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Brinkmann B, Payne CF, Kohler I, Harling G, Davies J, Witham M, Siedner MJ, Sie A, Bountogo M, Ouermi L, Coulibaly B, Bärnighausen T. Depressive symptoms and cardiovascular disease: a population-based study of older adults in rural Burkina Faso. BMJ Open 2020; 10:e038199. [PMID: 33371016 PMCID: PMC7757460 DOI: 10.1136/bmjopen-2020-038199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 08/03/2020] [Accepted: 08/19/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To contribute to the current understanding of depressive disorders in sub-Saharan African (SSA) countries by examining the association of depressive symptoms with cardiovascular and cardiometabolic conditions in a population-based study of middle-aged and older adults in rural Burkina Faso. SETTING This study was conducted in the Nouna Health and Demographic Surveillance System in north-western Burkina Faso, in a mixed rural and small-town environment. The data were obtained between May and July 2018. PARTICIPANTS Consenting adults over 40 years of age (n=3026). PRIMARY AND SECONDARY OUTCOME MEASURES Depressive symptoms were assessed using the Patient Health Questionnaire depression module (PHQ-9). Chronic cardiometabolic conditions were assessed via a lipid panel and glycated haemoglobin measures from serum, alongside anthropometry and blood pressure measurements and a self-reported questionnaire. Multivariable linear regression was used to test the relationship between depressive symptoms and cardiovascular/cardiometabolic conditions after controlling for sociodemographic factors. RESULTS Depressive symptoms were not associated with the metabolic syndrome (standardised beta coefficient=0.00 (95% CI -0.04 to 0.03)), hypertension (beta=0.01 (95% CI -0.02 to 0.05)), diabetes mellitus (beta=0.00 (95% CI -0.04 to 0.04)) and past diagnosis of elevated blood pressure or blood sugar. Prior stroke diagnosis (beta=0.04 (95% CI 0.01 to 0.07)) or heart disease (beta=0.08 (95% CI 0.05 to 0.11)) was positively associated with the standardised PHQ-9 score as were self-reported stroke symptoms. CONCLUSION Objectively measured cardiometabolic conditions had no significant association with depressive symptoms in an older, poor, rural SSA population, in contrast to observations in high income countries. However, consequences of cardiovascular disease such as stroke and heart attack were associated with depressive symptoms in older adults in Burkina Faso.
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Affiliation(s)
- Ben Brinkmann
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Collin F Payne
- School of Demography, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Iliana Kohler
- Population Studies Center (PSC) and Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Guy Harling
- Institute for Global Health, University College London, London, UK
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USA
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Miles Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Mark J Siedner
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Sie
- Centre de Recherche en Sante de Nouna, Nouna, Boucle du Mouhoun, Burkina Faso
| | - Mamadou Bountogo
- Centre de Recherche en Sante de Nouna, Nouna, Boucle du Mouhoun, Burkina Faso
| | - Lucienne Ouermi
- Centre de Recherche en Sante de Nouna, Nouna, Boucle du Mouhoun, Burkina Faso
| | - Boubacar Coulibaly
- Centre de Recherche en Sante de Nouna, Nouna, Boucle du Mouhoun, Burkina Faso
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Africa Health Research Institute, KwaZulu-Natal, South Africa
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He L, Geng Y, Pan Y, Tian J, He X, Deng X, Duan W, Peng H. Study protocol for a network meta-analysis of digital-technology-based psychotherapies for PTSD in adults. BMJ Open 2020; 10:e038951. [PMID: 33303442 PMCID: PMC7733188 DOI: 10.1136/bmjopen-2020-038951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Studies on various types of digital-technology-based psychotherapies (DTPs) have indicated that they are effective for post-traumatic stress disorder (PTSD) symptom relief among adults. The intervention efficacy or effectiveness hierarchy, however, is still not clear. Therefore, we propose to conduct a network meta-analysis to assess the relative effectiveness of various types of DTPs. We aim to establish the differential effectiveness of these therapies in terms of symptom reduction and provide high-quality evidence for treating PTSD. METHODS AND ANALYSES We will search Embase, CINAHL, MEDLINE, HealthSTAR, the Cochrane Library, PsycINFO, PubMed, the Chinese Biomedical Literature Database, clinical trials (eg, ClinicalTrials.gov) and other academic platforms for relevant studies, mainly in English and Chinese (as we plan to conduct a trial on PTSD patients in Wuhan, China, based on the results of this network meta-analysis), from inception to October 2020. Randomised controlled trials (RCTs) and meta-analyses investigating the effectiveness of any DTPs for PTSD patients for any controlled condition will be included. The number of intervention sessions and the research duration are unlimited; the effects for different durations will be tested via sensitivity analysis. For this project, the primary measure of outcome will be PTSD symptoms at the end of treatment using raw scores for one widely used PTSD scale, PCL-5. Secondary outcome measures will include (1) dropout rate; (2) effectiveness at longest follow-up, but not more than 12 months and (3) patients' functional recovery ratio (such as the return-to-work ratio or percentage of sick leave). Bayesian network meta-analysis will be conducted for all relative outcome measures. We will perform subgroup analysis and sensitivity analysis to see whether the results are influenced by study characteristics. The Grading of Recommendations, Assessments, Development, and Evaluation framework will be adopted to evaluate the quality of evidence contributing to network estimates of the primary outcome. ETHICS AND DISSEMINATION The researchers of the primary trials already have had ethical approval for the data used in our study. We will present the results of this meta-analysis at academic conferences and publish them in peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42020173253.
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Affiliation(s)
- Longtao He
- Research Institute of Social Development, Southwestern University of Finance and Economics, Chengdu, Sichuan, China
| | - Yanling Geng
- Department of Social Work, Northwest University, Xi'an, Shanxi, China
| | - Yangu Pan
- Research Institute of Social Development, Southwestern University of Finance and Economics, Chengdu, Sichuan, China
| | - Jinhui Tian
- Evidence-Based Medicine Centre & School of Basic Science, Lanzhou University, Lanzhou, Gansu, China
| | - Xinyu He
- School of Social Development, Xihua University, Chengdu, Sichuan, China
| | - Xiangshu Deng
- Research Institute of Social Development, Southwestern University of Finance and Economics, Chengdu, Sichuan, China
| | - Wenjie Duan
- Department of Social Work, East China University of Science and Technology, Shanghai, China
| | - Huamin Peng
- Department of Social Work and Social Policy, Nanjing University, Nanjing, China
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Zochil ML, Thorsteinsson EB. Exploring poor sleep, mental health, and help‐seeking intention in university students. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12160] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Marina L. Zochil
- Department of Psychology, University of New England, Armidale, New South Wales, Australia,
| | - Einar B. Thorsteinsson
- Department of Psychology, University of New England, Armidale, New South Wales, Australia,
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Bekker MJ, Griffiths KM, Barrett PM. Improving accessibility of cognitive behavioural therapy for children and adolescents: Review of evidence and future directions. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12099] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Marthinus J. Bekker
- National Institute for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia,
| | - Kathleen M. Griffiths
- National Institute for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia,
| | - Paula M. Barrett
- National Institute for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia,
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Domhardt M, Letsch J, Kybelka J, Koenigbauer J, Doebler P, Baumeister H. Are Internet- and mobile-based interventions effective in adults with diagnosed panic disorder and/or agoraphobia? A systematic review and meta-analysis. J Affect Disord 2020; 276:169-182. [PMID: 32697696 DOI: 10.1016/j.jad.2020.06.059] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/20/2020] [Accepted: 06/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is no meta-analysis that specifically evaluates the effectiveness of Internet- and mobile-based interventions (IMIs) in adults with diagnosed panic disorder and/or agoraphobia (PD/A) so far. The current meta-analysis aims to fill this gap (PROSPERO CRD 42016034016). METHODS Systematic literature searches in six databases for randomised and controlled clinical trials investigating IMIs in adults, who met diagnostic criteria for PD/A. Study selection and data extraction were conducted independently by two reviewers. Random-effects meta-analyses, pre-planned subgroup and sensitivity analyses were conducted when appropriate. Primary outcomes were PD and A symptom severity. In addition, adherence, response, remission, quality of life, anxiety and depression symptom severity were examined. RESULTS A total of 16 trials (1015 patients), with 21 comparisons (9 IMI vs. waitlist; 7 IMI vs. IMI; 5 IMI vs. active treatment condition), were included. IMIs revealed beneficial effects on panic (Hedges' g range -2.61 to -0.25) and agoraphobia symptom severity when compared to waitlist (pooled g = -1.15, [95%-CI = -1.56; -0.74]). Studies comparing IMIs to active controls (i.e., face-to-face CBT and applied relaxation) did not find significant differences for reductions in panic (g = -0.02, [95%-CI = -0.25; 0.21]) and agoraphobia symptom severity (g = -0.10, [95%-CI = -0.39; 0.19]). Furthermore, IMIs were superior to waitlist controls regarding anxiety and depression symptom severity and quality of life. LIMITATIONS Tests for publication bias were not feasible due to the limited number of trials per comparison, and the risk of bias assessment indicated some methodological shortcomings. CONCLUSIONS Findings from this meta-analytic review provide support for the effectiveness of IMIs in patients with verified PD/A. However, before IMIs can be included in treatment guidelines for PD/A, future high quality research is needed that substantiates and extends the evidence base, especially in regard to intervention safety.
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Affiliation(s)
- Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, Albert-Einstein-Allee-47, 89081 Ulm, Germany.
| | - Josefine Letsch
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Ulm, Germany
| | - Jonas Kybelka
- Department of Clinical Psychology and Psychotherapy, Ulm University, Albert-Einstein-Allee-47, 89081 Ulm, Germany
| | - Josephine Koenigbauer
- Department of Clinical Psychology and Psychotherapy, Ulm University, Albert-Einstein-Allee-47, 89081 Ulm, Germany
| | - Philipp Doebler
- Statistical Methods in the Social Sciences, Department of Statistics, TU Dortmund University, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Albert-Einstein-Allee-47, 89081 Ulm, Germany
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Patel M, James K, Moss-Morris R, Ashworth M, Husain M, Hotopf M, David AS, McCrone P, Landau S, Chalder T. BMC family practice integrated GP care for patients with persistent physical symptoms: feasibility cluster randomised trial. BMC FAMILY PRACTICE 2020; 21:207. [PMID: 33028243 PMCID: PMC7542765 DOI: 10.1186/s12875-020-01269-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/13/2020] [Indexed: 05/30/2023]
Abstract
BACKGROUND Patients continue to suffer from medically unexplained symptoms otherwise referred to as persistent physical symptoms (PPS). General practitioners (GPs) play a key role in the management of PPS and require further training. Patients are often frustrated with the care they receive. This study aims to assess the acceptability of an 'integrated GP care' approach which consists of offering self-help materials to patients with PPS and offering their GPs training on how to utilise cognitive behavioural skills within their consultations, as well as assessing the feasibility of conducting a future trial in primary care to evaluate its benefit. METHODS A feasibility cluster randomised controlled trial was conducted in primary care, South London, UK. GP practices (clusters) were randomly allocated to 'integrated GP care plus treatment as usual' or 'treatment as usual'. Patients with PPS were recruited from participating GP practices before randomisation. Feasibility parameters, process variables and potential outcome measures were collected at pre-randomisation and at 12- and 24-weeks post-randomisation at cluster and individual participant level. RESULTS Two thousand nine hundred seventy-eight patients were identified from 18 GP practices. Out of the 424 patients who responded with interest in the study, 164 fully met the eligibility criteria. One hundred sixty-one patients provided baseline data before cluster randomisation and therefore were able to participate in the study. Most feasibility parameters indicated that the intervention was acceptable and a future trial feasible. 50 GPs from 8 GP practices (randomised to intervention) attended the offer of training and provided positive feedback. Scores in GP knowledge and confidence increased post-training. Follow-up rate of patients at 24 weeks was 87%. However estimated effect sizes on potential clinical outcomes were small. CONCLUSIONS It was feasible to identify and recruit patients with PPS. Retention rates of participants up to 24 weeks were high. A wide range of health services were used. The intervention was relatively low cost and low risk. This complex intervention should be further developed to improve patients'/GPs' utilisation of audio/visual and training resources before proceeding to a full trial evaluation. TRIAL REGISTRATION NCT02444520 (ClinicalTrials.gov).
