A Validation Study of the Web Screening Questionnaire (WSQ) Compared With the Mini-International Neuropsychiatric Interview-Plus (MINI-Plus)

Background: There is a need for brief screening methods for psychiatric disorders in clinical practice. This study assesses the validity and accuracy of a brief self-report screening questionnaire, the Web Screening Questionnaire (WSQ), in detecting psychiatric disorders in a study group comprising the general population and psychiatric outpatients aged 18 years and older. Objective: The aim of this study was to investigate whether the WSQ is an adequate test to screen for the presence of depressive and anxiety disorders in clinical practice. Methods: Participants were 1292 adults (1117 subjects from the general population and 175 psychiatric outpatients), aged 18 to 65 years. The discriminant characteristics of the WSQ were examined in relation to the (“gold standard”) Mini-International Neuropsychiatric Interview-Plus (MINI-Plus) disorders, by means of sensitivity, specificity, area under the curve (AUC), and positive and negative predictive values (PPVs, NPVs). Results: The specificity of the WSQ to individually detect depressive disorders, anxiety disorders, and alcohol abuse or dependence ranged from 0.89 to 0.97 for most disorders, with the exception of post-traumatic stress disorder (0.52) and specific phobia (0.73). The sensitivity values ranged from 0.67 to 1.00, with the exception of depressive disorder (0.56) and alcohol abuse or dependence (0.56). Given the low prevalence of separate disorders in the general population sample, NPVs were extremely high across disorders (≥0.97), whereas PPVs were of poor strength (range 0.02-0.33). Conclusions: In this study group, the WSQ was a relatively good screening tool to identify individuals without a depressive or anxiety disorder, as it accurately identified those unlikely to suffer from these disorders (except for post-traumatic stress disorders and specific phobias). However, in case of a positive WSQ screening result, further diagnostic procedures are required

A randomized controlled trial of the efficacy and cost-effectiveness of a brief intensified cognitive behavioral therapy and/or pharmacotherapy for mood and anxiety disorders: Design and methods

Background: Anxiety and mood disorders involve a high disease burden and are associated with high economic costs. A stepped-care approach intervention and abbreviated diagnostic method are assumed to increase effectiveness and efficiency of the mental healthcare and are expected to reduce economic costs. Methods: Presented are the rationale, design, and methods of a two-armed randomized controlled trial comparing \u27treatment as usual\u27 (TAU) with a brief intensified cognitive behavioral therapy (CBT) and/or pharmacotherapy. Eligible participants (N =500) of five Dutch outpatient Mental Healthcare Centers are randomly assigned to either TAU or to the experimental condition (brief CBT and/or pharmacotherapy). Data on patients\u27 progress and clinical effectiveness of treatment are assessed at baseline, post-treatment (3. months after baseline), and at 6 and 12. months post-treatment by Routine Outcome Monitoring (ROM). Cost analysis is performed on the obtained data. Discussion: Since few studies have investigated both the clinical and cost effectiveness of a stepped-care approach intervention and a shortened diagnostic ROM method in both anxiety and/or mood disorders within secondary mental health care, the results of this study might contribute to the improvement of (cost)-effective treatment options and diagnostic methods for these disorders

The clinical effectiveness of concise cognitive behavioral therapy with or without pharmacotherapy for depressive and anxiety disorders; a pragmatic randomized controlled equivalence trial in clinical practice

Background: Depressive and anxiety disorders contribute to a high disease burden. This paper investigates whether concise formats of cognitive behavioral- and/or pharmacotherapy are equivalent with longer standard care in the treatment of depressive and/or anxiety disorders in secondary mental health care. Methods: A pragmatic randomized controlled equivalence trial was conducted at five Dutch outpatient Mental Healthcare Centers (MHCs) of the Regional Mental Health Provider (RMHP) \u27Rivierduinen\u27. Patients (aged 18-65 years) with a mild to moderate anxiety and/or depressive disorder, were randomly allocated to concise or standard care. Data were collected at baseline, 3, 6 and 12 months by Routine Outcome Monitoring (ROM). Primary outcomes were the Brief Symptom Inventory (BSI) and the Web Screening Questionnaire (WSQ). We used Generalized Estimating Equations (GEE) to assess outcomes. Results: Between March 2010 and December 2012, 182 patients, were enrolled (n = 89 standard care; n = 93 concise care). Both intention-to-treat and per-protocol analyses demonstrated equivalence of concise care and standard care at all time points. Severity of illness reduced, and both treatments improved patient\u27s general health status and subdomains of quality of life. Moreover, in concise care, the beneficial effects started earlier. Discussion: Concise care has the potential to be a feasible and promising alternative to longer standard secondary mental health care in the treatment of outpatients with a mild to moderate depressive and/or anxiety disorder. For future research, we recommend adhering more strictly to the concise treatment protocols to further explore the beneficial effects of the concise treatment

