1
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Matcham F, Simblett SK, Leightley D, Dalby M, Siddi S, Haro JM, Lamers F, Penninx BWHJ, Bruce S, Nica R, Zormpas S, Gilpin G, White KM, Oetzmann C, Annas P, Brasen JC, Narayan VA, Hotopf M, Wykes T. The association between persistent cognitive difficulties and depression and functional outcomes in people with major depressive disorder. Psychol Med 2023; 53:6334-6344. [PMID: 37743838 PMCID: PMC10520589 DOI: 10.1017/s0033291722003671] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/24/2022] [Accepted: 11/08/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cognitive symptoms are common during and following episodes of depression. Little is known about the persistence of self-reported and performance-based cognition with depression and functional outcomes. METHODS This is a secondary analysis of a prospective naturalistic observational clinical cohort study of individuals with recurrent major depressive disorder (MDD; N = 623). Participants completed app-based self-reported and performance-based cognitive function assessments alongside validated measures of depression, functional disability, and self-esteem every 3 months. Participants were followed-up for a maximum of 2-years. Multilevel hierarchically nested modelling was employed to explore between- and within-participant variation over time to identify whether persistent cognitive difficulties are related to levels of depression and functional impairment during follow-up. RESULTS 508 individuals (81.5%) provided data (mean age: 46.6, s.d.: 15.6; 76.2% female). Increasing persistence of self-reported cognitive difficulty was associated with higher levels of depression and functional impairment throughout the follow-up. In comparison to low persistence of objective cognitive difficulty (<25% of timepoints), those with high persistence (>75% of timepoints) reported significantly higher levels of depression (B = 5.17, s.e. = 2.21, p = 0.019) and functional impairment (B = 4.82, s.e. = 1.79, p = 0.002) over time. Examination of the individual cognitive modules shows that persistently impaired executive function is associated with worse functioning, and poor processing speed is particularly important for worsened depressive symptoms. CONCLUSIONS We replicated previous findings of greater persistence of cognitive difficulty with increasing severity of depression and further demonstrate that these cognitive difficulties are associated with pervasive functional disability. Difficulties with cognition may be an indicator and target for further treatment input.
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Affiliation(s)
- F. Matcham
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- School of Psychology, University of Sussex, Falmer, UK
| | - S. K. Simblett
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - D. Leightley
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M. Dalby
- Muna Therapeutics, Copenhagen, Denmark
| | - S. Siddi
- Parc Sanitari Sant Joan de Déu, Fundació San Joan de Déu, Universitat de Barcelona, CIBERSAM, Barcelona, Spain
| | - J. M. Haro
- Parc Sanitari Sant Joan de Déu, Fundació San Joan de Déu, Universitat de Barcelona, CIBERSAM, Barcelona, Spain
| | - F. Lamers
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands
| | - B. W. H. J. Penninx
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands
| | - S. Bruce
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - R. Nica
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- The Romanian League for Mental Health, Bucharest, Romania
| | - S. Zormpas
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- EPIONI Greek Carers Network, Athens, Greece
| | - G. Gilpin
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - K. M. White
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - C. Oetzmann
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - P. Annas
- H. Lundbeck A/S, Copenhagen, Denmark
| | | | | | - M. Hotopf
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - T. Wykes
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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2
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Sun S, Folarin AA, Zhang Y, Cummins N, Garcia-Dias R, Stewart C, Ranjan Y, Rashid Z, Conde P, Laiou P, Sankesara H, Matcham F, Leightley D, White KM, Oetzmann C, Ivan A, Lamers F, Siddi S, Simblett S, Nica R, Rintala A, Mohr DC, Myin-Germeys I, Wykes T, Haro JM, Penninx BWJH, Vairavan S, Narayan VA, Annas P, Hotopf M, Dobson RJB. Challenges in Using mHealth Data From Smartphones and Wearable Devices to Predict Depression Symptom Severity: Retrospective Analysis. J Med Internet Res 2023; 25:e45233. [PMID: 37578823 PMCID: PMC10463088 DOI: 10.2196/45233] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/11/2023] [Accepted: 04/23/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) affects millions of people worldwide, but timely treatment is not often received owing in part to inaccurate subjective recall and variability in the symptom course. Objective and frequent MDD monitoring can improve subjective recall and help to guide treatment selection. Attempts have been made, with varying degrees of success, to explore the relationship between the measures of depression and passive digital phenotypes (features) extracted from smartphones and wearables devices to remotely and continuously monitor changes in symptomatology. However, a number of challenges exist for the analysis of these data. These include maintaining participant engagement over extended time periods and therefore understanding what constitutes an acceptable threshold of missing data; distinguishing between the cross-sectional and longitudinal relationships for different features to determine their utility in tracking within-individual longitudinal variation or screening individuals at high risk; and understanding the heterogeneity with which depression manifests itself in behavioral patterns quantified by the passive features. OBJECTIVE We aimed to address these 3 challenges to inform future work in stratified analyses. METHODS Using smartphone and wearable data collected from 479 participants with MDD, we extracted 21 features capturing mobility, sleep, and smartphone use. We investigated the impact of the number of days of available data on feature quality using the intraclass correlation coefficient and Bland-Altman analysis. We then examined the nature of the correlation between the 8-item Patient Health Questionnaire (PHQ-8) depression scale (measured every 14 days) and the features using the individual-mean correlation, repeated measures correlation, and linear mixed effects model. Furthermore, we stratified the participants based on their behavioral difference, quantified by the features, between periods of high (depression) and low (no depression) PHQ-8 scores using the Gaussian mixture model. RESULTS We demonstrated that at least 8 (range 2-12) days were needed for reliable calculation of most of the features in the 14-day time window. We observed that features such as sleep onset time correlated better with PHQ-8 scores cross-sectionally than longitudinally, whereas features such as wakefulness after sleep onset correlated well with PHQ-8 longitudinally but worse cross-sectionally. Finally, we found that participants could be separated into 3 distinct clusters according to their behavioral difference between periods of depression and periods of no depression. CONCLUSIONS This work contributes to our understanding of how these mobile health-derived features are associated with depression symptom severity to inform future work in stratified analyses.
