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Lathe J, Silverwood RJ, Hughes AD, Patalay P. Examining how well economic evaluations capture the value of mental health. Lancet Psychiatry 2024; 11:221-230. [PMID: 38281493 DOI: 10.1016/s2215-0366(23)00436-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/30/2024]
Abstract
Health economics evidence informs health-care decision making, but the field has historically paid insufficient attention to mental health. Economic evaluations in health should define an appropriate scope for benefits and costs and how to value them. This Health Policy provides an overview of these processes and considers to what extent they capture the value of mental health. We suggest that although current practices are both transparent and justifiable, they have distinct limitations from the perspective of mental health. Most social value judgements, such as the exclusion of interindividual outcomes and intersectoral costs, diminish the value of improving mental health, and this reduction in value might be disproportionate compared with other types of health. Economic analyses might have disadvantaged interventions that improve mental health compared with physical health, but research is required to test the size of such differential effects and any subsequent effect on decision-making systems such as health technology assessment systems. Collaboration between health economics and the mental health sciences is crucial for achieving mental-physical health parity in evaluative frameworks and, ultimately, improving population mental health.
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Affiliation(s)
- James Lathe
- MRC Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, Faculty of Population Health Sciences, University College London, London, UK.
| | - Richard J Silverwood
- Centre for Longitudinal Studies, Social Research Institute, Institute of Education, Faculty of Education and Society, University College London, London, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, Faculty of Population Health Sciences, University College London, London, UK
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, Faculty of Population Health Sciences, University College London, London, UK; Centre for Longitudinal Studies, Social Research Institute, Institute of Education, Faculty of Education and Society, University College London, London, UK
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2
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van Kaam FE, Rohrbach PJ, van den Akker-Van Marle ME, van Furth EF, Dingemans AE. Sensitivity to change in well-being and health-related quality of life in adults with eating disorder symptoms: ICECAP-A versus EQ-5D-5L. Int J Eat Disord 2024; 57:593-601. [PMID: 38240329 DOI: 10.1002/eat.24142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE Economic evaluations of treatments help to inform decisions on allocating health care resources. These evaluations involve comparing costs and effectiveness in terms of quality of life. To calculate quality-adjusted life years, generic health related quality of life is often used, but is criticized for not being sensitive to change in mental health populations. Another approach, using experienced well-being measured through capabilities with the ICECAP-A, has been proposed as an alternative. The aim of this study was to investigate whether changes in individuals with eating disorder (ED) symptoms can be better captured using health related quality of life (EQ-5D-5L) or well-being (ICECAP-A). METHOD Measurements at two time points with an interval of 1 year were used from a sample of 233 participants with self-reported ED symptoms. An analysis of variance was used to test whether the EQ-5D-5L and ICECAP-A differed in sensitivity to change over time. In order to compare the two questionnaires in terms of clinically significant outcome, the reliable change index and clinical cut-off score were calculated. RESULTS The two questionnaires did not differ in sensitivity to change. More individuals had recovered but also more had deteriorated according to the EQ-5D-5L compared to the ICECAP. DISCUSSION The present study revealed no differences in sensitivity to change in health-related quality of life or well-being in individuals with ED symptoms in the context of mild clinical change. Results corroborated the pervasiveness of low quality of life in this population, even after alleviation of ED symptoms. PUBLIC SIGNIFICANCE STATEMENT Measuring treatment benefits in terms of improvements in quality of life is an integral part of economic evaluations in health care. It was expected that these treatment benefits would be better captured as changes in well-being (measured with the ICECAP-A) than as changes in health-related quality of life (measured with the EQ-5D-5L) for individuals with ED symptoms. Based on the results of this study, no preference for one of the two approaches was found.
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Affiliation(s)
- Fleur E van Kaam
- GGZ Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands
| | - Pieter J Rohrbach
- Department of Clinical Psychology, Open University, Heerlen, The Netherlands
| | - M Elske van den Akker-Van Marle
- Department of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Eric F van Furth
- GGZ Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexandra E Dingemans
- GGZ Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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Lenders M, Ouwens MA, Wilting RMHJ, Videler AC. First things first: An exploration of the effects of psychoeducation for older autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613231219745. [PMID: 38197411 DOI: 10.1177/13623613231219745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
LAY ABSTRACT After receiving an autism diagnosis, psychoeducation (i.e. information regarding autism) is a first intervention. We adjusted a psychoeducation program that was originally developed by the Dutch Association for Autism for older adults to enhance its feasibility and efficacy in later life. We expected that participants would report an increase in knowledge and acceptance of the diagnosis and that people close to them would also observe this. Indeed, we found this and participants and those close to them agreed on this. Furthermore, we found some evidence that older autistic adults were better at coping with their autism. We found no positive intervention effects on psychological distress. The feedback of participants and informants about the psychoeducation program was largely positive. In future research, we advise using larger group samples and larger time scales and we also advise to further adjust the program to the needs and requirements of older adults, and to help older autistic adults to construct a new narrative of themselves, and the life they have lived, in the light of the recent autism diagnosis.
