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Palacios JE, Richards D, Palmer R, Coudray C, Hofmann SG, Palmieri PA, Frazier P. Supported Internet-Delivered Cognitive Behavioral Therapy Programs for Depression, Anxiety, and Stress in University Students: Open, Non-Randomised Trial of Acceptability, Effectiveness, and Satisfaction. JMIR Ment Health 2018; 5:e11467. [PMID: 30552076 PMCID: PMC6315236 DOI: 10.2196/11467] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/19/2018] [Accepted: 10/27/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Many university campuses have limited mental health services that cannot cope with the high demand. One alternative is to use internet-delivered cognitive behavioral therapy (iCBT) as a way of tackling barriers such as lack of availability and scheduling issues. OBJECTIVE This study aimed to assess feasibility, acceptability, effectiveness, and satisfaction of a supported iCBT intervention offering 3 programs on depression, anxiety, and stress to university students. The design was an open or nonrandomized feasibility trial. METHODS Participants were recruited from 3 counseling centers at a large midwestern University in the United States. Those agreeing to take part chose 1 of 3 iCBT programs-Space from Depression, Space from Anxiety, or Space from Stress -all comprised 8 modules of media-rich interactive content. Participants were supported throughout the trial by a trained professional. The Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7) questionnaire, and stress subscale of the Depression Anxiety and Stress Scale (DASS-21) were completed at baseline, 8 weeks, and 3-month follow-up. A Satisfaction With Treatment (SAT) questionnaire was completed at 8 weeks, and qualitative interviews were completed by a subsample of participants at 3 months. RESULTS A total of 102 participants were recruited, with 52 choosing Space from Anxiety, 31 choosing Space from Depression, and 19 choosing Space from Stress. Mixed-effects models showed a significant decrease in symptoms of depression (F4=6.36, P<.001), anxiety (F4=7.97, P<.001), and stress (F4=8.50, P<.001) over time across all 3 programs. The largest decreases in PHQ-9 scores at 8 weeks were among participants who chose the Space from Depression program (d=0.84); at 3 months, the largest decreases in PHQ-9 scores were among those who chose the Space from Stress program (d=0.74). The largest decreases in GAD-7 scores were among those who chose the Space from Anxiety program (d=0.74 at 8 weeks and d=0.94 at 3 months). The largest decrease in DASS-21 stress subscale scores was among those who chose the Space from Stress program (d=0.49 at 8 weeks and d=1.16 at 3 months). The mean time spent using the platform per session was 27.4 min (SD 33.8), and participants completed 53% (SD 37.6) of the total program content on average. Most (37/53, 69%) participants found the programs helpful or very helpful and liked the convenience and flexibility of the intervention. Qualitative interviews (n=14) indicated the intervention met students' expectations, and they saw it as a valuable complement to face-to-face treatment. CONCLUSIONS The iCBT programs tested in our study appear to be feasible, acceptable, and effective in a university environment. Participants described the benefits of having a flexible, supported Web-based intervention available on campus. Larger trials should be conducted to further test the effectiveness of supported Web-based interventions that give students a choice of program depending on their symptom profile.
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Affiliation(s)
- Jorge E Palacios
- E-mental Health Research Group, School of Psychology, University of Dublin, Trinity College Dublin, Dublin, Ireland.,Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Derek Richards
- E-mental Health Research Group, School of Psychology, University of Dublin, Trinity College Dublin, Dublin, Ireland.,Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Riley Palmer
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States
| | - Carissa Coudray
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States
| | - Stefan G Hofmann
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, United States
| | - Patrick A Palmieri
- Summa Health Traumatic Stress Center, Summa Health System, Akron, OH, United States
| | - Patricia Frazier
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States
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Richards D, Duffy D, Burke J, Anderson M, Connell S, Timulak L. Supported Internet-Delivered Cognitive Behavior Treatment for Adults with Severe Depressive Symptoms: A Secondary Analysis. JMIR Ment Health 2018; 5:e10204. [PMID: 30279154 PMCID: PMC6231851 DOI: 10.2196/10204] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/12/2018] [Accepted: 08/28/2018] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Depression is a highly prevalent mental health issue that exacts significant economic, societal, personal, and interpersonal costs. Innovative internet-delivered interventions have been designed to increase accessibility to and cost-effectiveness of treatments. These treatments have mainly targeted mild to moderate levels of depression. The increased risk associated with severe depression, particularly of suicidal ideation often results in this population being excluded from research studies. As a result, the effectiveness of internet-delivered cognitive behavioral therapy (iCBT) in more severely depressed cohorts is less researched. OBJECTIVE The aim of this study is to examine the effect of iCBT on symptoms of severe depression, comorbid symptoms of anxiety, and levels of work and social functioning. METHODS Retrospective consent was provided by participants with elevated scores (>28 severe depression symptoms) on the Beck Depression Inventory (BDI-II) who accessed an iCBT intervention (Space from Depression) with support for up to 8 weeks. Data were collected at baseline, posttreatment, and 3-month follow-up on the primary outcome (BDI-II), and secondary outcomes (the Generalized Anxiety Disorder-7 and the Work and Social Adjustment Scale). RESULTS A significant change was observed on all measures between pre- and postmeasurement and maintained at 3-month follow-up. Clinical improvement was observed for participants on the BDI-II from pre- to postmeasurement, and suicidal ideation also reduced from pre- to postmeasurement. CONCLUSIONS Users of Space from Depression with symptoms of severe depression were found to have decreased symptoms of depression and anxiety and increased levels of work and social functioning. The intervention also demonstrated its potential to decrease suicidal ideation. Further investigation is required to determine why some individuals improve, and others do not. iCBT may have the potential to be used as an adjunct treatment for severe depression symptoms, but participants may require further treatment if they receive iCBT as a standalone intervention. Although promising, further research incorporating control groups is needed to support the utility of Space from Depression for use in or as an adjunct to treatment for severe depression.