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Affiliation(s)
- Meenal Patel
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Kirsty James
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neurosciences, Psychology and Neuroscience King's College, London, UK
| | - Rona Moss-Morris
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Mark Ashworth
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine King's College London, London, UK
| | - Mujtaba Husain
- UK South London and Maudsley NHS Foundation Trust, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.,UK South London and Maudsley NHS Foundation Trust, London, UK
| | - Anthony S David
- Division of Psychiatry, Maple House, UCL Institute of Mental Health, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Paul McCrone
- Institute for Lifecourse Development, University of Greenwich, Old Royal Naval College, Park Row, Greenwich, London, SE10 9LS, UK
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neurosciences, Psychology and Neuroscience King's College, London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
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Morabito DM, Mathes BM, Schmidt NB. The Impact of Two Brief Web-Based Psychological Interventions on Functional Outcomes. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10144-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Leffler JM, D'Angelo EJ. Implementing Evidence-Based Treatments for Youth in Acute and Intensive Treatment Settings. J Cogn Psychother 2020; 34:185-199. [PMID: 32817401 DOI: 10.1891/jcpsy-d-20-00018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Evidence-based treatments (EBTs) have been well studied in outpatient and research settings to address a myriad of mental health concerns. Research studies have found benefits and challenges when implementing these interventions. However, less is known about the implementation of EBTs in acute and intensive treatment settings such as inpatient psychiatric hospitalization (IPH) units, partial hospitalization programs (PHPs), or intensive outpatient programs (IOPs). As a result, the specific benefits and challenges of providing EBTs in these settings are less clear. For example, challenges of implementing EBTs in IPHs, PHPs, and IOPs can include working within a multi-disciplinary team setting and sustaining trained staff. The current article provides an overview of implementing EBTs in IPHs PHPs, and IOPs. Current PHP, IOP, and IPH models of implementing evidence-based interventions along with strategies for engaging stakeholders, program development and implementation, and measurement are reviewed. Further considerations for sustainability and practice consideration are also provided.
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Affiliation(s)
| | - Eugene J D'Angelo
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Malgaroli M, Hull TD, Wiltsey Stirman S, Resick P. Message Delivery for the Treatment of Posttraumatic Stress Disorder: Longitudinal Observational Study of Symptom Trajectories. J Med Internet Res 2020; 22:e15587. [PMID: 32347814 PMCID: PMC7221629 DOI: 10.2196/15587] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/16/2019] [Accepted: 01/24/2020] [Indexed: 01/18/2023] Open
Abstract
Background Individuals with posttraumatic stress disorder (PTSD) face symptoms that can hinder access to treatment, such as avoidance and guilt. Telemedicine offers a technological solution to increase access to mental health care and overcome barriers to treatment. Although an increasing body of literature focused on synchronous telehealth (eg, live video), no studies have examined the delivery of PTSD treatment via two-way multimedia messages (ie, texting or messaging). Objective The aim of this study was to conduct a longitudinal observation of treatment for PTSD delivered using two-way asynchronous messaging. We also sought to identify individual and treatment characteristics that could predict the observed outcome differences. Methods Outpatients diagnosed with PTSD (N=475) received interventions from licensed therapists, which were delivered via messaging once or more than once per day, 5 days a week for 12 weeks. PTSD symptoms were assessed every 3 weeks using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-5. Trajectories of PTSD symptoms were identified using growth mixture modeling (GMM). Using logistic regression, the demographic, treatment, and messaging characteristics of patient groups that improved were compared with the characteristics of patient groups that did not improve. Results The GMM identified 4 trajectories of PTSD symptoms: moderate improvement (197/475, 41.4%), high symptoms (197/475, 41.4%), chronic symptoms (61/475, 12.9%), and acute improvement (20/475, 4.3%). Patients with a clinically significant reduction in PTSD symptoms (231/475, 48.6%) were more likely to communicate via video (odds ratio [OR] 1.01, 95% CI 1.01-1.05; P=.03), have a higher working alliance with their therapist (OR 1.03, 95% CI 1.01-1.05; P=.02), and be at their first treatment experience (OR 2.03, 95% CI 1.18-3.54; P=.01). Treatment adherence was associated with greater therapeutic alliance (OR 1.07, 95% CI 1.03-1.10; P<.001), education (OR 2.13, 95% CI 1.13-4.03; P=.02), and more patient-generated messages per week (OR 1.08, 95% CI 1.04-1.13; P<.001). Conclusions Multimedia message delivery for PTSD treatment showed symptom-reduction rates similar to traditional forms of treatment delivery, suggesting further study of messaging as a treatment medium. Most patients completed an 8-week course, reflecting the acceptability of messaging interventions. Delivering treatment via two-way messaging offers increased opportunities for widespread access to mental health care.
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Affiliation(s)
| | - Thomas Derrick Hull
- Columbia University, New York, NY, United States.,Talkspace, New York, NY, United States
| | - Shannon Wiltsey Stirman
- Standford University, Stanford, CA, United States.,National Center for PTSD, Washington DC, DC, United States
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Abstract
Major depressive disorder (MDD) is a serious public health problem that has, at best, modest treatment response—potentially due to its heterogeneous clinical presentation. One way to parse the heterogeneity is to investigate the role of particular features of MDD, an endeavor that can also help identify novel and focal targets for treatment and prevention efforts. Our R01 focuses on the feature of psychomotor disturbance (e.g., psychomotor agitation (PmA) and retardation (PmR)), a particularly pernicious feature of MDD, that has not been examined extensively in MDD. Aim 1 is comparing three groups of individuals—those with current MDD (n = 100), remitted MDD (n = 100), and controls (n = 50)—on multiple measures of PmR and PmA (assessed both in the lab and in the subjects’ natural environment). Aim 2 is examining the structural (diffusion MRI) and functional (resting state fMRI) connectivity of motor circuitry of the three groups as well as the relation between motor circuitry and the proposed indicators of PmR and PmA. Aim 3 is following up with subjects three times over 18 months to evaluate whether motor symptoms change in tandem with overall depressive symptoms and functioning over time and/or whether baseline PmR/PmA predicts course of depression and functioning. Aim 3 is particularly clinically significant. Finding that motor functioning and overall depression severity co-vary over time, or that motor variables predict subsequent change in overall depression severity, would support the potential clinical utility of these novel, reliable, and easily administered motor assessments.
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Silva M, Antunes A, Azeredo-Lopes S, Cardoso G, Xavier M, Saraceno B, Caldas-de-Almeida JM. Barriers to mental health services utilisation in Portugal - results from the National Mental Health Survey. J Ment Health 2020; 31:453-461. [PMID: 32202450 DOI: 10.1080/09638237.2020.1739249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: The treatment gap for mental disorders remains a challenge worldwide. Identifying reasons for nontreatment may contribute to reducing this gap.Aims: To evaluate sociodemographic and clinical factors associated with use and barriers to treatment in Portugal.Method: Data from the 2009 National Mental Health Survey were used. Participants reported 12-month treatment and reasons for nontreatment. Logistic regression models analysed the association between sociodemographic (education; employment; income; marital status) and clinical variables (mental disorder diagnosis; disability) with treatment and type of barriers (low perceived need; structural; attitudinal).Results: The majority of participants with a mental disorder was not treated. Treatment was more common among participants with mood disorders (OR = 4.19; 95% CI: 2.72-6.46), and disability (OR = 2.43; 95% CI: 1.33-4.46), and less common among single participants (OR = 0.38; 95% CI: 0.20-0.70) and those with basic/secondary education (OR = 0.42; 95% CI: 0.24-0.73). Attitudinal barriers were more likely among participants with none/primary (OR = 2.90; 95% CI: 1.42-5.90) and basic/secondary education (OR = 1.70; 95% CI: 1.01-2.85), and less likely among those with substance use disorders (OR = 0.27; 95% CI: 0.10-0.70). Low perceived need was higher among single people (OR = 1.77; 95% CI: 1.01-3.08), and lower among those with anxiety (OR = 0.50; 95% CI: 0.28-0.90) and mood disorders (OR = 0.16; 95% CI: 0.09-0.30). Unemployed participants had higher odds of reporting structural barriers (OR = 3.76; 95% CI: 1.29-10.92).Conclusions: This study identifies factors associated with nontreatment, providing useful evidence to develop policies and effective interventions.
