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Biomedical subjects

Martin Härter

Publications and source records attributed to Martin Härter.

At least 19 recordsLinked to original sources
PubMed2006

Screening for mental disorders in cancer, cardiovascular and musculoskeletal diseases. Comparison of HADS and GHQ-12.

OBJECTIVE: The early detection of patients with comorbid mental illness is of high clinical importance in chronic somatic diseases. To identify cases, screening instruments are recommended. The study compared the discriminant validity of the Hospital Anxiety and Depression Scale (HADS) and the General Health Questionnaire (GHQ-12) to detect mental disorders in the most frequent chronic somatic diseases. METHODS: Five hundred sixty-nine patients with musculoskeletal, cardiovascular, and cancer diseases participated in the cross-sectional, two-stage survey. First, patients were assessed with the GHQ-12 and the HADS. Second, they were examined for DSM-IV mental disorders by clinical standardized interview (CIDI). Using CIDI diagnosis as a criterion, the validity of the instruments for the detection of any mental disorder as well as of depressive and anxiety disorders was analyzed with receiver-operating characteristics analyses. RESULTS: The HADS performed better in all analyses compared to the GHQ-12. Best screening results with the HADS total scale were achieved for depressive disorders with an area under the curve of 0.82, a sensitivity of 74%, a specificity of 80%, and a misclassification rate of 21% (cutoff point=18). The positive predictive value is best (44%) for the detection of any mental disorder, with a cutoff point of 17. CONCLUSIONS: The HADS total scale can be recommended as a valid screening instrument for the detection of comorbid mental disorders in patients with chronic somatic diseases. The use of the single HADS subscales has no advantage for screening performance.

Adult↗
PubMed2006

Further support for the pain stages of change model: suggestions for improved measurement.

Recent efforts to operationalize persons' readiness to adopt a self-management approach to chronic pain have met with promising, but somewhat limited, results. The current study describes the development and psychometric evaluation of a German version of Pain Stages of Change Questionnaire (PSOCQ). A new item pool was developed to attempt to improve in particular the discriminant validity of the scales and in order to obtain a shortened measure. The items were administered to 494 chronic pain patients who were split into two independent samples. Item- and factor-analysis performed on data from one half of the sample resulted in four scales: precontemplation, preparation, action, and maintenance. The scales of the new measure, called the "Freiburg Questionnaire-Stages of Chronic Pain Management (FQ-STAPM)", showed good indices of reliability, homogeneity, and discriminant validity. Both the concurrent and divergent validity indices and the relationships between scale scores and pain related variables proved to be consistent with the transtheoretical model. Confirmatory factor analysis using LISREL performed on the second half of the sample supported the goodness-of-fit of the structure model. Implications of these findings for future research exploring the relevance of the pain stages of change model are discussed.

Adaptation, Psychological↗
PubMed2005

Improving quality of care for depression: the German Action Programme for the implementation of evidence-based guidelines.

ISSUE: Depressive disorders are of great medical and political significance. The potential inherent in achieving better guideline orientation and a better collaboration between different types of care is clear. Throughout the 1990s, educational initiatives were started for implementing guidelines. Evidence-based guidelines on depression have been formulated in many countries. PURPOSE: This article presents an action programme for structural, educational, and research-related measures to implement evidence-based care of depressive disorders in the German health system. The starting points of the programme are the 'Guidelines Critical Appraisal Reports' of the 'Guideline Clearing House' and measures from the 'Competence Network on Depression and Suicidality' (CNDS) funded by the Federal Ministry of Education and Research. The article gives an overview of the steps achieved as recommended by the Guidelines Critical Appraisal Reports and the ongoing transfer process into the German health care system. RESULTS: The action programme shows that comprehensive interventions to develop and introduce evidence-based guidelines for depression can achieve benefits in the care of depression, e.g. in recognition, management, and clinical outcome. CONCLUSION: It was possible to implement the German Action Programme in selected care settings, and initial evaluation results suggest some improvements. The action programme provides preliminary work, materials, and results for developing a future 'Disease Management Programme' (DMP) for depression.

Depressive Disorder↗
PubMed2005

Psychiatric and somatic comorbidities are negatively associated with quality of life in physically ill patients.

