140 results on '"van Marwijk, Harm W. J."'
Search Results
2. Management of patients with persistent medically unexplained symptoms: a descriptive study
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Sitnikova, Kate, Pret-Oskam, Rinske, Dijkstra-Kersten, Sandra M. A., Leone, Stephanie S., van Marwijk, Harm W. J., van der Horst, Henriëtte E., and van der Wouden, Johannes C.
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- 2018
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3. Selective Serotonin Reuptake Inhibitors
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Moncrieff, Joanna, van Marwijk, Harm W. J., Adèr, Herman J., Peveler, Robert, and Kendrick, Tony
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- 2005
4. General Practice Postal Surveys: A Questionnaire Too Far?
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McAvoy, Brian R., Kaner, Eileen F. S., Lydeard, Sue, Springer, Machiel P., and Van Marwijk, Harm W. J.
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- 1996
5. Patient Factors Associated with Guideline-concordant Treatment of Anxiety and Depression in Primary Care
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Prins, Marijn A., Verhaak, Peter F. M., Smolders, Mirrian, Laurant, Miranda G. H., van der Meer, Klaas, Spreeuwenberg, Peter, van Marwijk, Harm W. J., Penninx, Brenda W. J. H., and Bensing, Jozien M.
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- 2010
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6. Test–retest reliability of the PRIME-MD: limitations in diagnosing mental disorders in primary care
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Bakker, Ingrid M., Terluin, Berend, van Marwijk, Harm W. J., van Mechelen, Willem, and Stalman, Wim A. B.
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- 2009
7. Selective serotonin reuptake inhibitors: Placebo washouts inflate antidepressant effects in general practice
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van Marwijk, Harm W J and Adèr, Herman J
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- 2005
8. Case-finding of dementia in general practice and effects of subsequent collaborative care; design of a cluster RCT
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van den Dungen Pim, Moll van Charante Eric P, van Marwijk Harm W J, van der Horst Henriëtte E, van de Ven Peter M, and van Hout Hein P J
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Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background In the primary care setting, dementia is often diagnosed relatively late in the disease process. Case finding and proactive collaborative care may have beneficial effects on both patient and informal caregiver by clarifying the cause of cognitive decline and changed behaviour and by enabling support, care planning and access to services. We aim to improve the recognition and diagnosis of individuals with dementia in general practice. In addition to this diagnostic aim, the effects of case finding and subsequent care on the mental health of individuals with dementia and the mental health of their informal carers are explored. Methods and design Design: cluster randomised controlled trial with process evaluation. Participants: 162 individuals ≥ 65 years, in 15 primary care practices, in whom GPs suspect cognitive impairment, but without a dementia diagnosis. Intervention; case finding and collaborative care: 2 trained practice nurses (PNs) invite all patients with suspected cognitive impairment for a brief functional and cognitive screening. If the cognitive tests are supportive of cognitive impairment, individuals are referred to their GP for further evaluation. If dementia is diagnosed, a comprehensive geriatric assessment takes place to identify other relevant geriatric problems that need to be addressed. Furthermore, the team of GP and PN provide information and support. Control: GPs provide care and diagnosis as usual. Main study parameters: after 12 months both groups are compared on: 1) incident dementia (and MCI) diagnoses and 2) patient and caregiver quality of life (QoL-AD; EQ5D) and mental health (MH5; GHQ 12) and caregiver competence to care (SSCQ). The process evaluation concerns facilitating and impeding factors to the implementation of this intervention. These factors are assessed on the care provider level, the care recipient level and on the organisational level. Discussion This study will provide insight into the diagnostic yield and the clinical effects of case finding and collaborative care for individuals with suspected cognitive impairment, compared to usual care. A process evaluation will give insight into the feasibility of this intervention. The first results are expected in the course of 2013. Trial registration NTR3389
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- 2012
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9. Comparative effect of collaborative care, pain medication, and duloxetine in the treatment of depression and comorbid pain in outpatient care: results of a randomized, placebo-controlled, multi-center trial
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de Heer, Eric W, Dekker, Jack, Beekman, Aartjan T F, van Marwijk, Harm W J, Holwerda, Tjalling J, Bet, Pierre M, Roth, Joost, Timmerman, Lotte, and van der Feltz-Cornelis, Christina M
- Abstract
Objective: Evidence exists for efficacy of collaborative care (CC) against MDD, for efficacy of consequent use of pain medication against pain, and for efficacy of duloxetine against both MDD and neuropathic pain. However, their relative effectiveness in comorbid major depression (MDD) and pain has never been established so far. This study evaluates the effectiveness of CC, pain medication and duloxetine, and CC, pain medication and placebo, compared to duloxetine alone, on depressive and pain outcomes.\ud Methods:\ud Three armed cluster randomized multi-centre placebo controlled trial in consecutive patients presented at three specialized mental health outpatient clinics who screened positive for MDD. All interventions lasted 12 weeks. In the CC groups duloxetine or placebo was prescribed. Pain medication was administered according to an algorithm that avoids opiate prescription as much as possible as an alternative to the current WHO pain ladder, with paracetamol, COX inhibitors and pregabalin as steps before opiates are considered. Patients who did not show up for three or more sessions were registered as noncompliant. Explorative, intention-to-treat and per protocol, multilevel regression analyses were performed. The trial is listed in the trial registration (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1089; NTR number: NTR1089).\ud Results:\ud This study was prematurely terminated because of massive reorganisations and reimbursement changes for mental health care during the study. 60 patients completed the study. Patients in all treatment groups reported significant less depressive and pain symptoms after 12 weeks. CC with placebo condition showed the fastest decrease of depressive symptoms compared to the duloxetine alone group (b = -.78; p = .01), Noncompliant patients did not improve over the 12 weeks period. Pain outcomes did not differ between the three groups.\ud Conclusions: In MDD and pain, compliance of patients and placebo effects are more important than choice of one of the three treatments. Active pain management in CC with COX inhibitors and pregabalin as alternatives to Tramadol or other opiates might provide an attractive alternative to the current WHO pain ladder as it avoids opiate prescription as much as possible. The study was sufficiently powered to show an exploratory result, but the generalizability is limited due to the small sample size. Larger studies are needed.
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- 2018
10. A supported self-help for recurrent depression in primary care; An economic evaluation alongside a multi-center randomised controlled trial
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Biesheuvel-Leliefeld, Karolien E. M., primary, Bosmans, Judith E., additional, Dijkstra-Kersten, Sandra M. A., additional, Smit, Filip, additional, Bockting, Claudi L. H., additional, van Schaik, Digna J. F., additional, van Marwijk, Harm W. J., additional, and van der Horst, Henriette E., additional
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- 2018
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11. Predictors of Persistent Medically Unexplained Physical Symptoms: Findings From a General Population Study
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van Eck van der Sluijs, Jonna F., primary, ten Have, Margreet, additional, de Graaf, Ron, additional, Rijnders, Cees A. Th., additional, van Marwijk, Harm W. J., additional, and van der Feltz-Cornelis, Christina M., additional
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- 2018
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12. Two-year effectiveness of a stepped-care depression prevention intervention and predictors of incident depression in primary care patients with diabetes type 2 and/or coronary heart disease and subthreshold depression: data from the Step-Dep cluster randomised controlled trial
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Pols, Alide Danielle, primary, Adriaanse, Marcel C, additional, van Tulder, Maurits W, additional, Heymans, Martijn W, additional, Bosmans, Judith E, additional, van Dijk, Susan E, additional, and van Marwijk, Harm W J, additional
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- 2018
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13. Commentary: an opposing view from the Netherlands
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Springer, Machiel P. and van Marwijk, Harm W. J.