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Affiliation(s)
- Shaoxiong Sun
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Amos A Folarin
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
- NIHR Biomedical Research Centre at South London and Maudsley, NHS Foundation Trust, London, United Kingdom
- Health Data Research UK London, University College London, London, United Kingdom
- NIHR Biomedical Research Centre at University College London Hospitals, NHS Foundation Trust, London, United Kingdom
| | - Yuezhou Zhang
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Nicholas Cummins
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Rafael Garcia-Dias
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Callum Stewart
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Yatharth Ranjan
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Zulqarnain Rashid
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Pauline Conde
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Petroula Laiou
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Heet Sankesara
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Faith Matcham
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- School of Psychology, University of Sussex, Falmer, United Kingdom
| | - Daniel Leightley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Katie M White
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Carolin Oetzmann
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Alina Ivan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Femke Lamers
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
- Mental Health Program, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Sara Siddi
- Teaching Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Sara Simblett
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Raluca Nica
- RADAR-CNS Patient Advisory Board, King's College London, London, United Kingdom
- The Romanian League for Mental Health, Bucharest, Romania
| | - Aki Rintala
- Department of Neurosciences, Center for Contextual Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
- Physical Activity and Functional Capacity Research Group, Faculty of Health Care and Social Services, LAB University of Applied Sciences, Lahti, Finland
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Inez Myin-Germeys
- Department of Neurosciences, Center for Contextual Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Josep Maria Haro
- Teaching Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
- Mental Health Program, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | | | | | | | - Matthew Hotopf
- NIHR Biomedical Research Centre at South London and Maudsley, NHS Foundation Trust, London, United Kingdom
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Richard J B Dobson
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
- NIHR Biomedical Research Centre at South London and Maudsley, NHS Foundation Trust, London, United Kingdom
- Health Data Research UK London, University College London, London, United Kingdom
- NIHR Biomedical Research Centre at University College London Hospitals, NHS Foundation Trust, London, United Kingdom
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Zenoaga-Barbăroșie C, Berca L, Vassu-Dimov T, Toma M, Nica MI, Alexiu-Toma OA, Ciornei C, Albu A, Nica S, Nistor C, Nica R. The Predisposition for Type 2 Diabetes Mellitus and Metabolic Syndrome. Balkan J Med Genet 2023; 26:21-26. [PMID: 37576792 PMCID: PMC10413885 DOI: 10.2478/bjmg-2023-0003] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) are diseases caused by the interaction of genetic and non-genetic factors. Therefore, the aim of our study was to investigate the association between six common genetic polymorphisms and T2DM and MetS in males. A total of 120 T2DM, 75 MetS, and 120 healthy controls (HC) were included in the study. ACE ID, eNOS 4a/b, ATR1 A1166C, OXTR (A>G), SOD1 +35A/C, CAT-21A/T gene polymorphisms were genotyped by PCR or PCR-RFLP techniques. T2DM was diagnosed at an earlier age compared to MetS (54 vs 55 years old, p=0.0003) and the difference was greater in carriers of the OXTR G allele (54 vs 56 years old, p=0.0002) or both OXTR G and eNOS b alleles (54 vs 56, p=0.00016). The SOD1 AA genotype (O.R.=0.11, p=0.0006) and the presence of both ACE I and OXTR1 A (O.R.=0.39, p=0.0005) alleles revealed to be protective for T2DM. SOD1 AA and AC genotypes were protective factors for triglyceride (p=0.0002 and p=0.0005, respectively) and HDL cholesterol (p=0.0002 and p=0.0004, respectively) levels in T2DM patients. ACE DD was identified more frequently in hypertensive T2DM patients (O.R.=3.77, p=0.0005) and in those who reported drinking alcohol (p=0.0001) comparing to HC and T2DM patients who did not drink alcohol, respectively. We observed that T2DM patients who reported drinking alcohol had an increased frequency of ACE DD and eNOS bb (p<0.0001), or ACE DD and OXTR G (p<0.0001) compared to non-drinkers. No gene polymorphisms were associated with MetS.
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Affiliation(s)
| | - L Berca
- Molecular Biology Department, National Research and Development Institute for Food Bioresources – IBA Bucharest, Bucharest, Romania
| | - T Vassu-Dimov
- Department of Genetics, University of Bucharest, Bucharest, Romania
| | - M Toma
- Emergency Department, Central Military Emergency Hospital Dr. Carol Davila, Bucharest, Romania
| | - MI Nica
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - OA Alexiu-Toma
- Department of Genetics, University of Bucharest, Bucharest, Romania
| | - C Ciornei
- Preclinical Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Emergency Department, Bucharest Emergency University Hospital, Bucharest, Romania
| | - A Albu
- Emergency Department, Bucharest Emergency University Hospital, Bucharest, Romania
| | - S Nica
- Emergency Department, Bucharest Emergency University Hospital, Bucharest, Romania
- Clinic Department 4, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - C Nistor
- Preclinical Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Thoracic Surgery, Central Military Emergency Hospital Dr. Carol Davila, Bucharest, Romania
| | - R Nica
- Surgery 2, Central Military Emergency Hospital Dr. Carol Davila, Bucharest, Romania
- Special Disciplines, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
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4
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Zhang Y, Pratap A, Folarin AA, Sun S, Cummins N, Matcham F, Vairavan S, Dineley J, Ranjan Y, Rashid Z, Conde P, Stewart C, White KM, Oetzmann C, Ivan A, Lamers F, Siddi S, Rambla CH, Simblett S, Nica R, Mohr DC, Myin-Germeys I, Wykes T, Haro JM, Penninx BWJH, Annas P, Narayan VA, Hotopf M, Dobson RJB. Long-term participant retention and engagement patterns in an app and wearable-based multinational remote digital depression study. NPJ Digit Med 2023; 6:25. [PMID: 36806317 PMCID: PMC9938183 DOI: 10.1038/s41746-023-00749-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 01/10/2023] [Indexed: 02/19/2023] Open
Abstract
Recent growth in digital technologies has enabled the recruitment and monitoring of large and diverse populations in remote health studies. However, the generalizability of inference drawn from remotely collected health data could be severely impacted by uneven participant engagement and attrition over the course of the study. We report findings on long-term participant retention and engagement patterns in a large multinational observational digital study for depression containing active (surveys) and passive sensor data collected via Android smartphones, and Fitbit devices from 614 participants for up to 2 years. Majority of participants (67.6%) continued to remain engaged in the study after 43 weeks. Unsupervised clustering of participants' study apps and Fitbit usage data showed 3 distinct engagement subgroups for each data stream. We found: (i) the least engaged group had the highest depression severity (4 PHQ8 points higher) across all data streams; (ii) the least engaged group (completed 4 bi-weekly surveys) took significantly longer to respond to survey notifications (3.8 h more) and were 5 years younger compared to the most engaged group (completed 20 bi-weekly surveys); and (iii) a considerable proportion (44.6%) of the participants who stopped completing surveys after 8 weeks continued to share passive Fitbit data for significantly longer (average 42 weeks). Additionally, multivariate survival models showed participants' age, ownership and brand of smartphones, and recruitment sites to be associated with retention in the study. Together these findings could inform the design of future digital health studies to enable equitable and balanced data collection from diverse populations.
