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Varley D, Scorer L, Bramley S, van der Feltz-Cornelis C. Dismissed, anxious, and feeling abandoned: The experiences and perspectives of people with functional neurological disorder accessing UK healthcare services. Gen Hosp Psychiatry 2024:S0163-8343(24)00076-8. [PMID: 38729863 DOI: 10.1016/j.genhosppsych.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/26/2024] [Accepted: 04/27/2024] [Indexed: 05/12/2024]
Affiliation(s)
- Danielle Varley
- Department of Health Sciences, University of York, Heslington, York, UK.
| | | | - Stephanie Bramley
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Christina van der Feltz-Cornelis
- Department of Health Sciences, University of York, Heslington, York, UK; Hull York Medical School, University of York, York, UK; Institute of Health Informatics, University College London, London, UK
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van der Feltz-Cornelis C, Turk F, Sweetman J, Khunti K, Gabbay M, Shepherd J, Montgomery H, Strain WD, Lip GYH, Wootton D, Watkins CL, Cuthbertson DJ, Williams N, Banerjee A. Prevalence of mental health conditions and brain fog in people with long COVID: A systematic review and meta-analysis. Gen Hosp Psychiatry 2024; 88:10-22. [PMID: 38447388 DOI: 10.1016/j.genhosppsych.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE Long COVID can include impaired cognition ('brain fog'; a term encompassing multiple symptoms) and mental health conditions. We performed a systematic review and meta-analysis to estimate their prevalence and to explore relevant factors associated with the incidence of impaired cognition and mental health conditions. METHODS Searches were conducted in Medline and PsycINFO to cover the start of the pandemic until August 2023. Included studies reported prevalence of mental health conditions and brain fog in adults with long COVID after clinically-diagnosed or PCR-confirmed SARS-CoV-2 infection. FINDINGS 17 studies were included, reporting 41,249 long COVID patients. Across all timepoints (3-24 months), the combined prevalence of mental health conditions and brain fog was 20·4% (95% CI 11·1%-34·4%), being lower among those previously hospitalised than in community-managed patients(19·5 vs 29·7% respectively; p = 0·047). The odds of mental health conditions and brain fog increased over time and when validated instruments were used. Odds of brain fog significantly decreased with increasing vaccination rates (p = ·000). CONCLUSIONS Given the increasing prevalence of mental health conditions and brain fog over time, preventive interventions and treatments are needed. Research is needed to explore underlying mechanisms that could inform further research in development of effective treatments. The reduced risk of brain fog associated with vaccination emphasizes the need for ongoing vaccination programs.
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Affiliation(s)
- Christina van der Feltz-Cornelis
- Department of Health Sciences, University of York, York, United Kingdom; Hull York Medical School, (HYMS), University of York, York, United Kingdom; Institute of Health Informatics, University College London, London, United Kingdom.
| | - Fidan Turk
- Department of Health Sciences, University of York, York, United Kingdom
| | - Jennifer Sweetman
- Department of Health Sciences, University of York, York, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Mark Gabbay
- Department of Primary Care and Mental Health University of Liverpool, Liverpool, United Kingdom
| | - Jessie Shepherd
- Department of Health Sciences, University of York, York, United Kingdom
| | - Hugh Montgomery
- Department of Medicine, University College London, London, United Kingdom
| | - W David Strain
- Diabetes and Vascular Medicine Research Centre, Institute of Clinical and Biomedical Science and College of Medicine and Health, University of Exeter, Exeter, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Dan Wootton
- Institute of Infection Veterinary and Ecological Sciences and NIHR HPRU in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom; Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Caroline Leigh Watkins
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, United Kingdom; School of Nursing and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Daniel J Cuthbertson
- Institute of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Nefyn Williams
- Department of Primary Care and Mental Health University of Liverpool, Liverpool, United Kingdom
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, United Kingdom; Department of Cardiology, University College London Hospitals NHS Trust, London, United Kingdom; Department of Cardiology, Barts Health NHS Trust, London, United Kingdom
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Turk F, Sweetman J, Allsopp G, Crooks M, Cuthbertson DJ, Gabbay M, Hishmeh L, Lip GYH, Strain WD, Williams N, Wootton D, Banerjee A, van der Feltz-Cornelis C. Pathways to care for Long COVID and for long-term conditions from patients' and clinicians' perspective. J Evid Based Med 2023; 16:435-437. [PMID: 38037477 DOI: 10.1111/jebm.12563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 10/04/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Fidan Turk
- Department of Health Sciences, University of York, York, UK
| | | | - Gail Allsopp
- CCG, NHS Derby and Derbyshire Foundation Trust, London, UK
| | - Michael Crooks
- Hull York Medical School, (HYMS), University of Hull, Hull, UK
- Department of Respiratory Medicine, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Dan J Cuthbertson
- Institute of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
| | - Mark Gabbay
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
- NWC, NIHR ARC NWC, Liverpool, UK
| | - Lyth Hishmeh
- Expert Advisor on the NICE Long Covid Panel, Oxford, UK
- PPI Member STIMULATE-ICP, London, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark
| | - W David Strain
- Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and College of Medicine and Health, University of Exeter, Exeter, UK
| | - Nefyn Williams
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
| | - Dan Wootton
- Institute of Infection Veterinary and Ecological Sciences and NIHR HPRU in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- Institute of Infection, Veterinary and Ecological Sciences (IVES), Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Amitava Banerjee
- Department of Cardiology, University College London Hospitals NHS Trust, London, UK
- Institute of Health Informatics, University College London, London, UK
| | - Christina van der Feltz-Cornelis
- Department of Health Sciences, University of York, York, UK
- Institute of Health Informatics, University College London, London, UK
- Hull York Medical School, (HYMS), University of York, York, UK
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Byrne A, Jones K, Backhouse M, Rose F, Moatt E, van der Feltz-Cornelis C. Patient and primary care practitioners' perspectives on consultations for fibromyalgia: a qualitative evidence synthesis. Prim Health Care Res Dev 2023; 24:e58. [PMID: 37750736 PMCID: PMC10540196 DOI: 10.1017/s1463423623000506] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/29/2023] [Accepted: 08/28/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Fibromyalgia presents a challenge to both the patients experiencing symptoms and the staff aiming to treat them. This qualitative review aimed to synthesise how patients and practitioners experience primary care consultations, develop a rounded picture of how they perceive each other, the challenges to primary care consultation and how they might be tackled. METHODS CINAHL, Embase, CENTRAL and Medline were searched from inception to November 2021. Qualitative studies were included if they explored the perspectives and experiences of either fibromyalgia patients or primary care practitioners. Quantitative data, studies not published in English, not set in primary care or that did not distinguish the type of patient or clinician were excluded. Included studies were analysed using thematic synthesis and their quality assessed. RESULTS In total, 30 studies met the inclusion criteria. Thematic synthesis identified three overarching themes: (1) life turned upside down - exploring the chaos experienced by patients as they seek help; (2) negative cycle - highlighting how patient and practitioner factors can create a detrimental cycle; and (3) breaking the cycle - validating patient-doctor relationships underpinned by clear communication can help break the negative cycle. CONCLUSIONS Fibromyalgia patients experience uncertainty and chaos that can clash with the attitudes of GPs and the help they can feasibly provide. Difficult consultations in which neither the GP nor patient are satisfied can easily occur. Promoting supportive, reciprocal and open patient-doctor relationships is essential. Future research is required to further explore GP attitudes and to develop an intervention that could improve consultations, patient outcomes and GP satisfaction.
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Affiliation(s)
- Ailish Byrne
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, UK
| | - Katherine Jones
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | - Fiona Rose
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, UK
| | - Emma Moatt
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, UK
| | - Christina van der Feltz-Cornelis
- Mental Health and Addictions Research Group, Department of Health Sciences, Hull York Medical School, University of York, Heslington, York, UK
- Institute of Health Informatics, University College London, London, UK
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van der Feltz-Cornelis C, Attree E, Heightman M, Gabbay M, Allsopp G. Integrated care pathways: a new approach for integrated care systems. Br J Gen Pract 2023; 73:422. [PMID: 37652731 PMCID: PMC10471334 DOI: 10.3399/bjgp23x734925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Affiliation(s)
- Christina van der Feltz-Cornelis
- Department of Health Sciences, Hull York Medical School, University of York, York; Institute of Health Informatics, University College London, London
| | - Emily Attree
- Ridgmount Practice and the Lawson Practice, London; Quality Improvement Clinical Lead, Central Camden Primary Care Network, PPI STIMULATE-ICP, London
| | - Mel Heightman
- Consultant Respiratory Physician and Deputy Clinical Divisional Director for Medical Specialities, University College London Hospital, London
| | - Mark Gabbay
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool; Academic Associate GP, Brownlow Health, Liverpool; National Institute of Health and Care Research Applied Research Collaboration North West Coast, Liverpool
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van der Feltz-Cornelis C, Heightman M, Allsopp G. Learning from long COVID: integrated care for multiple long-term conditions. Br J Gen Pract 2023; 73:196-197. [PMID: 37105737 PMCID: PMC10147422 DOI: 10.3399/bjgp23x732561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Affiliation(s)
- Christina van der Feltz-Cornelis
- Department of Health Sciences, Hull York Medical School, University of York, York; Honorary Professor, Institute of Health Informatics, University College London, London
| | | | - Gail Allsopp
- Royal College of General Practitioners, London; Associate Professor, Division of Primary Care, University of Nottingham, Nottingham
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Varley D, Sweetman J, Brabyn S, Lagos D, van der Feltz-Cornelis C. The clinical management of functional neurological disorder: A scoping review of the literature. J Psychosom Res 2023; 165:111121. [PMID: 36549074 DOI: 10.1016/j.jpsychores.2022.111121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To date, there have been no reviews bringing together evidence on the clinical management of functional neurological disorder (FND) and patients', caregivers', and healthcare workers' experiences. This review provides an overview of the literature focused on the clinical management of FND. METHODS Four databases were searched, and a consultation exercise was conducted to retrieve relevant records dated from September 2010 to September 2020. Articles documenting diagnostic methods, treatments or interventions, or the experiences and perspectives of patients and healthcare workers in the clinical management of FND were included. RESULTS In total, 2756 records were retrieved, with 162 included in this review. The diagnostic methods reported predominantly included positive clinical signs, v-EEG and EEG. Psychological treatments and medication were the most reported treatments. Mixed findings of the effectiveness of CBT were found. Haloperidol, physiotherapy and scripted diagnosis were found to be effective in reducing FND symptoms. Several facilitators and barriers for patients accessing treatment for FND were reported. CONCLUSION The literature describing the clinical management for FND has increased considerably in recent times. A wide variety of diagnostic tools and treatments and interventions were found, with more focus being placed on tests that confirm a diagnosis than 'rule-out' tests. The main treatment type found in this review was medication. This review revealed that there is a lack of high-quality evidence and reflects the need for official clinical guidelines for FND, providing healthcare workers and patients the support needed to navigate the process to diagnose and manage FND.
