Anna Levke Brütt

Health-related quality of life of children and adolescents with growth hormone deficiency or idiopathic short stature - part 2: available results and future directions.

Research on the health-related quality of life (HrQoL) impact of short stature and its treatment in children and adolescents has developed recently. Based on a PubMed literature search, studies addressing this issue were identified and considerable methodological problems mainly related to the HrQoL instruments used and conflicting results are discussed in this mini review. Additionally, this mini review identifies a need for further research and indicates potential directions.

Assessment of Health-Related Quality of Life and Patient Satisfaction in Children and Adolescents with Growth Hormone Deficiency or Idiopathic Short Stature – Part 1: A Critical Evaluation of Available Tools

The concept of health-related quality of life (HrQoL) reflects the subjective perception of health and includes aspects of well-being and functioning in physical, emotional, mental and social life domains. Nowadays, HrQoL has become a relevant treatment outcome from epidemiological and clinical perspectives and is also broadly employed in health economic analyses. To assess HrQoL generic as well as condition-specific instruments are used. The former are applicable to a wide range of health conditions and aim at measuring HrQoL across different conditions. The latter focus on capturing the impact of a specific disease. Although HrQoL research in adults is now well-advanced, there are still open questions regarding how to assess HrQoL in pediatric conditions, such as short stature. Eight generic (one chronic-generic) and seven condition-specific (one treatment-specific) instruments used in HrQoL research in short stature of youth are described. Additionally, this mini review identifies a need for further research and indicates potential directions.

Is a self-rated instrument appropriate to assess mentalization in patients with mental disorders? Development and first validation of the Mentalization Questionnaire (MZQ)

Abstract The purpose of this study was to develop and validate a self-rating scale for a differentiated assessment of mentalization. A pool of 40 items was developed and evaluated on n=434 inpatients with mental disorders at three time points. Symptom severity, self-injuring behavior, suicidal tendency and attachment style were also assessed. A varimax-rotated factor analysis supported the extraction of four factors. The model fit was checked by confirmatory factor analysis. Internal consistency of the Mentalization Questionnaire (MZQ) was .81. The relation between symptom severity and MZQ scores was found to be significant, and significant group differences were found between patients displaying self-injuring behavior and those who did not as well as between patients with and without suicide attempts. The MZQ can be considered as a practicable self-rated instrument with acceptable reliability and sufficient validity to assess at least aspects of mentalization in patients with mental disorders.

Factors associated with help-seeking behaviour among individuals with major depression: A systematic review.

Psychological models can help to understand why many people suffering from major depression do not seek help. Using the ‘Behavioral Model of Health Services Use’, this study systematically reviewed the literature on the characteristics associated with help-seeking behaviour in adults with major depression. Articles were identified by systematically searching the MEDLINE, EMBASE and PsycInfo databases and relevant reference lists. Observational studies investigating the associations between individual or contextual characteristics and professional help-seeking behaviour for emotional problems in adults formally diagnosed with major depression were included. The quality of the included studies was assessed, and factors associated with help-seeking behaviour were qualitatively synthesized. In total, 40 studies based on 26 datasets were included. Several studies investigated predisposing (age (N = 17), gender (N = 16), ethnicity (N = 9), education (N = 11), marital status (N = 12)), enabling (income (N = 12)), need (severity (N = 14), duration (N = 9), number of depressive episodes (N = 6), psychiatric comorbidity (N = 10)) and contextual factors (area (N = 8)). Socio-demographic and need factors appeared to influence help-seeking behaviour. Although existing studies provide insight into the characteristics associated with help seeking for major depression, cohort studies and research on beliefs about, barriers to and perceived need for treatment are lacking. Based on this review, interventions to increase help-seeking behaviour can be designed.

Development of an ICF-based core set of activities and participation for patients with mental disorders: an approach based upon data:

Objective: To use data and patient involvement to identify categories within the International Classification of Functioning, Disability and Health (ICF) component activities and participation relevant for patients with affective, somatoform, anxiety and adjustment disorders. Design: The first step was to identify systematically, outcome instruments used in randomized controlled trials, to relate item content to the ICF. Then four patient focus group discussions (n = 21 participants) were conducted, and finally an expert panel (n = 11 participants) was used to identify the most relevant categories in therapy settings. Participants: Focus groups: inpatient psychotherapy patients. Expert panel: clinicians, stakeholders, patient representative. Results: In the literature search, 313 measures were identified, which included 1562 meaningful concepts (separate content units). These were allocated to ICF categories that were validated and complemented in focus groups and by an expert panel. The resulting core set includes 27 categories related to the nine chapters of the ICF component activities and participation. Conclusions: A core set of items, set within the World Health Organization ICF and relevant to the treatment of people with affective, somatoform, anxiety and adjustment disorders, has been developed based on existing evidence.

ICF-basierte Messinstrumente zur Bedarfserfassung und Evaluation in der Behandlung von Patienten mit psychischen Störungen - ein systematisches Review

AIMS The aim of the study is to provide a systematic overview of assessment instruments that refer conceptually to the International Classification of Functioning, Disability, and Health (ICF) and can be used in the context of mental disorders. METHODS We conducted a systematic literature search in the scientific databases (EMBASE, Medline, PsycInfo, PSYNDEX) and screened relevant conference proceedings since 2001. From abstracts fitting our inclusion criteria we reviewed full texts. Identified assessments were compared regarding their operationalization of the ICF. RESULTS Out of 440 identified abstracts we selected 8 assessment instruments for interviewer-, proxy- or self-assessment. Two were generic and six disease-specific scales. Differences pertain to the extent as well as coverage and operationalization of the ICF. CONCLUSION Existing instruments differ in psychometric properties and operationalization of the ICF. This review might help clinicians to select ICF-based assessments.

