Moderate Symptom Levels Research Articles

Trajectories of depressive symptoms in Korean adults with diabetes: Individual differences and associations with life satisfaction and mortality.

We examined trajectories of depressive symptoms and their predictors in adults with diabetes. We assessed whether these trajectories were related to life satisfaction and mortality. Longitudinal, prospective observational study. We analysed data from 1217 adults with diabetes (aged ≥45 years) in the Korean Longitudinal Study of Aging (2006-2018). Three trajectories of depressive symptomology were identified in growth mixture models: low/stable (i.e., low and stable levels of symptoms; 85.56%), high/decreasing (i.e., high levels of symptoms with a decreasing trajectory; 7.47%), and moderate/increasing (i.e., moderate levels of symptoms with an increasing trajectory; 6.98%). Participants with poor perceived health status at baseline were more likely to be in the moderate/increasing or high/decreasing classes than in the low/stable class. The moderate/increasing class had the lowest satisfaction with quality of life, followed by the high/decreasing and low/stable classes. The moderate/increasing and the high/decreasing classes had lower satisfaction with relationships with spouse and children than the low/stable class. The high/decreasing class had a higher mortality risk than the low/stable class. Long-term monitoring of depressive symptoms in adults with diabetes is warranted given their potential adverse impact on life satisfaction and mortality.

Mental health problems, sleep quality and overuse injuries in advanced Swedish rock-climbers – the CLIMB study

ObjectivesTo examine the prevalence of mental health problems (depression, anxiety, and stress), sleep quality, and disability due to overuse injuries in advanced and elite rock-climbers. The rock-climbers were compared to a group of non-climbing controls.MethodsA self-selected sample of advanced and elite Swedish rock-climbing athletes was recruited through the Swedish Rock-climbing Federation, local rock-climbing gyms and through social media. A control group, matched in size was recruited. Participants in the control group answered an online survey of validated questionnaires, examining symptoms of stress, anxiety, depression, sleep quality. The climbing participants answered the same survey as the non-climbing controls but with additional questions regarding musculoskeletal problems and disabilities related to these. Outcome measures used were the Depression Anxiety Stress Scale, Pittsburgh Sleep Quality Index and The Oslo Sports Trauma Research Center Overuse Injury Questionnaire.ResultsA total of 183 participants were included in the rock-climbing group, and 180 participants in the control group. In the rock-climbing group the mean age (SD) was 28.2 (8.3) years among women and 30.5 (9.6) years in men. The mean BMI of women was 21.2 (2.2) and 22.8 (2.1) in men. A total of 30.6% of the rock-climbing group (26.7% of men, 35.9% of women) reported at least moderate levels of symptoms of depression and 23.1% (17.2% men, 30.8% women) at least moderate levels of symptoms of anxiety. A total of 48.4% of rock-climbers (39.1% men, and 61.6% women) reported at least moderate levels of symptoms of stress. Among the rock-climbers, 45.0% reported having poor sleep quality. There were no statistical significant differences (p = 0.052–0.96) in mental health problems or sleeping problems between the rock-climbers and the controls. Among rock-climbers, reports of one-week prevalence of injury related problems was: Finger and hand (49.5%), Shoulder (35.2%), Knee (29.1%), Lumbar back (26.4%), Arm (25.3%), Thoracic back and neck (17.0%), and Foot and lower leg (12.1%).ConclusionThe overall results indicate high levels of symptoms of mental health problems and poor sleep quality in both rock-climbers and controls. Although no significant differences between the climbing group and the control group was displayed, symptoms that warrant clinical attention is high. Overuse injuries were commonly reported among the rock-climbers in all examined injury locations. Previous studies reporting mental health problems to be more prevalent among athletes were contradicted in this study. The results display the need for a broader perspective regarding climbers general health and the need to provide structured care and adequate support in order to come to terms with these concerns.

Step away from depression-results from a multicenter randomized clinical trial with a pedometer intervention during and after inpatient treatment of depression.