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Affiliation(s)
| | | | | | - Arjan C Videler
- GGz Breburg, The Netherlands
- Tilburg University, The Netherlands
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van Krugten FCW, Jonker MF, Himmler SFW, Hakkaart-van Roijen L, Brouwer WBF. Estimating a Preference-Based Value Set for the Mental Health Quality of Life Questionnaire (MHQoL). Med Decis Making 2024; 44:64-75. [PMID: 37981788 PMCID: PMC10714713 DOI: 10.1177/0272989x231208645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 09/29/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Health economic evaluations using common health-related quality of life measures may fall short in adequately measuring and valuing the benefits of mental health care interventions. The Mental Health Quality of Life questionnaire (MHQoL) is a standardized, self-administered mental health-related quality of life instrument covering 7 dimensions known to be relevant across and valued highly by people with mental health problems. The aim of this study was to derive a Dutch value set for the MHQoL to facilitate its use in cost-utility analyses. METHODS The value set was estimated using a discrete choice experiment (DCE) with duration that accommodated nonlinear time preferences. The DCE was embedded in a web-based self-complete survey and administered to a representative sample (N = 1,308) of the Dutch adult population. The matched pairwise choice tasks were created using a Bayesian heterogeneous D-efficient design. The overall DCE design comprised 10 different subdesigns, with each subdesign containing 15 matched pairwise choice tasks. Each participant was asked to complete 1 of the subdesigns to which they were randomly assigned. RESULTS The obtained coefficients indicated that "physical health,""mood," and "relationships" were the most important dimensions. All coefficients were in the expected direction and reflected the monotonic structure of the MHQoL, except for level 2 of the dimension "future." The predicted values for the MHQoL ranged from -0.741 for the worst state to 1 for the best state. CONCLUSIONS This study derived a Dutch value set for the recently introduced MHQoL. This value set allows for the generation of an index value for all MHQoL states on a QALY scale and may hence be used in Dutch cost-utility analyses of mental healthcare interventions. HIGHLIGHTS A discrete choice experiment was used to derive a Dutch value set for the MHQoL.This allows the use of the MHQoL in Dutch cost-utility analyses.The dimensions physical health, mood, and relationships were the most important.The utility values range from -0.741 for the worst state to 1 for the best state.
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Affiliation(s)
- Frédérique C. W. van Krugten
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam (ESHPM), Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Marcel F. Jonker
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam (ESHPM), Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Sebastian F. W. Himmler
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam (ESHPM), Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Leona Hakkaart-van Roijen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam (ESHPM), Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Werner B. F. Brouwer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam (ESHPM), Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands
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Hafkemeijer L, Slotema K, de Haard N, de Jongh A. Case report: Brief, intensive EMDR therapy for borderline personality disorder: results of two case studies with one year follow-up. Front Psychiatry 2023; 14:1283145. [PMID: 38188059 PMCID: PMC10768556 DOI: 10.3389/fpsyt.2023.1283145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/26/2023] [Indexed: 01/09/2024] Open
Abstract
Background Exposure to adverse childhood events plays an important role in the development of borderline personality disorder (BPD). Emerging evidence suggests that trauma-focused therapy using eye movement desensitization and reprocessing (EMDR) can be beneficial for patients with BPD symptoms. To date, the effects of brief, intensive EMDR treatment for this target group have not been investigated in this population. Objective This study aimed to evaluate the effects of a brief and intensive trauma-focused therapy course using EMDR therapy in two patients diagnosed with BPD who did not fulfill the diagnostic criteria for post-traumatic stress disorder (PTSD). It was hypothesized that this approach would be associated with a decline in the core symptoms of BPD, and that this would have an enduring long-term effect on patients' diagnostic status. Method Ten sessions of EMDR therapy were carried out across four consecutive treatment days, with the aim of processing patients' core adverse childhood experiences. Both A-criterion-worthy memories (without intrusive reliving) and non-A-criterion-worthy memories that were considered responsible for the patients' most prominent symptoms were targeted. The effects of EMDR therapy on trauma symptom severity and BPD diagnostic status (as established by the Structured Clinical Interview DSM-5) were determined. Additionally, the effects on psychological distress, quality of life, and difficulties in emotion regulation were determined at intake, post-treatment, and at 3-, 6-, and 12-months follow-up. Results Both patients showed a strong decline in psychological distress and difficulties in emotion regulation, and reported an improvement in their quality of life. At post-treatment, and at 3-, 6-, and 12-months follow-up they no longer met the DSM-5 criteria for BPD. Conclusion The findings of this small case study are in line with mounting evidence that a brief track of intensive trauma-focused therapy can result in long-term remission in patients with BPD. EMDR therapy seems to be a promising treatment approach for patients with BPD; however, the results need to be replicated in clinical trials.
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Affiliation(s)
| | - Karin Slotema
- Department of Personality Disorders, Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Nicole de Haard
- Department of Adult Psychiatry, GGZ Delfland, Delft, Netherlands
| | - Ad de Jongh
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands
- Research Department PSYTREC, Bilthoven, Netherlands
- School of Health Sciences, Salford University, Manchester, United Kingdom
- Institute of Health and Society, University of Worcester, Worcester, United Kingdom
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Wang J, Wang R, Zhao P, Han T, Li M, He Y, Liu Y. Cross-cultural adaptation and validation of the Mental Health Quality of Life (MHQoL) questionnaire in a Chinese-speaking population with chronic musculoskeletal pain. BMC Psychol 2023; 11:435. [PMID: 38066558 PMCID: PMC10709826 DOI: 10.1186/s40359-023-01482-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The Mental Health Quality of Life (MHQoL) questionnaire is concise and suitable for rapid assessment of CMP (chronic musculoskeletal pain) patients in primary care. However, there is a lack of Chinese versions of the MHQoL. OBJECTIVE To cross-culturally translate the MHQoL into Chinese and to assess its psychometric properties in Chinese-speaking patients with CMP. METHODS The MHQoL was translated into Chinese according to the International Guidelines for the Cross-Cultural Adaptation of Self-Report Measures. 171 CMP patients were recruited to receive the Chinese versions of the MHQoL, SF-36, and HADS tests, and the MHQoL was retested seven days later. RESULT The Chinese version of MHQoL had good retest reliability (MHQoL-7D: ICC = 0.971; MHQoL-VAS: ICC = 0.988) and internal consistency (Cronbach's alpha = 0.829). It showed a moderate correlation with the SF-36 total score (r=-0.509); the MHQoL-VAS moderately correlated with the Hospital Anxiety Depression Scale (r=-0.548). The MHQoL-7D showed no correlations with the SF-36's PF (r=-0.083) and BP (r=-0.170), weak correlations with RP (r=-0.284), RE (r=-0.298), and SF (r=-0.380), and moderate-to-strong correlations with GH (r=-0.638), VT (r=-0.480), and MH (r=-0.632). CONCLUSION The Chinese version of the MHQoL can be used in clinical practice and research in Chinese-speaking CMP patients.