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- 1996
14. Effectiveness of supported self-help in recurrent depression: a randomized controlled trial in primary care
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Biesheuvel-Leliefeld, Karolien E M, Dijkstra-Kersten, Sandra M A, van Schaik, Digna J F, van Marwijk, Harm W J, Smit, Filip, van der Horst, Henriette E, Bockting, Claudi L H, Leerstoel Bockting, Clinical Psychology (onderzoeksprogramma), Leerstoel Bockting, Clinical Psychology (onderzoeksprogramma), General practice, EMGO - Mental health, Psychiatry, APH - Mental Health, Epidemiology and Data Science, APH - Aging & Later Life, Adult Psychiatry, Amsterdam Neuroscience - Mood, Anxiety, Psychosis, Stress & Sleep, and APH - Personalized Medicine
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Rate ratio ,Self-help ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Depressive Disorder, Major/therapy ,Quality of life ,Randomized controlled trial ,law ,Recurrence ,medicine ,History of depression ,Humans ,Psychiatry ,Applied Psychology ,Depressive Disorder, Major ,Depressive Disorder ,Cognitive Behavioral Therapy ,Primary Health Care ,business.industry ,Depression ,Prevention ,Absolute risk reduction ,General Medicine ,Major/therapy ,Middle Aged ,Primary care ,030227 psychiatry ,Cognitive behavioral therapy ,Self Care ,Psychotherapy ,Psychiatry and Mental health ,Clinical Psychology ,Treatment Outcome ,Number needed to treat ,Cognitive therapy ,Physical therapy ,Female ,business ,030217 neurology & neurosurgery - Abstract
Background: The burden and economic consequences of depression are high, mostly due to its recurrent nature. Due to current budget and time restraints, a preventive, low- cost, accessible minimal intervention is much needed. In this study, we evaluated the effectiveness of a supported self-help preventive cognitive therapy (S-PCT) added to treatment as usual (TAU) in primary care, compared to TAU alone. Methods: We conducted a randomized controlled trial among 248 patients with a history of depression, currently in full or partial remission or recovery. Participants were randomized to TAU augmented with S-PCT (n = 124) or TAU alone (n = 124). S-PCT consisted of an 8-week self-help intervention, supported by weekly telephone guidance by a counselor. The intervention included a self-help book that could be read at home. The primary outcome was the incidence of relapse or recurrence and was assessed over the telephone by the Structured Clinical Interview for DSM-IV axis 1 disorders. Participants were observed for 12 months. Secondary outcomes were depressive symptoms, quality of life (EQ-5D and SF-12), comorbid psychopathology, and self-efficacy. These secondary outcomes were assessed by digital questionnaires. Results: In the S-PCT group, 44 participants (35.5%) experienced a relapse or recurrence, compared to 62 participants (50.0%) in the TAU group (incidence rate ratio = 0.71, 95% CI 0.52-0.97; risk difference = 14, 95% CI 2-24, number needed to treat = 7). Compared to the TAU group, the S-PCT group showed a significant reduction in depressive symptoms over 12 months (mean difference -2.18; 95% CI -3.09 to -1.27) and a significant increase in quality of life (EQ-5D) (mean difference 0.04; 95% CI 0.004-0.08). S-PCT had no effect on comorbid psychopathology, self-efficacy, and quality of life based on the SF-12. Conclusions: A supported self-help preventive cognitive therapy, guided by a counselor in primary care, proved to be effective in reducing the burden of recurrent depression.
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- 2017
15. Effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression: A pragmatic cluster randomized controlled trial
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Barengo, Noel Christopher, Pols, Alide D, van Dijk, Susan E, Bosmans, Judith E, Hoekstra, Trynke, van Marwijk, Harm W J, van Tulder, Maurits W, Adriaanse, Marcel C, Health Economics and Health Technology Assessment, Methodology and Applied Biostatistics, Health Sciences, APH - Health Behaviors & Chronic Diseases, APH - Methodology, APH - Mental Health, AMS - Sports and Work, APH - Societal Participation & Health, AMS - Ageing and Morbidity, General practice, and Epidemiology and Data Science
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Male ,Time Factors ,Medical Doctors ,Health Care Providers ,lcsh:Medicine ,Nurses ,Coronary Disease ,Comorbidity ,Severity of Illness Index ,Vascular Medicine ,0302 clinical medicine ,Endocrinology ,Surveys and Questionnaires ,Medicine and Health Sciences ,Cluster Analysis ,Coronary Heart Disease ,030212 general & internal medicine ,lcsh:Science ,Problem Solving ,Netherlands ,Medicine(all) ,Multidisciplinary ,Agricultural and Biological Sciences(all) ,Depression ,Incidence ,Middle Aged ,Type 2 Diabetes ,Self-Help Groups ,Professions ,Female ,Research Article ,Drug Research and Development ,Patients ,Endocrine Disorders ,Cardiology ,Research and Analysis Methods ,03 medical and health sciences ,SDG 3 - Good Health and Well-being ,General Practitioners ,Physicians ,Mental Health and Psychiatry ,Diabetes Mellitus ,Humans ,Clinical Trials ,Watchful Waiting ,Primary Care ,Aged ,Pharmacology ,Depressive Disorder, Major ,Primary Health Care ,Mood Disorders ,Biochemistry, Genetics and Molecular Biology(all) ,lcsh:R ,Randomized Controlled Trials ,030227 psychiatry ,Health Care ,Diabetes Mellitus, Type 2 ,Metabolic Disorders ,People and Places ,lcsh:Q ,Population Groupings ,Clinical Medicine ,Follow-Up Studies - Abstract
Purpose\ud \ud Given the public health significance of poorly treatable co-morbid major depressive disorders (MDD) among patients with type 2 diabetes mellitus (DM2) and coronary heart disease (CHD), we need to investigate whether strategies to prevent the development of major depression could reduce its burden of disease. We therefore evaluated the effectiveness of a stepped-care program for subthreshold depression in comparison with usual care in patients with DM2 and/or CHD.\ud \ud Methods\ud \ud A cluster randomized controlled trial, with 27 primary care centers serving as clusters. A total of 236 DM2 and/or CHD patients with subthreshold depression (nine item Patient Health Questionnaire (PHQ-9) score ≥ 6, no current MDD according to DSM-IV criteria) were allocated to the intervention group (N = 96) or usual care group (n = 140). The stepped-care program was delivered by trained practice nurses during one year and consisted of four sequential treatment steps: watchful waiting, guided self-help, problem solving treatment and referral to the general practitioner. The primary outcome was the 12-month cumulative incidence of MDD as measured with the Mini International Neuropsychiatric Interview (MINI). Secondary outcomes included severity of depression (measured by PHQ-9) at 3, 6, 9 and 12 months.\ud \ud Results\ud \ud Of 236 patients (mean age, 67,5 (SD 10) years; 54.7% men), 210 (89%) completed the MINI at 12 months. The cumulative incidence of MDD was 9 of 89 (10.1%) participants in the intervention group and 12 of 121 (9.9%) participants in the usual care group. We found no statistically significant overall effect of the intervention (OR = 1.21; 95% confidence interval (0.12 to 12.41)) and there were no statistically significant differences in the course or severity of depressive symptoms between the two groups.\ud \ud Conclusions\ud \ud This study suggest that Step-Dep was not more effective in preventing MDD than usual care in a primary care population with DM2 and/or CHD and subthreshold depression.
