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1.
BMC Psychiatry ; 22(1): 511, 2022 07 28.
Article in English | MEDLINE | ID: mdl-35902851

ABSTRACT

BACKGROUND: Due to budget restrictions in mental health care, non-professional caregivers are increasingly burdened with the emotional and practical care for their depressed relatives. However, informal family caregiving is mostly a stressful role with negative consequences on the physical and mental health of the caretakers to the extent that they have an elevated risk of experiencing psychiatric disorders themselves. While psychoeducation for relatives of depressed individuals showed positive results both in terms of the caretakers' strain and the depressive symptoms of the affected person, there are major barriers to participate in presence in those programs. Digital programs might be a viable alternative. We found no empirically evaluated digital program available for informal caregivers of depressed patients. METHODS: An online program for relatives of depressed individuals has been developed including four interactive modules on 1) psychoeducation, 2) how to strengthen the relationship with the depressed person, 3) how to deal with the depressive symptoms of the patient, and 4) find the right balance between caring for the depressed person and self-care. We investigate if this self-help program is more effective when used with individualized versus automated e-mail support, and if both supported conditions are more effective than treatment-as-usual (TAU in form of written information material) in terms of the risk of mental diseases in caregivers. The primary outcome is the reduction of the caregiver's nonspecific mental distress as measured by the change of the Kessler Psychological Distress Scale score from baseline to four weeks after randomization. Caregivers (n = 500:500:250) will be randomized to one of the three conditions. DISCUSSION: Psychological support for caregivers of individuals with mental disorders such as depression should be offered as part of integrated services. There is a huge potential to develop and implement interactive online approaches to support informal caregivers of patients with depression to function in their multiple roles and to help them to remain healthy. TRIAL REGISTRATION: DRKS, DRKS00025241 . Registered 5 Mai 2021.


Subject(s)
Caregivers , Psychotic Disorders , Caregivers/psychology , Humans , Mental Health , Psychosocial Support Systems , Quality of Life , Randomized Controlled Trials as Topic , Self Care
2.
Psychiatr Prax ; 42(1): 21-9, 2015 Jan.
Article in German | MEDLINE | ID: mdl-24062156

ABSTRACT

OBJECTIVE: To analyse the administrative prevalence and regional differences in hyperkinetic disorder (HK) diagnoses in Germany. METHODS: The administrative prevalence of HK (ICD-10 F90) was analysed for 3,6 million children, up to 18 years old and in the whole year 2009 insured by the AOK, using health insurance data. Additionally, administrative prevalence changes between 2006 and 2008 were investigated. The prevalence analyses were differenciated according to postal code areas and regions of the associations of statutory health insurance physicians (SHIP-regions). RESULTS: The analyses revealed a continous increase of the administrative HK-prevalence between 2006 (2,8 %) and 2009 (3,8 %). The administrative prevalence was notably lower in the city states Bremen, Hamburg and Berlin, but rather high in four of five SHIP-regions in the New Laender. 14 % of children with HK were diagnosed with HK and ICD-10 F98.8. In 47 % these different diagnoses had been coded by different physicians. CONCLUSIONS: Regional differences in administrative prevalence rates and discrepancies in diagnosis coding by different physicians may indicate uncertainties regarding HK-diagnosis in routine health care. Future studies should analyse these associations more detailed.


Subject(s)
Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/epidemiology , National Health Programs/statistics & numerical data , Population Surveillance , Registries/statistics & numerical data , Adolescent , Affective Symptoms/classification , Affective Symptoms/diagnosis , Affective Symptoms/epidemiology , Age Factors , Attention Deficit Disorder with Hyperactivity/classification , Child , Child Behavior Disorders/classification , Child Behavior Disorders/diagnosis , Child Behavior Disorders/epidemiology , Child, Preschool , Comorbidity , Cross-Sectional Studies , Female , Germany , Humans , Infant , Insurance Claim Review/statistics & numerical data , International Classification of Diseases , Male
3.
Psychiatr Prax ; 40(8): 430-8, 2013 Nov.
Article in German | MEDLINE | ID: mdl-23695948

