21 results on '"van Marwijk, Harm W. J."'
Search Results
2. 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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3. 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
4. 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
5. Pulling out all the stops: what motivates 65+ year olds with depressive symptoms to participate in an outreaching preference-led intervention programme?
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van Beljouw, Ilse M J, Heerings, Marjolijn, Abma, Tineke A, Laurant, Miranda G H, Veer-Tazelaar, Petronella J Van't, Baur, Vivianne E, Stek, Max L, van Marwijk, Harm W J, Van Exel, Eric, Heerings, M., Technology Assessment (TA), Psychiatry, Ethics, Law & Medical humanities, General practice, and EMGO - Mental health
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Male ,medicine.medical_specialty ,Psychological intervention ,Logistic regression ,Severity of Illness Index ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] ,Intervention (counseling) ,Surveys and Questionnaires ,Medicine ,Humans ,Psychiatry ,Mass screening ,Depression (differential diagnoses) ,Aged ,Netherlands ,Aged, 80 and over ,business.industry ,Depression ,Loneliness ,Social Support ,Patient Acceptance of Health Care ,Preference ,Psychiatry and Mental health ,Cross-Sectional Studies ,Female ,Geriatrics and Gerontology ,Pshychiatric Mental Health ,medicine.symptom ,business ,Gerontology ,Qualitative research ,Clinical psychology - Abstract
Item does not contain fulltext OBJECTIVES: Many older adults have significant depressive symptoms but few people access care for these. This study explores which personal, clinical and need factors facilitate or hinder acceptance of a new outreaching preference-led intervention programme. METHODS: From a sample of 9661 community-dwelling 65+ year olds, 244 persons with depressive symptoms according to the Patient Health Questionnaire-9 were included. Data on programme effectiveness in terms of care utilisation were collected. Associations between programme acceptance and personal, clinical and need factors were studied using quantitative (logistic regression analyses) and qualitative methods (semi-structured interviews with 26 subjects, who accepted (n = 20) or declined (n = 6) the programme). RESULTS: Fifty-six per cent (n = 137) took part in the interventions. Quantitative logistic regression analyses showed that participants were more often female, suffered from more severe depressive symptoms and perceived more loneliness. Qualitative analyses revealed that people accepting the intervention programme felt that medical terms as having a depressed mood were applicable to their situation, more often perceived their symptoms as hindering, felt lonely and more often perceived a need for care. They were more often advised by their general practitioner to participate than individuals who refused the interventions. Many participating individuals did not see a match between the intervention programme and their needs, especially with respect to meeting new people. CONCLUSION: Many older persons with depressive symptoms did not feel the need to take part in the programme. Providing support in alleviating loneliness and further adaptation to older adults' illness representations and perceptions when discussing depressive symptoms might enhance care utilisation.
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- 2015
6. 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., Bosmans, Judith E., Dijkstra-Kersten, Sandra M. A., Smit, Filip, Bockting, Claudi L. H., van Schaik, Digna J. F., van Marwijk, Harm W. J., and van der Horst, Henriette E.
