Kosteneffektivität ambulanter Psychotherapie

Background

There is a lack of cost-effectiveness analyses (CEA) of psychotherapeutic treatments.

Material and methods

Cost-effectiveness analysis was applied to a sub-sample of 122 psychotherapy outpatients who participated in a large longitudinal study on outpatient psychotherapy (TRANS-OP study). Participants received either psychodynamic psychotherapy (PD, n=69) or cognitive behavioral therapy (CBT, n=53). Effectiveness (change in symptomatic impairment over 2 years) was assessed via the German version of the Outcome Questionnaire (OQ-45.2). Direct health care costs during a 2-year period (psychotherapy and other health care utilizations) were obtained from health insurance claims. Cost-effectiveness analysis methods included incremental cost-effectiveness ratios (ICER) and the net benefit regression approach.

Results

Cost-effectiveness analyses showed no significant differences between the two treatments, neither head-to-head, nor with regard to advantages in certain subgroups of psychotherapy outpatients. A slight dominance of CBT in costs was not maintained after controlling for covariates.

Conclusion

Provided that pivotal covariates such as treatment need are taken into account, cost-effectiveness analyses can contribute to a more equitable distribution of psychotherapeutic resources.     

Testicular Cancer and Genetics Knowledge Among Familial Testicular Cancer Family Members

Purpose  

It was our aim to determine baseline levels of testicular cancer and genetics knowledge among members of families with Familial Testicular Cancer (FTC).     

What Patients and Their Relatives Think About Testing for BMPR2

Clinical genetic testing is available for mutations in BMPR2 associated with pulmonary arterial hypertension (PAH). The aim of this study is to assess attitudes of individuals affected by or at risk for PAH regarding genetic testing. Structured telephone interviews were conducted with 119 individuals affected by or at risk for PAH recruited from pulmonary hypertension clinic at Vanderbilt, Vanderbilt familial PAH registry, attendees at 2006 PHA meeting, and a local PAH support group. Sixty-four percent reported knowing little or nothing about BMPR2 testing. Predictors of greater self-assessed knowledge included having an affected family member and learning about BMPR2 testing through the internet. Most respondents reported that while they spent some time thinking about being tested for BMPR2, they had little trouble deciding. The most frequently cited reason for testing was to provide information for their children. About 20% said they had been tested, even though <5% have actually received clinical testing. Although patients with PAH and their at-risk relatives typically feel relatively uninformed about testing for mutations in BMPR2 and at times are confused about their testing status, they nonetheless report that it is easy to decide about testing.     

Mindful Learning: A Moderator of Gender Differences in Mathematics Performance

Past research has demonstrated that males outperform females in mathematics (Hyde, J. S., Fennema, E., & Lamon, S. J., Psychol Bull 107:139–155, 1990a). Research has also shown that encouraging mindful learning–learning information in a conditional rather than an absolute way–can increase mathematics performance in females (Ritchhart, R., & Perkins, D. N., J Social Issues 56:27–47, 2000). This paper examines the moderating role of mindful learning for gender differences, by manipulating mindful learning for females’ and males’ performance on a novel math task. The results from this study show that males performed better than females when mindful learning was not encouraged (absolute instruction), but males and females performed equally well when mindful learning was encouraged (conditional instruction). Thus we find that mindful learning moderates gender differences in math performance.     

Components of executive control with advantages for bilingual children in two cultures

The present study used a behavioral version of an anti-saccade task, called the ‘faces task’, developed by [Bialystok, E., Craik, F. I. M., & Ryan, J. (2006). Executive control in a modified anti-saccade task: Effects of aging and bilingualism. Journal of Experimental Psychology: Learning, Memory, and Cognition, 32, 1341-1354] to isolate the components of executive functioning responsible for previously reported differences between monolingual and bilingual children and to determine the generality of these differences by comparing bilinguals in two cultures. Three components of executive control were investigated: response suppression, inhibitory control, and cognitive flexibility. Ninety children, 8-years old, belonged to one of three groups: monolinguals in Canada, bilinguals in Canada, and bilinguals in India. The bilingual children in both settings were faster than monolinguals in conditions based on inhibitory control and cognitive flexibility but there was no significant difference between groups in response suppression or on a control condition that did not involve executive control. The children in the two bilingual groups performed equivalently to each other and differently from the monolinguals on all measures in which there were group differences, consistent with the interpretation that bilingualism is responsible for the enhanced executive control. These results contribute to understanding the mechanism responsible for the reported bilingual advantages by identifying the processes that are modified by bilingualism and establishing the generality of these findings across bilingual experiences. They also contribute to theoretical conceptions of the components of executive control and their development.     

Language proficiency and executive control in proactive interference: evidence from monolingual and bilingual children and adults

Two studies are reported in which monolingual and bilingual children (Study 1) and adults (Study 2) completed a memory task involving proactive interference. In both cases, the bilinguals attained lower scores on a vocabulary test than monolinguals but performed the same on the proactive interference task. For the children, bilinguals made fewer intrusions from previous lists even though they recalled the same number of words. For the adults, bilinguals recalled more words than monolinguals when the scores were corrected for differences in vocabulary. In addition, there was a strong effect of vocabulary in which higher vocabulary participants recalled more words irrespective of language group. These results point to the important role of vocabulary in verbal performance and memory. They also suggest that bilinguals may compensate for weaker language proficiency with their greater executive control to achieve the same or better levels of performance as monolinguals.     

Religiosity and Spiritual Engagement in Two American Indian Populations

Social scientific investigation into the religiospiritual characteristics of American Indians rarely includes analysis of quantitative data. After reviewing information from ethnographic and autobiographical sources, we present analyses of data from a large, population-based sample of two tribes (n = 3,084). We examine salience of belief in three traditions: aboriginal, Christian, and Native American Church. We then investigate patterns in sociodemographic subgroups, determining the significant correlates of salience with other variables controlled. Finally, we examine frequency with which respondents assign high salience to only one tradition (exclusivity) or multiple traditions (nonexclusivity), again investigating subgroup variations. This first detailed, statistical portrait of American Indian religious and spiritual lives links work on tribal ethnic identity to theoretical work on America's "religious marketplace." Results may also inform social/behavioral interventions that incorporate religiospiritual elements.     

Sudden gains in interpersonal psychotherapy for depression

Sudden, precipitous improvements in depressive symptom severity have been identified as occurring among unipolar depressed individuals. These "sudden gains" have been associated with superior acute treatment outcome in several treatment modalities, including cognitive therapy. A better understanding of sudden gains may provide insight into the mechanisms of action in these and other psychotherapies. One efficacious therapy that has been overlooked in sudden gains research is interpersonal psychotherapy (IPT; Weissman, M. M., Markowitz, J. C., & Klerman, G. L. (2000). Comprehensive guide to interpersonal psychotherapy. New York: Basic Books). The present research examined the rates and concomitant features of sudden, precipitous improvements in depressive symptomotology among 185 women receiving IPT for recurrent depression. Sudden gains, defined using extant criteria for the Beck Depression Inventory, were assessed over 12 weeks of acute IPT treatment for depression and occurred for 33.5% of the sample. Sudden gains were not associated with diagnostic and demographic characteristics or with differential likelihood of achieving depression remission with IPT monotherapy during active treatment. Further, those with sudden gains were no more likely to maintain their recovery through maintenance treatment. The lack of impact of sudden gains on eventual outcome is discussed in terms of potentially disparate emphases and mechanisms of change between IPT and cognitive-behavioral therapy (CBT).