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Affiliation(s)
- Danielle Varley
- Department of Health Sciences, University of York, York YO10 5DD, UK.
| | - Jennifer Sweetman
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Sally Brabyn
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Dimitris Lagos
- Hull York Medical School, University of York, York YO10 5DD, UK
| | - Christina van der Feltz-Cornelis
- Department of Health Sciences, University of York, York YO10 5DD, UK; Hull York Medical School, University of York, York YO10 5DD, UK; York Biomedical Research Institute, University of York, York YO10 5DD, UK; Institute of Health Informatics, University College London, London NW1 2DA, UK
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Heseltine-Carp W, Dale V, van Eck van der Sluijs J, van der Feltz-Cornelis C. Are serum hsCRP and IL-6 prognostic markers in somatic symptom disorder and related disorders? An exploratory analysis in a prospective cohort study. J Psychiatr Res 2023; 157:88-95. [PMID: 36455378 DOI: 10.1016/j.jpsychires.2022.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/31/2022] [Accepted: 11/19/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the roles of hsCRP and IL-6 as prognostic markers for treatment outcome in SSRD. METHODS In this prospective cohort study, 237 consecutive outpatients diagnosed with SSRD at the Clinical Centre of Excellence for Body Mind and Health, the Netherlands were assessed. At intake, venepuncture was performed for serum hsCRP and IL-6. Baseline scores for PHQ-9, GAD7, physical symptom score (PSQ-51) and BPI questionnaires were obtained. Patients were followed up at the end of their usual treatment programme, which lasted approximately 12 months. RESULTS Higher baseline hsCRP was associated with high physical symptom scores (PSQ-51), but not BPI, GAD-7 and PHQ-9 questionnaire scores at end of treatment. No association was identified between baseline IL-6 and follow-up symptom questionnaire scores after treatment. Adjustment for age, gender and somatic comorbidity showed no significant change in the association. CONCLUSION This exploratory analysis provides some evidence that in patients with SSRD, high baseline serum hsCRP may predict poorer treatment outcomes in physical symptoms but not depression, anxiety or pain symptoms. Baseline serum hsCRP may therefore be a useful factor in identifying SSRD patients who are at risk of a persistent high physical symptom burden.
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Affiliation(s)
- William Heseltine-Carp
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK.
| | - Veronica Dale
- Department of Health Sciences, University of York, UK.
| | - Jonna van Eck van der Sluijs
- Altrecht, Psychosomatiek Eikenboom, the Netherlands; Clinical Centre of Excellence for Body Mind and Health, GGz Breburg, Tilburg, the Netherlands.
| | - Christina van der Feltz-Cornelis
- Clinical Centre of Excellence for Body Mind and Health, GGz Breburg, Tilburg, the Netherlands; Department of Health Sciences, Hull York Medical School (HYMS), University of York, UK.
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Fitton R, Sweetman J, Heseltine-Carp W, van der Feltz-Cornelis C. Anti-inflammatory medications for the treatment of mental disorders: A scoping review. Brain Behav Immun Health 2022; 26:100518. [PMID: 36217374 PMCID: PMC9547233 DOI: 10.1016/j.bbih.2022.100518] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/15/2022] [Accepted: 09/18/2022] [Indexed: 11/25/2022] Open
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Ramasawmy M, Mu Y, Clutterbuck D, Pantelic M, Lip GYH, van der Feltz-Cornelis C, Wootton D, Williams NH, Montgomery H, Mallinson Cookson R, Attree E, Gabbay M, Heightman M, Alwan NA, Banerjee A, Lorgelly P. STIMULATE-ICP-CAREINEQUAL (Symptoms, Trajectory, Inequalities and Management: Understanding Long-COVID to Address and Transform Existing Integrated Care Pathways) study protocol: Defining usual care and examining inequalities in Long Covid support. PLoS One 2022; 17:e0271978. [PMID: 35969597 PMCID: PMC9377596 DOI: 10.1371/journal.pone.0271978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Individuals with Long Covid represent a new and growing patient population. In England, fewer than 90 Long Covid clinics deliver assessment and treatment informed by NICE guidelines. However, a paucity of clinical trials or longitudinal cohort studies means that the epidemiology, clinical trajectory, healthcare utilisation and effectiveness of current Long Covid care are poorly documented, and that neither evidence-based treatments nor rehabilitation strategies exist. In addition, and in part due to pre-pandemic health inequalities, access to referral and care varies, and patient experience of the Long Covid care pathways can be poor. In a mixed methods study, we therefore aim to: (1) describe the usual healthcare, outcomes and resource utilisation of individuals with Long Covid; (2) assess the extent of inequalities in access to Long Covid care, and specifically to understand Long Covid patients' experiences of stigma and discrimination. METHODS AND ANALYSIS A mixed methods study will address our aims. Qualitative data collection from patients and health professionals will be achieved through surveys, interviews and focus group discussions, to understand their experience and document the function of clinics. A patient cohort study will provide an understanding of outcomes and costs of care. Accessible data will be further analysed to understand the nature of Long Covid, and the care received. ETHICS AND DISSEMINATION Ethical approval was obtained from South Central-Berkshire Research Ethics Committee (reference 303958). The dissemination plan will be decided by the patient and public involvement and engagement (PPIE) group members and study Co-Is, but will target 1) policy makers, and those responsible for commissioning and delivering Long Covid services, 2) patients and the public, and 3) academics.
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Affiliation(s)
- Mel Ramasawmy
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Yi Mu
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Donna Clutterbuck
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Marija Pantelic
- Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Christina van der Feltz-Cornelis
- Institute of Health Informatics, University College London, London, United Kingdom
- Department of Health Sciences, HYMS, University of York, York, United Kingdom
| | - Dan Wootton
- Institute of Infection Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Nefyn H. Williams
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
| | - Hugh Montgomery
- Department of Medicine, Centre for Human Health and Performance, University College London, London, United Kingdom
| | | | | | - Mark Gabbay
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
| | - Melissa Heightman
- University College London Hospitals NHS Trust, London, United Kingdom
| | - Nisreen A. Alwan
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- NIHR Applied Research Collaboration Wessex, Southampton, United Kingdom
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Paula Lorgelly
- School of Population Health and Department of Economics, University of Auckland, Auckland, New Zealand
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van der Feltz-Cornelis C, Bakker M, van der Sluijs JVE. Four clinical profiles of adult outpatients with somatic Symptom Disorders and Related Disorders (SSRD). A latent class analysis. J Psychosom Res 2022; 156:110775. [PMID: 35259552 DOI: 10.1016/j.jpsychores.2022.110775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To obtain more insight into the patterns of co-occurring symptoms, biomarkers and predictors in Somatic Symptom Disorders and Related Disorders (SSRD) and to identify subgroups with profiles that might allow for personalised treatment. METHODS Cross-sectional study design with Latent class analysis (LCA) to determine different subgroups in a cohort of 239 outpatients with SSRD in 3 steps: 1) building a latent class model; 2) assigning subjects to the latent classes that suited them best based on their posterior probability; 3) investigating the associations between these classes and personal characteristics such as age, gender, somatic comorbidity and general health perception. RESULTS Four classes with clinically relevant profiles were found. One with trauma plus elevated inflammation biomarkers, high somatic symptom levels, pain and comorbid depression and anxiety. One with pain plus elevated biomarkers, depression and anxiety. One with low IL-6 and hsCRP, mostly linked to Illness Anxiety. And one with high pain and high elevated biomarkers, but less probability of other factors, that occurred mostly in men. General health perception was lower in classes with elevated inflammation biomarkers. CONCLUSIONS The findings of this first study exploring latent classes in an SSRD sample corroborate the current DSM-5 SSD subclassification for pain and Illness Anxiety Disorder. There is scope to extend the current DSM-5 classification with a subclassification of SSD with trauma, and a subclassification with elevated IL6 or hsCRP, as relevant for developing new personalised treatments addressing trauma or SLI in SSRD. Further research is needed to explore this.