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MENTAL depression ,COGNITIVE therapy ,PRIMARY care ,MEDICAL care costs ,RANDOMIZED controlled trials - Abstract
Background: Major depression is a prevalent mental disorder with a high risk of relapse or recurrence. Only few studies have focused on the cost-effectiveness of interventions aimed at the prevention of relapse or recurrence of depression in primary care. Aim: To evaluate the cost-effectiveness of a supported Self-help Preventive Cognitive Therapy (S-PCT) added to treatment-as-usual (TAU) compared with TAU alone for patients with a history of depression, currently in remission. Methods: An economic evaluation alongside a multi-center randomised controlled trial was performed (n = 248) over a 12-month follow-up. Outcomes included relapse or recurrence of depression and quality-adjusted-life-years (QALYs) based on the EuroQol-5D. Analyses were performed from both a societal and healthcare perspective. Missing data were imputed using multiple imputations. Uncertainty was estimated using bootstrapping and presented using the cost-effectiveness plane and the Cost-Effectiveness Acceptability Curve (CEAC). Cost estimates were adjusted for baseline costs. Results: S-PCT statistically significantly decreased relapse or recurrence by 15% (95%CI 3;28) compared to TAU. Mean total societal costs were €2,114 higher (95%CI -112;4261). From a societal perspective, the ICER for relapse or recurrence was 13,515. At a Willingness To Pay (WTP) of 22,000 €/recurrence prevented, the probability that S-PCT is cost-effective, in comparison with TAU, is 80%. The ICER for QALYs was 63,051. The CEA curve indicated that at a WTP of 30,000 €/QALY gained, the probability that S-PCT is cost-effective compared to TAU is 21%. Conclusions: Though ultimately depending on the WTP of decision makers, we expect that for both relapse or recurrence and QALYs, S-PCT cannot be considered cost-effective compared to TAU. [ABSTRACT FROM AUTHOR]
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- 2018
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7. 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., 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.
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MENTAL depression ,THERAPEUTICS ,DULOXETINE ,RANDOMIZED controlled trials - Abstract
Objective: Evidence exists for the efficacy of collaborative care (CC) for major depressive disorder (MDD), for the efficacy of the consequent use of pain medication against pain, and for the efficacy of duloxetine against both MDD and neuropathic pain. Their relative effectiveness in comorbid MDD and pain has never been established so far. This study explores the effectiveness of CC with pain medication and duloxetine, and CC with pain medication and placebo, compared with duloxetine alone, on depressive and pain symptoms. This study was prematurely terminated because of massive reorganizations and reimbursement changes in mental health care in the Netherlands during the study period and is therefore of exploratory nature. Methods: Three-armed, randomized, multicenter, placebo-controlled trial at three specialized mental health outpatient clinics with patients who screened positive for MDD. Interventions lasted 12 weeks. Pain medication was administered according to an algorithm that avoids opiate prescription as much as possible, where paracetamol, COX inhibitors, and pregabalin are offered as steps before opiates are considered. Patients who did not show up for three or more sessions were registered as non-compliant. 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). Results: Sixty patients completed the study. Patients in all treatment groups reported significantly less depressive and pain symptoms after 12 weeks. CC with placebo condition showed the fastest decrease in depressive symptoms compared with the duloxetine alone group (b = -0.78; p = 0.01). Non-compliant patients (n = 31) did not improve over the 12-week period, in contrast to compliant patients (n = 29). Pain outcomes did not differ between the three groups. Conclusion: In MDD and pain, patient's compliance and placebo effects are more important in attaining effect than choice of one of the treatments. Active pain management 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 generalizability is limited due to the small sample size. Larger studies are needed. [ABSTRACT FROM AUTHOR]
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- 2018
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8. Cost-effectiveness of problem-solving treatment in comparison with usual care for primary care patients with mental health problems
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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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Adult ,Male ,Practice Patterns, Nurses' ,Primary Health Care ,Depression ,Cost-Benefit Analysis ,Research Support, Non-U.S. Gov't ,Health Care Costs ,Middle Aged ,Randomized Controlled Trial ,Journal Article ,Humans ,Psychotherapy, Brief ,Female ,Quality-Adjusted Life Years ,health care economics and organizations ,Problem Solving ,Aged - 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.
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- 2012
9. Depressive and anxiety disorders and risk of subclinical atherosclerosis Findings from the Netherlands Study of Depression and Anxiety (NESDA)
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Seldenrijk, Adrie, Vogelzangs, Nicole, van Hout, Hein P. J., van Marwijk, Harm W. J., Diamant, Michaela, and Penninx, Brenda W. J. H.
