Increased 12-Month Prevalence Rates of Mental Disorders in Patients with Chronic Somatic Diseases

Härter, Martin; Baumeister, Harald; Reuter, Katrin; Jacobi, Frank; Höfler, Michael; Bengel, Jürgen; Wittchen, Hans‐Ulrich

doi:10.1159/000107563

Cited by 209 publications

(133 citation statements)

References 70 publications

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“…Another explanation for these increased costs could be that patients with diabetes and comorbid mental disorders have a more severe somatic disease status, which in turn would result in more frequent healthcare utilisation and higher healthcare costs. This hypothesis is supported by previous findings highlighting the association between the severity of diseases and the presence of comorbid mental disorders [51][52][53]. However, a significant effect of mental disorders on healthcare costs was found in primary studies that had adjusted for medical comorbidities or diabetes complications [9, 14, 19, 20, 25, 26, 29-31, 34, 35, 39, 41, 42, 46, 47].…”

Section: Discussionsupporting

confidence: 83%

Healthcare costs in patients with diabetes mellitus and comorbid mental disorders—a systematic review

2010

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Aims/hypothesis We systematically reviewed the impact of comorbid mental disorders on healthcare costs in persons with diabetes. Method We conducted a comprehensive search for studies investigating adult persons (≥18 years old) with diabetes mellitus. All studies that allowed comparison of healthcare costs between diabetic patients with mental disorders and those without were included. Results We identified 4,273 potentially relevant articles from a comprehensive database search. Of these, 31 primary studies (39 publications) fulfilled inclusion criteria, of which 27 examined comorbid depression. Hospitalisation rates and hospitalisation costs, frequency and costs of outpatient visits, emergency department visits, medication costs and total healthcare costs were mainly increased with small to moderate effect sizes in patients with diabetes and comorbid mental disorders compared with diabetic patients without such problems. Frequency (standardised mean difference [SMD]=0.35-1.26) and costs (SMD= 0.33-0.85) of mental health specialist visits were increased in the group with mental health comorbidity. Results regarding diabetes-related preventive services were inconsistent but point to a reduced utilisation rate in diabetic patients with comorbid mental disorders. Statistical heterogeneity between studies was high (I 2 range 64-98%).Pooled overall effects are therefore not reported. Studies included differ substantially regarding sample selection, assessment of diabetes and comorbid mental disorders, as well as in assessment of cost variables. Conclusions/interpretation In light of the increased healthcare costs and inadequate use of preventive services, comorbid mental disorders in patients with diabetes must become a major focus of diabetes healthcare and research.

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Section: Discussionsupporting

confidence: 83%

Healthcare costs in patients with diabetes mellitus and comorbid mental disorders—a systematic review

2010

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“…Current mental health policy in the UK emphasises the notion of recovery (Department of Health, 2014), reinforcing a short-term view about common mental health problems in primary care. Our findings align with the extant literature (Burcusa & Iacono, 2007;Yiend et al, 2009;Harter et al, 2007;Hardeveld et al, 2010;Gopinath et al, 2007) and suggest taking the long view, recognising that 19 problems like depression often have to be managed like recurrent long-term conditions.In this regard, we would recommend two areas for future practice developments. First, the influence of residual depression symptoms on the risk of relapse is well documented (Vittengl et al, 2007;Paykel et al, 1995), and it is known that around 76% of such cases relapse within 10 months of treatment completion (Paykel, 2008).…”

supporting

confidence: 90%

How durable is the effect of low intensity CBT for depression and anxiety? Remission and relapse in a longitudinal cohort study