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Affiliation(s)
- Christina van der Feltz-Cornelis
- Department of Health Sciences, HYMS, University of York, York, UK; Clinical Centre for Body Mind and Health, GGz Breburg, Tilburg, the Netherlands.
| | - Marjan Bakker
- Department of Methodology and Statistics, Tilburg University, Tilburg, the Netherlands
| | - Jonna van Eck van der Sluijs
- Altrecht Psychosomatic Medicine, Zeist, the Netherlands; Clinical Centre for Body Mind and Health, GGz Breburg, Tilburg, the Netherlands
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Grigoroglou C, van der Feltz-Cornelis C, Hodkinson A, Coventry PA, Zghebi SS, Kontopantelis E, Bower P, Lovell K, Gilbody S, Waheed W, Dickens C, Archer J, Blakemore A, Adler DA, Aragones E, Björkelund C, Bruce ML, Buszewicz M, Carney RM, Cole MG, Davidson KW, Gensichen J, Grote NK, Russo J, Huijbregts K, Huffman JC, Menchetti M, Patel V, Richards DA, Rollman B, Smit A, Zijlstra-Vlasveld MC, Wells KB, Zimmermann T, Unutzer J, Panagioti M. Effectiveness of collaborative care in reducing suicidal ideation: An individual participant data meta-analysis. Gen Hosp Psychiatry 2021; 71:27-35. [PMID: 33915444 DOI: 10.1016/j.genhosppsych.2021.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
UNLABELLED To assess whether CC is more effective at reducing suicidal ideation in people with depression compared with usual care, and whether study and patient factors moderate treatment effects. METHOD We searched Medline, Embase, PubMed, PsycINFO, CINAHL, CENTRAL from inception to March 2020 for Randomised Controlled Trials (RCTs) that compared the effectiveness of CC with usual care in depressed adults, and reported changes in suicidal ideation at 4 to 6 months post-randomisation. Mixed-effects models accounted for clustering of participants within trials and heterogeneity across trials. This study is registered with PROSPERO, CRD42020201747. RESULTS We extracted data from 28 RCTs (11,165 patients) of 83 eligible studies. We observed a small significant clinical improvement of CC on suicidal ideation, compared with usual care (SMD, -0.11 [95%CI, -0.15 to -0.08]; I2, 0·47% [95%CI 0.04% to 4.90%]). CC interventions with a recognised psychological treatment were associated with small reductions in suicidal ideation (SMD, -0.15 [95%CI -0.19 to -0.11]). CC was more effective for reducing suicidal ideation among patients aged over 65 years (SMD, - 0.18 [95%CI -0.25 to -0.11]). CONCLUSION Primary care based CC with an embedded psychological intervention is the most effective CC framework for reducing suicidal ideation and older patients may benefit the most.
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Affiliation(s)
- Christos Grigoroglou
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England.
| | | | - Alexander Hodkinson
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Peter A Coventry
- Department of Health Sciences, University of York, York, England
| | - Salwa S Zghebi
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Evangelos Kontopantelis
- Faculty of Biology, Medicine and Health, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, England
| | - Peter Bower
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, England; Greater Manchester Mental Health NHS Foundation Trust, Manchester, England
| | - Simon Gilbody
- Department of Health Sciences, Hull York Medical School, HYMS, University of York, York, England
| | - Waquas Waheed
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | | | - Janine Archer
- School of Health and Society, School of Health and Society, University of Salford, England
| | - Amy Blakemore
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, England
| | - David A Adler
- Departments of Psychiatry and Medicine, Tufts Medical Center and Tufts University School of Medicine, England
| | - Enric Aragones
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Cecilia Björkelund
- Primary Health Care School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Martha L Bruce
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Marta Buszewicz
- Institute of Epidemiology and Health, Faculty of Population and Health Sciences, University College London, London, England
| | - Robert M Carney
- Department of Psychiatry, Washington University in St. Louis (WUSTL), St. Louis, Missouri, USA
| | - Martin G Cole
- Department of Psychiatry, St. Mary's Hospital Center, McGill University, Montreal, Quebec, Canada
| | - Karina W Davidson
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, LMU Klinikum, Ludwig-Maximilians, University Munich Pettenkoferstr. 10, 80336 Munich, Germany
| | - Nancy K Grote
- School of Social Work, University of Washington, Seattle, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Klaas Huijbregts
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Jeff C Huffman
- Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Vikram Patel
- The Pershing Square Professor of Global Health, Harvard Medical School, Boston, MA, USA
| | - David A Richards
- Institute of Health Research, University of Exeter College of Medicine and Health, Exeter, England; Western University of Norway, Bergen, Norway
| | - Bruce Rollman
- Center for Behavioral Health, Media and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Annet Smit
- HAN University of Applied Sciences, Nijmegen, Netherlands
| | | | - Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA; Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
| | - Thomas Zimmermann
- Department of General Practice / Primary Care, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jurgen Unutzer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Maria Panagioti
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
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13
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Grosselli L, Herzog K, Aseltine RH, Balazs J, Carli V, Ciffone J, De Leo D, van der Feltz-Cornelis C, Hawton K, Hegerl U, Kõlves K, Kutcher S, Mehlum L, Niederkrotenthaler T, Rezaeian M, Renaud J, Schneider B, Lewitzka U, Hoyer J, Knappe S. Dos and Don'ts in Designing School-Based Awareness Programs for Suicide Prevention. Crisis 2021; 43:270-277. [PMID: 34042491 PMCID: PMC9353877 DOI: 10.1027/0227-5910/a000783] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Abstract.Background: Despite the promising evidence for the
effectiveness of school-based awareness programs in decreasing the rates of
suicidal thoughts and suicide attempts in young people, no guidelines on the
targets and methods of safe and effective awareness programs exist.
Aims: This study intends to distill recommendations for
school-based suicide awareness and prevention programs from experts.
Method: A three-stage Delphi survey was administered to an
expert panel between November 2018 and March 2019. A total of 214 items obtained
from open-ended questions and the literature were rated in two rounds. Consensus
and stability were used as assessment criteria. Results: The
panel consisted of 19 participants in the first and 13 in the third stage.
Recommended targets included the reduction of suicide attempts, the enhancement
of help-seeking and peer support, as well as the promotion of mental health
literacy and life skills. Program evaluation, facilitating access to healthcare,
and long-term action plans across multiple levels were among the best strategies
for the prevention of adverse effects. Limitations: The study
is based on opinions of a rather small number of experts.
Conclusion: The promotion of help-seeking and peer support
as well as facilitating access to mental health-care utilities appear pivotal
for the success of school-based awareness programs.
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Affiliation(s)
- Luna Grosselli
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Kristina Herzog
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Robert H Aseltine
- Division of Behavioral Sciences and Community Health and Center for Population Health, UConn Health, University of Connecticut, Farmington, CT, USA
| | - Judit Balazs
- Institute of Psychology, Eötvös Loránd University Budapest, Hungary.,Department of Psychology, Bjørknes University College, Oslo, Norway
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institute, Stockholm, Sweden
| | | | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Mount Gravatt, QLD, Australia.,Slovene Suicide Research Centre, Primorska University, Koper, Slovenia
| | | | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK
| | - Ulrich Hegerl
- Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe-Universität Frankfurt, Germany
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, Griffith University, Mount Gravatt, QLD, Australia.,WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Stan Kutcher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, University of Oslo, Norway
| | - Thomas Niederkrotenthaler
- Unit Suicide Research & Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Austria
| | - Mohsen Rezaeian
- Occupational Environmental Research Center, Epidemiology and Biostatistics Department, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Johanne Renaud
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.,Manulife Centre for Breakthroughs in Teen Depression and Suicide Prevention, McGill University, Montreal, QC, Canada
| | - Barbara Schneider
- Department for Addictive Behavior, Psychiatry and Psychotherapy, LVR-Klinik Köln, Germany
| | - Ute Lewitzka
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Dresden, Germany
| | - Jürgen Hoyer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Susanne Knappe
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
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14
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van der Feltz-Cornelis C, Brabyn S, Ratcliff J, Varley D, Allgar V, Gilbody S, Clarke C, Lagos D. Assessment of cytokines, microRNA and patient related outcome measures in conversion disorder/functional neurological disorder (CD/FND): The CANDO clinical feasibility study. Brain Behav Immun Health 2021; 13:100228. [PMID: 34589743 PMCID: PMC8474571 DOI: 10.1016/j.bbih.2021.100228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Conversion disorder/functional neurological disorder (CD/FND) occurs often in neurological settings and can lead to long-term distress, disability and demand on health care services. Systemic low-grade inflammation might play a role, however, the pathogenic mechanism is still unknown. AIM 1) To explore the feasibility to establish and assess a cohort of CD/FND with motor symptoms, involving persons with lived experience (PPI). 2) To generate proof of concept regarding a possible role for cytokines, microRNA, cortisol levels and neurocognitive symptoms in patients with motor CD/FND. METHOD Feasibility study. RESULTS The study showed active involvement of patients despite high clinical illness burden and disability, neurocognitive symptoms, childhood adverse experiences (ACE) and current life events. The study provided valuable knowledge regarding the feasibility of conducting a study in these patients that will inform future study phases. In the sample there were elevated levels of IL6, IL12, IL17A, IFNg, TNFa and VEGF-a, suggesting systemic low-grade inflammation. Also, microRNAs involved in inflammation and vascular inflammation were correlated with TNFa and VEGFa respectively, suggesting proof of concept for an epigenetic mechanism. Owing to the COVID-19 outbreak, the patient sample was limited to 15 patients. CONCLUSION It is a novelty that this study is conducted in the clinical setting. This innovative, translational study explores stress-related SLI in CD/FND patients and the feasibility of a larger project aiming to develop new treatments for this vulnerable population. Given the positive findings, there is scope to conduct further research into the mechanism of disease in CD/FND.
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15
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Coventry PA, McMillan D, Clegg A, Brown L, van der Feltz-Cornelis C, Gilbody S, Ali S. Frailty and depression predict instrumental activities of daily living in older adults: A population-based longitudinal study using the CARE75+ cohort. PLoS One 2020; 15:e0243972. [PMID: 33320913 PMCID: PMC7737980 DOI: 10.1371/journal.pone.0243972] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 12/01/2020] [Indexed: 11/20/2022] Open
Abstract
Objectives To evaluate if depression contributes, independently and/or in interaction with frailty, to loss of independence in instrumental activities of daily living (ADL) in older adults with frailty. Methods Longitudinal cohort study of people aged ≥75 years living in the community. We used multi-level linear regression model to quantify the relationship between depression (≥5 Geriatric Depression Scale) and frailty (electronic frailty index), and instrumental activities of daily living (Nottingham Extended Activities of Daily Living scale; range: 0–66; higher score implies greater independence). The model was adjusted for known confounders (age; gender; ethnicity; education; living situation; medical comorbidity). Results 553 participants were included at baseline; 53% were female with a mean age of 81 (5.0 SD) years. Depression and frailty (moderate and severe levels) were independently associated with reduced instrumental activities of daily living scores. In the adjusted analysis, the regression coefficient was -6.4 (95% CI: -8.3 to -4.5, p<0.05) for depression, -1.5 (95% CI: -3.8 to 0.9, p = 0.22) for mild frailty, -6.1 (95% CI: -8.6 to -3.6, p<0.05) for moderate frailty, and -10.1 (95% CI: -13.5 to -6.8, p<0.05) for severe frailty. Moreover, depression interacted with frailty to further reduce instrumental activities of daily living score in individuals with mild or moderate frailty. These relationships remained significant after adjusting for confounders. Conclusion Frailty and depression are independently associated with reduced independence in instrumental activities of daily living. Also, depression interacts with frailty to further reduce independence for mild to moderately frail individuals, suggesting that clinical management of frailty should integrate physical and mental health care.