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Affiliation(s)
- Manuela Silva
- Comprehensive Health Research Centre (CHRC), Lisbon Institute of Global Mental Health, Nova Medical School, Nova University of Lisbon, Lisboa, Portugal
| | - Ana Antunes
- Comprehensive Health Research Centre (CHRC), Lisbon Institute of Global Mental Health, Nova Medical School, Nova University of Lisbon, Lisboa, Portugal
| | | | - Graça Cardoso
- Comprehensive Health Research Centre (CHRC), Lisbon Institute of Global Mental Health, Nova Medical School, Nova University of Lisbon, Lisboa, Portugal
| | - Miguel Xavier
- Chronic Diseases Research Centre (CEDOC), Nova Medical School, Nova University of Lisbon, Lisboa, Portugal
| | - Benedetto Saraceno
- Comprehensive Health Research Centre (CHRC), Lisbon Institute of Global Mental Health, Nova Medical School, Nova University of Lisbon, Lisboa, Portugal
| | - José Miguel Caldas-de-Almeida
- Comprehensive Health Research Centre (CHRC), Lisbon Institute of Global Mental Health, Nova Medical School, Nova University of Lisbon, Lisboa, Portugal
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Rebello TJ, Keeley JW, Kogan CS, Sharan P, Matsumoto C, Kuligyna M, Domínguez-Martínez T, Stona AC, Grenier J, Huang J, Zhong N, Stein DJ, Emmelkamp P, Chakrabarti S, Andrews HF, Reed GM. Anxiety and Fear-Related Disorders in the ICD-11: Results from a Global Case-controlled Field Study. Arch Med Res 2020; 50:490-501. [PMID: 32018071 DOI: 10.1016/j.arcmed.2019.12.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 12/17/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND This article reports the results of one of a series of global field studies implemented by the World Health Organization (WHO) to evaluate the accuracy, clinical utility, and global applicability of the new diagnostic guidelines for Mental, Behavioural and Neurological Disorders included in the next version of WHO's International Classification of Diseases (ICD-11). AIMS OF THE STUDY The purpose of this study was to compare the diagnostic accuracy and clinical utility ratings of global clinicians implementing the ICD-11 diagnostic guidelines for Anxiety and Fear-Related Disorders, relative to those applying ICD-10 guidelines. The study also aimed to identify elements of the guidelines that required further refinement or clarification. METHODS 1840 global mental health professionals registered with WHO's Global Clinical Practice Network completed the study in one of six study languages. Participants were randomly assigned to apply either the ICD-11 or ICD-10 guidelines to diagnose standardized case vignettes, and to rate the clinical utility of their assigned guidelines. RESULTS ICD-11's diagnostic accuracy and clinical utility were equivalent or superior to that of ICD-10. Global clinicians were significantly more accurate in diagnosing Generalized Anxiety Disorder, Specific Phobia and adult cases of Separation Anxiety Disorder when using ICD-11 and provided high clinical utility ratings for these disorders. Clinicians also found the ICD-11 guidelines easy to use, clear, and a good fit to patients they see in their clinical practice. However, clinicians had difficulty with distinguishing the boundary between disorder and normality for subthreshold cases of anxiety, and also with applying the new ICD-11 guidelines on panic attacks. CONCLUSIONS The new diagnostic guidelines for Anxiety Disorders in ICD-11 can be applied in an acceptably consistent manner by global clinicians and perform as well or better than the previous guidelines for ICD-10. Study findings also helped identify aspects of the ICD-11 guidelines that required refinement prior to their publication and areas that should be emphasized in training programs.
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Affiliation(s)
- Tahilia J Rebello
- Department of Psychiatry and WHO Collaborating Centre for Research and Capacity Building in Global Mental Health, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Jared W Keeley
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Cary S Kogan
- Department of Psychology, University of Ottawa, Ottawa, Canada
| | - Pratap Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Chihiro Matsumoto
- ICD-11 Committee, Japanese Society of Psychiatry and Neurology, Tokyo, Japan
| | - Maya Kuligyna
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | | | - Anne-Claire Stona
- Lee Kong Chian School of Medicine, Nanyang Technological Univerity, Singapore
| | - Jean Grenier
- Institut du savoir Montfort, Montfort Hospital & University of Ottawa, Ottawa, Canada
| | - Jingjing Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Na Zhong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Dan J Stein
- SA MRC Unit of Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Paul Emmelkamp
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Howard F Andrews
- Departments of Biostatistics and Psychiatry and New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Geoffrey M Reed
- Department of Psychiatry and WHO Collaborating Centre for Research and Capacity Building in Global Mental Health, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.
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63
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Finning K, Ford T, Moore DA, Ukoumunne OC. Emotional disorder and absence from school: findings from the 2004 British Child and Adolescent Mental Health Survey. Eur Child Adolesc Psychiatry 2020; 29:187-198. [PMID: 31054124 PMCID: PMC7024694 DOI: 10.1007/s00787-019-01342-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/19/2019] [Indexed: 12/22/2022]
Abstract
Emotional disorder may be associated with absence from school, but the existing evidence is methodologically weak. We studied the relationships between anxiety, depression and emotional difficulties, and school absence (total, authorised and unauthorised) using data from the 2004 British Child and Adolescent Mental Health Survey (BCAMHS). The BCAMHS was a cross-sectional, community survey of 7977 5- to 16-year-olds. Emotional disorder was assessed using the Development and Wellbeing Assessment (DAWBA), and emotional difficulties using the Strengths and Difficulties Questionnaire (SDQ) completed by teachers and parents. Teachers reported days absent in the previous school term. Multivariable negative binomial regression was used to examine the impact of emotional disorder and difficulties on absence. Age, gender and general health were explored as moderators. Anxiety, depression and emotional difficulties were associated with higher rates of all types of absence [rate ratios for total absence: anxiety 1.69 (1.39-2.06) p < 0.001; depression 3.40 (2.46-4.69) p < 0.001; parent-reported emotional difficulties 1.07 (1.05-1.10) p < 0.001; teacher-reported emotional difficulties 1.10 (1.08-1.13) p < 0.001]. The strongest association was observed for depression and unauthorised absence. Relationships were stronger for secondary compared to primary school children. Health and educational professionals should be aware that children with poor attendance may be experiencing emotional ill health, regardless of absence type. The absence may provide a useful tool to identify those who require additional mental health support. Findings highlight the widespread burden of emotional disorder and the need to support those with emotional ill health in continuing to access education.
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Affiliation(s)
- Katie Finning
- University of Exeter School of Medicine and Health, College House, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - Tamsin Ford
- University of Exeter School of Medicine and Health, College House, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Darren A Moore
- Graduate School of Education, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Obioha C Ukoumunne
- School of Medicine and Health, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
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64
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Beitchman JA, Griffiths DR, Hur Y, Ogle SB, Bromberg CE, Morrison HW, Lifshitz J, Adelson PD, Thomas TC. Experimental Traumatic Brain Injury Induces Chronic Glutamatergic Dysfunction in Amygdala Circuitry Known to Regulate Anxiety-Like Behavior. Front Neurosci 2020; 13:1434. [PMID: 32038140 PMCID: PMC6985437 DOI: 10.3389/fnins.2019.01434] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/18/2019] [Indexed: 01/01/2023] Open
Abstract
Up to 50% of traumatic brain injury (TBI) survivors demonstrate persisting and late-onset anxiety disorders indicative of limbic system dysregulation, yet the pathophysiology underlying the symptoms is unclear. We hypothesize that the development of TBI-induced anxiety-like behavior in an experimental model of TBI is mediated by changes in glutamate neurotransmission within the amygdala. Adult, male Sprague-Dawley rats underwent midline fluid percussion injury or sham surgery. Anxiety-like behavior was assessed at 7 and 28 days post-injury (DPI) followed by assessment of real-time glutamate neurotransmission in the basolateral amygdala (BLA) and central nucleus of the amygdala (CeA) using glutamate-selective microelectrode arrays. The expression of anxiety-like behavior at 28 DPI coincided with decreased evoked glutamate release and slower glutamate clearance in the CeA, not BLA. Numerous factors contribute to the changes in glutamate neurotransmission over time. In two additional animal cohorts, protein levels of glutamatergic transporters (Glt-1 and GLAST) and presynaptic modulators of glutamate release (mGluR2, TrkB, BDNF, and glucocorticoid receptors) were quantified using automated capillary western techniques at 28 DPI. Astrocytosis and microglial activation have been shown to drive maladaptive glutamate signaling and were histologically assessed over 28 DPI. Alterations in glutamate neurotransmission could not be explained by changes in protein levels for glutamate transporters, mGluR2 receptors, astrocytosis, and microglial activation. Presynaptic modulators, BDNF and TrkB, were significantly decreased at 28 DPI in the amygdala. Dysfunction in presynaptic regulation of glutamate neurotransmission may contribute to anxiety-related behavior and serve as a therapeutic target to improve circuit function.
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Affiliation(s)
- Joshua A Beitchman
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States.,College of Graduate Studies, Midwestern University, Glendale, AZ, United States
| | - Daniel R Griffiths
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States
| | - Yerin Hur
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States
| | - Sarah B Ogle
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States.,Banner University Medical Center, Phoenix, AZ, United States
| | - Caitlin E Bromberg
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States
| | - Helena W Morrison
- College of Nursing, University of Arizona, Tucson, AZ, United States
| | - Jonathan Lifshitz
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States.,Phoenix VA Health Care System, Phoenix, AZ, United States
| | - P David Adelson
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States
| | - Theresa Currier Thomas
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States.,Phoenix VA Health Care System, Phoenix, AZ, United States
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65
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Chin S, Lim K, Yap CK, Wong M. Depression Outcome Expectancy in Primary Care in Singapore: Symptom Severity as a Mediating Determinant. Indian J Psychol Med 2020; 42:39-45. [PMID: 31997864 PMCID: PMC6970309 DOI: 10.4103/ijpsym.ijpsym_442_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/11/2018] [Accepted: 06/30/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Depression has been identified as the most common mental illness in Singapore. To address this growing concern, the current study focused on the population within the primary care setting since depression has been demonstrated to be highly prevalent in these patients. This study examined the possible predictors of outcome expectancy based on illness perception and depression severity. METHODS One hundred and one adult patients with depressive symptoms in primary care were recruited for a cross-sectional study. Positive outcome expectancy was measured using the Depression Change Expectancy Scale, and illness perception was measured using the Illness Perception Questionnaire Mental Health. Depression severity was derived from the Patient Health Questionnaire-9 scores extracted from the participants' medical records. Regression and mediation analyses were applied to explore possible predictors of positive outcome expectancy. RESULTS Regression analysis demonstrated that symptom severity, and specific dimensions under illness perception (i.e., perception of chronicity, perception of personal control, and perception of treatment control) were the most significant predictors of positive outcome expectancy. Mediation analysis found that symptom severity partially mediated the relationship between perception of chronicity and positive outcome expectancy. CONCLUSIONS Pharmacotherapy, interventions from allied health professionals, and psychotherapeutic interventions (e.g., strategies from positive psychology, solution-focused therapy, and strengths-based cognitive behavioral therapy) that aim to directly alleviate depressive symptoms as well as improve the perceptions of chronicity, personal control, and treatment control could potentially enhance treatment benefits in primary care patients with depression.
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Affiliation(s)
- Shannon Chin
- Department of Psychology, James Cook University, Singapore
| | - Kokkwang Lim
- Department of Psychology, James Cook University, Singapore
| | - Chee Khong Yap
- Psychology Services, National Healthcare Group Polyclinics, Singapore
| | - Meiyin Wong
- Psychology Services, National Healthcare Group Polyclinics, Singapore
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66
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Nakash O, Hayat T, Abu Kaf S, Cohen M. Association between Knowledge about How to Search for Mental Health Information and Emotional Distress among Older Adults: The Moderating Role of Immigration Status. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2020; 63:78-91. [PMID: 31889477 DOI: 10.1080/01634372.2019.1709247] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 12/18/2019] [Accepted: 12/22/2019] [Indexed: 06/10/2023]
Abstract
Mental health literacy (MHL) provides a framework to overcome barriers to service use and reduce mental health disparities through public education. Acquiring basic knowledge about mental health problems can guide subsequent help-seeking behavior. Improving knowledge about how to search for mental health information is a critical first step in improving MHL. In this study, we examined the association between knowledge about how to search for mental health information and emotional distress among older adults. We further examined the moderating role of immigration status in this association. A sample of 605 older adults participated in the study (N = 357 Native Israelis; N = 222 Immigrants from the Former Soviet Union). Participants completed self-report measures assessing MHL and emotional distress. Our findings show that Native Israelis reported significantly lower levels of emotional distress and higher levels of knowledge about how to search for mental health information compared to immigrants. Moreover, while among native older adults, increased knowledge about how to search for mental health information was associated with lower emotional distress, among immigrant seniors there was no significant association between these variables. Our findings suggest that differences among immigrant and native older adults can impact the effectiveness of the mental health knowledge that is accessed.
