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Amha H, Getnet A, Munie BM, Workie T, Alem G, Mulugeta H, Bishaw KA, Ayenew T, Gedfew M, Desta M, Wubetu M. Relapse rate and predictors among people with severe mental illnesses at Debre Markos Comprehensive specialized hospital, Northwest Ethiopia: a prospective follow up study. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01900-1. [PMID: 39292261 DOI: 10.1007/s00406-024-01900-1] [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: 08/07/2024] [Accepted: 09/07/2024] [Indexed: 09/19/2024]
Abstract
Severe mental illness is usually marked by periods of remission, when symptoms are absent or well controlled, and of exacerbation, when symptoms return or worsen. Relapse of these severe illnesses costs a lot for patients and their families and imposes a financial burden on hospital and community services. Costs for relapse cases were four times higher than that of non-relapse cases. There is a dearth of evidence in on relapse rate on these vulnerable population in Sub-Saharan Africa, therefore this study assessed relapse rate and predictors among people with severe mental illnesses at Debre Markos Comprehensive specialized hospital, Northwest Ethiopia. Prospective follow up study design was employed among 315 people with severe mental illnesses who were selected by systematic random sampling technique. Epi.data version 4.2 was used for data entry and exported to STATA 14 for analysis. The Kaplan-Meier curve was used to estimate the median duration of occurrence and the Log rank test was used to compare survival curves between different categories of explanatory variables. A survival analysis was used to estimate the cumulative rate of relapse, Cox proportional hazards models was used to examine independent factors associated with time to develop relapse. To estimate the association between predictors and relapse, hazard ratio with 95% confidence intervals was used. Variables score p value < 0.25 with in the Bivariable analysis was entered in to the multivariable analysis model. The statistical significance was accepted at p-value < 0.05. Around 119 (37.78%) had develop relapse, and the remaining 196 (62.22%) were censored. The overall incidence rate of relapse was 3.66 per 100 person-month (95% CI:3.06-4.38) with a total of 3250 patient-month observations. Variables such as: age (18-36 years) [(AHR) = 3.42:95% (CI) :1.67,6.97)], marital status (single and widowed) 1.87 [AHR: 1.87; 95% CI: (1.06 ,3.27)] and 2.14 [AHR: 2.14; 95% CI: (1.03 ,4.44)], duration of delay in getting treatment ( > = 1 year) [(AHR = 2.55:CI:1.20, 5.38)], types of diagnosis (Major Depressive Disorder) (AHR = 2.38, CI:1.37 ,4.14), medication adherence (low adherence) (AHR = 5.252.45, 11.21) were statistically significant (P value < 0.05). Nearly two-fifth of people diagnosis with severe mental illnesses had develop relapse and the median survival time to develop relapse was nine months. It is advised that early detection of severe mental illness and early initiation of treatments are very crucial to prevent relapse. Psycho education, counseling that alleviates poor treatment adherence are highly recommended.
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Affiliation(s)
- Haile Amha
- College of Medicine and Health Science, Debre Markos University, P.O. Box:269, Debre Markos, Ethiopia.
| | - Asmamaw Getnet
- College of Medicine and Health Science, Debre Markos University, P.O. Box:269, Debre Markos, Ethiopia
| | - Birhanu Mengist Munie
- College of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tilahun Workie
- Debre Markos Comprehensive Specialized Hospital, Debre Markos, Ethiopia
| | - Girma Alem
- College of Medicine and Health Science, Debre Markos University, P.O. Box:269, Debre Markos, Ethiopia
| | - Henok Mulugeta
- College of Medicine and Health Science, Debre Markos University, P.O. Box:269, Debre Markos, Ethiopia
| | - Keralem Anteneh Bishaw
- College of Medicine and Health Science, Debre Markos University, P.O. Box:269, Debre Markos, Ethiopia
| | - Temesgen Ayenew
- College of Medicine and Health Science, Debre Markos University, P.O. Box:269, Debre Markos, Ethiopia
| | - Mihretie Gedfew
- College of Medicine and Health Science, Debre Markos University, P.O. Box:269, Debre Markos, Ethiopia
| | - Melaku Desta
- College of Medicine and Health Science, Debre Markos University, P.O. Box:269, Debre Markos, Ethiopia
| | - Muluken Wubetu
- College of Medicine and Health Science, Debre Markos University, P.O. Box:269, Debre Markos, Ethiopia
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Misiak B, Rejek M, Bielawski T, Błoch M, Samochowiec J, Bąba-Kubiś A, Gawęda Ł, Maciaszek J. The same but different too: Depression profiles in young adults without a history of psychiatric treatment identified using Bayesian and partial correlation networks. J Psychiatr Res 2024; 179:83-91. [PMID: 39260112 DOI: 10.1016/j.jpsychires.2024.09.002] [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: 06/23/2024] [Revised: 07/29/2024] [Accepted: 09/03/2024] [Indexed: 09/13/2024]
Abstract
Depression is a heterogenous diagnostic construct; however, dynamic interactions between specific depressive symptoms across their qualitatively different profiles remain largely unknown. The study aimed to recognize the most prevalent profiles of depressive symptoms and assess their dynamics in young adults without a history of psychiatric treatment. Depressive symptoms were recorded using the Patient Health Questionnaire-9 (PHQ-9). The data were assessed for all theoretical and empirical combinations of depressive symptoms in participants with a positive screening for depression. The profiles identified in the majority of participants were analyzed using partial correlation and Bayesian networks. Data from 3583 individuals with a positive screening for depression were analyzed. Out of 382 theoretical profiles, 150 profiles (39.3%) were present in this dataset. The majority of participants (56.8%) showed 4 profiles of depressive symptoms including the profile with all depressive symptoms present, the profile without suicidal ideation, the profile without psychomotor impairment, and the profile without both psychomotor impairment and suicidal ideation. The profiles differed largely in terms of their dynamics and symptoms that are necessary to activate the whole network. The network characteristics within specific profiles did not differ significantly across the level of difficulties attributable to depressive symptoms. Our findings indicate that depression emerging in young adults shows a limited number of symptom profiles. However, dynamics of depressive symptoms differs largely between specific profiles regardless of functional impairment indicating the need to personalize therapeutic approaches. Future studies should further disentangle the heterogeneity of depressive symptoms, e.g., by dissecting the symptoms that are combined together by single PHQ-9 items (i.e., hypersomnia and insomnia; psychomotor agitation and retardation).
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Affiliation(s)
- Błażej Misiak
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland.
| | - Maksymilian Rejek
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Tomasz Bielawski
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Marta Błoch
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland
| | - Agata Bąba-Kubiś
- Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Julian Maciaszek
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
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Ou K, Gide DN, El-Den S, Kouladjian O'Donnell L, Malone DT, O'Reilly CL. Pharmacist-led screening for mental illness: A systematic review. Res Social Adm Pharm 2024; 20:828-845. [PMID: 38866605 DOI: 10.1016/j.sapharm.2024.06.001] [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: 12/20/2023] [Revised: 05/29/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Early identification and treatment of mental illnesses is imperative for optimal patient outcomes. Pharmacists may play an important role in mental healthcare through the provision of screening services for mental illnesses. OBJECTIVE (s): To systematically review the impact of pharmacist-led mental illness screening on clinical or patient-reported outcomes and identify and report any follow-up or referral systems used in pharmacist-led screening interventions for mental illnesses. METHODS A systematic review was conducted by searching MEDLINE, CINAHL, Embase and APA PsycInfo via EBSCOhost from inception to 9 March 2023 to identify studies involving pharmacist-led screening interventions for mental illnesses. Data was collected on the mental illness in question, setting and population characteristics, screening tools used, clinical or patient-reported outcomes, and follow-up and referral systems reported. RESULTS Twenty six studies were identified that related to screening for mental illnesses, such as depressive disorders and substance use disorders. There were a variety of study designs, including uncontrolled studies (n = 23), pre-post studies (n = 2) and randomised controlled trials (n = 1). Screening was conducted in different settings, with most studies conducted in community pharmacies (n = 21/26, 87.8 %) and focusing on depression screening (n = 12/26, 46.1 %). A range of follow-up and referral methods to other healthcare professionals were reported, including verbal (n = 3/26, 11.5 %), both written and verbal (n = 3/26, 11.5 %), communications via electronic health record (n = 2/26, 7.7 %) and written (n = 1/26, 3.8 %). CONCLUSIONS Pharmacists provide screening for a variety of mental illnesses in different settings. Various referral methods and follow-up pathways may be utilised for post-screening patient care. However, current evidence is insufficient to establish improvements in early detection, treatment, or outcomes. Further large, well-designed studies are required to support the role of pharmacists in mental illness screening, provide evidence on the impact of pharmacist-led mental illness screening services and inform the most effective follow up and referral methods.
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Affiliation(s)
- Kevin Ou
- Pharmaceutical Society of Australia, Sydney, NSW, Australia
| | - Duha N Gide
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Sarira El-Den
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Kouladjian O'Donnell
- Clinical Pharmacology and Ageing, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Daniel T Malone
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Claire L O'Reilly
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Cavelti M, Ruppen NA, Sele S, Moessner M, Bauer S, Becker K, Krämer J, Eschenbeck H, Rummel-Kluge C, Thomasius R, Diestelkamp S, Gillé V, Baldofski S, Koenig J, Kaess M. An examination of sociodemographic and clinical factors influencing help-seeking attitudes and behaviors among adolescents with mental health problems. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02568-7. [PMID: 39190155 DOI: 10.1007/s00787-024-02568-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 08/15/2024] [Indexed: 08/28/2024]
Abstract
This study investigated sociodemographic and clinical factors influencing help-seeking attitudes and behavior among adolescents with mental health problems. As part of the ProHEAD ("Promoting Help-seeking using E-technology for ADolescents") consortium a school-based, online assessment of sociodemographic information, psychopathology, risk-taking and self-harming behavior, help-seeking attitudes and behavior, and barriers to help-seeking was conducted in adolescents aged ≥ 12 years recruited from randomly selected schools in five regions of Germany. Linear regression analyses with the LMG formula were performed to explore predictors of help-seeking attitudes and behavior and assess their relative importance. Nine thousand five hundred and nine participants (95.5%) completed the online assessment (mean age: 15.1 years, 58.6% female). In total, 1606 participants (16.9%) showed relevant mental health problems (e.g., depressive and eating disorder symptoms, alcohol problems, and thoughts of self-harming behavior). Among them, 895 (55.7%) reported having sought help (lifetime), with higher rates for informal (n = 842, 52.4%) compared to professional (n = 380, 23.7%) sources. High help-seeking propensity emerged as the most important factor contributing to professional help-seeking, followed by elevated levels of psychopathology and perceived barriers, with sociodemographic factors being less impactful. Psychopathological severity also outweighed sociodemographic factors in predicting negative help-seeking attitudes. These findings indicate that attitudes towards seeking professional help, perceived barriers, and psychopathology severity critically influence limited adolescent help-seeking behavior. This emphasizes the need for initiatives that promote help-seeking, reduce negative attitudes, and address structural barriers in adolescent mental health care.
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Affiliation(s)
- Marialuisa Cavelti
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland
| | - Noemi Anne Ruppen
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland
| | - Silvano Sele
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland
| | - Markus Moessner
- Centre for Psychotherapy Research, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Stephanie Bauer
- Centre for Psychotherapy Research, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Katja Becker
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, University of Marburg, Marburg, Germany
| | - Jennifer Krämer
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, University of Marburg, Marburg, Germany
| | - Heike Eschenbeck
- Department of Educational Psychology and Health Psychology, University of Education Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
| | - Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Rainer Thomasius
- German Center for Addiction Research in Childhood and Adolescence, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Silke Diestelkamp
- German Center for Addiction Research in Childhood and Adolescence, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Vera Gillé
- Department of Educational Psychology and Health Psychology, University of Education Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
| | - Sabrina Baldofski
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland.
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
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Probert-Lindström S, Bötschi S, Gysin-Maillart A. The Influence of Treatment Latency on Suicide-Specific Treatment Outcomes. Arch Suicide Res 2024; 28:1009-1021. [PMID: 37812204 DOI: 10.1080/13811118.2023.2265437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
INTRODUCTION The Attempted Suicude Short Intervention Program (ASSIP) provides an effective and cost-effective treatment option for people who have attempted suicide. Studies suggest that longer treatment latency is associated with poorer response to therapy, more severe symptomatology, and more suicide attempts This study examined the influence of treatment latency (time between suicide attempt and initiation of therapy) on the number of suicide attempts over the long-term course of ASSIP and the influence of treatment relationship on the extent of suicidal ideation. METHOD Survival and regression analyses were performed on 60 participants who had recently attempted suicide and received ASSIP at an outpatient psychiatric clinic. 60% were women and 40% were men. RESULTS The results found no significant association between treatment outcome in ASSIP and treatment latency (HR = 1.06; 95% CI: 0.92- 1.21, p = .44). Treatment relationship significantly influenced suicidal ideation at time t4 (B = - .35, t(55) = -3.21, p = .002), but treatment latency was not significantly associated with suicidal ideation (B = .02, t(55) = 0.87, p = .39). CONCLUSION No relationship between treatment latency and treatment outcome could be found, suggesting that ASSIP can be implemented at any time after the last suicide attempt. In contrast, the treatment relationship plays a central role in ASSIP.
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Kabotyanski KE, Najera RA, Banks GP, Sharma H, Provenza NR, Hayden BY, Mathew SJ, Sheth SA. Cost-effectiveness and threshold analysis of deep brain stimulation vs. treatment-as-usual for treatment-resistant depression. Transl Psychiatry 2024; 14:243. [PMID: 38849334 PMCID: PMC11161481 DOI: 10.1038/s41398-024-02951-7] [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: 11/13/2023] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 06/09/2024] Open
Abstract
Treatment-resistant depression (TRD) affects approximately 2.8 million people in the U.S. with estimated annual healthcare costs of $43.8 billion. Deep brain stimulation (DBS) is currently an investigational intervention for TRD. We used a decision-analytic model to compare cost-effectiveness of DBS to treatment-as-usual (TAU) for TRD. Because this therapy is not FDA approved or in common use, our goal was to establish an effectiveness threshold that trials would need to demonstrate for this therapy to be cost-effective. Remission and complication rates were determined from review of relevant studies. We used published utility scores to reflect quality of life after treatment. Medicare reimbursement rates and health economics data were used to approximate costs. We performed Monte Carlo (MC) simulations and probabilistic sensitivity analyses to estimate incremental cost-effectiveness ratios (ICER; USD/quality-adjusted life year [QALY]) at a 5-year time horizon. Cost-effectiveness was defined using willingness-to-pay (WTP) thresholds of $100,000/QALY and $50,000/QALY for moderate and definitive cost-effectiveness, respectively. We included 274 patients across 16 studies from 2009-2021 who underwent DBS for TRD and had ≥12 months follow-up in our model inputs. From a healthcare sector perspective, DBS using non-rechargeable devices (DBS-pc) would require 55% and 85% remission, while DBS using rechargeable devices (DBS-rc) would require 11% and 19% remission for moderate and definitive cost-effectiveness, respectively. From a societal perspective, DBS-pc would require 35% and 46% remission, while DBS-rc would require 8% and 10% remission for moderate and definitive cost-effectiveness, respectively. DBS-pc will unlikely be cost-effective at any time horizon without transformative improvements in battery longevity. If remission rates ≥8-19% are achieved, DBS-rc will likely be more cost-effective than TAU for TRD, with further increasing cost-effectiveness beyond 5 years.
