Matthias Richard

Four-Week Prevalence of Mental Disorders in Patients With Cancer Across Major Tumor Entities

PURPOSE To provide the 4-week prevalence estimates of mental disorders in cancer populations. PATIENTS AND METHODS We enrolled adult patients with cancer from in- and outpatient care facilities, using a proportional stratified random sample based on the nationwide cancer incidence in Germany. Patients who scored 9 or above on the Patient Health Questionnaire (PHQ-9) were administered to the standardized computer-assisted Composite International Diagnostic Interview for mental disorders adapted for cancer patients (CIDI-O). A random sample of those with a PHQ-9 score that was less than 9 were selected for a CIDI-O. RESULTS A total of 5,889 patients were identified, which led to 4,020 participants (a 68.3% response rate); of those, 2,141 patients were interviewed. The 4-week total prevalence for any mental disorder was 31.8% (95% CI, 29.8% to 33.8%); this included any anxiety disorder (11.5%; 95% CI, 10.2% to 12.9%), any adjustment disorder (11.1%; 95% CI, 9.7% to 12.4%), any mood disorder (6.5%; 95% CI, 5.5% to 7.5%), any somatoform/conversion disorder (5.3%; 95% CI, 4.3% to 6.2%), nicotine dependence (4.5%; 95% CI, 3.6% to 5.4%), alcohol abuse/dependence (0.3%; 95% CI, 0.1% to 0.6%), any mental disorder resulting from general medical condition (2.3%; 95% CI, 1.7% to 2.9%), and any eating disorder (0%). The highest prevalence for any mental disorder was found in patients with breast cancer (41.6%; 95% CI, 36.8% to 46.4%), followed by patients with head and neck cancer (40.8%; 95% CI, 28.5% to 53.0%). The lowest prevalence was found in patients with pancreatic cancer (20.3%; 95% CI, 8.9% to 31.6%) and stomach/esophagus cancers (21.2%; 95% CI, 12.8% to 29.6%). CONCLUSION Our findings provide evidence for the strong need for psycho-oncological interventions.

Computer-assisted feedback-driven quality management for psychotherapy: the Stuttgart-Heidelberg model.

The authors present the Stuttgart-Heidelberg Model for quality management of psychotherapy. The system is characterized as an active internal approach with external support from researchers. Problem-solving activities are initiated and maintained by computer-assisted feedback on possible treatment shortcomings. The system provides support for the 3 key tasks of quality management: (a) monitoring of relevant quality criteria in the clinical routine, (b) standardized assessment that allows comparison with established standards at various levels of service provision, and (c) transfer of information on achieved quality to those whom it concerns. The central function of the system is an alarm function, signaling a possible deficit of the provided psychotherapy on the basis of the standard evaluation of treatment outcome for individual patients. In this article, the main system components are described and data on its feasibility and validity are presented.

Therapy Amount and Outcome of Inpatient Psychodynamic Treatment of Eating Disorders in Germany: Data From a Multicenter Study

The present study investigates (a) factors that determine length of treatment and (b) the effect of treatment duration and other factors on outcome for patients with eating disorders. In this observational study, the symptomatic status of 1,171 patients was observed for 2.5 years after admission to 1 of 43 participating hospitals. Treatment and outcome were modeled using hierarchical linear models and logistic regression. To control for possible confounding factors, propensity score adjustment was used. Treatment modalities, especially length and intensity, varied considerably between and within hospitals and were related to patient characteristics to a very small degree. At 2.5-year follow-up, 33% of anorexia patients and 25% of bulimia patients were symptom free. Length of treatment showed a weak effect on outcome and only in interaction with other patient characteristics of relevance, whereas treatment intensity was not related to outcome. Implications for treatment planning are discussed.