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Affiliation(s)
- Ora Nakash
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzilya, Israel
- School for Social Work, Smith College, Northampton, Massachusetts, USA
| | - Tsahi Hayat
- Sami Offer School of Communication, Interdisciplinary Center, Herzilya, Israel
| | - Sarah Abu Kaf
- Conflict Management & Resolution Program, Department of Interdisciplinary Studies, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Michal Cohen
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzilya, Israel
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67
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Silk JS, Pramana G, Sequeira SL, Lindhiem O, Kendall PC, Rosen D, Parmanto B. Using a Smartphone App and Clinician Portal to Enhance Brief Cognitive Behavioral Therapy for Childhood Anxiety Disorders. Behav Ther 2020; 51:69-84. [PMID: 32005341 PMCID: PMC6995786 DOI: 10.1016/j.beth.2019.05.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 12/15/2022]
Abstract
Cognitive behavioral therapy (CBT) is an efficacious treatment for child anxiety disorders, but 40%-50% of youth do not respond fully to treatment, and time commitments for standard CBT can be prohibitive for some families and lead to long waiting lists for trained CBT therapists in the community. SmartCAT 2.0 is an adjunctive mobile health program designed to improve and shorten CBT treatment for anxiety disorders in youth by providing them with the opportunity to practice CBT skills outside of session using an interactive and gamified interface. It consists of an app and an integrated clinician portal connected to the app for secure 2-way communication with the therapist. The goal of the present study was to evaluate SmartCAT 2.0 in an open trial to establish usability, feasibility, acceptability, and preliminary efficacy of brief (8 sessions) CBT combined with SmartCAT. We also explored changes in CBT skills targeted by the app. Participants were 34 youth (ages 9-14) who met DSM-5 criteria for generalized, separation, and/or social anxiety disorder. Results demonstrated strong feasibility and usability of the app/portal and high satisfaction with the intervention. Youth used the app an average of 12 times between each therapy session (M = 5.8 mins per day). At posttreatment, 67% of youth no longer met diagnostic criteria for an anxiety disorder, with this percentage increasing to 86% at 2-month follow-up. Youth showed reduced symptom severity over time across raters and also improved from pre- to posttreatment in CBT skills targeted by the app, demonstrating better emotion identification and thought challenging and reductions in avoidance. Findings support the feasibility of combining brief CBT with SmartCAT. Although not a controlled trial, when benchmarked against the literature, the current findings suggest that SmartCAT may enhance the utility of brief CBT for childhood anxiety disorders.
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Affiliation(s)
- Jennifer S. Silk
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Gede Pramana
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA
| | | | - Oliver Lindhiem
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | | | - Dana Rosen
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Bambang Parmanto
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA
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68
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Davis AK, Barrett FS, Griffiths RR. Psychological flexibility mediates the relations between acute psychedelic effects and subjective decreases in depression and anxiety. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020; 15:39-45. [PMID: 32864325 PMCID: PMC7451132 DOI: 10.1016/j.jcbs.2019.11.004] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Prior research has shown that acute subjective psychedelic effects are associated with both spontaneous and intended changes in depression and anxiety. Psychedelics are also theorized to produce increases in psychological flexibility, which could explain decreases in depression and anxiety following a psychedelic experience. Therefore, the present cross-sectional survey study sought to examine whether psychological flexibility mediated the relationship between acute psychedelic experiences and spontaneous or intended changes in depression and anxiety among a large international sample of people who reported having used a psychedelic (n=985; male=71.6%; Caucasian/white=84.1%; M age=32.2, SD=12.6). A regression analysis showed that acute effects (i.e., mystical and insightful effects) were significantly associated with decreases in depression/anxiety following a psychedelic experience. A path analysis revealed that, while controlling for age and sex, increases in psychological flexibility fully mediated the effect of mystical and insightful experiences on decreases in depression and anxiety following a psychedelic experience. This suggests that psychological flexibility may be an important mediator of the therapeutic effects of psychedelic drugs. Future prospective experimental studies should examine the effect of psychedelic drug administration on psychological flexibility in order to gain a better understanding of the psychological processes that predict therapeutic effects of psychedelics.
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Affiliation(s)
- Alan K. Davis
- College of Social Work, The Ohio State University, Columbus, OH 43210
- Center for Psychedelic and Consciousness Research, Department of Psychiatry, Johns Hopkins School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224 USA
| | - Frederick S. Barrett
- Center for Psychedelic and Consciousness Research, Department of Psychiatry, Johns Hopkins School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224 USA
| | - Roland R. Griffiths
- Center for Psychedelic and Consciousness Research, Department of Psychiatry, Johns Hopkins School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224 USA
- Department of Neuroscience, Johns Hopkins School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224 USA
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69
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Distance-Delivered Parent Training for Childhood Disruptive Behavior (Strongest Families™): a Randomized Controlled Trial and Economic Analysis. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019. [PMID: 29516341 DOI: 10.1007/s10802-018-0413-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Disruptive behavior disorders are prevalent in youth, yet most children with disruptive behavior do not have access to timely, effective treatment. Distance-delivered service (e.g., via telephone, Internet) can overcome several barriers to care. This study tested the effectiveness of a 12-week parent training program, Strongest Families™ Parenting the Active Child, delivered via written material, skill-based videos, and telephone coaching sessions, as compared to usual care in reducing child externalizing behavior. Participants were 172 primary caregivers of a 6- to 12-year-old (29% girls; M age = 8.5 years) recruited from community children's mental health clinics. Participants were randomized to either Strongest Families™ or usual care and completed measures of child externalizing behavior, parenting practices, parent distress, and intervention services consumed at baseline and 5-, 10-, 16-, and 22-months post-baseline. Growth curve analysis showed significant reductions in externalizing behavior in both conditions over time. Improvements were significantly greater at 10 months in the Strongest Families™ condition (d = 0.43). At 22 months, however, the differences were not significant and small in magnitude (d = -0.05). The intervention decreased inconsistent discipline significantly more than usual care. Parents in both conditions showed significant reductions in distress. We also conducted a cost-effectiveness analysis to assess the value for money of the Strongest Families™ program versus usual care. Distance parent training is a promising way to increase access to, and reduce costs associated with, mental health care for families with a child with disruptive behavior.
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70
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Lewis K, Marrie RA, Bernstein CN, Graff LA, Patten SB, Sareen J, Fisk JD, Bolton JM. The Prevalence and Risk Factors of Undiagnosed Depression and Anxiety Disorders Among Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2019; 25:1674-1680. [PMID: 30888037 DOI: 10.1093/ibd/izz045] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is associated with a high prevalence of comorbid depressive and anxiety disorders. A significant proportion of IBD patients with comorbid psychiatric disorders remain undiagnosed and untreated, but factors associated with diagnosis are unknown. We evaluated the prevalence of undiagnosed depression and anxiety in an IBD cohort, along with the associated demographic and clinical characteristics. METHODS We obtained data from the enrollment visit of a cohort study of psychiatric comorbidity in immune-mediated diseases including IBD. Each participant underwent a Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID) to identify participants who met lifetime criteria for a diagnosis of depression or anxiety. Those with a SCID-based diagnosis were classified as diagnosed or undiagnosed based on participant report of a physician diagnosis. RESULTS Of 242 eligible participants, 97 (40.1%) met SCID criteria for depression, and 74 (30.6%) met criteria for anxiety. One-third of participants with depression and two-thirds with anxiety were undiagnosed. Males were more likely to have an undiagnosed depressive disorder (odds ratio [OR], 3.36; 95% confidence interval [CI], 1.28-8.85). Nonwhite participants were less likely to have an undiagnosed anxiety disorder (OR, 0.17; 95% CI, 0.042-0.72). CONCLUSION Our findings highlight the importance of screening for depression and anxiety in patients with IBD, with particular attention to those of male sex and with a lower education level.
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Affiliation(s)
- Kylee Lewis
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lesley A Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Scott B Patten
- Departments of Community Health Sciences & Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jitender Sareen
- Department of Psychiatry, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John D Fisk
- Nova Scotia Health Authority, Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, Canada
| | - James M Bolton
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Department of Psychiatry, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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71
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Staples LG, Dear BF, Johnson B, Fogliati V, Gandy M, Fogliati R, Nielssen O, Titov N. Internet-delivered treatment for young adults with anxiety and depression: Evaluation in routine clinical care and comparison with research trial outcomes. J Affect Disord 2019; 256:103-109. [PMID: 31170620 DOI: 10.1016/j.jad.2019.05.058] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 04/11/2019] [Accepted: 05/27/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Mood and anxiety disorders typically emerge in adolescence and early adult life, but young adults are often reluctant to seek treatment. The Mood Mechanic course is a transdiagnostic internet-delivered psychological intervention for symptoms of depression and anxiety, targeted at people aged 18-24 years. The current study compared the efficacy of the course when delivered under strict research trial conditions (research trial; n = 192) with its effectiveness in a routine health-care setting (routine care; n = 222). METHODS Symptoms of depression, anxiety and general distress at baseline, during, and after treatment were measured by the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and Kessler 10-Item Scale (K-10), respectively. RESULTS Both groups showed significant symptom reductions on all measures at post-treatment and 3-month follow-up. Deterioration rates were low, within-group effect sizes were large (>1.0) and both groups reported high levels of treatment satisfaction. Patients in routine care were less likely to complete post-treatment or follow-up symptom questionnaires. LIMITATIONS The study is based on self-reported data from treatment-seeking individuals that were motivated enough to start the course, and the absence of a control group and a formal diagnosis in the routine care sample means that some caution is needed in generalising the results. CONCLUSION The results show that the Mood Mechanic course is effective and acceptable in routine clinical care, and that online psychological interventions designed for young adults are an effective treatment option for this hard-to-reach group.
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Affiliation(s)
- Lauren G Staples
- Department of Psychology, Macquarie University, Sydney, Australia.
| | - Blake F Dear
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Bareena Johnson
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Vincent Fogliati
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Milena Gandy
- Department of Psychology, Macquarie University, Sydney, Australia
| | | | - Olav Nielssen
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Nickolai Titov
- Department of Psychology, Macquarie University, Sydney, Australia
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72
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Facilitating access to iCBT: a randomized controlled trial assessing a translated version of an empirically validated program using a minimally monitored delivery model. Behav Cogn Psychother 2019; 48:185-202. [PMID: 31416489 DOI: 10.1017/s135246581900047x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Despite its established efficacy, access to internet-delivered CBT (iCBT) remains limited in a number of countries. Translating existing programs and using a minimally monitored model of delivery may facilitate its dissemination across countries. AIMS This randomized control trial aims to evaluate the efficacy of an iCBT transdiagnostic program translated from English to French and offered in Canada using a minimally monitored delivery model for the treatment of anxiety and depression. METHOD Sixty-three French speakers recruited in Canada were randomized to iCBT or a waiting-list. A French translation of an established program, the Wellbeing Course, was offered over 8 weeks using a minimally monitored delivery model. Primary outcome measures were the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), which were obtained pre-treatment, post-treatment and at 3-month follow-up. RESULTS Mixed-effects models revealed that participants in the treatment group had significantly lower PHQ-9 and GAD-7 scores post-treatment than controls with small between-groups effect sizes (d = 0.34 and 0.37, respectively). Within-group effect sizes on primary outcome measures were larger in the treatment than control group. Clinical recovery rates on the PHQ-9 and GAD-7 were significantly higher among the treatment group (40 and 56%, respectively) than the controls (13 and 16%, respectively). CONCLUSIONS The provision of a translated iCBT program using a minimally monitored delivery model may improve patients' access to treatment of anxiety and depression across countries. This may be an optimal first step in improving access to iCBT before sufficient resources can be secured to implement a wider range of iCBT services.