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Affiliation(s)
- Jialin Wang
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
| | - Ruirui Wang
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
- College of Sports Medicine and Physical Therapy, Beijing Sports University, Beijing, China
| | - Peng Zhao
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China.
| | - Tianran Han
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
| | - Meng Li
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
- College of Sports Medicine and Physical Therapy, Beijing Sports University, Beijing, China
| | - Yuwei He
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
- College of Sports Medicine and Physical Therapy, Beijing Sports University, Beijing, China
| | - Yan Liu
- Centre for Chinese International Education, School of Humanities, Communication University of China, Beijing, China
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Ozmen S, Amarnath A, Struijs S, de Wit L, Cuijpers P. A Guided Web-Based Intervention Targeting Procrastination in College Students: Protocol for an Open Trial. JMIR Res Protoc 2023; 12:e44907. [PMID: 37921841 PMCID: PMC10656662 DOI: 10.2196/44907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/22/2023] [Accepted: 06/15/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Academic procrastination is a widespread problem among college students. It is linked to poor academic performance and increased college dropout intentions, as well as several mental health problems such as depression, anxiety, and stress. Guided web-based interventions can help reduce procrastination. However, guidance by professional clinicians draws upon valuable and limited societal resources, and a more efficient, scalable form of guidance is needed. Guidance by trained clinical psychology students has not yet been examined. OBJECTIVE The aim of this open trial is to examine the feasibility and acceptability of a web-based procrastination intervention for college students under the guidance of student digital coaches (e-coaches). METHODS We developed a single-arm trial of a guided web-based intervention targeting procrastination for the Dutch student population. Guidance is delivered by trained clinical psychology students asynchronously in the form of textual feedback on intervention progress, with the aim of supporting and motivating the participant. Participants are recruited at 7 Dutch universities. Primary outcomes are intervention satisfaction, usability, and adherence, which are assessed by the Client Satisfaction Scale (CSQ-8), System Usability Scale (SUS-10), and number of completed modules, respectively. The primary outcomes will be examined by calculating descriptive statistics. Secondary outcomes are e-coach satisfaction and changes to procrastination, depression, stress, and quality of life from pre- to posttest and follow-up. RESULTS The project was funded in 2019, and recruitment began in January 2021. As of May 2023, a total of 985 participants were enrolled, of which 372 had completed the posttest and 192 had completed the follow-up. The expected date of analysis and publication of the results is 2024. CONCLUSIONS The results are expected to contribute to the body of literature regarding eHealth in 3 ways. First, we will examine whether students who procrastinate adhere to and are satisfied with an eHealth intervention targeting this problem. Second, we will explore whether an intervention targeting procrastination can also decrease depression and stress. Lastly, we will investigate whether trained psychology students can effectively guide their peers in web-based interventions. Given the shortage of licensed psychologists, exploring alternative sources of guidance is much needed in order to provide students with the mental health support they need. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44907.
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Affiliation(s)
- Sevin Ozmen
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Arpana Amarnath
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Sascha Struijs
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Leonore de Wit
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Kindt M, Soeter M. A brief treatment for veterans with PTSD: an open-label case-series study. Front Psychiatry 2023; 14:1260175. [PMID: 37928919 PMCID: PMC10620904 DOI: 10.3389/fpsyt.2023.1260175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/10/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Despite the positive outcomes observed in numerous individuals undergoing trauma-focused psychotherapy for PTSD, veterans with this condition experience notably diminished advantages from such therapeutic interventions in comparison to non-military populations. Methods In a preliminary study we investigated the efficacy of an innovative treatment approach in a small sample of veterans (n = 7). Recognizing that accessing and targeting trauma memory in veterans with PTSD may be more challenging compared to other patient populations, we employed unique and personalized retrieval cues that engaged multiple senses and were connected to the context of their trauma. This was followed by a session focused on memory reconsolidation, which incorporated both psychological techniques (i.e., imagery rescripting) and a pharmacological component (i.e., 40 mg of propranolol). Results The findings from this small-scale case series cautiously indicate that this brief intervention, typically consisting of only one or two treatment sessions, shows promise in producing significant effects on symptoms of PTSD, distress and quality of life.This is particularly noteworthy given the complex symptomatology experienced by the veterans in this study. Conclusion To summarize, there are grounds for optimism regarding this brief treatment of combat-related PTSD. It appears that the potential for positive outcomes is far greater than commonly believed, as demonstrated by the encouraging results of this pilot study.
