Effects of psychosocial interventions on patient-reported outcomes in patients with psoriasis: a systematic review and meta-analysis.

BACKGROUND: Psoriasis can lead to high psychosocial burden, and the occurrence of psoriasis is related to psychological distress. OBJECTIVES: This study provides an overview of psychosocial interventions for patients with psoriasis and examines their effects on patient-reported outcomes. METHODS: A systematic search of four electronic databases (CENTRAL, MEDLINE, Embase and PsycINFO) was conducted in January 2017. All trials on psychosocial interventions for patients with psoriasis that used patient-reported outcomes and a comparison group were included. Data were extracted on intervention, study population and outcomes. Risk of bias was assessed according to the Cochrane Handbook. A meta-analysis on quality of life, depression and anxiety was performed. This review was registered on PROSPERO (CRD42016037934). RESULTS: Nineteen studies were included. Interventions primarily used cognitive behavioural or mindfulness-based techniques. Risk of bias was mostly rated 'unclear' due to nontransparent reporting (e.g. no study protocols were published, only one study reported blinding of patients). Meta-analysis using standardized mean differences between the intervention and control groups showed significant, small-to-medium effects (given with 95% confidence intervals) on quality of life (0·28, 0·04-0·51; six studies, n = 664) and anxiety (0·36, 0·15-0·57; six studies, n = 363). The effect on depression was not significant (0·37, -0·05 to 0·80; five studies, n = 326). CONCLUSIONS: Psychosocial interventions offer an effective means to improve quality of life and anxiety in patients with psoriasis. Although the importance of such psychosocial aspects for psoriasis is unquestioned, there is a lack of high-quality evaluation studies. Nontransparent reporting of risk of bias, low power and a lack of replication studies make it difficult to reach confident conclusions from the evidence. What's already known about this topic? Psoriasis symptoms and psychosocial burden reinforce one another. Different psychosocial interventions for patients with psoriasis exist to address this problem. Most studies report positive effects on psoriasis severity, and some also on certain patient-reported outcomes such as quality of life. Only a very few interventions have been subject to rigorous testing. Further research is needed on the evaluation of the effects and the methodological quality of these interventions. What does this study add? This review provides a comprehensive overview of psychosocial interventions for patients with psoriasis. It evaluates the effects of the interventions on patient-reported outcomes and rates the methodological quality of their evaluation studies. It underlines the importance and effectiveness of addressing psychosocial burden in patients with psoriasis by identifying adequate interventions. The results of this study show that further research, especially with adequately tested interventions, is strongly needed.

[Internet-based interventions in the treatment of mental disorders : Overview, quality criteria, perspectives]. / Internetbasierte Interventionen in der Behandlung psychischer Störungen : Überblick, Qualitätskriterien, Perspektiven.

BACKGROUND: Mental disorders are frequently not or only insufficiently treated. Internet-based interventions offer the potential of closing the existing gaps in the treatment of mental disorders; however, it is very difficult for patients and providers to choose from the numerous interventions available. OBJECTIVE: The aim of this study was to develop a set of quality criteria that can help patients and care providers to identify recommendable internet-based interventions. METHODS: A selective literature search was carried out and the existing evidence on internet-based interventions in the treatment of mental disorders was collated. A panel of experts then developed quality criteria based on existing models for the systematic assessment of telemedicine applications. RESULTS: Internet-based interventions are effective in the treatment of a broad range of mental disorders. The best evidence is available for depression and anxiety disorders. A set of criteria is proposed for the evaluation of available internet-based interventions using a checklist. These criteria have to be developed further with input from other stakeholders. DISCUSSION: When taking these quality criteria into account, evidence-based interventions available on the internet can make an important contribution to improvement of the care of patients with mental disorders.

[Data analysis based on the Classification of Therapeutic Procedures (CTL) of inpatient rehabilitation of depressive disorders]. / Analyse von Daten der Klassifikation Therapeutischer Leistungen (KTL) der stationären Rehabilitation bei depressiven Störungen.

OBJECTIVE: As an initiative of the German Pension Insurance Association (DRV), evidence-based therapeutic modules (ETM) for the rehabilitation of patients with depression were developed. The objective of the subsequent analysis was to analyse the therapeutic procedures in inpatient rehabilitation on the basis of the ETM to evaluate the principal needs for therapeutic standards. METHODS: Data based on the German Classification of Therapeutic Procedures (KTL) for 21 529 patients treated in rehabilitation clinics for people with mental illnesses was analysed with respect to differences between diagnostic groups/clinics regarding type, quantity and duration of measures coded. RESULTS: The mean quantity and duration of the interventions for patients with depressive disorders encoded varied greatly between the ETM. No or only minor differences were found between patients with depression and those with other diagnoses regarding the type, quantity and duration of measures coded. However, there were great variances between clinics. CONCLUSIONS: Therapeutic standards for rehabilitative practice appear necessary in order to reduce treatment heterogeneity between rehabilitation facilities, which could improve the quality of healthcare.

Non-pharmacological treatment of depressive disorders: a review of evidence-based treatment options.

