Anxiety, depression and psychosocial needs are the most frequent concerns reported by patients: preliminary results of a comparative explorative analysis of two hospital-based palliative care teams in Germany and Japan

4区 · 医学

Article

作者: Kusomoto, Yuko ; Flentje, Michael ; Mettenleiter, Andreas ; Zetzl, Theresa ; Roch, Carmen ; Ishii, Koji ; van Oorschot, Birgitt ; Ozawa, Hiroko ; Overbeck, Lea

AbstractIn the partnership between the medical departments of Würzburg University, Germany, and Nagasaki University, Japan, palliative care is a relevant topic. The aim of the study was to perform a comparative analysis of the hospital-based palliative care teams in Würzburg (PCT-W) and Nagasaki (PCT-N). Survey of staff composition and retrospective analysis of PCT patient charts in both PCTs were conducted. Patients self-assessed their symptoms in PCT-W and in Radiation Oncology Würzburg (RO-W). The (negative) quality indicator ‘percentage of deceased hospitalised patients with PCT contact for less than 3 days before death’ (Earle in Int J Qual Health Care 17(6):505–509, 2005) was analysed. Both PCTs follow a multidisciplinary team approach. PCT-N saw 410 cancer patients versus 853 patients for PCT-W (22.8% non-cancer patients). The Eastern Cooperative Oncology Group Performance Status at first contact with PCT-N was 3 or 4 in 39.3% of patients versus 79.0% for PCT-W. PCT-N was engaged in co-management longer than PCT-W (mean 20.7 days, range 1–102 versus mean 4.9 days, range 1–48). The most frequent patient-reported psychological symptom was anxiety (family anxiety: 98.3% PCT-W and 88.7% RO-W, anxiety 97.9% PCT-W and 85.9% RO-W), followed by depression (98.2% PCT-W and 80.3% RO-W). In 14 of the 148 deceased patients, PCT-N contact was initiated less than 3 days before death (9.4%) versus 121 of the 729 deceased PCT-W patients (16.6%). Psychological needs are highly relevant in both Germany and Japan, with more than 85% anxiety and depression in patients in the Japanese IPOS validation study (Sakurai in Jpn J Clin Oncol 49(3):257–262, 2019). This should be taken into account when implementing PCTs.

2015-02-01·Comprehensive Psychiatry3区 · 医学

Behavioral activation therapy for return to work in medication-responsive chronic depression with persistent psychosocial dysfunction

3区 · 医学

ArticleOA

作者: Jonathan W. Stewart ; David J. Hellerstein ; Ying Chen ; Amy Withers ; Donna O’Shea ; Patrick J. McGrath ; Kallio Hunnicutt-Ferguson ; Greg Erickson ; Yuanjia Wang ; Sarah K. Reynolds

OBJECTIVEChronic depression is associated with significant impairment in work functioning, relationships, and health. Such impairment often persists following medication-induced remission of depressive symptoms. We adapted and tested Behavioral Activation therapy with a goal of return to work (BA-W) in subjects with chronic depression who had responded to medication treatment but remained unemployed.METHODSixteen adults aged 18-65 with DSM-IV diagnosed Dysthymic Disorder or chronic Major Depression were recruited from clinical trials taking place at the New York State Psychiatric Institute between 4/2009 and 12/2012 and enrolled in 12 weeks of individual manual-driven BA-W. Functioning was measured at intake, post-treatment and at 24 week follow-up.RESULTSEighty-seven percent (n=14) of subjects completed the full 12 weeks of BA-W. Hours of work related activity (p<.005, d=0.83), hours of paid work (p<.0003, d=0.54), and work productivity (p<.0004, d=-0.48) increased significantly over the study period. Earned income increased post-treatment (p=.068) with significant changes by 24 week follow-up (p=.011). Secondary outcomes including behavioral avoidance (p<.004, d=-0.56), and global functioning (p<.0003, d=1.42) were also significantly improved post-treatment. Effect sizes, including for outcomes with non-significant changes, were generally in the range of 0.5-0.8.CONCLUSIONSThis pilot study provides preliminary evidence of the efficacy of a work-targeted psychotherapy to remediate vocational impairment in subjects with chronic depression. Data suggests that further testing of BA-W using a randomized controlled trial is warranted and may represent a significant advance in treatment for the residual disability present after successful pharmacotherapy.

1997-11-01·Behaviour Research and Therapy2区 · 心理学

Psychometric characteristics of the Scale for Suicide Ideation with psychiatric outpatients

2区 · 心理学

Article

作者: Robert A. Steer ; Gregory K. Brown ; Aaron T. Beck

The psychometric properties of the Scale for Suicide Ideation--Current (SSI-C; Beck, Kovacs & Weissman, 1979, Journal of Consulting and Clinical Psychology, 47, 343-352) and the Scale for Suicide Ideation--Worst (SSI-W; Beck, Brown, Steer, Dahlsgaard & Grisham, 1997, in press) were explored. These 19-item clinician-administered scales measure current suicide ideation (SSI-C) as well as suicide ideation at its worst point in the patient's life (SSI-W). For a sample of 4063 outpatients, both scales were positively correlated with a diagnosis of a principal mood disorder, a diagnosis of a personality disorder, and measures of depression and hopelessness. The relationship between the SSI-W and a history of suicide attempts was stronger (r = 0.50, P < 0.001) than the relationship between the SSI-C and previous suicide attempts (r = 0.31, P < 0.001). For 444 current and 1764 past suicide ideators, the SSI-C and the SSI-W had high internal consistencies (coefficient alpha s = 0.84 and 0.89, respectively). The SSI-C and the SSI-W were moderatedly correlated with each other (r = 0.51, P < 0.001). Iterated maximum-likelihood principal-factor analyses identified comparable Preparation and Motivation dimensions underlying both scales.

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