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Affiliation(s)
- Yuezhou Zhang
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Abhishek Pratap
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- Krembil Center for Neuroinformatics, CAMH, Toronto, ON, Canada.
- University of Toronto, Toronto, ON, Canada.
- University of Washington, Seattle, WA, USA.
- Davos Alzheimer's Collaborative, Geneva, Switzerland.
| | - Amos A Folarin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- University College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Health Data Research UK London, University College London, London, UK
| | - Shaoxiong Sun
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nicholas Cummins
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Faith Matcham
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- School of Psychology, University of Sussex, Falmer, East Sussex, UK
| | | | - Judith Dineley
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Yatharth Ranjan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Zulqarnain Rashid
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Pauline Conde
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Callum Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katie M White
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Carolin Oetzmann
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alina Ivan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Femke Lamers
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Sara Siddi
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - Carla Hernández Rambla
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - Sara Simblett
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Raluca Nica
- RADAR-CNS Patient Advisory Board, King's College London, London, UK
- The Romanian League for Mental Health, Bucharest, Romania
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventative Medicine, Northwestern University, Chicago, IL, USA
| | | | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - Brenda W J H Penninx
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | | | - Vaibhav A Narayan
- Davos Alzheimer's Collaborative, Geneva, Switzerland
- Janssen Research and Development, LLC, Titusville, NJ, USA
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Richard J B Dobson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- University College London, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
- Health Data Research UK London, University College London, London, UK.
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Polhemus A, Simblett S, Dawe-Lane E, Gilpin G, Elliott B, Jilka S, Novak J, Nica R, Temesi G, Wykes T. Health tracking via mobile apps for depression self-management: a qualitative content analysis of user reviews (Preprint). JMIR Hum Factors 2022; 9:e40133. [DOI: 10.2196/40133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/19/2022] [Accepted: 08/06/2022] [Indexed: 11/13/2022] Open
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6
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Matcham F, Leightley D, Siddi S, Lamers F, White K, Annas P, De Girolamo G, Difrancesco S, Haro J, Horsfall M, Ivan A, Lavelle G, Li Q, Lombardini F, Mohr D, Narayan V, Oetzmann C, Penninx B, Simblett S, Bruce S, Nica R, Wykes T, Brasen J, Myin-Germeys I, Rintala A, Conde P, Dobson R, Folarin A, Stewart C, Ranjan Y, Rashid Z, Cummins N, Manyakov N, Vairavan S, Hotopf M. Remote Assessment of Disease and Relapse in Major Depressive Disorder (RADAR-MDD): Recruitment, retention, and data availability in a longitudinal remote measurement study. Eur Psychiatry 2022. [PMCID: PMC9564033 DOI: 10.1192/j.eurpsy.2022.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Major Depressive Disorder (MDD) is prevalent, often chronic, and requires ongoing monitoring of symptoms to track response to treatment and identify early indicators of relapse. Remote Measurement Technologies (RMT) provide an exciting opportunity to transform the measurement and management of MDD, via data collected from inbuilt smartphone sensors and wearable devices alongside app-based questionnaires and tasks.
Objectives
To describe the amount of data collected during a multimodal longitudinal RMT study, in an MDD population.
Methods
RADAR-MDD is a multi-centre, prospective observational cohort study. People with a history of MDD were provided with a wrist-worn wearable, and several apps designed to: a) collect data from smartphone sensors; and b) deliver questionnaires, speech tasks and cognitive assessments and followed-up for a maximum of 2 years.
Results
A total of 623 individuals with a history of MDD were enrolled in the study with 80% completion rates for primary outcome assessments across all timepoints. 79.8% of people participated for the maximum amount of time available and 20.2% withdrew prematurely. Data availability across all RMT data types varied depending on the source of data and the participant-burden for each data type. We found no evidence of an association between the severity of depression symptoms at baseline and the availability of data. 110 participants had > 50% data available across all data types, and thus able to contribute to multiparametric analyses.
Conclusions
RADAR-MDD is the largest multimodal RMT study in the field of mental health. Here, we have shown that collecting RMT data from a clinical population is feasible.
Disclosure
No significant relationships.