BACKGROUND AND OBJECTIVES: The relationship between somatic and psychiatric comorbidity in patients with somatic diseases and diverse outcome variables like mortality, costs, and duration of treatment is often examined and confirmed. In the last years, quality of life (QoL) as another important outcome variable received more attention. METHODS: The present review comprises a summary of associations between comorbidity and QoL in patients with somatic diseases. For this reason a search for somatic diseases was performed, including metabolic, respiratory tract, musculoskeletal, cardiovascular, cancer, digestive system, and general somatic diseases. Four hundred eighty-one studies were found, of which 45 fulfilled the inclusion criteria. RESULTS: Overall, there are mostly significant negative correlations between comorbidity and QoL. Predominantly, this applies to somatic-psychiatric comorbidity, which accounts for 70.3% (psychosocial aspects of QoL) to 100% (QoL in general) significantly lowered QoL results. Somatic-somatic comorbidities are primarily associated with somatic aspects of QoL (56.5-80.7% significant results), while psychosocial aspects as well as QoL in general are significantly associated in 8.3% to 71.7% of all calculations. CONCLUSION: It is of high relevance for life quality research and clinical practice to pay attention to comorbidity. Methodological shortcomings should be taken into account in future research.

Activities of Daily Living↗
PubMed2005

Psychological comorbidity in medical rehabilitation--the need for education.

PURPOSE: Prevalence of comorbid mental disorders in rehabilitation patients is high. In spite of the bio-psycho-social approach in rehabilitation, recognition and treatment rates of comorbid mental disorders during rehabilitation are low. The purpose of the study was to raise specific information about current clinical practice concerning comorbid mental disorders and training needs of rehabilitation personnel. METHOD: 435 questionnaires were sent out to medical personnel in 54 rehabilitation hospitals in south-west Germany. RESULTS: Psychologists in rehabilitation spend most of their time on counselling (45%) and group interventions (29%). Physicians and psychologists both feel highly responsible for recognizing mental disorders and motivating patients to seek aftercare. Screeners are rarely used by psychologists and physicians. Seventy-six percent of the participants would take part in specific training sessions. High training needs were stated for affective, anxiety and somatoform disorders. A specific training session for mental health in rehabilitation should last at least half a day and cover affective, anxiety and somatoform disorders. CONCLUSIONS: Taking these results into account, it is possible to put together a training program in diagnostics of comorbid mental disorders, which fits the needs of the professionals.

Comorbidity↗
PubMed2005

[Bronchial asthma and mental disorders -- a systematic review of empirical studies].

Bronchial asthma occurs independently from gender and in all age groups belonging to the frequent diseases with a high demand for treatment. A part of those affected suffer from comorbid mental burden and disorders. The review analyses studies investigating the prevalence of mental burden and disorders in patients with bronchial asthma. The database MEDLINE was searched for studies published from 1980 to 2002. Patients with bronchial asthma frequently show mood and anxiety disorders, with prevalence rates up to 41 % and 52 %. There is no significant correlation between the severity of asthma and the existence of a mental burden or disorder. However, persons with difficult-to-treat asthma (brittle asthma) show more mental burden than patients with controllable symptoms. Compliant patients show a lower prevalence rate of depressive burden than noncompliant patients. The reviewed studies are very heterogeneous with respect to their methodology and the investigated samples limiting the interpretation of their results significantly. In the future more well-designed epidemiological studies have to be performed to achieve valid and representative conclusions about the prevalence rates of mental burden and disorders in patients with bronchial asthma.

Asthma↗
PubMed2005

Adherence to guidelines for treatment of depression in in-patients.

BACKGROUND: Adherence to treatment guidelines enhances treatment outcome. However, in clinical practice many patients with depression do not receive appropriate treatment. AIMS: To evaluate the treatment of depression in in-patients of German psychiatric hospitals with respect to treatment outcome and adherence to guidelines. METHOD: We recruited 1202 in-patients with depression from ten different hospitals. Quality data concerning treatment were collected at admission, during the treatment course and at discharge. RESULTS: The level of depression was significantly decreased and most patients were satisfied with treatment. Many aspects of the treatment routine adhered to guideline recommendations. Adherence to guidelines could be improved with respect to adjustment of antidepressant dosage, reduction of benzodiazepine prescription, enhanced use of electroconvulsive therapy and wider use of interpersonal therapy. CONCLUSIONS: The study reveals a high standard of psychiatric treatment of in-patients with depression. Nevertheless there is still room for improvement. Differences between hospitals in adherence to guidelines indicates the need for individual application of quality management tools.

