[Show abstract][Hide abstract] ABSTRACT: Major depression is a prevalent mental disorder with a high risk of relapses and recurrences, which are associated with considerable burden for patients and high costs for society. Despite these negative consequences, only few studies have focused on interventions aimed at the prevention of recurrences in primary care patients with depression.
To assess the cost-effectiveness of a psychoeducational prevention program (PEP) aimed at improving the long-term outcome of depression in primary care.
Recruitment took place in the northern part of the Netherlands, patients were referred by general practitioners. In total 267 patients were included in the study and randomly assigned to usual care (UC) or UC with one of three forms of PEP; PEP alone, psychiatric consultation followed by PEP (psychiatrist-enhanced PEP), and cognitive behavioral therapy followed by PEP (CBT-enhanced PEP). Costs and health outcomes were registered at three month intervals during the 36 months follow-up of the study. Primary outcome measure was the proportion of depression-free time.
Mean total costs during the 36 months of the study were 8200 euros in the UC group, 9816 euros in the PEP group, 9844 euros in the psychiatrist-enhanced PEP group, and 9254 euros in the CBT-enhanced PEP group. Costs of productivity losses, hospital admissions, contacts with regional institutions for mental healthcare, and medication use contributed substantially to the total costs in each group. Results of the primary outcome measure were less positive for PEP than for UC, but slightly better in the enhanced PEP groups. If decision-makers are willing to pay up to 300 euros for an additional proportion of depression-free time, UC is most likely to be the optimal intervention. For higher willingness to pay, CBT-enhanced PEP seems most efficient.
The basic PEP intervention was not cost-effective in comparison with UC. The economic impact of productivity losses associated with depression, and the importance of including these costs in economic studies, was illustrated by the findings of this study. Due to the drop-out of patients during the 36 months follow-up period, economic analyses had to account for missing data, which may complicate the interpretation of the results. Although Quality-Adjusted Life Years (QALYs) could not be assessed for all the patients, the results of analyses focusing on QALYs supported the overall conclusion that PEP is not cost-effective. IMPLICATIONS FOR HEALTH CARE PROVISION AND POLICIES: Results indicated that PEP should not be implemented in the Dutch healthcare system. Furthermore, is seems highly unlikely that PEP could be cost-effective in other (comparable) European healthcare systems.
The relatively positive economic results for CBT-enhanced PEP imply that UC enriched with CBT (but without PEP) might be cost-effective in preventing relapses in primary care patients with depression. The actual consequences of CBT for relapse prevention will have to be studied in further detail, both from a clinical and economic point of view.
The Journal of Mental Health Policy and Economics 12/2009; 12(4):195-204. · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to construct a patient- and user-friendly shortened version of the Geriatric Depression Scale (GDS) that is especially suitable for nursing home patients. The study was carried out on two different data bases including 23 Dutch nursing homes. Data on the GDS (n=410), the Mini Mental State Examination (n=410) and a diagnostic interview (SCAN; n=333), were collected by trained clinicians. Firstly, the items of the GDS-15 were judged on their clinical applicability by three clinical experts. Subsequently, seven items that were identified as unsuitable were removed using the GDS-data of the Assess-project (n=77), and internal consistency was calculated. Secondly, with respect to criterion validity (sensitivity, specificity, area under ROC and positive and negative predictive values), the newly constructed 8-item version of the GDS was validated in the AGED data set (n=333), using DSM-IV diagnosis for depression as measured by the SCAN as 'gold standard'. In the AGED dataset, the GDS-8 was internally consistent (alpha=.80) and high sensitivity rates of 96.3% for major depression and 83.0% for minor depression were found, with a specificity rate of 71.7% at a cut-off point of 2/3. The GDS-8 has good psychometric properties. Given that the GDS-8 is less burdening for the patient, more comfortable to use and less time consuming, it may be a more feasible screening test for the frail nursing home population.
