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Bergeron J, Avraam D, Calas L, Fraser W, Harris JR, Heude B, Mandhane P, Moraes TJ, Muckle G, Nader J, Séguin JR, Simons E, Subbarao P, Swertz MA, Tough S, Turvey SE, Fortier I, Rod NH, Andersen AMN. Stress and anxiety during pregnancy and length of gestation: a federated study using data from five Canadian and European birth cohorts. Eur J Epidemiol 2024:10.1007/s10654-024-01126-4. [PMID: 38805076 DOI: 10.1007/s10654-024-01126-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 04/14/2024] [Indexed: 05/29/2024]
Abstract
While its etiology is not fully elucidated, preterm birth represents a major public health concern as it is the leading cause of child mortality and morbidity. Stress is one of the most common perinatal conditions and may increase the risk of preterm birth. In this paper we aimed to investigate the association of maternal perceived stress and anxiety with length of gestation. We used harmonized data from five birth cohorts from Canada, France, and Norway. A total of 5297 pregnancies of singletons were included in the analysis of perceived stress and gestational duration, and 55,775 pregnancies for anxiety. Federated analyses were performed through the DataSHIELD platform using Cox regression models within intervals of gestational age. The models were fit for each cohort separately, and the cohort-specific results were combined using random effects study-level meta-analysis. Moderate and high levels of perceived stress during pregnancy were associated with a shorter length of gestation in the very/moderately preterm interval [moderate: hazard ratio (HR) 1.92 (95%CI 0.83, 4.48); high: 2.04 (95%CI 0.77, 5.37)], albeit not statistically significant. No association was found for the other intervals. Anxiety was associated with gestational duration in the very/moderately preterm interval [1.66 (95%CI 1.32, 2.08)], and in the early term interval [1.15 (95%CI 1.08, 1.23)]. Our findings suggest that perceived stress and anxiety are associated with an increased risk of earlier birth, but only in the earliest gestational ages. We also found an association in the early term period for anxiety, but the result was only driven by the largest cohort, which collected information the latest in pregnancy. This raised a potential issue of reverse causality as anxiety later in pregnancy could be due to concerns about early signs of a possible preterm birth.
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Affiliation(s)
- Julie Bergeron
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
- Research Institute of the McGill University Health Center, Montreal, Canada.
| | - Demetris Avraam
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Lucinda Calas
- Centre for Research in Epidemiology and Statistics, INSERM, Paris, France
| | - William Fraser
- Department of Obstetrics and Gynecology, Université de Sherbrooke, Sherbrook, Canada
| | - Jennifer R Harris
- Centre for Fertility and Health, The Norwegian Institute of Public Health, Oslo, Norway
| | - Barbara Heude
- Centre for Research in Epidemiology and Statistics, INSERM, Paris, France
| | - Piush Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Theo J Moraes
- Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Gina Muckle
- School of Psychology, Université Laval, Quebec, Canada
| | - Johanna Nader
- Centre for Fertility and Health, The Norwegian Institute of Public Health, Oslo, Norway
| | - Jean R Séguin
- Department of Psychiatry and Addictology, Université de Montréal and CHU Ste-Justine Research Center, Montreal, Canada
| | - Elinor Simons
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Padmaja Subbarao
- Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Morris A Swertz
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Suzanne Tough
- Department of Paediatrics, University of Calgary, Calgary, Canada
| | - Stuart E Turvey
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Isabel Fortier
- Research Institute of the McGill University Health Center, Montreal, Canada
| | - Naja Hulvej Rod
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Symptom perceptions in functional disorders, major health conditions, and healthy controls: A general population study. CLINICAL PSYCHOLOGY IN EUROPE 2022; 4:e7739. [DOI: 10.32872/cpe.7739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 08/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background
The present study investigated differences in symptom perceptions between individuals with functional disorders (FD), major health conditions, and FDs + major health conditions, respectively, and a group of healthy individuals. Furthermore, it investigated the relevance of FDs among other health-related and psychological correlates of symptom perceptions in the framework of the Common Sense Model of Self-Regulation (CMS).
Method
This cross-sectional study used epidemiological data from the Danish Study of Functional Disorders part two (N = 7,459 participants, 54% female, 51.99 ± 13.4 years). Symptom perceptions were assessed using the Brief Illness Perception Questionnaire (B-IPQ) and compared between the four health condition groups. Multiple regression analyses were performed to examine associations between symptom perceptions, FDs, and other health-related and psychological correlates from the CMS framework.
Results
Individuals with FDs (n = 976) and those with FDs + major health conditions (n = 162) reported less favorable symptom perceptions compared to the other two groups, particularly regarding perceived consequences, timeline, and emotional representations (effect size range Cohen’s d = 0.12-0.66). The presence of a FD was significantly associated with all B-IPQ items, even in the context of 16 other relevant health-related and psychological correlates from the CMS framework, whereas symptom presence last year or last week was not.
Conclusion
In the general population, symptom perceptions seem to play a more salient role in FD than in individuals with well-defined physical illness. Symptom perceptions should therefore be targeted in both primary and secondary interventions for FDs.
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Thastum MM, Schroeder A, Evald L, Naess-Schmidt E, Tuborgh A, Jensen JS, Svendsen SW, Nielsen JF, Rask CU. Self-Rated Executive Function and Health-Related Quality of Life in Young Adults With Persistent Post-Concussion Symptoms: A Cross-Sectional Study. Arch Clin Neuropsychol 2021; 37:762-774. [PMID: 34849526 DOI: 10.1093/arclin/acab091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To assess self-reported executive dysfunction in young adult patients with persistent post-concussion symptoms (PCS) 2-6 months post-injury, and the association with self-reported Health-Related Quality of Life (HRQoL). METHOD This cross-sectional study carried out in a hospital setting was a secondary analysis of data from a separate randomized trial testing the effect of a novel intervention, "Get going After concussIoN " (GAIN), for persistent PCS. Patients (18-30 years) were recruited from a clinical cohort of patients with a hospital diagnosis of concussion or referred by primary care physicians. Main measures were The Behaviour Rating Inventory of Executive Function-Adult Version providing two index scores, that is, the Metacognitive Index (MI) and the Behavioural Regulation Index (BRI), and the Quality of Life after Brain Injury-Overall Scale. RESULTS Compared with normative data, patients had elevated scores (i.e., worse functioning) on both the MI and the BRI. In linear regression analysis, the MI score, but not the BRI score, was negatively associated with self-reported HRQoL (MI: slope = -.27, 95% confidence interval, CI [-.53, -.02], p = .03; BRI: slope = -.19, 95% CI [-.49, .13], p = .24), suggesting a positive association of subjective executive dysfunction and lower HRQoL. However, the association was attenuated after adjustment for self-reported psychological distress (MI: slope = -.09, 95% CI [-.34, .17], p = .51). CONCLUSION Self-reported executive dysfunction is common in young adult patients with persistent PCS, but not strongly associated with decreased HRQoL after adjusting for concurrent psychological distress.
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Affiliation(s)
- Mille Moeller Thastum
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.,Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Andreas Schroeder
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Evald
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Erhard Naess-Schmidt
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Astrid Tuborgh
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Jens Sondergaard Jensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Susanne Wulff Svendsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Jørgen Feldbaek Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
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Petersen MW, Skovbjerg S, Jensen JS, Wisbech Carstensen TB, Dantoft TM, Fink P, Benros ME, Mortensen EL, Jørgensen T, Gormsen LK. Conditioned pain modulation and pain sensitivity in functional somatic disorders: The DanFunD study. Eur J Pain 2021; 26:154-166. [PMID: 34309927 PMCID: PMC9292427 DOI: 10.1002/ejp.1847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/20/2021] [Indexed: 11/09/2022]
Abstract
Background Disrupted pain regulation has been proposed as a component in functional somatic disorders (FSD). The objective of this study was to examine a general population sample, encompassing three delimitations of FSD while assessing pain sensitivity and conditioning pain modulation (CPM). Methods Pressure pain thresholds (PPTs) at the tibialis and trapezius muscles were recorded at baseline. During cold pressor stimulation of the hand, the tibialis PPTs were re‐assessed and the difference from baseline measures defined the CPM effect. Participants (n = 2,198, 53% females) were randomly selected from the adult Danish population. FSD was established by self‐reported symptom questionnaires. Results With a few exceptions, only weak associations were seen between PPTs and CPM in cases with FSD (p > .1). A high PPT was associated with lower odds of having multi‐organ bodily distress syndrome (ORPPT trapezius: 0.66, 95% CI: 0.49–0.88, p = .005), with the symptom profile characterized by all symptoms (ORPPT trapezius: 0.72, 95% CI: 0.58–0.90, p = .003 and ORPPT tibialis: 0.75, 95% CI: 0.62–0.91, p = .004), and with multiple chemical sensitivity (ORPPT trapezius: 0.81, 95% CI: 0.67–0.97, p = .022). High CPM was associated with high odds of having irritable bowel (ORCPM relative: 1.22, 95% CI: 1.04–1.43, p = .013 and ORCPM absolute = 2.66, 95% CI: 1.07–6.45, p = .033). Conclusion However, only PPT measured over the trapezius muscle were still significant after correction for multiple testing for the symptom profile characterized by all symptoms. Findings from this study do not support altered pain regulation in questionnaire‐based FSD which is in contrast with the existing presumption. Further epidemiological studies in this field are needed. Significance Disrupted pain regulation as measured by abnormal pain thresholds has been hypothesized as a central mechanism in Functional Somatic Disorders (FSD). The hypothesis has been raised in clinical setting where patients presented subjective and objective features of hypersensitivity. The present population‐based study does not support this notion. This points to the importance of further studies into the underlying pathophysiology mechanisms of FSD.
