RESUMO
BACKGROUND: Twice weekly sessions of cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) for major depressive disorder (MDD) lead to less drop-out and quicker and better response compared to once weekly sessions at posttreatment, but it is unclear whether these effects hold over the long run. AIMS: Compare the effects of twice weekly v. weekly sessions of CBT and IPT for depression up to 24 months since the start of treatment. METHODS: Using a 2 × 2 factorial design, this multicentre study randomized 200 adults with MDD to once or twice weekly sessions of CBT or IPT over 16-24 weeks, up to a maximum of 20 sessions. Main outcome measures were depression severity, measured with the Beck Depression Inventory-II and the Longitudinal Interval Follow-up Evaluation. Intention-to-treat analyses were conducted. RESULTS: Compared with patients who received once weekly sessions, patients who received twice weekly sessions showed a significant decrease in depressive symptoms up through month 9, but this effect was no longer apparent at month 24. Patients who received CBT showed a significantly larger decrease in depressive symptoms up to month 24 compared to patients who received IPT, but the between-group effect size at month 24 was small. No differential effects between session frequencies or treatment modalities were found in response or relapse rates. CONCLUSIONS: Although a higher session frequency leads to better outcomes in the acute phase of treatment, the difference in depression severity dissipated over time and there was no significant difference in relapse.
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Terapia Cognitivo-Comportamental , Transtorno Depressivo Maior , Psicoterapia Interpessoal , Adulto , Humanos , Psicoterapia , Depressão/terapia , Transtorno Depressivo Maior/terapia , Recidiva , Resultado do TratamentoRESUMO
BACKGROUND: Depression is a common mental disorder. Detecting (sub)clinical depressive symptoms in adolescents at an early stage and offering a low-threshold early intervention can minimize the risk of serious and/or long-term depression. As such, a digital intervention can be a low-threshold preventive and early intervention. This study aims to examine whether the Boost My Mood (BMM)-app is a suitable preventive early intervention for adolescents with (sub)clinical depressive symptoms. METHODS: This naturalistic single-arm evaluation study (N = 50) was conducted in adolescents aged 16-21 with (sub)clinical depressive symptoms. Furthermore, the BMM-app was studied in relation to anxiety, worrying, stress, and sleeping problems. An exploratory objective was to determine whether positive expectations and social support are related to app use. RESULTS: The study showed a significant decrease in not only depressive symptoms, but also anxiety, worrying and stress while using the BMM-app. Sleeping problems did not significantly decrease over time while using the BMM-app. The degree of use of the BMM-app and telling significant others about using the BMM-app were both not related to a decrease in depressive symptoms. The BMM-app was used significantly more when the adolescent had told relatives about their depressive symptoms. CONCLUSIONS: A digital intervention, such as the BMM-app, can be a low-threshold preventive and early intervention for adolescents with (sub)clinical depressive symptoms. Beneficial effects of the BMM-app were reported on depressive symptoms as well as other aspects of quality of life, such as anxiety, worrying, and stress. Whereas several factors may have played a role in the current findings on depressive symptoms, there are reasons to assume that part of the reduction in symptoms could be attributed to the BMM-app. Although no causality can be assumed, this study is a first step in the implementation of preventive apps in mental health care.
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Depressão , Aplicativos Móveis , Humanos , Adolescente , Masculino , Feminino , Depressão/prevenção & controle , Depressão/psicologia , Adulto Jovem , Intervenção Médica Precoce , Ansiedade/prevenção & controle , Estresse Psicológico/prevenção & controleRESUMO
BACKGROUND: It is unclear what session frequency is most effective in cognitive-behavioural therapy (CBT) and interpersonal psychotherapy (IPT) for depression. AIMS: Compare the effects of once weekly and twice weekly sessions of CBT and IPT for depression. METHOD: We conducted a multicentre randomised trial from November 2014 through December 2017. We recruited 200 adults with depression across nine specialised mental health centres in the Netherlands. This study used a 2 × 2 factorial design, randomising patients to once or twice weekly sessions of CBT or IPT over 16-24 weeks, up to a maximum of 20 sessions. Main outcome measures were depression severity, measured with the Beck Depression Inventory-II at baseline, before session 1, and 2 weeks, 1, 2, 3, 4, 5 and 6 months after start of the intervention. Intention-to-treat analyses were conducted. RESULTS: Compared with patients who received weekly sessions, patients who received twice weekly sessions showed a statistically significant decrease in depressive symptoms (estimated mean difference between weekly and twice weekly sessions at month 6: 3.85 points, difference in effect size d = 0.55), lower attrition rates (n = 16 compared with n = 32) and an increased rate of response (hazard ratio 1.48, 95% CI 1.00-2.18). CONCLUSIONS: In clinical practice settings, delivery of twice weekly sessions of CBT and IPT for depression is a way to improve depression treatment outcomes.
