Life satisfaction in persons with mental disorders

PURPOSE Life satisfaction refers to a cognitive and global evaluation of the quality of one's life as a whole. The arguably most often used measure of life satisfaction is the Satisfaction With Life Scale (SWLS). Persons with mental disorders generally report lower SWLS scores than healthy controls, yet there is a lack of studies that have compared different diagnostic groups, tested measurement invariance of the SWLS across these groups, and examined effects of treatment on life satisfaction. METHODS Data of 9649 inpatients of seven diagnostic categories were analyzed: depressive episode, recurrent depressive disorder, phobic disorders, obsessive-compulsive disorder, trauma-related disorders, somatoform disorders, and eating disorders. RESULTS The one-factor structure of the SWLS was replicated and full measurement invariance was demonstrated across groups. Patients with trauma-related disorders reported the lowest life satisfaction. Life satisfaction significantly increased during treatment across all groups and these changes were moderately related to changes in depressive symptoms. CONCLUSIONS Results support the excellent psychometric properties of the SWLS. They also demonstrate that although persons with mental disorder generally report lower life satisfaction than persons without mental disorders, life satisfaction also varies considerably between different diagnostic groups. Finally, results show that life satisfaction increases during inpatient treatment, although at discharge most patients have rarely reached levels of life satisfaction reported in non-clinical samples

Seasonal and subtype differences in body mass index at admission in inpatients with anorexia nervosa

Objective In the general population, body weight is—on average—higher in the winter than in the summer. In patients with anorexia nervosa (AN), however, the opposite pattern has been reported. Yet, only a handful of studies exist to date that suffer from small sample sizes and inconsistent results. Therefore, the current study examined seasonal effects on body weight in a large sample of patients with AN to dissolve previous inconsistencies. Method Clinical records of N = 606 inpatients (95.4% female) who received AN treatment at the Schoen Clinic Roseneck (Prien am Chiemsee, Germany) between 2014 and 2019 were analyzed. Results Patients with restrictive type AN had lower body mass index at admission in the winter than in the summer. This difference was not found for patients with binge/purge type AN and patients with atypical AN. Discussion Individuals with restrictive type AN show seasonal variations in body weight that are opposite to seasonal variations in body weight in individuals without AN. These seasonal effects are specific to the restrictive subtype and cannot be found for the binge/purge or atypical subtypes. Future studies that replicate this effect in other cultures or latitudes and that examine the mediating mechanisms are needed

Therapist-guidedsmartphone-based aftercare for inpatients with severeanorexianervosa (SMART-AN): Study protocol of a randomized controlled trial

Objective: Inpatient treatment for patients with anorexia nervosa (AN) is recommended in extreme or severe cases after failure of outpatient treatment and is highly effective. However, a number of patients show symptom increase and relapse after discharge. The aim of this study is to evaluate the efficacy of a therapist-guided smartphone-based aftercare intervention for inpatients with AN to support symptom stabilization. Method A total of 186 female patients with a DSM-5 diagnosis of AN (307.1) will be randomized either to receive a 16-week smartphone-based aftercare intervention with therapist feedback as add-on to treatment as usual (TAU) or TAU alone. Data will be assessed at discharge (= baseline, T0), after 16 weeks (= end of the aftercare intervention, T1) and after 10 months (= 6-month follow-up, T2). Primary outcome will be overall eating disorder symptomatology (Eating Disorder Examination Global score). Secondary outcome measures will include body mass index, depression, motivation to change, self-efficacy, patient satisfaction with and adherence to the smartphone-based aftercare intervention as well as rehospitalization rate. Discussion: This study will be the first randomized controlled trial to examine a therapist-guided smartphone-based aftercare intervention for inpatients with AN. Results may reveal whether and to which extent this novel intervention can support symptom stabilization after inpatient treatment

Specialized inpatient treatment of adult anorexia nervosa: effectiveness and clinical significance of changes

Background: Previous studies have predominantly evaluated the effectiveness of inpatient treatment for anorexia nervosa at the group level. The aim of this study was to evaluate treatment outcomes at an individual level based on the clinical significance of improvement. Patients' treatment outcomes were classified into four groups: deteriorated, unchanged, reliably improved and clinically significantly improved. Furthermore, the study set out to explore predictors of clinically significant changes in eating disorder psychopathology. Methods: A total of 435 inpatients were assessed at admission and at discharge on the following measures: body-mass-index, eating disorder symptoms, general psychopathology, depression and motivation for change. Results: 20.0-32.0% of patients showed reliable changes and 34.1-55.3% showed clinically significant changes in the various outcome measures. Between 23.0% and 34.5% remained unchanged and between 1.7% and 3.0% deteriorated. Motivation for change and depressive symptoms were identified as positive predictors of clinically significant changes in eating disorder psychopathology, whereas body dissatisfaction, impulse regulation, social insecurity and education were negative predictors. Conclusions: Despite high rates of reliable and clinically significant changes following intensive inpatient treatment, about one third of anorexia nervosa patients showed no significant response to treatment. Future studies should focus on the identification of non-responders as well as on the development of treatment strategies for these patients

