ML, van der Horst HE, Beekman ATF, van Hout HP. High incidence of clinically relevant depressive symptoms in vulnerable persons of 75 years or older living in the community. Aging Ment Health 2010; 14:828-33. [PMID: 20658371 DOI: 10.1080/13607861003781817] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Clinically relevant depressive symptoms are highly prevalent in people who are 75 years of age or older. However, very old people with a vulnerable health status are under-represented in studies focussing on incidence and risk factors, while the risk of developing depressive symptoms is expected to be very high in this group. The incidence rates of clinically relevant depressive symptoms and their predictors were investigated in a vulnerable elderly population. METHODS In a community-based cohort, 651 vulnerable elderly (75+) people were identified by means of the COOP-WONCA charts (Dartmouth Coop Functional Health Assessment Charts/World Organisation of Family Doctors). To study the incidence of clinically relevant symptoms of depression and their predictors, 266 people with no symptoms (Centre for Epidemiologic Studies Depression Scale, CES-D score <16 at baseline) were selected and measured again at six and 18 months. The incidence of clinically relevant symptoms of depression was defined as a CES-D score > or =16, in combination with at least a five-point change between measurements. Logistic regression analyses were applied to determine risk indicators. RESULTS After 18 months, the incidence rate of all clinically relevant symptoms of depression was 48% (95% confidence interval, CI 44.2-51.8). No specific risk factors were identified within this population. CONCLUSION Our estimates of the incidence of depressive symptoms were considerably higher than those previously found in elderly populations living in the community. A vulnerable health status is associated with a high risk of depressive symptoms.
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Affiliation(s)
- Els Dozeman
- Department of General Practice, VU University Medical Center, Amsterdam, The Netherlands.
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Dozeman E, van Schaik DJF, van Marwijk HWJ, de Wit AE, Beekman ATF. [Screening for depression and anxiety in residential homes for the elderly]. Tijdschr Gerontol Geriatr 2008; 39:100-106. [PMID: 18637397 DOI: 10.1007/bf03078135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Elderly persons in residential homes in the Netherlands are at high risk for developing major depressive and anxiety disorders. A stepped-care protocol being used in a study for vulnerable elderly in the community may also be feasible and effective for this group. A pilot study in a residential home in Amsterdam showed more problems than expected in screening and motivating the inhabitants for this intervention protocol. This article describes the problems in our screening procedure. A personal approach, performed by familiar persons, directed at the more independent inhabitants is most likely to succeed. The need for research on effectiveness and feasibility of evidence based methods in residential care remains evident. However, the more vulnerable inhabitants need something else. For this group of inhabitants we need to look more closely to the needs and possibilities by conducting research using a qualitative design.
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Dozeman E, van Schaik DJF, Beekman ATF, Stalman WAB, Bosmans JE, van Marwijk HWJ. Depression and anxiety, an indicated prevention (DIP) protocol in homes for the elderly: feasibility and (cost) effectiveness of a stepped care programme. BMC Geriatr 2007; 7:6. [PMID: 17346333 PMCID: PMC1828735 DOI: 10.1186/1471-2318-7-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 03/08/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depressive and anxiety disorders are a very common, serious and underdetected problem in homes for the elderly. Elderly persons in residential homes are at high risk for developing major depressive and anxiety disorders, and, therefore, deserve attention with regard to prevention. METHODS/DESIGN This protocol describes a randomised trial on the feasibility and (cost) effectiveness of a stepped-care programme for prevention of depressive and anxiety disorders in homes for the elderly. The main outcome measure is the incidence of depressive and anxiety disorder in one year with a two years follow up. Secondary outcomes are symptoms of depression and anxiety, quality of life, direct health care costs and satisfaction with treatment. DISCUSSION The number of studies examining the effects of preventive interventions on the incidence of mental disorders in the elderly population is very small. However, indicated prevention by means of a stepped-care programme seems to be an important option for decreasing the burden of illness for residents and their caregivers. This study contributes to the body of knowledge in this field. Positive effects may contribute to further use and development of tailored, (cost-) effective and easy to use interventions in a preventive stepped-care programme.
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Affiliation(s)
- Els Dozeman
- Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands
- Institute for Research in Extramurel Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Digna JF van Schaik
- Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands
- Institute for Research in Extramurel Medicine, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
| | - Aartjan TF Beekman
- Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands
- Institute for Research in Extramurel Medicine, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
| | - Wim AB Stalman
- Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands
- Institute for Research in Extramurel Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Institute for Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands
| | - Harm WJ van Marwijk
- Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands
- Institute for Research in Extramurel Medicine, VU University Medical Centre, Amsterdam, The Netherlands
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