Baseline predictors of treatment outcome in Internet-based alcohol interventions: a recursive partitioning analysis alongside a randomized trial

BACKGROUND: Internet-based interventions are seen as attractive for harmful users of alcohol and lead to desirable clinical outcomes. Some participants will however not achieve the desired results. In this study, harmful users of alcohol have been partitioned in subgroups with low, intermediate or high probability of positive treatment outcome, using recursive partitioning classification tree analysis. METHODS: Data were obtained from a randomized controlled trial assessing the effectiveness of two Internet-based alcohol interventions. The main outcome variable was treatment response, a dichotomous outcome measure for treatment success. Candidate predictors for the classification analysis were first selected using univariate regression. Next, a tree decision model to classify participants in categories with a low, medium and high probability of treatment response was constructed using recursive partitioning software. RESULTS: Based on literature review, 46 potentially relevant baseline predictors were identified. Five variables were selected using univariate regression as candidate predictors for the classification analysis. Two variables were found most relevant for classification and selected for the decision tree model: ‘living alone’, and ‘interpersonal sensitivity’. Using sensitivity analysis, the robustness of the decision tree model was supported. CONCLUSIONS: Harmful alcohol users in a shared living situation, with high interpersonal sensitivity, have a significantly higher probability of positive treatment outcome. The resulting decision tree model may be used as part of a decision support system but is on its own insufficient as a screening algorithm with satisfactory clinical utility. TRIAL REGISTRATION: Netherlands Trial Register (Cochrane Collaboration): NTR-TC1155

Interaction between the MTHFR C677T polymorphism and traumatic childhood events predicts depression

Childhood trauma is associated with the onset and recurrence of major depressive disorder (MDD). The thermolabile T variant of the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism (rs1801133) is associated with a limited (oxidative) stress defense. Therefore, C677T MTHFR could be a potential predictor for depressive symptomatology and MDD recurrence in the context of traumatic stress during early life. We investigated the interaction between the C677T MTHFR variant and exposure to traumatic childhood events (TCEs) on MDD recurrence during a 5.5-year follow-up in a discovery sample of 124 patients with recurrent MDD and, in an independent replication sample, on depressive syniptomatology in 665 healthy individuals from the general population. In the discovery sample, Cox regression analysis revealed a significant interaction between MTHFR genotype and TCEs on MOD recurrence (P = 0.017). Over the 5.5-year follow-up period, median time to recurrence was 191 days for T-allele carrying patients who experienced TCEs (T + and TCE +); 461 days for T - and TCE + patients; 773 days for T + and TCE - patients and 866 days for T - and TCE - patients. In the replication sample, a significant interaction was present between the MTHFR genotype and TCEs on depressive symptomatology (P = 0.002). Our results show that the effects of TCEs on the prospectively assessed recurrence of MOD and self-reported depressive symptoms in the general population depend on the MTHFR genotype. In conclusion, T-allele carriers may be at an increased risk for depressive symptoms or MOD recurrence after exposure to childhood trauma

The toll of stalking: the relationship between features of stalking and psychopathology of victims.

Information on the psychological consequences of stalking on victims is scarce. The present study aimed to investigate whether stalking victims have a heightened prevalence of psychopathology and the extent to which symptom levels are associated with stalking features. Stalking victims (N = 241) completed the General Health Questionnaire and provided information on specific features of their stalking experiences. High levels of psychopathology were found among stalking victims. Symptom levels were comparable with those of psychiatric outpatients. The frequency, pervasiveness, duration, and cessation of stalking were associated with symptom levels but explained only 9% of the variance of the level of distress. It is concluded that stalking victims generally have many symptoms of psychopathology. The symptoms are largely independent of features of their stalking experience. These findings indicate that better therapy outcomes can be expected from therapies focusing on boosting general coping skills and on decreasing general vulnerability than from therapies focusing on specifically dealing with the stalking situation

Effectevaluatie van de Strafrechtelijke Opvang Verslaafden (SOV)

