Predictors of Non-response and Persistent Functional Impairments in Treatment Adhering to Evidence-based Practice Guidelines for Anxiety Disorders
|Maarten K van Dijk1*, Marc JPM Verbraak1,2, Desiree B Oosterbaan3, Adriaan W Hoogendoorn4 and Anton JLM van Balkom4|
|1 HSK Group, Arnhem, The Netherlands|
|2 Behavioural Science Institute, Radboud University Nijmegen, The Netherlands|
|3 Department of Psychiatry, UMC St. Radboud, Nijmegen, The Netherlands|
|4 Department of Psychiatry and EMGO Institute, VU University Medical Center and GGZinGeest, Amsterdam, The Netherlands|
|*Corresponding Author :||Maarten K. van Dijk
MSc, HSK Arnhem, Oude Oeverstraat 120
6811 JZ Arnhem, The Netherlands
Tel: +3126 3687716
E-mail: [email protected]
|Received May 20, 2014; Accepted June 30, 2014; Published July 05, 2014|
|Citation: Van Dijk MK, Verbraak MJPM, Oosterbaan DB, Hoogendoorn AW, van Balkom AJM (2014) C Functional Impairments in Treatment Adhering to Evidence-based Practice Guidelines for Anxiety Disorders. J Depress Anxiety 3:159. doi:10.4172/2167-1044.1000159|
|Copyright: © 2014 Van Dijk MK, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
Background: Several countries have developed guidelines for anxiety disorders containing algorithms that summarize the recommended treatment steps for these disorders. It is important to know which patients have a poor prognosis for treatment according to such algorithms.
Aims: To investigate the predictive power of variables known to be able to influence treatment prognosis in situations where practice guidelines for anxiety disorders are adhered to.
Method: To study the predictive power of variables that are known to be able to influence treatment prognosis, 81 patients who participated in a guideline implementation study and whose treatment was found to adhere to available guidelines were selected. Using logistic regression analysis two models were constructed: one to predict treatment nonresponse; another to predict persistent functional impairments at the 1-year follow-up.
Results: The final prediction model for treatment non-response contains only gender and secondary gain variables. It appears that: males have a higher likelihood (p=.074), and patients that report hopes of obtaining external benefits by seeking treatment have a lower likelihood (p=.054) of showing treatment non-response at the 1-year follow-up. The discriminatory power of this model was found to be poor, however. The model for persistent functional impairments includes gender, satisfaction with the accessibility of healthcare services and the presence of a comorbid anxiety disorder. It appears that: males (p=.87) and patients who express dissatisfaction with the accessibility of care (p=.008) have a higher likelihood, and that; patients who suffer from an additional comorbid anxiety disorder have a lower likelihood (p=.079) of persistent functional impairments. The discriminatory power of this model is excellent.
Conclusion: It remains difficult to predict which anxiety disorder patients will not benefit from treatment that is tailored according to available practice guideline recommendations, therefore no one should be prevented from being offered such treatment, if one removes barriers in attending treatment.