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Vargiu N, Belfanti A, Roberti M, Trentin S, Ferrara C, Tosti M, Lazzeri M, Giupponi G, Conca A. Empowerment of Italian general practitioners in depression and suicide prevention: the iFightDepression tool, a game changer of the EAAD-Best project. Ann Gen Psychiatry 2024; 23:24. [PMID: 38926725 PMCID: PMC11210018 DOI: 10.1186/s12991-024-00506-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 05/15/2024] [Indexed: 06/28/2024] Open
Abstract
General Practitioners (GPs) play a key role in the early detection and management of depression and in preventing suicide risk. They are often the first healthcare professionals that people in crisis contact. However, their effectiveness can be limited by several barriers, including the lack of specific training and appropriate tools.The EAAD-Best project aims to fill these gaps through its iFightDepression tool, an online tool designed to support patients, psychologists, psychiatrists, and GPs in managing depression and preventing suicide. This article examines the implementation of the iFightDepression platform in Italy, assessing its impact on the empowerment of GPs in the fight against depression. Through a qualitative and quantitative analysis of the data collected by the project, the 'unmet need' of GPs' in Italy regarding their specific training in mental health is highlighted.The response of 2,068 Italian GPs in just 7 months after the start of the iFD project is an expression of GPs' engagement to work against depression and for suicide risk prevention.
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Affiliation(s)
- Nuhara Vargiu
- Azienda Sanitaria Alto Adige - South Tyrol Health Authority, Bolzano, Italy.
| | - Aurora Belfanti
- Azienda Sanitaria Alto Adige - South Tyrol Health Authority, Bolzano, Italy
| | - Michela Roberti
- Azienda Sanitaria Alto Adige - South Tyrol Health Authority, Bolzano, Italy
| | - Serena Trentin
- Azienda Sanitaria Alto Adige - South Tyrol Health Authority, Bolzano, Italy
| | - Camilla Ferrara
- Azienda Sanitaria Alto Adige - South Tyrol Health Authority, Bolzano, Italy
| | - Manuela Tosti
- Azienda Sanitaria Alto Adige - South Tyrol Health Authority, Bolzano, Italy
| | - Marco Lazzeri
- Azienda Sanitaria Alto Adige - South Tyrol Health Authority, Bolzano, Italy
| | - Giancarlo Giupponi
- Azienda Sanitaria Alto Adige - South Tyrol Health Authority, Bolzano, Italy
| | - Andreas Conca
- Azienda Sanitaria Alto Adige - South Tyrol Health Authority, Bolzano, Italy.
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Freund J, Piotrowski A, Bührmann L, Oehler C, Titzler I, Netter AL, Potthoff S, Ebert DD, Finch T, Köberlein-Neu J, Etzelmüller A. Validation of the German Normalisation Process Theory Measure G-NoMAD: translation, adaptation, and pilot testing. Implement Sci Commun 2023; 4:126. [PMID: 37845776 PMCID: PMC10578017 DOI: 10.1186/s43058-023-00505-4] [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: 05/30/2023] [Accepted: 09/23/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Implementing evidence-based healthcare practices (EBPs) is a complex endeavour and often lags behind research-informed decision processes. Understanding and systematically improving implementation using implementation theory can help bridge the gap between research findings and practice. This study aims to translate, pilot, and validate a German version of the English NoMAD questionnaire (G-NoMAD), an instrument derived from the Normalisation Process Theory, to explore the implementation of EBPs. METHODS Survey data has been collected in four German research projects and subsequently combined into a validation data set. Two versions of the G-NoMAD existed, independently translated from the original English version by two research groups. A measurement invariance analysis was conducted, comparing latent scale structures between groups of respondents to both versions. After determining the baseline model, the questionnaire was tested for different degrees of invariance (configural, metric, scalar, and uniqueness) across samples. A confirmatory factor analysis for three models (a four-factor, a unidimensional, and a hierarchical model) was used to examine the theoretical structure of the G-NoMAD. Finally, psychometric results were discussed in a consensus meeting, and the final instructions, items, and scale format were consented to. RESULTS A total of 539 health care professionals completed the questionnaire. The results of the measurement invariance analysis showed configural, partial metric, and partial scalar invariance indicating that the questionnaire versions are comparable. Internal consistency ranged from acceptable to good (0.79 ≤ α ≤ 0.85) per subscale. Both the four factor and the hierarchical model achieved a better fit than the unidimensional model, with indices from acceptable (SRMR = 0.08) to good (CFI = 0.97; TLI = 0.96). However, the RMSEA values were only close to acceptable (four-factor model: χ2164 = 1029.84, RMSEA = 0.10; hierarchical model: χ2166 = 1073.43, RMSEA = 0.10). CONCLUSIONS The G-NoMAD provides a reliable and promising tool to measure the degree of normalisation among individuals involved in implementation activities. Since the fit was similar in the four-factor and the hierarchical model, priority should be given to the practical relevance of the hierarchical model, including a total score and four subscale scores. The findings of this study support the further usage of the G-NoMAD in German implementation settings. TRIAL REGISTRATION Both the AdAM project (No. NCT03430336, 06/02/2018) and the EU-project ImpleMentAll (No. NCT03652883, 29/08/2018) were registered on ClinicalTrials.gov. The ImplementIT study was registered at the German Clinical Trial Registration (No. DRKS00017078, 18/04/2019). The G-NoMAD validation study was registered at the Open Science Framework (No7u9ab, 17/04/2023).
