Collaborative care for panic disorder, generalised anxiety disorder and social phobia in general practice: study protocol for three cluster-randomised, superiority trials

Nadja Kehler Curth, Ursula Ødum Brinck-Claussen, Annette Sofie Davidsen, Marianne Engelbrecht Lau, Merete Lundsteen, John Hagel Mikkelsen, Claudio Csillag, Carsten Hjorthøj, Merete Nordentoft, Lene Falgaard Eplov, Nadja Kehler Curth, Ursula Ødum Brinck-Claussen, Annette Sofie Davidsen, Marianne Engelbrecht Lau, Merete Lundsteen, John Hagel Mikkelsen, Claudio Csillag, Carsten Hjorthøj, Merete Nordentoft, Lene Falgaard Eplov

Abstract

Background: People with anxiety disorders represent a significant part of a general practitioner's patient population. However, there are organisational obstacles for optimal treatment, such as a lack of coordination of illness management and limited access to evidence-based treatment such as cognitive behavioral therapy. A limited number of studies suggest that collaborative care has a positive effect on symptoms for people with anxiety disorders. However, most studies are carried out in the USA and none have reported results for social phobia or generalised anxiety disorder separately. Thus, there is a need for studies carried out in different settings for specific anxiety populations. A Danish model for collaborative care (the Collabri model) has been developed for people diagnosed with depression or anxiety disorders. The model is evaluated through four trials, of which three will be outlined in this protocol and focus on panic disorder, generalised anxiety disorder and social phobia. The aim is to investigate whether treatment according to the Collabri model has a better effect than usual treatment on symptoms when provided to people with anxiety disorders.

Methods: Three cluster-randomised, clinical superiority trials are set up to investigate treatment according to the Collabri model for collaborative care compared to treatment-as-usual for 364 patients diagnosed with panic disorder, generalised anxiety disorder and social phobia, respectively (total n = 1092). Patients are recruited from general practices located in the Capital Region of Denmark. For all trials, the primary outcome is anxiety symptoms (Beck Anxiety Inventory (BAI)) 6 months after baseline. Secondary outcomes include BAI after 15 months, depression symptoms (Beck Depression Inventory) after 6 months, level of psychosocial functioning (Global Assessment of Functioning) and general psychological symptoms (Symptom Checklist-90-R) after 6 and 15 months.

Discussion: Results will add to the limited pool of information about collaborative care for patients with anxiety disorders. To our knowledge, these will be the first carried out in a Danish context and the first to report results for generalised anxiety and social phobia separately. If the trials show positive results, they could contribute to the improvement of future treatment of anxiety disorders.

Trial registration: ClinicalTrials.gov, ID: NCT02678624 . Retrospectively registered 7 February 2016; last updated 15 August 2016.

Keywords: Anxiety disorders; Cluster-randomised trial; Collaborative care; General practice; Generalised anxiety disorder; Panic disorder; Shared care; Social phobia.

Conflict of interest statement

Ethics approval and consent to participate

The trials will be conducted in compliance with this protocol, the Helsinki Declaration, Good Clinical Practice guidelines and following the rules for informed consent.

Electronically stored data will be kept in entry-restricted files and other data will be stored in sealed cupboards. Personally identifiable data will be treated according to the Danish law on the handling of personal information (in Danish ‘Lov om behandling af personoplysninger’).

The GP obtains the patients’ consent to participation, which is based on verbal information and written material. Written declarations of consent must be signed, and the participants will receive a copy. Participants will be informed of their rights to exit the study at any point and without consequences for their future treatment. If they withdraw from the study they can specify how their data are used.

The authors of this protocol are not aware of previous trials reporting any risks or adverse events of collaborative care. In order to minimise the possible risks of discomfort during interviews these will be conducted in a flexible manner with breaks if necessary. If any of the participants present acute suicidal ideation during interviews, the assessor will consult a clinician or contact the emergency services if necessary. There are currently no known circumstances that can lead to exclusion from participation once a patient is included. If such circumstances arise, the participant will be notified.