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LIFETIME HISTORY ,PSYCHOMETRIC PROPERTIES ,SYMPTOMS ,ANKLE-BRACHIAL INDEX ,Depression ,CAROTID ATHEROSCLEROSIS ,CORONARY-ARTERY-DISEASE ,WOMEN ,Subclinical atherosclerosis ,HEART-DISEASE ,MAJOR DEPRESSION ,Anxiety ,INTIMA-MEDIA THICKNESS - Abstract
Objective: Current evidence regarding the association between psychopathology and subclinical atherosclerosis show inconsistent results. The present study examined whether subclinical atherosclerosis was more prevalent in a large cohort of persons with depressive or anxiety disorders as compared to non-depressed and non-anxious controls. Methods: Baseline data from the Netherlands Study of Depression and Anxiety were used, including 2717 persons, free of clinical cardiovascular disease. Participants had a DSM-IV-based current or remitted depressive (major depressive disorder, dysthymia) or anxiety (social phobia, generalized anxiety disorder, panic disorder, agoraphobia) disorder (n=2115) or were healthy controls (n=602). Additional clinical characteristics (severity, duration, age of onset and medication) were assessed. Ankle-brachial index (ABI) was used as a measure of vascular risk and was categorized as low (1.40), which was previously designated as a cardiovascular risk factor, reflecting arterial stiffness and wall calcification. Results: As compared to normal controls, persons with current (i.e., past year) depressive, anxiety or comorbid depressive and anxiety disorders showed a two- to threefold increased odds of low ABI (OR=2.78, 95% CI=1.05-7.35; OR=3.14, 95% CI=1.25-7.85; OR=2.67, 95% CI=1.09-6.51, respectively). No associations were found with mildly low or high ABI. Also, we did not further find a differential role for symptoms severity, duration, age of onset, and use of psychotropic medication in the link between psychopathology and subclinical atherosclerosis. Conclusion: Persons with current depressive or anxiety disorders were more likely to have subclinical atherosclerosis compared to healthy controls. (C) 2010 Elsevier Inc. All rights reserved.
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- 2010
10. 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., van Dijk, Susan E., Bosmans, Judith E., Hoekstra, Trynke, van Marwijk, Harm W. J., van Tulder, Maurits W., and Adriaanse, Marcel C.
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PREVENTION of mental depression ,PEOPLE with diabetes ,PRIMARY care ,HEALTH self-care ,RANDOMIZED controlled trials - Abstract
Purpose: 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. Methods: 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. Results: 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. Conclusions: 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. [ABSTRACT FROM AUTHOR]
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- 2017
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11. 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, Unalan, Pemra C., Sipahioğlu, Nurver Turfaner, Özkul, Seda Arslan, and van Marwijk, Harm W. J.
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STATISTICAL correlation ,RESEARCH methodology ,QUESTIONNAIRES ,TRANSCULTURAL medical care ,LOGISTIC regression analysis ,RESEARCH methodology evaluation ,DIFFERENTIAL item functioning (Research bias) ,EVALUATION - Abstract
Background: The Four-Dimensional Symptom Questionnaire (4DSQ) is originally a Dutch 50 item questionnaire developed in primary care to assess distress, depression, anxiety and somatization. We aimed to develop and validate a Turkish translation of the 4DSQ. Methods: The questionnaire was translated using forward and backward translation, and pilot testing. Turkish 4DSQ-data were collected in 352 consecutive adult primary care patients. For comparison, gender and age matched Dutch reference data were drawn from a larger existing dataset. We used differential item and test functioning (DIF and DTF) analysis to validate the Turkish translation to the original Dutch questionnaire. Through additional inquiry we tried to obtain more insight in the background of DIF in some items. Results: Twenty-one items displayed DIF but this impacted only the distress and depression scores. Inquiry among Turkish people revealed that the reason for DTF in the distress scale was probably related to unfavourable socio-economic circumstances. On the other hand, the likely explanation for DTF in the depression scale appeared to be grounded in culturally and religiously determined optimistic beliefs. Raising the distress cut-offs by 2 points and lowering the depression cut-offs by 1 point ensures that individual Turkish 4DSQ scores be correctly interpreted. Conclusions: The Turkish translation of the 4DSQ (named: "Dört-Boyutlu Yakınma Listesi", 4BYL) measures the same constructs as the original Dutch questionnaire. Turkish anxiety and somatization scores can be interpreted in the same way as Dutch scores. However, when interpreting Turkish distress and depression scores, DTF should be taken into account. [ABSTRACT FROM AUTHOR]
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- 2016
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12. Does an Outreaching Stepped Care Program Reduce Depressive Symptoms in Community-Dwelling Older Adults? A Randomized Implementation Trial.
