We aimed to estimate the prevalence of current depressive disorder in 27 European countries, and to explore differences in prevalence between European countries and by gender.
In this ...population-based study, we analysed data from respondents living in 27 European countries who were included in the second wave of the European Health Interview Survey, collected between 2013 and 2015. We assessed the prevalence of current depressive disorder using the eight-item Patient Health Questionnaire (PHQ-8), with depressive disorder defined as a PHQ-8 score of 10 or higher. Prevalence estimates and 95% CIs were calculated for all 27 countries overall and for each country individually. We assessed variation in prevalence (country vs the rest of Europe) using crude and adjusted prevalence ratios obtained from negative binomial regression models. We did all analyses for the total sample and stratified by gender.
Our analysis sample comprised 258 888 individuals, of whom 117 310 (weighted proportion 47·8%) were men and 141 578 (52·2%) were women. The overall prevalence of current depressive disorder was 6·38% (95% CI 6·24–6·52) with important variation across countries, ranging from 2·58% (2·14–3·02) in the Czech Republic to 10·33% (9·33–11·32) in Iceland. Prevalence was higher in women (7·74% 7·53–7·95) than in men (4·89% 4·71–5·08), with clear gender differences for all countries except Finland and Croatia. Compared with the other European countries in our sample, those with the highest adjusted prevalence ratios were Germany (1·80 1·71–1·89) and Luxembourg (1·50 1·35–1·66), and those with the lowest adjusted prevalence ratios were Slovakia (0·28 0·24–0·33) and the Czech Republic (0·32 0·27–0·38).
Depressive disorders, although common across Europe, vary substantially in prevalence between countries. These results could be a baseline for monitoring the prevalence of current depressive disorder both at a country level in Europe and for planning health-care resources and services.
UK Medical Research Council and CIBER Epidemiology and Public Health (CIBERESP).
Objective
Catatonic stupor has been linked to extreme fear. Whether the underlying phenomenology of every catatonic dimension is intense anxiety or fear remains unknown.
Methods
One hundred and six ...patients aged ≥64 years were assessed for catatonia and clinical variables during the first 24 hours of admission. Two‐sample t test were used to test for group differences. A principal component analysis was developed. Analysis of variance was performed to assess for differences in the diagnostic groups. Correlation coefficients were used to examine the association between catatonic dimensions and psychopathological variables.
Results
There were statistically significant differences between catatonic and non‐catatonic patients in the Hamilton and NPI scores. The three factor‐model accounted for 52.23% of the variance. Factor 1 loaded on items concerned with “excitement,” factor 2 on “inhibition” items, and factor 3 on “parakinetic” items. There was a significant effect for factor 1 (F 5.36 = 2.83, P = .02), and not significant for factor 2 and factor 3. Compared with patients with depression, patients with mania scored significantly higher on factor “excitement” (P < .05). Factor 2 showed a moderate correlation with Hamilton total score (r = .346, P = .031) and Hamilton psychic score (r = .380, P = .017).
Conclusions
Catatonic patients experienced more anxiety and hyperactivity. A three‐factor solution provided best fit for catatonic symptoms. Patients with mania scored highest on Excitement, patients with depression on Inhibition, and patients with schizophrenia on Parakinetic. The main finding in this study was a positive moderate correlation between the Hamilton psychic score and the Inhibition factor score, meaning that not every catatonic dimension is associated to intense anxiety.
Abstract Objective To estimate the prevalence of the most common mental disorders in primary care patients with chronic somatic diseases based on physicians' diagnoses and compared with healthy ...probands. Method A systematic sample of 7940 adult primary care patients was recruited by 1925 general practitioners (GPs) in a large cross-sectional national epidemiological study. The Primary Care Evaluation of Mental Disorders (PRIME-MD) was used as standardized instrument for the assessment of mental disorders. Medical diagnoses were provided by patient's GP. Results The prevalence rate of mental disorder was significantly higher in patients with chronic somatic diseases (56.8%) compared with physically healthy subjects (48.9%; OR: 1.37). Prevalence of depressive and anxiety disorders is higher among individuals with neurological, oncological or liver disease. The differences are significant in all comparisons, with the exception of anxiety disorders in patients with musculoskeletal disorders. There is an increase in prevalence rates of mental disorders according to the number of somatic diseases. Conclusions The study provides evidence of the comorbidity of common mental disorders and somatic diseases. We need a predominant focus on affective and anxiety disorders in primary care patients with chronic somatic diseases. Symptoms overlap makes it necessary to discriminate these differences more in detail in future studies.
Help4Mood is an interactive system with an embodied virtual agent (avatar) to assist in self-monitoring of patients receiving treatment for depression. Help4Mood supports self-report and biometric ...monitoring and includes elements of cognitive behavioural therapy. We aimed to evaluate system use and acceptability, to explore likely recruitment and retention rates in a clinical trial and to obtain an estimate of potential treatment response with a view to conducting a future randomised controlled trial (RCT).