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Terapia Cognitivo-Comportamental , Transtorno Depressivo/terapia , Psicoterapia Interpessoal , Avaliação de Resultados em Cuidados de Saúde , Avaliação de Processos e Resultados em Cuidados de Saúde , Adulto , Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo Maior/terapia , Feminino , Seguimentos , Humanos , Psicoterapia Interpessoal/métodos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Fatores de TempoRESUMO
OBJECTIVES: Functional disability and fatigue are important consequences of systemic sclerosis (SSc), but little is known about their course over time. The aim of this study was to identify and characterise homogeneous subgroups with distinct 3-year trajectories of disability and fatigue, separately. METHODS: A 3-year cohort study including 215 patients with SSc was conducted. Functional disability was assessed using the Health Assessment Questionnaire-Disability Index (HAQ-DI). Fatigue was assessed using the SF-36 Vitality subscale. Longitudinal trajectories were identified using latent class growth analyses (LCGA). Baseline patient characteristics were compared across classes using multivariable logistic regression. RESULTS: Two disability classes were identified: a 'low' group (n=133) with low baseline HAQ-DI scores (intercept=0.48) and slight, statistically non-significant deterioration over time (slope=0.01), and a 'high' group (n=82) with high baseline HAQ-DI scores (intercept=1.63) and also slight, statistically non-significant deterioration over time (slope=0.01). Patients in the high disability group were more likely to be female, have higher fatigue, more helplessness, and less emotion-focused coping. Two fatigue classes were identified: an 'average' group (n=99) with average baseline Vitality scores (intercept=53.9) and slight, statistically non-significant deterioration over time (slope=-0.23), and a 'high' fatigue group (n=116) with low baseline Vitality scores (intercept=39.8) and also slight, but non-significant deterioration over time (slope=-0.15). Patients in the high fatigue group were more likely to be female, report more impact of lung involvement, and less acceptance. CONCLUSIONS: Functional disability and fatigue trajectories in SSc were relatively stable over a 3-year period, and differences in baseline scores, but not slopes, defined classes.
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Pessoas com Deficiência , Fadiga/etiologia , Escleroderma Sistêmico/complicações , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: To describe the non-pharmacological care in systemic sclerosis (SSc) provided by European health professionals (HPs) including referrals, treatment targets, interventions, and educational needs. METHODS: In this observational study, European HPs working in SSc care were invited to complete an online survey through announcements by EUSTAR (European League Against Rheumatism (EULAR) Scleroderma Trials and Research) and FESCA (Federation of European Scleroderma Associations), the EULAR HPs' newsletter, websites of national patient and HP associations, and by personal invitation. RESULTS: In total, 56 HPs, from 14 different European countries and 7 different disciplines, responded to the survey. A total of 133 specific indications for referral were reported, 72% of which could be linked to the International Classification of Functioning, Disability and Health domain "body functions and structures". Of the 681 reported treatment targets 45% was related to "body functions and structures". In total, 105 different interventions were reported as being used to address these treatment targets. Almost all (98%) respondents reported having educational needs, with the topics of management of stiffness (67%), pain (60%), and impaired hand function (56%) being mentioned most frequently. CONCLUSIONS: Non-pharmacological care in SSc varies in Europe with respect to the content of interventions, reasons for referral, and treatment targets. Reasons for referral to HPs are not well-aligned to HPs subsequent treatment targets in SSc care suggesting suboptimal communication between physicians and HPs. The wide variations reported indicate a need to consolidate geographically disparate expertise within countries and to develop and improve standards of non-pharmacological care in SSc.
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Educação Profissionalizante/tendências , Pessoal de Saúde/educação , Pessoal de Saúde/tendências , Disparidades em Assistência à Saúde/tendências , Padrões de Prática Médica/tendências , Escleroderma Sistêmico/terapia , Educação Profissionalizante/normas , Europa (Continente) , Fidelidade a Diretrizes , Pesquisas sobre Atenção à Saúde , Pessoal de Saúde/normas , Disparidades em Assistência à Saúde/normas , Humanos , Internet , Equipe de Assistência ao Paciente/tendências , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Prognóstico , Encaminhamento e Consulta , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/epidemiologia , Inquéritos e QuestionáriosRESUMO
People living with chronic illness often report uncertainty about the future, fear of disease progression, fear of becoming physically disabled, and a reduced life expectancy as important sources of stress. However, little is known about psychological interventions targeting these concerns. The aim of this study is to illustrate an intervention to reduce emotional distress and concerns about the future in a patient with systemic sclerosis (SSc), a rare chronic rheumatic disease with serious consequences for most patients, and to present a preliminary report on its effectiveness using a single-case study design. Because of the complexity of symptoms and complaints due to SSc, the psychological intervention was embedded in an interdisciplinary care program also consisting of physical therapy, occupational therapy, and specialized nurse care.