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van Beljouw, Ilse M. J., van Exel, Eric, van de Ven, Peter M., Joling, Karlijn J., Dhondt, Ton D. F., Stek, Max L., and van Marwijk, Harm W. J.
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The article presents a study which evaluated the effects of an outreaching stepped care intervention program called Lust for Life on the depressive symptoms of older adults living in a community. Study participants included 263 community-dwelling 65+-year-old patients with depressive symptoms in 18 general practices and a home care organization in the Netherlands. In the short term, it was found that the Lust for Life program relieves the depressive symptoms of older adults in primary care.
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- 2015
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13. The Two-Year Incidence of Depression and Anxiety Disorders in Spousal Caregivers of Persons with Dementia: Who is at the Greatest Risk?
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Joling, Karlijn J., van Marwijk, Harm W. J., Veldhuijzen, Aaltje E., van der Horst, Henriëtte E., Scheltens, Philip, Smit, Filip, and van Hout, Hein P. J.
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The article reports on research which was conducted to investigate the incidence of depression and anxiety in spousal caregivers who cared for patients with dementia. Researchers evaluated 181 caregivers. They found that caregivers of dementia patients have a high risk of developing a mental disorder, including anxiety and depression.
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- 2015
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14. The Association of Depression and Anxiety with Pain: A Study from NESDA.
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de Heer, Eric W., Gerrits, Marloes M. J. G., Beekman, Aartjan T. F., Dekker, Jack, van Marwijk, Harm W. J., de Waal, Margot W. M., Spinhoven, Philip, Penninx, Brenda W. J. H., and van der Feltz-Cornelis, Christina M.
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ANXIETY ,CHRONIC pain ,PAIN tolerance ,DEPRESSED persons - Abstract
Chronic pain is commonly co-morbid with a depressive or anxiety disorder. Objective of this study is to examine the influence of depression, along with anxiety, on pain-related disability, pain intensity, and pain location in a large sample of adults with and without a depressive and/or anxiety disorder. The study population consisted of 2981 participants with a depressive, anxiety, co-morbid depressive and anxiety disorder, remitted disorder or no current disorder (controls). Severity of depressive and anxiety symptoms was also assessed. In separate multinomial regression analyses, the association of presence of depressive or anxiety disorders and symptom severity with the Chronic Pain Grade and location of pain was explored. Presence of a depressive (OR = 6.67; P<.001), anxiety (OR = 4.84; P<.001), or co-morbid depressive and anxiety disorder (OR = 30.26; P<.001) was associated with the Chronic Pain Grade. Moreover, symptom severity was associated with more disabling and severely limiting pain. Also, a remitted depressive or anxiety disorder showed more disabling and severely limiting pain (OR = 3.53; P<.001) as compared to controls. A current anxiety disorder (OR = 2.96; p<.001) and a co-morbid depressive and anxiety disorder (OR = 5.15; P<.001) were more strongly associated with cardio-respiratory pain, than gastro-intestinal or musculoskeletal pain. These findings remain after adjustment for chronic cardio respiratory illness. Patients with a current and remitted depressive and/or anxiety disorder and those with more severe symptoms have more disabling pain and pain of cardio-respiratory nature, than persons without a depressive or anxiety disorder. This warrants further research. [ABSTRACT FROM AUTHOR]
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- 2014
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15. 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]
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- 2014
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16. “Being all alone makes me sad”: loneliness in older adults with depressive symptoms.