ABSTRACT

OBJECTIVE: To analyze the impact of a capitated multi-sector-financing model for psychiatric care (RPB) in the model region Rendsburg-Eckernförde on costs and effectiveness of care. METHODS: In a prospective controlled cohort study 244 patients with a diagnosis according to ICD-10: F10, F2 or F3 were interviewed in the model region (MR) and compared to 244 patients from a control region (CR) financed according to the fee-for-service principle. At baseline, 1.5 years and 3.5 years follow-up patients were interviewed using measures of psychopathology (CGI-S, HONOS, SCL-90 R/GSI, PANSS, BRMAS/BRMES), functioning (GAF, SOFAS), quality of life (EQ-5 D) and service use/costs (CSSRI). RESULTS: Subjective symptom severity (GSI) and functioning (GAF) developed more favourably in the MR than in the CR, the HONOS score developed slightly worse in the MR. The latter effect occurred mainly in ICD-10: F10 patients, while patients with F2/3 rather did benefit under RPB conditions. The development of total costs of care was not different between MR and CR. The potential to reduce costs of in-patient care was low due to the initially low capacity of inpatient beds. CONCLUSIONS: The RPB did not reduce the total costs of mental health care, but certain diagnosis groups may benefit from improved trans-sectoral treatment flexibility.


Subject(s)
Budgets/organization & administration , Delivery of Health Care/economics , Hospital Bed Capacity/economics , Mental Disorders/economics , Mental Disorders/therapy , Mental Health Services/economics , National Health Programs/economics , Psychiatric Department, Hospital/economics , Regional Health Planning/economics , Adult , Capitation Fee/organization & administration , Cohort Studies , Cost-Benefit Analysis/economics , Direct Service Costs , Fee-for-Service Plans/economics , Female , Financing, Government/economics , Follow-Up Studies , Germany , Health Care Sector/economics , Health Services Research , Humans , Male , Mental Disorders/diagnosis , Mental Disorders/psychology , Middle Aged , Outcome and Process Assessment, Health Care , Prospective Studies
4.
Psychiatr Prax ; 38(8): 397-404, 2011 Nov.
Article in German | MEDLINE | ID: mdl-21811954

ABSTRACT

OBJECTIVE: Office based psychiatrists are playing a decisive role regarding the provision and coordination of community based, continuous mental health care. Although the estimated need for office based psychiatrists and neurologists is covered to 125 % in Germany, a physician shortage is emerging in some regions. Therefore, the present study aimed to investigate factors influencing the decision of future psychiatrists to a practice establishment. METHODS: 14,939 young physicians aged under 40 without completed specialist medical training were contacted by mail using databases of five state chambers of physicians (Lower Saxony, Westfalen-Lippe, Saxony, Saxony-Anhalt, Mecklenburg-Western Pomerania). The physicians were asked to answer questions regarding socio-demographic characteristics, the aspired medical speciality, their purpose to establish a practice, and an 18-items questionniare regarding important aspects for the latter decision. As revealed in a former study, the 18 items are related to six factors for practice establishment. The answers of 5,053 respondents were eligible for data analysis. RESULTS: 4.3 % of the examined physicians aspired a medical specialist training in psychiatry, 44 % of them plan to establish a practice. Future psychiatrists as well as other physicians valued the surrounding conditions for family as most important factor regarding a practice establishment, followed by professional duties (e. g. on-call duty) and financial conditions. The quality of life in the surrounding area had least importance. CONCLUSIONS: The results point on measures which could be suited making a practice establishment for young physicians attractive.


