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Loesken C, Maehder K, Buck L, Hartl J, Löwe B, Schramm C, Toussaint A. Understanding illness experiences of patients with primary sclerosing cholangitis: a qualitative analysis within the SOMA.LIV study. BMC Gastroenterol 2023; 23:12. [PMID: 36635643 PMCID: PMC9838018 DOI: 10.1186/s12876-023-02645-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/09/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Primary sclerosing cholangitis (PSC) is a rare cholestatic liver disease with a largely unpredictable course. Due to limited treatment options, individuals may for many years suffer from distressing symptoms and the emotional burden of an uncertain future. The need to shift from cure to care of PSC has spurred an interest into patients' health-related quality of life. Qualitative research in this context remains scarce. Hence, this study aimed to enrich the clinical understanding about the lived experience of PSC through a qualitative approach. METHODS A total of 20 patients with PSC were recruited at a specialist centre for autoimmune liver disease in Germany and engaged in semi-structured telephone-based interviews between March and June 2022. Verbatim transcripts were interpreted using inductive thematic analysis. RESULTS An overarching concept of 'a wave-like experience' was formulated to illustrate the dual and shifting nature of living with PSC. Reflecting upon this central idea, three major themes were generated to address important aspects of participants' illness experiences: 'Invisible presence' focused on perceptions of suffering from a seemingly hidden illness that periodically reveals itself through specific trigger events. 'Embracing the threat' captured the psycho-emotional response shift to this chronic disease from a predominantly negative to a coping-oriented pattern with regular setbacks. 'Between control and constraints' uncovered restrictions that PSC enforces onto patients' lives and their desire for controllability. CONCLUSIONS The present study provides an in-depth look at the fluctuating tensions arising from a life with PSC. Insights on perceived invisibility, disease-related triggers of emotional distress and the complexity behind self-management highlight opportunities for enhanced clinical support of this patient group.
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Affiliation(s)
- Caroline Loesken
- grid.13648.380000 0001 2180 3484Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kerstin Maehder
- grid.13648.380000 0001 2180 3484Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Laura Buck
- grid.13648.380000 0001 2180 3484Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Hartl
- grid.13648.380000 0001 2180 34841st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany ,Hamburg Center for Translational Immunology (HCTI), Hamburg, Germany
| | - Bernd Löwe
- grid.13648.380000 0001 2180 3484Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Schramm
- grid.13648.380000 0001 2180 34841st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany ,grid.13648.380000 0001 2180 3484Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany ,Hamburg Center for Translational Immunology (HCTI), Hamburg, Germany
| | - Anne Toussaint
- grid.13648.380000 0001 2180 3484Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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2
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Implementing collaborative care for major depression in a cancer center: An observational study using mixed-methods. Gen Hosp Psychiatry 2022; 76:3-15. [PMID: 35305403 DOI: 10.1016/j.genhosppsych.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/16/2022] [Accepted: 03/03/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe the implementation of a collaborative care (CC) screening and treatment program for major depression in people with cancer, found to be effective in clinical trials, into routine outpatient care of a cancer center. METHOD A mixed-methods observational study guided by the RE-AIM implementation framework using quantitative and qualitative data collected over five years. RESULTS Program set-up took three years and required more involvement of CC experts than anticipated. Barriers to implementation were uncertainty about whether oncology or psychiatry owned the program and the hospital's organizational complexity. Selecting and training CC team members was a major task. 90% (14,412/16,074) of patients participated in depression screening and 61% (136/224) of those offered treatment attended at least one session. Depression outcomes were similar to trial benchmarks (61%; 78/127 patients had a treatment response). After two years the program obtained long-term funding. Facilitators of implementation were strong trial evidence, effective integration into cancer care and ongoing clinical and managerial support. CONCLUSION A CC program for major depression, designed for the cancer setting, can be successfully implemented into routine care, but requires time, persistence and involvement of CC experts. Once operating it can be an effective and valued component of medical care.
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3
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Yates R, Anderson PJ, Lee KJ, Doyle LW, Cheong JLY, Pace CC, Spittle AJ, Spencer-Smith M, Treyvaud K. Maternal Mental Health Disorders Following Very Preterm Birth at 5 Years Post-Birth. J Pediatr Psychol 2021; 47:327-336. [PMID: 34664642 DOI: 10.1093/jpepsy/jsab101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Mothers of children born very preterm (VP) are at increased risk of developing postnatal depression, anxiety, and post-traumatic stress symptoms. However, mental health disorder rates are rarely assessed in this population compared with full-term peers, and it is unclear if postnatal distress symptoms precede higher rates of maternal mental health disorders at 5 years post-birth in both birth groups. METHODS Mothers of children born VP (n = 65; mean [SD] age at birth, 33.9 [5.0]; 72.1% tertiary educated) and full-term (n = 90; mean [SD] age at birth, 33.4 [4.0]; 88.2% tertiary educated) completed questionnaires assessing symptoms of depression, anxiety, and trauma within 4 weeks of birth. At 5 years post-birth, they participated in a structured diagnostic interview assessing mood, anxiety, and trauma-related mental health disorders, both current and over the lifetime. RESULTS There was little evidence for differences between mothers in the VP and full-term groups in rates of any mental health disorder at 5 years (VP = 14%, full-term = 14%) or lifetime (VP = 41%, full-term = 37%). In mothers of children born VP, elevated postnatal post-traumatic stress symptoms were associated with higher rates of mental health disorders at 5 years (odds ratio = 21.5, 95% confidence interval = 1.35-342). CONCLUSIONS Findings suggest that preterm birth may not lead to increased odds of later developing maternal mental health disorders, despite known risks of elevated postnatal distress following a VP birth. However, those with post-traumatic stress symptoms following a VP birth could be more vulnerable, and assessment and monitoring is recommended.
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Affiliation(s)
- Rosemary Yates
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Vic, Australia.,Murdoch Children's Research Institute, Parkville, Vic, Australia
| | - Peter J Anderson
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Vic, Australia.,Murdoch Children's Research Institute, Parkville, Vic, Australia
| | - Katherine J Lee
- Murdoch Children's Research Institute, Parkville, Vic, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Vic, Australia
| | - Lex W Doyle
- Murdoch Children's Research Institute, Parkville, Vic, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Vic, Australia.,Neonatal Services, Royal Women's Hospital, Parkville, Vic, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Vic, Australia
| | - Jeanie L Y Cheong
- Murdoch Children's Research Institute, Parkville, Vic, Australia.,Neonatal Services, Royal Women's Hospital, Parkville, Vic, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Vic, Australia
| | - Carmen C Pace
- Murdoch Children's Research Institute, Parkville, Vic, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Vic, Australia.,Department of Adolescent Medicine, Royal Children's Hospital, Parkville, Vic, Australia.,Mental Health, Royal Children's Hospital, Parkville, Vic, Australia
| | - Alicia J Spittle
- Murdoch Children's Research Institute, Parkville, Vic, Australia.,Neonatal Services, Royal Women's Hospital, Parkville, Vic, Australia.,Department of Physiotherapy, University of Melbourne, Parkville, Vic, Australia
| | - Megan Spencer-Smith
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Vic, Australia.,Murdoch Children's Research Institute, Parkville, Vic, Australia
| | - Karli Treyvaud
- Murdoch Children's Research Institute, Parkville, Vic, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Vic, Australia.,Neonatal Services, Royal Women's Hospital, Parkville, Vic, Australia.,Department of Psychology and Counselling, La Trobe University, Bundoora, Vic, Australia
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The Challenges of Predicting Suicidal Thoughts and Behaviours in a Sample of Rural Australians with Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15050928. [PMID: 29735902 PMCID: PMC5981967 DOI: 10.3390/ijerph15050928] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/03/2018] [Accepted: 05/03/2018] [Indexed: 11/16/2022]
Abstract
Suicide is a leading cause of death, particularly in rural and remote areas. Although depression is strongly related to both suicidal ideation and attempt, it lacks specificity as a predictor, and little is known about characteristics that increase suicide risk among people with depression. A telephone version of the World Mental Health Composite International Diagnostic Interview explored lifetime depression, suicidal ideation, suicide attempt, and related factors among a community-dwelling sample of rural and remote Australians, selected for an interview based on a screener for psychological distress (100% of those with high distress, 75% of those with moderate distress, and 16% of those with low distress). Of 1051 participants interviewed, 364 reported lifetime symptoms of depression; of these, 48% reported lifetime suicidal ideation and 16% reported a lifetime suicide attempt. While depression severity was a significant correlate of suicidality for both males and females, suicide attempt was significantly more common among females with a younger age of depression onset, and a higher number of psychiatric comorbidities. No additional factors were significant for males. Among rural and remote residents with lifetime symptoms of depression, the identification of suicide risk may be enhanced by considering individual and contextual factors beyond depression severity. Further research focusing on risk factors for males would be beneficial.
