Introduction: Relatively little research has assessed predictors of both treatment outcomes and attrition in binge eating disorder (BED) treatment. Even fewer studies did so for digital forms of...Show moreIntroduction: Relatively little research has assessed predictors of both treatment outcomes and attrition in binge eating disorder (BED) treatment. Even fewer studies did so for digital forms of therapy. This study thus aims to contribute to the current pool of knowledge by examining the predictive value of various variables in a recently developed digital BED-treatment: BED-online. Methods: This study was part of a RCT into the effects of BED-online therapy. Participants were over the age of 18, Dutch-speaking and diagnosed with the DSM-V BED. A total of 180 participants were found to be eligible, of whom 40 (22.2%) dropped-out before the last session. Post-treatment measurements from an interview (EDE) and a self-report questionnaire (EDE-Q) were used to determine the immediate treatment effects. A follow-up (24 weeks post-treatment) EDE-Q measurement determined the long-term effects. These variables served as the dependent variables in three different hierarchical linear regression analyses. A fourth logistical regression analysis was conducted, where treatment-related drop-out formed the dependent variable. The following eight predictor variables were chosen based on literature research: ethnicity, age, gender, educational level, comorbidity, frequency of binge eating episodes, levels of BED pathology and treatment condition. The predictor variables served as the independent variables. Results: BED pathology at baseline was found to be the only significant predictor of treatment outcomes as measured by the EDE (β=.41, t=3.71, p<.001), EDE-Q (β=.57, t=8.23, p<.001) and at follow-up (β=.47, t= 6.24, p< .001). Attrition could be predicted by both ethnicity and gender, where males were 5.63 times more likely to discontinue treatment prematurely (OR=5.63, 95%CI [1.81, 17.53]) and participants born abroad were 3.91 times more likely to discontinue treatment (OR=3.91, 95%CI [1.43, 8.76]). Other independent variables did not significantly contribute to the final regression models. Discussion and conclusion: All predictor variables are discussed in detail, reflecting on the results found and comparing them to findings of previous studies. Limitations are elaborated in depth. Due to these limitations, and the modest number of previous studies, further research is encouraged, exploring both the current and other dependent variablesShow less
Psychological tests are often used to make important decisions about a patient’s trajectory. A high-quality test is characterized by norms that allow meaningful interpretation of the raw scores....Show morePsychological tests are often used to make important decisions about a patient’s trajectory. A high-quality test is characterized by norms that allow meaningful interpretation of the raw scores. With normed scores an individual’s performance can be evaluated properly by taking into account the influence of relevant individual characteristics, such as age, gender, education level or socio-economic status. From several norming techniques, regression-based norming has proven to be most efficient one and especially useful when including more than one demographical predictor variable. Recently, the R package GAMLSS has been proposed as a framework for this technique. It is an exhaustive family of flexible models that may fit a wide variety of empirical data. This research investigated the performance of GAMLSS compared to traditionally used approaches of multiple regression-based norming. Both techniques were applied to data of the Brief-Symptom Inventory, which was collected in a sample representative of the Dutch population (N = 1662). Age and gender were taken into account as normpredictors. The approaches showed very high correspondence, expect for a deviation of GAMLSS-based scores in the lower score ranges. None of the two approaches was able to properly capture the relationship between raw scores and age. GAMLSS-based norms did not outperform the regression-based approach. They can be considered equally suitable but in practice the complexity of the GAMLSS approach makes it less convenient. However, its flexibility could be advantageous when applied to tests that are heavily dependent on continuous norm predictors.Show less
