Is loneliness associated with cancellation of medical appointments during the COVID-19 pandemic? Evidence from the Hamburg City Health Study (HCHS)

BACKGROUND

The COVID-19 pandemic engendered numerous societal and economic challenges in addition to health-related concerns. Maintenance of healthcare utilization assumed immense significance during this period. However, few studies have examined the association between loneliness and cancelled medical appointments during the COVID-19 pandemic. This study aimed to examine whether medical appointments are less likely to be cancelled with increased loneliness during a pandemic. We analyzed the association between loneliness and both patient- and provider-initiated appointment cancellations.

METHODS

Cross-sectional data from the Hamburg City Health Study (HCHS) were collected during April 2020-November 2021. The analytical sample included 1,840 participants with an average age of 55.1 years (standard deviation: 6.5, range 45-76 years). Medical appointments cancelled by individuals-medical appointments in general, and GP, specialist, and dentist appointments-and appointments cancelled by healthcare providers served as outcome measures. Loneliness was quantified using a single item ranging from 0 to 10. Accordingly, we created empirical loneliness tertiles. Covariates were selected based on the Andersen model. Several penalized maximum likelihood logistic regressions were utilized to examine the association between loneliness and cancellation of medical appointments during the COVID-19 pandemic.

RESULTS

The penalized maximum likelihood logistic regressions showed that, compared to individuals in the lowest loneliness tertiles, individuals in the other two tertiles reported a higher chance of medical appointments cancellation by individuals, particularly driven by cancelled GP appointments. Except for age and sex, none of the covariates were comparably associated with the outcomes. When appointments cancelled by healthcare providers served as outcomes, only a higher number of chronic conditions was significantly positively associated with it.

CONCLUSIONS

Individuals scoring higher in loneliness had a greater chance of cancelling medical (particularly GP) appointments. This may contribute to a potential cascade of loneliness and skipped medical appointments in the future, resulting in adverse health outcomes over the medium-to-long term. Future research should examine whether lonely people are more likely to lack the social motivation to visit the doctor.

[The Current Therapy of Asbestos-Associated Malignant Pleural Mesothelioma - An Expert Consensus Paper]

Asbestos-related mesotheliomas belong to the group of the most frequent occupational diseases in Germany, reaching about 1,000 new cases per year. The disease has a dismal prognosis because most tumors remain asymptomatic for a long time and therefore are diagnosed as incidental findings at later stages.During the last decade the German Social Accident Insurance (DGUV) has made considerable efforts to prepone the diagnosis in order to detect the disease at earliest possible stages. These efforts resulted in new findings showing that, in a high-risk group, a combination of the biomarkers calretinin and mesothelin was able to advance the diagnosis up to 12 months.Ideally, the diagnosis of a mesothelioma at an early stage has to be accompanied by the best possible individualized therapy. Standard therapeutic strategies are surgery and chemotherapy, added by radiotherapy and psycho-oncology. In recent years, several new therapeutic avenues are being explored. This review comprehensively presents both old and new therapeutic options in mesothelioma, based on international Leitlinien and new studies.

Health-related quality of life 90 days after stroke assessed by the International Consortium for Health Outcome Measurement standard set

BACKGROUND AND PURPOSE

Stroke has detrimental effects in multiple health domains not captured by routine scales. The International Consortium for Health Outcome Measurement has developed a standardized set for self-reported assessment to overcome this limitation. The aim was to assess this set in acute stroke care.

METHODS

Consecutive patients with acute ischaemic stroke, transient ischaemic attack or intracerebral hemorrhage were enrolled. Demographics, living situation and cardiovascular risk factors were collected from medical records and interviews. The Patient-reported Outcomes Measurement Information System 10-Question Short Form (PROMIS-10) and the Patient Health Questionnaire-4 (PHQ-4) were conducted 90 days after admission. Linear and logistic regression analyses were used to identify predictors of outcome. The study is registered at ClinicalTrials.gov, NCT03795948.

RESULTS

In all, 1064 patients were enrolled; mean age was 71.6 years, 51% were female, and median National Institutes of Health Stroke Scale (NIHSS) on admission was 3. Diagnosis was acute ischaemic stroke in 74%, transient ischaemic attack in 20% and intracerebral hemorrhage in 6%. 673 patients were available for outcome evaluation at 90 days; of these 90 (13%) had died. In survivors, t scores of PROMIS-10 physical and mental health were 40.3 ± 6.17 and 44.3 ± 8.63, compared to 50 ± 10 in healthy populations. 16% reported symptoms indicating depression or anxiety on the PHQ-4. Higher NIHSS, prior stroke and requiring help pre-stroke predicted lower values in physical and mental health scores. Higher NIHSS and diabetes were associated with anxiety or depression.