Subject(s)
Career Choice , Practice Patterns, Physicians'/trends , Private Practice/trends , Psychiatry/education , Adult , Data Collection , Decision Making , Female , Forecasting , Germany , Health Services Needs and Demand/trends , Humans , Male , Socioeconomic Factors , Workforce
5.
Psychiatry Res ; 185(1-2): 261-8, 2011 Jan 30.
Article in English | MEDLINE | ID: mdl-20537717

ABSTRACT

Assessments of service utilization is often based on self-reports. Concerns regarding the accuracy of self-reports are raised especially in mental health care. The purpose of this study was to analyze the accuracy of self-reports and calculated costs of mental health services. In a prospective cohort study in Germany, self-reports regarding psychiatric inpatient and day-care use collected by telephone interviews based on the Client Socio-Demographic and Service Receipt Inventory (CSSRI) as well as calculated costs were compared to computerized hospital records. The sample consisted of patients with mental and behavioral disorders resulting from alcohol (ICD-10 F10, n=84), schizophrenia, schizophrenic and delusional disturbances (F2, n=122) and affective disorders (F3, n=124). Agreement was assessed using the concordance correlation coefficient (CCC), mean difference (95% confidence intervals (CI)) and the 95% limits of agreement. Predictors for disagreement were derived. Overall agreement of mean total costs was excellent (CCC=0.8432). Costs calculated based on self-reports were higher than costs calculated based on hospital records (15 EUR (95% CI -434 to 405)). Overall agreement of total costs for F2 patients was CCC=0.8651, for F3 CCC=0.7850 and for F10 CCC=0.6180. Depending on type of service, measure of service utilization and costs agreement ranged from excellent to poor and varied substantially between individuals. The number of admissions documented in hospital records was significantly associated with disagreement. Telephone interviews can be an accurate data collection method for calculating mean total costs in mental health care. In the future more standardization is needed.


Subject(s)
Day Care, Medical/methods , Mental Disorders , Mental Health Services , Mental Health/statistics & numerical data , Self Report/statistics & numerical data , Adult , Aged , Aged, 80 and over , Cohort Studies , Female , Health Care Costs/statistics & numerical data , Humans , Inpatients , Male , Mental Disorders/diagnosis , Mental Disorders/economics , Mental Disorders/nursing , Mental Health Services/economics , Middle Aged , Retrospective Studies , Statistics as Topic , Young Adult
6.
Epidemiol Psichiatr Soc ; 19(1): 52-62, 2010.
Article in English | MEDLINE | ID: mdl-20486424

ABSTRACT

AIM: We aimed at developing a prioritized set of quality indicators for schizophrenia care to be used for continuous quality monitoring. They should be evidence-based and rely on routine data. METHODS: A systematic literature search was performed to identify papers on validated quality indicators published between 1990 to April 2008 in MEDLINE, the Cochrane databases, EMBASE and PsycINFO. Databases of relevant national and international organizations were searched. Indicators were described with respect to meaningfulness, feasibility and actionability. A workshop with relevant stakeholders evaluated the measures through a structured consensus process. RESULTS: We identified 78 indicators through literature search and selected 22 quality indicators. Furthermore, 12 structural and case-mix indicators were choosen. Only five quality indicators were rated "essential indicators" (priority 1), 14 were rated "additional first choice" (priority 2), and three were rated as "additional second choice" (priority 3). Only four indicators assessed outcome quality. In the majority of indicators the evidence base supporting the indicator recommendation was weak. None of the selected indicators was validated in experimental studies. CONCLUSIONS: Evidence and validation base played only a subordinate role for indicator prioritisation by stakeholders indicating that there are discrepancies between clinical questions and requirements in schizophrenia care and scientific research.