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73
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Amir N, Taboas W, Montero M. Feasibility and dissemination of a computerized home-based treatment for Generalized Anxiety Disorder: A randomized clinical trial. Behav Res Ther 2019; 120:103446. [PMID: 31376708 DOI: 10.1016/j.brat.2019.103446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 07/11/2019] [Accepted: 07/26/2019] [Indexed: 11/19/2022]
Abstract
Generalized Anxiety Disorder (GAD) is a prevalent, impairing, and undertreated psychiatric disorder. We examined if a home-based computerized treatment program can feasibly be delivered and successfully treat GAD symptoms. Using a randomized control trial, we compared three active groups receiving computerized sequenced Attention Bias Modification (ABM) followed by Applied Relaxation psychoeducation (AR-pe), the reversed sequence of AR-pe and ABM, and a simultaneous ABM and AR-pe group to an assessment only control group. The participants comprised 169 adults with a diagnosis of GAD. We asked participants to complete as many as twenty-four 30-min sessions of an at-home computerized treatment program over 12 weeks. The control group received 24 brief assessment questionnaires as well as assessments of attention bias. Results from intent-to-treat analyses show faster rate of improvement for symptoms of anxiety as measured by the Hamilton Anxiety Rating Scale (HAM-A) over time in groups that received active training in contrast to the clinical monitoring (CM) control group. Follow-up analyses revealed that both sequenced groups improved in anxiety when compared to the control group, while the simultaneous group did not outperform the control group. Results suggest that sequenced delivery of ABM and AR, may be a viable home-based treatment option for individuals with GAD who have limited access to resources or are otherwise unable to seek available treatments that require engagement outside of the home. TRIAL REGISTRATION: clinicaltrial. gov Identifier: NCT00602563.
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Affiliation(s)
- Nader Amir
- Joint Doctoral Program in Clinical Psychology, San Diego State University and University of California, San Diego, San Diego, CA, USA; Center for Understanding and Treating Anxiety (CUTA), San Diego State University, San Diego, CA, USA.
| | - William Taboas
- Center for Understanding and Treating Anxiety (CUTA), San Diego State University, San Diego, CA, USA
| | - Miguel Montero
- Center for Understanding and Treating Anxiety (CUTA), San Diego State University, San Diego, CA, USA
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74
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Dorr F, Maun A, Farin-Glattacker E, Fichtner U, Bengel J. Kooperation in der Versorgung psychischer Störungen aus hausärztlicher, fachärztlicher und fachpsychotherapeutischer Perspektive. VERHALTENSTHERAPIE 2019. [DOI: 10.1159/000500962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Daeem R, Mansbach-Kleinfeld I, Farbstein I, Apter A, Elias R, Ifrah A, Chodick G, Fennig S. Barriers to help-seeking in Israeli Arab minority adolescents with mental health problems: results from the Galilee study. Isr J Health Policy Res 2019; 8:45. [PMID: 31122285 PMCID: PMC6532130 DOI: 10.1186/s13584-019-0315-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 05/13/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The Galilee Study assessed mental health service needs among Israeli Muslim and Druze adolescents and their mothers. Studies show that mothers of adolescents belonging to the Arab minority have much lower help-seeking rates than Jewish mothers. This paper examines mothers' structural and cultural barriers to help-seeking. METHODS All 9th grade students living in 5 towns representative of Muslim and Druze localities in northern Israel, were eligible for the study and 1639 (69.3%) obtained parental agreement and participated. Emotional or behavioral problem were assessed in the classroom using the Strengths and Difficulties Questionnaire. A total of 704 adolescent-mother dyads participated in the follow-up, and were interviewed at home, using the Development and Well Being Assessment inventory, the Composite Barriers to Help-Seeking Questionnaire, the General Health Questionnaire - 12, the Subjective Feelings of Discrimination Index and socio-demographic questions. Pearson χ2 test and multivariate binary logistic regressions were performed to analyze mothers' consultation rates by risk factors. Exploratory factor analysis was performed to identify underlying factors and assess construct validity of the Composite Barriers to Help-Seeking Questionnaire, and also mean scores and standard deviations for the distinct scales were calculated. RESULTS More mothers of adolescents with a mental disorder than those without a mental disorder consulted a professional or school source (39.7% vs. 20.5%; χ2 = 45.636; p = < 0.001). The most important barriers to help-seeking were those related to "Accessibility", followed by barriers related to the belief that "Treatment is detrimental" and to the possibility of "Reprisal by authorities". Barriers related to "Stigma" and "Distrust of professionals" had the lowest means scores. Differences by ethnicity/religion were found. CONCLUSIONS Structural barriers related to lack of access, were considered the main obstacle to help-seeking in this Israeli Arab minority population. Cultural barriers such as stigma were considered of secondary importance. Structural barriers could be reduced by increasing the number of accessible public mental health clinics in the minority localities, a responsibility of the Ministry of Health and the HMOs. Information campaigns and psychoeducation for parents would help reduce other barriers to mental health treatment.
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Affiliation(s)
- Raida Daeem
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Child and Adolescent Mental Health Department, Ziv Medical Center, 13100 Zefat, Israel
| | - Ivonne Mansbach-Kleinfeld
- The Feinberg Child Study Center, Schneider Medical Center for Children in Israel, 49202 Petach Tikvah, Israel
| | - Ilana Farbstein
- Child and Adolescent Mental Health Department, Ziv Medical Center, 13100 Zefat, Israel
| | - Alan Apter
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Psychiatry, Schneider Children’s Medical Center of Israel, 49202 Petach Tikva, Israel
- Ruppin Academic Center, Netanya, Israel
- Inter-Disciplinary Center, Herzliya, Israel
| | - Rasha Elias
- Child and Adolescent Mental Health Department, Ziv Medical Center, 13100 Zefat, Israel
| | - Anneke Ifrah
- Israel Center for Disease Control, Gertner Institute, Sheba Medical Center, 5265601 Tel Hashomer, Israel
| | - Gabriel Chodick
- School of Public Health, Tel Aviv University, Tel Aviv, Israel
- Epidemiology and Data Base, MaccabiTech, Tel Aviv, Israel
| | - Silvana Fennig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Psychiatry, Schneider Children’s Medical Center of Israel, 49202 Petach Tikva, Israel
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76
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Zhang X, Xiao H, Chen Y. Evaluation of a WeChat‐based life review programme for cancer patients: A quasi‐experimental study. J Adv Nurs 2019; 75:1563-1574. [DOI: 10.1111/jan.14018] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 01/19/2019] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Xiaoling Zhang
- School of Nursing Fujian Medical University Fuzhou China
| | - Huimin Xiao
- School of Nursing Fujian Medical University Fuzhou China
| | - Ying Chen
- School of Nursing Fujian Medical University Fuzhou China
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Steinmann M, Heddaeus D, Liebherz S, Daubmann A, Härter M, Watzke B. Effectiveness of Telephone-Administered Cognitive-Behavioral Psychotherapy for Depression With Versus Without Additional Letters: A Randomized Controlled Trial. Telemed J E Health 2019; 26:347-353. [PMID: 31013466 DOI: 10.1089/tmj.2018.0311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: Telephone-administered cognitive-behavioral psychotherapy (T-CBT) can effectively treat patients with depressive symptoms. Introduction: We investigated whether adding letters (via postal mail) to T-CBT reduces depressive symptoms and increases response and remission. Additionally, we assessed whether T-CBT reduced all patients' symptoms in the first depression-specific T-CBT sample in German healthcare. Materials and Methods: Primary care patients were randomized to T-CBT with versus without letters. All received 1 face-to-face and 8-12 telephone-administered sessions. An intention-to-treat sample was analyzed. Between-groups differences in symptom change and the total sample's symptom change were computed using linear mixed models with group as fixed effect, referring general practice as random effect and several covariates. Differences in response and remission were assessed using logistic regressions. Results: Fifty-nine patients were referred to T-CBT and randomized. Twenty-six patients actually participated in T-CBT with letters and 21 without letters. The groups did not differ significantly regarding symptom change (Patient Health Questionnaire [PHQ-9]) from baseline to end: T-CBT without letters showed 1.05 points greater reduction (95% confidence interval: -4.72 to 2.62; p = 0.56; Cohen's d = -0.12) (adjusted mean change). The groups did not differ significantly regarding symptom change from baseline to 6-month follow-up nor odds of response or remission. The total sample's PHQ-9 showed significant adjusted mean reduction from baseline to end of T-CBT and to 6-month follow-up. Discussion: Additional letters did not lead to greater symptom reduction. Overall results for the first German T-CBT intervention for depression appear promising but require further assessment using a control condition. Conclusions: Additional letters do not appear to enhance the effectiveness of T-CBT.
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Affiliation(s)
- Maya Steinmann
- Department of Medical Psychology and University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniela Heddaeus
- Department of Medical Psychology and University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Liebherz
- Department of Medical Psychology and University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology and University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgit Watzke
- Clinical Psychology and Psychotherapy Research, Institute of Psychology, University of Zurich, Zurich, Switzerland
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78
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Stoop C, Pouwer F, Pop V, Den Oudsten B, Nefs G. Psychosocial health care needs of people with type 2 diabetes in primary care: Views of patients and health care providers. J Adv Nurs 2019; 75:1702-1712. [PMID: 30883846 PMCID: PMC6850404 DOI: 10.1111/jan.13996] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/22/2018] [Accepted: 02/18/2019] [Indexed: 01/28/2023]
Abstract
Aims This study examined (a) psychosocial health care needs of people with type 2 diabetes from the perspective of patients and diabetes healthcare providers in primary care, in terms of topics, attention in diabetes care and preferences and (b) factors associated with a positive attitude towards specialized psychosocial health care. Design Qualitative focus group study. Methods Using purposive sampling, participants were selected from general practices. In 2012–2013, three focus groups were conducted in people with type 2 diabetes (N = 20) and three with healthcare providers (N = 18). Results Opinions differed considerably on whether there was a need for psychosocial health care. Topics focused mainly on diabetes‐specific issues ranging from a need for additional diabetes education to attention and support in regular diabetes care. However, not all healthcare providers felt competent enough to address psychosocial problems. Some participants reported a need for specialized psychosocial help. A positive attitude towards specialized psychosocial health care appeared to be influenced by care setting (e.g., in the primary care practice or ‘outside’ mental health care), care accessibility, proactive discussion of psychosocial issues with and referral by healthcare providers and previous experiences with psychosocial health care. Conclusion Although only few participants expressed a need for specialized psychosocial care, attention for psychosocial well‐being in regular diabetes care was generally appreciated. Impact People with type 2 diabetes generally felt psychosocial care could be provided as part of regular diabetes care. Suggestions for healthcare providers to meet psychosocial health care needs include training and discussion tools.