Tijdschrift voor gerontologie en geriatrie 01/2008; 38(6):298-304.
[Show abstract][Hide abstract] ABSTRACT: The GDS-8; a short, client- and user-friendly shortened version of the Geriatric Depression Scale for nursing homes The objective of this study was to construct a patient- and user-friendly shortened version of the Geriatric Depression Scale
(GDS) that is especially suitable for nursing home patients. The study was carried out on two different data bases including
23 Dutch nursing homes. Data on the GDS (n=410), the Mini Mental State Examination (n=410) and a diagnostic interview (SCAN;
n=333), were collected by trained clinicians. Firstly, the items of the GDS-15 were judged on their clinical applicability
by three clinical experts. Subsequently, seven items that were identified as unsuitable were removed using the GDS-data of
the Assess-project (n=77), and internal consistency was calculated. Secondly, with respect to criterion validity (sensitivity,
specificity, area under ROC and positive and negative predictive values), the newly constructed 8-item version of the GDS
was validated in the AGED data set (n=333), using DSM-IV diagnosis for depression as measured by the SCAN as ‘gold standard’.
In the AGED dataset, the GDS-8 was internally consistent (a=.80) and high sensitivity rates of 96.3% for major depression
and 83.0% for minor depression were found, with a specificity rate of 71.7% at a cut-off point of 2/3. The GDS-8 has good
psychometric properties. Given that the GDS-8 is less burdening for the patient, more comfortable to use and less time consuming,
it may be a more feasible screening test for the frail nursing home population.
Tijdschr Gerontol Geriatr 2007; 38: 298-304
De Geriatrische Depressie Schaal heeft als screeningsinstrument zijn sporen verdiend, maar heeft veel items en is belastend
voor de fragiele verpleeghuispopulatie. Een veelgebruikte verkorte versie, de GDS-15, bevat items die niet geschikt zijn voor
gebruik in verpleeghuizen. Doel van deze studie was het construeren van een verkorte verpleeghuisversie. Voor twee onderzoeksprojecten
werd bij 410 cliënten de GDS afgenomen. Uit GDS-data van het Assess-project (N=77) werden zeven items verwijderd die volgens
drie deskundigen niet van toepassing, onbegrijpelijk of ergerniswekkend waren. Van de resterende acht items werd berekend
of zij een intern consistente schaal vormden. Vervolgens werden betrouwbaarheid en criteriumvaliditeit van deze acht-itemversie
bepaald in de AGED dataset (N=333). Hierbij werd de DSM-IV diagnose voor depressie (gemeten met de SCAN) gebruikt als gouden
standaard. In de AGED-dataset had de GDS-8 een goede interne consistentie (?=0,80) en een hoge sensitiviteit voor een depressieve
stoornis (major depression) (96,3%) en een iets minder hoge sensitiviteit (83,0%) voor een lichte depressieve stoornis (minor
depression) bij een specificiteit van 71,7% (cut-off 2/3).
De GDS-8 heeft goede psychometrische eigenschappen en is bovendien minder belastend voor de cliënt, prettiger af te nemen
en minder tijdsintensief. Gebruik van de GDS-8 zou de opsporing van depressie in verpleeghuizen kunnen verbeteren.
depressie-screening-Geriatrische Depressie Schaal-verpleeghuizen
Tijdschrift voor gerontologie en geriatrie 12/2007; 38(6):264-269. DOI:10.1007/BF03074864
[Show abstract][Hide abstract] ABSTRACT: To construct a patient- and user-friendly shortened version of the Geriatric Depression Scale (GDS) that is especially suitable for nursing home patients.
The study was carried out on two different data bases including 23 Dutch nursing homes. Data on the GDS (n = 410), the Mini Mental State Examination (n = 410) and a diagnostic interview (SCAN; n = 333), were collected by trained clinicians. Firstly, the items of the GDS-15 were judged on their clinical applicability by three clinical experts. Subsequently, items that were identified as unsuitable were removed using the data of the Assess project (n = 77), and internal consistency was calculated. Secondly, with respect to criterion validity (sensitivity, specitivity, area under ROC and positive and negative predictive values), the newly constructed shortened GDS was validated in the AGED data set (n = 333), using DSM-IV diagnosis for depression as measured by the SCAN as 'gold standard'.
