Older adults' awareness of modifiable risk and protective factors for dementia and interest in eHealth interventions for brain health: a comparison between the Netherlands and Germany.

BACKGROUND: Evidence on modifiable risk factors for dementia is accumulating rapidly, including e.g. smoking, hypertension, and diabetes. Comparing knowledge of risk factors for dementia and factors associated with knowledge and motivation to learn about dementia risk reduction in different countries may support the design of tailored public health campaigns. We investigated (1) differences in knowledge of risk and protective factors for dementia between the Netherlands and Germany, and interest in (2) information on brain health and (3) eHealth for brain health. MATERIALS AND METHODS: Population-based telephone (Germany) or web-based surveys (Netherlands) were conducted among adults aged 60-75 (ntotal=614; Germany: n = 270; Netherlands: n = 344), assessing sociodemographic factors, knowledge of risk and protective factors for dementia, interest in information on brain health and respective eHealth-tools. Correlates of knowledge, interest in information on brain health and eHealth for brain health were analyzed using multivariable regression, by country and in pooled analyses. RESULTS: In the total sample (Mage: 67.3 (SD: 4.3) years; %female: 48.6), knowledge of risk and protective factors (sum score assessing number of correctly identified factors) was higher among German participants (M (SD) = 7.6 (2.5) vs. 6.0 (4.3), p < .001). This was confirmed using linear regression analyses, controlling for sociodemographic covariates (b = 1.51; 95% CI: 1.00; 2.01). High education was linked to better knowledge of risk and protective factors (b = 1.61; 95% CI: 0.89; 2.34). Controlling for covariates, interest in information on brain health (OR: 0.05, 95% CI: 0.02; 0.09) and eHealth for brain health (OR: 0.40, 95% CI: 0.25; 0.65) was lower in German participants. Widowed participants were less interested in information on brain health, while widowed and single participants expressed less interest in eHealth for brain health in pooled analyses. Further associations between sociodemographic factors, interest in information on brain health and eHealth for brain health by country were detected. DISCUSSION: Engaging older adults in the design of eHealth interventions and cooperation with trusted sources, e.g., general practitioners, might enhance appreciation of eHealth for brain health. Education on risk and protective factors for dementia is warranted in both countries. However, differences in recruitment and assessment need to be acknowledged.

[What does the population know about risk and protective factors for dementia? An international review of the current state of knowledge in various countries]. / Was weiß die Bevölkerung über Risiko- und Schutzfaktoren für Demenz? Eine internationale Übersicht zum aktuellen Kenntnisstand in verschiedenen Ländern.

BACKGROUND: The scientific state of knowledge on modifiable risk factors for dementia has greatly improved in recent years. The established risk and protective factors include physical and social inactivity, hypertension, diabetes mellitus, excessive alcohol consumption and smoking; however, it is assumed that this knowledge is so far insufficiently disseminated among the general population, indicating untapped potential for primary prevention of dementia. OBJECTIVE: To assess the state of knowledge on established risk and protective factors for dementia in the general population. MATERIAL AND METHODS: Based on a systematic literature search in the PubMed database, international studies that investigated the knowledge on modifiable risk and/or protective factors for dementia in samples from the general population were identified. RESULTS AND CONCLUSION: A total of 21 publications were included in the review. The majority of publications (n = 17) collated risk and protective factors using closed questions, while n = 4 studies used open questions. Lifestyle factors, e.g. cognitive, social and physical activity, were most frequently named as protective against dementia. Furthermore, many participants recognized depression as a risk factor for dementia. Knowledge of cardiovascular risk constellations for dementia, such as hypertension, hypercholesterolemia or diabetes mellitus were much less known among the participants. The results indicate that there is a need for a targeted clarification of the role of pre-existing cardiovascular diseases as risk factors for dementia. Studies assessing the state of knowledge on social and environmental risk and protective factors for dementia are currently scarce.

Beneficial and Impeding Factors for the Implementation of Health-Promoting Lifestyle Interventions-A Gender-Specific Focus Group Study.

