Predictors of return to work in people with major depression: Results from a supported employment program in Germany.

BACKGROUND: Depression is a common mental disorder and is associated with work disability. For the implementation of evidence-based interventions, such as Individual Placement and Support (IPS) for people with depression in Germany, the aim of this study was to investigate client variables that predict return to work. METHODS: The sample consisted of 129 participants, initially treated in a psychiatric hospital due to major depression, who participated in IPS as part of a German clinical trial. Baseline demographic (age, sex, education, sickness absence days, employment status), psychiatric (symptom severity, comorbidity, general physical and mental health, disability), and neuropsychological (self-rated deficits, test performance) variables were included. Return to work within one year was predicted using separate and overall binary logistic regression analyses. RESULTS: A total of 70 participants (56 %) returned to work within the one-year follow-up period. >100 days of sick leave in the year prior to study entry (vs. <100 days) and higher self-rated cognitive deficits were significantly associated with reduced odds of return to work within one year of IPS. LIMITATIONS: The sample consisted of participants with a relatively good work history who were assigned to IPS by the treatment team, thus, the generalizability of the results is limited. CONCLUSIONS: People with depression who participate in IPS interventions might benefit from specifically targeting perceived cognitive deficits. Factors associated with prolonged sick leave due to depression and their role in return to work with IPS need further investigation.

Two Sides of the Same Coin in Female Borderline Personality Disorder: Self-Reported Guilt and Shame and Their Neurofunctional Correlates.

OBJECTIVE: Patients with borderline personality disorder (BPD) report to be especially prone to social emotions like shame and guilt. At the same time, these emotions seem to play an important role in BPD pathology. The present study aimed to deepen the knowledge about the processes behind shame and guilt in patients with BPD. METHODS: Twenty patients with BPD and twenty healthy controls (HCs) took part in an experiment that induced shame and guilt by imagining scenarios during scanning using functional brain imaging. Participants also filled out self-report questionnaires and took part in diagnostic interviews. RESULTS: BPD patients reported more proneness to guilt but not to shame than the HCs. There was no difference in the self-reported intensity rating of experimentally induced emotions between the groups. Between-group contrast of neural signals in the shame condition revealed a stronger activation of cingulate and fusiform gyrus for the BPD patients compared to the controls, and a more pronounced activation in the lingual gyrus and cuneus for the HCs. In the guilt condition, activation in the caudate nucleus, the fusiform gyrus, and the posterior cingulate cortex was stronger in BPD patients, while HC showed stronger activations in cuneus, lingual gyrus, and fronto-temporal regions. CONCLUSIONS: Differences in the neuro-functional processes between BPD patients and HC were found, even though the two groups did not differ in their self-report of subjective proneness to guilt and emotional intensity of shame and guilt during the experiment. While the HCs may be engaged more by the emotional scenarios themselves, the BPD patients may be more occupied with cognitive regulatory and self-referential processing.

Somatic Factors Predict On-Road Driving Skills in Older Drivers and Drivers with Mild Cognitive Impairment.

BACKGROUND: On-road driving skills can be impaired in older drivers and drivers with mild cognitive impairment (MCI) due to different driving-relevant deficits. Among these deficits, somatic factors have received little attention so far. METHODS: In a prospective observational on-road driving study, we examined whether somatic factors can predict on-road driving skills in a mixed sample of healthy older drivers and drivers with MCI (n = 99) and whether the inclusion of age explains additional variance. Somatic factors included the number of prescribed drugs, visual acuity, peripheral visual field integrity, mobility of the cervical spine, and hearing impairment. A hierarchical regression analysis was used to predict on-road driving skills by adding the somatic factors in the first step and age in the second step. RESULTS: Results revealed that the combination of somatic factors significantly predicted on-road driving skills (R2adjusted = 0.439). The inclusion of age led to a significant increase of explained variance (R2adjusted = 0.466). CONCLUSIONS: Our results suggest that somatic factors can accurately predict on-road driving skills in healthy older drivers and drivers with MCI. In addition, our results suggest that there is a significant but rather small effect of age beyond somatic changes.

Two Sides of Theory of Mind: Mental State Attribution to Moving Shapes in Paranoid Schizophrenia Is Independent of the Severity of Positive Symptoms.

