Nurse-led interpersonal counselling for depressive symptoms in patients with myocardial infarction

The broad interest of this intervention study is in two worldwide remarkable diseases, myocardial infarction and depression. The purpose of the 18-month follow-up study was to evaluate the outcomes of interpersonal counselling implemented by a psychiatric nurse, and to examine the recovery experienced by the patients after myocardial infarction. The interpersonal counseling consisted of a short-term (max 6 sessions) depression-focused intervention modified for myocardial infarction patients. The main principle of interpersonal counselling is that depressive symptoms relate to interpersonal relations. The measured outcomes of the intervention consisted of changes in depressive symptoms and distress, health-related quality of life and the use of health care services. The data consisted of 103 patients with acute myocardial infarction and with sufficient knowledge of Finnish language, and they were randomized into intervention group (n=51) and control group (n=52) with standard care. Depressive symptoms were measured using Beck Depression Inventory, and distress using Symptom Checklist-25. The instrument to measure health-related quality of life was EuroQol-5 Dimensions. All instruments were used at three measurements: in hospital, at 6 months and at 18 months after hospital discharge. The Use of Health Care Services questionnaire was used during the 6- and 18-month period after hospital discharge. In addition, satisfaction with the intervention and with information received from the health-care professional was evaluated during the follow-up. To examine recovery, the patients kept diaries during a 6-month period and they were interviewed at 18 months after myocardial infarction. The number of patients with depressive symptoms decreased significantly more in the intervention group compared with the control group during 18 months of follow-up. Distress decreased significantly more among patients under 60 years in the intervention group than in the control group, but the difference was not significant between the groups. No differences in the changes of health-related quality of life were found between the groups during follow-up. However, in the group of patients under 60 years, the improvement of health-related quality of life in the intervention was significantly better in the intervention group compared with the control group during the follow-up. During the follow-up period, there was even a decline in the use of somatic specialized health care services in the intervention group and among intervention patients who had no other long-term disease. Considering recovery experienced by the patients, main categories including many supporting and inhibiting factors and subcategories were identified: clinical and physical, psychological, social, functional and professional category. No differences between the groups were found in satisfaction with information received from the professionals. The brief and easy-to-learn intervention, with which the patients were satisfied, seems to decrease depressive symptoms after myocardial infarction. Interpersonal counselling seems to be beneficial especially with younger patients. These results justify adopting depression screening and interpersonal counselling as part of routine care after myocardial infarction. The first stage evaluation of the use of health care services is interesting, and calls for more studies. From the perspective of individual patients, recovery after myocardial infarction seems to consist of many supporting and inhibiting factors. This is something that is important to take into account in developing nursing practice. The results indicate a need for further studies in outcomes of