Adult↗
PubMed2004

Depressive symptom patterns and their consequences for diagnosis of affective disorders in cancer patients.

GOALS OF WORK: In order to obtain references for adequate diagnostic procedures of depressive syndromes in cancer patients, the present study analyzes first the prevalence of somatic, emotional, and cognitive symptoms of depression. In a second part, the ability of diagnostic procedures to discriminate between patients with and without comorbid affective disorder is investigated. PATIENTS AND METHODS: From a cross-sectional survey investigating comorbid mental disorders in cancer patients with standardized clinical assessment, a subsample of 71 patients with current affective disorders and depressive symptoms according to the Diagnostic and Statistic Manual of Mental Disorders, 4th edition (DSM-IV) were analyzed. In addition to patients' symptom patterns, a discriminant analysis including all depressive symptoms was conducted. MAIN RESULTS: Cognitive symptoms are less prevalent in cancer patients than somatic and emotional symptoms. Loss of interest discriminated best between patients with and without diagnosis of comorbid affective disorder. Additionally, decreased energy and fatigue proved to have discriminatory value. CONCLUSIONS: Cognitive symptoms should receive special attention in diagnostic procedures for affective disorders in cancer patients. In spite of possible symptom overlap with the cancer disease and its treatment, fatigue proves to be a useful criteria for diagnosis of depression.

Adult↗
PubMed2004

Recognition of psychiatric disorders in musculoskeletal and cardiovascular rehabilitation patients.

OBJECTIVE: To investigate the detection rate of psychiatric disorders in rehabilitation inpatients with musculoskeletal and cardiovascular diseases (CVDs). DESIGN: Cross-sectional survey; analysis of medical charts and discharge reports, combined with standardized diagnostic interviews. SETTING: Four orthopedic and 6 cardiovascular rehabilitation hospitals in southwest Germany. PARTICIPANTS: More than 1700 inpatients with different musculoskeletal disorders and CVDs participated in the survey. On the basis of their General Health Questionnaire score, 205 patients with musculoskeletal diseases and 164 patients with CVDs were selected randomly for standardized interviews. Discharge reports of interviewed patients were analyzed. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Clinical interview (Composite International Diagnostic Interview [CIDI]) to obtain diagnoses of psychiatric disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Assessment of psychosocial burden and diagnoses of mental disorders, as well as admission to psychologic treatments, based on discharge reports of the attending physicians. RESULTS: The detection rate (sensitivity) of mental disorders was 48% in the orthopedic rehabilitation patients and 32% in the cardiovascular patients. Specificity was 80% in musculoskeletal patients and 87% in cardiovascular patients. Differential diagnostic competencies were lacking, and only half of the physicians' diagnoses corresponded to the CIDI diagnoses. CONCLUSIONS: The results showed a need for current DSM-IV or International Classification of Diseases, 10th edition, psychodiagnostics in medical rehabilitation to detect mental disorders in patients in the rehabilitation process at an earlier stage and to refer patients with comorbid mental disorders to adequate treatment.

Adult↗
PubMed2004

Identification of somatic and anxiety symptoms which contribute to the detection of depression in primary health care.

Somatic symptoms and anxiety symptoms are often disregarded in the detection of depression in primary care. The present investigation examined to what extent somatic and anxiety symptoms recorded with the Composite International Diagnostic Interview-Primary Health Care Version (CIDI-PHC) can improve the detection of depression as compared to the General Health Questionnaire-12-item version alone. Data from the World Health Organization study on Psychological Problems in General Health Care were used. The study sample consisted of primary care attenders from 15 centres from all over the world who underwent a psychiatric examination with the CIDI-PHC. Medically unexplained somatic symptoms (back pain, feelings of heaviness/lightness in parts of the body, periods of bodily weakness, seizures/convulsions, permanent tiredness, exhaustion after a minimum of effort) and-to a smaller extent-diverse anxiety symptoms (e.g. feelings of anxiousness/nervousness, feelings of tension, difficulties relaxing) significantly contributed to the detection of depression in a logistic regression analysis. The results confirm the observation that in primary care somatic symptoms play an important role in the manifestation of depressive disorders. The items investigated herein could prove beneficial for future depression screening instruments to improve the detection of depressive disorders in primary care.