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Zarski AC, Berking M, Reis D, Lehr D, Buntrock C, Schwarzer R, Ebert DD. Turning Good Intentions Into Actions by Using the Health Action Process Approach to Predict Adherence to Internet-Based Depression Prevention: Secondary Analysis of a Randomized Controlled Trial. J Med Internet Res 2018; 20:e9. [PMID: 29326097 PMCID: PMC5785685 DOI: 10.2196/jmir.8814] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 09/27/2017] [Accepted: 09/28/2017] [Indexed: 01/08/2023] Open
Abstract
Background Many individuals engaging in Internet-based interventions fail to complete these treatments as intended. The processes responsible for treatment adherence in Internet-based interventions are still poorly understood. Objective The aim of this study was to investigate to what extent adherence in an Internet-based intervention can be predicted by motivational and volitional factors outlined in the health action process approach (HAPA). Methods This study investigated motivational and volitional factors included in HAPA in a randomized controlled trial to predict treatment adherence of N=101 individuals with subclinical depression in the intervention group of a depression prevention intervention (GET.ON Mood Enhancer). Adherence was operationalized as the number of completed treatment modules. Using longitudinal structural equation modeling, HAPA variables (motivational, maintenance, and recovery self-efficacy, outcome expectancies, intention, and planning) were assessed at baseline and their associations with adherence 7 weeks later. Results Planning predicted adherence. Better planning was, in turn, associated with higher levels of maintenance self-efficacy, and the latter significantly affected treatment adherence via planning. The other hypothesized direct associations were not significant. In total, the HAPA variables accounted for 14% of variance in treatment adherence. Conclusions Planning emerged as the strongest predictor of treatment adherence in highly motivated participants in an Internet-based intervention out of all HAPA variables investigated. Findings are in line with the hypothesis that planning facilitates the translation of good intentions into actions. The findings imply that systematically fostering planning skills and maintenance self-efficacy prior to or during Internet-based interventions would help participants to successfully complete these treatments. Trial Registration German Clinical Trials Register DRKS00005973; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00005973 (Archived by WebCite at http://www.webcitation.org/6uxCy64sy).
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Affiliation(s)
- Anna-Carlotta Zarski
- Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.,Leuphana University Lüneburg, Lüneburg, Germany
| | - Matthias Berking
- Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Dirk Lehr
- Leuphana University Lüneburg, Lüneburg, Germany
| | - Claudia Buntrock
- Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Ralf Schwarzer
- SWPS University of Social Sciences and Humanities, Warszawa, Poland
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Abstract
Avoidable disability associated with depression, anxiety, and impaired cognition among older adults is pervasive. Incentives for detection of mental disorders in late life include increased reimbursement, reduced cost, and less burden for patients and families. However, screening not aligned with diagnosis, intervention, and outcome assessment has questionable utility. The link between screening, treatment, and outcomes is well established for depression, less so for anxiety and impaired cognition. This article details the use of common instruments to screen and assess depression, anxiety, and cognitive impairment.
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Affiliation(s)
- Gary J Kennedy
- Division of Geriatric Psychiatry, Department of Psychiatry and Behavioral Science, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA.
| | - Mirnova E Ceïde
- Division of Geriatric Psychiatry, Department of Psychiatry and Behavioral Science, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA; Division of Geriatric Medicine, Department of Psychiatry and Behavioral Science, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA; Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
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7
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The epidemiology of current depression in Macau, China: towards a plan for mental health action. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1227-1235. [PMID: 28664241 DOI: 10.1007/s00127-017-1415-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/25/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Macau is a Special Administrative Region in China that has experienced tremendous development in its gambling industry during its post-colonial years. To inform mental health planning, this study presents the first population estimates and correlates of the current depression in Macau. METHODS A population-representative sample of 1068 Macau Chinese citizens aged 18 or above responded to a household telephone survey in January, 2015. The Patient Health Questionnaire-9 measured the current depression. Logistic regression models assessed the association between depression and potential correlates. RESULTS Overall, 8.0% (95% CI 6.3-9.7) of persons reported the current depression. A higher but non-significant proportion of women reported depression than men (9.3 vs. 6.6%) and older women reported higher prevalence (13.4%) than other demographic groups. Persons who were unemployed (OR = 4.9, 2.3-10.5), separated or divorced (OR = 3.1, 1.1-8.9), and reported poor self-rated health (OR = 5.0, 2.8-9.0), low quality of life (OR = 6.2, 3.1-12.7), lower social standing (OR = 2.4, 1.4-4.0), lower community trust (OR = 1.9, 1.2-3.1), lower perceived fairness (OR = 2.3, 1.4-3.8), lower social cohesion (OR = 3.8, 2.3-6.2), and lower social integration (OR = 3.0, 1.9-5.0) had greater odds of depression than their comparison group. CONCLUSIONS The current study demonstrated the burden of depression among Macau adults disproportionately affects women during emerging adolescence and old age, and men during middle adulthood. Key strategies to improve mental health services in Macau are discussed.
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Wozney L, Olthuis J, Lingley-Pottie P, McGrath PJ, Chaplin W, Elgar F, Cheney B, Huguet A, Turner K, Kennedy J. Strongest Families™ Managing Our Mood (MOM): a randomized controlled trial of a distance intervention for women with postpartum depression. Arch Womens Ment Health 2017; 20:525-537. [PMID: 28593360 DOI: 10.1007/s00737-017-0732-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 05/12/2017] [Indexed: 12/18/2022]
Abstract
The present study investigated whether a distance-delivered intervention could significantly decrease mild to moderate postpartum depression (PPD) in mothers as compared to usual care. Mothers with PPD (n = 62) were randomly assigned to the intervention or standard community care. Participants receiving the intervention followed a 12-session cognitive behavioural informed handbook supplemented with telephone-based coaching support. Diagnostic status and depressive symptoms were assessed at baseline and 3, 6 and 12 months postrandomization. Odds ratios indicated that intervention group participants were 1.5 times as likely to experience diagnostic remission at 3 months (mid-intervention) (p = 0.742), 1.54 times as likely at 6 months (p = 0.696) and 12.5 times as likely at 12 months (p = 0.009). Intervention 'dosage' significantly moderated this effect; for every additional coaching session completed, individuals had a 1.4 times greater chance of showing improvement at 3 and 6 months. Mothers reported high satisfaction with the intervention. Findings suggest positive outcomes at each time point and superior outcomes to the control condition at the long-term follow-up. Caution in interpreting these results is warranted due to small sample size and incomplete data; however, they support further investigation into the use of distance interventions as an accessible and effective solution for women with PPD.
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Affiliation(s)
- Lori Wozney
- Centre for Research in Family Health, 5850-5980 University Avenue, Halifax, NS, B3K 6R8, Canada. .,IWK Health Centre, 5850-5980 University Avenue, Halifax, NS, B3K 6R8, Canada.
| | - Janine Olthuis
- University of New Brunswick, PO Box 4400, Fredericton, NB, E3B 5A3, Canada
| | - Patricia Lingley-Pottie
- Centre for Research in Family Health, 5850-5980 University Avenue, Halifax, NS, B3K 6R8, Canada.,IWK Health Centre, 5850-5980 University Avenue, Halifax, NS, B3K 6R8, Canada.,Dalhousie University, 6299 South Street, Halifax, NS, B3H 3J5, Canada.,Strongest Families Institute, 267 Cobequid Road, Lower Sackville, NS, B4C 4E8, Canada
| | - Patrick J McGrath
- Centre for Research in Family Health, 5850-5980 University Avenue, Halifax, NS, B3K 6R8, Canada.,IWK Health Centre, 5850-5980 University Avenue, Halifax, NS, B3K 6R8, Canada.,Dalhousie University, 6299 South Street, Halifax, NS, B3H 3J5, Canada.,Strongest Families Institute, 267 Cobequid Road, Lower Sackville, NS, B4C 4E8, Canada
| | - William Chaplin
- Department of Psychology, St. John's University, Jamaica, Queens, NY, 11439, USA
| | - Frank Elgar
- McGill University, 1130 Pine Avenue West, Montreal, QC, H3A1A3, Canada
| | - Brianna Cheney
- Department of Psychology, St. John's University, Jamaica, Queens, NY, 11439, USA
| | - Anna Huguet
- Centre for Research in Family Health, 5850-5980 University Avenue, Halifax, NS, B3K 6R8, Canada.,IWK Health Centre, 5850-5980 University Avenue, Halifax, NS, B3K 6R8, Canada.,Dalhousie University, 6299 South Street, Halifax, NS, B3H 3J5, Canada
| | - Karen Turner
- Centre for Research in Family Health, 5850-5980 University Avenue, Halifax, NS, B3K 6R8, Canada
| | - Jillian Kennedy
- Strongest Families Institute, 267 Cobequid Road, Lower Sackville, NS, B4C 4E8, Canada
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Wanat M, Walker J, Burke K, Sevdalis N, Richardson A, Mulick A, Frost C, Sharpe M. Linked symptom monitoring and depression treatment programmes for specialist cancer services: protocol for a mixed-methods implementation study. BMJ Open 2017; 7:e016186. [PMID: 28674143 PMCID: PMC5734371 DOI: 10.1136/bmjopen-2017-016186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION There is growing awareness that cancer services need to address patients' well-being as well as treating their cancer. We developed systematic approaches to (1) monitoring patients' symptoms including depression using a 'Symptom Monitoring Service' and (2) providing treatment for those with major depression using a programme called 'Depression Care for People with Cancer'. Used together, these two programmes were found to be highly effective and cost-effective in clinical trials. The overall aims of this project are to: (1) study the process of introducing these programmes into routine clinical care in a large cancer service, (2) identify the challenges associated with implementation and how these are overcome, (3) determine their effectiveness in a routine non-research setting and (4) describe patients' and clinicians' experience of the programmes. METHODS AND ANALYSIS This is a mixed-methods longitudinal implementation study. We will study the process of implementation in three phases (April 2016-December 2018): 'Pre-implementation' (setting up of the new programmes), 'Early Implementation' (implementation of the programmes in a small number of clinics) and 'Implementation and Maintenance' (implementation in the majority of clinics). We will use the following methods of data collection: (1) contemporaneous logs of the implementation process, (2) interviews with healthcare professionals and managers, (3) interviews with patients and (4) routinely collected clinical data. ETHICS AND DISSEMINATION The study has been reviewed by a joint committee of Oxford University Hospitals National Health Service Foundation Trust Research and Development Department and the University of Oxford's Clinical Trials and Research Governance Department and judged to be service evaluation, not requiring ethics committee approval. The findings of this study will guide the scaling up implementation of the programmes across the UK and will enable us to construct an implementation toolkit. We will disseminate our findings in publications and at relevant national and international conferences.