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Affiliation(s)
| | - Ricardo A Najera
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Garrett P Banks
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Himanshu Sharma
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Nicole R Provenza
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Benjamin Y Hayden
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Sanjay J Mathew
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
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Sato A, Sugawara N, Kawamata Y, Yasui‐Furukori N. Changes in suicidal ideation during treatment among patients with major depressive disorder: A 6-month naturalistic follow-up study. Neuropsychopharmacol Rep 2024; 44:371-380. [PMID: 38443150 PMCID: PMC11144608 DOI: 10.1002/npr2.12428] [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: 11/18/2023] [Revised: 02/02/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
AIM There is limited evidence regarding predictors of changes in suicidal ideation (SI) in patients with major depressive disorder (MDD). The objective of this study was to describe changes in SI over a 6-month period and identify their predictors from naturalistic observations of MDD patients. METHODS In the cross-sectional analysis, we examined 257 patients with MDD at the first-visit assessment. Among the patients, 119 who completed the 6-month assessment (completers) were included in the longitudinal analysis. For the evaluation of depressive symptoms, including SI, the Quick Inventory of Depressive Symptomatology-Japanese version was administered at both the first-visit and follow-up assessments. At baseline, we also administered the Japanese version of the Ten Item Personality Inventory to assess personality traits and the PRIME Screen-Revised to assess psychotic symptoms. RESULTS In the cross-sectional analysis of first-visit patients, 36.2% (93/257) exhibited SI. Among completers, 14.3% (17/119) had prolonged SI. Among the completers with SI at the first-visit assessment, 38.6% (17/44) had SI at the follow-up assessment (prolonged SI). In linear regression models including all completers, prolonged SI was positively associated with endorsement of suspiciousness/persecutory ideas and negatively associated with higher age. CONCLUSION More than one-third of completers who had SI at the first-visit assessment experienced prolonged SI (SI at follow-up). Our findings can help clinicians predict the course of MDD by identifying associated demographic and clinical characteristics.
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Affiliation(s)
- Aoi Sato
- Department of PsychiatryDokkyo Medical University School of MedicineMibuJapan
| | - Norio Sugawara
- Department of PsychiatryDokkyo Medical University School of MedicineMibuJapan
| | - Yasushi Kawamata
- Department of PsychiatryDokkyo Medical University School of MedicineMibuJapan
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Liu W, Jiang X, Deng Z, Xie Y, Guo Y, Wu Y, Sun Q, Kong L, Wu F, Tang Y. Functional and structural alterations in different durations of untreated illness in the frontal and parietal lobe in major depressive disorder. Eur Arch Psychiatry Clin Neurosci 2024; 274:629-642. [PMID: 37542558 PMCID: PMC10995069 DOI: 10.1007/s00406-023-01625-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/22/2023] [Indexed: 08/07/2023]
Abstract
Major depressive disorder (MDD) is one of the most disabling illnesses that profoundly restricts psychosocial functions and impairs quality of life. However, the treatment rate of MDD is surprisingly low because the availability and acceptability of appropriate treatments are limited. Therefore, identifying whether and how treatment delay affects the brain and the initial time point of the alterations is imperative, but these changes have not been thoroughly explored. We investigated the functional and structural alterations of MDD for different durations of untreated illness (DUI) using regional homogeneity (ReHo) and voxel-based morphometry (VBM) with a sample of 125 treatment-naïve MDD patients and 100 healthy controls (HCs). The MDD patients were subgrouped based on the DUI, namely, DUI ≤ 1 M, 1 < DUI ≤ 6 M, 6 < DUI ≤ 12 M, and 12 < DUI ≤ 48 M. Subgroup comparison (MDD with different DUIs) was applied to compare ReHo and grey matter volume (GMV) extracted from clusters of regions with significant differences (the pooled MDD patients relative to HCs). Correlations and mediation effects were analysed to estimate the relationships between the functional and structural neuroimaging changes and clinical characteristics. MDD patients exhibited decreased ReHo in the left postcentral gyrus and precentral gyrus and reduced GMV in the left middle frontal gyrus and superior frontal gyrus relative to HCs. The initial functional abnormalities were detected after being untreated for 1 month, whereas this duration was 3 months for GMV reduction. Nevertheless, a transient increase in ReHo was observed after being untreated for 3 months. No significant differences were discovered between HCs and MDD patients with a DUI less than 1 month or among MDD patients with different DUIs in either ReHo or GMV. Longer DUI was related to reduced ReHo with GMV as mediator in MDD patients. We identified disassociated functional and anatomical alterations in treatment-naïve MDD patients at different time points in distinct brain regions at the early stage of the disease. Additionally, we also discovered that GMV mediated the relationship between a longer DUI and diminished ReHo in MDD patients, disclosing the latent deleterious and neuro-progressive implications of DUI on both the structure and function of the brain and indicating the necessity of early treatment of MDD.
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Affiliation(s)
- Wen Liu
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Xiaowei Jiang
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
- Department of Radiology, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Zijing Deng
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Yu Xie
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Yingrui Guo
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Yifan Wu
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Qikun Sun
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Lingtao Kong
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Feng Wu
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Yanqing Tang
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China.
- Department of Gerontology, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China.
- Department of Psychiatry and Geriatric Medicine, The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, Liaoning, People's Republic of China.
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Löwe B, Scherer M, Braunschneider LE, Marx G, Eisele M, Mallon T, Schneider A, Linde K, Allwang C, Joos S, Zipfel S, Schulz S, Rost L, Brenk-Franz K, Szecsenyi J, Nikendei C, Härter M, Gallinat J, König HH, Fierenz A, Vettorazzi E, Zapf A, Lehmann M, Kohlmann S. Clinical effectiveness of patient-targeted feedback following depression screening in general practice (GET.FEEDBACK.GP): an investigator-initiated, prospective, multicentre, three-arm, observer-blinded, randomised controlled trial in Germany. Lancet Psychiatry 2024; 11:262-273. [PMID: 38432236 DOI: 10.1016/s2215-0366(24)00035-x] [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: 11/30/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Screening for depression in primary care alone is not sufficient to improve clinical outcomes. However, targeted feedback of the screening results to patients might result in beneficial effects. The GET.FEEDBACK.GP trial investigated whether targeted feedback of the depression screening result to patients, in addition to feedback to general practitioners (GPs), leads to greater reductions in depression severity than GP feedback alone or no feedback. METHODS The GET.FEEDBACK.GP trial was an investigator-initiated, multicentre, three-arm, observer-blinded, randomised controlled trial. Depression screening was conducted electronically using the Patient Health Questionnaire-9 (PHQ-9) in 64 GP practices across five regions in Germany while patients were waiting to see their GP. Currently undiagnosed patients (aged ≥18 years) who screened positive for depression (PHQ-9 score ≥10), were proficient in the German language, and had a personal consultation with a GP were randomly assigned (1:1:1) into a group that received no feedback on their depression screening result, a group in which only the GP received feedback, or a group in which both GP and patient received feedback. Randomisation was stratified by treating GP and PHQ-9 depression severity. Trial staff were masked to patient enrolment and study group allocation and GPs were masked to the feedback recieved by the patient. Written feedback, including the screening result and information on depression, was provided to the relevant groups before the consultation. The primary outcome was PHQ-9-measured depression severity at 6 months after randomisation. An intention-to-treat analysis was conducted for patients who had at least one follow-up visit. This study is registered at ClinicalTrials.gov (NCT03988985) and is complete. FINDINGS Between July 17, 2019, and Jan 31, 2022, 25 279 patients were approached for eligibility screening, 17 150 were excluded, and 8129 patients completed screening, of whom 1030 (12·7%) screened positive for depression. 344 patients were randomly assigned to receive no feedback, 344 were assigned to receive GP-targeted feedback, and 339 were assigned to receive GP-targeted plus patient-targeted feedback. 252 (73%) patients in the no feedback group, 252 (73%) in the GP-targeted feedback group, and 256 (76%) in the GP-targeted and patient-targeted feedback group were included in the analysis of the primary outcome at 6 months, which reflected a follow-up rate of 74%. Gender was reported as female by 637 (62·1%) of 1025 participants, male by 384 (37·5%), and diverse by four (0·4%). 169 (16%) of 1026 patients with available migration data had a migration background. Mean age was 39·5 years (SD 15·2). PHQ-9 scores improved for each group between baseline and 6 months by -4·15 (95% CI -4·99 to -3·30) in the no feedback group, -4·19 (-5·04 to -3·33) in the GP feedback group, and -4·91 (-5·76 to -4·07) in the GP plus patient feedback group, with no significant difference between the three groups (global p=0·13). The difference in PHQ-9 scores when comparing the GP plus patient feedback group with the no feedback group was -0·77 (-1·60 to 0·07, d=-0·16) and when comparing with the GP-only feedback group was -0·73 (-1·56 to 0·11, d=-0·15). No increase in suicidality was observed as an adverse event in either group. INTERPRETATION Providing targeted feedback to patients and GPs after depression screening does not significantly reduce depression severity compared with GP feedback alone or no feedback. Further research is required to investigate the potential specific effectiveness of depression screening with systematic feedback for selected subgroups. FUNDING German Innovation Fund. TRANSLATION For the German translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Lea-Elena Braunschneider
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriella Marx
- Department of General Practice and Primary Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marion Eisele
- Department of General Practice and Primary Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Tina Mallon
- Department of General Practice and Primary Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Antonius Schneider
- Department of Clinical Medicine, Institute of General Practice and Health Services Research, TUM School of Medicine and Health, Technical University Munich, Munich, Germany
| | - Klaus Linde
- Department of Clinical Medicine, Institute of General Practice and Health Services Research, TUM School of Medicine and Health, Technical University Munich, Munich, Germany
| | - Christine Allwang
- Department of Psychosomatic Medicine and Psychotherapy, TUM School of Medicine and Health, Technical University Munich, Munich, Germany
| | - Stefanie Joos
- Institute of General Practice and Interprofessional Care, University of Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, German Centre of Mental Health, University of Tübingen, Tübingen, Germany
| | - Sven Schulz
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - Liliana Rost
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - Katja Brenk-Franz
- Institute of Psychosocial Medicine, Psychotherapy and Psychoonocology, Jena University Hospital, Jena, Germany
| | - Joachim Szecsenyi
- Department of General Practice, University of Heidelberg, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Institute of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Fierenz
- Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Eik Vettorazzi
- Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marco Lehmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Kohlmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Shin JE, Lee YS, Park SY, Jeong MY, Choi JK, Cha JH, Lee YJ. The Relationship between Depression Severity and Prefrontal Hemodynamic Changes in Adolescents with Major Depression Disorder: A Functional Near-infrared Spectroscopy Study. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2024; 22:118-128. [PMID: 38247418 PMCID: PMC10811388 DOI: 10.9758/cpn.23.1073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/17/2023] [Accepted: 06/17/2023] [Indexed: 01/23/2024]
Abstract
Objective : Numerous studies have identified hemodynamic changes in adults with major depressive disorder (MDD) by using functional near-infrared spectroscopy (fNIRS). However, studies on adolescents with MDD are limited. As adolescence is a stage of rapid brain development, differences may occur depending on age. This study used fNIRS as an objective tool to investigate hemodynamic changes in the frontal lobe according to depression severity and age in adolescents with MDD. Methods : Thirty adolescents (12 aged 12-15 years and 18 aged 16-18 years) were retrospectively investigated. The Children's Depression Inventory was used as a psychiatric evaluation scale, fNIRS was used as an objective brain function evaluation tool, and the Verbal Fluency Test was performed. Results : During the Verbal Fluency Test, in the younger MDD group, oxygenated-hemoglobin concentration increased in the right dorsolateral prefrontal cortex region as the severity of depression increased. In the older MDD group, the oxygenated-hemoglobin concentration decreased in the right dorsolateral prefrontal cortex region as the severity of depression increased. Conclusion : These results suggest that fNIRS may be an objective tool for identifying age differences among adolescents with MDD. To generalize the results and verify fNIRS as a potential biomarker tool, follow-up studies with a larger sample group should be conducted.
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Affiliation(s)
- Jeong Eun Shin
- Department of Medical Sciences, Graduate School of Soonchunhyang University, Asan, Korea
| | - Yun Sung Lee
- Sejong Special Self-Governing City Mental Health Welfare Center, Sejong, Korea
| | - Seo Young Park
- Sejong Special Self-Governing City Mental Health Welfare Center, Sejong, Korea
| | - Mi Young Jeong
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | - Yeon Jung Lee
- Department of Psychiatry, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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11
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Demissie M, Birhane R, Hanlon C, Eshetu T, Medhin G, Minaye A, Habtamu K, Cleare AJ, Milkias B, Prince M, Fekadu A. Developing interventions to improve detection of depression in primary healthcare settings in rural Ethiopia. BJPsych Open 2024; 10:e52. [PMID: 38404026 PMCID: PMC10897685 DOI: 10.1192/bjo.2024.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND The poor detection of depression in primary healthcare (PHC) in low- and middle-income countries continues to threaten the plan to scale up mental healthcare coverage. AIMS To describe the process followed to develop an intervention package to improve detection of depression in PHC settings in rural Ethiopia. METHOD The study was conducted in Sodo, a rural district in south Ethiopia. The Medical Research Council's framework for the development of complex interventions was followed. Qualitative interviews, observations of provider-patient communication, intervention development workshops and pre-testing of the screening component of the intervention were conducted to develop the intervention. RESULTS A multicomponent intervention package was developed, which included (a) manual-based training of PHC workers for 10 days, adapted from the World Health Organization's Mental Health Gap Action Programme Intervention Guide, with emphasis on depression, locally identified depressive symptoms, communication skills, training by people with lived experience and active learning methods; (b) screening for culturally salient manifestations of depression, using a four-item tool; (c) raising awareness among people attending out-patient clinics about depression, using information leaflets and health education; and (d) system-level interventions, such as supportive supervision, use of posters at health facilities and a decision support mobile app. CONCLUSIONS This contextualised, multicomponent intervention package may lead to meaningful impact on the detection of depression in PHC in rural Ethiopia and similar settings. The intervention will be pilot tested for feasibility, acceptability and effectiveness before its wider implementation.