interpersonal counselling and recovery experienced by the patients after myocardial infarction. In addition, the results encourage widening the research perspective to nursing administration and educational level.Tässä tutkimuksessa tarkastellaan laaja-alaisesti kahta, kansainvälisesti merkittävää sairautta: sydäninfarktia ja depressiota. Tutkimus oli 18 kuukauden seurantatutkimus, jossa arvioitiin sairaanhoitajan tekemän interpersonal counselling (interpersoonallinen ohjaus) –intervention tuloksia ja potilaiden kokemuksia sydäninfarktista selviytymisestä. Sydäninfarktipotilaiden masennukseen kohdistunut interventio oli lyhyt, enintään 6 tapaamisen ohjaus, jonka perusidea on tarkastella ihmissuhteiden ja mielialan yhteyttä. Tutkimuksen tulokset koostuivat muutoksista, joita havaittiin potilaiden masennusoireissa, rasittuneisuudessa, terveyteen liittyvässä elämänlaadussa ja terveyspalvelujen käytössä. Aineisto koostui 103:sta akuutin sydäninfarktin saaneesta potilaasta, joilla oli riittävän hyvä suomen kielen taito, ja heidät satunnaistettiin interventioryhmään (n=51) ja kontrolliryhmään (n=52), joka sai normaalihoidon. Depressio-oireita mitattiin Beck Depression Inventory -kyselyllä ja rasittuneisuutta Symptom Checklist-25 –kyselyllä. Terveyteen liittyvää elämänlaatua mitattiin EuroQol-5D -mittarilla. Kaikkia näitä mittareita käytettiin sairaalahoidossa sekä 6 ja 18 kuukautta sairaalahoidon loppumisesta. Terveyspalvelujen käyttö -kyselyä käytettiin 6 ja 18 kuukauden kuluttua sairaalahoidon loppumisesta. Lisäksi seurannan aikana kartoitettiin, kuinka tyytyväisiä potilaat olivat interventioon ja ammattilaisilta saamaansa tietoon. Selviytymiskokemuksen kartoittamiseksi potilaat kirjoittivat päiväkirjoja kuuden kuukauden ajan, ja heidät haastateltiin 18 kuukautta sydäninfarktin jälkeen. Depressio-oireista kärsivien potilaiden määrä väheni enemmän interventioryhmässä kuin kontrolliryhmässä, jossa se pysyi korkeana koko seurannan ajan. Alle 60-vuotiaiden interventiopotilaiden rasittuneisuus väheni enemmän kuin kontrolliryhmässä, mutta koeja kontrolliryhmän välinen ero ei ollut merkitsevä. Terveyteen liittyvän elämänlaadun muutoksissa ei seurannan aikana havaittu ryhmienvälistä eroa. Kuitenkin alle 60-vuotiailla terveyteen liittyvä elämänlaatu parani enemmän interventioryhmässä kuin kontrolliryhmässä. Seurannan aikana interventiopotilaiden sekä interventiopotilaiden, joilla ei ollut muita pitkäaikaissairauksia, tarve somaattiseen erikoissairaanhoitoon osittain jopa väheni. Potilaiden kokemuksissa havaittiin pääkategoriat: kliininen ja fyysinen, psykologinen, sosiaalinen, toiminnallinen ja ammatillinen. Pääkategoriat koostuivat alakategorioista, joihin kuului paljon selviytymisessä tukevia ja estäviä tekijöitä. Tyytyväisyys ammattilaisilta saatuun tietoon ei vaihdellut ryhmittäin. Lyhytkestoinen ja helposti opittava interventio, johon potilaat ovat tyytyväisiä, näyttää vähentävän depressio-oireita sydäninfarktin jälkeen. Interpersonal counselling -interventio vaikuttaa olevan hyödyllinen erityisesti nuoremmille potilaille. Tulokset osoittavat, että depressioseulonta ja interpersonal counselling -interventio saattaisi olla hyödyllistä ottaa osaksi rutiinihoitoa sydäninfarktin jälkeen. Alustava selvitys terveyspalvelujen käytöstä on mielenkiintoinen ja osoittaa, että jatkotutkimuksia tarvitaan. Selviytyminen sydäninfarktin jälkeen näyttää koostuvan lukuisista tukevista ja estävistä tekijöistä yksittäisen potilaan omasta näkökulmasta, mikä on hyvä huomioida kehitettäessä käytännön hoitotyötä. Tulokset interpersonal counselling –interventiosta ja potilaan kokemasta selviytymisestä sydäninfarktin jälkeen ovat tuottaneet jatkotutkimusaiheita. Lisäksi tulokset rohkaisevat laajentamaan tutkimusnäkökulmaa sairaanhoidon hallintoon ja koulutukseen.Siirretty Doriast