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- 2017
16. Comparative Effect of Collaborative Care, Pain Medication, and Duloxetine in the Treatment of Major Depressive Disorder and Comorbid (Sub)Chronic Pain: Results of an Exploratory Randomized, Placebo-Controlled, Multicenter Trial (CC:PAINDIP)
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de Heer, Eric W., primary, Dekker, Jack, additional, Beekman, Aartjan T. F., additional, van Marwijk, Harm W. J., additional, Holwerda, Tjalling J., additional, Bet, Pierre M., additional, Roth, Joost, additional, Timmerman, Lotte, additional, and van der Feltz-Cornelis, Christina M., additional
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- 2018
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17. Effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression: A pragmatic cluster randomized controlled trial
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Pols, Alide D., primary, van Dijk, Susan E., additional, Bosmans, Judith E., additional, Hoekstra, Trynke, additional, van Marwijk, Harm W. J., additional, van Tulder, Maurits W., additional, and Adriaanse, Marcel C., additional
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- 2017
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18. The CIPRUS study, a nurse-led psychological treatment for patients with undifferentiated somatoform disorder in primary care: study protocol for a randomised controlled trial
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Sitnikova, Kate, primary, Leone, Stephanie S., additional, Zonneveld, Lyonne N. L., additional, van Marwijk, Harm W. J., additional, Bosmans, Judith E., additional, van der Wouden, Johannes C., additional, and van der Horst, Henriëtte E., additional
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- 2017
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19. Process evaluation of a stepped-care program to prevent depression in primary care: patients’ and practice nurses’ experiences
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Pols, Alide D., primary, Schipper, Karen, additional, Overkamp, Debbie, additional, van Dijk, Susan E., additional, Bosmans, Judith E., additional, van Marwijk, Harm W. J., additional, Adriaanse, Marcel C., additional, and van Tulder, Maurits W., additional
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- 2017
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20. Case Finding of Mild Cognitive Impairment and Dementia and Subsequent Care; Results of a Cluster RCT in Primary Care
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van den Dungen, Pim, primary, Moll van Charante, Eric P., additional, van de Ven, Peter M., additional, van Marwijk, Harm W. J., additional, van der Horst, Henriëtte E., additional, and van Hout, Hein P. J., additional
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- 2016
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21. Cross-cultural validation of the Turkish Four-Dimensional Symptom Questionnaire (4DSQ) using differential item and test functioning (DIF and DTF) analysis
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Terluin, Berend, primary, Unalan, Pemra C., additional, Turfaner Sipahioğlu, Nurver, additional, Arslan Özkul, Seda, additional, and van Marwijk, Harm W. J., additional
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- 2016
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22. The association between medically unexplained physical symptoms and health care use over two years and the influence of depressive and anxiety disorders and personality traits: a longitudinal study
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den Boeft, Madelon, primary, Twisk, Jos W. R., additional, Terluin, Berend, additional, Penninx, Brenda W. J. H., additional, van Marwijk, Harm W. J., additional, Numans, Mattijs E., additional, van der Wouden, Johannes C., additional, and van der Horst, Henriette E., additional
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- 2016
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23. Reliability of consultation skills assessments using standardised versus real patients
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Reinders, Marcel E., Blankenstein, Annette H., van Marwijk, Harm W. J., Knol, Dirk L, Ram, Paul, van der Horst, Henriette E., de Vet, Henrica C. W., van der Vleuten, Cees P. M., Family Medicine, Onderwijsontw & Onderwijsresearch, and RS: SHE School of Health Professions Education
- Abstract
Objectives Training in and assessment of consultation skills are high on the agenda of vocational training institutes for postgraduate training. There is a need to establish valid and reliable instruments to assess consultation skills in authentic settings. We investigated the number of assessors and observations needed to achieve reliable assessments of the consultation skills of general practice trainees (GPTs) using a communication instrument (MAAS-Global) and either standardised patient (SP) encounters or videotaped real patient (RP) encounters. Methods Eight teachers at the Vrije Universiteit (VU) University Medical Centre in Amsterdam attended a training course on the use of the MAAS-Global instrument, which they subsequently used to assess the consultation skills of 53 GPTs in 176 videotaped consultations (102 with SPs, 74 with RPs). All consultations were randomly allocated and assessed by two teachers independently. The reliability of the ratings was estimated using generalisability theory. Results It was easier to obtain acceptable reliability using RP consultations than SP consultations. Two assessors and five consultations were required to achieve minimal reliability (generalisability coefficient 0.7) with RPs, whereas three assessors and 30 consultations were needed to achieve minimal reliability with SPs. Conclusions Inter-observer and context variability in the assessment of the consultation skills of GPTs remains high. To achieve acceptable levels of reliability, large samples of observations are required in both formats, but, interestingly, RP encounters require a smaller sample than SP encounters.
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- 2011
24. Dutch family physicians’ awareness of cognitive impairment among the elderly
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van den Dungen, Pim, primary, Moll van Charante, Eric P., additional, van de Ven, Peter M., additional, Foppes, Gerbrand, additional, van Campen, Jos P. C. M., additional, van Marwijk, Harm W. J., additional, van der Horst, Henriëtte E., additional, and van Hout, Hein P. J., additional
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- 2015
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25. Depression increases the onset of cardiovascular disease over and above other determinants in older primary care patients, a cohort study
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van Marwijk, Harm W. J., primary, van der Kooy, Koen G., additional, Stehouwer, Coen D. A., additional, Beekman, Aartjan T. F., additional, and van Hout, Hein P. J., additional
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- 2015
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26. The Association of Depression and Anxiety with Pain: A Study from NESDA
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de Heer, Eric W., primary, Gerrits, Marloes M. J. G., additional, Beekman, Aartjan T. F., additional, Dekker, Jack, additional, van Marwijk, Harm W. J., additional, de Waal, Margot W. M., additional, Spinhoven, Philip, additional, Penninx, Brenda W. J. H., additional, and van der Feltz-Cornelis, Christina M., additional
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- 2014
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27. Effects of Two-Year Vitamin B12 and Folic Acid Supplementation on Depressive Symptoms and Quality of Life in Older Adults with Elevated Homocysteine Concentrations: Additional Results from the B-PROOF Study, an RCT.
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de Koning, Elisa J., van der Zwaluw, Nikita L., van Wijngaarden, Janneke P., Sohl, Evelien, Brouwer-Brolsma, Elske M., van Marwijk, Harm W. J., Enneman, Anke W., Swart, Karin M. A., van Dijk, Suzanne C., Ham, Annelies C., van der Velde, Nathalie, Uitterlinden, André G., Penninx, Brenda W. J. H., Elders, Petra J. M., Lips, Paul, Dhonukshe-Rutten, Rosalie A. M., van Schoor, Natasja M., and de Groot, Lisette C. P. G. M.
- Abstract
Lowering elevated plasma homocysteine (Hcy) concentrations by supplementing vitamin B
12 and folic acid may reduce depressive symptoms and improve health-related quality of life (HR-QoL) in older adults. This study aimed to test this hypothesis in a randomized controlled trial. Participants (N = 2919, ≥65 years, Hcy concentrations ≥12 µmol/L) received either 500 µg vitamin B12 and 400 µg folic acid daily or placebo for two years. Both tablets contained 15 µg vitamin D3 . Depressive symptoms were measured with the Geriatric Depression Scale-15 (GDS-15). HR-QoL was assessed with the SF-12 Mental and Physical component summary scores and the EQ-5D Index score and Visual Analogue Scale. Differences in two-year change scores were analyzed with Analysis of Covariance (ANCOVA). Hcy concentrations decreased more in the intervention group, but two-year change scores of the GDS-15 and three of four HR-QoL measures did not differ between groups. The EQ-5D Index score declined less in the intervention group than in the placebo group (mean change 0.00 vs. -0.02, p = 0.004). In conclusion, two-year supplementation with vitamin B12 and folic acid in older adults with hyperhomocysteinemia showed that lowering Hcy concentrations does not reduce depressive symptoms, but it may have a small positive effect on HR-QoL. [ABSTRACT FROM AUTHOR]- Published
- 2016
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28. Long-term antidepressant use: a qualitative study on perspectives of patients and GPs in primary care.
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Bosman, Renske C., Huijbregts, Klaas M., Verhaak, Peter F. M., Ruhé, Henricus G., van Marwijk, Harm W. J., van Balkom, Anton J. L. M., Batelaan, Neeltje M., Verhaak, Peter Fm, van Marwijk, Harm Wj, and van Balkom, Anton Jlm
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ANTIDEPRESSANTS ,MENTAL depression ,THERAPEUTICS ,ANXIETY ,PATIENT acceptance of health care ,HEALTH outcome assessment ,ATTITUDE (Psychology) ,DRUG administration ,FAMILY medicine ,INTERVIEWING ,LONG-term health care ,RESEARCH methodology ,MEDICAL personnel ,PRIMARY health care ,QUALITATIVE research ,TREATMENT effectiveness ,ANXIETY disorders ,PSYCHOLOGY - Abstract
Background: Antidepressant use is often prolonged in patients with anxiety and/or depressive disorder(s) compared with recommendations in treatment guidelines to discontinue after sustained remission.Aim: To unravel the motivations of patients and GPs causing long-term antidepressant use and to gain insight into possibilities to prevent unnecessary long-term use.Design and Setting: Qualitative study using semi-structured, in-depth interviews with patients and GPs in the Netherlands.Method: Patients with anxiety and/or depressive disorder(s) (n = 38) and GPs (n = 26) were interviewed. Innovatively, the interplay between patients and their GPs was also investigated by means of patient-GP dyads (n = 20).Results: The motives and barriers of patients and GPs to continue or discontinue antidepressants were related to the availability of supportive guidance during discontinuation, the personal circumstances of the patient, and considerations of the patient or GP. Importantly, dyads indicated a large variation in policies of general practices around long-term use and continuation or discontinuation of antidepressants. Dyads further indicated that patients and GPs seemed unaware of each other's (mismatching) expectations regarding responsibility to initiate discussing continuation or discontinuation.Conclusion: Although motives and barriers to antidepressant continuation or discontinuation were related to the same themes for patients and GPs, dyads indicated discrepancies between them. Discussion between patients and GPs about antidepressant use and continuation or discontinuation may help clarify mutual expectations and opinions. Agreements between a patient and their GP can be included in a patient-tailored treatment plan. [ABSTRACT FROM AUTHOR]- Published
- 2016
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29. Mental health care use in medically unexplained and explained physical symptoms: findings from a general population study.