Waiting time for treatment in Dutch mental healthcare is increasing. General practitioners substantially deviate from the allocation guideline which seems to contribute to the increase of waiting...Show moreWaiting time for treatment in Dutch mental healthcare is increasing. General practitioners substantially deviate from the allocation guideline which seems to contribute to the increase of waiting time. This study aimed to investigate whether undertreatment can be beneficial for patients and the MHC system. In addition, this study aimed to identify characteristics of undertreated patients that suffered unfavorable undertreatment based on clinical data and clinical judgement by general practitioners. Data was obtained in a naturalistic environment in a mental healthcare institution in the Netherlands and patients received treatment as usual. A total of 6193 electronic patient records were included. Exclusion criteria and missing data left 1057 cases eligible for analyses. A one-way ANOVA and a forward hierarchical binary logistic regression were conducted to investigate both aims. Results showed that undertreatment relates to worse treatment outcomes in comparison to patients in S-MHC. Unfavorable undertreatment was best predicted by waiting time and level of pre-treatment functioning. Longer waiting time is related to the need for more specialized care. Also, lower levels of pre-treatment functioning is related to the need for more specialized care. B-MHC care for undertreated patients must be improved. GPs seem to have valid reason to deviate from the allocation guideline. The allocation guideline could benefit from the addition of variables based on clinical judgement. To provide the care that undertreated patients need, treatment in B-MHC could be prolonged to match outcomes in S-MHC. Another solution could be to limit the negative effects during waiting time for patients.Show less
Research master thesis | Psychology (research) (MSc)
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Using a wide variety of clinical questionnaires might hamper the communication between clinicians and researchers in Routine outcome monitoring (ROM). Linking test scores to T scores as a common...Show moreUsing a wide variety of clinical questionnaires might hamper the communication between clinicians and researchers in Routine outcome monitoring (ROM). Linking test scores to T scores as a common metric might be a solution. Item response theory (IRT) is the preferred way to estimate T-scores. However, required software and a large dataset is needed for that. In this thesis, two methods were used to arrive at a common metric for often used questionnaires and their subversions: the BSI, BSI-18, the DASS-42 and the DASS-21. As one method, we used an IRT approach to estimate theta-based T-scores, leading to crosswalk tables. For the second approach, conversion formulas were estimated for raw scores to calculated T-scores based on the best-fitting regression equation between the raw scores and the previously estimated theta-based T-scores. Crosswalk tables and conversion formulas are both alternative ways to link individual scores to a common metric. It was investigated if conversion formulas are valid by comparing calculated T-scores with theta-based T-scores. The agreement between calculated T-scores and theta-based T-scores were high for all questionnaires except the DASS-42. The agreement was also lower at the extreme ends of the questionnaires (T= < 50 and T= >75). All in all, conversion formulas seem to be a good alternative for estimating a common metric. Offering different options to calculate common metrics can help in improving the communication between professionals in the clinical field. Increased involvement and better communication in ROM is able to increase the quality of mental health care.Show less
Background: The societal lockdown due to COVID-19 forced a change from in-person therapy to videoconferencing, which was introduced on March 16, 2020. Swift implementation of telehealth care was...Show moreBackground: The societal lockdown due to COVID-19 forced a change from in-person therapy to videoconferencing, which was introduced on March 16, 2020. Swift implementation of telehealth care was asked of therapists all over the country. Aim: To investigate whether the effects of treatment for personality disorders through videoconferencing were lower than through in-person therapy. Method: Patients who received treatment between January 2018 and May 2021 were divided into three groups, before (1), partially (2) and entirely during COVID-19 (3). With the ROM score OQ-45 SD as pre- and posttest measurements, a general linear model repeated ANOVA was conducted. We controlled for other variables that were potentially of influence on the achieved outcomes. Results: The hypothesis was not confirmed by the results. The results rather suggested that treatment through videoconferencing was more effective than treatment (predominantly) conducted through in-person. Conclusion: No evidence was found supporting the hypothesized diminished effects of treatment for personality disorder through videoconferencing. Videoconference therapy appeared non-inferior to face-to-face therapy for the treatment of personality disorders. The groups did not differ at the onset. However, treatments were shorter and the dropout rate was 15% higher in the videoconferencing group, which could have led to selection bias. Keywords: Personality disorder; COVID-19; treatment outcome; videoconference therapy; face-to-face therapy; observational design.Show less
