Age and professional experience as determinants of the utilization of psychoneuroimmunological research in clinical practice: An exploratory study.

The immune system is affected by psychosocial stimuli and plays a major role in the development of various diseases. Psychoneuroimmunology (PNI)-based interventions may positively influence the disease course; however, the impact of PNI research findings on clinical practice differs depending on the medical specialties involved. A comprehensive overview of the use of PNI research findings in clinical practice is currently lacking. This exploratory study aimed to provide insight into the dissemination of PNI research findings and their practical applications among clinical practitioners. Data was collected from 50 physicians using an ad hoc online questionnaire. We invited participants to take part in our online survey via an article in the DocCheck Newsletter, a German-language newsletter for physicians. Bivariate nonparametric correlation analysis (Spearman correlation) were used to explore the relationship between independent variables (age, sex, medical specialty, professional experience, and clinical environment) and dependent variables (six questionnaire items concerned with awareness, relevance, and utilization of PNI concepts). While 46% of respondents believed that PNI research findings were relevant to patient treatment, only 22% used PNI-based interventions as part of their therapeutic regimen. Furthermore, 90% of participants could not refer their patients to therapists offering PNI-based interventions. Moderately positive correlations were identified between the increasing age (rs = .48, P < .001) and increasing amount of professional experience (rs = .34, P = .02) of study participants and awareness of the theoretical foundations of PNI research. Although there is some awareness of PNI among medical practitioners, there appears to be a clear barrier inhibiting the implementation of research findings in current treatment practices. Therefore, it is necessary to examine the impact of increasing age and professional experience on the utilization of PNI-based interventions in patient care.

[Patients with ICD-10 disorders F3 and F4 in psychiatric and psychosomatic in-patient units - who is treated where? : Allocation features from the PfAD study]. / Patienten mit Störungen nach ICD-10 F3 und F4 in Psychiatrie und Psychosomatik ­ wer wird wo behandelt? : Merkmale der Zuweisung aus der PfAD-Studie.

BACKGROUND: In Germany, in-patient treatment of patients with depressive, neurotic, anxiety, and somatoform disorders (ICD-10 F3, F4) is carried out in different settings in psychiatry and psychosomatics. Which patient characteristics determine referral to one or the other specialty is a crucial question in mental health policy and is a matter of ongoing controversy. However, comparative data on patient populations are widely lacking. METHODS: In the study of Treatment Pathways of Patients with Anxiety and Depression (PfAD study), a total of 320 patients with ICD-10 F3/F4 clinical diagnoses were consecutively recruited from four treatment settings (psychiatric depression ward, psychiatric crisis intervention ward, psychiatric day hospitals, or psychosomatic hospital units; 80 participants per setting) and investigated. RESULTS: In all treatment settings, patients with considerable severity of illness and chronicity were treated. Female gender, higher education, and higher income predicted referral to psychosomatic units; male gender, transfer from another hospital or emergency hospitalization, co-morbidity with a personality disorder, higher general psychiatric co-morbidity, and danger to self at admission predicted referral to psychiatric unit. Patients in psychosomatic units had neither more psychosomatic disorders nor more somatic problems. DISCUSSION: There is considerable overlap between the clientele of psychiatric and psychosomatic units. Referral and allocation appears to be determined by aspects of severity and social status.

[Pre- and posttreatment results of an inpatient neurotologic and psychosomatic tinnitus therapy]. / Prä- und Post-Ergebnisse einer stationären neurootologisch fundierten und psychosomatischen Tinnitustherapie.

BACKGROUND: Inpatient treatment of chronic complex tinnitus can be necessary for patients with a high symptomatic strain, mostly accompanied by a corresponding mental comorbidity, and/or for patients that can only perceive their psychogenic suffering through somatization into tinnitus. METHODS: We report the results of 368 consecutively treated inpatients with chronic complex tinnitus. Patients' audiometric data were collected, and at the beginning and end of treatment, the Mini-Tinnitus Questionnaire (Mini-TQ12; Hiller und Goebel) was completed, as was the German version of the Hospitality Anxiety and Depression Score (HADS). Effect sizes were calculated for both questionnaires. Mean treatment duration was 38.8 days (standard deviation, SD: 13.6 days). The main therapeutic elements were intensive disorder-specific neurotologic counselling and psychoeducation; improvement of hearing by fitting of hearing aids, complemented by an individualized hearing therapy; and intensive individual and group-based psychotherapy. RESULTS: In addition to tinnitus, 82.1% of the patients had reduced hearing requiring rehabilitation with hearing aids. After hospitalization, a highly significant improvement in tinnitus strain could be demonstrated by the Mini-TQ12. Furthermore, a significant reduction in the depression and anxiety components of HADS was also achieved, with high effect sizes of 1.6 to 2.2. No reduction of tinnitus symptoms to a medium- or low-range level was experienced by 8.9% of patients. CONCLUSION: With corresponding symptomatic suffering, disorder-specific inpatient tinnitus treatment comprising neurotologic and psychosomatic alignment can achieve medium- to high-range therapeutic effects.