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Affiliation(s)
- Mekdes Demissie
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Ethiopia; and School Of Nursing and Midwifery, College of Health Sciences and Medicine, Haramaya University, Ethiopia
| | - Rahel Birhane
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Ethiopia
| | - Charlotte Hanlon
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Ethiopia; and Centre for Global Mental Health & Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Tigist Eshetu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Ethiopia
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Ethiopia
| | - Abebaw Minaye
- School of Psychology, College of Education and Behavioral Studies, Addis Ababa University, Ethiopia
| | - Kassahun Habtamu
- School of Psychology, College of Education and Behavioral Studies, Addis Ababa University, Ethiopia
| | - Anthony J Cleare
- Center for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Barkot Milkias
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Martin Prince
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and King's Global Health Institute, Faculty of Life Sciences and Medicine, King's College London, UK
| | - Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Ethiopia; Department of Psychiatry, College of Health Sciences, Addis Ababa University, Ethiopia; Center for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Department of Global Health & Infection, Brighton and Sussex Medical School, UK
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12
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Iglhaut L, Primbs R, Kaubisch S, Koppenhöfer C, Piechaczek CE, Keim PM, Kloek M, Feldmann L, Schulte-Körne G, Greimel E. Evaluation of a web-based information platform on youth depression and mental health in parents of adolescents with a history of depression. Child Adolesc Psychiatry Ment Health 2024; 18:7. [PMID: 38218899 PMCID: PMC10787406 DOI: 10.1186/s13034-023-00703-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/29/2023] [Indexed: 01/15/2024] Open
Abstract
Research shows the important role of parents' mental health literacy in detecting depressive symptoms and supporting their children to seek professional help. Improving mental health literacy in parents has recently gained even greater importance due to the negative impact of the COVID-19 pandemic on children and adolescents' mental health. The aim of the present experimental pre-post-follow-up study was to examine knowledge change after the reception of contents from an innovative web-based platform ( www.ich-bin-alles.de/eltern ) containing evidence-based information on youth depression and mental health in parents of adolescents with a history of depression. A second aim was to assess evaluation of the layout and the acceptance of the platform. N = 33 parents of adolescents with a history of depression (either current or remitted depression) were presented different content domains of the website. Participants' knowledge about depression was assessed at pre- and post-intervention, and at a four week follow-up. Moreover, parents evaluated the acceptance and the layout of the website. The trial was preregistered at clinicaltrials.gov (NCT05335564). The results showed a significant increase in total knowledge from pre to post, which remained stable over the course of four weeks. Explorative analyses showed that sociodemographic variables did not influence the extent of knowledge gain. Acceptance rates were high and evaluations of the website's layout were positive. The findings show that the web-based information portal is a promising and appealing means to increase parental knowledge on youth depression. Low-threshold psychoeducational approaches like websites are particularly relevant in times of crisis and increased prevalence rates of depressive symptoms and disorders (ehealth). These results are an important basis for future studies as well as approaches that aim to impart knowledge about mental disorders like youth depression via web-based means. Furthermore, they bear implications for policy decisions concerning mental health education and campaigns.
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Affiliation(s)
- Lucia Iglhaut
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Nussbaumstraße 5, 80336, Munich, Germany.
| | - Regine Primbs
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Nussbaumstraße 5, 80336, Munich, Germany
| | - Sara Kaubisch
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Nussbaumstraße 5, 80336, Munich, Germany
| | - Chiara Koppenhöfer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Nussbaumstraße 5, 80336, Munich, Germany
| | - Charlotte E Piechaczek
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Nussbaumstraße 5, 80336, Munich, Germany
| | - Pia-Marie Keim
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Nussbaumstraße 5, 80336, Munich, Germany
| | - Maria Kloek
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Nussbaumstraße 5, 80336, Munich, Germany
| | - Lisa Feldmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Nussbaumstraße 5, 80336, Munich, Germany
| | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Nussbaumstraße 5, 80336, Munich, Germany
| | - Ellen Greimel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Nussbaumstraße 5, 80336, Munich, Germany
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Sheehan JJ, LaVallee C, Maughn K, Balakrishnan S, Pesa JA, Joshi K, Nelson C. Real-world assessment of treatment inertia in the management of patients treated for major depressive disorder in the USA. J Comp Eff Res 2024; 13:e230091. [PMID: 37987716 PMCID: PMC10842298 DOI: 10.57264/cer-2023-0091] [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: 06/08/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023] Open
Abstract
Aim: Major depressive disorder (MDD) is a debilitating illness in which depressive symptoms may persist after treatment. Treatment inertia is the continued use of the same pharmacotherapy regimen when treatment goals are not met. This study assessed the frequency of treatment inertia among adult patients with MDD treated in a real-world setting. Patients & methods: This was a retrospective, observational study of patients with MDD identified in the Decision Resources Group Real World Evidence US Data Repository from January 2014 to June 2018. Patients (≥18 years) had an elevated Patient Health Questionnaire-9 (PHQ-9) score (≥5) following 8 weeks of stable baseline antidepressant use with/without mental-health outpatient therapy. Treatment inertia, modification and discontinuation were evaluated over a 16-week follow-up period (timeline based on the APA Practice Guidelines). The primary outcome was the proportion of MDD patients experiencing treatment inertia. Results: 2850 patients (median age, 55 years; 74% female) met the study criteria. Of these patients, 834 (29%) had study-defined treatment inertia, 1534 (54%) received treatment modification and 482 (17%) discontinued treatment. Use of mirtazapine (Odd ratio [OR]: 0.63; 95% confidence interval [CI]: 0.50-0.79), selective serotonin reuptake inhibitors (OR: 0.64; 95% CI: 0.54-0.75) or bupropion (OR: 0.71; 95% CI: 0.60-0.84) in the baseline period was associated with an increased likelihood of treatment modification versus not receiving treatment with these medications. Frequency of treatment inertia may differ among those who do not have a documented PHQ-9 score. Conclusion: Effective symptom management is critical for optimal outcomes in MDD. Results demonstrate that treatment inertia is common in MDD despite guidelines recommending treatment modification in patients not reaching remission.
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Affiliation(s)
- John J Sheehan
- Janssen Scientific Affairs, LLC, Titusville, NJ 08560, USA
| | - Chris LaVallee
- Health Outcomes Research, Decision Resources Group, Boston, MA 02116, USA
| | - Keshia Maughn
- Analytics, Decision Resources Group, Boston, MA 02116, USA
| | | | | | - Kruti Joshi
- Janssen Scientific Affairs, LLC, Titusville, NJ 08560, USA
| | - Craig Nelson
- Department of Psychiatry, University of California San Francisco, San Francisco, CA 94143, USA
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Johnson EM, Possemato K, Chinman M, True G, Hedges J, Hampton BN, Edelman EJ, Maisto SA. Integrating stakeholder feedback into the design of a peer-delivered primary care wellness program: A rapid qualitative study. BMC Health Serv Res 2023; 23:1370. [PMID: 38062433 PMCID: PMC10701982 DOI: 10.1186/s12913-023-10324-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Individuals seen in Primary Care with behavioral health concerns who decline behavioral health treatment may benefit from the support of peers (consumers in recovery from behavioral health concerns employed to support other consumers). Whole Health STEPS is a new intervention for Veterans in Primary Care with behavioral health concerns which combines essential elements of peers' role and the Whole Health model using a stepped-care design. We incorporated stakeholder feedback in the Whole Health STEPS design to improve fit with Veterans, peers, and primary care settings. METHODS We conducted semi-structured qualitative interviews with VA staff using questions derived from the Consolidated Framework for Implementation Research (CFIR). Participants were recruited via a maximum variation strategy across a national sample and interviewed between January 2021-April 2021. The analytic design was a rapid qualitative analysis. Interviews addressed design decisions and potential barriers and facilitators to future implementation. Then, we made adaptations to Whole Health STEPS and catalogued changes using the Framework for Adaptations and Modifications-Enhanced (FRAME). A VA peer conducted the interviews, participated in analyses, assisted with design modifications, and co-wrote this paper. RESULTS Sixteen staff members from 9 VA primary care peer programs participated (8 peers and 8 supervisors/administrators). Feedback themes included: capitalizing on peer skills (e.g., navigation), ensuring patient-centered and flexible design, and making it easy and efficient (e.g., reducing session length). Understanding the structure of primary care peers' roles and their interactions with other programs helped us identify role conflicts (e.g., overlap with Whole Health Coaches and Health Behavior Coordinators), which led to design modifications to carve out a unique role for Whole Health STEPS. Staff also made recommendations about marketing materials and training tools to support Whole Health STEPS roll out. CONCLUSIONS Feedback from frontline staff, including peers, in the design process was crucial to identifying essential modifications that would not have been possible after initial trials without re-evaluating efficacy due to the extent of the changes. Whole Health STEPS was adapted to fit within a range of program structures, emphasize peers' unique contributions, and streamline delivery. Lessons learned can be applied to other interventions.
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Affiliation(s)
- Emily M Johnson
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave. (116C), Syracuse, NY, 13210, USA.
| | - Kyle Possemato
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave. (116C), Syracuse, NY, 13210, USA
| | - Matthew Chinman
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- RAND Corporation, Pittsburgh, PA, USA
- VISN 4 Mental Illness Research, Education, and Clinical Center, Pittsburgh, PA, USA
| | - Gala True
- South Central Mental Illness Research Education and Clinical Center, Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA
- Department of Medicine, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Jacob Hedges
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave. (116C), Syracuse, NY, 13210, USA
| | - Brittany N Hampton
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave. (116C), Syracuse, NY, 13210, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine and Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Stephen A Maisto
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave. (116C), Syracuse, NY, 13210, USA
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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15
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Hostutler C, Wolf N, Snider T, Butz C, Kemper AR, Butter E. Increasing Access to and Utilization of Behavioral Health Care Through Integrated Primary Care. Pediatrics 2023; 152:e2023062514. [PMID: 37969039 DOI: 10.1542/peds.2023-062514] [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] [Accepted: 08/29/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVES To evaluate changes in access to and utilization of behavioral health (BH) services after the integration of psychologists into primary care clinics compared with clinics without integrated psychologists. METHODS We integrated 4 of 12 primary care clinics within our academic health system. We used the median wait time for BH services as a proxy for changes in access and defined BH utilization as the percentage of primary care visits that resulted in contact with a BH clinician within 180 days. We compared changes in access and utilization from the year before integration (September 2015 to September 2016) with the 2 years after integration (October 2016 to October 2018) within integrated clinics and between integrated and nonintegrated clinics. We used difference-in-difference analysis to test the association of study outcomes with the presence of integrated psychologists. RESULTS Access and utilization were similar across all practices before integration. After integration, BH utilization increased by 143% in integrated clinics compared with 12% in nonintegrated clinics. The utilization of BH services outside of the medical home (ie, specialty BH service) decreased for integrated clinics only. In clinics with integrated psychologists, 93% of initial BH visits happened on the same day as a need was identified. The median wait time for the 7% in integrated clinics who were not seen on the same day was 11.4 days (interquartile range = 5.3-17.7) compared with 48.3 days (interquartile range = 20.4-93.6) for nonintegrated clinics. CONCLUSIONS A team-based integration model increased BH utilization and access.
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Affiliation(s)
- Cody Hostutler
- Department of Pediatric Psychology and Neuropsychology
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Noelle Wolf
- Department of Pediatric Psychology and Neuropsychology
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Tyanna Snider
- Department of Pediatric Psychology and Neuropsychology
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Catherine Butz
- Department of Pediatric Psychology and Neuropsychology
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Alex R Kemper
- Division of Primary Care Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Eric Butter
- Department of Pediatric Psychology and Neuropsychology
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
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Dudek D, Chrobak AA, Krupa AJ, Gorostowicz A, Gerlich A, Juryk A, Siwek M. TED-trazodone effectiveness in depression: a naturalistic study of the effeciveness of trazodone in extended release formulation compared to SSRIs in patients with a major depressive disorder. Front Pharmacol 2023; 14:1296639. [PMID: 38027034 PMCID: PMC10646491 DOI: 10.3389/fphar.2023.1296639] [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] [Received: 09/18/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction: Selective serotonin reuptake inhibitors (SSRIs) are the most often used medications to treat major depressive disorder (MDD). Despite their effectiveness in reducing depressive symptoms, several issues are associated with their use in MDD, such as limited improvement of anhedonia, emergence of emotional blunting, induction or exacerbation of insomnia, and sexual dysfunction. Due to its also devoid of the issues related to treatment noted with SSRIs. The aim of this 12-week non-inferiority naturalistic observation was to compare the effectiveness and tolerability of SSRIs and trazodone in extended release (XR) in MDD. Methods: A total of 186 subjects were recruited, of which 92 received trazodone XR and 94 received SSRIs. Patients were allocated to trazodone XR or SSRIs, according to the attending physician based on clinical evaluation. Assessments at baseline and weeks 2, 4, 8, and 12 were conducted to evaluate the severity of depression (Montgomery-Åsberg Depression Rating Scale, clinician- and patient-rated Quick Inventory of Depressive Symptomatology-the primary endpoints of the study), anhedonia (the Snaith-Hamilton Pleasure Scale), anxiety (the Hamilton Anxiety Rating Scale), insomnia (the Athens Insomnia Scale), and therapeutic effectiveness (the Clinical Global Impression Scale). Results: After 12 weeks, trazodone XR was more effective than SSRIs in reducing the severity of depression, anxiety, and insomnia. There was a trend for higher effectiveness of in reduction of anhedonia, which became insignificant after controlling the results for the duration of previous psychiatric treatment as a covariate. The proportion of treatment-responsive subjects in the trazodone XR group compared to SSRIs was comparable or higher. The proportion of patients achieving remission was higher in the trazodone XR arm vs. the SSRI arm. Discussion: In summary, the results indicate that trazodone XR is effective in MDD in the "real-world" setting. Its potential superiority over SSRIs in addressing particular symptomatic dimensions should be verified in future studies.