The aim of this research was to test the test-retest reliability of two new indicators for quality of health care and compare these indicators with an indicator based on outcome of healthcare that...Show moreThe aim of this research was to test the test-retest reliability of two new indicators for quality of health care and compare these indicators with an indicator based on outcome of healthcare that has already been found reliable. These new indicators are based on the ratio between outcome and costs of treatment and the ratio between outcome and duration in days of treatment. The reliability of the three indicators is assessed with the Intra Class Correlation coefficient from data (N = 633) of a division of a mental health care institution specialized in the treatment of post-traumatic stress disorder. Outcome of the treatment was assessed with a pre- and posttest measurement of the severity of complaints, as measured with the symptomatic distress subscale of the Outcome Questionnaire 45.2. The reliability of the original indicator, based solely on outcome, was good (ICC = 0.613). The reliability of the indicator based on outcome and duration of treatment was fair (ICC = 0.549) and the reliability of the indicator based on outcome and costs was poor (ICC = 0.088). Presumably, these lower ICC values on the enriched indicators are a result of instability over time of the cost and duration components of the indicators in combination with a disproportionate increase of costs and days of treatment in comparison with outcome of treatment. The research suffered from low statistical power and this precludes definite conclusions about the statistical significance of differences in reliability among the indicators. For a better comparison of the test-retest reliability between the indicators with a statistical test, replication of this research with a larger set of evaluable treatments is necessary.Show less
Current mental health care systems evaluate the quality of care mainly based on the outcome of treatment. However, for patients, the time spent to achieve this outcome is a relevant factor which is...Show moreCurrent mental health care systems evaluate the quality of care mainly based on the outcome of treatment. However, for patients, the time spent to achieve this outcome is a relevant factor which is often overlooked in modern health care systems. For insurance providers, the incurred cost of treatment is an important criterion for quality of mental health care. In order to offer truly valuable care in the eyes of both of these parties, the result of treatment must measure up to its required effort, both temporal and financial. Including cost and duration in the evaluation of health care will ultimately benefit all parties involved. Therefore, the present study tests the validity of two new quality indicators based on the principle of value-based health care. Value here is defined as outcome relative to cost or outcome relative to duration. Data used was collected by Routine Outcome Monitoring at several outpatient clinics providing specialized mental health care in the Netherlands. MANOVA testing revealed that the two new quality indicators showed larger differences in quality of care than outcome alone. These results were supported by differences among clinics in the cost and duration of treatment per improved and recovered patient. Based on the results of this study, the use of quality indicators of value-based health care over outcome alone in the mental health care sector is advised.Show less
De huidige financiering van zorg stimuleert eerder tot het verlenen van meer zorg dan tot betere zorg. Bij het streven naar de best mogelijke zorg, zijn goede indicatoren nodig om de kwaliteit te...Show moreDe huidige financiering van zorg stimuleert eerder tot het verlenen van meer zorg dan tot betere zorg. Bij het streven naar de best mogelijke zorg, zijn goede indicatoren nodig om de kwaliteit te meten. Het doel van dit onderzoek is het bepalen en vergelijken van de testhertestbetrouwbaarheid van drie indicatoren voor het meten van kwaliteit van zorg bij persoonlijkheidsstoornissen: de uitkomst van de behandeling en twee nieuwe indicatoren: de uitkomst in verhouding tot kosten en tot duur. De gegevens zijn aangeleverd door het Nederlands Psychoanalytisch Instituut, onderdeel van Arkin. De test-hertestbetrouwbaarheid van de indicatoren is bepaald middels de Intraclass Correlatie Coëfficiënt (ICC) en is berekend door herhaalde verstelling van de kwaliteit