[Value-based healthcare in mental health care: a practical example]. / Waardegedreven zorg in de ggz: een praktijkvoorbeeld.

BACKGROUND: To promote quality improvement in Dutch mental health care, it is imperative to line up methods of quality improvement with daily care practice. In value-based healthcare the joint vision of medical professionals and patients is leading in the design and execution of care improvements. AIM: To demonstrate the value of value-based care. METHOD: Description of a practical example of the application of value based healthcare in mental healthcare, including a practical example of value-based improvement of patient care. RESULTS: A multidisciplinary improvement team was formed, consisting of patients and employees who were involved in the depression care pathway. The team determined important outcomes of care from the patient’s perspective, and successfully executed several improvement initiatives. CONCLUSION: The bottom-up approach of value-based healthcare is in line with day-to-day care practice and provides opportunities for effectively improving the quality of mental health care.

Big Five personality characteristics are associated with depression subtypes and symptom dimensions of depression in older adults.

OBJECTIVE: This study examined the associations of personality characteristics with both subtypes and symptom dimensions of depression in older adults. METHODS: Three hundred and seventy-eight depressed older adults participated in the Netherlands Study of Depression in Older Persons. Personality characteristics were assessed by the NEO-Five Factor Inventory. Subtypes and symptom dimensions of depression were determined using the Composite International Diagnostic Interview and the Inventory of Depressive Symptomatology (IDS). Multinomial logistic regression analyses were performed to examine the associations between personality and atypical, melancholic, and unspecified subtypes of major depression. Linear regression analyses examined the associations between personality and the IDS mood, somatic, and motivation symptom dimensions. The analyses were adjusted for confounders and additionally adjusted for depression severity. RESULTS: Neuroticism, Extraversion, Conscientiousness, and Agreeableness were associated with specified (atypical or melancholic) major depression compared with unspecified major depression in the bivariate analyses but lost their significance after adjustments for functional limitations and severity of depression. Neuroticism was positively associated with the IDS mood and motivation symptom dimensions, also in the adjusted models. Further, Extraversion and Agreeableness were negatively associated with the IDS mood symptom dimension, and Extraversion and Conscientiousness were negatively associated with the IDS motivation symptom dimension. None was associated with the IDS somatic symptom dimension. CONCLUSIONS: This study demonstrated the association of personality characteristics with mood and motivational symptoms of late-life depression. The lacking ability of personality to differentiate between melancholic and atypical depression seems to be largely explained by severity of depressive symptoms. Copyright © 2017 John Wiley & Sons, Ltd.

The effect of pain on presence and severity of depressive disorders in older persons: The role of perceived control as mediator.

BACKGROUND: The relation between pain and depression is reported repeatedly. It is suggested that pain by itself is not sufficient for the development of depression. We aim to study the role of perceived control as mediating factor in the relation between pain and depressive disorders at old age. METHODS: Baseline data of the Netherlands Study of Depression in Older Persons (NESDO) were used, including 345 persons with DSM-IV depressive disorders (CIDI) and 125 control persons without depressive disorders, aged 60 years and over. Measures included severity of depression (Inventory of Depressive Symptomatology), presence and intensity of pain and pain-related disability (Chronic Graded Pain scale), and a general measure of perceived control over life (Pearlin Mastery Scale). In mediation analyses direct and indirect effects were estimated. RESULTS: Older persons with depressive disorders reported pain more frequently with higher intensity than controls. After controlling for confounding, the direct effect of pain intensity and the indirect effect through perceived control on depression were OR=1.10 (CI 95% .98;1.25) and OR=1.24 (1.15;1.35). For pain-related disability these were OR=1.14 (1.02;1.29) and OR=1.21 (1.13;1.29). In depressed persons there was a strong direct effect of pain intensity and disability and a smaller indirect effect through perceived control on severity of depressive symptoms. LIMITATIONS: This cross-sectional study cannot give evidence on causal direction. CONCLUSIONS: Perceived control plays an important role as mediator in the association between pain and presence of depression. In depressed persons however, the direct role of pain seems more important in the association with depression severity.

Depression in later life: a more somatic presentation?

BACKGROUND: Depression later in life may have a more somatic presentation compared with depression earlier in life due to chronic somatic disease and increasing age. This study examines the influence of the presence of chronic somatic diseases and increasing age on symptom dimensions of late-life depression. METHODS: Baseline data of 429 depressed and non-depressed older persons (aged 60-93 years) in the Netherlands Study of Depression in Old Age were used, including symptom dimension scores as assessed with the mood, somatic and motivation subscales of the Inventory of Depressive Symptomatology-Self Report (IDS-SR). Linear regression was performed to investigate the effect of chronic somatic diseases and age on the IDS-SR subscale scores. RESULTS: In depressed older persons a higher somatic disease burden was associated with higher scores on the mood subscale (B = 2.02, p = 0.001), whereas higher age was associated with lower scores on the mood (B = -2.30, p < 0.001) and motivation (B = -1.01, p = 0.006) subscales. In depressed compared with non-depressed persons, a higher somatic disease burden showed no different association with higher scores on the somatic subscale (F(1,12) = 9.2; p = 0.003; partial η(2)=0.022). LIMITATIONS: Because the IDS-SR subscales are specific for old age, it was not feasible to include persons aged < 60 years to investigate differences between earlier and later life. CONCLUSIONS: It seems that neither higher somatic disease burden nor higher age contributes to more severe somatic symptoms in late-life depression. In older old persons aged ≥ 70 years, late-life depression may not be adequately recognized because they may show less mood and motivational symptoms compared with younger old persons.

