7 research outputs found

    Towards Personalized Medicine for Persistent Depressive Disorder: Moving from “one size fits all” to “what works for whom?”

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    Persistent Depressive Disorder (PDD) is, by definition, a chronic mental disorder that severely affects the quality of life of those affected. Despite numerous available treatment options, response and remission rates are generally scarce in patients with PDD, with effectiveness of different treatments varying between individual patients. However, empirical evidence predicting and understanding the individual treatment benefit is largely lacking. Personalized medicine aims to match patients with the most promising treatment on an individual basis by identifying pre-treatment characteristics that predict the outcome of a particular treatment for an individual patient. While other medical disciplines have achieved great progress in the field of personalized medicine, psychiatry still lags far behind, holding on to the ‘one size fits all’ concept, which assumes that a certain treatment will work equally well for all patients diagnosed with a particular disorder. This is also broadly applicable to the research field on PDD. The overarching aim of this publication-based dissertation is to advance the field of personalized medicine for PDD by providing evidence for the effectiveness of certain psychotherapeutic and pharmacological treatments for specific subgroups of patients with PDD based on their multivariable pre-treatment profile. Beginning with an introduction, this thesis will first provide a theoretical framework for the two main thematical concepts of this work, namely PDD and personalized medicine, as well as an overview of previous evidence on treatment prediction in patients with PDD. Afterwards, the main objectives and research questions of this thesis are presented with respect to two specific clinical decision-making scenarios that have been studied in the three scientific papers presented thereafter, namely the selection of and between two psychotherapies (Paper 1 and Paper 2) and the choice between psychotherapy and antidepressant medication (Paper 3). Paper 1 identified and combined pretreatment characteristics of patients with early-onset PDD that moderate their benefit from disorder-specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) versus nonspecific Supportive Psychotherapy (SP), thereby detecting two subgroups with differential treatment benefits. Paper 2 investigated treatment predictors and identified several subgroups of patients experiencing a comparable treatment effectiveness of CBASP and SP. Finally, following the same question and methodology as Paper 1 for the comparison of CBASP and pharmacotherapy with Escitalopram plus Clinical Management (ESC/CM), Paper 3 identified two subgroups of patients with differential benefit from these two treatment options. Altogether, the main findings of the three papers extend the body of evidence for treatment prediction in patients with PDD in several aspects: first, they show that behind the general cross-sample effects reported in the main studies, there exist underlying subgroup effects, suggesting that the effectiveness of the investigated treatments varies greatly depending on the patient’s pre-treatment profile. Second, they present novel methodological approaches together with advantages of a multivariable consideration of the pre-treatment profile and its prediction of treatment response. Third and lastly, they provide new evidence for whom the treatments studied are more or less likely to work, possible underlying reasons, and other research questions that arise and need to be investigated by future research

    Supporting employees with mental illness and reducing mental illness-related stigma in the workplace: an expert survey

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    An expert survey was designed to support the development of a workplace-based multi-country intervention tackling depression, anxiety, and mental illness-related stigma in small- and medium-sized enterprises (SMEs). Academic experts and representatives of SME organisations, specific sector organisations, labour or advocacy groups, and occupational health organisations, were contacted across eight European countries and Australia. The survey comprised closed and open text questions to assess expert opinion about interventions for employees with mental health difficulties, interventions supporting their managers, and anti-stigma interventions. The survey was available in six languages. The online platform Qualtrics was used for data collection. Quantitative data was analysed through descriptive statistics and qualitative data was analysed through thematic analysis. Sixty-five of 146 experts responded, representing a 42% response rate. Results showed only 26.2% of experts agreed that employees could speak openly about mental health issues, and 81.5% of experts indicated a large or medium unmet need for support for employees with mental health issues. Psychoeducational materials, face-to-face workshops and interventions based on cognitive behavioural therapy were ranked most likely to be taken up by employees. Experts rated as most useful for managers’ guidelines on how to act if an employee has mental health issues (67.7%). The greatest number of experts indicated workshops of people with lived experience of mental illness (80.0%) and awareness campaigns (78.5%) were most required to tackle stigma. Responses were consistent between experts from different countries and areas of expertise. Experts in this multinational survey assessed that interventions supporting mental health in the workplace and tackling stigma are greatly needed. A multicomponent intervention with a wide range of materials and tools is supported.Additional co-authors: Doireann Ni Dhalaigh, Hanna Reich, Victoria Ross, Sarita Sanches, Katherine Thomson, Chantal Van Audenhove, Victor PĂ©rez, Ella Arensman, Gyorgy Purebl, Benedikt L. Amann MENTUPP consortium members are Ainslie O’Connor, Andras Szekely, Anthony LaMontagne, Ariel Como, Arilda Dushaj, Asmae Doukani, Azucena Justicia, Birgit A. Greiner, Chris Lockwood, Cliodhna O’Connor, David McDaid, Dooyoung Kim, Eileen Williamson, Eve Griffin, Evelien Coppens, Genc Burazeri, Gentiana Qirjako, Grace Davey, Jaap van Weeghel, Joe Eustace, Joseph Kilroy, Juliane Hug, Kairi Kolves, Karen Mulcahy, Karen Michell, Kristian Wahlbeck, Lars de Winter, Laura Cox, Luigia D’Alessandro, Margaret Maxwell, Nicola Reavley, Peter Trembeczky, Paul Corcoran, Reiner Rugulies, Ruth Benson, Saara Rapeli, Sarah Ihinonvien, Sevim Mustafa, Sharna Mathieu, Stefan Hackel, Tanya King, Ulrich Hegerl, Vanda Scott & Wendy Orchar