BACKGROUND: The primary goals of this paper are to describe the collection and evaluation of various nonpharmacological treatment options for depressive disorders and to establish a basis for the development of a standard for the treatment of patients with depressive disorders. METHOD: To identify evidence-based treatment elements, a comprehensive investigation of national and international guidelines was conducted. The extracted guidelines were then assessed with regard to aspects of methodological quality and evidence-based treatment elements. In a further step, specific and systematic literature searches for residual treatment elements were conducted. For the corresponding literature search, a hierarchical approach was chosen in which current guidelines were reviewed first and systematic reviews and meta-analyses second. Psychopharmacological treatments were excluded from the analysis because this is covered by specific guidelines. RESULTS: The treatment elements with an adequate level of evidence were identified as follows: psychotherapeutic interventions, marital/couples/family therapy and counseling, inclusion of family members, psycho-education, exercise, problem solving therapy, guided self-help and behavioral activation treatments. Further evidence-based methods include diagnostic treatment elements, participative decision-making, development of the therapeutic alliance, Cognitive Behavioral Analysis System for Psychotherapy, computerized cognitive behavior therapy, psychopharmacological therapy, combined psychopharmacological and psychotherapeutic therapy, electroconvulsive therapy, phototherapy, sleep deprivation, repetitive trans-cranial magnetic stimulation (rTMS) and acupuncture. CONCLUSION: In summary, using a hierarchical approach, it was possible to assign different levels of evidence to the various treatment options for depression.

[Strengthening patient involvement in rehabilitation]. / Stärkung der Selbstbeteiligung in der Rehabilitation.

Stronger involvement from the patient in health care is advocated because of the changed role perception, due to the increasing therapeutic possibilities in the course of medical progress, thoughts concerning ethical considerations and medical legislation, and also on the basis of scientific findings. Different levels of personal involvement can be identified: participation in decision-making processes, participation in the management of diseases, as well as participation on the system level. The implementation of these in health care is still insufficient due to various barriers at different levels. Besides barriers on the physicians' side, limited health literacy and low patient activation are discussed as obstacles for stronger patient involvement. Furthermore, specific adjustments are necessary for implementation in rehabilitative health care, especially due to the treatment in a multiprofessional team. In a current funding initiative with an emphasis on rehabilitation, research projects with a focus on participative healthcare are being performed.

[Longitudinal associations between depressive symptoms and type 2 diabetes and their impact on mortality in primary care patients]. / Longitudinale Assoziationen zwischen depressiven Symptomen und Typ-2-Diabetes sowie deren Auswirkung auf die Mortalität von Hausarztpatienten.

It is unclear whether depressive symptoms are a risk factor for incident diabetes or diabetes is a risk factor for depressive conditions. Therefore, we examined the longitudinal bidirectional associations between depressive symptoms and type 2 diabetes (T2D) as well as the impact of both diseases on (all cause) mortality in a sample of primary care patients over a 3.5-years follow-up period on average. Depressive symptomatology, defined by the Depression Screening Questionnaire (DSQ), was examined both categorically and dimensionally. Patients were categorized as normal fasting glucose (NFG), impaired fasting glucose (IFG), and T2D (untreated, oral antidiabetics, insulin/combined treatment) according to physician ratings and baseline lab values. Incidence rates of T2D were 25.6 and 20.9 per 1000 person-years for those with and without depressive symptoms, respectively. The unadjusted risk of incident type 2 diabetes was 1.03 times higher (CI(95%): 1.01-1.06) for each 1-point increment in DSQ score. The incidence rates of elevated depressive symptoms per 1000 person-years were 30.5 for NFG, 34.2 for IFG, 36.4 for untreated T2D, 32.3 for oral treated T2D, and 47.8 for insulin/combined-treated T2D patients. Compared to NFG patients, insulin-treated patients had a higher risk of incident depressive symptoms (HR: 1.71; CI(95%): 1.03-2.83) and oral-treated patients had a lower risk (HR: 0.58; CI(95%): 0.36-0.96). Higher mortality rates were associated with both diseases compared to patients without T2D or depressive symptoms at baseline (HR: 2.49; CI(95%):1.45-4.28). Results indicate that especially insulin treatment in T2D patients is associated with incident depressive symptoms.

[Health services research in psychosocial medicine]. / Versorgungsforschung in der psychosozialen Medizin.

The following article presents aspects of the field of psychosocial medicine in Germany from the perspective of health services research. First, the tasks and topics of health services research are listed. The identification and appropriate treatment of people with mental disorders is one of the core themes of psychosocial health care; therefore, a brief overview of research results on the epidemiology of mental disorders is first presented. The primary focus of this article is then to provide a description and analysis of the structures of psychosocial care in inpatient and outpatient settings. Research findings concerning treatment processes and the result of these processes are additionally presented. The findings show that there is still a considerable lack of research results regarding the treatment of patients with mental disorders, as is also the case in other health care areas. An important empirical basis for rationally founded treatment planning in this area is thus lacking.

[The development of a case group concept for patients with mental diseases]. / DRG-Systeme in der Versorgung von Patienten mit psychischen Störungen: Zur Konzeption eines Klassifikationssystems für Fallgruppen.

In the year 2000 the German legislative decided to implement a case-dependent reimbursement system in an acute inpatient setting beginning in 2003. The German-Diagnoses Related Group System (G-DRGs) will adopt the refined version of the Australian-Diagnoses Related Group System (AR-DRG, version 4.1). Based on empirical data and experts panels the acute psychiatric hospitals have been exempted from the adoption of the case-based payment system. With regard to national and international experiences in the development of patient classification systems in psychiatry and medical rehabilitation this article illustrates the development of a case group concept for patients with mental disorders.