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Affiliation(s)
- Marie Weinreich Petersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Sine Skovbjerg
- Center for Clinical Research and Prevention, Bispebjerg & Frederiksberg Hospital, Capital Region and University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, The Danish Center for Mindfulness, Aarhus University, Aarhus, Denmark
| | - Jens Søndergaard Jensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Tina Birgitte Wisbech Carstensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention, Bispebjerg & Frederiksberg Hospital, Capital Region and University of Copenhagen, Copenhagen, Denmark
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | | | - Erik Lykke Mortensen
- Department of Public health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg & Frederiksberg Hospital, Capital Region and University of Copenhagen, Copenhagen, Denmark.,Department of Public health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.,Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Lise Kirstine Gormsen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
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Petersen MW, Dantoft TM, Jensen JS, Pedersen HF, Frostholm L, Benros ME, Carstensen TBW, Ørnbøl E, Fink P. The impact of the Covid-19 pandemic on mental and physical health in Denmark - a longitudinal population-based study before and during the first wave. BMC Public Health 2021; 21:1418. [PMID: 34275461 PMCID: PMC8286431 DOI: 10.1186/s12889-021-11472-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/01/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In the continuation of the first wave of the Covid-19 outbreak in Denmark, unprecedented restrictions with great impact on the citizen's everyday life were implemented. The objectives of this study were to investigate the influence of the Covid-19 pandemic on mental and physical health in the Danish population during the spring 2020 first wave outbreak and lockdown. METHODS A sample from the adult Danish population (n = 2190) were included. Self-reported measures of illness worry (Whiteley-6-R), emotional distress (SCL-90), and physical symptom load (SLC-90) were obtained before and during the first wave of the pandemic and compared with Wilcoxon signed-rank tests. Impact of covariates on physical and mental health was evaluated with ordinal regression analyses. Results from a tailored questionnaire regarding the Covid-19 pandemic were presented to explore the direct impact of the pandemic. RESULTS We only found minor increases in illness worry, emotional distress and physical symptom load (0-1 points difference, p ≤ 0.007) during the Covid-19 pandemic compared to before the pandemic. Sex, age, education, and physical disease were not associated with illness worry, emotional distress, or physical symptom load. Overall, the participants were trustful in the authorities' recommendations and felt that they managed the pandemic and the restrictions to a great extent despite that some expected great/major future consequences of the pandemic. CONCLUSIONS This study suggested that the first wave of the Covid-19 pandemic only had minor impact on mental and physical health in the Danish general population. Future studies should address the impact of the second wave of the pandemic and the renewed implementation of the concomitant restrictions.
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Affiliation(s)
- Marie Weinreich Petersen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University hospital, Universitetsbyen 21-23, 8000, Aarhus C, Denmark.
| | - Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Copenhagen, Denmark
| | - Jens Søndergaard Jensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University hospital, Universitetsbyen 21-23, 8000, Aarhus C, Denmark
| | - Heidi Frølund Pedersen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University hospital, Universitetsbyen 21-23, 8000, Aarhus C, Denmark
| | - Lisbeth Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University hospital, Universitetsbyen 21-23, 8000, Aarhus C, Denmark
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Michael Eriksen Benros
- Mental Health Centre Copenhagen, The Capital Region of Denmark, Copenhagen, Denmark
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Tina Birgitte Wisbech Carstensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University hospital, Universitetsbyen 21-23, 8000, Aarhus C, Denmark
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Eva Ørnbøl
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University hospital, Universitetsbyen 21-23, 8000, Aarhus C, Denmark
| | - Per Fink
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University hospital, Universitetsbyen 21-23, 8000, Aarhus C, Denmark
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
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Evald L, Brønnick K, Duez CHV, Grejs AM, Jeppesen AN, Søreide E, Kirkegaard H, Nielsen JF. Younger age is associated with higher levels of self-reported affective and cognitive sequelae six months post-cardiac arrest. Resuscitation 2021; 165:148-153. [PMID: 33887400 DOI: 10.1016/j.resuscitation.2021.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/01/2021] [Accepted: 04/10/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Affective and cognitive sequelae are frequently reported in cardiac arrest survivors; however, little is known about the risk factors. We assessed the hypothesis that self-reported affective and cognitive sequelae six months after OHCA may be associated with demography, acute care and cerebral outcome. METHODS This is a sub-study of the multicentre "Target Temperature Management for 48 vs. 24 h and Neurologic Outcome after Out-of-Hospital Cardiac Arrest: A Randomised Clinical Trial" (the TTH48 trial) investigating the effect of prolonged TTM at 33 ± 1 °C. We invited patients with good outcome on the Cerebral Performances Categories (CPC score ≤ 2) to answer questionnaires on anxiety, depression, emotional distress, perceived stress and cognitive failures six months post OHCA. RESULTS In total 79 of 111 eligible patients were included in the analysis. There were no significant differences in baseline characteristics between the included group and the group lost to follow-up. Younger age was a negative predictor across all self-reported outcomes, even when controlling for gender, ROSC time, treatment allocation, cognitive impairment and global outcome (CPC 1 or 2). Female gender was a predictor of anxiety, though this should be interpreted cautiously as only eight women participated. A CPC score of 2 score was a negative predictor of self-reported affective outcomes, albeit not for self-reported cognitive failures. CONCLUSION Younger age was associated with higher levels of self-reported affective and cognitive sequelae six months post OHCA. Female gender may be associated with self-reported anxiety. A higher CPC score may be a proxy for self-reported affective sequelae.
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Affiliation(s)
- Lars Evald
- Hammel Neurorehabilitation Clinic and University Research Centre, Hammel, Denmark.
| | - Kolbjørn Brønnick
- Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Christophe Henri Valdemar Duez
- Research Centre for Emergency Medicine and Department of Intensive Care Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Anders Morten Grejs
- Research Centre for Emergency Medicine and Department of Intensive Care Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Anni Nørgaard Jeppesen
- Research Centre for Emergency Medicine and Department of Intensive Care Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Eldar Søreide
- Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hans Kirkegaard
- Research Centre for Emergency Medicine and Department of Intensive Care Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
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Feasibility of group-based acceptance and commitment therapy for adolescents (AHEAD) with multiple functional somatic syndromes: a pilot study. BMC Psychiatry 2020; 20:457. [PMID: 32957944 PMCID: PMC7507241 DOI: 10.1186/s12888-020-02862-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 09/10/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Recurrent and impairing functional somatic syndromes (FSS) are common in adolescents. Despite a high need for care, empirically supported treatments are lacking for youth. The aim of this uncontrolled pilot study was to assess feasibility and treatment potential of a new intervention with group-based Acceptance and Commitment Therapy (ACT) in a generic treatment approach for adolescents with multiple FSS. METHODS Twenty-one patients received 'ACT for Health in Adolescents' (AHEAD) (30 h), specifically developed for adolescents (aged 15-19 years) with moderate to severe FSS. Close relatives attended an information meeting to facilitate support of the patients throughout treatment. Treatment satisfaction was evaluated by means of self-report and relatives' impressions. Self-reported physical health at 3 months follow-up (FU) after end of treatment was the primary outcome whereas secondary outcomes included symptom burden, limitation due to symptoms, illness worry, emotional distress and physical and emotional symptoms. Treatment targets were assessed by measures on illness behaviour, illness perception and psychological inflexibility. RESULTS Nineteen patients (90.5%) completed the treatment with a high overall attendance rate of 93%. All would recommend the treatment to a friend with similar problems. Close relatives rated it valuable to participate in an information meeting. Patients' physical health improved significantly from assessment to FU with a clinically relevant mean change of 8.9 points (95% CI [5.4; 12.4]; SRM 0.91 [0.26;1.57]). Improvement was also seen on all secondary outcome measures, from assessment to FU. Maladaptive illness behaviours and perceptions as well as psychological inflexibility showed a significant decline from assessment to FU. CONCLUSION AHEAD was feasible and potentially efficacious and warrants testing in a larger clinical trial. TRIAL REGISTRATION Clinical Trials gov NCT04464447 , registration date July 9th, 2020. Retrospectively registered.
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Carstensen TBW, Ørnbøl E, Fink P, Jørgensen T, Dantoft TM, Madsen AL, Buhmann CCB, Eplov LF, Frostholm L. Adverse life events in the general population - a validation of the cumulative lifetime adversity measure. Eur J Psychotraumatol 2020; 11:1717824. [PMID: 32128043 PMCID: PMC7034458 DOI: 10.1080/20008198.2020.1717824] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 12/13/2019] [Accepted: 01/03/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Negative life events are a predictor for mental illness. However, most research has focused on selected domains, e.g. childhood or recent adversity. The Cumulative Lifetime Adversity Measure (CLAM), a newly introduced questionnaire not yet validated, examines cumulative effect of a range of events including number of exposure to the same event. This measure gives opportunity to collect detailed data on lifetime adversity in large cohort studies. Objective: The aim of this study was translation of the CLAM into Danish and validation of the CLAM in a large general population cohort. Secondly, we aimed to describe the occurrence of adverse life events in a large representative sample of the general population in Denmark. Methods: Translation and validation followed the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) for formative models. Content and construct validity were evaluated including hypothesis testing of accumulated lifetime adversity having a U-shaped pattern with low levels of cumulated lifetime adversity as opposed to no or high levels being associated with lower emotional distress, functional impairment, and pain impairment. The field testing sample was the DanFunD cohort (n = 7493) randomly drawn in a Danish population and examined between 2012 and 2015. Results: Pilot interviews showed that the questions were confronting but not offensive, straight forward, and easy to answer. Acceptability was good. U-shaped patterns between accumulated lifetime adversity and the outcome measures were found. Quadratic term: Emotional distress (β(95%CI) 0.007(0.002;0.012), p < 0.007), functional impairment (β(95%CI) -0.002(-0.003;-0.001), p < 0.001), and pain impairment (β(95%CI) 0.004(0.002;0.006), p = 0.001). Field testing provided basic numbers for adverse life events for the Danish general population, with a cumulated lifetime adversity mean (SD), 5.9 (3.7). Compared to the US there were lower rates of violence, social/environmental stress, and disaster. Conclusions: The results from the original version were replicated, indicating high construct validity. Furthermore, content validity was good.