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Affiliation(s)
- Dominika Dudek
- Department of Adult Psychiatry, Jagiellonian University Medical College, Cracow, Poland
| | | | - Anna Julia Krupa
- Department of Affective Disorders, Jagiellonian University Medical College, Cracow, Poland
| | | | - Adrian Gerlich
- Department of Adult, Child and Adolescent Psychiatry, University Hospital in Cracow, Cracow, Poland
| | - Andrzej Juryk
- Department of Adult Psychiatry, Jagiellonian University Medical College, Cracow, Poland
| | - Marcin Siwek
- Department of Affective Disorders, Jagiellonian University Medical College, Cracow, Poland
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17
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Delgado-García G, Engbers JDT, Wiebe S, Mouches P, Amador K, Forkert ND, White J, Sajobi T, Klein KM, Josephson CB. Machine learning using multimodal clinical, electroencephalographic, and magnetic resonance imaging data can predict incident depression in adults with epilepsy: A pilot study. Epilepsia 2023; 64:2781-2791. [PMID: 37455354 DOI: 10.1111/epi.17710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE This study was undertaken to develop a multimodal machine learning (ML) approach for predicting incident depression in adults with epilepsy. METHODS We randomly selected 200 patients from the Calgary Comprehensive Epilepsy Program registry and linked their registry-based clinical data to their first-available clinical electroencephalogram (EEG) and magnetic resonance imaging (MRI) study. We excluded patients with a clinical or Neurological Disorders Depression Inventory for Epilepsy (NDDI-E)-based diagnosis of major depression at baseline. The NDDI-E was used to detect incident depression over a median of 2.4 years of follow-up (interquartile range [IQR] = 1.5-3.3 years). A ReliefF algorithm was applied to clinical as well as quantitative EEG and MRI parameters for feature selection. Six ML algorithms were trained and tested using stratified threefold cross-validation. Multiple metrics were used to assess model performances. RESULTS Of 200 patients, 150 had EEG and MRI data of sufficient quality for ML, of whom 59 were excluded due to prevalent depression. Therefore, 91 patients (41 women) were included, with a median age of 29 (IQR = 22-44) years. A total of 42 features were selected by ReliefF, none of which was a quantitative MRI or EEG variable. All models had a sensitivity > 80%, and five of six had an F1 score ≥ .72. A multilayer perceptron model had the highest F1 score (median = .74, IQR = .71-.78) and sensitivity (84.3%). Median area under the receiver operating characteristic curve and normalized Matthews correlation coefficient were .70 (IQR = .64-.78) and .57 (IQR = .50-.65), respectively. SIGNIFICANCE Multimodal ML using baseline features can predict incident depression in this population. Our pilot models demonstrated high accuracy for depression prediction. However, overall performance and calibration can be improved. This model has promise for identifying those at risk for incident depression during follow-up, although efforts to refine it in larger populations along with external validation are required.
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Affiliation(s)
- Guillermo Delgado-García
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | | | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Pauline Mouches
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kimberly Amador
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nils D Forkert
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James White
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tolulope Sajobi
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Karl Martin Klein
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Colin B Josephson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada
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18
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Uhlhaas PJ, Davey CG, Mehta UM, Shah J, Torous J, Allen NB, Avenevoli S, Bella-Awusah T, Chanen A, Chen EYH, Correll CU, Do KQ, Fisher HL, Frangou S, Hickie IB, Keshavan MS, Konrad K, Lee FS, Liu CH, Luna B, McGorry PD, Meyer-Lindenberg A, Nordentoft M, Öngür D, Patton GC, Paus T, Reininghaus U, Sawa A, Schoenbaum M, Schumann G, Srihari VH, Susser E, Verma SK, Woo TW, Yang LH, Yung AR, Wood SJ. Towards a youth mental health paradigm: a perspective and roadmap. Mol Psychiatry 2023; 28:3171-3181. [PMID: 37580524 PMCID: PMC10618105 DOI: 10.1038/s41380-023-02202-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/04/2023] [Accepted: 07/21/2023] [Indexed: 08/16/2023]
Abstract
Most mental disorders have a typical onset between 12 and 25 years of age, highlighting the importance of this period for the pathogenesis, diagnosis, and treatment of mental ill-health. This perspective addresses interactions between risk and protective factors and brain development as key pillars accounting for the emergence of psychopathology in youth. Moreover, we propose that novel approaches towards early diagnosis and interventions are required that reflect the evolution of emerging psychopathology, the importance of novel service models, and knowledge exchange between science and practitioners. Taken together, we propose a transformative early intervention paradigm for research and clinical care that could significantly enhance mental health in young people and initiate a shift towards the prevention of severe mental disorders.
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Affiliation(s)
- Peter J Uhlhaas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK.
- Department of Child and Adolescent Psychiatry, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Christopher G Davey
- Department of Psychiatry, The University of Melbourne, Carlton, VIC, Australia
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Jai Shah
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - John Torous
- Division of Digital Psychiatry and Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Shelli Avenevoli
- Office of the Director, National Institute of Mental Health, Bethesda, MD, USA
| | - Tolulope Bella-Awusah
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Andrew Chanen
- Orygen: National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Eric Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Departments of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hostra/Northwell, Hempstead, NY, USA
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - Kim Q Do
- Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Helen L Fisher
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Sophia Frangou
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Kerstin Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, RWTH, Aachen, Germany
- JARA-Brain Institute II, Molecular Neuroscience and Neuroimaging, Research Center Jülich, Jülich, Germany
| | - Francis S Lee
- Department of Psychiatry, Weill Cornell Cornell Medicall College, New York, NY, USA
| | - Cindy H Liu
- Departments of Pediatrics and Psychiatry, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick D McGorry
- Orygen: National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Merete Nordentoft
- CORE-Copenhagen Research Centre for Mental Health, Mental Health Center Copenhagen, University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Hellerup, Denmark
| | - Dost Öngür
- McLean Hospital/Harvard Medical School, Belmont, MA, USA
| | - George C Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute, University of Melbourne, Parkville, VIC, Australia
| | - Tomáš Paus
- Departments of Psychiatry and Neuroscience, Faculty of Medicine and Centre Hospitalier Universitaire Sainte Justine, University of Montreal, Montreal, QC, Canada
- Department of Psychology and Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Mannheim, Germany
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Akira Sawa
- The John Hopkins Schizophrenia Center, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Schoenbaum
- Division of Service and Intervention Research, National Institute of Mental Health, Bethesda, MD, USA
| | - Gunter Schumann
- Centre for Population Neuroscience and Stratified Medicine, ISTBI, Fudan University, Shanghai, China
- Department of Psychiatry and Neuroscience, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Vinod H Srihari
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Program for Specialized Treatment Early in Psychosis (STEP), New Haven, VIC, USA
| | - Ezra Susser
- Departments of Epidemiology and Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Swapna K Verma
- Department of Psychosis, Institute of Mental Health, Buangkok, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - T Wilson Woo
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Laboratory for Cellular Neuropathology, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Lawrence H Yang
- Department of Social and Behavioral Sciences, New York University, New York, NY, USA
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Alison R Yung
- School of Medicine, Faculty of Health, Deakin University, Melbourne, VIC, Australia
- Department of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Stephen J Wood
- Orygen: National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
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Kohlmann S, Stielow L, Löwe B. Did online information seeking for depression increase during COVID-19 lockdown times? A google trend analysis on data from Germany and the UK. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023; 13:100587. [PMID: 37152682 PMCID: PMC10141789 DOI: 10.1016/j.jadr.2023.100587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/25/2023] [Accepted: 04/27/2023] [Indexed: 05/09/2023] Open
Affiliation(s)
- Sebastian Kohlmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Building W 37, Room 6010, Martinistr. 52, Hamburg 20246, Germany
| | - Laura Stielow
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Building W 37, Room 6010, Martinistr. 52, Hamburg 20246, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Building W 37, Room 6010, Martinistr. 52, Hamburg 20246, Germany
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Hühne V, Chacur C, de Oliveira MVS, Fortes PP, Bezerra de Menezes GM, Fontenelle LF. Considerations for the treatment of obsessive-compulsive disorder in patients who have comorbid major depression. Expert Rev Neurother 2023; 23:955-967. [PMID: 37811649 DOI: 10.1080/14737175.2023.2265066] [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: 05/22/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder that affects a significant number of individuals worldwide. Major depressive disorder (MDD) is among the most common comorbidities reported in people with OCD. The emergence of MDD in individuals with OCD can be attributed to the increased severity of OCD symptoms and their profound impact on daily functioning. Depressive symptoms can also modify the course of OCD. AREAS COVERED In this review, the authors explore potential shared neurobiological mechanisms that may underlie both OCD and MDD, such as disturbed sleep patterns, immunological dysregulations, and neuroendocrine changes. Furthermore, they address the challenges clinicians face when managing comorbid OCD and MDD. The authors also discuss a range of treatment options for OCD associated with MDD, including augmentation strategies for serotonin reuptake inhibitors (e.g. aripiprazole), psychotherapy (especially CBT/EPR), transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), and deep brain stimulation (DBS). EXPERT OPINION Although there is no 'rule of thumb' or universally acceptable strategy in the treatment of OCD comorbid with MDD, many clinicians, including the authors, tend to adopt a unique transdiagnostic approach to the treatment of OCD and related disorders, focusing on strategies known to be effective across diagnoses. Nevertheless, the existing 'cisdiagnostic approaches' still retain importance, i.e. specific therapeutic strategies tailored for more severe forms of individual disorders.
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Affiliation(s)
- Verônica Hühne
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Carina Chacur
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Marcos Vinícius Sousa de Oliveira
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Pedro Pereira Fortes
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Gabriela M Bezerra de Menezes
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Leonardo F Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
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21
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Wang X, Wang C, Zhang Y, An Z. Effect of pharmacogenomics testing guiding on clinical outcomes in major depressive disorder: a systematic review and meta-analysis of RCT. BMC Psychiatry 2023; 23:334. [PMID: 37173736 PMCID: PMC10176803 DOI: 10.1186/s12888-023-04756-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/06/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Pharmacogenomic testing guided treatment have been developed to guide drug selection or conversion in major depressive disorder patients. Whether patients benefit from pharmacogenetic testing remains unclear. We aim to evaluates the effect of pharmacogenomic testing guiding on clinical outcomes of major depressive disorder. METHODS Pubmed, Embase, and Cochrane Library of Clinical Trials were searched from inception until August 2022. Key terms included pharmacogenomic and antidepressive. Odds ratios (RR) with 95% confidence intervals (95%CIs) were calculated using fixed-effects model for low or moderate heterogeneity or random-effects model for high heterogeneity. RESULTS Eleven studies (5347 patients) were included. Compared with usual group, pharmacogenomic testing guided group was associated with an increased response rate at week 8 (OR 1.32, 95%CI 1.15-1.53, 8 studies, 4328 participants) and week 12 (OR 1.36, 95%CI 1.15-1.62, 4 studies, 2814 participants). Similarly, guided group was associated with an increased rate of remission at week 8 (OR 1.58, 95%CI 1.31-1.92, 8 studies, 3971 participants) and week 12 (OR 2.23, 95%CI 1.23-4.04, 5 studies, 2664 participants). However, no significant differences were found between the two groups in response rate at week 4 (OR 1.12, 95%CI 0.89-1.41, 2 studies, 2261 participants) and week 24 (OR 1.16, 95%CI 0.96-1.41, 2 studies, 2252 participants), and remission rate at week 4 (OR 1.26, 95%CI 0.93-1.72, 2 studies, 2261 participants) and week 24 (OR 1.06, 95%CI 0.83-1.34, 2 studies, 2252 participants). Medication congruence in 30 days was significantly reduced in the pharmacogenomic guided group compared with the usual care group (OR 2.07, 95%CI 1.69-2.54, 3 studies, 2862 participants). We found significant differences between subgroups of target population in response and remission rate. CONCLUSION Patients with major depressive disorder may benefit from pharmacogenomic testing guided treatment by achieving target response and remission rates more quickly.
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Affiliation(s)
- Xinrui Wang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China
| | - Chenfei Wang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China
| | - Yi Zhang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China.
| | - Zhuoling An
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China.
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22
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Owen D, Antypas D, Hassoulas A, Pardiñas AF, Espinosa-Anke L, Collados JC. Enabling Early Health Care Intervention by Detecting Depression in Users of Web-Based Forums using Language Models: Longitudinal Analysis and Evaluation. JMIR AI 2023; 2:e41205. [PMID: 37525646 PMCID: PMC7614849 DOI: 10.2196/41205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Background Major depressive disorder is a common mental disorder affecting 5% of adults worldwide. Early contact with health care services is critical for achieving accurate diagnosis and improving patient outcomes. Key symptoms of major depressive disorder (depression hereafter) such as cognitive distortions are observed in verbal communication, which can also manifest in the structure of written language. Thus, the automatic analysis of text outputs may provide opportunities for early intervention in settings where written communication is rich and regular, such as social media and web-based forums. Objective The objective of this study was 2-fold. We sought to gauge the effectiveness of different machine learning approaches to identify users of the mass web-based forum Reddit, who eventually disclose a diagnosis of depression. We then aimed to determine whether the time between a forum post and a depression diagnosis date was a relevant factor in performing this detection. Methods A total of 2 Reddit data sets containing posts belonging to users with and without a history of depression diagnosis were obtained. The intersection of these data sets provided users with an estimated date of depression diagnosis. This derived data set was used as an input for several machine learning classifiers, including transformer-based language models (LMs). Results Bidirectional Encoder Representations from Transformers (BERT) and MentalBERT transformer-based LMs proved the most effective in distinguishing forum users with a known depression diagnosis from those without. They each obtained a mean F1-score of 0.64 across the experimental setups used for binary classification. The results also suggested that the final 12 to 16 weeks (about 3-4 months) of posts before a depressed user's estimated diagnosis date are the most indicative of their illness, with data before that period not helping the models detect more accurately. Furthermore, in the 4- to 8-week period before the user's estimated diagnosis date, their posts exhibited more negative sentiment than any other 4-week period in their post history. Conclusions Transformer-based LMs may be used on data from web-based social media forums to identify users at risk for psychiatric conditions such as depression. Language features picked up by these classifiers might predate depression onset by weeks to months, enabling proactive mental health care interventions to support those at risk for this condition.
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Affiliation(s)
- David Owen
- School of Computer Science and Informatics, Cardiff University,
Cardiff, United Kingdom
| | - Dimosthenis Antypas
- School of Computer Science and Informatics, Cardiff University,
Cardiff, United Kingdom
| | - Athanasios Hassoulas
- Centre for Medical Education, School of Medicine, Cardiff
University, Cardiff, United Kingdom
| | - Antonio F Pardiñas
- Centre for Neuropsychiatric Genetics and Genomics, School of
Medicine, Cardiff University, Cardiff, United Kingdom
| | - Luis Espinosa-Anke
- School of Computer Science and Informatics, Cardiff University,
Cardiff, United Kingdom
| | - Jose Camacho Collados
- School of Computer Science and Informatics, Cardiff University,
Cardiff, United Kingdom
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23
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Encina-Zúñiga E, Agrest M, Tapia-Munoz T, Vidal-Zamora I, Ardila-Gómez S, Alvarado R, Leiderman EA, Reavley N. Development of mental health first-aid guidelines for depression: a Delphi expert consensus study in Argentina and Chile. BMC Psychiatry 2023; 23:161. [PMID: 36918853 PMCID: PMC10013290 DOI: 10.1186/s12888-023-04661-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Depression is one of the most common mental health problems worldwide and, while prevalence rates in Latin America are relatively high, most people who meet the criteria for diagnosis do not receive treatment. Family and friends of a person with depression can play an important role in supporting a person to seek and engage with treatment. However, many people do not have the necessary skills or confidence to help. English-language mental health first aid guidelines have been developed to support people to provide such help. The aim of this study was to culturally adapt these guidelines for Chile and Argentina. METHODS A Delphi expert consensus study was conducted with two expert panels, one of people with lived experience of depression (either their own or as a carer; n = 26) and one of health professionals (n = 29). Overall, 172 statements from the English-language guidelines were translated and compiled into a questionnaire. Participants were asked to rate statements based on how essential or important those statements were for Chile and Argentina and to suggest new statements if necessary. RESULTS Data were obtained over two survey rounds. Consensus was achieved on 172 statements. A total of 137 statements were adopted from the English-language guidelines, whereas 35 new endorsed statements were generated from panel suggestions. There were similarities between the English-language guidelines and those for Chile and Argentina. The adapted guidelines did not include some of the items from the English-language guidelines related to commenting on a person's strengths or making judgements about their character, and also incorporated new items related to the incorporation of sociocultural considerations as causes of depression and attention to inequities in mental health. CONCLUSIONS The significant number of new items underscores the importance of undertaking a careful process of cultural adaptation. Further research on dissemination and incorporation of the guidelines into the Mental Health First Aid training course for Chile and Argentina is still required.