Evidence for the effectiveness of physical activity (PA) in the treatment of depression prevails for outpatients with mild and moderate symptom levels. For inpatient treatment of severe depression, evidence-based effectiveness exists only for structured and supervised group PA interventions. The Step Away from Depression (SAD) study investigated the effectiveness of an individual pedometer intervention (PI) combined with an activity diary added to inpatient treatment as usual (TAU). In this multicenter randomized controlled trial, 192 patients were randomized to TAU or TAU plus PI. The two primary outcomes at discharge were depression-blindly rated with the Montgomery-Åsberg Depression Rating Scale (MADRS)-and average number of daily steps measured by accelerometers. Secondary outcomes were self-rated depression and PA, anxiety, remission and response rates. Multivariate analysis of variance (MANOVA) revealed no significant difference between both groups for depression and daily steps. Mean MADRS scores at baseline were 29.5 (SD = 8.3) for PI + TAU and 28.8 (SD = 8.1) for TAU and 16.4 (SD = 10.3) and 17.2 (SD = 9.9) at discharge, respectively. Daily steps rose from 6285 (SD = 2321) for PI + TAU and 6182 (SD = 2290) for TAU to 7248 (SD = 2939) and 7325 (SD = 3357). No differences emerged between groups in secondary outcomes. For severely depressed inpatients, a PI without supervision or further psychological interventions is not effective. Monitoring, social reinforcement and motivational strategies should be incorporated in PA interventions for this population to reach effectiveness.

Different mediators of applied theory-of-mind competence in children with autism spectrum disorder

BackgroundChildren with autistic spectrum disorder (ASD) with mild and moderate symptom levels have significant differences in applied theory of mind (ToM) competence. However, their mediators of applied ToM competence have not been documented. AimsThis study aimed to identify the mediators of applied ToM competence in these two clinically distinct groups. MethodsA total of 163 children with ASD aged 3–12 years old (88 and 75 children respectively in the mild and moderate groups) and their caregivers participated in this study. Data of children’s verbal comprehension, explicit ToM knowledge and applied ToM competence were collected and then analyzed using mediation analysis. ResultsThe results of mediation analysis showed that verbal comprehension (95% confidence interval [CI] of indirect effect: 0.02 − 0.19) and explicit ToM knowledge (95% CI of indirect effect: 0.01 − 0.07) were the mediators of applied ToM competence in children with mild and those with moderate symptoms, respectively. Conclusions and ImplicationsOur findings demonstrate that the mediators of applied ToM competence differ by symptom level in children with ASD. Applied ToM competence and the mediators should be assessed for designing tailored and effective intervention plans for these children according to their symptom level.

Symptom experiences in advanced cancer: Relationships to acceptance and commitment therapy constructs.

This study examined relations between acceptance and commitment therapy (ACT) constructs and symptom-based subgroups of advanced cancer patients. Patients with advanced breast, gastrointestinal, lung, and prostate cancer (N=201) completed questionnaires assessing five common symptoms and ACT variables (i.e., psychological inflexibility, cognitive fusion, values obstruction and progress, peaceful acceptance, mindfulness, and activity engagement) on one occasion. Latent profile analysis showed three patient classes: (1) normal levels of all symptoms (32%); (2) normal levels of all symptoms except for mild sleep problems and moderate fatigue (19%); and (3) normal pain, mild levels of sleep problems, anxiety, and depressive symptoms, and moderate fatigue (48%). Controlling for demographic covariates, lower psychological inflexibility, cognitive fusion, and values obstruction were associated with a higher likelihood of being in classes 1 or 2 than class 3. In addition, greater values progress, peaceful acceptance, mindfulness, and activity engagement were associated with a higher likelihood of being in class 1 than class 3. Of these four factors, only greater mindfulness and activity engagement were associated with a higher likelihood of being in class 2 than class 3. Advanced cancer patients show heterogeneous symptom profiles, and even mild to moderate symptom levels are related to greater withdrawal from personally meaningful activities and less acceptance of cancer and internal experiences (e.g., symptoms, thoughts, feelings). Findings are consistent with the ACT model and support further testing of ACT to address symptom interference with functioning in advanced cancer patients.

Group Cognitive Behavioural Analysis System of Psychotherapy (CBASP) for persistently depressed outpatients: a retrospective chart review.

BackgroundCognitive behavioural analysis system of psychotherapy (CBASP) is an effective individual treatment for persistent depressive disorder (PDD), but evidence on group treatment (Group‐CBASP) is limited. Our aim was to review the effect of Group‐CBASP on self‐report depression severity in outpatients with PDD, overall and by age of depression‐onset.MethodsA retrospective chart review study (November 2011–March 2017) in 54 patients with PDD (29 late‐onset, 25 early‐onset). Patients were previously treated by pharmacotherapy (92.6%), psychotherapy (98.1%) and/or electroconvulsive therapy (11.1%). Group‐CBASP involved 24 weekly sessions during 6 months, followed by individual appointments over 6 months. The Inventory of Depressive Symptoms ‐self rating(IDS‐SR) was used at baseline and after 3, 6, 9 and 12 months, computing mean differences and response rates.ResultsThe mean IDS‐SR score decreased significantly from 39.83 at baseline to 33.78 at 6 months: a decrease from severe to moderate depression after 24 weeks of Group‐CBASP, with a medium effect size (Cohen’s d = .49). At 12 months, the mean IDS‐SR score was 32.81, indicating moderate symptom levels remained. At 6 and 12 months, mean IDS‐SR scores were similar among late‐ versus early‐onset patients, but at 12 months response rates were higher among late‐onset patients.LimitationsAlthough results of our study provide valuable input for future prospective studies, limitations were the use of a retrospective design and the small group size.ConclusionGroup‐CBASP offered to an outpatient population with PDD was associated with clinically relevant decrease in self‐reported symptom severity, and with sustained response particularly in patients with late onset of depression.Practitioner points Group‐CBASP seems to be a good alternative for CBASP in individual setting.Patients with late age of depression‐onset seem to benefit more from Group‐CBASP.This study shows that clinical relevant effects of Group‐CBASP, followed by individual contacts, remain at least for 6 months.Research on personalizing treatment strategies is needed to improve patient assignment for Group‐CBASP.

