Comorbid diabetes and depression:Do E-health treatments achieve better diabetes control?

Research in the field of comorbid depression in diabetes shows that the optimum treatment to attain better diabetes disease control is still undecided. Although several treatment models are effective and available, interventions aimed at improving disease control, such as glycemic control, are less effective, with moderate evidence for pharmacological treatment and a lot of evidence for psychotherapy in combination with self-management techniques. New developments such as M-health and E-health are much less effective and show much less effect in terms of glycemic control than earlier developed, face-to-face psychotherapeutic treatments, and demonstrate higher mortality rates in patients with diabetes mellitus or with multimorbidity, which gives reason for caution in the evaluation, testing and implementation of E-health and M-health models in patients with diabetes and depression. Further research into blended E-health models, in which the clinical diagnostic and treatment evaluation is strongly embedded, and with a focus not only on depression treatment, but also on diabetes control and taking mortality into account as outcome, is neede

Ten years of integrated care for mental disorders in the Netherlands

Background and problem statement: Integrated care for mental disorders aims to encompass forms of collaboration between different health care settings for the treatment of mental disorders. To this end, it requires integration at several levels, i.e. integration of psychiatry in medicine, of the psychiatric discourse in the medical discourse; of localization of mental health care and general health care facilities; and of reimbursement systems.  Description of policy practice: Steps have been taken in the last decade to meet these requirements, enabling psychiatry to move on towards integrated treatment of mental disorder as such, by development of a collaborative care model that includes structural psychiatric consultation that was found to be applicable and effective in several Dutch health care settings. This collaborative care model is a feasible and effective model for integrated care in several health care settings. The Bio Psycho Social System has been developed as a feasible instrument for assessment in integrated care as well.Discussion: The discipline of Psychiatry has moved from anti-psychiatry in the last century, towards an emancipated medical discipline. This enabled big advances towards integrated care for mental disorder, in collaboration with other medical disciplines, in the last decade.Conclusion: Now is the time to further expand this concept of care towards other mental disorders, and towards integrated care for medical and mental co-morbidity. Integrated care for mental disorder should be readily available to the patient, according to his/her preference, taking somatic co-morbidity into account, and with a focus on rehabilitation of the patient in his or her social roles.</p