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Affiliation(s)
- Corinne Stoop
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands.,PoZoB, Veldhoven, The Netherlands
| | - François Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,School of Psychology, Deakin University, Geelong, Australia
| | - Victor Pop
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Brenda Den Oudsten
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Giesje Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands.,Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, The Netherlands
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79
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Bullis JR, Boettcher H, Sauer‐Zavala S, Farchione TJ, Barlow DH. What is an emotional disorder? A transdiagnostic mechanistic definition with implications for assessment, treatment, and prevention. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2019. [DOI: 10.1111/cpsp.12278] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Jacqueline R. Bullis
- Center for Anxiety and Related Disorders Boston University Boston Massachusetts
- Division of Depression and Anxiety Disorders Harvard Medical School McLean Hospital Belmont Massachusetts
| | - Hannah Boettcher
- Center for Anxiety and Related Disorders Boston University Boston Massachusetts
| | | | - Todd J. Farchione
- Center for Anxiety and Related Disorders Boston University Boston Massachusetts
| | - David H. Barlow
- Center for Anxiety and Related Disorders Boston University Boston Massachusetts
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80
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Davis AK, So S, Lancelotta R, Barsuglia JP, Griffiths RR. 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) used in a naturalistic group setting is associated with unintended improvements in depression and anxiety. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:161-169. [PMID: 30822141 DOI: 10.1080/00952990.2018.1545024] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND A recent epidemiological study suggested that 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) used for spiritual and recreational reasons is associated with subjective improvement in depression and anxiety. Further exploration of the potential psychotherapeutic effects of 5-MeO-DMT could inform future clinical trials. OBJECTIVES We examined self-reported improvement in depression and anxiety among people who use 5-MeO-DMT in a group setting with structured procedures guiding dose and administration of 5-MeO-DMT. Such procedures also include activities for the preparation of, and support during/following sessions, which are similar to procedures used in clinical trials of hallucinogen administration. Next, we examined whether depression or anxiety were improved following use, and whether the acute subjective effects (mystical/challenging) or beliefs about the 5-MeO-DMT experience were associated with improvements in these conditions. METHODS Respondents (n = 362; Mage = 47.7; Male = 55%; White/Caucasian = 84%) completed an anonymous web-based survey. RESULTS Of those reporting having been diagnosed with depression (41%) or anxiety (48%), most reported these conditions were improved (depression = 80%; anxiety = 79%) following 5-MeO-DMT use, and fewer reported they were unchanged (depression = 17%; anxiety = 19%) or worsened (depression = 3%; anxiety = 2%). Improvement in depression/anxiety conditions were associated with greater intensity of mystical experiences and higher ratings of the spiritual significance and personal meaning of the 5-MeO-DMT experience. There were no associations between depression or anxiety improvement and the intensity of acute challenging physical/psychological effects during the 5-MeO-DMT experience. CONCLUSIONS Future prospective controlled clinical pharmacology studies should examine the safety and efficacy of 5-MeO-DMT administration for relieving depression and anxiety.
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Affiliation(s)
- Alan K Davis
- a Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences , Johns Hopkins School of Medicine , Baltimore , MD USA
| | - Sara So
- b Bloomberg School of Public Health, Department of Mental Health , Johns Hopkins University , Baltimore , MD , USA
| | - Rafael Lancelotta
- c School of Counseling, Leadership, Advocacy, and Design , University of Wyoming , Laramie , WY USA
| | | | - Roland R Griffiths
- a Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences , Johns Hopkins School of Medicine , Baltimore , MD USA.,e Department of Neuroscience , Johns Hopkins School of Medicine , Baltimore , MD USA
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81
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Finning K, Ukoumunne OC, Ford T, Danielsson-Waters E, Shaw L, Romero De Jager I, Stentiford L, Moore DA. The association between child and adolescent depression and poor attendance at school: A systematic review and meta-analysis. J Affect Disord 2019; 245:928-938. [PMID: 30699878 DOI: 10.1016/j.jad.2018.11.055] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/17/2018] [Accepted: 11/03/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Depression in young people may lead to reduced school attendance through social withdrawal, loss of motivation, sleep disturbance and low energy. We systematically reviewed the evidence for an association between depression and poor school attendance. METHODS Seven electronic databases were searched for quantitative studies with school-aged children and/or adolescents, reporting a measure of association between depression and school attendance. Articles were independently screened by two reviewers. Synthesis incorporated random-effects meta-analysis and narrative synthesis. RESULTS Searches identified 4930 articles. Nineteen studies from eight countries across North America, Europe, and Asia, were included. School attendance was grouped into: 1) absenteeism (i.e. total absences), 2) excused/medical absences, 3) unexcused absences/truancy, and 4) school refusal. Meta-analyses demonstrated small-to-moderate positive cross-sectional associations between depression and absenteeism (correlation coefficient r = 0.11, 95% confidence interval 0.07 to 0.15, p = 0.005, I2 = 63%); and depression and unexcused absences/truancy (r = 0.15, 95% confidence interval 0.13 to 0.17, p < 0.001, I2 = 4%; odds ratio = 3.74, 95% confidence interval 2.11 to 6.60, p < 0.001, I2 = 65%). Few studies reported associations with school refusal or excused/medical absences, and few utilised longitudinal data, although results from two studies suggested an association between depression and subsequent absenteeism. LIMITATIONS Study quality was poor overall, and methodological heterogeneity, despite creating a broad evidence-base, restricted meta-analysis to only small subsamples of studies. CONCLUSIONS Findings suggest associations between depression and poor school attendance, particularly absenteeism and unexcused absences/truancy. Clinicians and school staff should be alert to the possibility of depression in children and adolescents with poor attendance. Future research should utilise longitudinal data to confirm the direction of the association, investigate associations with excused absences, and test potential moderators of the relationship.
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Affiliation(s)
- Katie Finning
- University of Exeter Medical School, Child Mental Health Research Group, 2.05 South Cloisters, St Luke's Campus, College Road, Exeter EX1 2LU, United Kingdom.
| | - Obioha C Ukoumunne
- NIHR CLAHRC South West Peninsula, University of Exeter Medical School, Exeter, United Kingdom
| | - Tamsin Ford
- University of Exeter Medical School, Child Mental Health Research Group, 2.05 South Cloisters, St Luke's Campus, College Road, Exeter EX1 2LU, United Kingdom
| | | | - Liz Shaw
- Exeter HS&DR Evidence Synthesis Centre, University of Exeter Medical School, Exeter, United Kingdom
| | | | - Lauren Stentiford
- University of Exeter Graduate School of Education, Exeter, United Kingdom
| | - Darren A Moore
- University of Exeter Graduate School of Education, Exeter, United Kingdom
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82
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Owens VA, Hadjistavropoulos HD, Schneider LH, Gullickson KM, Karin E, Titov N, Dear BF. Transdiagnostic, internet-delivered cognitive behavior therapy for depression and anxiety: Exploring impact on health anxiety. Internet Interv 2019; 15:60-66. [PMID: 30723691 PMCID: PMC6350228 DOI: 10.1016/j.invent.2019.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 01/15/2019] [Accepted: 01/15/2019] [Indexed: 11/17/2022] Open
Abstract
Health anxiety is associated with significant personal distress and economic cost; as such, widely available and effective treatment options are crucial. Several studies suggest that Internet-delivered cognitive behavior therapy (ICBT) programs that specifically target health anxiety are efficacious for this condition. However, no known studies have examined the impact of transdiagnostic ICBT, which emphasizes the acquisition of broad coping skills applicable to a variety of mental health concerns, on symptoms of health anxiety. The current study sought to explore changes in health anxiety symptoms by utilizing data available from a previously published study of 8-week transdiagnostic ICBT. Specifically, changes in symptoms of health anxiety in response to a transdiagnostic ICBT program that targeted broad symptoms of depression and anxiety, were examined in a subsample of individuals who endorsed elevated symptom scores on the Short Health Anxiety Inventory at pre-treatment (n = 72). Following treatment, large reductions in health anxiety symptoms (Cohen's d = 0.91; 20% improvement), depression (Cohen's d = 0.85; reduction = 38%), generalized anxiety (Cohen's d = 1.21; reduction = 42%), and disability (Cohen's d = 0.90; reduction = 35%) were reported. Furthermore, results showed that transdiagnostic ICBT was rated as acceptable to people with high health anxiety symptoms. Despite elevated pre-treatment health anxiety scores, email correspondence between clients and their therapist revealed very few mentions of health anxiety. These findings provide preliminary evidence for transdiagnostic ICBT for symptoms of health anxiety and suggest further research is warranted.
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Affiliation(s)
| | - Heather D. Hadjistavropoulos
- Department of Psychology, University of Regina, Regina, Canada
- Corresponding author at: University of Regina, Department of Psychology, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada.
| | | | | | - Eyal Karin
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Nickolai Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Blake F. Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
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83
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Möller HJ, Volz HP, Dienel A, Schläfke S, Kasper S. Efficacy of Silexan in subthreshold anxiety: meta-analysis of randomised, placebo-controlled trials. Eur Arch Psychiatry Clin Neurosci 2019; 269:183-193. [PMID: 29150713 PMCID: PMC6726711 DOI: 10.1007/s00406-017-0852-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 11/02/2017] [Indexed: 12/19/2022]
Abstract
Subthreshold psychiatric disorders do not fully meet the diagnostic criteria of syndromal disorders but may be associated with comparable disability. To investigate the anxiolytic effect of Silexan, an active substance from lavender oil for oral administration, in patients with subthreshold anxiety, a meta-analysis that included all published trials with Silexan in this indication was performed. Three randomised, placebo-controlled trials in subthreshold anxiety disorders (anxiety disorder not otherwise specified, restlessness and agitation, mixed anxiety and depressive disorder) were included. Eligible participants with a baseline Hamilton Anxiety Rating Scale (HAMA) total score ≥ 18 points received 1 × 80 mg/day Silexan or placebo for 10 weeks. Outcomes included the HAMA, the Pittsburgh Sleep Quality Index, the Zung Self-rating Anxiety Scale, the Clinical Global Impressions questionnaire and the SF-36 health status inventory. Data were analysed using meta-analysis based on pooled raw data of individual patients (random effects models). A total of 697 patients were assessed for efficacy. Silexan was superior to placebo in reducing the HAMA total score during 10 weeks' treatment [mean value difference, 95% confidence interval: 3.83 (1.28; 6.37) points]. Superiority was comparably pronounced for psychic and somatic anxiety as well as for observer- and self-rated anxiety. Silexan had a beneficial effect on sleep (secondary to the anxiolytic effect) without causing sedation and improved the patients' health-related quality of life. Adverse event incidence in both treatment groups was comparable [risk ratio: 1.06 (0.85; 1.33)]. Silexan has a significant and clinically meaningful anxiolytic effect in subthreshold anxiety. The results cannot be generalised to other lavender oil products.