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Affiliation(s)
- Marta Wanat
- Department of Psychiatry, Psychological Medicine Research, University of Oxford, Warneford Hospital, Oxford, UK
| | - Jane Walker
- Department of Psychiatry, Psychological Medicine Research, University of Oxford, Warneford Hospital, Oxford, UK
| | - Katy Burke
- Department of Psychiatry, Psychological Medicine Research, University of Oxford, Warneford Hospital, Oxford, UK
| | - Nick Sevdalis
- Centre for Implementation Science, King’s College London, London, UK
| | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Amy Mulick
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Chris Frost
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Sharpe
- Department of Psychiatry, Psychological Medicine Research, University of Oxford, Warneford Hospital, Oxford, UK
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10
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Sander L, Paganini S, Lin J, Schlicker S, Ebert DD, Buntrock C, Baumeister H. Effectiveness and cost-effectiveness of a guided Internet- and mobile-based intervention for the indicated prevention of major depression in patients with chronic back pain-study protocol of the PROD-BP multicenter pragmatic RCT. BMC Psychiatry 2017; 17:36. [PMID: 28109247 PMCID: PMC5251328 DOI: 10.1186/s12888-017-1193-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 01/02/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Reducing the disease burden of major depressive disorder (MDD) is of major public health relevance. The prevention of depression is regarded as one possible approach to reach this goal. People with multiple risk factors for MDD such as chronic back pain and subthreshold depressive symptoms may benefit most from preventive measures. The Internet as intervention setting allows for scaling up preventive interventions on a public mental health level. METHODS This study is a multicenter pragmatic randomized controlled trial (RCT) of parallel design aiming to investigate the (cost-) effectiveness of an Internet- and mobile-based intervention (IMI) for the prevention of depression in chronic back pain patients (PROD-BP) with subthreshold depressive symptoms. eSano BackCare-DP is a guided, chronic back pain-specific depression prevention intervention based on cognitive behavioral therapy (CBT) principles comprising six weekly plus three optional modules and two booster sessions after completion of the intervention. Trained psychologists provide guidance by sending feedback messages after each module. A total of 406 patients with chronic back pain and without a depressive disorder at baseline will be recruited following orthopedic rehabilitation care and allocated to either intervention or treatment-as-usual (TAU). Primary patient-relevant endpoint of the trial is the time to onset of MDD measured by the telephone-administered Structured Clinical Interview for DSM (SCID) at baseline and 1-year post-randomization. Key secondary outcomes are health-related quality of life, depression severity, pain intensity, pain-related disability, ability to work, intervention satisfaction and adherence as well as side effects of the intervention. Online assessments take place at baseline and 9 weeks as well as 6 and 12 months post-randomization. Cox regression survival analysis will be conducted to estimate hazard ratio at 12-month follow-up. Moreover, an economic analysis will be conducted from a societal and public health perspective. DISCUSSION This is the first study examining an IMI for depression prevention in a sample of chronic pain patients. If this implementation of a depression prevention IMI into orthopedic aftercare proves effective, the intervention could be integrated into routine care with minimal costs and extended for use with other chronic diseases. Results will have implications for researchers, health care providers and public health policy makers. TRIAL REGISTRATION The trial is registered at the WHO International Clinical Trials Registry Platform via the German Clinical Studies Trial Register (DRKS): DRKS00007960 . Registered 12 August 2015.
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Affiliation(s)
- L. Sander
- grid.5963.9Institute of Psychology, Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, Engelbergerstr. 41, D-79085 Freiburg, Germany ,grid.5963.9Medical Faculty, Medical Psychology and Medical Sociology, University of Freiburg, Hebelstraße 29, Freiburg, 79104 Germany
| | - S. Paganini
- grid.5963.9Institute of Psychology, Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, Engelbergerstr. 41, D-79085 Freiburg, Germany
| | - J. Lin
- grid.5963.9Institute of Psychology, Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, Engelbergerstr. 41, D-79085 Freiburg, Germany
| | - S. Schlicker
- 0000 0001 2107 3311grid.5330.5Institute of Psychology, Department of Clinical Psychology and Psychotherapy, University of Erlangen-Nürnberg, Nägelsbachstr. 25a, D- 91052 Erlangen, Germany
| | - D. D. Ebert
- 0000 0001 2107 3311grid.5330.5Institute of Psychology, Department of Clinical Psychology and Psychotherapy, University of Erlangen-Nürnberg, Nägelsbachstr. 25a, D- 91052 Erlangen, Germany
| | - C. Buntrock
- 0000 0001 2107 3311grid.5330.5Institute of Psychology, Department of Clinical Psychology and Psychotherapy, University of Erlangen-Nürnberg, Nägelsbachstr. 25a, D- 91052 Erlangen, Germany
| | - H. Baumeister
- 0000 0004 1936 9748grid.6582.9Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, University of Ulm, Albert-Einstein-Allee 47, D-89069 Ulm, Germany
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11
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Walker J, Wanat M, Fielding J, Martin P, Petit A, Burke K, Sharpe M. Screening Medical Patients for Depression: Lessons From a National Program in Cancer Clinics. PSYCHOSOMATICS 2017; 58:274-280. [PMID: 28336194 DOI: 10.1016/j.psym.2017.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Screening has been recommended to improve the identification of depression in medical patients. There is, therefore, a need for useful practical information on how to successfully implement large-scale depression screening in medical clinics. OBJECTIVE To describe the practical lessons learned from our experience of implementing a large-scale depression screening program in cancer clinics throughout Scotland, UK. METHOD Reflective review based on the experience of the screening team and records of the iterative development of the program. FINDINGS Systematic screening for depression in patients with medical illnesses can be delivered in clinics as long as the program is well designed. Design issues include ensuring the engagement of staff and patients, implementing efficient 2-stage screening processes and effectively managing workflow and quality assurance. DISCUSSION Screening has the potential to offer a solution to the well-documented problem of missed depression and other psychiatric diagnoses, thereby improving patient care if closely linked to treatment provision.
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Affiliation(s)
- Jane Walker
- Psychological Medicine Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Marta Wanat
- Psychological Medicine Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Josephine Fielding
- Psychological Medicine Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Paul Martin
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Ariane Petit
- Psychological Medicine Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Katy Burke
- Psychological Medicine Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Michael Sharpe
- Psychological Medicine Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
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Buntrock C, Berking M, Smit F, Lehr D, Nobis S, Riper H, Cuijpers P, Ebert D. Preventing Depression in Adults With Subthreshold Depression: Health-Economic Evaluation Alongside a Pragmatic Randomized Controlled Trial of a Web-Based Intervention. J Med Internet Res 2017; 19:e5. [PMID: 28052841 PMCID: PMC5244034 DOI: 10.2196/jmir.6587] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/24/2016] [Accepted: 12/13/2016] [Indexed: 11/16/2022] Open
Abstract
Background Psychological interventions for the prevention of depression might be a cost-effective way to reduce the burden associated with depressive disorders. Objective To evaluate the cost-effectiveness of a Web-based guided self-help intervention to prevent major depressive disorder (MDD) in people with subthreshold depression (sD). Methods A pragmatic randomized controlled trial was conducted with follow-up at 12 months. Participants were recruited from the general population via a large statutory health insurance company and an open access website. Participants were randomized to a Web-based guided self-help intervention (ie, cognitive-behavioral therapy and problem-solving therapy assisted by supervised graduate students or health care professionals) in addition to usual care or to usual care supplemented with Web-based psycho-education (enhanced usual care). Depression-free years (DFYs) were assessed by blinded diagnostic raters using the telephone-administered Structured Clinical Interview for DSM-IV Axis Disorders at 6- and 12-month follow-up, covering the period to the previous assessment. Costs were self-assessed through a questionnaire. Costs measured from a societal and health care perspective were related to DFYs and quality-adjusted life years (QALYs). Results In total, 406 participants were enrolled in the trial. The mean treatment duration was 5.84 (SD 4.37) weeks. On average, participants completed 4.93 of 6 sessions. Significantly more DFYs were gained in the intervention group (0.82 vs 0.70). Likewise, QALY health gains were in favor of the intervention, but only statistically significant when measured with the more sensitive SF-6D. The incremental per-participant costs were €136 (£116). Taking the health care perspective and assuming a willingness-to-pay of €20,000 (£17,000), the intervention’s likelihood of being cost-effective was 99% for gaining a DFY and 64% or 99% for gaining an EQ-5D or a SF-6D QALY. Conclusions Our study supports guidelines recommending Web-based treatment for sD and adds that this not only restores health in people with sD, but additionally reduces the risk of developing a MDD. Offering the intervention has an acceptable likelihood of being more cost-effective than enhanced usual care and could therefore reach community members on a wider scale. Trial registration German Clinical Trials Register: DRKS00004709; http://www.drks.de/DRKS00004709 (Archived by WebCite at http://www.webcitation.org/6kAZVUxy9)
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Affiliation(s)
- Claudia Buntrock
- Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany.,EMGO+ Institute for Health and Care Research, Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, Amsterdam, Netherlands.,Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias Berking
- Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany.,Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Filip Smit
- EMGO+ Institute for Health and Care Research, Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, Amsterdam, Netherlands.,Trimbos Institute, Centre of Health-Economic Evaluation, Utrecht, Netherlands.,EMGO+ Institute for Health and Care Research, Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, Netherlands
| | - Dirk Lehr
- Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany
| | - Stephanie Nobis
- Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany.,Department for Gerontology, University of Vechta, Vechta, Germany
| | - Heleen Riper
- Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany.,EMGO+ Institute for Health and Care Research, Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, Amsterdam, Netherlands.,Institute of Telepsychiatry, University of Southern Denmark, Odense, Denmark
| | - Pim Cuijpers
- Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany.,EMGO+ Institute for Health and Care Research, Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, Amsterdam, Netherlands
| | - David Ebert
- Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany.,Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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13
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Le Grande MR, Murphy BM, Higgins RO, Worcester MUC, Parkinson A, Brown SL, Elliott PC, Goble AJ. Physical activity and negative emotional response after percutaneous coronary intervention. ACTA ACUST UNITED AC 2016; 13:254-60. [PMID: 16575281 DOI: 10.1097/01.hjr.0000189808.22224.b0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aims of this study were to investigate the association between negative emotional response (NER) and physical activity levels in percutaneous coronary intervention (PCI) patients, and to examine the extent to which physical activity levels were influenced by factors such as the patients' age, sex, and attendance at a cardiac rehabilitation (CR) programme. METHODS A consecutive series of 200 PCI patients [mean age 59.0 (+/-10.1) years] completed telephone interviews 2 weeks and 6 months after their procedure. NER was assessed using 12 items addressing patients' perceptions and concerns regarding symptoms, diagnosis and prognosis. Physical activity was assessed by asking four questions relating to the frequency and duration of walking and of moderate activity. CR attendance, medical history and sociodemographic data were also collected. Hierarchical linear regression was used to assess the association between NER and physical activity over time. RESULTS After controlling for baseline levels of moderate activity and other covariates, NER significantly predicted change in moderate activity over 6 months. Only baseline walking levels predicted the duration and frequency of walking at 6 months. CONCLUSION NER can be considered an inhibitive factor towards increased moderate activity uptake after PCI. Walking after PCI does not appear to be affected by NER. These findings highlight the need to focus on improving the emotional aspects of patients' recovery.