Subject(s)
Delivery of Health Care, Integrated/standards , Quality Indicators, Health Care , Schizophrenia/therapy , Humans
7.
Health Qual Life Outcomes ; 8: 47, 2010 May 05.
Article in English | MEDLINE | ID: mdl-20444251

ABSTRACT

BACKGROUND: The EQ-5D is a generic questionnaire which generates a health profile as well as index scores for health-related quality of life that may be used in cost-utility analysis. AIMS OF THE STUDY: To examine validity and responsiveness of the EQ-5D in patients with anxiety disorders. METHODS: 389 patients with anxiety disorders completed the EQ-5D at baseline and 6-month follow-up. Subjective measures of quality of life (WHOQOL-BREF) and psychopathology (BAI, BDI-II, BSQ, ACQ, MI) were used for comparison. Validity was analyzed by assessing associations between EQ-5D scores and related other scores. Responsiveness was analyzed by calculating effect sizes of differences in scores between baseline and follow-up for 3 groups indicating more, constant or less anxiety. Meaningful difference scores for shifting to less or more anxiety were derived by means of regression analysis. RESULTS: 88.4% of respondents reported problems in at least one of the EQ-5D dimension at baseline; the mean EQ VAS score was 63.8. The EQ-5D dimension most consistently associated with the measures used for comparison was 'anxiety/depression'. EQ VAS and EQ-5D index scores were highly correlated (|r|>0.5) with scores of the WHOQOL-BREF dimensions 'physical', 'mental' and 'overall' as well as BAI and BDI-II. The EQ-5D index tended to be the most responsive score. Standardized meaningful difference scores were not significantly different between EQ VAS, EQ-5D index and measures used for comparison. CONCLUSIONS: The EQ-5D seems to be reasonably valid and moderately responsive in patients with anxiety disorders. The EQ-5D index may be suitable for calculating QALYs in economic evaluation of health care interventions for patients with anxiety disorders. TRIAL REGISTRATION: Current Controlled Trials ISRCTN15716049.


Subject(s)
Anxiety Disorders , Health Status Indicators , Psychometrics/instrumentation , Surveys and Questionnaires , Activities of Daily Living , Anxiety Disorders/complications , Anxiety Disorders/psychology , Female , Humans , Male , Reproducibility of Results , Surveys and Questionnaires/standards
9.
Psychiatr Prax ; 37(1): 34-42, 2010 Jan.
Article in German | MEDLINE | ID: mdl-20072988

ABSTRACT

OBJECTIVE: To analyze the impact of a capitated multi-sector-financing model for psychiatric care (RPB) on costs and effectiveness of care. METHODS: Patients with a diagnosis according to ICD-10 F10, F2 or F3 were interviewed in the model region (MR, n = 258) and a control region (CR, n = 244) financed according to the fee-for-service principle. At baseline, 1.5 years and 3.5 years follow-up patients were interviewed using measures of psychopathology (CGI-S, HoNOS, SCL-90R, PANSS, BRMAS / BRMES), functioning (GAF, SOFAS) and quality of life (WHOQOL-BREF, EQ-5D). Use of care was determined semi-annually. RESULTS: There were no significant differences in the development of psychopathology and quality of life between MR and CR. In the MR, functioning of patients with schizophrenia and affective disorders improved significantly more strongly. The development of total mental health care costs was not different between MR and CR. However, the costs of office based mental health care increased slightly more strongly in the MR, indicating a small cost-shift from the RPB to extrabudgetary financed services. CONCLUSIONS: The RPB showed slight advantages regarding the effectiveness of care and did not significantly change the total mental health care costs.


Subject(s)
Budgets , Capitation Fee , Fee-for-Service Plans/economics , Hospitals, Psychiatric/economics , Mental Disorders/economics , Models, Economic , National Health Programs/economics , Patient Admission/economics , Adult , Ambulatory Care/economics , Cohort Studies , Cost Allocation , Cost-Benefit Analysis , Female , Germany , Health Care Costs , Humans , Male , Mental Disorders/diagnosis , Mental Disorders/rehabilitation , Middle Aged , Mood Disorders/economics , Mood Disorders/psychology , Mood Disorders/rehabilitation , Prospective Studies , Psychiatric Status Rating Scales , Psychopathology , Quality of Life , Schizophrenia/economics , Schizophrenia/rehabilitation , Schizophrenic Psychology , Treatment Outcome
10.
Br J Psychiatry ; 195(4): 308-17, 2009 Oct.
Article in English | MEDLINE | ID: mdl-19794198

