Intensive Psychological Interventions Research Articles

Effects of intensive psychological intervention on treatment compliance, psychological status, and quality of life of patients with epilepsy.

Epilepsy is a nervous system disease characterized by recurrent attacks, a long disease course, and an unfavorable prognosis. It is associated with an enduring therapeutic process, and finding a cure has been difficult. Patients with epilepsy are predisposed to adverse moods, such as resistance, anxiety, nervousness, and anxiety, which compromise treatment compliance and overall efficacy. To explored the influence of intensive psychological intervention on treatment compliance, psychological status, and quality of life (QOL) of patients with epilepsy. The clinical data of 105 patients with epilepsy admitted between December 2019 and July 2023 were retrospectively analyzed, including those of 50 patients who underwent routine intervention (control group) and 55 who underwent intensive psychological intervention (research group). Treatment compliance, psychological status based on the Self-Rating Anxiety Scale (SAS) and Depression Scale Self-Rating Depression Scale (SDS) scores, hope level assessed using the Herth Hope Scale (HHS), psychological resilience evaluated using the Psychological Resilience Scale, and QOL determined using the QOL in Epilepsy-31 Inventory (QOLIE-31) were comparatively analyzed. Treatment compliance in the research group was 85.5%, which is significantly better than the 68.0% of the control group. No notable intergroup differences in preinterventional SAS and SDS scores were identified (P > 0.05); however, after the intervention, the SAS and SDS scores decreased significantly in the two groups, especially in the research group (P < 0.05). The two groups also exhibited no significant differences in preinterventional HHS, Connor-Davidson Resilience Scale (CD-RISC), and QOLIE-31 scores (P > 0.05). After 6 months of intervention, the research group showed evidently higher HHS, CD-RISC, tenacity, optimism, strength, and QOLIE-31 scores (P < 0.05). Intensive psychological intervention enhances treatment compliance, psychological status, and QOL of patients with epilepsy.

Responses to the Strengths and Difficulties Questionnaire predict HbA1c trajectories in children and adolescents with type 1 diabetes: a population-based study

IntroductionWe aimed to determine whether caregiver responses to the Strengths and Difficulties Questionnaire (SDQ) are predictive of HbA1c trajectory membership in children and adolescents with type 1 diabetes, when adjusting...

Impact of the intensive psychological intervention care on post-traumatic stress disorder and negative emotions of teenage female patients seeking an induced abortion.

This study aimed to investigate the effects of intensive psychological intervention care on adverse emotions and post-traumatic stress disorder (PTSD) symptoms in female teenage patients after induced abortion. This prospective cohort study included 100 teenage female patients seeking induced abortion who were randomly divided into two groups: the intervention group (n = 50) and the control group (n = 50). The intervention group received intensive psychological intervention care, while the control group received standard routine nursing. The scores of the PTSD checklist for DSM-5 (PCL-5), self-rating depression (SDS), and self-rating anxiety scale (SAS) were compared between the two groups at 1 month and 3 months after the operation. The intervention group had lower risk of developing PTSD (24% vs. 44%), depression (10% vs. 32%), and anxiety (0% vs. 12%) symptoms at 1 month after the surgery. However, there were no significant differences observed between the two groups at 3 months after the surgery. Furthermore, the intervention group had significantly lower scores in PCL-5 (27.4 ± 5.4 vs. 31.8 ± 5.7; 20.5 ± 7.1 vs. 25.0 ± 7.5; p < 0.05), SDS (31.8 ± 5.4 vs. 37.8 ± 6.6; 26.8 ± 5.0 vs. 31.4 ± 7.2; p < 0.05), and SAS (32.7 ± 5.0 vs. 39.8 ± 6.9; 25.0 ± 2.7 vs. 27.5 ± 2.8; p < 0.05) at 1 month and 3 months after induced abortion. These findings suggest that intensive psychological intervention care can reduce the incidence and severity of depression, anxiety, and PTSD symptoms in teenage patients who undergo induced abortion. https://www.chictr.org.cn/showproj.html?proj=185200, identifier ChiCTR2300067531.

