Enhanced Free-Text Search for Aggregated Medication Error Report Analysis and Risk Detection.

OBJECTIVES: Detecting medication errors (MEs) and learning from them are the key elements of medication safety management in health care. While the aggregation of the data and learning across the ME reports could help detect and manage organizational risks, the inconsistent and partly missing structural data complicate the analysis. The objective of this study was to examine whether an analysis of free-text data of aggregated ME reports could contribute to the detection of organizational risks. METHODS: A retrospective, cross-sectional analysis of ME reports from a patient safety incident reporting system in a tertiary hospital 2017-2021. Clustering of characteristics and variables of ME reports with an enhanced free-text search of the 10 most frequent active substances (TOP10) related to ME reports using Microsoft Excel. Validity analysis of the four most frequent active substances of the search results (TOP4). Evaluation of the possible impact of the enhanced free-text search method on ME report analysis and risk detection. RESULTS: The enhanced free-text search increased significantly the number of relevant ME reports of TOP10 active substances from 698 reports to 1578 reports. The validity of the enhanced free-text search results in TOP4 active substances was more than 74%. The enhanced free-text search revealed also new ME findings. CONCLUSIONS: Enhanced free-text search can contribute to the aggregate analysis of clustered ME reports and to the improvement of ME risk detection. The enhanced free-text search method enables more comprehensive analysis of the free-text data with commonly available software and provides new insights into medication safety improvement.

Interventions to support nurses as second victims of patient safety incidents: A qualitative study of nurse managers' perceptions.

AIMS: To describe nurse managers' perceptions of interventions to support nurses as second victims of patient safety incidents and to describe the management of interventions and ways to improve them. DESIGN: A qualitative study using interviews. METHODS: A purposive sample of nurse managers (n = 16) recruited from three hospital districts in Finland was interviewed in 2021. The data were analysed using elements of inductive and deductive content analysis. RESULTS: The study identified three main categories: (1) Management of second victim support, which contained three sub-categories related to the nurse manager's role, support received by the nurse manager and challenges of support management; (2) interventions to support second victims included existing interventions and operating models; and (3) improving second victim support, based on the sub-categories developing practices and developing an open and non-blaming patient safety culture. CONCLUSION: Nurse managers play a crucial role in supporting nurses as second victims of patient safety incidents and coordinating additional support. Operating models for managing interventions could facilitate nurse managers' work and ensure adequate support for second victims. The support could be improved by increasing the awareness of the second victim phenomenon. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Mitigating the harmful effects of patient safety incidents can improve nurses' well-being, reduce burden and attrition risks and positively impact patient safety. IMPACT: Increasing awareness of the second victim phenomenon and coherent operation models would provide equal support for the nurses and facilitate nurse managers' work. REPORTING METHOD: COREQ checklist was used. What does this paper contribute to the wider global clinical community? Nurse managers' role is significant in supporting the second victims and coordinating additional support. Awareness of the second victim phenomenon and coherent operating models can secure adequate support for the nurses and facilitate nurse managers' work.

Evaluation of Global trigger tool as a medication safety tool for adverse drug event detection-a cross-sectional study in a tertiary hospital.

The objective of this study is to describe and analyze adverse drug events (ADE) identified using the Global trigger tool (GTT) in a Finnish tertiary hospital during a 5-year period and also to evaluate whether the medication module of the GTT is a useful tool for ADE detection and management or if modification of the medication module is needed. A cross-sectional study of retrospective record review in a 450-bed tertiary hospital in Finland. Ten randomly selected patients from electronic medical records were reviewed bimonthly from 2017 to 2021. The GTT team reviewed a total of 834 records with modified GTT method, which includes the evaluation of possible polypharmacy, National Early Warning Score (NEWS), highest nursing intensity raw score (NI), and pain triggers. The data set contained 366 records with triggers in medication module and 601 records with the polypharmacy trigger that were analyzed in this study. With the GTT, a total of 53 ADEs were detected in the 834 medical records, which corresponds to 13 ADEs/1000 patient-days and 6% of the patients. Altogether, 44% of the patients had at least one trigger found with the GTT medication module. As the number of medication module triggers increased per patient, it was more likely that the patient had also experienced an ADE. The number of triggers found with the GTT medication module in patients' records seems to correlate with the risk of ADEs. Modification of the GTT could provide even more reliable data for ADE prevention.

How the reliability and validity of the patient classification system can be ensured in daily nursing work? A follow-up study.