How size matters: exploring the association between quality of mental health services and catchment area size

Background: The diversity of mental health and substance abuse services (MHS) available to service users is seen as an indicator of the quality of the service system. In most countries MHS are provided by a mix of public, private and third sector providers. In Finland, officially, the municipalities are responsible for organizing the services needed, but the real extent and roles of private and third sector service providers are not known. Our previous study showed that the catchment area population size was strongly associated with diversity of mental health services. It is not known whether this was due to some types of services or some provider types being more sensitive to the size effect than others.The aim of this study was to investigate the association between area population size and diversity of mental health services, i.e. which types of services and which service providers' contributions are sensitive to population size.Methods: To map and classify services, we used the ESMS-R. The diversity of services was defined as the count of main types of care. Providers were classified as public, private or third sectors.Results: The diversity of outpatient, residential and voluntary services correlated positively with catchment area population size. The strongest positive correlation between the size of population and services available was found in third sector activities followed by public providers, but no correlation was found for diversity of private services. The third sector and public corporations each provided 44 % of the service units.Third sector providers produced all self-help services and most of the day care services. Third sector and private companies provided a significant part (59 %) of the residential care service units.Conclusions: Significant positive correlations were found between size of catchment area population and diversity of residential, outpatient and voluntary services, indicating that these services concentrate on areas with larger population bases. The third sector seems to significantly complement the public sector in providing different services. Thus the third sector be needs to be functionally integrated with other MHS services to achieve a diversified and integrated service system

Identifying Local and Centralized Mental Health ServicesThe Development of a New Categorizing Variable

The challenges of mental health and substance abuse services (MHS) require shifting of the balance of resources from institutional care to community care. In order to track progress, an instrument that can describe these attributes of MHS is needed. We created a coding variable in the European Service Mapping Schedule-Revised (ESMS-R) mapping tool using a modified Delphi panel that classified MHS into centralized, local services with gatekeeping and local services without gatekeeping. For feasibility and validity, we tested the variable on a dataset comprising MHS in Southern Finland, covering a population of 2.3 million people. There were differences in the characteristics of services between our study regions. In our data, 41% were classified as centralized, 37% as local without gatekeeping and 22% as local services with gatekeeping. The proportion of resources allocated to local services varied from 20% to 43%. Reclassifying ESMS-R is an easy way to compare the important local vs. centralized balance of MHS systems globally, where such data exists. Further international studies comparing systems and validating this approach are needed.Peer reviewe

Regional Correlates of Psychiatric Inpatient Treatment

Current reforms of mental health and substance abuse services (MHS) emphasize community-based care and the downsizing of psychiatric hospitals. Reductions in acute and semi-acute hospital beds are achieved through shortened stays or by avoiding hospitalization. Understanding the factors that drive the current inpatient treatment provision is essential. We investigated how the MHS service structure (diversity of services and balance of personnel resources) and indicators of service need (mental health index, education, single household, and alcohol sales) correlated with acute and semi-acute inpatient treatment provision. The European Service Mapping Schedule-Revised (ESMS-R) tool was used to classify the adult MHS structure in southern Finland (population 1.8 million, 18+ years). The diversity of MHS in terms of range of outpatient and day care services or the overall personnel resourcing in inpatient or outpatient services was not associated with the inpatient treatment provision. In the univariate analyses, sold alcohol was associated with the inpatient treatment provision, while in the multivariate modeling, only a general index for mental health needs was associated with greater hospitalization. In the dehospitalization process, direct resource re-allocation and substituting of inpatient treatment with outpatient care per se is likely insufficient, since inpatient treatment is linked to contextual factors in the population and the health care system. Mental health services reforms require both strategic planning of service system as a whole and detailed understanding of effects of societal components

Identifying Local and Centralized Mental Health ServicesThe Development of a New Categorizing Variable

The challenges of mental health and substance abuse services (MHS) require shifting of the balance of resources from institutional care to community care. In order to track progress, an instrument that can describe these attributes of MHS is needed. We created a coding variable in the European Service Mapping Schedule-Revised (ESMS-R) mapping tool using a modified Delphi panel that classified MHS into centralized, local services with gatekeeping and local services without gatekeeping. For feasibility and validity, we tested the variable on a dataset comprising MHS in Southern Finland, covering a population of 2.3 million people. There were differences in the characteristics of services between our study regions. In our data, 41% were classified as centralized, 37% as local without gatekeeping and 22% as local services with gatekeeping. The proportion of resources allocated to local services varied from 20% to 43%. Reclassifying ESMS-R is an easy way to compare the important local vs. centralized balance of MHS systems globally, where such data exists. Further international studies comparing systems and validating this approach are needed