Anxiety Disorders↗
PubMed2004

[Cost of care for depressive disorders in primary and specialized care in Germany].

Service utilization and total direct cost of care was assessed in 270 patients suffering from depressive disorder. Patients were recruited from primary care physicians or family doctors (n = 43) or psychiatrists (n = 23) in office practice, from three different regions in Germany (county of Düren and city of Aachen, Lörrach-county, city of Munich). A detailed catalogue of unit costs (including inpatient, outpatient and rehabilitative services) was used for calculating total cost of care on an individual basis. Service utilization and costs referred to 2001. Mean cost of total medical care of the study patients was euro 3849 (excluding cost of drugs for physical illness). The cost for treating depressive disorders and additional psychiatric co-morbidity (which is included into the total cost of care) was euro 2073 per patient and year. When cross-checking with ICD-10 criteria for depressive disorders, the original diagnosis by family doctors or psychiatrists could be confirmed in 186 patients of the total sample (n = 270), suggesting that there is a high amount of falsely diagnosed patients in primary and specialized care of depressive patients in Germany. Direct cost of the 186 confirmed patients was higher (total care cost: euro 4715, cost for treatment of depression and psychiatric co-morbidity: euro 2541) than in the total group and should be considered as reference cost, when discussing cost of care in depressive patients in Germany. Results suggest to analyse cost of care in depressive patients further and to discuss a more efficient allocation of health budgets in the field.

Adult↗
PubMed2004

[Information and participation interests of patients with depression in clinical decision making in primary care].

A main flaw in the primary care of depression is the patients' skepticism about adequate treatment. Despite effective treatment options patients' medical demand is poor and their information insufficient. The present study aims to improve patients' information and their participation in decision making to enhance treatment motivation and satisfaction with treatment and clinical outcome. It is unclear, though, if patients are able to show interest in information and participation because of depression-specific deficits (e.g. an impairment of cognition and concentration). In a controlled study 232 patients with depression from 30 GP practices completed questionnaires assessing information and participation needs. Patients with all severity grades of depression are highly interested in information (mean = 85.2; range 0-100) and moderately interested in participating in decision making (mean = 46.8; range 0-100). Perceived involvement in care achieved a mean of 68.4 (range 0-100). The implementation of shared decision making in the primary care of depressive patients is reasonable and will be realised and evaluated within the scope of a targeted continuing education program for general practitioners.

Depression↗
PubMed2004

[Measuring shared decision making].

Since October 2001 the German Ministry of Health and Social Security has been funding 10 projects to introduce shared decision making in clinical practice. A national meeting was held on assessment procedures to achieve consensus on a core set of instruments for the measurement of process and outcome of shared decision making. Project collaboration is co-ordinated through the methodological centre in Freiburg. Currently there are no validated measuring instruments available for German-speaking countries. Thus four international questionnaires were translated into German. In a second step the questionnaires were validated on a sample of 646 patients across 10 different diseases. To this purpose, the data of these 10 projects were combined in one database. Comprehensibility of the questionnaires used was checked in patient interviews. Moreover, the semantic structure of the questionnaires was tested by the Centre for Surveys. Methods and Analyses (ZUMA) in Mannheim. The results of this assessment process point towards problems of both comprehensibility and lack of specification of reference points for clinical decision. The statistical results for two of these questionnaires deviate from previous studies. These data indicate a potential for improving the instruments currently used for shared decision making. Separate validation across different languages and health care systems is needed in the field of shared decision making. Further research efforts on the methodological field now focus on the integration of these results with a new measuring instrument and the validation of this tool.

Germany↗
PubMed2003

[Chronic diseases, psychological distress and coping -- challenges for psychosocial care in medicine].