AIMS AND OBJECTIVES: This study aimed to determine the reliability and validity of the RAFAELA patient classification system (PCS) for qualified and efficient nurses. BACKGROUND: The number of patients per nurse or diagnosis-based determination of nursing workload are imprecise measures that do not consider the variation in patients' care needs. Ensuring the reliability and validity of the RAFAELA is important for the efficient allocation of nursing resources. METHODS: In this study, we investigated how the maintenance (parallel classification measurement and professional assessment of optimal nursing care intensity level measurement) of the RAFAELA was done with 9 years of follow-up data. The results were analysed using quantitative methods supplemented with qualitative audit descriptions. The STROBE checklist was used. RESULTS: The RAFAELA was used continuously in 44 units (40%). The length of use of the RAFAELA influenced the success of parallel classification measurements. Six per cent of units passed parallel classification measurement over 75% after 1-3 years' use, 42% after 4-6 years and 83% after 7-9 years. Among the units that used the RAFAELA PCS continuously, only four (9%) passed the professional assessment of optimal nursing care intensity level measurement. CONCLUSIONS: This study shows that ensuring the reliability and validity of the use of the RAFAELA is laborious, requires several years of use and continuous investments in nurses' skills and motivation. RELEVANCE TO CLINICAL PRACTICE: Qualified use of PCS is challenging, and organisations should invest to maintenance, training, support and user motivation. Each patient should be classified comprehensively, and nursing resources should be calculated correctly. In addition, utilisation of the nursing intensity level should be maximised. CLINICAL TRIAL REGISTRATION NUMBER: Kuopio University Hospital organisation permit number 73/2014. PATIENT OR PUBLIC CONTRIBUTION: Information regarding individual patients or nurses was not available to the researchers. All materials are in the form of summary tables.

Learning From Student Experience: Development of an International Multimodal Patient Safety Education Package.

BACKGROUND: Patient safety is a global concern. Learning to provide safe, high-quality care is core to nursing education. PROBLEM: Students are exposed to diverse clinical practices, and experiences may vary between placements and across countries. Student experience is seldom used as an educational resource. APPROACH: An international, European Union-funded project, Sharing Learning from Practice for Patient Safety (SLIPPs), aimed to develop an innovative online educational package to assist patient safety learning. Based on student reported data and educational theory, multiple elements were iteratively developed by a multicountry, multidisciplinary group. OUTCOMES: The educational package is freely available on the SLIPPs Web site. Materials include a student reporting and reflection tool, virtual seminars, student reports data set, pedagogical game, high-fidelity simulation scenarios, scenario development and use guidelines, debriefing session model, and videos of simulations already performed. CONCLUSIONS: E-learning enables removal of physical barriers, allowing educators, professionals, and students from all over the world to collaborate, interact, and learn from each other.

Development of an International Tool for Students to Record and Reflect on Patient Safety Learning Experiences.

BACKGROUND: Underpinning all nursing education is the development of safe practitioners who provide quality care. Learning in practice settings is important, but student experiences vary. PURPOSE: This study aimed to systematically develop a robust multilingual, multiprofessional data collection tool, which prompts students to describe and reflect on patient safety experiences. APPROACH: Core to a 3-year, 5-country, European project was development of the SLIPPS (Sharing Learning from Practice for Patient Safety) Learning Event Recording Tool (SLERT). Tool construction drew on literature, theory, multinational and multidisciplinary experience, and involved pretesting and translation. Piloting included assessing usability and an initial exploration of impact via student interviews. OUTCOMES: The final SLERT (provided for readers) is freely available in 5 languages and has face validity for nursing across 5 countries. Student reports (n = 368) were collected using the tool. CONCLUSIONS: The tool functions well in assisting student learning and for collecting data. Interviews indicated the tool promoted individual learning and has potential for wider clinical teams.

Artificial Intelligence for Identifying the Prevention of Medication Incidents Causing Serious or Moderate Harm: An Analysis Using Incident Reporters' Views.