Variation in Criminogenic Risks by Mental Health Symptom Severity: Implications for Mental Health Services and Research.

Although a growing body of literature has demonstrated that justice-involved people with mental illnesses have criminogenic risk factors at similar or elevated rates as compared to justice-involved people without mental illnesses, more information about how criminogenic risks vary by intensity of mental health symptoms is needed. This information is particularly important for probation agencies who supervise the vast majority of justice-involved individuals with mental illnesses and who are increasingly implementing specialty mental health supervision approaches. To this end, this study examines the relationship between criminogenic risk and intensity of self-reported symptoms of mental illnesses among 201,905 individuals on probation from a large southeastern state. Self-report measures of symptoms of mental illnesses were categorized as low, moderate or high and criminogenic risks were compared among the following three groups: (1) those with no or low self-reported symptoms of mental illness; (2) those reporting moderate levels of symptoms; and (3) those reporting high or elevated levels of symptoms. Our findings suggest that the strength of relationships between symptoms of mental illnesses and criminogenic risks varies by type of criminogenic risk. Also, elevated symptoms of mental illness are associated with higher levels of criminogenic risks. More research about interventions that address mental illnesses and criminogenic risks is needed to inform practice and policy.

Psychosoziale Arbeitsbedingungen und Burnout-Symptome in der stationären somatischen und psychiatrischen Gesundheits- und Krankenpflege.

Psychosocial working conditions and symptoms of burnout in somatic and psychiatric nursing Abstract. Background: While mental workload and stress among nurses are generally well-documented, differences within the nursing profession have hardly been investigated so far. Aim: This study aims to examine the differences and associations between psychosocial working conditions and symptoms of burnout of nurses working in somatic and psychiatric settings. Methods: A cross-sectional study has been conducted with employees in one somatic and one psychiatric hospital (n = 576). The Copenhagen Psychosocial Questionnaire and the Copenhagen Burnout Inventory were used to assess psychosocial workloads and burnout symptoms. The data analysis was carried out by univariate, bivariate and multivariate (regression) analyses. Results: About 50 % of respondents report at least a moderate level of symptoms of burnout with somatic nurses more frequently affected. While quantitative and physical demands are higher in somatic nursing, psychiatric nurses have a higher degree of emotional demands, socialβ = 0.33) in somatic nursing and emotional demands (β = 0.29) in psychiatric nursing serve as strongest predictors of burnout symptoms. Conclusions: Findings suggest specific profiles of psychosocial workload in somatic and psychiatric nursing as well as a high need for differentiated approaches for occupational health promotion.

Thoughts of self-harm and associated risk factors among postpartum women in Canada

BackgroundThe prevalence of thoughts of self-harm during the postpartum period is not well documented in Canada. To estimate the prevalence of thoughts of self-harm among postpartum women in Canada, this study explored prevalence by socio-demographic characteristics and examined the associations between thoughts of self-harm and aspects of maternal mental health. MethodsThis study used data from the 2018/2019 Survey on Maternal Health which surveyed women living in the 10 provinces anywhere between 6–13 months postpartum. Participants were asked to report experiencing thoughts of self-harm, rate their mental health, and participate in the abbreviated Edinburgh Postpartum Depression Scale and Generalized Anxiety Disorder (GAD) scale. Adjusted logistic regression analyses were performed to examine associations. ResultsOf the 6,558 respondents who agreed to share their data, 10.4% reported thoughts of self-harm since the birth of their child. Of these women, 37.0% reported low mental health, 54.2% had moderate levels of symptoms of postpartum depression (PPD) and 37.1% had symptoms of GAD. Women who experienced low mental health, moderate levels of symptoms of PPD and/or GAD were more likely to report thoughts of self-harm. LimitationsAs thoughts of self-harm and aspects of mental health are self-reported, there is the potential for social desirability bias and underreporting. The cross-sectional survey design did not allow the reporting of thoughts of self-harm at different time points. DiscussionThe high proportion of postpartum women in Canada reporting thoughts of self-harm and strong associations with aspects of maternal mental health highlight the need for effective supports during postpartum.