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Affiliation(s)
- Merel Kindt
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Marieke Soeter
- Work Health Technology, The Netherlands Organization for Applied Scientific Research TNO, Leiden, Netherlands
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Schawo S, Hoefman R, Reckers-Droog V, Lawerman-van de Wetering L, Kaminer Y, Brouwer W, Hakkaart-van Roijen L. Obtaining preference scores for an abbreviated self-completion version of the Teen-Addiction Severity Index (ASC T-ASI) to value therapy outcomes of systemic family interventions: a discrete choice experiment. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023:10.1007/s10198-023-01633-3. [PMID: 37755542 DOI: 10.1007/s10198-023-01633-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 09/11/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Systemic family interventions for adolescents with problems of substance use and/or delinquency are increasingly focused subject of economic evaluations. Treatment effects go beyond improvements in commonly measured health-related quality of life (HRQOL). The Teen-Addiction Severity Index (T-ASI) was identified as capable of capturing these broad outcomes. However, it lacks preference-based scores. An abbreviated self-completion version (ASC T-ASI) was created and validated, covering the T-ASI domains substance use, school, work, family, social relationships, justice, and mental health. This study aimed to obtain societal preference scores for the ASC T-ASI. METHODS Preferences were elicited in a sample of the Dutch general adult population (n = 1500), using a web-based Discrete Choice Experiment. Choice tasks included two unlabeled alternatives with attributes and levels corresponding to the domains and levels of the ASC T-ASI. A pilot study (n = 106) informed priors, optimal presentation, and number of choice tasks applied in the main study. Data were analyzed using a mixed multinomial logit model. RESULTS Preference scores were logically ordered, with lower scores for worse ASC T-ASI states. Scores were most influenced by reductions in problems concerning the domains substance use, mental health, justice, and family. Tariffs were calculated for each ASC T-ASI state, ranging from 0 (worst situation) to 1 (best situation). CONCLUSIONS The tariffs enable preference-based assessments of the broad effects of systemic family interventions for adolescents with problems of substance use and/or delinquency. The outcome reflects addiction-related rather than health-related utility and can be used next to generic HRQOL instruments in relevant economic evaluations. Given the source used for the preferences, interpretations and valuation of scores require attention.
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Affiliation(s)
- Saskia Schawo
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Renske Hoefman
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Vivian Reckers-Droog
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - Liesbet Lawerman-van de Wetering
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Yifrah Kaminer
- University of Connecticut School of Medicine, University of Connecticut, Farmington, USA
| | - Werner Brouwer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Leona Hakkaart-van Roijen
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
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K Alharbi K, A Hafiz T. The Effects of Hand Preference on Measures of Psychological Well-Being in a Sample of Older Adults in the Kingdom of Saudi Arabia. Cureus 2023; 15:e39058. [PMID: 37323329 PMCID: PMC10267294 DOI: 10.7759/cureus.39058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Generally, being left-handed has been linked to poorer mental health and quality of life. However, given that few studies have investigated these links in Saudi Arabia and that the prevalence of mental illness in the general population is rising, it is important to explore whether left-handedness can be considered a risk factor in a sizable, general population. AIM To investigate whether left-handers experience psychological well-being or good quality of life. METHODS A cross-sectional study among adults in Saudi Arabia was conducted from March 6, 2022 to February 27, 2023. RESULTS The study included (N = 2862) respondents who met the inclusion criteria, with an average age of 28.95 years. Left-handed individuals made up 31.7%, whereas right-handed individuals made up 60.3%, and ambidextrous individuals made up 7.9% of the population. Using the Mental Health Quality of Life questionnaire (MHQoL-7D) scoring manual, the quality of life for both left-and right-handers was evaluated. Those who were right-handed had a higher quality of life than those who were left-handed. Multivariate Analysis of Variance (MANOVA) was conducted, and the findings showed that neither the left-handed nor the right-handed group significantly differed in their levels of poor quality of life or psychological well-being. CONCLUSION Using the left or the right hand had no effect on one's quality of life or degree of well-being. Further studies with a larger sample size are needed to examine this result in more detail.
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Affiliation(s)
- Khulud K Alharbi
- Department of Health Services Management, Faculty of Public Health & Health Informatics, Umm Al-Qura University, Makkah, SAU
| | - Tamara A Hafiz
- Department of Health Promotion and Education, Faculty of Public Health & Health Informatics, Umm Al-Qura University, Makkah, SAU
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Amarnath A, Ozmen S, Struijs SY, de Wit L, Cuijpers P. Effectiveness of a guided internet-based intervention for procrastination among university students - A randomized controlled trial study protocol. Internet Interv 2023; 32:100612. [PMID: 36922962 PMCID: PMC10009202 DOI: 10.1016/j.invent.2023.100612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Procrastination is a widespread problem that is highly prevalent among the young adult population and is associated with several negative consequences. However, current evidence on the effectiveness of e-health interventions for procrastination either lack a comparison to an inactive control, do not include a student population or are of poor quality. This protocol describes the design of a trial that will overcome these limitations and examine the effectiveness of a guided internet-based intervention (GetStarted) to reduce problematic procrastinating behaviors in college students compared to a waitlist control. This study will be a two-armed randomized controlled trial with a calculated sample size of N = 176. Participants will be students from seven universities in the Netherlands. The intervention group will receive a four-week e-coach-guided intervention for procrastination. The waitlist control group will get access to treatment four weeks after randomization. Assessments will take place at baseline, post-test (4 weeks post-baseline) and follow-up (6 months post-baseline). Data will be analyzed with an intent-to-treat principle. The primary outcome is change in procrastination behaviors measured on the Irrational Procrastination scale (IPS). Secondary outcomes are depression, anxiety, stress, and quality of life. Additionally, sociodemographic characteristics of the participants, satisfaction with treatment, program usability, satisfaction with e-coach and treatment adherence will be examined as potential moderators. The results from this study can build evidence for the effectiveness of a guided internet-based intervention for treating procrastination in college students. Should it be effective, GetStarted could provide a flexible, low-intense and cost-effective treatment for procrastination and prevent common mental health problems in college students. Trial registration This trial is registered at ClinicalTrials.gov Protocol Registration and Results System (Trial number: NCT05478096).