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Matcham F, Leightley D, Siddi S, Lamers F, White KM, Annas P, de Girolamo G, Difrancesco S, Haro JM, Horsfall M, Ivan A, Lavelle G, Li Q, Lombardini F, Mohr DC, Narayan VA, Oetzmann C, Penninx BWJH, Bruce S, Nica R, Simblett SK, Wykes T, Brasen JC, Myin-Germeys I, Rintala A, Conde P, Dobson RJB, Folarin AA, Stewart C, Ranjan Y, Rashid Z, Cummins N, Manyakov NV, Vairavan S, Hotopf M. Remote Assessment of Disease and Relapse in Major Depressive Disorder (RADAR-MDD): recruitment, retention, and data availability in a longitudinal remote measurement study. BMC Psychiatry 2022; 22:136. [PMID: 35189842 PMCID: PMC8860359 DOI: 10.1186/s12888-022-03753-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 02/02/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Major Depressive Disorder (MDD) is prevalent, often chronic, and requires ongoing monitoring of symptoms to track response to treatment and identify early indicators of relapse. Remote Measurement Technologies (RMT) provide an opportunity to transform the measurement and management of MDD, via data collected from inbuilt smartphone sensors and wearable devices alongside app-based questionnaires and tasks. A key question for the field is the extent to which participants can adhere to research protocols and the completeness of data collected. We aimed to describe drop out and data completeness in a naturalistic multimodal longitudinal RMT study, in people with a history of recurrent MDD. We further aimed to determine whether those experiencing a depressive relapse at baseline contributed less complete data. METHODS Remote Assessment of Disease and Relapse - Major Depressive Disorder (RADAR-MDD) is a multi-centre, prospective observational cohort study conducted as part of the Remote Assessment of Disease and Relapse - Central Nervous System (RADAR-CNS) program. People with a history of MDD were provided with a wrist-worn wearable device, and smartphone apps designed to: a) collect data from smartphone sensors; and b) deliver questionnaires, speech tasks, and cognitive assessments. Participants were followed-up for a minimum of 11 months and maximum of 24 months. RESULTS Individuals with a history of MDD (n = 623) were enrolled in the study,. We report 80% completion rates for primary outcome assessments across all follow-up timepoints. 79.8% of people participated for the maximum amount of time available and 20.2% withdrew prematurely. We found no evidence of an association between the severity of depression symptoms at baseline and the availability of data. In total, 110 participants had > 50% data available across all data types. CONCLUSIONS RADAR-MDD is the largest multimodal RMT study in the field of mental health. Here, we have shown that collecting RMT data from a clinical population is feasible. We found comparable levels of data availability in active and passive forms of data collection, demonstrating that both are feasible in this patient group.
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Affiliation(s)
- Faith Matcham
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Daniel Leightley
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sara Siddi
- grid.5841.80000 0004 1937 0247Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - Femke Lamers
- grid.12380.380000 0004 1754 9227Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Katie M. White
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Peter Annas
- grid.424580.f0000 0004 0476 7612H. Lundbeck A/S, Valby, Denmark
| | - Giovanni de Girolamo
- grid.419422.8IRCCS Instituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Sonia Difrancesco
- grid.12380.380000 0004 1754 9227Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Josep Maria Haro
- grid.5841.80000 0004 1937 0247Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - Melany Horsfall
- grid.12380.380000 0004 1754 9227Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Alina Ivan
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Grace Lavelle
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Qingqin Li
- grid.497530.c0000 0004 0389 4927Janssen Research and Development, LLC, Titusville, NJ USA
| | - Federica Lombardini
- grid.5841.80000 0004 1937 0247Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - David C. Mohr
- grid.16753.360000 0001 2299 3507Center for Behavioral Intervention Technologies, Department of Preventative Medicine, Northwestern University, Chicago, IL USA
| | - Vaibhav A. Narayan
- grid.497530.c0000 0004 0389 4927Janssen Research and Development, LLC, Titusville, NJ USA
| | - Carolin Oetzmann
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Brenda W. J. H. Penninx
- grid.12380.380000 0004 1754 9227Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Stuart Bruce
- grid.13097.3c0000 0001 2322 6764RADAR-CNS Patient Advisory Board, King’s College London, London, UK
| | - Raluca Nica
- grid.13097.3c0000 0001 2322 6764RADAR-CNS Patient Advisory Board, King’s College London, London, UK
| | - Sara K. Simblett
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Til Wykes
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Inez Myin-Germeys
- grid.5596.f0000 0001 0668 7884Department for Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Aki Rintala
- grid.5596.f0000 0001 0668 7884Department for Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium ,grid.508322.eFaculty of Social and Health Care, LAB University of Applied Sciences, Lahti, Finland
| | - Pauline Conde
- grid.13097.3c0000 0001 2322 6764Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Richard J. B. Dobson
- grid.13097.3c0000 0001 2322 6764Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Amos A. Folarin
- grid.13097.3c0000 0001 2322 6764Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Callum Stewart
- grid.13097.3c0000 0001 2322 6764Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Yatharth Ranjan
- grid.13097.3c0000 0001 2322 6764Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Zulqarnain Rashid
- grid.13097.3c0000 0001 2322 6764Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Nick Cummins
- grid.13097.3c0000 0001 2322 6764Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.7307.30000 0001 2108 9006Chair of Embedded Intelligence for Health Care and Wellbeing, University of Augsburg, Augsburg, Germany
| | | | - Srinivasan Vairavan
- grid.497530.c0000 0004 0389 4927Janssen Research and Development, LLC, Titusville, NJ USA
| | - Matthew Hotopf
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.37640.360000 0000 9439 0839South London and Maudsley NHS Foundation Trust, London, UK
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8