Empirische evidence voor de effectiviteit van routine outcome monitoring; een literatuuronderzoek

achtergrond Routine outcome monitoring (ROM) is een belangrijk kwaliteitsinstrument om effecten van behandeling zichtbaar te maken en wordt landelijk geïmplementeerd in de Nederlandse ggz. doel Evalueren van de wetenschappelijke stand van zaken betreffende de effectiviteit van ROM voor diagnostiek, behandeling en andere uitkomsten. methode Literatuuronderzoek in PubMed, Medline, Psycinfo en Embase Psychiatry (1975-2009) naar gerandomiseerde gecontroleerde trials (rct\u27s) van ROM bij alle leeftijdsgroepen patiënten (algemeen en ggz). De voornaamste zoektermen waren \u27routine outcome monitoring\u27 c.q. \u27routine outcome measurement\u27. resultaten Er werden 52 rct\u27s geïncludeerd betreffende ROM bij volwassen patiënten. Hiervan waren 45 rct\u27s gericht op psychische klachten, zij het niet altijd in een psychiatrische setting of als primaire uitkomstmaat. Er bleken positieve effecten van ROM op de diagnostiek en behandeling, en op de communicatie tussen patiënt en behandelaar. Andere uitkomsten waren minder eenduidig. conclusie ROM blijkt vooral effectief voor het monitoren van behandelingen die onvoldoende aanslaan. Nader onderzoek is nodig naar de klinische effectiviteit en de kosteneffectiviteit van ROM in zowel de volwassenen- als de kinder- en jeugdpsychiatrie

A randomized controlled trial of the efficacy and cost-effectiveness of a brief intensified cognitive behavioral therapy and/or pharmacotherapy for mood and anxiety disorders: Design and methods

Background: Anxiety and mood disorders involve a high disease burden and are associated with high economic costs. A stepped-care approach intervention and abbreviated diagnostic method are assumed to increase effectiveness and efficiency of the mental healthcare and are expected to reduce economic costs. Methods: Presented are the rationale, design, and methods of a two-armed randomized controlled trial comparing \u27treatment as usual\u27 (TAU) with a brief intensified cognitive behavioral therapy (CBT) and/or pharmacotherapy. Eligible participants (N =500) of five Dutch outpatient Mental Healthcare Centers are randomly assigned to either TAU or to the experimental condition (brief CBT and/or pharmacotherapy). Data on patients\u27 progress and clinical effectiveness of treatment are assessed at baseline, post-treatment (3. months after baseline), and at 6 and 12. months post-treatment by Routine Outcome Monitoring (ROM). Cost analysis is performed on the obtained data. Discussion: Since few studies have investigated both the clinical and cost effectiveness of a stepped-care approach intervention and a shortened diagnostic ROM method in both anxiety and/or mood disorders within secondary mental health care, the results of this study might contribute to the improvement of (cost)-effective treatment options and diagnostic methods for these disorders

The value of psychological treatment for borderline personality disorder: Systematic review and cost offset analysis of economic evaluations.

AIM:Borderline Personality Disorder (BPD) is a common mental health condition with high patterns of service utilisation of inpatient and community treatment. Over the past five years there has been significant growth in research with economic data, making this systematic review a timely update. METHODS:Empirical studies written in English or German, published up to December 2015, and cited in major electronic databases were examined using the PRISMA systematic review method. Papers were included that had one of the following: data related to cost of BPD to society, the individual, the carer or families; cost benefits of interventions. Reported cost data were inflated to the year 2015 and converted into US- dollars (USD $) using purchasing power parities. RESULTS:We identified 30 economic evaluations providing cost data related to interventions for BPD across 134,136 patients. The methodological quality was good, almost all studies fulfilled ≥ 50$2,987.82 per patient per year. A further mean weighted reduction of USD $1,551 per patient per year (range$83 - $29,392) was found compared to treatment as usual. Evidence-based psychological treatment was both less expensive as well as more effective, despite considerable differences in health cost arrangements between individual studies and countries. Where it was able to be calculated, a significant difference in cost-savings between different types of evidence-based psychotherapies was found. DISCUSSION:Individuals with BPD consistently demonstrate high patterns of service utilization and therefore high costs. The findings of this review present a strong argument in favour of prioritizing BPD treatments in reimbursement decisions, both for the affected individual and the family. The provision of evidence based treatment, irrespective of the type of psychological treatment, may lead to widespread reductions in healthcare costs

Economic evaluation of concise Cognitive Behavioural Therapy and/or pharmacotherapy for depressive and anxiety disorders

