Meyrose, Ann-Katrin

Background: Many patients with depressive disorders use antidepressants longer than clinically indicated. Long-term use is associated with high individual and societal costs. Patients often perceive antidepressant discontinuation as challenging. Aim: To understand patients’ expectations towards discontinuation, document their experiences with long-term use and discontinuation, and identify factors that can help or hinder discontinuation. Design and Setting: Qualitative study using semi-structured interviews via telephone with adult patients in Germany. Method: Thirty-two patients with remitted Major Depressive Disorder and long-term antidepressant use were interviewed. We analysed transcripts with content analysis aided by MaxQDA to derive thematic categories. Results: Patients expected to eliminate side effects or regain independence following discontinuation. Such positive expectations were perceived as facilitators and motivated patients’ discontinuation wish. However, patients also had negative expectations such as recurrence or discontinuation symptoms. Patients’ negative expectations were often fuelled by negative experiences, persisted despite a wish to stop antidepressants, and hindered discontinuation. Most patients perceived antidepressants as effective, but experienced side effects and further hassles. Patients felt inadequately informed about treatment duration and methods for discontinuation. Further barriers and facilitators included a stable environment, availability of support, and treatment information. Conclusion: Patients prefer to discontinue antidepressants within structured frameworks that provide information and support. Identified facilitators and barriers may help optimise appropriate use and discontinuation of antidepressants in routine practice. The utility of functional expectations and specification of individualised approaches to minimise dysfunctional expectations, adapted to patients’ previous experiences, appear to be especially important.

Background: Treatment expectations influence clinical outcomes in various physical and psychological conditions; however, no studies have explored their role in endometriosis treatment. It is necessary to understand how these expectations can be measured to study treatment expectations and their effects in clinical practice. This study aimed to psychometrically analyze and compare different treatment expectation measurements and describe treatment expectations in women with suspected endometriosis. Method: Analysis of cross-sectional baseline data of a mixed-method clinical observational study of N=699 patients undergoing laparoscopy in Germany. Descriptives, bivariate associations, convergent and discriminant validity of four expectation measurements (Treatment Expectation Questionnaire (TEX-Q); Generic rating scale for previous treatment experiences, treatment expectations, and treatment effects (GEEE); numerical rating scales (NRS) assessing improvement and worsening of endometriosis symptoms, expected Pain Disability Index (PDI); range: 0 to 10) were estimated. A cluster analysis was performed on the three GEEE items. Results: Most participants expected high improvement (M=6.68 to 7.20, SD=1.90 to 2.09) and low worsening (M=1.09 to 2.52, SD=1.80 to 2.25) of disability from laparoscopy. Participants who expected greater worsening expected more side effects (r=.31 to .60, p<.001). Associations between the positive and negative expectation dimensions, including side effects, were small to non-significant (r =|.24| to .00, p<.001 to.978). Four distinct clusters, described as’positive’, ‘no pain, no gain’, ‘diminished’, and ‘uniform’ were found, with a total PVE of 62.2%. Conclusions: Women with suspected endometriosis reported positive expectations concerning laparoscopy, but wide ranges indicated interindividual differences. Treatment expectations seem to be a multidimensional construct in this patient group. The investigated measurements did not correlate to the extent that they measured exactly the same construct. The selection of measurements should be carefully considered and adapted for the study purposes. Clusters provide initial indications for individualized interventions that target expectation manipulation. Trial Registration Number: ID NCT05019612 (ClinicalTrials.gov)

Die Aufklärung und informierte Einwilligung stellen eine rechtliche und ethische Voraussetzung für eine Psychotherapie dar. Wir befragten daher 530 psychotherapeutisch Praktizierende in Deutschland zu ihren Einstellungen und zur praktischen Umsetzung der Aufklärung mit informierter Einwilligung für Psychotherapie. Für die meisten Behandelnden (84%) war das Einholen einer informierten Behandlungseinwilligung alltägliche Routine. Viele Psychotherapeut*innen fühlten sich unsicher, ob sie die rechtlichen (63%) und ethischen Verpflichtungen (52%) zufriedenstellend erfüllen. Vier von fünf Behandelnden (80%) gaben an, Patient*innen auch über mögliche Risiken zu informieren. Viele Befragte (52%) befürchteten allerdings, durch diese Informationen Ängste bei Patient*innen auszulösen. Obwohl die informierte Einwilligung für Psychotherapie in der klinischen Praxis eher die Regel als die Ausnahme zu sein scheint, bleibt die Umsetzungsqualität im Hinblick auf die rechtlichen, ethischen und klinischen Anforderungen fraglich.

Introduction Overall, 20%–30% of women with endometriosis report endometriosis-related disability after successful laparoscopy. This indicates a potential impact of psychological factors, such as expectations, on treatment outcomes. It is already known that expectations determine treatment outcomes in various health conditions, such as cardiologic or gynaecology. Therefore, we investigate the impact of expectations and other psychological factors on patients’ course of treatment outcomes after laparoscopy. Methods and analysis A longitudinal mixed-methods study with N=300 women treated at a specialised centre of surgical endoscopy and endometriosis will be conducted with one preoperative and eight postoperative assessments of endometriosis-related disability and a priori specified predictors such as expectations. Additionally, two subsamples (each ~n=30) will be either interviewed about their endometriosis-related disability, expectations, and experiences of laparoscopy before and after surgery or asked once per day for 30 consecutive days using ambulatory assessments. Quantitative data will be analysed using multilevel modelling for longitudinal data. Structural content analysis will be used for qualitative data. Discussion To optimise treatment for women with endometriosis, it is essential to understand how treatment expectations and other psychological and medical factors influence treatment outcomes after laparoscopy. Ethics and dissemination The Ethics Committee of the Psychotherapeutenkammer Hamburg, Germany, gave ethical approval (ROXWELL-2021-HH, 25 June 2021). Trial registration number ClinicalTrials.gov Registry (NCT05019612).