ABSTRACT

BACKGROUND: Individuals with anxiety disorders often do not receive an accurate diagnosis or adequate treatment in primary care. AIMS: To analyse the cost-effectiveness of an optimised care model for people with anxiety disorders in primary care. METHOD: In a cluster randomised controlled trial, 46 primary care practices with 389 individuals positively screened with anxiety were randomised to intervention (23 practices, 201 participants) or usual care (23 practices, 188 participants). Physicians in the intervention group received training on diagnosis and treatment of anxiety disorders combined with the offer of a psychiatric consultation-liaison service for 6 months. Anxiety, depression, quality of life, service utilisation and costs were assessed at baseline, 6-month and 9-month follow-up. RESULTS: No significant differences were observed between intervention and control group on the Beck Anxiety Inventory, Beck Depression Inventory and EQ-5D during follow-up. Total costs were higher in the intervention group (euro4911 v. euro3453, P = 0.09). The probability of an incremental cost-effectiveness ratio

Subject(s)
Anxiety Disorders/therapy , Cognitive Behavioral Therapy/economics , Family Practice/economics , Primary Health Care/economics , Adolescent , Adult , Aged , Anxiety Disorders/economics , Cognitive Behavioral Therapy/education , Cost-Benefit Analysis , Family Practice/education , Family Practice/methods , Germany , Humans , Middle Aged , Practice Guidelines as Topic , Primary Health Care/methods , Primary Health Care/statistics & numerical data , Psychiatric Status Rating Scales , Quality of Life , Referral and Consultation , Surveys and Questionnaires , Young Adult
11.
Pharmacoeconomics ; 27(5): 405-19, 2009.
Article in English | MEDLINE | ID: mdl-19586078

ABSTRACT

BACKGROUND: Preference-based health-state values, also referred to as utility scores, are considered an important measure of outcome in the evaluation of healthcare. A common approach to elicit utility scores is the use of the time trade-off (TTO) method; however, the data on TTO utility scores in patients with mental disorders are scarce. OBJECTIVE: To analyse the TTO method in patients with mental disorders in terms of discriminative ability, validity and the refusal to trade life time (zero trade). METHODS: In patients with affective (n = 172), schizophrenia spectrum (n = 166) and alcohol-related (n = 160) mental disorders, TTO utilities were administered through a standardized interview. Measures of quality of life (QOL) EQ-5D, WHOQOL-BREF, subjective (SCL-90R) and objective (CGI-S) psychopathology, and functioning (GAF, GARF, SOFAS, HoNOS) provided comparison. Discriminative ability was analysed by assessing frequency distributions of TTO utilities. Validity was analysed by assessing the correlation of TTO utilities with all other scores. The association of a patient's QOL, sociodemographic and disease-related variables with zero trade was analysed by logistic regression. RESULTS: Of patients with affective/schizophrenic/alcohol-related mental disorders, 153/143/145 (89/86/91%), respectively, completed the TTO elicitation; 29/43/28% of the respondents were zero traders. The mean TTO utility was 0.66/0.75/0.61 and the median was 0.85/0.95/0.75. TTO utility scores discriminated well among more impaired mental health states, but discrimination was limited among less impaired health states. In patients with affective and alcohol-related mental disorders, TTO utility scores were significantly correlated (mostly moderate: 0.3 < r < 0.5) with all other scores. However, in schizophrenic patients, TTO utility scores were only a little correlated with other subjective measures and not correlated with objective measures. QOL was significantly associated with zero trade; the influence of the other variables on zero trade was negligible. CONCLUSIONS: TTO utility scores in patients with affective or alcohol-related mental disorders were reasonably valid, but discriminative ability was compromised by a ceiling effect due to zero trade. In schizophrenic patients, validity of TTO utility scores was not demonstrated.