Reducing sickness absence and stigma due to mental health difficulties: a randomised control treatment trial (RCT) of a low intensity psychological intervention and stigma reduction programme for common mental disorder (Prevail)

BackgroundCommon mental disorders are the leading cause of workplace absences. The Prevail intervention programme aims to reduce stigma and to educate staff and managers about evidence-based low intensity psychological interventions for common mental disorders (depression, anxiety, stress, and distress). Prevail is innovative in taking a public health approach. It is designed to be given to all employees irrespective of their past or current mental health. Prevail was evaluated in three studies examining: (1) the acceptability of the intervention and perceived usefulness; (2) whether the intervention altered stigmatic attitudes and motivation to seek help; and (3) whether the intervention reduced sickness absence, both overall and due to mental health problems.MethodsA two-armed cluster randomised control trial (RCT) evaluated the effectiveness of Prevail. Employees (N = 1051) at a large UK government institution were randomised to an active intervention or control arm in teams identified by their managers (n = 67). Employees in the active arm received the Prevail Staff Intervention. The managers in the active arm also received the Prevail Managers Intervention. Participants’ satisfaction and analysis of the Prevail Intervention were gathered by a bespoke questionnaire. Questionnaire measures of attitudes to mental health and mental health stigma were taken 1–2 weeks prior to the intervention and approximately 4 weeks post-intervention. Data relating to sickness absence were gathered via the official records in the time period 3-month post-intervention and for the same period 12 months earlier.ResultsPrevail was evaluated highly favourably by both the staff and their managers. Prevail produced significant reductions in self-stigma and anticipated stigma due to mental health difficulties. Crucially, sickness absence was significantly reduced by the Prevail Intervention.DiscussionPrevail achieved its goals of producing a palatable and engaging intervention that altered staff’s attitudes and stigmatic beliefs related to mental health and, crucially, produced a strong reduction in work-pace absenteeism. As the Prevail programme is aimed at common mental health problems and was not specialised to this particular workforce, the study provides the evidence-base for a mental health intervention programme that could be used by many organisations across the world.Trial RegistrationISRCTN12040087. Registered 04/05/2020. https://doi.org/10.1186/ISRCTN12040087. A full protocol for the randomised control trial was published: Gray NS, Davies H, Snowden RJ: Reducing stigma and increasing workplace productivity due to mental health difficulties in a large government organization in the UK: a protocol for a randomised control treatment trial (RCT) of a low intensity psychological intervention and stigma reduction programme for common mental disorder (Prevail). BMC Public Health 2020, 20(1):1–9.

Effect of intensive psychological intervention on the psychological state and quality of life of patients with liver cancer

Effect of intensive psychological intervention on the psychological state and quality of life of patients with liver cancer

Predictors for quitting smoking in smoking cessation clinics among female smokers in China.

The number of cessation clinics in China have been increasing ever since the Chinese government supported the establishment of smoking cessation clinics (SCCs) in each province in 2014. Many studies have examined smoking cessation behaviors among male smokers, but few of female smokers. This study aimed to understand female smokers' quitting behaviors in SCCs and identify predictors of successful cessation. This study used data of the SCCs Platform in China from 2018 to 2020. The self-reported 7-day point prevalence of abstinence rate (PPAR) at 1 month and at 3 months follow-up and the continuous abstinence rate (CAR) at 3 months follow-up are reported based on smokers' characteristics and intention to treat analysis. A multiple logistic regression model was used to identify predictors of continuous abstinence at 3 months follow-up. The 7-day PPAR of female outpatients in SCCs was 29.20% at 1 month follow-up and 28.36% at 3 months follow-up. The CAR at 3 months follow-up was 19.88%. Female smokers who were prepared to quit within 7 days (AOR=2.86; 95% CI: 1.53-5.32), today (AOR=4.01; 95% CI: 2.35-6.85), had started to quit (AOR=7.11; 95% CI: 4.12-12.27), and used a combination of counseling and drugs (AOR=2.41; 95% CI: 1.73-3.35) were more likely to quit smoking. Associated with lower quitting rates were: living in the central region of China (AOR=0.47; 95% CI: 0.31-0.73) and the west region (AOR=0.48; 95% CI: 0.31-0.73); being aged 30-39 years (AOR=0.39; 95% CI: 0.23-0.64), and 40-49 years (AOR=0.41; 95% CI:0.24-0.69); being unemployed (AOR=0.64; 95% CI: 0.45-0.91); having a fair perceived health status at the first visit (AOR=0.65; 95% CI: 0.47-0.91) and a poor one (AOR=0.37; 95% CI: 0.21-0.64); having a moderate nicotine dependence (AOR=0.64; 95% CI: 0.44-0.92) and a severe one (AOR=0.50; 95% CI: 0.34-0.72). In our study, the region of residence, age, employment, perceived health status, Fagerström test for nicotine dependence (FTND), readiness to quit, and intervention model were independent predictors of quitting for female smokers. Improving the motivation to quit, providing intensive psychological interventions and equipping SCCs with cessation medication would assist female smokers to quit.