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Affiliation(s)
- Tina Birgitte Wisbech Carstensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus University, Aarhus C, Denmark
| | - Eva Ørnbøl
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus University, Aarhus C, Denmark
| | - Per Fink
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus University, Aarhus C, Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen K, Denmark.,Faculty of Medicine, Aalborg University, Aalborg East, Denmark
| | - Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Anja Lykke Madsen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | | | - Lene Falgaard Eplov
- Mental, Health Services, Mental Health Centre Copenhagen, Copenhagen Ø, Denmark
| | - Lisbeth Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus University, Aarhus C, Denmark
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Hoffmann D, Rask CU, Hedman-Lagerlöf E, Eilenberg T, Frostholm L. Accuracy of self-referral in health anxiety: comparison of patients self-referring to internet-delivered treatment versus patients clinician-referred to face-to-face treatment. BJPsych Open 2019; 5:e80. [PMID: 31496462 PMCID: PMC6737511 DOI: 10.1192/bjo.2019.54] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Severe health anxiety is a chronic and costly disorder if untreated. Patient self-referral may lower barriers to treatment and decrease diagnostic delay. AIMS This study evaluated the accuracy of self-referral for severe health anxiety and compared characteristics of patients self-referred to internet-delivered treatment with patients referred by a clinician to face-to-face treatment. METHOD Two trials in the same clinic employed different referral methods for health anxiety, namely self-referral and clinician-referral (trial registration: clinicaltrials.gov: NCT01158430 and NCT02735434). The trials were conducted at different time points but with largely comparable eligibility criteria. The accuracy of the recruitment methods was compared by looking at the number of eligible patients in the two trials. Patients completed a baseline questionnaire and subsequently underwent a diagnostic interview by experienced clinicians. Mean differences in self-report and clinical data explored between-group demographic and clinical characteristics. RESULTS In total, 101/151 (67%) self-referred patients were eligible compared with 126/254 (50%) clinician-referred patients (P = 0.001). Self-referred patients were 3.4 years older (P = 0.008) and had a somewhat higher educational level (P = 0.030). Patients who self-referred reported significantly higher levels of health anxiety, emotional distress and somatic symptoms compared with clinician-referred patients. Yet, they had less clinician-assessed comorbid anxiety disorders (P<0.001) and better physical health-related quality of life (P<0.001) suggesting a more distinct symptom profile. CONCLUSIONS Self-referral was found to be an accurate method to recruit highly relevant patients with treatment-demanding health anxiety. Thus, both self-referral and clinician-referral seem feasible and valid referral methods, but they may recruit patients with slightly different characteristics. DECLARATION OF INTEREST None.
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Affiliation(s)
- Ditte Hoffmann
- Postdoctoral Researcher, The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - Charlotte Ulrikka Rask
- Professor, Child and Adolescent Psychiatric Centre, Risskov, Aarhus University Hospital, Denmark
| | - Erik Hedman-Lagerlöf
- Associate Professor, Department of Clinical Neuroscience, Karolinska Institute, Sweden
| | - Trine Eilenberg
- Clinical Psychologist, Department of Occupational Medicine, Aarhus University Hospital, Denmark
| | - Lisbeth Frostholm
- Associate Professor, The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
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Udholm S, Nyboe C, Dantoft TM, Jørgensen T, Rask CU, Hjortdal VE. Small atrial septal defects are associated with psychiatric diagnoses, emotional distress, and lower educational levels. CONGENIT HEART DIS 2019; 14:803-810. [DOI: 10.1111/chd.12808] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Sebastian Udholm
- Department of Cardiothoracic Surgery Aarhus University Hospital Aarhus Denmark
| | - Camilla Nyboe
- Department of Cardiothoracic Surgery Aarhus University Hospital Aarhus Denmark
| | - Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention Bispebjerg & Frederiksberg Hospital Capital Region Copenhagen Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention Bispebjerg & Frederiksberg Hospital Capital Region Copenhagen Denmark
- Department of Public Health, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
- Faculty of Medicine Aalborg University Aalborg Denmark
| | - Charlotte U. Rask
- Department of Child and Adolescent Psychiatry, Psychiatry Aarhus University Hospital Aarhus Denmark
| | - Vibeke E. Hjortdal
- Department of Cardiothoracic Surgery Aarhus University Hospital Aarhus Denmark
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11
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Thastum MM, Rask CU, Naess-Schmidt ET, Jensen JS, Frederiksen OV, Tuborgh A, Svendsen SW, Nielsen JF, Schröder A. Design of an early intervention for persistent post-concussion symptoms in adolescents and young adults: A feasibility study. NeuroRehabilitation 2018; 43:155-167. [PMID: 30040756 DOI: 10.3233/nre-172391] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND About 5-15 % of patients with concussion experience persistent post-concussion symptoms (PCS) longer than 3 months post-injury. OBJECTIVE To explore the feasibility of a new intervention for young patients with persistent PCS and long-term changes after intervention. METHODS Thirty-two consecutive patients (15-30 years) with persistent PCS 2-4 months post-injury were recruited from a cohort study or referred to a non-randomized feasibility study of an individually tailored, 8-week, multidisciplinary intervention. Assessment was performed at baseline, end of intervention (EOI), and at 3- and 12-month follow-up (FU). Main measures were The Experience of Service Questionnaire (ESQ), Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and The Quality of Life after Brain Injury - Overall Scale (QOLIBRI-OS). RESULTS Twenty-three (72%) patients completed the intervention. The ESQ demonstrated high patient satisfaction. There was a decrease of PCS and an increase in quality of life from baseline to EOI: RPQ score -8.9 points, 95% CI 4.5 to 13.3, p < 0.001; QOLIBRI-OS score +10.5 points, 95% CI 2.5 to 18.5, p = 0.010. Improvement was maintained at 3- and 12-month FU. CONCLUSION The new early intervention is feasible and may prevent chronification of PCS. An RCT is currently performed to evaluate the effect of the intervention.
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Affiliation(s)
- Mille Moeller Thastum
- The Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- The Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark.,Child and Adolescent Psychiatric Center, Risskov, Aarhus University Hospital, Denmark
| | | | | | - Oana-Veronica Frederiksen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Astrid Tuborgh
- The Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark.,Child and Adolescent Psychiatric Center, Risskov, Aarhus University Hospital, Denmark
| | - Susanne Wulff Svendsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Joergen Feldbaek Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Andreas Schröder
- The Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark
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12
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13
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Curto M, Pompili E, Silvestrini C, Bellizzi P, Navari S, Pompili P, Manzi A, Bianchini V, Carlone C, Ferracuti S, Nicolò G, Baldessarini RJ. A novel SCL-90-R six-item factor identifies subjects at risk of early adverse outcomes in public mental health settings. Psychiatry Res 2018; 267:376-381. [PMID: 29957556 DOI: 10.1016/j.psychres.2018.06.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/28/2018] [Accepted: 06/13/2018] [Indexed: 11/29/2022]
Abstract
To increase access to treatment, Italy made assessment at community mental health centers (CMHCs) independent of medical referral, resulting in increased numbers of patients to be triaged efficiently. To support this process, we evaluated SCL-90-R item-ratings to identify factors that best predicted adverse early outcomes among persons seeking first-time CMHC care in a 24-month period in Rome. A psychiatric nurse screened subjects with a brief interview and self-administered SCL-90-R and psychiatrists provided CGI ratings and ICD-9 diagnosis. Of 832 screened subjects, 32 (3.85%) were hospitalized or attempted suicide within 90 days. Six SCL-90 items (15,41,55,57,78,88) scored much higher with than without such adverse outcomes; their sum is proposed as a predictive measure ("SCL-6″). In binary multivariable logistic modeling, this factor, but not age, sex, diagnosis, or other SCL-90-derived subscales strongly predicted adverse outcomes. A ROC curve for SCL-6 reflected a strong separation between subjects with versus without adverse outcomes (AUC = 0.76). This simple screening tool may support timely identification of patients at risk of early adverse clinical outcome who require especially close follow-up.