CONCLUSIONS

Integrated in the routine of acute stroke care, systematic assessment of patient-reported outcomes reveals impairments in physical and mental health. Main predictors are severity of stroke symptoms and comorbidities such as hypertension and diabetes.

[Multiprofessional outpatient psychosocial treatment for elderly patients with mental disorders]

Mental disorders contribute substantially to the loss of quality of life and life expectancy in old age. Life expectancy is reduced especially by the bidirectional interaction with heart diseases, diabetes mellitus as well as the depression-specific risk of suicide. Depression in old age is a strong risk factor for nursing home placement, which is usually an undesired outcome for older people. Utilization of mental health services is hindered by self-stigmatization and prejudice; however, according to recent surveys older people increasingly value psychotherapeutic services. Shortcomings in the diagnostics and therapy in the primary treatment of old age depression have stimulated research in low-threshold options in primary care and collaborative multiprofessional outpatient interventions in many countries. The core features of collaborative care approaches are improved diagnostics, stepped-care protocols, continuous disease monitoring, and access to psychiatric and psychotherapeutic supervision or services. Collaborative multiprofessional outpatient approaches have been shown to be superior for the treatment of old age depression compared to treatment as usual.

Qualitätsindikatoren in der Praxis

Hintergrund: Zur Erfassung der psychiatrischen Versorgungsqualität bedarf es geeigneter Qualitätsindikatoren. Diese sollten neben der klinischen Relevanz die Perspektiven von Behandler und Patienten berücksichtigen, verschiedene Dimensionen der Behandlung abdecken und sich auf veränderbare Versorgungsaspekte beziehen. Ziel der Studie war die Entwicklung und Erprobung von Qualitätsindikatoren zur Erfassung von Prozess- und Ergebnisqualität in der stationären Depressionsbehandlung. Diese Indikatoren wurden für den systematischen Qualitätsvergleich zwischen den Kliniken (Benchmarking) genutzt. Methode: Eine Multicenter-Studie wurde von Oktober 2001 bis April 2004 in 10 psychiatrisch-psychotherapeutischen Kliniken durchgeführt. Ergebnisse: Die Behandlung von über 2000 depressiven Patienten wurde mittels BADO dokumentiert, die depressionsspezifisch modifiziert wurde. Die Ergebnisse für verschiedene Qualitätsindikatoren werden dargestellt und diese bezüglich Relevanz, Praktikabilität und Validität für die stationäre Depressionsbehandlung beurteilt. Diskussion: Die Ergebnisse bestätigen die in der Literatur diskutierten methodischen Schwierigkeiten von Qualitätsindikatoren. Für die stationäre Depressionsbehandlung werden sinnvolle Qualitätsindikatoren empfohlen. Ein Ausblick über den Nutzen der Qualitätsindikatoren und eines Krankenhausvergleichs wird gegeben.

[Internet-based interventions in the treatment of mental disorders : Overview, quality criteria, perspectives]

BACKGROUND

Mental disorders are frequently not or only insufficiently treated. Internet-based interventions offer the potential of closing the existing gaps in the treatment of mental disorders; however, it is very difficult for patients and providers to choose from the numerous interventions available.

OBJECTIVE

The aim of this study was to develop a set of quality criteria that can help patients and care providers to identify recommendable internet-based interventions.

METHODS

A selective literature search was carried out and the existing evidence on internet-based interventions in the treatment of mental disorders was collated. A panel of experts then developed quality criteria based on existing models for the systematic assessment of telemedicine applications.

RESULTS

Internet-based interventions are effective in the treatment of a broad range of mental disorders. The best evidence is available for depression and anxiety disorders. A set of criteria is proposed for the evaluation of available internet-based interventions using a checklist. These criteria have to be developed further with input from other stakeholders.

DISCUSSION

When taking these quality criteria into account, evidence-based interventions available on the internet can make an important contribution to improvement of the care of patients with mental disorders.

The risk of being depressed is significantly higher in cancer patients than in the general population: Prevalence and severity of depressive symptoms across major cancer types

BACKGROUND

Depression is a common co-morbidity of cancer that has a detrimental effect on quality of life, treatment adherence and potentially survival. We conducted an epidemiological multi-center study including a population-based random comparison sample and estimated the prevalence of depressive symptoms by cancer site, thereby identifying cancer patients with the highest prevalence of depression.

