ObjectivesEarly identification of patients with major depressive disorder (MDD) that cannot be managed by secondary mental health services and who require highly specialized mental healthcare could enhance need-based patient stratification. This, in turn, may reduce the number of treatment steps needed to achieve and sustain an adequate treatment response. The development of a valid tool to identify patients with MDD in need of highly specialized care is hampered by the lack of a comprehensive understanding of indicators that distinguish patients with and without a need for highly specialized MDD care. The aim of this study, therefore, was to systematically review studies on indicators of patients with MDD likely in need of highly specialized care.MethodsA structured literature search was performed on the PubMed and PsycINFO databases following PRISMA guidelines. Two reviewers independently assessed study eligibility and determined the quality of the identified studies. Three reviewers independently executed data extraction by using a pre-piloted, standardized extraction form. The resulting indicators were grouped by topical similarity, creating a concise summary of the findings.ResultsThe systematic search of all databases yielded a total of 7,360 references, of which sixteen were eligible for inclusion. The sixteen papers yielded a total of 48 unique indicators. Overall, a more pronounced depression severity, a younger age of onset, a history of prior poor treatment response, psychiatric comorbidity, somatic comorbidity, childhood trauma, psychosocial impairment, older age, and a socioeconomically disadvantaged status were found to be associated with proxies of need for highly specialized MDD care.ConclusionsSeveral indicators are associated with the need for highly specialized MDD care. These indicators provide easily measurable factors that may serve as a starting point for the development of a valid tool to identify patients with MDD in need of highly specialized care.

Health problems may cause decreased productivity among working people. It is unclear if this also applies for people living with HIV (PLWH). This cross-sectional study compares data of PLWH of one of the main HIV treatment centres in the Netherlands (n = 298) to data of the general working population from a previously conducted study (n = 986). We investigate whether productivity at work differs between these groups. The questionnaires used in these studies contained a core of identical questions regarding productivity losses, in the form of absenteeism and presenteeism, over a four-week period and a variety of baseline characteristics, including health status measured with EQ-5D. For PLWH additional clinical data were collected from patient records. From the data, descriptive statistics were computed to characterize the samples. Pearson correlations were used to explore significant associations of productivity with baseline characteristics. A two-part model was used to evaluate both the occurrence and of size of productivity losses in working PLWH and an aggregated sample of PLWH and the general population. It was observed that, on average, total productivity losses do not differ significantly between working PWLH and the general working population, but that the occurrence and size of absenteeism and presenteeism were different. Furthermore, more health problems were associated with higher productivity losses. HIV status was not significantly associated with productivity losses. We conclude that among working people, health status was related to productivity losses but HIV status was not. However, further research is needed into the relation between HIV status and unemployment.

A529ants (from 1 in Turkey to 30 in Switzerland), costs spent for mental health (% from healthcare) also differ significantly from 2 % (Bulgaria) to almost 14 % (UK). Average European costs for pharmacotherapy (ATC groups N3-N7) is 25 Euro/capita (2013 data); from 6 € in Russia to 57 € in Switzerland. Since 2009 the penetration of atypical antipsychotics steadily increases across Europe from 48 % among all antipsychotics (2009) to 56 % (2013). We however found differences in individual countries (46 % penetration in Slovenia; 69 % penetration in Hungary). The average annual European consumption of antidepressants is 18 units per capita (2 units in Russia; 42 units in the UK). SSRIs represent approximately 50 % of all antidepressants in the majority of countries. Penetration of pharmacotherapy for dementia (ATC group N7D1) is poor across Europe except Finland and Greece. In almost all countries it is below 50 % if a hypothetical common prevalence of 1.17 % is assumed. ConClusions: Our findings indicate unequal access, treatment penetration and allocation of financial resources across 29 evaluated European countries.

Background Early identification of patients with an anxiety disorder, obsessive-compulsive disorder (OCD), or post-traumatic stress disorder (PTSD) in need of highly specialized care could facilitate the selection of the optimal initial treatment in these patients. This paper describes the development and psychometric evaluation of the Decision Tool Anxiety Disorders, OCD and PTSD (DTAOP), which aims to aid clinicians in the early identification of patients with an anxiety disorder, OCD, or PTSD in need of highly specialized mental healthcare. Methods A systematic literature review and a concept mapping procedure were carried out to inform the development of the DTAOP. To evaluate the psychometric properties of the DTAOP, a cross-sectional study in 454 patients with a DSM-IV-TR anxiety disorder was carried out. Feasibility was evaluated by the completion time and the content clarity of the DTAOP. Inter-rater reliability was assessed in a subsample of 87 patients. Spearman’s rank correlation coefficients between the DTAOP and EuroQol five-dimensional questionnaire (EQ-5D-5L) scores were computed to examine the convergent validity. Criterion validity was assessed against independent clinical judgments made by clinicians. Results The average time required to complete the eight-item DTAOP was 4.6 min and the total DTAOP was evaluated as clear in the majority (93%) of the evaluations. Krippendorff’s alpha estimates ranged from 0.427 to 0.839. Based on the qualitative feedback, item wording and instructions were improved. As hypothesized, the DTAOP correlated negatively with EQ-5D-5L scores. The area under the curve was 0.826 and the cut-off score of ≥4 optimized sensitivity (70%) and specificity (71%). Conclusions The DTAOP demonstrated excellent feasibility and good validity, but weak inter-rater reliability. Based on the qualitative feedback and reliability estimates, revisions and refinements of the wording and instructions were made, resulting in the final version of the DTAOP.

A529ants (from 1 in Turkey to 30 in Switzerland), costs spent for mental health (% from healthcare) also differ significantly from 2 % (Bulgaria) to almost 14 % (UK). Average European costs for pharmacotherapy (ATC groups N3-N7) is 25 Euro/capita (2013 data); from 6 € in Russia to 57 € in Switzerland. Since 2009 the penetration of atypical antipsychotics steadily increases across Europe from 48 % among all antipsychotics (2009) to 56 % (2013). We however found differences in individual countries (46 % penetration in Slovenia; 69 % penetration in Hungary). The average annual European consumption of antidepressants is 18 units per capita (2 units in Russia; 42 units in the UK). SSRIs represent approximately 50 % of all antidepressants in the majority of countries. Penetration of pharmacotherapy for dementia (ATC group N7D1) is poor across Europe except Finland and Greece. In almost all countries it is below 50 % if a hypothetical common prevalence of 1.17 % is assumed. ConClusions: Our findings indicate unequal access, treatment penetration and allocation of financial resources across 29 evaluated European countries.