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Affiliation(s)
- Martina Curto
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome 00185, Italy; Department of Mental Health, ASL Roma 5, Via degli Esplosivi 9, Colleferro (RM) 00034, Italy; International Mood & Psychotic Disorders Research Consortium, Mailman Research Center, McLean Hospital, 15 Mill Street, Belmont, MA 02478-9106, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Enrico Pompili
- Department of Mental Health, ASL Roma 5, Via degli Esplosivi 9, Colleferro (RM) 00034, Italy
| | - Cristiana Silvestrini
- Department of Mental Health, ASL Roma 5, Via degli Esplosivi 9, Colleferro (RM) 00034, Italy
| | - Pina Bellizzi
- Department of Mental Health, ASL Roma 5, Via degli Esplosivi 9, Colleferro (RM) 00034, Italy
| | - Serena Navari
- Department of Mental Health, ASL Roma 5, Via degli Esplosivi 9, Colleferro (RM) 00034, Italy
| | - Pieritalo Pompili
- Department of Mental Health, ASL Roma 5, Via degli Esplosivi 9, Colleferro (RM) 00034, Italy
| | - Agostino Manzi
- Department of Mental Health, ASL Roma 5, Via degli Esplosivi 9, Colleferro (RM) 00034, Italy
| | - Valeria Bianchini
- Department of Mental Health, ASL Roma 5, Via degli Esplosivi 9, Colleferro (RM) 00034, Italy
| | - Cristiano Carlone
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome 00185, Italy
| | - Stefano Ferracuti
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome 00185, Italy
| | - Giuseppe Nicolò
- Department of Mental Health, ASL Roma 5, Via degli Esplosivi 9, Colleferro (RM) 00034, Italy
| | - Ross J Baldessarini
- International Mood & Psychotic Disorders Research Consortium, Mailman Research Center, McLean Hospital, 15 Mill Street, Belmont, MA 02478-9106, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Mehlsen M, Hegaard L, Ørnbøl E, Jensen JS, Fink P, Frostholm L. The effect of a lay-led, group-based self-management program for patients with chronic pain: a randomized controlled trial of the Danish version of the Chronic Pain Self-Management Programme. Pain 2017; 158:1437-1445. [PMID: 28644822 PMCID: PMC5515636 DOI: 10.1097/j.pain.0000000000000931] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 04/03/2017] [Accepted: 04/19/2017] [Indexed: 11/27/2022]
Abstract
The Stanford Chronic Pain Self-Management Programme (CPSMP) consists of 6 2½-hour weekly workshops focusing on how to manage pain in daily life. The workshops are facilitated by 2 workshop leaders of whom at least 1 must suffer from a long-term pain condition. The program is highly structured and manualized. Only few controlled trials testing the effect of CPSMP exist. Enrolled in the study were 424 adults from 19 Danish municipalities, (72% women; age: 25-93 years) with pain of any etiology and great variation in pain history (0-50 yrs). Of these, 216 were randomized to a lay-led version of the CPSMP. The primary outcome was pain-related disability. Secondary outcomes were pain, pain catastrophizing, self-efficacy, emotional distress, physical symptoms, and illness worry. Outcomes were measured before randomization, immediately after the CPSMP (response rate: 94%), and at 3-month follow-up (response rate: 92%). National register data on health expenditure were obtained to examine effects on health care use. ClinicalTrials.gov Identifier: NCT01306747. The CPSMP had no effect on the primary outcome pain-related disability or on health expenditure during intervention and follow-up period. Small positive effects on emotional distress and illness worry 3 months after CPSMP were observed. Lay-led CPSMP is not recommended as treatment for chronic pain-related disability. This heterogeneous group of patients with pain did not benefit from the CPSMP except for a small, but clinically insignificant improvement in psychological well-being.
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Affiliation(s)
- Mimi Mehlsen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Lea Hegaard
- Danish Committee for Health Education, Copenhagen, Denmark
| | - Eva Ørnbøl
- Research Clinic for Functional Disorders, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Søndergaard Jensen
- Research Clinic for Functional Disorders, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Per Fink
- Research Clinic for Functional Disorders, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lisbeth Frostholm
- Research Clinic for Functional Disorders, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Vollrath ME, Sengpiel V, Landolt MA, Jacobsson B, Latal B. Is maternal trait anxiety a risk factor for late preterm and early term deliveries? BMC Pregnancy Childbirth 2016; 16:286. [PMID: 27680098 PMCID: PMC5041314 DOI: 10.1186/s12884-016-1070-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 09/13/2016] [Indexed: 12/02/2022] Open
Abstract
Background Anxiety is associated with preterm deliveries in general (before week 37 of pregnancy), but is that also true for late preterm (weeks 34/0–36/6) and early term deliveries (weeks 37/0–38/6)? We aim to examine this association separately for spontaneous and provider-initiated deliveries. Methods Participants were pregnant women from the Norwegian Mother and Child Cohort Study (MoBa), which has been following 95 200 pregnant women since 1999. After excluding pregnancies with serious health complications, 81 244 participants remained. National ultrasound records were used to delineate late preterm, early term, and full-term deliveries, which then were subdivided into spontaneous and provider-initiated deliveries. We measured trait anxiety based on two ratings of the anxiety items on the Symptom Checklist-8 (Acta Psychiatr Scand 87:364–7, 1993). Trait anxiety was transformed into categorizing the score at the mean and at ± 2 standard deviations. Results Trait anxiety was substantially associated with late preterm and early term deliveries after adjusting for confounders. In the whole sample, women with the highest anxiety scores (+2 standard deviations) were more likely [(odds ratio (OR) = 1.7; 95 % confidence-interval (CI) 1.3-2.0)] to delivering late preterm than women with the lowest anxiety scores. Their odds of delivering early term were also high (OR = 1.4; CI 1.3-1.6). Women with spontaneous deliveries and the highest anxiety scores had higher odds (OR = 1.4; CI 1.1-1.8) of delivering late preterm and early term (OR = 1.3; CI = 1.3-1.5). The corresponding odds for women with provider-initiated deliveries were OR = 1.7 (CI = 1.2-2.4) for late preterm and OR = 1.3 for early term (CI = 1.01-1.6). Irrespective of delivery onset, women with provider-initiated deliveries had higher levels of anxiety than women delivering spontaneously. However, women with high anxiety were equally likely to have provider-initiated or spontaneous deliveries. Conclusions This study is the first to show substantial associations between high levels of trait anxiety and late preterm delivery. Increased attention should be given to the mechanism underlying this association, including factors preceding the pregnancy. In addition, acute treatment should be offered to women displaying high levels of anxiety throughout pregnancy to avoid suffering for the mother and the child.
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Affiliation(s)
- Margarete Erika Vollrath
- Domain of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway. .,Psychological Institute, University of Oslo, Oslo, Norway.
| | - Verena Sengpiel
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Markus A Landolt
- University Children's Hospital Zurich, Zurich, Switzerland.,Department of Child and Adolescent Health Psychology, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - Bo Jacobsson
- Department of Obstetrics and Gynaecology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Genes and Environment, Norwegian Institute of Public Health, Oslo, Norway
| | - Beatrice Latal
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
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16
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Kallesøe KH, Schröder A, Wicksell RK, Fink P, Ørnbøl E, Rask CU. Comparing group-based acceptance and commitment therapy (ACT) with enhanced usual care for adolescents with functional somatic syndromes: a study protocol for a randomised trial. BMJ Open 2016; 6:e012743. [PMID: 27633643 PMCID: PMC5030556 DOI: 10.1136/bmjopen-2016-012743] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/17/2016] [Accepted: 08/24/2016] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Functional somatic syndromes (FSS) are common in adolescents, characterised by severe disability and reduced quality of life. Behavioural treatments such as acceptance and commitment therapy (ACT) has shown promising results in children and adolescents with FSS, but has focused on specific syndromes such as functional pain. The current study will compare the efficacy of group-based ACT with that of enhanced usual care (EUC) in adolescents with a range of FSS operationalised by the unifying construct of multiorgan bodily distress syndrome (BDS). METHODS AND ANALYSIS A total of 120 adolescents aged 15-19 and diagnosed with multiorgan BDS, of at least 12 months duration, will be assessed and randomised to either: (1) EUC: a manualised consultation with a child and adolescent psychiatrist and individualised treatment plan or (2) manualised ACT-based group therapy plus EUC. The ACT programme consists of 9 modules (ie, 27 hours) and 1 follow-up meeting (3 hours). The primary outcome is physical health, assessed by an Short Form Health Survey (SF-36) aggregate score 12 months after randomisation. Secondary outcomes include self-reported symptom severity, symptom interference, depression and anxiety, illness worry, perceived stress and global improvement; as well as objective physical activity and bodily stress response measured by heart rate variability, hair cortisol and inflammatory biomarkers. Process measures are illness perception, illness-related behaviour and psychological flexibility. ETHICS AND DISSEMINATION The study is conducted in accordance with Helsinki Declaration II. Approval has been obtained from the Science Ethics Committee of the Central Denmark Region and the Danish Data Protection. The results will be sought to be published according to the CONSORT statement in peer-reviewed journals. DISCUSSION This is one of the first larger randomised clinical trials evaluating the effect of a group-based intervention for adolescents with a range of severe FSS. TRIAL REGISTRATION NUMBER NCT02346071; Pre-results.
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Affiliation(s)
- Karen Hansen Kallesøe
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Andreas Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Rikard K Wicksell
- Behavior Medicine Pain Treatment Services, Karolinska, Stockholm, Sweden
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Eva Ørnbøl
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Regional Centre for Child and Adolescent Psychiatry, Risskov, Aarhus University Hospital, Aarhus, Denmark
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Eilenberg T, Fink P, Jensen JS, Rief W, Frostholm L. Acceptance and commitment group therapy (ACT-G) for health anxiety: a randomized controlled trial. Psychol Med 2016; 46:103-115. [PMID: 26281857 DOI: 10.1017/s0033291715001579] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Severe health anxiety is frequent and costly, yet rarely diagnosed or treated. Earlier treatment studies show problems with recruitment, dropout and recovery. In the current study, the authors aimed to test the effect of acceptance and commitment group therapy (ACT-G) compared to waitlist in patients with severe health anxiety. METHOD During March 2010 to April 2012, 126 consecutively referred patients meeting research criteria for severe health anxiety were block-randomized (1:1) to ACT-G or a 10 months' waitlist (Clinicaltrials.gov, no. NCT01158430). Patients allocated to ACT-G were treated in seven groups of nine patients between December 2010 and October 2012 and received nine weekly 3-h group sessions and a booster session consisting of ACT techniques. The primary outcome was decided a priori as the mean change in self-reported illness worry on the Whiteley-7 Index (WI) from baseline to 10 months' follow-up. Secondary outcomes were improvement in emotional distress and health-related quality of life at 10 months' follow-up. RESULTS Intention-to-treat analysis showed a statistically significant mean difference of 20.5 points [95% confidence interval (CI) 11.7-29.4, p < 0.001] on the WI between the groups at 10 months, and the between-group effect sizes were large (Cohen's d = 0.89, 95% CI 0.50-1.29). The number needed to treat was 2.4 (95% CI 1.4-3.4, p < 0.001). Diagnosis and treatment were well accepted by the patients. CONCLUSIONS ACT-G seems feasible, acceptable and effective in treating severe health anxiety.
