Determining Key Features of Effective Depression Interventions

Determining Key Features of Effective Depression Interventions
Author: U. S. Department of Veterans Affairs
Publisher: Createspace Independent Pub
Total Pages: 72
Release: 2013-05-29
Genre: Medical
ISBN: 9781490303987

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Current clinical guidelines for depression address depression treatment for patients detected in primary care; VA/DOD depression guidelines; and NICE guidelines. Research to date indicates that, under usual care conditions, less than half of primary care patients found to have major depression complete minimally adequate medications or psychotherapy. A variety of organizational changes aimed at improving care for depression in primary care have been tested. Yet evidence-based guidance for healthcare organizations and their primary care practices about which organizational changes are necessary for achieving improved depression outcomes is lacking. The purpose of this review is to establish a basis for organizational guidelines or best practices for achieving improved depression care. The collaborative care model for depression has been extensively studied, and found to be both effective and cost-effective in prior meta-analysis. Collaborative care models are organizational interventions designed to remedy known deficits in current depression care. These multifaceted models are loosely defined as involving collaboration between providers from different specialties to provide appropriate, timely depression care or as involving two of three types of professionals (a case manager, a primary care clinician, and a mental health specialist) working collaboratively within primary care. Thus, while all applications of this model are similar in focusing on supporting effective management of primary care patients detected outside of a mental health specialty setting, the specific features of the model vary from study to study. These variations make it difficult for care settings to know what features of the models tested and found to be effective in randomized trials of collaborative care are essential for achieving the expected effects. Collaborative care definitions like these have been directed primarily at staffing (e.g., the presence of case manager or mental health specialist). Current theories of chronic illness care, however, postulate that key additional organizational changes are required to achieve consistent, sustainable improvement. When the multiple facets of collaborative care models are considered, most can be considered specific applications of the general, across-disease chronic illness care model. This review focuses on high quality depression care randomized trials that involved at least one change in the organization of care as described in the chronic illness care model. Our main research question was whether there are specific design features of collaborative care interventions that are consistently associated with greater impact on depression symptoms compared to a usual care control group. We also aimed to explore additional outcomes including patient satisfaction and functioning. In addition, we asked whether there were specific design features of randomized trial evaluations of collaborative care that were associated with consistently greater effects. Secondarily, we aimed to assess whether any patient characteristics, such as comorbidities, were associated with differential collaborative care effects, and the degree to which model effects persisted over time. We investigated these goals based on the following research questions. 1) Primary Research Question: What is the core set of intervention features that characterize collaborative care interventions, and which additional features are most linked to enhanced outcome effects? 2) Secondary Research Question: Are there specific evaluation features among randomized trials of collaborative care that are associated with effect size differences, independently of intervention features? 3) Secondary Research Question: To what extent is collaborative care more effective than usual care for decreasing depressive symptoms among patients with comorbid mental health conditions (PTSD, dementia, anxiety, dysthymia, substance abuse) or medical conditions?

Determining Key Features of Effective Depression Interventions

Determining Key Features of Effective Depression Interventions
Author:
Publisher:
Total Pages:
Release: 2009
Genre:
ISBN:

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Our main research question was whether there are specific design features of collaborative care interventions that are consistently associated with greater impact on depression symptoms compared to a usual care control group. We also aimed to explore additional outcomes including patient satisfaction and functioning. In addition, we asked whether there were specific design features of randomized trial evaluations of collaborative care that were associated with consistently greater effects. Secondarily, we aimed to assess whether any patient characteristics, such as comorbidities, were associated with differential collaborative care effects, and the degree to which model effects persisted over time. We investigated these goals based on the following research questions. (1) Primary Research Question: What is the core set of intervention features that characterize collaborative care interventions, and which additional features are most linked to enhanced outcome effects? (2) Secondary Research Question: Are there specific evaluation features among randomized trials of collaborative care that are associated with effect size differences, independently of intervention features? (3) Secondary Research Question: To what extent is collaborative care more effective than usual care for decreasing depressive symptoms among patients with comorbid mental health conditions (PTSD, dementia, anxiety, dysthymia, substance abuse) or medical conditions? Methods: We used a set of articles identified and preliminarily reviewed as part of an earlier, nonquantitative literature review on depression care models (Williams, Gerrity et al. 2007) to carry out quantitative meta-regression analysis of collaborative care features. Studies were high quality randomized trials of depression collaborative care interventions compared to usual care that incorporated at least two features of the chronic illness care model. At least one of these features had to directly support patients in completing depression treatment. We did not review studies that only sought to change primary care clinician behavior (e.g., using reminders), without an additional patient-directed component, such as care management. We contacted authors extensively to identify, clarify, or verify study variables such as chronic illness care features or patient population characteristics. We began our analyses by assessing correlations between features. For study outcomes, we evaluated the effect size across studies for changes in depression symptoms, and relative risk across studies for changes in rates of resolution of depression. For these analyses we used study effect sizes comparing intervention to usual care arms as the unit of analysis. The effect size analyses treated short (six weeks to four months), medium (five to eight months), and long (nine to twelve months) outcomes separately. We also measured intervention impact (high, medium, low and little or none) for each study based on reviewer ratings of de-identified sets of study outcomes, including adherence, patient satisfaction, and functioning. We eliminated variables with inadequate distributions for meaningful quantitative analysis, using a rule of thumb of at least three studies per variable category. We carried out univariate and multivariate regression to determine relationships between intervention and evaluation features and effectiveness. Finally, we conducted cross-case qualitative analysis (Miles and Huberman 1994) of intervention and evaluation features, including comorbidities, against intervention impact.