Stress Management Skills in the Physicians Practice of Primary Care Level

Current approaches to non-specialized help with stress are set out in this article and stress management tools are provided, which are developed by WHO in the stress management handbook “Doing What Matters in Times of Stress: An Illustrated Guide”. This knowledge is especially current in the giving of first aid in emergencies, and in giving psychosocial support to patients as well, by primary care physicians, who must have effective communication skills and mutual understanding, and have experience in supporting people in difficult situations too, as it is specified in numerous WHO recommendations on mental health, in such as : «mhGAP Intervention Guide for mental, neurological and substance use disorders in nonspecialized health settings», «IASC Guidelines for mental health and psychosocial support in emergency settings»,«mhGAP Humanitarian Intervention Guide (mhGAP-HIG): clinical management of mental, neurological and substance use conditions in humanitarian emergencies», «Support for Rehabilitation: Self-Management after COVID-19 Related Illness» and etc. Aim – to give the information for the distant self-learning of the primary care professionals to use the simple stress-management tools in difficult circumstances. Distance learning is built on the basis of the evidence based WHO documents and recommendations about low intensity psychological interventions. The WHO Guide has five sections, where five ideas and techniques for reducing stress are descibed, which are designed as the acquisition of five skills. The authors at the end of each section of the Guide developed algorithms of use the skills of such tools as: «Grounding», «Unhooking», «Acting according to own values», «Showing kindness», «Creating space». The psychosocial support provided by the primary care physician / facilitator / assistant lies in helping people to use guidance and apply strategies in their own lives, and it prevents the professional burnout of healthcare professionals as well. The short information about WHO guide and stress -management methods are described in sufficient details to enhance the awareness level of the primary care personnel about stress-management tools use. As the result of using the Guide will enhance the capacity of local helth care staff and non medical staff to provide the mental health services and psychosocial support during the current COVID-19 pandemic, and readiness for the future emergencies.

Effect of Intensive Psychological Nursing Intervention on HAMD and SF-36 Scores in Patients with Severe Liver Cancer in ICU.

The aim of the study was to explore the effect of intensive psychological nursing intervention on HAMD and SF-36 scores in patients with severe liver cancer in intensive care unit (ICU). 134 critically ill patients with liver cancer in ICU who underwent resection of primary liver cancer from July 2019 to November 2021 were selected. The patients were randomly divided into control group and study group. The patients in the control group received routine nursing. The patients in the study group received intensive psychological nursing intervention on the basis of routine nursing. Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), and the MOS 36-item short-form health survey (SF-36) scores before and after nursing were compared between the two groups. The satisfaction of the two groups of patients with nursing was counted. The HAMA, HAMD, and SF-36 scores of patients receiving intensive psychological nursing intervention were significantly better than those receiving routine nursing. The nursing satisfaction of patients receiving intensive psychological nursing intervention was significantly higher than that of patients receiving routine nursing. Intensive psychological nursing intervention for patients with severe liver cancer in ICU can significantly reduce HAMD, improve SF-36 score, and patient nursing satisfaction. It is worthy of wide clinical promotion.