PATIENTS AND METHODS

We included 4020 adult cancer inpatients and outpatients from five distinct regions across Germany in a proportional stratified random sample based on the nationwide cancer incidence and a comparison group consisting of 5018 participants. Both groups reported depressive symptoms by filling in the Patient Health Questionnaire (PHQ-9). In multivariate analyses adjusted for age and sex, we calculated the odds of being depressed.

RESULTS

Out of 5818 eligible patients, 69% participated (51% women, mean age = 58 years). We estimated that one in four cancer patients (24%) is depressed (PHQ-9 ≥ 10). The odds of being depressed among cancer patients were more than five times higher than in the general population (OR, 5.4; 95% CI, 4.6-6.2). Patients with pancreatic (M = 8.0, SD = 5.0), thyroid (M = 7.8, SD = 6.3) and brain tumours (M = 7.6, SD = 4.9) showed the highest prevalence, whereas patients with prostate cancer (M = 4.3, SD = 3.8) and malignant melanoma (M = 5.3, SD = 4.3) had the lowest levels of depressive symptoms.

CONCLUSION

Our results help clinicians identify cancer patients in need of psychosocial support when navigating in the growing survivor population.

Patients with Postpartum Depression in Gynaecological Practices in Germany - Results of a Representative Survey of Local Gynaecologists about Diagnosis and Management

THEORETICAL BACKGROUND AND CURRENT ISSUES

For the sake of pre-emptive child protection it is necessary to recognise signs of postpartum depression (PPD) in pregnant women and young mothers as early as possible and to initiate adequate assistance. Because of their high acceptance, especially in the phases of pregnancy and birth, the local gynaecologists offer ideal prerequisites for access to the parents. This study evaluates the current status of diagnosis and management of PPD in gynaecological practices.

MATERIAL AND METHODS

In a representative German nation-wide questionnaire survey taking the regional distribution into account n = 3000 local gynaecologists were selected at random and contacted by post. The questionnaire addressed their approaches to the diagnosis and management of PPD as well as the encountered barriers.

RESULTS

Among the n = 1034 participating gynaecologists (response rate: 35 %) half of them dealt actively with PPD; 16 % used a questionnaire for this purpose. Consultation by the gynaecologist (84 %) or referral to therapists or hospitals (86 %) were among the most common interventions in the management of PPD. A need for improvement in the management of women with PPD was recognised equally often. As barriers the gynaecologists mentioned above all the lack of time, the low reimbursements for consultations and the lack of effective treatment options. Predictors for an active anamnesis were found to be female gender of the gynaecologist, possession of an additional psychosomatic qualification and practice located in an urban catchment area or state of the former West Germany.

CONCLUSION

The results clearly demonstrate a high acceptance for the management of PPD by gynaecologists as well as the need for further action to improve the care of patients with PPD in gynaecological practices.

[Transcultural prevention of alcohol-related disorders : effects of a culture- and migration-sensitive approach in elderly migrants with respect to attitudes and behavior: a cluster randomized controlled trial]

BACKGROUND

For migrants who are older than 50, alcohol frequently becomes a problem. Simultaneously alcohol-related prevention measures only reach this group insufficiently. Therefore, a transcultural concept for preventing alcohol-related disorders in elderly (≥ 45 years) migrants has been developed.

METHOD

The transcultural concept, which consisted of a prevention event as well as a cultural and language-sensitive information booklet, was evaluated in a cluster-randomized controlled trial (n = 310 immigrants). As a control condition there was a prevention event with materials from Deutsche Hauptstelle für Suchtfragen (German Centre for Addiction Issues). Data were obtained before and after the event, as well as after 6 months. All materials were available both in German and in Russian, Italian, Spanish and Turkish.

RESULTS

Directly after the event, as well as 6 months thereafter, the transcultural approach was rated significantly better than the general prevention event. 73.4 % of the participants read the cultural and migration-sensitive booklet, whereas only 21.2 % in the control condition (p = 0.0001). Furthermore, significantly more participants of the transcultural approach reported a reduced alcohol consumption (49.4 vs. 16.7 %; p = 0.004) after 6 months.

CONCLUSION

The consideration of diversity with respect to cultural, migration-related, socio demographic und linguistic aspects improves the effectiveness of prevention measures.

[Patient participation in medical decision making within an integrated health care system in Germany: results of a controlled cohort study]

An integrated health care project called "Gesundes Kinzigtal" was conducted in a rural area in Germany. As part of the project, physicians were trained and other measures were taken to enhance patient involvement in medical decision making. As part of the external evaluation, various effects regarding patient involvement in medical decision making, patient involvement and information preference, decision confidence, patient satisfaction with ambulatory care and patient quality of life were examined. The data were gathered by means of a questionnaire on an annual basis between 2007 and 2009. Effects were compared between patients who were participating in the integrated care project and two control groups. Analyses are based on the data of 1,205 patients. Over time all outcomes decreased slightly, except for information preference and physical quality of life. No statistically significant intervention effects on patient involvement in medical decision making or any other outcome variable could be found. The intensity of the training was presumably too low to establish an enduring change in the physician-patient interaction.

