Low predictive power of clinical features for relapse prediction after antidepressant discontinuation in a naturalistic setting.

The risk of relapse after antidepressant medication (ADM) discontinuation is high. Predictors of relapse could guide clinical decision-making, but are yet to be established. We assessed demographic and clinical variables in a longitudinal observational study before antidepressant discontinuation. State-dependent variables were re-assessed either after discontinuation or before discontinuation after a waiting period. Relapse was assessed during 6 months after discontinuation. We applied logistic general linear models in combination with least absolute shrinkage and selection operator and elastic nets to avoid overfitting in order to identify predictors of relapse and estimated their generalisability using cross-validation. The final sample included 104 patients (age: 34.86 (11.1), 77% female) and 57 healthy controls (age: 34.12 (10.6), 70% female). 36% of the patients experienced a relapse. Treatment by a general practitioner increased the risk of relapse. Although within-sample statistical analyses suggested reasonable sensitivity and specificity, out-of-sample prediction of relapse was at chance level. Residual symptoms increased with discontinuation, but did not relate to relapse. Demographic and standard clinical variables appear to carry little predictive power and therefore are of limited use for patients and clinicians in guiding clinical decision-making.

The relationship between resting-state functional connectivity, antidepressant discontinuation and depression relapse.

The risk of relapsing into depression after stopping antidepressants is high, but no established predictors exist. Resting-state functional magnetic resonance imaging (rsfMRI) measures may help predict relapse and identify the mechanisms by which relapses occur. rsfMRI data were acquired from healthy controls and from patients with remitted major depressive disorder on antidepressants. Patients were assessed a second time either before or after discontinuation of the antidepressant, and followed up for six months to assess relapse. A seed-based functional connectivity analysis was conducted focusing on the left subgenual anterior cingulate cortex and left posterior cingulate cortex. Seeds in the amygdala and dorsolateral prefrontal cortex were explored. 44 healthy controls (age: 33.8 (10.5), 73% female) and 84 patients (age: 34.23 (10.8), 80% female) were included in the analysis. 29 patients went on to relapse and 38 remained well. The seed-based analysis showed that discontinuation resulted in an increased functional connectivity between the right dorsolateral prefrontal cortex and the parietal cortex in non-relapsers. In an exploratory analysis, this functional connectivity predicted relapse risk with a balanced accuracy of 0.86. Further seed-based analyses, however, failed to reveal differences in functional connectivity between patients and controls, between relapsers and non-relapsers before discontinuation and changes due to discontinuation independent of relapse. In conclusion, changes in the connectivity between the dorsolateral prefrontal cortex and the posterior default mode network were associated with and predictive of relapse after open-label antidepressant discontinuation. This finding requires replication in a larger dataset.

In-person and computer-based alcohol interventions at general hospitals: reach and retention.

BACKGROUND: High reach of target populations is relevant for public health impact of interventions. Concerning intervention programs requiring multiple contacts, little is known about how many persons may be kept in the intervention program over multiple time points. The aim of this study was to investigate (i) the reach of general hospital inpatients with at-risk alcohol use through screening and brief intervention and (ii) whether their continued intervention participation after hospital discharge differs by in-person vs. computer-based intervention (CO) delivery. METHODS: As part of a randomized controlled trial, general hospital inpatients aged 18-64 years were screened for at-risk alcohol use on 13 wards. Participants were allocated to in-person intervention (PE), CO and assessment only. Both interventions were provided on site, and 1 and 3 months after baseline. RESULTS: Ninety-two percent of all eligible inpatients ( N: = 6251) completed the screening. Eighty-one percent ( N: = 961) of the screening-positives participated in the trial and received their allocated intervention. At months 1 and 3, interventions were delivered to 83 and 79% of the CO participants and to 74 and 64% of the PE participants. The delivery of CO and PE required an average of 5.2 and 7.7 contact attempts per delivered intervention, respectively. CONCLUSION: General hospital inpatients with at-risk alcohol use were well reached through proactive interventions. COs may result in higher retention rates over 1 and 3 months and may require less contact attempts than PEs. Public health efforts that aim to achieve high intervention retention should consider proactive COs.

Belief incongruence and the intention-behavior gap in persons with at-risk alcohol use.

