Background: This study evaluated a multifaceted psychiatric intervention targeted at the complex medically ill identified by means of the INTERMED, an instrument to assess case complexity. Methods: Of 885 rheumatology inpatients and diabetes outpatients who were assessed for eligibility, 247 were identified as complex (INTERMED score >20) and randomized to the intervention (n = 125, 84 rheumatology and 41 diabetes patients) or care as usual (n = 122, 78 rheumatology and 44 diabetes patients). For the majority of the cases the multifaceted intervention consisted of an intervention conducted by a psychiatric liaison nurse and/or of referral to a liaison psychiatrist, followed by advice to the treating physician or organization of a multidisciplinary case conference. Baseline and follow-up at months 3, 6, 9 and 12 measured prevalence of major depression (Mini-International Neuropsychiatric Interview), depressive symptoms (Center for Epidemiological Studies Depression Rating Scale), physical and mental health (SF-36), quality of life (EuroQol), health care utilization and HbA_1c levels (diabetic patients). Results: Prevalence of major depression was reduced from 61% (T0) to 28% (T4) in the intervention group and remained stable in care as usual (57% at T0 to 50% at T4). Compared to care as usual, significant improvement over time was observed in the intervention group with regard to depressive symptoms (F = 11.9; p = 0.001), perception of physical (F = 5.7; p = 0.018) and mental health (F = 3.9; p = 0.047) and quality of life (F = 21.8; p < 0.001). Effects tended to be stronger in diabetes patients, in patients with baseline major depression and in patients with moderate INTERMED scores. Finally, hospital admissions occurred less often in the intervention group, reaching statistical significance for the period between 6 and 9 months of follow-up (p = 0.02). Conclusions: The results suggest that a psychiatric intervention targeted for complex medical patients can improve health outcomes.

Background The aims of the study were (a) to assess individual meaning in life (MiL) in a mixed sample of cancer patients with the Schedule for Meaning in Life Evaluation (SMiLE), (b) to evaluate the acceptability of its French version, and (c) to compare it to a student sample. Materials and methods Consecutive cancer patients (N = 100) treated as outpatients in the University Hospital Lausanne (N = 80) and in a nearby hospice (N = 20) were evaluated with the SMiLE, a reliable and validated respondent-generated instrument for the assessment of MiL. The respondents list three to seven areas, which provide meaning to their life and rate the level of importance (weighting) and satisfaction of each area. Indices of total weighting (index of weighting (IoW), range 20-100), total satisfaction (index of satisfaction (IoS), range 0-100), and total weighted satisfaction (index of weighted satisfaction (IoWS), range 0-100) are calculated. Results Patients most often indicated areas related to relationships as providing MiL, while material things were listed less often. Since satisfaction with relevant areas was high, cancer patients reported the same level of weighted satisfaction (IoWS) as a healthy student sample, assessed with the SMiLE in a prior validation study. Patients judged the SMiLE as reflecting well their MiL, not distressing to fill in and were moderately positive with regard to its helpfulness. Conclusions MiL of cancer patients was surprisingly high, possibly due to the "response shift" of the severely ill. The SMiLE might become a useful tool for research and an opener to communication between patients and clinicians about this highly relevant topic in cancer care. Further studies with larger sample sizes and different designs, complemented by qualitative research, are needed to deepen our understanding of this so characteristically human topic, which is so easy to perceive and so difficult to grasp.

The intervention was not effective with regards to psychometric outcome. The results have to be interpreted in light of the study design [untargeted intervention], the low levels of psychiatric symptoms, dropout of symptomatic patients, and the high prevalence of alexithymia.

Background: Depression is highly prevalent in patients with