bij 14 groepen die zijn gekozen op basis van locatie, het niveau van functioneren en pre-test ernstniveau. De betrouwbaarheid van de behandeluitkomst indicator ICC = ,494, de kostenindicator ICC = ,516 en duurindicator ICC = ,480. De ICC’s van de indicatoren verschilden niet significant van elkaar, vanwege de grote betrouwbaarheidsintervallen van de drie indicatoren, die onderling een aanzienlijke overlap vertoonden. Het verrijken van de uitkomst indicator met een kosten of een duur component hebben niet tot statisch significant betrouwbaardere indicatoren geleid. Vanwege het geringe aantal groepen waar kwaliteit van zorg bij kon worden vastgesteld was er onvoldoende statistische power voor een redelijke kans op het vinden van een significant verschil in betrouwbaarheid tussen de indicatoren. Vervolgonderzoek met meer evalueerbare behandelingen is nodig om te bepalen of het verrijken van de behandeluitkomst indicator tot een betrouwbaardere indicator leidt.Show less
Een veelgebruikte indicator van kwaliteit van zorg is de uitkomst van de behandeling. Dit geld ook zo in de GGZ. Afname van psychische klachten of verbeteren van functioneren, is ook het doel...Show moreEen veelgebruikte indicator van kwaliteit van zorg is de uitkomst van de behandeling. Dit geld ook zo in de GGZ. Afname van psychische klachten of verbeteren van functioneren, is ook het doel waarvoor cliënten in behandeling komen. Het is belangrijk voor de cliënt dat klachten zo snel mogelijk verminderen, en er zo snel mogelijk resultaat te zien is van de behandeling. Snel herstel impliceert gewonnen levensgeluk. Daarnaast zijn voor de financiers (zorgverzekeraar en de overheid) de kosten van een behandeling een belangrijk aspect van de kwaliteit van de zorg. Vanuit de waarde gedreven zorg beweging is er dan ook voor gepleit naast uitkomst ook de gepleegde inspanning en kosten op te nemen in de kwaliteitsindicator. Door de variabelen duur en kosten te betrekken in een indicator zou er een veel vollediger beeld van de kwaliteit van zorg ontstaan. Deze stelling wordt in dit onderzoek onderzocht: of de kwaliteitsindicatoren duur-efficiëntie en kosten-efficiëntie valide zijn. Duur-efficiëntie wordt hier gedefinieerd als uitkomst gedeeld door duur; kosten-efficiëntie als uitkomst gedeeld door kosten. De kwaliteitsindicatoren zijn valide wanneer ze duidelijker verschil aantonen tussen natuurlijke groepen cliënten die op verschillende locaties van een GGZ instelling zijn behandeld dan uitkomst alleen. Er is data gebruikt van de instelling Arkin in Amsterdam. MANOVA testen lieten zien dat door het toevoegen van kwaliteitsindicatoren er een groter verschil wordt gezien tussen de groepen. Uit de MANOVA bleek dat zowel de indicator gebaseerd op uitkomst alleen als de indicator voor kosten-efficiëntie onderscheid significant maakte tussen de diverse groepen; de groepen verschilden niet op de indicator voor duur-efficiëntie. Vervolgonderzoek is nodig, met betere indeling in te vergelijken groepen, om na te gaan of de toevoegingen van duur en kosten aan de kwaliteitsindicatoren tot betere indicatoren leidt.Show less
Het beoordelen van de prestatie van de aanbieders van geestelijke gezondheidszorg (GGZ) op alleen hun uitkomst (mate van genezing en herstel) is niet voldoende. Factoren zoals kosten en duur,...Show moreHet beoordelen van de prestatie van de aanbieders van geestelijke gezondheidszorg (GGZ) op alleen hun uitkomst (mate van genezing en herstel) is niet voldoende. Factoren zoals kosten en duur, zouden ook meegenomen moeten worden voor een zinvolle en allesomvattende beoordeling van de kwaliteit van deze zorg. Dit onderzoek richt zich op het vergelijken van de betrouwbaarheid van een kwaliteitsindicator op basis van behandeluitkomst met twee nieuwe kwaliteitsindicatoren; behandeluitkomst gedeeld door kosten en behandeluitkomst gedeeld door duur. Uitkomstgegevens van patiënten met een depressie of angststoornis van de organisatie PuntP zijn gebruikt. Met behulp van deze data is de test-hertest betrouwbaarheid vastgesteld door middel van de Intraclass Correlatie Coëfficiënt (ICC) en vergeleken tussen de al bestaande kwaliteitsindicator en de nieuwe kwaliteitsindicatoren. Uit de resultaten bleek dat de hoogste betrouwbaarheid werd gevonden bij de uitkomstindicator (ICC = .466); de duurindicator (ICC = .230) en de kostenindicator (ICC = .112) hadden een lagere test-hertest betrouwbaarheid. De betrouwbaarheidsindicatoren verschillen onderling niet significant van elkaar aangezien de betrouwbaarheidsintervallen overlappen. Oorzaak hiervan zou de aanzienlijke kans op een Type II fout kunnen zijn, vanwege een lage statistische power. Vervolgonderzoek met een groter aantal te evalueren groepen zal moeten uitwijzen of het verrijken van de behandeluitkomst indicator daadwerkelijk tot een hogere betrouwbaarheid leidt.Show less