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Affiliation(s)
- Johanna Freund
- Professorship Psychology & Digital Mental Health Care, Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, Munich, 80992, Germany.
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
| | - Alexandra Piotrowski
- Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany
- Chair of General Practice II and Patient Centredness in Primary Care, Institute of General Practice and Primary Care (IAMAG), Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Leah Bührmann
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle Upon Tyne, UK
| | - Caroline Oehler
- German Depression Foundation, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Ingrid Titzler
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Anna-Lena Netter
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Philipps University of Marburg, Marburg, Germany
| | - Sebastian Potthoff
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle Upon Tyne, UK
| | - David Daniel Ebert
- Professorship Psychology & Digital Mental Health Care, Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, Munich, 80992, Germany
| | - Tracy Finch
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle Upon Tyne, UK
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany
| | - Anne Etzelmüller
- Professorship Psychology & Digital Mental Health Care, Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, Munich, 80992, Germany
- HelloBetter, GET.ON Institut für Online Gesundheitstrainings GmbH, Berlin, Germany
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Lindgren LH, Thomsen T, de Thurah A, Aadahl M, Hetland ML, Kristensen SD, Esbensen BA. Newly diagnosed with inflammatory arthritis (NISMA)-development of a complex self-management intervention. BMC Health Serv Res 2023; 23:123. [PMID: 36750937 PMCID: PMC9902823 DOI: 10.1186/s12913-022-09007-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/23/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Patients newly diagnosed with inflammatory arthritis (IA) request regular consultations and support from health professionals to manage physiological, emotional, and social challenges. Evidence suggests that providing a tailored multi-component self-management program may benefit disease management. However, there is a lack of evidence of effective interventions with multiple components targeting the needs of this group. Therefore, the aim of this study was to develop a self-management intervention targeting newly diagnosed patients with IA, following the Medical Research Council (MRC) framework for developing complex interventions. METHODS The development of the complex self-management intervention covered three steps. First, the evidence base was identified through literature reviews, in which we described a preliminary nurse-led intervention. Secondly, we chose Social Cognitive Theory as the underlying theory along with Acceptance and Commitment Theory to support our communication strategy. Thirdly, the preliminary intervention was discussed and further developed in workshops to ensure that the intervention was in accordance with patients' needs and feasible in clinical practice. RESULTS The developed intervention comprises a 9-month nurse-led intervention (four individual and two group sessions). A physiotherapist and an occupational therapist will attend the group sessions along with the nurse. All sessions should target IA-specific self-management with a particular focus on medical, role, and emotional management. CONCLUSION Through the workshops, we involved all levels of the organization to optimize the intervention, but also to create ownership and commitment, and to identify barriers and shortcomings of the preliminary intervention. As a result, from the existing evidence, we believe that we have identified effective mechanisms to increase self-management in people newly diagnosed with IA. Further, we believe that the involvement of various stakeholders has contributed significantly to developing a relevant and feasible intervention. The intervention is a nurse-led complex self-management intervention embedded in a multidisciplinary team (named NISMA). The intervention is currently being tested in a feasibility study.