The eight-item GDS that resulted from stage 1 showed good internal consistency in both the Assess data set (alpha = 0.86) and the AGED dataset (alpha = 0.80). In the AGED dataset, high sensitivity rates of 96.3% for major depression and 83.0% for minor depression were found, with a specificity rate of 71.7% at a cut-off point of 2/3.
The GDS-8 has good psychometric properties. Given that the GDS-8 is less burdening for the patient, more comfortable to use and less time consuming, it may be a more feasible screening test for the frail nursing home population.
International Journal of Geriatric Psychiatry 09/2007; 22(9):837-42. DOI:10.1002/gps.1748 · 2.87 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The long-term outcome of major depression is often unfavorable, and because most cases of depression are managed by general practitioners (GPs), this places stress on the need to improve treatment in primary care. This study evaluated the long-term effects of enhancing the GP's usual care (UC) with three experimental interventions.
A randomized controlled trial was conducted from 1998 to 2003. The main inclusion criterion was receiving GP treatment for a depressive episode. We compared: (1) UC (n=72) with UC enhanced with: (2) a psycho-educational prevention (PEP) program (n=112); (3) psychiatrist-enhanced PEP (n=37); and (4) brief cognitive behavioral therapy followed by PEP (CBT-enhanced PEP) (n=44). We assessed depression status quarterly during a 3-year follow-up.
Pooled across groups, depressive disorder-free and symptom-free times during follow-up were 83% and 17% respectively. Almost 64% of the patients had a relapse or recurrence, the median time to recurrence was 96 weeks, and the mean Beck Depression Inventory (BDI) score over 12 follow-up assessments was 9.6. Unexpectedly, PEP patients had no better outcomes than UC patients. However, psychiatrist-enhanced PEP and CBT-enhanced PEP patients reported lower BDI severity during follow-up than UC patients [mean difference 2.07 (95% confidence interval (CI) 1.13-3.00) and 1.62 (95% CI 0.70-2.55) respectively] and PEP patients [2.37 (95% CI 1.35-3.39) and 1.93 (95% CI 0.92-2.94) respectively].
The PEP program had no extra benefit compared to UC and may even worsen outcome in severely depressed patients. Enhancing treatment of depression in primary care with psychiatric consultation or brief CBT seems to improve the long-term outcome, but findings need replication as the interventions were combined with the ineffective PEP program.
Psychological Medicine 07/2007; 37(6):849-62. DOI:10.1017/S0033291706009809 · 5.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study compares the skin reactions to the niacin flushing test of 16 schizophrenic patients with those of 17 depressed patients and 16 healthy controls. Methyl nicotinate (niacin) in a concentration of 0.1 M was applied to the forearm for 5 min. Significant differences could be observed between the group of schizophrenic patients (less flushing) in comparison to the other groups. There were no statistical differences in niacin flushing between patients with depression and healthy controls. Gender, age and the use of antipsychotic agents did not appear to be confounders. The differences in flushing within the group of schizophrenic patients were striking, however. Most patients showed little or no flushing, but some patients reacted strongly. Although the three groups could be differentiated by the niacin flushing test, to develop a reliable clinical application of this test, further research is necessary.
Psychiatry Research 09/2006; 143(2-3):303-6. DOI:10.1016/j.psychres.2005.10.010 · 2.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Depression is a highly prevalent, often recurring or persistent disorder. The majority of patients are initially seen and treated in primary care. Effective treatments are available, but possibilities for providing adequate follow-up care are often limited in this setting. This study assesses the effectiveness of primary-care-based enhanced treatment modalities on short-term patient outcomes.