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Affiliation(s)
- Esteban Encina-Zúñiga
- grid.443909.30000 0004 0385 4466School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- grid.443909.30000 0004 0385 4466Department of Psychology, Faculty of Social Sciences, Universidad de Chile, Santiago, Chile
| | - Martín Agrest
- Proyecto Suma, Güemes 4130 (1425), Ciudad Autónoma de Buenos Aires, Argentina
| | - Thamara Tapia-Munoz
- grid.83440.3b0000000121901201Department of Behavioural Science and Health, University College London, London, UK
| | - Isidora Vidal-Zamora
- grid.443909.30000 0004 0385 4466Department of Psychology, Faculty of Social Sciences, Universidad de Chile, Santiago, Chile
| | - Sara Ardila-Gómez
- grid.7345.50000 0001 0056 1981Facultad de Psicología, Instituto de Investigaciones, Universidad de Buenos Aires, Buenos Aires, Argentina
- grid.423606.50000 0001 1945 2152Consejo Nacional de Investigaciones Científicas Y Técnicas (CONICET), Buenos Aires, Argentina
| | - Rubén Alvarado
- grid.443909.30000 0004 0385 4466School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- grid.412185.b0000 0000 8912 4050Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaíso, Valparaíso, Chile
| | - Eduardo A. Leiderman
- grid.441624.10000 0001 1954 9157Departamento de Neurociencias, Facultad de Ciencias Sociales, Universidad de Palermo, Buenos Aires, Argentina
| | - Nicola Reavley
- grid.1008.90000 0001 2179 088XCentre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria Australia
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Lee DY, Cho YH, Kim M, Jeong CW, Cha JM, Won GH, Noh JS, Son SJ, Park RW. Association between impaired glucose metabolism and long-term prognosis at the time of diagnosis of depression: Impaired glucose metabolism as a promising biomarker proposed through a machine-learning approach. Eur Psychiatry 2023; 66:e21. [PMID: 36734114 PMCID: PMC9970146 DOI: 10.1192/j.eurpsy.2023.10] [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] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Predicting the course of depression is necessary for personalized treatment. Impaired glucose metabolism (IGM) was introduced as a promising depression biomarker, but no consensus was made. This study aimed to predict IGM at the time of depression diagnosis and examine the relationship between long-term prognosis and predicted results. METHODS Clinical data were extracted from four electronic health records in South Korea. The study population included patients with depression, and the outcome was IGM within 1 year. One database was used to develop the model using three algorithms. External validation was performed using the best algorithm across the three databases. The area under the curve (AUC) was calculated to determine the model's performance. Kaplan-Meier and Cox survival analyses of the risk of hospitalization for depression as the long-term outcome were performed. A meta-analysis of the long-term outcome was performed across the four databases. RESULTS A prediction model was developed using the data of 3,668 people, with an AUC of 0.781 with least absolute shrinkage and selection operator (LASSO) logistic regression. In the external validation, the AUCs were 0.643, 0.610, and 0.515. Through the predicted results, survival analysis and meta-analysis were performed; the hazard ratios of risk of hospitalization for depression in patients predicted to have IGM was 1.20 (95% confidence interval [CI] 1.02-1.41, p = 0.027) at a 3-year follow-up. CONCLUSIONS We developed prediction models for IGM occurrence within a year. The predicted results were related to the long-term prognosis of depression, presenting as a promising IGM biomarker related to the prognosis of depression.
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Affiliation(s)
- Dong Yun Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Yong Hyuk Cho
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Korea.,Department of Medical Sciences, Graduate School of Ajou University, Suwon, South Korea
| | | | - Chang-Won Jeong
- Medical Convergence Research Center, Wonkwang University, Iksan, Korea
| | - Jae Myung Cha
- Department of Gastroenterology, Gang Dong Kyung Hee University Hospital, Seoul, Korea
| | - Geun Hui Won
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jai Sung Noh
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
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25
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Luo G, Li Y, Yao C, Li M, Li J, Zhang X. Duration of untreated illness and clinical correlates in first-episode and drug-naïve patients with major depressive disorder. Psychiatry Res 2023; 320:115056. [PMID: 36680911 DOI: 10.1016/j.psychres.2023.115056] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/28/2022] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUNDS The notion that a prolonged duration of untreated illness (DUI) leads to poorer outcomes has contributed to extensive changes in mental health services worldwide. However, most studies on DUI have focused on schizophrenia and related psychosis. This study aimed to assess the possible relationship between DUI and certain clinical correlates in first-episode and drug-naïve patients with major depressive disorder (MDD). METHODS This cross-sectional study recruited 1718 first-episode and drug-naïve MDD outpatients. All participants were scored on the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Positive and Negative Syndrome Scale, and thyroid hormone and metabolic parameters were measured. We used the Structure Clinical Interview for DSM-IV for clinical diagnosis and investigated suicide attempts through face-to-face interviews. RESULTS A total of 171 (10%) of MDD patients had co-morbid psychiatric symptoms. Participants who were older, with lower education level, and married were less likely to seek a timely treatment compared to the counterparts. One-month longer untreated duration was associated with 2% to 9% higher odds of being with most of the investigated clinical conditions. For those with the longest DUI, the risk was increased for most of the investigated clinical conditions, with absolute risk differences ranging from 5.19% to 29.48%. CONCLUSIONS These findings suggest that longer DUI may be negatively associated with clinical correlates in MDD. Further long-term follow-up studies are warranted to confirm these preliminary results.
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Affiliation(s)
- Guoshuai Luo
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin 300222, China
| | - Yaxi Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 3210 Humin Rd, Shanghai 201108, China
| | - Cong Yao
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin 300222, China
| | - Meijuan Li
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin 300222, China
| | - Jie Li
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin 300222, China.
| | - Xiangyang Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Beijing 100101, China.
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26
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van Dijk DA, Meijer RM, van den Boogaard TM, Spijker J, Ruhé HG, Peeters FPML. Worse off by waiting for treatment? The impact of waiting time on clinical course and treatment outcome for depression in routine care. J Affect Disord 2023; 322:205-211. [PMID: 36372129 DOI: 10.1016/j.jad.2022.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/31/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Long-term untreated major depressive disorder (MDD) is associated with a less favorable clinical course. Waiting time, defined as the interval between diagnostic workup and treatment initiation, may be clinically relevant given the prolongation of the pre-existing duration of untreated MDD. However, it is currently unknown whether and to what extent waiting time affects treatment course in routine outpatient care. METHODS Retrospectively extracted data from 715 outpatients with MDD who received naturalistic outpatient MDD treatment were examined. Treatment outcome was defined as the difference in depression severity at the start of treatment and six months thereafter. Clinical course during waiting time was defined by the difference in severity at diagnostic workup and at treatment initiation. We analyzed the association between waiting time and treatment outcome and between waiting time and clinical course during this waiting time using multivariable regression analyses. We adjusted for severity and suicidality as potential confounders. RESULTS An increased duration of the waiting time was associated with a less favorable treatment outcome (B = 0.049, SE = 0.019, p = 0.01). This association persisted after adjustment for potential confounders (B = 0.053, SE = 0.02, p = 0.01). No association was found between length of waiting time and clinical course during waiting time. LIMITATIONS Strict definitions resulted in smaller sample sizes for the final analyses. The uncontrolled design may be questionable to definitively establish the impact of waiting time on treatment outcome. CONCLUSIONS A prolonged waiting time is significantly associated with less favorable treatment outcome. Reduction of waiting time deserves priority in depression treatment planning to improve clinical outcomes.
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Affiliation(s)
- D A van Dijk
- Department of Clinical Psychological Science, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, the Netherlands; Parnassia Group, PsyQ Haaglanden, Department of Mood Disorders, The Hague, the Netherlands.
| | - R M Meijer
- Antes/Parnassia Psychiatric Institute, Rotterdam, the Netherlands
| | - Th M van den Boogaard
- Parnassia Group, PsyQ Haaglanden, Department of Mood Disorders, The Hague, the Netherlands
| | - J Spijker
- Pro Persona Mental Healthcare, Nijmegen, the Netherlands; Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - H G Ruhé
- Department of Psychiatry, Radboudumc, Nijmegen, the Netherlands; Donders Institute for Brain and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - F P M L Peeters
- Department of Clinical Psychological Science, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, the Netherlands
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27
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The clinical implications of climate change for mental health. Nat Hum Behav 2022; 6:1474-1481. [DOI: 10.1038/s41562-022-01477-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/10/2022] [Indexed: 11/18/2022]
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28
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Paetzold I, Schick A, Rauschenberg C, Hirjak D, Banaschewski T, Meyer-Lindenberg A, Butz S, Floesser C, Schueltke L, Boehnke JR, Boecking B, Reininghaus U. A Hybrid Ecological Momentary Compassion–Focused Intervention for Enhancing Resilience in Help-Seeking Young People: Prospective Study of Baseline Characteristics in the EMIcompass Trial. JMIR Form Res 2022; 6:e39511. [PMID: 36331526 PMCID: PMC9675017 DOI: 10.2196/39511] [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: 05/13/2022] [Revised: 07/19/2022] [Accepted: 08/09/2022] [Indexed: 11/06/2022] Open
Abstract
Background Young people are a target population for mental health–related early intervention and prevention. Although evidence for early intervention is promising, availability of and access to youth mental health services remain limited. Therefore, the development of an evidence-based hybrid intervention is urgently needed. Objective This study aimed to present a manual for a hybrid intervention, combining an ecological momentary intervention and face-to-face sessions aimed for enhancing resilience in help-seeking young people based on compassion-focused interventions, and explore whether participants’ baseline characteristics are associated with putative mechanisms and outcomes of the EMIcompass intervention. Specifically, we aimed to explore initial signals as to whether participants’ sociodemographic, clinical, and functional characteristics at baseline are associated with putative mechanisms (ie, change in self-compassion, change in emotion regulation, working alliance, training frequency); and whether participants’ sociodemographic, clinical, and functional characteristics, self-compassion, and emotion regulation at baseline are associated with clinical outcomes (ie, psychological distress and general psychopathology at postintervention and 4-week follow-ups) in the experimental condition and obtain first parameter estimates. Methods We recruited young people aged 14 to 25 years, with psychological distress, Clinical High At-Risk Mental State, or first episodes of severe mental disorder for an exploratory randomized controlled trial with assessments at baseline and postintervention and 4-week follow-ups. A structured manual was developed and optimized based on a pilot study’s manual, a scoping review of existing literature and manuals, exchange with experts, the team’s clinical experience of working with compassion-focused interventions, and the principles of ecological momentary interventions. This analysis focuses on the experimental condition receiving the EMIcompass intervention. Results A total of 46 young individuals were randomized to the experimental condition. There was evidence for initial signals of effects of age (B=0.11, 95% CI 0.00-0.22), general psychopathology (B=0.08, 95% CI −0.01 to 0.16), and clinical stage (B=1.50, 95% CI 0.06-2.93) on change in momentary self-compassion and change in emotion regulation from baseline to postintervention assessments. There was no evidence for associations of other baseline characteristics (eg, gender, minority status, and level of functioning) and putative mechanisms (eg, overall self-compassion, working alliance, and training frequency). In addition, except for an initial signal for an association of momentary self-compassion at baseline and psychological distress (B=−2.83, 95% CI −5.66 to 0.00), we found no evidence that baseline characteristics related to clinical outcomes. Conclusions The findings indicated the reach of participants by the intervention largely independent of sociodemographic, clinical, and functional baseline characteristics. The findings need to be confirmed in a definitive trial. Trial Registration German Clinical Trials Register NDRKS00017265; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017265 International Registered Report Identifier (IRRID) RR2-10.2196/27462
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Affiliation(s)
- Isabell Paetzold
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Anita Schick
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian Rauschenberg
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sebastian Butz
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Chiara Floesser
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Leonie Schueltke
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Benjamin Boecking
- Tinnitus Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- ESRC Centre for Society and Mental Health and Social Epidemiology Research Group, King's College London, London, United Kingdom
- Health Service and Population Research Department, Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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Tuijnman A, Kleinjan M, Olthof M, Hoogendoorn E, Granic I, Engels RC. A Game-Based School Program for Mental Health Literacy and Stigma on Depression (Moving Stories): Cluster Randomized Controlled Trial. JMIR Ment Health 2022; 9:e26615. [PMID: 35976200 PMCID: PMC9434393 DOI: 10.2196/26615] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/31/2021] [Accepted: 07/28/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Depressive symptoms are highly prevalent among adolescents in Western countries. However, although treatment for depressive symptoms is available, many adolescents do not seek help when they need it. Important barriers to help-seeking among adolescents include low mental health literacy and high stigma. Therefore, we have developed a game-based school program, Moving Stories, which combines mental health literacy training for depression with contact with someone with lived experience both in the digital and nondigital world. OBJECTIVE The aim of this study is to conduct a first test of the effectiveness of the newly developed game-based program, Moving Stories, using a cluster randomized controlled trial. METHODS A total of 185 adolescents participated, divided over 10 classes from 4 schools. Half of the classes were randomly selected to follow the Moving Stories program, whereas the other half were in the control group, where no intervention was provided. The adolescents filled out digital questionnaires at 4 time points, with questions on mental health literacy, stigma, depressive symptoms, and the program itself (before the program, after the program, 3-month follow-up, and 6-month follow-up). Using R (R Foundation for Statistical Computing), we ran linear mixed-effects models for all continuous outcome variables and generalized linear mixed-effects models for all binary outcome variables. RESULTS Compared with the control group, participants in the Moving Stories group improved after the program in personal stigma (b=-0.53, 95% CI -1.02 to -0.03; t179.16=-2.08; P=.04). Effects on personal stigma lasted over time (3-month follow-up: b=-0.57, 95% CI -1.11 to -0.03; t174.39=-2.07; P=.04). Most adolescents in the Moving Stories group participated in the introduction (97/99, 98%) and contact session (93/99, 94%), played the game for 4 or 5 days (83/99, 83%), and indicated that they would recommend the game to their peers (90/98, 92%). CONCLUSIONS The results of this study show the potential of Moving Stories as a stigma reduction program. With changes in the program to improve its effects on mental health literacy, Moving Stories could be implemented in schools to improve help-seeking in adolescents and reduce the negative consequences and burden of depressive symptoms. TRIAL REGISTRATION Dutch Trial Register NTR7033; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7033. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/11255.