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Affiliation(s)
- Arpana Amarnath
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Sevin Ozmen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Sascha Y Struijs
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands.,Institute of Clinical Psychology, Leiden University, Leiden, the Netherlands
| | - Leonore de Wit
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands.,WHO Collaborating Centre for Research and Dissemination of Psychological Interventions
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12
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Bremmers LGM, Hakkaart-van Roijen L, Gräler ES, Uyl-de Groot CA, Fabbricotti IN. How Do Shifts in Patients with Mental Health Problems' Formal and Informal Care Utilization Affect Informal Caregivers?: A COVID-19 Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16425. [PMID: 36554308 PMCID: PMC9778175 DOI: 10.3390/ijerph192416425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: This study investigated how potential shifts in patients' formal and informal care utilization during the COVID-19 pandemic impacted their informal caregivers in terms of their subjective burden, psychological wellbeing, and happiness. (2) Methods: A retrospective cohort study design was employed for a panel of Dutch informal caregivers of persons with mental health problems (n = 219) in June 2020. Descriptive statistics and differences between means were determined for the patients' informal and care utilization and informal caregivers' subjective burden, happiness, and psychological wellbeing. Three mediation analyses were conducted using the PROCESS macro. (3) Results: Informal caregivers reported significantly worse happiness and subjective burden scores during the COVID-19 pandemic compared with before the lockdown. There were minimal shifts in patient's care utilization reported, with the exception of a decrease in significant emotional and practical support provided by the informal caregiver. In the mediation analyses, there was not a significant indirect effect of shifts in patients' formal care utilization on informal caregivers' subjective burden, psychological wellbeing, and happiness through shifts in patients' informal care utilization. (4) Discussion and conclusion: Whilst we found that shifts in patients' care utilization during the first wave of the pandemic did not affect the informal caregiver in the short term, it is unclear what the long-term impact of the pandemic might be on informal caregivers. More research should be conducted to understand the implications of short- and long-term impact of substitution on informal caregivers of persons with mental health problems, with special consideration of the COVID-19 context and uptake of e-health technology.
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Affiliation(s)
- Leonarda G. M. Bremmers
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Leona Hakkaart-van Roijen
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Eleonora S. Gräler
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Carin A. Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Isabelle N. Fabbricotti
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
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13
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Olaya B, Van der Feltz-Cornelis CM, Hakkaart-van Roijen L, Merecz-Kot D, Sinokki M, Naumanen P, Shepherd J, van Krugten F, de Mul M, Staszewska K, Vorstenbosch E, de Miquel C, Lima RA, Ayuso-Mateos JL, Salvador-Carulla L, Borrega O, Sabariego C, Bernard RM, Vanroelen C, Gevaert J, Van Aerden K, Raggi A, Seghezzi F, Haro JM. Study protocol of EMPOWER: A cluster randomized trial of a multimodal eHealth intervention for promoting mental health in the workplace following a stepped wedge trial design. Digit Health 2022; 8:20552076221131145. [PMID: 36276189 PMCID: PMC9583218 DOI: 10.1177/20552076221131145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 09/12/2022] [Accepted: 09/20/2022] [Indexed: 11/05/2022] Open
Abstract
Objective: This article describes the EMPOWER study, a controlled trial aiming to determine the effectiveness and cost-effectiveness of an eHealth intervention to prevent common health problems and reduce presenteeism and absenteeism in the workplace. Intervention: The EMPOWER intervention spans universal, secondary and tertiary prevention and consists of an eHealth platform delivered via a website and a smartphone app designed to guide employees throughout different modules according to their specific profiles. Design: A stepped-wedge cluster randomized trial will be implemented in four countries (Finland, Poland, Spain and UK) with employees from small and medium enterprises (SMEs) and public agencies. Companies will be randomly allocated in one of three groups with different times at which the intervention is implemented. The intervention will last 7 weeks. Employees will answer several questionnaires at baseline, pre- and post-intervention and follow-up. Outcome measures: The main outcome is presenteeism. Secondary outcomes include depression, anxiety, insomnia, stress levels, wellbeing and absenteeism. Analyses will be conducted at the individual level using the intention-to-treat approach and mixed models. Additional analyses will evaluate the intervention effects according to gender, country or type of company. Cost-effectiveness and cost-utility analyses [based on the use of quality-adjusted life-years (QALYS)] will consider a societal, employers' and employees' perspective.
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Affiliation(s)
- Beatriz Olaya
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de
Déu, Sant Boi de Llobregat, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Madrid, Spain,Beatriz Olaya, Research, Innovation and
Teaching Unit, Parc Sanitari Sant Joan de Déu, Carrer Doctor Pujadas 42, 08830
Sant Boi de Llobregat, Spain.