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Affiliation(s)
- Derek Richards
- Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland.,E-Mental Health Group, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Daniel Duffy
- Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland.,E-Mental Health Group, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - John Burke
- Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Melissa Anderson
- Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Sarah Connell
- Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland.,E-Mental Health Group, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Ladislav Timulak
- E-Mental Health Group, School of Psychology, Trinity College Dublin, Dublin, Ireland
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Weitz E, Kleiboer A, van Straten A, Cuijpers P. The effects of psychotherapy for depression on anxiety symptoms: a meta-analysis. Psychol Med 2018; 48:2140-2152. [PMID: 29361995 DOI: 10.1017/s0033291717003622] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND More than half of patients who present with depressive disorders also have elevated comorbid anxiety symptoms. Given the high comorbidity between these disorders, it is important to understand the extent that psychotherapies for depression additionally ameliorate symptoms of anxiety. METHODS Systematic searches were conducted in PubMed, PSYCinfo, EMBASE, and the Cochrane Registry of Controlled Trials. Included studies were randomized controlled trials that compared psychotherapy compared with a control condition for the treatment of adults with a primary diagnosis or elevated symptoms of depression and that examined the effects of treatment on anxiety outcomes. Acute phase depression and anxiety (continuous measure) outcomes were extracted. Effect sizes were calculated by subtracting the average post-treatment scores of the psychotherapy group from the average post-treatment scores of the comparison group divided by the pooled standard deviation. RESULTS Fifty-two studies of varying quality met the inclusion criteria. Pooled effect sizes showed that anxiety outcomes were significantly lower in the psychotherapy conditions than in control conditions at post-treatment [g = 0.52; 95% confidence interval (CI) 0.44-0.60; NNT (numbers-needed-to-treat) = 3.50]. Moderate heterogeneity was observed (I2 = 55%, 95% CI 40-66). Bivariate metaregression analysis revealed a significant association between depression and anxiety effect sizes at post-treatment Longer-term follow-ups of up to 14 months post-baseline showed indications for a small lasting effect of psychotherapy on anxiety outcomes (g = 0.27). CONCLUSIONS This meta-analysis provides evidence that psychotherapy aimed at depression can also reduce anxiety symptoms in relation to control conditions.
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Affiliation(s)
- Erica Weitz
- Department of Clinical, Neuro and Developmental Psychology,EMGO Institute for Health and Care Research,Vrije Universiteit Amsterdam,Van der Boechorststraat 1, 1081 BT Amsterdam,The Netherlands
| | - Annet Kleiboer
- Department of Clinical, Neuro and Developmental Psychology,EMGO Institute for Health and Care Research,Vrije Universiteit Amsterdam,Van der Boechorststraat 1, 1081 BT Amsterdam,The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology,EMGO Institute for Health and Care Research,Vrije Universiteit Amsterdam,Van der Boechorststraat 1, 1081 BT Amsterdam,The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology,EMGO Institute for Health and Care Research,Vrije Universiteit Amsterdam,Van der Boechorststraat 1, 1081 BT Amsterdam,The Netherlands
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Borgueta AM, Purvis CK, Newman MG. Navigating the ethics of Internet-guided self-help interventions. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2018; 25. [PMID: 33664555 DOI: 10.1111/cpsp.12235] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Internet-guided self-help (IGSH) programs have proliferated recently to treat common mental health problems such as anxiety and depression. However, technology has outpaced the development of ethical guidelines for this mode of delivery. We examine ethical challenges in this new space, including defining the role "guides" play in treatment, crisis management, and user selection and screening. IGSH programs can provide safe and ethical care when they (a) coordinate care effectively with other systems; (b) provide competent and well-defined guidance; and (c) reach users that are appropriate for and well-educated about the services they are going to receive. We argue that jurisdictional practice constraints and outdated regulatory and ethical guidelines may impede the ability of IGSH programs to maintain or even improve performance when faced with greater demand, larger populations, heterogeneous settings, and the desire for large-scale dissemination.