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14
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Prisnie JC, Fiest KM, Coutts SB, Patten SB, Atta CA, Blaikie L, Bulloch AG, Demchuk A, Hill MD, Smith EE, Jetté N. Validating screening tools for depression in stroke and transient ischemic attack patients. Int J Psychiatry Med 2016; 51:262-77. [PMID: 27284119 DOI: 10.1177/0091217416652616] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The best screening questionnaires for detecting post-stroke depression have not been identified. We aimed to validate four commonly used depression screening tools in stroke and transient ischemic attack patients. METHODS Consecutive stroke and transient ischemic attack patients visiting an outpatient stroke clinic in Calgary, Alberta (Canada) completed a demographic questionnaire and four depression screening tools: Patient Health Questionnaire (PHQ)-9, PHQ-2, Hospital Anxiety and Depression Scale (HADS-D), and Geriatric Depression Scale (GDS-15). Participants then completed the Structured Clinical Interview for DSM-IV (SCID), the gold-standard for diagnosing major depression. The questionnaires were validated against the SCID and sensitivity and specificity were calculated at various cut-points. Optimal cut-points for each questionnaire were determined using receiver-operating curve analyses. RESULTS Among 122 participants, 59.5% were diagnosed with stroke and 40.5% with transient ischemic attack. The point prevalence of SCID-diagnosed current major depression was 9.8%. At the optimal cut-points, the sensitivity and specificity for each screening tool were as follows: PHQ-9 (sensitivity: 81.8%, specificity: 97.1%), PHQ-2 (sensitivity: 75.0%, specificity: 96.3%), HADS-D (sensitivity: 63.6%, specificity: 98.1%), and GDS-15 (sensitivity: 45.5%, specificity: 84.8%). Areas under the receiver operating characteristic curves were as follows: PHQ-9 86.6%, PHQ-2 86.7%, HADS-D 85.9%, and GDS-15 66.3%. CONCLUSIONS The PHQ-2 and PHQ-9 are both suitable depression screening tools, taking less than 5 minutes to complete. The HADS-D does not appear to have any advantage over the PHQ-based scales, even though it was designed specifically for medically ill populations. The GDS-15 cannot be recommended for general use in a stroke clinic based on this study as it had worse discrimination due to low sensitivity.
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Affiliation(s)
- Joey C Prisnie
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Canada
| | - Kirsten M Fiest
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Canada Department of Critical Care Medicine, University of Calgary, Canada
| | - Shelagh B Coutts
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Canada Department of Medicine, Department of Radiology, University of Calgary, Canada
| | - Scott B Patten
- Department of Psychiatry and Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Canada Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Canada
| | - Callie Am Atta
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Canada
| | - Laura Blaikie
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Canada
| | - Andrew Gm Bulloch
- Department of Psychiatry and Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Canada Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Canada
| | - Andrew Demchuk
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Canada Department of Medicine, Department of Radiology, University of Calgary, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Canada Department of Medicine, Department of Radiology, University of Calgary, Canada Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Canada
| | - Eric E Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Canada Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Canada
| | - Nathalie Jetté
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Canada Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Canada
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15
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Fiest KM, Patten SB, Wiebe S, Bulloch AG, Maxwell CJ, Jetté N. Validating screening tools for depression in epilepsy. Epilepsia 2014; 55:1642-50. [DOI: 10.1111/epi.12754] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2014] [Indexed: 01/02/2023]
Affiliation(s)
- Kirsten M. Fiest
- Department of Community Health Sciences; Institute for Public Health; University of Calgary; Calgary Alberta Canada
- Department of Psychiatry; Mathison Centre for Mental Health Research & Education; University of Calgary; Calgary Alberta Canada
- Department of Clinical Neurosciences; Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
| | - Scott B. Patten
- Department of Community Health Sciences; Institute for Public Health; University of Calgary; Calgary Alberta Canada
- Department of Psychiatry; Mathison Centre for Mental Health Research & Education; University of Calgary; Calgary Alberta Canada
| | - Samuel Wiebe
- Department of Community Health Sciences; Institute for Public Health; University of Calgary; Calgary Alberta Canada
- Department of Clinical Neurosciences; Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
| | - Andrew G.M. Bulloch
- Department of Community Health Sciences; Institute for Public Health; University of Calgary; Calgary Alberta Canada
- Department of Psychiatry; Mathison Centre for Mental Health Research & Education; University of Calgary; Calgary Alberta Canada
| | - Colleen J. Maxwell
- Department of Community Health Sciences; Institute for Public Health; University of Calgary; Calgary Alberta Canada
- School of Public Health and Health Systems; University of Waterloo; Waterloo Ontario Canada
- School of Pharmacy; University of Waterloo; Waterloo Ontario Canada
| | - Nathalie Jetté
- Department of Community Health Sciences; Institute for Public Health; University of Calgary; Calgary Alberta Canada
- Department of Clinical Neurosciences; Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
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16
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Buntrock C, Ebert DD, Lehr D, Cuijpers P, Riper H, Smit F, Berking M. Evaluating the efficacy and cost-effectiveness of web-based indicated prevention of major depression: design of a randomised controlled trial. BMC Psychiatry 2014; 14:25. [PMID: 24485283 PMCID: PMC3914724 DOI: 10.1186/1471-244x-14-25] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 01/27/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) imposes a considerable disease burden on individuals and societies. Web-based interventions have shown to be effective in reducing depressive symptom severity. However, it is not known whether web-based interventions may also be effective in preventing the onset of MDD. The aim of this study is to evaluate the (cost-) effectiveness of an indicated web-based guided self-help intervention (GET.ON Mood Enhancer Prevention) on the onset of MDD. METHODS/DESIGN A randomised controlled trial (RCT) will be conducted to compare the (cost-) effectiveness of the GET.ON Mood Enhancer Prevention training with a control condition exclusively receiving online-based psychoeducation on depression. Adults with subthreshold depression (N = 406) will be recruited from the general population and randomised to one of the two conditions. The primary outcome is time to onset of MDD within a 12-months follow-up period. MDD will be assessed according to DSM-IV criteria as assessed by the telephone-administered Structured Clinical Interview for DSM-IV (SCID). Time to onset of MDD will be assessed using life charts. Secondary outcomes include changes on various indicators of depressive symptom severity, anxiety and quality of life from baseline to post-treatment, to a 6-month and a 12-month follow up. Additionally, an economic evaluation using a societal perspective will be conducted to examine the intervention's cost-effectiveness. DISCUSSION This is one of the first randomised controlled trials that examines the effect of an indicated guided self-help web-based intervention on the incidence of major depression. If shown to be effective, the intervention will contribute to reducing the disease burden due to MDD in the general population. TRIAL REGISTRATION German Clinical Trial Registration DRKS00004709.