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Affiliation(s)
- Peter A. Coventry
- Department of Health Sciences, University of York, York, United Kingdom
- * E-mail:
| | - Dean McMillan
- Department of Health Sciences and Hull York Medical School, University of York, York, United Kingdom
| | - Andrew Clegg
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, United Kingdom
| | - Lesley Brown
- Academic Unit of Elderly Care and Rehabilitation, Bradford, Institute for Health Research, Bradford, United Kingdom
| | | | - Simon Gilbody
- Department of Health Sciences and Hull York Medical School, University of York, York, United Kingdom
| | - Shehzad Ali
- Department of Health Sciences, University of York, York, United Kingdom
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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16
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Allen SF, Gilbody S, Atkin K, van der Feltz-Cornelis C. The associations between loneliness, social exclusion and pain in the general population: A N=502,528 cross-sectional UK Biobank study. J Psychiatr Res 2020; 130:68-74. [PMID: 32791383 DOI: 10.1016/j.jpsychires.2020.06.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/26/2020] [Accepted: 06/27/2020] [Indexed: 01/01/2023]
Abstract
Chronic pain presents a huge burden for individuals and society and evidence suggests intrinsic links with loneliness, social exclusion and sleep. Research examining how these factors interact is warranted. We aimed to explore the relationships between social exclusion, loneliness, acute and chronic pain, and the influence of poor sleep, in the general UK population. A cross-sectional analysis of UKBiobank participants with baseline data for acute and chronic pain, loneliness and sleep. Principal components analysis (PCA) used data relating to social isolation and deprivation to establish a composite measure of social exclusion. Binary logistic regression analyses were performed. 502,528 UKBiobank participants (mean age = 56.6years, 54.4%female, 94.6%white) were included in the analysis. PCA suggested three social exclusion factors "social participation", "individual deprivation" and "area deprivation". Loneliness significantly predicted acute (OR:1.887; 95%CI1.857-1.917) and chronic pain (OR:1.843; 95%CI1.816-1.870). Each social exclusion factor alone and in combination significantly predicted pain with largest effects for individuals scoring high on all social exclusion factors, for acute (OR:2.087; 95%CI2.026-2.150) and chronic (OR:2.314; 95%CI2.249-2.380) pain. Coefficients remained statistically significant when models were adjusted for demographics and sleep. Social exclusion (as a multifaceted construct) and loneliness are associated with an increased prevalence of acute and chronic pain. Poor sleep has a potential mediating effect on these associations. Exploration of the incidence of pain in loneliness and social exclusion in the general population is warranted. From a public health perspective these findings could be used to design social interventions to prevent or manage pain and mitigate social exclusion.
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Affiliation(s)
- Sarah F Allen
- Department of Health Sciences, University of York, York, UK; Department of Psychology, School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK.
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK; Hull York Medical School, University of York, York, UK
| | - Karl Atkin
- Department of Health Sciences, University of York, York, UK
| | - Christina van der Feltz-Cornelis
- Department of Health Sciences, University of York, York, UK; Hull York Medical School, University of York, York, UK; York Biomedical Research Institute, University of York, York, UK
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17
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Moriarty AS, Coventry PA, Hudson JL, Cook N, Fenton OJ, Bower P, Lovell K, Archer J, Clarke R, Richards DA, Dickens C, Gask L, Waheed W, Huijbregts KM, van der Feltz-Cornelis C, Ali S, Gilbody S, McMillan D. The role of relapse prevention for depression in collaborative care: A systematic review. J Affect Disord 2020; 265:618-644. [PMID: 31791677 DOI: 10.1016/j.jad.2019.11.105] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 10/01/2019] [Accepted: 11/21/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Relapse (the re-emergence of depression symptoms before full recovery) is common in depression and relapse prevention strategies are not well researched in primary care settings. Collaborative care is effective for treating acute phase depression but little is known about the use of relapse prevention strategies in collaborative care. We undertook a systematic review to identify and characterise relapse prevention strategies in the context of collaborative care. METHODS We searched for Randomised Controlled Trials (RCTs) of collaborative care for depression. In addition to published material, we obtained provider and patient manuals from authors to provide more detail on intervention content. We reported the extent to which collaborative care interventions addressed four relapse prevention components. RESULTS 93 RCTs were identified. 31 included a formal relapse prevention plan; 42 had proactive monitoring and follow-up after the acute phase; 39 reported strategies for optimising sustained medication adherence; and 20 of the trials reported psychological or psycho-educational treatments persisting beyond the acute phase or focussing on long-term health/relapse prevention. 30 (32.3%) did not report relapse prevention approaches. LIMITATIONS We did not receive trial materials for approximately half of the trials, which limited our ability to identify relevant features of intervention content. CONCLUSION Relapse is a significant risk amongst people treated for depression and interventions are needed that specifically address and minimise this risk. Given the advantages of collaborative care as a delivery system for depression care, there is scope for more consistency and increased effort to implement and evaluate relapse prevention strategies.
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Affiliation(s)
- Andrew S Moriarty
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Peter A Coventry
- Department of Health Sciences and Centre for Reviews and Dissemination, University of York, Heslington, York, YO10 5DD, UK.
| | - Joanna L Hudson
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Natalie Cook
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Oliver J Fenton
- Tees, Esk and Wear Valleys NHS Foundation Trust, South and West Community Mental Health Team, Acomb Garth, 2 Oak Rise, York, YO24 4LJ, UK.
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Janine Archer
- School of Health and Society, University of Salford, Mary Seacole Building, Broad St, Frederick Road Campus, Salford, M6 6PU, UK.
| | - Rose Clarke
- Sheffield IAPT, St George's Community Health Centre, Winter Street, Sheffield, South Yorkshire, S3 7ND, UK.
| | - David A Richards
- Institute of Health Research, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Chris Dickens
- Institute of Health Research, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Linda Gask
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Waquas Waheed
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Klaas M Huijbregts
- GGNet, Mental Health, RGC SKB Winterswijk, Beatrixpark 1, 7101 BN Winterswijk, The Netherlands.
| | | | - Shehzad Ali
- Epidemiology and Biostatistics Department, Schulich School of Medicine & Dentistry, Western University, Kresge Building, Room K201, London, Ontario, N6A 5C1, Canada; Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
| | - Simon Gilbody
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Dean McMillan
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
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18
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Carlier IVE, van Eeden WA, de Jong K, Giltay EJ, van Noorden MS, van der Feltz-Cornelis C, Zitman FG, Kelderman H, van Hemert AM. Testing for response shift in treatment evaluation of change in self-reported psychopathology amongst secondary psychiatric care outpatients. Int J Methods Psychiatr Res 2019; 28:e1785. [PMID: 31206911 PMCID: PMC6852603 DOI: 10.1002/mpr.1785] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 03/18/2019] [Accepted: 04/01/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES If patients change their perspective due to treatment, this may alter the way they conceptualize, prioritize, or calibrate questionnaire items. These psychological changes, also called "response shifts," may pose a threat to the measurement of therapeutic change in patients. Therefore, it is important to test the occurrence of response shift in patients across their treatment. METHODS This study focused on self-reported psychological distress/psychopathology in a naturalistic sample of 206 psychiatric outpatients. Longitudinal measurement invariance tests were computed across treatment in order to detect response shifts. RESULTS Compared with before treatment, post-treatment psychopathology scores showed an increase in model fit and factor loading, suggesting that symptoms became more coherently interrelated within their psychopathology domains. Reconceptualization (depression/mood) and reprioritization (somatic and cognitive problems) response shift types were found in several items. We found no recalibration response shift. CONCLUSION This study provides further evidence that response shift can occur in adult psychiatric patients across their mental health treatment. Future research is needed to determine whether response shift implies an unwanted potential bias in treatment evaluation or a desired cognitive change intended by treatment.
