Psychometric properties of the EQ-5D-5L in patients with major depression: factor analysis and Rasch analysis.

BACKGROUND: The EQ-5D is one of the most recommended questionnaires for cost-effectiveness studies. AIMS: To study the psychometric properties of the EQ-5D-5L in patients with major depression. METHODS: This prospective observational study included 433 patients with major depression who completed the EQ-5D-5L and Patient Health Questionnaire-9 (PHQ-9) questionnaires at baseline, of whom 310 also did six months later. The structural validity was assessed by confirmatory factor analysis, the item functioning by item response analysis, and reliability by Cronbach's alpha. Convergent validity and known-groups validity was studied using the PHQ-9 and a general health question. To assess responsiveness effect sizes were calculated. RESULTS: The results supported the unidimensionality and showed adequate item functioning, with somewhat age-related item differential functioning for the mobility dimension. Cronbach's alpha was 0.77. The EQ-5D-5L showed a high correlation with the PHQ-9 and general health. The more severe the depression level and the poorer the general health, the lower the EQ-5D-5L scores (p < 0.001). Responsiveness parameters showed moderate changes among "improved" patients. CONCLUSIONS: These findings support the adequate psychometric properties of the EQ-5D-5L in patients with major depression. It could be very useful for clinicians and researchers as an outcome measure and for use in economic evaluation.

Health Related Quality of Life in Major Depressive Disorder: evolution in time and factors associated.

Major Depressive Disorder (MDD) is the most prevalent mental disorder. We aimed to analyze which factors were associated to their Health-Related Quality of Life (HRQoL) perception in patients diagnosed of MDD and how they evolved over six months.

[Primary care and mental health care collaboration in patients with depression: Evaluation of a pilot experience]. / Colaboración atención primaria-salud mental en la asistencia a pacientes con depresión: evaluación de una experiencia piloto.

OBJECTIVE: To implement and assess a collaborative experience between Primary Care (PC) and Mental Health (MH) in order to improve the care of patients with depression. DESIGN: Pilot collaborative project from a participatory action research approach during 2013. LOCATION: Basque Country. Osakidetza (Basque Health Service). Bizkaia and Gipuzkoa. PARTICIPANTS: The study included 207 professionals from general practice, nursing, psychiatry, psychiatric nursing, psychology and social work of 9 health centres and 6 mental health centres of Osakidetza. INTERVENTIONS: Shared design and development of four axes of intervention: 1) Communication and knowledge between PC and MH professionals, 2) Improvement of diagnostic coding and referral of patients, 3) Training programmes with meetings and common Clinical Practice Guidelines, and 4) Evaluation. MAIN MEASUREMENTS: Intervention and control questionnaires to professionals of the centres on the knowledge and satisfaction in the PC-MH relationship, joint training activities, and assessment of the experience. Osakidetza registers of prevalences, referrals and treatments. Follow-up meetings. RESULTS: Improvement in the 4 axes of intervention in the participant centres compared with the controls. Identification of factors to be considered in the development and sustainability of PC-MH collaborative care. CONCLUSIONS: The pilot experience confirms that collaborative projects promoted by PC and MH can improve depression care and the satisfaction of professionals. They are complex projects that need simultaneous interventions adjusted to the particularities of the health services. Multidisciplinary and continuous participation and management and information system support are necessary for their implementation.

La calidad de vida relacionada con la salud en el trastorno depresivo mayor: factores asociados con su evolución / Health-related quality of life in major depressive disorder: factors associated with its evolution

