The cost of mood disorders

A Novel Approach to Clustering Accelerometer Data for Application in Passive Predictions of Changes in Depression Severity

The treatment of mood disorders, which can become a lifelong process, varies widely in efficacy between individuals. Most options to monitor mood rely on subjective self-reports and clinical visits, which can be burdensome and may not portray an accurate representation of what the individual is experiencing. A passive method to monitor mood could be a useful tool for those with these disorders. Some previously proposed models utilized sensors from smartphones and wearables, such as the accelerometer. This study examined a novel approach of processing accelerometer data collected from smartphones only while participants of the open-science branch of the BiAffect study were typing. The data were modeled by von Mises-Fisher distributions and weighted networks to identify clusters relating to different typing positions unique for each participant. Longitudinal features were derived from the clustered data and used in machine learning models to predict clinically relevant changes in depression from clinical and typing measures. Model accuracy was approximately 95%, with 97% area under the ROC curve (AUC). The accelerometer features outperformed the vast majority of clinical and typing features, which suggested that this new approach to analyzing accelerometer data could contribute towards unobtrusive detection of changes in depression severity without the need for clinical input.

[Resource use and financing of guideline-adherent psychotherapeutic inpatient care]

BACKGROUND

The financing of psychiatric psychotherapeutic care in Germany is determined by the German psychiatric staffing regulations which are unchanged since 1991. Psychotherapy was established after 1991 as an effective and indispensable treatment of mental and behavioral disorders.

AIMS AND OBJECTIVES

The aim of this study was to empirically investigate the use of psychiatrists' and psychologists' working time for psychotherapy in guideline-adherent hospital care. A further aim was to compare these results to the resources defined by the German psychiatric staffing regulations and in the new prospective payment system for psychiatry and psychosomatics in Germany.

MATERIAL AND METHODS

University hospitals for psychiatry and psychotherapy were asked to retrospectively provide data of patients for which guideline-adherent care was possible. Participating institutions provided both data describing the staff time utilization of psychotherapeutic services provided by psychiatrists and psychologists and patient classifications according to the German psychiatric staffing regulations and the new prospective payment system for psychiatry and psychosomatics.

RESULTS

Resources defined by the German psychiatric staffing regulations covered a mean of only 71 min of psychotherapy per patient and week while the actual mean intensity of psychotherapeutic care provided by the participating hospitals was 194 min per patient and week. The associated use of staff time was 102 min per patient and week. Both figures increased during an inpatient episode. The resources defined by the German psychiatric staffing regulations covered only 70 % of medical and psychological personnel. The current configuration of the new prospective payment system for psychiatry and psychosomatics covered only 59 % of staff time.

CONCLUSION

The results of this study provide another unambiguous recommendation to adjust the out-dated German psychiatric staffing regulations to the current evidence and S3 guidelines for psychiatric psychotherapeutic hospital care. In particular, more resources are required for the provision of psychotherapeutic care.

[Guideline-conform psychiatric psychotherapeutic treatment for patients with schizophrenia : A normative evaluation of necessary personnel requirements]

BACKGROUND

Although national treatment guidelines and current publications of the German Federal Joint Committee (Gemeinsamer Bundesausschuss) recommend cognitive behavior therapy for all patients with schizophrenia, the implementation of these recommendations in current inpatient and outpatient treatment is only rudimentary.

OBJECTIVES

The aim of this study was to systematically search randomized controlled studies (RCTs), meta-analyses and the guidelines of the German Association for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) and the British National Institute for Health and Clinical Excellence (NICE) in order to assess the number of personnel necessary for psychiatric and therapeutic inpatient treatment in line with present guidelines. Moreover, the number of staff required was compared with the personnel resources designated by the German psychiatry personnel regulations (Psych-PV).

METHODS

The German and NICE guidelines, RCTs and meta-analyses were analyzed and an adequate weekly treatment plan for an inpatient unit was developed. Moreover, the number of personnel necessary to realize the treatment plan was calculated.