Fragebogen zum Ergebnis von Psychotherapie

Zusammenfassung.Theoretischer Hintergrund: Routinemasige Qualitatssicherung psychotherapeutischer Versorgung erfordert Instrumente zur unaufwendigen, aber zuverlassigen Erfassung von Behandlungsergebnissen. Fragestellung: Ziel der Studie ist eine deutsche Adaptation (EB-45) des in den USA bewahrten Outcome Questionnaire 45.2. Methode: Der EB-45 wurde von einer nicht-klinischen Stichprobe (n =232) im Abstand von 2 Wochen zweimal bearbeitet. Zur Konstruktvalidierung wurden parallel die Symptom Checklist 90, das Inventar Interpersoneller Probleme sowie die Fragebogen zur sozialen Integration und zur Lebenszufriedenheit vorgelegt. Ergebnisse: Fur die interne Konsistenz wurden Werte von .59 bis .93 und fur die Retest-Reliabilitaten von .71 bis .87 geschatzt. Die Korrelationen mit den zur Validierung hinzugezogenen Instrumenten lagen zwischen .45 und .76. Schlusfolgerungen: Die Standardisierung rechtfertigt es, den EB-45 in der Evaluation und Qualitatssicherung einzusetzen; die Beschrankungen der Stichprobe erm...

Twelve-Month and Lifetime Prevalence of Mental Disorders in Cancer Patients

Background: Psychological problems are common in cancer patients. For the purpose of planning psycho-oncological interventions and services tailored to the specific needs of different cancer patient populations, it is necessary to know to what extent psychological problems meet the criteria of mental disorders. The purpose of this study was to estimate the 12-month and lifetime prevalence rates of mental disorders in cancer patients. Methods: A representative sample of patients with different tumour entities and tumour stages (n = 2,141) in outpatient, inpatient and rehabilitation settings underwent the standardized computer-assisted Composite International Diagnostic Interview for mental disorders adapted for cancer patients (CIDI-O). Results: The overall 12-month prevalence for any mental disorder was 39.4% (95% CI: 37.3-41.5), that for anxiety disorders was 15.8% (95% CI: 14.4-17.4), 12.5% (95% CI: 11.3-14.0) for mood disorders, 9.5% (95% CI: 8.3-10.9) for somatoform disorders, 7.3% (95% CI: 6.2-8.5) for nicotine dependence, 3.7% (95% CI: 3.0-4.6) for disorders due to general medical condition, and 1.1% (95% CI: 0.7-1.6) for alcohol abuse or dependence. Lifetime prevalence for any mental disorder was 56.3% (95% CI 54.1-58.6), that for anxiety disorders was 24.1% (95% CI: 22.3-25.9), 20.5% (95% CI: 18.9-22.3) for mood disorders, 19.9% (95% CI: 18.3-21.7) for somatoform disorders, 18.2% (95% CI: 16.6-20.0) for nicotine dependence, 6.4% (95% CI: 5.4-7.6) for alcohol abuse or dependence, 4.6% (95% CI: 3.8-5.6) for disorders due to general medical condition, and 0.2% (95% CI: 0.1-0.6) for eating disorders. Conclusions: Mental disorders are highly prevalent in cancer patients, indicating the need for provision of continuous psycho-oncological support from inpatient to outpatient care, leading to an appropriate allocation of direct personnel and other resources.

Development and Validation of the Theistic Spiritual Outcome Survey

Abstract The authors developed the Theistic Spiritual Outcome Survey (TSOS) to measure the spiritual outcomes of psychotherapy from a theistic spiritual perspective. A 17-item version of the TSOS was found to have adequate reliability and validity in a sample of college students. Three factors emerged from the analyses that corresponded to the Love of God, Love of Others, and Love of Self subscales. Correlations with measures of psychological outcomes were statistically significant. In subsequent analyses, the TSOS was administered over an 8-week period to a sample of inpatient women with eating disorders and to two samples from inpatient psychological clinics in Germany. The analyses resulting from these studies were also supportive of the psychometric properties and clinical sensitivity of the TSOS.