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Affiliation(s)
- Anouk Tuijnman
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands.,Trimbos-institute, Utrecht, Netherlands
| | - Marloes Kleinjan
- Trimbos-institute, Utrecht, Netherlands.,Department of Interdisciplinary Social Sciences, Youth Studies, Utrecht University, Utrecht, Netherlands
| | - Merlijn Olthof
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands
| | | | - Isabela Granic
- Faculty of Social Sciences, McMaster University, Hamilton, ON, Canada
| | - Rutger Cme Engels
- Erasmus School of Social and Behavioural Sciences, Erasmus University, Rotterdam, Netherlands
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Clinical and psychopathological correlates of duration of untreated illness (DUI) in affective spectrum disorders. Eur Neuropsychopharmacol 2022; 61:60-70. [PMID: 35810585 DOI: 10.1016/j.euroneuro.2022.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 11/23/2022]
Abstract
Affective disorders represent psychopathological entities lying on a continuum, characterized by high prevalence and functional impairment. A delay in treatment initiation might increase the burden associated with affective spectrum disorders. The present study was aimed at analyzing the correlates of a long duration of untreated illness (DUI) in these conditions. We recruited subjects diagnosed with affective disorders, both in- and outpatients, and collected information concerning socio-demographic, clinical, and psychopathological characteristics. Long DUI was defined according to previous research criteria as >2 years for Bipolar Disorders or >1 year for Depressive Disorders. Bivariate analyses were performed to compare subjects with a long and short DUI (p<0.05). A logistic regression was operated to evaluate the correlates of long DUI. In the present sample (n=135), 34.1% (n=46) subjects showed a long DUI. This subgroup presented with more physical comorbidities (p=0.003), higher body mass index (BMI) (p<0.001), more frequent anxiety onset (p=0.018), younger onset age (p=0.042), and more severe depressive symptoms (Hamilton Depression Rating Scale item 1-depressed mood (p=0.032) and item 2-guilt feelings (p=0.018)). At the logistic regression, higher severity of depressed mood (OR 1.568), higher BMI (OR 1.264), and younger age at onset (OR 0.935) were associated with long DUI. The present study confirmed a possible role of DUI as a construct underpinning higher clinical severity in affective spectrum disorders, possibly linked to worse illness course and unfavorable outcomes. Intervention strategies targeting physical comorbidities and depressive symptoms severity may decrease disease burden in subjects with a long DUI.
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31
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Schwartzman JM, Corbett BA. Depression and Employment Outcomes in Autistic Adults: A Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022. [DOI: 10.1007/s40489-022-00331-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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32
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Faisal-Cury A, Ziebold C, Rodrigues DMDO, Matijasevich A. Depression underdiagnosis: Prevalence and associated factors. A population-based study. J Psychiatr Res 2022; 151:157-165. [PMID: 35486997 DOI: 10.1016/j.jpsychires.2022.04.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/01/2022] [Accepted: 04/20/2022] [Indexed: 12/14/2022]
Abstract
UNLABELLED Despite its high prevalence and negative consequences, depression is often underdiagnosed. We aimed to estimate the prevalence and sociodemographic and health related factors associated with depression underdiagnosis among a nationally representative population-based sample in Brazil. METHOD We used data from 70,806 participants (15-107 years old) of the Brazilian National Survey (PNS 2019). Depression underdiagnosis was considered for participants with a Patient Health Questionnaire-9 (PHQ-9) score >9 and with no diagnosis made by a health provider. Logistic regression models were performed to assess the crude and adjusted association between depression underdiagnosis and sociodemographic and health related factors. Population attributable risk fractions were calculated for significant predictors. RESULTS The prevalence of depression (according the PHQ-9) was 11.2% (IC95% 10.8:11.7). Depression underdiagnosis prevalence was 63.6% (IC95% 62.0%:65.2%) and was more frequent among male, elderly population, those with lower income, lower schooling, living in the North/Central region of the country, with best health perception, lower number of chronic disease and medical appointments. A significant percentage of depression underdiagnosed cases in Brazil in 2019 would be prevent by improving education (10.18%), income (3.99%), access to health visits (5.59%) and addressing barriers for depression diagnosis among males (5.44%), elderlies (3.32%), and population from the North region (8.29%). CONCLUSION(S) depression underdiagnosis is common in Brazil. Preventive measures should target the sociodemographic and health related factors associated with depression underdiagnosis.
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Affiliation(s)
- Alexandre Faisal-Cury
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Carolina Ziebold
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
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Alhalaseh L, Alsawalha K, Al-Sabbagh MQ, Al-Khaleefa F. Depression rates and health-seeking behavior in primary care: Andersen model of health- care utilization. PSYCHOL HEALTH MED 2022:1-10. [PMID: 35765716 DOI: 10.1080/13548506.2022.2093927] [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] [Indexed: 01/09/2023]
Abstract
Depression imposes a tremendous burden on the health-care systems. Many patients prefer informal (family & friends) over formal mental health services (MHS) provided by professionals. We aimed to investigate the prevalence of depression among primary care patients and to examine the factors predicting seeking MHS using the Andersen Health Care Utilization Model. We interviewed 300 primary care patients in Jordan. The mean age was 39.85 ± 14.45, and 80% were women. 35.7% had depression, and 28.7% had significant depression impairing daily function. The most commonly reported source of help was family members and less than one-third had the intention to seek formal MHS. The predisposing-factors domain was the only predictive of seeking MHS in depression and suicide, whereas the 'enabling' and 'need' domains were not. Knowledge, stigma and life satisfaction were predictive of seeking formal MHS. Raising awareness and empowering doctors to screen for depression is needed as less than a third would seek formal MHS.
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Affiliation(s)
- Lana Alhalaseh
- Department of Family and Community Medicine, School of Medicine, University of Jordan, Sweifieh, Amman, Jordan
| | - Karim Alsawalha
- School of Medicine, University of Jordan, Sweifieh, Amman, Jordan
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Strawbridge R, McCrone P, Ulrichsen A, Zahn R, Eberhard J, Wasserman D, Brambilla P, Schiena G, Hegerl U, Balazs J, Caldas de Almeida J, Antunes A, Baltzis S, Carli V, Quoidbach V, Boyer P, Young AH. Care pathways for people with major depressive disorder: a European Brain Council Value of Treatment study. Eur Psychiatry 2022; 65:1-21. [PMID: 35703080 PMCID: PMC9280921 DOI: 10.1192/j.eurpsy.2022.28] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Despite well-established guidelines for managing major depressive disorder, its extensive disability burden persists. This Value of Treatment mission from the European Brain Council aimed to elucidate the nature and extent of “gaps” between best-practice and current-practice care, specifically to:Identify current treatment gaps along the care pathway and determine the extent of these gaps in comparison with the stepped-care model and Recommend policies intending to better meet patient needs (i.e., minimize treatment gaps). Methods After agreement upon a set of relevant treatment gaps, data pertaining to each gap were gathered and synthesized from several sources across six European countries. Subsequently, a modified Delphi approach was undertaken to attain consensus among an expert panel on proposed recommendations for minimizing treatment gaps. Results Four recommendations were made to increase the depression diagnosis rate (from ~50% episodes), aiming to both increase the number of patients seeking help, and the likelihood of a practitioner to correctly detect depression. These should reduce time to treatment (from ~1 to ~8 years after illness onset) and increase rates of treatment; nine further recommendations aimed to increase rates of treatment (from ~25 to ~50% of patients currently treated), mainly focused on targeting the best treatment to each patient. To improve follow-up after treatment initiation (from ~30 to ~65% followed up within 3 months), seven recommendations focused on increasing continuity of care. For those not responding, 10 recommendations focused on ensuring access to more specialist care (currently at rates of ~5–25% of patients). Conclusions The treatment gaps in depression care are substantial and concerning, from the proportion of people not entering care pathways to those stagnating in primary care with impairing and persistent illness. A wide range of recommendations can be made to enhance care throughout the pathway.
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Affiliation(s)
- Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Paul McCrone
- Centre for Mental Health, University of Greenwich, London, United Kingdom
| | - Andrea Ulrichsen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Roland Zahn
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Jonas Eberhard
- Division of Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giandomenico Schiena
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ulrich Hegerl
- Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Judit Balazs
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
- Department of Psychology, Bjørknes University College, Oslo, Norway
| | - Jose Caldas de Almeida
- Chronic Diseases Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Ana Antunes
- Chronic Diseases Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Spyridon Baltzis
- Division of Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Vladmir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
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Birnbaum ML, Garrett C, Baumel A, Germano NT, Lee C, Sosa D, Ngo H, Fox KH, Dixon L, Kane JM. Digital Strategies to Accelerate Help-Seeking in Youth With Psychiatric Concerns in New York State. Front Psychiatry 2022; 13:889602. [PMID: 35664474 PMCID: PMC9157179 DOI: 10.3389/fpsyt.2022.889602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Mental illness in transition age youth is common and treatment initiation is often delayed. Youth overwhelmingly report utilizing the Internet to gather information while psychiatric symptoms emerge, however, most are not yet ready to receive a referral to care, forestalling the established benefit of early intervention. Methods A digital outreach campaign and interactive online care navigation platform was developed and deployed in New York State on October 22, 2020. The campaign offers live connection to a peer or counselor, a self-assessment mental health quiz, and educational material all designed to promote help-seeking in youth and their allies. Results Between October 22, 2020 and July 31, 2021, the campaign resulted in 581,981 ad impressions, 16,665 (2.9%) clicks, and 13,717 (2.4%) unique website visitors. A third (4,562, 33.2%) completed the quiz and 793 (0.1%) left contact information. Of those, 173 (21.8%) completed a virtual assessment and 155 (19.5%) resulted in a referral to care. The median age of those referred was 21 years (IQR = 11) and 40% were considered to be from low-income areas. Among quiz completers, youth endorsing symptoms of depression or anxiety were more likely to leave contact information (OR = 2.18, 95% CI [1.39, 3.41] and OR = 1.69, 95% CI [1.31, 2.19], respectively) compared to those not reporting symptoms of depression or anxiety. Youth endorsing symptoms of psychosis were less likely to report a desire to receive a referral to care (OR = 0.58, 95% CI [0.43, 0.80]) compared to those who did not endorse symptoms of psychosis. Conclusion Self-reported symptomatology impact trajectories to care, even at the earliest stages of help-seeking, while youth and their allies are searching for information online. An online care navigation team could serve as an important resource for individuals with emerging behavioral health concerns and help to guide the transition between online information seeking at baseline to care.
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Affiliation(s)
- Michael L. Birnbaum
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
- The Feinstein Institutes for Medical Research, Manhasset, NY, United States
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Chantel Garrett
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Amit Baumel
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Nicole T. Germano
- The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Cynthia Lee
- The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Danny Sosa
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
- The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Hong Ngo
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States
| | - Kira H. Fox
- Department of Psychology, Barnard College, Columbia University, New York, NY, United States
| | - Lisa Dixon
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States
| | - John M. Kane
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
- The Feinstein Institutes for Medical Research, Manhasset, NY, United States
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
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Franzoi IG, Sauta MD, Carnevale G, Granieri A. Student Counseling Centers in Europe: A Retrospective Analysis. Front Psychol 2022; 13:894423. [PMID: 35529546 PMCID: PMC9072741 DOI: 10.3389/fpsyg.2022.894423] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/24/2022] [Indexed: 12/20/2022] Open
Abstract
Objective Tertiary education can be stressful for many young people, who consistently report high levels of distress. The issue has major implications for campus health services and mental health policymaking more widely. The present study proposes to map student counseling services in Europe. Methods The sample of institutions was sourced, using standardized data extraction, from the European Tertiary Education Register (ETER). Then, each institution's website was analyzed for information about the availability of student counseling centers and the services provided. Data extracted from the ETER database were: ETER ID, national identifier, institution name, English institution name, number of students, legal status (in English), institution category (in English), and institutional website. Data extracted from institutions' websites concerned the availability of students' psychological centers and the services provided. Analyses were carried out using the SPSS Statistics software package (IBM Corp., Armonk, NY, United States), version 26. Results Overall, it was found that most institutions do not provide mental health counseling services for their students. Institutions of medium dimensions showed a higher probability of reporting students' psychological centers than small institutions. Moreover, private institutions and public institutions were more likely to report having such centers, while private government-dependent institutions were less likely. Universities of applied sciences and universities were more likely to report having them, while other institutions were less likely. Regarding provision according to geographic area, compared to Northern Europe, every other European region was less likely to report featuring such centers. Most institutions reported offering counseling, career counseling, or not otherwise specified psychological services, but only a small number reported providing services such as psychotherapy, psychiatric services, or counseling for learning-specific disabilities. Conclusion It is critically important to catalog European data on student counseling centers and services, to encourage tertiary education institutions to invest in such services as key sites for mental health promotion. Indeed, professionally trained staff and the possibility of long-term treatment options would go a long way in supporting students who might not otherwise have access to treatment.