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Affiliation(s)
- T Eilenberg
- The Research Clinic for Functional Disorders and Psychosomatics,Aarhus University Hospital,Aarhus,Denmark
| | - P Fink
- The Research Clinic for Functional Disorders and Psychosomatics,Aarhus University Hospital,Aarhus,Denmark
| | - J S Jensen
- The Research Clinic for Functional Disorders and Psychosomatics,Aarhus University Hospital,Aarhus,Denmark
| | - W Rief
- Department of Clinical Psychology and Psychotherapy,University of Marburg,Marburg,Germany
| | - L Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics,Aarhus University Hospital,Aarhus,Denmark
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Frostholm L, Ørnbøl E, Fink PK. Physical symptom attributions: a defining characteristic of somatoform disorders? Gen Hosp Psychiatry 2015; 37:147-52. [PMID: 25677210 DOI: 10.1016/j.genhosppsych.2015.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 12/04/2014] [Accepted: 01/08/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES We examined whether primary care patients were more likely to perceive a current health problem as 'physical illness only' as opposed to entailing psychological difficulties if they had a comorbid somatoform disorder compared to patients who had (a) both comorbid somatoform disorder and anxiety/depression or (b) comorbid anxiety and/or depression, and a reference group of (c) patients with well-defined physical disease. We examined whether attributions predicted future health expenditures. METHODS A total of 1209 of 1785 patients completed questions on patient-perceived illness. The physicians diagnosed the current health problem. A stratified subsample was interviewed using the Schedules for Clinical Assessment in Neuropsychiatry. Health expenditure was obtained from registers for a 2-year period. RESULTS The belief that the current health problem was only physical was endorsed by 86% of patients presenting physical disease, 58% of patients with somatoform disorders, 29% of patients with both somatoform disorders and anxiety/depression and 24% of patients with anxiety or depressive disorders (χ2=269.2, df=3, P<.0001). In a multiple regression model, a 'physical illness only' perception predicted lower health expenditures [β = -0.31, 95% confidence interval (-0.55; -0.07), P=.013]. CONCLUSIONS The prevalent assumption that physical symptom attributions are a central aspect in somatoform disorders is not supported by the current study.
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Affiliation(s)
- Lisbeth Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics, Noerrebrogade 44, Aarhus University Hospital, DK-8000 Aarhus C, Denmark.
| | - Eva Ørnbøl
- The Research Clinic for Functional Disorders and Psychosomatics, Noerrebrogade 44, Aarhus University Hospital, DK-8000 Aarhus C, Denmark
| | - Per K Fink
- The Research Clinic for Functional Disorders and Psychosomatics, Noerrebrogade 44, Aarhus University Hospital, DK-8000 Aarhus C, Denmark
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Rask MT, Rosendal M, Fenger-Grøn M, Bro F, Ørnbøl E, Fink P. Sick leave and work disability in primary care patients with recent-onset multiple medically unexplained symptoms and persistent somatoform disorders: a 10-year follow-up of the FIP study. Gen Hosp Psychiatry 2015; 37:53-9. [PMID: 25456975 DOI: 10.1016/j.genhosppsych.2014.10.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 10/10/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The objective was to explore patient characteristics and 10-year outcome of sick leave and work disability for patients with recent-onset multiple medically unexplained symptoms (MUS) and persistent somatoform disorders (SD). METHOD Consecutive patients consulting their family physician (FP) completed a preconsultation questionnaire on symptoms and mental illness (n=1785). The main problem was categorized by the FP after the consultation, and a stratified subsample was examined using a standardized diagnostic interview (n=701). Patients were grouped into three cohorts: recent onset of multiple MUS (n=84); Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, persistent SD (n=183); and reference group with well-defined physical disease according to FP (n=833). Register data on sick leave and disability pension were obtained. RESULTS At index consultation, disability pension was received by 8.3% (n=7) in the recent-onset multiple MUS group, 19.1% (n=35) in the SD group and 3.5% (n=29) in the reference group. Both the recent-onset multiple MUS group [hazard ratio (HR)=2.28, 95% confidence interval (CI): 1.14-4.55] and the SD group (HR=3.26, 95% CI:1.93-5.51) had increased risk of new disability pension awards. Furthermore, the SD group had increased risk of sick leave. CONCLUSIONS Both recent-onset and persistent MUS have significant long-term impact on patient functioning in regard to working life; this calls for early recognition and adequate management of MUS in primary care.
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Affiliation(s)
- Mette T Rask
- Research Unit for General Practice, Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark.
| | - Marianne Rosendal
- Research Unit for General Practice, Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark.
| | - Morten Fenger-Grøn
- Research Unit for General Practice, Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark.
| | - Flemming Bro
- Research Unit for General Practice, Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark.
| | - Eva Ørnbøl
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Barthsgade 5, 8200 Aarhus N, Denmark.
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Barthsgade 5, 8200 Aarhus N, Denmark.
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Frostholm L, Petrie KJ, Ornbøl E, Fink P. Are illness perceptions related to future healthcare expenditure in patients with somatoform disorders? Psychol Med 2014; 44:2903-2911. [PMID: 25066790 DOI: 10.1017/s003329171400035x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Somatoform disorders are costly for society in terms of increased healthcare expenditure. Patients' illness perceptions have been found to play a role in somatoform disorders. However, it is unclear whether illness perceptions predict higher health costs in these patients. METHOD A total of 1785 primary care patients presenting a new health complaint completed a questionnaire on their illness perceptions and emotional distress before the consultation. The physicians completed a questionnaire for each patient on diagnostics after the consultation. In a stratified subsample, physician interviewers established diagnoses of DSM-IV somatization and undifferentiated somatoform disorders (n = 144) using the Schedules for Clinical Assessment in Neuropsychiatry. Healthcare expenditure was obtained from Danish health registers for a 2-year follow-up period. RESULTS Patients had more negative perceptions of their well-defined physical health problems when they had a co-morbid somatoform disorder. A strong illness identity [β = 0.120, 95% confidence interval (CI) 0.029-0.212, p = 0.012], perceived negative consequences (β = 0.010, 95% CI 0.001-0.019, p = 0.024), a long timeline perspective (β = 0.013, 95% CI 0.005-0.021, p = 0.001), low personal control (β = - 0.009, 95% CI -0.015 to -0.002, p = 0.011) and negative emotional representations (β = 0.009, 95% CI 0.002-0.017, p = 0.020) predicted healthcare expenditure in somatoform disorders. CONCLUSIONS The results suggest that illness perceptions play a role in the perpetuation of symptoms in somatoform disorders and predict higher future healthcare expenditure among a subgroup of these patients.
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Affiliation(s)
- L Frostholm
- Research Clinic for Functional Disorders,Aarhus University Hospital,Aarhus,Denmark
| | - K J Petrie
- Department of Psychological Medicine,Auckland University,Auckland,New Zealand
| | - E Ornbøl
- Research Clinic for Functional Disorders,Aarhus University Hospital,Aarhus,Denmark
| | - P Fink
- Research Clinic for Functional Disorders,Aarhus University Hospital,Aarhus,Denmark
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Risk of vaginal bleeding and postpartum hemorrhage after use of antidepressants in pregnancy: a study from the Norwegian Mother and Child Cohort Study. J Clin Psychopharmacol 2014; 34:143-8. [PMID: 24135843 DOI: 10.1097/jcp.0000000000000036] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to examine obstetric bleeding outcomes after exposure during pregnancy to selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic (TCAs), and other antidepressants (OADs).The Norwegian Mother and Child Cohort Study and the Medical Birth Registry of Norway constituted the data source for the present study. We included 57,279 pregnant women, of which 1.02% reported use of antidepressants during pregnancy, mostly SSRIs/SNRIs (0.92%). We categorized exposure according to antidepressant use in pregnancy (SSRIs/SNRIs, n = 527; TCAs/OADs, n = 59; nonexposed, nondepressed, n = 55,411) with inclusion of a disease comparison group (nonexposed, depressed, n = 1282). We used logistic regression to estimate adjusted odds ratio (aOR) and 95% confidence interval (CI) for vaginal bleeding outcomes in pregnancy and postpartum hemorrhage.Compared with nonexposed subjects, first trimester exposure to SSRIs/SNRIs or TCAs/OADs did not confer any increased risk of vaginal bleeding in early pregnancy (aOR, 0.91; 95% CI, 0.72-1.16 and aOR, 0.83; 95% CI, 0.36-1.92, respectively). No increased risk for vaginal bleeding in midpregnancy was observed among users of SSRIs/SNRIs (aOR, 0.81; 95% CI, 0.50-1.31) or TCAs/OADs (aOR, 0.96; 95% CI, 0.26-3.53) in second trimester. Exposure to SSRIs/SNRIs during gestational week 30 to childbirth did not confer any increased risk of postpartum hemorrhage after vaginal (aOR, 0.90; 95% CI, 0.47-1.74) or cesarean (aOR, 1.47; 95% CI, 0.51-4.22) delivery. Women in the disease comparison group presented a significant moderate increased risk of vaginal bleeding in early pregnancy (aOR, 1.22; 95% CI, 1.06-1.39) and midpregnancy (aOR, 1.28; 95% CI, 1.07-1.55) but not postpartum.Among this Norwegian cohort of pregnant women, use of antidepressants in pregnancy was not associated with any obstetrical bleeding outcome.