Posttraumatic Stress Symptoms and Posttraumatic Growth in Mothers of Children With Intellectual Disability - The Role of Intrusive and Deliberate Ruminations: A Preliminary Report.

BackgroundThe aim of this study was to find out if mothers of children with intellectual disability (ID) demonstrate symptoms of posttraumatic stress and posttraumatic growth (PTG), and to define the role of intrusive and deliberate ruminations in this area.MethodsThe questionnaire-based study included 85 mothers of children with ID. Three standardized questionnaires were used: Impact of Event Scale-Revised, PTG Inventory, Event-Related Rumination Scale.ResultsRelative to the population norm in Poland, 52% of mothers of children with ID demonstrated at least moderate level of symptoms of posttraumatic stress. The mean level of PTG was high in this group. Intrusive ruminations and mothers’ age served as a predictor for posttraumatic stress symptoms (PTSS). None of the types of rumination correlated with PTG.ConclusionMothers of children with ID demonstrated symptoms of both posttraumatic stress and PTG. Intrusive ruminations proved to be significant predictors for PTSS.

Identifying crime victims vulnerable to persistent depressive symptoms: Results from a secondary analysis

BackgroundAlthough depression has been extensively studied in relations to Intimate Partner Violence (IPV) and Childhood Maltreatment (CM), we still know little about its relationship with other types of violent crimes (e.g., physical assault, mugging) or how symptoms evolve over time. MethodsUsing a clinical sample of 132 crime victims, this study sought to map out group-based symptoms trajectories using Latent Growth Curve Analysis (LCGA) over the course of one year. ResultsLess than one month after having been assaulted, 30% of the sample reached the severe depression threshold. Symptoms tended to improve over time, with only 8% of participants reporting severe depression one year later. Analyses indicate the presence of three distinct profiles: one marked by severe and stable symptomatology over time (17%), the second characterized by a moderate level of symptoms that decreases exponentially over time (57%) and a third one describing a pattern of minimal depression throughout the year. People who suffered from persistent depression reported significantly lower levels of social support, scored higher on the ASDI and were also more likely to report some type of maltreatment in childhood but not IPV in adulthood, and appeared non-responsive to treatment. LimitationsResults must be nuanced by the size (i.e., LCGA requirements and attrition) and nature of the sample (i.e., help-seeking victims only). ConclusionsAlthough violence is a risk factor for depression, some individuals, especially those with a history of CM, appear to be more vulnerable to severe, persistent and treatment-resistant depression than others.

Psychological therapies for anxiety and depression in children and adolescents with long-term physical conditions.

