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  • 1.
    Dragioti, Elena
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. University of Ioannina, Greece.
    Dimoliatis, Ioannis
    University of Ioannina, Greece.
    Fountoulakis, Konstantinos N.
    Aristotle University of Thessaloniki, Greece.
    Evangelou, Evangelos
    University of Ioannina, Greece; University of London Imperial Coll Science Technology and Med, England.
    A systematic appraisal of allegiance effect in randomized controlled trials of psychotherapy2015In: Annals of General Psychiatry, ISSN 1744-859X, E-ISSN 1744-859X, Vol. 14, no 25Article in journal (Refereed)
    Abstract [en]

    Background: Experimenters allegiance (EA) refers to a personal confidence of the superiority of a specific psychotherapy treatment. This factor has been linked with larger treatment effects in favor of the preferred treatment. However, various studies have displayed contradictory results between EA and the pattern of treatment effects. Aims: Using a systematic approach followed by meta-analysis, we aimed to evaluate the impact of an allegiance effect on the results of psychotherapeutic studies. Method: We considered the meta-analyses of randomized controlled trials (RCTs) of different types of psychotherapies in the Cochrane Database of Systematic Reviews. Eligible articles included meta-analyses of RCTs with at least one study showing evidence of EA (i.e., allegiant study). Effect sizes in allegiant RCTs were compared with non-allegiant using random and fixed models and a summary relative odds ratio (ROR) were calculated. Heterogeneity was quantified with the I-2 metric. Results: A total of 30 meta-analyses including 240 RCTs were analyzed. The summary ROR was 1.31 [(95 % confidence interval (CI: 1.03-1.66) P = 0.30, I-2 = 53 %] indicating larger effects when allegiance exists. The impact of allegiance did not differ significantly (P greater than 0.05) when we compared psychiatric versus medical outcomes. Allegiance effect was significant for all forms of psychotherapy except for cognitive behavioral therapy. Moreover, the impact of allegiance was significant only when the treatment integrity of delivered psychotherapy was not assessed. Allegiance effect was even stronger where the experimenter was also both the developer of the preferred treatment and supervised or trained the therapists. No significant differences were found between allegiant and non-allegiant studies in terms of overall quality of studies. Conclusions: Experimenters allegiance influences the effect sizes of psychotherapy RCTs and can be considered non-financial conflict of interest introducing a form of optimism bias, especially since blinding is problematic in this kind of research. A clear reporting of EA in every single study should be given an opportunity to investigators of minimizing its overestimation effects.

  • 2.
    Dragioti, Elena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Insomnia severity and its relationship with demographics, pain features, anxiety, and depression in older adults with and without pain: cross-sectional population-based results from the PainS65+cohort2017In: Annals of General Psychiatry, ISSN 1744-859X, E-ISSN 1744-859X, Vol. 16, article id 15Article in journal (Refereed)
    Abstract [en]

    Background: Insomnia is a major cause of concern in the elderly with and without pain. This study set out to examine the insomnia and its correlates in a large sample of community adults aged amp;gt;= 65 years. Methods: A cross-sectional postal survey was completed by 6205 older individuals (53.8% women; mean age = 76.2 years; SD = 7.5). The participants also completed the Insomnia Severity Index (ISI) and questionnaires assessing pain intensity, pain spreading, anxiety, depression, and basic demographic information. The sample was divided into three groups based on the presence and duration of pain: chronic pain (CP; n = 2790), subacute pain (SP; n = 510), and no pain (NP; n = 2905). Results: A proportion of each of the groups had an ISI score of 15 or greater (i.e., clinical insomnia): CP = 24.6%; SP = 21.3%; and NP = 13.0%. The average scores of ISI differed significantly among CP, SP, and NP groups (p amp;lt; 0.001). Stratified regression analyses showed that pain intensity, pain spreading, anxiety, and depression were independently related to insomnia in the CP group. Anxiety and depression were independently related to insomnia in the SP group, but only anxiety was significantly associated with insomnia in the NP group. Age and sex were not associated with insomnia. Conclusions: This study confirms that insomnia is not associated with chronological aging per se within the elderly population. Although the possible associations of insomnia with pain are complex, ensuing from pain intensity, pain spreading, anxiety, and depression, our results highlighted that anxiety was more strongly associated with insomnia in all groups than the depression and pain characteristics. Therapeutic plans should consider these relations during the course of pain, and a comprehensive assessment including both pain and psychological features is essential when older people are seeking primary health care for insomnia complaints.