Subject(s)
Choice Behavior , Health Status Indicators , Health Status , Mental Disorders/psychology , Models, Econometric , Value of Life , Adult , Aged , Aged, 80 and over , Disability Evaluation , Female , Humans , Life Expectancy , Male , Middle Aged , Mood Disorders/psychology , Psychoses, Alcoholic/psychology , Quality of Life , Schizophrenia , Severity of Illness Index
13.
Psychiatr Prax ; 35(6): 279-85, 2008 Sep.
Article in German | MEDLINE | ID: mdl-18773374

ABSTRACT

OBJECTIVE: To evaluate a new multi-sector financing model for psychiatric care based on the capitation principle (Regional Psychiatry Budget, RPB). METHODS: Patients with a diagnosis according to ICD-10 F10, F2, and F3 were interviewed in the model region (MR, N=258) and a control region (CR, N=244) financed according to the fee-for-service principle. Effectiveness of care was assessed before RPB-introduction and after 1.5 years. Use of care was determined semi-annually. RESULTS: Costs of inpatient psychiatric treatment decreased more strongly in the MR, while hospital based outpatient care and day clinic treatment were intensified in comparison to the CR. Quality of life, severity of illness and illness-specific symptoms in patients improved similarly in MR and CR. The functional level improved more in the MR than in the CR, which was especially evident in schizophrenia patients. CONCLUSIONS: Inpatient psychiatric care costs can be reduced with the RPB without compromising the quality of care.


Subject(s)
Budgets , Day Care, Medical/economics , Hospitalization/economics , Mental Disorders/economics , National Health Programs/economics , Psychiatry/economics , Quality Assurance, Health Care/economics , Regional Health Planning/economics , Adult , Aged , Capitation Fee , Cost-Benefit Analysis/economics , Fee-for-Service Plans/economics , Female , Germany , Humans , Male , Mental Disorders/therapy , Middle Aged
14.
Neuropsychiatr ; 22(2): 100-11, 2008.
Article in German | MEDLINE | ID: mdl-18606112

ABSTRACT

OBJECTIVE: Schizophrenia patients have in many aspects an unhealthier lifestyle than the general population. The aim of this study is to determine if disadvantageous health habits of schizophrenia patients present a general pattern that repeats itself in other regions and if psychosocial consequences of schizophrenia (singleness, unemployment) influence patients' health habits. METHODS: 95 schizophrenia outpatients from Germany and 97 from Austria were examined regarding eating-, drinking-, smoking- and physical-activity habits. Differences in health habits and the influence of psychosocial parameters were examined with regression analyses. RESULTS: Health habits of schizophrenia patients in Germany and Austria were very similar. Subjects from Austria lived unhealthier only regarding cigarette consumption and grocery choices, while they had a healthier lifestyle regarding physical activity on the weekend. Singleness had no influence on health habits, unemployment was connected with less physical activity on workdays. CONCLUSIONS: Health habits of schizophrenia patients seem to have a general pattern, but psychosocial consequences of schizophrenia explain little about the patients' health habits.


Subject(s)
Health Behavior , Life Style , Schizophrenia/diagnosis , Schizophrenic Psychology , Adult , Alcohol Drinking/epidemiology , Alcohol Drinking/psychology , Austria , Exercise/psychology , Feeding Behavior , Female , Germany , Health Surveys , Humans , Male , Middle Aged , Pilot Projects , Schizophrenia/epidemiology , Smoking/epidemiology , Smoking/psychology , Socioeconomic Factors
16.
J Affect Disord ; 105(1-3): 81-91, 2008 Jan.
Article in English | MEDLINE | ID: mdl-17532051