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Raventós B, Pistillo A, Reyes C, Fernández-Bertolín S, Aragón M, Berenguera A, Jacques-Aviñó C, Medina-Perucha L, Burn E, Duarte-Salles T. Impact of the COVID-19 pandemic on diagnoses of common mental health disorders in adults in Catalonia, Spain: a population-based cohort study. BMJ Open 2022; 12:e057866. [PMID: 35396302 PMCID: PMC8995576 DOI: 10.1136/bmjopen-2021-057866] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 09/29/2021] [Accepted: 03/10/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To investigate how trends in incidence of anxiety and depressive disorders have been affected by the COVID-19 pandemic. DESIGN Population-based cohort study. SETTING Retrospective cohort study from 2018 to 2021 using the Information System for Research in Primary Care (SIDIAP) database in Catalonia, Spain. PARTICIPANTS 3 640 204 individuals aged 18 or older in SIDIAP on 1 March 2018 with no history of anxiety and depressive disorders. PRIMARY AND SECONDARY OUTCOMES MEASURES The incidence of anxiety and depressive disorders during the prelockdown period (March 2018-February 2020), lockdown period (March-June 2020) and postlockdown period (July 2020-March 2021) was calculated. Forecasted rates over the COVID-19 periods were estimated using negative binomial regression models based on prelockdown data. The percentage of reduction was estimated by comparing forecasted versus observed events, overall and by sex, age and socioeconomic status. RESULTS The incidence rates per 100 000 person-months of anxiety and depressive disorders were 151.1 (95% CI 150.3 to 152.0) and 32.3 (31.9 to 32.6), respectively, during the prelockdown period. We observed an increase of 37.1% (95% prediction interval 25.5 to 50.2) in incident anxiety diagnoses compared with the expected in March 2020, followed by a reduction of 15.8% (7.3 to 23.5) during the postlockdown period. A reduction in incident depressive disorders occurred during the lockdown and postlockdown periods (45.6% (39.2 to 51.0) and 22.0% (12.6 to 30.1), respectively). Reductions were higher among women during the lockdown period, adults aged 18-34 years and individuals living in the most deprived areas. CONCLUSIONS The COVID-19 pandemic in Catalonia was associated with an initial increase in anxiety disorders diagnosed in primary care but a reduction in cases as the pandemic continued. Diagnoses of depressive disorders were lower than expected throughout the pandemic.
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Affiliation(s)
- Berta Raventós
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrea Pistillo
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Carlen Reyes
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Sergio Fernández-Bertolín
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Maria Aragón
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Anna Berenguera
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Constanza Jacques-Aviñó
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Medina-Perucha
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edward Burn
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
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Sanatkar S, Counson I, Mackinnon A, Bartholomew A, Glozier N, Harvey S. Preliminary investigation of Shift, a novel smartphone application to support junior doctors’ mental health and wellbeing: Examination of symptom progression, usability, and acceptability after one month of use (Preprint). J Med Internet Res 2022; 24:e38497. [PMID: 36129745 PMCID: PMC9536518 DOI: 10.2196/38497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Shift is a novel smartphone app for providing a digital-first mental health resource to junior doctors. It contains psychoeducational material, cognitive behavioral modules, guided mediations, information on common work stressors, and a section on help-seeking options for psychological problems through workplace and private avenues. Objective This study aimed to conduct a preliminary investigation of the use and potential effectiveness of Shift on depressive and anxiety symptoms (primary outcomes) and work and social functioning, COVID-19 safety concerns, and help seeking (secondary outcomes). This study also sought feedback on whether Shift was seen as an acceptable tool. Methods Junior doctors in New South Wales, Australia, were approached through promotional activities from the Ministry of Health, specialist medical colleges, and social media advertisements between June and August 2020. Consenting participants provided web-based baseline data, used the Shift app for 30 days, and were asked to complete a poststudy web-based questionnaire. Outcomes were analyzed under the intention-to-treat principle. Results A total of 222 female (n=156, 70.3%; mean age 29.2, SD 4.61 years) junior doctors provided full baseline data. Of these, 89.2% (198/222) downloaded the app, logged into the app approximately 6 times (mean 5.68, SD 7.51), completed 4 in-app activities (mean 3.77, SD 4.36), and spent a total of 1 hour on in-app activities (mean 52:23, SD 6:00:18) over 30 days. Postintervention and app use data were provided by 24.3% (54/222) of participants. Depressive and anxiety symptoms significantly decreased between the pre- and postassessment points as expected; however, physicians’ COVID-19 safety concerns significantly increased. Work and social functioning, COVID-19 concerns for family and friends, and help seeking did not change significantly. There was no significant relationship between symptom changes and app use (number of log-ins, days between first and last log-in, and total activity time). Most poststudy completers (31/54, 57%) rated Shift highly or very highly. Conclusions Despite high levels of nonresponse to the poststudy assessment and increases in COVID-19 safety concerns, junior doctors who used the app reported some improvements in depression and anxiety, which warrant further exploration in a robust manner.
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Affiliation(s)
- Samineh Sanatkar
- Black Dog Institute, Randwick, Australia
- School of Psychiatry, Faculty of Medicine, University of New South Wales Sydney, Kensington, Australia
| | - Isabelle Counson
- Black Dog Institute, Randwick, Australia
- School of Psychiatry, Faculty of Medicine, University of New South Wales Sydney, Kensington, Australia
| | | | | | - Nick Glozier
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Samuel Harvey
- Black Dog Institute, Randwick, Australia
- School of Psychiatry, Faculty of Medicine, University of New South Wales Sydney, Kensington, Australia
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Suicide mortality among psychiatric patients in Northeast Italy: a 10-year cohort study. Epidemiol Psychiatr Sci 2022; 31:e17. [PMID: 35352672 PMCID: PMC8967697 DOI: 10.1017/s2045796021000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
AIMS The present study investigated the relationship between suicide mortality and contact with a community mental health centre (CMHC) among the adult population in the Veneto Region (northeast Italy, population 4.9 million). Specifically, it estimated the effects of age, gender, time elapsed since the first contact with a CMHC, calendar year of diagnosis and diagnostic category on suicide mortality and modality. METHODS The regional mortality archive was linked to electronic medical records for all residents aged 18-84 years who had been admitted to a CMHC in the Veneto Region in 2008. In total, 54 350 subjects diagnosed with a mental disorder were included in the cohort and followed up for a period of 10 years, ending in 2018. Years of life lost (YLL) were computed and suicide mortality was estimated as a mortality rate ratio (MRR). RESULTS During the follow-up period, 4.4% of all registered deaths were from suicide, but, given the premature age of death (mean 52.2 years), suicide death accounted for 8.7% of YLL; this percentage was particularly high among patients with borderline personality disorder (27.2%), substance use disorder (12.1%) and bipolar disorder (11.5%) who also presented the highest suicide mortality rates. Suicide mortality rates were halved in female patients (MRR 0.45; 95% CI 0.37-0.55), highest in patients aged 45-54 years (MRR 1.56; 95% CI 1.09-2.23), and particularly elevated in the 2 months following first contact with CMHCs (MRR 10.4; 95% CI 5.30-20.3). A sensitivity analysis restricted to patients first diagnosed in 2008 confirmed the results. The most common modalities of suicide were hanging (47%), jumping (18%), poisoning (13%) and drowning (10%), whereas suicide from firearm was rare (4%). Gender, age at death and time since first contact with CMHCs influenced suicide modality. CONCLUSIONS Suicide prevention strategies must be promptly initiated after patients' first contact with CMHCs. Patients diagnosed with borderline personality disorder, substance use disorder and bipolar disorder may be at particularly high risk for suicide.
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40
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Kelley SW, Mhaonaigh CN, Burke L, Whelan R, Gillan CM. Machine learning of language use on Twitter reveals weak and non-specific predictions. NPJ Digit Med 2022; 5:35. [PMID: 35338248 PMCID: PMC8956571 DOI: 10.1038/s41746-022-00576-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 02/11/2022] [Indexed: 11/30/2022] Open
Abstract
Depressed individuals use language differently than healthy controls and it has been proposed that social media posts can be used to identify depression. Much of the evidence behind this claim relies on indirect measures of mental health and few studies have tested if these language features are specific to depression versus other aspects of mental health. We analysed the Tweets of 1006 participants who completed questionnaires assessing symptoms of depression and 8 other mental health conditions. Daily Tweets were subjected to textual analysis and the resulting linguistic features were used to train an Elastic Net model on depression severity, using nested cross-validation. We then tested performance in a held-out test set (30%), comparing predictions of depression versus 8 other aspects of mental health. The depression trained model had modest out-of-sample predictive performance, explaining 2.5% of variance in depression symptoms (R2 = 0.025, r = 0.16). The performance of this model was as-good or superior when used to identify other aspects of mental health: schizotypy, social anxiety, eating disorders, generalised anxiety, above chance for obsessive-compulsive disorder, apathy, but not significant for alcohol abuse or impulsivity. Machine learning analysis of social media data, when trained on well-validated clinical instruments, could not make meaningful individualised predictions regarding users’ mental health. Furthermore, language use associated with depression was non-specific, having similar performance in predicting other mental health problems.
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Affiliation(s)
- Sean W Kelley
- School of Psychology, Trinity College Dublin, Dublin, Ireland. .,Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
| | | | - Louise Burke
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Robert Whelan
- School of Psychology, Trinity College Dublin, Dublin, Ireland.,Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Claire M Gillan
- School of Psychology, Trinity College Dublin, Dublin, Ireland.,Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
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Egberts K, Fekete S, Häge A, Hiemke C, Scherf-Clavel M, Taurines R, Unterecker S, Gerlach M, Romanos M. [Therapeutic drug monitoring to optimize psychopharmacotherapy in children and adolescents - Update and guidelines for practice]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2022; 50:133-152. [PMID: 35274573 DOI: 10.1024/1422-4917/a000845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Therapeutic drug monitoring to optimize psychopharmacotherapy in children and adolescents - Update and guidelines for practice Abstract. Despite the improved evidence base, many uncertainties remain in child and adolescent psychiatric pharmacotherapy about the efficacy and tolerability of drugs, which are often prescribed off-label or in combination therapy in this age group. Because medium- to long-term use is unavoidable in many cases, clinicians should minimize adverse drug reactions as far as possible and tailor an effective dosage to the individual characteristics of the patient. Not only are children and adolescents particularly vulnerable to certain adverse drug effects, they are also exposed to iatrogenic risks from dosing or application errors, which can lead to under- or overdosing with correspondingly negative effects on the success of the therapy. In addition to determining a strict indication, it is therefore essential to establish precise dosage and systematic monitoring of the safety of the psychopharmacotherapy. This article introduces therapeutic drug monitoring as a useful clinical tool and describes how its correct application in practice can improve the efficacy as well as the safety and tolerability of psychotropic therapy in children and adolescents for the immediate benefit of patients. Keywords: Psychopharmacotherapy, adverse drug reactions, pharmacovigilance, therapeutic drug monitoring, quality assurance.
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Affiliation(s)
- Karin Egberts
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Zentrum für Psychische Gesundheit, Universitätsklinikum Würzburg.,Arbeitsgruppe "Therapeutisches Drug-Monitoring" der Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) e. V.,Arbeitsgruppe "Kinder- und jugendpsychiatrische Pharmakologie" der AGNP e. V.,Kompetenznetz Therapeutisches Drug Monitoring in der Kinder- und Jugendpsychiatrie g. e. V
| | - Stefanie Fekete
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Zentrum für Psychische Gesundheit, Universitätsklinikum Würzburg.,Arbeitsgruppe "Kinder- und jugendpsychiatrische Pharmakologie" der AGNP e. V
| | - Alexander Häge
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg.,Kompetenznetz Therapeutisches Drug Monitoring in der Kinder- und Jugendpsychiatrie g. e. V
| | - Christoph Hiemke
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Mainz.,Arbeitsgruppe "Therapeutisches Drug-Monitoring" der Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) e. V
| | - Maike Scherf-Clavel
- Speziallabor für Therapeutisches Drug Monitoring, Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie, Zentrum für Psychische Gesundheit, Universitätsklinikum Würzburg.,Arbeitsgruppe "Therapeutisches Drug-Monitoring" der Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) e. V
| | - Regina Taurines
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Zentrum für Psychische Gesundheit, Universitätsklinikum Würzburg.,Kompetenznetz Therapeutisches Drug Monitoring in der Kinder- und Jugendpsychiatrie g. e. V
| | - Stefan Unterecker
- Speziallabor für Therapeutisches Drug Monitoring, Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie, Zentrum für Psychische Gesundheit, Universitätsklinikum Würzburg.,Arbeitsgruppe "Therapeutisches Drug-Monitoring" der Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) e. V
| | - Manfred Gerlach
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Zentrum für Psychische Gesundheit, Universitätsklinikum Würzburg.,Arbeitsgruppe "Therapeutisches Drug-Monitoring" der Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) e. V.,Arbeitsgruppe "Kinder- und jugendpsychiatrische Pharmakologie" der AGNP e. V.,Kompetenznetz Therapeutisches Drug Monitoring in der Kinder- und Jugendpsychiatrie g. e. V
| | - Marcel Romanos
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Zentrum für Psychische Gesundheit, Universitätsklinikum Würzburg.,Arbeitsgruppe "Kinder- und jugendpsychiatrische Pharmakologie" der AGNP e. V.,Kompetenznetz Therapeutisches Drug Monitoring in der Kinder- und Jugendpsychiatrie g. e. V
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Tarsitani L, Della Rocca B, Pancheri C, Biondi M, Pasquini M, Ferracuti S, Ventriglio A, Mandarelli G. Involuntary psychiatric hospitalization among migrants in Italy: A matched sample study. Int J Soc Psychiatry 2022; 68:429-434. [PMID: 33719677 DOI: 10.1177/00207640211001903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Immigrants in Europe appear to be at higher risk of psychiatric coercive interventions. Involuntary psychiatric hospitalization poses significant ethical and clinical challenges. Nonetheless, reasons for migration and other risk factors for involuntary treatment were rarely addressed in previous studies. The aims of this study are to clarify whether immigrant patients with acute mental disorders are at higher risk to be involuntarily admitted to hospital and to explore clinical and migratory factors associated with involuntary treatment. METHODS In this cross-sectional matched sample study, we compared the rates of involuntary treatment in a sample of first-generation immigrants admitted in a Psychiatric Intensive Care Unit of a large metropolitan academic hospital to their age-, gender-, and psychiatric diagnosis-matched native counterparts. Clinical, sociodemographic, and migratory variables were collected. The Brief Psychiatric Rating Scale-expanded (BPRS-E) and the Clinical Global Impression-Severity (CGI-S) scale were administered. McNemar test was used for paired categorical variables and a binary logistic regression analysis was performed. RESULTS A total of 234 patients were included in the analysis. Involuntary treatment rates were significantly higher in immigrants as compared to their matched natives (32% vs. 24% respectively; p < .001). Among immigrants, involuntary hospitalization was found to be more frequent in those patients whose length of stay in Italy was less than 2 years (OR = 4.2, 95% CI [1.4-12.7]). CONCLUSION Recently arrived immigrants appear to be at higher risk of involuntary admission. Since coercive interventions can be traumatic and negatively affect outcomes, strategies to prevent this phenomenon are needed.