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Affiliation(s)
- Ingrid V E Carlier
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Wessel A van Eeden
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kim de Jong
- Clinical Psychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | | | | | - Frans G Zitman
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Henk Kelderman
- Department of Methodology and Statistics, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Albert M van Hemert
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
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19
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Van Den Eede F, van der Feltz-Cornelis C. The Need to Distinguish between Bodily Distress Disorder and Somatic Symptom Disorder. Psychother Psychosom 2018; 87:234-235. [PMID: 30021214 DOI: 10.1159/000490731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 06/05/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Filip Van Den Eede
- University Department of Psychiatry, Antwerp University Hospital, Edegem, Belgium.,Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium
| | - Christina van der Feltz-Cornelis
- Tranzo Department, Tilburg School of Behavioral and Social Sciences, Tilburg University, Tilburg, the Netherlands.,Department of Health Science, HYMS, University of York, York, United Kingdom
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20
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Metz M, Elfeddali I, Veerbeek M, de Beurs E, Beekman A, van der Feltz-Cornelis C. Effectiveness of a multi-facetted blended eHealth intervention during intake supporting patients and clinicians in Shared Decision Making: A cluster randomised controlled trial in a specialist mental health outpatient setting. PLoS One 2018; 13:e0199795. [PMID: 29944712 PMCID: PMC6019395 DOI: 10.1371/journal.pone.0199795] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/12/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate the effectiveness of a multi-facetted blended eHealth intervention, called SDM-Digital Intake (SDM-DI), in which patients and clinicians are supported in Shared Decision Making during the intake process. METHODS The study is a two-arm matched-paired cluster Randomised Controlled Trial in a specialist mental health outpatient setting with two conditions: SDM-DI and Intake As Usual (IAU). Four intake teams were allocated to each arm. All patients who followed an intake, were asked to participate if they were capable to complete questionnaires. Decisional Conflict (DC), referring to patients' engagement and satisfaction with clinical decisions, was the primary outcome. Secondary outcomes were patient participation, applying Shared Decision Making (SDM), working alliance, treatment adherence and symptom severity. Effects were measured at two weeks (T1) and two months (T2) after intake. Multilevel regression and intention-to-treat analyses were used. Additionally, the influence of subgroups and intervention adherence on DC were explored. RESULTS At T1, 200 patients participated (47% intervention, 53% control), and at T2 175 patients (47% intervention, 53% control). At T1 and T2, no differences were found between conditions on DC. Subgroup analyses showed that effects of SDM-DI on DC were not modified by primary diagnoses mood, anxiety and personality disorders. Compared to IAU, at T2, patients reported positive effects of SDM-DI on SDM (β 7.553, p = 0.038, 95%CI:0.403-14.703, d = 0.32) and reduction of symptoms (β -7.276, p = 0.0497, 95%CI:-14.544--0.008, d = -0.43). No effects were found on patient participation, working alliance and treatment adherence. Exploratory analyses demonstrated that if SDM was applied well, patients reported less DC (β = -0.457, p = 0.000, 95%CI:-0.518--0.396, d = -1.31), which was associated with better treatment outcomes. CONCLUSION Although, this trial fails to demonstrate that SDM-DI by itself is sufficient to reduce DC, the results are encouraging for further efforts in improving and implementing the SDM intervention.
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Affiliation(s)
- Margot Metz
- GGz Breburg, Tilburg, The Netherlands
- Trimbos Institute, Utrecht, The Netherlands
- VU University, EMGO, Amsterdam, The Netherlands
| | - Iman Elfeddali
- GGz Breburg, Tilburg, The Netherlands
- Tilburg University, Tranzo Department, Tilburg, The Netherlands
| | | | - Edwin de Beurs
- Foundation for Benchmarking Mental Health Care, Bilthoven, The Netherlands
- University of Leiden, Department of Clinical Psychology, Leiden, The Netherlands
| | - Aartjan Beekman
- GGZ inGeest, Amsterdam, The Netherlands
- VU University Medical Centre, Department of Psychiatry, Amsterdam, The Netherlands
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21
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Rief W, Burton C, Frostholm L, Henningsen P, Kleinstäuber M, Kop WJ, Löwe B, Martin A, Malt U, Rosmalen J, Schröder A, Shedden-Mora M, Toussaint A, van der Feltz-Cornelis C. Core Outcome Domains for Clinical Trials on Somatic Symptom Disorder, Bodily Distress Disorder, and Functional Somatic Syndromes: European Network on Somatic Symptom Disorders Recommendations. Psychosom Med 2018; 79:1008-1015. [PMID: 28691994 DOI: 10.1097/psy.0000000000000502] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The harmonization of core outcome domains in clinical trials facilitates comparison and pooling of data, and simplifies the preparation and review of research projects and comparison of risks and benefits of treatments. Therefore, we provide recommendations for the core outcome domains that should be considered in clinical trials on the efficacy and effectiveness of interventions for somatic symptom disorder, bodily distress disorder, and functional somatic syndromes. METHODS The European Network on Somatic Symptom Disorders group of more than 20 experts in the field met twice in Hamburg to discuss issues of assessment and intervention research in somatic symptom disorder, bodily distress disorder, and functional somatic syndromes. The consensus meetings identified core outcome domains that should be considered in clinical trials evaluating treatments for somatic symptom disorder and associated functional somatic syndromes. RESULTS The following core domains should be considered when defining ascertainment methods in clinical trials: a) classification of somatic symptom disorder/bodily distress disorder, associated functional somatic syndromes, and comorbid mental disorders (using structured clinical interviews), duration of symptoms, medical morbidity, and prior treatments; b) location, intensity, and interference of somatic symptoms; c) associated psychobehavioral features and biological markers; d) illness consequences (quality of life, disability, health care utilization, health care costs; e) global improvement and treatment satisfaction; and f) unwanted negative effects. CONCLUSIONS The proposed criteria are intended to improve synergies of clinical trials and to facilitate decision making when comparing different treatment approaches. These recommendations should not result in inflexible guidelines, but increase consistency across investigations in this field.
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Affiliation(s)
- Winfried Rief
- From the Department of Psychology (Rief), Philipps University, Marburg, Germany; University of Aberdeen (Burton), Aberdeen, UK; University of Aarhus (Frostholm, Schröder), Aarhus, Denmark; Technical University of Munich (Henningsen), München, Germany; University of Marburg (Kleinstäuber), Marburg, Germany; Tilburg University (Kop, van der Feltz-Cornelis), Tilburg, the Netherlands; University Medical Center, Hamburg-Eppendorf (Löwe, Shedden-Mora, Toussaint), Hamburg, Germany; University of Wuppertal (Martin), Wuppertal, Germany; University of Oslo (Malt), Oslo, Norway; and University of Groningen (Rosmalen), Groningen, the Netherlands
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Kolovos S, Bosmans JE, van Dongen JM, van Esveld B, Magai D, van Straten A, van der Feltz-Cornelis C, van Steenbergen-Weijenburg KM, Huijbregts KM, van Marwijk H, Riper H, van Tulder MW. Utility scores for different health states related to depression: individual participant data analysis. Qual Life Res 2017; 26:1649-1658. [PMID: 28260149 PMCID: PMC5486895 DOI: 10.1007/s11136-017-1536-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2017] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Depression is associated with considerable impairments in health-related quality-of-life. However, the relationship between different health states related to depression severity and utility scores is unclear. The aim of this study was to evaluate whether utility scores are different for various health states related to depression severity. METHODS We gathered individual participant data from ten randomized controlled trials evaluating depression treatments. The UK EQ-5D and SF-6D tariffs were used to generate utility scores. We defined five health states that were proposed from American Psychiatric Association and National Institute for Clinical Excellence guidelines: remission, minor depression, mild depression, moderate depression, and severe depression. We performed multilevel linear regression analysis. RESULTS We included 1629 participants in the analyses. The average EQ-5D utility scores for the five health states were 0.70 (95% CI 0.67-0.73) for remission, 0.62 (95% CI 0.58-0.65) for minor depression, 0.57 (95% CI 0.54-0.61) for mild depression, 0.52 (95%CI 0.49-0.56) for moderate depression, and 0.39 (95% CI 0.35-0.43) for severe depression. In comparison with the EQ-5D, the utility scores based on the SF-6D were similar for remission (EQ-5D = 0.70 vs. SF-6D = 0.69), but higher for severe depression (EQ-5D = 0.39 vs. SF-6D = 0.55). CONCLUSIONS We observed statistically significant differences in utility scores between depression health states. Individuals with less severe depressive symptoms had on average statistically significant higher utility scores than individuals suffering from more severe depressive symptomatology. In the present study, EQ-5D had a larger range of values as compared to SF-6D.
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Affiliation(s)
- Spyros Kolovos
- Department of Health Sciences, and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
| | - Judith E Bosmans
- Department of Health Sciences, and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
| | - Johanna M van Dongen
- Department of Health Sciences, and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
| | - Birre van Esveld
- Department of Health Sciences, and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
| | - Dorcas Magai
- Department of Clinical, Neuro and Developmental Psychology, and the EMGO Institute for Health and Care Research, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology, and the EMGO Institute for Health and Care Research, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Christina van der Feltz-Cornelis
- Department of Social Psychiatry Tranzo, Tilburg University, Tilburg, The Netherlands
- Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands
| | | | | | - Harm van Marwijk
- Centre for Primary Care, Institute for Population Health, University of Manchester, Manchester, UK
- Department of General Practice and Elderly Care Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, and the EMGO Institute for Health and Care Research, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Maurits W van Tulder
- Department of Health Sciences, and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
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23
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Panagioti M, Bower P, Kontopantelis E, Lovell K, Gilbody S, Waheed W, Dickens C, Archer J, Simon G, Ell K, Huffman JC, Richards DA, van der Feltz-Cornelis C, Adler DA, Bruce M, Buszewicz M, Cole MG, Davidson KW, de Jonge P, Gensichen J, Huijbregts K, Menchetti M, Patel V, Rollman B, Shaffer J, Zijlstra-Vlasveld MC, Coventry PA. Association Between Chronic Physical Conditions and the Effectiveness of Collaborative Care for Depression: An Individual Participant Data Meta-analysis. JAMA Psychiatry 2016; 73:978-89. [PMID: 27602561 DOI: 10.1001/jamapsychiatry.2016.1794] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Collaborative care is an intensive care model involving several health care professionals working together, typically a physician, a case manager, and a mental health professional. Meta-analyses of aggregate data have shown that collaborative care is particularly effective in people with depression and comorbid chronic physical conditions. However, only participant-level analyses can rigorously test whether the treatment effect is influenced by participant characteristics, such as chronic physical conditions. OBJECTIVE To assess whether the effectiveness of collaborative care for depression is moderated by the presence, type, and number of chronic physical conditions. DATA SOURCES Data were obtained from MEDLINE, EMBASE, PubMed, PsycINFO, CINAHL Complete, and Cochrane Central Register of Controlled Trials, and references from relevant systematic reviews. The search and collection of eligible studies was ongoing until May 22, 2015. STUDY SELECTION This was an update to a previous meta-analysis. Two independent reviewers were involved in the study selection process. Randomized clinical trials that compared the effectiveness of collaborative care with usual care in adults with depression and reported measured changes in depression severity symptoms at 4 to 6 months after randomization were included in the analysis. Key search terms included depression, dysthymia, anxiety, panic, phobia, obsession, compulsion, posttraumatic, care management, case management, collaborative care, enhanced care, and managed care. DATA EXTRACTION AND SYNTHESIS Individual participant data on baseline demographics and chronic physical conditions as well as baseline and follow-up depression severity symptoms were requested from authors of the eligible studies. One-step meta-analysis of individual participant data using appropriate mixed-effects models was performed. MAIN OUTCOMES AND MEASURES Continuous outcomes of depression severity symptoms measured using self-reported or observer-rated measures. RESULTS Data sets from 31 randomized clinical trials including 36 independent comparisons (N = 10 962 participants) were analyzed. Individual participant data analyses found no significant interaction effects, indicating that the presence (interaction coefficient, 0.02 [95% CI, -0.10 to 0.13]), numbers (interaction coefficient, 0.01 [95% CI, -0.01 to 0.02]), and types of chronic physical conditions do not influence the treatment effect. CONCLUSIONS AND RELEVANCE There is evidence that collaborative care is effective for people with depression alone and also for people with depression and chronic physical conditions. Existing guidance that recommends limiting collaborative care to people with depression and physical comorbidities is not supported by this individual participant data meta-analysis.