Introducción. La Depresión Mayor (DM) es el trastorno de salud mental más prevalente. Se pretende analizar el peso de los factores asociados a la percepción de la Calidad de Vida Relacionada con la Salud (CVRS) en pacientes con diagnóstico de DM y su evolución durante seis meses. Metodología. Se incluyeron 432 sujetos con DM (DSMIV-TR) de consultas hospitalarias, centros de salud mental y centros de atención primaria en País Vasco, Madrid y Canarias. Se siguió a los pacientes durante 6 meses. Se recogieron variables clínicas, sociodemográficas y de abordaje terapéutico. La CVRS se midió mediante el EQ-5D-5L, expresado como “utilidades”. Se construyeron Modelos Lineales Generalizados para responder los objetivos. Resultados. Las mujeres, las personas de mayor edad, los grupos sociales menos favorecidos y aquellos con mayor comorbilidad “orgánica” expresaron una peor CVRS inicial. A los 6 meses permanecían en seguimiento 305 sujetos. El cambio medio en las “utilidades” fue de 0,033 (IC95%: 0,008-0,059), y de 0,132 (IC95%: 0,093-0,171) en los 109 sujetos (35,51%) que expresaron mejoría en su estado de salud. Se asociaron negativamente con la evolución de la CVRS la comorbilidad “orgánica”, la presencia de trastornos de la conducta alimentaria, una mayor edad, el pertenecer a grupos socioeconómicos desfavorecidos o la necesidad de un mayor esfuerzo terapéutico. Conclusiones. La DM se asocia con un gran impacto en la CVRS, que revierte parcialmente en el grupo con buena evolución clínica. La mayor edad, la comorbilidad y el grupo socioeconómico se asocian a una peor evolución de la CVRS.(AU)

Introduction. Major Depressive Disorder (MDD) is the most prevalent mental disorder. We aimed to analyze which factors were associated to their Health-Related Quality of Life (HRQoL) perception in patients diagnosed of MDD and how they evolved over six months. Methods. We included 432 subjects with MDD (DSM-IVTR) from hospital consultations, mental health centres and primary care centres in Basque Country, Madrid and Canary Islands. Patients were followed for 6 months. Clinical, sociodemographic and therapeutic variables were collected. HRQoL was measured by EQ-5D-5L, expressed as “utilities”. Generalized Linear Models were constructed to meet the objectives. Results. Women, older people, disadvantaged social groups and those with higher “physical comorbidity” expressed a worse HRQoL at inclusion. At 6 months, 305 subjects remained in follow-up. The average change in “utilities” was 0.033 (CI95%: 0.008-0.059), and 0.132 (CI95%: 0.093-0.171) in the 109 subjects (35.51%) who expressed improvement in their health status. “Physical comorbidity”, the presence of eating disorders, older age, belonging to disadvantaged socioeconomic groups or the need for greater therapeutic effort were negatively associated with HRQoL evolution. Conclusion. MDD is associated with a great impact on HRQoL, which partially reverts when the patients showed good clinical evolution. Older age, comorbidity and disadvantaged socioeconomic group are associated with a worse evolution of HRQOoL.(AU)

Colaboración atención primaria-salud mental en la asistencia a pacientes con depresión: evaluación de una experiencia piloto / Primary care and mental health care collaboration in patients with depression: Evaluation of a pilot experience

OBJETIVO: Implementar y evaluar una experiencia colaborativa entre Atención Primaria (AP) y Salud Mental (SM) para mejorar la asistencia a los pacientes con depresión. DISEÑO: Proyecto colaborativo piloto con enfoque de investigación acción participativa (IAP) durante 2013. EMPLAZAMIENTO: País Vasco. Osakidetza (Servicio Vasco de Salud). Bizkaia y Gipuzkoa. PARTICIPANTES: Doscientos siete profesionales de medicina de familia, enfermería, psiquiatría, enfermería psiquiátrica, psicología y trabajo social de 9 centros de salud y 6 centros de salud mental de Osakidetza. INTERVENCIONES: Diseño y desarrollo compartido de 4 ejes de intervención: 1) comunicación y conocimiento entre profesionales de AP y SM; 2) mejora en la codificación diagnóstica y derivación de pacientes; 3) formación compartida mediante sesiones y guías de práctica clínica comunes, y 4) evaluación. MEDICIONES PRINCIPALES: Encuestas a profesionales de centros de intervención y control sobre conocimiento y satisfacción en la relación AP-SM, actividades formativas conjuntas y valoración de la experiencia. Registros de Osakidetza sobre prevalencias, derivaciones y tratamientos. Reuniones de seguimiento. RESULTADOS: Mejoría en los centros de intervención respecto a los de control en los 4 ejes de intervención. Identificación de factores a considerar en el desarrollo y la sostenibilidad de la colaboración AP-SM. CONCLUSIONES: La experiencia piloto confirma que los proyectos colaborativos promovidos por AP y SM pueden mejorar la asistencia y satisfacción de los profesionales. Son proyectos complejos que requieren intervenciones simultáneas adecuadas a las singularidades de los servicios de salud. La participación pluridisciplinaria y continuada, y el apoyo de la gestión y los sistemas de información, son condiciones necesarias para su implementación