| | - Christina M. Van der Feltz-Cornelis
- MHARG, Department of Health Sciences, Hull York Medical School, University of York, York, UK,Institute of Health Informatics, University College London, London,
UK
| | - Leona Hakkaart-van Roijen
- Erasmus School of Health Policy and Management (ESHPM), Erasmus
University Rotterdam, Rotterdam, The Netherlands
| | | | - Marjo Sinokki
- Turku Centre for Occupational Health, University of Turku, Turku, Finland
| | - Päivi Naumanen
- Turku Centre for Occupational Health, University of Turku, Turku, Finland
| | - Jessie Shepherd
- MHARG, Department of Health Sciences, Hull York Medical School, University of York, York, UK
| | - Frédérique van Krugten
- Erasmus School of Health Policy and Management (ESHPM), Erasmus
University Rotterdam, Rotterdam, The Netherlands
| | - Marleen de Mul
- Erasmus School of Health Policy and Management (ESHPM), Erasmus
University Rotterdam, Rotterdam, The Netherlands
| | | | - Ellen Vorstenbosch
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de
Déu, Sant Boi de Llobregat, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Madrid, Spain
| | - Carlota de Miquel
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de
Déu, Sant Boi de Llobregat, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Madrid, Spain
| | - Rodrigo Antunes Lima
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de
Déu, Sant Boi de Llobregat, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Madrid, Spain
| | - José Luis Ayuso-Mateos
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Madrid, Spain,Department of Psychiatry, Faculty of Medicine, Universidad Autónoma
de Madrid, Madrid, Spain
| | - Luis Salvador-Carulla
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia,National Centres for Epidemiology and Population Health, College of
Health and Medicine, Australian National University, Canberra, Australia
| | | | - Carla Sabariego
- Swiss Paraplegic Research
(SPF), Nottwil, Switzerland,Department of Health Sciences and Medicine, University of Lucerne,
Lucerne, Switzerland; Center for Rehabilitation in Global Health Systems, World
Health Organization Collaborating Center, University of Lucerne, Lucerne,
Switzerland
| | | | - Christophe Vanroelen
- Interface Demography, Department of Sociology, Vrije
Universiteit Brussel, Brussels, Belgium
| | - Jessie Gevaert
- Interface Demography, Department of Sociology, Vrije
Universiteit Brussel, Brussels, Belgium
| | - Karen Van Aerden
- Interface Demography, Department of Sociology, Vrije
Universiteit Brussel, Brussels, Belgium
| | - Alberto Raggi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, UO Neurologia
Salute Pubblica e Disabilità, Milano, Italy
| | | | | | - Josep Maria Haro
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de
Déu, Sant Boi de Llobregat, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Madrid, Spain
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14
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Enzing JJ, van Krugten FCW, Sabat I, Neumann-Böhme S, Boer B, Knies S, Brouwer WBF. Psychometric evaluation of the Mental Health Quality of Life (MHQoL) instrument in seven European countries. Health Qual Life Outcomes 2022; 20:129. [PMID: 36050766 PMCID: PMC9434504 DOI: 10.1186/s12955-022-02041-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/14/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction To make efficient use of available resources, decision-makers in healthcare may assess the costs and (health) benefits of health interventions. For interventions aimed at improving mental health capturing the full health benefits is an important challenge. The Mental Health Quality of Life (MHQoL) instrument was recently developed to meet this challenge. Evaluating the pyschometric properties of this instrument in different contexts remains important.
Methods A psychometric evaluation of the MHQoL was performed using existing international, cross-sectional data with 7155 respondents from seven European countries (Denmark, France, Germany, Italy, Portugal, The Netherlands, Portugal and the United Kingdom). Reliability was examined by calculating Cronbach’s alpha, a measure of internal consistency of the seven MHQoL dimensions, and by examining the association of the MHQoL sum scores with the MHQoL-VAS scores. Construct validity was examined by calculating Spearman’s rank correlation coefficients between the MHQoL sum scores and EQ-5D index scores, EQ-VAS scores, EQ-5D anxiety/depression dimension scores, ICECAP-A index scores and PHQ-4 sum scores. Results The MHQoL was found to have good internal consistency for all seven countries. The MHQoL sum score and the MHQoL-VAS had a high correlation. Spearman’s rank correlation coefficients were moderate to very high for all outcomes. Conclusion Our results, based on data gathered in seven European countries, suggest that the MHQoL shows favourable psychometrical characteristics. While further validation remains important, the MHQoL may be a useful instrument in measuring mental health-related quality of life in the Western European context. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-022-02041-6.
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Affiliation(s)
- Joost J Enzing
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands. .,Zorginstituut Nederland, Diemen, The Netherlands.
| | - Frédérique C W van Krugten
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Iryna Sabat
- Nova School of Business and Economics, Lisbon, Portugal.,Hamburg Center for Health Economics, Hamburg, Germany
| | - Sebastian Neumann-Böhme
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.,Hamburg Center for Health Economics, Hamburg, Germany
| | - Bert Boer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Saskia Knies
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.,Zorginstituut Nederland, Diemen, The Netherlands
| | - Werner B F Brouwer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
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15