In a randomized controlled trial we evaluated a psycho-educational self-management intervention. We included 267 adult patients meeting criteria for a DSM-IV diagnosis of major depressive disorder, assessed by a structured psychiatric interview. Patients were randomly assigned to: the Depression Recurrence Prevention (DRP) program (n=112); a combination of the DRP program with psychiatric consultation (PC+DRP, n=39); a combination with brief cognitive behavior therapy (CBT+DRP, n=44); and care as usual (CAU, n=72). Follow-up assessments were made at 3 months (response 90%) and 6 months (85%).
Patient acceptance of enhanced care was good. The mean duration of the index episode was 11 weeks (S.D.=9.78) and similar in CAU and enhanced care. Recovery rate after 6 months was 67% overall; 17% of all participants remained depressed for the entire 6-month period.
Enhanced care did not result in better short-term outcomes. We found no evidence that the DRP program was more effective than CAU and no indications for added beneficial effects of either the psychiatric evaluation or the CBT treatment to the basic format of the DRP program. Observed depression treatment rates in CAU were high.
Psychological Medicine 02/2006; 36(1):15-26. DOI:10.1017/S0033291705006318 · 5.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine the diagnostic accuracy of the 30-item and shortened versions of the Geriatric Depression Scale (GDS) in diagnosing depression in older nursing home patients.
Three hundred and thirty-three older nursing home patients participated in a prospective cross-sectional study in the Netherlands. Sensitivity and specificity, positive and negative predictive values, and the area under the receiver operating curve (ROC) were assessed. Cronbach alphas were also calculated. Both major depression (MDD) and minor depression (MinD) according to the DSM-IV criteria, measured with the Schedules of Clinical Assessment in Neuropsychiatry (SCAN), were used as 'gold standard'.
The cut-off point > or = 11 on the GDS-30 gave a sensitivity of 96.3% for MDD and 85.1% for MinD, with a specificity of 69.1%. The sensitivity of most of the shortened versions was sufficient, varying between 88.9% and 100% for MDD, and between 63.8% and 97.9% for MinD. With regard to the shortened versions, best sensitivity (96.3% and 78.7%) and specificity (69.5%) were found for the GDS-10 developed by D'Ath et al. (1994). The specificity rates for most of the shortened versions were found to be less satisfactory, varying between 18.9% and 74.1%. Sufficient internal consistency was found for the GDS-30, the GDS-15, the GDS-12 and the GDS-10, with Cronbach's alphas varying between 0.88 and 0.72.
The GDS-30 was found to be a valid and reliable case-finding tool for both major and minor depression in nursing home patients with no cognitive impairment and in patients with mild to moderate cognitively impairment (MMSE > or = 15). The GDS-10 (D'Ath et al., 1994) appeared to be the best least time-consuming alternative for the nursing home setting.
International Journal of Geriatric Psychiatry 11/2005; 20(11):1067-74. DOI:10.1002/gps.1398 · 2.87 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Many people with depression in residential care homes for the elderly do not receive treatment because their depression remains undetected.
To determine the effects of staff training on the detection, treatment and outcome of depression in residents of ten homes.
We conducted a randomised controlled trial in ten residential homes. The intervention consisted of a training programme for staff and collaborative evaluation by staff and a mental health specialist of residents with possible depression.
Recognition of depression increased more in homes where staff received the training than in the control homes. Treatment rates also increased compared with control homes, but the increase was not significant. Residents with depressive symptoms had a more favourable course when staff had received training. Moreover, the prevalence of depressive symptoms decreased, but the decrease was not significant.
Training of care staff results in the increased detection of depression in the elderly, a trend towards more treatment and better outcomes.