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van Eck van der Sluijs, Jonna F., ten Have, Margreet, Rijnders, Cees A., van Marwijk, Harm W. J., de Graaf, Ron, and van der Feltz-Cornelis, Christina M.
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MENTAL health ,MENTAL illness ,PATHOLOGICAL psychology ,MENTAL health services ,MEDICAL care - Abstract
Objective: The aim of this study was to explore mental health care utilization patterns in primary and specialized mental health care of people with unexplained or explained physical symptoms. Methods: Data were derived from the first wave of the Netherlands Mental Health Survey and Incidence Study-2, a nationally representative face-to-face cohort study among the general population aged 18-64 years. We selected subjects with medically unexplained symptoms (MUS) only (MUSonly; n=177), explained physical symptoms only (PHYonly, n=1,952), combined MUS and explained physical symptoms (MUS + PHY, n=209), and controls without physical symptoms (NONE, n=4,168). We studied entry into mental health care and the number of treatment contacts for mental problems, in both primary care and specialized mental health care. Analyses were adjusted for sociodemographic characteristics and presence of any 12-month mental disorder assessed with the Composite International Diagnostic Interview 3.0. Results: At the primary care level, all three groups of subjects with physical symptoms showed entry into care for mental health problems significantly more often than controls. The adjusted odds ratios were 2.29 (1.33, 3.95) for MUSonly, 1.55 (1.13, 2.12) for PHYonly, and 2.25 (1.41, 3.57) for MUS + PHY. At the specialized mental health care level, this was the case only for MUSonly subjects (adjusted odds ratio 1.65 [1.04, 2.61]). In both the primary and specialized mental health care, there were no significant differences between the four groups in the number of treatment contacts once they entered into treatment. Conclusion: All sorts of physical symptoms, unexplained as well as explained, were associated with significant higher entry into primary care for mental problems. In specialized mental health care, this was true only for MUSonly. No differences were found in the number of treatment contacts. This warrants further research aimed at the content of the treatment contacts. [ABSTRACT FROM AUTHOR]
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- 2016
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30. Collaborative care for anxiety disorders in primary care: a systematic review and meta-analysis.
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Muntingh, Anna D. T., van der Feltz-Cornelis, Christina M., van Marwijk, Harm W. J., Spinhoven, Philip, and van Balkom, Anton J. L. M.
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ANXIETY treatment ,ANXIETY ,CINAHL database ,INFORMATION storage & retrieval systems ,MEDICAL databases ,MEDICAL information storage & retrieval systems ,PSYCHOLOGY information storage & retrieval systems ,MEDICAL practice ,MEDLINE ,META-analysis ,ONLINE information services ,PRIMARY health care ,SYSTEMATIC reviews ,TREATMENT effectiveness - Abstract
Background: Studies evaluating collaborative care for anxiety disorders are recently emerging. A systematic review and meta-analysis to estimate the effect of collaborative care for adult patients with anxiety disorders in primary care is therefore warranted. Methods: A literature search was performed. Data sources: PubMed, Psycinfo, Embase, Cinahl, and the Cochrane library. Study eligibility criteria: Randomized controlled trials examining the effects of collaborative care for adult primary care patients with an anxiety disorder, compared to care as usual or another intervention. Synthesis methods: Standardized mean differences (SMD) on an anxiety scale closest to twelve months follow-up were calculated and pooled in a random effects meta-analysis. Results: Of the 3073 studies found, seven studies were included with a total of 2105 participants. Included studies were of moderate to high quality. Collaborative care was superior to care as usual, with a small effect size (SMD = 0.35 95 % CI 0.14-0.56) for all anxiety disorders combined and a moderate effect size (SMD = 0.59, 95 % CI 0.41-0.78) in a subgroup analysis (five studies) on patients with panic disorder. Conclusions: Collaborative care seems to be a promising strategy for improving primary care for anxiety disorders, in particular panic disorder. However, the number of studies is still small and further research is needed to evaluate the effectiveness in other anxiety disorders. [ABSTRACT FROM AUTHOR]
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- 2016
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31. Non-fatal disease burden for subtypes of depressive disorder: population-based epidemiological study.
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Biesheuvel-Leliefeld, Karolien E. M., Kok, Gemma D., Bockting, Claudi L. H., de Graaf, Ron, ten Have, Margreet, van der Horst, Henriette E., van Schaik, Anneke, van Marwijk, Harm W. J., and Smit, Filip
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DEPRESSED persons ,EPIDEMIOLOGICAL research ,PSYCHIATRIC research ,MENTAL health ,DIAGNOSIS of mental depression - Abstract
Background: Major depression is the leading cause of non-fatal disease burden. Because major depression is not a homogeneous condition, this study estimated the non-fatal disease burden for mild, moderate and severe depression in both single episode and recurrent depression. All estimates were assessed from an individual and a population perspective and presented as unadjusted, raw estimates and as estimates adjusted for comorbidity. Methods: We used data from the first wave of the second Netherlands-Mental-Health-Survey-and-Incidence-Study (NEMESIS-2, n = 6646; single episode Diagnostic and Statistical Manual (DSM)-IV depression, n = 115; recurrent depression, n = 246). Disease burden from an individual perspective was assessed as 'disability weight * time spent in depression' for each person in the dataset. From a population perspective it was assessed as 'disability weight * time spent in depression *number of people affected'. The presence of mental disorders was assessed with the Composite International Diagnostic Interview (CIDI) 3.0. Results: Single depressive episodes emerged as a key driver of disease burden from an individual perspective. From a population perspective, recurrent depressions emerged as a key driver. These findings remained unaltered after adjusting for comorbidity. Conclusions: The burden of disease differs between the subtype of depression and depends much on the choice of perspective. The distinction between an individual and a population perspective may help to avoid misunderstandings between policy makers and clinicians. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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32. Vitamin D supplementation to prevent depression and poor physical function in older adults: Study protocol of the D-Vitaal study, a randomized placebo-controlled clinical trial.
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de Koning, Elisa J., van Schoor, Natasja M., Penninx, Brenda W. J. H., Elders, Petra J. M., Heijboer, Annemieke C., Smit, Jan. H., Bet, Pierre M., van Tulder, Maurits W., den Heijer, Martin, van Marwijk, Harm W. J., and Lips, Paul
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VITAMIN D in human nutrition ,PREVENTION of mental depression ,QUALITY of life ,ANXIETY ,RANDOMIZED controlled trials ,DIAGNOSIS of mental depression ,THERAPEUTICS ,ACTIVITIES of daily living ,COGNITION ,COMPARATIVE studies ,MENTAL depression ,DIETARY supplements ,RESEARCH methodology ,MEDICAL cooperation ,MOTOR ability ,HEALTH outcome assessment ,RESEARCH ,STATISTICAL sampling ,VITAMIN D ,VITAMINS ,EVALUATION research ,BLIND experiment ,PSYCHOLOGY - Abstract
Background: Depressive symptoms and decreased physical functioning are interrelated conditions and common in older persons, causing significant individual and societal burden. Evidence suggests that vitamin D supplementation may be beneficial for both mental and physical functioning. However, previous randomized controlled trials have yielded inconsistent results and often had suboptimal designs. This study examines the effect of vitamin D supplementation on both depressive symptoms and physical functioning in a high-risk population of older persons with low vitamin D status.Methods/design: The D-Vitaal study is a randomized, double-blind, placebo-controlled trial investigating the effects of a daily dose of 1200 IU vitamin D3 versus placebo for one year on depressive symptoms and physical functioning (primary outcomes) in older adults. Participants (N = 155, age 60-80 years) were recruited from the general population. Eligibility criteria included the presence of depressive symptoms, ≥1 functional limitation and serum 25-hydroxyvitamin D levels between 15 and 50/70 nmol/L (depending on season). Secondary outcomes include incidence of major depressive disorder, anxiety symptoms, health-related quality of life, cognitive function and cost-effectiveness of the intervention.Discussion: With this study, we aim to elucidate the effects of vitamin D supplementation on depressive symptoms and physical functioning in older persons who are at high risk of developing more substantial mental and physical problems. If effective, vitamin D supplementation can be a preventive intervention strategy that is easy to implement in the primary care setting.Trial Registration: Netherlands Trial Register NTR3845. Registered 6 February 2013. [ABSTRACT FROM AUTHOR]- Published
- 2015
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33. Effectiveness of Family Meetings for Family Caregivers on Delaying Time to Nursing Home Placement of Dementia Patients: A Randomized Trial
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Joling, Karlijn J., primary, van Marwijk, Harm W. J., additional, van der Horst, Henriëtte E., additional, Scheltens, Philip, additional, van de Ven, Peter M., additional, Appels, Bregje A., additional, and van Hout, Hein P. J., additional
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- 2012
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34. Does a Family Meetings Intervention Prevent Depression and Anxiety in Family Caregivers of Dementia Patients? A Randomized Trial
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Joling, Karlijn J., primary, van Marwijk, Harm W. J., additional, Smit, Filip, additional, van der Horst, Henriëtte E., additional, Scheltens, Philip, additional, van de Ven, Peter M., additional, Mittelman, Mary S., additional, and van Hout, Hein P. J., additional
- Published
- 2012
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35. A Cluster-Randomised Trial Evaluating an Intervention for Patients with Stress-Related Mental Disorders and Sick Leave in Primary Care
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Bakker, Ingrid M, primary, Terluin, Berend, additional, van Marwijk, Harm W. J, additional, van der Windt, Daniëlle A. W. M, additional, Rijmen, Frank, additional, van Mechelen, Willem, additional, and Stalman, Wim A. B, additional
- Published
- 2007
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36. Implementing an outreaching, preference-led stepped care intervention programme to reduce late life depressive symptoms: results of a mixed-methods study.
