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Buckman JEJ, Saunders R, Stott J, Cohen ZD, Arundell LL, Eley TC, Hollon SD, Kendrick T, Ambler G, Watkins E, Gilbody S, Kessler D, Wiles N, Richards D, Brabyn S, Littlewood E, DeRubeis RJ, Lewis G, Pilling S. Socioeconomic Indicators of Treatment Prognosis for Adults With Depression: A Systematic Review and Individual Patient Data Meta-analysis. JAMA Psychiatry 2022; 79:406-416. [PMID: 35262620 PMCID: PMC8908224 DOI: 10.1001/jamapsychiatry.2022.0100] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Socioeconomic factors are associated with the prevalence of depression, but their associations with prognosis are unknown. Understanding this association would aid in the clinical management of depression. Objective To determine whether employment status, financial strain, housing status, and educational attainment inform prognosis for adults treated for depression in primary care, independent of treatment and after accounting for clinical prognostic factors. Data Sources The Embase, International Pharmaceutical Abstracts, MEDLINE, PsycINFO, and Cochrane (CENTRAL) databases were searched from database inception to October 8, 2021. Study Selection Inclusion criteria were as follows: randomized clinical trials that used the Revised Clinical Interview Schedule (CIS-R; the most common comprehensive screening and diagnostic measure of depressive and anxiety symptoms in primary care randomized clinical trials), measured socioeconomic factors at baseline, and sampled patients with unipolar depression who sought treatment for depression from general physicians/practitioners or who scored 12 or more points on the CIS-R. Exclusion criteria included patients with depression secondary to a personality or psychotic disorder or neurologic condition, studies of bipolar or psychotic depression, studies that included children or adolescents, and feasibility studies. Studies were independently assessed against inclusion and exclusion criteria by 2 reviewers. Data Extraction and Synthesis Data were extracted and cleaned by data managers for each included study, further cleaned by multiple reviewers, and cross-checked by study chief investigators. Risk of bias and quality were assessed using the Quality in Prognosis Studies (QUIPS) and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tools, respectively. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses-Individual Participant Data (PRISMA-IPD) reporting guidelines. Main Outcomes and Measures Depressive symptoms at 3 to 4 months after baseline. Results This systematic review and individual patient data meta-analysis identified 9 eligible studies that provided individual patient data for 4864 patients (mean [SD] age, 42.5 (14.0) years; 3279 women [67.4%]). The 2-stage random-effects meta-analysis end point depressive symptom scale scores were 28% (95% CI, 20%-36%) higher for unemployed patients than for employed patients and 18% (95% CI, 6%-30%) lower for patients who were homeowners than for patients living with family or friends, in hostels, or homeless, which were equivalent to 4.2 points (95% CI, 3.6-6.2 points) and 2.9 points (95% CI, 1.1-4.9 points) on the Beck Depression Inventory II, respectively. Financial strain and educational attainment were associated with prognosis independent of treatment, but unlike employment and housing status, there was little evidence of associations after adjusting for clinical prognostic factors. Conclusions and Relevance Results of this systematic review and meta-analysis revealed that unemployment was associated with a poor prognosis whereas home ownership was associated with improved prognosis. These differences were clinically important and independent of the type of treatment received. Interventions that address employment or housing difficulties could improve outcomes for patients with depression.
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Affiliation(s)
- Joshua E. J. Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom
- iCope Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, United Kingdom
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom
| | - Joshua Stott
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom
| | | | - Laura-Louise Arundell
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom
| | - Thalia C. Eley
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, Tennessee
| | - Tony Kendrick
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Gareth Ambler
- Statistical Science, University College London, London, United Kingdom
| | - Edward Watkins
- Department of Psychology, University of Exeter, Exeter, United Kingdom
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, United Kingdom
| | - David Kessler
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Nicola Wiles
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - David Richards
- Institute of Health Research, University of Exeter College of Medicine and Health, Exeter, United Kingdom
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Sally Brabyn
- Department of Health Sciences, University of York, York, United Kingdom
| | | | - Robert J. DeRubeis
- University of Pennsylvania College of Arts and Sciences, Department of Psychology, Philadelphia
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, United Kingdom
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom
- Camden & Islington NHS Foundation Trust, London, United Kingdom
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Jatta S, Ian BS, Robert M. Inequalities in recovery or methodological artefact? A comparison of models across physical and mental health functioning. SSM Popul Health 2022; 17:101067. [PMID: 35284618 PMCID: PMC8914363 DOI: 10.1016/j.ssmph.2022.101067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/31/2022] [Accepted: 03/03/2022] [Indexed: 12/03/2022] Open
Abstract
Considerable attention has been paid to inequalities in health. More recently, focus has also turned to inequalities in ‘recovery’; with research, for example, suggesting that lower grade of employment is strongly associated with slower recovery from both poor physical and poor mental health. However, this research has tended to operationalise recovery as ‘return to baseline’, and we know less about patterns and predictors when recovery is situated as a ‘process’. This paper seeks to address this gap. Drawing on data from the UK Household Longitudinal Study, we operationalise recovery as both an ‘outcome’ and as a ‘process’ and compare patterns and predictors across the two models. Our analysis demonstrates that the determinants of recovery from poor health, measured by the SF-12, are robust, regardless of whether recovery is operationalised as an outcome or as a process. For example, being employed and having a higher degree were found to increase the odds of recovery both from poor physical and mental health functioning, when recovery was operationalised as an outcome. These variables were also important in distinguishing health functioning trajectories following a poor health episode. At one and the same time, our analysis does suggest that understandings of inequalities in recovery will depend in part on how we define it. When recovery is operationalised as a simple transition from poor health state to good, it loses sight of the fact that there may be inequalities (i) within a ‘poor health’ state, (ii) in how individuals are able to step into the path of recovery, and (iii) in whether health states are maintained over time. We therefore need to remain alert to the additional nuance in understanding which comes from situating recovery as a process; as well as possible methodological artefacts in population research which come from how recovery is operationalised. There is no consensus on what recovery is and how it should be operationalised. Understanding of inequalities in recovery across health conditions remains scarce. We operationalised recovery both as an outcome and as a process. We found robust inequalities in recovery across the two approaches. Considering recovery as a process revealed more nuanced patterns in inequalities.