Long-term physical conditions affect 10% to 12% of children and adolescents worldwide. These individuals are at greater risk of developing psychological problems, particularly anxiety and depression, sometimes directly related to their illness or medical care (e.g. health-related anxiety). There is limited evidence regarding the effectiveness of psychological therapies for treating anxiety and depression in this population. Therapies designed for children and adolescents without medical issues may or may not be appropriate for use with those who have long-term physical conditions. This review was undertaken to assess the effectiveness and acceptability of psychological therapies in comparison with controls (treatment-as-usual, waiting list, attention placebo, psychological placebo, or non-psychological treatment) for treating anxiety and depression in children and adolescents with long-term physical conditions. We searched Ovid MEDLINE (1950- ), Embase (1974- ), PsycINFO (1967- ) and the Cochrane Central Register of Controlled Trials (CENTRAL) to 27 September 2018. An earlier search of these databases was conducted via the Cochrane Common Mental Disorders Controlled Trial Register (CCMD-CTR) (all years to May 2016). In addition we searched the Web of Science (Core Collection) (12 October 2018) and conducted a cited reference search for reports of all included trials. We handsearched relevant conference proceedings, reference lists of included articles, and grey literature. Randomised controlled trials (RCTs), cluster-randomised trials and cross-over trials of psychological therapies for treating anxiety or depression in children with long-term physical conditions were included. Abstracts and complete articles were independently reviewed by two authors. Discrepancies were addressed by a third author. Odds ratio (OR) was used for comparing dichotomous data and standardised mean differences (SMD) for comparing continuous data. Meta-analysis was undertaken when treatments, participants, and the underlying clinical question were similar. Otherwise, narrative analysis of data was undertaken. Twenty-eight RCTs and one cross-over trial with 1349 participants were included in the review. Most participants were recruited from community settings and hospital clinics in high-income countries. For the primary outcome of treatment efficacy, short-term depression (versus any control), there was low-quality evidence from 16 trials involving 1121 participants suggesting that psychological therapies may be more effective than control therapies (SMD -0.31, 95% CI -0.59 to -0.03; I2 = 79%). For the primary outcome of treatment efficacy, short-term anxiety (versus any control), there was inadequate evidence of moderate-quality from 13 studies involving 578 participants to determine whether psychological therapies were more effective than control conditions (SMD -0.26, CI -0.59 to 0.07, I2 = 72%). Planned sensitivity analyses could not be undertaken for risk of bias due to the small number of trials that rated high for each domain. Additional sensitivity analysis demonstrated that psychological interventions specifically designed to reduce anxiety or depression were more effective than psychological therapies designed to improve other symptoms or general coping. There was some suggestion from subgroup analyses that they type of intervention (Chi² = 14.75, df = 5 (P = 0.01), I² = 66.1%), the severity of depression (Chi² = 23.29, df = 4 (P = 0.0001), I² = 82.8%) and the type of long-term physical condition (Chi² = 10.55, df = 4 (P = 0.03), I² = 62.1%) may have an impact on the overall treatment effect.There was qualitative (reported), but not quantitative evidence confirming the acceptability of selected psychological therapies for anxiety and depression. There was low-quality evidence that psychological therapies were more effective than control conditions in improving quality of life (SMD 1.13, CI 0.44 to 1.82, I2 = 89%) and symptoms of long-term physical conditions (SMD -0.34, CI -0.6 to -0.06, I2 = 70%), but only in the short term. There was inadequate low-quality evidence to determine whether psychological therapies were more effective than control conditions at improving functioning in either the short term or long term. No trials of therapies for addressing health-related anxiety were identified and only two trials reported adverse effects; these were unrelated to psychological therapies. Overall, the evidence was of low to moderate quality, results were heterogeneous, and only one trial had an available protocol. A limited number of trials of variable quality have been undertaken to assess whether psychological therapies are effective for treating anxiety and depression in children and adolescents with long-term physical conditions. According to the available evidence, therapies specifically designed to treat anxiety or depression (especially those based on principles of cognitive behaviour therapy (CBT)) may be more likely to work in children and adolescents who have mild to moderate levels of symptoms of these disorders, at least in the short term. There is a dearth of therapies specifically designed to treat health-related anxiety in this age group.

Central lumbar spinal stenosis: natural history of non-surgical patients

PurposeThe aim of the present study was to examine the natural history in patients with lumbar spinal stenosis. The incidence of surgery for this condition has increased considerably during the past decades in spite of a fairly favorable natural history in previous studies.Methods146 consecutive patients with clinical signs and image findings of lumbar spinal stenosis, who were not recommended surgical treatment, were followed; the reason as to why surgery was not recommended was a moderate symptom level. The follow-up rate was 89% after 3.3 years. Group values for comorbidities and diagnostic imaging were comparable to patients selected for surgery, with the exception of a lower frequency of degenerative spondylolisthesis among the non-operative patients. The mean age of those observed was 68 (21–91), and 58% were females.ResultsDuring the observation period spontaneous improvements were found for pain and health-related quality of life, but not for walking. Using the minimum clinically important difference for VAS, leg and back pain improved in 32 and 36% of patients, respectively, were unchanged in 55 and 54%, and worsened in 13 and 10%. Findings on diagnostic imaging did not influence patient outcome, except for stenoses with cross-sectional area <0.5 cm2 where spontaneous improvement was not seen. Revision of the decision not to operate occurred in 10 cases (7%).ConclusionsThe natural history of LSS with moderate symptom levels rarely shows symptom deterioration over a median of 3.3 years; in fact, a slight improvement of symptoms was seen at group levels. The treatment decision was revised for 7%, and for the rest an increase in pain was seen in 10–13%. The results support reluctance towards surgery, if the symptom levels are tolerable for the patients.

Psychological therapies for anxiety and depression in children and adolescents with long-term physical conditions