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Affiliation(s)
| | | | - Michelle G Newman
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
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55
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Harrer M, Adam SH, Fleischmann RJ, Baumeister H, Auerbach R, Bruffaerts R, Cuijpers P, Kessler RC, Berking M, Lehr D, Ebert DD. Effectiveness of an Internet- and App-Based Intervention for College Students With Elevated Stress: Randomized Controlled Trial. J Med Internet Res 2018; 20:e136. [PMID: 29685870 PMCID: PMC5938594 DOI: 10.2196/jmir.9293] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/07/2018] [Accepted: 02/12/2018] [Indexed: 02/06/2023] Open
Abstract
Background Mental health problems are highly prevalent among college students. Most students with poor mental health, however, do not receive professional help. Internet-based self-help formats may increase the utilization of treatment. Objective The aim of this randomized controlled trial was to evaluate the efficacy of an internet-based, app-supported stress management intervention for college students. Methods College students (n=150) with elevated levels of stress (Perceived Stress Scale 4-item version, PSS-4 ≥8) were randomly assigned to either an internet- and mobile-based stress intervention group with feedback on demand or a waitlist control group. Self-report data were assessed at baseline, posttreatment (7 weeks), and 3-month follow-up. The primary outcome was perceived stress posttreatment (PSS-4). Secondary outcomes included mental health outcomes, modifiable risk and protective factors, and college-related outcomes. Subgroup analyses were conducted in students with clinically relevant symptoms of depression (Center for Epidemiological Studies’ Depression Scale >17). Results A total of 106 participants (76.8%) indicated that they were first-time help-seekers, and 77.3% (intervention group: 58/75; waitlist control group: 58/75) showed clinically relevant depressive symptoms at baseline. Findings indicated significant effects of the intervention compared with the waitlist control group for stress (d=0.69; 95% CI 0.36-1.02), anxiety (d=0.76; 95% CI 0.43-1.09), depression (d=0.63; 95% CI 0.30-0.96), college-related productivity (d=0.33; 95% CI 0.01-0.65), academic work impairment (d=0.34; 95% CI 0.01-0.66), and other outcomes after 7 weeks (posttreatment). Response rates for stress symptoms were significantly higher for the intervention group (69%, 52/75) compared with the waitlist control group (35%, 26/75, P<.001; number needed to treat=2.89, 95% CI 2.01-5.08) at posttest (7 weeks). Effects were sustained at 3-month follow-up, and similar findings emerged in students with symptoms of depression. Conclusions Internet- and mobile-based interventions could be an effective and cost-effective approach to reduce consequences of college-related stress and might potentially attract students with clinically relevant depression who would not otherwise seek help. Trial Registration German Clinical Trial Register DRKS00010212; http://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00010212 (Archived by WebCite at http://www.webcitation.org/6w55Ewhjd)
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Affiliation(s)
- Mathias Harrer
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Sophia Helen Adam
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | | | - Harald Baumeister
- Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
| | - Randy Auerbach
- Department of Psychiatry, Columbia University, New York, NY, United States
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Matthias Berking
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Dirk Lehr
- Division of Online Health Trainings, Innovation Incubator, Leuphana University, Lüneburg, Germany
| | - David Daniel Ebert
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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Andrews G, Basu A, Cuijpers P, Craske MG, McEvoy P, English CL, Newby JM. Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: An updated meta-analysis. J Anxiety Disord 2018; 55:70-78. [PMID: 29422409 DOI: 10.1016/j.janxdis.2018.01.001] [Citation(s) in RCA: 488] [Impact Index Per Article: 81.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/16/2017] [Accepted: 01/03/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND A 2010 meta-analysis of internet-delivered CBT (iCBT) RCTs argued 'computer therapy for the anxiety and depressive disorders was effective, acceptable and practical health care' without data on effectiveness or practicality in routine practice. METHODS Databases, reviews and meta-analyses were searched for randomised controlled trials of cCBT or iCBT versus a control group (care as usual, waitlist, information control, psychological placebo, pill placebo, etc.) in people who met diagnostic criteria for major depression, panic disorder, social anxiety disorder or generalised anxiety disorder. Number randomised, superiority of treatment versus control (Hedges'g) on primary outcome measure, length of follow-up, follow up outcome, patient adherence and satisfaction/harm were extracted; risk of bias was assessed. A search for studies on effectiveness of iCBT in clinical practice was conducted. RESULTS 64 trials were identified. The mean effect size (efficacy) was g = 0.80 (NNT 2.34), and benefit was evident across all four disorders. Improvement was maintained at follow-with good acceptability. Research probity was good, and bias risk low. In addition, nine studies comparing iCBT with traditional face-to-face CBT and three comparing iCBT with bibliotherapy were identified. All three modes of treatment delivery appeared equally beneficial. The results of effectiveness studies were congruent with the results of the efficacy trials. LIMITATIONS Studies variably measured changes in quality of life and disability, and the lack of comparisons with medications weakens the field. CONCLUSIONS The conclusions drawn in the original meta-analysis are now supported: iCBT for the anxiety and depressive disorders is effective, acceptable and practical health care.
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Affiliation(s)
- G Andrews
- School of Psychiatry, University of New South Wales, Sydney Australia.