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Leightley D, Lavelle G, White KM, Sun S, Matcham F, Ivan A, Oetzmann C, Penninx BWJH, Lamers F, Siddi S, Haro JM, Myin-Germeys I, Bruce S, Nica R, Wickersham A, Annas P, Mohr DC, Simblett S, Wykes T, Cummins N, Folarin AA, Conde P, Ranjan Y, Dobson RJB, Narayan VA, Hotopf M. Investigating the impact of COVID-19 lockdown on adults with a recent history of recurrent major depressive disorder: a multi-Centre study using remote measurement technology. BMC Psychiatry 2021; 21:435. [PMID: 34488697 PMCID: PMC8419819 DOI: 10.1186/s12888-021-03434-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes a clinical illness Covid-19, has had a major impact on mental health globally. Those diagnosed with major depressive disorder (MDD) may be negatively impacted by the global pandemic due to social isolation, feelings of loneliness or lack of access to care. This study seeks to assess the impact of the 1st lockdown - pre-, during and post - in adults with a recent history of MDD across multiple centres. METHODS This study is a secondary analysis of an on-going cohort study, RADAR-MDD project, a multi-centre study examining the use of remote measurement technology (RMT) in monitoring MDD. Self-reported questionnaire and passive data streams were analysed from participants who had joined the project prior to 1st December 2019 and had completed Patient Health and Self-esteem Questionnaires during the pandemic (n = 252). We used mixed models for repeated measures to estimate trajectories of depressive symptoms, self-esteem, and sleep duration. RESULTS In our sample of 252 participants, 48% (n = 121) had clinically relevant depressive symptoms shortly before the pandemic. For the sample as a whole, we found no evidence that depressive symptoms or self-esteem changed between pre-, during- and post-lockdown. However, we found evidence that mean sleep duration (in minutes) decreased significantly between during- and post- lockdown (- 12.16; 95% CI - 18.39 to - 5.92; p < 0.001). We also found that those experiencing clinically relevant depressive symptoms shortly before the pandemic showed a decrease in depressive symptoms, self-esteem and sleep duration between pre- and during- lockdown (interaction p = 0.047, p = 0.045 and p < 0.001, respectively) as compared to those who were not. CONCLUSIONS We identified changes in depressive symptoms and sleep duration over the course of lockdown, some of which varied according to whether participants were experiencing clinically relevant depressive symptoms shortly prior to the pandemic. However, the results of this study suggest that those with MDD do not experience a significant worsening in symptoms during the first months of the Covid - 19 pandemic.
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Affiliation(s)
- Daniel Leightley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Grace Lavelle
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Katie M. White
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Shaoxiong Sun
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Faith Matcham
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Alina Ivan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Carolin Oetzmann
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Femke Lamers
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Sara Siddi
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Josep Mario Haro
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Stuart Bruce
- RADAR-CNS Patient Advisory Board, King’s College London, London, UK
| | - Raluca Nica
- RADAR-CNS Patient Advisory Board, King’s College London, London, UK
- Romanian League for Mental Health, London, UK
| | - Alice Wickersham
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - David C. Mohr
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, USA
| | - Sara Simblett
- King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Til Wykes
- King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Nicholas Cummins
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Chair of Embedded Intelligence for Health Care & Wellbeing, University of Augsburg, Augsburg, Germany
| | - Amos Akinola Folarin
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Health Informatics, University College London, London, UK
| | - Pauline Conde
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Yatharth Ranjan
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Richard J. B. Dobson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Maudsley Biomedical Research Centre, National Institute for Health Research, South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Mathew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Maudsley Biomedical Research Centre, National Institute for Health Research, South London and Maudsley NHS Foundation Trust, London, UK
| | - On behalf of the RADAR-CNS Consortium
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
- RADAR-CNS Patient Advisory Board, King’s College London, London, UK
- Romanian League for Mental Health, London, UK
- H. Lundbeck A/S, Copenhagen, Denmark
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, USA
- King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Chair of Embedded Intelligence for Health Care & Wellbeing, University of Augsburg, Augsburg, Germany
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Health Informatics, University College London, London, UK
- Maudsley Biomedical Research Centre, National Institute for Health Research, South London and Maudsley NHS Foundation Trust, London, UK
- Janssen Research and Development, LLC, Titusville, NJ USA
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9
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Oprea V, Mardale S, Buia F, Gheorghescu D, Nica R, Zdroba S, Grad O. The influence of Transversus Abdominis Muscle Release (TAR) for complex incisional hernia repair on the intraabdominal pressure and pulmonary function. Hernia 2021; 25:1601-1609. [PMID: 33751278 PMCID: PMC7983096 DOI: 10.1007/s10029-021-02395-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/13/2021] [Accepted: 03/08/2021] [Indexed: 11/25/2022]
Abstract
Introduction Among many other techniques for Abdominal Wall Reconstruction (AWR), posterior component separation with Transversus Abdominis Release (TAR), continues to gain popularity and it is increasingly used with promising long-term results. Our goal was to evaluate the influence of TAR with mesh retromuscular reinforcement on the intra-abdominal pressure (IAP) and respiratory function in a series of patients with complex incisional hernias (IH). Methods Since November 2014 through February 2019, patients with TAR were identified in the Clinical Department of Surgery database and were retrospectively reviewed. Outcome measures include: demographics, pre- and perioperative details, preoperative and postoperative IAP and plateau pressure (PP). Results One-hundred-and-one consecutive TAR procedures (19.7% from all incisional hernia repairs) were analyzed. Mean age was 63 years with a mean Body Mass Index (BMI) of 31.85 kg/m2 (25–51). Diabetes and Chronic Obstructive Pulmonary Disease (COPD) were the main major comorbidities. Mean hernia defect area was 247 cm2 (104–528 cm2). Conclusion TAR is a safe and sound procedure with acceptable modifications of the IAP morbidity and recurrence rate when correctly performed on the right patient.