BACKGROUND: Theory of Mind (ToM) impairment has repeatedly been found in paranoid schizophrenia. The current study aims at investigating whether this is related to a deficit in ToM (undermentalizing) or an increased ToM ability to hyperattribute others' mental states (overmentalizing). METHODS: Mental state attribution was examined in 24 patients diagnosed with schizophrenia (12 acute paranoid (APS) and 12 post-acute paranoid (PPS)) with regard to positive symptoms as well as matched healthy persons using a moving shapes paradigm. We used 3-T-functional magnetic resonance imaging (fMRI) to provide insights into the neural underpinnings of ToM due to attributional processes in different states of paranoid schizophrenia. RESULTS: In the condition that makes demands on theory of mind skills (ToM condition), in patients with diagnosed schizophrenia less appropriate mental state descriptions have been used, and they attributed mental states less often to the moving shapes than healthy persons. On a neural level, patients suffering from schizophrenia exhibited within the ToM network hypoactivity in the medial prefrontal cortex (MPFC) and hyperactivity in the temporo-parietal junction (TPJ) as compared to the healthy sample. CONCLUSIONS: Our results indicate both undermentalizing and hypoactivity in the MPFC and increased overattribution related to hyperactivity in the TPJ in paranoid schizophrenia, providing new implications for understanding ToM in paranoid schizophrenia.

The effect of repeated concussions on clinical and neurocognitive symptom severity in different contact sports.

INTRODUCTION: The potential consequences of repeated concussions in sport are well documented. However, it remains unclear whether the cumulative impact of sports-related concussions differs between different contact sports. Therefore, the aim of the current study was to investigate the cumulative effects of sports-related concussions on clinical and neurocognitive health in different contact sports. MATERIALS AND METHODS: In a prospective multicenter study, we examined 507 (74 females) active professional athletes between 18 and 40 years of age from five different contact sports (soccer, handball, American football, basketball, and ice hockey). Data collection involved concussion history, clinical symptom evaluation, neurocognitive assessment, and the collection of other sports-related information. Composite scores were built for clinical symptoms (such as neck pain and balance disturbances) and for neurocognitive symptoms (such as memory and attention impairments). RESULTS: Athletes having suffered 3+ concussions in the past showed disproportionally higher clinical symptom severity than athletes with less than three concussions across all sports. The level of clinical symptom burden in athletes with 3+ concussions indicated mild impairment. The number of past concussions did not affect neurocognitive performance. DISCUSSION: Repeated sports-related concussions appear to have a cumulative impact on clinical-but not cognitive-symptom severity. Although clinical symptom burden in athletes with 3+ concussions in the past was not alarmingly high yet in our sample, increased caution should be advised at this point. Despite few exceptions, results are similar for different contact sports, suggesting a similar multidisciplinary concussion management across all types of sport.

Everyday memory in patients with depression: An explorative pilot study using an ecological assessment paradigm.

BACKGROUND: People with major depressive disorder (MDD) often experience significant memory problems in their daily lives, which, however, frequently do not correspond to standardized memory test (SMT) results. The present pilot study aimed to examine the everyday memory performance of people with MDD by means of an ecological assessment paradigm (EAP). METHODS: Participants were unexpectedly called one week after their neuropsychological test assessment and asked about their memories of specific details of the former test situation. Associations of this EAP with SMT, subjective everyday memory problems, and symptom coping were exploratively analyzed. RESULTS: The study involved 22 MDD inpatients (M = 42.5 years, 64% female) and 22 comparable healthy control persons. MDD patients showed a significantly reduced performance in the EAP as well as in the SMT and they reported more memory problems in their daily lives. However, the EAP was not related to SMT results assessed a week before. Moreover, only the EAP was significantly associated with subjective daily memory problems and (distraction) coping style in the MDD group. CONCLUSIONS: The EAP appears to better reflect the everyday memory problems of persons with depression than standardized test procedures. However, the findings need to be validated by further research with larger samples.

Therapeutic alliance and dropout in patients with borderline pathology receiving residential dialectical behavior therapy.