    Implementation and evaluation of a multi-level mental health promotion intervention for the workplace (MENTUPP): study protocol for a cluster randomised controlled trial

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    Background Well-organised and managed workplaces can be a source of wellbeing. The construction, healthcare and information and communication technology sectors are characterised by work-related stressors (e.g. high workloads, tight deadlines) which are associated with poorer mental health and wellbeing. The MENTUPP intervention is a flexibly delivered, multi-level approach to supporting small- and medium-sized enterprises (SMEs) in creating mentally healthy workplaces. The online intervention is tailored to each sector and designed to support employees and leaders dealing with mental health difficulties (e.g. stress), clinical level anxiety and depression, and combatting mental health-related stigma. This paper presents the protocol for the cluster randomised controlled trial (cRCT) of the MENTUPP intervention in eight European countries and Australia. Methods Each intervention country will aim to recruit at least two SMEs in each of the three sectors. The design of the cRCT is based on the experiences of a pilot study and guided by a Theory of Change process that describes how the intervention is assumed to work. SMEs will be randomly assigned to the intervention or control conditions. The aim of the cRCT is to assess whether the MENTUPP intervention is effective in improving mental health and wellbeing (primary outcome) and reducing stigma, depression and suicidal behaviour (secondary outcome) in employees. The study will also involve a process and economic evaluation. Conclusions At present, there is no known multi-level, tailored, flexible and accessible workplace-based intervention for the prevention of non-clinical and clinical symptoms of depression, anxiety and burnout, and the promotion of mental wellbeing. The results of this study will provide a comprehensive overview of the implementation and effectiveness of such an intervention in a variety of contexts, languages and cultures leading to the overall goal of delivering an evidence-based intervention for mental health in the workplace

    Altered Brain Activity in Unipolar Depression Revisited

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    During the past 20 years, numerous neuroimaging experiments have investigated aberrant brain activation during cognitive and emotional processing in patients with unipolar depression (UD). The results of those investigations, however, vary considerably; moreover, previous meta-analyses also yielded inconsistent findings

    Supporting employees with mental illness and reducing mental illness-related stigma in the workplace: an expert survey.

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    An expert survey was designed to support the development of a workplace-based multi-country intervention tackling depression, anxiety, and mental illness-related stigma in small- and medium-sized enterprises (SMEs). Academic experts and representatives of SME organisations, specific sector organisations, labour or advocacy groups, and occupational health organisations, were contacted across eight European countries and Australia. The survey comprised closed and open text questions to assess expert opinion about interventions for employees with mental health difficulties, interventions supporting their managers, and anti-stigma interventions. The survey was available in six languages. The online platform Qualtrics was used for data collection. Quantitative data was analysed through descriptive statistics and qualitative data was analysed through thematic analysis. Sixty-five of 146 experts responded, representing a 42% response rate. Results showed only 26.2% of experts agreed that employees could speak openly about mental health issues, and 81.5% of experts indicated a large or medium unmet need for support for employees with mental health issues. Psychoeducational materials, face-to-face workshops and interventions based on cognitive behavioural therapy were ranked most likely to be taken up by employees. Experts rated as most useful for managers' guidelines on how to act if an employee has mental health issues (67.7%). The greatest number of experts indicated workshops of people with lived experience of mental illness (80.0%) and awareness campaigns (78.5%) were most required to tackle stigma. Responses were consistent between experts from different countries and areas of expertise. Experts in this multinational survey assessed that interventions supporting mental health in the workplace and tackling stigma are greatly needed. A multicomponent intervention with a wide range of materials and tools is supported
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