Background Long-term physical conditions affect 10% to 12% of children and adolescents worldwide. These individuals are at greater risk of developing psychological problems, particularly anxiety and depression, sometimes directly related to their illness or medical care (e.g. health-related anxiety). There is limited evidence regarding the effectiveness of psychological therapies for treating anxiety and depression in this population. Therapies designed for children and adolescents without medical issues may or may not be appropriate for use with those who have long-term physical conditions. Objectives This review was undertaken to assess the effectiveness and acceptability of psychological therapies in comparison with controls (treatment-as-usual, waiting list, attention placebo, psychological placebo, or non-psychological treatment) for treating anxiety and depression in children and adolescents with long-term physical conditions. Search methods We searched Ovid MEDLINE (1950- ), Embase (1974- ), PsycINFO (1967- ) and the Cochrane Central Register of Controlled Trials (CENTRAL) to 27 September 2018. An earlier search of these databases was conducted via the Cochrane Common Mental Disorders Controlled Trial Register (CCMD-CTR) (all years to May 2016). In addition we searched the Web of Science (Core Collection) (12 October 2018) and conducted a cited reference search for reports of all included trials. We handsearched relevant conference proceedings, reference lists of included articles, and grey literature. Selection criteria Randomised controlled trials (RCTs), cluster-randomised trials and cross-over trials of psychological therapies for treating anxiety or depression in children with long-term physical conditions were included. Data collection and analysis Abstracts and complete articles were independently reviewed by two authors. Discrepancies were addressed by a third author. Odds ratio (OR) was used for comparing dichotomous data and standardised mean differences (SMD) for comparing continuous data. Meta-analysis was undertaken when treatments, participants, and the underlying clinical question were similar. Otherwise, narrative analysis of data was undertaken. Main results Twenty-eight RCTs and one cross-over trial with 1349 participants were included in the review. Most participants were recruited from community settings and hospital clinics in high-income countries. For the primary outcome of treatment efficacy, short-term depression (versus any control), there was low-quality evidence from 16 trials involving 1121 participants suggesting that psychological therapies may be more effective than control therapies (SMD -0.31, 95% CI -0.59 to -0.03; I2 = 79%). For the primary outcome of treatment efficacy, short-term anxiety (versus any control), there was inadequate evidence of moderate-quality from 13 studies involving 578 participants to determine whether psychological therapies were more effective than control conditions (SMD -0.26, CI -0.59 to 0.07, I2 = 72%). Planned sensitivity analyses could not be undertaken for risk of bias due to the small number of trials that rated high for each domain. Additional sensitivity analysis demonstrated that psychological interventions specifically designed to reduce anxiety or depression were more effective than psychological therapies designed to improve other symptoms or general coping. There was some suggestion from subgroup analyses that they type of intervention (Chi² = 14.75, df = 5 (P = 0.01), I² = 66.1%), the severity of depression (Chi² = 23.29, df = 4 (P = 0.0001), I² = 82.8%) and the type of long-term physical condition (Chi² = 10.55, df = 4 (P = 0.03), I² = 62.1%) may have an impact on the overall treatment effect.There was qualitative (reported), but not quantitative evidence confirming the acceptability of selected psychological therapies for anxiety and depression. There was low-quality evidence that psychological therapies were more effective than control conditions in improving quality of life (SMD 1.13, CI 0.44 to 1.82, I2 = 89%) and symptoms of long-term physical conditions (SMD -0.34, CI -0.6 to -0.06, I2 = 70%), but only in the short term. There was inadequate low-quality evidence to determine whether psychological therapies were more effective than control conditions at improving functioning in either the short term or long term. No trials of therapies for addressing health-related anxiety were identified and only two trials reported adverse effects; these were unrelated to psychological therapies. Overall, the evidence was of low to moderate quality, results were heterogeneous, and only one trial had an available protocol. Authors' conclusions A limited number of trials of variable quality have been undertaken to assess whether psychological therapies are effective for treating anxiety and depression in children and adolescents with long-term physical conditions. According to the available evidence, therapies specifically designed to treat anxiety or depression (especially those based on principles of cognitive behaviour therapy (CBT)) may be more likely to work in children and adolescents who have mild to moderate levels of symptoms of these disorders, at least in the short term. There is a dearth of therapies specifically designed to treat health-related anxiety in this age group.

Examining Trait × Method Interactions Using Mixture Distribution Multitrait–Multimethod Models

Multitrait-multimethod (MTMM) analyses are used in psychology to assess convergent and discriminant validity and to study method effects. Most current MTMM approaches assume that measures have equal convergent and discriminant validity across the entire range of trait values and thus do not account for potential trait × method interactions. A novel approach is presented that allows analyzing trait × method interactions using factor mixture modeling. The new MTMM mixture model allows identifying latent classes of individuals who differ with respect to convergent and discriminant validity. The new approach was applied to mother’s and father’s ratings of children’s attention deficit hyperactivity disorder (ADHD) symptoms (N = 618). Results revealed four latent classes: one with no symptom levels, two with low symptom levels, and one with moderate symptom levels. Three classes showed evidence for convergent and discriminant validity, whereas a low symptom class lacked convergent validity for ratings of inattention.Keywords: mixture distribution, factor mixture model, convergent and discriminant validity, multitrait-multimethod analysis

P.3.f.012 - Dangerousness evaluation of psychotic patients in a Tunisian psychiatric department

