Behavioural activation by mental health nurses for late-life depression in primary care: a randomized controlled trial

Background: Depressive symptoms are common in older adults. The effectiveness of pharmacological treatments and the availability of psychological treatments in primary care are limited. A behavioural approach to depression treatment might be beneficial to many older adults but such care is still largely unavailable. Behavioural Activation (BA) protocols are less complicated and more easy to train than other psychological therapies, making them very suitable for delivery by less specialised therapists. The recent introduction of the mental health nurse in primary care centres in the Netherlands has created major opportunities for improving the accessibility of psychological treatments for late-life depression in primary care. BA may thus address the needs of older patients while improving treatment outcome and lowering costs.The primary objective of this study is to compare the effectiveness and cost-effectiveness of BA in comparison with treatment as usual (TAU) for late-life depression in Dutch primary care. A secondary goal is to explore several potential mechanisms of change, as well as predictors and moderators of treatment outcome of BA for late-life depression. Methods/design: Cluster-randomised controlled multicentre trial with two parallel groups: a) behavioural activation, and b) treatment as usual, conducted in primary care centres with a follow-up of 52 weeks. The main inclusion criterion is a PHQ-9 score > 9. Patients are excluded from the trial in case of severe mental illness that requires specialized treatment, high suicide risk, drug and/or alcohol abuse, prior psychotherapy, change in dosage or type of prescribed antidepressants in the previous 12 weeks, or moderate to severe cognitive impairment. The intervention consists of 8 weekly 30-min BA sessions delivered by a trained mental health nurse. Discussion: We expect BA to be an effective and cost-effective treatment for late-life depression compared to TAU. BA delivered by mental health nurses could increase the availability and accessibility of non-pharmacological treatments for late-life depression in primary care. Trial registration: This study is retrospectively registered in the Dutch Clinical Trial Register NTR6013on August 25th 2016. © 2017 The Author(s)

Appunti di agricoltura benadiriana. Relazione del Dottore Romolo Onor

Relazione del dott. Romolo Onor sull'agricoltura nel Benadir.Warbixintii Dr. Romolo Onor oo ku saabsan beerqodaalka iyo Banaadir.Dr. Romolo Onor's report on agriculture in Benadir

Major depressive disorder in late life: a multifocus perspective on care needs

Background: The effectiveness of late-life depression treatment can be improved by tailoring interventions to patients' needs. Unmet needs perceived by patients suffering from a severe mental illness, e.g. depression, may have a negative impact on their recovery. Aim: The aim of this study is to gain insight into the needs of outpatients with late-life depression. Method: Ninety-nine outpatients (aged 58-92) receiving treatment for major depressive disorder were recruited from six specialized mental health care facilities in the Netherlands. They were interviewed using the Dutch version of the Camberwell Assessment of Needs for the Elderly (CANE-NL) to identify met and unmet needs. The Montgomery-Äsberg Depression Rating Scale was administered to measure depression severity. Results: Depression severity levels varied from remission (23%), mild (31%), moderate (31%) to severe depression (15%). The average number of needs reported was 8.86, comprising 6.5 met needs and 2.3 unmet needs. Most of the unique variance in depression severity was explained by psychological unmet needs, more in particular by needs representing psychological distress. The environmental, social or physical unmet needs, respectively, showed less or no meaningful predictive value for variance in depression severity. Conclusion: The psychological needs category of the CANE appeared to be the strongest predictor of depression severity. Systematic needs assessment may be considered as a necessary complement to medical examination and a prerequisite for the development of tailored treatment plans for older people with depression. © 2010 Taylor & Francis

Late-life depression: systematic assessment of care needs as a basis for treatment

Research shows that most of the variance in depression severity levels in late life can be explained by the unmet psychological needs of patients, more in particular the care needs of patients related with psychological distress. This case report describes the treatment of an 84-year-old patient suffering from depression. Her complaints faded upon the use of nursing interventions that were defined on the basis of a systematic assessment of her care needs with the Camberwell Assessment of Needs for the Elderly. The methodical attention to her needs for care and the interventions carried out led to the patient feeling acknowledged and to a diminished need for care and a better quality of life. Although there is no scientific evidence to date, a systematic assessment of care needs may well be a meaningful addition to the nursing diagnostic process. Moreover, alleviating distress in patients by fulfilling unmet care needs through tailored interventions can be seen as an essential element of an effective multidisciplinary depression treatment process. © 2011 Blackwell Publishing