[Indicators of patient care in Psychiatric and Psychosomatic Facilities (VIPP project)--a database project]. / Versorgungsindikatoren in der Psychiatrie und Psychosomatik (VIPP)--Ein Datenbank-Projekt.

INTRODUCTION: In Germany a new and unique remuneration system for psychiatric and psychosomatic stationary treatments (PEPP system) was introduced in 2013 on an optional basis. From 2015 it will be mandatory for psychiatric and psychosomatic facilities. The introduction of the PEPP system brings up different questions regarding the possible incentives of the new remuneration system and its effects on the supply of psychiatric and psychosomatic treatments. To conduct these necessary analyses a reliable database is needed. MATERIAL AND METHODS: The goal of the project "Indicators of patient care in Psychiatric and Psychosomatic Facilities" (VIPP project) is to gather a representative database which reflects the situation of day-to-day patient care performed by German psychiatric and psychosomatic facilities. The §â€Š21 data set represents the basis of this database which will be complemented by other data sources (i. e., financial statements and other economic data). A number of more than 100 ,000 cases per year has already been exceeded. These case data were provided by a wide range of psychiatric hospitals, departments and universities that participate in this project. The dataset is anonymised and by pooling the data it is not possible to identify the cases of a specific clinic. Participants receive a web-based access and have the possibility to analyse the data independently. RESULTS: Using the examples of coding accuracy and rehospitalisation rates the variety as well as the enormous potential of this database can be demonstrated. DISCUSSION: On the base of the VIPP database valid patient care indicators can be identified and cross-sectional analyses can be conducted. From such results key data on health economic strategies can be derived and the incentives, strengths and limitations of this constantly changing system can be identified.

Multilevel modeling in psychosomatic medicine research.

The primary purpose of this study is to provide an overview of multilevel modeling for Psychosomatic Medicine readers and contributors. The article begins with a general introduction to multilevel modeling. Multilevel regression modeling at two levels is emphasized because of its prevalence in psychosomatic medicine research. Simulated data sets based on some core ideas from the Familias Unidas effectiveness study are used to illustrate key concepts including communication of model specification, parameter interpretation, sample size and power, and missing data. Input and key output files from Mplus and SAS are provided. A cluster randomized trial with repeated measures (i.e., three-level regression model) is then briefly presented with simulated data based on some core ideas from a cognitive-behavioral stress management intervention in prostate cancer.

Revealing causal heterogeneity using time series analysis of ambulatory assessments: application to the association between depression and physical activity after myocardial infarction.

OBJECTIVE: Studies in psychosomatic medicine are characterized by analyses that typically compare groups. This nomothetic approach leads to conclusions that apply to the average group member but not necessarily to individual patients. Idiographic studies start at the individual patient and are suitable to study associations that differ between time points or between individuals. We illustrate the advantages of the idiographic approach in analyzing ambulatory assessments, taking the association between depression and physical activity after myocardial infarction as an example. METHODS: Five middle-aged men who had myocardial infarction with mild to moderate symptoms of depression were included in this study. Four of these participants monitored their physical activity and depressive symptoms during a period of 2 to 3 months using a daily self-registration form. The time series of each individual participant were investigated using vector autoregressive modeling, which enables the analysis of temporal dynamics between physical activity and depression. RESULTS: We found causal heterogeneity in the association between depression and physical activity. Participants differed in the predominant direction of effect, which was either from physical activity to depression (n = 1, 85 observations, unstandardized effect size = -0.183, p = .03) or from depression to physical activity (n = 2, 65 and 59 observations, unstandardized effect sizes = -0.038 and -0.381, p < .001 and p = .04). Also, the persistency of effects differed among individuals. CONCLUSIONS: Vector autoregressive models are suitable in revealing causal heterogeneity and can be easily used to analyze ambulatory assessments. We suggest that these models might bridge the gap between science and clinical practice by translating epidemiological results to individual patients.