BACKGROUND: This study focused on the impact of therapeutic alliance on therapy dropout in a naturalistic sample of patients with borderline pathology receiving dialectical behavior therapy (DBT) in a residential setting. We assumed that low therapeutic alliance shortly after admission would be associated with elevated dropout. METHODS: 44 participants with borderline pathology (≥ 3 DSM-5 borderline personality disorder criteria) in a residential DBT program completed a quality assurance questionnaire set assessing demographic information, pretreatment psychopathology and therapeutic alliance during the first seven days of their residential stay. Predictors of dropout were investigated using binary logistic regression analyses. RESULTS: The dropout rate was 34.1% (n = 15). In binary logistic regression analyses with variables covering demographic and clinical characteristics, comorbidities and childhood trauma history, only the therapeutic alliance significantly predicted dropout (z = -2.371, p = .018). CONCLUSIONS: This study supports the importance of therapy process variables, here the therapeutic alliance at the beginning of treatment, as predictors of therapy dropout in borderline pathology. If this finding is replicated, it shows the potential importance of monitoring the therapeutic relationship throughout the therapeutic process. CLINICALTRIALS: gov Identifier: NCT05289583, retrospectively registered on March 11, 2022.

Do depressed patients really over-report cognitive impairment?

BACKGROUND: Depressed patients report more severe cognitive impairment than is detectable by neuropsychological tests because they may underestimate their cognitive performance. Alternatively, it is possible that cognitive impairment primarily occurs under everyday life conditions as referred to in most questionnaires. The aim of the present study is to investigate the validity of self-reports in patients with major depression in order to better understand the pronounced impairment in self-reports. METHODS: We investigated 58 patients with major depression and 28 heathy control participants. We administered the "Screen for Cognitive Impairment in Psychiatry" (SCIP) to assess cognitive performance, the "Questionnaire for Cognitive Complaints" (FLei), and the newly developed scale for "Self-Perception of Cognitive Performance in everyday life and test settings" to ask for the self-assessed cognitive performance in everyday life and in a test situation more specifically. RESULTS: Depressed patients showed an inferior test performance and reported much more general everyday life related cognitive problems compared to healthy participants. When asked more specifically for their cognitive performance in the test-situation compared to others and compared to everyday life, they did not report more test-related and everyday life related impairment than healthy participants did. LIMITATIONS: Results might be influenced by comorbidity. CONCLUSIONS: These results have implications for the assessment of subjective cognitive performance of depressed patients and shed light on the negative effects of general versus more specific recall of autobiographical information.

Overestimation of on-road driving performance is associated with reduced driving safety in older drivers.

OBJECTIVES: Older drivers often show less precise self-ratings with a tendency to overestimate themselves. It is unclear, however, how overestimators differ from underestimators or drivers with adequate self-ratings. METHODS: 59 healthy older drivers participated in this on-road study. Besides standardized on-road driving assessment, the study protocol included the collection of neuropsychological and driving-related data as well as different self-ratings. Statistical analyses involved correlations between different subjective and objective ratings as well as statistical comparisons between drivers who overestimated and drivers who adequately rated their on-road driving performance (no drivers underestimated their performance). RESULTS: Despite positive correlations between different self- and expert ratings, our results revealed that 25 % of the participants overestimated their on-road driving skills. Among other things, overestimators showed poorer on-road driving performances, more prospective near and minor at-fault accidents, poorer cognitive performances in specific driving-related domains and reduced annual mileage. DISCUSSION: Our results suggest that older drivers who overestimate their driving skills show poorer performances within a broad range of skills that directly reflect or are closely related to driving safety. Against the background that an adequate self-assessment is required by German traffic regulations, our findings suggest that overestimators represent a risk group among the population of older drivers.

Combined physical activity training versus aerobic activity training in unipolar depressive disorder: a quasi-randomised evaluation study.