ABSTRACT

INTRODUCTION: The EQ-5D provides preference weights (utilities) for health-related quality of life to be used for calculating quality-adjusted life years (QALYs) in cost-utility analysis. The aim of this study was to compare differences in EQ-5D utility scores with differences in quality of life, psychopathology, and social functioning scores. METHODS: In an observational longitudinal cohort study, EQ-5D utilities (EQ visual analogue scale (EQ VAS), EQ-5D indices of the United Kingdom (EQ-5D index-UK) and Germany (EQ-5D index-D)) were compared with scores of the WHOQOL-BREF, CGI, and GAF at baseline and at 18 months (N=104). The patients' health status at follow-up was categorized as "worse", "stable", or "better" using the EQ-5D transition question (patient-based anchor) and the Bech-Rafaelsen melancholy scale (clinician-based anchor). Effect sizes (ES) were used to compare differences in scores within each group over time; regression analysis was used to derive meaningful difference scores in health status associated with a shift from "stable" to "better" health status. RESULTS: The most responsive instrument was the CGI (patient-based anchor: ES=|0.98|; clinician-based anchor: ES=|1.35|); responsiveness was large in EQ VAS (patient-based anchor: ES=|0.84|; clinician-based anchor: ES=|1.19|), but rather small to medium for EQ-5D index-UK (patient-based anchor: ES=|0.55|; clinician-based anchor: ES=|0.65|) and EQ-5D index-D (patient-based anchor: ES=|0.41|; clinician-based anchor: ES=|0.45|). Compared with the other instruments, the shift to a "better health status" was smaller if elicited by the EQ-5D indices. DISCUSSION: Both EQ-5D indices were less responsive and need larger patient samples to detect meaningful differences compared with EQ VAS and the other instruments.


Subject(s)
Depressive Disorder/diagnosis , Depressive Disorder/psychology , Quality of Life/psychology , Social Behavior , Surveys and Questionnaires , Adult , Aged , Aged, 80 and over , Cohort Studies , Female , Follow-Up Studies , Germany , Health Status , Humans , Male , Middle Aged , Reproducibility of Results , United Kingdom
17.
Drug Alcohol Depend ; 92(1-3): 291-5, 2008 Jan 01.
Article in English | MEDLINE | ID: mdl-17888587

ABSTRACT

INTRODUCTION: The EQ-5D provides community-based preference weights (utilities) for calculating quality adjusted life years (QALYs) in cost-utility analysis. This study aimed to analyze the responsiveness of EQ-5D-based utilities in patients with alcohol dependence. METHODS: In an observational longitudinal cohort study of alcohol-dependent patients (N=52), three different EQ-5D-based utilities (EQ-Index United Kingdom, United States, and Germany) were calculated and compared with the scores of the WHOQOL-BREF (mental domain), HoNOS (total score), and GAF at baseline and at 18 months. Patients were categorized with more/same/less problems according to their self reported consumption of alcohol (patient-based anchor) and their problem status due to alcohol consumption using a question of the HoNOS scale (clinician-based anchor). Effect sizes (ES) were used to compare longitudinal changes in scores within each group; regression analysis was used to derive difference scores in health status associated with a shift from "same" to "less" problems according to the two anchors. RESULTS: ES were rather trivial to medium for all EQ-5D indices (ranging from |0.10| to |0.59|) related to a shift from "same" to "less" problems in the two anchors. Differences in scores of the EQ-5D indices revealing a shift from "same" to "less" problems according to the two anchors were not significant. CONCLUSIONS: These results suggest that the EQ-5D indices are less responsive and require larger patient samples to detect meaningful clinical differences compared to the other used instruments. Additional research is needed to compare societal and clinical views on relevant change in health status in this patient group.


Subject(s)
Alcoholism/psychology , Quality of Life/psychology , Surveys and Questionnaires , Activities of Daily Living/psychology , Adult , Aged , Alcoholism/complications , Anxiety/complications , Anxiety/psychology , Cohort Studies , Depression/complications , Depression/psychology , Female , Humans , Linear Models , Longitudinal Studies , Male , Mental Health/statistics & numerical data , Middle Aged , Pain/complications , Quality-Adjusted Life Years , Social Behavior
18.
Br J Psychiatry ; 190: 333-8, 2007 Apr.
Article in English | MEDLINE | ID: mdl-17401040