The Rehabilitation of Drug-Addicted Offenders Act (SOV) was launched on 1 April 2001. This law permitted the compulsory placement of criminal addicts for up two years in government-designated secure and semi-secure facilities. The evaluation focusses on the main aims of SOV: 10 reduction of criminal recidivism, 2) reduction of addiction problems and 3) improvement of social functioning.De wet Strafrechtelijke Opvang Verslaafden (SOV) maakte het in 2001 mogelijk om de harde kern van criminele drugsverslaafden maximaal twee jaar gedwongen in een speciale opvanginrichting te plaatsen. Dit onderzoek laat zien welke personen de maatregel opgelegd hebben gekregen en gaat in op de vraag of de SOV leidt tot minder criminaliteit, minder verslaving en beter maatschappelijk functioneren dan 'gewone' gevangenisstraf. Ten slotte worden de uitkomsten vergeleken met die van de dranginterventies van de Forensische Verslavingskliniek en Triple-Ex. INHOUD: 1. Inleiding: drang en dwang bij justitiabele verslaafden 2. Onderzoeksopzet en onderzoeksvraag 3. Baseline kenmerken: profiel van de onderzoeksgroepen 4. Veranderingen bij de SOV'ers gedurende het SOV-traject 5. Het effect van de SOV 6. Voorspellers voor succes van dwang 7. De mening van de respondenten 8. Conclusi

Trajectories of peer nominated aggression: Risk status, predictors and outcomes

Developmental trajectories of peer-nominated aggression, risk factors at baseline, and outcomes were studied. Peer nominations of aggression were obtained annually from grades 1 to 3. Three developmental trajectories were identified: an early-onset/increasers trajectory with high levels of peer-nominated aggression at elementary school entry and increasing levels throughout follow-up; a moderate-persistent trajectory of aggression in which children were characterized by moderate levels of physical aggression at baseline; and a third trajectory with stable low levels of aggression. Children following the early-onset/increasers trajectory showed physical forms of aggression at baseline. Male gender and comorbid attention deficit/hyperactivity problems, oppositional defiant problems and poor prosocial behavior plus negative life events predicted which children would follow the early-onset/increasers trajectory of aggression. The outcomes associated with the early-onset/increaser children suggest high risk for chronically high levels of aggressive behavior. © 2005 Springer Science+Business Media, Inc

Cost-effectiveness of problem-solving treatment in comparison with usual care for primary care patients with menthal health problems: a randomized trial

BACKGROUND: Mental health problems are common and are associated with increased disability and health care costs. Problem-Solving Treatment (PST) delivered to these patients by nurses in primary care might be efficient. The aim of this study was to evaluate the cost-effectiveness of PST by mental health nurses compared with usual care (UC) by the general practitioner for primary care patients with mental health problems. METHODS: An economic evaluation from a societal perspective was performed alongside a randomized clinical trial. Patients with a positive General Health Questionnaire score (score ≥ 4) and who visited their general practitioner at least three times during the past 6 months were eligible. Outcome measures were improvement on the Hospital Anxiety and Depression Scale and QALYs based on the EQ-5D. Resource use was measured using a validated questionnaire. Missing cost and effect data were imputed using multiple imputation techniques. Bootstrapping was used to analyze costs and cost-effectiveness of PST compared with UC. RESULTS: There were no statistically significant differences in clinical outcomes at 9 months. Mean total costs were €4795 in the PST group and €6857 in the UC group. Costs were not statistically significantly different between the two groups (95% CI -4698;359). The cost-effectiveness analysis showed that PST was cost-effective in comparison with UC. Sensitivity analyses confirmed these findings. CONCLUSIONS: PST delivered by nurses seems cost-effective in comparison with UC. However, these results should be interpreted with caution, since the difference in total costs was mainly caused by 3 outliers with extremely high indirect costs in the UC group. TRIAL REGISTRATION: Nederlands Trial Register ISRCTN5102101