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van Beljouw, Ilse M. J., Laurant, Miranda G. H., Heerings, Marjolijn, Stek, Max L., van Marwijk, Harm W. J., and van Exel, Eric
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MENTAL depression ,HOME care services ,CONDUCT of life ,HUMAN ecology ,BLOOD pressure - Abstract
Background Depressive symptoms are highly prevalent in old age, but they remain mostly untreated. Several clinical trials have shown promising results in preventing or reducing depressive symptoms. However, it is not clear how robust these effects are in the real world of day-today care. Therefore, we have implemented the 'Lust for Life' programme, which significantly reduced depressive symptoms in community-dwelling older adults in the first three months after implementation. This mixed-methods study was conducted alongside the trial to develop a contextualised understanding of factors affecting the implementation. Methods A total of 263 persons of 65 years and older with depressive symptoms were recruited from 18 general practices and home care organizations in the Netherlands. We used qualitative data (in-depth interviews and focus group discussions with participants with depressive symptoms and healthcare professionals) as well as quantitative data (longitudinal data on the severity of depressive symptoms) to explore hindering and facilitating factors to the implementation of the 'Lust for Life' programme. Results The uptake of the routine screening was poor and imposed significant burdens on participants and healthcare professionals, and drop-out rates were high. Participants' perceived mental problems and need for care played a key role in their decision to participate in the programme and to step up to consequent interventions. Older people preferred interventions that focused on interpersonal contact. The programme was only effective when delivered by mental healthcare nurses, compared to home care nurses with limited experience in providing mental healthcare. Conclusions The intervention programme was effective in reducing depressive symptoms, and valuable lessons can be learned from this implementation trial. Given the low uptake and high investment, we advise against routine screening for depressive symptoms in general healthcare. Further, agreement between the participant and healthcare professional on perceived need for care and intervention is vital. Rather than providing a stepped care intervention programme, we showed that offering only one single preference-led intervention is effective. Lastly, since the provision of the interventions seems to ask for specific skills and experiences, it might require mental healthcare nurses to offer the programme. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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37. Pain, not chronic disease, is associated with the recurrence of depressive and anxiety disorders.
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Gerrits, Marloes M. J. G., van Oppen, Patricia, Leone, Stephanie S., van Marwijk, Harm W. J., van der Horst, Henriëtte E., and Penninx, Brenda W.
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CHRONIC diseases ,DISEASE relapse ,MENTAL depression ,ANXIETY disorders ,PUBLIC health ,PAIN - Abstract
Background Studies suggest that poor physical health might be associated with increased depression and anxiety recurrence. The objectives of this study were to determine whether specific chronic diseases and pain characteristics are associated with depression and anxiety recurrence and to examine whether such associations are mediated by subthreshold depressive or anxiety symptoms. Methods 1122 individuals with remitted depressive or anxiety disorder (Netherlands Study of Depression and Anxiety) were followed up for a period of four years. The impact of specific chronic diseases and pain characteristics on recurrence was assessed using Cox regression and mediation analyses. Results Chronic diseases were not associated with recurrence. Neck (HR 1.45, p < .01), chest (HR 1.65, p < .01), abdominal (HR 1.52, p < .01) pain, an increase in the number of pain locations (HR 1.10, p < .01) and pain severity (HR 1.18, p = .01) were associated with an increased risk of depression recurrence but not anxiety. Subthreshold depressive symptoms mediated the associations between pain and depression recurrence. Conclusions Pain, not chronic disease, increases the likelihood of depression recurrence, largely through its association with aggravated subthreshold depressive symptoms . These findings support the idea of the existence of a mutually reinforcing mechanism between pain and depression and are indicative of the importance of shedding light on neurobiological links in order to optimize pain and depression management. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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38. To what extent does the anxiety scale of the Four-Dimensional Symptom Questionnaire (4DSQ) detect specific types of anxiety disorder in primary care? A psychometric study.
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Terluin, Berend, Oosterbaan, Desiree B., Brouwers, Evelien P. M., van Straten, Annemieke, van de Ven, Peter M., Langerak, Wendy, and van Marwijk, Harm W. J.
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ANXIETY disorders ,PSYCHOMETRICS ,PRIMARY care ,MEDICAL personnel ,PSYCHOLOGICAL distress ,PSYCHIATRIC diagnosis ,OBSESSIVE-compulsive disorder - Abstract
Background Anxiety scales may help primary care physicians to detect specific anxiety disorders among the many emotionally distressed patients presenting in primary care. The anxiety scale of the Four-Dimensional Symptom Questionnaire (4DSQ) consists of an admixture of symptoms of specific anxiety disorders. The research questions were: (1) Is the anxiety scale unidimensional or multidimensional? (2) To what extent does the anxiety scale detect specific DSM-IV anxiety disorders? (3) Which cut-off points are suitable to rule out or to rule in (which) anxiety disorders? Methods We analyzed 5 primary care datasets with standardized psychiatric diagnoses and 4DSQ scores. Unidimensionality was assessed through confirmatory factor analysis (CFA). We examined mean scores and anxiety score distributions per disorder. Receiver operating characteristic (ROC) analysis was used to determine optimal cut-off points. Results Total n was 969. CFA supported unidimensionality. The anxiety scale performed slightly better in detecting patients with panic disorder, agoraphobia, social phobia, obsessive compulsive disorder (OCD) and post traumatic stress disorder (PTSD) than patients with generalized anxiety disorder (GAD) and specific phobia. ROC-analysis suggested that ≥4 was the optimal cut-off point to rule out and ≥10 the cut-off point to rule in anxiety disorders. Conclusions The 4DSQ anxiety scale measures a common trait of pathological anxiety that is characteristic of anxiety disorders, in particular panic disorder, agoraphobia, social phobia, OCD and PTSD. The anxiety score detects the latter anxiety disorders to a slightly greater extent than GAD and specific phobia, without being able to distinguish between the different anxiety disorder types. The cut-off points ≥4 and ≥10 can be used to separate distressed patients in three groups with a relatively low, moderate and high probability of having one or more anxiety disorders. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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39. The cost-effectiveness of a family meetings intervention to prevent depression and anxiety in family caregivers of patients with dementia: a randomized trial.
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Joling, Karlijn J., Bosmans, Judith E., van Marwijk, Harm W. J., van der Horst, Henriëtte E., Scheltens, Philip, Vroomen, Janet L. MacNeil, and van Hout, Hein P. J.
