Integration of psychological care into a nontuberculous mycobacteria (NTM) program in the Southeastern United States..., 2025, Mingora et al

[rvallee]

Integration of psychological care into a nontuberculous mycobacteria (NTM) program in the Southeastern United States: A retrospective cohort study
Therapeutic advances in respiratory disease
PubMed: https://pubmed.ncbi.nlm.nih.gov/41222255/
PDF: https://journals.sagepub.com/doi/pdf/10.1177/17534666251394479

Abstract

Background: Nontuberculous mycobacterial lung disease (NTM-LD) is a chronic infection of the lungs with a high symptom burden. NTM-LD treatment is typically long and complicated, which can impact quality of life and mental health. Increased support for psychological challenges is a priority for this population.

Objectives: We describe integrating psychological care into a multidisciplinary outpatient NTM program, patient characteristics, and results of patient-reported outcomes (PRO) screening (of depression, anxiety, fatigue, health-related quality of life, quality of life, and Top Problems).

Design: Retrospective observational cohort study design.

Methods: Processes and structure around psychology integration are described. Descriptive data obtained via retrospective chart review (IRB approved) are presented on patient sociodemographic factors, psychiatric medication and psychotherapy use, and results of PRO screenings with NTM-LD patients anticipated to start NTM antibiotic treatment or already on treatment. Relationships between variables were examined using nonparametric statistics.

Results: From 2020 to 2024, 175 patients with NTM-LD were screened. Patients were on average 65.7 ± 9.8 years old, female (74.2%), white (91.4%), and on Medicare (69.1%). On average, this group experienced a moderate degree of socioeconomic disadvantage; 94.9% of patients lived in areas with a mental health provider shortage, and 42.3% lived in medically underserved areas. Patients reported considerable rates of mild or higher depression (54.3%) and anxiety (32.0%). Many utilized psychiatric (52.6%) or pain (20.6%) medications, while engagement in psychotherapy was low (5.1%). Patients reported impacts on quality of life, fatigue, and health-related quality of life, and the most common Top Problems were: "Shortness of breath, Breathlessness, Getting winded," "Fatigue/Low energy," and "Cough/Choking."

Conclusion: A licensed psychologist was successfully integrated into the NTM program. The disparity between PRO results and psychotherapy engagement highlights a key opportunity for mental health interventions. Integrated psychological services may provide streamlined access to mental healthcare.

 

[rvallee]

I don't see what psychology has to do with any of the top problems listed. Obviously anyone can be integrated into a team, I have no idea what this is doing in a conclusion. They could have integrated a chef, so what?

Posted mainly for this, though:



As it says it's merely an illustrative list. I have no idea why that makes sense to someone. Why not include ghost sightings or lorem ipsum if it's just about filling space?

References 43-47 are:

• 43: Marques MM, De Gucht V, Gouveia MJ, et al. Differential effects of behavioral interventions with a graded physical activity component
  in patients suffering from Chronic Fatigue (Syndrome): an updated systematic review and meta-analysis. Clin Psychol Rev 2015; 40: 123–137
• 44: Castell BD, Kazantzis N and Moss-Morris RE. Cognitive behavioral therapy and graded exercise for chronic fatigue syndrome: a meta-analysis. Clin Psychol Sci Pract 2011; 18: 311–324.
• 45: Ehde DM, Dillworth TM and Turner JA. Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and
  directions for research. Am Psychol 2014; 69: 153–166.
• 46: Ma TW, Yuen AS and Yang Z. The efficacy of acceptance and commitment therapy for chronic pain: a systematic review and meta-analysis.
  Clin J Pain 2023; 39: 147–157.
• 47: O'Halloran PD, Blackstock F, Shields N, et al. Motivational interviewing to increase physical activity in people with chronic health conditions: a systematic review and meta-analysis. Clin Rehabil 2014; 28: 1159–1171.

Because this illustrative list recommends treatment models that don't even work for the things they are recommended for in the references, using fatigue as a completely generic concept, for which there is also no credible evidence, as some illustrative treatment despite no evidence for it. This is just layers of systemic failure.