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Skakkebæk A, Gravholt CH, Rasmussen PM, Bojesen A, Jensen JS, Fedder J, Laurberg P, Hertz JM, Ostergaard JR, Pedersen AD, Wallentin M. Neuroanatomical correlates of Klinefelter syndrome studied in relation to the neuropsychological profile. NEUROIMAGE-CLINICAL 2013; 4:1-9. [PMID: 24266006 PMCID: PMC3830066 DOI: 10.1016/j.nicl.2013.10.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 10/06/2013] [Accepted: 10/21/2013] [Indexed: 10/31/2022]
Abstract
Brain imaging in Klinefelter syndrome (47, XXY) (KS), a genetic disorder characterized by the presence of an extra X chromosome, may contribute to understanding the relationship between gene expression, brain structure, and subsequent cognitive disabilities and psychiatric disorders. We conducted the largest to date voxel-based morphometry study of 65 KS subjects and 65 controls matched for age and education and correlated these data to neuropsychological test scores. The KS patients had significantly smaller total brain volume (TBV), total gray matter volume (GMV) and total white matter volume (WMV) compared to controls, whereas no volumetric difference in cerebral spinal fluid (CSF) was found. There were no differences in TBV, GMV, WMV or CSF between testosterone treated KS (T-KS) and untreated KS (U-KS) patients. Compared to controls, KS patients had significantly decreased GMV bilaterally in insula, putamen, caudate, hippocampus, amygdala, temporal pole and frontal inferior orbita. Additionally, the right parahippocampal region and cerebellar volumes were reduced in KS patients. KS patients had significantly larger volumes in right postcentral gyrus, precuneus and parietal regions. Multivariate classification analysis discriminated KS patients from controls with 96.9% (p < 0.001) accuracy. Regression analyses, however, revealed no significant association between GMV differences and cognitive and psychological factors within the KS patients and controls or the groups combined. These results show that although gene dosage effect of having and extra X-chromosome may lead to large scale alterations of brain morphometry and extended cognitive disabilities no simple correspondence links these measures.
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Affiliation(s)
- Anne Skakkebæk
- Department of Endocrinology and Internal Medicine (MEA), Aarhus University Hospital, 8000 Aarhus C, Denmark
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Acceptance and commitment group therapy for health anxiety--results from a pilot study. J Anxiety Disord 2013; 27:461-8. [PMID: 23871841 DOI: 10.1016/j.janxdis.2013.06.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 05/03/2013] [Accepted: 06/01/2013] [Indexed: 10/26/2022]
Abstract
Health anxiety (or hypochondriasis) is prevalent, may be persistent and disabling for the sufferers and associated with high societal costs. Acceptance and Commitment Therapy (ACT) is a new third-wave behavioral cognitive therapy that has not yet been tested in health anxiety. 34 consecutive Danish patients with severe health anxiety were referred from general practitioners or hospital departments and received a ten-session ACT group therapy. Patients were followed up by questionnaires for 6 months. There were significant reductions in health anxiety, somatic symptoms and emotional distress at 6 months compared to baseline: a 49% reduction in health anxiety (Whiteley-7 Index), a 47% decrease in emotional distress (SCL-8), and a 40% decrease in somatic symptoms (SCL-90R Somatization Subscale). The patients' emotional representations and perception of the consequences of their illness (IPQ) improved significantly, and 87% of the patients were very or extremely satisfied with the treatment.
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Schröder A, Rehfeld E, Ornbøl E, Sharpe M, Licht RW, Fink P. Cognitive-behavioural group treatment for a range of functional somatic syndromes: randomised trial. Br J Psychiatry 2012; 200:499-507. [PMID: 22539780 DOI: 10.1192/bjp.bp.111.098681] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many specialty-specific functional somatic syndrome diagnoses exist to describe people who are experiencing so-called medically unexplained symptoms. Although cognitive-behavioural therapy can be effective in the management of such syndromes, it is rarely available. A cognitive-behavioural therapy suitable for group treatment of people with different functional somatic syndromes could address this problem. AIMS To test the efficacy of a cognitive-behavioural therapy (Specialised Treatment for Severe Bodily Distress Syndromes, STreSS) designed for patients with a range of severe functional somatic syndromes. METHOD A randomised controlled trial (clinicaltrials.gov, NCT00132197) compared STreSS (nine 3.5 h sessions over 4 months, n = 54) with enhanced usual care (management by primary care physician or medical specialist, n = 66). The primary outcome was improvement in aggregate score on subscales of the 36-item Short Form Health Survey (physical functioning, bodily pain and vitality) at 16 months. RESULTS Participants receiving STreSS had a greater improvement on the primary outcome (adjusted mean difference 4.0, 95% CI 1.4-6.6, P = 0.002) and on most secondary outcomes. CONCLUSIONS In the management of functional somatic syndromes, a cognitive-behavioural group treatment was more effective than enhanced usual care.
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Affiliation(s)
- Andreas Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark.
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Solberg Ø, Grønning Dale MT, Holmstrøm H, Eskedal LT, Landolt MA, Vollrath ME. Trajectories of maternal mental health: a prospective study of mothers of infants with congenital heart defects from pregnancy to 36 months postpartum. J Pediatr Psychol 2012; 37:687-96. [PMID: 22408057 DOI: 10.1093/jpepsy/jss044] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To chart mothers' trajectories of mental health from pregnancy to 36 months postpartum in order to investigate the association between infants' congenital heart defects (CHD) and compromised maternal mental health. METHODS Mothers of infants with mild, moderate, or severe CHD (n = 141) and mothers (n = 36,437) enrolled in the Norwegian Mother and Child Cohort Study were assessed at regular intervals from pregnancy up to 36 months postpartum, including measurements at 6 and 18 months, using an 8-item version of the Hopkins Symptom Checklist-25. RESULTS Mean score trajectories of SCL-8 for mothers of infants with severe CHD deviated significantly from cohort controls 6, 18, and 36 months postpartum, indicating heightened symptoms of depression and anxiety. CONCLUSIONS Mothers of infants with severe CHD are at risk of compromised mental health from delivery to 36 months postpartum. Strain due to CHD-related interventions is identified as a possible partial mediator of the distress.
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Affiliation(s)
- Øivind Solberg
- Department of Psychosomatics and Health Behaviour, Norwegian Institute of Public Health, Box 4404 Nydalen, 0403 Oslo, Norway.
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Are there gender differences in coping with neck pain following acute whiplash trauma? A 12-month follow-up study. Eur J Pain 2012; 16:49-60. [DOI: 10.1016/j.ejpain.2011.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Adams SS, Eberhard-Gran M, Hofoss D, Eskild A. Maternal emotional distress in pregnancy and delivery of a small-for-gestational age infant. Acta Obstet Gynecol Scand 2011; 90:1267-73. [PMID: 21644934 DOI: 10.1111/j.1600-0412.2011.01204.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the association between maternal emotional distress in pregnancy and delivery of a small-for-gestational age offspring. DESIGN A cohort study in pregnancy. SETTING Fifty hospitals with a maternity ward in Norway during 1998-2008. POPULATION Seventy-one thousand eight hundred and ninety-eight women with a singleton pregnancy in the Norwegian Mother and Child Cohort Study were followed from early pregnancy to delivery. METHODS Information on presence of emotional distress was obtained through self-administered questionnaires in pregnancy weeks 17 and 30 and on birthweight, gestational length at delivery and sex by linkage to the Medical Birth Registry of Norway. Emotional distress was measured by short forms of the Hopkins Symptom Checklist-25. MAIN OUTCOME MEASURE Small-for-gestational age offspring (birthweight <2.5th percentile). RESULTS Being emotionally distressed at gestational weeks 17 and 30 was not significantly associated with subsequent delivery of a small-for-gestational age infant (adjusted odds ratio 1.16; 95% confidence interval 0.87-1.54). This estimate was adjusted for smoking in pregnancy, parity, diabetes, pre-eclampsia, body mass index, education and maternal age. CONCLUSIONS Emotional distress during pregnancy was not associated with subsequent delivery of a small-for-gestational age infant.
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Affiliation(s)
- Samantha S Adams
- Health Services Research Centre, Akershus University Hospital, Lørenskog, Norway.
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Hall NM, Kuzminskyte R, Pedersen AD, Ørnbøl E, Fink P. The relationship between cognitive functions, somatization and behavioural coping in patients with multiple functional somatic symptoms. Nord J Psychiatry 2011; 65:216-24. [PMID: 21062124 DOI: 10.3109/08039488.2010.528024] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Patients with multiple functional somatic symptoms (MFS) often express cognitive complaints. The aim of this descriptive study was to investigate whether these patients have cognitive deficits and whether the patients' cognitive functioning relates to their experience of physical and psychological distress and to their use of pain-related coping strategies. METHODS Neuropsychological assessment of verbal ability, psychomotor speed, attention, working memory, perceptual organization and memory, was conducted on 22 MFS patients and 27 healthy age- and gender-matched controls. Psychological distress, health anxiety, health status and pain coping were measured with questionnaires [Symptom Checklist 90-Revised (SCL-somatization, SCL-depression, SCL-anxiety), the Whiteley-7 scale, the Short Form (SF-36) and the Coping Strategies Questionnaire (CSQ)]. RESULTS For patients, a high score on the SCL-somatization subscale was associated with poor performance on tests of attention and psychomotor speed, and with a high score on the coping scale Increasing behavioural activities. A high score on this coping scale was associated with poor performance on tests of verbal ability and executive functioning. After controlling for years of education, controls performed significantly better than patients on verbal as well as performance IQ scales but not on tests of memory. CONCLUSION In the present study, we found that physical complaints are related to deficits in attention and psychomotor speed. Moreover, our results suggest that poor verbal skills may play a role in the development of MFS because of an increased tendency to apply behavioural/avoidant coping strategies. We suggest that treatment of MFS should involve training of attention as well as practicing the use of cognitive coping strategies.