The release of insanity acquittees requires making informed decisions regarding both the presence and severity of an individuals' mental illness and the dangerousness of these individuals. This study evaluated the usefulness of employing structured assessments of mental health and violence risk factors in the conditional release decision-making process. All persons found Not Guilty by Reason of Insanity at East Louisiana Mental Health System, Forensic Division who underwent a review panel between July 1, 1997 and July 1, 1999 were included in this study. The Classification and Regression Tree analysis was utilized to arrive at cutpoints that would optimize the predictive ability of the decision tree analysis. The results indicated that the Community Outpatient Treatment Readiness Profile score was the strongest predictor — all patients receiving a score of 62 or greater on this scale were recommended to remain at the facility. When women were recommended for release, it was to civil facilities and with moderate levels of symptoms. For males with moderate symptoms, low PCL-R scores were associated with recommendations for release, whereas high scores were associated with recommendations for continued commitment. Our data suggests that algorithms may be useful to governing bodies when making release decisions.

Identifying the symptom and functional domains in patients with fibromyalgia: results of a cross-sectional Internet-based survey in Italy.

ObjectiveThe aims of this cross-sectional study were to investigate the usefulness of using an Internet survey of patients with fibromyalgia in order to obtain information concerning symptoms and functionality and identify clusters of clinical features that can distinguish patient subsets.MethodsAn Internet website has been used to collect data. Fibromyalgia Impact Questionnaire Revised version, self-administered Fibromyalgia Activity Score, and Self-Administered Pain Scale were used as questionnaires. Hierarchical agglomerative clustering was applied to the data obtained in order to identify symptoms and functional-based subgroups.ResultsThree hundred and fifty-three patients completed the study (85.3% women). The highest scored items were those related to sleep quality, fatigue/energy, pain, stiffness, degree of tenderness, balance problems, and environmental sensitivity. A high proportion of patients reported pain in the neck (81.4%), upper back (70.1%), and lower back (83.2%). A three-cluster solution best fitted the data. The variables were significantly different (P<0.0001) among the three clusters: cluster 1 (117 patients) reflected the lowest average scores across all symptoms, cluster 3 (116 patients) the highest scores, and cluster 2 (120 patients) captured moderate symptom levels, with low depression and anxiety.ConclusionThree subgroups of fibromyalgia samples in a large cohort of patients have been identified by using an Internet survey. This approach could provide rationale to support the study of individualized clinical evaluation and may be used to identify optimal treatment strategies.

Is it true remission? A study of remitted patients affected by schizophrenia and schizoaffective disorders

To date, few studies have reported analytical data relating to clinical remission, functional remission and subjective experience. The present study aimed to investigate these aspects in a sample of chronic outpatients. Methods: 112 schizophrenic or schizoaffective outpatients (Males=60; Females=52; mean age 43.5±9.42yr) were evaluated with regard to symptomatology (SCID-I; PANSS, CGI-SCH scales), functioning (PSP scale), subjective wellbeing (SWN-K scale) and Quality of Life (WHO-QoL-Bref scale). Results: 50% of patients were found to be in remission. Significantly higher scores at PANNS, CGI-SCH, PSP, but not at SWN and WHO-QoL, were found among remitted patients; a relevant proportion of remitted subjects continued to manifest a moderate level of symptoms (score >3) both at PANSS (35% of cases) and CGI-SCH (29% of cases), significant functional impairment (total score <70) at PSP (68% of cases ), and a lesser degree of wellbeing (total score <80) at SWN-K (34% of cases). Conclusion: patients in whom clinical remission was confirmed may display persisting symptoms, relevant areas of functional impairment and a decreased sense of wellbeing.

Determinants of Global QOL and Physical and Social Functionality In Multiple Myeloma