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van Beljouw, Ilse M. J., van Exel, Eric, de Jong Gierveld, Jenny, Comijs, Hannie C., Heerings, Marjolijn, Stek, Max L., and van Marwijk, Harm W. J.
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Background:The consequences of co-occurring persistent loneliness and late life depression are yet unknown. The aim of this study was to get a deeper insight into the mental health consequences of loneliness in older persons with depressive symptoms and their perspectives of emotional distress by using a mixed-methods study design.Methods:Two hundred and forty nine community-dwelling older persons with depressive symptoms according to the Patient Health Questionnaire-9 (≥6) were included. A validated cut-off score on the Loneliness Scale was used to distinguish lonely elders from elders who were not lonely. Quantitative and qualitative data were used to examine differences in mental health and perspectives on emotional distress between lonely and not lonely older persons with depressive symptoms.Results:Loneliness was highly prevalent among older persons with depressive symptoms (87.8%). Lonely people suffered from worse mental ill-health (e.g., more severe depressive symptoms, more often a depressive disorder and a lower quality of life) compared to not lonely individuals. Depressive symptoms were regarded as a logical consequence of loneliness. Lonely people perceived little command over their situation: causes of loneliness were attributed externally to perceived deficits in their social networks and they mainly expressed the need to be listened to.Conclusion:Our findings underline the importance of paying considerable attention to (severe) loneliness in older adults with depressive symptoms given its high prevalence and serious mental health consequences. Future studies should look into whether addressing loneliness when discussing depressive symptoms in clinical practice may provide an opportunity to better adjust to older persons’ depression perceptions and might therefore improve care utilization. [ABSTRACT FROM AUTHOR]
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- 2014
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17. 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.
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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]
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- 2013
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18. Cost-effectiveness of problem-solving treatment in comparison with usual care for primary care patients with mental health problems: a randomized trial.
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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]
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- 2012
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19. Prevention of Late-Life Anxiety and Depression Has Sustained Effects Over 24 Months: A Pragmatic Randomized Trial.
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Van't Veer-Tazelaar, Petronella J., Van Marwijk, Harm W. J., van Oppen, Patricia, van der Horst, Henriëtte E., Smit, Filip, Cuijpers, Pim, and Beekman, Aartjan T. F.
- Abstract
Objective: Depressive and anxiety disorders in later life have a high incidence and are associated with reduced quality of life. Elsewhere, we demonstrated that a stepped-care prevention approach was successful in halving the incidence of these disorders over a period of 12 months. As a decreasing effect over time is to be expected, our aim was to investigate the longer-term effects. Design: Randomized controlled trial. Setting: Thirty-three primary care practices in the Netherlands. Participants: One hundred seventy consenting individuals, age 75 years and older, presenting with subthreshold depression or anxiety, not meeting the diagnostic criteria. Intervention: Participants were randomized to a preventive intervention or usual care. In the first 12 months, the preventive intervention entailed watchful waiting, minimally supported CBT-based self-help intervention, problem-solving treatment, and referral to a primary care physician for medication, if required. In the last 12 months, 95% of the participants ceased to receive such support. Measurements: Mini International Neuropsychiatric Interview. Results: The cumulative incidence rate of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, major depression or anxiety disorder over a period of 24 months was halved by the intervention, from 33 of 84 (39-3%) in the usual care group to 17 of 86 (19-8%) in the intervention group (odds ratio = 0.38; 95% confidence interval = 0.19-0.76), which was significant (z = 2.75; p = 0.006). The corresponding number needed to treat was 5 (95% confidence interval = 3-16). Conclusions: A stepped-care approach to the prevention of depression and anxiety in late life was not only successful in halving the incidence of depressive and anxiety disorders after 1 year, but these favorable effects were also sustained over 24 months. [ABSTRACT FROM AUTHOR]
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- 2011
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20. Incidence of Depression and Anxiety in the Spouses of Patients With Dementia: A Naturalistic Cohort Study of Recorded Morbidity With a 6-Year Follow-Up.
