Secondary traumatization in partners and parents of Dutch peacekeeping soldiers.

This study examines secondary traumatization among 708 partners and 332 parents of Dutch peacekeepers (i.e., personnel who participated in military actions implemented by international organizations such as the United Nations). Partners or parents of peacekeepers with 4 levels of posttraumatic stress symptoms were compared on posttraumatic stress, health problems, the quality of the marital relationship, and social support. In comparison with partners of peacekeepers without posttraumatic stress disorder (PTSD) symptoms, partners of peacekeepers with PTSD symptoms reported more sleeping and somatic problems, reported more negative social support, and judged the marital relationship as less favorable. No significant differences were found for parents. Thus, peacekeepers' stress reactions were related to various problems of their partners. A systemic approach to the treatment of persons with PTSD appears appropriate

Clinical effectiveness of usual care with or without antidepressant medication for primary care patients with minor or mild-major depression: a randomized equivalence trial

<p>Abstract</p> <p>Background</p> <p>Minor and mild-major depression are highly prevalent in primary care. There is insufficient evidence for the effectiveness of antidepressants in the treatment of minor and mild-major depression. We compared the effectiveness of usual primary care treatment, with or without antidepressants, in minor and mild-major depression.</p> <p>Methods</p> <p>A pragmatic patient-randomized equivalence trial with 52 weeks follow-up was conducted in The Netherlands. In total, 59 primary care physicians (PCPs) recruited and treated 181 adult patients with minor or mild-major depression. Patients were randomized to four consultations within 3 months of usual care plus antidepressants (UCandAD) or usual care alone (UCnoAD). The Montgomery Åsberg Depression Rating Scale (MADRS) was used to assess changes in severity of depressive symptoms. The predefined equivalence margin was set at five points. Multilevel analysis was used to analyze the data. Secondary outcome measures were the Short-Form 36 (SF-36), and the Client Satisfaction Questionnaire (CSQ-8).</p> <p>Results</p> <p>Patients received on average 3.0 (SD 1.4) 15-min consultations within 3 months with (n = 85) or without paroxetine (n = 96). Equivalence of UCandAD and UCnoAD was demonstrated in the intention-to-treat analyses as well as the per-protocol analysis after 6 weeks, but not at 13, 26 and 52 weeks follow-up. No statistical differences in effectiveness between treatment groups were found in the intention-to-treat analysis. No differences in the physical and mental functioning (SF-36) were found between the treatment groups. Patients allocated to UCandAD were slightly more satisfied with their treatment at 13 weeks follow-up (but not at 52 weeks follow-up) than patients allocated to UCnoAD. Preliminary analyses suggested that subgroups such as patients with mild-major (instead of a minor) depression might benefit from antidepressant treatment. Patients who were assigned to their preferred treatment (in particular to UCnoAD) were more often compliant and had better clinical outcomes.</p> <p>Conclusion</p> <p>UCandAD was as effective as UCnoAD over the first 6 weeks, but not at 13, 26, and 52 weeks. However, superiority of either treatment could not be demonstrated either. The question whether antidepressants add any clinical effect to usual care remains unresolved. We recommend future studies to look for subgroups of patients who may benefit from antidepressants.</p> <p>Trial registration</p> <p>Dutch Trial Registry ISRCN03007807.</p

The Four-Dimensional Symptom Questionnaire (4DSQ): a validation study of a multidimensional self-report questionnaire to assess distress, depression, anxiety and somatization

BACKGROUND: The Four-Dimensional Symptom Questionnaire (4DSQ) is a self-report questionnaire that has been developed in primary care to distinguish non-specific general distress from depression, anxiety and somatization. The purpose of this paper is to evaluate its criterion and construct validity. METHODS: Data from 10 different primary care studies have been used. Criterion validity was assessed by comparing the 4DSQ scores with clinical diagnoses, the GPs' diagnosis of any psychosocial problem for Distress, standardised psychiatric diagnoses for Depression and Anxiety, and GPs' suspicion of somatization for Somatization. ROC analyses and logistic regression analyses were used to examine the associations. Construct validity was evaluated by investigating the inter-correlations between the scales, the factorial structure, the associations with other symptom questionnaires, and the associations with stress, personality and social functioning. The factorial structure of the 4DSQ was assessed through confirmatory factor analysis (CFA). The associations with other questionnaires were assessed with Pearson correlations and regression analyses. RESULTS: Regarding criterion validity, the Distress scale was associated with any psychosocial diagnosis (area under the ROC curve [AUC] 0.79), the Depression scale was associated with major depression (AUC = 0.83), the Anxiety scale was associated with anxiety disorder (AUC = 0.66), and the Somatization scale was associated with the GPs' suspicion of somatization (AUC = 0.65). Regarding the construct validity, the 4DSQ scales appeared to have considerable inter-correlations (r = 0.35-0.71). However, 30–40% of the variance of each scale was unique for that scale. CFA confirmed the 4-factor structure with a comparative fit index (CFI) of 0.92. The 4DSQ scales correlated with most other questionnaires measuring corresponding constructs. However, the 4DSQ Distress scale appeared to correlate with some other depression scales more than the 4DSQ Depression scale. Measures of stress (i.e. life events, psychosocial problems, and work stress) were mainly associated with Distress, while Distress, in turn, was mainly associated with psychosocial dysfunctioning, including sick leave. CONCLUSION: The 4DSQ seems to be a valid self-report questionnaire to measure distress, depression, anxiety and somatization in primary care patients. The 4DSQ Distress scale appears to measure the most general, most common, expression of psychological problems

Collaborative stepped care for anxiety disorders in primary care: aims and design of a randomized controlled trial