The purpose of this study was to describe incident reporters' views identified by artificial intelligence concerning the prevention of medication incidents that were assessed, causing serious or moderate harm to patients. The information identified the most important risk management areas in these medication incidents. This was a retrospective record review using medication-related incident reports from one university hospital in Finland between January 2017 and December 2019 (n = 3496). Of these, incidents that caused serious or moderate harm to patients (n = 137) were analysed using artificial intelligence. Artificial intelligence classified reporters' views on preventing incidents under the following main categories: (1) treatment, (2) working, (3) practices, and (4) setting and multiple sub-categories. The following risk management areas were identified: (1) verification, documentation and up-to-date drug doses, drug lists and other medication information, (2) carefulness and accuracy in managing medications, (3) ensuring the flow of information and communication regarding medication information and safeguarding continuity of patient care, (4) availability, update and compliance with instructions and guidelines, (5) multi-professional cooperation, and (6) adequate human resources, competence and suitable workload. Artificial intelligence was found to be useful and effective to classifying text-based data, such as the free text of incident reports.

Psychiatric nursing care experiences of immigrant patients: A Focused ethnographic study.

This study aimed to describe the psychiatric nursing care experiences of immigrant patients. The incidence of mental health problems is higher and the use of mental health services is lower among immigrants, especially refugees, compared with the majority of the population. The study uses a qualitative research approach, with an emphasis on focused ethnography research methods. The participants were immigrant patients (N = 14) residing in adult psychiatric wards of certain hospitals (N = 3) selected for the study. A majority of the participants were refugees or asylum seekers. A total of 21 in-depth interviews were conducted. The experiences of these immigrant patients, both in their home countries and in their country of residence, had had an adverse effect on their mental health, with past traumatic experiences being the most central factor. Their symptoms included depression, anxiety, somatization, and psychosis. The findings show that the categories of factors that helped promote recovery among immigrant patients were nursing, medical treatment, care environment, and the patients' own methods. Based on the findings, a systematic evaluation of traumatic experiences is recommended for immigrants from countries with a history of war and/or political violence. Healthcare providers should also consider the importance of cultural desire in psychiatric nursing for the recovery of patients.

Wrong-patient incidents during medication administrations.

AIMS AND OBJECTIVES: To describe the factors pertaining to medication being administered to the wrong patient and to describe how patient identification is mentioned in wrong-patient incident reports. BACKGROUND: Although patient identification has been given high priority to improve patient safety, patient misidentifications occur, and wrong-patient incidents are common. DESIGN: A descriptive content analysis. METHODS: Incident reports related to medication administration (n = 1,012) were collected from two hospitals in Finland between 1 January 2013-31 December 2014. Of those, only incidents involving wrong-patient medication administration (n = 103) were included in this study. RESULTS: Wrong-patient incidents occurred due for many reasons, including nurse-related factors (such as tiredness, a lack of skills or negligence) but also system-related factors (such as rushing or heavy workloads). In 77% (n = 79) of wrong-patient incident reports, the process of identifying of the patient was not described at all. CONCLUSIONS: There is need to pay more attention to and increase training in correct identification processes to prevent wrong-patient incidents, and it is important to adjust system factors to support nurses. RELEVANCE TO CLINICAL PRACTICE: Active patient identification procedures, double-checking and verification at each stage of the medication process should be implemented. More attention should also be paid to organisational factors, such as division of work, rushing and workload, as well as to correct communication. The active participation of nurses in handling incidents could increase risk awareness and facilitate useful protection actions.

Functionality of Triggers for Epilepsy Patients Assessed by Text and Data Mining of Medical and Nursing Records.

A trigger is a powerful tool for identifying adverse events to measure the level of any kind of harm caused in patient care. Studies with epilepsy patients have illustrated that using triggers as a methodology with data mining may increase patient well-being. The purpose of this study is to test the functionality and validity of the previously defined triggers to describe the status of epilepsy patient's well-being. In both medical and nursing data, the triggers described patients' well-being comprehensively. The narratives showed that there was overlapping in triggers. The preliminary results of triggers encourage us to develop some reminders to the documentation of epilepsy patient well-being. These provide healthcare professionals with further and more detailed information when necessary.

Hospital mortality and optimality of nursing workload: A study on the predictive validity of the RAFAELA Nursing Intensity and Staffing system.