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Affiliation(s)
- Maria Panagioti
- National Institute of Health Research School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, England
| | - Peter Bower
- National Institute of Health Research School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, England
| | - Evangelos Kontopantelis
- National Institute of Health Research School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, England
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, England
| | - Simon Gilbody
- Mental Health and Addiction Research Group, Department of Health Sciences, Hull York Medical School, University of York, York, England
| | - Waquas Waheed
- National Institute of Health Research School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, England
| | - Chris Dickens
- Institute of Health Research, University of Exeter Medical School, Exeter, England 5National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula, University of Exeter, Exeter, England
| | - Janine Archer
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, England
| | - Gregory Simon
- Group Health Research Institute, Seattle, Washington
| | - Kathleen Ell
- Ethnicity and Poverty, School of Social Work, University of Southern California, Los Angeles
| | - Jeff C Huffman
- Harvard Medical School, General Hospital/Blake 11, Boston, Massachusetts
| | - David A Richards
- Institute of Health Research, University of Exeter Medical School, Exeter, England
| | - Christina van der Feltz-Cornelis
- Department of Psychiatry and Behavioral Sciences, Faculty of Social and Behavioral Sciences, Tilburg University, the Netherlands
| | - David A Adler
- Department of Psychiatry, Tufts Medical Center, Boston, Massachusetts
| | - Martha Bruce
- Department of Psychiatry, Weill Cornell Medical College, White Plains, New York
| | - Marta Buszewicz
- Institute of Epidemiology and Health, Faculty of Population and Health Sciences, University College London, London, England
| | - Martin G Cole
- Department of Psychiatry, St. Mary's Hospital Center, McGill University, Montreal, Quebec, Canada
| | - Karina W Davidson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University, New York, New York
| | - Peter de Jonge
- Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, the Netherlands
| | - Jochen Gensichen
- Institute of General Practice, Friedrich-Schiller-University, School of Medicine, University Hospital, Jena, Germany
| | - Klaas Huijbregts
- Netherlands Institute of Mental Health and Addiction, Trimbos Institute, Utrecht, the Netherlands
| | - Marco Menchetti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Vikram Patel
- Public Health Foundation of India, Gurgaon, India
| | - Bruce Rollman
- Psychiatry, Biomedical Informatics, and Clinical and Translational Science, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Peter A Coventry
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, England23Centre for Reviews and Dissemination, University of York, York, England
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Wykes T, Haro JM, Belli SR, Obradors-Tarragó C, Arango C, Ayuso-Mateos JL, Bitter I, Brunn M, Chevreul K, Demotes-Mainard J, Elfeddali I, Evans-Lacko S, Fiorillo A, Forsman AK, Hazo JB, Kuepper R, Knappe S, Leboyer M, Lewis SW, Linszen D, Luciano M, Maj M, McDaid D, Miret M, Papp S, Park AL, Schumann G, Thornicroft G, van der Feltz-Cornelis C, van Os J, Wahlbeck K, Walker-Tilley T, Wittchen HU. Mental health research priorities for Europe. Lancet Psychiatry 2015; 2:1036-42. [PMID: 26404415 DOI: 10.1016/s2215-0366(15)00332-6] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/14/2015] [Accepted: 07/15/2015] [Indexed: 12/18/2022]
Abstract
Mental and brain disorders represent the greatest health burden to Europe-not only for directly affected individuals, but also for their caregivers and the wider society. They incur substantial economic costs through direct (and indirect) health-care and welfare spending, and via productivity losses, all of which substantially affect European development. Funding for research to mitigate these effects lags far behind the cost of mental and brain disorders to society. Here, we describe a comprehensive, coordinated mental health research agenda for Europe and worldwide. This agenda was based on systematic reviews of published work and consensus decision making by multidisciplinary scientific experts and affected stakeholders (more than 1000 in total): individuals with mental health problems and their families, health-care workers, policy makers, and funders. We generated six priorities that will, over the next 5-10 years, help to close the biggest gaps in mental health research in Europe, and in turn overcome the substantial challenges caused by mental disorders.
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Affiliation(s)
- Til Wykes
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Josep Maria Haro
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
| | - Stefano R Belli
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Carla Obradors-Tarragó
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Celso Arango
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - José Luis Ayuso-Mateos
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - István Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Matthias Brunn
- Fondation FondaMental, Créteil, France; URC Eco Ile-de-France (AP-HP), Paris, France
| | - Karine Chevreul
- Fondation FondaMental, Créteil, France; URC Eco Ile-de-France (AP-HP), Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM U955), and Department of Psychiatry, Henri Mondor Hospital, University Paris-Est-Créteil, Creteil, Paris, France
| | - Jacques Demotes-Mainard
- Institut National de la Santé et de la Recherche Médicale (INSERM U955), and Department of Psychiatry, Henri Mondor Hospital, University Paris-Est-Créteil, Creteil, Paris, France; ECRIN Coordination Office, Paris, France
| | - Iman Elfeddali
- Tilburg University, Tranzo Department, Tilburg, Netherlands; Department of Health Promotion, School of Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Sara Evans-Lacko
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Andrea Fiorillo
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Anna K Forsman
- The Nordic School of Public Health, Gothenburg, Sweden; National Institute for Health and Welfare, Vaasa, Finland
| | - Jean-Baptiste Hazo
- Fondation FondaMental, Créteil, France; URC Eco Ile-de-France (AP-HP), Paris, France
| | - Rebecca Kuepper
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, Euron, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Susanne Knappe
- Institute of Clinical Psychology and Psychotherapy, and Center for Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France; Institut National de la Santé et de la Recherche Médicale (INSERM U955), and Department of Psychiatry, Henri Mondor Hospital, University Paris-Est-Créteil, Creteil, Paris, France
| | - Shôn W Lewis
- University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Donald Linszen
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, Euron, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Mario Luciano
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Mario Maj
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - David McDaid
- Personal Social Services Research Unit, LSE Health and Social Care, London School of Economics and Political Science, London, UK
| | - Marta Miret
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Szilvia Papp
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - A-La Park
- Personal Social Services Research Unit, LSE Health and Social Care, London School of Economics and Political Science, London, UK
| | - Gunter Schumann
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Graham Thornicroft
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Jim van Os
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, Euron, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Kristian Wahlbeck
- The Nordic School of Public Health, Gothenburg, Sweden; National Institute for Health and Welfare, Vaasa, Finland; Finnish Association for Mental Health, Helsinki, Finland
| | - Tom Walker-Tilley
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, and Center for Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
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Carlier IVE, Kovács V, van Noorden MS, van der Feltz-Cornelis C, Mooij N, Schulte-van Maaren YWM, van Hemert AM, Zitman FG, Giltay EJ. Evaluating the Responsiveness to Therapeutic Change with Routine Outcome Monitoring: A Comparison of the Symptom Questionnaire-48 (SQ-48) with the Brief Symptom Inventory (BSI) and the Outcome Questionnaire-45 (OQ-45). Clin Psychol Psychother 2015; 24:61-71. [PMID: 26450457 DOI: 10.1002/cpp.1978] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 07/01/2015] [Accepted: 08/19/2015] [Indexed: 11/11/2022]
Abstract
Assessment of psychological distress is important, because it may help to monitor treatment effects and predict treatment outcomes. We previously developed the 48-item Symptom Questionnaire (SQ-48) as a public domain self-report psychological distress instrument and showed good internal consistency as well as good convergent and divergent validity among clinical and non-clinical samples. The present study, conducted among psychiatric outpatients in a routine clinical setting, describes additional psychometric properties of the SQ-48. The primary focus is on responsiveness to therapeutic change, which to date has been rarely examined within psychiatry or clinical psychology. Since a questionnaire should also be stable when no clinically important change occurs, we also examined test-retest reliability within a test-retest design before treatment (n = 43). A pre-treatment/post-treatment design was used for responsiveness to therapeutic change, comparing the SQ-48 with two internationally widely used instruments: the Brief Symptom Inventory (n = 97) and the Outcome Questionnaire-45 (n = 109). The results showed that the SQ-48 has excellent test-retest reliability and good responsiveness to therapeutic change, without significant differences between the questionnaires in terms of responsiveness. In sum, the SQ-48 is a psychometrically sound public domain self-report instrument that can be used for routine outcome monitoring, as a benchmark tool or for research purposes. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message The SQ-48 is developed as a public domain self-report questionnaire, in line with growing efforts to develop clinical instruments that are free of charge. The SQ-48 has excellent test-retest reliability and good responsiveness to therapeutic change or patient progress. There were no significant differences in terms of responsiveness between the SQ-48 and BSI or OQ-45. The SQ-48 can be used as a routine evaluation outcome measure for quality assurance in clinical practice. Providing feedback on patient progress via outcome measures could contribute to the enhancement of treatment outcomes.