DSM-5 Classification

DSM-5 Classification
Author: American Psychiatric Association
Publisher: American Psychiatric Publishing
Total Pages: 0
Release: 2015-08-25
Genre: Mental illness
ISBN: 9780890425664

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This handy DSM-5(R) Classification provides a ready reference to the DSM-5 classification of disorders, as well as the DSM-5 listings of ICD-9-CM and ICD-10-CM codes for all DSM-5 diagnoses. To be used in tandem with DSM-5(R) or the Desk Reference to the Diagnostic Criteria From DSM-5(R), the DSM-5(R) Classification makes accessing the proper diagnostic codes quick and convenient. With the advent of ICD-10-CM implementation in the United States on October 1, 2015, this resource provides quick access to the following: - The DSM-5(R) classification of disorders, presented in the same sequence as in DSM-5(R), with both ICD-9-CM and ICD-10-CM codes. All subtypes and specifiers for each DSM-5(R) disorder are included.- An alphabetical listing of all DSM-5 diagnoses with their associated ICD-9-CM and ICD-10-CM codes.- Separate numerical listings according to the ICD-9-CM codes and the ICD-10-CM codes for each DSM-5(R) diagnosis.- For all listings, any codable subtypes and specifiers are included with their corresponding ICD-9-CM or ICD-10-CM codes, if applicable. The easy-to-use format will prove indispensable to a diverse audience--for example, clinicians in a variety of fields, including psychiatry, primary care medicine, and psychology; coders working in medical centers and clinics; insurance companies processing benefit claims; individuals conducting utilization or quality assurance reviews of specific cases; and community mental health organizations at the state or county level.

E Therapy

E Therapy
Author: Robert C Hsiung
Publisher: W. W. Norton & Company
Total Pages: 260
Release: 2002-10-29
Genre: Computers
ISBN: 9780393703702

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In a world of information that tends toward randomness, therapists and clinicians often need guidance regarding how best to use new technologies and yet not allow the chaos of new media to undermine their practice. Here, a leading provider of online mental health information, Dr. Robert Hsiung, has gathered a group of distinguished contributors to discuss clinical, ethical, and legal issues pertaining to e-therapy. Full of case studies and examples of active programs that deliver mental health information and therapy via new media, E-Therapy offers first-hand accounts of the potential and risks of recent trends in 'distance therapy' and 'telepsychiatry.' Chapters include The Internet 'Expert': Ronald Pies An E-Patient's Story: Martha Ainsworth Chat Room Therapy: Gary S. Stofle Using E-mail to Support Outpatient Treatment: Joel Yager Community Telepsychiatry: Sara F. Gibson An Online Self-Help Group Hosted by a Mental Health Professional: Robert C Hsiung Principles of Professional Ethics: Robert C Hsiung Legal Ethics in On-line Mental Health: Nicholas P. Terry

The Massachusetts General Hospital Guide to Depression

The Massachusetts General Hospital Guide to Depression
Author: Benjamin G. Shapero
Publisher: Springer
Total Pages: 263
Release: 2018-10-17
Genre: Medical
ISBN: 3319972413

