2 research outputs found
Indicators of patients with major depressive disorder in need of highly specialized care: A systematic review
Objectives Early identification of patients with major depressive disorder (MDD) that cannot be managed by secondary mental health services and who require highly specialized mental healthcare could enhance need-based patient stratification. This, in turn, may reduce the number of treatment steps needed to achieve and sustain an adequate treatment response. The development of a valid tool to identify patients with MDD in need of highly specialized care is hampered by the lack of a comprehensive understanding of indicators that distinguish patients with and without a need for highly specialized MDD care. The aim of this study, therefore, was to systematically review studies on indicators of patients with MDD likely in need of highly specialized care. Methods A structured literature search was performed on the PubMed and PsycINFO databases following PRISMA guidelines. Two reviewers independently assessed study eligibility and determined the quality of the identified studies. Three reviewers independently executed data extraction by using a pre-piloted, standardized extraction form. The resulting indicators were grouped by topical similarity, creating a concise summary of the findings. Results The systematic search of all databases yielded a total of 7,360 references, of which sixteen were eligible for inclusion. The sixteen papers yielded a total of 48 unique indicators. Overall, a more pronounced depression severity, a younger age of onset, a history of prior poor treatment response, psychiatric comorbidity, somatic comorbidity, childhood trauma,psychosocial impairment, older age, and a socioeconomically disadvantaged status were found to be associated with proxies of need for highly specialized MDD care. Conclusions Several indicators ar
Cost-effectiveness of blended vs. face-to-face cognitive behavioural therapy for severe anxiety disorders: study protocol of a randomized controlled trial
Background: Anxiety disorders are among the most prevalent psychiatric conditions, and are associated with poor
quality of life and substantial economic burden. Cognitive behavioural therapy is an effective treatment to reduce
anxiety symptoms, but is also costly and labour intensive. Cost-effectiveness could possibly be improved by delivering
cognitive behavioural therapy in a blended format, where face-to-face sessions are partially replaced by online sessions.
The aim of this trial is to determine the cost-effectiveness of blended cognitive behavioural therapy for adults with
anxiety disorders, i.e. panic disorder, social phobia or generalized anxiety disorder, in specialized mental health care
settings compared to face-to-face cognitive behavioural therapy. In this paper, we present the study protocol. It is
hypothesized that blended cognitive behavioural therapy for anxiety disorders is clinically as effective as face-to-face
cognitive behavioural therapy, but that intervention costs may be reduced. We thus hypothesize that blended
cognitive behavioural therapy is more cost-effective than face-to-face cognitive behavioural therapy.
Methods/design: In a randomised controlled equivalence trial 156 patients will be included (n = 78 in blended
cognitive behavioural therapy, n = 78 in face-to-face cognitive behavioural therapy) based on a power of 0.80,
calculated by using a formula to estimate the power of a cost-effectiveness analysis:
Measurements will take place at baseline, midway treatment (7 weeks), immediately after treatment (15 weeks)
and 12-month follow-up. At baseline a diagnostic interview will be administered. Primary clinical outcomes
are changes in anxiety symptom severity as measured with the Beck Anxiety Inventory. An incremental cost-effectiveness
ratio will be calculated to obtain the costs per quality-adjusted life years (QALYs) measured by the
EQ-5D (5-level version). Health-economic outcomes will be explored from a societal and health care perspective.
Discussion: This trial will be one of the first to provide information on the cost-effectiveness of blended
cognitive behavioural therapy for anxiety disorders in routine specialized mental health care settings, both from
a societal and a health care perspective