Maria Cabello

Psychosocial features of depression: A systematic literature review

BACKGROUND Despite the great burden of depression on sufferers and society, there is a lack of reliable information regarding the full range of psychosocial difficulties associated with depression and their related variables. This systematic review aimed to demonstrate the utility of the International Classification of Functioning, Disability and Health (ICF) in describing the psychosocial difficulties that shape the lived experience of persons with depression. METHODS An electronic search that included publications from 2005 to 2010 in the MEDLINE and PsycHINFO databases was conducted to collect psychosocial outcomes. Quality of studies was also considered. RESULTS 103 studies were included. 477 outcomes referring psychosocial difficulties were extracted and grouped into 32 ICF related categories. Emotional functions (19% of studies), followed by energy and drive (17% of studies), were the most frequent psychosocial outcomes. The onset, course, determinants, and related variables of the most important psychosocial difficulties, reported in at least 10% of studies, were described. Medication played a dual role as determinant of onset and change in some psychosocial areas, e.g. in pain, sleep, and energy and drive. LIMITATIONS The search was limited by year of publication and focused only on minor and major depression diagnoses: other depressive disorders were not included. Some underresearched, but relevant psychosocial areas could have not been analyzed. CONCLUSIONS The present systematic review provides information on the psychosocial difficulties that depressive patients face in their daily lives. Future studies on depression should include outcome instruments that cover these relevant areas in order to comprehensively describe psychosocial functioning.

Functioning and disability in bipolar disorders: a systematic review of literature using the ICF as a reference

OBJECTIVES To systematically identify and examine the frequency of use of concepts contained in outcome variables across bipolar disorder (BD) studies using the International Classification of Functioning, Disability and Health (ICF) as a reference. METHODS Original studies published between 2000 and 2006 were located on the MEDLINE and PsycINFO databases and selected according to predetermined criteria. Outcome variables were extracted, and concepts contained therein were linked to the ICF. RESULTS A total of 109 final studies were included. The concepts contained in these studies were linked to 145 different ICF categories. ICF category b152, emotional functions, was the most frequently represented category, appearing in 94% of the publications, followed by b126, temperament and personality functions (73%). E110, products or substances for personal consumption, and e580, health services, systems, and policies, appeared in 68% of the studies. CONCLUSIONS The present systematic review reflects the research focus of the literature on BD in recent years. Most of the studies performed concentrate on body functions rather than activities and participation domains. Experimental studies are mostly pharmacological, reflecting the need to study nonpharmacological interventions. Furthermore, our study shows that outcome variables used in studies with persons with BD can, to a large extent, be mapped to the ICF.

Narratives Reflecting the Lived Experiences of People with Brain Disorders: Common Psychosocial Difficulties and Determinants

Background People with brain disorders - defined as both, mental disorders and neurological disorders experience a wide range of psychosocial difficulties (PSDs) (e.g., concentrating, maintaining energy levels, and maintaining relationships). Research evidence is required to show that these PSDs are common across brain disorders. Objectives To explore and gain deeper understanding of the experiences of people with seven brain disorders (alcohol dependency, depression, epilepsy, multiple sclerosis, Parkinson’s disease, schizophrenia, stroke). It examines the common PSDs and their influencing factors. Methods Seventy seven qualitative studies identified in a systematic literature review and qualitative data derived from six focus groups are used to generate first-person narratives representing seven brain disorders. A theory-driven thematic analysis of these narratives identifies the PSDs and their influencing factors for comparison between the seven disorders. Results First-person narratives illustrate realities for people with brain disorders facilitating a deeper understanding of their every-day life experiences. Thematic analysis serves to highlight the commonalities, both of PSDs, such as loneliness, anger, uncertainty about the future and problems with work activities, and their determinants, such as work opportunities, trusting relationships and access to self-help groups. Conclusions The strength of the methodology and the narratives is that they provide the opportunity for the reader to empathise with people with brain disorders and facilitate deeper levels of understanding of the complexity of the relationship of PSDs, determinants and facilitators. The latter reflect positive aspects of the lives of people with brain disorders. The result that many PSDs and their influencing factors are common to people with different brain disorders opens up the door to the possibility of using cross-cutting interventions involving different sectors. This strengthens the message that ‘a great deal can be done’ to improve the lived experience of persons with brain disorders when medical interventions are exhausted.

