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- Johansson, Peter, et al.
(författare)
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Time-course of depressive symptoms in patients with heart failure
- 2013
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Ingår i: Journal of Psychosomatic Research. - : Elsevier BV. - 0022-3999 .- 1879-1360. ; 74:3, s. 238-243
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Tidskriftsartikel (refereegranskat)abstract
- Background It is unclear how depressive symptoms in patients with heart failure developover time and whether this trajectory of depressive symptoms is associated with hospital admission and prognosis.Aim To describe the time-course of depressive symptoms and determine the relationship with hospital admission and mortality.Method Data was analysed using 611 patients with completed CES-D questionnaires at baseline and at 18 months. Data on hospital readmission was collected 18 months after discharge and data on mortality was collected 18 and 36 months post-discharge.Results The prevalence of depressive symptoms was 38% (n=229) at discharge and 26% (n=160) after 18 months. A total of 140 (61%) of the 229 patients with depressive symptoms at discharge had recovered from depressive symptoms after 18 months whereas 71 (18%) of the 382 non-depressed developed depressive symptoms and 89 (39%) of the 229 depressed remained depressed. Depressive symptoms at discharge were not associated with mortality after 18 months but patients with recently (i.e. during 18 months) developed depressive symptoms showed a significantly higher risk for cardiovascular readmissions (HR 1.7, p=0.016). After 36 months, patients with developed depressive symptoms after discharge were at a higher risk of all-cause mortality (HR 2.0, p=0.012) and there was a trend towards a higher risk of all-cause mortality in patients with ongoing depressive symptoms (HR 1.7, p=0.056).Conclusion A significant proportion of patients with HF, who were reported depressive symptoms at discharge recovered from depressive symptoms during the following 18 months. However, patients who remained having depressive symptoms or patients who developed depressive symptoms had a worse prognosis.
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| 3. |
- Lundgren, Johan, 1977-
(författare)
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Internet Cognitive Behavioural Therapy - A New Tool for Depressed Heart Failure Patients. : - A Developmental and Feasibility Study
- 2014
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Ingår i: Svenska Kardiovaskulära Vårmötet, 2014.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: In patients with heart failure (HF) depression is common and is linked to a poor quality of life as well as a poorer prognosis. Despite this less is known about how to treat depression in HF patients.Aim: The purpose of this study was (I) to design and construct an internet cognitive behavioural therapy (CBT) –program adapted to patients with HF, (II) and in a pilot-study evaluate the feasibility of the program, with respect to its ability to treat depression, time consumption and to identify areas in the need of improvements.Methods: literature review and expert panel was used to design the program. The feasibility of the program was evaluated in 7 HF patients with depression. Montgomery-Åsberg Depression Rating Scale (MADRS) and Patient Health Questionnaire-9 (PHQ-9) were used to measure depression. Qualitative interviews were conducted to describe the patients perceptions of the program.Results: The developed 9 week internet CBT program consists of seven modules addressing; introduction, psychoeducation about HF and depression, behavioural activation, problem solving and completion. Before the pilot testing participants mean depression score on MADRS and PHQ-9 was 20 and 11 respectively. After the intervention the mean had decreased to 11.5 and 5.5 respectively. No participants’ depression deteriorated. Time consumption for guidance and feedback was about 20 minutes per participants and week. In interviews pros stated by the participants were: the freedom of time disposition, being able to take the time needed when working with the program and learning about their health problems and what they could do about them. Cons stated were: parts of the program required quiet a lot of reading and work from the participants and some technical problems.Conclusion: The newly developed 9 week internet CBT-program for patients with HF and depression appears to be feasible and safe.
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| 4. |
- Lundgren, Robin, 1977-
(författare)
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Convergence of Option Rewards
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis consists of an introduction and five articles devoted to optimal stopping problems of American type options. In article A, we get general convergence results for the American option rewards for multivariate Markov price processes. These results are used to prove convergence of tree approximations presented in papers A, B, C and E.In article B, we study the problem of optimal reselling for European options. The problem can be transformed to the problem of exercising an American option with two underlying assets. An approximative binomial-trinomial tree algorithm for the reselling model is constructed. In article C, we continue our study of optimal reselling of European options and give the complete solution of the approximation problem. In the article D, we consider general knockout options of American type. A Monte-Carlo method is used to study structure of optimal stopping domains generated by combinations of different pay-off functions and knockout domains.In article E the American option with knock out domains is considered. In order to show convergence of the reward functional the problem is reformulated in such a way that the convergence results in paper A can be applied.
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