Evaluating the Use of Trauma‐Informed Mental Health Assessment Measures in Care Planning for Children and Adolescents in Out‐of‐Home Residential Care in Singapore

Children and young people (CYP) within the Child Welfare System (CWS) often experience a range of trauma‐related difficulties. However, systematic use of evidence‐based measures to support mental health assessment and care planning appeared to be lacking within CWS in Singapore. This study evaluated the use of evidence‐based measures to inform care planning in out‐of‐home residential care in Singapore. Participants were 65 CYP in care. Measures consisted of the Child PTSD Symptom Scale for DSM‐5 (CPSS‐5), Assessment Checklist for Children (ACC) and Adolescents (ACA), Child Behavior Checklist (CBCL) and Youth Self‐Report (YSR). Care plans were identified based on the measures' clinical criteria and validated against the Child and Adolescent Needs and Strengths (CANS) and Adverse Childhood Experience (ACE) questionnaire. More intensive measurement‐based care plans were associated with higher service needs and lower strengths on the CANS, and higher ACE exposure. However, there was limited support for the validity of care plans when evaluated against the CANS and ACE questionnaire. Methodological implications for mental health assessment are discussed. Compared to service‐allocation‐as‐usual, measurement‐based care plans identified more cases that may require intensive psychological intervention. Overall, study findings provided some support for the use of assessment measures to supplement care planning in residential care.‘This study evaluated the use of evidence‐based measures to inform care planning in out‐of‐home residential care in Singapore’Key Practitioner Messages A comprehensive approach to care planning for CYP in out‐of‐home residential care should include the use of multi‐informant evidence‐based mental health assessment measures. The use of mental health assessment measures may reduce information gaps and complement the use of service needs assessment tools. Measurement‐based care planning may provide added value to supplement existing standard psychological care planning practices in out‐of‐home residential care.

Psychotherapy in obstetrics: implementing low intensity psychological interventions

Összefoglaló. A szülés utáni időszakban megjelenő aggodalmak természetesnek tekinthetők, az anyák jelentős részénél azonban klinikai szintű szorongásos megbetegedés alakulhat ki. A postpartum időszakban a szorongásos tünetek gyakori előfordulása ronthatja az anya életminőségét, pszichés állapotát, s ezáltal kedvezőtlen hatást gyakorol az anya-gyermek kapcsolatra, a gyermek mentális fejlődésére, a párkapcsolatra, valamint a családi rendszer egyensúlyára. Kutatási eredmények igazolják, hogy a szorongásos zavar a későbbiekben megjelenő anyai depresszió előrejelzője lehet. A nemzetközi irányelvek (NICE) a peri- és postnatalis időszakban jelentkező szorongásos zavarok kezdeti kezelésében az alacsony intenzitású pszichoterápiás módszereket javasolják. Tanulmányunk elsődleges célja, hogy egy esetismertetésen keresztül, kérdőívekkel követve az állapot változását, bemutassuk a szülészet-nőgyógyászat területén alkalmazható, kis intenzitású pszichológiai intervenciók eszköztárát. Az utóbbi a kognitív viselkedésterápia alapmódszereit használja kórházi osztályos, illetve ambuláns keretek között. A pszichoedukációt, normalizálást és átkeretezést, problémafókuszú keresztmetszeti konceptualizálást, szisztematikus deszenzitizálást és problémamegoldó technikákat tartalmazó intervenciók hatására az anya jelentős szenvedést okozó szorongásos panaszai már négy pszichoterápiás találkozást követően csökkentek, az anya képessé vált arra, hogy gyermekét ellássa. A terápia hatékonyságát, a szorongás és a depresszió csökkenését a páciens szubjektív megélésén túlmenően az állapotkövető kérdőívek eredményei is teljesen mértékben alátámasztották. Eredményeink megerősítik, hogy az alacsony intenzitású pszichológiai intervenciók hatékonyan alkalmazhatók a kórházi osztályokon a szorongásos, depressziós panaszok csökkentésében és ezáltal költségkímélő módon a pszichés zavarok megelőzésében. Orv Hetil. 2021; 162(44): 1776-1782. Summary. The occurrence of postpartum worries is considered a normative phenomenon, although the threshold of anxiety reaches clinical level and can lead to the development of postpartum anxiety disorder for a significant number of new mothers. Frequent occurrence of anxiety-related symptoms can negatively influence the mother's quality of life, psychological status, the mother-child relationship, the newborn's mental development, the relationship of the couple as well as the balance of the family system as a whole. Studies show that postpartum anxiety disorder can lead to depression later on. International guidelines (NICE) suggest peri- and postnatal anxiety disorders to be treated using low intensity psychological interventions (LIPIs). The aim of this study is to present the different methods of LIPIs used in obstetrics and gynecology through a clinical case study, while monitoring the outcomes in the mothers' psychological status by the use of questionnaires. LIPIs contain the basics of cognitive behavioural therapy used in hospitals in both in- and outpatient care. After only four psychotherapy sessions using psychoeducation, normalizing and reframing, problem-centered cross-sectional conceptualisation, systematic desensitization and problem solving techniques, the mother's severe symptoms of anxiety decreased significantly, enabling her to take proper care of the newborn. The efficacy of the therapy was confirmed thoroughly not only by the subjective experience of the patient, but the results of the questionnaires used to follow the psychological status of the patient. Our results show that LIPIs can be effectively used as a cost-effective method to reduce symptoms of anxiety or depression, and to prevent the development of mental health problems among hospital patients. Orv Hetil. 2021; 162(44): 1776-1782.