BACKGROUND: Patient classification systems have been developed to manage workloads by estimating the need for nursing resources through the identification and quantification of individual patients' care needs. There is in use a diverse variety of patient classification systems. Most of them lack validity and reliability testing and evidence of the relationship to nursing outcomes. OBJECTIVE: Predictive validity of the RAFAELA system was tested by examining whether hospital mortality can be predicted by the optimality of nursing workload. METHODS: In this cross-sectional retrospective observational study, monthly mortality statistics and reports of daily registrations from the RAFAELA system were gathered from 34 inpatient units of two acute care hospitals in 2012 and 2013 (n=732). The association of hospital mortality with the chosen predictors (hospital, average daily patient to nurse ratio, average daily nursing workload and average daily workload optimality) was examined by negative binomial regression analyses. RESULTS: Compared to the incidence rate of death in the months of overstaffing when average daily nursing workload was below the optimal level, the incidence rate was nearly fivefold when average daily nursing workload was at the optimal level (IRR 4.79, 95% CI 1.57-14.67, p=0.006) and 13-fold in the months of understaffing when average daily nursing workload was above the optimal level (IRR 12.97, 95% CI 2.86-58.88, p=0.001). CONCLUSIONS: Hospital mortality can be predicted by the RAFAELA system. This study rendered additional confirmation for the predictive validity of this patient classification system. In future, larger studies with a wider variety of nurse sensitive outcomes and multiple risk adjustments are needed. Future research should also focus on other important criteria for an adequate nursing workforce management tool such as simplicity, efficiency and acceptability.

Trigger Development for the Improvement of Neurological Patient Care.

By analyzing medical records, we developed triggers for epilepsy patients' care coordination. Thirteen triggers with potential to affect patient care outcomes and safety were found.

The future of the clinical nurse specialist role in Finland.

PURPOSE: To identify and examine the expert panelists' visions on the future implementation of the clinical nurse specialist (CNS) role in Finland. DESIGN AND METHODS: A policy Delphi design was conducted in 2013. A purposive sampling method was used to recognize expert panelists in the areas of advanced practice nursing (APN), healthcare management, and advanced practice nurse education. Three iterative Web-based survey rounds were conducted (n = 25, n = 22, n = 19). Both qualitative and quantitative methods were used to analyze the data. FINDINGS: The expert panelists envisioned the future of the CNS role in Finland. This study portrayed the CNS role in Finland as generally consistent with the international role. CNS have comprehensive skills and knowledge that they use to guide and develop nursing practice; however, several threats may affect their role achievement. The existing national consensus, contradiction, and ambivalence related to CNS roles were revealed through the examination of the results, thus pointing out the areas for consideration when further developing these roles and role policies. CONCLUSIONS: This is the first national study to examine the implementation of the CNS role in Finland. Expert panelists' views regarding the CNS role will be valuable in the forthcoming national policy formulation process. Although the policy Delphi design is not often utilized, this study reveals that it is very well suited to guide and inform national and international APN policy development. CLINICAL RELEVANCE: This study contributes to CNS role development and describes the methods facilitating the essential policy formulation process.

From challenges to advanced practice registered nursing role development: Qualitative interview study.

The aim of this study is to describe the factors hindering and facilitating the implementation of the advanced practice registered nurses role at Finnish university hospitals, and to examine the implications for its future development. A descriptive qualitative approach, using thematic individual interviews, was conducted in 2011 with a sample of 11 advanced practice registered nurses. The data were analysed using qualitative content analysis. The advanced practice registered nurses role barriers had an impact on the role development needs. In turn, the facilitating factors helped encounter the challenges of the role, therefore having an impact on both the current role achievement, as well as contributing to the future role development. The factors hindering and facilitating the advanced practice registered nurses role need to be acknowledged to support the role implementation and planning of the future of the role.

Advanced nursing roles: a systematic review.

In this systematic literature review, we analyzed and synthesized the literature on one specialized advance practice nursing role in three countries for the purpose of describing and comparing these roles, as well as discussing whether an international consensus of the advance practice nursing definition is possible. A systematic search on CINAHL and PubMed Medline was conducted in 2011 to search the literature on the nurse consultant in the UK, the clinical nurse specialist in the USA, and the clinical nurse consultant in Australia. The studies (n = 42) were analyzed and combined using qualitative content analysis method. The roles of the nurse consultant, clinical nurse specialist, and clinical nurse consultant were similar. The variation in the roles appears to derive from organizational or individual choices, not the country in question. The study process comprised a synthesized representation of one specialized advance practice nursing role. More work is needed to further define the concept of the advance practice nursing, as well as its implementation on other cultures beyond this review. Based on this review, an international consensus regarding the definition of advance practice nursing and its subroles is possible.

Population-based comparison of health-related quality of life between healthy subjects and those with specific psychiatric or somatic diseases.