The trial protocol has been evaluated and approved by the Regional Ethics Committees of the Capital Region (identification no: H-3-2013-203). It is also approved by the Danish College of General Practitioners’ Multi Practices Committee, the Danish Data Protection Agency (journal no: 2007-58-0015, local journal no: RHP-2014-012) and has been registered at http://www.clinicaltrials.gov (identification no: NCT02678624). No substantial deviation from the protocol will be implemented without the prior review and approval of relevant authorities. Results will be published in international journals.

A Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) Checklist has been completed and is available in Additional file 1. The (SPIRIT) figure for an overview of time schedule, assessment instruments and source of data collection has been completed and is available in Fig. 2.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart for participants. Each trial has a flow chart similar to this
Fig. 2
Fig. 2
Time schedule, assessment instruments and source of data collection

References

    1. Kessler RC, Aguilar-gaxiola S, Alonso J, Chatterji S, Lee S, Ormel J, Üstün TB, Wang PS. The global burden of mental disorders: an update from the WHO World Mental Health (WMH) Surveys. Epidemiol Psichiatr Soc. 2009;18:23–33. doi: 10.1017/S1121189X00001421.
    1. Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, et al. Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand. 2004;109(Suppl 420):21–7.
    1. Kroenke K, Spitzer R, Williams J, Monahan P, Lowe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2013;146:317–26. doi: 10.7326/0003-4819-146-5-200703060-00004.
    1. Brown TA, Campbell LA, Lehman CL, Grisham JR, Mancill RB. Current and lifetime comorbidity of the DSM-IV Anxiety and Mood Disorders in a large clinical sample. J Abnorm Psychol. 2001;110:585–99. doi: 10.1037/0021-843X.110.4.585.
    1. Muller JE, Koen L, Stein DJ. Anxiety and medical disorders. Curr Psychiatry Rep. 2005;7:245–51. doi: 10.1007/s11920-005-0077-5.
    1. Meier SM, Mattheisen M, Mors O, Mortensen PB, Laursen TM, Penninx BW. Increased mortality among people with anxiety disorders: total population study. Br J Psychiatry. 2016;209:216–21. doi: 10.1192/bjp.bp.115.171975.
    1. Psychiatric illness and the labour market. Discussion paper [Psykisk sygdom og arbejdsmarkedet. Debatoplæg]. Danish College of Psychiatrists, Danish Union for Psychologists, Union for Danish Psychiatrists and Children-Youth Psychiatrists, Danish Regions [Dansk Psykiatrisk Selskab, Dansk Psykolog Forening, Danske Psykiateres og Børne- Ungdomspsykiateres organisation, Danske regioner]. 2009. . Accessed 30 Oct 2016.
    1. Interventions for people with psychiatric illness—development in diagnoses and treatment [Indsatsen for mennesker med psykiske lidelser—udvikling i diagnoser og behandling. Bilagsrapport 2]. The Government’s Committee on Psychiatry [Regeringens udvalg om psykiatri]. 2013. - Publikationer_i_pdf/2013/Rapport-psykiatriudvalg-okt-2013/21-10-2013/21102013Indsatsenformenneskermedpsyliskelidelserbilag2web.ashx. Accessed 30 Oct 2016.
    1. Flachs E, Eriksen L, Koch M, Ryd J, Dibba E, Skov-Ettrup L, Juel K. The disease burden in Denmark—diseases [Sygdomsbyrden I Danmark—Sygdomme]. National Institute of Public Health, University of Southern Denmark [Statens Institut for Folkesundhed, Syddansk Universitet]. 2015. . Accessed 30 Oct 2016.
    1. Kujanpää T, Jokelainen J, Auvinen J, Timonen M. Generalised anxiety disorder symptoms and utilisation of health care services. A cross-sectional study from the ‘Northern Finland 1966 Birth Cohort’. Scand J Prim Health Care. 2016;34:151–8. doi: 10.3109/02813432.2016.1160631.