The subscale structure of the Inventory of Depressive Symptomatology Self Report (IDS-SR) in older persons.

BACKGROUND: Using symptom dimensions may be more effective than using categorical subtypes when investigating clinical outcome and underlying mechanisms of late-life depression. Therefore, this study aims to identify both the factor and subscale structure of late-life depression underlying the Inventory of Depressive Symptomatology Self Report (IDS-SR) in older persons. METHOD: IDS-SR data of 423 participants in the Netherlands Study of Depression in Older Persons (NESDO) were analyzed by exploratory (EFA) and confirmatory factor analysis (CFA). The best-fitting factor solution in a group of older persons with a major depressive disorder diagnosis in the last month (n = 229) was replicated in a control group of older persons with no or less severe depression (n = 194). Multiple group (MG-CFA) was performed to evaluate generalizability of the best-fitting factor solution across subgroups, and internal consistency coefficients were calculated for each factor. RESULTS: EFA and CFA show that a 3-factor model fits best to the data [comparative fit index (CFI) = 0.98; Tucker Lewis Index (TLI) = 0.99; and root mean square error of approximation (RMSEA) = 0.052], consisting of a 'mood', 'motivation' and 'somatic' factor with adequate internal consistencies (alpha coefficient 0.93, 0.83 and 0.70, respectively). MG-CFA shows a structurally similar factor model across subgroups. CONCLUSION: The IDS-SR can be used to measure three homogeneous symptom dimensions that are specific to older people. Application of these dimensions that may serve as subscales of the IDS-SR may benefit both clinical practice and scientific research.

Phenomenology of depression in older compared with younger adults: meta-analysis.

BACKGROUND: Late-life depression may differ from early-life depression in its phenomenology. AIMS: To investigate the effect of age on the phenomenology of major depression. METHOD: A systematic search was conducted in PubMed, Embase and PsycINFO for all studies examining the relation between age and phenomenology of major depression according to RDC, DSM and ICD criteria. Studies were included only if the age groups were compared at the single-item level using the 17-, 21- or 24-item versions of the Hamilton Rating Scale for Depression; a meta-analysis was done for each item of the 17-item scale. RESULTS: Eleven papers met the inclusion criteria. Older depressed adults, compared with younger depressed adults, demonstrated more agitation, hypochondriasis and general as well as gastrointestinal somatic symptoms, but less guilt and loss of sexual interest. CONCLUSIONS: The phenomenology of late-life depression differs only in part from that of early-life depression. Major depression in older people may have a more somatic presentation, whereas feelings of guilt and loss of sexual function may be more prevalent in younger people.

[The efficacy of electroconvulsive therapy in adolescents. A restrospective study]. / De effectiviteit van elektroconvulsietherapie bij adolescenten. Een retrospectief vergelijkend onderzoek.

BACKGROUND: Electroconvulsive therapy (ECT) is an effective treatment for depressive disorders in adults and the elderly. For adolescents however, ect is still a controversial treatment because little research has been done into the efficacy and side effects of ECT in adolescents and because psychiatrists working with children and adolescents are relatively unfamiliar with this form of treatment. AIM: To investigate the efficacy of ECT in adolescents who were treated in Meerkanten between 2000 and 2006 for a therapy-resistant depressive episode and/or suicidal behaviour. METHOD: Scores on the Hamilton Depression Rating Scale or the Montgomery-Asberg Depression Rating Scale before and after ECT were compared. The percentage improvement on the depression scales and the percentage of patients who showed an improvement of at least 60% on the scales in the group of adolescents were compared with the percentage improvement in a group of adults treated in Meerkanten. RESULTS: One-third of the adolescent patients showed an improvement of 60% or more on these scales; the average improvement was 46%. ECT was found to be equally effective in adolescents and adults. CONCLUSION: ECT is a successful form of treatment for one-third of adolescents with a severe therapy-resistant depressive episode; this is a clinically relevant result for these patients for whom no alternative treatments are available.

[Electroconvulsive therapy in depressed adolescents]. / Elektroconvulsietherapie bij depressieve adolescenten.

Two patients, young women aged 15 and 17, both suffering from major depression with psychotic features, were resistant to treatment with antidepressive regimen and psychotherapy. Both patients became severely suicidal and were subsequently successfully treated with electroconvulsive therapy (ECT). The second patient needed maintenance ECT once a month in order to stay in remission. Whereas ECT is a well-studied and accepted treatment option in adult psychiatry, in child psychiatry people are reluctant to even consider this option. This resistance is partly based on the possible side effects ofECT i.e. memory problems. As a result, the effect ofECT in adolescents has not yet been well studied. In 2004, the American Academy of Child and Adolescent Psychiatry proposed guidelines for the use of ECT in adolescents. Following these guidelines, the use ofECT in adolescents seems to be a safe treatment option, however further research to the effect of ECT in this age group is warranted.