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CLINICAL trials ,MEDICAL care costs ,DEMENTIA ,PREVENTION of mental depression ,NURSING care facilities ,HEALTH outcome assessment - Abstract
Background: Dementia imposes a heavy burden on health and social care systems as well as on family caregivers who provide a substantial portion of the care. Interventions that effectively support caregivers may prevent or delay patient institutionalization and hence be cost-effective. However, evidence about the cost-effectiveness of such interventions is scarce. The aim of this study was to evaluate the cost-effectiveness of a family meetings intervention for family caregivers of dementia patients in comparison with usual care over a period of 12 months. Methods: The economic evaluation was conducted from a societal perspective alongside a randomized trial of 192 primary caregivers with community-dwelling dementia patients. Outcome measures included the Quality Adjusted Life-Years (QALY) of caregivers and patients and the incidence of depression and anxiety disorders in caregivers. Missing cost and effect data were imputed using multiple imputations. Bootstrapping was used to estimate uncertainty around the cost-differences and the incremental cost-effectiveness ratio (ICER). The bootstrapped cost-effect pairs were plotted on a cost-effectiveness plane and used to estimate cost-effectiveness curves. Results: No significant differences in costs and effects between the groups were found. At 12 months, total costs per patient and primary caregiver dyad were substantial: 77,832 for the intervention group and 75,201 for the usual care group (adjusted mean difference per dyad 4,149, 95% CI -13,371 to 21,956, ICER 157,534). The main cost driver was informal care (66% of total costs), followed by patients' day treatment and costs of hospital and long-term care facility admissions (23%). Based on the cost-effectiveness acceptability curves, the maximum probability that the intervention was considered cost-effective in comparison with usual care reached 0.4 for the outcome QALY per patient-caregiver dyad and 0.6 for the caregivers' incidence of depression and/or anxiety disorders regardless of the willingness to pay. Conclusions: The annual costs of caring for a person with dementia were substantial with informal care being by far the largest contributor to the total societal costs. Based on this study, family meetings cannot be considered a cost-effective intervention strategy in comparison with usual care. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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40. Screening high-risk patients and assisting in diagnosing anxiety in primary care: the Patient Health Questionnaire evaluated.
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Muntingh, Anna D. T., De Heer, Eric W., Van Marwijk, Harm W. J., Adèr, Herman J., Van Balkom, Anton J. L. M., Spinhoven, Philip, and Van der Feltz-Cornelis, Christina M.
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ANXIETY diagnosis ,PRIMARY care ,GENERAL practitioners ,ANXIETY disorders ,ELECTRONIC health records ,PATIENTS - Abstract
Background: Questionnaires may help in detecting and diagnosing anxiety disorders in primary care. However, since utility of these questionnaires in target populations is rarely studied, the Patient Health Questionnaire anxiety modules (PHQ) were evaluated for use as: a) a screener in high-risk patients, and/or b) a case finder for general practitioners (GPs) to assist in diagnosing anxiety disorders. Methods: A cross-sectional analysis was performed in 43 primary care practices in the Netherlands. The added value of the PHQ was assessed in two samples: 1) 170 patients at risk of anxiety disorders (or developing them) according to their electronic medical records (high-risk sample); 2) 141 patients identified as a possible 'anxiety case' by a GP (GP-identified sample). All patients completed the PHQ and were interviewed using the Mini International Neuropsychiatric interview to classify DSM-IV anxiety disorders. Psychometric properties were calculated, and a logistic regression analysis was performed to assess the diagnostic value of the PHQ. Results: Using only the screening questions of the PHQ, the area under the curve was 83% in the high-risk sample. In GP-identified patients the official algorithm showed the best characteristics with an area under the curve of 77%. Positive screening questions significantly increased the odds of an anxiety disorder diagnosis in high-risk patients (odds ratio = 23.4; 95% confidence interval 6.9 to 78.8) as did a positive algorithm in GP-identified patients (odds ratio = 13.9; 95% confidence interval 3.8 to 50.6). Conclusions: The PHQ screening questions can be used to screen for anxiety disorders in high-risk primary care patients. In GP-identified patients, the benefit of the PHQ is less evident. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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41. Effectiveness and cost-effectiveness of transmural collaborative care with consultation letter (TCCCL) and duloxetine for major depressive disorder (MDD) and (sub)chronic pain in collaboration with primary care: design of a randomized placebo-controlled multi-Centre trial: TCC:PAINDIP
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de Heer, Eric W., Dekker, Jack, van Eck van der Sluijs, Jonna F., Beekman, Aartjan T. F., van Marwijk, Harm W. J., Holwerda, Tjalling J., Bet, Pierre M., Roth, Joost, Roijen, Leona Hakkaart-Van, Ringoir, Lianne, Kat, Fiona, and Van der Feltz-Cornelis, Christina M.
- Subjects
COMORBIDITY ,DULOXETINE ,MENTAL depression ,THERAPEUTICS ,TREATMENT effectiveness ,PRIMARY care ,HEALTH outcome assessment - Abstract
Background: The comorbidity of pain and depression is associated with high disease burden for patients in terms of disability, wellbeing, and use of medical care. Patients with major and minor depression often present themselves with pain to a general practitioner and recognition of depression in such cases is low, but evolving. Also, physical symptoms, including pain, in major depressive disorder, predict a poorer response to treatment. A multi-faceted, patient-tailored treatment programme, like collaborative care, is promising. However, treatment of chronic pain conditions in depressive patients has, so far, received limited attention in research. Cost effectiveness of an integrated approach of pain in depressed patients has not been studied. This article describes the aims and design of a study to evaluate effects and costs of collaborative care with the antidepressant duloxetine for patients with pain symptoms and a depressive disorder, compared to collaborative care with placebo and compared to duloxetine alone. Methods/Design: This study is a placebo controlled double blind, three armed randomized multi centre trial. Patients with (sub)chronic pain and a depressive disorder are randomized to either a) collaborative care with duloxetine, b) collaborative care with placebo or c) duloxetine alone. 189 completers are needed to attain sufficient power to show a clinically significant effect of 0.6 SD on the primary outcome measures (PHQ-9 score). Data on depression, anxiety, mental and physical health, medication adherence, medication tolerability, quality of life, patient-doctor relationship, coping, health resource use and productivity will be collected at baseline and after three, six, nine and twelve months. In the collaborative care conditions a) and b), a care-manager provides Problem Solving Treatment and integrated symptom management guidance with a self-help manual, monitors depressive and pain symptoms, and refers patients to a physiotherapist for treatment according to a 'Graded Activity' protocol. A psychiatrist provides duloxetine or placebo and pain medication according to algorithms, and also monitors pain and depressive symptoms. In condition c), the psychiatrist prescribes duloxetine without collaborative care. After 12 weeks, the patient is referred back to the general practitioner with a consultation letter, with information for further treatment of the patient. Discussion: This study enables us to show the value of a closely monitored integrated treatment model above usual pharmacological treatment. Furthermore, a comparison with a placebo arm enables us to evaluate effectiveness of duloxetine in this population in a real life setting. Also, this study will provide evidence-based treatments and tools for their implementation in practice. This will facilitate generalization and implementation of results of this study. Moreover, patients included in this study are screened for pain symptoms, differentiating between nociceptive and neuropathic pain. Therefore, pain relief can be thoroughly evaluated. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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42. Cost-effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression: design of a cluster-randomized controlled trial.
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Van Dijk, Susan E. M., Pols, Alide D., Adriaanse, Marcel C., Bosmans, Judith E., Elders, Petra J. M., Van Marwijk, Harm W. J., and Van Tulder, Maurits W.
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MENTAL depression ,DIABETES ,PEOPLE with diabetes ,ENDOCRINE diseases ,CLINICAL trials - Abstract
Background: Co-morbid major depression is a significant problem among patients with type 2 diabetes mellitus and/or coronary heart disease and this negatively impacts quality of life. Subthreshold depression is the most important risk factor for the development of major depression. Given the highly significant association between depression and adverse health outcomes and the limited capacity for depression treatment in primary care, there is an urgent need for interventions that successfully prevent the transition from subthreshold depression into a major depressive disorder. Nurse led stepped-care is a promising way to accomplish this. The aim of this study is to evaluate the cost-effectiveness of a nurse-led indicated stepped-care program to prevent major depression among patients with type 2 diabetes mellitus and/or coronary heart disease in primary care who also have subthreshold depressive symptoms. Methods/design: An economic evaluation will be conducted alongside a cluster-randomized controlled trial in approximately thirty general practices in the Netherlands. Randomization takes place at the level of participating practice nurses. We aim to include 236 participants who will either receive a nurse-led indicated stepped-care program for depressive symptoms or care as usual. The stepped-care program consists of four sequential but flexible treatment steps: 1) watchful waiting, 2) guided self-help treatment, 3) problem solving treatment and 4) referral to the general practitioner. The primary clinical outcome measure is the cumulative incidence of major depressive disorder as measured with the Mini International Neuropsychiatric Interview. Secondary outcomes include severity of depressive symptoms, quality of life, anxiety and physical outcomes. Costs will be measured from a societal perspective and include health care utilization, medication and lost productivity costs. Measurements will be performed at baseline and 3, 6, 9 and 12 months. Discussion: The intervention being investigated is expected to prevent new cases of depression among people with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression, with subsequent beneficial effects on quality of life, clinical outcomes and health care costs. When proven cost-effective, the program provides a viable treatment option in the Dutch primary care system. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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43. Cost-effectiveness of problem-solving treatment in comparison with usual care for primary care patients with mental health problems: a randomized trial.