    1. Bélanger L, Ladouceur R, Morin CM. Generalized anxiety disorder and health care use. Can Fam Physician. 2005;51:1363.
    1. Üstün TB, Sartorius N. Mental illness in general health care. An international study. Chichester, New York, Brisbane, Toronto, Singapore: Wiley; 1995.
    1. Grandes G, Montoya I, Arietaleanizbeaskoa MS, Arce V, Sanchez A. The burden of mental disorders in primary care. Eur Psychiatry. 2011;26:428–35. doi: 10.1016/j.eurpsy.2010.11.002.
    1. Toft T, Fink P, Oernboel E, Christensen K, Frostholm L, Olesen F. Mental disorders in primary care: prevalence and co-morbidity among disorders. Results from the Functional Illness in Primary care (FIP) study. Psychol Med. 2005;35:1175–84. doi: 10.1017/S0033291705004459.
    1. Munk-Jørgensen P, Allgulander C, Dahl A, Foldager L, Holm M, Rasmussen I, Virta A, Huuhtanen M, Wittchen H. Prevalence of generalized anxiety disorder in general practice in Denmark, Finland, Norway, and Sweden. Psychiatr Serv. 2006;57:1738–44. doi: 10.1176/ps.2006.57.12.1738.
    1. Preventive outpatient treatment for severe affective disorder (depression and mania)—a health technology assessment [Forebyggende ambulant behandling ved svær affektiv lidelse (depression og mani)—en medicinsk teknologivurdering]. Danish Health Authority [Sundhedsstyrelsen]. 2006. . Accessed 30 Oct 2016.
    1. Treatment of psychiatric non-psychotic disorders [Behandling af psykiske lidelser af ikke- psykotisk karakter]. Danish College of Psychiatrists [Dansk Psykiatrisk Selskab]. 2001. . Accessed 30 Oct 2016.
    1. Improved patient courses for patients with non-psychotic psychiatric disorders [Bedre patientforløb for patienter med psykiske lidelser af ikke- psykotisk karakter]. The Danish College of Psychiatrists and The Danish College of General Practitioners [Dansk Psykiatrisk Selskab og Dansk Selskab for Almen Medicin]. 2004. . Accessed 30 Oct 2016.
    1. Reference program for anxiety disorders for adults [Referenceprogram for angstlidelser hos voksne]. Danish Health Authority [Sundhedsstyrelsen]. 2007. . Accessed 30 Oct 2016.
    1. Francis JL, Ph D, Weisberg RB, Dyck IR, Culpepper L, Smith K, Edelen MO, Keller MB. Characteristics and Course of Panic Disorder and Panic Disorder With Agoraphobia in Primary Care Patients. Prim Care Companion J Clin Psychiatry. 2007;9(3):173–9. doi: 10.4088/PCC.v09n0301.
    1. Goodwin RD, Faravelli C, Rosi S, Cosci F, Truglia E, de Graaf R, Wittchen HU. The epidemiology of panic disorder and agoraphobia in Europe. Eur Neuropsychopharmacol. 2005;15:435–43. doi: 10.1016/j.euroneuro.2005.04.006.
    1. Christensen KS, Fink P, Toft T, Frostholm L, Ørnbøl E, Olesen F. A brief case-finding questionnaire for common mental disorders: The CMDQ. Fam Pract. 2005;22:448–57. doi: 10.1093/fampra/cmi025.
    1. Hauge-Helgestad A, Schlepern Johansen K, Hansen J. Treatment of people with anxiety and depression. Mapping of the treatment and discussion about perspectives of implementing collaborative care [Behandling af mennesker med angst og depression. Kortlægning af behandlingsfelt og diskussion af perspektiverne]. Danish Health Institute [Dansk Sundhedsinstitut]. 2012. . Accessed 30 Oct 2016.
    1. Clinical guide for general practice. Anxiety disorders, diagnostics and treatment [Klinisk vejledning for almen praksis. Angsttilstande. Diagnostik og behandling]. Danish College of General Practitioners. 2010. . Accessed 30 Oct 2016.
    1. Agreement for general practice, changed 1 Mar 2014 [Overenskomst for almen praksis. Af 3 Jun 1991, senest ændret ved aftale af 1 Mar 2014]. Danish College for General Practitioners [Praktiserende Lægers Organisation]. 2014. . Accessed 30 Oct 2016.