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Affiliation(s)
- Hans-Jürgen Möller
- 0000 0004 1936 973Xgrid.5252.0Clinic and Polyclinic for Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | - Angelika Dienel
- 0000 0004 0390 2958grid.476242.1Department of Clinical Research 1, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
| | - Sandra Schläfke
- 0000 0004 0390 2958grid.476242.1Department of Biostatistics, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Apolinário-Hagen J. Internet-Delivered Psychological Treatment Options for Panic Disorder: A Review on Their Efficacy and Acceptability. Psychiatry Investig 2019; 16:37-49. [PMID: 30122031 PMCID: PMC6354039 DOI: 10.30773/pi.2018.06.26] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/26/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Internet-delivered psychological treatments have been suggested as a chance to expand the access to professional help. However, little is known about the usefulness of different support formats and approaches of digital treatments for panic disorder among clinicians. OBJECTIVE This narrative review aimed to explore the recent evidence base on the efficacy and acceptability of different internet-delivered treatments for adults with panic disorder. METHODS A systematic search in electronic databases (Pubmed/Medline, PSYNDEX) and a hand search were performed to identify articles on randomized controlled trials published within the past five years (2012/12/10-2017/12/12) in English peer-reviewed journals. RESULTS Eight studies (1,013 participants) involving 10 interventions met the inclusion criteria. Nine interventions were primarly based on Cognitive Behavioral Therapy principles. Most interventions were effective, when compared to a control condition (6 of 8 comparisons). Minimal guidance was associated with improved outcomes in one study and adherence in two studies (3 comparisons). Furthermore, no differences were found based on treatment approach (2 comparisons). Regarding acceptability, the attrition rates were moderate to high, ranging from 9.8% to 42.1% of randomized participants. Adherence rates also varied largely (7.8-75%), whereas participant satisfaction of program completers was assessed overall high (5 studies). CONCLUSION Diverse effective internet-delivered treatments are available for the self-management of panic symptoms. Especially selfguided and transdiagnostic Cognitive Behavioral Therapy approaches appear being efficient options for the dissemination in routine care. However, due to the limited evidence base, further efforts are required to improve the actual uptake of internet-delivered treatments and identify moderators of outcomes.
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85
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Heddaeus D, Steinmann M, Daubmann A, Härter M, Watzke B. Treatment selection and treatment initialization in guideline-based stepped and collaborative care for depression. PLoS One 2018; 13:e0208882. [PMID: 30586371 PMCID: PMC6306173 DOI: 10.1371/journal.pone.0208882] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 11/27/2018] [Indexed: 11/18/2022] Open
Abstract
In order to optimize patient allocation, guidelines recommend stepped and collaborative care models (SCM) including low-intensity treatments. The aim of this study is to investigate the implementation of guideline-adherent treatments in a SCM for depression in routine care. We analyzed care provider documentation data of n = 569 patients treated within a SCM. Rates of guideline-adherent treatment selections and initializations as well as accordance between selected and initialized treatment were evaluated for patients with mild, moderate and severe depression. Guideline-adherent treatment selection and initialization was highest for mild depression (91% resp. 85%). For moderate depression, guideline-adherent treatments were selected in 68% and applied in 54% of cases. Guideline adherence was lowest for severe depression (59% resp. 19%). In a multiple mixed logistic regression model a significant interaction between guideline adherence in treatment selection/initialization and severity degree was found. The differences between treatment selection and initialization were significant for moderate (OR: 1.8 [95% CI: 1.30 to 2.59; p = 0.0006]) and severe depression (OR: 6.9; [95% CI: 4.24 to 11.25; p < .0001] but not for mild depression (OR = 1.8, [95%-CI: 0.68 to 4.56; p = 0.2426]). Accordance between selected and initialized treatment was highest for mild and lowest for severe depression. We conclude that SCMs potentially improve care for mild depression and guideline adherence of treatment selections. Guideline adherence of treatment initialization and accordance between treatment selection and initialization varies with depression severity. Deficits in treating severe depression adequately may be more a problem of failed treatment initializations than of inadequate treatment selections.
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Affiliation(s)
- Daniela Heddaeus
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Maya Steinmann
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgit Watzke
- Clinical Psychology and Psychotherapy Research, Institute of Psychology, University of Zurich, Zurich, Switzerland
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86
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Gros DF, Allan NP, Silva C, Lancaster CL, Conner KR, Stecker T. Relations Between Thwarted Belongingness, Perceived Burdensomeness, and History of Suicide Attempts and Readiness for Mental Health Treatment in High-Risk Veterans, Reserves, and Active Duty Service Members. MILITARY BEHAVIORAL HEALTH 2018; 6:326-333. [PMID: 38264674 PMCID: PMC10805456 DOI: 10.1080/21635781.2018.1486760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 03/29/2018] [Accepted: 05/29/2018] [Indexed: 01/25/2024]
Abstract
Suicide rates for service members and veterans are growing rapidly in the United States. Despite availability of evidence-based approaches, a large number of high-risk individuals are reluctant to seek out treatment. The present study used the interpersonal theory of suicide, involving 3 primary predictors of death by suicide to investigate treatment readiness in high-risk U. S. veterans, reserves, and active duty service members. Four hundred and two service members were recruited. Inclusion criteria involved (a) reporting active suicidal ideation and (b) denying active behavioral health treatment. All participants completed a self-report battery that assessed burdensomeness, thwarted belongingness, lifetime suicide attempts, and perceptions about treatment. Regression analyses revealed that thwarted belongingness was significantly predictive of treatment perceptions and readiness, in that higher or more severe scores on the thwarted belongingness scale were significantly related to lower or less likely treatment perceptions and readiness scores. The findings suggested that, in high-risk service members, thwarted belongingness is predictive of lower treatment readiness, and contributes to the growing literature on perceived stigmas, treatment barriers and readiness, and suicidal behaviors and risk factors.
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Affiliation(s)
- Daniel F. Gros
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | | | - Caroline Silva
- Department of Emergency Medicine and Psychiatry, University of Rochester Medical Center, Rochester, New York
| | | | - Kenneth R. Conner
- Department of Emergency Medicine and Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Tracy Stecker
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
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Breen LJ, Croucamp CJ, Rees CS. What do people really think about grief counseling? Examining community attitudes. DEATH STUDIES 2018; 43:611-618. [PMID: 30204555 DOI: 10.1080/07481187.2018.1506527] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 03/01/2018] [Accepted: 03/14/2018] [Indexed: 06/08/2023]
Abstract
To understand why bereaved people who are highly distressed significantly underutilize grief counseling and therapy, we surveyed adults (N = 156) to investigate community attitudes toward grief counseling. Overall attitude was positive and women reported a significantly more positive attitude than men; there were no associations between attitude and age, country of birth, previous counseling, or bereavement experience. After controlling for gender, beliefs and affects explained attitudes toward grief counseling; behavioral responses did not. Targeting beliefs about grief counseling may promote positive attitudes so that people most likely to benefit from intervention will be more likely to seek it.
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Affiliation(s)
- Lauren J Breen
- School of Psychology, Curtin University , Perth , Australia
| | | | - Clare S Rees
- School of Psychology, Curtin University , Perth , Australia
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88
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The Effect of Antidepressants on the Course of Inflammatory Bowel Disease. Can J Gastroenterol Hepatol 2018; 2018:2047242. [PMID: 30271765 PMCID: PMC6151237 DOI: 10.1155/2018/2047242] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/17/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS Mood may have an important role in the natural history of inflammatory bowel disease (IBD). However, the impact of antidepressant use on prognosis is unknown. We aimed to address this in a longitudinal study in a referral population. METHODS We collected demographic data, clinical disease activity and mood using validated questionnaires, and antidepressant use at baseline. Longitudinal disease activity was defined by disease flare or need for glucocorticosteroids, escalation of medical therapy, hospitalisation, or intestinal resection. We compared rates of these over a minimum period of 2 years according to antidepressant use at baseline. RESULTS In total, 331 patients provided complete data, of whom 54 (15.8%) were taking an antidepressant at study entry. Older age, female gender, and abnormal mood scores were associated with antidepressant use. During longitudinal follow-up, there was a trend towards lower rates of any of the four endpoints of IBD activity of interest in patients with abnormal anxiety scores at baseline and who were receiving an antidepressant (42.3% versus 64.6%, P = 0.05). Based on univariate Cox regression analysis, there was a trend towards lower rates of escalation of medical therapy among patients receiving antidepressants at baseline (hazard ratio (HR) = 0.59; 95% confidence interval (CI) 0.35-1.00, P = 0.05). None of the differences observed persisted after multivariate Cox regression. CONCLUSIONS Antidepressants may have some beneficial effects on the natural history of IBD, but larger studies with longer follow-up are required. Whether these effects are limited to patients with abnormal mood remains uncertain.
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89
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Thisted CN, Nielsen CV, Bjerrum M. Work Participation Among Employees with Common Mental Disorders: A Meta-synthesis. JOURNAL OF OCCUPATIONAL REHABILITATION 2018; 28:452-464. [PMID: 29234956 DOI: 10.1007/s10926-017-9743-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Purpose The aim was to aggregate knowledge about the opportunities, challenges and need for support employees with common mental disorders experience in relation to work participation in order to develop recommendations for practice. Methods A meta-synthesis was conducted using a meta-aggregative approach to accurately and reliably present findings that could be used to meet our aim. Qualitative inductive content analysis was used to analyze and synthesize the findings. Results In all, 252 findings were extracted from 16 papers, and six categories were generated and aggregated into two synthesized findings. One synthesized finding indicates that a strong work identity and negative perceptions regarding mental disorders can impede work participation, creating an essential need for a supportive work environment. The other reveals that the diffuse nature of the symptoms of mental disorders causes instability in life and loss of control, but through the use of internal motivation and external support, employees may be able to regain control of their lives. However, external support is hampered by insufficient cooperation and coordination between vocational stakeholders. Conclusions Based on the synthesized findings, we recommended that the employer is involved in the rehabilitation process, and that rehabilitation professionals seek to strengthen the employee's ability to manage work-related stress. In addition, rehabilitation professionals should provide individualized and active support and ensure meaningful cooperation across the multidisciplinary disciplines involved in the rehabilitation process.