Psychoeducation for borderline personality difficulties: a preliminary study

PurposeNational Institute for Clinical and Health Excellence guidelines (2009) state that low intensity psychological interventions should not be used for borderline personality disorder. However, an emerging body of evidence suggests brief interventions such as psychoeducation may be relevant for those presenting with borderline personality difficulties. The purpose of this study is to evaluate the benefit of learning about thinking, emotions and relationships (LATER), a co-produced psychoeducation programme for borderline personality difficulties in a community-based setting.Design/methodology/approachParticipants (n = 125) self-referred to LATER, a group-based psychoeducation programme delivered at the [NHS Trust] Recovery College. Participants were assessed pre- and post-intervention using the tailor-made psychological education group evaluation scale, the borderline evaluation of severity over time and work and social adjustment scale. Paired t-tests were conducted on pre- and post-scores, and effect sizes were calculated.FindingsAfter LATER, participants reported a significant decrease in negative thoughts and feelings, destructive behaviours and overall borderline symptom severity, but no significant increase in positive behaviours. Significant decreases were found in areas of work and social impairment. Participants’ overall understanding of personality difficulties significantly improved. Effect sizes were small to moderate.Research limitations/implicationsLimitations of the study include the lack of a control group, adjustment for confounders and follow-up. Replication with a more robust methodology is needed.Originality/valueThis study contributes to the evidence for the usefulness of brief interventions for personality difficulties, particularly in the context of a stepped model of care and adds to the research on co-production.

SEXUAL VIOLENCE AGAINST WOMEN IN NIGERIA AND VICTIMS’ SUSCEPTIBILITY TO PSYCHOLOGICAL DISTRESS AND SEXUAL DYSFUNCTION

The purpose of this paper was to present a comprehensive review of sexual violence against women and the victims’ susceptibility to emotional distress and sexual dysfunction. A total of 50 cases of rape victims and rape statistics report were gathered from secondary sources of information. From the retrospective description of some victims’ traumatic experiences, the picture of their negative emotions and grief were carefully analyzed and explanation provided on their exposure to psychological distress and psychosexual dysfunction. Deducing from the review and analysis of the histories and experiences of sexual violence victims, there is a strong relationship between women with history of sexual violence and susceptible to psychological distress sexual dysfunction such as; PTSD, sexual arousal inhibition, sexual avoidance contact, anger and hatred. Others include paranoia, fear of relationship with men as well as stress and re-experience of grief from the unpleasant memories of the rape incidence. Pathologically, sexual violence can threaten the psychological well-being of the survivors in a short and long-term depending on the circumstances and probably where the victim is left without care and support from friends, family and appropriate professional intervention. Thus, women who have been exposed to rape need intensive and suitable psychological intervention to heal their traumatized emotions that induce psychological distress and sexual dysfunction.