(1) Background: The prevalence of dementia increases and so does the number of interventions that address modifiable risk factors for dementia. Recent evidence suggests that there are gender differences in the prevalence of those lifestyle factors as well as in the effectiveness of interventions. This study aims to identify differences in factors that benefit or hinder the effectiveness of interventions since a target group's perspective gets more relevant. (2) Methods: Two focus groups, a female (n = 11) and a male (n = 8) group, were interviewed, audio recorded and transcribed. Qualitative analyses were performed and main- and subcategories were identified. (3) Results: Main differences were observed including aspects of lifestyle changes (e.g., respective diet and importance of an active lifestyle) and gender-typical behavior and perception by relevant healthcare actors. (4) Conclusions: Identified differences might help to address and raise the efficiency of lifestyle interventions. Further, the importance of social aspects and retirement as an auspicious moment to start interventions were identified as relevant by study participants.

Higher FORTA (Fit fOR The Aged) scores are associated with poor functional outcomes, dementia, and mortality in older people.

PURPOSE: Higher Fit fOR The Aged (FORTA) scores have been shown to be negatively associated with adverse clinical outcomes in older hospitalized patients. This has not been evaluated in other health care settings. The aim of this study was to examine the association of the FORTA score with relevant outcomes in the prospective AgeCoDe-AgeQualiDe cohort of community-dwelling older people. In particular, the longitudinal relation between the FORTA score and mortality and the incidence of dementia was evaluated. METHODS: Univariate and multivariate correlations between the FORTA score and activities of daily living (ADL) or instrumental activities of daily living (IADL) as well as comparisons between high vs. low FORTA scores were conducted. RESULTS: The FORTA score was significantly correlated with ADL/IADL at baseline and at all follow-up visits (p < 0.0001). ADL/IADL results of participants with a low FORTA score were significantly better than in those with high FORTA scores (p < 0.0001). The FORTA score was also significantly (p < 0.0001) correlated with ADL/IADL in the multivariate analysis. Moreover, the mean FORTA scores of participants with dementia were significantly higher (p < 0.0001) than in those without dementia at follow-up visits 6 through 9. The mean FORTA scores of participants who died were significantly higher than those of survivors at follow-up visits 7 (p < 0.05), 8 (p < 0.001), and 9 (p < 0.001). CONCLUSION: In this study, an association between higher FORTA scores and ADL as well as IADL was demonstrated in community-dwelling older adults. Besides, higher FORTA scores appear to be linked to a higher incidence of dementia and even mortality.

Association of Alcohol and Tobacco Consumption with Depression Severity in the Oldest Old. Results from the Age Different Old Age Cohort Platform.

This study aimed to examine the association of alcohol and tobacco use with severity of depression in older age. Analyses were performed on a pooled data set (n = 3724) from two German old-age cohort studies (LEILA 75+, 6 follow-ups and AgeCoDe/AgeQualiDe, 9 follow-ups). Depressive symptoms were assessed via two screening scales for depression (CES-D and GDS-15) which were harmonized for pooled analysis. A mixed-effects linear regression model for the total sample and additional stratified models for men and women were used. Smoking at baseline was significantly associated with a higher level of depression severity (ß = 0.142, 95% CI: 0.051-0.233, p = 0.002), whereas drinking was significantly associated with a decreased level of depression (ß = -0.069, 95% CI: -0.119--0.021, p = 0.005). Concurrent substance use at baseline increased longitudinal depression severity (ß = 0.193, 95% CI: 0.011-0.375, p = 0.037). Analyses stratified by gender showed a significant inverse association between drinking and depressive symptoms in men (ß = -0.138, 95% CI: -0.231--0.045, p = 0.004), but not in women (ß = -0.060, 95% CI: -0.120-0.001, p = 0.052). Given the burden of major depression, it is important that health care providers, especially primary care physicians, assess and monitor lifestyle factors, even at older ages.

Risk factors and protective factors of depression in older people 65+. A systematic review.

