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Biomedical subjects

Peter de Jonge

Publications and source records attributed to Peter de Jonge.

At least 19 recordsLinked to original sources
PubMed2006

Only incident depressive episodes after myocardial infarction are associated with new cardiovascular events.

OBJECTIVES: The purpose of this research was to study whether incident and non-incident depression after myocardial infarction (MI) are differentially associated with prospective fatal and non-fatal cardiovascular events. BACKGROUND: Post-MI depression is defined as the presence of depression after MI. However, only about one-half of post-MI depressions represent an incident episode, whereas the other half are ongoing or recurrent depressions. We investigated whether these subtypes differ in cardiovascular prognosis. METHODS: A total of 468 MI patients were assessed for the presence of an International Classification of Diseases-10 depressive disorder during the year after index MI. A comparison was made on new cardiovascular events (mean follow up: 2.5 years) between patients with no, incident, and non-incident post-MI depression by survival analysis. RESULTS: Compared with non-depressed patients, those with an incident depression had an increased risk of cardiovascular events (hazard ratio [HR] 1.65; 95% confidence interval [CI] 1.02 to 2.65), but not those with a non-incident depression (HR 1.12; 95% CI 0.61 to 2.06), which remained after controlling for confounders (HR 1.76; 95% CI 1.06 to 2.93 and HR 1.39; 95% CI 0.74 to 2.61, respectively). CONCLUSIONS: Only patients with incident post-MI depression have an impaired cardiovascular prognosis. A more detailed subtyping of post-MI depression is needed, based on an integration of recent findings on the differential impact of depression symptom profiles and personality on cardiac outcomes.

Cardiovascular Diseases↗
PubMed2006

Beta-blockers and depression after myocardial infarction: a multicenter prospective study.

OBJECTIVES: The purpose of this research was to explore the prospective relationship between the use of beta-blockers and depression in myocardial infarction (MI) patients. BACKGROUND: Beta-blocker use has been reported to be associated with the development of depression, but the methodological quality of studies in this field is weak. METHODS: In a multicenter study, MI patients (n = 127 non-beta-blocker users and n = 254 beta-blocker users) were assessed for depressive symptoms (using the Beck Depression Inventory [BDI] at baseline and t = 3, 6, and 12 months post-MI) and International Classification of Diseases-10 depressive disorder (Composite International Diagnostic Interview). Patients were matched using the frequency matching procedure according to age, gender, hospital of admission, presence of baseline depressive symptoms, and left ventricular function. RESULTS: No significant differences were found between non-beta-blocker users and beta-blocker users on the presence of depressive symptoms (p > 0.10 at any of the time points) or depressive disorder (p = 0.86). Controlling for confounders did not alter these findings. A trend toward increasing BDI scores was seen in patients with long-term use of beta-blockers and patients with higher beta-blocker dose. CONCLUSIONS: In post-MI patients, prescription of beta-blockers is not associated with an increase in depressive symptoms or depressive disorders in the first year after MI. However, long-term and high-dosage effects cannot be ruled out.

Adrenergic beta-Antagonists↗
PubMed2006

Course of depressive symptoms after myocardial infarction and cardiac prognosis: a latent class analysis.

OBJECTIVE: The presence of depressive symptoms after myocardial infarction (MI) is a risk factor for new cardiovascular events. The importance of the course of post-MI depressive symptoms for cardiac prognosis is not clear. We therefore set out to investigate whether different courses of post-MI depressive symptoms can be identified and determine their associations with cardiac events. METHODS: Data were derived from the Depression after Myocardial Infarction (DepreMI) study, a naturalistic follow-up study of patients admitted for an MI in four hospitals in The Netherlands (N = 475). Scores on the Beck Depression Inventory (BDI) during hospitalization and at 3, 6, and 12 months post-MI were analyzed. Using latent class analysis (LCA), we identified classes characterized by distinctive courses of depressive symptoms and then examined their link to cardiac prognosis. RESULTS: The prevalence of significant depressive symptoms ranged from 22.7% to 25.5% throughout the post-MI year. Five distinct courses were found: no depressive symptoms (56.4%), mild depressive symptoms (25.7%), moderate and increasing depressive symptoms (9.3%), significant but decreasing depressive symptoms (4.6%), and significant and increasing depressive symptoms (4.0%). Subjects in this last class had, statistically, a significantly higher risk for a new cardiovascular event compared with subjects without depressive symptoms (hazard ratio (HR) = 2.73; p = .01). Controlling for baseline cardiac status and sociodemographic data did not alter the association (HR = 2.46; p = .03). CONCLUSIONS: Post-MI depressed subjects with significant and increasing depressive symptoms are at particular risk of new cardiac events. This subgroup may be most suited for evaluation of the effects of antidepressant treatment on cardiac prognosis.

Activities of Daily Living↗
PubMed2006

Major depressive episodes and random mood.

CONTEXT: Mathematical models describing changes in mood in affective disorders may assist in the identification of underlying pathologic and neurobiologic mechanisms and in differentiating between alternative interpretations of psychiatric data. OBJECTIVE: Using time-to-event data from a large epidemiologic survey on recovery from major depression, to model the survival probability, in terms of an underlying process, with parameters which might be recognized and influenced in clinical practice. DESIGN: We present a sequential-phase model for survival analysis, which describes depression as a state with or without an additional incubation phase. Recovery is seen as the transition to a nondepressive state. We show that this sequential-phase model finds a microscopic realization in a dynamic description, the random-mood model, which depicts mood as governed by an Ornstein-Uhlenbeck type of stochastic process, driven by intermittent gaussian noise. RESULTS: For reversible depression (80%), the fractional probability of recovery is remarkably independent of the history of the depression. Analysis with the sequential-phase model suggests single exponential decay in this group, possibly with a short incubation phase. Within the random-mood model, the data for this reversibly depressed cohort are compatible with an intermittent noise pattern of stimuli with average spacing of 4 months and incompatible with nonintermittent noise. CONCLUSIONS: Time-to-event data from psychiatric epidemiologic studies can be conceptualized through modeling as intrasubject processes. The proposed random-mood model reproduces the time-to-event data and explains the incubation phase as an artifact due to the inclusion criterion of 14 days in most current psychiatric diagnostic systems. Depression is found to result more often from pileup of negative stimuli than from single life events. Time sequences, generated using the random-mood model, produce power plots, phase-space trajectories, and pair-correlation sums, similar to recent results for individual patients. This suggests possible clinical relevance along with the model's use as a tool in survival analysis.

Affect↗
PubMed2006

Decreased impact of post-myocardial infarction depression on cardiac prognosis?

OBJECTIVE: A recent meta-analysis suggests that the impact of post-myocardial infarction (MI) depression on cardiac prognosis has decreased over the last decade. We tested whether depression still significantly affects prognosis in the present health care situation. METHODS: Four hundred ninety-four MI patients were screened for depression. Patients with depression were compared with patients without on cardiovascular events (fatal or nonfatal) during an average follow-up of 2.5 years. Demographic characteristics and cardiac risk factors were controlled for. RESULTS: We found that depression was associated with the occurrence of cardiovascular events in both univariate [hazard ratio (HR), 1.84; 95% confidence interval, 1.24-2.72] and multivariate analysis (HR, 1.56; 1.02-2.38). CONCLUSIONS: Depression still has an independent impact on cardiac prognosis after MI, but this influence is smaller than found in early studies. Improvements in general care for MI and better recognition and treatment of post-MI depression may have decreased the impact of depression on prognosis.

Major Depressive Disorder↗
PubMed2006

Case and care complexity in the medically ill.

The authors have argued that complexity in general health care is increasingly prevalent because of the increase in patients who have multimorbid conditions, and the increased professional and technical possibilities of medicine. In the increasingly complex care systems, it is necessary-specifically when treating patients in need of integrated care by several providers-that an optimal match between case and care complexity be found in order to prevent poor outcomes in this vulnerable group. The authors discussed several approaches to case complexity that can be identified in the literature. Most of them seem unsuitable for adjusting case and care complexity, and inadequate for designing multidisciplinary care. Theoretic approaches to case complexity may be of interest, but did not result in clinically meaningful information. The INTERMED, which can be considered the first empirically based instrument to link case and care complexity, is an attempt to improve care delivery and outcomes for the complex medically ill.

Cardiovascular Diseases↗
PubMed2006

Identifiers, or "red flags," of complexity and need for integrated care.

Because complex medical patients are a subgroup of the medical population and because complexity assessment involves extra effort, preselection of these patients through identifiers is necessary. There is no best identifier for complexity, and the one most suitable for the population served should be selected. This article provides a table with potential identifiers and discusses the difference between disease-oriented screening and treatment and a more generic approach such as complexity screening and complexity management.

Decision Support Systems, Clinical↗
PubMed2006

Operationalizing integrated care on a clinical level: the INTERMED project.

During the last 10 years the INTERMED method has been developed as a generic method for the assessment of bio-psychosocial health risks and health needs and for planning of integrated treatment. The INTERMED has been conceptualized to counteract divisions and fragmentation of medical care. Designed to enhance the communication between patients and the health providers as well as between different professions and disciplines, the INTERMED is a visualized, action-oriented decision-support tool. This article presents various aspects of the INTERMED, such as its relevance, description, scoring, the related patient interview and treatment planning, scientific evaluation, implementation, and support for the method.

Decision Support Systems, Clinical↗
PubMed2006

Symptom dimensions of depression following myocardial infarction and their relationship with somatic health status and cardiovascular prognosis.

OBJECTIVE: The reporting of depressive symptoms following myocardial infarction may be confounded by complaints originating from the myocardial infarction. Therefore, it is difficult to estimate the effects of post-myocardial infarction depression and its treatment on cardiovascular prognosis. The authors' goal was to study the relationship between depressive symptom dimensions following myocardial infarction and both somatic health status and prospective cardiovascular prognosis. METHOD: In two studies of myocardial infarction patients (N=494 and 1,972), the Beck Depression Inventory was used to determine the dimensional structure of depressive symptoms following myocardial infarction. Three symptom dimensions-somatic/affective, cognitive/affective, and appetitive-were compared with baseline left ventricular ejection fraction, Charlson comorbidity index, Killip class, and previous myocardial infarction. The relationship between depressive symptom dimensions and prospective cardiovascular mortality and cardiac-related readmissions was also examined (mean follow-up duration=2.5 years). RESULTS: Somatic/affective symptoms were associated with poor health status (left ventricular ejection fraction, Charlson comorbidity index, Killip class, and previous myocardial infarction) and predicted cardiovascular mortality and cardiac events. Cognitive/affective symptoms were only marginally associated with somatic health status and not with cardiovascular death and cardiac events. Appetitive symptoms were related to somatic health status but did not predict cardiovascular death or cardiac events. CONCLUSIONS: Somatic/affective depressive symptoms following myocardial infarction were confounded by somatic health status yet were prospectively associated with cardiac prognosis even after somatic health status was controlled. Cognitive/affective depressive symptoms were only marginally related to health status and not to cardiac prognosis. These findings suggest that treatment of depression following myocardial infarction might improve cardiovascular prognosis when it reduces somatic/affective symptoms.

Cause of Death↗
PubMed2006

Treatment of depression in acute coronary syndromes with selective serotonin reuptake inhibitors.

Depression in patients with acute coronary syndromes (ACS) is common and associated with impaired cardiovascular prognosis in terms of cardiac mortality and new cardiovascular events. It remains unclear whether antidepressant treatment may reverse these effects. In this review, the literature is evaluated on (i) the antidepressant efficacy of selective serotonin reuptake inhibitors (SSRIs) for depression in patients with ACS; (ii) the pleiomorphic effects of SSRIs that may be associated with cardiovascular prognosis; and (iii) the effects of SSRIs on cardiovascular prognosis.SSRIs provide modest relief of depressive symptoms in selected subgroups of depressed patients with ACS. With respect to the pleiomorphic effects of SSRIs, three mechanisms of how SSRIs may improve cardiovascular prognosis are discussed: via platelet function, via the autonomic nervous system (ANS) and via vasomotor tone. Some studies show that SSRIs may reduce platelet activity and sympathetic nervous system activation, but results are inconclusive. SSRIs are associated with vasodilation but this needs to be confirmed with in vivo experiments. Some non-experimental studies describe favourable effects of SSRIs on cardiovascular prognosis. Despite recent developments, much of the effect of SSRIs on cardiovascular prognosis remains unclear. Although some studies suggest effects of SSRIs on platelet function, ANS and vasomotor tone, which may lead to improved cardiovascular prognosis, results are largely inconclusive. More well designed studies addressing these questions are needed. Moreover, since the effects of SSRIs on depression itself are limited, efforts should be dedicated to study the diagnostic validity and homogeneity of depression in the context of ACS and the presence of clinically relevant subtypes.

Acute Disease↗
PubMed2005

Relationship between left ventricular dysfunction and depression following myocardial infarction: data from the MIND-IT.

AIMS: Depression in patients following myocardial infarction (MI) is associated with an increased risk of mortality, but this association may be confounded by cardiac disease severity. We explored the relationship between left ventricular ejection fraction (LVEF) and depression in MI patients. METHODS AND RESULTS: In the Myocardial Infarction and Depression-Intervention Trial (MIND-IT), 1989 MI patients were assessed for depressive symptoms [Beck Depression Inventory (BDI) t = 0, 3, 6, 9, and 12 months post-MI]. Patients with BDI score > or =10 were assessed for the presence of International Classification of Diseases, 10th revision (ICD-10) depressive disorder (t = 3, 6, 9, and 12 months post-MI). Patients were divided into categories according to their LVEF during hospitalization, i.e. LVEF <30%, LVEF 30-45%, LVEF 45-60%, and LVEF > or = 60%. During hospitalization, presence of depressive symptoms was higher in patients with LV dysfunction. A relationship was found between LVEF and ICD-10 depressive disorder, i.e. a lower LVEF was associated with a higher rate of depression from 3-12 months post-MI (P < 0.01). Levels of LVEF inversely correlated with the BDI score at 3 months post-MI. Associations persisted after adjustment for demographics, risk factors for coronary artery disease, co-morbidity, Killip class, and baseline BDI score. CONCLUSION: In MI patients, the rate of depression and the severity of depressive symptoms are significantly related to the severity of LV dysfunction. The association between depression and LV dysfunction must be acknowledged when evaluating the prognostic effects of depression in cardiac patients.

Depressive Disorder↗
PubMed2005

Prediction of depressive disorder following myocardial infarction data from the Myocardial INfarction and Depression-Intervention Trial (MIND-IT).

BACKGROUND: Depression following myocardial infarction (MI) is associated with complicated cardiac rehabilitation, non-compliance and poor prognosis. Whether depression following MI can be predicted from variables routinely assessed during hospitalization for MI is unknown. METHODS: Using data from the Myocardial INfarction and Depression-Intervention Trial (MIND-IT), we identified 2,177 MI patients (mean age 63 years; 23% female). Patients were randomly divided into a derivation and a validation sample. In the derivation sample, we analyzed variables potentially associated with the development of post-MI depressive disorder, which were tested in the validation sample. RESULTS: In the year following MI, 18.5% suffered from depressive disorder (ICD-10 criteria). In a multivariate model, factors associated with depression were younger age (OR 1.94; CI 1.38-2.74), hypercholesterolemia (OR 1.68; CI 1.08-2.61), the use of calcium channel blockers at discharge (OR 1.80; CI 1.20-2.71), and left ventricular ejection fraction (LVEF) (OR 4.14 for patients with LVEF <30%; CI (2.42-7.10). The derived predictors were tested in the validation sample. The final model yielded two clinical predictors, i.e., younger age and severe LV-dysfunction, which correctly predicted post-discharge depression status in 82.9% of the MI patients. The model yielded a high negative predictive value (89%). A positive depression questionnaire (BDI) during hospitalization increased the positive predictive value of 23% to 52%. CONCLUSIONS: During hospitalization for MI and using a two-step strategy with common clinical variables, i.e., younger age, severe LV-dysfunction and BDI score during hospitalization, it is possible to identify MI patients with a high risk for subsequent development of depression.

Adult↗
PubMed2005

The effects of teaching medical professionalism by means of vignettes: an exploratory study.

The purpose of this study is (1) to evaluate whether an educational program for preclinical students has an effect on the knowledge of professional behaviour for clerks and (2) to study how preclinical students compare with advanced clinical students concerning this knowledge. The authors used an observer-rated test consisting of vignettes describing a dilemma concerning professional behaviour. Students' description of proposed behaviour was scored in one of three categories: unacceptable, acceptable or excellent. Preclinical students were compared with clinical students and the effect of an educational session on student scores on this test was assessed. The educational programme had a positive effect on student scores. However, the knowledge of professional behaviour did not generalize to situations that had not been the explicit topic of the session. A difference was found between preclinical and clinical students in two of the four vignettes: in one vignette clinical students had better scores, in another vignette they had worse scores. It is concluded that the educational programme had a positive effect on student knowledge of professional behaviour but there was no generalization. For more generic rules to sink in, probably many cases need to be discussed, with explicit attention paid to the rationales of these rules. Students who were advanced in their clerkships held different views on professional behaviour compared with preclinical students, possibly due to a socialization process.

Anecdotes as Topic↗
PubMed2005

Operationalization of biopsychosocial case complexity in general health care: the INTERMED project.

OBJECTIVE: Lack of operationalization of the biopsychosocial model hinders its effective application to the increasingly prevalent problems of comorbidities in clinical presentations. Here, we describe the INTERMED, an instrument to assess biopsychosocial case complexity in general health care, and provide an overview of its psychometric evaluation. METHOD: Review and summary of our publications to date, and re-analysis of findings. RESULTS: The INTERMED has face-validity, is brief and easy to use, and several research reports support its reliability and validity. It has the capacity to detect patients at risk for poor clinical outcome and quality of life. CONCLUSIONS: The INTERMED project is relevant to various agents involved in the care process. It provides a basis for effective multidisciplinary treatment of patients with a high case complexity.

Comorbidity↗
PubMed2003

A simple risk score predicts poor quality of life and non-survival at 1 year follow-up in dialysis patients.

BACKGROUND: Quality of life (QoL) in end-stage renal disease patients has become an important focus of attention in evaluating dialysis. We studied risk factors of poor QoL at 1 year follow-up. METHODS: Of a baseline sample of 80 dialysis patients, we contacted 60 patients who were alive at 1 year follow-up. QoL data were obtained for 46 (76.7%) of these patients. QoL measured with the SF-36 [physical health component score (PCS) and mental health component score (MCS)] at 1 year-follow-up was predicted by means of multivariate regression analysis by data collected at baseline using INTERMED-an observer-rated method to assess biopsychosocial care needs-and several indicators for disease severity and comorbidity. RESULTS: The regression models explained 32% of the variance in PCS and 40% in MCS. INTERMED score (P < 0.01) was the only independent risk factor for low MCS, while for low PCS, diabetic comorbidity (P = 0.02) and age (P = 0.03) were independent risk factors. A simple risk score consisting of INTERMED > or =21, diabetic comorbidity and age > or =65 was significantly correlated with non-survival (P = 0.02) and with PCS (P < 0.01) and MCS (P < 0.01) in surviving patients, although not with hospital admissions during follow-up. CONCLUSIONS: A simple risk score based on INTERMED, age (> or =65) and comorbid diabetes (yes/no) can be used to detect patients at risk of poor QoL and non-survival at an early stage of treatment.

Adolescent↗
PubMed2002

Interrater reliability of the INTERMED in a heterogeneous somatic population.

The INTERMED has been developed to score biopsychosocial case complexity and care needs. In this study, the interrater reliability of the INTERMED was assessed by calculating the agreement of two independent raters, based on the same information. Forty-three in- and outpatients with varying somatic complaints were double scored by a psychologist and a psychiatric C-L nurse. Correlations between total scores of the two raters were ranging from 0.91-0.96. On item level, in 83% there were no differences between the raters, in 16% there was a 1-point difference and in 1% a 2-point difference. Based on a cut-off score of 20/21, a constant k of 0.85 was found. We concluded that the two experienced raters had a high agreement, and that after sufficient training the INTERMED can be reliably scored. Its utility in improving health care delivery for patients with complex biopsychosocial care needs still has to be demonstrated.

Adolescent↗