ABSTRACT

BACKGROUND: Burden on the relatives of patients with schizophrenia may be influenced not only by patient and caregiver characteristics, but also by differences in mental health service provision. AIMS: To analyse whether family burden is affected by national differences in the provision of mental health services. METHOD: Patients with schizophrenia and their key relatives were examined in Germany (n=333) and Britain (n=170). Differences in family burden in both countries were analysed with regression models controlling for patient and caregiver characteristics. RESULTS: Family burden was associated with patients'symptoms, male gender, unemployment and marital status, as well as caregivers'coping abilities, patient contact and being a patient's parent. However, even when these attributes were controlled for, British caregivers reported more burden than German caregivers. CONCLUSIONS: National differences in family burden may be related to different healthcare systems in Germany and Britain. Support for patients with schizophrenia may be shifted from the professional to the informal healthcare sector more in Britain than in Germany.


Subject(s)
Delivery of Health Care/statistics & numerical data , Family/psychology , Quality of Health Care/statistics & numerical data , Schizophrenia/therapy , Adaptation, Psychological , Adolescent , Adult , Caregivers , Cost of Illness , Female , Germany , Humans , Male , Marital Status , Middle Aged , Unemployment , United Kingdom
19.
Psychiatr Prax ; 34(3): 108-16, 2007 Apr.
Article in German | MEDLINE | ID: mdl-17443451

ABSTRACT

OBJECTIVE: The measurement of quality of life (QoL) in dementia is a methodological challenge because of the patients' cognitive impairment and anosognosia. This review gives an overview of the possibilities and methodological problems of QoL measurement in dementia patients. METHODS: With literature searches conducted in PubMed and Web of Science 12 dementia-specific QoL-measures were identified. RESULTS: Most authors agreed that patients with mild to moderate dementia themselves can validly and reliably estimate their QoL. But with increasing severity of the disease, patient ratings must mostly be replaced by proxy ratings. The latter are especially essential in longitudinal studies, but are not a satisfying substitute for the patients' perspective. Thus, the influence of depression and care-related burden on the proxies' QoL-ratings should be controlled. CONCLUSIONS: QoL-instruments, applicable to all stages of dementia should be preferred, because longitudinal QoL-measures are more meaningful than cross sectional analyses. The patients' perspective should be taken into consideration as long as possible, since proxies assess the QoL of dementia patients differently from the persons affected.


Subject(s)
Alzheimer Disease/psychology , Quality of Life/psychology , Sickness Impact Profile , Aged , Caregivers/psychology , Humans , Personality Assessment/statistics & numerical data , Reproducibility of Results , Social Adjustment , Social Environment , Surveys and Questionnaires
20.
Soc Psychiatry Psychiatr Epidemiol ; 42(4): 268-76, 2007 Apr.
Article in English | MEDLINE | ID: mdl-17370043

ABSTRACT

BACKGROUND: The aim of the study was to analyze the physical activity, dietary, drinking, and smoking habits of schizophrenia patients (SP). METHODS: Data from 194 schizophrenia outpatients collected using sections of the German National Health Interview and Examination Survey were compared with data from the German general population (GP). In addition to univariate data analyses, a multivariate regression analysis was performed. RESULTS: Schizophrenia patients have a supper snack more frequently, consume instant meals and calorie-reduced food more frequently, and eat healthy groceries more rarely. Though they drink less alcohol, a greater proportion currently smokes, smoking on average 4 cigarettes more per day. On workdays they spend less time with strenuous activities, and in leisure time a greater proportion is involved in no sports. Regression analysis revealed that schizophrenia by itself or in interaction with demographic variables influences physical activity as well as alcohol, nicotine, and healthy grocery consumption. Health habits were particularly disadvantageously affected by schizophrenia in connection with unemployment. CONCLUSIONS: Schizophrenia patients are an appropriate target group for public health interventions. They need information about a healthy diet and motivation to prepare their own meals, to quit smoking, and to exercise.


Subject(s)
Habits , Health Behavior , Schizophrenia/epidemiology , Adult , Alcohol Drinking/epidemiology , Choice Behavior , Feeding Behavior , Female , Humans , Male , Motor Activity
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