Selective serotonin reuptake inhibitors and tricyclic antidepressants in the acute treatment of chronic depression and dysthymia: a systematic review and meta-analysis

INTRODUCTION

Chronic depression represents a substantial portion of depressive disorders and is associated with severe consequences. This review examined the efficacy and acceptability of selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) in the treatment of chronic depression. Additionally, the comparative effectiveness of the two types of antidepressants has been examined.

METHODS

A systematic search was conducted in the following databases: CENTRAL, MEDLINE, EMBASE, ISI Web of Science, BIOSIS, PsycINFO, and CINAHL. Primary efficacy outcome was a response to treatment; primary acceptance outcome was dropping out of the study. Only randomized controlled trials were considered.

RESULTS

We identified 20 studies with 22 relevant comparisons. 19 studies focused on samples with a majority of dysthymic patients. Both SSRIs and TCAs are efficacious in terms of response rates when compared to placebo (Benefit Ratio [BR]=1.49; p<0.001 for SSRIs and BR=1.74; p<0.001 for TCAs) and no statistically significant differences between the active drugs and placebo in terms of dropout rates could be found. No differences in effectiveness were found between SSRIs and TCAs in terms of response rates (BR=1.01; p=0.91), yet, SSRIs showed statistically better acceptability in terms of dropout rates than TCAs (Odds Ratio [OR]=0.41; p=0.02).

LIMITATIONS

The methodological quality of the primary studies was evaluated as unclear in many cases and more evidence is needed to assess the efficacy of SSRIs and TCAs in patients suffering from chronic forms of depression other than dysthymia.

CONCLUSIONS

This systematic review provides evidence for the efficacy of both SSRIs and TCAs in the treatment of chronic depression and showed a better acceptability of SSRIs.

[Evidence-based therapy of depression: S3 guidelines on unipolar depression]

Unipolar depressive disorders are among the most frequent reasons for utilizing the health care system. Although efficacious treatments are available and further advances have recently been made there is still a need for improving diagnostic and therapeutic procedures. Alignment of treatment on evidence-based treatment guidelines establishes an essential mainstay. The new S3 and National Health Care guidelines on unipolar depression, the compilation of which was coordinated by the German Society of Psychiatry, Psychotherapy and Neurology (DGPPN) and which were approved by 29 scientific and professional associations, is the ambitious effort to present state of the art evidence and clinical consensus for the treatment of depression. For pharmacotherapy of depression differentiated recommendations can be given, also separate from and in addition to psychotherapy.

[Attitudes of chronically-ill patients to telephone health coaching]

OBJECTIVE

The aim of this study was to assess the general attitudes of health insurants with chronic conditions towards a health coaching and their reasons for participation in or refusal of the telephone health coaching provided by their sickness fund.

METHOD

The survey was designed as a cross-sectional study on insurants who had either participated in the coaching (n=834), declined participation (n=530) or were members of a control group (n=544). Furthermore, we investigated whether the reasons and attitudes differed with regard to socio-demographic variables of the participants (age, sex, primary condition).

RESULTS

The most common reason for participation in health coaching was the feeling of obligation towards the society to take care of one's own health (80.1%). Further reasons included a general interest in prevention (75.4%) and health-related issues (51.1%). The main reason for declining participation was a sufficient care by family members or a general practitioner (96.4%). This was in particular the case with older insured persons. Most people in the control group estimated health coaching as effective and appropriate for them. Those who had declined to participate were more critical in their appraisal. The younger the insured were, the more positive was their attitude towards health coaching.

CONCLUSIONS

The results show that, on the one hand, insured feel obligated to participate in prevention programs but, on the other hand, they are also interested in information about their condition and in the possibility to contribute to their treatment. The telephone health coaching by the KKH-Allianz is a new approach in the German health care and can be regarded as a supplement to medical treatment. Specifically, younger insured are highly interested in this new concept. Further studies on its efficacy are required to show the extent to which expectations and needs of insurants can actually be met.

The effects of nonpharmacological interventions on subjective memory complaints: a systematic review and meta-analysis

BACKGROUND

Subjective memory complaints (SMC) in the absence of psychiatric or neurological disorders are common among older adults. Although increasing numbers of individuals are suffering from SMC, research into interventions alleviating SMC is sparse. The present systematic review was conducted in order to present a clearer picture of the quality, quantity and outcomes of SMC intervention research.