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Affiliation(s)
- V Oprea
- Clinical Department of Surgery, "Constantin Papilian" Emergency Military Clinical Hospital, No. 22 General Traian Mosoiu Street, Cluj-Napoca, Cluj County, Romania.
| | - S Mardale
- Department of Radiology, "Constantin Papilian" Emergency Military Clinical Hospital, Cluj-Napoca, Romania
| | - F Buia
- Clinical Department of Surgery, "Constantin Papilian" Emergency Military Clinical Hospital, No. 22 General Traian Mosoiu Street, Cluj-Napoca, Cluj County, Romania
| | - D Gheorghescu
- Clinical Department of Surgery, "Constantin Papilian" Emergency Military Clinical Hospital, No. 22 General Traian Mosoiu Street, Cluj-Napoca, Cluj County, Romania
| | - R Nica
- Intensive Care Unit, "Constantin Papilian" Emergency Military Clinical Hospital, Cluj-Napoca, Romania
| | - S Zdroba
- Intensive Care Unit, "Constantin Papilian" Emergency Military Clinical Hospital, Cluj-Napoca, Romania
| | - O Grad
- Clinical Department of Surgery, "Constantin Papilian" Emergency Military Clinical Hospital, No. 22 General Traian Mosoiu Street, Cluj-Napoca, Cluj County, Romania.,2nd Department of Surgery, Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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10
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Roth C, Wensing M, Koetsenruijter J, Istvanovic A, Novotni A, Tomcuk A, Dedovic J, Djurisic T, Milutinovic M, Kuzman MR, Nica R, Bjedov S, Medved S, Rotaru T, Hipple Walters B, Petrea I, Shields-Zeeman L. Perceived Support for Recovery and Level of Functioning Among People With Severe Mental Illness in Central and Eastern Europe: An Observational Study. Front Psychiatry 2021; 12:732111. [PMID: 34621196 PMCID: PMC8490702 DOI: 10.3389/fpsyt.2021.732111] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/23/2021] [Indexed: 11/14/2022] Open
Abstract
Background: Many people with severe mental illness experience limitations in personal and social functioning. Care delivered in a person's community that addresses needs and preferences and focuses on clinical and personal recovery can contribute to addressing the adverse impacts of severe mental illness. In Central and Eastern Europe, mental health care systems are transitioning from institutional-based care toward community-based care. The aim of this study is to document the level of functioning and perceived support for recovery in a large population of service users with severe mental illness in Central and Eastern Europe, and to explore associations between perceived support for recovery and the degree of functional limitations. Methods: The implementation of community mental health teams was conducted in five mental health centers in five countries in Central and Eastern Europe. The present study is based on trial data at baseline among service users across the five centers. Baseline data included sociodemographic, the World Health Organization Disability Assessment Schedule (WHODAS 2.0) for functional limitations, and the Recovery Support (INSPIRE) tool for perceived staff support toward recovery. We hypothesized that service users reporting higher levels of perceived support for their recovery would indicate lower levels of functional limitation. Results: Across all centers, the greatest functional limitations were related to participation in society (43.8%), followed by daily life activities (33.3%), and in education or work (35.6%). Service users (N = 931) indicated that they were satisfied overall with the support received from their mental health care provider for their social recovery (72.5%) and that they valued their relationship with their providers (80.3%). Service users who perceived the support they received from their provider as valuable (b = -0.10, p = 0.001) and who reported to have a meaningful relationship with them (b = -0.13, p = 0.003) had a lower degree of functional limitation. Conclusion: As hypothesized, the higher the degree of perceived mental health support from providers, the lower the score in functional limitations. The introduction of the community-based care services that increase contact with service users and consider needs and which incorporate recovery-oriented principles, may improve clinical recovery and functional outcomes of service users with severe mental illness.
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Affiliation(s)
- Catharina Roth
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, Heidelberg, Germany
| | - Jan Koetsenruijter
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, Heidelberg, Germany
| | - Ana Istvanovic
- Croatian Institute of Public Health, Rockefellerova, Zagreb, Croatia
| | - Antoni Novotni
- University St. Cyril and Methodius, University Clinic of Psychiatry, Skopje, North Macedonia
| | - Aleksandr Tomcuk
- Health Institution Special Psychiatric Hospital Dobrota Kotor, Mental Health Promotion and International Cooperation Department and Department of Forensic Psychiatry, Kotor, Montenegro
| | - Jovo Dedovic
- Health Institution Special Psychiatric Hospital Dobrota Kotor, Mental Health Promotion and International Cooperation Department and Department of Forensic Psychiatry, Kotor, Montenegro
| | | | - Milos Milutinovic
- University St. Cyril and Methodius, University Clinic of Psychiatry, Skopje, North Macedonia
| | - Martina Rojnic Kuzman
- Zagreb University Hospital Centre and the Zagreb School of Medicine, Zagreb, Croatia
| | - Raluca Nica
- Institute Liga Romana Pentru Sanatate Mintala, Bucuresti-Sector, Romania
| | - Sarah Bjedov
- Zagreb University Hospital Centre, Clinic for Psychiatry and Psychological Medicine, Zagreb, Croatia
| | - Sara Medved
- Zagreb University Hospital Centre, Clinic for Psychiatry and Psychological Medicine, Zagreb, Croatia
| | - Tiberiu Rotaru
- Siret Psychiatric Hospital, Psychotherapy Unit, Siret, Romania
| | - Bethany Hipple Walters
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Department of Mental Health Prevention and Expertise Centre for Tobacco Control, Utrecht, Netherlands
| | - Ionela Petrea
- INSIGHT International Institute for Mental Health and Integrated Health Systems, Amsterdam, Netherlands
| | - Laura Shields-Zeeman
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Department of Mental Health Prevention and Expertise Centre for Tobacco Control, Utrecht, Netherlands
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11