| | - A Basu
- University of New South Wales, Sydney, Australia
| | - P Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Vrije Universiteit and VU Medical Center Amsterdam, The Netherlands
| | - M G Craske
- Department of Psychology, University of California, Los Angeles, United States
| | - P McEvoy
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia; Centre for Clinical Interventions, Perth, Australia
| | - C L English
- St George's University of London, United Kingdom
| | - J M Newby
- School of Psychology, University of New South Wales, Sydney Australia
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Richards D, Duffy D, Blackburn B, Earley C, Enrique A, Palacios J, Franklin M, Clarke G, Sollesse S, Connell S, Timulak L. Digital IAPT: the effectiveness & cost-effectiveness of internet-delivered interventions for depression and anxiety disorders in the Improving Access to Psychological Therapies programme: study protocol for a randomised control trial. BMC Psychiatry 2018; 18:59. [PMID: 29499675 PMCID: PMC5833053 DOI: 10.1186/s12888-018-1639-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 02/23/2018] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Depression and anxiety are common mental health disorders worldwide. The UK's Improving Access to Psychological Therapies (IAPT) programme is part of the National Health Service (NHS) designed to provide a stepped care approach to treating people with anxiety and depressive disorders. Cognitive Behavioural Therapy (CBT) is widely used, with computerised and internet-delivered cognitive behavioural therapy (cCBT and iCBT, respectively) being a suitable IAPT approved treatment alternative for step 2, low- intensity treatment. iCBT has accumulated a large empirical base for treating depression and anxiety disorders. However, the cost-effectiveness and impact of these interventions in the longer-term is not routinely assessed by IAPT services. The current study aims to evaluate the clinical and cost-effectiveness of internet-delivered interventions for symptoms of depression and anxiety disorders in IAPT. METHODS The study is a parallel-groups, randomised controlled trial examining the effectiveness and cost-effectiveness of iCBT interventions for depression and anxiety disorders, against a waitlist control group. The iCBT treatments are of 8 weeks duration and will be supported by regular post-session feedback by Psychological Wellbeing Practitioners. Assessments will be conducted at baseline, during, and at the end of the 8-week treatment and at 3, 6, 9, and 12-month follow-up. A diagnostic interview will be employed at baseline and 3-month follow-up. Participants in the waitlist control group will complete measures at baseline and week 8, at which point they will receive access to the treatment. All adult users of the Berkshire NHS Trust IAPT Talking Therapies Step 2 services will be approached to participate and measured against set eligibility criteria. Primary outcome measures will assess anxiety and depressive symptoms using the GAD-7 and PHQ-9, respectively. Secondary outcome measures will allow for the evaluation of long-term outcomes, mediators and moderators of outcome, and cost-effectiveness of treatment. Analysis will be conducted on a per protocol and intention-to-treat basis. DISCUSSION This study seeks to evaluate the immediate and longer-term impact, as well as the cost effectiveness of internet-delivered interventions for depression and anxiety. This study will contribute to the already established literature on internet-delivered interventions worldwide. The study has the potential to show how iCBT can enhance service provision, and the findings will likely be generalisable to other health services. TRIAL REGISTRATION Current Controlled Trials ISRCTN ISRCTN91967124. DOI: https://doi.org/10.1186/ISRCTN91967124 . Web: http://www.isrctn.com/ISRCTN91967124 . Clinicaltrials.gov : NCT03188575. Trial registration date: June 8, 2017 (prospectively registered).
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Affiliation(s)
- Derek Richards
- Cinical Research & Innovation, SilverCloud Health, Dublin, Ireland
- E-mental Health Research Group, School of Psychology, University of Dublin, Trinity College, Dublin, Ireland
| | - Daniel Duffy
- Cinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Brid Blackburn
- Cinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Caroline Earley
- Cinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Angel Enrique
- Cinical Research & Innovation, SilverCloud Health, Dublin, Ireland
- E-mental Health Research Group, School of Psychology, University of Dublin, Trinity College, Dublin, Ireland
| | - Jorge Palacios
- Cinical Research & Innovation, SilverCloud Health, Dublin, Ireland
- E-mental Health Research Group, School of Psychology, University of Dublin, Trinity College, Dublin, Ireland
| | | | | | | | - Sarah Connell
- Cinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Ladislav Timulak
- E-mental Health Research Group, School of Psychology, University of Dublin, Trinity College, Dublin, Ireland
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Salamanca-Sanabria A, Richards D, Timulak L, Castro-Camacho L, Mojica-Perilla M, Parra-Villa Y. Assessing the efficacy of a culturally adapted cognitive behavioural internet-delivered treatment for depression: protocol for a randomised controlled trial. BMC Psychiatry 2018; 18:53. [PMID: 29482586 PMCID: PMC5828178 DOI: 10.1186/s12888-018-1634-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 02/14/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Depression is the principal cause of disability in the world. High prevalence rates of depression in general populations and college students have been found worldwide and in various cultural groups. Low-intensity cognitive behavioural internet-delivered treatment has demonstrated efficacy in high-income-countries (HICs). However little is known of their potential for adaptation and efficacy in low and middle-income countries. METHODS Study (1) involves the cultural adaptation of the Space from Depression cognitive-behaviour internet-delivered programme with an asynchronous support for depressive symptoms. This includes initial researcher/clinician adaptation and the integration of cultural assessment feedback of the programme by a panel of experts and users through the theoretically-based Cultural Relevance Questionnaire (CRQ). Study (2) describes the implementation of the culturally adapted intervention using a randomised controlled trial methodology. The efficacy trial will include an active treatment group and a waiting-list control group of participants meeting eligibility criteria (mild to moderate depression symptoms). The active condition will consist of 7 weekly modules of internet-delivered cognitive behavioural therapy (iCBT) Space from Depression, with post-session feedback support. The primary outcome will be the Patient Health Questionnaire (PHQ-9). The study also involves collection of client reported significant events and client satisfaction with the internet-delivered treatment. Data will be collected at baseline and at post-treatment (week 7), and at follow-up (week 20/3 months). Analysis will be conducted on the intention-to-treat basis. DISCUSSION The study seeks to establish a theoretically robust methodology for culturally adapting internet-delivered interventions for mental health disorders and to evaluate the efficacy of a culturally adapted internet-delivered treatment for depression in Colombia, with support. The study will be a first contribution to a method for culturally adapting internet-delivered interventions and also a first to examine the efficacy of such an adapted intervention in Latin America. TRIAL REGISTRATION Clinical trials NCT03062215. Retrospectively registered 14th February 2017.