The British Journal of Psychiatry 06/2005; 186(5):404-9. DOI:10.1192/bjp.186.5.404 · 7.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: We describe the contents and feasibility of the Depression Recurrence Prevention (DRP)–Program, a structured psycho-educational self-management intervention based on an ongoing relationship between patient, prevention specialist and primary care physician. The DRP-Program consisted of three individual face-to-face sessions with a trained prevention specialist, followed by four telephone contacts per year.Methods: 267 primary care patients with a DSM-IV diagnosis of major depression were included and randomly assigned to care as usual (CAU; n = 72) or enhanced care (n = 195), which consisted of the DRP-Program either by itself or in combination with a psychiatric consultation or brief cognitive behavioral therapy.Results: DRP-program participation rates were high, both in the initial phase (92%) as during the first year of follow-up (95%) and patient evaluations were generally positive. Enhanced care patients were significantly more satisfied with effects of the depression care than CAU patients after three months. Perceived self-efficacy in dealing with depression was mostly similar in the four treatment groups. The use of antidepressants was lowest throughout the year in patients assigned to CBT plus DRP, who also kept less in touch with their PCP.Conclusion: The DRP-program proved to be feasible and appreciated.
Primary Care and Community Psychiatry 05/2005; 10(2):39-49. DOI:10.1185/135525705X40382 · 0.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Depression is a common and disabling psychiatric disorder in later life. Particular frail nursing home patients seem to be at increased risk. Nursing home-based studies on risk indicators of depression are scarce.
Prevalence and risk indicators of depression were assessed in 333 nursing home patients living on somatic wards of 14 nursing homes in the North West of the Netherlands. Depressive symptoms were measured by means of the Geriatric Depression Scale (GDS). Major and minor depression were diagnosed according to the DSM-IV criteria, sub-clinical depression was defined as a GDS score >10 while not meeting the DSM-V criteria for depression.
The prevalence of major depression was assessed to be 8.1% and the prevalence of minor depression was 14.1%, while a further 24% of the patients suffered from sub-clinical depression. For major depression significant risk indicators were found for pain, functional limitations, visual impairment, stroke, loneliness, lack of social support, negative life events and perceived inadequacy of care. For sub-clinical depression the same risk indicators were found, with the exception of lack of social support.
Data were collected cross-sectional.
The prevalence of depression in the nursing home population is very high. Whichever way defined, the prevalence rates found were three to four times higher than in the community-dwelling elderly. Age, pain, visual impairment, stroke, functional limitations, negative life events, loneliness, lack of social support and perceived inadequacy of care were found to be risk indicators for depression. Consequently, optimal physical treatment and special attention and focus on psychosocial factors must be major goals in developing care programs for this frail population.
[Show abstract][Hide abstract] ABSTRACT: To assess risk indicators of depressive symptoms in social and personal domains of residents of residential homes.
In a cross-sectional study risk indicators for depressive symptoms (Geriatric Depression Scale) were examined in bivariate and multivariate analyses, four hundred and seventy-nine elderly subjects from 11 residential homes took part in the study.
Functional impairment, loneliness, higher education levels, a family history of depression and neuroticism are associated with depressive symptom.
The risk indicators of depression found in residential homes are similar to those in the community.
International Journal of Geriatric Psychiatry 07/2004; 19(7):634-40. DOI:10.1002/gps.1137 · 2.87 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To compare sexual functioning in patients treated with quetiapine or risperidone.
This open-label study included patients with schizophrenia or a related psychotic illness who were randomized to quetiapine (200-1200 mg/d) or risperidone (1-6 mg/d) for 6 weeks. Sexual dysfunction was assessed by a semistructured interview, the Antipsychotics and Sexual Functioning Questionnaire (ASFQ), based upon the Utvalg for Kliniske Undersogelser (UKU).
Four of 25 quetiapine-treated patients (16%) and 12 of 24 risperidone-treated patients (50%) reported sexual dysfunction (chi 2 = 6.4; df = 1; P = 0.006) on the ASFQ. Six patients (11.7%; 4 on risperidone, 2 on quetiapine) spontaneously reported sexual dysfunction. The mean+/-SD dose was 580+/-224 mg/d for quetiapine and 3.2 +/- 1.3 mg/d for risperidone. Mean +/- SD prolactin levels in quetiapine- and risperidone-treated patients were 13.8 +/- 17.9 and 57.7 +/- 39.7 ng/mL, respectively.
