Abstracts / Journal of Psychosomatic Research 78 (2015) 588–634
Long-term economic evaluation of group CBT for functional somatic syndromes A. Schrödera, E. Ørnbøla, J.S. Jensena, M. Sharpeb, P. Finka a The Research Clinic for Functional Somatic Syndromes, Aarhus University Hospital, Aarhus, Denmark, b Department of Psychiatry, University of Oxford, Oxford, UK Background: Functional somatic syndromes (FSS) are associated with excess healthcare and societal costs. Cognitive–behavioural treatment (CBT) improves functioning and quality of life in FSS; however, knowledge about its cost-effects is scarce. We aimed to compare the long-term cost-effects of group CBT with that of enhanced usual care (EUC) from both a healthcare and a societal perspective. Method: 120 participants from a previous randomised controlled trial (BJP 2012;200(6):499–507) were followed by means of public registries as regards societal (labour-marked-related and health-related beneﬁts) and healthcare (primary and secondary care and medication) costs. All costs were calculated as annual per capita public expenses, corrected for estimated tax income as regards societal costs, and inﬂated to 2010 €. Groups were compared using regression models controlling for baseline costs, and differences are reported with bias corrected and accelerated (BCa) conﬁdence intervals obtained via bootstrap with 1000 repetitions. Moreover, we analysed development of societal costs for seven years before and three years after treatment, as compared to a matched population control group, by means of random effects modelling allowing individual levels and slopes in a group-speciﬁc, piecewise linear model. Results: Group CBT was associated with a reduction in annual healthcare costs, as compared to the year before randomisation, during the ﬁrst year after treatment (−1293 €, BCa 95% CI −2155 to −460), while EUC patients remained stable (+94 €, −1300 to 1697). Excess treatment costs of 1545 € were offset by savings of −1569 € (−2927 to −211, p = 0.024) in other healthcare domains already during the ﬁrst year, and outperformed by subsequent savings in the following two years. An annual increase in societal costs of +2027 € during the seven years prior to trial entry changed into an annual decrease of −1499 € after group CBT, while societal costs continued to rise after EUC (+1300 €). The difference in annual changes (slopes) was 2798 € (541 to 5056, p = 0.015) in favour of group CBT, leading to an ultimate annual saving in societal costs during the third year of −8565 € (−12,095 to −5034, p b 0.001). Conclusion: Group CBT was associated with large, sustainable reductions of societal costs as compared to EUC. A wider implementation of psychological treatment for severely impaired FSS patients may have the potential to induce large savings in public expenses.
On the complex interrelationships between stressors, sleep disturbance and immunological and endocrinological stress system variables: An integrative single case study on a healthy woman C. Schuberta, M. Singera, W. Geserb, D. Fuchsc a Medical University Innsbruck, Medical Psychology, Innsbruck, Austria, b University Innsbruck, Psychology, Innsbruck, Austria, c Medical University Innsbruck, Division of Biological Chemistry, Biocentre, Innsbruck, Austria Background: The interactions between stress system activity and sleep are complex and fraught with inconsistencies when investigated with the usual methodological approach to PNI research (e.g. pre-post-design). Method: In this study, we therefore applied an integrative research design to investigate the complex interrelationships between stressors,
sleep disturbance and immunological and endocrinological stress system variables under conditions of “life as it is lived”. For this purpose, a healthy 27-year-old woman collected her entire urine for 63 days in 12-h intervals (from 8 p.m. to 8 a.m. and from 8 a.m. to 8 p.m.) (total: 126 measurements) for the determination of cortisol (ELISA) and neopterin (immune activation marker) per creatinine levels (HPLC). In addition, every 12 h, the proband ﬁlled out questionnaires to measure emotional states (EWL) and daily routine variables (DIARI) including sleep behavior, and determined her body temperature. Weekly interviews with the proband provided information on the occurrence of emotionally meaningful stressors during the period of the study. This study applied time series analysis according to Box and Jenkins (1976) consisting of ARIMA modeling and crosscorrelation analyses (p b 0.05). Results: Bivariate analyses revealed a network like structure between the variables measured. Speciﬁcally, stressors were followed by signiﬁcant decreases in recreational value of sleep and total sleep time (TST). Moreover, stress system variables (neopterin, cortisol) as well as body temperature ﬁtted consistently into the stress–sleep connections with regard to the directions, signs and temporal delays of the crosscorrelations. Conclusion: These ﬁndings on a healthy woman suggest a possible mediating role of immunological and endokrinological stress system parameters between the occurrence of stressors and sleep problems. Further studies must follow to strengthen these ﬁrst ﬁndings. doi:10.1016/j.jpsychores.2015.03.118