Revisiting measurement models in psychosomatic medicine research: a latent variable approach.

In this article, we describe how a latent variable modeling approach to the specification of measurement error unifies and benefits traditional methods of examining reliability in psychology and medicine. The models presented include classical reliability and generalizability theory to account for measurement error, latent class analysis to assess sensitivity and specificity, and item response theory to improve questionnaire development. We also illustrate how working with latent variables, in addition to addressing measurement error, may help deal with some instances of missing data. Throughout the article, analyses and results from examples and published articles are presented to illustrate the advantage of working with latent variables.

[Modern information and communication technology in medical rehabilitation. Enhanced sustainability through Internet-delivered aftercare]. / Moderne Informations- und Kommunikationstechnologie in der Rehabilitation. Mehr Nachhaltigkeit durch Internet-vermittelte Nachsorge.

Internet and mobile phones open new avenues for the optimization of health services in medical rehabilitation. Various models of Internet-delivered aftercare after psychosomatic inpatient treatment have shown promising results. The focus of this report is on the experience in translating one of the promising models, the Internet-Bridge ("Internet-Brücke"), to every day health care. Effectiveness was estimated through comparison of 254 patients who were treated in a hospital specialized in psychosomatic medicine and who participated in the Internet-Bridge as well as in the 1-year follow-up in the frame of standard quality assurance between 2003-2010 with 364 patients of the same hospital who also participated in the 1-year follow-up, but did not utilize the aftercare. Sustainable, reliable, and clinically significant improvements were more frequent in participants of the Internet-Bridge, especially with regard to psychological well-being, social problems, and psychosocial competence-at small additional costs. Results are understood as encouragement to start translation to routine care accompanied by research.

Confirmatory factor analysis: an introduction for psychosomatic medicine researchers.

We present an introduction to the basic concepts essential to understanding confirmatory factor analysis (CFA). We initially discuss the underlying mathematical model and its graphical representation. We then show how parameters are estimated for the CFA model based on the maximum likelihood function. Finally, we discuss several ways in which model fit is evaluated as well as introduce the concept of model identification. In our presentation, we use an example to illustrate the application of CFA to psychosomatic research and touch on the more general role of structural equation modeling in psychosomatic research.

More than the sum of its parts: meta-analysis and its potential to discover sources of heterogeneity in psychosomatic medicine.

Meta-analyses may contribute to more reliable knowledge about the existence of certain relations in the area of psychosomatic research. Surprisingly, the increasing popularity of meta-analysis is not reflected in the number of meta-analyses of observational studies published in Psychosomatic Medicine. This may be due to the specific difficulties that apply to meta-analyses of observational research. The aim of this paper is to provide a nontechnical overview of the principles of meta-analysis applied to observational research. We will highlight general principles of meta-analysis and discuss the major threats to its validity, with an emphasis on its specific merits and pitfalls for psychosomatic research, using several examples. We conclude that meta-analysis is a relatively simple technique, leaving little reason for not routinely applying it when performing a systematic review. An adequately conducted meta-analysis may not only provide a summary estimate of a certain association, but it has additional value in discovering relevant confounders, mediators, and moderators, as well as identifying areas of research that require more attention.

Introduction to health measurement scales.

Both research and clinical decision making rely on measurement scales. These scales vary with regard to their psychometric properties, ease of administration, dimensions covered by the scale, and other properties. This article reviews the main psychometric characteristics of scales and assesses their utility.

Multivariable models in biobehavioral research.

OBJECTIVE: To review contemporary multivariable modeling and statistical reporting practices in psychosomatic and behavioral medicine research. METHODS: A random sample of 40 original research articles involving multivariable models was obtained from the 2005 volumes of four of the leading psychosomatic and behavioral medicine research journals. A random comparison sample was obtained from the 2005 volumes of four of the leading general medical and psychiatric journals. Multivariable modeling and reporting practices were systematically coded. The evaluation focused primarily on issues raised in 2004 Statistical Corner article by Babyak. RESULTS: Deficiencies were found in a large proportion of the articles published in psychosomatic and behavioral medicine journals. The single most common problem was a lack of clear information, or any information at all, about important aspects of the statistical methods. Other frequent problems included post hoc selection of variables, lack of clear rationales and well-specified roles for selected variables, inadequate information about models as a whole (e.g., goodness of fit), failure to test model assumptions, and lack of model validation. Overfitting of multivariable models was the exception rather than the rule, but still a significant problem. CONCLUSIONS: There is room for improvement in the use and reporting of multivariable models in psychosomatic and behavioral medicine research journals. These problems can be overcome by adopting best statistical practices, such as those recommended by Psychosomatic Medicine's statistical guidelines and by authoritative guidebooks on statistical reporting practices.