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Hofman S, Hafkemeijer L, de Jongh A, Starrenburg A, Slotema K. Trauma-focused EMDR for Personality disorders among Outpatients (TEMPO): study protocol for a multi-centre, single-blind, randomized controlled trial. Trials 2022; 23:196. [PMID: 35246228 PMCID: PMC8896281 DOI: 10.1186/s13063-022-06082-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 02/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background Existing recommended treatment options for personality disorders (PDs) are extensive and costly. There is emerging evidence indicating that trauma-focused treatment using eye movement desensitization and reprocessing (EMDR) therapy aimed at resolving memories of individuals’ adverse events can be beneficial for this target group within a relatively short time frame. The primary purpose of the present study is to determine the effectiveness of EMDR therapy versus waiting list in reducing PD symptom severity. Furthermore, the effects of EMDR therapy on trauma symptom severity, loss of diagnosis, personal functioning, quality of life, and mental health outcomes will be determined. In addition, the cost-effectiveness of EMDR therapy in the treatment of PDs is investigated. Moreover, predictors of treatment success, symptom deterioration and treatment discontinuation will be assessed. Lastly, experiences with EMDR therapy will be explored. Method In total, 159 patients with a PD will be included in a large multicentre single-blind randomized controlled trial. The Structured Clinical Interview for DSM-5 Personality Disorders will be used to determine the presence of a PD. Participants will be allocated to either a treatment condition with EMDR therapy (ten biweekly 90-min sessions) or a waiting list. Three months after potential treatment with EMDR therapy, patients can receive treatment as usual for their PD. All participants are subject to single-blinded baseline, post-intervention and 3-, 6- and 12-month follow-up assessments. The primary outcome measures are the Assessment of DSM-IV Personality Disorders and the Clinician-Administered PTSD Scale for DSM-5. For cost-effectiveness, the Treatment Inventory of Costs in Patients with psychiatric disorders, EuroQol-5D-3L, and the Mental Health Quality of Life Questionnaire will be administered. The PTSD Checklist for DSM-5, Brief State Paranoia Checklist and Difficulties in Emotion Regulation Scale will be used to further index trauma symptom severity. Type of trauma is identified at baseline with the Childhood Trauma Questionnaire-SF and Life Events Checklist for the DSM-5. Personal functioning and health outcome are assessed with the Level of Personality Functioning Scale-BF 2.0, Outcome Questionnaire-45 and Mental Health Quality of Life Questionnaire. Experiences with EMDR therapy of patients in the EMDR therapy condition are explored with a semi-structured interview at post-intervention. Discussion It is expected that the results of this study will contribute to knowledge about the effectiveness, and cost-effectiveness of trauma-focused treatment using EMDR therapy in individuals diagnosed with a PD. Follow-up data provide documentation of long-term effects of EMDR therapy on various outcome variables, most importantly the reduction of PD symptom severity and loss of diagnoses. Trial registration Netherlands Trial Register NL9078. Registered on 31 November 2020
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Affiliation(s)
- Simon Hofman
- Department of Personality Disorders, Parnassia Psychiatric Institute, Lijnbaan 4, 2512VA, The Hague, The Netherlands
| | | | - Ad de Jongh
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.,Research Department, PSYTREC, Bilthoven, The Netherlands.,School of Health Sciences, Salford University, Manchester, UK.,Institute of Health and Society, University of Worcester, Worcester, UK.,School of Psychology, Queen's University Belfast, Belfast, Northern Ireland
| | | | - Karin Slotema
- Department of Personality Disorders, Parnassia Psychiatric Institute, Lijnbaan 4, 2512VA, The Hague, The Netherlands. .,Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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16
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Wibbelink CJM, Arntz A, Grasman RPPP, Sinnaeve R, Boog M, Bremer OMC, Dek ECP, Alkan SG, James C, Koppeschaar AM, Kramer L, Ploegmakers M, Schaling A, Smits FI, Kamphuis JH. Towards optimal treatment selection for borderline personality disorder patients (BOOTS): a study protocol for a multicenter randomized clinical trial comparing schema therapy and dialectical behavior therapy. BMC Psychiatry 2022; 22:89. [PMID: 35123450 PMCID: PMC8817780 DOI: 10.1186/s12888-021-03670-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/21/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Specialized evidence-based treatments have been developed and evaluated for borderline personality disorder (BPD), including Dialectical Behavior Therapy (DBT) and Schema Therapy (ST). Individual differences in treatment response to both ST and DBT have been observed across studies, but the factors driving these differences are largely unknown. Understanding which treatment works best for whom and why remain central issues in psychotherapy research. The aim of the present study is to improve treatment response of DBT and ST for BPD patients by a) identifying patient characteristics that predict (differential) treatment response (i.e., treatment selection) and b) understanding how both treatments lead to change (i.e., mechanisms of change). Moreover, the clinical effectiveness and cost-effectiveness of DBT and ST will be evaluated. METHODS The BOOTS trial is a multicenter randomized clinical trial conducted in a routine clinical setting in several outpatient clinics in the Netherlands. We aim to recruit 200 participants, to be randomized to DBT or ST. Patients receive a combined program of individual and group sessions for a maximum duration of 25 months. Data are collected at baseline until three-year follow-up. Candidate predictors of (differential) treatment response have been selected based on the literature, a patient representative of the Borderline Foundation of the Netherlands, and semi-structured interviews among 18 expert clinicians. In addition, BPD-treatment-specific (ST: beliefs and schema modes; DBT: emotion regulation and skills use), BPD-treatment-generic (therapeutic environment characterized by genuineness, safety, and equality), and non-specific (attachment and therapeutic alliance) mechanisms of change are assessed. The primary outcome measure is change in BPD manifestations. Secondary outcome measures include functioning, additional self-reported symptoms, and well-being. DISCUSSION The current study contributes to the optimization of treatments for BPD patients by extending our knowledge on "Which treatment - DBT or ST - works the best for which BPD patient, and why?", which is likely to yield important benefits for both BPD patients (e.g., prevention of overtreatment and potential harm of treatments) and society (e.g., increased economic productivity of patients and efficient use of treatments). TRIAL REGISTRATION Netherlands Trial Register, NL7699 , registered 25/04/2019 - retrospectively registered.