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Affiliation(s)
- Alicia Salamanca-Sanabria
- E-mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland
- Aras an Phiarsaigh, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Derek Richards
- E-mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland
- Clinical Research and Innovation, SilverCloud Health, Dublin, Ireland
| | - Ladislav Timulak
- E-mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland
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Papadatou-Pastou M, Goozee R, Payne E, Barrable A, Tzotzoli P. A review of web-based support systems for students in higher education. Int J Ment Health Syst 2017; 11:59. [PMID: 29021822 PMCID: PMC5613335 DOI: 10.1186/s13033-017-0165-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 09/16/2017] [Indexed: 01/15/2023] Open
Abstract
Background Recent evidence suggests that there is an increasing need for accessible and anonymous services to support higher education (HE) students suffering from psychological and/or academic difficulties. Such difficulties can lead to several negative outcomes, including poor academic performance, sub-optimal mental health, reduced study satisfaction, and dropout from study. Currently, universities in the UK lack financial resources and the on-campus mental health services traditionally offered to students are increasingly economically unsustainable. Compounded by the perceived stigma of using such services, mental health providers have been driven to address the escalating needs of students through online services. Methods In this paper, we review online support systems identified through a literature search and a manual search of references in the identified papers. Further systems were identified through web searches, and systems still in development were identified by consultation with researchers in the field. We accessed systems online to extract relevant information, regarding the main difficulties addressed by the systems, the psychological techniques used and any relevant research evidence to support their effectiveness. Conclusion A large number of web-based support systems have been developed to support mental health and wellbeing, although few specifically target HE students. Further research is necessary to establish the effectiveness of such interventions in providing a cost-effective alternative to face-to-face therapy, particularly in certain settings such as HE institutions.
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Affiliation(s)
- Marietta Papadatou-Pastou
- School of Education, Research Centre for Psychophysiology and Education, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Erika Payne
- University of Derby, Kedleston Rd, Derby, UK
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Richards D, Dowling M, O'Brien E, Viganò N, Timulak L. Significant events in an Internet-delivered (Space from Depression
) intervention for depression. COUNSELLING & PSYCHOTHERAPY RESEARCH 2017. [DOI: 10.1002/capr.12142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Derek Richards
- E-mental Health Research Group; School of Psychology; University of Dublin; Trinity College Dublin; Dublin Ireland
- SilverCloud Health; Dublin Ireland
| | - Mairéad Dowling
- E-mental Health Research Group; School of Psychology; University of Dublin; Trinity College Dublin; Dublin Ireland
| | - Emma O'Brien
- E-mental Health Research Group; School of Psychology; University of Dublin; Trinity College Dublin; Dublin Ireland
| | - Noemi Viganò
- E-mental Health Research Group; School of Psychology; University of Dublin; Trinity College Dublin; Dublin Ireland
| | - Ladislav Timulak
- E-mental Health Research Group; School of Psychology; University of Dublin; Trinity College Dublin; Dublin Ireland
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Castro A, López-Del-Hoyo Y, Peake C, Mayoral F, Botella C, García-Campayo J, Baños RM, Nogueira-Arjona R, Roca M, Gili M. Adherence predictors in an Internet-based Intervention program for depression. Cogn Behav Ther 2017; 47:246-261. [PMID: 28871896 DOI: 10.1080/16506073.2017.1366546] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Internet-delivered psychotherapy has been demonstrated to be effective in the treatment of depression. Nevertheless, the study of the adherence in this type of the treatment reported divergent results. The main objective of this study is to analyze predictors of adherence in a primary care Internet-based intervention for depression in Spain. A multi-center, three arm, parallel, randomized controlled trial was conducted with 194 depressive patients, who were allocated in self-guided or supported-guided intervention. Sociodemographic and clinical characteristics were gathered using a case report form. The Mini international neuropsychiatric interview diagnoses major depression. Beck Depression Inventory was used to assess depression severity. The visual analogic scale assesses the respondent's self-rated health and Short Form Health Survey was used to measure the health-related quality of life. Age results a predictor variable for both intervention groups (with and without therapist support). Perceived health is a negative predictor of adherence for the self-guided intervention when change in depression severity was included in the model. Change in depression severity results a predictor of adherence in the support-guided intervention. Our findings demonstrate that in our sample, there are differences in sociodemographic and clinical variables between active and dropout participants and we provide adherence predictors in each intervention condition of this Internet-based program for depression (self-guided and support-guided). It is important to point that further research in this area is essential to improve tailored interventions and to know specific patients groups can benefit from these interventions.