And the other ones for shortness of breath and GI issues are just as bad. This is death of expertise. It has nothing to do with the actual aims and goals of this profession, it's just filler meant for publication so that more people can publish more filler material. It's so absurd seeing how much medicine is regressing, all entirely self-inflicted for absolutely no actual gain to anyone, it's pure sabotage but it's meant well so whatever, I guess.

 

[Utsikt]

Patients reported impacts on quality of life, fatigue, and health-related quality of life, and the most common Top Problems were: "Shortness of breath, Breathlessness, Getting winded," "Fatigue/Low energy," and "Cough/Choking."

Doesn’t seem like there’s much need for psychologists.

Patients reported considerable rates of mild or higher depression (54.3%) and anxiety (32.0%).

They used the usual suspects of questionnaires that are very prone to flagging sick people as depressed, anxious etc. Pretty much all of them scored relatively low all things considered.

@rvallee that list is telling..

 

[Hutan]

This is just layers of systemic failure.

It really is.

"Integration of psychological care into a nontuberculous mycobacteria (NTM) program ....: A retrospective cohort study"
The title makes it sound as if they have trialled psychological care in people with this disease.

Conclusion: A licensed psychologist was successfully integrated into the NTM program. The disparity between PRO results and psychotherapy engagement highlights a key opportunity for mental health interventions. Integrated psychological services may provide streamlined access to mental healthcare.

The abstract tells us they added a psychologist to the team. The abstract tells us nothing at all about how the psychologist changed any of the reported depression and anxiety rates, or anything else. There are no before and after figures. Frankly, I bet the participants would have preferred a chef instead, Rvallee. At least there would have been some nice cake at morning tea and some packaged lasagnas to take home for dinner.

The words used in that abstract conclusion are interesting. There's nothing about making the patients' lives better. Instead, the authors see an opportunity for 'mental health interventions' (and presumably an opportunity for the therapists providing those interventions).

It looks to me as though those interventions in the list of what a psychologist might do could easily make life worse for the patients. The suggestion that psychological treatment might be needed for 'treatment-related burdens' is truly ironic - as so many of those psychological interventions could add to those burdens.

It's an extensive list, aiming to correct problems such as food avoidance that we aren't even told that the patients have - the only mention of food avoidance in the paper is in that list. And yet the note on the list ("These interventions have not been tested on people with NTM-LD") makes me wonder what an earth the integrated psychologist actually did during their time on the team. Possibly they just administered biased surveys and came up with aspects of life that they would like to badger sick people about?

It really is an extraordinary abstract. 'We integrated a psychologist in the treatment team. We aren't telling you anything about what happened with that though. Still, we think it's a good idea.'

@Joan Crawford - this might be an interesting example for your British Psychological Society team of how prejudice and an enthusiasm to help can run ahead of evidence. It's an example of just how bad the justification for offering psychological therapies can be.

The observation that patients aren't using psychotherapy does not automatically mean that they need a psychologist. A finding that chronically ill patients score highly on a biased depression survey doesn't necessarily mean that that 1. they are depressed, 2. that they want a psychologist to train them in thinking differently, and 3. that the psychologist's tools will be of any use in making them less sad.

42.3% lived in medically underserved areas.

I'm a lot more concerned about that finding in this cohort of people who are dealing with a treatment regime that is reported to be 'long and complicated' and who face moderate socio-economic disadvantage. I suspect access to an experienced specialist nurse and a support group and a taxi service are likely to be of more use to most of the patients than a psychologist with an ambition to adjust people's thinking.

 

[Joan Crawford]

Ridiculous nonsense.

If they had demonstrated something objective like patients were more likely to stick with the long term medical care etc well at least that'd be something. I imagine it's quite difficult for multiple reasons to keep people in treatment long term.

It's poor to see, for example:

- Inappropriate use of questionnaires to screen and pseudo 'diagnose'

- List of rag tag 'treatments' for 'fatigue' etc. We know how that goes. They seem unaware of any issues with this

- CBT for IBS including diarrhea Oh really. Noddy nonsense.

