ORCID Profile
0000-0002-4895-8969
Current Organisation
Black Dog Institute
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Publisher: Wiley
Date: 02-01-2021
DOI: 10.1002/GPS.5486
Publisher: Wiley
Date: 08-2019
DOI: 10.1111/AJR.12524
Abstract: Stepped care models are a possible solution to address service gaps in the provision of psychological therapies for anxiety and/or depression. The benefits may be particularly relevant for people in rural and remote areas and other under-serviced and/or hard to reach populations, such as older adults. Narrative literature review. Narrative literature review of the PubMed, Medline, and Psycinfo databases for studies reporting on the results of stepped care psychological interventions for older adults with anxiety and/or depressive symptoms. Seventy-seven papers were identified for evaluation of which nine papers met the study criteria (reporting on four in idual trials). We identified four controlled studies. Three of the four studies found stepped care intervention to be associated with significantly better clinical outcomes and cost-effectiveness compared to treatment as usual. Studies primarily targeted subthreshold symptoms, mostly in primary care. Various interventions and stepping models were used. Stepped care has been associated with improved clinical outcomes and costs in older adults, particularly in primary care. There have been no rigorous studies of stepped delivery of psychological interventions to older depressed and anxious adults in alternative settings such as in specialist older adult mental health services or in private clinics. Although the evidence-base for stepped care interventions is growing, it is not clear what evidence-based treatment model should be adopted and in what services it could apply. More research is needed. However, the evidence to date is promising and suggests that stepped care approaches are feasible in older adults, and are likely to increase access to high quality interventions for older adults living in rural communities.
Publisher: University of Buckingham Press
Date: 06-2018
Abstract: Rationale, aims and objectives: Concise forms of psychotherapy and psychopharmacotherapy have shown clinical effectiveness. Identifying the factors that predict who is most likely to benefit from such treatment may help to deliver the most adequate and person-centered care. Methods: Secondary care outpatients aged 18-65 years with mild to moderate DSM-IV depressive and/or anxiety disorders, participated in a pragmatic randomized controlled equivalence trial comparing a concise format of cognitive behavioural and/or pharmacotherapy (i.e., concise care) to standard care. A range of putative factors associated with treatment outcome - socio-demographic characteristics and clinical characteristics - were assessed at baseline. Subgroup analyses were conducted analyzing the effects of interaction terms on changes over time in the Brief Symptom Inventory (BSI) scores as the outcome measure.Results: A total of 182 participants were included and randomized to concise care (n = 93) and to standard care (n = 89). Participants were on average 36.5 (SD 12.3) years old and 61% were women. Patients suffering from any ‘anxiety (without depressive) disorder’ benefited significantly less from concise care than standard care (P = 0.012).Conclusions: The benefit of a concise form of psychotherapy and pharmacotherapy was independent from demographic and clinical characteristics. Only patients with anxiety (without depressive) disorders benefit less from concise treatment.
Publisher: Public Library of Science (PLoS)
Date: 27-06-2022
DOI: 10.1371/JOURNAL.PONE.0269981
Abstract: Increasing both the frequency and quality of social interactions within treatments for anxiety and depressive disorders in older adults may improve their mental health outcomes and quality of life. This study aims to evaluate the clinical efficacy and cost utility of an enhanced cognitive behavioural therapy (CBT) plus social participation program in a s le of older adults with depression and/or anxiety. A total of 172 community-dwelling adults aged 65 years or older with an anxiety and/or depressive disorder will be randomly allocated to either an enhanced CBT plus social participation program (n = 86) or standard CBT (n = 86). Both treatments will be delivered during 12 weekly in idual sessions utilising structured manuals and workbooks. Participants will be assessed at pre-treatment, post-treatment, and 12-month follow-up. The primary outcome evaluates mean change in clinician-rated diagnostic severity of anxiety and depressive disorders from baseline to post-treatment (primary endpoint) based on a semi-structured diagnostic interview. Secondary outcomes evaluate changes in symptomatology on self-report anxiety and depression measures, as well as changes in social/community participation, social network, and perceived social support, loneliness, quality of life, and use of health services. Economic benefits will be evaluated using a cost-utility analysis to derive the incremental cost utility ratios for the enhanced CBT program. Outcomes from this study will provide support for the establishment of improved psychosocial treatment for older adults with anxiety and/or depression. Study outcomes will also provide health systems with a clear means to reduce the impact of poor emotional health in older age and its associated economic burden. In addition to the empirical validation of a novel treatment, the current study will contribute to the current understanding of the role of social participation in older adult wellbeing. Prospectively registered on the Australian New Zealand Clinical Trials Registry (ID: ACTRN12619000242123 registered 19 th February 2019) and the ISRCTN registry (ID: ISRCTN78951376 registered 10 th July 2019).
Publisher: JMIR Publications Inc.