  • 3.
    Larsson, Britt
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Dragioti, Elena
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Bjork, Jonas
    Lund Univ, Sweden; Skane Univ Hosp Lund, Sweden.
    Positive psychological well-being predicts lower severe pain in the general population: a 2-year follow-up study of the SwePain cohort2019In: Annals of General Psychiatry, ISSN 1744-859X, E-ISSN 1744-859X, Vol. 18, article id 8Article in journal (Refereed)
    Abstract [en]

    BackgroundPositive psychology indicators like well-being and life satisfaction may play a pivotal role in pain-related outcomes. In this study, we aimed to examine the prospective associations of positive well-being and life satisfaction with pain severity.Methods and SubjectsThis longitudinal study, with a follow-up of 2years, included 9361 participants (4266 males, 5095 females; mean age: 52.5years; SD: 17.5) without and with chronic pain (CP) at baseline. All analyses were stratified by the two sub-cohortsparticipants without CP (sub-cohort 1) and participants with CP (sub-cohort 2) at baseline. The predictive associations, assessed using ordinal regression in a Generalized Linear Model, were adjusted for baseline potential confounders and reported as odds ratios (ORs) with corresponding 95% confidence intervals (CIs).ResultsAfter adjustments, in sub-cohort 1 positive well-being at baseline was associated with lower severe pain at follow-up compared to participants with severe distress (OR: 0.64; 95% CI 0.49-0.84; pamp;lt;0.001). In sub-cohort 2, both positive well-being and life satisfaction at baseline were associated with lower severe pain at follow-up compared to participants with severe distress and not satisfied with life (OR: 0.80; 95% CI 0.65-0.98; p=0.031 and OR: 0.82; 95% CI 0.69-0.96; p=0.014, respectively).ConclusionsPositive well-being is predictive of lower pain severity both among participants without and with CP at baseline, whereas life satisfaction was found predictive of lower pain severity only for subjects with CP. Future research should emphasize implementing treatments associated with promoting and maintaining positive well-being and life satisfaction in patients who suffer from chronic pain and in risk populations.

  • 4.
    Lester, Nigel
    et al.
    Washington Univ, Sch Med, Dept Psychiat, Ctr Well Being, St Louis, MO 63110 USA..
    Garcia, Danilo
    Washington University School of Medicine, Department of Psychiatry, Center for Well-Being, St. Louis, MO, United States.
    Lundström, Sebastian
    Univ Gothenburg, Ctr Eth Law & Mental Hlth CELAM, Inst Neurosci & Physiol, Gothenburg, Sweden.
    Brändström, Sven
    Univ Gothenburg, Ctr Eth Law & Mental Hlth CELAM, Inst Neurosci & Physiol, Gothenburg, Sweden.
    Råstam, Maria
    Lund Univ, Dept Clin Sci, Lund, Sweden.
    Kerekes, Nora
    University West, Department of Health Sciences, Section for health promotion and care sciences. University of Gothenburg, Centre for Ethics, Law and Mental Health (CELAM), Institute for Neuroscience and Physiology, Sweden; Swedish Prison and Probation Service, Gothenburg, Sweden.
    Nilsson, Thomas
    Univ Gothenburg, Ctr Eth Law & Mental Hlth CELAM, Inst Neurosci & Physiol, Gothenburg, Sweden.
    Cloninger, C Robert
    Washington University School of Medicine in St. Louis, St Louis, USA.
    Anckarsäter, Henrik
    Univ Gothenburg, Ctr Eth Law & Mental Hlth CELAM, Inst Neurosci & Physiol, Gothenburg, Sweden.
    The genetic and environmental structure of the character sub-scales of the temperament and character inventory in adolescence.2016In: Annals of General Psychiatry, ISSN 1744-859X, E-ISSN 1744-859X, Vol. 15, article id 10Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The character higher order scales (self-directedness, cooperativeness, and self-transcendence) in the temperament and character inventory are important general measures of health and well-being [Mens Sana Monograph 11:16-24 (2013)]. Recent research has found suggestive evidence of common environmental influence on the development of these character traits during adolescence. The present article expands earlier research by focusing on the internal consistency and the etiology of traits measured by the lower order sub-scales of the character traits in adolescence.