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Affiliation(s)
- Carlijn J. M. Wibbelink
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
| | - Arnoud Arntz
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
| | - Raoul P. P. P. Grasman
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
| | - Roland Sinnaeve
- grid.5596.f0000 0001 0668 7884Department of Neurosciences, Mind Body Research, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Michiel Boog
- grid.491189.cDepartment of Addiction and Personality, Antes Mental Health Care, Max Euwelaan 1, Rotterdam, 3062 MA the Netherlands ,grid.6906.90000000092621349Institute of Psychology, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR the Netherlands
| | - Odile M. C. Bremer
- grid.491093.60000 0004 0378 2028Arkin Mental Health, NPI Institute for Personality Disorders, Domselaerstraat 128, Amsterdam, 1093 MB the Netherlands
| | - Eliane C. P. Dek
- grid.491389.ePsyQ Personality Disorders Rotterdam-Kralingen, Max Euwelaan 70, Rotterdam, 3062 MA the Netherlands
| | | | - Chrissy James
- grid.420193.d0000 0004 0546 0540Department of Personality Disorders, Outpatient Clinic De Nieuwe Valerius, GGZ inGeest, Amstelveenseweg 589, Amsterdam, 1082 JC the Netherlands
| | | | - Linda Kramer
- grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Stationsplein 138, 1703 WC Heerhugowaard, the Netherlands
| | - Maria Ploegmakers
- grid.491369.00000 0004 0466 1666Pro Persona, Siependaallaan 3, Tiel, 4003 LE the Netherlands
| | - Arita Schaling
- grid.491369.00000 0004 0466 1666Pro Persona, Willy Brandtlaan 20, Ede, 6716 RR the Netherlands
| | - Faye I. Smits
- grid.468622.c0000 0004 0501 8787GGZ Rivierduinen, Sandifortdreef 19, Leiden, 2333 ZZ the Netherlands
| | - Jan H. Kamphuis
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
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17
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Wibbelink CJM, Lee CW, Bachrach N, Dominguez SK, Ehring T, van Es SM, Fassbinder E, Köhne S, Mascini M, Meewisse ML, Menninga S, Morina N, Rameckers SA, Thomaes K, Walton CJ, Wigard IG, Arntz A. The effect of twice-weekly versus once-weekly sessions of either imagery rescripting or eye movement desensitization and reprocessing for adults with PTSD from childhood trauma (IREM-Freq): a study protocol for an international randomized clinical trial. Trials 2021; 22:848. [PMID: 34838102 PMCID: PMC8626728 DOI: 10.1186/s13063-021-05712-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 10/11/2021] [Indexed: 11/30/2022] Open
Abstract
Background Trauma-focused treatments for posttraumatic stress disorder (PTSD) are commonly delivered either once or twice a week. Initial evidence suggests that session frequency affects treatment response, but very few trials have investigated the effect of session frequency. The present study’s aim is to compare treatment outcomes of twice-weekly versus once-weekly sessions of two treatments for PTSD related to childhood trauma, imagery rescripting (ImRs) and eye movement desensitization and reprocessing (EMDR). We hypothesize that both treatments will be more effective when delivered twice than once a week. How session frequency impacts treatment response, whether treatment type moderates the frequency effect, and which treatment type and frequency works best for whom will also be investigated. Methods The IREM-Freq trial is an international multicenter randomized clinical trial conducted in mental healthcare centers across Australia, Germany, and the Netherlands. We aim to recruit 220 participants, who will be randomized to one of four conditions: (1) EMDR once a week, (2) EMDR twice a week, (3) ImRs once a week, or (4) ImRs twice a week. Treatment consists of 12 sessions. Data are collected at baseline until one-year follow-up. The primary outcome measure is clinician-rated PTSD symptom severity. Secondary outcome measures include self-reported PTSD symptom severity, complex PTSD symptoms, trauma-related cognitions and emotions, depressive symptoms, dissociation, quality of life, and functioning. Process measures include memory, learning, therapeutic alliance, motivation, reluctance, and avoidance. Additional investigations will focus on predictors of treatment outcome and PTSD severity, change mechanisms of EMDR and ImRs, the role of emotions, cognitions, and memory, the optimization of treatment selection, learned helplessness, perspectives of patients and therapists, the network structure of PTSD symptoms, and sudden treatment gains. Discussion This study will extend our knowledge on trauma-focused treatments for PTSD related to childhood trauma and, more specifically, the importance of session frequency. More insight into the optimal session frequency could lead to improved treatment outcomes and less dropout, and in turn, to a reduction of healthcare costs. Moreover, the additional investigations will broaden our understanding of how the treatments work and variables that affect treatment outcome. Trial registration Netherlands Trial Register NL6965, registered 25/04/2018. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05712-9.
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Affiliation(s)
- Carlijn J M Wibbelink
- Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS, Amsterdam, the Netherlands.
| | - Christopher W Lee
- Faculty of Health and Medical Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - Nathan Bachrach
- GGZ Oost Brabant, RINO Zuid and Tilburg University, Kluisstraat 2, 5427 EM, Boekel, the Netherlands
| | - Sarah K Dominguez
- School of Psychology and Exercise Science, Murdoch University and Sexual Assault Resource Centre, 90 South Street, Murdoch, Western Australia, 6150, Australia
| | - Thomas Ehring
- Department of Psychology, LMU Munich, Leopoldstr. 13, 80802, Munich, Germany
| | - Saskia M van Es
- PsyQ Amsterdam, Parnassia Groep, Overschiestraat 57, 1062 HN, Amsterdam, the Netherlands
| | - Eva Fassbinder
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, Niemannsweg 147, 24105, Kiel, Germany.,Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Sandra Köhne
- Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Magda Mascini
- GGZ Noord-Holland-Noord, Stationsplein 138, 1703 WC, Heerhugowaard, the Netherlands
| | - Marie-Louise Meewisse
- Abate, Centre of Expertise in Anxiety and Trauma, Postweg 3, 1601 SX, Enkhuizen, the Netherlands
| | - Simone Menninga
- PsyQ Beverwijk, Parnassia Groep, Leeghwaterweg 1a, 1951 NA, Velsen-Noord, the Netherlands
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Fliednerstr. 21, 48149, Muenster, Germany
| | - Sophie A Rameckers
- Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS, Amsterdam, the Netherlands
| | - Kathleen Thomaes
- Sinai Center, the Psychotrauma Expertise Center of Arkin and Amsterdam UMC, location VUmc, Department Psychiatry and Department of Anatomy and Neuroscience, Laan van de Helende Meesters 2, 1186 AM, Amstelveen, the Netherlands
| | - Carla J Walton
- Centre for Psychotherapy, Hunter New England Mental Health Service, NSW, Australia, PO Box 833, Newcastle, NSW, 2300, Australia
| | - Ingrid G Wigard
- PsyQ Amsterdam, Parnassia Groep, Overschiestraat 57, 1062 HN, Amsterdam, the Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS, Amsterdam, the Netherlands
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