Reducing stigma and increasing workplace productivity due to mental health difficulties in a large government organization in the UK: a protocol for a randomised control treatment trial (RCT) of a low intensity psychological intervention and stigma reduction programme for common mental disorder (Prevail)

BackgroundCommon mental disorders are the leading cause of workplace absences. While the reasons for this are multifarious, there is little doubt that stigma related to common mental disorder plays a large role in sickness absence and in poor help-seeking. Frequently both managers and staff are unsure of how to approach and intervene with mental health related problems. We have therefore devised a mental health intervention programme (Prevail) that aims to reduce stigma and to educate staff about evidence-based low intensity psychological interventions. These can be used by the individual, as well as in collaboration with managers via co-production of problem-focussed solutions, with the aim of improving mental health, reducing sickness absence, and increasing workplace productivity.MethodsThis two-armed cluster randomised control trial (RCT) will evaluate the effectiveness of Prevail. Eighty managers at a large UK government institution (the DVLA) and their teams (approximately 960 employees) will be randomised into the active intervention group or control (employment as usual) arms of the study. All participants will be invited to complete a series of questionnaires related to mental health stigma, their current and past mental health, and their recent workplace productivity (absenteeism and presenteeism). All employees in the active arm will receive the Prevail Staff intervention, which covers stigma reduction and includes psychoeducation about evidence-based low intensity psychological interventions for common mental disorder. The managers in the active arm will also receive the Prevail Managers programme which covers communication skills, problem formulation, and problem-solving skills. The questionnaire battery will then be given to both groups again 4 weeks post training, and 12 months post-training. Official records of absenteeism from Human Resources will also be gathered from both active and control groups at 12 months post-training.DiscussionThe treatment trial aims to evaluate if Prevail reduces mental health related stigma (of a number of forms), increases help-seeking behaviours, and increases workplace productivity (via decreased absenteeism and presenteeism).Trial registrationISRCTN12040087. Retrospectively registered 04/05/2020.

Impact of Psychological Grief Counseling on the Severity of Post-Traumatic Stress Symptoms in Mothers after Stillbirths

ABSTRACTPlanned support and interventions are necessary in the care and support of women who have experienced stillbirth. The present study was conducted to determine the effect of psychological grief counseling on the symptom severity of post-traumatic stress disorder (PTSD) in mothers after stillbirths. This interventional study is semi-experimental. The study was conducted on 100 women who had recently had stillbirths. Eligible samples were selected and randomly divided into the two groups of intervention and control. The data collection tool was the PPQ,1 which was completed as a pre-test and post-test in both groups. The intervention group received four sessions of psychological grief counseling over two weeks, and the control group received only routine postnatal care. PTSD severity was evaluated in both groups at the end of the fourth week after the final session. The results showed that there was a statistically significant difference in the mean score of the severity of the PTSD symptoms in both groups after the intervention (P = 0.0001), which means that psychological grief counseling led to the reduction of PTSD severity in mothers. Given the positive impact of psychological grief counseling on reducing the severity of PTSD, integration of intensive psychological interventions in the maternity care system seems essential for faster transition of grief stages and for the prevention of severe cases of PTSD.