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Joling, Karlijn J., Van Hout, Hein P. J., Schellevis, Francois G., van der Horst, Henriette E., Scheltens, Philip, Knot, Dirk L., and Van Marwijk, Harm W. J.
- Abstract
Objective: Living with a demented person has been associated with high levels of clinical depression and anxiety. However, there are no prospective studies that allow good estimates of the incidence of depression and anxiety. In this study, the authors assess the long-term incidence of depression and anxiety in the spouses of patients with dementia as recorded by general practitioners. Design: Prospective naturalistic cohort study with a comparison group. Data from medical records in 2001-2007 were analyzed. Participants: Two hundred eighteen spouses of patients with dementia and 353 age and gender-matched spouses of nondemented persons. Setting: Seventy-one general practices in the Netherlands with a listed source population of 320,309 patients. Measurements: Incidence rates (IRs) per 1,000 person-years and hazard ratios (HRs) of depression and anxiety; prescription rates (per 1,000 person-years) for antidepressants and anxiolytics. Results: A new episode of depression was diagnosed in 18 spouses and 7 comparison spouses (IRs of 18.8/1,000person-years and 4.4/1,000 person-years, respectively). Spouses of patients with dementia were far more likely to be diagnosed with depression than the comparison spouses (HR, 4.16; 95% CI: 1.73-9-98). Spouses did not have a higher incidence of anxiety than the comparison group (HR, 1.26; 95% CI: 0.58-2.71). The prescription rates for both antidepressants and anxiolytics were significantly higher for spouses than for the comparison group. Conclusion: The spouses of patients with dementia have a fourfold higher risk of a diagnosis of depression than the spouses of nondemented persons. The authors could not establish this for anxiety. [ABSTRACT FROM AUTHOR]
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- 2010
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21. Prevalence of depression in older patients consulting their general practitioner in The Netherlands.
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Licht-Strunk, Els, Van der Kooij, Koen G., Van Schaik, Digna J. F., Van Marwijk, Harm W. J., Van Hout, Hein P. J., De Haan, Marten, and Beekman, Aartjan T. F.
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DEPRESSION in old age ,OLDER people with mental illness ,MENTAL depression ,AFFECTIVE disorders - Abstract
Background Little is known about the prevalence of depression in older patients consulting their general practitioner. Aim To estimate the prevalence of major and minor depression in older GP attendees. Design Cross sectional two-stage screening design. Setting Seventeen GPs in urban and 41 GPs in rural settings. Methods Data of The West Friesland Study were used. Five thousand, six hundered and eight-six GP attendees of 55 years and older filled in the Geriatric Depression Scale—15 items as a screening instrument for depression (response 62%). Of those screened positive on the GDS-15, 846 (77.5%) were interviewed using the Primary Care Evaluation of Mental Disorders (PRIME-MD). A random sample (n = 102) scoring below the threshold of the GDS-15 was interviewed to estimate the proportion of false negatives. Results Major depression was prevalent in 13.7% and minor depression in 10.2% of the patients. Depressed patients were older (mean difference 0.7 years; p = 0.037), more often female (OR 1.3; p < 0.001) and lived more often in urban districts (OR 1.5; p < 0.001). Patients with major depression were younger (mean difference 1.9 years; p < 0.001) and more often female (OR 1.4; p = 0.026) than those with a minor depression. Only 22.9% of the patients with a major depression were treated with antidepressants. Conclusion Depression in older GP attendees is a very common health problem. Further research should focus on identifying those groups of patients with high risk of persistence of depression. This could help to focus the limited resources available in general practice to those patients in whom treatment is most urgently needed. Copyright © 2005 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]
- Published
- 2005
- Full Text
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