OBJECTIVES: Identifying risk factors of depression can provide a better understanding of the disorder in older people. However, to minimize bias due to the influence of confounders and to detect reverse influence, a focus on longitudinal studies using multivariate analysis is required. DESIGN: A systematic literature search was conducted by searching the databases MEDLINE, Cochrane, PsycINFO and Web of Science for all relevant articles published from January 2000 to the end of March 2020. The following inclusion criteria were used: prospective design, nationally or regionally representative sample, published in English or German, analyzed risk factors for depression of individuals 65+ identified by multivariate analysis, and provided validity of diagnostic instrument. All results of multivariate analysis were reported and summarized. RESULTS: Thirty articles were identified. Heterogeneous results were found for education, female gender, self-rated health, cognitive impairment and older age, although significant in several studies. Findings hinted at a protective quality of physical activity. In terms of physical health, chronic disease and difficulty initiating sleep homogeneously increased risk of depression. Mobility impairment resulted as a risk factor in three studies. IADL impairment and vision impairment were mostly identified as significant risk factors. Alcohol consumption and smoking behavior yielded heterogenous results. Psychosocial factors were assessed similarly in multiple studies and yielded heterogenous results. LIMITATIONS: Research was limited to articles published in English or German. Length of follow up was not considered for the presentation of results. Adjustments for and inclusion of different variables in the studies may distort results. CONCLUSION: Our findings demonstrate the necessity of refined, more comparable assessment tools for evaluating potential risk factors.

[Diagnosed Depression and Utilization of Health Care Services and Preventive Measures in the General Adult Population in Germany - Results from a Nationwide Cross-Sectional Telephone Survey]. / Diagnostizierte Depression und Inanspruchnahme von medizinischen Versorgungs- und Vorsorgeleistungen bei Erwachsenen in Deutschland.

OBJECTIVE: To examine the association of diagnosed depression with the utilization of health care services and preventive measures among men and women in the general population in Germany. METHODS: Cross-sectional analysis of data from a representative telephone survey (men N = 18,675, women N = 24,518, 18 years and older). Self-reported health professional-diagnosed depression (past 12 months) and the use of a range of health care and preventive services were assessed. RESULTS: Diagnosed depression was associated with increased health care service utilization in both sexes. Diagnosed depression was associated with higher utilization of some preventive services, such as general health check-ups (odds ratio [OR] 1.2), cancer screening (OR 1.2) and flu vaccination (OR 1.3) among women and cancer screening (OR 1.4) among men. CONCLUSIONS: Health professional-diagnosed depression is associated with increased health service utilization independent of somatic comorbidity and socio-demographic confounders. There was no indication for specific under-treatment with preventive measures among people with depression diagnosis.

Five A's counseling in weight management of obese patients in primary care: a cluster-randomized controlled trial (INTERACT).

BACKGROUND: Obesity is one of the most prevalent health problems in western societies. However, it seems not effectively managed in the healthcare system at present. Originating from smoking cessation a tool called the 5As for obesity management has been drafted and adapted by the Canadian Obesity Network (CON) to improve weight counseling and provider-patient-interaction. This paper describes the rationale and design of the INTERACT study. The objective of the INTERACT study is to evaluate the effectiveness and intervention costs of a 5As eLearning program for obesity management aimed specifically at general practitioners (GPs). METHODS: The INTERACT study is a cluster randomized controlled trial aimed at implementing and evaluating an online-tutorial for obesity management based on the 5As approach in cooperating primary health care practices. Effectiveness of the 5As intervention will be evaluated by assessing patients and doctors perspectives on obesity management in primary care before and after the training. GPs in the intervention group will get access to the 5As obesity management online-tutorial while GPs in the control group will be assigned to a waiting list. Outcome measures for patients and GPs will be compared between the intervention group (treatment as usual + training of the GP) and the control group (treatment as usual). Hierarchical regression models will be used to analyze effects over time pre- and post-intervention. DISCUSSION: The 5As present physicians with a simple mnemonic for patient counseling in the primary care context. While the use of the 5As in weight counseling seems to be associated with improved doctor-patient interaction and motivation to lose weight, intervention studies assessing the effectiveness of a short 5A eLearning tutorial for physicians on secondary outcomes, such as weight development, are lacking. TRIAL REGISTRATION: The study has been registered at the German Clinical Trials Register ( DRKS00009241 ; date of registration: 03.02.2016).

Choosing the right rehabilitation setting after herniated disc surgery: Motives, motivations and expectations from the patients' perspective.