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Wijnen BFM, Smit F, Uhernik AI, Istvanovic A, Dedovic J, Dinolova R, Nica R, Velickovski R, Wensing M, Petrea I, Shields-Zeeman L. Sustainability of Community-Based Specialized Mental Health Services in Five European Countries: Protocol for Five Randomized Controlled Trial-Based Health-Economic Evaluations Embedded in the RECOVER-E Program. JMIR Res Protoc 2020; 9:e17454. [PMID: 32476658 PMCID: PMC7296406 DOI: 10.2196/17454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/13/2019] [Revised: 03/06/2020] [Accepted: 03/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background Community-based recovery-oriented mental health services for people with severe mental disorders have not been fully implemented in Bulgaria, Croatia, Macedonia, Montenegro, and Romania. The RECOVER-E project facilitates the implementation of specialized mental health care delivered by setting up services, implementing the services, and evaluating multidisciplinary community mental health teams. The outcomes of the RECOVER-E project are assessed in a trial-based outcome evaluation in each of the participating countries with a health-economic evaluation linked to these trials. Objective The aim of this protocol paper is to describe the methodology that will be used for the health-economic evaluation alongside the trials. Methods Implementation sites have been selected in each of the five countries where hospital-based mental health services are available (care as usual [CAU]) for patients with severe mental disorders (severe depression, bipolar disorder, schizophrenia, and other psychotic disorders). The newly implemented health care system will involve community-based recovery-oriented mental health care (CMHC). At each site, 180 consenting patients will be randomized to either CAU or CMHC. Patient-level outcomes are personal and social functioning and quality-adjusted life years (QALYs). Data on participants’ health care use will be collected and corresponding health care costs will be computed. This enables evaluation of health care costs of CMHC as compared with CAU, and these costs can be related to patient-level outcomes (functioning and QALY gains) in health-economic evaluation. Results Data collection was started in December 2018 (Croatia), February 2019 (Montenegro), April 2019 (Romania), June 2019 (North Macedonia), and October 2019 (Bulgaria). The findings of the outcome evaluations will be reported for each of the five countries separately, and the five trials will be pooled for multilevel analysis on a combined dataset. Conclusions The results of the health-economic evaluation of the RECOVER-E project will contribute to the growing evidence base on the health and economic benefits of recovery-oriented and community-based service models for health systems in transition. Trial Registration (1) ClinicalTrials.gov NCT03922425 (Bulgaria); https://clinicaltrials.gov/ct2/show/NCT03922425 (2) ClinicalTrials.gov NCT03862209 (Croatia); https://clinicaltrials.gov/ct2/show/NCT03862209 (3) ClinicalTrials.gov NCT03892473 (Macedonia); https://clinicaltrials.gov/ct2/show/NCT03892473 (4) ClinicalTrials.gov NCT03837340 (Montenegro); https://clinicaltrials.gov/ct2/show/NCT03837340 (5) ClinicalTrials.gov NCT03884933 (Romania); https://clinicaltrials.gov/ct2/show/NCT03884933 International Registered Report Identifier (IRRID) DERR1-10.2196/17454
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Affiliation(s)
- Ben F M Wijnen
- Center for Economic Evaluation and Machine Learning, Trimbos Institute, Utrecht, Netherlands.,Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Filip Smit
- Center for Economic Evaluation and Machine Learning, Trimbos Institute, Utrecht, Netherlands.,Department of Biostatistics and Epidemiology and Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | | | - Ana Istvanovic
- Division of Public Health, Croatian Institute of Public Health, Zagreb, Croatia
| | | | - Roumyana Dinolova
- National Centre of Public Health Protection-Mental Health, Sofia, Bulgaria
| | - Raluca Nica
- Romanian League for Mental Health, Bucharest, Romania
| | - Robert Velickovski
- University Clinic of Psychiatry, Skopje, the Former Yugoslav Republic of Macedonia
| | - Michel Wensing
- Department of General Practice and Health Service Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Ionela Petrea
- Department of Public Mental Health, Trimbos Institute, Utrecht, Netherlands
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Shields-Zeeman L, Petrea I, Smit F, Walters BH, Dedovic J, Kuzman MR, Nakov V, Nica R, Novotni A, Roth C, Tomcuk A, Wijnen BFM, Wensing M. Towards community-based and recovery-oriented care for severe mental disorders in Southern and Eastern Europe: aims and design of a multi-country implementation and evaluation study (RECOVER-E). Int J Ment Health Syst 2020; 14:30. [PMID: 32336984 PMCID: PMC7178587 DOI: 10.1186/s13033-020-00361-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 04/11/2020] [Indexed: 11/29/2022] Open
Abstract
Background Substantial strides have been made around the world in reforming mental health systems by shifting away from institutional care towards community-based services. Despite an extensive evidence base on what constitutes effective care for people with severe mental ill-health, many people in Europe do not have access to optimal mental health care. In an effort to consolidate previous efforts to improve community mental health care and support the complex transition from hospital-based to community-based care delivery, the RECOVER-E (LaRge-scalE implementation of COmmunity based mental health care for people with seVere and Enduring mental ill health in EuRopE) project aims to implement and evaluate multidisciplinary community mental health teams in five countries in Central and Eastern Europe. This paper provides a brief overview of the RECOVER-E project and its methods. Methods Five implementation sites were selected (Sofia, Bulgaria; Zagreb, Croatia; Skopje, North Macedonia; Kotor, Montenegro; Siret-Suceava, Romania) where hospital-based mental health services are available (care as usual, CAU) for patients with severe mental disorders (severe depression, bipolar disorder, schizophrenia). The intervention consists of the introduction of a new service delivery model in each site, consisting of community-based recovery-oriented care delivered by trained multidisciplinary community mental health teams (including a peer worker with lived experience of a severe mental disorder). The implementation outcomes of the teams and the effect of the team’s approach on patient and service utilisation outcomes will be evaluated using a mix of research methods. The study includes five planned hybrid implementation-effectiveness trials (1 per site) with patient-level randomization (n = 180, with patients randomised to either care as usual or intervention condition). Effectiveness is evaluated using a pragmatic non-blinded design with patients randomised into two parallel groups: receiving new community-based care or receiving usual care in the form of institutional, hospital-based mental health care. Trial-based health economic evaluation will be conducted; implementation outcomes will be evaluated, with data aligned with dimensions from the RE-AIM framework. Pathways to sustaining project results will be developed through policy dialogue sessions, which will be carried out in each country and through ongoing policy engagement activities at the European level. Discussion The RECOVER-E project has been developed and conducted to demonstrate the impact of implementing an evidence-based service delivery model for people with severe mental illness in different contexts in middle-income countries in Central and Eastern Europe. It is expected that the results will contribute to the growing evidence-base on the health and economic benefits of recovery-oriented and community-based service models for health systems in transition. Trial registration Each trial was registered before participant enrolment in the clinicaltrials.gov database: Site—Croatia, Zagreb (Trial Reg. No. NCT03862209); Montenegro, Kotor (Trial Reg. No. NCT03837340); Romania, Suceava (Trial Reg. No. NCT03884933); Macedonia, Skopje (Trial Reg. No. NCT03892473); Bulgaria, Sofia (Trial Reg. No. NCT03922425)