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Affiliation(s)
- L. H. Lindgren
- grid.475435.4Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Valdemar Hansens Vej 17, 2600 Glostrup, Denmark
| | - T. Thomsen
- grid.475435.4Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Valdemar Hansens Vej 17, 2600 Glostrup, Denmark ,grid.512917.9Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - A. de Thurah
- grid.154185.c0000 0004 0512 597XDepartment of Rheumatology, Aarhus University Hospital, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - M. Aadahl
- grid.512917.9Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M. L. Hetland
- grid.475435.4Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Valdemar Hansens Vej 17, 2600 Glostrup, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - B. A. Esbensen
- grid.475435.4Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Valdemar Hansens Vej 17, 2600 Glostrup, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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How are guide profession and routine care setting related to adherence and symptom change in iCBT for depression? - an explorative log-data analysis. Internet Interv 2021; 26:100476. [PMID: 34804811 PMCID: PMC8590032 DOI: 10.1016/j.invent.2021.100476] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND While the antidepressant efficacy of guided digital interventions has been proven in randomized controlled trials, findings from routine care are less clear. Low adherence rates are common and limit the potential effectiveness. Adherence has been linked to sociodemographic variables and the amount of guidance, but the role of the guide's profession and their work setting has not yet been studied for routine care. METHODS Routinely collected log data from a digital intervention for depressed patients (iFightDepression tool) were analyzed in an exploratory manner. The sample is a convenience sample from routine care, where guidance is provided by general practitioners (GP), certified psychotherapists (PT) or medical doctors specialized in mental health. Log data from 2184 patients were analyzed and five usage parameters were extracted to measure adherence (first-to-last login, time on tool, number of sessions, workshops completed and minimal dose). Multiple logistic regression was used to analyze relations between the guide's profession and clinical context as well as other covariates and adherence and symptom change on a brief depression questionnaire (PHQ-9). RESULTS The analyses showed a significant relation of guide profession and adherence. Guidance by PT was associated to the highest adherence scores (reference category). The odds ratios (ORs) of scoring above the median in each usage parameter for patients guided by GPs were 0.50-0.63 (all ps < 0.002) and 0.61-0.80 (p = .002-0.197) for MH. Higher age, initial PHQ-9 score and self-reported diagnosis of depression were also significantly associated with higher adherence scores. In a subsample providing enough data on the PHQ-9 (n = 347), no association of guide profession with symptom reduction was found. Instead, a greater reduction was observed for patients with a higher baseline PHQ-9 (β = -0. 39, t(341.75) = -8.814, p < .001) and for those who had achieved minimal dose (β = -2.42, t(340.34) = -4.174, P < .001) and those who had achieved minimal dose and scored high on time on tool (β = 0.22, t(341.75) = 1.965, P = .050). CONCLUSION Being guided by PT was associated with the highest adherence. The lowest adherence was observed in patients who were guided by GP. While no association of guide profession and symptom reduction was found in a subsample, greater adherence was associated with symptom reduction.
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Oehler C, Scholze K, Reich H, Sander C, Hegerl U. Intervention Use and Symptom Change With Unguided Internet-Based Cognitive Behavioral Therapy for Depression During the COVID-19 Pandemic: Log Data Analysis of a Convenience Sample. JMIR Ment Health 2021; 8:e28321. [PMID: 34115604 PMCID: PMC8288646 DOI: 10.2196/28321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/06/2021] [Accepted: 05/27/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Internet- and mobile-based interventions are most efficacious in the treatment of depression when they involve some form of guidance, but providing guidance requires resources such as trained personnel, who might not always be available (eg, during lockdowns to contain the COVID-19 pandemic). OBJECTIVE The current analysis focuses on changes in symptoms of depression in a guided sample of patients with depression who registered for an internet-based intervention, the iFightDepression tool, as well as the extent of intervention use, compared to an unguided sample. The objective is to further understand the effects of guidance and adherence on the intervention's potential to induce symptom change. METHODS Log data from two convenience samples in German routine care were used to assess symptom change after 6-9 weeks of intervention as well as minimal dose (finishing at least two workshops). A linear regression model with changes in Patient Health Questionnaire (PHQ-9) score as a dependent variable and guidance and minimal dose as well as their interaction as independent variables was specified. RESULTS Data from 1423 people with symptoms of depression (n=940 unguided, 66.1%) were included in the current analysis. In the linear regression model predicting symptom change, a significant interaction of guidance and minimal dose revealed a specifically greater improvement for patients who received guidance and also worked with the intervention content (β=-1.75, t=-2.37, P=.02), while there was little difference in symptom change due to guidance in the group that did not use the intervention. In this model, the main effect of guidance was only marginally significant (β=-.53, t=-1.78, P=.08). CONCLUSIONS Guidance in internet-based interventions for depression is not only an important factor to facilitate adherence, but also seems to further improve results for patients adhering to the intervention compared to those who do the same but without guidance.