OBJECTIVE: To implement and assess a collaborative experience between Primary Care (PC) and Mental Health (MH) in order to improve the care of patients with depression. DESIGN: Pilot collaborative project from a participatory action research approach during 2013. LOCATION: Basque Country. Osakidetza (Basque Health Service). Bizkaia and Gipuzkoa. PARTICIPANTS: The study included 207 professionals from general practice, nursing, psychiatry, psychiatric nursing, psychology and social work of 9 health centres and 6 mental health centres of Osakidetza. INTERVENTIONS: Shared design and development of four axes of intervention: 1) Communication and knowledge between PC and MH professionals, 2) Improvement of diagnostic coding and referral of patients, 3) Training programmes with meetings and common Clinical Practice Guidelines, and 4) Evaluation. MAIN MEASUREMENTS: Intervention and control questionnaires to professionals of the centres on the knowledge and satisfaction in the PC-MH relationship, joint training activities, and assessment of the experience. Osakidetza registers of prevalences, referrals and treatments. Follow-up meetings. RESULTS: Improvement in the 4 axes of intervention in the participant centres compared with the controls. Identification of factors to be considered in the development and sustainability of PC-MH collaborative care. CONCLUSIONS: The pilot experience confirms that collaborative projects promoted by PC and MH can improve depression care and the satisfaction of professionals. They are complex projects that need simultaneous interventions adjusted to the particularities of the health services. Multidisciplinary and continuous participation and management and information system support are necessary for their implementation

[How does collective violence shape the health status of its victims? Conceptual model and design of the ISAVIC study]. / ¿Cómo influye la violencia colectiva en la salud? Modelo conceptual y diseño del estudio ISAVIC.

OBJECTIVES: Epidemiologic research on collective violence (violence exerted by and within groups in pursuit of political, social or economic goals) is very scarce despite its growing recognition as a major public health issue. This paper describes the conceptual model and design of one of the first research studies conducted in Spain aiming to assess the impact of collective violence in the health status of its victims (study known as ISAVIC, based on its Spanish title Impacto en la SAlud de la VIolencia Colectiva). METHODS: Starting with a comprehensive but non-systematic review of the literature, the authors describe the sequelae likely produced by collective violence and propose a conceptual model to explain the nature of the relationships between collective violence and health status. The conceptual model informed the ISAVIC study design and its measurement instruments. RESULTS: The possible sequelae of collective violence, in the physical, emotional and social dimensions of health, are described. Also, the review distinguishes the likely impact in primary and secondary victims, as well as the interplay with the social environment. The mixed methodological design of the ISAVIC study supports the coherence of the conceptual model described. CONCLUSIONS: The ISAVIC study suggests that collective violence may affect the main dimensions of the health status of its victims, in intimate relation to the societal factors where it operates. It is necessary to validate these results with new studies.

Uso de servicios ambulatorios de salud mental en España. Consumo de recursos en el primer año de asistencia a pacientes nuevos / Use of spanish mental health services during the first year of ambulatory attendance

Objetivo: se compara el consumo de servicios ambulatorios en pacientes atendidos por primera vez en tres zonas geográficas, sociales y sanitarias del país bastante diversas entre sí, buscando similitudes y diferencias para conocer su actividad y obtener información que permita organizar mejor los servicios. Material y método: se han incluido los 3.696 pacientes atendidos por primera vez en el año 1.996 en los servicios ambulatorios de salud mental de Fuenlabrada y Getafe (Madrid), Basauri y Galdako (Vizcaya) y Camas y Carmona (Sevilla), recogiendo datos de su primera consulta ambulatoria y del consumo de recursos ambulatorios en el año posterior, medido a través del número de consultas y de una estimación del tiempo empleado en cada una de las diferentes intervenciones que se realizan. Resultados y conclusiones: el consumo de recursos de atención ambulatoria se asocia con el sexo (mayor en mujeres), la edad(mayor en jóvenes),el tener titulación académica, el distrito (mayor en distritos vascos y menor en los sevillanos), la procedencia de la demanda y el ser diagnosticado de esquizofrenia, psicosis afectiva o trastorno de alimentación. Las diferencias asistenciales entre los centros participantes se explicarían en su mayor parte por la diferente dotación de recursos (AU)