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Affiliation(s)
- Laura Shields-Zeeman
- 1Trimbos Institute (Netherlands Institute of Mental Health and Addiction), P.O. Box 725, 3500 AS Utrecht, The Netherlands.,3Department of Public Mental Health and Prevention, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - Ionela Petrea
- 1Trimbos Institute (Netherlands Institute of Mental Health and Addiction), P.O. Box 725, 3500 AS Utrecht, The Netherlands
| | - Filip Smit
- 2Centre for Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands.,3Department of Public Mental Health and Prevention, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands.,4Department of Biostatistics and Epidemiology and Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Bethany Hipple Walters
- 1Trimbos Institute (Netherlands Institute of Mental Health and Addiction), P.O. Box 725, 3500 AS Utrecht, The Netherlands
| | - Jovo Dedovic
- Special Psychiatric Hospital Dobrota, Kotor, Montenegro
| | | | - Vladimir Nakov
- 7National Center for Public Health Analyses, Sofia, Bulgaria
| | - Raluca Nica
- Romanian League for Mental Health, Bucharest, Romania
| | - Antoni Novotni
- 9University Clinic of Psychiatry, Skopje, North Macedonia
| | - Catharina Roth
- 10Department of General Practice and Health Service Research, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Ben F M Wijnen
- 2Centre for Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - Michel Wensing
- 10Department of General Practice and Health Service Research, University Hospital Heidelberg, Heidelberg, Germany
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Petrea I, Shields-Zeeman L, Keet R, Nica R, Kraan K, Chihai J, Condrat V, Curocichin G. Mental health system reform in Moldova: Description of the program and reflections on its implementation between 2014 and 2019. Health Policy 2019; 124:83-88. [PMID: 31810580 DOI: 10.1016/j.healthpol.2019.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/18/2019] [Revised: 10/21/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
In 2014, the Republic of Moldova started a systematic process of reforming its mental health system, implementing priority actions set out in the National Mental Health Programme. The reform entailed a service delivery re-design, instituting mechanisms for collaboration across health and social sectors, and revision of the policy framework. Outcomes of the first 4 years of the reform included: 1) the establishment of a network of mental health services in 4 pilot districts embedding mental health diagnosis, treatment and referral in primary and specialized mental healthcare; 2) creation of an enabling policy environment at the national and district level; and 3) strengthened community support and acceptance of mental health issues. Objectives of the first Phase were achieved and the reform is now in its second Phase (2018-2022). The implementation strategy in Phase 1 focused efforts on 4 pilot districts, whereas Phase 2 harnesses lessons learned from Phase 1 and facilitates local leaders and actors to scale-up the model to all 32 districts and municipalities in Moldova. Ownership over the reform process shifted from project-led in Phase 1 to national and local government-led in Phase 2. We reflect on the process and contents of the mental health reform, discuss lessons learned and implementation challenges encountered. We conclude with learning points for policymakers and researchers considering mental health reform in other countries.
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Affiliation(s)
- Ionela Petrea
- Trimbos Institute, Da Costakade 45, 3521 VS Utrecht, the Netherlands.
| | | | - Rene Keet
- GGZ Noord Holland Noord, Alkmaar, the Netherlands
| | - Raluca Nica
- Romanian League for Mental Health, Bucharest, Romania
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Kremslehner C, Miller A, Nica R, Lachner J, Nagelreiter I, Mildner M, Tschachler E, Haschemi A, Gruber F. 254 Automated immuno-histo-enzymatic investigation of metabolic enzyme activity in cryosections of skin and epidermal equivalents. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Priebe S, Matanov A, Demi N, Blagovcanin Simic J, Jovanovic S, Gajic M, Radonic E, Bajraktarov S, Boderscova L, Konatar M, Nica R, Muijen M. Community mental health centres initiated by the South-Eastern Europe Stability Pact: evaluation in seven countries. Community Ment Health J 2012; 48:352-62. [PMID: 21617994 DOI: 10.1007/s10597-011-9417-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 12/15/2009] [Accepted: 11/15/2010] [Indexed: 01/18/2023]
Abstract
Eight community mental health care centres (initiated by the South-Eastern Europe Stability Pact) in Albania, Bosnia-Herzegovina, Croatia, Macedonia, Moldova, Montenegro and Romania were evaluated. Characteristics of patients, patient reported outcomes and patient views of care were assessed in 305 psychiatric patients. Patient characteristics varied across centres, with most patients having long term psychotic disorders. Treatment satisfaction and therapeutic relationships were rated favourably. Subjective quality of life mean scores were rather low, with higher satisfaction with health and dissatisfaction with the financial and employment situation. Being unemployed was the only factor associated with poor quality of life and lower treatment satisfaction. Most developing centres target patients with persistent psychotic disorders. Care appears highly valued by the patients. The findings encourage establishing more centres in the region and call for employment schemes for people with mental illnesses.
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Affiliation(s)
- Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, Newham Centre for Mental Health, London, UK.
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Pop C, Nica R, Vlaicu R, Vinereanu D. Vasospastic angina caused by 5-fluorouracil. A case report. Rom J Intern Med 2003; 41:433-7. [PMID: 15526525] [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] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- C Pop
- County Hospital, Baia-Mare, Bucharest, Romania
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