    1. Fjeldsted R, Christensen KS.Evaluation of the psychologist scheme for persons with mild to moderate depression [Evaluering af ordning med psykologbehandling af personer med let til moderat depression]. Research Unit for General Practice, Aarhus University [Forskningsenheden for Almen Praksis, Århus Universitet]. 2011. . Accessed 30 Oct 2016.
    1. Davidsen A. Talking therapy as part of the general practitioner’s normal working day [Samtaleterapi ind i den praktiserende læges hverdag] Ugeskr Laeger. 2010;5:2025–9.
    1. Nielsen HG, Söderström M. Group supervision in general practice as part of continuing professional development. Dan Med J. 2012;59:2.
    1. Reference program for unipolar depression for adults [Referenceprogram for Unipolar Depression Hos Voksne]. Danish Health Authority [Sundhedsstyrelsen]. 2007. . Accessed 30 Oct 2016.
    1. Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P. Collaborative care for depression and anxiety problems (Review). Cochrane Database Syst Rev. 2012;10:CD006525. doi:10.1002/14651858.CD006525.pub2.
    1. Roy-Byrne PP, Craske MG, Stein MB, Sullivan G, Bystritsky A, Katon W, Golinelli D, Sherbourne CD. A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder. Arch Gen Psychiatry. 2005;62:290–8. doi: 10.1001/archpsyc.62.3.290.
    1. Roy-Byrne PP, Katon W, Cowley DS, Russo J. A randomized effectiveness trial of collaborative care for patients with panic disorder in primary care. Arch Gen Psychiatry. 2001;58:869–76. doi: 10.1001/archpsyc.58.9.869.
    1. Rollman BL, Belnap BH, Mazumdar S, Houck PR, Zhu F, Gardner W, Reynolds CF, Schulberg HC, Shear MK. A randomized trial to improve the quality of treatment for panic and generalized anxiety disorders in primary care. Arch Gen Psychiatry. 2005;62:1332–41. doi: 10.1001/archpsyc.62.12.1332.
    1. Roy-byrne P, Craske MG, Sullivan G, Rose RD, Edlund MJ, Lang AJ, Bystritsky A, Welch SS, Chavira DA, Golinelli D, Campbell-sills L, Sherbourne CD, Stein MB. Delivery of evidence-based treatment for multiple anxiety disorders in primary care. JAMA. 2010;303:1921–8. doi: 10.1001/jama.2010.608.
    1. Muntingh ADT, Van Der Feltz-cornelis CM, Van Marwijk HWJ, Spinhoven P, Van Balkom AJLM. Collaborative care for anxiety disorders in primary care: a systematic review and meta-analysis. BMC Fam Pract. 2016;17:62. doi: 10.1186/s12875-016-0466-3.
    1. König H-H, Born A, Heider D, Matschinger H, Heinrich S, Riedel-Heller SG, Surall D, Angermeyer MC, Roick C. Cost-effectiveness of a primary care model for anxiety disorders. Br J Psychiatry. 2009;195:308–17. doi: 10.1192/bjp.bp.108.058032.
    1. Oosterbaan DB, Verbraak MJPM, Terluin B, Hoogendoorn AW, Peyrot WJ, Muntingh A, Van Balkom AJLM. Collaborative stepped care v. Care as usual for common mental disorders: 8-month, cluster randomised controlled trial. Br J Psychiatry. 2013;203:132–9. doi: 10.1192/bjp.bp.112.125211.
    1. Muntingh A, van der Feltz-Cornelis C, van Marwijk H, Spinhoven P, Assendelft W, de Waal M, Adèr H, van Balkom A. Effectiveness of collaborative stepped care for anxiety disorders in primary care: a pragmatic cluster randomised controlled trial. Psychother Psychosom. 2014;83:37–44. doi: 10.1159/000353682.
    1. Bertelsen A. WHO ICD-10—Mental and Behavioural Disorders—classification and diagnostic criteria [WHO ICD-10—Psykiske Lidelser Og Adfærdsmæssige Forstyrrelser—Klassifikation Og Diagnostiske Kriterier]. 1st edition. Gyldendal Akademisk; 2000.
    1. Eplov L, Lundsteen M, Birket-Smith M. Shared care for non-psychotic diseases. recommendations based on a systematic literature review [Shared care for ikke-psykotiske sygdomme. Anbefalinger på baggrund af en systematisk litteraturundersøgelse]. Danish Regions. 2009.
    1. Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults. management in primary, secondary and community care. National Institute for Health and Clinical Excellence. 2011. . Accessed 30 Oct 2016.