RESULTS

In order to realize adequate inpatient treatment approximately 107 min extra for medical psychotherapeutic personnel per patient and week (of which 72 min for psychotherapy) and another 60 min for nursing staff per patient and week are required in addition to the current Psych-PV regulations. Thus, implementation in an open ward with 20 inpatients would require 3.62 positions for physicians, 0.7 positions in psychology and 12.85 positions for nursing staff (including management positions and night shifts).

DISCUSSION

These evidence-based recommendations for precise specifications of inpatient treatment should lead to improved inpatient treatment in line with present guidelines. Moreover, outpatients and day patients could be included in this treatment model. The results should be considered in the construction of the future prospective payment system for inpatient psychiatric healthcare in Germany.

Cost-of-illness studies for bipolar disorder: systematic review of international studies

BACKGROUND AND OBJECTIVES

Bipolar disorder (BD) may result in a greater burden than all forms of cancer, Alzheimer's disease and epilepsy. Cost-of-illness (COI) studies provide useful information on the economic burden that BD imposes on a society. Furthermore, COI studies are pivotal sources of evidence used in economic evaluations. This study aims to give a general overview of COI studies for BD and to discuss methodological issues that might potentially influence results. This study also aims to provide recommendations to improve practice in this area, based on the review.

METHODS

A search was performed to identify COI studies of BD. The following electronic databases were searched: MEDLINE, EMBASE, PsycInfo, Cochrane Database of Systematic Reviews, HMIC and openSIGLE. The primary outcome of this review was the annual cost per BD patient. A narrative assessment of key methodological issues was also included. Based on these findings, recommendations for good practice were drafted.

RESULTS

Fifty-four studies were included in this review. Because of the widespread methodological heterogeneity among included studies, no attempt has been made to pool results of different studies. Potential areas for methodological improvement were identified. These were: description of the disease and population, the approach to deal with comorbidities, reporting the rationale and impact for choosing different cost perspectives, and ways in which uncertainty is addressed.

CONCLUSIONS

This review showed that numerous COI studies have been conducted for BD since 1995. However, these studies employed varying methods, which limit the comparability of findings. The recommendations provided by this review can be used by those conducting COI studies and those critiquing them, to increase the credibility and reporting of study results.

Efficacy of psychoeducation and relaxation interventions on stress-related variables in people with mental disorders: a literature review

This paper aimed to critically review and summarize empirical evidence concerning the efficacy of psychoeducation or relaxation-based stress management interventions on stress-related variables in people with mental disorders. Electronic databases were used during the literature search. Thirteen articles that fulfilled the preset eligible criteria were included in the review. Findings indicated that psychoeducation and relaxation-based interventions mitigated stress and depression; and enhanced relaxation intensity and knowledge on stress management. However, mixed results were obtained on anxiety. In addition, interventions using virtual reality technology revealed positive effects on depression, relaxation intensity and anxiety. Limitations and recommendations for future research are discussed.

Rapid antidepressant effects of repeated doses of ketamine compared with electroconvulsive therapy in hospitalized patients with major depressive disorder

Accumulating evidence suggests that N-methyl-d-aspartate receptor (NMDAR) antagonists (e.g. ketamine) may exert rapid antidepressant effects in MDD patients. In the present study, we evaluated the rapid antidepressant effects of ketamine compared with the electroconvulsive therapy (ECT) in hospitalized patients with MDD. In this blind, randomized study, 18 patients with DSM-IV MDD were divided into two groups which received either three intravenous infusions of ketamine hydrochloride (0.5 mg/kg over 45 min) or ECT on 3 test days (every 48 h). The primary outcome measure was the Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS), which was used to rate overall depressive symptoms at baseline, 24 h after each treatment, 72 h and one week after the last (third) ketamine or ECT. Within 24 h, depressive symptoms significantly improved in subjects receiving the first dose of ketamine compared with ECT group. Compared to baseline level, this improvement remained significant throughout the study. Depressive symptoms after the second dose ketamine was also lower than the second ECT. This study showed that ketamine is as effective as ECT in improving depressive symptoms in MDD patients and have more rapid antidepressant effects compared with the ECT.