Low intensity interventions for Obsessive-Compulsive Disorder (OCD): a qualitative study of mental health practitioner experiences

BackgroundObsessive-compulsive disorder (OCD) is a debilitating mental health disorder that can substantially impact upon quality of life and everyday functioning. Guidelines recommend pharmacological and psychological treatments, using a cognitive behaviour therapy approach (CBT) including exposure and response prevention, but access has generally been poor. Low intensity psychological interventions have been advocated. The evidence base for these interventions is emerging but there is a paucity of information regarding practitioners’ perceptions and experiences of supporting individuals with OCD using this approach.MethodsQualitative interviews were undertaken with psychological wellbeing practitioners (PWPs) (n = 20) delivering low intensity psychological interventions for adults with OCD within the context of a large pragmatic effectiveness trial. Interviews explored the feasibility and acceptability of delivering two interventions; guided self-help and supported computerised cognitive behaviour therapy (cCBT), within Improving Access to Psychological Therapies (IAPT) services in NHS Trusts. Interviews were recorded with consent, transcribed and analysed using thematic analysis.ResultsPWPs acknowledged the benefits of low intensity psychological interventions for individuals experiencing OCD symptoms on an individual and population level. Offering low intensity support provided was perceived to have the opportunity to overcome existing service barriers to access treatment, improve patient choice and flexibility. Professional and service relevant issues were also recognised including self-beliefs about supporting people with OCD and personal training needs. Challenges to implementation were recognised in relation to practitioner resistance and intervention delivery technical complications.ConclusionsThis study has provided insight into the implementation of new low intensity approaches to the management of OCD within existing mental health services. Benefits from a practitioner, service and patient perspective are identified and potential challenges highlighted.Trial registrationCurrent Controlled Trials: ISRCTN73535163. Date of registration: 5 April 2011.

Impact of long-term medical conditions on the outcomes of psychological therapy for depression and anxiety.

Long-term conditions often coexist with depression and anxiety. To assess the effectiveness of stepped-care psychological therapies for patients with long-term conditions. Data from 28 498 patients were analysed using regression to model depression (Patient Health Questionnaire (PHQ-9)) and anxiety (Generalised Anxiety Disorder scale (GAD-7)) outcomes. Post-treatment symptoms and effect sizes (d) were estimated for individuals with and without long-term conditions, controlling for covariates. The likelihood of access and response to intensive psychological interventions was also examined. Higher post-treatment symptoms were predicted for patients with musculoskeletal problems (d = 0.22-0.27), chronic obstructive pulmonary disease (d = 0.26-0.33), diabetes (d = 0.05-0.13) and psychotic disorders (d = 0.50-0.58). Most long-term conditions were associated with greater odds of accessing high-intensity therapies, yet individuals who accessed these continued to have higher average post-treatment symptoms. Some long-term conditions are associated with greater intensity of care and poorer outcomes after therapy.

Collaborative space using the andalousian integrated care process of anxiety, depression and somatization

Introduction/objectivesThe Integrated Care Process of Anxiety, Depression and Somatization (ICP-ADS) lays out the cooperation between primary care (PC) and mental health (MH) as basic premises. Showing this model improves patient detection, inadequate patient referrals, adherence and response to medical treatment.AimsThe Therapeutic Program (TP) established in PC includes low intensity psychological and psychosocial interventions, pharmacological treatment, and use of collaborative space with MH combining consultations, case tracking and educational activities. Our rotation as MH residents in the Community Mental Health Unit (CMHU) has focused on this framework, encouraging the use of a collaborative space.MethodsThree training sessions were used to deal with the process as a whole. PC professionals were given self-help handbooks for low intensity interventions and clinical practice handbooks for psychopharmacological treatment. The referral space was established afterwards, where we took part in the TP founded by the PC doctor. In case the demand would continue, we opened consultation one day a week for co-therapy. With brief interventions of 3–4 sessions we continued the work with self-help guides, which also optimized psychopharmacotherapy.ResultsReferrals were sufficient in many cases. Sixteen procedures were completed in co-therapy, half of which required referrals to encourage adherence. Only a referral to MH had to be done. Three months later, a follow-up showed that no patient in co-therapy had to be referred to specialized care.ConclusionsThe amount of referrals was reduced in comparison to previous months, adherence to interventions of low intensity was improved and was useful in both detection and prevention of new cases.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Different people respond differently to therapy: A demonstration using patient profiling and risk stratification