How size matters : exploring the association between quality of mental health services and catchment area size

Background: The diversity of mental health and substance abuse services (MHS) available to service users is seen as an indicator of the quality of the service system. In most countries MHS are provided by a mix of public, private and third sector providers. In Finland, officially, the municipalities are responsible for organizing the services needed, but the real extent and roles of private and third sector service providers are not known. Our previous study showed that the catchment area population size was strongly associated with diversity of mental health services. It is not known whether this was due to some types of services or some provider types being more sensitive to the size effect than others. The aim of this study was to investigate the association between area population size and diversity of mental health services, i.e. which types of services and which service providers' contributions are sensitive to population size. Methods: To map and classify services, we used the ESMS-R. The diversity of services was defined as the count of main types of care. Providers were classified as public, private or third sectors. Results: The diversity of outpatient, residential and voluntary services correlated positively with catchment area population size. The strongest positive correlation between the size of population and services available was found in third sector activities followed by public providers, but no correlation was found for diversity of private services. The third sector and public corporations each provided 44 % of the service units. Third sector providers produced all self-help services and most of the day care services. Third sector and private companies provided a significant part (59 %) of the residential care service units. Conclusions: Significant positive correlations were found between size of catchment area population and diversity of residential, outpatient and voluntary services, indicating that these services concentrate on areas with larger population bases. The third sector seems to significantly complement the public sector in providing different services. Thus the third sector be needs to be functionally integrated with other MHS services to achieve a diversified and integrated service system.Peer reviewe

Regional Correlates of Psychiatric Inpatient Treatment

Peer reviewe

Internet-based interventions for the secondary prevention of coronary heart disease

Background The Internet could provide a means of delivering secondary prevention programmes to people with coronary heart disease (CHD). Objectives To determine the effectiveness of Internet-based interventions targeting lifestyle changes and medicines management for the secondary prevention of CHD. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, in December 2014. We also searched six other databases in October 2014, and three trials registers in January 2015 together with reference checking and handsearching to identify additional studies. Selection criteria Randomised controlled trials (RCTs) evaluating Internet-delivered secondary prevention interventions aimed at people with CHD. Data collection and analysis Two review authors independently assessed risk of bias and extracted data according to the Cochrane Handbook for Systematic Reviews of Interventions. We assessed evidence quality using the GRADE approach and presented this in a 'Summary of findings' table

Depression in Primary care: Interpersonal Counseling vs Selective serotonin reuptake inhibitors. The DEPICS Study. A multicenter randomized controlled trial. Rationale and design

<p>Abstract</p> <p>Background</p> <p>Depression is a frequently observed and disabling condition in primary care, mainly treated by Primary Care Physicians with antidepressant drugs. Psychological interventions are recommended as first-line treatment by the most authoritative international guidelines but few evidences are available on their efficacy and effectiveness for mild depression.</p> <p>Methods/Design</p> <p>This multi-center randomized controlled trial was conducted in 9 Italian centres with the aim to compare the efficacy of Inter-Personal Counseling, a brief structured psychological intervention, to that of Selective Serotonin Reuptake Inhibitors. Patients with depressive symptoms referred by Primary Care Physicians to psychiatric consultation-liaison services were eligible for the study if they met the DSM-IV criteria for major depression, had a score ≥13 on the 21-item Hamilton Depression Rating Scale, and were at their first or second depressive episode. The primary outcome was remission of depressive symptoms at 2-months, defined as a HDRS score ≤ 7. Secondary outcome measures were improvement in global functioning and recurrence of depressive symptoms at 12-months. Patients who did not respond to Inter-Personal Counseling or Selective Serotonin Reuptake Inhibitors at 2-months received augmentation with the other treatment.</p> <p>Discussion</p> <p>This trial addresses some of the shortcomings of existing trials targeting major depression in primary care by evaluating the comparative efficacy of a brief psychological intervention that could be easily disseminated, by including a sample of patients with mild/moderate depression and by using different outcome measures.</p> <p>Trial registration</p> <p>Australian New Zealand Clinical Trials Registry ACTRN12608000479303</p