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Affiliation(s)
- Claudia Buntrock
- Innovation Incubator, Division Health Training Online, Leuphana University, Lueneburg, Germany.
| | - David D Ebert
- Innovation Incubator, Division Health Training Online, Leuphana University, Lueneburg, Germany,Department of Psychology, Clinical Psychology and Psychotherapy, Philipps University Marburg, Marburg, Germany
| | - Dirk Lehr
- Innovation Incubator, Division Health Training Online, Leuphana University, Lueneburg, Germany
| | - Pim Cuijpers
- Innovation Incubator, Division Health Training Online, Leuphana University, Lueneburg, Germany,Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
| | - Heleen Riper
- Innovation Incubator, Division Health Training Online, Leuphana University, Lueneburg, Germany,GGZ inGeest, Regional Mental Health Service Centre, VU University Medical Centre, Amsterdam, The Netherlands,Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
| | - Filip Smit
- Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands,Department of Public Mental Health, Netherlands Institute of Mental Health and Addiction, Trimbos Institute, Utrecht, The Netherlands,Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Matthias Berking
- Innovation Incubator, Division Health Training Online, Leuphana University, Lueneburg, Germany,Department of Psychology, Clinical Psychology and Psychotherapy, Philipps University Marburg, Marburg, Germany
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17
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Joffres M, Jaramillo A, Dickinson J, Lewin G, Pottie K, Shaw E, Connor Gorber S, Tonelli M. Recommendations on screening for depression in adults. CMAJ 2013; 185:775-82. [PMID: 23670157 DOI: 10.1503/cmaj.130403] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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18
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Contributors to suicidality in rural communities: beyond the effects of depression. BMC Psychiatry 2012; 12:105. [PMID: 22873772 PMCID: PMC3477044 DOI: 10.1186/1471-244x-12-105] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 07/10/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rural populations experience a higher suicide rate than urban areas despite their comparable prevalence of depression. This suggests the identification of additional contributors is necessary to improve our understanding of suicide risk in rural regions. Investigating the independent contribution of depression, and the impact of co-existing psychiatric disorders, to suicidal ideation and suicide attempts in a rural community sample may provide clarification of the role of depression in rural suicidality. METHODS 618 participants in the Australian Rural Mental Health Study completed the Composite International Diagnostic Interview, providing assessment of lifetime suicidal ideation and attempts, affective disorders, anxiety disorders and substance-use disorders. Logistic regression analyses explored the independent contribution of depression and additional diagnoses to suicidality. A receiver operating characteristic (ROC) analysis was performed to illustrate the benefit of assessing secondary psychiatric diagnoses when determining suicide risk. RESULTS Diagnostic criteria for lifetime depressive disorder were met by 28% (174) of the sample; 25% (154) had a history of suicidal ideation. Overall, 41% (63) of participants with lifetime suicidal ideation and 34% (16) of participants with a lifetime suicide attempt had no history of depression. When lifetime depression was controlled for, suicidal ideation was predicted by younger age, being currently unmarried, and lifetime anxiety or post-traumatic stress disorder. In addition to depression, suicide attempts were predicted by lifetime anxiety and drug use disorders, as well as younger age; being currently married and employed were significant protective factors. The presence of comorbid depression and PTSD significantly increased the odds of reporting a suicide attempt above either of these conditions independently. CONCLUSIONS While depression contributes significantly to suicidal ideation, and is a key risk factor for suicide attempts, other clinical and demographic factors played an important role in this rural sample. Consideration of the contribution of factors such as substance use and anxiety disorders to suicidal ideation and behaviours may improve our ability to identify individuals at risk of suicide. Acknowledging the contribution of these factors to rural suicide may also result in more effective approaches for the identification and treatment of at-risk individuals.
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Hajebi A, Motevalian A, Amin-Esmaeili M, Hefazi M, Radgoodarzi R, Rahimi-Movaghar A, Sharifi V. Telephone versus face-to-face administration of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, for diagnosis of psychotic disorders. Compr Psychiatry 2012; 53:579-83. [PMID: 21820651 DOI: 10.1016/j.comppsych.2011.06.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Revised: 05/31/2011] [Accepted: 06/07/2011] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE The current study aims to compare telephone vs face-to-face administration of the version of Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (SCID) for diagnosis of "any psychotic disorder" in a clinical population in Iran. METHOD The sample consisted of 72 subjects from 2 psychiatric outpatient services in Tehran, Iran. The subjects were interviewed using face-to-face SCID for the purpose of diagnosing psychotic disorders. A second independent telephone SCID was administered to the entire sample within 5 to 10 days, and the lifetime and 12-month diagnoses were compared. RESULTS The positive likelihood ratio of telephone-administered SCID for diagnosis of "any lifetime psychotic disorder" was 5.1 when compared with the face-to-face SCID. The value for the primary psychotic disorders in the past 12 months was lower (2.3). CONCLUSIONS The data indicate that telephone administration of the SCID is an acceptable method to differentiate between subjects with lifetime psychotic disorders and those who have had no psychotic disorders and provides a less resource-demanding alternative to face-to-face assessments.
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Affiliation(s)
- Ahmad Hajebi
- Mental Health Research Centre, Tehran Psychiatric Institute, Tehran University of Medical Sciences, Tehran 15745-344, Iran
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20
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Poon Y, Chung KF, Tso KC, Chang CL, Tang D. The use of Mood Disorder Questionnaire, Hypomania Checklist-32 and clinical predictors for screening previously unrecognised bipolar disorder in a general psychiatric setting. Psychiatry Res 2012; 195:111-7. [PMID: 21816486 DOI: 10.1016/j.psychres.2011.07.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 03/12/2011] [Accepted: 07/06/2011] [Indexed: 12/29/2022]
Abstract
Bipolar disorder is often unrecognised and misdiagnosed in the general psychiatric setting. This study compared the psychometric properties of the Mood Disorder Questionnaire (MDQ) and the Hypomania Checklist-32 (HCL-32), examined the clinical predictors of bipolar disorder and determined the best approach for screening previously unrecognised bipolar disorder in a general psychiatric clinic. A random sample of 340 non-psychotic outpatients with no previous diagnosis of bipolar disorder completed the MDQ and HCL-32 during their scheduled clinic visits. Mood and alcohol/substance use disorders were reassessed using a telephone-based Structured Clinical Interview for DSM-IV. We found that the HCL-32 had better psychometric performance and discriminatory capacity than the MDQ. The HCL-32's internal consistency and 4-week test-retest reliability were higher. The area under the curve was also greater than that of the MDQ at various clustering and impairment criteria. The optimal cut-off of the MDQ was co-occurrence of four symptoms with omission of the impairment criterion; for the HCL-32, it was 11 affirmative responses. Multivariable logistic regression found that bipolar family history was associated with an increased risk of bipolar disorder (odds ratio=4.93). The study showed that simultaneous use of the HCL-32 and bipolar family history was the best approach for detecting previously unrecognised bipolar disorder.
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Affiliation(s)
- Yvette Poon
- Department of Psychiatry, Queen Mary Hospital, Hong Kong, China
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21
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Madianos M, Economou M, Alexiou T, Stefanis C. Depression and economic hardship across Greece in 2008 and 2009: two cross-sectional surveys nationwide. Soc Psychiatry Psychiatr Epidemiol 2011; 46:943-52. [PMID: 20614103 DOI: 10.1007/s00127-010-0265-4] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 06/24/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE In many western countries during the recent years, people have witnessed the deterioration of their economies and the emergence of related phenomena such as loss of property, unemployment and social disruption. These phenomena have also been associated with increasing levels of demoralization and the developing of major depressive episodes (MDE). Greece in the years 2008 and mainly in 2009 started facing a sharp economic decline. The purpose of this study was to explore the consequences of this condition and the ways are reflected in the prevalence of MDE during these two critical years. METHOD Two nationwide cross-sectional telephone surveys were carried out in 2008 and 2009 with representative samples of 2,197 and 2,192 respondents, respectively. The interview comprised the SCID I module of MDE and an Index of Personal Economic Distress (IPED). RESULTS The 1-month prevalence of MDE in 2009 was found to be 6.8%, compared to corresponding rates of 3.3% in 2008. Respondents facing serious economic hardship (with higher scores in IPED) were mostly at risk for developing an MDE. CONCLUSIONS The findings of both studies underline the significance of the risk involved in developing MDE when individuals have been exposed in extreme and stressful economic situations.
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Affiliation(s)
- Michael Madianos
- Department of Mental Health and Behavioral Sciences, University of Athens, Athens, Greece.
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22
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Patel D, Sharpe L, Thewes B, Bell ML, Clarke S. Using the Distress Thermometer and Hospital Anxiety and Depression Scale to screen for psychosocial morbidity in patients diagnosed with colorectal cancer. J Affect Disord 2011; 131:412-6. [PMID: 21130501 DOI: 10.1016/j.jad.2010.11.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 11/11/2010] [Accepted: 11/11/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Distress Thermometer (DT) and Hospital Anxiety and Depression Scale (HADS) are commonly used within oncology settings. However there is a paucity of research comparing these measures to gold standard structured clinical interviews assessing for clinical disorders. The aim of this study is to establish the sensitivity, specificity and optimal cut-off scores on these measures when compared to a clinical interview. METHOD Ninety-nine patients with colorectal cancer completed the DT and HADS and a psychologist-administered gold standard structured clinical interview (the Composite International Diagnostic Interview-CIDI). Receiver Operator Characteristic analyses (ROC) were conducted to establish the optimal cut-off score on the DT and HADS to identify clinical disorders based on the CIDI. RESULTS Seventeen patients met criteria for a clinical disorder in the sample. A cut-off score of 4 on the DT indicated acceptable sensitivity (60%) and specificity (67%) to detect a current clinical disorder, while the optimal cut-off for the HADS was 10 (sensitivity=73%, specificity=72%). The area under the ROC values were 0.66 for the DT (95% CI: 0.51, 0.82) and 0.78 for the HADS (95% CI: 0.67, 0.90). The difference in AUC between the two measures was not statistically significant. LIMITATIONS The limitations to the design and methodology of the study are discussed. CONCLUSION The single item DT performed fairly, however not as well as the longer HADS in identifying clinical disorders amongst oncology patients, particularly anxiety disorders.