Ali

Rhodes

Moreea

et al. 2017

Behaviour Research and Therapy

113

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Background: Depression and anxiety disorders are relapse-prone conditions, even after successful treatment with pharmacotherapy or psychotherapy. Cognitive behavioural therapy (CBT) is known to prevent relapse, but there is little evidence of the durability of remission after low intensity forms of CBT (LiCBT).Method: This study aimed to examine relapse rates 12 months after completing routinely-delivered LiCBT. A cohort of 439 LiCBT completers with remission of symptoms provided monthly depression (PHQ-9) and anxiety (GAD-7) measures during 12 months after treatment. Survival analysis was conducted to model time-to-relapse while controlling for patient characteristics.Results: Overall, 53% of cases relapsed within 1 year. Of these relapse events, the majority (79%) occurred within the first 6 months posttreatment. Cases reporting residual depression symptoms (PHQ-9 = 5 to 9) at the end of treatment had significantly higher risk of relapse (hazard ratio = 1.90, p < 0.001). Conclusions:The high rate of relapse after LiCBT highlights the need for relapse prevention, particularly for those with residual depression symptoms.Key words: depression; anxiety; relapse; cognitive behavioural therapy 3 IntroductionDepression is known to have a high recurrence rate, even after the successful treatment of acute-phase symptoms (Burcusa & Iacono, 2007;Yiend et al., 2009;Harter et al., 2007;Hardeveld et al., 2010;Gopinath et al., 2007). For example, after a first episode of depression, the probability of a further episode is approximately 50%; this rises to 70% following two episodes and 90% after a third episode (Burcusa & Iacono, 2007;Kessler et al., 1996). It also appears that with each further episode there is an increase in the severity of depressive symptoms and an increased probability that these symptoms will become resistant to treatment (Kendler et al., 2000).Similarly, research on anxiety disorders suggests high recurrence rates between 39% and 56% after treatment (Bruce et al., 2005;Eisen et al., 1999;Vervliet et al., 2013).Literature in the field draws conceptual distinctions between relapsea deterioration after initial response to treatment-and recurrence -a new episode of the disorder following a period of recovery- (Bockting et al., 2015).Meta-analyses of trials in this area show that accessing cognitive behavioural therapy (CBT) reduces the risk of depression relapse (Vittengl et al., 2007; Cuijpers et al., 2013) by comparison to acute-phase pharmacological treatment. The prophylactic effects of CBT appear to be as durable as to those of long-term maintenance on pharmacological treatment, but better at preventing relapse and recurrence compared to acute-phase pharmacological treatment without a maintenance phase (Hollon et al., 2005). Similarly, CBT is associated with sustained maintenance of improvements after the acute phase of treatment in various anxiety disorders (Otto, Smits, & Reese, 2005). It is, however, unclear if this 4 apparent durability of therapeutic effects primarily applies to conventi...

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“…1 It is now well-established that particular cohorts of patients with chronic medical illness have a much greater prevalence of affective disorders than the general population. 2 Furthermore, it has been demonstrated that these patients experience worse health outcomes -including a reduced quality of life and increased mortality -compared to matched patients without depression. 3,4 Recent studies suggest that the scale and impact of depression in patients with CLD or OLT is comparable to that of other chronic medical diseases, and that these adverse effects may be reduced through the optimal use of antidepressants.…”

Section: Discussionmentioning

confidence: 99%

Review article: depression and the use of antidepressants in patients with chronic liver disease or liver transplantation

Mullish

Kabir

Thursz

et al. 2014

Aliment Pharmacol Ther

115

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SummaryBackgroundThe scale of depression in patients with chronic liver disease (CLD) and those who have received orthotopic liver transplantation (OLT) is poorly characterised. Clinicians are uncertain of how best to manage depression within these patients.AimsTo review the literature evaluating both the prevalence and impact of depression in patients with CLD and post‐OLT, and to assess the safety and efficacy of antidepressant use within this context.MethodsA PubMed search using the phrases ‘chronic liver disease’, ‘cirrhosis’, ‘liver transplantation’, ‘depression’, ‘antidepressant’ and the names of specific causes of liver disease and individual antidepressants.ResultsOver 30% of cirrhotic patients have depressive features, and they experience worse clinical outcomes than nondepressed cirrhotic patients. CLD patients with chronic hepatitis C are particularly prone to depression, partly related to the use of interferon therapy. OLT patients with depression have higher mortality rates than nondepressed patients; appropriate antidepressant use reverses this effect. Selective serotonin reuptake inhibitors (SSRIs) and selective noradrenaline reuptake inhibitors (SNRIs) are effective and generally safe in both CLD and OLT patients.ConclusionsDepression is much more prevalent in CLD or OLT patients than is generally recognised, and it adversely affects clinical outcomes. The reasons for this relationship are complex and multifactorial. Antidepressants are effective in both CLD and post‐OLT, although lower doses or a reduced dosing frequency may be required to minimise side effects, e.g. exacerbation of hepatic encephalopathy. Further research is needed to establish optimal management of depression in these patients, including the potential role of nonpharmacological treatments.

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Increased 12-Month Prevalence Rates of Mental Disorders in Patients with Chronic Somatic Diseases

Cited by 209 publications

References 70 publications

Healthcare costs in patients with diabetes mellitus and comorbid mental disorders—a systematic review

Healthcare costs in patients with diabetes mellitus and comorbid mental disorders—a systematic review

How durable is the effect of low intensity CBT for depression and anxiety? Remission and relapse in a longitudinal cohort study

Review article: depression and the use of antidepressants in patients with chronic liver disease or liver transplantation

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