Psychological distress and quality of life in lung transplant patients. A six-month observational study A. Seilera, J. Jeneweina, C. Martin-Soelchb, L. Goetzmannc, I. Incid, W. Wederd, M. Schuurmanse, C. Bendene, A. Bruchera, R. Klaghofera a University Hospital Zurich, Department of Psychiatry & Psychotherapy, Zurich, Switzerland, bUniversity of Fribourg, Department of Psychology, Fribourg, Switzerland, cSegeberger Kliniken, Department of Psychosomatic Medicine & Psychotherapy, Bad Segeberg, Germany, dUniversity Hospital Zurich, Department of Thoracic Surgery, Zurich, Switzerland, eUniversity Hospital Zurich, Division of Pulmonary Medicine, Zurich, Switzerland Background: It is crucial to identify lung transplant recipients who experience no signiﬁcant improvement in health-related quality of life (HRQoL), and, thus require psychosocial care. Objectives: To (1) assess psychosocial outcome trajectories in lung transplant recipients related to psychological distress and HRQoL during the ﬁrst six months post-transplant; (2) identify patients with poor psychosocial trajectories; and (3) assess potential outcome predictors regarding psychological distress and HRQoL at six months posttransplant. Method: A total of 40 patients were examined for psychological distress (SCL-K-9) and HRQoL (EQ-5D) during their ﬁrst six months post-transplant. Hierarchical cluster analyses were performed to identify distinct types of postoperative outcome trajectory. Correlational analyses examined medical and psychosocial predictors of the outcome at six months post-transplant. Results: Three distinctive clusters were identiﬁed, summarizing either patients with (1) optimal post-operative trajectories (35%), (2) good post-operative trajectories (42.5%), and (3) poor post-operative trajectories (22.5%). The latter tended to be older, to suffer from more severe disease, to have more co-morbidities, and to have had a prolonged ICU and/or hospital stay. Disease severity, length of stay and EQ-5D two weeks post-transplant were strong predictors of psychological distress and impaired HRQoL at six months of follow-up. Conclusion: Results underscore the psychosocial needs of patients with poor post-transplant trajectories. Further longitudinal research
Abstracts / Journal of Psychosomatic Research 78 (2015) 588–634
with larger subject samples is needed to further investigate outcome proﬁles of these patients and identify additional outcome predictors. doi:10.1016/j.jpsychores.2015.03.119
Evaluation of a stepped, collaborative and coordinated health care network for somatoform and functional disorders (Sofu-Net) M. Shedden-Moraa, K. Laua, B. Großa, M. Gladigaua, A. Gumza, K. Wegscheiderb, B. Löwea a University Medical Center Hamburg-Eppendorf & Schön Clinic, HamburgEilbek, Department of Psychosomatic Medicine & Psychotherapy, Hamburg, Germany, bUniversity Medical Center Hamburg-Eppendorf, Department of Medical Biometry & Epidemiology, Hamburg, Germany Background: The successful management of somatoform and functional disorders in primary care is often limited due to low diagnostic accuracy, delayed referral to psychotherapy, and unstructured overuse of health care. This study aims to analyse whether establishing a stepped, collaborative and coordinated health care network for somatoform and functional disorders improves the diagnostic process, treatment recommendations, and reduces health care utilisation. Method: A regional network (Sofu-Net) was established to connect 41 primary care physicians (PCP), 35 psychotherapists, 7 mental health clinics, and a specialized outpatient clinic. The network was evaluated in a pre- and 12-month-post-intervention study through the identiﬁcation of primary care patients at high-risk for somatization using the Patient Health Questionnaire, and subsequent detailed assessment via a telephone interview and a PCP questionnaire. Results: Out of the pre- (n = 1882, 51 years, 60.7% female) and 12month-post Sofu-Net samples (n = 2200, 50.5 years, 59.4% female), 267 (16.2%) and 269 (15.3%) patients were at high-risk for somatization respectively. From these, 156 and 123 patients were interviewed. Twelve months after Sofu-Net establishment, high-risk patients more frequently discussed psychosocial distress with their PCP (63.3% vs 79.2%, p b .001). PCPs prescribed more antidepressants (3.8% vs. 25.2%, p b .001) and less benzodiazepines (21.8% vs. 6.5%, p b .001). Sofu-Net did not affect physicians' detection rates of somatoform disorders, rates of recommendation to initiate psychotherapy, or patients' health care utilisation. Conclusion: The network fostered shared Conclusion of psychosocial distress and improved medication prescription behaviour. Sofu-Net might change the treatment process and thereby improve the management of somatoform and functional disorders.