METHODS

PubMed and PsychInfo were searched with a comprehensive search string delivering 4,496 hits. Abstracts and - if applicable - full texts of these studies were screened by independent raters according to predefined criteria. Fourteen relevant studies were included in the review. The categories of intervention were: conventional memory training (MT; n = 8), expectancy change (EC: cognitive restructuring, psychoeducation, etc.; n = 5), combined interventions (n = 5), physical training (n = 1), and physical and mental training combined (n = 2). The outcomes were: subjective memory measures, objective memory, depressive symptoms and well-being.

RESULTS

EC, followed by combined interventions, was most efficient in influencing subjective memory. MT or physical and mental training combined were not efficient. On objective memory, MT was the only efficient intervention. No effects were found on depressive symptoms and well-being, with low numbers of studies in these comparisons.

CONCLUSION

EC seems to be most efficient in influencing SMC, whereas in objective memory MT is the only effective intervention. Depressive symptoms or well-being do not seem to be influenced significantly by any of the interventions. To date, the number of high-quality publications on SMC interventions is relatively low. More randomized controlled trials including measures of depressive symptoms and well-being are needed.

Depression and anxiety in patients undergoing herniated disc surgery: relevant but underresearched - a systematic review

BACKGROUND

An association between depression and anxiety and musculoskeletal disorders has been consistently reported in the past years. This article provides a systematic overview of the literature on the prevalence rates of depression and anxiety in patients undergoing surgery for a herniated disc.

METHODS

A systematic literature search was conducted in the following electronic databases: PubMed, PsycINFO, Web of Science, Cochrane Library and PSYNDEXplus. The identified articles were evaluated for prevalence rates of depression and anxiety, methodological issues, change of depression and anxiety over time, and major findings on the impact of depression and anxiety on patients undergoing disc surgery.

RESULTS

Fourteen studies were identified. Prevalence rates for depression and anxiety in patients undergoing disc surgery varied between 21.5% and 49.3% before and between 4.1% and 79.6% after disc surgery. The study designs, the use of assessment instruments and cut-off values varied greatly. Depression and anxiety decreased within the population of disc surgery patients over time. Depression and anxiety were found to have a great impact on the postoperative outcome of surgery, return to work, analgesia abuse, pain experience, and abnormal illness behaviour.

CONCLUSIONS

Little research has been done to investigate depression and anxiety in patients undergoing surgery for a herniated disc. Evidently disc surgery patients are at higher risk of suffering from depression and anxiety than the general population. The review outlines the importance for clinicians to be more sensitive to psychological concerns in patients undergoing disc surgery. Psychological assessment and assistance from mental health professionals should be considered during the hospital stay and rehabilitation period, depending on local feasibility. Further investigations are necessary to examine whether the implementation of a multidisciplinary in-patient treatment program will improve postoperative outcome in patients undergoing intervertebral disc surgery.

Cluster-randomized controlled trial of dissemination strategies of an online quality improvement programme for alcohol-related disorders

AIMS

This project investigated different dissemination strategies of an online quality improvement programme for alcohol-related disorders into routine care in South Baden and South Württemberg in Germany.

METHODS

In a cluster-randomized controlled trial, 112 general practices were randomized into three groups. The first group (n = 43) received access to the online system and a training programme for the general practitioners (GPs). The second group (n = 42) additionally received education for the whole practice team. The third group (n = 27) acted as control and received only access to the online system.

RESULTS

Two thousand six hundred and forty-seven practitioners were asked to take part in the study, and it was possible to randomize 112 (4%) practices. There were no significant differences concerning the use of the system between the groups: 41.9% of the GPs in the first group, 42.9% in the second group and 44.4% in the control group used the system. In terms of only the system users, 55.6% of the GPs in the first group, 33.3% in the second group and 8.3% in the control group used the system six times or more (P = 0.019). Diagnostic assessments made by the GPs in the groups differed substantially: 72.2% of diagnoses in the first group were correct, while this figure lay at 69.7% in the second group and 36.4% in the control group (P = 0.034).

CONCLUSIONS

No effect of the additional training on the primary outcome (acceptance) was identified, but on two of the secondary outcomes. Further cost-effectiveness studies should investigate whether the effort involved in providing training additionally to the system is justifiable. The study is registered at ClinicalTrials.gov: NCT00314067. This article conforms to the guidelines in the Consolidated Standards of Reporting Trials (CONSORT) statement (Moher et al., 2001; Campbell et al., 2004).