And it goes on......

I mean seriously if any of the medical team thought that a patient would benefit from some psychological intervention for, for example, concurrent untreated post trauma stress, agoraphobia, debilitating panic etc etc ideally there would be a mechanism via local psychologists or via their GP for this to be treated. The issue with this is it can go wonky if the patient's focus does not remain on the medical care first and foremost. That's where having a psychologist at least alongside the medical team can be helpful.

No clue why a team would be essentially advertising how fabulous they are by coming across as out if date, adhering or working by methods strung together with no coherence and being apparently quite blind to other more practical, helpful support for patients. Seems like a mismatch of resources since there is a lack of psychologists for mainstream mental health services, especially for children and young people.

 

[Hutan]

The issue with this is it can go wonky if the patient's focus does not remain on the medical care first and foremost. That's where having a psychologist at least alongside the medical team can be helpful.

No clue why a team would be essentially advertising how fabulous they are by coming across as out if date, adhering or working by methods strung together with no coherence and being apparently quite blind to other more practical, helpful support for patients. Seems like a mismatch of resources since there is a lack of psychologists for mainstream mental health services, especially for children and young people.

Yes, exactly.

The problem here is not that support from psychologists cannot be helpful to people with chronic illnesses - certainly they can be to. It's that this paper doesn't test what sort of psychological support is useful. It only muddies the water with speculation about various CBT interventions.

There is actually some good work in the paper in identifying the problems the patients are having (see table 4 and the following quote). The authors had information that could have made for a compelling and useful abstract.

Independent-Samples Mann–Whitney U Tests were conducted to examine whether patients starting NTM antibiotic treatment (n=106) differed on
PROS from patients already on antibiotic treatment (n=69). Results indicated that there was no signifi-cant difference between those on NTM antibiotic treatment and those not on treatment on depression, fatigue, HRQOL, or overall QOL (p’s>0.05).

However, there was a significant difference in anxiety; the median GAD-7 score was 3.0 (interquartile range (IQR) =5.1) in those not on NTM treatment, and 1.0 (IQR =4.4) in those on treatment (Mann–Whitney U=2929.6, p=0.025).

From Table 4 - psychological concerns were not the most pressing problems, and the comments from the patients used to illustrate them suggest psychological issues are a reasonable reaction to the situation:

“Fears of the unknown”
“Depressed over functioning”

Those patients on the disease modifying treatment were less likely to be anxious than those not yet on the treatment. It seems likely that one key way to reduce anxiety is to get the person started with the antibiotics. (It's possible that people who are already on a treatment have some socioeconomic advantages that improve access to medical care and reduce worries about the future too.)

I think this paper is an example of the point we often make - some concern about the future is a reasonable reaction to having a debilitating chronic disease. One effective way to deal with that reaction is to make some real progress towards finding an effective treatment and giving people access to it.

 

[Hutan]

One last thing from Table 4 which has percentages of people in the study cohort reporting various problems:

Breathlessness: 22%
Fatigue, low energy 19%
Cough and choking 14%
Pain aches 10%
.....
Anxiety, depression and cognitive concerns 4%

Very few people in the cohort are reporting having an issue with psychological concerns, and, even then, issues with brain fog ("hard to get my thoughts together"), which might actually be an aspect of fatigue and breathlessness, have been lumped in together with anxiety and depression. So, not even four percent.
And yet, this is what they lead with in the Discussion section:

A screening program focusing on patients start- ing antibiotics or already on treatment for NTM-LD revealed a high burden of mental health symptoms—over half had mild or higher depression scores, and one-third had mild or higher anxiety scores. Strikingly, only 5% of patients were engaged with any form of psycho-therapy at the time of screening, highlighting an unmet need in this population.

Why did they bother to ask patients about their concerns if they are going to ignore the results?

As others have said, this paper is an illustration of a solution in search of a problem, and of the problems with the screening tools used for depression and anxiety in debilitating chronic conditions.