Do measures used in studies of anxiety disorders reflect activities and participation as defined in the WHO International Classification of Functioning, Disability and Health?:

Background: Besides the measurement of symptoms, information on functioning and disability in daily routines expands the description of impairments in patients with anxiety disorders. Therefore, the measurement of activities and participation, as theoretically included in the International Classification of Functioning, Disability and Health (ICF) is of increasing importance. The objective of this study is to give an overview over the implementation of the concept ‘activities and participation’ in outcome measurements of patients with anxiety disorders. Methods: Based on a literature review in PubMed and PsycInfo databases and including 200 papers, this study analyses 65 outcome instruments used in randomized controlled trials in anxiety disorders according to their content related to the ICF domain of ‘Activities and participation’. Results: Instruments used in trials evaluating outcome in patients with anxiety disorder only partially address activities and participation. Over all 65 instruments, the chapters on ‘Interpersonal interactions and relationships’ and ‘Mobility’ were most frequently included in measurements. Conclusions: The identification of relevant ICF categories (core sets) according to activities and participation and especially interpersonal interactions and relationships as well as mobility, can be a basis for describing functioning and evaluating treatment in anxiety disorders, helping to improve outcome assessment in clinical practice.

Psychometric properties of an instrument to measure activities and participation according to the ICF concept in patients with mental disorders

Abstract Purpose: The International Classification of Functioning, Disability and Health (ICF) conceptualizes the bio-psycho-social model of health and illness, but cannot be used as an assessment instrument in routine care. The objective of this study was to psychometrically test a self-report instrument for measuring activities and social participation (ICF-Mental-A&P) of psychotherapy patients. Methods: For the psychometric evaluation of the ICF-Mental-A&P, participants completed a questionnaire on symptoms, interpersonal problems and quality of life at admission and at discharge of in-patient treatment. A consecutive sample of 2256 patients diagnosed with at least one mental disorder was recruited from eight in-patient units in Germany. Results: After item selection, the ICF-Mental-A&P contained 31 items comprising six subscales examined by confirmatory factor analysis. Subscales had acceptable internal consistency (α = 0.78–0.90) and test–retest correlations (r = 0.71–0.86). There were several expected correlations (r ≥ 0.6) between ICF-Mental-A&P scores and measures of symptoms and interpersonal problems. Conclusions: Findings suggest that the ICF-Mental-A&P is a comprehensive, reliable measure of activities and participation according to the ICF concept for patients with mental disorders. It may therefore be an important instrument in clinical practice and could help to determine and evaluate functioning-related and patient-focused treatment outcomes. Implications for Rehabilitation The ICF-Mental-A&P offers the opportunity to assess activities and participation from the patient’s perspective. Besides the reduction of symptoms, these patient-centered outcomes based on limitations and restrictions in daily life are relevant treatment goals. The instrument is available from the first author.

[How to do Research? Development and Evaluation of a Research Training for Patients with Mental Disorders].

Objective Participation of mental health services users in research is increasingly acknowledged in Germany. Principles for successful involvement include research training for service users. The aims of the project were (1) to develop and (2) to evaluate a research training. Methods The research training was developed in five participatory meetings and piloted with 28 participants. They answered questions on the research training and about their interest in research, research-related empowerment and research participation. Results Interest in research did not change. But there is a difference between research-related empowerment before (t1) and after (t2) the research training (z = - 2.237; p = 0.025). The number of participants registered in scientific studies increased from 4 (t1) to 8 three months later (t3) whereas the number of participants reporting own research ideas decreased from 7 (t1) to 5 (t3). Conclusion Although interest has not been affected, the evaluation shows significant effects on research-related empowerment in participants. Results concerning transfer are divergent. However, feedback was positive. We are planning to disseminate and refine the training.

A Systematic Literature Review of Self-Reported Smoking Cessation Counseling by Primary Care Physicians.

Tobacco consumption is a risk factor for chronic diseases and worldwide around six million people die from long-term exposure to first- or second-hand smoke annually. One effective approach to tobacco control is smoking cessation counseling by primary care physicians. However, research suggests that smoking cessation counseling is not sufficiently implemented in primary care. In order to understand and address the discrepancy between evidence and practice, an overview of counseling practices is needed. Therefore, the aim of this systematic literature review is to assess the frequency of smoking cessation counseling in primary care. Self-reported counseling behavior by physicians is categorized according to the 5A’s strategy (ask, advise, assess, assist, arrange). An electronic database search was performed in Embase, Medline, PsycINFO, CINAHL and the Cochrane Library and overall, 3491 records were identified. After duplicates were removed, the title and abstracts of 2468 articles were screened for eligibility according to inclusion/exclusion criteria. The remaining 97 full-text articles reporting smoking cessation counseling by primary care physicians were assessed for eligibility. Eligible studies were those that measured physicians’ self-reported smoking cessation counseling activities via questionnaire. Thirty-five articles were included in the final review (1 intervention and 34 cross-sectional studies). On average, behavior corresponding to the 5A’s was reported by 65% of physicians for “Ask”, 63% for “Advise”, 36% for “Assess”, 44% for “Assist”, and 22% of physicians for “Arrange”, although the measurement and reporting of each of these counseling practices varied across studies. Overall, the results indicate that the first strategies (ask, advise) were more frequently reported than the subsequent strategies (assess, assist, arrange). Moreover, there was considerable variation in the items used to assess counseling behaviour and developing a standardized instrument to assess the counseling strategies implemented in primary care would help to identify and address current gaps in practice.