subprojekt 2.3
DESCRIPTION
Subprojekt 2.3. Prevention of Chronification in Patients with Depression and Somatoform Disorders Winfried Rief Philipps University, Marburg. Final Presentation, 06/10/03. E. Rauh A. Nanke W. Rief. N. Baltruschat S. Pausch E. Geissner M. Fichter. Study centers. Marburg. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Subprojekt 2.3](https://reader036.vdocuments.mx/reader036/viewer/2022070408/568143f8550346895db087e4/html5/thumbnails/1.jpg)
Subprojekt 2.3
Final Presentation,06/10/03
Prevention of Chronification in Patients with Depression and Somatoform Disorders
Winfried Rief
Philipps University, Marburg
![Page 2: Subprojekt 2.3](https://reader036.vdocuments.mx/reader036/viewer/2022070408/568143f8550346895db087e4/html5/thumbnails/2.jpg)
Study centers
E. Rauh
A. Nanke
W. Rief
N. Baltruschat
S. Pausch
E. Geissner
M. Fichter
![Page 3: Subprojekt 2.3](https://reader036.vdocuments.mx/reader036/viewer/2022070408/568143f8550346895db087e4/html5/thumbnails/3.jpg)
Subprojekt 2.3
Final Presentation,06/10/03
The aims of the study were:
Analysis of predictors of outcome in patients with unexplained physical symptoms (SFD) and comorbid depression inPrimary Care
Development of a brief intervention which is feasible withPrimary Care needs
Evaluation of this intervention Development of Primary Care networks
![Page 4: Subprojekt 2.3](https://reader036.vdocuments.mx/reader036/viewer/2022070408/568143f8550346895db087e4/html5/thumbnails/4.jpg)
Subprojekt 2.3
Final Presentation,06/10/03
Design
Aquisition of 200 patients in GP offices
4 weeks later: 2nd assessment
6 months later: 3rd assessment
Initial assessmentRandomization
Standard Medical CareN = 100
Brief InterventionN = 100
![Page 5: Subprojekt 2.3](https://reader036.vdocuments.mx/reader036/viewer/2022070408/568143f8550346895db087e4/html5/thumbnails/5.jpg)
Subprojekt 2.3
Final Presentation,06/10/03
Start 4 weeks later
6 months later
Prien Intervention 70 57 56
Control 17 12 10
Marburg Intervention 74 61 60
Control 66 62 56
Total 227 192 (85%)
182(80%)
Completers
![Page 6: Subprojekt 2.3](https://reader036.vdocuments.mx/reader036/viewer/2022070408/568143f8550346895db087e4/html5/thumbnails/6.jpg)
Subprojekt 2.3
Final Presentation,06/10/03
Sample Characteristics
• 77,7 % female; Mean age: 48 years
• no. of doctor visits (last 6 months): 16
• no. of doctor visits without psychiatrists/psychotherapists (last 6 months): 14
• BDI 16.0
• no. of somatoform symptoms (Interview): 11
• Time since onset of unexplained physical symptoms (first symptoms): 10 years
![Page 7: Subprojekt 2.3](https://reader036.vdocuments.mx/reader036/viewer/2022070408/568143f8550346895db087e4/html5/thumbnails/7.jpg)
Consumer Satisfaction:Patient ratings of intervention (n = 106) - „confirmed mostly/ completely“ -
97,20%
95,20%
92,50%
90,00%
96,30%
0% 20% 40% 60% 80% 100%
new copingstrategies
coping promising
felt understood bytherapist
recommend to afriend
should be offeredmore often
![Page 8: Subprojekt 2.3](https://reader036.vdocuments.mx/reader036/viewer/2022070408/568143f8550346895db087e4/html5/thumbnails/8.jpg)
Hypochondriasis WI (all data; interaction p<0.01)
0
1
2
3
4
5
6
7
8
Intervention Control
INDEX
6 months later
![Page 9: Subprojekt 2.3](https://reader036.vdocuments.mx/reader036/viewer/2022070408/568143f8550346895db087e4/html5/thumbnails/9.jpg)
Somatization SCL (all data; interaction p<0.02)
0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
0,8
0,9
Intervention Control
INDEX
6 months later
![Page 10: Subprojekt 2.3](https://reader036.vdocuments.mx/reader036/viewer/2022070408/568143f8550346895db087e4/html5/thumbnails/10.jpg)
General Psychopathology SCL (all data; interaction p<0.05)
0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
0,8
0,9
Intervention Control
INDEX
6 months later
![Page 11: Subprojekt 2.3](https://reader036.vdocuments.mx/reader036/viewer/2022070408/568143f8550346895db087e4/html5/thumbnails/11.jpg)
Somatization SCL (only Marburg data; interaction p<0.02)
0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
0,8
Intervention Control
INDEX
6 months later
![Page 12: Subprojekt 2.3](https://reader036.vdocuments.mx/reader036/viewer/2022070408/568143f8550346895db087e4/html5/thumbnails/12.jpg)
Doctor Visits (non-psychiatrists; only Marburg data; p<0.09)
0
2
4
6
8
10
12
14
16
Intervention Control
6 months before
6 months after
![Page 13: Subprojekt 2.3](https://reader036.vdocuments.mx/reader036/viewer/2022070408/568143f8550346895db087e4/html5/thumbnails/13.jpg)
Subprojekt 2.3
Final Presentation,06/10/03
Prediction of Improvement• Linear regression analysis (difference scores;
T1-T3, criterium: SOMS)• Somatization SOMS (T1); β = 0.70; p<.001• Depression BDI (T1); β = -.42; p<.001• Hypochondriasis WI (T1); β = -.25; p<.006• (Psychological illness attributions; β = .15; p<.10)
![Page 14: Subprojekt 2.3](https://reader036.vdocuments.mx/reader036/viewer/2022070408/568143f8550346895db087e4/html5/thumbnails/14.jpg)
Subprojekt 2.3
Final Presentation,06/10/03
Next Steps• Analysis of specific aspects of health care use (c.f.,
detailed interview on investigations, treatments, pharmaceutics etc.)
• Short-term versus long-term effects (Preliminary analyses: Improvements develop slowly)
• Responders versus non-responders; development of indication rules
• Cross-sectional analyses (e.g., >100 blood samples for genetic and other tests)
• Problem: Sample with persisting symptoms; high user; severely disabled
![Page 15: Subprojekt 2.3](https://reader036.vdocuments.mx/reader036/viewer/2022070408/568143f8550346895db087e4/html5/thumbnails/15.jpg)
Subprojekt 2.3
Final Presentation,06/10/03
Conclusions• Significant improvements of participants of the one-
session intervention• This intervention could become an important tool to
improve the ineffective health care use of these patients• For a broader, long-lasting effect, it would be necessary
to-> train GPs in the use of our minimal intervention-> define ways for compensation of GPs doing this
intervention (e.g., „Modellprojekt“ of the health care insurances)