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Major Depressive Disorder (MDD) is one of the most prevalent psychiatric disorders, with a lifetime prevalence rate of roughly 20%. MDD is a leading cause of disability and premature death worldwide, leads to greater impairment in work functioning than other chronic medical conditions, and has an estimated annual cost of $210 billion in the US. The proposed text is designed for mental health professionals and will present state-of-the-art treatment options that are used in the Depression Clinical and Research Program (DCRP) at the Massachusetts General Hospital. The text provides different treatment options so that providers can ‘think outside the box’ of conventional interventions. The introductory sections discuss general themes about diagnosing and treating depression. The major body of the book, however, consists of chapters organized under the topics of new medication, new psychotherapy, alternative treatments, and consideration of specific populations and how to modify interventions to best treat these patients. Each chapter begins with a case vignette to illustrate key characteristics of the disorder process or treatment and reviews the history, research support, and new advances of these topics. In addition, the chapters include a description of how to apply this topic in treatment and frequently asked questions and answers. This book will be a unique contribution to the field. Existing guides focus on individual treatments of Depression, or include brief descriptions of interventions as a whole. The DCRP has consistently been a forerunner of clinical treatments for depression and often treats challenging cases of this disorder. This book will provide a practical and useful resource with wide applicability.

Depression

Depression
Author: Mark A. Reinecke PhD
Publisher: Springer Publishing Company
Total Pages: 536
Release: 2007-01-29
Genre: Psychology
ISBN: 9780826146816

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This volume comprehensively compares and contrasts alternative models of, and treatment approaches to, clinical depression. Each contributor, a recognized expert in his or her modality, analyzes the same case and provides: an overview of the treatment model empirical evidence for both the model and treatment derived from it treatment strategies and interventions, including termination issues, relapse prevention, and recommendations for follow-up care Among the 12 approaches presented are Object Relations, Cognitive Therapies, Schema-Focused, Couple and Family, Integrative Psychotherapy, and Psychopharmacology. A significant contribution to this volume is the chapter on cultural considerations for understanding, assessing, and treating depression.

Depression in Parents, Parenting, and Children

Depression in Parents, Parenting, and Children
Author: Institute of Medicine
Publisher: National Academies Press
Total Pages: 488
Release: 2009-10-28
Genre: Medical
ISBN: 0309121787

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Depression is a widespread condition affecting approximately 7.5 million parents in the U.S. each year and may be putting at least 15 million children at risk for adverse health outcomes. Based on evidentiary studies, major depression in either parent can interfere with parenting quality and increase the risk of children developing mental, behavioral and social problems. Depression in Parents, Parenting, and Children highlights disparities in the prevalence, identification, treatment, and prevention of parental depression among different sociodemographic populations. It also outlines strategies for effective intervention and identifies the need for a more interdisciplinary approach that takes biological, psychological, behavioral, interpersonal, and social contexts into consideration. A major challenge to the effective management of parental depression is developing a treatment and prevention strategy that can be introduced within a two-generation framework, conducive for parents and their children. Thus far, both the federal and state response to the problem has been fragmented, poorly funded, and lacking proper oversight. This study examines options for widespread implementation of best practices as well as strategies that can be effective in diverse service settings for diverse populations of children and their families. The delivery of adequate screening and successful detection and treatment of a depressive illness and prevention of its effects on parenting and the health of children is a formidable challenge to modern health care systems. This study offers seven solid recommendations designed to increase awareness about and remove barriers to care for both the depressed adult and prevention of effects in the child. The report will be of particular interest to federal health officers, mental and behavioral health providers in diverse parts of health care delivery systems, health policy staff, state legislators, and the general public.

Depression Conceptualization and Treatment

Depression Conceptualization and Treatment
Author: Christos Charis
Publisher: Springer Nature
Total Pages: 184
Release: 2021-06-04
Genre: Psychology
ISBN: 3030689328