Date: 29-08-2017
DOI: 10.2196/MENTAL.5453
Abstract: There is a need for brief screening methods for psychiatric disorders in clinical practice. This study assesses the validity and accuracy of a brief self-report screening questionnaire, the Web Screening Questionnaire (WSQ), in detecting psychiatric disorders in a study group comprising the general population and psychiatric outpatients aged 18 years and older. The aim of this study was to investigate whether the WSQ is an adequate test to screen for the presence of depressive and anxiety disorders in clinical practice. Participants were 1292 adults (1117 subjects from the general population and 175 psychiatric outpatients), aged 18 to 65 years. The discriminant characteristics of the WSQ were examined in relation to the (“gold standard”) Mini-International Neuropsychiatric Interview-Plus (MINI-Plus) disorders, by means of sensitivity, specificity, area under the curve (AUC), and positive and negative predictive values (PPVs, NPVs). The specificity of the WSQ to in idually detect depressive disorders, anxiety disorders, and alcohol abuse or dependence ranged from 0.89 to 0.97 for most disorders, with the exception of post-traumatic stress disorder (0.52) and specific phobia (0.73). The sensitivity values ranged from 0.67 to 1.00, with the exception of depressive disorder (0.56) and alcohol abuse or dependence (0.56). Given the low prevalence of separate disorders in the general population s le, NPVs were extremely high across disorders (≥0.97), whereas PPVs were of poor strength (range 0.02-0.33). In this study group, the WSQ was a relatively good screening tool to identify in iduals without a depressive or anxiety disorder, as it accurately identified those unlikely to suffer from these disorders (except for post-traumatic stress disorders and specific phobias). However, in case of a positive WSQ screening result, further diagnostic procedures are required.
Publisher: Elsevier BV
Date: 05-2021
Publisher: Elsevier BV
Date: 03-2016
DOI: 10.1016/J.CCT.2015.12.021
Abstract: Depressive and anxiety disorders contribute to a high disease burden. This paper investigates whether concise formats of cognitive behavioral- and/or pharmacotherapy are equivalent with longer standard care in the treatment of depressive and/or anxiety disorders in secondary mental health care. A pragmatic randomized controlled equivalence trial was conducted at five Dutch outpatient Mental Healthcare Centers (MHCs) of the Regional Mental Health Provider (RMHP) 'Rivierduinen'. Patients (aged 18-65 years) with a mild to moderate anxiety and/or depressive disorder, were randomly allocated to concise or standard care. Data were collected at baseline, 3, 6 and 12 months by Routine Outcome Monitoring (ROM). Primary outcomes were the Brief Symptom Inventory (BSI) and the Web Screening Questionnaire (WSQ). We used Generalized Estimating Equations (GEE) to assess outcomes. Between March 2010 and December 2012, 182 patients, were enrolled (n=89 standard care n=93 concise care). Both intention-to-treat and per-protocol analyses demonstrated equivalence of concise care and standard care at all time points. Severity of illness reduced, and both treatments improved patient's general health status and subdomains of quality of life. Moreover, in concise care, the beneficial effects started earlier. Concise care has the potential to be a feasible and promising alternative to longer standard secondary mental health care in the treatment of outpatients with a mild to moderate depressive and/or anxiety disorder. For future research, we recommend adhering more strictly to the concise treatment protocols to further explore the beneficial effects of the concise treatment. The study is registered in the Netherlands Trial Register, number NTR2590. Clinicaltrials.gov identifier: NCT01643642.
Publisher: JMIR Publications Inc.
Date: 19-07-2023
Abstract: mergency service workers (ESWs) are at greater risk of stressor-related psychopathology than the general population. Barriers to help-seeking are widespread across the sector and appropriate interventions need to be tailored to this population. Build Back Better is a smartphone app–based intervention designed to provide evidence-based prevention strategies for anxiety, depression, and posttraumatic stress disorder (PTSD) for high-risk professionals, such as ESWs. his paper presents the development and pilot testing of the app’s usability, acceptability, feasibility, and preliminary effectiveness. single group (N = 67), 1-month pilot study was undertaken with ESWs, to assess their use of a smartphone-based mental health (MH) intervention, the Build Back Better app. Demographic data, acceptability and utility questionnaires, general distress (Kessler Psychological Distress) other MH and well-being measures were collected at baseline and 1-month follow-up. he majority of respondents rated the app quality as very high (79%), felt that the app was easy to use (61%), easily understood (55%), improved their mental fitness (80%), and would recommend the app to others (61%). Encouraging trends toward improvement were found across symptom and wellbeing outcomes. These trends were not statistically significant, which may be attributed to smaller than expected s le size. he Build Back Better app was found to have satisfactory levels of usability and acceptability. Favorable trends toward better clinical outcomes over time suggest progression to a larger efficacy trial is justified. Participants furthermore highlighted the importance of clarity in both their user journey and presentation of app content to further enhance the in-app user experience. ew Zealand Clinical Trials Registry (ACTRN12621001006831p)
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1016/J.CCT.2012.05.002
Abstract: Anxiety and mood disorders involve a high disease burden and are associated with high economic costs. A stepped-care approach intervention and abbreviated diagnostic method are assumed to increase effectiveness and efficiency of the mental healthcare and are expected to reduce economic costs. Presented are the rationale, design, and methods of a two-armed randomized controlled trial comparing 'treatment as usual' (TAU) with a brief intensified cognitive behavioral therapy (CBT) and/or pharmacotherapy. Eligible participants (N=500) of five Dutch outpatient Mental Healthcare Centers are randomly assigned to either TAU or to the experimental condition (brief CBT and/or pharmacotherapy). Data on patients' progress and clinical effectiveness of treatment are assessed at baseline, post-treatment (3 months after baseline), and at 6 and 12 months post-treatment by Routine Outcome Monitoring (ROM). Cost analysis is performed on the obtained data. Since few studies have investigated both the clinical and cost effectiveness of a stepped-care approach intervention and a shortened diagnostic ROM method in both anxiety and/or mood disorders within secondary mental health care, the results of this study might contribute to the improvement of (cost)-effective treatment options and diagnostic methods for these disorders.