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Affiliation(s)
- Adoración Castro
- a IUNICS-IDISBA , University of Balearic Islands , Palma de Mallorca , Spain.,b Primary Care Prevention and Health Promotion Research Network , RedIAPP , Madrid , Spain
| | - Yolanda López-Del-Hoyo
- b Primary Care Prevention and Health Promotion Research Network , RedIAPP , Madrid , Spain.,c Department of Psychiatry, Hospital Miguel Servet , University of Zaragoza , Zaragoza , Spain
| | - Christian Peake
- d Facultad de Educación, Departamento de Fundamentos de la Pedagogía , Universidad Católica de la Santísima Concepción , Concepción , Chile
| | - Fermín Mayoral
- e Mental Health Department, Institute of Biomedicine of Málaga , University Regional Hospital of Málaga , Málaga , Spain
| | - Cristina Botella
- f Faculty of Health Sciences, Department of Clinical and Basic Psychology and Biopsychology , University Jaume I , Castellon , Spain.,g CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III , Madrid , Spain
| | - Javier García-Campayo
- b Primary Care Prevention and Health Promotion Research Network , RedIAPP , Madrid , Spain.,c Department of Psychiatry, Hospital Miguel Servet , University of Zaragoza , Zaragoza , Spain
| | - Rosa María Baños
- g CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III , Madrid , Spain.,h Department of Psychological, Personality, Evaluation and Treatment , University of Valencia , Valencia , Spain
| | - Raquel Nogueira-Arjona
- i Faculty of Psychology, Department of Personality, Assessment and Psychological Treatments , University of Malaga, Malaga, Spain of Malaga , Malaga , Spain
| | - Miquel Roca
- a IUNICS-IDISBA , University of Balearic Islands , Palma de Mallorca , Spain.,b Primary Care Prevention and Health Promotion Research Network , RedIAPP , Madrid , Spain
| | - Margalida Gili
- a IUNICS-IDISBA , University of Balearic Islands , Palma de Mallorca , Spain.,b Primary Care Prevention and Health Promotion Research Network , RedIAPP , Madrid , Spain
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Earley C, Joyce C, McElvaney J, Richards D, Timulak L. Preventing depression: Qualitatively examining the benefits of depression-focused iCBT for participants who do not meet clinical thresholds. Internet Interv 2017; 9:82-87. [PMID: 30135841 PMCID: PMC6096201 DOI: 10.1016/j.invent.2017.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 07/01/2017] [Indexed: 01/19/2023] Open
Abstract
•First qualitative study on the benefits of iCBT for those who do not meet clinical thresholds•Successful application of cognitive and behavioural strategies reported•Increased insight/awareness and improved self-efficacy reported•The format of online delivery was reported as helpful.•Findings align with previous face-to-face and iCBT treatments.
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Affiliation(s)
- C. Earley
- SilverCloud Health, The Priory, John's Street West, Dublin, Ireland
- School of Psychology, Trinity College Dublin, Ireland
| | - C. Joyce
- SilverCloud Health, The Priory, John's Street West, Dublin, Ireland
| | - J. McElvaney
- School of Psychology, Trinity College Dublin, Ireland
| | - D. Richards
- SilverCloud Health, The Priory, John's Street West, Dublin, Ireland
- School of Psychology, Trinity College Dublin, Ireland
| | - L. Timulak
- School of Psychology, Trinity College Dublin, Ireland
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63
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Hill C, Martin JL, Thomson S, Scott-Ram N, Penfold H, Creswell C. Navigating the challenges of digital health innovation: considerations and solutions in developing online and smartphone-application-based interventions for mental health disorders. Br J Psychiatry 2017; 211:65-69. [PMID: 28522435 DOI: 10.1192/bjp.bp.115.180372] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/22/2017] [Accepted: 03/24/2017] [Indexed: 11/23/2022]
Abstract
This article presents an analysis of challenges and considerations when developing digital mental health innovations. Recommendations include collaborative working between clinicians, researchers, industry and service users in order to successfully navigate challenges and to ensure e-therapies are engaging, acceptable, evidence based, scalable and sustainable.
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Affiliation(s)
- Claire Hill
- Claire Hill, BSc, PhD, DClinPsy, School of Psychology & Clinical Language Sciences, University of Reading, Reading; Jennifer Leila Martin, BSc, PhD, NIHR MindTech Healthcare Technology Co-operative, The University of Nottingham, Nottingham; Simon Thomson, Dip Psyche, UKCP Reg, Berkshire Eating Disorders Service, St Marks Hospital, Maidenhead; Nick Scott-Ram, MA, PhD, Hugh Penfold, MA, PhD, Oxford Academic Health Science Network, Oxford; Cathy Creswell, BA Ox(Hons), PhD, DClinPsy, School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Jennifer L Martin
- Claire Hill, BSc, PhD, DClinPsy, School of Psychology & Clinical Language Sciences, University of Reading, Reading; Jennifer Leila Martin, BSc, PhD, NIHR MindTech Healthcare Technology Co-operative, The University of Nottingham, Nottingham; Simon Thomson, Dip Psyche, UKCP Reg, Berkshire Eating Disorders Service, St Marks Hospital, Maidenhead; Nick Scott-Ram, MA, PhD, Hugh Penfold, MA, PhD, Oxford Academic Health Science Network, Oxford; Cathy Creswell, BA Ox(Hons), PhD, DClinPsy, School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Simon Thomson
