The care of patients with subthreshold depression in primary care: Is it all that bad? A qualitative study on the views of general practitioners and patients

Contains fulltext : 53656.pdf ( ) (Open Access)BACKGROUND: Studies show that subthreshold depression is highly prevalent in primary care, has impact on the quality of life and causes immense health care costs. Although this points to the clinical relevance of subthreshold depression, contradictory results exist regarding the often self-remitting course of this state. However, first steps towards quality improvement in the care of subthreshold depressive patients are being undertaken. This makes it important to gather information from both a GPs' and a patients' point of view concerning the clinical relevance as well as the status quo of diagnosis and treatment in order to appraise the need for quality improvement research. METHOD: We conducted qualitative, semi-structured interviews for the questioning of 20 GPs and 20 patients with subthreshold depression on aspects of clinical relevance and on the status quo of diagnosis and treatment. Interviews were transcribed and analyzed on a content analytical theoretical background using Atlas.ti software. RESULTS: Most of the GPs found subthreshold depression to be clinically significant. Although some problems in diagnosis and treatment were mentioned, the GPs had sensible diagnostic and treatment strategies at hand which resulted from the long and trustful relationship with the patients and which corresponded to the patients' expectations. The patients rather expected their GP to listen to them than to take specific actions towards symptom relief and, in the main, were satisfied with the GPs' care. CONCLUSION: The study shows that subthreshold depression is a clinically relevant issue for GPs but raises the possibility that quality improvement might not be as necessary as past studies showed. Further quantitative research using larger random samples is needed to determine the effectiveness of the strategies used by the GPs, patients' satisfaction with these strategies and the course of these patients' symptoms in primary care

Development of an Emotion-Sensitive mHealth Approach for Mood-State Recognition in Bipolar Disorder

Internet- and mobile-based approaches have become increasingly significant to psychological research in the field of bipolar disorders. While research suggests that emotional aspects of bipolar disorders are substantially related to the social and global functioning or the suicidality of patients, these aspects have so far not sufficiently been considered within the context of mobile-based disease management approaches. As a multiprofessional research team, we have developed a new and emotion-sensitive assistance system, which we have adapted to the needs of patients with bipolar disorder. Next to the analysis of self-assessments, third-party assessments, and sensor data, the new assistance system analyzes audio and video data of these patients regarding their emotional content or the presence of emotional cues. In this viewpoint, we describe the theoretical and technological basis of our emotion-sensitive approach and do not present empirical data or a proof of concept. To our knowledge, the new assistance system incorporates the first mobile-based approach to analyze emotional expressions of patients with bipolar disorder. As a next step, the validity and feasibility of our emotion-sensitive approach must be evaluated. In the future, it might benefit diagnostic, prognostic, or even therapeutic purposes and complement existing systems with the help of new and intuitive interaction models

Problems and needs for improving primary care of osteoarthritis patients: the views of patients, general practitioners and practice nurses

BACKGROUND: Osteoarthritis (OA) is highly prevalent and has substantial impact on quality of life as well as on healthcare costs. The general practitioner (GP) often is the first care provider for patients with this chronic disease. The aim of this study was to identify health care needs of patients with OA and to reveal possible obstacles for improvements in primary care management of OA patients. METHODS: We performed semi-structured interviews with a stratified sample of 20 patients, 20 GPs and 20 practice nurses. RESULTS: Diagnosing OA posed no major problem, but during the course of OA, GPs found it difficult to distinguish between complaints resulting from the affection of the joints and complaints related to a concomitant depression. Patients felt to be well informed about the degenerative nature of the disease and possible side effects of medications, but they lacked information on individual consequences of the disease. Therefore, the most important concerns of many patients were pain and fear of disability which they felt to be addressed by GPs only marginally. Regarding pain treatment, physicians and patients had an ambivalent attitude towards NSAIDs and opiates. Therefore, pain treatment was not performed according to prevailing guidelines. GPs felt frustrated about the impact of counselling regarding life style changes but on the other hand admitted to have no systematic approach to it. Patients stated to be aware of the impact of life style on OA but lacked detailed information e.g. on how to exercise. Several suggestions were made concerning improvement. CONCLUSION: GPs should focus more on disability and pain and on giving information about treatment since these topics are inadequately addressed. Advanced approaches are needed to increase GPs impact on patients' life style. Being aware of the problem of labelling patients as chronically ill, a more proactive, patient-centred care is needed

Internetbasierte Therapie in der Versorgung von Patienten mit depressiven Störungen: Ein Überblick

Internet- und mobilbasierten Interventionen wird großes Potenzial in der Behandlung von Menschen mit depressiver Symptomatik zugeschrieben. Diese Einschätzung hat sich in den letzten Jahren vor dem Hintergrund mehrerer Programmentwicklungen und einer Vielzahl von Studien zur Wirksamkeitsprüfung der zumeist auf der kognitiven Verhaltenstherapie basierten Angebote etabliert. Ziel der vorliegenden Übersichtsarbeit ist es, zu prüfen, inwieweit sich aus der empirischen Befundlage wissenschaftlich fundierte Empfehlungen für die Versorgungsbereiche Prävention, Primärversorgung, ambulante Psychotherapie, fachärztliche Versorgung sowie die stationäre Behandlung ableiten lassen. Hierfür werden die Ergebnisse ausgewählter Studien, die in den genannten Versorgungsbereichen angesiedelt sind und die Erhebung der Diagnose depressive Störung auf ein Expertenurteil stützen, kritisch bewertet. In der Schlussfolgerung ermöglicht die gegenwärtige Studienlage keine eindeutige Empfehlung zum Einsatz von internetbasierten Behandlungsprogrammen in den genannten Versorgungsbereichen. = Internet and mobile interventions have the potential to transform depression care. This assumption is supported by a rapidly growing number of randomized controlled trials that evaluate the efficacy of mostly CBT-based self-help programs for the treatment of depressive symptoms under experimental conditions. However, fewer research has focused on the use of internet-based interventions in the treatment of clinical depression in real-life settings of depression care, ranging from prevention to primary and secondary care, and to inpatient treatment. Thus, it remains unclear if the current evidence translates to clinical settings. The present paper discusses studies on internet-based interventions that have been conducted under these conditions of care. The focus is on studies that have been conducted in clinical populations of patients formally diagnosed with a major depression. In conclusion, the review indicates that in many of these areas the current research lacks clear evidence for the effectiveness of internet-based interventions yet

The temporal dynamics of cognitive reactivity and their association with the depression risk:an exploratory study

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; Cognitive reactivity is the change in depressive thinking in response to negative mood. Previous research indicates that cognitive reactivity is an important variable in the etiology and course of depression. The present study tested which time interval after a negative mood induction is critical for the prediction of the depression risk. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; Participants suffering from a major depressive disorder were recruited when entering inpatient treatment. At the end of inpatient treatment they completed an experimental procedure to assess their depressive thinking once before and twice after a negative mood induction. Subsequently, patients were followed up for 26 weeks. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; The immediate change in depressive thinking in response to the negative mood induction was negatively associated with future depression. The delayed change did not predict the depression risk. &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; The negative association between the immediate change in depressive thinking and the depression risk is not in line with results from previous studies on cognitive reactivity. Previous research on emotion context insensitivity and the avoidance of negative thoughts offers hypotheses which could account for this result. Further research is needed to shed light on the processes underlying cognitive reactivity.</jats:p