    METHODS: The twin modeling analysis of 423 monozygotic pairs and 408 same sex dizygotic pairs estimated additive genetics (A), common environmental (C), and non-shared environmental (E) influences on twin resemblance. All twins were part of the on-going longitudinal Child and Adolescent Twin Study in Sweden (CATSS).

    RESULTS: The twin modeling analysis suggested a common environmental contribution for two out of five self-directedness sub-scales (0.14 and 0.23), for three out of five cooperativeness sub-scales (0.07-0.17), and for all three self-transcendence sub-scales (0.10-0.12).

    CONCLUSION: The genetic structure at the level of the character lower order sub-scales in adolescents shows that the proportion of the shared environmental component varies in the trait of self-directedness and in the trait of cooperativeness, while it is relatively stable across the components of self-transcendence. The presence of this unique shared environmental effect in adolescence has implications for understanding the relative importance of interventions and treatment strategies aimed at promoting overall maturation of character, mental health, and well-being during this period of the life span.

  • 5.
    Li, Gang
    et al.
    Janssen Res & Dev, Real World Evidence Stat & Decis Sci, 920 US Highway 202 S, Raritan, NJ 08869 USA.
    Fife, Daniel
    Janssen Res & Dev, Dept Epidemiol, 920 US Highway 202 S, Raritan, NJ 08869 USA.
    Wang, Grace
    Janssen Res & Dev, Real World Evidence Stat & Decis Sci, 920 US Highway 202 S, Raritan, NJ 08869 USA.
    Sheehan, John J.
    Janssen Sci Affairs LLC, Titusville, NJ USA.
    Bodén, Robert
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Brandt, Lena
    Karolinska Univ Hosp, Karolinska Inst, Dept Med Solna, Ctr Pharmacoepidemiol, Stockholm, Sweden.
    Brenner, Philip
    Karolinska Univ Hosp, Karolinska Inst, Dept Med Solna, Ctr Pharmacoepidemiol, Stockholm, Sweden.
    Reutfors, Johan
    Karolinska Univ Hosp, Karolinska Inst, Dept Med Solna, Ctr Pharmacoepidemiol, Stockholm, Sweden.
    DiBernardo, Allitia
    Janssen Res & Dev, Real World Evidence Stat & Decis Sci, 920 US Highway 202 S, Raritan, NJ 08869 USA.
    All-cause mortality in patients with treatment-resistant depression: a cohort study in the US population2019In: Annals of General Psychiatry, ISSN 1744-859X, E-ISSN 1744-859X, Vol. 18, no 1, article id 23Article in journal (Refereed)
    Abstract [en]

    Background Treatment-resistant depression (TRD) may represent a substantial proportion of major depressive disorder (MDD); however, the risk of mortality in TRD is still incompletely assessed. Methods Data were obtained from Optum Clinformatics (TM) Extended, a US claims database. Date of the first antidepressant (AD) dispensing was designated as the index date for study entry and 6 months prior to that was considered the baseline period. Patients with MDD aged >= 18 years, index date between January 1, 2008 and September 30, 2015, no AD claims during baseline, and continuous enrollment in the database during baseline were included. Patients who started a third AD regimen after two regimens of appropriate duration were included in the TRD cohort. All-cause mortality was compared between patients with TRD and non-TRD MDD using a proportional hazards model and Kaplan-Meier estimate with TRD status being treated as a time-varying covariate. The model was adjusted for study year, age, gender, depression diagnosis, substance use disorder, psychiatric comorbidities, and Charlson comorbidity index. Results Out of 355,942 patients with MDD, 34,176 (9.6%) met the criterion for TRD. TRD was associated with a significantly higher mortality compared with non-TRD MDD (adjusted HR: 1.29; 95% CI 1.22-1.38; p < 0.0001). Survival time was significantly shorter in the TRD cohort compared with the non-TRD MDD cohort (p < 0.0001). Conclusions Patients with TRD had a higher all-cause mortality compared with non-TRD MDD patients.

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