Costs of the principal mood disorders: a study of comparative direct and indirect costs incurred by those with bipolar I, bipolar II and unipolar disorders

BACKGROUND

While there have been many studies comparing direct and indirect costs engendered individually and nationally by those with unipolar (UP) and bipolar (BP) disorders, there has been no previous study comparing costs across the bipolar I (BP I) and bipolar II (BP II) disorders.

METHODS

We examine direct and indirect costs attributable to a mood disorder in a sample of 44 BP I, 102 BP II and 279 UP patients attending a tertiary referral clinic, and with comparable illness durations of some 20 years and comparable treatment durations. We calculated direct and indirect costs incurred for their lifetime of illness based on relevant cost structures, in Australian dollars.

RESULTS

The mean lifetime indirect costs for BP I patients was $134,318, as against $76,821 for BP II and $68,347 for UP patients, joining with respective health care costs of $26,353, $17,580 and $27, 237, to generate total costs of $160,671/BP I patient, $94,401/BP II patient and $95,584/UP patient. BP I patients differentiated most distinctly in costs as a consequence of a higher prevalence of government benefits, time off work and longer periods in hospital. UP patients had more stable work histories than both BP sub-sets. BP II patients were less likely to be hospitalised than both the BP I and UP patients.

LIMITATIONS

Being drawn from a tertiary referral clinic, the study sample is not necessarily representative, with this nuance potentially having influenced cost differences between groups.

CONCLUSIONS

This is the first cost of illness study directly comparing BP I and BP II patients (and with an additional comparison group of UP patients). Findings indicate that BP I illness generates more direct and indirect costs than BP II illness, while the latter was generally comparable with UP depression in terms of the lifetime cost.

Cognitive impairment and its associations with the path of illness in affective disorders: a comparison between patients with bipolar and unipolar depression in remission

The goals of this study were to investigate differences in neurocognitive performance between groups of patients with unipolar major depressive disorder (MDD) or bipolar I disorder (BD-I) in a euthymic state, and to analyze associations among cognitive performance, sociodemographic and clinical variables, and global functioning. The study evaluated 25 outpatients with MDD and 25 outpatients with BD-I. Controls consisted of a sample of 29 healthy adult volunteers. All of the subjects were administered a battery of neuropsychological tests (Babcock Story Recall Test, Wisconsin Card Sorting Test, Trail Making Test Part B, Stroop Color and Word Test, Symbol- Number Association Test, and Digit Span). Patients demonstrated reduced performance on tasks involving executive functions (Trail Making Test Part B and Wisconsin Card Sorting Test) and attention (Digit Span and Symbol-Number Association Test) compared with healthy controls. Performance on neurocognitive tasks did not differentiate patients with MDD from those with BD-I. Improved performance on tasks that assessed executive functions by patients with BDI and MDD, considered as a single group, was associated with better global functioning, even when controlling for several sociodemographic and clinical confounders. Patients with MDD and BD-I showed a similar profile of information-processing deficits and similar global functioning. Global functioning was also moderately associated with performance on executive function tasks.

The efficacy and cost effectiveness of integrative medicine: a review of the medical and corporate literature

Data supporting the efficacy and cost effectiveness of an integrative approach to healthcare comes from three sources: medical research conducted at universities, studies carried out by corporations developing employee wellness programs, and pilot projects run by insurance companies. The integrative approaches being studied place the patient at the center of the care and address the full range of physical, emotional, mental, social, spiritual, and environmental influences that affect a person's health. Most importantly, they promote prevention by engaging the whole person in the attainment of a personalized lifestyle that supports health. A review of the medical, corporate, and payer literature reveals that, to start, immediate and significant health benefits and cost savings could be realized throughout our healthcare system by utilizing three integrative strategies: (1) integrative lifestyle change programs for those with chronic disease, (2) integrative interventions for people experiencing depression, and (3) integrative preventive strategies to support wellness in all populations.