OBJECTIVE: The positive effect of sport and exercise interventions on the treatment of unipolar depressive disorder (UDD) is well documented with respect to aerobic exercise. However, few studies have determined the effectiveness of other types of interventions (e.g., weight training, body and mind oriented, qigong or progressive muscle relaxation). Additionally, the effectiveness of specific combined sport and exercise approaches has rarely been investigated. Therefore, recommendations for the use of sport and exercise therapy to treat UDD have been developed. METHODS: This quasi-randomised study used a pretest/posttest design to compare the effectiveness of two different interventions (aerobic activity training vs. combined physical activity training) on psychiatric outcome parameters in a day clinic psychiatric setting. A total of 62 participants were quasi-randomised to one of the two conditions. Affective, cognitive, psychosocial and neuropsychological changes were assessed by a battery of questionnaires before (t1) and after (t2) treatment. Accelerometers were used to assess energy consumption. RESULTS: The results show that both training interventions have similar effects on the treatment of UDD. CONCLUSION: These findings highlight the effectiveness of different physical activities in the treatment of UDD and provide further information for good clinical practice.

Give Me a Sign: Concrete Symbols Facilitate Orientation in Alzheimer's Disease Dementia.

OBJECTIVES: Persons with Alzheimer's disease dementia (ADD) often show impaired orientation, particularly in unknown environments. Signs may offer an opportunity to compensate for these deficits and thus improve participation. METHODS: We assessed 30 persons with ADD and 36 healthy controls by using a sign comprehension paradigm (SCP) in a real-life environment. Nonparametric mixed model analyses of variance were used to analyze the effect of different symbols and additional scripture (coding condition) on SCP performance speed and accuracy. RESULTS: Analyses revealed a significant main effect of symbol design on SCP speed as well as an interaction effect of group × symbol, indicating a benefit of concrete, optimized signs for persons with ADD. Furthermore, analyses of SCP error rates revealed the main effects of group and coding condition as well as an interaction effect of group × coding. Persons with ADD made more errors than healthy controls, but SCP error rates decreased significantly in ADD in the double-coding condition. DISCUSSION: Our findings revealed an advantage of concrete double-coded symbols over conventional symbols and therefore strongly suggest the implementation of concrete double-coded signs to support older people living with ADD.

The Collaborative Assessment and Management of Suicidality compared to enhanced treatment as usual for inpatients who are suicidal: A randomized controlled trial.

Background: Although use of inpatient crisis hospital intervention for suicide risk is common, the evidence for inpatient treatments that reduce suicidal thoughts and behaviors is remarkably limited. To address this need, this novel feasibility pilot randomized controlled trial compared the use of the Collaborative Assessment and Management of Suicidality (CAMS) to enhanced treatment as usual (E-TAU) within a standard acute inpatient mental health care setting. Objectives: We hypothesized that CAMS would be more effective than E-TAU in reducing suicidal thoughts and behaviors. As secondary outcomes we also investigated depressive symptoms, general symptom burden, reasons for living, and quality of the therapeutic relationship. Methods: All patients were admitted due to acute suicidal thoughts or behaviors. They were randomly assigned to CAMS (n = 43) or E-TAU (n = 45) and assessed at four time points (admission, discharge, 1 month and 5 months after discharge). We used mixed-effects models, effect sizes, and reliable change analyses to compare improvements across and between treatment groups over time. Results: Intent-to-treat analyses of 88 participants [mean age 32.1, SD = 13.5; n = 47 (53%) females] showed that both groups improved over time across all outcome measures with no significant between-group differences in terms of change in suicidal ideation, depression, reasons for living, and distress. However, CAMS showed larger effect sizes across all measures; for treatment completers CAMS patients showed significant improvement in suicidal ideation (p = 0.01) in comparison to control patients. CAMS patients rated the therapeutic relationship significantly better (p = 0.02) than E-TAU patients and were less likely to attempt suicide within 4 weeks after discharge (p = 0.05). Conclusions: CAMS and E-TAU were both effective in reducing suicidal thoughts and symptom distress. Within this feasibility RCT the pattern of results was generally supportive of CAMS suggesting that inpatient use of CAMS is both feasible and promising. However, our preliminary results need further replication within well-powered multi-site randomized controlled trials. Trial registration: DRKS-ID/ICTRP-ID: DRKS00013727. The trial was retrospectively registered in the German Clinical Trials Register, registration code/ DRKS-ID: DRKS00013727 on 12.01.2018 and also in the International Clinical Trials Registry Platform of the World Health Organization (identical registration code).

The magnitude of neurocognitive impairment is overestimated in depression: the role of motivation, debilitating momentary influences, and the overreliance on mean differences.