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Affiliation(s)
- Ingrid V E Carlier
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Viktória Kovács
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Christina van der Feltz-Cornelis
- Clinical Centre for Body, Mind and Health, GGZ Breburg, Tilburg, The Netherlands.,Tranzo Department, Tilburg University, Tilburg, The Netherlands
| | - Nanda Mooij
- Psychiatric Institute, GGZ inGeest, Amsterdam, The Netherlands
| | | | - Albert M van Hemert
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Frans G Zitman
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
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26
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Koburger N, Mergl R, Rummel-Kluge C, Ibelshäuser A, Meise U, Postuvan V, Roskar S, Székely A, Ditta Tóth M, van der Feltz-Cornelis C, Hegerl U. Celebrity suicide on the railway network: Can one case trigger international effects? J Affect Disord 2015; 185:38-46. [PMID: 26143403 DOI: 10.1016/j.jad.2015.06.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 06/20/2015] [Accepted: 06/20/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND After the railway suicide of the German national goalkeeper Robert Enke in 2009, a significant increase of railway suicides was observed nationally. This study analyses whether this incident also triggered copycat effects in other European countries. Additionally, media coverage proxied by Google Trends and long-term changes taking into account general changes in suicide rates and kilometres driven by trains were examined. METHODS The numbers of railway suicides before and after Enke´s suicide were analysed for short and long-term periods (2 weeks and 2 years post-event) across five European countries. Incidence ratios and resulting percentage changes were computed. RESULTS Similar to Germany, there were significant short and long-term effects for the combined data of the four other countries (increase of 93.9%; p=0.004 and 16.7%; p=0.003). There was no indication that long-term effects are a mere reflection of an overall increase in suicide frequencies or due to increased numbers of kilometres driven by trains. Analyses on country level revealed heterogeneous results. LIMITATIONS Due to incomplete data, analyses regarding age and gender were not performed. Media coverage was only proxied by a Google Trends analysis. The study includes a small sample of European countries. CONCLUSIONS Enke's suicide in 2009 was followed by increasing train suicide numbers in Europe. Although this incident may have reinforced an existing European trend of growing railway suicides, an international copycat effect and/or an increased overall awareness about this particular suicide method appears to be one likely explanation for the changes.
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Affiliation(s)
- Nicole Koburger
- Depression Research Centre, German Depression Foundation, Leipzig, Germany.
| | - Roland Mergl
- Depression Research Centre, German Depression Foundation, Leipzig, Germany; Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Christine Rummel-Kluge
- Depression Research Centre, German Depression Foundation, Leipzig, Germany; Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | | | - Ullrich Meise
- Society for Mental Health - pro mente tirol, Innsbruck, Austria
| | - Vita Postuvan
- Slovene Centre for Suicide Research, Institute Andrej Marusic, University of Primorska, Koper, Slovenia
| | - Saska Roskar
- National Institute for Public Health, Ljubljana, Slovenia
| | - András Székely
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
| | - Mónika Ditta Tóth
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
| | - Christina van der Feltz-Cornelis
- Faculty of Social Sciences, Department Tranzo, University of Tilburg, Tilburg, Netherlands; Topclinical Center for Body, Mind and Health, GGz Breburg, Tilburg, Netherlands
| | - Ulrich Hegerl
- Depression Research Centre, German Depression Foundation, Leipzig, Germany; Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
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27
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Pincus HA, Jun M, Franx G, van der Feltz-Cornelis C, Ito H, Mossialos E. How Can We Link General Medical and Behavioral Health Care? International Models for Practice and Policy. Psychiatr Serv 2015; 66:775-7. [PMID: 25930046 DOI: 10.1176/appi.ps.201400461] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A range of integration models for providing effective care to individuals with comorbid general medical and behavioral health conditions have been described and tested in varied settings internationally for several subsets of this population. This column examines models in three countries selected to showcase implementation in a variety of health systems: the national health system in England, nationally regulated individual insurance market in the Netherlands, and a mixture of employer-sponsored and government-funded health insurance plans in Japan. The authors describe a set of key practices for and challenges to the successful implementation of these models.
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Affiliation(s)
- Harold Alan Pincus
- Dr. Pincus is with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and the Irving Institute for Clinical and Translational Research, Columbia University and New York-Presbyterian, New York City (e-mail: ). Ms. Jun and Dr. Mossialos are with the Department of Health and Social Care, London School of Economics and Political Science, London. Dr. Franx is with the Department of Innovation of Care, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht. Prof. van der Feltz-Cornelis is with the Tranzo Department, Tilburg University, and the Top Clinical Centre for Body, Mind and Health, GGz Breburg, both in Tilburg, the Netherlands. Dr. Ito is with the Department of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo. Benjamin G. Druss, M.D., M.P.H., is editor of this column
| | - Miraya Jun
- Dr. Pincus is with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and the Irving Institute for Clinical and Translational Research, Columbia University and New York-Presbyterian, New York City (e-mail: ). Ms. Jun and Dr. Mossialos are with the Department of Health and Social Care, London School of Economics and Political Science, London. Dr. Franx is with the Department of Innovation of Care, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht. Prof. van der Feltz-Cornelis is with the Tranzo Department, Tilburg University, and the Top Clinical Centre for Body, Mind and Health, GGz Breburg, both in Tilburg, the Netherlands. Dr. Ito is with the Department of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo. Benjamin G. Druss, M.D., M.P.H., is editor of this column
| | - Gerdien Franx
- Dr. Pincus is with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and the Irving Institute for Clinical and Translational Research, Columbia University and New York-Presbyterian, New York City (e-mail: ). Ms. Jun and Dr. Mossialos are with the Department of Health and Social Care, London School of Economics and Political Science, London. Dr. Franx is with the Department of Innovation of Care, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht. Prof. van der Feltz-Cornelis is with the Tranzo Department, Tilburg University, and the Top Clinical Centre for Body, Mind and Health, GGz Breburg, both in Tilburg, the Netherlands. Dr. Ito is with the Department of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo. Benjamin G. Druss, M.D., M.P.H., is editor of this column
| | - Christina van der Feltz-Cornelis
- Dr. Pincus is with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and the Irving Institute for Clinical and Translational Research, Columbia University and New York-Presbyterian, New York City (e-mail: ). Ms. Jun and Dr. Mossialos are with the Department of Health and Social Care, London School of Economics and Political Science, London. Dr. Franx is with the Department of Innovation of Care, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht. Prof. van der Feltz-Cornelis is with the Tranzo Department, Tilburg University, and the Top Clinical Centre for Body, Mind and Health, GGz Breburg, both in Tilburg, the Netherlands. Dr. Ito is with the Department of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo. Benjamin G. Druss, M.D., M.P.H., is editor of this column
| | - Hiroto Ito
- Dr. Pincus is with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and the Irving Institute for Clinical and Translational Research, Columbia University and New York-Presbyterian, New York City (e-mail: ). Ms. Jun and Dr. Mossialos are with the Department of Health and Social Care, London School of Economics and Political Science, London. Dr. Franx is with the Department of Innovation of Care, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht. Prof. van der Feltz-Cornelis is with the Tranzo Department, Tilburg University, and the Top Clinical Centre for Body, Mind and Health, GGz Breburg, both in Tilburg, the Netherlands. Dr. Ito is with the Department of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo. Benjamin G. Druss, M.D., M.P.H., is editor of this column
| | - Elias Mossialos
- Dr. Pincus is with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and the Irving Institute for Clinical and Translational Research, Columbia University and New York-Presbyterian, New York City (e-mail: ). Ms. Jun and Dr. Mossialos are with the Department of Health and Social Care, London School of Economics and Political Science, London. Dr. Franx is with the Department of Innovation of Care, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht. Prof. van der Feltz-Cornelis is with the Tranzo Department, Tilburg University, and the Top Clinical Centre for Body, Mind and Health, GGz Breburg, both in Tilburg, the Netherlands. Dr. Ito is with the Department of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo. Benjamin G. Druss, M.D., M.P.H., is editor of this column
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van Eck van der Sluijs J, ten Have M, Rijnders C, van Marwijk H, de Graaf R, van der Feltz-Cornelis C. Medically unexplained and explained physical symptoms in the general population: association with prevalent and incident mental disorders. PLoS One 2015; 10:e0123274. [PMID: 25853676 PMCID: PMC4390312 DOI: 10.1371/journal.pone.0123274] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 02/18/2015] [Indexed: 12/02/2022] Open
Abstract
Background Clinical studies have shown that Medically Unexplained Symptoms (MUS) are related to common mental disorders. It is unknown how often common mental disorders occur in subjects who have explained physical symptoms (PHY), MUS or both, in the general population, what the incidence rates are, and whether there is a difference between PHY and MUS in this respect. Aim To study the prevalence and incidence rates of mood, anxiety and substance use disorders in groups with PHY, MUS and combined MUS and PHY compared to a no-symptoms reference group in the general population. Method Data were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a nationally representative face-to-face survey of the general population aged 18-64 years. We selected subjects with explained physical symptoms only (n=1952), with MUS only (n=177), with both MUS and PHY (n=209), and a reference group with no physical symptoms (n=4168). The assessment of common mental disorders was through the Composite International Diagnostic Interview 3.0. Multivariate logistic regression analyses were used to examine the association between group membership and the prevalence and first-incidence rates of comorbid mental disorders, adjusted for socio-demographic characteristics. Results MUS were associated with the highest prevalence rates of mood and anxiety disorders, and combined MUS and PHY with the highest prevalence rates of substance disorder. Combined MUS and PHY were associated with a higher incidence rate of mood disorder only (OR 2.9 (95%CI:1.27,6.74)). Conclusion In the general population, PHY, MUS and the combination of both are related to mood and anxiety disorder, but odds are highest for combined MUS and PHY in relation to substance use disorder. Combined MUS and PHY are related to a greater incidence of mood disorder. These findings warrant further research into possibilities to improve recognition and early intervention in subjects with combined MUS and PHY.