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Affiliation(s)
- Deepa Patel
- School of Psychology, University of Sydney, NSW, Australia
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Abstract
BACKGROUND Diagnostic and Statistical Manual (DSM) IV-based depression interviews, valued for their diagnostic accuracy, are often considered to be essential for depression treatment trials. However, this requirement can be problematic because of participant burden. The purpose of this article is to describe our experience with the depression component of the Structured Clinical Interview for DSM Disorders (SCID) in a postpartum depression treatment trial. METHODS In this prospective cohort study of 506 mothers of infants from 7 primary care clinics, participants were asked to complete the depression module of the SCID interview soon after enrollment. They were asked to complete the 9-item Patient Health Questionnaire (PHQ-9) depression survey at 0 to 1, 2, 4, 6, and 9 months postpartum. RESULTS Forty-five women (8.9%) had a positive SCID interview and 112 (22.1%) had a positive PHQ-9 during 0 to 9 months postpartum. Problems encountered when using the SCID depression interview included (1) lower than expected SCID-based rates of depression diagnosis (8.9%); (2) SCID noncompletion by 75 women (14.8%); SCID noncompleters (vs completers) were younger, poorer, less educated, and more likely to be single and black (vs white); and (3) inconsistent SCID/PHQ-9 results. Nineteen women with moderately severe to severe PHQ-9 score elevations (≥15) had negative SCID scores; all of these women were functionally impaired. More than 90% of women with positive PHQ-9 scores reported some degree of impairment because of their depressive symptoms. CONCLUSIONS The requirement of a diagnostic depression interview resulted in selection bias and missed opportunities for depression diagnosis; these are problems that detract from the interview's key strength-its diagnostic accuracy. These problems should be considered when electing to use a DSM-IV-based depression interview in research.
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Thekkumpurath P, Walker J, Butcher I, Hodges L, Kleiboer A, O'Connor M, Wall L, Murray G, Kroenke K, Sharpe M. Screening for major depression in cancer outpatients: the diagnostic accuracy of the 9-item patient health questionnaire. Cancer 2010; 117:218-27. [PMID: 20737537 DOI: 10.1002/cncr.25514] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 04/29/2010] [Accepted: 06/02/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Systematic screening for depression has been recommended for patients who have medical conditions like cancer. The 9-item Patient Health Questionnaire (PHQ-9) is becoming widely used, but its diagnostic accuracy has not yet been tested in a cancer patient population. In this article, the authors report on the performance of the PHQ-9 as a screening instrument for major depressive disorder (MDD) in patients with cancer. METHODS Data obtained from a depression screening service for patients who were attending clinics of a Regional Cancer Centre in Edinburgh, United Kingdom were used. Patients had completed both the PHQ-9 and a 2-stage procedure to identify cases of MDD. Performance of the PHQ-9 in identifying cases of MDD was determined using receiver operating characteristic (ROC) analysis. RESULTS Data were available on 4264 patients. When scored as a continuous measure, the PHQ-9 performed well with an area under the ROC curve of 0.94 (95% confidence interval [CI], 0.93-0.95). A cutoff score of ≥ 8 provided a sensitivity of 93% (95% CI, 89%-95%), a specificity of 81% (95% CI, 80%-82%), a positive predictive value (PPV) of 25%, and a negative predictive value (NPV) of 99% and could be considered optimum in a screening context. The PHQ-9 did not perform as well when it was scored using an algorithm with a sensitivity of 56% (95% CI, 55%-57%), a specificity of 96% (95% CI, 95%-97%), a PPV of 52%, and an NPV of 97%. CONCLUSIONS The PHQ-9 scored as a continuous measure with a cutoff score of ≥ 8 performed well in identifying MDD in cancer patients and should be considered as a screening instrument in this population.
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Affiliation(s)
- Parvez Thekkumpurath
- Psychological Medicine Research, University of Edinburgh Cancer Research Center, University of Edinburgh, Edinburgh, United Kingdom.
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Kelly BJ, Stain HJ, Coleman C, Perkins D, Fragar L, Fuller J, Lewin TJ, Lyle D, Carr VJ, Wilson JM, Beard JR. Mental health and well-being within rural communities: The Australian Rural Mental Health Study. Aust J Rural Health 2010; 18:16-24. [DOI: 10.1111/j.1440-1584.2009.01118.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Mack R, Giarelli E, Bernhardt BA. The adolescent research participant: strategies for productive and ethical interviewing. J Pediatr Nurs 2009; 24:448-57. [PMID: 19931142 DOI: 10.1016/j.pedn.2008.07.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Revised: 07/07/2008] [Accepted: 07/20/2008] [Indexed: 10/20/2022]
Abstract
Nurse researchers who seek to study the experiences of adolescents have limited resources to assist them with the process. Although some elements of interviewing are standard practice, special approaches are needed for the adolescent participating in research. Interviews are especially challenging. The purpose of this article is to present strategies to assist researchers as they engage this cohort in research. These strategies include evaluating the adolescent's developmental level, designing developmentally appropriate questions, and refining interviewing techniques to optimize the experience for the participants. Strategies presented are useful to clinicians who wish to establish a therapeutic rapport with young patients.
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Affiliation(s)
- Rita Mack
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA.
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[Outcome of simultaneous psychosomatic/internal-medicine inpatient care--a naturalistic follow-up study]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2009; 55:229-47. [PMID: 19886592 DOI: 10.13109/zptm.2009.55.3.229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The effectiveness of simultaneous psychosomatic and internal-medicine inpatient care has not yet been satisfyingly investigated. What outcome is found in patients treated in a psychosomatic/internal medicine setting? Can we predict a reduction in depression and symptom severity? METHODS The study design is prospective and naturalistic. Patients from a psychosomatic/internal-medicine setting and a solely internal-medicine ward filled in self-report questionnaires on the day of admission, five days thereafter, and three months after discharge. RESULTS A total of 221 patients from a psychosomatic/internal-medicine setting and 418 patients from a solely internal-medicine ward were included. Patient characteristics differed significantly between the two wards. Treatment was associated with a reduction of depression and somatic symptom severity over time. Depression severity improved more in the psychosomatic/internal-medicine setting than in the internal-medicine ward (ES = 0.37 vs. ES = 0.65). The strongest predictor of improvement of depression and somatic symptom severity was the patients' belief that their physical well-being was influenced by psychological factors (B = 1.44 and 1 = 0.65). CONCLUSIONS The results document a differential approach to admission in an integrated psychosomatic/internal medicine setting and underline the favourable course for psychological and somatic symptoms.
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Kroenke K, Theobald D, Norton K, Sanders R, Schlundt S, McCalley S, Harvey P, Iseminger K, Morrison G, Carpenter JS, Stubbs D, Jacks R, Carney-Doebbeling C, Wu J, Tu W. The Indiana Cancer Pain and Depression (INCPAD) trial Design of a telecare management intervention for cancer-related symptoms and baseline characteristics of study participants. Gen Hosp Psychiatry 2009; 31:240-53. [PMID: 19410103 PMCID: PMC2743872 DOI: 10.1016/j.genhosppsych.2009.01.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 01/29/2009] [Accepted: 01/30/2009] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Pain and depression are two of the most prevalent and treatable cancer-related symptoms, each present in at least 20-30% of oncology patients. Both symptoms are frequently either unrecognized or undertreated, however. This article describes a telecare management intervention delivered by a nurse-psychiatrist team that is designed to improve recognition and treatment of pain and depression. The enrolled sample is also described. METHODS The Indiana Cancer Pain and Depression study is a National Cancer Institute-sponsored randomized clinical trial. Four hundred five patients with cancer-related pain and/or clinically significant depression from 16 urban or rural oncology practices throughout Indiana have been enrolled and randomized to either the intervention group or to a usual-care control group. Intervention patients receive centralized telecare management coupled with automated home-based symptom monitoring. Outcomes will be assessed at 1, 3, 6 and 12 months by research assistants blinded to treatment arms. RESULTS Of 4465 patients screened, 2185 (49%) endorsed symptoms of pain or depression. Of screen-positive patients, about one-third were ineligible (most commonly due to pain or depression not meeting severity thresholds or to pain that is not related to cancer). Of the 405 patients enrolled, 32% have depression only, 24% have pain only and 44% have both depression and pain. At baseline, participants reported an average of 16.8 days out of the past 4 weeks during which they were confined to bed or had to reduce their usual activities by > or =50% due to pain or depression. Also, 176 (44%) reported being unable to work due to health reasons. CONCLUSIONS When completed, the Indiana Cancer Pain and Depression trial will test whether centralized telecare management coupled with automated home-based symptom monitoring improves outcomes in cancer patients with depression and/or pain. Findings will be important for both oncologists and mental health clinicians confronted with oncology patients' depression or pain.