BackgroundThis study aimed to identify patient characteristics associated with poor outcomes in psychological therapy, and to develop a patient profiling method. MethodClinical assessment data for 1347 outpatients was analysed. Final treatment outcome was based on reliable and clinically significant improvement (RCSI) in depression (PHQ-9) and anxiety (GAD-7) measures. Thirteen patient characteristics were explored as potential outcome predictors using logistic regression in a cross-validation design. ResultsDisability, employment status, age, functional impairment, baseline depression and outcome expectancy predicted post-treatment RCSI. Regression coefficients for these factors were used to derive a weighting scheme called Leeds Risk Index (LRI), used to assign risk scores to individual cases. After stratifying cases into three levels of LRI scores, we found significant differences in RCSI and treatment completion rates. Furthermore, LRI scores were significantly correlated with the proportion of treatment sessions classified as ‘not on track’. ConclusionsThe LRI tool can identify cases at risk of poor progress to inform personalized treatment recommendations for low and high intensity psychological interventions.

Association of Pre-Transplant Depression with Clinical Outcomes and Resource Utilization after Allogeneic Hematopoietic Stem Cell Transplantation

s / Biol Blood Marrow Transplant 22 (2016) S19eS481 S23 Cox regression analyses controlling for significant confounders. Results: We included 1116 (15%) patients with pre-HCT depression and 6317 (85%) patients without pre-HCT depression transplanted between 2008 and 2012. Patients with pre-HCT depression were similar to those without pre-HCT depressionwith regards to age, disease distribution, disease risk index, time from diagnosis to transplant, conditioning regimen, receipt of total body irradiation, graft type, donor type, and stem cell source, but they were more likely to be female, white, divorced, less educated, not working full-time, and had lower performance status and higher number of comorbid conditions. In multivariable analyses, pre-HCT depression was associated with higher overall mortality (HR 1.13, 95% CI 1.04-1.23, p 1⁄4 0.004) and higher risk of grade II-IV acute GVHD (HR 1.25, 95%CI 1.141.37, p < 0.0001), but similar risk of chronic GVHD (HR 1.06, 95% CI 0.96-1.16, p 1⁄4 0.26). Pre-HCT depression was associated with fewer days alive and out-of-the hospital during the first 100 days (Means Ratio (MR)1⁄4 0.97, 95% CI 0.95-0.99, P1⁄4 0.004). Conclusion: Pre-HCT depression was associated with higher mortality, fewer days out of the hospital in the first 100 days, and higher risk of acute GVHD among allogeneic HCT recipients. Therefore patients with pre-HCT depression represent a highly vulnerable population at risk for posttransplant mortality and complications, and they may benefit from more intensive medical and psychological interventions.

Economic evaluation of a psychological intervention for high distress cancer patients and carers: costs and quality-adjusted life years.

This study compared the cost-effectiveness of a psychologist-led, individualised cognitive behavioural intervention (PI) to a nurse-led, minimal contact self-management condition for highly distressed cancer patients and carers. This was an economic evaluation conducted alongside a randomised trial of highly distressed adult cancer patients and carers calling cancer helplines. Services used by participants were measured using a resource use questionnaire, and quality-adjusted life years were measured using the assessment of quality of life - eight-dimension - instrument collected through a computer-assisted telephone interview. The base case analysis stratified participants based on the baseline score on the Brief Symptom Inventory. Incremental cost-effectiveness ratio confidence intervals were calculated with a nonparametric bootstrap to reflect sampling uncertainty. The results were subjected to sensitivity analysis by varying unit costs for resource use and the method for handling missing data. No significant differences were found in overall total costs or quality-adjusted life years (QALYs) between intervention groups. Bootstrapped data suggest the PI had a higher probability of lower cost and greater QALYs for both carers and patients with high distress at baseline. For patients with low levels of distress at baseline, the PI had a higher probability of greater QALYs but at additional cost. Sensitivity analysis showed the results were robust. The PI may be cost-effective compared with the nurse-led, minimal contact self-management condition for highly distressed cancer patients and carers. More intensive psychological intervention for patients with greater levels of distress appears warranted. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.