Due to the increase of chronic diseases within the last decades the need and demand for psychosocial treatment in medicine has been realized. This review focuses on the psychosocial aspects of chronic diseases and discusses selected topics of medical and rehabilitation psychology. Recent developments in quantitative and qualitative methods have allowed the systematic analysis of psychosocial distress and coping with chronic disease as well as the consequences on social relationships. The need for psychosocial treatment in acute care and rehabilitation can be diagnosed by differential assessment tools for coping and psychiatric morbidity. Specific approaches of psychology and psychotherapy for patients with somatic diseases have been developed and may be regarded as an integrative part of medical treatment in acute care and rehabilitation. In rehabilitation, the traditional individualistic view of psychotherapy has been broadened towards vocational integration and participation in social activities as outcome criteria. Evaluation research as well as the rehabilitation sciences have provided empirical data on psychosocial treatment of chronically ill patients. Under increasing financial restrictions and problems of the health care systems there is a need for quality assurance and the proof of scientific evidence to guarantee psychosocial treatment as an integrated part of medical care in the future.

Adaptation, Psychological↗
PubMed2003

[Comprehensive ambulatory care quality management for patients with depressive disorders].

Depressive disorders are of great medical and political significance. Despite improvements in the treatment of depressive patients, the potential for guideline-oriented diagnosis and therapy as well as better co-operation between different levels of care is evident. This study is part of the German Research Network on Depression and Suicidality. The study is conducted in Southern Baden, North Rhine and Munich. The objective is to develop a quality management program for primary care physicians and psychiatrists. A comprehensive continuous medical education concept as well as quality management measures were developed, implemented and evaluated. A total of 66 physicians (43 primary care physicians and 23 psychiatrists) participated. They documented the diagnostic and treatment measures provided to depressive patients before and after the intervention that had been implemented in the intervention regions of Southern Baden and North Rhine. Effects regarding guideline orientation and implementation of stepped-care treatment are analysed with an intervention/control group design and prepost data measurement.

Ambulatory Care↗
PubMed2003

[Clinical practice guidelines for the diagnosis and therapy of depressive disorders in primary care].

The guidelines for diagnosis and treatment of depressive disorders are practice-oriented and evidence-based recommendations for primary care of depressive patients. They were developed in the context of subproject 3.1 "Comprehensive Quality Management in Outpatient Care" within the German Research Network on Depression and Suicidality. The guidelines were developed by research groups from study centres in Freiburg, Duesseldorf and Munich and an external expert group. In addition, a close co-operation was established with the Guideline Clearing Commission of the Agency for Quality in Medicine (AQuMed) and the Drug Commission of the German Medical Profession (AkdA) and are intended as an orientational aid in terms of a "pathway of care". The guidelines particularly address physicians in primary care. The development process followed the methodological recommendations of the Association of the Scientific Medical Societies in Germany (AWMF) and the requirements of evidence-based medicine. National and international guidelines for depressive disorders as well as Cochrane reviews (CR) and quality-assessed reviews (CRD) were taken into account. The present formulation of the treatment guidelines and the evidence was agreed upon in a consensus process that included all participants.

Depressive Disorder↗
PubMed2003

[Development and evaluation of a basic documentation tool for guideline-oriented ambulatory care of depressive patients].

Quality assurance in the treatment of mental disorders is becoming increasingly significant. In this context, documentation systems are important in order to control the implementation of guidelines, to analyse shortcomings and to reveal improvement possibilities. Up till now there is no specific documentation tool for the outpatient care of depressive disorders. Within the project "Comprehensive Quality Management in Out-patient Care" a documentation tool for primary care as well as for psychiatric care of depressive patients has been developed, which embraces the principal diagnostic and therapeutic measures. This documentation tool consisting of an instrument for the physician to record the first consultation, a second instrument to record the following consultations as well as a patient questionnaire has been implemented and evaluated in primary care and psychiatric practices. The evaluation results demonstrate that the documentation tool is able to assess guideline-oriented treatment measures. Physicians evaluated the usefulness and practicability of the documentation tool positively. And although the documentation efforts required are quite extensive, this documentation tool provides a suitable basis for external or internal quality assurance as well as patient-oriented case-monitoring.

Ambulatory Care↗