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Buckman JEJ, Saunders R, Arundell LL, Oshinowo ID, Cohen ZD, O'Driscoll C, Barnett P, Stott J, Ambler G, Gilbody S, Hollon SD, Kendrick T, Watkins E, Eley TC, Skelton M, Wiles N, Kessler D, DeRubeis RJ, Lewis G, Pilling S. Life events and treatment prognosis for depression: A systematic review and individual patient data meta-analysis. J Affect Disord 2022; 299:298-308. [PMID: 34920035 PMCID: PMC9113943 DOI: 10.1016/j.jad.2021.12.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/10/2021] [Accepted: 12/12/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To investigate associations between major life events and prognosis independent of treatment type: (1) after adjusting for clinical prognostic factors and socio-demographics; (2) amongst patients with depressive episodes at least six-months long; and (3) patients with a first life-time depressive episode. METHODS Six RCTs of adults seeking treatment for depression in primary care met eligibility criteria, individual patient data (IPD) were collated from all six (n = 2858). Participants were randomized to any treatment and completed the same baseline assessment of life events, demographics and clinical prognostic factors. Two-stage random effects meta-analyses were conducted. RESULTS Reporting any major life events was associated with poorer prognosis regardless of treatment type. Controlling for baseline clinical factors, socio-demographics and social support resulted in minimal residual evidence of associations between life events and treatment prognosis. However, removing factors that might mediate the relationships between life events and outcomes reporting: arguments/disputes, problem debt, violent crime, losing one's job, and three or more life events were associated with considerably worse prognoses (percentage difference in 3-4 months depressive symptoms compared to no reported life events =30.3%(95%CI: 18.4-43.3)). CONCLUSIONS Assessing for clinical prognostic factors, social support, and socio-demographics is likely to be more informative for prognosis than assessing self-reported recent major life events. However, clinicians might find it useful to ask about such events, and if they are still affecting the patient, consider interventions to tackle problems related to those events (e.g. employment support, mediation, or debt advice). Further investigations of the efficacy of such interventions will be important.
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Affiliation(s)
- Joshua E J Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London WC1E 7HB, United Kingdom; iCope - Camden & Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, 4St Pancras Way, London NW1 0PE, United Kingdom.
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London WC1E 7HB, United Kingdom
| | - Laura-Louise Arundell
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London WC1E 7HB, United Kingdom
| | - Iyinoluwa D Oshinowo
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London WC1E 7HB, United Kingdom
| | - Zachary D Cohen
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA 90095, United States
| | - Ciaran O'Driscoll
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London WC1E 7HB, United Kingdom
| | - Phoebe Barnett
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London WC1E 7HB, United Kingdom
| | - Joshua Stott
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London WC1E 7HB, United Kingdom
| | - Gareth Ambler
- Statistical Science, University College London, London WC1E 7HB, United Kingdom
| | - Simon Gilbody
- Department of Health Sciences, University of York, York YO10 5DD, United Kingdom
| | - Steven D Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN 407817, United States
| | - Tony Kendrick
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton SO16 5ST, United Kingdom
| | - Edward Watkins
- Department of Psychology, University of Exeter, Exeter, EX4 4QG, United Kingdom
| | - Thalia C Eley
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, United Kingdom
| | - Megan Skelton
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, United Kingdom
| | - Nicola Wiles
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Bristol, United Kingdom
| | - David Kessler
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, United Kingdom
| | - Robert J DeRubeis
- School of Arts and Sciences, Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104-60185, United States
| | - Glyn Lewis
- Division of Psychiatry, University College London, London W1T 7NF, United Kingdom
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London WC1E 7HB, United Kingdom; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4St Pancras Way, London NW1 0PE United Kingdom
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Woodhead E, Cronkite R, Finlay A, Wong J, Haverfield M, Timko C. The role of depression course on life functioning and coping outcomes from baseline through 23-year follow-up. J Ment Health 2020; 31:348-356. [PMID: 32667276 DOI: 10.1080/09638237.2020.1793127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although studies have examined how depressed patients' baseline characteristics predict depression course, still needed are studies of how depression course is associated with modifiable long-term outcomes. AIMS This study examined six outcomes of three groups representing distinct depression courses (low baseline severity, rapid decline; moderate baseline severity, rapid decline; and high baseline severity, slow decline): medical functioning, coping patterns, family functioning, social functioning, employment, and work functioning. METHOD Adults with depression at baseline (N = 382; 56% women) were followed for 23 years on self-reported outcomes (79% response rate). Data from the baseline assessment and follow-ups (1, 4, 10, and 23 years) were used in a longitudinal analysis to examine associations between depression course and outcomes. RESULTS All depression course groups declined on medical and social functioning and employment over follow-up. The high- and moderate-severity depression course groups reported poorer coping patterns than the low-severity group. The high-severity depression course group reported poorer family functioning than the moderate-severity group, and had the poorest work functioning outcome, followed by the moderate-severity and then the low-severity groups. CONCLUSIONS Patients with a high- or moderate-severity depression course may benefit from treatment that manages coping patterns and improves family and work functioning.