- Claire Hill, BSc, PhD, DClinPsy, School of Psychology & Clinical Language Sciences, University of Reading, Reading; Jennifer Leila Martin, BSc, PhD, NIHR MindTech Healthcare Technology Co-operative, The University of Nottingham, Nottingham; Simon Thomson, Dip Psyche, UKCP Reg, Berkshire Eating Disorders Service, St Marks Hospital, Maidenhead; Nick Scott-Ram, MA, PhD, Hugh Penfold, MA, PhD, Oxford Academic Health Science Network, Oxford; Cathy Creswell, BA Ox(Hons), PhD, DClinPsy, School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Nick Scott-Ram
- Claire Hill, BSc, PhD, DClinPsy, School of Psychology & Clinical Language Sciences, University of Reading, Reading; Jennifer Leila Martin, BSc, PhD, NIHR MindTech Healthcare Technology Co-operative, The University of Nottingham, Nottingham; Simon Thomson, Dip Psyche, UKCP Reg, Berkshire Eating Disorders Service, St Marks Hospital, Maidenhead; Nick Scott-Ram, MA, PhD, Hugh Penfold, MA, PhD, Oxford Academic Health Science Network, Oxford; Cathy Creswell, BA Ox(Hons), PhD, DClinPsy, School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Hugh Penfold
- Claire Hill, BSc, PhD, DClinPsy, School of Psychology & Clinical Language Sciences, University of Reading, Reading; Jennifer Leila Martin, BSc, PhD, NIHR MindTech Healthcare Technology Co-operative, The University of Nottingham, Nottingham; Simon Thomson, Dip Psyche, UKCP Reg, Berkshire Eating Disorders Service, St Marks Hospital, Maidenhead; Nick Scott-Ram, MA, PhD, Hugh Penfold, MA, PhD, Oxford Academic Health Science Network, Oxford; Cathy Creswell, BA Ox(Hons), PhD, DClinPsy, School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Cathy Creswell
- Claire Hill, BSc, PhD, DClinPsy, School of Psychology & Clinical Language Sciences, University of Reading, Reading; Jennifer Leila Martin, BSc, PhD, NIHR MindTech Healthcare Technology Co-operative, The University of Nottingham, Nottingham; Simon Thomson, Dip Psyche, UKCP Reg, Berkshire Eating Disorders Service, St Marks Hospital, Maidenhead; Nick Scott-Ram, MA, PhD, Hugh Penfold, MA, PhD, Oxford Academic Health Science Network, Oxford; Cathy Creswell, BA Ox(Hons), PhD, DClinPsy, School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
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64
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Wahle F, Bollhalder L, Kowatsch T, Fleisch E. Toward the Design of Evidence-Based Mental Health Information Systems for People With Depression: A Systematic Literature Review and Meta-Analysis. J Med Internet Res 2017; 19:e191. [PMID: 28566267 PMCID: PMC5471345 DOI: 10.2196/jmir.7381] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 03/10/2017] [Accepted: 04/06/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Existing research postulates a variety of components that show an impact on utilization of technology-mediated mental health information systems (MHIS) and treatment outcome. Although researchers assessed the effect of isolated design elements on the results of Web-based interventions and the associations between symptom reduction and use of components across computer and mobile phone platforms, there remains uncertainty with regard to which components of technology-mediated interventions for mental health exert the greatest therapeutic gain. Until now, no studies have presented results on the therapeutic benefit associated with specific service components of technology-mediated MHIS for depression. OBJECTIVE This systematic review aims at identifying components of technology-mediated MHIS for patients with depression. Consequently, all randomized controlled trials comparing technology-mediated treatments for depression to either waiting-list control, treatment as usual, or any other form of treatment for depression were reviewed. Updating prior reviews, this study aims to (1) assess the effectiveness of technology-supported interventions for the treatment of depression and (2) add to the debate on what components in technology-mediated MHIS for the treatment of depression should be standard of care. METHODS Systematic searches in MEDLINE, PsycINFO, and the Cochrane Library were conducted. Effect sizes for each comparison between a technology-enabled intervention and a control condition were computed using the standard mean difference (SMD). Chi-square tests were used to test for heterogeneity. Using subgroup analysis, potential sources of heterogeneity were analyzed. Publication bias was examined using visual inspection of funnel plots and Begg's test. Qualitative data analysis was also used. In an explorative approach, a list of relevant components was extracted from the body of literature by consensus between two researchers. RESULTS Of 6387 studies initially identified, 45 met all inclusion criteria. Programs analyzed showed a significant trend toward reduced depressive symptoms (SMD -0.58, 95% CI -0.71 to -0.45, P<.001). Heterogeneity was large (I2≥76). A total of 15 components were identified. CONCLUSIONS Technology-mediated MHIS for the treatment of depression has a consistent positive overall effect compared to controls. A total of 15 components have been identified. Further studies are needed to quantify the impact of individual components on treatment effects and to identify further components that are relevant for the design of future technology-mediated interventions for the treatment of depression and other mental disorders.
