The economic cost of treatment-resistant depression in patients referred to a specialist service

McCrone, Paul; Rost, Felicitas; Koeser, Leonardo; Koutoufa, Iakovina; Stephanou, Stephanie; Knapp, Martín; Goldberg, David; Taylor, David; Fonagy, Peter

doi:10.1080/09638237.2017.1417562

Cited by 25 publications

(32 citation statements)

References 34 publications

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“…Associated diagnoses in patients who are frequently considered difficult include substance abusers or psychotic patients (e.g., Sellers et al, ). Of particular interest for this study, treatment‐resistant depression and depression in the context of personality vulnerabilities may often trigger the labeling of a patient as difficult, given that these patients will not typically respond to first‐line psychotherapy or pharmacology (Greden, ; McCrone et al, ). In nonspecialized treatment settings, these clients present many problems, including, frequent comorbidities and multiple emotional demands on therapists and treatment teams.…”

Section: Introductionmentioning

confidence: 99%

What makes a difficult patient so difficult? Examining the therapist's experience beyond patient characteristics

et al. 2019

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The primary aim of this study is to improve our understanding of therapists' experience of a "difficult patient" and consider the different variables involved in this label. What makes a patient be perceived as difficult by a therapist in public health services? Results of our analysis of 10 qualitative semistructured interviews of therapists working in public health service in Chile indicated that therapists' perceptions of a "difficult patient" depend on variables that go beyond the patient's intrinsic characteristics, including patients' negative attitude toward the therapist and treating team, patients' negative effects on therapists, and a difficult treatment context (e.g., work overload, scarce resources, limited number, and frequency of sessions). We illustrate the interaction of these dimensions and focus on the impact of the treating context on therapists' experience of a "difficult patient" through the case of a therapist working with a patient with complex depression in the public health system of Chile.

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Section: Introductionmentioning

confidence: 99%

What makes a difficult patient so difficult? Examining the therapist's experience beyond patient characteristics

et al. 2019

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“…We believe that the present results might be of broader interest: First, in terms of the costs for the companies (hiring new employee and absent or less productive employees) and for the employees (health and changing the job). Specifically, costs in employees being less productive or absent will result in several high costs per employee (26,27,30,57). Second, the public health cost should also be mentioned here although we did not calculate the costs.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies (24)(25)(26)(27) show that, compared to healthy individuals, individuals with MDD are at an increased risk to lose their current job position (24,25,27), to have more difficulties to go back to their workplace (24,25,27), to find a new job, once they have been dismissed, and to keep their job position, when they return to their job after a period of illness-related unemployment. Furthermore, data on health costs show that, compared to an accident-related absence from work, depression-related absence from work cause higher economic burden for the individual (25,27), the employer (27)(28)(29), and the public (24,26,27,30). In addition, losing a job position or experiencing difficulties to go back to work turned out to be a risk factor for further relapses of MDD (24).…”

Section: Introductionmentioning

confidence: 99%

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Workplace-Related Interpersonal Group Psychotherapy to Improve Life at Work in Individuals With Major Depressive Disorders: A Randomized Interventional Pilot Study

et al. 2020

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Objectives: Individuals suffering from major depressive disorder (MDD) often report workplace-related stress as the major cause of their disorder. Accordingly, workplacerelated stress was established as a fifth psychosocial problem area of Interpersonal Psychotherapy (workplace-related Interpersonal Psychotherapy, W-IPT). The aim of the study was to investigate the influence of W-IPT on depressive symptoms and on workplace-related issues in individuals with MDD compared to a treatment-as-usual (TAU) condition. Methods: A total of 27 individuals with MDD (mean age = 43 years, 48% males) were randomly assigned either to eight weekly group sessions of W-IPT or to the TAU condition. At baseline, 8 weeks later at the end of the intervention, and 20 weeks later at follow-up, the Hamilton Rating Scale for Depression was conducted. In addition, the participants completed the Beck Depression Inventory, the Work Ability Index (WAI), the Return to Work Attitude (RTW-SE), and the Insomnia Severity Index (ISI). Results: Symptoms of depression in experts' ratings as well as in self-rated ratings decreased over time, but more so in the W-IPT condition compared to the TAU condition [experts rating: large effect size (d = 1.25) and self-assessment: large effect sizes (d = 0.94)]. The subjective ability to work (WAI) [medium effect size (d = 0.68)], self-efficacy to returning to work RTW-SE [medium effect size (d = 0.57)], and subjective symptoms of insomnia (ISI) [large effect size (d = 1.15)] increased over time, but again more so in the W-IPT condition compared to the TAU condition. The effects of the intervention remained stable from the end of the intervention to follow-up. Conclusions: The pattern of results of this pilot study suggests that a newly established fifth IPT focus on workplace-related stress appeared to be particularly efficient in

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“…Epidemiological surveys have repeatedly indicated a high lifetime prevalence of this illness, amounting to 6.7% of the population worldwide [ 2 ]. The costs of MDD to society, in terms of personal and familial suffering and health care consumption, are high [ 3 , 4 ]. Despite the progress in pharmacopoeia and in psychological therapies, clinicians involved in the management of MDD are regularly faced with clinical situations marked by treatment resistance.…”

Section: Introductionmentioning

confidence: 99%

Transcranial Direct Current Stimulation (tDCS): A Promising Treatment for Major Depressive Disorder?

Bennabi

Haffen

2018

Brain Sciences

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Background: Transcranial direct current stimulation (tDCS) opens new perspectives in the treatment of major depressive disorder (MDD), because of its ability to modulate cortical excitability and induce long-lasting effects. The aim of this review is to summarize the current status of knowledge regarding tDCS application in MDD. Methods: In this review, we searched for articles published in PubMed/MEDLINE from the earliest available date to February 2018 that explored clinical and cognitive effects of tDCS in MDD. Results: Despite differences in design and stimulation parameters, the examined studies indicated beneficial effects of tDCS for MDD. These preliminary results, the non-invasiveness of tDCS, and its good tolerability support the need for further research on this technique. Conclusions: tDCS constitutes a promising therapeutic alternative for patients with MDD, but its place in the therapeutic armamentarium remains to be determined.

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The economic cost of treatment-resistant depression in patients referred to a specialist service

Abstract: Severe forms of TRD are associated with high costs in which unpaid care and lost work predominate. Treatments that improve functioning may reduce the large degree of burden.

Cited by 25 publications

References 34 publications

What makes a difficult patient so difficult? Examining the therapist's experience beyond patient characteristics

What makes a difficult patient so difficult? Examining the therapist's experience beyond patient characteristics

Workplace-Related Interpersonal Group Psychotherapy to Improve Life at Work in Individuals With Major Depressive Disorders: A Randomized Interventional Pilot Study

Transcranial Direct Current Stimulation (tDCS): A Promising Treatment for Major Depressive Disorder?

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