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Affiliation(s)
- Erin Woodhead
- Psychology Department, San José State University, San Jose, CA, USA
| | - Ruth Cronkite
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Center for Health Policy/Center on Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA.,Department of Sociology, Stanford University, Stanford, CA, USA
| | - Andrea Finlay
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Veterans Affairs, National Center on Homelessness Among Veterans, Menlo Park, CA, USA
| | - Jessie Wong
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Center for Health Policy/Center on Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Marie Haverfield
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Center for Health Policy/Center on Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Christine Timko
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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Ahmad F, Othman N, Hynie M, Bayoumi AM, Oda A, McKenzie K. Depression-level symptoms among Syrian refugees: findings from a Canadian longitudinal study. J Ment Health 2020; 30:246-254. [PMID: 32438842 DOI: 10.1080/09638237.2020.1765998] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Canada launched the Syrian Refugee Resettlement Initiative in 2015 and resettled over 40,000 refugees. AIM To evaluate the prevalence of depression-level symptoms at baseline and one year post-resettlement and analyze its predictors. METHODS Data come from the Syrian Refugee Integration and Long-term Health Outcomes in Canada study (SyRIA.lth) involving 1924 Syrian refugees recruited through a variety of community-based strategies. Data were collected using structured interviews in 2017 and 2018. Depression symptoms were measured using Patient Health Questionnaire 9 (PHQ-9). Analysis for associated factors was executed using multinomial logistic regression. RESULTS Mean age was 38.5 years (SD 13.8). Sample included 49% males and 51% females settled in Ontario (48%), Quebec (36%) and British Columbia (16%). Over 74% always needed an interpreter, and only 23% were in employment. Prevalence of depression-level symptoms was 15% at baseline and 18% in year-2 (p < 0.001). Significant predictors of depression-level symptoms at year-2 were baseline depression, sponsorship program, province, poor language skills, lack of satisfaction with housing conditions and with health services, lower perceived control, lower perceived social support and longer stay in Canada. CONCLUSION Increase in depression-level symptoms deserves attention through focusing on identified predictors particularly baseline depression scores, social support, perceived control and language ability.
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Affiliation(s)
- Farah Ahmad
- School of Health Policy and Management, York University, Toronto, Canada
| | - Nasih Othman
- School of Health Policy and Management, York University, Toronto, Canada
| | - Michaela Hynie
- Department of Psychology/Centre for Refugee Studies, York University, Toronto, Canada
| | - Ahmed M Bayoumi
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Anna Oda
- Centre for Refugee Studies, Refugee Integration and Long-term Health Outcomes in Canada, York University, Toronto, Canada
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Howell AN, Rheingold AA, Uhde TW, Guille C. Web-based CBT for the prevention of anxiety symptoms among medical and health science graduate students. Cogn Behav Ther 2019; 48:385-405. [PMID: 30526364 PMCID: PMC6559871 DOI: 10.1080/16506073.2018.1533575] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 09/27/2018] [Indexed: 10/27/2022]
Abstract
Medical and health science graduate students report greater anxiety problems than the general population, but they are less likely to seek treatment due to cultural and logistical barriers. One preventative approach that overcomes these barriers is web-based cognitive behavioral therapy (webCBT). It is unknown whether webCBT is effective for preventing anxiety escalation within this population. A randomized controlled trial was conducted, comparing the effects of webCBT versus a control group (CG). Medical university students (n=594; Mage=27; 67% female; 80% Caucasian) completed online baseline measures and four assigned online activities. Measures were re-administered after approximately three months. There was a small interaction effect between time of assessment and treatment condition. Anxiety severity was lower in the webCBT (M[SD]=2.88[3.36]) versus CG condition (M[SD]=3.69 [3.35]) at follow-up. This effect was moderate for students with mild, versus minimal, anxiety at baseline. The proportion of students with possible anxiety disorder was lower in the webCBT (4.5%) versus CG (8.5%) condition, and the proportion of mildly anxious students with a clinically significant increase in symptoms was lower in the webCBT (10%) versus CG (20%) condition. WebCBT may aid in preventing anxiety escalation in this population, particularly for at-risk students who report mild anxiety symptoms.