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Affiliation(s)
- Nicoline M Hall
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospitals, Denmark.
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Sheng L. Better detection of non-psychotic mental disorders by case description method in China. Asian J Psychiatr 2010; 3:227-32. [PMID: 23050893 DOI: 10.1016/j.ajp.2010.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 07/13/2010] [Accepted: 07/19/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The tools for detection of mental disorders in China were all translated from their western versions. Descriptions of three common psychiatric syndromes (neurasthenia, anxiety and depression) were applied to psychiatric outpatients and normal controls to test their validity in detection of non-psychotic mental disorders and the psychometric quality was compared with that of Hospital Anxiety and Depression Scale (HADS). METHODS A consecutive sample of psychiatric outpatients were collected as a patient group (N=51) after psychotic patients were ruled out. The research psychiatrist held clinical interviews under the guide of Mini International Neuro-psychiatric Interview and gave a psychiatric diagnosis based on ICD-10. The normal control group (N=29) came from a general hospital and the community nearby. Both groups had read descriptions and ranked the similarity of their situations with the descriptions; they also had completed the HADS. RESULTS Of the 51 outpatients, the most common diagnosis was neuroses non-specified (N=14, 27.5%, including neurasthenia); following that, anxiety disorders (N=13, 25.5%) and depressive disorders (N=12, 23.5%). With the case description method, the areas under the Receiver Operating Characteristic (ROC) for the three syndromes and the total score were 0.955, 0.865, 0.910 and 0.998, respectively. To distinguish between the two groups, the cut-off of the total score was 3, the sensitivity was 98%, the specificity was 93%, even better than that of HADS total score (sensitivity 88%, specificity 90%). CONCLUSION This preliminary study suggested better validity of case description method than HADS in detection of non-psychotic disorders, which warrants further confirmative study.
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Affiliation(s)
- Li Sheng
- Huayuan Bei Rd 51, Haidian District, Beijing 100191, China
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Fink P, Schröder A. One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders. J Psychosom Res 2010; 68:415-26. [PMID: 20403500 DOI: 10.1016/j.jpsychores.2010.02.004] [Citation(s) in RCA: 204] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 02/04/2010] [Accepted: 02/04/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND In order to clarify the classification of physical complaints not attributable to verifiable, conventionally defined diseases, a new diagnosis of bodily distress syndrome was introduced. The aim of this study was to test if patients diagnosed with one of six different functional somatic syndromes or a DSM-IV somatoform disorder characterized by physical symptoms were captured by the new diagnosis. METHOD A stratified sample of 978 consecutive patients from neurological (n=120) and medical (n=157) departments and from primary care (n=701) was examined applying post-hoc diagnoses based on the Schedules for Clinical Assessment in Neuropsychiatry diagnostic instrument. Diagnoses were assigned only to clinically relevant cases, i.e., patients with impairing illness. RESULTS Bodily distress syndrome included all patients with fibromyalgia (n=58); chronic fatigue syndrome (n=54) and hyperventilation syndrome (n=49); 98% of those with irritable bowel syndrome (n=43); and at least 90% of patients with noncardiac chest pain (n=129), pain syndrome (n=130), or any somatoform disorder (n=178). The overall agreement of bodily distress syndrome with any of these diagnostic categories was 95% (95% CI 93.1-96.0; kappa 0.86, P<.0001). Symptom profiles of bodily distress syndrome organ subtypes were similar to those of the corresponding functional somatic syndromes with diagnostic agreement ranging from 90% to 95%. CONCLUSION Bodily distress syndrome seem to cover most of the relevant "somatoform" or "functional" syndromes presenting with physical symptoms, not explained by well-recognized medical illness, thereby offering a common ground for the understanding of functional somatic symptoms. This may help unifying research efforts across medical disciplines and facilitate delivery of evidence-based care.
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Affiliation(s)
- Per Fink
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, 8000 Aarhus, Denmark.
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Fink P, Ørnbøl E, Christensen KS. The outcome of health anxiety in primary care. A two-year follow-up study on health care costs and self-rated health. PLoS One 2010; 5:e9873. [PMID: 20352043 PMCID: PMC2844425 DOI: 10.1371/journal.pone.0009873] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 02/13/2010] [Indexed: 11/18/2022] Open
Abstract
Background Hypochondriasis is prevalent in primary care, but the diagnosis is hampered by its stigmatizing label and lack of valid diagnostic criteria. Recently, new empirically established criteria for Health anxiety were introduced. Little is known about Health anxiety's impact on longitudinal outcome, and this study aimed to examine impact on self-rated health and health care costs. Methodology/Principal Findings 1785 consecutive primary care patients aged 18–65 consulting their family physicians (FPs) for a new illness were followed-up for two years. A stratified subsample of 701 patients was assessed by the Schedules for Clinical Assessment in Neuropsychiatry interview. Patients with mild (N = 21) and severe Health anxiety (N = 81) and Hypochondriasis according to the DSM-IV (N = 59) were compared with a comparison group of patients who had a well-defined medical condition according to their FPs and a low score on the screening questionnaire (N = 968). Self-rated health was measured by questionnaire at index and at three, 12, and 24 months, and health care use was extracted from patient registers. Compared with the 968 patients with well-defined medical conditions, the 81 severe Health anxiety patients and the 59 DSM-IV Hypochondriasis patients continued during follow-up to manifest significantly more Health anxiety (Whiteley-7 scale). They also continued to have significantly worse self-rated functioning related to physical and mental health (component scores of the SF-36). The severe Health anxiety patients used about 41–78% more health care per year in total, both during the 3 years preceding inclusion and during follow-up, whereas the DSM-IV Hypochondriasis patients did not have statistically significantly higher total use. A poor outcome of Health anxiety was not explained by comorbid depression, anxiety disorder or well-defined medical condition. Patients with mild Health anxiety did not have a worse outcome on physical health and incurred significantly less health care costs than the group of patients with a well-defined medical condition. Conclusions/Significance Severe Health anxiety was found to be a disturbing and persistent condition. It is costly for the health care system and must be taken seriously, i.e. diagnosed and treated. This study supports the validity of recently introduced new criteria for Health anxiety.
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Affiliation(s)
- Per Fink
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
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Søgaard HJ, Bech P. Psychometric analysis of Common Mental Disorders — Screening Questionnaire (CMD-SQ) in long-term sickness absence. Scand J Public Health 2009; 37:855-63. [PMID: 19717571 DOI: 10.1177/1403494809344653] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims: Mental disorders often go undetected in primary care, for persons awarded disability pension, and in sick-leave certificates. No validity tests of instruments for detection and measurement of mental disorders have been performed in long-term sickness absence (LSA). This is the aim of the present study for Common Mental Disorders — Screening Questionnaire (CMD-SQ). Methods: It is validity tested in a well-defined Danish population comprising all persons on continuous sickness absence just exceeding eight weeks. CMD-SQ is composed of SCL-SOM (somatization), Whiteley-7 (illness worry and conviction), SCL-ANX4 (anxiety), SCL-DEP6 (depression), SCL-8 (emotional disorder), and CAGE (alcohol dependency). Results: Of 2,414 incident persons on long-term sickness absence within one year, 1,121 participated in the study by filling in CMD-SQ and a subsample of 337 was diagnosed by a psychiatric examination including Present State Examination. Psychometric properties such as scalability and monotonicity, construct validity, and predictive validity were analyzed. Further change over time was analyzed. SCL-SOM and Whiteley-7 showed slight psychometric and screening statistics whereas a combined scale of SC-ANX4, SCL-DEP6, and SCL-8, called SCL-8AD, showed the best and excellent psychometric and screening statistics. Conclusions: SCL-8AD, a sub-scale of CMD-SQ, is a promising candidate for screening and measurement of mental disorders in long-term sickness absence.
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Affiliation(s)
- Hans Jørgen Søgaard
- Psychiatric Research Unit West, Central Region Denmark, Lægårdsvej 12, DK-7500 Holstebro
| | - Per Bech
- Psychiatric Research Unit, Frederiksborg General Hospital, Dyrehavevej 48, DK-3400 Hillerød
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Carstensen TBW, Frostholm L, Oernboel E, Kongsted A, Kasch H, Jensen TS, Fink P. Post-trauma ratings of pre-collision pain and psychological distress predict poor outcome following acute whiplash trauma: A 12-month follow-up study. Pain 2008; 139:248-259. [PMID: 18499350 DOI: 10.1016/j.pain.2008.04.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 03/11/2008] [Accepted: 04/08/2008] [Indexed: 11/19/2022]
Affiliation(s)
- Tina B W Carstensen
- The Research Clinic for Functional Disorders and Psychosomatics, Noerrebrogade 44, Aarhus University Hospital, DK-8000 Aarhus, Denmark The Back Research Center, Backcenter Funen, Ringe, Denmark Department of Neurology, Aarhus University Hospital, Aarhus, Denmark Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
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Ahmed S, Ernst P, Tamblyn R, Colman N. Evaluating asthma control: a comparison of measures using an item response theory approach. J Asthma 2007; 44:547-54. [PMID: 17885858 DOI: 10.1080/02770900701537024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Self-reported symptoms, FEV(1), and clinician judgment are all used to evaluate asthma control. The relative utility of each measure of control cannot be easily assessed. Item response theory (IRT) approaches allow for the direct comparison of the utility of different types of measures used to assess control. The objective of this study was to evaluate the validity and reliability of evaluating asthma control using symptom, clinical, and physiologic measures by applying an IRT approach. Subjects receiving care at an asthma clinic were evaluated on measures of asthma control. Based on 114 evaluations, IRT parameters were estimated to evaluate whether measures assessed a single underlying construct, the hierarchical relationship between the measures and the level of control each measure assessed, whether measures targeted all levels of asthma control, and whether the scoring categories distinguished between different levels of control. Infit statistics (0.74-1.5) for individual items showed that all items fit the underlying concept of asthma control. The reproducibility of the hierarchal scale was high (0.9). The results also demonstrated that items differentiated two strata (high, low) of control. The gaps in the hierarchal scale showed that for many subjects (37%) there were no items at their level of asthma control. The IRT approach identified gaps in current measurement that need to be addressed to provide more precise evaluations of control required to accurately monitor changes in patient status.