Cause–effect relations between immune activity and sleep in a patient with prior breast cancer and current cancer-related fatigue and depression: A time-series analysis approach M. Singera, W. Geserc, S. Peterlinia, K. Fritzscheb, C. Burbaumb, D. Fuchsd, C. Schuberta a Medical University Innsbruck, Clinical Department of Medical Psychology, Innsbruck, Austria, bUniversity Hospital, Department of Psychosomatic Medicine & Psychotherapy, Freiburg, Germany, cUniversity Innsbruck, Psychology, Innsbruck, Austria, dMedical University Innsbruck, Division of Biological Chemistry, Biocentre, Innsbruck, Austria Background & Method: This study on a prior breast cancer patient with cancer-related fatigue (CaRF) and depression investigated the bidirectional cause–effect relations between cellular immune activity and subjective sleep variables. The 49-year-old patient (cancer diagnosis
5 years ago) collected her entire urine for 28 days in 12-h intervals (from 8 pm to 8 am, from 8 am to 8 pm) (total: 55 measurements; night only: 28 measurements). Urinary interleukin-6 (IL-6), neopterin (immune activation marker) and creatinine levels were determined using ELISA and HPLC technique. Every morning, she answered questions on the following variables: sleep quality (SQ), sleep recreational value (SRV), total sleep time (TST), time in bed before falling asleep (TIB), times waking up during the night. Results: Cross-correlational analyses after ARIMA modelling of the serial data showed that high levels of SQ were ﬁrst followed by IL-6 decreases after 24 h (lag 1, r = −.535) and then by IL-6 increases after a total of 96 h (lag 4, r = +.435). Furthermore, increases in SRV and TST were followed ﬁrst by IL-6 decreases after 24 h (lag 1: r = − .428, r = −.426) and then by IL-6 increases after a total of 96 h (lag 4: r = + .326, r = + .392; p = n.s.). Regarding neopterin, opposite response patterns were observed: Increases in SQ and SRV were followed by neopterin level increases after 24 h (lag 1; r = + .231, r = + .282; p = n.s.) and then by decreases after a total of 96 h (lag 4; r = −.411, r = −.472). No other sleep variables were signiﬁcantly related to IL-6 and neopterin levels. No systematic effects in the other direction were observed in this study, i.e. from immunological parameters to sleep characteristics. Conclusion: This study supports our previous ﬁndings by showing that positive incidents like good sleep ﬁnally lead to neopterin decreases in patients with a disrupted stress system. The observed opposite patterns of IL-6 could indicate anti-inﬂammatory capacities of this cytokine. Further studies must follow to generalize these ﬁndings.
Outcome of cognitive behaviour therapy for patients with severe health anxiety treated in groups. Preliminary results from the pilot study of the CHAG-Trial M. Skjernova, P. Finkb, B. Fallonc, E. Simonsend a Clinic for Liaison Psychiatry, Department of Special Functions, Koege, Denmark, b Research Clinic for Functional Disorders & Psychosomatics, Department of Clinical Medicine, Aarhus, Denmark, c Columbia University, Department of Psychiatry, New York, USA, d Psychiatric Research Unit, Psychiatry Region Zealand, Roskilde, Denmark Background: No randomised controlled trials of the outcome of classical CBT (2.wave) delivered solely in groups for patients with severe health anxiety (hypochondriasis) has yet been conducted (The CHAG-Trial). Aims: 1) To examine with a pilot study the outcome of classical CBT for patients with severe health anxiety treated solely in a group setting using the clinical setup and the developed manual for the CHAG-Trial to improve the essentials of the design for the CHAG-Trial. Method: 14 patients referred from Medical Doctors in 2013 to the Clinic of Liaison Psychiatry in Koege, Region Zealand, Denmark, were included and treated by 2 therapists in 2 groups of 7 patients. Inclusion criteria: Severe health anxiety (dominant mental disorder), score on Whiteley Index 7 (WI-7) N 21,4, age 18–65 years, Danish reading and speaking, informed consent. Exclusion criteria: Another severe treatment demanding mental disorder, risk of suicide or psychosis, a serious somatic disease, pregnancy, dependency of drugs, alcohol or medication. Diagnostic assessment: A clinical interview using research criteria for severe health anxiety and diagnostic criteria from ICD-10. Outcome measures: The primary outcome measures were the self-reporting questionnaire for health