New potential clinical indicators of consultation-liaison psychiatry's effectiveness in Brazilian general hospitals.

The authors identified patients' subjective well-being (SWB), relatives' satisfaction with their information needs, and the medical team's difficulty in helping patients, as potential indicators of effectiveness of consultation-liaison psychiatry. A random sampling of 74 beds was carried out (1 bed=1 patient + 1 relative + 1 nurse + 1 physician). There were negative correlations between SWB and anxious and depressive symptoms, and positive correlations with nurses' difficulty in helping patients and patients' depressive symptoms, nurses' difficulty in helping patients and their perception about anxious and depressive symptoms; and physicians' difficulty in helping patients and their perception about anxious and depressive symptoms. Patients' SWB and difficulty in helping them constituted potential indicators in consultation-liaison psychiatry, whereas relatives' satisfaction did not.

[Experiences of a working group about linking inpatient psychosomatic rehabilitation and outpatient psychotherapy]. / Aus der psychosomatischen Rehabilitation in die ambulante Psychotherapie: Erfahrungen eines Qualitätszirkels zur Vernetzung zwischen Klinik und niedergelassenen Therapeuten.

UNLABELLED: Long waiting times and other reasons make it difficult to carry on outpatient psychotherapy after completion of inpatient psychosomatic rehabilitation. Therefore instant linking between the both settings was provided by a working group. METHODS: Rate of patients taking part, kind of performed outpatient psychotherapy, working state and its change and therapeutic experiences were assessed. RESULTS: 43 patients were referred directly from inpatient psychosomatic rehabilitation to outpatient psychotherapy. 79% came to briefings, 63% started treatment, during which the rate of patients able to work increased from 42% to 67%. Especially in the beginning of therapies structure centered techniques were necessary. DISCUSSION: Results are encouraging, but need to be confirmed by a prospective control group design.

Toward defining the scope of psychosomatic medicine practice: psychosomatic medicine in an outpatient, tertiary-care practice setting.

BACKGROUND: Because psychosomatic medicine (PM) is increasingly practiced in outpatient settings, the scope of practice needs to be delineated from community psychiatry and inpatient psychiatry work. OBJECTIVE: The authors sought to address the question of whether outpatient activities are a definably part the scope of practice of PM. METHOD: Three clinical groups were compared: 200 PM outpatients, 200 consultation-liaison (CL) inpatients, and 200 community-psychiatry (CP) outpatients. RESULTS: The groups differed significantly in 49 of 112 demographic and clinical comparisons (43.8%). Analysis of individual measures validated the concept that PM outpatient practice requires traditional PM/CL expertise with medical-psychiatric differential diagnosis, unexplained physical symptoms, pain, and psychopharmacological management in medically ill and geriatric patients. CONCLUSION: Outpatient PM experiences may also enhance training opportunities, given an expanded case-mix.

Applying mixed regression models to the analysis of repeated-measures data in psychosomatic medicine.

OBJECTIVE: Although repeated-measures designs are increasingly common in research on psychosomatic medicine, they are not well suited to the conventional statistical techniques that scientists often apply to them. The goal of this article is to introduce readers to mixed regression models, which provide a more flexible and accurate framework for managing repeated-measures data. METHODS AND RESULTS: We begin with a summary of the advantages that mixed regression models have over conventional statistical techniques in the context of repeated-measures designs. Next, we outline the conceptual and mathematical underpinnings of mixed regression models for a nonstatistical audience. The article ends with two examples of how these models can be applied in psychosomatic research; one deals with a prospective investigation of depressive symptoms and change in body mass index in older adults and the other with a diary study of social interactions and cortisol secretion. CONCLUSIONS: Mixed regression models offer a flexible and powerful approach to analyzing repeated-measures data. They possess important advantages over more traditional strategies, and more widespread application of these models is likely to enhance the overall quality of psychosomatic research.