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Affiliation(s)
- Sara Ahmed
- Department of Medicine, McGill University, Montreal, Canada.
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Emons WHM, Meijer RR, Denollet J. Negative affectivity and social inhibition in cardiovascular disease: evaluating type-D personality and its assessment using item response theory. J Psychosom Res 2007; 63:27-39. [PMID: 17586335 DOI: 10.1016/j.jpsychores.2007.03.010] [Citation(s) in RCA: 151] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Revised: 02/19/2007] [Accepted: 03/01/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Individuals with increased levels of both negative affectivity (NA) and social inhibition (SI)-referred to as type-D personality-are at increased risk of adverse cardiac events. We used item response theory (IRT) to evaluate NA, SI, and type-D personality as measured by the DS14. The objectives of this study were (a) to evaluate the relative contribution of individual items to the measurement precision at the cutoff to distinguish type-D from non-type-D personality and (b) to investigate the comparability of NA, SI, and type-D constructs across the general population and clinical populations. METHODS Data from representative samples including 1316 respondents from the general population, 427 respondents diagnosed with coronary heart disease, and 732 persons suffering from hypertension were analyzed using the graded response IRT model. RESULTS In Study 1, the information functions obtained in the IRT analysis showed that (a) all items had highest measurement precision around the cutoff and (b) items are most informative at the higher end of the scale. In Study 2, the IRT analysis showed that measurements were fairly comparable across the general population and clinical populations. CONCLUSIONS The DS14 adequately measures NA and SI, with highest reliability in the trait range around the cutoff. The DS14 is a valid instrument to assess and compare type-D personality across clinical groups.
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Affiliation(s)
- Wilco H M Emons
- Department of Methodology and Statistics, Faculty of Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands.
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Fink P, Toft T, Hansen MS, Ørnbøl E, Olesen F. Symptoms and syndromes of bodily distress: an exploratory study of 978 internal medical, neurological, and primary care patients. Psychosom Med 2007; 69:30-9. [PMID: 17244846 DOI: 10.1097/psy.0b013e31802e46eb] [Citation(s) in RCA: 203] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Physical complaints not attributable to verifiable, conventionally defined diseases, i.e., medically unexplained or functional somatic symptoms, are prevalent in all medical settings, but their classification is contested as numerous overlapping diagnoses and syndrome labels have been introduced. This study aims to determine whether functional somatic symptoms cluster into distinct syndromes and diagnostic entities. METHODS The 978 consecutively admitted patients from a neurological department (n = 120), a medical department (n = 157), and from primary care (n = 701) were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) diagnostic instrument. RESULTS Patients complained of a median of five functional somatic symptoms; women of six, men of four (p < .0001). No single symptoms stood out as distinctive for patients with multiple symptoms. Principal component factor analysis identified a cardiopulmonary including autonomic (CP), a musculoskeletal (MS), and a gastrointestinal (GI) symptom group explaining 36.9% of the variance. Latent class analysis showed that the symptom groups are likely to materialize in the same patients, suggesting that they are different manifestations of a common latent phenomenon. Inclusion of a group of five additional general, unspecific symptoms in latent class analysis allowed construction of clinical diagnostic criteria for 'bodily distress disorder' dividing patients into three classes: nonbodily distress (n = 589), modest bodily distress (n = 329, prevalence 25.3%, men 20.4%, women 25.6%), and severe bodily distress (n = 60, prevalence 3.3%, men 1.2%, women 4.8%). CONCLUSION The study suggests that bodily distress disorder as defined here may unite many of the functional somatic syndromes and some somatoform disorder diagnoses. Bodily distress may be triggered by stress rather than being distinct diseases of noncerebral pathology.
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Affiliation(s)
- Per Fink
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C, Denmark.
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Abstract
The data that were reviewed in this article documented that in health systems, which manage behavioral health disorders independently from general medical disorders, the estimated 10% to 30% of patients with behavioral health service needs can expect (1) poor access or barriers to medical or mental health care; (2) when services are available, most provided will not meet minimum standards for expected outcome change; and (3) as a consequence of (1) and (2), medical and behavioral disorders will be more persistent with increased complications, will be associated with greater disability, and will lead to higher total health care and disability costs than will treatment of patients who do not have behavioral health disorders. This article proposes that these health system deficiencies will persist unless behavioral health services become an integral part of medical care (ie, integrated). By doing so, it creates a win-win situation for virtually all parties involved. Complex patients will receive coordinated general medical and behavioral health care that leads to improved outcomes. Clinicians and the hospitals that support integrated programs will be less encumbered by cross-disciplinary roadblocks as they deliver services that augment patient outcomes. Health plans (insurers) will be able to decrease administrative and claims costs because the complex patients who generate more than 80% of service use will have less complicated claims adjudication and better clinical outcomes. As a result, purchaser premiums, whether government programs, employers, or individuals, will decrease and the impact on national budgets will improve. Ongoing research will be important to assure that application of the best clinical and administrative practices are used to achieve these outcomes.
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Affiliation(s)
- Roger Kathol
- Cartesian Solutions, Inc., 3004 Foxpoint Road, Burnsville, MN 55337, USA.
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Christensen KS, Fink P, Toft T, Frostholm L, Ornbøl E, Olesen F. A brief case-finding questionnaire for common mental disorders: the CMDQ. Fam Pract 2005; 22:448-57. [PMID: 15814580 DOI: 10.1093/fampra/cmi025] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of the study was to validate a new case-finding instrument for common mental disorders (CMDQ). METHODS A cross-sectional, stratified, two-phase study was carried out in 28 general practices in Aarhus County, Denmark. 1785 consecutive patients, 18-65 years old, consulting 38 GPs with a new health problem participated. Patients were screened before consultation using a one-page screening questionnaire including subscales for somatisation (SCL-SOM and Whiteley-7), anxiety (SCL-ANX4), depression (SCL-DEP6) and alcohol abuse (CAGE). A stratified subsample of 701 patients was interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) interview. We tested the external validity of the scales using the SCAN interview as gold standard. All data were analysed using appropriate weighted procedures to control for the two-phase sampling design and non-response bias. RESULTS Estimates of sensitivity and specificity for relevant ICD-10 diagnoses at theoretical optimal cut-off points on subscales: Depressive disorder: 78/86 (SCL-DEP6); Alcohol abuse or dependence: 78/97 (CAGE); Severe anxiety disorder: 77/85 (SCL-ANX4); Somatisation disorder: 83/56 (SCL-SOM); and 75/52 (Whiteley-7); any mental disorder: 72/72 (SCL-8). At the theoretical optimal cut-off points the CMDQ demonstrated higher diagnostic accuracy than GPs on any diagnosis evaluated. CONCLUSION The study results suggest that the CMDQ has excellent external validity for use as a diagnostic aid in primary care settings.
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Fink P, Ørbøl E, Hansen MS, Søndergaard L, De Jonge P. Detecting mental disorders in general hospitals by the SCL-8 scale. J Psychosom Res 2004; 56:371-5. [PMID: 15046976 DOI: 10.1016/s0022-3999(03)00071-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2002] [Accepted: 01/08/2003] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study is to validate the eight-item dichotomised version of the Symptoms Check List (SCL-8d) as a screening tool for psychiatric disorders. METHODS The study population included 198 consecutive new neurological inpatients and outpatients and 294 consecutive internal medical inpatients, aged 18 or older. All patients received the SCL-8d questionnaire, and a stratified subsample was interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) interview. We tested the external SCL-8d validity using the SCAN interview as gold standard. The test was performed based on weighted data to correct for the skewness introduced by stratification. RESULTS The diagnostic performance of the SCL-8d was excellent in the internal medical setting but not quite as good in the neurological sample. It performed better among the older compared with the younger patients, whereas the scale was not affected by gender. In the combined sample at the cut point 0/1, the sensitivity (SE) of the SCL-8d was 0.73 (confidence interval [CI](95%): 0.60-0.82), the specificity (SP) 0.61 (CI(95%): 0.53-0.68) and the positive predictive value (PPV) 0.42 (CI(95%): 0.34-0.50), using any International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) psychiatric disorder, excluding somatoform and substance abuse disorders, as gold standard. The risk of a patient having a mental disorder (except phobia, substance abuse or somatoform disorder) was less than 6% in case of a negative screening test. In patients with a current depressive disorder, 87.1% (27/31) were screening positive, and all except 1 (93.0%) of the 14 patients with a modest to severe depression scored 1 or higher on the SCL-8d. All 17 patients with an anxiety disorder, excluding phobias, were screening positive. CONCLUSION The study suggests that the SCL-8d is a valid, brief screening tool for use in nonpsychiatric medical settings, especially to detect emotional psychiatric disorders (EPDs).
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Affiliation(s)
- Per Fink
- Research Unit for Functional Disorders, Psychosomatics and CL Psychiatry, Aarhus University Hospital, Noerrebrogade 44, DK-8000 Aarhus C, Denmark.
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