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Affiliation(s)
- Kurt Kroenke
- Department of Medicine, Indiana University, Indianapolis, IN 46202, USA.
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Lee S, Tsang A, Lau L, Mak A, Ng KL, Chan DML. Concordance between telephone survey classification and face-to-face structured clinical interview in the diagnosis of generalized anxiety disorder in Hong Kong. J Anxiety Disord 2008; 22:1403-11. [PMID: 18406569 DOI: 10.1016/j.janxdis.2008.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 02/04/2008] [Accepted: 02/22/2008] [Indexed: 12/15/2022]
Abstract
Telephone surveys of estimating mental disorders have been found to generate comparable findings to large-scale community surveys but the concordance between telephone instruments and clinical interviews is rarely examined. In this study, 100 Chinese respondents who had taken part in a telephone-based population survey of generalized anxiety disorder (GAD) in Hong Kong were administered the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) by clinical interviewers. The discriminability and predictive indicators of the telephone survey instrument were assessed using receiver operating characteristic analysis. Results showed that the telephone survey instrument identified individuals with a positive SCID diagnosis of GAD better than those without. Although its individual questions performed well in identifying the endorsement of the corresponding core SCID criterion of GAD, further studies are needed to find out the optimal combination of questions in the telephone instrument for identifying GAD in community surveys.
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Affiliation(s)
- Sing Lee
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong.
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Lee S, Tsang A, Chui H, Kwok K, Cheung E. A community epidemiological survey of generalized anxiety disorder in Hong Kong. Community Ment Health J 2007; 43:305-19. [PMID: 17333348 DOI: 10.1007/s10597-006-9077-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2005] [Accepted: 11/21/2006] [Indexed: 10/23/2022]
Abstract
Generalized anxiety disorder (GAD) is understudied in Asian communities. There were 3,304 Chinese subjects (aged 15-60 years) randomly drawn from the general population of Hong Kong and successfully interviewed. The participation rate was 65.8%. The six-month prevalence of DSM-IV GAD was 4.1%. Over half of the GAD subjects reported palpitations and bowel symptoms. Comorbid depressive mood (65%) and substance use (35%) were common. Forty-one percent of GAD subjects sought help, usually from general practitioners who prescribed tranquilizers after negative physical investigations. Telephone-based surveys have limitations but provide an affordable and destigmatizing alternative to face-to-face surveys for communities with limited mental health resources.
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Affiliation(s)
- Sing Lee
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, PR China.
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Walker J, Postma K, McHugh GS, Rush R, Coyle B, Strong V, Sharpe M. Performance of the Hospital Anxiety and Depression Scale as a screening tool for major depressive disorder in cancer patients. J Psychosom Res 2007; 63:83-91. [PMID: 17586341 DOI: 10.1016/j.jpsychores.2007.01.009] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 12/14/2006] [Accepted: 01/04/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES (1) To assess the overall performance of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument to identify cases of major depressive disorder (MDD) in mixed cancer outpatients. (2) To determine the sensitivity and specificity of various HADS cut-off scores. (3) To recommend an optimal HADS cut-off score for use in this population. METHODS A cross-sectional questionnaire and interview survey of consecutive patients attending outpatient clinics in a regional cancer centre in Edinburgh, Scotland, United Kingdom. RESULTS Thirty (8.3%) of 361 patients met criteria for MDD at interview. With the use of the total HADS score to identify these cases of MDD, the area under the receiver operating characteristic curve was 0.94 (95% CI, 0.91-0.97). A cut-off of 14/15 gave a sensitivity of 0.87 (95% CI, 0.70-0.95), a specificity of 0.85 (95% CI, 0.81-0.89), and a positive predictive value of 0.35, and was considered optimal. CONCLUSION The HADS can be used effectively as an initial screening tool for the detection of MDD in outpatients attending mixed cancer clinics.
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Affiliation(s)
- Jane Walker
- Psychological Medicine and Symptoms Research Group, School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh, Scotland, United Kingdom.
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Peterson CB, Crosby RD, Wonderlich SA, Joiner T, Crow SJ, Mitchell JE, Bardone-Cone AM, Klein M, le Grange D. Psychometric properties of the eating disorder examination-questionnaire: factor structure and internal consistency. Int J Eat Disord 2007; 40:386-9. [PMID: 17304585 DOI: 10.1002/eat.20373] [Citation(s) in RCA: 284] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this investigation was to evaluate the factor structure and the internal consistency of the Eating Disorder Examination-Questionnaire (EDE-Q). METHOD The EDE-Q was administered to 203 women with bulimic symptoms, who were recruited from five Midwestern communities. RESULTS Acceptable levels of internal consistency were observed for the EDE-Q total score (alpha = .90) and subscales: Restraint (alpha = .70), Eating Concern (alpha = 0.73), Shape Concern (alpha = 0.83) and Weight Concern (alpha = 0.72). Exploratory factor loadings using Principal Axis Analysis supported the Eating Concern and Restraint subscales. Most of the Shape Concern and Weight Concern items loaded on one factor, with the exception of the items focusing on the importance of weight and shape in self-evaluation and preoccupation with shape and weight. CONCLUSION The results of this study provide support for the internal consistency of the EDE-Q and indicate a need for further examination of the factor structure of this instrument.
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Affiliation(s)
- Carol B Peterson
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota 55454, USA
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Wilkinson SM, Love SB, Westcombe AM, Gambles MA, Burgess CC, Cargill A, Young T, Maher EJ, Ramirez AJ. Effectiveness of Aromatherapy Massage in the Management of Anxiety and Depression in Patients With Cancer: A Multicenter Randomized Controlled Trial. J Clin Oncol 2007; 25:532-9. [PMID: 17290062 DOI: 10.1200/jco.2006.08.9987] [Citation(s) in RCA: 219] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PurposeTo test the effectiveness of supplementing usual supportive care with aromatherapy massage in the management of anxiety and depression in cancer patients through a pragmatic two-arm randomized controlled trial in four United Kingdom cancer centers and a hospice.Patients and MethodsTwo hundred eighty-eight cancer patients, referred to complementary therapy services with clinical anxiety and/or depression, were allocated randomly to a course of aromatherapy massage or usual supportive care alone.ResultsPatients who received aromatherapy massage had no significant improvement in clinical anxiety and/or depression compared with those receiving usual care at 10 weeks postrandomization (odds ratio [OR], 1.3; 95% CI, 0.9 to 1.7; P = .1), but did at 6 weeks postrandomization (OR, 1.4; 95% CI, 1.1 to 1.9; P = .01). Patients receiving aromatherapy massage also described greater improvement in self-reported anxiety at both 6 and 10 weeks postrandomization (OR, 3.4; 95% CI, 0.2 to 6.7; P = .04 and OR, 3.4; 95% CI, 0.2 to 6.6; P = .04), respectively.ConclusionAromatherapy massage does not appear to confer benefit on cancer patients’ anxiety and/or depression in the long-term, but is associated with clinically important benefit up to 2 weeks after the intervention.
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Affiliation(s)
- Susie M Wilkinson
- Marie Curie Palliative Care Research Unit, Royal Free and University College Medical School, Department of Mental Health Sciences, Cancer Research UK London Psychosocial Group, Institute of Psychiatry, London, United Kingdom
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Lee S, Tsang A, Kwok K. Twelve-month prevalence, correlates, and treatment preference of adults with DSM-IV major depressive episode in Hong Kong. J Affect Disord 2007; 98:129-36. [PMID: 16934333 DOI: 10.1016/j.jad.2006.07.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Revised: 07/13/2006] [Accepted: 07/14/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND The most recent large-scale community mental health survey of depression among adults in Hong Kong was conducted over two decades ago. The lifetime prevalence rates of DSM-III major depressive disorder (females 2.44% and males 1.29%) in that study do not tally with several indices of worsened social health and clinical prevalence studies of depression in contemporary Hong Kong. METHODS Each of 5004 adults randomly drawn from the general population completed a telephone interview that generated the DSM-IV-based diagnosis of major depressive episode (MDE), sociodemography, help-seeking, and other epidemiological data. RESULTS Twelve-month prevalence of MDE was 8.4%. The female-to-male ratio was low but typical of surveys in Chinese communities. Female sex and unemployment were associated with increased risk. 32.5% of respondents with MDE reported frequent thoughts of suicide. Recognition of the need for treatment of depression was high but actual treatment rate and preference for mental health specialists were low. LIMITATIONS Response rate was low though cooperation rate was moderately high. Detailed demography, comorbidity, and clinical reappraisal interviews were not covered. CONCLUSIONS Resolving issues of stigma and mode of symptom elicitation may lead to more valid prevalence estimates of depression among Chinese people. Although longitudinal studies are needed to confirm a genuine increase in prevalence, depression is likely to be more common in Hong Kong than previously suggested. High recognition of the need for treatment but low rate of actual treatment calls for policy and programs that improve access to treatment.
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Affiliation(s)
- Sing Lee
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong.