INTRODUCTION: When intentions are expressed, e.g., when filling in a health questionnaire, people may have unrealistic beliefs towards behavior change resulting in strong intentions to change. These may fail to correspond to reality when the behavior actually should be performed. Belief incongruence was tested as a possible source of the intention-behavior gap. METHODS: The study sample consisted of 433 job agency clients with at-risk alcohol use (64% men, mean age=30.6 (SD=11.6) years). Behavioral, normative, and control beliefs, intention, and alcohol use were assessed at baseline and three months later. The influence of belief incongruence on the intention-behavior gap was examined using latent interaction models. RESULTS: The gap between stated intentions and at-risk alcohol use three months later was larger when the according normative beliefs were incongruent (total effect: b=-0.44, p<0.05 for persons with congruent beliefs vs. b=-0.06, p>0.10 for persons with incongruent beliefs). When controlling for the mediating effect of changes in intentions, the association between belief incongruence and intention-behavior gap was attenuated (direct effect: b=-0.56, p<0.01 for persons with congruent beliefs vs. b=-0.28, p<0.05 for persons with incongruent beliefs). Neither behavioral belief incongruence nor control belief incongruence was significantly associated with the intention-behavior gap. CONCLUSIONS: Normative belief incongruence may contribute to the gap between intentions to adhere to recommended drinking limits and subsequent at-risk alcohol use. Focusing on the reduction of misperceptions about drinking norms could help to increase the proportion of persons who succeed in translating their intentions into behavior.

The Stability of Social Desirability: A Latent Change Analysis.

Social desirability has been shown to be stable in samples with higher school education. However, little is known about the stability of social desirability in more heterogeneous samples differing in school education. This study aimed to investigate the stability of social desirability and which factors predict interindividual differences in intraindividual change. As part of a randomized controlled trial, 1,243 job seekers with unhealthy alcohol use were systematically recruited at three job agencies. A total of 1,094 individuals (87.8%) participated in at least one of two follow-ups (6 and 15 months after baseline) and constitute this study's sample. The Social Desirability Scale-17 was applied. Two latent change models were conducted: Model 1 tested for interindividual differences in intraindividual change of social desirability between both follow-ups; Model 2 included possible predictors (age, sex, education, current employment status) of interindividual differences in intraindividual change. Model 1 revealed a significant decrease of social desirability over time. Model 2 revealed school education to be the only significant predictor of change. These findings indicate that stability of social desirability may depend on school education. It may not be as stable in individuals with higher school education as in individuals with lower education.

Patterns of health risk behaviors among job-seekers: a latent class analysis.

OBJECTIVES: To examine the patterning of four behavior-related health risk factors (tobacco smoking, risky alcohol drinking, overweight, and physical inactivity) among job-seekers and to investigate socio-demographic and health-related predictors of patterning. METHODS: The sample of 3,684 female and 4,221 male job-seekers was proactively recruited at three job agencies in northeastern Germany in 2008/09. Participants provided data on socio-demographics, substance use, body mass index, physical activity and self-rated health. Latent class analyses (LCA) and multinomial logistic regression analyses were applied to identify health risk patterns and possible predictors of patterning, respectively. RESULTS: Forty-three percent of the female and 58% of the male participants had two or more health risk factors. LCA revealed three similar patterns for women and men: Substance use (tobacco smoking, risky drinking), Non-exercising overweight (physical inactivity, overweight/obesity) and Health-conscious (non-smoking, low-risk drinking, under-/normal weight, physical activity). Age, education, marital status, life-time unemployment and self-rated health were significantly associated with patterning in both genders. CONCLUSIONS: Our results may help to define target populations for improving health behaviors among job-seekers.

The impact of a stage tailored intervention on alcohol use trajectories among those who do not intend to change.

BACKGROUND: Persons not intending to change are an important target population for public health efforts. The aim of this study was to investigate whether subgroups characterized by different trajectories of alcohol use frequency and quantity among persons with unhealthy drinking but no intention to change benefitted differently from a stage tailored intervention. METHODS: This study was part of a randomized controlled trial among job-seekers. The participants of the intervention group (n=413) received feedback letters tailored to their motivational stage. The control group (n=414) received minimal assessment only. Among all participants, 629 (76.1%) did not intend to change alcohol use and constitute the study sample (60.7% men; mean age=29.7 years, SD=10.8). 3-, 6-, and 15-month follow-ups were conducted. Growth mixture modeling was applied to identify classes representing the heterogeneity in the development of alcohol use frequency and quantity and the influence of the intervention on different trajectories. RESULTS: Four classes were identified: a class of persons who achieved abstinence (2%), a class with low-frequent drinking with declining quantity (35%), a class with high-frequent drinking with low but slightly increasing quantity (30%), and a class with constant heavy episodic drinking (33%). Although non-significant, there was a tendency of different intervention effects for different classes. CONCLUSIONS: A sample of persons not intending to change unhealthy alcohol use was composed of subgroups characterized by different trajectories of alcohol use quantity and frequency. Trends towards beneficial intervention effects on motivation and drinking outcomes were not significant, possibly due to low power.

Does stage tailoring matter in brief alcohol interventions for job-seekers? A randomized controlled trial.