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Affiliation(s)
- Fabian Wahle
- Center for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zürich, Zürich, Switzerland
| | - Lea Bollhalder
- Institute of Technology Management, University of St Gallen, St Gallen, Switzerland
| | - Tobias Kowatsch
- Center for Digital Health Interventions, Institute of Technology Management, University of St Gallen, St Gallen, Switzerland
| | - Elgar Fleisch
- Institute of Technology Management, University of St Gallen, St Gallen, Switzerland
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65
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Effectiveness of an internet-delivered intervention for generalized anxiety disorder in routine care: A randomised controlled trial in a student population. Internet Interv 2016; 6:80-88. [PMID: 30135817 PMCID: PMC6096214 DOI: 10.1016/j.invent.2016.10.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 10/26/2016] [Accepted: 10/27/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cognitive behavioural therapy is one of the main and preferred treatments for generalized anxiety disorder. Numerous barriers can hinder an individual from seeking or receiving appropriate treatment; internet-delivered CBT interventions offer a relatively new means of increasing access to treatment. METHODS A service-based effectiveness randomised waiting list control trial examined the impact of an internet-delivered CBT intervention, Calming Anxiety, amongst Irish university students (N = 137). Primary outcome was self-reported GAD and secondary outcomes included depression and work and social functioning. RESULTS Analyses returned inconclusive results. Both treatment and waiting list conditions displayed significant decreases in anxiety symptoms post-treatment, but we did not observe a significant between-group effect (p = 0.076). Significant within-group differences from pre to post time points were observed for depression (BDI-II) and work and social functioning (WASA), and between group differences were also significant for depression (d = 0.46) and functioning (d = 0.36). Both groups demonstrated cases of remission and recovery from anxiety, however differences in the number of cases reaching clinically meaningful change between conditions were non-significant. CONCLUSIONS Several explanations regarding the results are presented, examining issues related to active waiting lists, study limitations and treatment expectancies.Trial registration: Current Controlled Trials ISRCTN16303842.
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Richards D, Richardson T, Timulak L, Viganò N, Mooney J, Doherty G, Hayes C, Sharry J. Predictors of depression severity in a treatment-seeking sample. Int J Clin Health Psychol 2016; 16:221-229. [PMID: 30487865 PMCID: PMC6225048 DOI: 10.1016/j.ijchp.2016.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/19/2016] [Indexed: 11/05/2022] Open
Abstract
Background/Objective: Depression is a common mental health disorder and an emerging public health concern. Few studies have investigated prevalence and predictors of depression severity in the Irish context. To investigate the relative contribution of known risk factors that predicts depression severity in a treatment-seeking sample of adults in Ireland. Method: As part of a randomised controlled trial of an internet-delivered intervention for depression participants (N = 641) completed online screening questionnaires including BDI-II and information associated with common predictors of depression. Results: The mean score on the BDI-II was 24.13 (SD = 11.20). Several factors were shown to predict greater severity of depression in the sample including female gender, younger age, unemployment, being single or partnered as opposed to married, previous diagnosis of depression, recent experience of life stressors. Alcohol use, recent losses, knowing a suicide completer, education level, type of employment and income level were not found to be significant. Conclusions: The study contributes to the profiling of the incidence and predictors of severity of depression in an Irish context. The results confirm some of the known risk factors and highlight the need for further research to be carried out on screening for depression and increasing access to interventions.
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Affiliation(s)
- Derek Richards
- The Priory, John's Street West, Dublin 8, Ireland
- Trinity College Dublin, Ireland
| | - Thomas Richardson
- Solent NHS Trust, Portsmouth, United Kingdom
- University of Southampton, United Kingdom
| | | | - Noemi Viganò
- The Priory, John's Street West, Dublin 8, Ireland
| | | | | | | | - John Sharry
- The Priory, John's Street West, Dublin 8, Ireland
- Parents Plus Charity, Ireland
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67
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Richards D, Murphy T, Viganó N, Timulak L, Doherty G, Sharry J, Hayes C. Acceptability, satisfaction and perceived efficacy of " Space from Depression" an internet-delivered treatment for depression. Internet Interv 2016; 5:12-22. [PMID: 30135802 PMCID: PMC6096253 DOI: 10.1016/j.invent.2016.06.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There are clear advantages to internet-delivered interventions for depression. Users' perspectives on the acceptability, satisfaction, and efficacy of an internet-delivered treatment for depression can inform future developments in the area. METHODS Respondents (n = 281) were participants in an 8 week supported internet-delivered Cognitive Behaviour Therapy treatment for depressive symptoms. Self-report online questionnaires gathered quantitative and qualitative data on the user experience. PRINCIPLE FINDINGS Most respondents were satisfied with the programme (n = 191), felt supported (n = 203), reported positive gains and impact resulting from use of the programme, and perceived these to be likely to be lasting effects (n = 149). Flexibility and accessibility were the most liked aspects. A small number of respondents felt their needs were not met by the intervention (n = 64); for this group suggestions for improvements centred on the programme's structure and how supporter feedback is delivered. CONCLUSION Results will deepen the understanding of users' experience and inform the development and implementation of evidence-based internet-delivered interventions.
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Affiliation(s)
- Derek Richards
- SilverCloud Health, The Priory, John's Street West, Dublin, Ireland
- School of Psychology, Trinity College Dublin, Ireland
- Corresponding author at: SilverCloud Health, The Priory, John's Street West, Dublin, Ireland.
| | - Treasa Murphy
- SilverCloud Health, The Priory, John's Street West, Dublin, Ireland
| | - Noemi Viganó
- SilverCloud Health, The Priory, John's Street West, Dublin, Ireland
| | | | - Gavin Doherty
- School of Computer Science and Statistics, Trinity College Dublin, Ireland
| | - John Sharry
- SilverCloud Health, The Priory, John's Street West, Dublin, Ireland
- Parents Plus Charity, Dublin, Ireland
| | - Claire Hayes
- Aware National Charity, 72 Lower Leeson Street, Dublin 2, Ireland
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Walsh A, Richards D. Experiences and engagement with the design features and strategies of an internet-delivered treatment programme for generalised anxiety disorder: a service-based evaluation. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2016. [DOI: 10.1080/03069885.2016.1153039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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