title: Vitality predicts level of guideline-concordant care in routine treatment of mood, anxiety and somatoform disorders.
abstract: OBJECTIVE
  To examine the clinical and psychosocial correlates of adherence to treatment guidelines among outpatients with common mental disorders in a routine clinical setting.
  
  
  METHODS
  In this retrospective cohort study, we analysed 192 patients who were treated for a mood, anxiety or somatoform disorder with pharmacotherapy, psychotherapy or a combination of both treatment modalities. Guideline adherence was assessed with a disorder independent set of quality indicators during up to 3 years of follow-up. At baseline, a standardized diagnostic interview, the Brief Symptom Inventory (BSI), the Short Form 36 (SF-36) and demographic variables were assessed. Using multivariable regression analysis we identified independent predictors associated with guideline adherence.
  
  
  RESULTS
  Patients were aged 36.8 years (SD 11.6) on average. The majority of patients were treated with psychotherapy (47.4%), followed by pharmacotherapy (37.5%) and a combination of pharmacotherapy and psychotherapy (15.1%). Three adherence groups were defined: low (29.7%), intermediate (43.2%) and high (27.1%). Univariate predictors of low adherence were low scores on the subscales vitality and social functioning of the SF-36. In the multivariable model, low adherence was independently predicted by a score lower than 50 on the subscale vitality of the SF-36 (odds ratio per 10 units increase in vitality = 1.34, 95% confidence interval: 1.06-1.71). No significant differences were found within socio-demographic variables, co-morbidity and the scores on the BSI subscales between the adherence groups.
  
  
  CONCLUSIONS
  We found that patients with low scores on the vitality subscale of the SF-36 were at the highest risk to receive low guideline-concordant care. Understanding factors that affect treatment adherence may help to prevent non-adherence and increase the quality of care as well as cost-effectiveness.
authors.affiliation: Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands. e.m.vanfenema@lumc.nl
authors.forename: Esther M
authors.initials: EM
authors.lastname: van Fenema
authors.forename: Nic J A
authors.initials: NJ
authors.lastname: van der Wee
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Giltay
authors.forename: Margien E
authors.initials: ME
authors.lastname: den Hollander-Gijsman
authors.forename: Frans G
authors.initials: FG
authors.lastname: Zitman
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000628:therapy*; D015897:Comorbidity; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008297:Male; D019964:Mood Disorders / Q000628:therapy*; D009426:Netherlands; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013001:Somatoform Disorders / Q000628:therapy*