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Affiliation(s)
- Ashley N. Howell
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC
| | - Alyssa A. Rheingold
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC
| | - Thomas W. Uhde
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC
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Serafini G, Santi F, Gonda X, Aguglia A, Fiorillo A, Pompili M, Carvalho AF, Amore M. Predictors of recurrence in a sample of 508 outpatients with major depressive disorder. J Psychiatr Res 2019; 114:80-87. [PMID: 31051436 DOI: 10.1016/j.jpsychires.2019.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Specific predictors of relapse/recurrence in major depressive disorder (MDD) have been identified but evidence across studies are inconsistent. This study aimed to identify the most relevant socio-demographic/clinical predictors of MDD recurrence in a sample of 508 outpatients. METHODS This naturalistic cohort study included 508 currently euthymic MDD patients (mean age = 54.1 ± 16.2) of which 53.9% had a single and 46.1% recurrent depressive episodes. A detailed data collection was performed and illness histories were retraced through clinical files and lifetime computerized medical records. RESULTS Compared to patients with single episode, MDD patients with recurrent episodes significantly differ regarding current age, gender, working status, positive history of psychiatric disorders in family, first-lifetime illness episode characteristics, first-episode and current psychotic symptoms, current melancholic features and seasonality, age at first treatment, duration of untreated illness, and comorbid cardiovascular/endocrinological conditions. However, after multivariate analyses controlling for current age, gender, educational level, working status differences, psychiatric conditions in family, and age of illness episode, recurrence was associated with older age (p ≤ .001), younger age at first treatment (p ≤ .005), being treated with previous psychoactive treatments (p .001), and longer duration of untreated illness (p .001). CONCLUSIONS The variables associated with MDD recurrence identified in the current study may aid in the stratification of patients who could benefit from more intensive maintenance treatments for MDD. However, clinicians should rapidly identify cases that are not likely to recur in order to avoid unnecessary treatments which are commonly considered as the standard of care.
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Affiliation(s)
- Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Francesca Santi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary; NAP-2-SE New Antidepressant Target Research Group, Semmelweis University, Budapest, Hungary
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Suicide Prevention Center, Sant'Andrea Hospital, University of Rome, Rome, Italy
| | - André F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Law YW, Yeung TL, Ip FWL, Yip PSF. Evidence-Based Suicide Prevention: Collective Impact of Engagement with Community Stakeholders. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2019; 16:211-227. [PMID: 30784376 DOI: 10.1080/23761407.2019.1578318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Purpose: In response to the rising suicide trend in Hong Kong, the Centre for Suicide Research and Prevention ("CSRP") was established in 2002, with the aim to capitalize on the collective impact of research-support practices to prevent suicides.Method: The CSRP has since become an international knowledge hub that applies a public health approach and innovative strategies to address suicide-related problems at multiple levels.Results: The CSRP actively engages in research, teaching, and knowledge exchange with community stakeholders. These effort are associated with Hong Kong's more than 30% reduction in suicide rates between 2003 and 2016.Discussion: The rationale for and examples of the CSRP's practices in face of the suicide prevention challenges lay ahead were also discussed.Conclusion: The outcomes of these practices, which hold great potential for suicide prevention worldwide, have contributed to important academic debates in the field of suicidology.
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Affiliation(s)
- Yik Wa Law
- Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong SAR, PRC
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, PRC
| | - Tsz Long Yeung
- Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong SAR, PRC
| | - Flora Wai Lam Ip
- Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong SAR, PRC
| | - Paul Siu Fai Yip
- Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong SAR, PRC
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, PRC
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Wagner CJ, Dintsios CM, Metzger FG, L'Hoest H, Marschall U, Stollenwerk B, Stock S. Longterm persistence and nonrecurrence of depression treatment in Germany: a four-year retrospective follow-up using linked claims data. Int J Methods Psychiatr Res 2018; 27:e1607. [PMID: 29446186 PMCID: PMC6877203 DOI: 10.1002/mpr.1607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/15/2017] [Accepted: 12/20/2017] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To measure persistence and nonrecurrence of depression treatment and investigate potential risk factors. METHODS We retrospectively observed a closed cohort of insurees with new-onset depression treatment in 2007 and without most psychiatric comorbidity for 16 quarters (plus one to ascertain discontinuation). We linked inpatient/outpatient/drug-data per person and quarter. Person-quarters containing specified depression services were classified as depression-treatment-person-quarters (DTPQ). We defined longterm-DTPQ-persistence as 16 + 1 continuous DTPQ and longterm-DTPQ-nonrecurrence as 12 continuous quarters without DTPQ and used multivariate logistic regression to explore associations with these outcomes. RESULTS Within first 16 quarters, 28,348 patients' first period (total time) persisted for a mean/median 5.4/3 (8.7/8) quarters. Fourteen percent had longterm-DTPQ-persistence, associated (p < .05) with baseline hospital (odds ratio, OR = 1.80), psychotherapy/specialist-interview and antidepressants (OR = 1.81), age (years, OR = 1.03), unemployment (OR = 1.21), retirement (OR = 1.31), and insured as a dependent (OR = 1.32). Thirty-four percent had longterm-DTPQ-nonrecurrence, associated with psychotherapy/specialist-interview (OR = 1.40), antidepressants (OR = 0.54), female sex (OR = 0.84), age (years, OR = 0.99), retirement (OR = 1.18), and insured as a dependent (OR = 0.88). Women differed for episodic and not chronic treatment. CONCLUSION Treatment measures compared to survey's symptoms measures. We suggest further research on "treatment-free-time." Antidepressants(-) and psychotherapy/specialist-interview(+) were significantly associated with longterm-DTPQ-nonrecurrence. This was presumably moderated by possible short-time/low-dosage antidepressants use(-) and selective therapy assignment(+). Sample selectivity limited data misclassification.