Background. Panic disorder (PD) and generalized anxiety disorder (GAD) are two of the most disabling and costly anxiety disorders seen in primary care. However, treatment quality of these disorders in primary care generally falls beneath the standard of international guidelines. Collaborative stepped care is recommended for improving treatment of anxiety disorders, but cost-effectiveness of such an intervention has not yet been assessed in primary care. This article describes the aims and design of a study that is currently underway. The aim of this study is to evaluate effects and costs of a collaborative stepped care approach in the primary care setting for patients with PD and GAD compared with care as usual. Methods/design. The study is a two armed, cluster randomized controlled trial. Care managers and their primary care practices will be randomized to deliver either collaborative stepped care (CSC) or care as usual (CAU). In the CSC group a general practitioner, care manager and psychiatrist work together in a collaborative care framework. Stepped care is provided in three steps: 1) guided self-help, 2) cognitive behavioral therapy and 3) antidepressant medication. Primary care patients with a DSM-IV diagnosis of PD and/or GAD will be included. 134 completers are needed to attain sufficient power to show a clinically significant effect of 1/2 SD on the primary outcome measure, the Beck Anxiety Inventory (BAI). Data on anxiety symptoms, mental and physical health, quality of life, health resource use and productivity will be collected at baseline and after three, six, nine and twelve months. Discussion. It is hypothesized that the collaborative stepped care intervention will be more cost-effective than care as usual. The pragmatic design of this study will enable the researchers to evaluate what is possible in real clinical practice, rather than under ideal circumstances. Many requirements for a high quality trial are being met. Results of this study will contribute to treatment options for GAD and PD in the primary care setting. Results will become available in 2011. Trial registration. NTR1071

Emergent Literacy: Preschool Teachers’ Beliefs and Practices

https://stars.library.ucf.edu/cfm-ch-register-vol11/1076/thumbnail.jp

Monitoring of psychological well-being in outpatients with diabetes: Effects on mood, HbA1c, and the patient's evaluation of the quality of diabetes care: A randomized controlled trial

OBJECTIVE - To investigate whether monitoring and discussing psychological well-being in outpatients with diabetes improves mood, glycemic control, and the patient's evaluation of the quality of diabetes care. RESEARCH DESIGN AND METHODS - This study was a randomized controlled trial of 461 outpatients with diabetes who were randomly assigned to standard care or to the monitoring condition. In the latter group, the diabetes nurse specialist assessed and discussed psychological well-being with the patient (with an interval of 6 months) in addition to standard care. The computerized Well-being Questionnaire was used for this purpose. Primary outcomes were mood, HbA1c, and the patient's evaluation of the quality of diabetes care at 1-year follow-up. The number of referrals to the psychologist was analyzed as a secondary outcome. Intention-to-treat analysis was used. RESULTS - The monitoring group reported better mood compared with the standard care group, as indicated by significantly lower negative well-being and significantly higher levels of energy, higher general well-being, better mental health, and a more positive evaluation of the quality of the emotional support received from the diabetes nurse. The two groups did not differ for HbA1c or in their overall evaluation of the quality of diabetes care. In the monitoring condition, significantly more subjects were referred to the psychologist. CONCLUSIONS - Monitoring and discussing psychological well-being as part of routine diabetes outpatient care had favorable effects on the mood of patients but did not affect their HbA1c. Our results support the recommendation to monitor psychological well-being in patients with diabetes

Test-characteristics of the GDS-15 in screening for major depression in elderly patients in general practice

The aim of this study was to assess whether a cut-off of five on the 15-item version of the Geriatric Depression Scale (GDS) that was determined beforehand yielded the best sensitivity and specificity for the diagnosis of major depression in the elderly in primary care. A sample of 330 patients was drawn from a group of elderly patients (≥ 55 years) that participated in a clinical trial, the West-Friesland Study (WFS). The mood-module of the PRIMary care Evaluation of Mental Disorder (PRIME-MD) served as the external criterion for major depression. The results showed that using a ROC-curve the best cut-off score of the GDS-15 was five. This cut-off score gave a sensitivity of 0.79 and a specificity of 0.67 and a negative predictive value of 0.94. It is concluded that the validation in retrospect of the a priori chosen cut-off score of five in a sample of the study population supports our a priori choice

Serial isotropic three-dimensional fast FLAIR imaging: Using image registration and subtraction to reveal active multiple sclerosis lesions

OBJECTIVE. Image registration and subtraction to detect the change of disease burden in multiple sclerosis on serial MR images should benefit from the use of high-resolution isotropic voxels. We compared 1.2-mm isotropic three-dimensional (3D) fast fluid-attenuated inversion recovery (FLAIR) images with standard 3-mm two-dimensional spin-echo images for the detection of new or enlarging lesions in longitudinal studies. SUBJECTS AND METHODS. Serial MR images were obtained at baseline, month 6 (n = 20), and month 7 (n = 16). For the half-yearly intervals, subtracted 3D FLAIR images and T2-weighted spin-echo images were compared. For the monthly intervals, subtracted 3D FLAIR images were compared with triple-dose contrast-enhanced T1-weighted spin-echo images. New, enlarging, and enhancing lesions were marked in consensus by two radiologists. RESULTS. At the half-yearly intervals, 3D FLAIR imaging detected more new or enlarging lesions than T2-weighted spin-echo imaging, both at the initial interpretation (80 vs 52; p 0.05). CONCLUSION. Isotropic 3D FLAIR imaging holds great promise for the detection of new or enlarging lesions in multiple sclerosis using registration and subtraction techniques certainly at longer intervals