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Atitude Frente a Saúde , Terapia Cognitivo-Comportamental/métodos , Progressão da Doença , Medo/psicologia , Escleroderma Sistêmico/psicologia , Estresse Psicológico/terapia , Adaptação Psicológica , Feminino , Humanos , Pessoa de Meia-Idade , Escleroderma Sistêmico/complicações , Estresse Psicológico/etiologia , Estresse Psicológico/psicologia , Inquéritos e Questionários , Resultado do TratamentoRESUMO
OBJECTIVES: To assess health care utilisation in Dutch patients with systemic sclerosis (SSc) and its associated factors. To evaluate patients' perspectives on quality of care and its association with health care use. METHODS: In a cross-sectional design, 198 Dutch patients with SSc completed an anonymous survey concerning health care utilisation, quality of care (CQ Index), and quality of life (SF-36). RESULTS: In the last 12 months, 95% of the patients had contact with at least one medical specialist and two-thirds contacted at least one health professional (HP). The median numbers of visits to medical specialists and HPs were 7 and 7.5, respectively. Having a partner and reduced physical health status (SF-36 role-physical) were significantly associated with more visits to medical specialists and HPs. The median numbers of disciplines contacted since the onset of SSc and in the last 12 months were 8 and 4, respectively. Patients with less fatigue (SF-36 vitality) and more pain (SF-36 bodily pain) contacted more disciplines. A higher number of disciplines involved in the care was significantly associated with less satisfaction with the coordination of care (r=-0.14, p=0.03). CONCLUSIONS: Health care utilisation in Dutch patients with SSc is substantial, as is reflected in the high number of visits and the number of disciplines. Patients' rating of care coordination was lower if more disciplines were involved in their care.
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Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde/normas , Satisfação do Paciente , Qualidade da Assistência à Saúde/estatística & dados numéricos , Escleroderma Sistêmico/psicologia , Escleroderma Sistêmico/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Medicina/estatística & dados numéricos , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Escleroderma Sistêmico/epidemiologiaRESUMO
BACKGROUND: Cost-effective treatments are needed to reduce the burden of depression. One way to improve the cost-effectiveness of psychotherapy might be to increase session frequency, but keep the total number of sessions constant. AIM: To evaluate the cost-effectiveness of twice-weekly compared with once-weekly psychotherapy sessions after 12 months, from a societal perspective. METHOD: An economic evaluation was conducted alongside a randomised controlled trial comparing twice-weekly versus once-weekly sessions of psychotherapy (cognitive-behavioural therapy or interpersonal psychotherapy) for depression. Missing data were handled by multiple imputation. Statistical uncertainty was estimated with bootstrapping and presented with cost-effectiveness acceptability curves. RESULTS: Differences between the two groups in depressive symptoms, physical and social functioning, and quality-adjusted life-years (QALY) at 12-month follow-up were small and not statistically significant. Total societal costs in the twice-weekly session group were higher, albeit not statistically significantly so, than in the once-weekly session group (mean difference 2065, 95% CI -686 to 5146). The probability that twice-weekly sessions are cost-effective compared with once-weekly sessions was 0.40 at a ceiling ratio of 1000 per point improvement in Beck Depression Inventory-II score, 0.32 at a ceiling ratio of 50 000 per QALY gained, 0.23 at a ceiling ratio of 1000 per point improvement in physical functioning score and 0.62 at a ceiling ratio of 1000 per point improvement in social functioning score. CONCLUSIONS: Based on the current results, twice-weekly sessions of psychotherapy for depression are not cost-effective over the long term compared with once-weekly sessions.