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Affiliation(s)
- Christoph J Wagner
- Institute for Health Economics and Clinical Epidemiology (IGKE), Cologne University Hospital, Cologne, Germany
| | - Charalabos Markos Dintsios
- Institute for Health Services Research and Health Economics, Heinrich Heine University, Duesseldorf, Germany
| | - Florian G Metzger
- Department of Psychiatry and Psychotherapy and Geriatric Centre, Tuebingen University Hospital, Tuebingen, Germany
| | - Helmut L'Hoest
- Department of Medicine and Health Services Research, BARMER Statutory Health Insurance Fund (former BARMER GEK), Wuppertal, Germany
| | - Ursula Marschall
- Department of Medicine and Health Services Research, BARMER Statutory Health Insurance Fund (former BARMER GEK), Wuppertal, Germany
| | - Bjoern Stollenwerk
- Helmholtz Zentrum Muenchen, Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology (IGKE), Cologne University Hospital, Cologne, Germany
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Pandya SP. Spiritual Counseling Program For Children with Anxiety Disorders: A multi-city experiment. THE JOURNAL OF PASTORAL CARE & COUNSELING : JPCC 2018; 72:45-57. [PMID: 29623802 DOI: 10.1177/1542305018761631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This article reports on a multi-city two-year long experiment on the effect of a spiritual counseling program (SCP) on children diagnosed with anxiety disorders. The two-year customized SCP was conducted with 1238 children from 20 private schools in five cities across five countries, with an equal number in a control group. Results showed that post-treatment self-reported and counselor-tested anxiety outcome measure scores were lower for the treatment group. Girls, children from more affluent cities, middle-class children, and those who had one stay-at-home parent and no siblings showed reduced anxiety disorders post-treatment. Children who voluntarily attended more SCP rounds than those prescribed and those who regularly self-practiced also showed lower anxiety symptoms post-treatment. Child-focused spiritual counseling intervention comprising components of connection with God within, recognizing and annihilating fear through introspection and breath control, stilling, centering, and consciousness seemed effective. Socio-cultural factors, parental involvement, and child's own engagement with the treatment were significant determinants of effectiveness.
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11
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Hoertel N, Blanco C, Oquendo MA, Wall MM, Olfson M, Falissard B, Franco S, Peyre H, Lemogne C, Limosin F. A comprehensive model of predictors of persistence and recurrence in adults with major depression: Results from a national 3-year prospective study. J Psychiatr Res 2017; 95:19-27. [PMID: 28759845 PMCID: PMC5653405 DOI: 10.1016/j.jpsychires.2017.07.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/19/2017] [Accepted: 07/20/2017] [Indexed: 10/19/2022]
Abstract
Identifying predictors of persistence and recurrence of depression in individuals with a major depressive episode (MDE) poses a critical challenge for clinicians and researchers. We develop using a nationally representative sample, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 34,653), a comprehensive model of the 3-year risk of persistence and recurrence in individuals with MDE at baseline. We used structural equation modeling to examine simultaneously the effects of four broad groups of clinical factors on the risk of MDE persistence and recurrence: 1) severity of depressive illness, 2) severity of mental and physical comorbidity, 3) sociodemographic characteristics and 4) treatment-seeking behavior. Approximately 16% and 21% of the 2587 participants with an MDE at baseline had a persistent MDE and a new MDE during the 3-year follow-up period, respectively. Most independent predictors were common for both persistence and recurrence and included markers for the severity of the depressive illness at baseline (as measured by higher levels on the general depressive symptom dimension, lower mental component summary scores, prior suicide attempts, younger age at onset of depression and greater number of MDEs), the severity of comorbidities (as measured by higher levels on dimensions of psychopathology and lower physical component summary scores) and a failure to seek treatment for MDE at baseline. This population-based model highlights strategies that may improve the course of MDE, including the need to develop interventions that target multiple psychiatric disorders and promotion of treatment seeking to increase access to timely mental health care.
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Affiliation(s)
- Nicolas Hoertel
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA; Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France; INSERM UMR 894, Psychiatry and Neurosciences Center, France.