We conducted a pilot RCT of Help4Mood in three centres, in Romania, Spain and Scotland, UK. Patients with diagnosed depression (major depressive disorder) and current mild/moderate depressive symptoms were randomised to use the system for four weeks in addition to treatment as usual (TAU) or to TAU alone.
Twenty-seven individuals were randomised and follow-up data were obtained from 21 participants (12/13 Help4Mood, 9/14 TAU). Half of participants randomised to Help4Mood used it regularly (more than 10 times); none used it every day. Acceptability varied between users. Some valued the emotional responsiveness of the system, while others found it too repetitive. Intention to treat analysis showed a small difference in change of Beck Depression Inventory II (BDI-2) scores (Help4Mood -5.7 points, TAU -4.2). Post-hoc on-treatment analysis suggested that participants who used Help4Mood regularly experienced a median change in BDI-2 of -8 points.
Help4Mood is acceptable to some patients receiving treatment for depression although none used it as regularly as intended. Changes in depression symptoms in individuals who used the system regularly reached potentially meaningful levels.
Background: Telephone assessment of depression for research purposes is increasingly being used. The Patient Health Questionnaire 9‐item depression module (PHQ‐9) is a well‐validated, brief, ...self‐reported, diagnostic, and severity measure of depression designed for use in primary care (PC). To our knowledge, there are no available data regarding its validity when administered over the telephone.
Objective: The aims of the present study were to evaluate agreement between self‐administered and telephone‐administered PHQ‐9, to investigate possible systematic bias, and to evaluate the internal consistency of the telephone‐administered PHQ‐9.
Methods: Three hundred and forty‐six participants from two PC centers were assessed twice with the PHQ‐9. Participants were divided into 4 groups according to administration procedure order and administration procedure of the PHQ‐9: Self‐administered/Telephone‐administered; Telephone‐administered/Self‐administered; Telephone‐administered/Telephone‐administered; and Self‐administered/Self‐administered. The first 2 groups served for analyzing the procedural validity of telephone‐administered PHQ‐9. The last 2 allowed a test–retest reliability analysis of both self‐ and telephone‐administered PHQ‐9. Intraclass correlation coefficient (ICC) and weighted κ (for each item) were calculated as measures of concordance. Additionally, Pearson's correlation coefficient, Student's t‐test, and Cronbach's α were analyzed.
Results: Intraclass correlation coefficient and weighted κ between both administration procedures were excellent, revealing a strong concordance between telephone‐ and self‐administered PHQ‐9. A small and clinically nonsignificant tendency was observed toward lower scores for the telephone‐administered PHQ‐9. The internal consistency of the telephone‐administered PHQ‐9 was high and close to the self‐administered one.
Conclusions: Telephone and in‐person assessments by means of the PHQ‐9 yield similar results. Thus, telephone administration of the PHQ‐9 seems to be a reliable procedure for assessing depression in PC.
Aims
This study aimed to assess the frequency of dosing inconsistencies in prescription data and the effect of four dosing assumption strategies on adherence estimates for antipsychotic treatment.
...Methods
A retrospective cohort, which linked prescription and dispensing data of adult patients with ≥1 antipsychotic prescription between 2015‐2016 and followed up until 2019, in Catalonia (Spain). Four strategies were proposed for selecting the recommended dosing in overlapping prescription periods for the same patient and antipsychotic drug: (i) the minimum dosing prescribed; (ii) the dose corresponding to the latest prescription issued; (iii) the highest dosing prescribed; and (iv) all doses included in the overlapped period. For each strategy, one treatment episode per patient was selected, and the Continuous Medication Availability measure was used to assess adherence. Descriptive statistics were used to describe results by strategy.
Results
Of the 277 324 prescriptions included, 76% overlapped with other prescriptions (40% with different recommended dosing instructions). The number and characteristics of patients and treatment episodes (18 292, 18 303, 18 339 and 18 536, respectively per strategy) were similar across strategies. Mean adherence was similar between strategies, ranging from 57 to 60%. However, the proportion of patients with adherence ≥90% was lower when selecting all doses (28%) compared with the other strategies (35%).
Conclusion
Despite the high prevalence of overlapping prescriptions, the strategies proposed did not show a major effect on the adherence estimates for antipsychotic treatment. Taking into consideration the particularities of antipsychotic prescription practices, selecting the highest dose in the overlapped period seemed to provide a more accurate adherence estimate.
We explore, from the perspective of primary care health professionals, the motivations that lead patients to not initiate prescribed treatments, by developing a qualitative study in Spanish primary ...care. Six focus groups (N = 46) were conducted with general practitioners, nurse practitioners, social workers and community pharmacists and carried out in primary care (PC) of Barcelona Province, from April to July of 2018. The 46 participants were identified by three general practitioners and two pharmacists. In the interviews, the reasons for non‐initiation of PC patients' medication were explored. Triangulated content analysis was performed. Patients' perspective, analysed in a previous study, and professionals' perspective agree on most of the factors that affect non‐initiation. New factors were categorized into existent categories, confirming, and supplementing the model developed with patients. Health professionals identified some new factors which were not present in the patients' discourse, such as stigma related to the drug, hidden reasons for consultation, the role of nurses in prescription and support, the role of the pharmacy technician, illiteracy and lack of social support. The professionals confirm and expand on the Theoretical Model of Medication Non‐Initiation. Primary care professionals should consider the factors described when prescribing a new medication. Knowledge contributed by the model should guide the design of interventions to improve initiation.