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OBJECTIVE: To systematically and comprehensively document the effectiveness of nonpharmacologic interventions on physical functioning and psychological well-being in patients with systemic sclerosis (SSc). METHODS: Multiple electronic databases were searched for studies on the effectiveness of nonpharmacologic interventions in SSc. Randomized clinical trials (RCTs), controlled clinical trials (CCTs), and observational designs (ODs) with ≥10 participants were included. Two reviewers independently assessed methodologic quality using the Downs and Black checklist. RESULTS: Twenty-three studies (9 RCTs, 4 CCTs, and 10 ODs) were included. Studies assessing comparable interventions were grouped, resulting in data for 16 different interventions. The total number of patients included per study ranged from 10 to 53. Seventeen different outcome domains were assessed, with hand function, limitations in activities, and quality of life being assessed most frequently. Three studies, all RCTs, were rated as high quality. These RCTs reported that 1) a multifaceted oral health intervention improves mouth hygiene, and additional orofacial exercises did not improve mouth opening, 2) a multidisciplinary team-care program improves limitations in activities, mouth opening, and hand grip strength, and 3) manual lymph drainage improves hand function, limitations in activities, and quality of life. CONCLUSION: The body of knowledge regarding nonpharmacologic care in SSc is very limited due to the wide variety in studied interventions and outcomes in the relatively uncommon but highly disabling disease. To structure and focus future research, an international consensus should be established to prioritize primary targets for nonpharmacologic treatment and the content of interventions and to agree on a core set of outcome measures.
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Terapia por Exercício/métodos , Qualidade de Vida , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/reabilitação , Ensaios Clínicos Controlados como Assunto , Feminino , Seguimentos , Humanos , Masculino , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Escleroderma Sistêmico/terapia , Resultado do TratamentoRESUMO
BACKGROUND: A major problem in the field of transplantation is the persistent shortage of donor organs and tissues for transplantation. This study was initiated to (1) chart the donor potential for organs and tissue in The Netherlands and (2) to identify factors influencing whether donation is discussed with next of kin. METHODS: A registration form was constructed to obtain information at time of death of patients about the demographic characteristics, diagnosis, and medical suitability for donation. A prospective study was conducted among 11 hospitals in The Netherlands that gathered 4,877 filled-in forms equaling 8% to 10% of the people dying in a hospital in The Netherlands per year. RESULTS: In the year of the study, organs were retrieved from 22 donors and tissues from 264 donors in the 11 hospitals. The organ potential is estimated at a maximum of 38.7 per million population per year. A mere 5% of the physicians got a 100% score on criteria and contraindications for donation. Factors of influence on receiving consent for donation were the will of the donor, using a protocol, giving verbal information to the relatives, and presence of the partner of the deceased patient. For 26% of the potential tissue donors and 69% of the potential organ donors, donation was discussed with the relatives. Consent for tissue donation was obtained in 27%, and consent for organ donation was obtained in 60%. CONCLUSIONS: In The Netherlands, when taking into account current refusal percentages, 320 to 360 organ donations and 5,800 tissue donations could be effectuated if organ donation is posed to all possible donors. For this, knowledge of medical criteria and contraindications for donation by the physicians and their willingness to discuss donation with next of kin must be improved.
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Atitude do Pessoal de Saúde , Doadores de Tecidos/provisão & distribuição , Recusa do Paciente ao Tratamento , Distribuição por Idade , Atitude Frente a Morte , Família , Feminino , Hospitais/classificação , Humanos , Masculino , Análise Multivariada , Países Baixos , Médicos , Encaminhamento e Consulta , Doadores de Tecidos/psicologia , Doadores de Tecidos/estatística & dados numéricosRESUMO
OBJECTIVE: The Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) is commonly used to assess fatigue in rheumatic diseases, and has shown to discriminate better across levels of the fatigue spectrum than other commonly used measures. The aim of this study was to assess the cross-language measurement equivalence of the English, French, and Dutch versions of the FACIT-F in systemic sclerosis (SSc) patients. METHODS: The FACIT-F was completed by 871 English-speaking Canadian, 238 French-speaking Canadian and 230 Dutch SSc patients. Confirmatory factor analysis was used to assess the factor structure in the three samples. The Multiple-Indicator Multiple-Cause (MIMIC) model was utilized to assess differential item functioning (DIF), comparing English versus French and versus Dutch patient responses separately. RESULTS: A unidimensional factor model showed good fit in all samples. Comparing French versus English patients, statistically significant, but small-magnitude DIF was found for 3 of 13 items. French patients had 0.04 of a standard deviation (SD) lower latent fatigue scores than English patients and there was an increase of only 0.03 SD after accounting for DIF. For the Dutch versus English comparison, 4 items showed small, but statistically significant, DIF. Dutch patients had 0.20 SD lower latent fatigue scores than English patients. After correcting for DIF, there was a reduction of 0.16 SD in this difference. CONCLUSIONS: There was statistically significant DIF in several items, but the overall effect on fatigue scores was minimal. English, French and Dutch versions of the FACIT-F can be reasonably treated as having equivalent scoring metrics.