OBJECTIVES: This study aims to investigate (1) motives, motivations and expectations regarding the choice for a specific rehabilitation setting after herniated disc surgery and (2) how rehabilitation-related motivations and expectations are associated with rehabilitation outcome (ability to work, health-related quality of life and satisfaction with rehabilitation) three months after disc surgery. METHODS: The longitudinal cohort study refers to 452 disc surgery patients participating in a subsequent rehabilitation. Baseline interviews took part during acute hospital stay (pre-rehabilitation), follow-up interviews three months later (post-rehabilitation). Binary logistic regression and multiple linear regression analyses were applied. RESULTS: (1) Motives, motivations and expectations: Inpatient rehabilitation (IPR) patients stated "less effort/stress" (40.9%), more "relaxation and recreation" (39.1%) and greater "intensity of care and treatment" (37.0%) regarding their setting preference, whereas outpatient rehabilitation (OPR) patients indicated "family reasons" (45.3%), the wish for "staying in familiar environment" (35.9%) as well as "job-related reasons" (11.7%) as most relevant. IPR patients showed significantly higher motivation/expectation scores regarding regeneration (p < .001), health (p < .05), coping (p < .001), retirement/job (p < .01), psychological burden (p < .05) and physical burden (p < .001) compared to OPR patients. (2) Associations with rehabilitation outcome: Besides other factors (e.g. age, gender and educational level) rehabilitation-related motivations/expectations were significantly associated with rehabilitation outcome measures. For example, patients with less motivations/expectations to achieve improvements regarding "physical burden" showed a better health-related quality of life (p < .01) three months after disc surgery. Less motivations/expectations to achieve improvements regarding "psychological burden" was linked to a better mental health status (p < .001) and a greater satisfaction with rehabilitation (OR = .806; p < .05). CONCLUSION: Rehabilitation-related motivations and expectations differed substantially between IPR and OPR patients before rehabilitation and were significantly associated with rehabilitation outcome. Taking motivational and expectation-related aspects into account may help to improve allocation procedures for different rehabilitation settings and may improve rehabilitation success.

[Barriers and Opportunities for Optimized Treatment of Late Life Depression]. / "Die vergessenen Patienten" ­ Barrieren und Chancen einer optimierten Behandlung depressiver Erkrankungen im Alter.

Objective: To identify barriers and opportunities of an optimized treatment of depression in late life in Germany. Methods: Qualitative analysis of 12 expert interviews. Results: Experts recognized much room for improvement regarding late life depression care. A number of barriers were identified on the part of individuals affected, caring relatives and physicians and other therapists, as well as at the structural level. Lack of knowledge as well as a number of structural barriers result in diagnostic deficits and limited or inadequate treatment. The potential for improvement is explored. Conclusions: Parallel initiatives at different levels of care are suggested to optimize the treatment of depressed elderly people in Germany.

Is the Short Form of the Mini-Mental State Examination (MMSE) a better screening instrument for dementia in older primary care patients than the original MMSE? Results of the German study on ageing, cognition, and dementia in primary care patients (AgeCoDe).

The aim of the study was to investigate the psychometric properties of a Short Form of the Mini-Mental State Examination (SMMSE) for the screening of dementia in older primary care patients. Data were obtained from a large longitudinal cohort study of initially nondemented individuals recruited via primary care chart registries and followed at 18-month intervals. Item and scale parameters for MMSE and SMMSE scores were analyzed and cross-validated for 2 follow-up assessments (n1 = 2,657 and n2 = 2,274). Binary logistic regression and receiver-operating-characteristic (ROC) curve analyses were conducted in order to assess diagnostic accuracy parameters for MMSE and SMMSE scores. Cross-sectional differentiation between dementia-free and dementia patients yielded moderate to good results for MMSE and SMMSE scores. With regard to most diagnostic accuracy parameters, SMMSE scores did not outperform the MMSE scores. The current study provides first evidence regarding the psychometric properties of the SMMSE score in a sample of older primary care patients. However, our findings do not confirm previous findings that the SMMSE is a more accurate screening instrument for dementia than the original MMSE. Further studies are needed in order to assess and to develop short, reliable and valid instruments for routine cognitive screening in clinical practice and primary care settings.

