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BACKGROUND: Depressive symptoms are a common problem in patients with diabetes, laying an additional burden on both the patients and the health care system. Patients suffering from these symptoms rarely receive adequate evidence-based psychological help as part of routine clinical care. Offering brief evidence-based treatments aimed at alleviating depressive symptoms could improve patients' medical and psychological outcomes. However, well-designed trials focusing on the effectiveness of psychological treatments for depressive symptoms in patients with diabetes are scarce. The Mood Enhancement Therapy Intervention Study (METIS) tests the effectiveness of two treatment protocols in patients with diabetes. Individually administered Cognitive Behavioral Therapy (CBT) and Mindfulness-Based Cognitive Therapy (MBCT) are compared with a waiting list control condition in terms of their effectiveness in reducing the severity of depressive symptoms. Furthermore, we explore several potential moderators and mediators of change underlying treatment effectiveness, as well as the role of common factors and treatment integrity. METHODS/DESIGN: The METIS trial has a randomized controlled design with three arms, comparing CBT and MBCT with a waiting list control condition. Intervention groups receive treatment immediately; the waiting list control group receives treatment three months later. Both treatments are individually delivered in 8 sessions of 45 to 60 minutes by trained therapists. Primary outcome is severity of depressive symptoms. Anxiety, well-being, diabetes-related distress, HbA1c levels, and intersession changes in mood are assessed as secondary outcomes. Assessments are held at pre-treatment, several time points during treatment, at post-treatment, and at 3-months and 9-months follow-up. The study has been approved by a medical ethical committee. DISCUSSION: Both CBT and MBCT are expected to help improve depressive symptoms in patients with diabetes. If MBCT is at least equally effective as CBT, MBCT can be established as an alternative approach to CBT for treating depressive symptoms in patients with diabetes. By analyzing moderators and mediators of change, more information can be gathered for whom and why CBT and MBCT are effective. TRIAL REGISTRATION: Clinical Trials NCT01630512.
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BACKGROUND: A combination of multiple factors, including a strong genetic predisposition and environmental factors, are considered to contribute to the developmental pathways to borderline personality disorder (BPD). However, these factors have mostly been investigated retrospectively, and hardly in adolescents. The current study focuses on maternal factors in BPD features in adolescence. METHODS: Actual parenting was investigated in a group of referred adolescents with BPD features (N = 101) and a healthy control group (N = 44). Self-reports of perceived concurrent parenting were completed by the adolescents. Questionnaires on parental psychopathology (both Axis I and Axis II disorders) were completed by their mothers. RESULTS: Adolescents reported significantly less emotional warmth, more rejection and more overprotection from their mothers in the BPD-group than in the control group. Mothers in the BPD group reported significantly more parenting stress compared to mothers in the control group. Also, these mothers showed significantly more general psychopathology and clusters C personality traits than mothers in the control group. Contrary to expectations, mothers of adolescents with BPD features reported the same level of cluster B personality traits, compared to mothers in the control group. Hierarchical logistic regression revealed that parental rearing styles (less emotional warmth, and more overprotection) and general psychopathology of the mother were the strongest factors differentiating between controls and adolescents with BPD symptoms. CONCLUSIONS: Adolescents with BPD features experience less emotional warmth and more overprotection from their mothers, while the mothers themselves report more symptoms of anxiety and depression. Addition of family interventions to treatment programs for adolescents might increase the effectiveness of such early interventions, and prevent the adverse outcome that is often seen in adult BPD patients.
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INTRODUCTION: Re-offending, as a measure of success in forensic psychiatry, gives no information about other behaviours that may have changed. The development of the Forensic Inpatient Observation Scale (FIOS), an observation instrument to assess the non-offending functioning of forensic patients, is described. STUDY 1: In the first study the development of the initial item pool of the FIOS is described. This resulted in an instrument consisting of 78 items and seven scales. The internal reliability of the scales ranged from 0.78 to 0.91. The inter-rater reliability of the scales varied from 0.50 to 0.85 and the test retest reliability over a period of three weeks was high for most scales, ranging from 0.74 to 0.89. STUDY 2: In the second study the FIOS was developed further in another sample of forensic patients. This time exploratory factor analysis with Varimax rotation and post hoc reliability analysis were applied to determine the factor structure among the items. This resulted in an item pool of 35 items, among which six factors could be distinguished that closely resemble the factor structure of the FIOS in study one: (1) self-care, (2) social behaviour, (3) oppositional behaviour, (4) insight offence/problems, (5) verbal skills and (6) distress. Most items have high loadings on the factor they are assigned; 29 items have a loading of 0.60 or higher. The internal consistency of the scales ranges from 0.73 to 0.91 and the scales appear to be measuring independent constructs. Twenty-five out of the 35 items have an inter-rater correspondence of 90% or higher and 30 out of 35 items have an inter-rater correspondence of 87.5% or higher. The inter-rater reliability on the scale level, however, was somewhat less satisfying with correlations ranging from 0.50 to 0.69. DISCUSSION: It is argued that training the observers on a more regular basis will improve the inter-rater reliability. There is some evidence for the convergent validity of the FIOS. The FIOS has some advantages over existing inpatient scales in that it is developed specifically for forensic patients, it does not particularly focus on axis 1 symptoms but includes oppositional behaviour and attitudes to offending.