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Affiliation(s)
- Caroline Oehler
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Leipzig, Leipzig, Germany.,Forschungszentrum Depression, Stiftung Deutsche Depressionshilfe, Leipzig, Germany
| | - Katharina Scholze
- Forschungszentrum Depression, Stiftung Deutsche Depressionshilfe, Leipzig, Germany
| | - Hanna Reich
- Forschungszentrum Depression, Stiftung Deutsche Depressionshilfe, Frankfurt, Germany
| | - Christian Sander
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Ulrich Hegerl
- Forschungszentrum Depression, Stiftung Deutsche Depressionshilfe, Frankfurt, Germany.,Clinic for Psychiatry, Psychosomatics and Psychotherapy, Universitätsklinikum Frankfurt, Frankfurt, Germany
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Oehler C, Görges F, Rogalla M, Rummel-Kluge C, Hegerl U. Efficacy of a Guided Web-Based Self-Management Intervention for Depression or Dysthymia: Randomized Controlled Trial With a 12-Month Follow-Up Using an Active Control Condition. J Med Internet Res 2020; 22:e15361. [PMID: 32673233 PMCID: PMC7388040 DOI: 10.2196/15361] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 04/01/2020] [Accepted: 04/26/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND An increasing number of studies suggest that web-based interventions for patients with depression can reduce their symptoms and are expected to fill currently existing treatment gaps. However, evidence for their efficacy has mainly been derived from comparisons with wait-list or treatment as usual controls. In particular, designs using wait-list controls are unlikely to induce hope and may even have nocebo effects, making it difficult to draw conclusions about the intervention's efficacy. Studies using active controls are rare and have not yielded conclusive results. OBJECTIVE The main objective of this study is to assess the acute and long-term antidepressant efficacy of a 6-week, guided, web-based self-management intervention building on the principles of cognitive behavioral therapy (iFightDepression tool) for patients with depression compared with web-based progressive muscle relaxation as an active control condition. METHODS A total of 348 patients with mild-to-moderate depressive symptoms or dysthymia (according to the Mini International Neuropsychiatric Interview) were recruited online and randomly assigned to 1 of the 2 intervention arms. Acute antidepressant effects after 6 weeks and long-term effects at 3-, 6-, and 12-month follow-up were studied using the Inventory of Depressive Symptomatology-self-rating as a primary outcome parameter and change in quality of life (Short Form 12) and user satisfaction (client satisfaction questionnaire) as secondary outcome parameters. Treatment effects were assessed using mixed model analyses. RESULTS Over the entire observation period, a greater reduction in symptoms of depression (P=.01) and a greater improvement of life quality (P<.001) was found in the intervention group compared with the active control group. Separate tests for each time point revealed significant effects on depressive symptoms at the 3-month follow-up (d=0.281; 95% CI 0.069 to 0.493), but not after 6 weeks (main outcome:d=0.192; 95% CI -0.020 to 0.404) and 6 and 12 months. The intervention was significantly superior to the control condition with respect to user satisfaction (25.31 vs 21.97; t259=5.804; P<.01). CONCLUSIONS The fact that antidepressant effects have been found for a guided self-management tool in comparison with an active control strengthens the evidence base for the efficacy of web-based interventions. The antidepressant effect became most prominent at the 3-month follow-up. After 6 weeks of intervention, significant positive effects were observed on life quality but not on depressive symptoms. Although the effect size of such web-based interventions on symptoms of depression might be smaller than that suggested by earlier studies using wait-list control conditions, they can be a cost-effective addition to antidepressants and face-to-face psychotherapy. TRIAL REGISTRATION International Clinical Trials Registry Platform ICTRP080-15-09032015; https://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00009323.
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Affiliation(s)
| | - Frauke Görges
- Department of Psychiatry and Psychotherapy, University Leipzig, Leipzig, Germany
| | - Mandy Rogalla
- Department of Psychiatry and Psychotherapy, University Leipzig, Leipzig, Germany
| | | | - Ulrich Hegerl
- Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe-Universität Frankfurt, Frankfurt, Germany
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