Sexual dysfunction was less common in patients treated with quetiapine than with risperidone. Direct questioning about sexual functioning is necessary to avoid underestimating the frequency of sexual side effects in patients with schizophrenia and related psychotic disorders.
[Show abstract][Hide abstract] ABSTRACT: The literature is reviewed and preliminary results of new studies are presented showing that treatment with classical antipsychotics, as well as risperidone, induces sexual dysfunctions in 30-60% of the patients. These antipsychotics also frequently induce amenorrhoea and galactorrhoea. Although comparative studies are rare, it is likely that prolactin-sparing antipsychotics, as recently shown in a randomized trial of olanzapine versus risperidone, induce less sexual side effects.From these studies, it becomes apparent that prolactin elevation induced by classical antipsychotics and risperidone is probably a factor in inducing sexual dysfunctions, amenorrhoea and galactorrhoea. The role of other factors inducing sexual dysfunctions like sedation, proportional, variant -blockade, testosterone, dopamine, and serotonin is discussed. Finally, it is concluded that sexual and hormonal effects of antipsychotics, although clearly important, are often neglected in research as in clinical practice. Lowering the dosage or switching to a prolactin-sparing antipsychotic often reduces sexual side effects, amenorrhoea, and galactorrhoea.
[Show abstract][Hide abstract] ABSTRACT: Depression is a common disorder in later life. The prevalence of depression in aged nursing home patients in 36 studies in various countries was reviewed. Results show prevalence rates ranging from 2% to 61%. Average prevalences were calculated for depressive symptoms, minor depression and major depression each. The averages thus found are 43.9% for depressive symptoms, 25.7% for minor depression and 15.5% for major depression. In order to find an explanation for the variation in occurrence of depression in nursing homes, factors that may have influenced the results are described. Both the definition of depression and the kind of instrument used in measuring depression appear to be highly responsible for the variations found.
Tijdschrift voor gerontologie en geriatrie 05/2003; 34(2):52-9.
[Show abstract][Hide abstract] ABSTRACT: Cognitive dysfunction in schizophrenia has well-known functional consequences. The ability to learn (learning potential) may be an important mediator. This study examines the relationship between learning and functional status in schizophrenia patients before and after participation in a rehabilitation program. We reasoned that learning is a broad construct, encompassing controlled, effortful as well as automatic (learning by doing) mechanisms, called explicit and implicit learning, respectively. Both types of learning ability are important in daily life. The study included 44 medicated schizophrenia patients and 79 healthy controls. We included measures of implicit and explicit learning as well as measures of the cognitive domains for which significant relationships with functional outcome have been established: immediate and secondary verbal memory, card sorting and vigilance. Learning potential and the patient's 'learner status' were also assessed. The results show that learning, as assessed by measures of explicit and implicit learning and learning potential, was not associated with social functioning or rehabilitation outcome. The highest correlations between cognitive functioning and social functioning were found for more or less 'static' performance measures when they were assessed for a second time with or without instructions on how to do the test. Optimized cognitive performance (i.e. performance after instruction or training) seems to be a better predictor of complex domains of functioning than naive or everyday performance.
Schizophrenia Research 03/2003; 59(2-3):287-96. DOI:10.1016/S0920-9964(02)00163-9 · 3.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Day hospitals are a less restrictive alternative to inpatient admission for people who are acutely and severely mentally ill. This review compares acute day hospital care to inpatient care. It was found that at least one in five patients currently admitted to inpatient care could feasibly be cared for in an acute day hospital. The psychiatric symptoms of inpatients deemed suitable for acute day care appeared to improve more quickly than if the person had been cared for as an inpatient. Day hospital care was also less expensive than inpatient care.