PARADISE 24: A measure to assess the impact of brain disorders on people's lives

Objective To construct a metric of the impact of brain disorders on people’s lives, based on the psychosocial difficulties (PSDs) that are experienced in common across brain disorders. Study Design Psychometric study using data from a cross-sectional study with a convenience sample of 722 persons with 9 different brain disorders interviewed in four European countries: Italy, Poland, Spain and Finland. Questions addressing 64 PSDs were first reduced based on statistical considerations, patient’s perspective and clinical expertise. Rasch analyses for polytomous data were also applied. Setting In and outpatient settings. Results A valid and reliable metric with 24 items was created. The infit of all questions ranged between 0.7 and 1.3. There were no disordered thresholds. The targeting between item thresholds and persons’ abilities was good and the person-separation index was 0.92. Persons’ abilities were linearly transformed into a more intuitive scale ranging from zero (no PSDs) to 100 (extreme PSDs). Conclusion The metric, called PARADISE 24, is based on the hypothesis of horizontal epidemiology, which affirms that people with brain disorders commonly experience PSDs. This metric is a useful tool to carry out cardinal comparisons over time of the magnitude of the psychosocial impact of brain disorders and between persons and groups in clinical practice and research.

Psychosocial difficulties from the perspective of persons with neuropsychiatric disorders

Abstract Purpose: The objective of this study is to determine whether persons with neuropsychiatric disorders experience a common set of psychosocial difficulties using qualitative data from focus groups and individual interviews. Method: The study was performed in five European countries (Finland, Italy, Germany, Poland and Spain) using the focus groups and individual interviews with persons with nine neuropsychiatric disorders (dementia, depression, epilepsy, migraine, multiple sclerosis, Parkinson’s disease, schizophrenia, stroke and substance dependence). Digitally recorded sessions were analysed using a step-by-step qualitative and quantitative methodology resulting in the compilation of a common set of psychosocial difficulties using the International Classification of Functioning, Disability and Health (ICF) as a framework. Results: Sixty-seven persons participated in the study. Most persons with neuropsychiatric disorders experience difficulties in emotional functions, sleeping, carrying out daily routine, working and interpersonal relationships in common. Sixteen out of 33 psychosocial difficulties made up the common set. This set includes mental functions, pain and issues addressing activities and participation and provides first evidence for the hypothesis of horizontal epidemiology of psychosocial difficulties in neuropsychiatric disorders. Conclusions: This study provides information about psychosocial difficulties that should be covered in the treatment and rehabilitation of persons with neuropsychiatric disorders regardless of clinical diagnoses. Implications for Rehabilitation Emotional problems, work and sleep problems should be addressed in all the treatments of neuropsychiatric disorders regardless of their specific diagnosis, etiology and severity. Personality issues should be targeted in the treatment for neurological disorders, whereas communication skill training may also be useful for mental disorders. The effects of medication and social environment on patient’s daily life should be considered in all the neuropsychiatric conditions.

Application of ICF in clinical settings across Europe

In 2002, a report of Brunel University [1] showed that different countries, for different purposes, define disability differently: some countries define disability in terms of performance levels in...