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Depressive symptoms following herpes simplex encephalitis--an underestimated phenomenon? Gen Hosp Psychiatry 2006; 28:403-7. [PMID: 16950375 DOI: 10.1016/j.genhosppsych.2006.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2006] [Revised: 05/14/2006] [Accepted: 05/16/2006] [Indexed: 01/20/2023]
Abstract
OBJECTIVE In view of the herpes simplex virus' neurotropism for the limbic system and the temporal lobe, little is known about potential negative effects of this necrotizing encephalitis on affective functioning and health-related quality of life (HRQoL) after recovery. We therefore set out to explore an association between herpes simplex virus encephalitis (HSE) and both depressive symptoms and HRQoL. METHODS A structured telephone interview was conducted in 26 subjects (F/M=10/16; age at follow-up, 49.3+/-15.0 years; range, 29-80) at a mean time interval of 5.2+/-3.1 years (range, 1-11) after their initial diagnosis of HSE. WHO-5 Well-Being Index (WHO-5) was used as screening instrument for depression, and Short Form-12 was used as HRQoL instrument. We also determined the spatial extent of morphologic abnormalities on magnetic resonance imaging (MRI). RESULTS Ten of the interviewees (38.5%) had a WHO-5 score below 13, which is considered indicative of a depressive disorder. Accordingly, concerning their HRQoL, patients felt more impaired by affective than by physical symptoms. MRI ratings and WHO-5 score were not correlated. CONCLUSIONS While this pilot study does not allow to establish a causal relationship with focal brain damage, findings suggest both a high frequency of depressive symptoms and a low quality of life with respect to mental health following HSE. These results should be confirmed by a prospective trial.
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Abstract
Panic disorder (PD) is prevalent, impairing, under-recognized, and often mistreated. Previous surveys in Chinese communities indicate very low prevalence estimates and provide limited information about its clinical characteristics. A random telephone survey of the general population (age range, 15-60 years) in Hong Kong was conducted using a questionnaire that generated the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV-based diagnosis of PD, its symptom profile, help-seeking behavior, and health visit expenditure. Of 3,004 interviews successfully completed, 3.89% of participants (n=117) met criteria of PD in the previous 6 months. Their demographic and clinical profile resembled that of their Western counterparts. Excessive physical investigations and under-treatment were common. Participants with subthreshold PD (14.9%; n=449) exhibited a similar but attenuated clinical profile. We conclude that PD may be more common in Chinese people than what previous epidemiological surveys suggest. The present study is limited by the lack of clinical reappraisal, examination of comorbidity, and a low overall response rate. Nonetheless, it suggests that telephone interviews may provide a cost-effective alternative to large-scale epidemiological surveys for communities with limited resources for mental health research and high unmet needs for treatment.
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Affiliation(s)
- Sing Lee
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong.
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Cameron C, Statham J. Variations in duty arrangements to respond to concerns about children's welfare. HEALTH & SOCIAL CARE IN THE COMMUNITY 2006; 14:167-76. [PMID: 16460366 DOI: 10.1111/j.1365-2524.2006.00608.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Reception and initial contact arrangements and practices in social services play a key role in safeguarding children and providing an avenue for the public and professionals to report concerns about a child's welfare. This paper reports on findings from a small-scale study, commissioned in the wake of the Laming Inquiry into the circumstances surrounding the death of Victoria Climbié. The aim of the study was an exploration of the arrangements local authorities had in place in early 2004 to receive referrals from the public and professional sources, and to report on duty team managers' levels of satisfaction with these arrangements. It drew on interviews with 70 social work managers responsible for daytime and out-of-hours duty services in 28 English local authorities. The authors argue that, while the Inquiry recommendations to improve the organisation of initial contact with social services in the event of concerns about a child's welfare remain important, wide variations exist in practice. The paper concludes with a discussion of possible contributory factors for such variation, and policy and practice measures that could address the variation.
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Affiliation(s)
- Claire Cameron
- Thomas Coram Research Unit, 27/28 Woburn Square, London WC1H OAA, UK.
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Fann JR, Bombardier CH, Dikmen S, Esselman P, Warms CA, Pelzer E, Rau H, Temkin N. Validity of the Patient Health Questionnaire-9 in assessing depression following traumatic brain injury. J Head Trauma Rehabil 2006; 20:501-11. [PMID: 16304487 DOI: 10.1097/00001199-200511000-00003] [Citation(s) in RCA: 282] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To test the validity and reliability of the Patient Health Questionnaire-9 (PHQ-9) for diagnosing major depressive disorder (MDD) among persons with traumatic brain injury (TBI). DESIGN Prospective cohort study. SETTING Level I trauma center. PARTICIPANTS 135 adults within 1 year of complicated mild, moderate, or severe TBI. MAIN OUTCOME MEASURES PHQ-9 Depression Scale, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID). RESULTS Using a screening criterion of at least 5 PHQ-9 symptoms present at least several days over the last 2 weeks (with one being depressed mood or anhedonia) maximizes sensitivity (0.93) and specificity (0.89) while providing a positive predictive value of 0.63 and a negative predictive value of 0.99 when compared to SCID diagnosis of MDD. Pearson's correlation between the PHQ-9 scores and other depression measures was 0.90 with the Hopkins Symptom Checklist depression subscale and 0.78 with the Hamilton Rating Scale for Depression. Test-retest reliability of the PHQ-9 was r = 0.76 and kappa = 0.46 when using the optimal screening method. CONCLUSIONS The PHQ-9 is a valid and reliable screening tool for detecting MDD in persons with TBI.
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Affiliation(s)
- Jesse R Fann
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle 98195, USA.
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Löwe B, Kroenke K, Gräfe K. Detecting and monitoring depression with a two-item questionnaire (PHQ-2). J Psychosom Res 2005; 58:163-71. [PMID: 15820844 DOI: 10.1016/j.jpsychores.2004.09.006] [Citation(s) in RCA: 880] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2004] [Accepted: 09/22/2004] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study evaluates the two-item Patient Health Questionnaire (PHQ-2) as a measure for diagnosing and monitoring depression. METHODS We assessed construct validity in a cross-sectional sample of 1619 medical outpatients (mean age 43+/-14 years, 64% female) by comparing the PHQ-2 to four longer self-report questionnaires. Criterion validity was established in a subsample of 520 participants with reference to the Structured Clinical Interview for DSM-IV (SCID). Sensitivity to change was investigated in a prospective study of 167 patients who completed the SCID both at baseline and the 1-year follow-up. RESULTS With reference to the SCID, the PHQ-2 had a sensitivity of 87% and a specificity of 78% for major depressive disorder and a sensitivity of 79% and a specificity of 86% for any depressive disorder. Its diagnostic performance was comparable with that of longer depression scales. PHQ-2 change scores accurately reflected improved, unchanged, and deteriorated depression outcomes. CONCLUSION The PHQ-2 performed favorably with respect to a standard diagnostic interview, as well as established depression scales and proved sensitive to change. Thus, the PHQ-2 appears promising as a brief multipurpose measure for detecting depression, grading its severity, and monitoring outcomes over time.
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Affiliation(s)
- Bernd Löwe
- Department of General Internal and Psychosomatic Medicine, University of Heidelberg Medical Center, Im Neuenheimer Feld 410, Heidelberg D-69120, Heidelberg, Germany.
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Sharpe M, Strong V, Allen K, Rush R, Postma K, Tulloh A, Maguire P, House A, Ramirez A, Cull A. Major depression in outpatients attending a regional cancer centre: screening and unmet treatment needs. Br J Cancer 2004; 90:314-20. [PMID: 14735170 PMCID: PMC2409546 DOI: 10.1038/sj.bjc.6601578] [Citation(s) in RCA: 167] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A screening programme designed to identify cases of Major Depressive Disorder (MDD) in patients attending a Regional Cancer Centre outpatient department was established. It comprised two stages: (1) The Hospital Anxiety and Depression Scale (HADS) self-rating questionnaire administered by a touch-screen computer; (2) we interviewed patients with high scores on the HADS (15 or more total score) over the telephone using the depression section of the Structured Clinical Interview for DSMIV (SCID). A large consecutive sample (5613) of oncology clinic attenders was screened, and practical difficulties in the screening process were identified. The estimated prevalence of major depressive disorder (MDD) in the sample surveyed was approximately 8% (7.8%; 95% confidence intervals 6.9–8.5%). We assessed a consecutive series of 150 patients identified as having MDD to determine how many had received evidence-based treatment for MDD. Only half had discussed their low mood with their general practitioner, only one-third had been prescribed any antidepressant medication, and very few had taken a therapeutic dose for an adequate period. Very few had received psychological treatment or had been referred to mental health services. Most were receiving no potentially effective therapy.
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Affiliation(s)
- M Sharpe
- Division of Psychiatry, School of Molecular and Clinical Medicine, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh EH10 5HF, UK.
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Sharpe M, Strong V, Allen K, Rush R, Maguire P, House A, Ramirez A, Cull A. Management of major depression in outpatients attending a cancer centre: a preliminary evaluation of a multicomponent cancer nurse-delivered intervention. Br J Cancer 2004; 90:310-3. [PMID: 14735169 PMCID: PMC2410153 DOI: 10.1038/sj.bjc.6601546] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A novel nurse-delivered multicomponent intervention for major depressive disorder (MDD) in cancer outpatients was compared with usual care alone in a nonrandomised matched group design (n=30 per group). At the final 6-month outcome, 38.5% (95% CI, 5.4–57%) fewer patients in the intervention group still met the criteria for MDD.
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Affiliation(s)
- M Sharpe
- Division of Psychiatry, School of Molecular and Clinical Medicine, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh EH10 5HF, UK.
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