BACKGROUND: Depressive and anxiety disorders cause great suffering and disability and are associated with high health care costs. In a previous conducted pragmatic randomised controlled trial, we have shown that a concise format of cognitive behavioural- and/or pharmacotherapy is as effective as standard care in reducing depressive and anxiety symptoms and in improving subdomains of general health and quality of life in secondary care psychiatric outpatients. AIMS OF THE STUDY: In this economic evaluation, we examined whether a favourable cost-utility of concise care compared to standard care was attained. METHODS: The economic evaluation was performed alongside a pragmatic randomised controlled trial. Health-related quality of life was measured using the Short-Form (SF-36) questionnaire. Cost of healthcare utilization and productivity loss (absenteeism and presenteeism) were assessed using the Trimbos/iMTA questionnaire for Costs associated with Psychiatric Illness (TiC-P). A cost-utility analysis, using cost-effectiveness acceptability curves, comparing differences in societal costs and Quality-Adjusted Life Years (QALYs) at 1 year was performed. RESULTS: One year after study entry, the difference in mean cost per patient of the two primary treatments was not significant between both groups. No significant differences in other healthcare and non- healthcare costs could be detected between patients receiving concise care and standard care. Also, QALYs were not statistically different between the groups during the study period. From both the societal and healthcare perspective, the probability that concise care is more cost-effective compared to standard care remains below the turning point of 0.5 for all acceptable values of the willingness to pay for a QALY. The economic evaluation suggests that concise care is unlikely to be cost-effective compared to standard care in the treatment for depressive- and anxiety disorders in secondary mental health care during a one year follow up period. DISCUSSION: Total costs and QALYs were not significantly different between standard and concise care, with no evidence for cost-effectiveness of concise care in the first year. The longer impact of concise care for patients with mild to moderate symptoms of depressive and/or anxiety disorders compared to standard care in secondary care needs to be further studied. IMPLICATIONS: This economic evaluation failed to find significant differences in cost between concise and standard care over the study period of one year. Replication of our economic evaluation might benefit from an extended follow-up period and strict adherence to the study protocol. If concise care will be found to be cost-effective in the long term, this would have major implications for recommendations how to optimize secondary mental health care in the treatment of depressive - and anxiety disorders

Efficacy and effectiveness of psychological interventions on co‐occurring mood and anxiety disorders in older adults: A systematic review and meta‐analysis

Objectives Co‐occurring mood and anxiety disorders are common in older adult populations and are associated with worse long‐term outcomes and poorer treatment response than either disorder alone. This systematic review and meta‐analysis aimed to examine the efficacy and effectiveness of psychological interventions for treating co‐occurring mood and anxiety disorders in older adults. Method The study was registered (PROSPERO CRD4201603834), databases systematically searched (MEDLINE, PSYCINFO, PubMed and Cochrane Reviews) and articles screened according to PRISMA guidelines. Inclusion Participants aged ≥60 years with clinically significant anxiety and depression, psychological intervention evaluated against control in randomised controlled trial, changes in both anxiety and depression reported at post‐treatment. ResultsFour studies were included (total n = 255, mean age range 67–71 years). Overall, psychological interventions (cognitive behavioural therapy, mindfulness) resulted in significant benefits over control conditions (active, waitlist) for treating depression in the presence of co‐occurring anxiety (Hedges' g = −0.44), and treating anxiety in the presence of depression (Hedges' g = −0.55). However, conclusions are limited; the meta‐analysis was non‐significant, few studies were included, several were low quality and there was high heterogeneity between studies. Benefits at follow‐up were not established. Conclusion Co‐occurring anxiety and mood disorders can probably be treated simultaneously with psychological interventions in older adults with moderate effect sizes, however, more research is needed. Given comorbidity is common and associated with worse clinical outcomes, more high‐quality clinical trials are needed that target the treatment of co‐occurring anxiety and mood disorders, and report changes in diagnostic remission for both anxiety and mood disorders independently

Biomarker correlates of psychotherapy outcomes in borderline personality disorder: A systematic review

Studies of neurobiological mechanisms in borderline personality disorder (BPD) have increased our understanding of the pathophysiology of its development and course. Less is known about how psychotherapy may influence these neurobiological factors, and also whether biomarkers may predict psychotherapy outcomes. We conducted a systematic review using PRISMA guidelines. Fourteen studies providing data from 467 participants diagnosed with BPD met inclusion criteria to: (a) investigate biomarkers predicting response to psychotherapy for BPD; or (b) examine neurobiological factors altered by psychotherapy. Neuroimaging studies (n=11) used mostly functional magnetic resonance imaging methods to scope brain regions related to emotion regulation and cognitive control. Three studies examined genetic or neuroendocrine markers. The evidence suggests that psychotherapy alters neural activation and connectivity of regions subserving executive control and emotion regulation. Additionally, hypoactivation in prefrontal and cingulate regions predicted treatment response. Further work in this area may inform personalised treatment approaches in clinical practice for BPD through elucidating neural mechanisms of evidence-based psychotherapy