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Depression, a highly common clinical disorder, is an important and clinically relevant topic for both clinical researchers and practitioners to address, because of its prevalence, impact on the individual and society, association with other mental and physical health problems and the social contexts in which it develops. Depression ranks in Germany and central Europe as the third among the leading mental disorders and world-wide is a leading cause of disability. It is estimated that 8.3 % of the German population is depressed within a year (11.2 % women, 5.5 % men). These statistics mean that 4 million people per year are depressed in Germany alone (one year prevalence). According to the WHO, over 300 million people world-wide experience depression and in the USA the financial burden of this disorder, due to disability and work absenteeism, reaches Depression is also becoming more frequent over time and has a high risk of recidivism –particularly since its most common form, Major Depressive Disorder (DSM-5; ICD10) tends to occur in episodes. For example, 20% to 40% of people become depressed again within two years after their first depressive episode, meaning that a major aim of any therapeutic intervention should be to prevent future relapses. Depression also shows very high comorbidities with other mental and physical health conditions. Its overlap with anxiety pathology is so high that clinicians are concerned with whether the two disorder categories are indeed distinct or if they show substantial etiological overlap. Depression is also associated with heart disease and even cancer, making it a risk factor for mortality and morbidity that needs to be identified early and addressed effectively. In addition to Major Depressive Disorder, the often severe Bipolar Disorder, and the chronic form of Depression referred to as dysthymia are additional mood disorders that among them require careful differential diagnosis. They also lead to questions regarding their common or distinct etiological mechanisms. In order to gain a better understanding of Depression as a clinical disorder, one needs to look at it as a multifaceted phenomenon. Depression is a neurobehavioral condition, and one has to be up to date and have solid understanding of its biological substrate, at a genetic, neuronal, hormonal and pharmacological level. Depression is also a socio-demographic phenomenon, and one needs to examine its epidemiology, that might contain significant cues towards its clearer understanding. It is more prevalent, for example, in certain regions, climates, age groups and genders (much more prevalent in women, with age of appearance in young adulthood but also presents as a significant problem for youth and the elderly), is associated with stereotypes and stigma and can be the aftermath of crises, trauma and loss. The etiology of Depression remains under scrutiny, though recently much more knowledge is emerging from contemporary neuroimaging, genotyping and data science methods. Different neural and behavioral systems may be involved contributing to the significant heterogeneity within the disorder. Social roles, stressors, attachment patterns, family support and social networks, and individual (e.g. gender linked) vulnerabilities may contribute significantly towards increasing risk for developing depression. Different therapeutic approaches, like those stemming from the psychoanalytic/psychodynamic perspectives and those stemming from the cognitive/behavioral (2nd and 3rd wave) tradition focus on the components of etiology considered most dominant. As science progresses with clearer evidence regarding the important etiological factors and their interactions, these different perspectives, each with its own contribution, may need to take new developments into consideration, adapt and even begin to converge. These different aspects of the topic of Depression, which are central to the scientific aims of clinical scientists, but also permeate the way clinicians approach assessment, diagnosis, case formulation and treatment, become the focus of the present volume. Following a conference held at the University of Cyprus, in Nicosia, Cyprus in October 2019, which included presentations by internationally renowned experts in the field on these various aspects of Depression, the idea of extending the topics presented and discussed at the meeting into more elaborated and substantive chapters and synthesizing them into an edited volume was generated. The aim was to fill a substantive gap, with a volume that would be beneficial to a wider, interdisciplinary audience of clinicians, trainees and researchers with examine the different aspects of Depression. In this Edited volume, with contributions from prominent experts in the field, we propose to discuss the subject of conceptualizing and treating Depression and related conditions (e.g. Suicide, Bipolar Disorder) from different theoretical perspectives and after taking into consideration current research into the etiology and maintenance of this condition. Chapters on theoretical perspectives of treatment cover a wide range of approaches, that could be broadly clustered under behavioural and psychodynamic points of view. Perspectives discussed in this volume are psychodynamic therapy, 2nd waver CBT, acceptance and commitment therapy and mentalization therapy. Special topics with great relevance to treatment, include treatment in different levels of care (e.g. partial hospital setting; prevention of suicide; working with cancer patients). The book provides a unique combination of current empirical findings on etiology of depression and suicide, treatment considerations and practical recommendations, treatment in different settings and combination of different theoretical perspectives that can enrich a therapists’ repertoire of tools for understanding and approaching depression. The book describes various theoretical approaches without adhering to anyone but with an effort to highlight common underlying themes like issues of loss, self-esteem, guilt, grief and emotion regulation as these permeate the various perspectives. In this way the book presents a combination of science and practice and of various views that constitute an excellent resource of researchers, clinicians and students of mental health professions. In a final chapter the two editors, Drs. Christos Charis and Georgia Panayiotou, make an effort to impartially integrate information from the various perspectives, highlighting the utility of each approach to address specific vulnerability and etiological factors discussed in the book. In this regard, the volume stresses the idea of the need for continuous and open dialogue between perspectives, theories, levels of investigation, research areas, practitioner needs and scientific views to help make progress in treatment and address this complex and multi-faceted phenomenon in the service of patients, their carers and societies in general.