- Author
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Bosmans, Judith E., Schreuders, Bettine, van Marwijk, Harm W. J., Smit, Jan H., van Oppen, Patricia, and van Tulder, Maurits W.
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MENTAL illness treatment ,CONFIDENCE intervals ,COST effectiveness ,MEDICAL care ,MULTIVARIATE analysis ,PATIENTS ,PRIMARY health care ,PROBLEM solving ,QUESTIONNAIRES ,RESEARCH funding ,SCALES (Weighing instruments) ,COST analysis ,STATISTICAL power analysis ,RANDOMIZED controlled trials ,QUALITY-adjusted life years ,DATA analysis software - Abstract
Background: Mental health problems are common and are associated with increased disability and health care costs. Problem-Solving Treatment (PST) delivered to these patients by nurses in primary care might be efficient. The aim of this study was to evaluate the cost-effectiveness of PST by mental health nurses compared with usual care (UC) by the general practitioner for primary care patients with mental health problems. Methods: An economic evaluation from a societal perspective was performed alongside a randomized clinical trial. Patients with a positive General Health Questionnaire score (score ≥ 4) and who visited their general practitioner at least three times during the past 6 months were eligible. Outcome measures were improvement on the Hospital Anxiety and Depression Scale and QALYs based on the EQ-5D. Resource use was measured using a validated questionnaire. Missing cost and effect data were imputed using multiple imputation techniques. Bootstrapping was used to analyze costs and cost-effectiveness of PST compared with UC. Results: There were no statistically significant differences in clinical outcomes at 9 months. Mean total costs were €4795 in the PST group and €6857 in the UC group. Costs were not statistically significantly different between the two groups (95% CI -4698;359). The cost-effectiveness analysis showed that PST was cost-effective in comparison with UC. Sensitivity analyses confirmed these findings. Conclusions: PST delivered by nurses seems cost-effective in comparison with UC. However, these results should be interpreted with caution, since the difference in total costs was mainly caused by 3 outliers with extremely high indirect costs in the UC group. Trial registration: Nederlands Trial Register ISRCTN51021015 [ABSTRACT FROM AUTHOR]
- Published
- 2012
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44. Is the beck anxiety inventory a good tool to assess the severity of anxiety? A primary care study in The Netherlands study of depression and anxiety (NESDA).
- Author
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Muntingh, Anna D. T., van der Feltz-Cornelis, Christina M., van Marwijk, Harm W. J., Spinhoven, Philip, Penninx, Brenda W. J. H., and van Balkom, Anton J. L. M.
- Abstract
Background: Appropriate management of anxiety disorders in primary care requires clinical assessment and monitoring of the severity of the anxiety. This study focuses on the Beck Anxiety Inventory (BAI) as a severity indicator for anxiety in primary care patients with different anxiety disorders (social phobia, panic disorder with or without agoraphobia, agoraphobia or generalized anxiety disorder), depressive disorders or no disorder (controls). Methods: Participants were 1601 primary care patients participating in the Netherlands Study of Depression and Anxiety (NESDA). Regression analyses were used to compare the mean BAI scores of the different diagnostic groups and to correct for age and gender. Results: Patients with any anxiety disorder had a significantly higher mean score than the controls. A significantly higher score was found for patients with panic disorder and agoraphobia compared to patients with agoraphobia only or social phobia only. BAI scores in patients with an anxiety disorder with a co-morbid anxiety disorder and in patients with an anxiety disorder with a co-morbid depressive disorder were significantly higher than BAI scores in patients with an anxiety disorder alone or patients with a depressive disorder alone. Depressed and anxious patients did not differ significantly in their mean scores. Conclusions: The results suggest that the BAI may be used as a severity indicator of anxiety in primary care patients with different anxiety disorders. However, because the instrument seems to reflect the severity of depression as well, it is not a suitable instrument to discriminate between anxiety and depression in a primary care population. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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45. The course of untreated anxiety and depression, and determinants of poor one-year outcome: a one-year cohort study.
- Author
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van Beljouw, Ilse M. J., Verhaak, Peter F. M., Cuijpers, Pim, van Marwijk, Harm W. J., and Penninx, Brenda W. J. H.
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ANXIETY ,MENTAL depression ,HEALTH outcome assessment ,PRIMARY care ,MENTAL health services - Abstract
Background: Little is known about the course and outcome of untreated anxiety and depression in patients with and without a self-perceived need for care. The aim of the present study was to examine the one-year course of untreated anxiety and depression, and to determine predictors of a poor outcome. Method: Baseline and one-year follow-up data were used of 594 primary care patients with current anxiety or depressive disorders at baseline (established by the Composite Interview Diagnostic Instrument (CIDI)), from the Netherlands Study of Depression and Anxiety (NESDA). Receipt of and need for care were assessed by the Perceived Need for Care Questionnaire (PNCQ). Results: In depression, treated and untreated patients with a perceived treatment need showed more rapid symptom decline but greater symptom severity at follow-up than untreated patients without a self-perceived mental problem or treatment need. A lower education level, lower income, unemployment, loneliness, less social support, perceived need for care, number of somatic disorders, a comorbid anxiety and depressive disorder and symptom severity at baseline predicted a poorer outcome in both anxiety and depression. When all variables were considered at the same time, only baseline symptom severity appeared to predict a poorer outcome in anxiety. In depression, a poorer outcome was also predicted by more loneliness and a comorbid anxiety and depressive disorder. Conclusion: In clinical practice, special attention should be paid to exploring the need for care among possible risk groups (e.g. low social economic status, low social support), and support them in making an informed decision on whether or not to seek treatment. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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46. Primary care management of major depression in patients aged ≥55 years: outcome of a randomised clinical trial.
- Author
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Van Marwijk, Harm W. J., Ader, Herman, De Haan, Marten, and Beekman, Aartjan
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DEPRESSION in old age ,PSYCHIATRIC treatment ,ANTIDEPRESSANTS ,PSYCHIATRIC rating scales ,PRIMARY care - Abstract
Background Late-life depression is associated with chronic illness, disability, and a poor prognosis. Primary care management may be in need of improvement. Aim To compare the effects of an intervention programme that aims to improve the identification, diagnosis, and treatment of depression in patients aged ≥55 years with the effects of usual care. Design of study Cluster randomised controlled trial. Setting General practices in the Netherlands. Method Trained GPs performed the intervention and their practice assistants conducted the screenings. Patients were screened with the 15-item Geriatric Depression Scale (GDS-15) and given a consultation with the GP who diagnosed depression with the mood module of the Primary Care Evaluation of Mental Disorders (PRIME-MD). Antidepressant treatment was proposed. Primary outcomes were measured with the Montgomery Åsberg Depression Rating Scale (MÅDRS). Trained independent research assistants performed independent evaluations in both arms. Results Eighteen practices (23 GPs) were allocated to the intervention and 16 practices (20 GPs) to usual care. From June 2000 to September 2002, 3937 patients were screened; 579 patients had a positive Score on the GDS-15, 178 had major depression, of whom 145 participated in the trial. MÅDRS scores for the intervention group dropped from 21.66 at baseline to 9.23 at 6 months, and the usual care group from 20.94 at baseline to 11.45 at 6 months. MÅDRS scores decreased during the year in both arms. For the intervention group, these scores increased between 6 and 12 months. Conclusion The programme resulted in lower MÅDRS scores in the intervention group than in the usual care group, but only at the end of the intervention, at 6 months after baseline. [ABSTRACT FROM AUTHOR]
- Published
- 2008
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47. Multidisciplinary Collaborative Care for Depressive Disorder in the Occupational Health Setting: design of a randomised controlled trial and cost-effectiveness study.