Risk of dementia in elderly patients with the use of proton pump inhibitors.

Drugs that modify the risk of dementia in the elderly are of potential interest for dementia prevention. Proton pump inhibitors (PPIs) are widely used to reduce gastric acid production, but information on the risk of dementia is lacking. We assessed association between the use of PPIs and the risk of dementia in elderly people. Data were derived from a longitudinal, multicenter cohort study in elderly primary care patients, the German Study on Aging, Cognition and Dementia in Primary Care Patients (AgeCoDe), including 3,327 community-dwelling persons aged ≥ 75 years. From follow-up 1 to follow-up 4 (follow-up interval 18 months), we identified a total of 431 patients with incident any dementia, including 260 patients with Alzheimer's disease. We used time-dependent Cox regression to estimate hazard ratios of incident any dementia and Alzheimer's disease. Potential confounders included in the analysis comprised age, sex, education, the Apolipoprotein E4 (ApoE4) allele status, polypharmacy, and the comorbidities depression, diabetes, ischemic heart disease, and stroke. Patients receiving PPI medication had a significantly increased risk of any dementia [Hazard ratio (HR) 1.38, 95% confidence interval (CI) 1.04-1.83] and Alzheimer's disease (HR 1.44, 95% CI 1.01-2.06) compared with nonusers. Due to the major burden of dementia on public health and the lack of curative medication, this finding is of high interest to research on dementia and provides indication for dementia prevention.

Obesity and associated lifestyle in a large sample of multi-morbid German primary care attendees.

BACKGROUND: Obesity and the accompanying increased morbidity and mortality risk is highly prevalent among older adults. As obese elderly might benefit from intentional weight reduction, it is necessary to determine associated and potentially modifiable factors on senior obesity. This cross-sectional study focuses on multi-morbid patients which make up the majority in primary care. It reports on the prevalence of senior obesity and its associations with lifestyle behaviors. METHODS: A total of 3,189 non-demented, multi-morbid participants aged 65-85 years were recruited in primary care within the German MultiCare-study. Physical activity, smoking, alcohol consumption and quantity and quality of nutritional intake were classified as relevant lifestyle factors. Body Mass Index (BMI, general obesity) and waist circumference (WC, abdominal obesity) were used as outcome measures and regression analyses were conducted. RESULTS: About one third of all patients were classified as obese according to BMI. The prevalence of abdominal obesity was 73.5%. Adjusted for socio-demographic variables and objective and subjective disease burden, participants with low physical activity had a 1.6 kg/m2 higher BMI as well as a higher WC (4.9 cm, p<0.001). Current smoking and high alcohol consumption were associated with a lower BMI and WC. In multivariate logistic regression, using elevated WC and BMI as categorical outcomes, the same pattern in lifestyle factors was observed. Only for WC, not current but former smoking was associated with a higher probability for elevated WC. Dietary intake in quantity and quality was not associated with BMI or WC in either model. CONCLUSIONS: Further research is needed to clarify if the huge prevalence discrepancy between BMI and WC also reflects a difference in obesity-related morbidity and mortality. Yet, age-specific thresholds for the BMI are needed likewise. Encouraging and promoting physical activity in older adults might a starting point for weight reduction efforts.

Inpatient or outpatient rehabilitation after herniated disc surgery? - Setting-specific preferences, participation and outcome of rehabilitation.