A computer assisted eating disorder specific quality management system: EQUAL‐TREAT

In 1997 the COST B6 European Collaboration, which includes researchers from 19 European countries, began to develop a system of quality management to be used in the treatment of eating disorders. The system which arose out of this collaboration is presented in the current article. It is an extension of the ‘Heidelberg–Stuttgart Model’ of quality management which was designed for the treatment of patients with psychiatric illnesses. This model is well established in Germany where it has been used in a number of psychiatric hospitals for over 6 years. The model relies on the concept of ‘active internal quality management’ with external support. It incorporates solutions of the three key tasks of quality management: (1) the construction of an inventory for monitoring of relevant quality criteria in clinical practice, (2) operationalization of assessment tools which allow comparison with norms (Ist–Soll–Vergleich) on various levels of service provision and (3) provision of feedback tools. The central function of the system is the alarm function, which signals a possible deficit in treatment. This is based on treatment outcomes for individual patients according to the system. This information is then aggregated to facilitate continuous internal monitoring of quality, and is finally arranged for external comparisons. In this article we explain the principles of the system, introduce the model and illustrate its use with two clinical examples. Copyright

Performance status and depressive symptoms as predictors of quality of life in cancer patients. A structural equation modeling analysis

This study aimed to examine whether depressive symptoms and performance status are independent predictors of both the physical and psychological domains of health‐related quality of life (HRQoL) in cancer patients.

Unmet needs for information and psychosocial support in relation to quality of life and emotional distress: A comparison between gynecological and breast cancer patients

OBJECTIVE We compared gynecological and breast cancer patients regarding their needs for information and psychosocial support, quality of life (QoL), and emotional distress and the relationship among these constructs. METHODS In a multicenter, cross-sectional study in Germany, we evaluated 1214 female cancer patients (317 with gynecological cancer, 897 with breast cancer). We obtained self-reports of unmet needs, using a self-developed measure. We measured QoL with the EORTC QLQ-C30, symptoms of depression with the Patient Health Questionnaire (PHQ-9), and symptoms of anxiety with the Generalized Anxiety Disorder Scale (GAD-7). RESULTS Compared to breast cancer patients, gynecological cancer patients felt less informed about several aspects of their disease, particularly regarding psychological support (p<0.001), tended to have more unmet information needs, and reported lower QoL levels. Lower emotional functioning, but higher physical functioning were independent correlates of the level of unmet information needs. Depressive symptoms and higher physical functioning (only in breast cancer) were independent correlates of higher needs for psychosocial support. CONCLUSION Compared to breast cancer, gynecological cancer patients were less satisfied with the information received and reported lower levels of QoL. PRACTICE IMPLICATIONS Both clinicians and policy makers should take efforts to address the higher needs of gynecological cancer patients.

Symptoms of depression and anxiety as predictors of physical functioning in breast cancer patients. A prospective study using path analysis

Abstract Background: Although symptoms of depression and anxiety are linked to health-related quality of life (HRQoL), the nature of this relationship remained unclear. We therefore aimed to examine, in a prospective study, both possible directions of impact in this relationship. To avoid conceptual and measurement overlap between depressive and anxiety symptoms, on the one hand, and HRQoL, on the other hand, we focused on the physical functioning component of HRQoL. Material and methods: We conducted a secondary analysis of a prospective cohort study with 436 female breast cancer patients (mean age 51 years). Both at baseline and after 12 months, we measured symptoms of depression and anxiety with the four-item Patient Heath Questionnaire (PHQ-4) and physical functioning with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Using path analysis, we estimated (1) the predictive value of symptoms of depression/anxiety for subsequent physical functioning and (2) the predictive value of physical functioning for subsequent symptoms of depression/anxiety, in the same model. Results: Baseline symptoms of depression/anxiety predicted 1-year levels of physical functioning (depression: standardized β =  −.09, p = .024; anxiety: standardized β =  −.10, p = .009), while the reciprocal paths linking baseline physical functioning to subsequent depressive and anxiety symptoms were not significant, adjusting for the baseline scores of all outcome variables. Conclusions: Depressive and anxiety symptoms were predictors of the physical functioning component of HRQoL. Thus, if this relation is causal, treating breast cancer patients’ depressive and anxiety symptoms may have a favorable impact on their self-reported physical functioning.