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Quality of treatment and disability compensation in depression: comparison of 2 nationally representative samples with a 10-year interval in Finland.

https://arctichealth.org/en/permalink/ahliterature159609
Source
J Clin Psychiatry. 2007 Dec;68(12):1886-93
Publication Type
Article
Date
Dec-2007
Author
Teija I Honkonen
Timo A Aro
Erkki T Isometsä
E Marianna Virtanen
Heikki O Katila
Author Affiliation
Finnish Institute of Occupational Health, Helsinki, Finland. teija.honkonen@ttl.fi
Source
J Clin Psychiatry. 2007 Dec;68(12):1886-93
Date
Dec-2007
Language
English
Publication Type
Article
Keywords
Antidepressive Agents - therapeutic use
Data Collection
Depressive Disorder - complications - economics - therapy
Disabled Persons - psychology
Electroconvulsive Therapy
Female
Finland
Humans
Insurance, Disability - statistics & numerical data
Male
Middle Aged
Physician's Practice Patterns - statistics & numerical data
Psychotherapy
Quality of Health Care
Workers' Compensation - statistics & numerical data
Abstract
Depressive disorders cause substantial work impairment that can lead to disability compensation. The authors compared treatment received for depression preceding disability pension between 2 nationally representative samples with a 10-year interval.
The medical statements for 2 random samples drawn from the Finnish national disability pension registers, representing populations granted a disability pension for DSM-III-R major depression during a 12-month period from October 1993 through September 1994 (N = 277) and for ICD-10 depressive disorders (F32-F33) from October 2003 through September 2004 (N = 265) were examined. The proportions of persons receiving weekly psychotherapy, antidepressants, adequate antidepressant dosage, sequential antidepressant trials, lithium augmentation, and electroconvulsive therapy (ECT) were compared.
No significant differences emerged between the 2 samples, except for the adequacy of antidepressant dosage. Few subjects in either of the samples (8.7% for 1993-1994 vs. 10.6% for 2003-2004, p = .45) had received weekly psychotherapy. Most had received antidepressants (87.4% vs. 85.6%, p = .55) with increasingly adequate dosage (75.6% vs. 85.0%, p = .02), but only a minority had received sequential antidepressant trials (39.5% vs. 44.5%, p = .24). Lithium augmentation and ECT were rare (1.1% vs. 1.5%, p = .66 and 4.0% vs. 1.5%, p = .08, respectively). Even in 2003-2004, over half of the subjects were granted a disability pension without sequential antidepressant trials.
This nationally representative study indicates that, despite an increased antidepressant use and improved practice guidelines for depression, a considerable proportion of the people granted long-term compensation for depression seem to be suboptimally treated. Given the enormous costs of the disability, attention to the quality of treatment provided for depression is warranted before long-term disability compensations are granted.
PubMed ID
18162019 View in PubMed
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Treatment attitudes and adherence of psychiatric patients with major depressive disorder: a five-year prospective study.