Unmet care needs, care provision and patient satisfaction in patients with a late life depression: a cross-sectional study

BACKGROUND: Research has shown that some 30% of total care needs in people with late-life depression (LLD) are unmet. It is not known to what extent patients actually don't receive any care for these needs or consider the care to be insufficient and their satisfaction with the provided care. AIM: The aim of this study is to obtain insight into the care provided in relation to the reported unmet care needs and satisfaction with the total care provided is examined. METHOD: A cross-sectional study of 99 people with LLD in an ambulatory setting. RESULTS: In 67% of patients, at least one unmet need was ascertained. In most cases (80%) care was actually provided for those needs by professionals and/or informal caregivers. Patients were satisfied with the care delivered for 81% of the reported care needs. Satisfaction was lowest for social care needs (67%). For six specific care needs it was demonstrated that dissatisfied patients were significantly more depressed than satisfied patients. CONCLUSION: Even though patients might receive care for certain needs, this does not mean that their needs are met. A substantial proportion of patients with LDD feel that they need additional help for unmet needs. KEYWORDS: Depression; late life; satisfaction; unmet need

The impact of an unfavorable depression course on network size and loneliness in older people: A longitudinal study in the community

Objective: This work aims to gain insight into the long-term impact of depression course on social network size and perceived loneliness in older people living in the community

Good clinical practice en medisch-ethische toetsing: handvatten voor (beginnend) onderzoekers in de GGZ

In de geestelijke gezondheidszorg wordt in toenemende mate wetenschappelijk onderzoek gedaan, vooral in het kader van opleidingen. Er is onbekendheid met de regelgeving en ethiek bij beginnend onderzoekers. Zorgvuldige overwegingen - conform de richtlijnen voor good clinical practice (gcp) en medisch-ethische toetsing, worden daardoor lang niet altijd gemaakt. DOEL Beschrijven van praktische handvatten en stimuleren van het medisch-ethische denken bij patiëntgebonden onderzoek in de geestelijke gezondheidszorg. METHODE In dit artikel wordt een op de praktijkbehoefte gebaseerd overzicht van praktische handvatten en ethische overwegingen gegeven. RESULTATEN Dit artikel benadrukt dat onderzoekers reeds vóór de start van het onderzoek belangrijke afwegingen dienen te maken. Instructies daarvoor en richtlijnen voor medisch-ethische toetsing zijn te vinden in: het richtsnoer voor good clinical practice, het stroomschema van de Centrale Commissie Mensgebonden Onderzoek (ccmo) met de bijbehorende e-learningmodule en in de basiscursus ‘Regelgeving en organisatie voor klinisch onderzoekers’(brok). Praktische tips, geïllustreerd met voorbeelden, schetsen een kader om het medisch-ethisch denken te stimuleren. Tot slot is het van belang om de organisatorische inbedding van onderzoek in het kader van opleidingen te verbeteren. CONCLUSIE Basisinformatie over gcp en medisch-ethische toetsing bij patiëntgebonden onderzoek is via diverse kanalen beschikbaar. De uitdaging zit vooral in de inbedding van gcp in patiëntgebonden onderzoek door beginnend onderzoekers in de ggz

Unmet needs of outpatients with late-life depression; a comparison of patient, staff and carer perceptions

AbstractBackgroundThere is evidence that late life depression is associated with high levels of unmet needs. Only a minority of the depressed patients appears to be adequately treated.MethodsNinety-nine older patients (58–92years), 96 informal carers and 85 health-care professionals were recruited from six outpatient facilities for old age psychiatry in the Netherlands and interviewed to identify met and unmet needs, using the Camberwell Assessment of Needs for the Elderly (CANE). The severity of depression was measured with the Montgomery Åsberg Depression Rating Scale (MADRS).ResultsOn average patients scored more unmet needs than staff and carers. On item level, patients and staff showed the highest agreement in the psychological needs category. Patient and carers showed the highest agreement on physical health needs. Logistic regression showed that severe depression is a significant predictor of low concordance between stakeholders on a substantial number of CANE items.LimitationsKappa coefficients were computed to determine agreement between parties involved. However, Kappa coefficients should be interpreted with caution, especially when obvious disparity in unmet needs scores between groups of interest can be observed.ConclusionHome dwelling older patients with major depressive disorder, their practitioners and their informal carers have different perceptions of the older patients unmet needs.Practitioners should be aware of the negative impact of depression severity on reaching agreement regarding unmet needs and its possible consequences for mutual goal setting and compliance