PURPOSE: The purpose of this study was to compare health-related quality of life (HRQL) of healthy subjects and those with psychiatric or somatic diseases. DESIGN AND METHODS: Eight dimensions of the RAND 36-Item Health Survey 1.0 (RAND-36) were investigated in a population-based sample. FINDINGS: Scores in all 8 RAND dimensions were lower in subjects with psychiatric diagnoses than in healthy subjects. In logistic regression models, poor social functioning (odds ratio [OR] 1.07-1.12) associated with psychiatric diagnoses. Lowered energy (OR 1.06) associated with major depression, poor general health with personality disorders (OR 1.06) and heart disease (OR 1.06), and physical limitations with heart (OR 1.04) and musculoskeletal disease (OR 1.07). PRACTICE IMPLICATIONS: Acknowledging the lowest HRQL dimensions among subjects with psychiatric diagnoses may help to promote mental, physical, and social well-being more efficiently.

Is alexithymia a risk factor for major depression, personality disorder, or alcohol use disorders? A prospective population-based study.

OBJECTIVE: Disagreements concerning the stability of alexithymia and its ability to predict subsequent psychiatric disorders prevail. The aim of this 7-year follow-up study was to examine whether alexithymia predicts subsequent major depression, personality disorder, or alcohol use disorders in a population-based sample. METHODS: The four-phase Kuopio Depression Study (KUDEP) was conducted in the eastern part of Central Finland. The study population (aged 25-64, n=2050) was randomly selected from the National Population Register. Data were collected in 1998, 1999, and 2001. In 2005, a subsample (n=333, 43 were excluded) of the 3-year follow-up population (1998-2001) was gathered and their diagnoses of mental disorders were confirmed by the Structure Clinical Interview for DSM-IV Axis I (SCID-I). Alexithymia was measured using the Toronto Alexithymia Scale (TAS-20) and depressive symptoms using the Beck Depression Inventory (BDI-21). For both of these measures, two groups were formed based on the median of their sum score (summing the 1998, 1999, and 2001 scores). Logistic regression analyses were performed. RESULTS: BDI sum scores, but not those of TAS, were associated with subsequent major depressive disorder, personality disorder, and alcohol use disorders in 2005. The BDI sum scores explained 35.7% of the variation in concurrent TAS sum scores. CONCLUSION: Alexithymia did not predict diagnoses of major depressive disorder, personality disorder, or alcohol use disorders. Alexithymia was closely linked to concurrent depressive symptoms. Thus, depressive symptoms may act as a mediator between alexithymia and psychiatric morbidity.

Curso de la disociación en la población general: estudio de seguimiento de 3 años de duración / The course of dissociation in the general population: a 3-year follow-up study

Objetivo: No se han efectuado estudios previos en la población general sobre la estabilidad de los síntomas disociativos. El objetivo del presente estudio es examinar el curso y los cambios de los síntomas y factores disociativos relacionados con dichos cambios durante un seguimiento de 3 años de una muestra de la población general finlandesa. Método: La muestra de la población general incluyó una cohorte de 1.497 individuos. Los síntomas disociativos se evaluaron con la escala de experiencias disociativas (Dissociative Experiences Scale [DES]) y la categoría taxonómica DES-taxón (DES-t). Los síntomas depresivos y la ideación suicida se evaluaron con el cuestionario de depresión de Beck (Beck Depression Inventory [BDI]). La muestra se clasificó en disociadores bajos con puntuaciones obtenidas en la escala DES < 20 y disociadores altos con puntuaciones ≥ 20. Resultados: En el periodo basal, 98 individuos eran disociadores altos. En el seguimiento, 28 de ellos seguían siendo disociadores altos, mientras que, entre 70 individuos, la puntuación DES disminuyó por debajo del punto de corte. Durante el periodo de seguimiento, 28 de 1.399 individuos llegaron a ser nuevos disociadores altos, y los disociadores constantemente bajos fueron 1.371 de 1.399 individuos. Los pertenecientes a la categoría taxonómica disociativa se detectaron en 39 individuos en el periodo basal o en el seguimiento, pero sólo 4 de ellos cumplieron los criterios en ambas evaluaciones. La disociación alta estable se asoció con un aumento de la puntuación obtenida en el BDI en el seguimiento, ideación suicida en el periodo basal, y una disminución de la capacidad para trabajar. Entre los disociadores altos en el periodo basal, el restablecimiento de la disociación alta se asoció con una disminución de la puntuación BDI en el seguimiento y con la ausencia de pensamientos suicidas, una edad más avanzada y una capacidad satisfactoria de trabajar en el periodo basal. Conclusiones: Sólo se identificaron niveles constantemente altos de síntomas disociativos en una proporción reducida de la población general. La estabilidad en la categoría taxonómica disociativa fue más débil que la de las variables continuas de disociación. Las experiencias disociativas tuvieron tendencia a cambiar, y estos cambios se asociaron con variaciones en la puntuación obtenida en el BDI. Se requieren estudios adicionales que revelen los factores relacionados con los cambios de los síntomas disociativos (AU)