https://arctichealth.org/en/permalink/ahliterature142869
Source
J Affect Disord. 2010 Dec;127(1-3):102-12
Publication Type
Article
Date
Dec-2010
Author
Irina A K Holma
K Mikael Holma
Tarja K Melartin
Erkki T Isometsä
Author Affiliation
Mood, Depression, and Suicidal Behaviour Unit, National Institute for Health and Welfare, Helsinki, Finland.
Source
J Affect Disord. 2010 Dec;127(1-3):102-12
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Adult
Alcoholism - epidemiology - psychology - rehabilitation
Antidepressive Agents - therapeutic use
Anxiety Disorders - epidemiology - psychology - rehabilitation
Combined Modality Therapy
Comorbidity
Depressive Disorder, Major - epidemiology - psychology - rehabilitation
Female
Finland
Follow-Up Studies
Humans
Male
Middle Aged
Patient Compliance - psychology
Patient satisfaction
Personality Disorders - epidemiology - psychology - rehabilitation
Prospective Studies
Psychotherapy
Rehabilitation, Vocational - psychology
Social Support
Abstract
The prevalence, long-term temporal consistency and factors influencing negative attitudes and poor treatment adherence among psychiatric patients with major depressive disorder (MDD) are not well known.
In the Vantaa Depression Study (VDS), a prospective 5-year study of psychiatric patients with DSM-IV MDD, 238 (88.5%) patients' attitudes towards and adherence to both antidepressants and psychotherapeutic treatments at baseline, 6 months, 18 months and 5 years was investigated.
Throughout the follow-up, most patients reported positive attitudes towards pharmacotherapy and psychosocial treatments, and good adherence. While attitudes became more critical over time, adherence to psychosocial treatment improved, but remained unchanged for pharmacotherapy. Employment predicted positive attitude (OR=1.97, 95% CI 1.01-3.83, P=0.046), and larger social network good adherence (OR=1.11, 95% CI 1.00-1.23, P=0.042) to pharmacotherapy at the last follow-up. Cluster B personality disorder symptoms predicted negative attitude (OR=0.82, 95% CI 0.70-0.96, P=0.012) and poor adherence (OR=0.83, 95% CI 0.72-0.95, P=0.007), but cluster C symptoms positive attitude (OR=1.30, 95% CI 1.09-1.54, P=0.003), and living alone good adherence (OR=3.13, 95% CI 1.10-9.09, P=0.032) to psychosocial treatment.
Patients may exaggerate their adherence to treatments. Attrition from follow-up may occur due to undetected negative change in treatment attitude or adherence.
Among psychiatric MDD patients in long-term follow-up, treatment attitudes and adherence to pharmaco- and psychotherapy were and remained mostly positive. They were significantly predicted by personality features and social support. Attention to adherence of those with cluster B personality disorders, or poor social support, may be needed.
PubMed ID
20546916 View in PubMed
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Continuity is the main challenge in treating major depressive disorder in psychiatric care.

https://arctichealth.org/en/permalink/ahliterature176228
Source
J Clin Psychiatry. 2005 Feb;66(2):220-7
Publication Type
Article
Date
Feb-2005
Author
Tarja K Melartin
Heikki J Rytsälä
Ulla S Leskelä
Paula S Lestelä-Mielonen
T Petteri Sokero
Erkki T Isometsä
Author Affiliation
Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland.
Source
J Clin Psychiatry. 2005 Feb;66(2):220-7
Date
Feb-2005
Language
English
Publication Type
Article
Keywords
Acute Disease
Adult
Antidepressive Agents - administration & dosage - therapeutic use
Attitude to Health
Cohort Studies
Continuity of Patient Care - standards
Depressive Disorder, Major - drug therapy - psychology - therapy
Drug Administration Schedule
Female
Finland
Follow-Up Studies
Humans
Male
Patient compliance
Patient Dropouts
Preventive Health Services - standards
Probability
Prospective Studies
Psychiatric Status Rating Scales
Psychotherapy - methods
Treatment Outcome
Abstract
Several evidence-based treatment guidelines for major depressive disorder (MDD) have been published. However, little is known about how recommendations for treatment are adhered to by patients in current usual psychiatric practice.
The Vantaa Depression Study is a prospective, naturalistic cohort study of 269 psychiatric patients with a new episode of DSM-IV MDD who were interviewed with the Schedules for Clinical Assessment in Neuropsychiatry and Structured Clinical Interview for DSM-III-R Personality Disorders between February 1, 1997, and May 31, 1998, and again at 6 and 18 months. Treatments provided, as well as adherence to and attitudes toward both antidepressants and psychotherapeutic support/psychotherapy, were investigated among the 198 unipolar patients followed for 18 months.
Most depression patients (88%) received antidepressants in the early acute phase, but about half (49%) terminated treatment prematurely. This premature termination was associated with worse outcome of major depressive episodes, and with negative attitudes, mainly explained by fear of dependence on or side effects of antidepressants. Nearly all patients (98%) received some psychosocial treatment in the acute phase; about one fifth (16%) had weekly psychotherapy during the follow-up. About a quarter of patients admitted nonadherence to ongoing treatments.
Problems of psychiatric care seem most related to continuity of treatment. While adequate treatments are provided in the early acute phase, antidepressants are terminated too soon in about half of patients, often following their autonomous decisions. From a secondary and tertiary preventive point of view, improving continuity of treatment would appear a crucial task for improving the outcome of psychiatric patients with MDD.
PubMed ID
15705008 View in PubMed
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