AbstractAbstract 934 Introduction:Multiple myeloma (MM) and its treatments are associated with a number of symptoms and potential adverse events (AEs) which can impact the health-related quality of life (HRQOL) of patients. This study explored the relationship between patients' symptom level and global QOL, physical and social functioning, and aimed to identify specific symptoms/AEs that further explain variability in these measures. Methods:Prospective data came from a survey of patients with MM in 11 centers in the United Kingdom and Germany. The data included socio-demographic characteristics, disease and current/prior treatment history, presence and severity of 39 MM-related symptoms/AEs (e.g., bone pain, fatigue, depression, motor and sensory neuropathy), comorbidities, and HRQOL measured by the EORTC QLQ-C30 and MY20. Patients' general symptom level was defined as asymptomatic, mild, moderate or severe based on the highest severity reported from the 39 symptoms/AE items. Multiple linear regression analyses were carried out to identify determinants of global QOL and physical and social functioning scores, focusing particularly on patients' general symptom level and specific MM symptoms/AEs. The aim was to identify specific symptoms/AEs that are associated with HRQOL over and above the patients' general symptom level. In other words, whether within a given symptom level, the presence and severity of specific symptoms/AEs further explains HRQOL. The following strategy was used to prioritize variables: univariate regression models tested each of the 39 specific items against the global, physical and social functioning scales of QLQ-C30; those that were statistically significant (p-value < 0.10) were then tested in a model including general symptom level. Those found to be significant in this second step were combined in a multivariate model that was then trimmed to exclude items that lost significance. Other potential determinants like sociodemographic or disease and treatment history variables found to be significant in univariate analyses were added to the trimmed multivariate model, which was further reduced by excluding non-significant terms. Results:The survey included 154 patients: 63.0% were male with mean age 66.4 (SD: 10.0). Mean time since diagnosis was 3.7 years (SD: 3.7), 51.9% were currently on treatment, and 42.9% had at least one prior line of MM therapy. A quarter of patients were severely symptomatic, 32.5% were moderately and 31.5% were mildly symptomatic, and the remaining 11% were asymptomatic. Fatigue (59.1%), bone pain (51.6%), sleepiness (35.7%), hypoesthesia or paresthesis (32.5%) and muscle cramps (31.2%) were most commonly reported AEs/ symptoms. The regression model for global QOL included symptom level, bone pain, fatigue, depression, disease duration and being on treatment. Severe bone pain (vs. moderate or lower) and being severely symptomatic (vs. lower levels) were the strongest determinants being associated with approximately 20 points lower global QOL scores. Moderate fatigue (vs. mild or none) was associated with 11 points reduction in global QoL. Being on MM treatment (of any type) was associated with a 9.5 point lower global QoL score (p-value = 0.01). Predictors of physical functioning included symptom level, bone pain, bone fracture, fatigue, and infection, each of which was associated with at least 10 points lower scores even at mild or moderate levels. Younger patients and those identifying themselves as British tended to report better physical functioning. Prior treatment with bortezomib, was associated with worse physical functioning; treatment lasting more than 111 days (approximately 5.5 cycles) was associated with 10 point lower physical functioning scores. Prior thalidomide and alkylating agents-containing treatments had no impact on physical functioning. Social functioning was strongly affected by severe or moderate symptom levels, which were associated with 34 and 24 point lower scores (p-values < 0.01), respectively, compared to asymptomatic patients. Changes in mental status, dizziness and bone fracture were also associated with reduced social functioning. Conclusion:Disease symptoms and treatment AEs have a strong impact on HRQOL of patients with MM. Symptoms related to bones (i.e., pain and fracture) are particularly important determinants, affecting global QoL, physical and social functioning beyond general symptom levels. Disclosures:Off Label Use: Some of the patients in the study received Thalidomide for the treatment of relapsed or refractory multiple myeloma. Ishak:United BioSource Corporation: Consultancy, Research Funding. Lewis:Celgene International SARL: Employment. Proskorovsky:United BioSource Corporation: Consultancy, Research Funding. Payne:United BioSource Corporation: Consultancy, Research Funding. Lordan:United BioSource Corporation: Consultancy, Research Funding. Davies:Celgene: Honoraria, Speakers Bureau; Ortho Biotech: Honoraria, Speakers Bureau. Peters:Celgene: Consultancy. Williams:Celgene: Honoraria; Jansen Cilag: Consultancy, Honoraria.

Outcomes of the Chinese Basic Conversation Skill Module (CBCSM) for people with schizophrenia having mild to moderate symptoms and dysfunction in Hong Kong

This study tested the effectiveness of a culturally adapted Chinese Basic Conversation Skill Module (CBCSM) for Hong Kong Chinese with schizophrenia. A total of 106 participants with schizophrenia who had mild to moderate levels of symptoms and dysfunction were recruited between January 2004 and September 2005. After random allocation, 35 participants were assigned to the CBCSM group with skill generalization training (SGT), 35 participants were assigned to the CBCSM group without SGT, and 36 participants were assigned to the placebo group. All participants were assessed by a blind rater at baseline, 5 weeks after commencement of skills training, and 3 and 6 months after completion of skills training on conversation skill mastery, subjective personal well being, and self esteem. After 15 sessions of intervention, the CBCSM group with SGT and the CBCSM group outperformed the placebo group in social skills. At the 6-month follow-up, social skill of CBCSM group with SGT was better than the CBCSM group and the placebo group. CBCSM with SGT was found to be effective in improving conversation skill of people with schizophrenia in Hong Kong. This combined strategy was also shown to be better than mere application of CBCSM in helping conversation skill mastery.