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Affiliation(s)
- Jonna van Eck van der Sluijs
- Topclinical Centre for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands
- Tranzo department, Tilburg University, Tilburg, the Netherlands
- * E-mail:
| | - Margreet ten Have
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Cees Rijnders
- Department of Residency training, GGz Breburg, Tilburg, The Netherlands
| | - Harm van Marwijk
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, United Kingdom
- Department of General Practice & Elderly Care Medicine and the EMGO+-Institute for Health and Care Research of VU University medical centre (VUmc), Amsterdam, The Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Christina van der Feltz-Cornelis
- Topclinical Centre for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands
- Tranzo department, Tilburg University, Tilburg, the Netherlands
- Department of Residency training, GGz Breburg, Tilburg, The Netherlands
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29
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Muntingh A, van der Feltz-Cornelis C, van Marwijk H, Spinhoven P, Assendelft W, de Waal M, Adèr H, van Balkom A. Effectiveness of collaborative stepped care for anxiety disorders in primary care: a pragmatic cluster randomised controlled trial. Psychother Psychosom 2014; 83:37-44. [PMID: 24281396 DOI: 10.1159/000353682] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 06/11/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Collaborative stepped care (CSC) may be an appropriate model to provide evidence-based treatment for anxiety disorders in primary care. METHODS In a cluster randomised controlled trial, the effectiveness of CSC compared to care as usual (CAU) for adults with panic disorder (PD) or generalised anxiety disorder (GAD) in primary care was evaluated. Thirty-one psychiatric nurses who provided their services to 43 primary care practices in the Netherlands were randomised to deliver CSC (16 psychiatric nurses, 23 practices) or CAU (15 psychiatric nurses, 20 practices). CSC was provided by the psychiatric nurses (care managers) in collaboration with the general practitioner and a consultant psychiatrist. The intervention consisted of 3 steps, namely guided self-help, cognitive behavioural therapy and antidepressants. Anxiety symptoms were measured with the Beck Anxiety Inventory (BAI) at baseline and after 3, 6, 9 and 12 months. RESULTS We recruited 180 patients with a DSM-IV diagnosis of PD or GAD, of whom 114 received CSC and 66 received usual primary care. On the BAI, CSC was superior to CAU [difference in gain scores from baseline to 3 months: -5.11, 95% confidence interval (CI) -8.28 to -1.94; 6 months: -4.65, 95% CI -7.93 to -1.38; 9 months: -5.67, 95% CI -8.97 to -2.36; 12 months: -6.84, 95% CI -10.13 to -3.55]. CONCLUSIONS CSC, with guided self-help as a first step, was more effective than CAU for primary care patients with PD or GAD.
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Affiliation(s)
- Anna Muntingh
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, The Netherlands
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30
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Goorden M, Muntingh A, van Marwijk H, Spinhoven P, Adèr H, van Balkom A, van der Feltz-Cornelis C, Hakkaart-van Roijen L. Cost utility analysis of a collaborative stepped care intervention for panic and generalized anxiety disorders in primary care. J Psychosom Res 2014; 77:57-63. [PMID: 24913343 DOI: 10.1016/j.jpsychores.2014.04.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/11/2014] [Accepted: 04/14/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Generalized anxiety and panic disorders are a burden on the society because they are costly and have a significant adverse effect on quality of life. The aim of this study was to evaluate the cost-utility of a collaborative stepped care intervention for panic disorder and generalized anxiety disorder in primary care compared to care as usual from a societal perspective. METHODS The design of the study was a two armed cluster randomized controlled trial. In total 43 primary care practices in the Netherlands participated in the study. Eventually, 180 patients were included (114 collaborative stepped care, 66 care as usual). Baseline measures and follow-up measures (3, 6, 9 and 12 months) were assessed using questionnaires. We applied the TiC-P, the SF-HQL and the EQ-5D respectively measuring health care utilization, production losses and health related quality of life. RESULTS The average annual direct medical costs in the collaborative stepped care group were 1854 Euro (95% C.I., 1726 to 1986) compared to €1503 (95% C.I., 1374 to 1664) in the care as usual group. The average quality of life years (QALYs) gained was 0.05 higher in the collaborative stepped care group, leading to an incremental cost effectiveness ratio (ICER) of 6965 Euro per QALY. Inclusion of the productivity costs, consequently reflecting the full societal costs, decreased the ratio even more. CONCLUSION The study showed that collaborative stepped care was a cost effective intervention for panic disorder and generalized anxiety disorder and was even dominant when a societal perspective was taken. TRIAL REGISTRATION trialregister.nl, Netherlands Trial Register NTR107.
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Affiliation(s)
- Maartje Goorden
- Institute for Medical Technology Assessment, Institute of Health Policy & Management, PO Box 1783, Rotterdam, The Netherlands.
| | - Anna Muntingh
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), PO Box 725, Utrecht, The Netherlands; Faculty of Social Sciences, Tranzo Department, Tilburg University, PO Box 90153, Tilburg, The Netherlands; Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
| | - Harm van Marwijk
- Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research (EMGO+), PO Box 7057, Amsterdam, The Netherlands
| | - Philip Spinhoven
- Institute of Psychology, Leiden University, PO Box 9555, Leiden, The Netherlands; Department of Psychiatry, Leiden University Medical Centre, PO Box 9600, Leiden, The Netherlands
| | - Herman Adèr
- Johannes van Kessel Advising, Huizen, The Netherlands
| | - Anton van Balkom
- Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
| | - Christina van der Feltz-Cornelis
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), PO Box 725, Utrecht, The Netherlands; Clinical Centre for Body, Mind and Health, GGZ Breburg, Tilburg, The Netherlands; Faculty of Social Sciences, Tranzo Department, Tilburg University, PO Box 90153, Tilburg, The Netherlands
| | - Leona Hakkaart-van Roijen
- Institute for Medical Technology Assessment, Institute of Health Policy & Management, PO Box 1783, Rotterdam, The Netherlands
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31
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Soffers R, Meijboom B, van Zaanen J, van der Feltz-Cornelis C. Modular health services: a single case study approach to the applicability of modularity to residential mental healthcare. BMC Health Serv Res 2014; 14:210. [PMID: 24886367 PMCID: PMC4101855 DOI: 10.1186/1472-6963-14-210] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 04/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Dutch mental healthcare sector has to decrease costs by reducing intramural capacity with one third by 2020 and treating more patients in outpatient care. This transition necessitates enabling patients to become as self-supporting as possible, by customising the residential care they receive to their needs for self-development. Theoretically, modularity might help mental healthcare institutions with this. Modularity entails the decomposition of a healthcare service in parts that can be mixed-and-matched in a variety of ways, and combined form a functional whole. It brings about easier and better configuration, increased transparency and more variety without increasing costs. AIM this study aims to explore the applicability of the modularity concept to the residential care provided in Assisted Living Facilities (ALFs) of Dutch mental healthcare institutions. METHODS A single case study is carried out at the centre for psychosis in Etten-Leur, part of the GGz Breburg IMPACT care group. The design enables in-depth analysis of a case in a specific context. This is considered appropriate since theory concerning healthcare modularity is in an early stage of development. The present study can be considered a pilot case. Data were gathered by means of interviews, observations and documentary analysis. RESULTS At the centre for psychosis, the majority of the residential care can be decomposed in modules, which can be grouped in service bundles and sub-bundles; the service customisation process is sufficiently fit to apply modular thinking; and interfaces for most of the categories are present. Hence, the prerequisites for modular residential care offerings are already largely fulfilled. For not yet fulfilled aspects of these prerequisites, remedies are available. CONCLUSION The modularity concept seems applicable to the residential care offered by the ALF of the mental healthcare institution under study. For a successful implementation of modularity however, some steps should be taken by the ALF, such as developing a catalogue of modules and a method for the personnel to work with this catalogue in application of the modules. Whether implementation of modular residential care might facilitate the transition from intramural residential care to outpatient care should be the subject of future research.
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Affiliation(s)
- Rutger Soffers
- Department of Management, Tilburg University, Warandelaan 2, Tilburg 5037 AB, Netherlands.
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32
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Zenger M, Schaefert R, van der Feltz-Cornelis C, Brähler E, Häuser W. Validation of the Patient-Doctor-Relationship Questionnaire (PDRQ-9) in a representative cross-sectional German population survey. PLoS One 2014; 9:e91964. [PMID: 24637904 PMCID: PMC3956823 DOI: 10.1371/journal.pone.0091964] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 02/16/2014] [Indexed: 11/18/2022] Open
Abstract
The patient-doctor relationship (PDR) as perceived by the patient is an important concept in primary care and psychotherapy. The PDR Questionnaire (PDRQ-9) provides a brief measure of the therapeutic aspects of the PDR in primary care. We assessed the internal and external validity of the German version of the PDRQ-9 in a representative cross-sectional German population survey that included 2,275 persons aged≥14 years who reported consulting with a primary care physician (PCP). The acceptance of the German version of this questionnaire was good. Confirmatory factor analysis demonstrated that the PRDQ-9 was unidimensional. The internal reliability (Cronbach's α) of the total score was .95. The corrected item-total correlations were≥.94. The mean satisfaction index of persons with a probable depressive disorder was lower than that of persons without a probable depressive disorder, indicating good discriminative concurrent criterion validity. The correlation coefficient between satisfaction with PDR and satisfaction with pain therapy was r = .51 in 489 persons who reported chronic pain, indicating good convergent validity. Despite the limitation of low variance in the PDRQ-9 total scores, the results indicate that the German version of the PDRQ-9 is a brief questionnaire with good psychometric properties to assess German patients' perceived therapeutic alliance with PCPs in public health research.
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Affiliation(s)
- Markus Zenger
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
- * E-mail:
| | - Rainer Schaefert
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Christina van der Feltz-Cornelis
- Tranzo Department, Faculty of Social Sciences of the University of Tilburg, Tilburg; Clinical Center for Body, Mind and Health, Tilburg, The Netherlands
- Trimbos Instituut, Utrecht, The Netherlands
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Winfried Häuser
- Department of Internal Medicine I, Klinikum Saarbrücken, Saarbrücken, Germany
- Department of Psychosomatic Medicine, Technische Universität München, München, Germany
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