Efficacy of a therapist‐guided smartphone‐based intervention to support recovery from bulimia nervosa: Study protocol of a randomized controlled multi‐centre trial

Objective Although inpatient treatment is highly effective for patients with bulimia nervosa (BN), some patients show a resurgence of symptoms and relapse after discharge. Therefore, the aim of this study is to evaluate the efficacy of a guided smartphone-based aftercare intervention following inpatient treatment to support recovery. Method 172 female patients with BN (DSM-5: 307.51) will be randomized to receive a 16-week smartphone-based aftercare intervention (German version of ‘Recovery Record’) with therapist feedback as an add-on element to treatment as usual (TAU) or TAU alone. Assessments will take place at baseline (discharge, T0), during the intervention (after 4 weeks, T1), post-intervention (after 16 weeks, T2) and at 6-month follow-up (T3). Primary outcome will be remission at T2. Moderator and mediator analyses will investigate for whom the aftercare intervention suits best and how it works. Conclusions This is the first randomized controlled trial to examine a guided smartphone-based aftercare intervention following inpatient treatment of patients with BN. We expect that this innovative aftercare intervention is highly accepted by the patients and that it has the potential to support recovery after inpatient treatment and thereby could contribute to improving aftercare for patients with BN

Improving Mild to Moderate Depression With an App-Based Self-Guided Intervention: Protocol for a Randomized Controlled Trial

Background: Depression is one of the most prevalent mental disorders and frequently co-occurs with other mental disorders. Despite the high direct and indirect costs to both individuals and society, more than 80% of those diagnosed with depression remain with their primary care physician and do not receive specialized treatment. Self-guided digital interventions have been shown to improve depression and, due to their scalability, have a large potential public health impact. Current digital interventions often focus on specific disorders, while recent research suggests that transdiagnostic approaches are more suitable. Objective: This paper presents the protocol for a study that aims to assess the efficacy of a self-guided transdiagnostic app-based self-management intervention in patients with mild or moderate depression with and without comorbid mental disorders. Specifically, we are investigating the impact of the intervention on symptoms of depression, quality of life, anxiety symptoms, and mental health–related patient empowerment and self-management skills. Methods: The intervention under investigation, MindDoc with Prescription, is a self-guided digital intervention aimed at supporting individuals with mild to moderate mental disorders from the internalizing spectrum, including depression. The app can be used as a low-threshold psychosocial intervention. Up to 570 adult patients will be randomized to either receive the intervention in addition to care as usual or only care as usual. We are including adults with a permanent residency in Germany and mild or moderate depression according to International Classification of Diseases, 10th Revision, criteria (F32.0, F32.1, F33.0, and F33.1). Clinical interviews will be conducted to confirm the diagnosis. Data will be collected at baseline as well as 8 weeks and 6 months after randomization. The primary outcome will be depression symptom severity after 8 weeks. Secondary outcomes will be quality of life, anxiety symptom severity, and patient empowerment and self-management behaviors. Data will be analyzed using multiple imputations, using the intention-to-treat principle, while sensitivity analyses will be based on additional imputation strategies and a per-protocol analysis. Results: Recruitment for the trial started on February 7, 2023, and the first participant was randomized on February 14, 2023. As of September 5, 2023, 275 participants have been included in the trial and 176 have provided the primary outcome. The rate of missing values in the primary outcome is approximately 20%. Conclusions: Data from this efficacy trial will be used to establish whether access to the intervention is associated with an improvement in depression symptoms in individuals diagnosed with mild or moderate depression. The study will contribute to expanding the evidence base on transdiagnostic digital interventions. Trial Registration: German Registry of Clinical Trials DRKS00030852; https://drks.de/search/de/trial/DRKS0003085

Langfristige Wirkung von Psychotherapie bei nichtchronischen Depressionen: Ein systematisches Review von Studien im Vergleich mit Pharmakotherapie