Aims
Adherence to medicines is vital in treating diseases. Initial medication non‐adherence (IMNA) – defined as not obtaining a medication the first time it is prescribed – has been poorly explored. ...Previous studies show IMNA rates between 6 and 28% in primary care (PC). The aims of this study were to determine prevalence and predictive factors of IMNA in the most prescribed and expensive pharmacotherapeutic groups in the Catalan health system.
Methods
This is a retrospective, register‐based cohort study which linked the Catalan PC System (Spain) prescription and invoicing databases. Medication was considered non‐initiated when it was not collected from the pharmacy by the end of the month following the one in which it was prescribed. IMNA prevalence was calculated using July 2013–June 2014 prescription data. Predictive factors related to patients, general practitioners and PC centres were identified through multilevel logistic regression analyses. Missing data were attributed using simple imputation.
Results
Some 1.6 million patients with 2.9 million prescriptions were included in the study sample. Total IMNA prevalence was 17.6% of prescriptions. The highest IMNA rate was observed in anilides (22.6%) and the lowest in angiotensin‐converting‐enzyme (ACE) inhibitors (7.4%). Predictors of IMNA are younger age, American nationality, having a pain‐related or mental disorder and being treated by a substitute/resident general practitioner in a resident‐training centre.
Conclusions
The rate of IMNA is high when all medications are taken into account. Attempts to strengthen trust in resident general practitioners and improve motivation to initiate a needed medication in the general young and older immigrant population should be addressed in Catalan PC.
Non-adherence to antidepressants generates higher costs for the treatment of depression. Little is known about the cost-effectiveness of pharmacist's interventions aimed at improving adherence to ...antidepressants. The study aimed to evaluate the cost-effectiveness of a community pharmacist intervention in comparison with usual care in depressed patients initiating treatment with antidepressants in primary care.
Patients were recruited by general practitioners and randomized to community pharmacist intervention (87) that received an educational intervention and usual care (92). Adherence to antidepressants, clinical symptoms, Quality-Adjusted Life-Years (QALYs), use of healthcare services and productivity losses were measured at baseline, 3 and 6 months.
There were no significant differences between groups in costs or effects. From a societal perspective, the incremental cost-effectiveness ratio (ICER) for the community pharmacist intervention compared with usual care was €1,866 for extra adherent patient and €9,872 per extra QALY. In terms of remission of depressive symptoms, the usual care dominated the community pharmacist intervention. If willingness to pay (WTP) is €30,000 per extra adherent patient, remission of symptoms or QALYs, the probability of the community pharmacist intervention being cost-effective was 0.71, 0.46 and 0.75, respectively (societal perspective). From a healthcare perspective, the probability of the community pharmacist intervention being cost-effective in terms of adherence, QALYs and remission was of 0.71, 0.76 and 0.46, respectively, if WTP is €30,000.
A brief community pharmacist intervention addressed to depressed patients initiating antidepressant treatment showed a probability of being cost-effective of 0.71 and 0.75 in terms of improvement of adherence and QALYs, respectively, when compared to usual care. Regular implementation of the community pharmacist intervention is not recommended.
ClinicalTrials.gov NCT00794196.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objective
The present study attempted to fill a research gap by performing the first dimensionality analysis of the Revised Fibromyalgia Impact Questionnaire (FIQR) using exploratory and confirmatory ...techniques. A second objective was to report on the reliability and construct validity of the FIQR in Spanish patients.
Methods
FIQR data from a sample of adult fibromyalgia patients (n = 113) were analyzed using principal components analysis (PCA). Subsequently, a set of confirmatory factor analyses (CFAs) was conducted in another sample (n = 179) to analyze the goodness of fit of various factor models. FIQR reliability was assessed by computing Cronbach's alpha and coefficient H. Construct validity was evaluated by comparing the FIQR scores of participants categorized by employment status.
Results
According to the PCA, the FIQR structure might be described as having 1 global factor of functional impairment. Although subsequent CFAs confirmed that 1 factor accounted for the greatest proportion of common variance in the FIQR items, a confirmatory bifactor analysis indicated that the items were multidimensional because of their simultaneous significant loading on specific factors. The Cronbach's alpha values of the FIQR domains were very good (>0.80) and the H estimate for the FIQR total score was excellent (0.93). Overall, the FIQR domains were able to distinguish between patients differing in employment status (working outside the home versus on sick leave).
Conclusion
Our results indicate that the Spanish version of the FIQR has a complex factor structure, has excellent reliability, and shows good construct validity.
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