OBJECTIVE: To examine rehabilitation preferences, participation and determinants for the choice of a certain rehabilitation setting (inpatient vs. outpatient) and setting-specific rehabilitation outcomes. METHODS: The longitudinal observational study referred to 534 consecutive disc surgery patients (18-55 years). Face-to-face baseline interviews took place about 3.6 days after disc surgery during acute hospital stay. 486 patients also participated in a follow-up interview via telephone three months later (dropout-rate: 9%). The following instruments were used: depression and anxiety (Hospital Anxiety and Depression Scale), pain intensity (numeric analog scale), health-related quality of life (Short Form 36 Health Survey), subjective prognosis of gainful employment (SPE-scale) as well as questions on rehabilitation attendance, return to work, and amount of sick leave days. RESULTS: The vast majority of patients undergoing surgery for a herniated disc attended a post-hospital rehabilitation treatment program (93%). Thereby two-thirds of these patients took part in an inpatient rehabilitation program (67.9%). Physical, psychological, vocational and health-related quality of life characteristics differed widely before as well as after rehabilitation depending on the setting. Inpatient rehabilitees were significantly older, reported more pain, worse physical quality of life, more anxiety and depression and a worse subjective prognosis of gainful employment before rehabilitation. Pre-rehabilitation differences remained significant after rehabilitation. More than half of the outpatient rehabilitees (56%) compared to only one third of the inpatient rehabilitees (33%) returned to work three months after disc surgery (p<.001). CONCLUSION: The results suggest a "pre-selection" of patients with better health status in outpatient rehabilitation. Gaining better knowledge about setting-specific selection processes may help optimizing rehabilitation allocation procedures and improve rehabilitation effects such as return to work.

[Screening for depression by telephone using the German version of the Center for Epidemiological Studies Depression Scale (CES-D)]. / Depressionsscreening am Telefon mittels der Allgemeinen Depressionsskala (ADS).

OBJECTIVE: Analyses of the reliability and validity of the German version of the Center for Epidemiological Studies Depression Scale (CES-D) and the assessment of normative values. METHOD: A representative sample of 868 people (German population, 18 to 94 years) was assessed via structured interviews in a telephone survey. RESULTS: According to the cut-off score of 16 points, 8.5 % of the total sample (11.0 % women and 5.6 % men) showed relevant depressive symptoms. When using the cut-off score of 22 points, 3.5 % of the subjects of the total sample, 4.2 % of the women and 2.5% of the men, were classified as depressed. The analysis of the psychometric properties of the instrument such as internal consistency, test-retest reliability, construct validity and factor structure revealed moderate to good results. Percentile standard values were determined. CONCLUSION: The German version of the CES-D can be described as a reliable and valid instrument for detecting depressive symptoms. The present study offers current normative data for the specific use in telephone surveys.

Incidence and predictors of depression in non-demented primary care attenders aged 75 years and older: results from a 3-year follow-up study.

OBJECTIVE: to determine incidence and predictors of late-life depression. METHODS: this is a 3-year observational cohort study of 3,214 non-demented patients aged 75 and over completing three waves of assessment. The patients were recruited in 138 primary care practices in six urban areas in Germany. Depressive symptoms were measured at baseline, and 18 months and 36 months later using the GDS-15 Geriatric Depression Scale with a cut-off 0-5/6-15. Cox proportional hazard regression models were applied to examine predictors of incident depression, adjusting for sex, age, education, living situation, activities of daily living - and instrumental activities of daily living impairment, somatic comorbidity, alcohol consumption, smoking, mild cognitive impairment and apoE4 status. RESULTS: the incidence of depression was 36.8 (95% CI: 29.6-45.3) per 1,000 person-years in men and 46.0 (95% CI: 39.9-52.8) in women (sex difference P = 0.069). The incidence increased from 35.4 (95% CI: 29.7-41.9) per 1000 person-years between the ages of 75 and 79 to 75.2 (95% CI: 53.2-103.2) for subjects 85 years and older. After full adjustment for confounding variables, hazard ratios (HR) for incident depression were significantly higher for subjects 85 years and older (HR: 1.83, 95% CI: 1.24-2.70) and those with mobility impairment (HR: 2.53, 95% CI: 1.97-3.25), vision impairment (HR: 1.41, 95% CI: 1.04-1.91), mild cognitive impairment (HR: 1.52, 95% CI: 1.10-2.10), subjective memory impairment (HR: 1.33, 95% CI: 1.01-1.74) and current smoking (HR: 1.69, 95% CI: 1.13-2.53). CONCLUSIONS: the incidence of depression increased significantly with age. In designing prevention programmes, it is important to call more attention on functional impairment, cognitive impairment and smoking.

Attitudes towards bariatric surgery in the general public.