    1. Instructions in the use of services in the agreement about general practice [Vejledning i anvendelse af overenskomstens ydelser. Overenskomst om almen praksis 1 Sep 2014]. The Regions’ Salary Board, The Danish College for General Practitioners [Regionernes Lønnings- og Takstnævn (RLTN), Praktiserende lægers Organisation (PLO)]. 2014. . Accessed 30 Oct 2016.
    1. Sheehan D, Lecrubier Y, Harnett Sheehan K, Janavs J, Weiller E, Keskiner A, Schinka J, Knapp E, Sheehan M, Dunbar G. The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. Eur Psychiatry. 1997;12:232–41. doi: 10.1016/S0924-9338(97)83297-X.
    1. Hesse M, Moran P. Screening for personality disorder with the Standardised Assessment of Personality: Abbreviated Scale (SAPAS): further evidence of concurrent validity. BMC Psychiatry. 2010;10:10. doi: 10.1186/1471-244X-10-10.
    1. Osman A, Hoffman J, Barrios FX, Kopper BA, Breitenstein JL, Hahn SK. Factor structure, reliability, and validity of the Beck Anxiety Inventory in adolescent psychiatric inpatients. J Clin Psychol. 2002;58:443–56. doi: 10.1002/jclp.1154.
    1. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56:893–7. doi: 10.1037/0022-006X.56.6.893.
    1. Beck A, Ward C, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561–71. doi: 10.1001/archpsyc.1961.01710120031004.
    1. Pedersen G, Hagtvet KA, Karterud S. Generalizability studies of the Global Assessment of Functioning-Split version. Compr Psychiatry. 2007;48:88–94. doi: 10.1016/j.comppsych.2006.03.008.
    1. Derogatis L. SCL-90-R. Symptom Checklist-90-R. Administration, scoring and procedures manual. 3rd ed. Minneapolis: National Computer Systems, Inc; 1994.
    1. Beck AT, Steer RA, Garbin MG. Psychometric properties of the Beck Depression Inventory: twenty five years of evaluation. Clin Psychol Rev. 1988;8:77–100. doi: 10.1016/0272-7358(88)90050-5.
    1. Prinz, et al. Comparative psychometric analyses of the SCL-90-R and its short versions in patients with affective disorders. BMC Psychiatry. 2013;13:104. doi: 10.1186/1471-244X-13-104.
    1. Morosini PL, Magliano L, Brambilla L, Ugolini S, Pioli R. Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatr Scand. 2000;101:323–9.
    1. Rabin R, De Charro F. EQ-SD: a measure of health status from the EuroQol Group. Ann Med. 2001;33:337–43. doi: 10.3109/07853890109002087.
    1. Sheehan D, Harnett-Sheehan K, Raj B. The measurement of disability. Int Clin Psy-chopharmacology. 1996;11(Suppl 3):89–95. doi: 10.1097/00004850-199606003-00015.
    1. Bech P. Measuring the dimensions of psychological general well-being by the WHO-5. QoL Newsl. 2004;32:15–6.
    1. Moss-Morris R, Weinman J, Petrie K, Horne R, Cameron L, Buick D. The Revised Illness Perception Questionnaire (IPQ-R) Psychol Health. 2002;17:1–16. doi: 10.1080/08870440290001494.
    1. Lorig K, Stewart A, Ritter P, González V, Laurent D, Lynch J. Outcome measures for health education and other health care interventions. Thousand Oaks: Sage Publications; 1996.
    1. Hellström L, Eplov LF, Nordentoft M, Ostergaard SD, Bech P. The Diagnostic Apathia Scale predicts the ability to return to work following depression or anxiety. Acta Neuropsychiatr. 2014;26:364–71. doi: 10.1017/neu.2014.23.
    1. Katz AJ, Dusetzina SB, Farley JF, Ellis AR, Gaynes BN, Castillo WC, Stürmer T, Hansen R. Distressing adverse events after antidepressant switch in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial: influence of adverse events during initial treatment with citalopram on development of subsequent adverse events with an alternative antidepressant. Pharmacotherapy. 2012;32:234–43. doi: 10.1002/j.1875-9114.2011.01020.x.