BACKGROUND: Meta-analyses agree that depression is characterized by neurocognitive dysfunctions relative to nonclinical controls. These deficits allegedly stem from impairments in functionally corresponding brain areas. Increasingly, studies suggest that some performance deficits are in part caused by negative task-taking attitudes such as poor motivation or the presence of distracting symptoms. A pilot study confirmed that these factors mediate neurocognitive deficits in depression. The validity of these results is however questionable given they were based solely on self-report measures. The present study addresses this caveat by having examiners assess influences during a neurocognitive examination, which were concurrently tested for their predictive value on performance. METHODS: Thirty-three patients with depression and 36 healthy controls were assessed on a battery of neurocognitive tests. The examiner completed the Impact on Performance Scale, a questionnaire evaluating mediating influences that may impact performance. RESULTS: On average, patients performed worse than controls at a large effect size. When the total score of the Impact on Performance Scale was accounted for by mediation analysis and analyses of covariance, group differences were reduced to a medium effect size. A total of 30% of patients showed impairments of at least one standard deviation below the mean. CONCLUSIONS: This study confirms that neurocognitive impairment in depression is likely overestimated; future studies should consider fair test-taking conditions. We advise researchers to report percentages of patients showing performance deficits rather than relying solely on overall group differences. This prevents fostering the impression that the majority of patients exert deficits, when in fact deficits are only true for a subgroup.

Neuropsychological predictors of vocational rehabilitation outcomes in individuals with major depression: A scoping review.

Background: Major depression is one of the leading causes of disability and limited capacity to work. Neuropsychological impairment is a common symptom in acute and remitted major depression and is associated with poor psychosocial functioning. This scoping review aimed to identify research on the role of neuropsychological functioning in outcomes of vocational rehabilitation programs in individuals with depression. Methods: We report on the conduct of this pre-registered (https://osf.io/5yrnf) scoping review in accordance with PRISMA-ScR guidelines. PubMed and PsychInfo were systematically searched for English or German research articles published between 1990 and September 2021 that studied objective neuropsychological tests as predictors of vocational rehabilitation interventions and included participants with depression. Results: The systematic literature search yielded no studies that specifically targeted subjects with major depression. However, eight articles published since 2016 were included in the review, analyzing data from five trials that evaluated the effectiveness of supported employment in North America and Europe in severe mental illnesses. An estimated 31% of the total number of participants included (n = 3,533) had major depression. Using a variety of cognitive tests and covariates, seven articles found that neuropsychological functioning - especially global cognition scores, verbal and visual learning and memory - significantly predicted vocational outcomes of rehabilitation programs. Conclusion: Despite a lack of studies specifically targeting major depressive disorder, the identified literature suggests that higher baseline neuropsychological functioning predicts better vocational outcomes of supported employment programs in individuals with depression. In clinical practice, additional neuropsychological modules during return-to-work interventions might be helpful for vocational outcomes of such programs.

Evaluation of a supported education and employment program for adolescents and young adults with mental health problems: A study protocol of the StAB project.

The majority of mental illnesses begins in childhood, adolescence and young adulthood before the age of 25. The transition from adolescence to adulthood is a particularly vulnerable time for adolescents with mental illness, affecting psychosocial functioning and participation in work life. Therefore, they need-in contrast to classic standard vocational interventions-a long-term, holistic and individually oriented vocational rehabilitation program. With the innovative model project "Start in education and employment (StAB)", adolescents and young adults with mental illnesses are to be supported with regard to their vocational perspectives and participation by a new type of individualized, holistic, long-term job coaching. It follows the Individual Placement and Support (IPS) concept, as a manualized form of the Supported Employment Approach and is based on the "first place-then train" principle. In order to evaluate the effectiveness and feasibility of the StAB program, a double-centre prospective single arm evaluation study in a mixed-methods design will be conducted. The focus is on quantitative research analysing pre-post-effects of the StAB intervention in a two-year observational study. Young people between 15 and 25 years with a psychiatric diagnosis who are currently in receipt of means-tested benefits or are entitled to them will be recruited. The study will take place in two major cities in the north-western part of Germany, Bielefeld and Dortmund. We expect to contribute to gain more empirical data about the implementation of Supported Employment and Education to severely mentally ill adolescents and young adults in German settings. Moreover, these results may also provide the scientific foundation for future measures focusing the improvement of vocational rehabilitation for young people with mental illness. The study was registered in the German Clinical Trials Register (DRKS00027576) on March 10, 2022.