The short-term effects of psychotherapy and pharmacotherapy as monotherapy or in combination - in the treatment of depression have been documented in various studies. Strikingly, there are only a few studies proving the long-term efficacy 1 year or more after acute treatment. Therefore, a systematic review was conducted searching the databases Pubmed and PsychINFO. 13 randomized controlled trials (RCTs) could be retrieved (psychotherapy vs. pharmacotherapy in combination or as monotherapies). The follow-up period varied between 12 and 75 months (M = 27.06), cognitive behavioral therapy being the most frequently used psychotherapeutic strategy. The results indicate an advantage of psychotherapy alone or the combination of psychotherapy and pharmacotherapy when compared with pharmacotherapy alone. The advantage persisted even if the pharmacotherapy was maintained during the follow-up period. However, comparing studies is difficult due to methodological issues (e.g., selection of data relating to patients with or without therapy success after acute therapy;further treatments during follow-up). In order to make more valid statements about the long-term efficacy of psychotherapy and pharmacotherapy in the treatment of depression, more RCTs with longer follow-up periods are needed.Die kurzfristige Wirksamkeit von Psycho- und Pharmakotherapie bei Depressionen, ob als Monotherapie oder in Kombination, ist durch viele Studien gut belegt. Weitaus weniger Belege gibt es jedoch für die langfristige Wirksamkeit ab 1 Jahr nach Akuttherapie dieser Behandlungsformen. Durch eine systematische Suche in den Datenbanken Pubmed und PsychINFO konnten 13 randomisierte kontrollierte Studien (RCTs; Psychotherapie vs. Pharmakotherapie in Kombination oder als Monotherapien) identifiziert werden, bei denen Follow-up-Ergebnisse vorliegen; der entsprechende Follow-up-Zeitraum lag dabei zwischen 13 und 75 Monaten (M = 27,06). Meist kam als psychotherapeutisches Verfahren die kognitive Verhaltenstherapie zum Einsatz. Die Studienlage spricht für eine Überlegenheit der Psychotherapie oder der Kombination aus Psychotherapie und Pharmakotherapie im Vergleich zur Pharmakotherapie mit oder ohne Erhaltungsphase nach der Akutbehandlung bezüglich langfristiger Effekte über die Beendigung der Therapie hinaus. Die Studien sind aufgrund vielfältiger methodischer Faktoren nur begrenzt vergleichbar (z.B. hinsichtlich der Datenselektion zu Patienten mit und ohne Therapieerfolg nach Akuttherapie oder weiterer Behandlungen im Follow-up-Zeitraum). Um besser abgesicherte Aussagen zur langfristigen Wirksamkeit von Psycho- und Pharmakotherapie in der Behandlung der Depression treffen zu können, bedarf es weiterer RCTs mit längeren Follow-up-Zeiträumen. © 2016 S. Karger GmbH, Freibur

Comparing ICD‐11 and DSM‐5 eating disorder diagnoses with the Munich eating and feeding disorder questionnaire (ED‐Quest)

Objective The new ICD-11 eating disorders (ED) guidelines are similar to the DSM-5 criteria. One difference to the DSM-5 is the inclusion of subjective binges in the definition of bulimia nervosa (BN) and binge-eating disorder (BED). The aim of this study was to identify differences between the ICD-11 guidelines and DSM-5 ED criteria, which could impact access to medical care and early treatment. Method Data of 3863 ED inpatients who completed the Munich Eating and Feeding Disorder Questionnaire were analyzed using standardized diagnostic algorithms for DSM-5 and ICD-11. Results Agreement of diagnoses was high (Krippendorff's α = .88, 95% CI [.86, .89]) for anorexia nervosa (AN; 98.9%), BN (97.2%) and BED (100%), and lower for other feeding and eating disorders (OFED; 75.2%). Of the 721 patients with a DSM-5 OFED, 19.8% were diagnosed with AN, BN or BED by the ICD-11 diagnostic algorithm, reducing the number of OFED diagnoses. One-hundred and twenty-one patients received an ICD-11 diagnosis of BN or BED because of subjective binges. Discussion For over 90% of patients, applying either DSM-5 or ICD-11 diagnostic criteria/guidelines resulted in the same full-threshold ED diagnosis. Sub-threshold and feeding disorders exhibited a discrepancy of 25%. Public Significance Statement For about 98% of inpatients, the ICD-11 and DSM-5 agree on the same specified eating disorder diagnosis. This is important when comparing diagnoses made by different diagnostic systems. Including subjective binges in the definition of bulimia nervosa and binge-eating disorder contributes to improved ED diagnoses. Clarifying the wording of diagnostic criteria at several places could further increase this agreement

The Potential of Technology-Based Psychological Interventions for Anorexia and Bulimia Nervosa: A Systematic Review and Recommendations for Future Research

Background: Previous studies have shown an unmet need in the treatment of eating disorders. In the last decade, interest in technology-based interventions (TBIs) (including computer-and Internet-based interventions [CBIs] or mobile interventions) for providing evidence-based therapies to individuals with different mental disorders has increased. Objective: The aim of this review was to systematically evaluate the potential of TBIs in the field of eating disorders, namely for anorexia nervosa (AN) and bulimia nervosa (BN),for both prevention and treatment, and also for carers of eating disorder patients. Methods: A systematic literature search was conducted using Medline and PsycINFO. Bibliographies of retrieved articles were also reviewed without date or study type restrictions. Results: Forty studies resulting in 45 publications reporting outcomes fulfilled the inclusion criteria: 22 randomized controlled trials, 2 controlled studies, and 16 uncontrolled studies. In total, 3646 patients were included. Overall, the studies provided evidence for the efficacy of guided CBIs, especially for BN patients and for compliant patients. Furthermore, videoconferencing also appeared to be a promising approach. Evaluation results of Internet-based prevention of eating disorders and Internet-based programs for carers of eating disorder patients were also encouraging. Finally, there was preliminary evidence for the efficacy of mobile interventions. Conclusions: TBIs may be an additional way of delivering evidence-based treatments to eating disorder patients and their use is likely to increase in the near future. TBIs may also be considered for the prevention of eating disorders and to support carers of eating disorder patients. Areas of future research and important issues such as guidance, therapeutic alliance, and dissemination are discussed