- Author
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Vlasveld, Moniek C., Anema, Johannes R., Beekman, Aartjan T. F., van Mechelen, Willem, Hoedeman, Rob, van Marwijk, Harm W. J., Rutten, Frans F., Hakkaart-van Roijen, Leona, and van der Feltz-Cornelis, Christina M.
- Subjects
MEDICAL cooperation ,THERAPEUTICS ,MENTAL depression ,OCCUPATIONAL health services ,GENERAL practitioners ,OCCUPATIONAL physicians ,RANDOMIZED controlled trials ,COST effectiveness - Abstract
Background: Major depressive disorder (MDD) has major consequences for both patients and society, particularly in terms of needlessly long sick leave and reduced functioning. Although evidence-based treatments for MDD are available, they show disappointing results when implemented in daily practice. A focus on work is also lacking in the treatment of depressive disorder as well as communication of general practitioners (GPs) and other health care professionals with occupational physicians (OPs). The OP may play a more important role in the recovery of patients with MDD. Purpose of the present study is to tackle these obstacles by applying a collaborative care model, which has proven to be effective in the USA, with a focus on return to work (RTW). From a societal perspective, the (cost)effectiveness of this collaborative care treatment, as a way of transmural care, will be evaluated in depressed patients on sick leave in the occupational health setting. Methods/Design: A randomised controlled trial in which the treatment of MDD in the occupational health setting will be evaluated in the Netherlands. A transmural collaborative care model, including Problem Solving Treatment (PST), a workplace intervention, antidepressant medication and manual guided self-help will be compared with care as usual (CAU). 126 Patients with MDD on sick leave between 4 and 12 weeks will be included in the study. Care in the intervention group will be provided by a multidisciplinary team of a trained OP-care manager and a consultant psychiatrist. The treatment is separated from the sickness certification. Data will be collected by means of questionnaires at baseline and at 3, 6, 9 and 12 months after baseline. Primary outcome measure is reduction of depressive symptoms, secondary outcome measure is time to RTW, tertiary outcome measure is the cost effectiveness. Discussion: The high burden of MDD and the high level of sickness absence among people with MDD contribute to the relevance of this study. The intervention is an innovative approach, with trained OPs in a new role as care managers in the treatment of MDD. If this intervention proves to be cost-effective, implementation will be very relevant for individual patients as well as for society. Trial registration: ISRCTN78462860 [ABSTRACT FROM AUTHOR]
- Published
- 2008
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48. A stepped care programme for depression management: an uncontrolled pre-post study in primary and secondary care in The Netherlands.
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Meeuwissen, Jolanda A. C., van der Feltz-Cornelis, Christina M., van Marwijk, Harm W. J., Rijnders, Paul B. M., and Donker, Marianne C. H.
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MENTAL depression ,THERAPEUTICS ,PRIMARY care ,MEDICAL care ,DEPRESSED persons ,MEDICAL referrals ,MEDICAL protocols - Abstract
Introduction: Stepped care strategies are potentially effective to organise integrated care but unknown is whether they function well in practice. This paper evaluates the implementation of a stepped care programme for depression in primary care and secondary care. Theory and methods: We developed a stepped care algorithm for diagnostics and treatment of depression, supported by a liaison-consultation function. In a 21/2 year study with pre-post design in a pilot region, adherence to the protocol was assessed by interviewing 28 caregivers of 235 patients with mild, moderate, or severe major depression. Consultation and referral patterns between primary and secondary care were analysed. Results: Adherence of general practitioners and consultant caregivers to the stepped care protocol proved to be 96%. The percentage of patients referred for depression to secondary care decreased significantly from 26% to 21% (p=0.0180). In the post-period more patients received treatment in primary care and requests for consultation became more concordant with the stepped care protocol. Conclusions: Implementation of a stepped care programme is feasible in a primary and secondary care setting and is associated with less referrals. Discussion: Further research on all subsequent treatment steps in a standardised stepped care protocol is needed. [ABSTRACT FROM AUTHOR]
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- 2008
49. (Cost)-effectiveness of family meetings on indicated prevention of anxiety and depressive symptoms and disorders of primary family caregivers of patients with dementia: design of a randomized controlled trial.
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Joling, Karlijn J., van Hout, Hein P. J., Scheltens, Philip, Vernooij-Dassen, Myrra, van den Berg, Bernard, Bosmans, Judith, Gillissen, Freek, Mittelman, Mary, and van Marwijk, Harm W. J.
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CARE of dementia patients ,MEDICAL economics ,FAMILY communication ,MENTAL depression ,AFFECTIVE disorders - Abstract
Background: Dementia is a major public health problem with enormous costs to society and major consequences for both patients and their relatives. Family members of persons with dementia provide much of the care for older adults with dementia in the community. Caring for a demented relative is not easy and fraught with emotional strain, distress, and physical exhaustion. Family caregivers of dementia patients have an extremely high risk developing affective disorders such as major depression and anxiety disorder. Family meetings appear to be among the most powerful psychosocial interventions to reduce depression in caregivers. An American landmark study reported substantial beneficial effects of a multifaceted intervention where family meetings had a central place on depression in family caregivers as well as on delay of institutionalization of patients. These effects were not replicated in other countries yet. We perform the first trial comparing only structured family meetings with significant others versus usual care among primary family caregivers of community dwelling demented patients and measure the effectiveness on both depression and anxiety in the primary caregiver, both on disorder and symptom levels. Methods/design: In this randomized controlled trial effectiveness as well as cost-effectiveness of family meetings is evaluated. The intervention group receives four family meetings with family and close friends of the primary family caregiver of a community dwelling patient with a clinical diagnosis of dementia. Dyads of patients and their primary caregiver are followed up to one year after baseline assessment. The main outcome measures are the incidence of anxiety and depressive disorders assessed with the Mini-International Neuropsychiatric Interview (MINI) and the severity of anxiety and depressive symptoms in caregivers is measured by validated self report instruments: the Centre for Epidemiologic Studies Depression Scale (CES-D) for depression and the anxiety scales of the Hospital Anxiety and Depression scales (HADS) for anxiety. The economic evaluation is performed from a societal perspective. Discussion: By evaluating the effectiveness of only structured family meetings organized in the Netherlands, this study will contribute to the existing literature about the value of psychosocial interventions for dementia caregivers. Trial registration: Dutch Trial Registry ISRCTN90163486 [ABSTRACT FROM AUTHOR]
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- 2008
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50. Interpersonal psychotherapy (IPT) for late-life depression ingeneral practice: uptake and satisfaction by patients, therapists andphysicians.
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van Schaik, Digna J. F., van Marwijk, Harm W. J., Beekman, Aartjan T. F., de Haan, Marten, and van Dyck, Richard
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INTERPERSONAL psychotherapy , *MENTAL depression , *THERAPEUTICS , *OLDER patients , *FAMILY medicine , *MENTAL health personnel , *RANDOMIZED controlled trials - Abstract
Background: Interpersonal Psychotherapy (IPT) is recommended in most depression treatment guidelines and proved to be a suitable treatment for elderly depressed patients. Despite the favorable results of IPT in research populations, the dissemination to general practice is surprisingly limited. Little is known about uptake and satisfaction when this therapy is introduced into real-life general practice. Methods: Motivation and evaluation of patients, GPs and therapists were recorded and organizational barriers described alongside a randomized controlled trial. IPT, given by mental health workers, was compared with usual general practitioner (GP) care. Included were patients (≥55 years) who met the DSM-IV criteria for major depressive disorder. Results: Patients were motivated for the psychotherapy intervention: of the 205 eligible patients, 143 (70%) entered the study, and of the 69 patients who were offered IPT, 77% complied with the treatment. IPT proved to be an attractive therapy for patients as well as for therapists from mental health organizations. General practitioners evaluated the intervention positively afterwards, mainly because of the time-limited and structured approach. Organizational barriers: no IPT therapists were available; an IPT trainer and supervisor had to be trained and training materials had to be developed and translated. Additionally, there was a lack of office space in some general practices; for therapists from private practices it was not feasible to participate because of financial reasons. IPT was superior to usual care in patients with moderate to severe depression. Conclusion: As we succeeded in delivering IPT in primary care practice, and as IPT was superior to usual care, there are grounds to support the implementation of IPT for depressed elderly patients within general practice, as long as the practices have room for the therapists and financial barriers can be overcome. Consolidation may be achieved by making this intervention available through practice nurses or community psychiatric nurses who deliver IPT as part of a more comprehensive depression management program. [ABSTRACT FROM AUTHOR]
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- 2007
- Full Text
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