AIMS: To investigate whether or not a stage tailored intervention is more effective than a non-stage tailored intervention of the same intensity in reducing alcohol use among job-seekers with unhealthy alcohol use, and whether initial motivation to change is a moderator of efficacy. DESIGN: A three-group randomized controlled trial with 3-, 6- and 15-month follow-ups. SETTING: Three job agencies in Germany. PARTICIPANTS: A total of 1243 job-seekers with unhealthy alcohol use were randomized to (i) stage tailored intervention based on the transtheoretical model of change (ST), (ii) non-stage tailored intervention based on the theory of planned behaviour (NST) and (iii) assessment only (controls). Participants received feedback letters and manuals at baseline and 3 months later. MEASUREMENTS: Piecewise latent growth models were calculated measuring change in 'alcohol use' from baseline to month 3 (active intervention phase) and from months 3 to 15 (post-intervention phase, primary outcome). Motivation to change was included as a 4-point continuous measure. FINDINGS: All groups reduced alcohol use from months 0 to 3 (controls: mean = -0.866, NST: mean = -0.883, ST: mean = -0.718, Ps ≤ 0.001). Post-intervention (months 3-15), low-motivated individuals in the ST group showed a greater reduction than those in the control group (ß = 0.135, P = 0.039, Cohen's d = 0.42) and in the NST group (ß = 0.180, P = 0.009, Cohen's d = 0.55). In contrast, compared to the ST group (ß = 0.030, P = 0.361), alcohol use decreased more strongly with higher initial motivation in the NST group (ß = -0.118, P = 0.010). CONCLUSIONS: Among job-seekers with high levels of alcohol consumption, an intervention tailored to motivational 'stage of change' was more effective than a non-stage tailored intervention for reducing alcohol use 15 months after baseline assessment in participants with low initial motivation to change.

How well do TTM measures work among a sample of individuals with unhealthy alcohol use that is characterized by low readiness to change?

Little is known about the applicability of the transtheoretical model of intentional behavior change (TTM) to individuals with unhealthy alcohol use that is primarily characterized by low readiness to change. This study examined the psychometric properties of short measures by assessing three core constructs of the TTM: the 20-item Processes of Change (POC-20) scale, and short versions of the Alcohol Decisional Balance Scale (ADBS) and the Alcohol Abstinence Self-Efficacy (AASE) scale. A sample of 427 individuals with unhealthy alcohol use (Mage = 30 years, 65% men), identified at job agencies in northeastern Germany, completed all three scales. Item difficulty (d), selectivity (rit), and Cronbach's alpha were calculated. Confirmatory factory analyses were used to test for construct validity and latent mean differences across the stages. The psychometric properties of the 8-item AASE were adequate (d range: 0.59-0.78; rit range: 0.59-0.68; α range: 0.74-0.81), except for one subscale. Most items of the POC-20 and the 10-item ADBS were difficult (dPOC range: 0.08-0.40; dADBS range: 0.21-0.58); selectivity (ritPOC range: 0.26-0.62; ritADBS range: 0.34-0.68) and internal consistency (αPOC range: 0.41-0.76; αADBS range: 0.64-0.78) were low to moderate. Construct validity was acceptable (Comparative Fit Index range: 0.95-0.99). The association between stages and TTM constructs partially followed expected patterns. Suggestions for modifications of TTM measures are discussed for better applicability among proactively recruited samples of individuals with unhealthy alcohol use and with primarily low readiness to change. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Gender-specific predictors of risky alcohol use among general hospital inpatients.

OBJECTIVE: To investigate sociodemographic-, living situation- and substance-related variables as predictors of current risky alcohol use for both female and male general hospital inpatients. METHOD: The sample of 6050 female and 8282 male general hospital inpatients was recruited in 2002-2004. Using the Alcohol Use Disorder Identification Test-Consumption, they were assigned to four drinking groups: abstinent, moderate use, slightly increased use and notably increased use. Gender-specific predictors of group affiliation were determined using multivariate multinomial logistic regressions. RESULTS: In both genders, younger age, rural living environment, the occurrence of lifetime alcohol use disorders (AUDs) and current tobacco smoking were positively associated with risky alcohol use. Higher education was positively associated with slightly and notably increased use for women. Living alone, being divorced/ widowed and being unemployed (relative risk ratios=1.4-1.7) were positively associated with notably increased use for men. In both genders, older age, less education and the occurrence of lifetime AUDs were positively associated with abstinence. CONCLUSIONS: Higher educated women are likely to report risky alcohol use. Marriage may have a protective effect on level of alcohol use for men only. In addition to the implementation of routine alcohol screening, the examined data may provide cost-effective information that could be used to tailor interventions.