Publisher: Wiley
Date: 13-11-2018
DOI: 10.1111/CEA.13290
Abstract: Markers of microbial exposure are thought to be associated with risk of allergic sensitization however, the associations are inconsistent and may be related to gene-environment interactions. To examine the relationship between polymorphisms in the CD14 gene and allergic sensitization and whether sibling exposure, as a marker of microbial exposure, modified this relationship. We used data from the Tasmanian Longitudinal Health Study and the Melbourne Atopy Cohort Study. Two CD14 polymorphisms were genotyped. Allergic sensitization was defined by a positive response to a skin prick test. Sibling exposure was measured as cumulative exposure to siblings before age 6 months, 2 and 4 years. Logistic regression and multi-level mixed-effects logistic regression were used to examine the associations. Effect estimates across the cohorts were pooled using random-effects meta-analysis. CD14 SNPs were not in idually associated with allergic sensitization in either cohort. In TAHS, cumulative sibling exposure before age 6 months, 2 and 4 years was each associated with a reduced risk of allergic sensitization at age 45 years. A similar effect was observed in MACS. Meta-analysis across the two cohorts showed consistent evidence of an interaction between cumulative sibling exposure before 6 months and the rs5744455-SNP (P = 0.001) but not with the rs2569190-SNP (P = 0.60). The pooled meta-analysis showed that the odds of sensitization with increasing cumulative exposure to sibling before 6 months of age was 20.9% smaller in those with the rs5744455-C-allele than the T-allele (OR = 0.83 vs 1.05, respectively). Cumulative sibling exposure reduced the risk of sensitization from childhood to middle age in genetically susceptible in iduals.
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.NEUBIOREV.2018.09.001
Abstract: Studies of neurobiological mechanisms in borderline personality disorder (BPD) have increased our understanding of the pathophysiology of its development and course. Less is known about how psychotherapy may influence these neurobiological factors, and also whether biomarkers may predict psychotherapy outcomes. We conducted a systematic review using PRISMA guidelines. Fourteen studies providing data from 467 participants diagnosed with BPD met inclusion criteria to: (a) investigate biomarkers predicting response to psychotherapy for BPD or (b) examine neurobiological factors altered by psychotherapy. Neuroimaging studies (n = 11) used mostly functional magnetic resonance imaging methods to scope brain regions related to emotion regulation and cognitive control. Three studies examined genetic or neuroendocrine markers. The evidence suggests that psychotherapy alters neural activation and connectivity of regions subserving executive control and emotion regulation. Additionally, hypoactivation in prefrontal and cingulate regions predicted treatment response. Further work in this area may inform personalised treatment approaches in clinical practice for BPD through elucidating neural mechanisms of evidence-based psychotherapy.
Publisher: Public Library of Science (PLoS)
Date: 03-2017
Publisher: Wiley
Date: 16-09-2010
DOI: 10.1111/J.1365-2753.2010.01543.X
Abstract: Routine Outcome Monitoring (ROM) is an important quality tool for measuring outcome of treatment in health care. The objective of this article is to summarize the evidence base that supports the provision of feedback on ROM results to (mental) health care professionals and patients. Also, some relevant theoretical aspects are considered. Literature study (Pubmed, Medline, PsychINFO, Embase Psychiatry, 1975-2009) concerning randomized controlled trials (RTC's) of ROM and feedback on physical or mental health status of patients of all ages. Main search terms were routine outcome monitoring/measurement, feedback, health status measurement, patient reported outcome measures. Included were 52 RCT's concerning ROM and feedback with adult or older patients: of these seven RCT's were exclusively focused on physical health and 45 RCT's (also) on the mental health of the patient, although not always in a mental health care setting or as primary outcome measure. There appears to be a positive impact of ROM on diagnosis and monitoring of treatment, and on communication between patient and therapist. Other results were less clear. There were no published RCT's on this topic with children or adolescents. ROM appears especially effective for the monitoring of patients who are not doing well in therapy. Further research into this topic and the clinical-and cost-effectiveness of ROM is recommended, especially in mental health care for both adults and children. Also, more theory-driven research is needed with relevant conceptualizations such as Feedback Intervention Theory, Therapeutic Assessment.
No related grants have been discovered for Denise Meuldijk.