Work disability and depressive disorders: impact on the European population

ObjectiveOur aim was to study the impact of depressive disorders on work disability to discover the determinants of depression for work disability in the European countries. DesignThe sample was composed of 31,126 individuals from 29 countries included in the 2002 World Health Survey of the World Health Organization. National representative samples of countries from all regions of Europe and with different levels of economic development and health coverage were selected. ResultsEstimates of people not working because of ill health did not differ among European countries in relation to levels of economic development or health coverage. Significant determinants of people with diagnosis of depression not working because of ill health (reference category) versus working were age (odds ratio = 0.97), female sex (odds ratio = 1.71), education (odds ratio = 1.11), marital status (being unmarried indicating less probability), lowest income level, and comorbidity with angina pectoris (odds ratio = 0.51). Moreover, according to previous studies, we found some determinants (comorbidity with other diseases, young age, and unemployment) impacting on health status. ConclusionsDepression is a substantial cause of work disability and it is a complex phenomenon that involves many variables. Investigation into this relationship should improve, focusing on the role of determinants.

Diagnosis delay in first episodes of major depression: A study of primary care patients in Spain

BACKGROUND Diagnosis delay may negatively influence the clinical course of major depression; however, few studies have analysed the role of environmental factors on diagnosis delay. This study was aimed to identify personal and environmental factors related to a longer delay. METHODS A cross-sectional observational study with 3615 primary care patients with a first diagnosis of major depression was conducted. Diagnosis delay was defined as the time between onset of symptoms and diagnosis of major depression. RESULTS Mean of delay was 9.89 weeks. Lower years of education, triggering stressful life events before the current episode, history of previous undiagnosed depressive episodes and somatic comorbidity were related to longer delay. Health system variables, such as urban setting, public health care setting, younger doctors and female doctors were also related to a longer delay. LIMITATIONS Onset of first depressive symptoms was retrospectively collected. The cross-sectional design does not allow making inferences about the temporal ordering between predictors and outcomes. CONCLUSIONS Both personal and environmental variables were related to diagnosis delay. Identification of these factors helps to design early diagnosis programs to ultimate reduce the morbidity associated with major depression.

The state of the art on European well-being research within the area of mental health

As part of A Roadmap for Mental Health Research in Europe project, the aim of the present study was to perform a systematic mapping of the main publications in peer-reviewed journals for well-being research within the area of mental health or mental disorders in Europe. The PubMed and PsycINFO databases were used to identify papers on well-being within the area of mental health and mental disorders published from January 2007 to September 2014. Mean 5-year impact factors were obtained. The number of publications for each country was analysed by population size and gross domestic product (GDP). A total of 4,423 unique publications were identified. The number of publications increased for the analysed time period. France and the Netherlands had the highest 5-year mean impact factor. Publications per capita were higher in the Nordic countries, Ireland and the Netherlands. After adjusting for GPD, the most productive countries were the Nordic countries and the Netherlands. There is a marked variation in well-being publications by country in Europe. Eastern European countries produce little research taking into consideration the levels of resources available. Research on older adults was underrepresented and should be prioritised.

How much do we know about the functional effectiveness of interventions for depression? A systematic review

BACKGROUND Functional difficulties are determined as one of the reasons for the public health priority given to depression. However, previous literature shows that the evidence on treatment effectiveness in depression does not reflect all relevant functional areas affected. This paper aimed to review recent literature and identify which areas are addressed and what are the gaps in the measurement of treatment effectiveness in depression. METHODS Electronic search was performed in PsycINFO, PubMed, Web of science, and the Cochrane Central Register of Controlled Trials. A content item analysis of outcome measures was performed. RESULTS Two hundred and fourty-seven studies were included. The functional areas addressed in the measurement process did not vary across studies assessing psychotherapeutic, pharmacological or alternative interventions. The content analysis revealed that 80% of the areas covered by instruments represented symptomatology. Many functional areas were insufficiently covered, whereas others like handling stress, solving problems, maintaining daily routine, problems in education, or participation in community, political or religious life were not addressed at all. LIMITATIONS Only articles in English were included and the time frame was limited. CONCLUSIONS More than 10 years after the first global burden of disease studies have been published evidence on the treatment effectiveness in depression is still based primarily on symptoms. Many important functional areas remain unexplored. Consequently the effectiveness of well recognized interventions might be overestimated. Future steps should include use of comprehensive tools, provision of detailed information on functional areas instead of global scores of instruments, and design of functional impairment oriented therapies.