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Maria A Oquendo
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA
| | - Melanie M Wall
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Mark Olfson
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA
| | - Bruno Falissard
- Centre de Recherche en Epidemiologie et Santé des Populations (CESP), Paris-Saclay University, Paris-Sud University, UVSQ, INSERM, APHP, Paris, France
| | - Silvia Franco
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA
| | - Hugo Peyre
- Assistance Publique-Hôpitaux de Paris (APHP), Robert-Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France
| | - Cédric Lemogne
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
| | - Frédéric Limosin
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
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Delgadillo J, Moreea O, Lutz W. Different people respond differently to therapy: A demonstration using patient profiling and risk stratification. Behav Res Ther 2016; 79:15-22. [DOI: 10.1016/j.brat.2016.02.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 12/24/2015] [Accepted: 02/18/2016] [Indexed: 10/22/2022]
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Impact of functional and structural social relationships on two year depression outcomes: A multivariate analysis. J Affect Disord 2016; 193:274-81. [PMID: 26774514 DOI: 10.1016/j.jad.2015.12.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/29/2015] [Accepted: 12/20/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND High rates of persistent depression highlight the need to identify the risk factors associated with poor depression outcomes and to provide targeted interventions to people at high risk. Although social relationships have been implicated in depression course, interventions targeting social relationships have been disappointing. Possibly, interventions have targeted the wrong elements of relationships. Alternatively, the statistical association between relationships and depression course is not causal, but due to shared variance with other factors. We investigated whether elements of social relationships predict major depressive episode (MDE) when multiple relevant variables are considered. METHOD Data is from a longitudinal study of primary care patients with depressive symptoms. 494 participants completed questionnaires at baseline and a depression measure (PHQ-9) two years later. Baseline measures included functional (i.e. quality) and structural (i.e. quantity) social relationships, depression, neuroticism, chronic illness, alcohol abuse, childhood abuse, partner violence and sociodemographic characteristics. Logistic regression with generalised estimating equations was used to estimate the association between social relationships and MDE. RESULTS Both functional and structural social relationships predicted MDE in univariate analysis. Only functional social relationships remained significant in multivariate analysis (OR: 0.87; 95%CI: 0.79-0.97; p=0.01). Other unique predictors of MDE were baseline depression severity, neuroticism, childhood sexual abuse and intimate partner violence. LIMITATIONS We did not assess how a person's position in their depression trajectory influenced the association between social relationships and depression. CONCLUSIONS Interventions targeting relationship quality may be part of a personalised treatment plan for people at high risk due of persistent depression due to poor social relationships.
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Xu H, Zhang W, Wang X, Yuan J, Tang X, Yin Y, Zhang S, Zhou H, Qu Z, Tian D. Prevalence and influence factors of suicidal ideation among females and males in Northwestern urban China: a population-based epidemiological study. BMC Public Health 2015; 15:961. [PMID: 26404535 PMCID: PMC4582628 DOI: 10.1186/s12889-015-2257-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 09/11/2015] [Indexed: 11/25/2022] Open
Abstract
Background Suicide is an urgent public health challenge for China. This study aims to examine the prevalence, influence factors, and gender differences of suicidal ideation among general population in Northwestern Urban China. Methods Data used in this study were derived from the third wave of a cohort study of a randomized community sample with 4291 participants (≥20 years) in 2008 in Lanzhou City and Baiyin City, Gansu Province. Data were collected via face-to-face interview by the trained interviewers. Descriptive analyses, chi-square tests and multivariate logistic regressions were performed by using Stata 12.0, as needed. Results The prevalence of 12-month suicidal ideation was 4.29 %, there was no significant difference between males and females [5.04 % vs 3.62 %, Adjusted Odds Ratio (AOR) = 0.83, p = 0.351]. Several risk factors for suicidal ideation were confirmed, including being unmarried (AOR = 1.55, p = 0.030), having depression symptoms (AOR = 2.33, p < 0.001), having other insurance (AOR = 1.83, p = 0.01) or no insurance (AOR = 1.73, p = 0.024). In addition, several influence factors were significantly different in males and females, such as being currently married (unmarried vs married, AOR = 1.84, p = 0.027, for females; no difference for males), feeling hopeless (hopless vs hopeful, AOR = 1.92, p = 0.06, for females; no difference for males), having other insurances (having other insurances vs having basic employee medical insurance, AOR = 1.92, p = 0.044, for males; no difference for females), having debts (having debts vs no debts, AOR = 2.69, p = 0.001, for males; no difference for females), currently smoking (smoking vs nonsmoking, AOR = 3.01, p = 0.019 for females, no difference for males), and currently drinking (drinking vs nondrinking, AOR = 2.01, p = 0.022, for males; no difference for females). Discussion and conclusion These findings suggested that comprehensive suicide prevention strategies should be developed or strengthened in order to prevent suicide ideation in China, and the gender-specific differences need to be explored through further researches.
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Affiliation(s)
- Huiwen Xu
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875, China. .,Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642, USA.
| | - Weijun Zhang
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875, China.
| | - Xiaohua Wang
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875, China.
| | - Jiaqi Yuan
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875, China.
| | - Xinfeng Tang
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875, China.
| | - Yi Yin
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875, China.
| | - Shengfa Zhang
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875, China.
| | - Huixuan Zhou
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875, China.
| | - Zhiyong Qu
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875, China.
| | - Donghua Tian
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875, China.
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Villaggi B, Provencher H, Coulombe S, Meunier S, Radziszewski S, Hudon C, Roberge P, Provencher MD, Houle J. Self-Management Strategies in Recovery From Mood and Anxiety Disorders. Glob Qual Nurs Res 2015; 2:2333393615606092. [PMID: 28462317 PMCID: PMC5342854 DOI: 10.1177/2333393615606092] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 08/20/2015] [Accepted: 08/20/2015] [Indexed: 12/13/2022] Open
Abstract
Mood and anxiety disorders are the most prevalent mental disorders. People with such disorders implement self-management strategies to reduce or prevent their symptoms and to optimize their health and well-being. Even though self-management strategies are known to be essential to recovery, few researchers have examined them. The aim of this study is to explore strategies used by people recovering from depressive, anxiety, and bipolar disorders by asking 50 of them to describe their own strategies. Strategies were classified according to dimensions of recovery: social, existential, functional, physical, and clinical. Within these themes, 60 distinct strategies were found to be used synergistically to promote personal recovery as well as symptom reduction. Findings highlight the diversity of strategies used by people, whether they have depressive, anxiety, or bipolar disorders. This study underscores the importance of supporting self-management in a way that respects individual experience.