    1. Lynge E, Sandegaard JL, Rebolj M. The Danish National Patient Register. Scand J Public Health. 2011;39(Suppl 7):30–3. doi: 10.1177/1403494811401482.
    1. Kildemoes HW, Sorensen HT, Hallas J. The Danish National Prescription Registry. Scand J Public Heal. 2011;39(Suppl 7):38–41. doi: 10.1177/1403494810394717.
    1. Helweg-Larsen K. The Danish Register of Causes of Death. Scand J Public Health. 2011;39(Suppl 7):26–9. doi: 10.1177/1403494811399958.
    1. The DREAM database, Statistics Denmark [DREAM databasen, Danmarks Statistik]. The National Labour Market Authority in Denmark. . Accessed 30 Oct 2016.
    1. Williams J, Leamy M, Bird V, Le C, Sam B, Francesca N. Development and evaluation of the INSPIRE measure of staff support for personal recovery. Soc Psychiatry Psychiatr Epidemiol. 2014. doi: 10.1007/s00127-014-0983-0.
    1. Larsen DL, Attkisson CC, Hargreaves WA, Nguyen TD. Assessment of client/patient satisfaction: development of a general scale. Eval Program Plann. 1979;2:197–207. doi: 10.1016/0149-7189(79)90094-6.
    1. Statistics Denmark [Danmarks statistik]. . Accessed 30 Oct 2016.
    1. Swindle RW, Rao JK, Helmy A, Plue L, Zhou XH, Eckert GJ, Weinberger M. Integrating clinical nurse specialists into the treatment of primary care patients with depression. Int J Psychiatry Med. 2003;33:17–37. doi: 10.2190/QRY5-B61V-QE4R-8141.
    1. Proudfoot J, Ryden C, Everitt B, Shapiro DA, Goldberg D, Mann A, Tylee A, Marks I, Gray JA. Clinical efficacy of computerised cognitive-behavioural therapy for anxiety and depression in primary care: randomised controlled trial. Br J Psychiatry. 2004;185:46–54. doi: 10.1192/bjp.185.1.46.
    1. Proudfoot J, Goldberg D, Mann A, Everitt B, Marks I, Gray J. Computerized, interactive, multimedia cognitive-behavioural program for anxiety and depression in general practice. Psychol Med. 2003;33:217–27. doi: 10.1017/S0033291702007225.
    1. Adams G, Gulliford M, Ukoumunne O, Eldridge S, Chinn S, Campbell M. Patterns of intra-cluster correlation from primary care research to inform study design and analysis. J Clin Epidemiol. 2004;57:785–94. doi: 10.1016/j.jclinepi.2003.12.013.
    1. Yonkers K, Dyck IR, Keller MB. An eight-year longitudinal comparison of clinical course and characteristics of social phobia among men and women. Psychiatric Services. 2001;52:637–43. doi: 10.1176/appi.ps.52.5.637.
    1. Stant AD, Ten Vergert EM, den Boer PCAM, Wiersma D. Cost-effectiveness of cognitive self-therapy in patients with depression and anxiety disorders. Acta Psychiatr Scand. 2008;117:57–66.
    1. Porta N, Bonet C, Cobo E. Discordance between reported intention-to-treat and per protocol analyses. J Clin Epidemiol. 2007;60:663–9. doi: 10.1016/j.jclinepi.2006.09.013.
    1. Wittchen H-U, Jacobi F. Size and burden of mental disorders in Europe—a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol. 2005;15:357–76. doi: 10.1016/j.euroneuro.2005.04.012.
    1. Wood L, Egger M, Gluud LL, Schulz KF, Jüni P, Altman DG, Gluud C, Martin RM, Wood AJG, Sterne JAC. Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta-epidemiological study. Br Med J. 2008;336:601–5. doi: 10.1136/.
    1. Muntingh ADT, van der Feltz-Cornelis CM, van Marwijk HWJ, Spinhoven P, Penninx BWJH, van Balkom AJLM. Is the Beck Anxiety Inventory a good tool to assess the severity of anxiety? A primary care study in the Netherlands Study of Depression and Anxiety (NESDA) BMC Fam Pract. 2011;12:66. doi: 10.1186/1471-2296-12-66.
    1. Buszewicz M, Griffin M, McMahon EM, Beecham J, King M. Evaluation of a system of structured, proactive care for chronic depression in primary care: a randomised controlled trial. BMC Psychiatry. 2010;10:61. doi: 10.1186/1471-244X-10-61.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa