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Subprojekt 2.3

Subprojekt 2.3. Prevention of Chronification in Patients with Depression and Somatoform Disorders Winfried Rief Philipps University, Marburg. Final Presentation, 06/10/03. E. Rauh A. Nanke W. Rief. N. Baltruschat S. Pausch E. Geissner M. Fichter. Study centers. Marburg.

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Subprojekt 2.3

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  1. Subprojekt 2.3 Prevention of Chronification in Patients with Depression and Somatoform Disorders Winfried Rief Philipps University, Marburg Final Presentation, 06/10/03

  2. E. Rauh A. Nanke W. Rief N. Baltruschat S. Pausch E. Geissner M. Fichter Study centers Marburg Prien/Chiemsee

  3. Subprojekt 2.3 • The aims of the study were: • Analysis of predictors of outcome in patients with unexplained physical symptoms (SFD) and comorbid depression in Primary Care • Development of a brief intervention which is feasible with Primary Care needs • Evaluation of this intervention • Development of Primary Care networks Final Presentation, 06/10/03

  4. Design Aquisition of 200 patients in GP offices Subprojekt 2.3 Initial assessment Randomization Brief Intervention N = 100 Standard Medical Care N = 100 4 weeks later: 2nd assessment 6 months later: 3rd assessment Final Presentation, 06/10/03

  5. Start 4 weeks later 6 months later Prien Intervention 70 57 56 Control 17 12 10 Marburg Intervention 74 61 60 Control 66 62 56 Total 227 192 (85%) 182 (80%) Subprojekt 2.3 Completers Final Presentation, 06/10/03

  6. 77,7 % female; Mean age: 48 years no. of doctor visits (last 6 months): 16 no. of doctor visits without psychiatrists/psychotherapists (last 6 months): 14 BDI 16.0 no. of somatoform symptoms (Interview): 11 Time since onset of unexplained physical symptoms (first symptoms): 10 years Sample Characteristics Subprojekt 2.3 Final Presentation, 06/10/03

  7. Consumer Satisfaction:Patient ratings of intervention (n = 106) - „confirmed mostly/ completely“ -

  8. Hypochondriasis WI (all data; interaction p<0.01)

  9. Somatization SCL (all data; interaction p<0.02)

  10. General Psychopathology SCL (all data; interaction p<0.05)

  11. Somatization SCL (only Marburg data; interaction p<0.02)

  12. Doctor Visits (non-psychiatrists; only Marburg data; p<0.09)

  13. Linear regression analysis (difference scores;T1-T3, criterium: SOMS) Somatization SOMS (T1); β = 0.70; p<.001 Depression BDI (T1); β = -.42; p<.001 Hypochondriasis WI (T1); β = -.25; p<.006 (Psychological illness attributions; β = .15; p<.10) Prediction of Improvement Subprojekt 2.3 Final Presentation, 06/10/03

  14. Analysis of specific aspects of health care use (c.f., detailed interview on investigations, treatments, pharmaceutics etc.) Short-term versus long-term effects (Preliminary analyses: Improvements develop slowly) Responders versus non-responders; development of indication rules Cross-sectional analyses (e.g., >100 blood samples for genetic and other tests) Problem: Sample with persisting symptoms; high user; severely disabled Next Steps Subprojekt 2.3 Final Presentation, 06/10/03

  15. Significant improvements of participants of the one-session intervention This intervention could become an important tool to improve the ineffective health care use of these patients For a broader, long-lasting effect, it would be necessary to -> train GPs in the use of our minimal intervention -> define ways for compensation of GPs doing this intervention (e.g., „Modellprojekt“ of the health care insurances) Conclusions Subprojekt 2.3 Final Presentation, 06/10/03

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