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Affiliation(s)
| | | | - Simon Coulombe
- Université du Québec à Montréal, Montréal, Québec, Canada
| | - Sophie Meunier
- Université du Québec à Montréal, Montréal, Québec, Canada
| | | | | | | | | | - Janie Houle
- Université du Québec à Montréal, Montréal, Québec, Canada
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Høifødt RS, Mittner M, Lillevoll K, Katla SK, Kolstrup N, Eisemann M, Friborg O, Waterloo K. Predictors of Response to Web-Based Cognitive Behavioral Therapy With High-Intensity Face-to-Face Therapist Guidance for Depression: A Bayesian Analysis. J Med Internet Res 2015; 17:e197. [PMID: 26333818 PMCID: PMC4642793 DOI: 10.2196/jmir.4351] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/08/2015] [Accepted: 07/08/2015] [Indexed: 01/20/2023] Open
Abstract
Background Several studies have demonstrated the effect of guided Internet-based cognitive behavioral therapy (ICBT) for depression. However, ICBT is not suitable for all depressed patients and there is a considerable level of nonresponse. Research on predictors and moderators of outcome in ICBT is inconclusive. Objective This paper explored predictors of response to an intervention combining the Web-based program MoodGYM and face-to-face therapist guidance in a sample of primary care patients with mild to moderate depressive symptoms. Methods Participants (N=106) aged between 18 and 65 years were recruited from primary care and randomly allocated to a treatment condition or to a delayed treatment condition. The intervention included the Norwegian version of the MoodGYM program, face-to-face guidance from a psychologist, and reminder emails. In this paper, data from the treatment phase of the 2 groups was merged to increase the sample size (n=82). Outcome was improvement in depressive symptoms during treatment as assessed with the Beck Depression Inventory-II (BDI-II). Predictors included demographic variables, severity variables (eg, number of depressive episodes and pretreatment depression and anxiety severity), cognitive variables (eg, dysfunctional thinking), module completion, and treatment expectancy and motivation. Using Bayesian analysis, predictors of response were explored with a latent-class approach and by analyzing whether predictors affected the slope of response. Results A 2-class model distinguished well between responders (74%, 61/82) and nonresponders (26%, 21/82). Our results indicate that having had more depressive episodes, being married or cohabiting, and scoring higher on a measure of life satisfaction had high odds for positively affecting the probability of response. Higher levels of dysfunctional thinking had high odds for a negative effect on the probability of responding. Prediction of the slope of response yielded largely similar results. Bayes factors indicated substantial evidence that being married or cohabiting predicted a more positive treatment response. The effects of life satisfaction and number of depressive episodes were more uncertain. There was substantial evidence that several variables were unrelated to treatment response, including gender, age, and pretreatment symptoms of depression and anxiety. Conclusions Treatment response to ICBT with face-to-face guidance may be comparable across varying levels of depressive severity and irrespective of the presence and severity of comorbid anxiety. Being married or cohabiting, reporting higher life satisfaction, and having had more depressive episodes may predict a more favorable response, whereas higher levels of dysfunctional thinking may be a predictor of poorer response. More studies exploring predictors and moderators of Internet-based treatments are needed to inform for whom this treatment is most effective. Trial Registration Australian New Zealand Clinical Trials Registry number: ACTRN12610000257066; https://www.anzctr.org.au/trial_view.aspx?id=335255 (Archived by WebCite at http://www.webcitation.org/6GR48iZH4).
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Affiliation(s)
- Ragnhild Sørensen Høifødt
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
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Smith L, Hill N, Kokanovic R. Experiences of depression, the role of social support and its impact on health outcomes. J Ment Health 2015; 24:342-6. [DOI: 10.3109/09638237.2014.954693] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Knöchel C, Alves G, Friedrichs B, Schneider B, Schmidt-Rechau A, Wenzlera S, Schneider A, Prvulovic D, Carvalho AF, Oertel-Knöchel V. Treatment-resistant Late-life Depression: Challenges and Perspectives. Curr Neuropharmacol 2015; 13:577-91. [PMID: 26467408 PMCID: PMC4761630 DOI: 10.2174/1570159x1305151013200032] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 02/25/2015] [Accepted: 02/27/2015] [Indexed: 12/28/2022] Open
Abstract
The current Review article provides a narrative review about the neurobiological underpinnings and treatment of treatment resistant late-life depression (TRLLD). The manuscript focuses on therapeutic targets of late-life depression, which include pharmacological, psychological, biophysical and exercise treatment approaches. Therefore, we summarize available evidences on that kind of therapies for patients suffering from late-life depression. The search for evidences of therapeutic options of late-life depression were done using searching websites as "pubmed", and using the searching terms "depression", "late-life depression", "treatment", "biophysical therapy", "exercise therapy", "pharmacological therapy" and "psychological therapy". To the end, we summarize and discuss current data, providing some directions for further research. Treatment recommendations for elderly depressive patients favour a multimodal approach, containing psychological, pharmacological and secondary biophysical therapeutic options. Particularly, a combination of psychotherapy and antidepressant medication reflects the best therapeutic option. However, mostly accepted and used is the pharmacological treatment although evidence suggests that the drug therapy is not as effective as it is in younger depressive patients. Further studies employing larger samples and longer follow-up periods are necessary and may focus on comparability of study designs and involve novel approaches to establish the validity and reliability of multimodal treatment programs.