Objective: There have been no previous general population studies on the stability of dissociative symptoms. The aim of this study was to examine the course of and the changes in dissociative symptoms and factors associated with these changes during a 3-year follow-up of a Finnish general population sample. Methods: The general population sample included a cohort of 1497 subjects. Dissociative symptoms were assessed with the Dissociative Experiences Scale (DES) and the DES-taxon (DES-T). Depressive symptoms and suicidal ideation were measured with the Beck Depression Inventory (BDI). The sample was categorized into low dissociators with DES scores less than 20 and high dissociators with DES scores of 20 or more. Results: At baseline, 98 subjects were high dissociators. On follow-up, 28 of them were still high dissociators, whereas among 70 subjects, the DES score declined below the cutoff score. During the follow-up period, 28 of 1399 subjects became new high dissociators, and constantly low dissociators consisted of 1371 of 1399 subjects. Dissociative taxon membership was detected in 39 subjects either at baseline or at follow-up, but only 4 of them met the criteria at both assessments. Stable high dissociation was associated with an increase in the BDI score on follow-up, baseline suicidal ideation, a younger age, a reduced working ability, and smoking. Risk factors for becoming a new high dissociator were an increase in the BDI score, a younger age at baseline, and a reduced working ability. Among the baseline high dissociators, recovery from high dissociation was associated with a decline in the BDI score at follow-up and with no suicidal thoughts, older age, and a good working ability at baseline. Conclusions: Only a small proportion of the general population had constantly high levels of dissociative symptoms. The stability of dissociative taxon membership was weaker than the stability of the continuous variables of dissociation. The dissociative experiences had a tendency to change, and these changes were associated with changes in the BDI scores. Further studies are needed to reveal the factors associated with the changes in dissociative symptoms (AU)

Are factors associated with suicidal ideation true risk factors? A 3-year prospective follow-up study in a general population.

BACKGROUND: Adverse life events or the commencement of adverse lifestyles associate with suicidal ideation, but most associations only have been identified in cross-sectional studies. More information is needed about whether they are true risk factors and independently predict the development of suicidal ideation. METHOD: A sample of the general population from Eastern Finland (n = 1,339) was followed-up for three-years with baseline and two follow-up assessments using postal questionnaires. The main adverse life events and changes in lifestyles were screened at baseline and on one- and three-year follow-up. The Beck Depression Inventory was used to assess the level of depression and the presence of suicidal ideation. RESULTS: Suicidal ideation was common in the sample (annual incidence 4.3%). At baseline it associated with a cluster of adverse life events and lifestyles, as well as depression. Nevertheless, only the Beck Depression Inventory score on 3-year follow-up (OR 1.33, 95% CI 1.22-1.45) and the onset of daily smoking during the follow-up period (OR 5.38, 95% CI 1.41-20.62) independently predicted the presence of suicidal ideation on 3-year follow-up among those who had been non-suicidal at baseline and on 1-year follow-up. CONCLUSION: Depressive mood appears to be a necessary precondition for the occurrence of suicidal ideation even after adverse life events.

Partial remission indicates poor functioning and a high level of psychiatric symptoms: a 3-phase 6-year follow-up study on major depression.

Patients with depression in partial remission are at high risk of relapse, but factors associated with being in this outcome group are not well known. We conducted a clinical survey to examine the course of major depression in 87 patients during a follow-up period of 6 years. Beck Depression Inventory (BDI) scores indicated the outcome of depression, i.e. remission, partial remission or fully symptomatic, at 6, 12 and 24 months and after 6 years. The prevalence of partial remission varied from 16% to 23% at different follow-ups. All symptom and functioning scale scores indicated at every assessment that the partial depression group managed better than those in the fully symptomatic group, but worse than those in remission. Partial remission was associated with a significant impairment in psychosocial functioning and a high level of symptoms throughout the follow-up. The partial remission group must be recognized and actively treated.