Participating in Longitudinal Observational Research on Psychiatric Rehabilitation: Quantitative Results From a Patient Perspective Study.

BACKGROUND: Longitudinal observational studies play on an important role for evidence-based research on health services and psychiatric rehabilitation. However, information is missing about the reasons, why patients participate in such studies, and how they evaluate their participation experience. METHODS: Subsequently to their final assessment in a 2-year follow-up study on supported housing for persons with severe mental illness, n = 182 patients answered a short questionnaire on their study participation experience (prior experiences, participation reasons, burden due to study assessments, intention to participate in studies again). Basic respondent characteristics as well as symptom severity (SCL-K9) were also included in the descriptive and analytical statistics. RESULTS: To help other people and curiosity were cited as the main initial reasons for study participation (>85%). Further motives were significantly associated with demographic and/or clinical variables. For instance, "relieve from boredom" was more frequently reported by men and patients with substance use disorders (compared to mood disorders), and participants 'motive" to talk about illness" was associated with higher symptom severity at study entry. Furthermore, only a small proportion of respondents indicated significant burdens by study participation and about 87% would also participate in future studies. CONCLUSIONS: The respondents gave an overall positive evaluation regarding their participation experience in an observational study on psychiatric rehabilitation. The results additionally suggest that health and social care professionals should be responsive to the expectations and needs of patients with mental illness regarding participation in research.

Effectiveness of supported housing versus residential care in severe mental illness: a multicenter, quasi-experimental study.

PURPOSE: Up to now there are only few studies and no RCT comparing efficacy or effectiveness of supported housing (SH) versus residential care (RC) in severe mental illness (SMI) without homelessness. Here we present an observational follow-up study in SMI subjects, who entered SH or RC, to compare clinical and functional outcomes 2 years later. METHODS: In this prospective study in more than 30 locations throughout a German federal state, we included SMI subjects, who entered SH (n = 153) or RC (n = 104). About one quarter suffered from each substance use, psychotic, affective, or other disorders. To avoid sampling bias, we used the propensity score matching method to establish a quasi-experimental design. Outcome measures were social functioning (SFS), the number of psychiatric hospitalisations, psychopathology (SCL-9-K), and quality of life (MANSA). Apart from descriptive methods we analysed primarily using repeated-measures ANOVAS. RESULTS: Our analyses revealed significant effects of time for all outcomes in both study groups. However, there were not any group differences of outcome measures, i.e., not any significant effects of group or interactional effects of group x time. Moreover, these results hold true for intent-to-treat and per-protocol sample analyses. CONCLUSION: The results show, that SH and RC for non-homeless people with SMI achieve the same clinical and psychosocial outcomes across a 2-year period. Taking into account the users' preferences, the present findings should give reason to ensure the availability of affordable housing and to support the expansion of supported housing approaches.

Impaired Color Discrimination in Alzheimer Disease Dementia.

OBJECTIVE: Patients with Alzheimer disease dementia (ADD) often show impaired orientation and navigation. Signage offers an opportunity to compensate for these deficits, communicate information efficiently and facilitate wayfinding. Certain properties of signs such as colors and contrasts may beneficially affect the uptake and processing of information particularly in ADD patients. METHODS: Thirty-six healthy older adults and 30 ADD patients performed a computerized color perception task that required discriminating different color combinations. The effects of different contrast features on performance accuracy and speed in the 2 experimental groups were examined by nonparametric mixed analysis of variances. RESULTS: Analyses revealed a significant effect of contrast polarity on reaction times, significant effects of group on reaction times and errors as well as a marginally significant interaction of group×color on errors. All participants benefitted from positive contrast polarity (ie, dark target on lighter background) as indicated by increased performance speed. Furthermore, ADD patients reacted slower and less accurate than healthy controls, but showed higher accuracy at black-white and red-yellow than at blue-green color combinations. CONCLUSIONS: Our findings suggest the implementation of signs with positive contrast polarity to ensure faster reactions. In addition, certain color combinations may enhance accuracy, particularly in patients with ADD.