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Affiliation(s)
- Christian Knöchel
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | - Gilberto Alves
- Center for Alzheimer’s Disease and Related Disorders, Universidade Federal, do Rio de Janeiro, Brazil
| | - Benedikt Friedrichs
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | | | - Anna Schmidt-Rechau
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | - Sofia Wenzlera
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | - Angelina Schneider
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | - David Prvulovic
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | - André F. Carvalho
- Center for Alzheimer’s Disease and Related Disorders, Universidade Federal, do Rio de Janeiro, Brazil
| | - Viola Oertel-Knöchel
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
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Steinert C, Hofmann M, Kruse J, Leichsenring F. The prospective long-term course of adult depression in general practice and the community. A systematic literature review. J Affect Disord 2014; 152-154:65-75. [PMID: 24210624 DOI: 10.1016/j.jad.2013.10.017] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 09/03/2013] [Accepted: 10/08/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Findings about the prospective long-term course of depression are usually derived from clinical populations while knowledge about the course in community and primary care samples is rarer. As depressive disorders are highly prevalent and associated with considerable disability and costs, this information is needed to identify the percentages of subjects with a favorable or unfavorable prognosis. Therefore our aim was to summarize the available evidence on the prospective longitudinal course of depression in both general practice and the community. METHODS We conducted a systematic, computerized search of Medline and PsycINFO. Main selection criteria were (a) adults with observer assessed depressive disorder recruited in the community or in general practice and (b) naturalistic study with follow-up length of at least three years. As primary outcome the percentages of stable recovery, recovery during or at follow-up, recurrence and chronic course were used. RESULTS We identified 12 cohorts, with 4009 followed-up individuals. Follow-up intervals ranged between three and 49 years. Between 35% and 60% of participants experienced a stable recovery with no (further) recurrences, while 70-85% recovered at least once during follow-up. A consistent percentage of 10-17% had a chronic course. Recurrence rates varied considerably ranging between 7% and 65%. Significant predictors of an unfavorable course appear to be mainly those variables that lie within the course of depression itself, i.e. history of depression, baseline severity, and comorbidity. LIMITATIONS Use of broad inclusion criteria heightened study heterogeneity and hampered comparability. CONCLUSION Regarding stable recovery, the long-term course within general practice and community samples seems more favorable than within clinical samples. Further research applying a standardized methodology is required.
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Affiliation(s)
- Christiane Steinert
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Giessen, Germany.
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Risk factors for onset of multiple or long major depressive episodes versus single and short episodes. Soc Psychiatry Psychiatr Epidemiol 2013. [PMID: 23179095 DOI: 10.1007/s00127-012-0626-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Major depressive disorder may vary according to number and duration of episodes. It is unclear whether risk factors for onset of multiple or long episodes of depression (MDE) differ from risk factors for the onset of single and short ones. METHODS Data were used from a cohort study of 5,256 GP attendees without major depressive disorder at baseline, who were followed up three times (predictD). The numbers and duration of MDE were noted and categorized into no episodes, single and short (≤3 months), and multiple or long (>3 months) episodes at follow-up. Log-binomial regression models were used to calculate relative risks between the groups for 18 risk factors examined at baseline. RESULTS 165 persons (3 %) had a single and short MDE and 328 (6 %) had multiple or long MDE at follow-up. Lower education, anxiety, problems at work and financial strain significantly increased the risk of multiple or long MDE when compared to single and short MDE. Younger people were at reduced risk of multiple or long MDE. CONCLUSIONS Our findings suggest that several risk factors can be identified that may help to predict onset of different types of MDE. These factors are easy to assess and may be used in the prevention of depression.
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The natural course and outcome of major depressive disorder in primary care: the PREDICT-NL study. Soc Psychiatry Psychiatr Epidemiol 2012; 47:87-95. [PMID: 21057769 PMCID: PMC3249585 DOI: 10.1007/s00127-010-0317-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 10/21/2010] [Indexed: 12/27/2022]
Abstract
PURPOSE To examine the natural course and outcome of major depressive disorder (MDD) in primary care over 39 months. METHODS Prospective cohort study of 1,338 consecutive attendees with follow-up after 6, 12, and 39 months with DSM-IV MDD using the Composite International Diagnostic Interview (CIDI). We measured severity of depressive symptoms (Patient Health Questionnaire 9), somatic symptoms (Patient Health Questionnaire 15), and mental and physical function (Short Form 12, mental and physical component summary). Analysis of variance and random coefficient models were performed. RESULTS At baseline, 174 people (13%) had MDD of which 17% had a chronic and 40% had a fluctuating course, while 43% remitted. Patients with chronic courses had more severe depressive symptoms (mean difference 6.54; 95% CI 4.38-8.70), somatic symptoms (mean difference 3.31; 95% CI 1.61-5.02), and greater mental dysfunction (mean difference -10.49; 95% CI -14.42 to -6.57) at baseline than those who remitted from baseline, independent of age, sex, level of education, presence of a chronic disease, and a lifetime history of depression. CONCLUSIONS Although 43% of patients with MDD attending primary care recover, this leaves a majority of patients (57%) who have a chronic or intermittent course. Chronic courses are associated with higher levels of depressive symptoms and somatic symptoms and greater mental dysfunction at baseline.
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