BACKGROUND: Prevalence rates of obesity are still rising. Weight loss surgery (WLS) is the most invasive but also most effective treatment option when behavioral modification has failed. Research indicates that health care professionals hold ambivalent views on bariatric surgery, while views of the general public have not yet been investigated. METHODS: In a German representative sample of n = 3,003 respondents in a computer-assisted telephone interview, n = 1,008 persons were interviewed on their views of the effectiveness of bariatric surgery and other interventions for obesity. Also, willingness to recommend a treatment was assessed. RESULTS: Lifestyle-based interventions were viewed as most effective in terms of weight loss. About 50 % of the population stated that WLS is "very effective" while still a quarter of respondents did not ascribe effectiveness to WLS. Higher age was associated with lower expectations of effectiveness while higher stigmatizing attitudes and genetic attributes for obesity were associated with higher expectations of effectiveness. Seventy-two percent would not recommend WLS or undergo it, if applicable, themselves. Higher educated respondents and those that viewed WLS as effective were more likely to recommend WLS. CONCLUSIONS: The German general public seems to be rather cautious regarding bariatric surgery. It may be assumed that false beliefs on the effectiveness and risk patterns of bariatric surgery are still very common, despite rising surgery numbers. Our results further emphasize the need for providing evidence-based information on bariatric surgery to the general public.

Psychiatric comorbidity as predictor of costs in back pain patients undergoing disc surgery: a longitudinal observational study.

BACKGROUND: Psychiatric comorbidity is common in back pain patients undergoing disc surgery and increases economic costs in many areas of health. The objective of this study was to analyse psychiatric comorbidity as predictor of direct and indirect costs in back pain patients undergoing disc surgery in a longitudinal study design. METHODS: A sample of 531 back pain patients was interviewed after an initial disc surgery (T0), 3 months (T1) and 15 months (T2) using the Composite International Diagnostic Interview to assess psychiatric comorbidity and a modified version of the Client Sociodemographic and Service Receipt Inventory to assess resource utilization and lost productivity for a 3-month period prior interview. Health care utilization was monetarily valued by unit costs and productivity by labour costs. Costs were analysed using random coefficient models and bootstrap techniques. RESULTS: Psychiatric comorbidity was associated with significantly (p < 0.05) increased direct (+664 Euro) and indirect costs (+808 Euro) at T0. The direct cost difference predominantly resulted from medical health care utilization and was nearly unchanged at T2. Further important cost predictors were clinical variables like the presence of chronic medical disease, the number of previous disc surgeries, and time and gender. CONCLUSION: Psychiatric comorbidity presents an important predictor of direct and indirect costs in back pain patients undergoing disc surgery, even if patients do not utilize mental health care. This effect seems to be stable over time. More attention should be given to psychiatric comorbidity and cost-effective treatments should be applied to treat psychiatric comorbidity in back pain patients undergoing disc surgery to reduce health care utilization and costs associated with psychiatric comorbidity.

The course of depression and anxiety in patients undergoing disc surgery: a longitudinal observational study.

OBJECTIVE: This study examines longitudinal depression and anxiety rates in disc surgery patients in comparison to the general population, the change and associated determinants of depression and anxiety over time. METHODS: The longitudinal observational study refers to 305 consecutive disc surgery patients (age range: 18-55 years). Depression and anxiety was assessed with the Hospital Anxiety and Depression Scale. Random effects regression models for unbalanced panel data were used. RESULTS: Depression and anxiety decreases significantly during nine months after surgery. Depression rates vary between 23.6% (T0), 9.6% (T1) and 13.1% (T2). Only at T0 the depression rate differs significantly from the general population. Anxiety rates range between 23.7% (T0), 10.9% (T1) and 11.1% (T2). Compared to the general population anxiety rates are significantly higher at all three assessment points. Risk factors for anxiety or depression at the time of the surgery are psychiatric comorbidity before surgery, higher age, female gender, lower educational level, lower physical health status and higher pain intensity. Regarding depression and anxiety in the course of time significant time interactions were found for the existence of other chronic diseases, higher pain intensity and vocational dissatisfaction. CONCLUSIONS: Compared to the general population patients undergoing herniated disc surgery are often affected by depression and anxiety during hospital treatment and also in the course of time. Multimodal diagnostics regarding psychological well-being, pain and physical health status may help to identify this risk group. The assistance by mental health professionals during hospital and rehabilitation treatment may reduce poor postoperative outcome.