Effectiveness of a clinical practice guideline implementation strategy for patients with anxiety disorders in primary care: cluster randomized trial

<p>Abstract</p> <p>Background</p> <p>Anxiety is a common mental health problem seen in primary care. However, its management in clinical practice varies greatly. Clinical practice guidelines (CPGs) have the potential to reduce variations and improve the care received by patients by promoting interventions of proven benefit. However, uptake and adherence to their recommendations can be low.</p> <p>Method/design</p> <p>This study involves a community based on cluster randomized trial in primary healthcare centres in the Madrid Region (Spain). The project aims to determine whether the use of implementation strategy (including training session, information, opinion leader, reminders, audit, and feed-back) of CPG for patients with anxiety disorders in primary care is more effective than usual diffusion.</p> <p>The number of patients required is 296 (148 in each arm), all older than 18 years and diagnosed with generalized anxiety disorder, panic disorder, and panic attacks by the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). They are chosen by consecutive sampling.</p> <p>The main outcome variable is the change in two or more points into Goldberg anxiety scale at six and twelve months. Secondary outcome variables include quality of life (EuroQol 5D), and degree of compliance with the CPG recommendations on treatment, information, and referrals to mental health services. Main effectiveness will be analyzed by comparing the patients percentage improvement on the Goldberg scale between the intervention group and the control group. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis.</p> <p>Discussion</p> <p>There is a need to identify effective implementation strategies for CPG for the management of anxiety disorders present in primary care. Ensuring the appropriate uptake of guideline recommendations can reduce clinical variation and improve the care patients receive.</p> <p>Trial registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN83365316">ISRCTN83365316</a></p

Psychometric Properties of the Spanish Short Depressive Rumination Scale in a Nonclinical Sample

Repetitive negative thinking (RNT) is considered a transdiagnostic variable underlying common symptoms (e.g., depressed mood) across various mood disorders. Depressive rumination is one typical and frequent manifestation of RNT and is a well-known vulnerability factor of depression onset, maintenance and recurrence. Due to the time-related constraints in assessment settings and the association of rumination on sadness with diagnosis of depression, the rapid identification of individuals scoring high on this construct may become a useful screening tool in non-clinical samples. The main aim of the present study was to test the psychometric properties of the Spanish version of the Short Depressive Rumination Scale (SDRS) in a large sample (N = 649). Confirmatory Factor Analysis supported a one-factor model accounting for 75% of variance with an excellent internal consistency (α = .93) in spite of the reduced number of items (4 items). Criterion validity results based on associations with other well-established rumination (sub)scales, age, scores in depression and gender differences, were congruent. The results suggest that the SDRS, the shortest existing scale assessing depressive rumination to our knowledge, can be a useful instrument for a rapid assessment of depressive rumination in community samples.status: Published onlin

Age and gender differences in emotion regulation strategies: autobiographical memory, rumination, problem solving and distraction

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.Our study tested the hypothesis that older adults and men use more adaptive emotion regulatory strategies but fewer negative emotion regulatory strategies than younger adults and women. In addition, we tested the hypothesis that rumination acts as a mediator variable for the effect of age and gender on depression scores. Differences in rumination, problem solving, distraction, autobiographical recall and depression were assessed in a group of young adults (18-29 years) compared to a group of older adults (50-76 years). The older group used more problem solving and distraction strategies when in a depressed state than their younger counterparts (ps .06). Ordinary least squares regression analyses with bootstrapping showed that rumination mediated the association between age, gender and depression scores. These results suggest that older adults and men select more adaptive strategies to regulate emotions than young adults and women with rumination acting as a significant mediator variable in the association between age, gender, and depression

Efficacy of memory training in healthy community-dwelling older people: study protocol for a randomized controlled trial

Background. There is limited evidence on the efficacy and social utility of cognitive training. To address this, we have designed a randomized controlled trial to assess the effectiveness of memory training workshops for healthy older people in terms of their short- and long-term impact on cognitive function, health-related quality of life, and functionality./nMethods/design. A randomized controlled trial will be performed in health care centers in Barcelona (Spain) through comparison of a group of individuals participating in memory training workshops (experimental group) with another group with similar characteristics not participating in the workshops (control group). The intervention will consist of twelve 90-minute group sessions imparted once a week by a psychologist specialized in memory training. The groups will each comprise approximately 15 people, for a total number of 230 patients involved in the study. Each session has its own objectives, materials and activities. The content of the intervention is based on memory training from different perspectives, including cognitive and emotional aspects and social and individual skills. Data will be collected at baseline, at 3–4 months and at 6 months. To assess the efficacy of the intervention on cognitive function, health-related quality of life and functionality, a statistical analysis will be performed by fitting a repeated-measures mixed effects model for each main outcome: Self-perceived memory, measured by a Subjective Self-reported Memory Score (from 0 to 10) and by the Memory Failures in Everyday life questionnaire (MFE); Everyday memory, measured using the Rivermead Behavioural Memory Test-3 (RBMT-3) and Executive control abilities, measured in terms of visual-perceptual ability, working memory and task-switching ability with the Trail Making Test (TMT) and with the digit span scale of the Wechsler Adult Intelligence Scale III (WAIS III)./nDiscussion. The results of this study will be highly useful for social and public health policies related to older people. Given the continuous increase in the prevalence of older people, a large number of interventions targeting memory loss are funded by public resources. To ensure transparency and effective prioritization, research such as the present study is needed to provide evidence of the effectiveness and usefulness of these interventions.This protocol was designed with financial assistance from the Ministry of Health of Spain, provided by the Carlos III Health Institute (PI11/02060). We would like to express our gratitude to Manel Nebot, who was the principal investigator of the protocol and who died during its development. Without his courage, experience and motivation, the project would have not been possible