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Affiliation(s)
- Lorenzo Tarsitani
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - Bianca Della Rocca
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - Corinna Pancheri
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - Massimo Biondi
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - Massimo Pasquini
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - Stefano Ferracuti
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Italy
| | - Gabriele Mandarelli
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Italy
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Oluboka OJ, Katzman MA, Habert J, Khullar A, Oakander MA, McIntosh D, McIntyre RS, Soares CN, Lam RW, Klassen LJ, Tanguay R. Early Optimized Pharmacological Treatment in Patients With Depression and Chronic Pain. CNS Spectr 2022; 28:1-40. [PMID: 35195060 DOI: 10.1017/s1092852922000128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractMajor depressive disorder (MDD) is the leading cause of disability worldwide. Patients with MDD have high rates of comorbidity with mental and physical conditions, one of which is chronic pain. Chronic pain conditions themselves are also associated with significant disability, and the large number of patients with MDD who have chronic pain drives high levels of disability and compounds healthcare burden. The management of depression in patients who also have chronic pain can be particularly challenging due to underlying mechanisms that are common to both conditions, and because many patients with these conditions are already taking multiple medications. For these reasons, healthcare providers may be reluctant to treat such patients. The Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines provide evidence-based recommendations for the management of MDD and comorbid psychiatric and medical conditions such as anxiety, substance use disorder, and cardiovascular disease; however, comorbid chronic pain is not addressed. In this article, we provide an overview of the pathophysiological and clinical overlap between depression and chronic pain and review evidence-based pharmacological recommendations in current treatment guidelines for MDD and for chronic pain. Based on clinical experience with MDD patients with comorbid pain, we recommend rapidly and aggressively treating depression according to CANMAT treatment guidelines, using antidepressant medications with analgesic properties, while addressing pain with first-line pharmacotherapy as treatment for depression is optimized. We review options for treating pain symptoms that remain after response to antidepressant treatment is achieved.
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Perceived mental illness stigma among family and friends of young people with depression and its role in help-seeking: a qualitative inquiry. BMC Psychiatry 2022; 22:107. [PMID: 35144565 PMCID: PMC8832742 DOI: 10.1186/s12888-022-03754-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 01/31/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Depressive disorders are a serious public health concern. Left untreated, further clinical distress and impairment in important life domains may arise. Yet, the treatment gap remains large. Prior research has shown that individuals with depressive disorders prefer seeking help from informal sources such as family and friends ahead of formal sources. However, this preference has its disadvantages such as experiencing actual, perceived and internalized stigmatizing responses from them which may delay or deter help-seeking. This paper aimed to determine the role of perceived stigma among family and friends in an individual's help-seeking behavior. METHODS Data were collected using semi-structured interviews with patients with depressive disorders from a tertiary psychiatric hospital in Singapore to capture individuals' self-reported experience with depression and stigmatization among family and friends. Interviews were audio recorded and transcribed verbatim. Data of 33 young adults (mean age = 26 years, SD =4.6; 18 female, 15 male) were analyzed using thematic analysis. RESULTS In all, four broad themes were developed: (1) absence of support, (2) provision of unhelpful support, (3) preference for non-disclosure, and (4) opposition towards formal help-seeking. Lack of awareness of depression and perpetuation of stigma manifests as barriers towards help-seeking in the form of absence of support and provision of unhelpful support which subsequently leads to a preference for non-disclosure, as well as opposition by family and friends towards formal help-seeking. CONCLUSIONS Data from this study can contribute to the development of public health programs aimed at improving awareness and support from family and friends and facilitating earlier help-seeking among young people with depressive disorders.
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Paquin V, LeBaron N, Kraus GE, Yung EC, Iskric A, Cervantes P, Kolivakis T, Saint-Laurent M, Gobbi G, Auger N, Low N. Examining the association between duration of untreated illness and clinical outcomes in patients with major depressive and bipolar disorders. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Galkin S, Ivanova S, Bokhan N. Current methods for predicting therapeutic response in patients with depressive disorders. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:15-21. [DOI: 10.17116/jnevro202212202115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mekonen T, Ford S, Chan GCK, Hides L, Connor JP, Leung J. What is the short-term remission rate for people with untreated depression? A systematic review and meta-analysis. J Affect Disord 2022; 296:17-25. [PMID: 34583099 DOI: 10.1016/j.jad.2021.09.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Depression is one of the prevalent mental illnesses and leading cause of global disease burden. However, most people with depression do not access treatment. Remission without treatment may occur in some cases of depression. This study aimed to estimate the short-term remission (natural recovery) from untreated depression. METHODS A systematic review and meta-analysis was registered on PROSPERO and conducted following PRISMA guidelines. EMBASE, PsycINFO, and PubMed were searched, supplemented with an additional hand search to identify studies reporting natural recovery from untreated depression. Study selection and screening were carried out by three independent reviewers. Methodological quality assessment of the included studies was conducted. Remission was defined as no longer meeting the diagnostic criteria or scoring below the cut off points of the validated tools as reported by the included studies. The data were synthesized using narrative summary and random-effects meta-analysis. RESULTS Sixteen waitlist-controlled trial studies were included in the systematic review and meta-analysis. The duration of follow-up ranged from 4 to 12 weeks with a median duration of 8 weeks. The overall pooled remission from untreated depression was 12.5%, 95% confidence interval (7.8, 18.0%). Due to lack of published data, we were unable to determine if the severity of depression symptoms was associated with remission rates. CONCLUSIONS Short-term remission from depression without treatment is uncommon. Across studies, 8 - 18% of people remitted without treatment within 12 weeks. Waitlist control groups may not represent all persons with depression.
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Affiliation(s)
- Tesfa Mekonen
- School of Psychology, The University of Queensland, Australia; Psychiatry Department, Bahir Dar University, Ethiopia; National Centre for Youth Substance Use Research, The University of Queensland, Australia.
| | - Sarah Ford
- School of Psychology, The University of Queensland, Australia
| | - Gary C K Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Australia
| | - Leanne Hides
- School of Psychology, The University of Queensland, Australia; National Centre for Youth Substance Use Research, The University of Queensland, Australia
| | - Jason P Connor
- National Centre for Youth Substance Use Research, The University of Queensland, Australia; Discipline of Psychiatry, The University of Queensland, Australia
| | - Janni Leung
- School of Psychology, The University of Queensland, Australia; National Centre for Youth Substance Use Research, The University of Queensland, Australia
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Rafaeli AK, Bar-Kalifa E, Verdeli H, Miller L. Interpersonal Counseling for College Students: Pilot Feasibility and Acceptability Study. Am J Psychother 2021; 74:165-171. [PMID: 34905934 DOI: 10.1176/appi.psychotherapy.202120200038] [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: 11/30/2022]
Abstract
OBJECTIVE University counseling centers struggle to meet the growing demand for mental health treatment by students in distress. More acutely distressed students typically receive priority, whereas those with mild to moderate depression often face longer wait times and fewer available therapy sessions. For this reason, interpersonal counseling for college students (IPC-C) was created as a brief manualized psychotherapy, suitable for students with mild to moderate depression, that maintains the core components of interpersonal counseling and integrates components from interpersonal psychotherapy for adolescents and other developmentally appropriate techniques. This article describes a pilot trial of IPC-C. METHODS IPC-C is delivered in three to six psychotherapy sessions focused on alleviating depressive symptoms and increasing social support. Ten participants from two university counseling centers were recruited to receive IPC-C. The inclusion criterion was a Patient Health Questionnaire-9 (PHQ-9) score of 5-14, indicating mild to moderate depression. Participants completed the PHQ-9 at each session, the College Adjustment Test at baseline and termination, and the IPC Satisfaction Scale at termination. RESULTS Nine of the 10 participants completed the study, attending an average of five therapy sessions each. Participants agreed that the number of sessions was appropriate and indicated satisfaction with the IPC-C intervention. Participants exhibited significantly reduced depression severity (Cohen's d=2.45) and significantly improved college adjustment (d=0.92). CONCLUSIONS In this pilot trial, IPC-C was found to be a feasible and acceptable intervention for university-based treatment of young adults with mild to moderate depressive symptoms. IPC-C holds promise as a potentially effective intervention for this population and warrants further study in a randomized trial.
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Affiliation(s)
- Alexandra K Rafaeli
- Department of Psychological Services, Tel Aviv University, Tel Aviv, Israel (Rafaeli); Department of Psychology, Ben-Gurion University, Be'er Sheva, Israel (Bar-Kalifa); Department of Clinical Psychology, Teachers College, Columbia University, New York City (Verdeli); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Miller)
| | - Eran Bar-Kalifa
- Department of Psychological Services, Tel Aviv University, Tel Aviv, Israel (Rafaeli); Department of Psychology, Ben-Gurion University, Be'er Sheva, Israel (Bar-Kalifa); Department of Clinical Psychology, Teachers College, Columbia University, New York City (Verdeli); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Miller)
| | - Helen Verdeli
- Department of Psychological Services, Tel Aviv University, Tel Aviv, Israel (Rafaeli); Department of Psychology, Ben-Gurion University, Be'er Sheva, Israel (Bar-Kalifa); Department of Clinical Psychology, Teachers College, Columbia University, New York City (Verdeli); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Miller)
| | - Leslie Miller
- Department of Psychological Services, Tel Aviv University, Tel Aviv, Israel (Rafaeli); Department of Psychology, Ben-Gurion University, Be'er Sheva, Israel (Bar-Kalifa); Department of Clinical Psychology, Teachers College, Columbia University, New York City (Verdeli); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Miller)
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Iorfino F, Carpenter JS, Cross SP, Crouse J, Davenport TA, Hermens DF, Yee H, Nichles A, Zmicerevska N, Guastella A, Scott EM, Hickie IB. Social and occupational outcomes for young people who attend early intervention mental health services: a longitudinal study. Med J Aust 2021; 216:87-93. [PMID: 34664282 DOI: 10.5694/mja2.51308] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify trajectories of social and occupational functioning in young people during the two years after presenting for early intervention mental health care; to identify demographic and clinical factors that influence these trajectories. DESIGN Longitudinal, observational study of young people presenting for mental health care. SETTING Two primary care-based early intervention mental health services at the Brain and Mind Centre (University of Sydney), 1 June 2008 - 31 July 2018. PARTICIPANTS 1510 people aged 12-25 years who had presented with anxiety, mood, or psychotic disorders, for whom two years' follow-up data were available for analysis. MAIN OUTCOME MEASURES Latent class trajectories of social and occupational functioning based on growth mixture modelling of Social and Occupational Assessment Scale (SOFAS) scores. RESULTS We identified four trajectories of functioning during the first two years of care: deteriorating and volatile (733 participants, 49%); persistent impairment (237, 16%); stable good functioning (291, 19%); and improving, but late recurrence (249, 16%). The less favourable trajectories (deteriorating and volatile; persistent impairment) were associated with physical comorbidity, not being in education, employment, or training, having substance-related disorders, having been hospitalised, and having a childhood onset mental disorder, psychosis-like experiences, or a history of self-harm or suicidality. CONCLUSIONS Two in three young people with emerging mental disorders did not experience meaningful improvement in social and occupational functioning during two years of early intervention care. Most functional trajectories were also quite volatile, indicating the need for dynamic service models that emphasise multidisciplinary interventions and measurement-based care.
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Affiliation(s)
- Frank Iorfino
- Brain and Mind Centre, the University of Sydney, Sydney, NSW
| | | | - Shane Pm Cross
- Brain and Mind Centre, the University of Sydney, Sydney, NSW
| | - Jacob Crouse
- Brain and Mind Centre, the University of Sydney, Sydney, NSW
| | | | - Daniel F Hermens
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD
| | - Hannah Yee
- Brain and Mind Centre, the University of Sydney, Sydney, NSW
| | - Alissa Nichles
- Brain and Mind Centre, the University of Sydney, Sydney, NSW
| | | | - Adam Guastella
- Brain and Mind Centre, the University of Sydney, Sydney, NSW
| | | | - Ian B Hickie
- Brain and Mind Centre, the University of Sydney, Sydney, NSW
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Moskowitz JT, Addington EL, Shiu E, Bassett SM, Schuette S, Kwok I, Freedman ME, Leykin Y, Saslow LR, Cohn MA, Cheung EO. Facilitator Contact, Discussion Boards, and Virtual Badges as Adherence Enhancements to a Web-Based, Self-guided, Positive Psychological Intervention for Depression: Randomized Controlled Trial. J Med Internet Res 2021; 23:e25922. [PMID: 34550076 PMCID: PMC8495567 DOI: 10.2196/25922] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 04/16/2021] [Accepted: 05/24/2021] [Indexed: 01/26/2023] Open
Abstract
Background Adherence to self-guided interventions tends to be very low, especially in people with depression. Prior studies have demonstrated that enhancements may increase adherence, but little is known about the efficacy of various enhancements in comparison to, or in combination with, one another. Objective The aim of our study is to test whether 3 enhancements—facilitator contact (FC), an online discussion board, and virtual badges (VB)—alone, or in combination, improve adherence to a self-guided, web-based intervention for depression. We also examined whether age, gender, race, ethnicity, comfort with technology, or baseline depression predicted adherence or moderated the effects that each enhancement had on adherence. Methods Participants were recruited through web-based sources and, after completing at least 4 out of 7 daily emotion reports, were sequentially assigned to 1 of 9 conditions—the intervention alone; the intervention plus 1, 2, or all 3 enhancements; or an emotion reporting control condition. The intervention was a positive psychological program consisting of 8 skills that specifically targeted positive emotions, and it was delivered over 5 weeks in a self-guided, web-based format. We operationalized adherence as the number of skills accessed. Results A total of 602 participants were enrolled in this study. Participants accessed, on average, 5.61 (SD 2.76) of 8 skills. The total number of enhancements participants received (0-3) did not predict the number of skills accessed. Participants who were assigned to the VB+FC condition accessed significantly more skills than those in the intervention only conditions. Furthermore, participants in arms that received the combination of both the VB and FC enhancements (VB+FC and VB+FC+online discussion board) accessed a greater number of skills relative to the number of skills accessed by participants who received either VB or FC without the other. Moderation analyses revealed that the receipt of VB (vs no VB) predicted higher adherence among participants with moderately severe depression at baseline. Conclusions The results suggested that the VB+FC combination significantly increased the number of skills accessed in a self-guided, web-based intervention for elevated depression. We have provided suggestions for refinements to these enhancements, which may further improve adherence. Trial Registration ClinicalTrials.gov NCT02861755; http://clinicaltrials.gov/ct2/show/NCT02861755
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Affiliation(s)
- Judith Tedlie Moskowitz
- Department of Medical Social Sciences, Osher Center for Integrative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Elizabeth L Addington
- Department of Medical Social Sciences, Osher Center for Integrative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Eva Shiu
- Department of Obstetrics and Gynecology, Biological Sciences Division, University of Chicago, Chicago, IL, United States
| | - Sarah M Bassett
- Department of Medical Social Sciences, Osher Center for Integrative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Stephanie Schuette
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Ian Kwok
- Department of Psychiatry and Behavioral Sciences, Osher Center for Integrative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Melanie E Freedman
- Department of Psychiatry and Behavioral Sciences, Osher Center for Integrative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Yan Leykin
- Department of Psychology, Palo Alto University, Palo Alto, CA, United States
| | - Laura R Saslow
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, United States
| | - Michael A Cohn
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Elaine O Cheung
- Department of Medical Social Sciences, Osher Center for Integrative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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