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Affiliation(s)
- Cecilie Nørby Thisted
- Department of Public Health, Section of Nursing, Aarhus University, Bartholins Allé 2, 3., 8000, Aarhus C, Denmark.
| | - Claus Vinther Nielsen
- Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Merete Bjerrum
- Department of Public Health, Section of Nursing, Aarhus University, Bartholins Allé 2, 3., 8000, Aarhus C, Denmark
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Chisholm K, Patterson P, Greenfield S, Turner E, Birchwood M. Adolescent construction of mental illness: implication for engagement and treatment. Early Interv Psychiatry 2018; 12:626-636. [PMID: 27168481 DOI: 10.1111/eip.12347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 03/28/2016] [Indexed: 11/26/2022]
Abstract
AIMS Understanding how adolescents perceive mental illness is important for clinicians wishing to improve engagement, and for the development of educational programmes and health-behaviour directed policies. The current research aimed to develop a preliminary model of how adolescents perceive mental illness and construct their understanding of mental health. METHOD Forty-six participants aged 11-18 from six schools in Birmingham, UK, took part in one of 12 group interviews. RESULTS A thematic analysis highlighted a dual perception of mental illness. Adolescents discussed stereotypes and extreme examples of illness, but also displayed an insightful understanding of mental distress which had developed through participants' own experiences. Participants attempted to reconcile and negotiate these conflicting perceptions by creating distinctions between concepts of 'craziness' and 'normality', and reported experiencing negative emotions relating to both perceptions of illness. CONCLUSIONS The findings suggest that once media stereotypes have been acknowledged, adolescents demonstrate a relatively sophisticated understanding of mental illness, although one which differed at times from the diagnostic medical model of mental illness. Focusing on individual symptoms, prevalence rates and prior contact adolescents have had with individuals with mental illnesses provides a framework to discuss mental health and ill-health with adolescents.
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Affiliation(s)
- Katharine Chisholm
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - Paul Patterson
- Youth Programme, Birmingham and Solihull Mental Health Foundation Trust, Research and Innovation, Birmingham, UK
| | - Sheila Greenfield
- School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Erin Turner
- Early Intervention Services, Birmingham and Solihull Mental Health Foundation Trust, Newington Resource Centre, Marston Green, Birmingham, UK
| | - Max Birchwood
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
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91
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Dear BF, Fogliati VJ, Fogliati R, Johnson B, Boyle O, Karin E, Gandy M, Kayrouz R, Staples LG, Titov N. Treating anxiety and depression in young adults: A randomised controlled trial comparing clinician-guided versus self-guided Internet-delivered cognitive behavioural therapy. Aust N Z J Psychiatry 2018; 52:668-679. [PMID: 29064283 DOI: 10.1177/0004867417738055] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Internet-delivered cognitive behaviour therapy may increase access by young adults to evidence-based treatments for anxiety and depression. OBJECTIVE The aim of this study was to compare the efficacy of an Internet-delivered cognitive behaviour therapy intervention designed for adults aged 18-24 years, when delivered in clinician-guided versus self-guided formats. DESIGN The intervention, the Mood Mechanic Course, is a transdiagnostic treatment that simultaneously targets symptoms of anxiety and depression using cognitive and behavioural skills. The brief intervention comprised four lessons, delivered over 5 weeks. Following a brief telephone interview, young adults ( n = 191) with symptoms of anxiety and depression were randomly allocated to either (1) clinician-guided treatment ( n = 96) or (2) self-guided treatment ( n = 95). RESULTS At post treatment, large reductions (average improvement; clinician guided vs self-guided) were observed in symptoms of anxiety (44% vs 35%) and depression (40% vs 31%) in both groups. Significant improvements were also observed in general psychological distress (33% vs 29%), satisfaction with life (18% vs 15%) and disability (36% vs 29%). No marked or consistent differences in clinical outcomes emerged between conditions at post-treatment, at 3-month or 12-month follow-up. Satisfaction was high with both treatment formats, but slightly higher for clinician-guided treatment. CONCLUSION These results indicate the potential of carefully developed Internet-delivered cognitive behaviour therapy interventions for young adults with anxiety and depression provided in either self or therapist-guided format. Further large-scale research is required to determine the short- and long-term advantages and disadvantages of different models of support.
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Affiliation(s)
- Blake F Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Vincent J Fogliati
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Rhiannon Fogliati
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Bareena Johnson
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Olivia Boyle
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Eyal Karin
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Milena Gandy
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Rony Kayrouz
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Lauren G Staples
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Nickolai Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW, Australia
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Chin EG, Buchanan EM, Ebesutani C, Young J. Depression, Anxiety, and Stress: How Should Clinicians Interpret the Total and Subscale Scores of the 21-Item Depression, Anxiety, and Stress Scales? Psychol Rep 2018; 122:1550-1575. [PMID: 29932351 DOI: 10.1177/0033294118783508] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The 21-item Depression, Anxiety, and Stress Scales (DASS-21) is a self-report measure that is easy to administer, quick to score, and is freely available. Widely used in diverse settings and populations, confirmatory factor analytic evidence has accumulated for a bifactor model underlying this multidimensional measure. Studies employing an exploratory bifactor approach to more closely examine its underlying structure and inter-relations of factors, however, have been scarce. This is unfortunate because confirmatory techniques often employ indirect ways of handling model misspecification, whereas exploratory methods enable more direct approaches. Moreover, more precise approaches to modeling an exploratory bifactor structure have not been examined with the DASS-21. Based on several large samples of undergraduate students in the United States, the first two parts of the paper (Studies 1 and 2) utilized both exploratory (M = 19.7 years of age) and confirmatory factor analytic methods (M = 19.7 years of age) following those presented by contemporary multidimensional modeling theorists. Building upon these results, the third part of the paper (Study 3; M = 20.0 years of age) examined sensitivity-/specificity-related indices to provide cut-off score recommendations for a revised DASS-21 instrument based on a newly identified and supported bifactor structure. Implications of these results are discussed in terms of taxonomy, challenges inherent in multidimensional modeling, and potential use of the revised DASS-21 measure as a component of an actuarial decision-making strategy to inform clinical referrals.
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Affiliation(s)
- Eu Gene Chin
- Department of Psychology, Southeast Missouri State University, Cape Girardeau, MO, USA
| | - Erin M Buchanan
- Psychology Department, Missouri State University, Springfield, MO, USA
| | - Chad Ebesutani
- Department of Psychology, Duksung Women's University, Seoul, South Korea
| | - John Young
- Department of Psychology, University of Mississippi, Oxford, MS, USA
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Wols A, Lichtwarck-Aschoff A, Schoneveld EA, Granic I. In-Game Play Behaviours during an Applied Video Game for Anxiety Prevention Predict Successful Intervention Outcomes. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2018; 40:655-668. [PMID: 30459485 PMCID: PMC6223766 DOI: 10.1007/s10862-018-9684-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Anxiety disorder is the most prevalent and frequently diagnosed disorder in youth, and associated with serious negative health outcomes. Our most effective prevention programs, however, have several limitations. These limitations can be addressed using game-based interventions. Results from two randomized controlled trials on the video game MindLight show improvements in anxiety that are maintained up to 6 months. The game was designed based on evidence-based therapeutic techniques; however, it is unclear if children's engagement with these techniques actually predict improvements in anxiety symptoms. An important advantage of game-based interventions is that they provide excellent opportunities to isolate therapeutic action mechanisms and test their impact on intervention outcomes. In the current study, on-screen videotaped output while playing MindLight was coded and analysed for forty-three 8 to 12-year old children with elevated levels of anxiety. Results showed that changes in in-game play behaviours representing therapeutic exposure techniques predicted improvements in anxiety symptoms 3 months later (when children had not played the game for 3 months). The current study is a first step towards identifying and validating game mechanics that can be used in new applied games to target anxiety symptoms or other psychopathologies with the same underlying deficits.
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Affiliation(s)
- Aniek Wols
- Behavioural Science Institute, Radboud University, P.O. BOX 9104, 6500 HE Nijmegen, The Netherlands
| | - Anna Lichtwarck-Aschoff
- Behavioural Science Institute, Radboud University, P.O. BOX 9104, 6500 HE Nijmegen, The Netherlands
| | - Elke A. Schoneveld
- Behavioural Science Institute, Radboud University, P.O. BOX 9104, 6500 HE Nijmegen, The Netherlands
| | - Isabela Granic
- Behavioural Science Institute, Radboud University, P.O. BOX 9104, 6500 HE Nijmegen, The Netherlands
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Salekin A, Eberle JW, Glenn JJ, Teachman BA, Stankovic JA. A Weakly Supervised Learning Framework for Detecting Social Anxiety and Depression. PROCEEDINGS OF THE ACM ON INTERACTIVE, MOBILE, WEARABLE AND UBIQUITOUS TECHNOLOGIES 2018; 2:81. [PMID: 31187083 PMCID: PMC6559734 DOI: 10.1145/3214284] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 04/01/2018] [Indexed: 01/04/2023]
Abstract
Although social anxiety and depression are common, they are often underdiagnosed and undertreated, in part due to difficulties identifying and accessing individuals in need of services. Current assessments rely on client self-report and clinician judgment, which are vulnerable to social desirability and other subjective biases. Identifying objective, nonburdensome markers of these mental health problems, such as features of speech, could help advance assessment, prevention, and treatment approaches. Prior research examining speech detection methods has focused on fully supervised learning approaches employing strongly labeled data. However, strong labeling of individuals high in symptoms or state affect in speech audio data is impractical, in part because it is not possible to identify with high confidence which regions of a long speech indicate the person's symptoms or affective state. We propose a weakly supervised learning framework for detecting social anxiety and depression from long audio clips. Specifically, we present a novel feature modeling technique named NN2Vec that identifies and exploits the inherent relationship between speakers' vocal states and symptoms/affective states. Detecting speakers high in social anxiety or depression symptoms using NN2Vec features achieves F-1 scores 17% and 13% higher than those of the best available baselines. In addition, we present a new multiple instance learning adaptation of a BLSTM classifier, named BLSTM-MIL. Our novel framework of using NN2Vec features with the BLSTM-MIL classifier achieves F-1 scores of 90.1% and 85.44% in detecting speakers high in social anxiety and depression symptoms.
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Affiliation(s)
- Asif Salekin
- Department of Computer Science, University of Virginia, Charlottesville, VA, 22903, USA
| | - Jeremy W Eberle
- Department of Psychology, University of Virginia, Charlottesville, VA, 22903, USA
| | - Jeffrey J Glenn
- Department of Psychology, University of Virginia, Charlottesville, VA, 22903, USA
| | - Bethany A Teachman
- Department of Psychology, University of Virginia, Charlottesville, VA, 22903, USA
| | - John A Stankovic
- Department of Computer Science, University of Virginia, Charlottesville, VA, 22903, USA
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95
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Pramana G, Parmanto B, Lomas J, Lindhiem O, Kendall PC, Silk J. Using Mobile Health Gamification to Facilitate Cognitive Behavioral Therapy Skills Practice in Child Anxiety Treatment: Open Clinical Trial. JMIR Serious Games 2018; 6:e9. [PMID: 29748165 PMCID: PMC5968217 DOI: 10.2196/games.8902] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 03/03/2018] [Accepted: 03/14/2018] [Indexed: 11/16/2022] Open
Abstract
Background Cognitive behavioral therapy is an efficacious treatment for child anxiety disorders. Although efficacious, many children (40%-50%) do not show a significant reduction in symptoms or full recovery from primary anxiety diagnoses. One possibility is that they are unwilling to learn and practice cognitive behavioral therapy skills beyond therapy sessions. This can occur for a variety of reasons, including a lack of motivation, forgetfulness, and a lack of cognitive behavioral therapy skills understanding. Mobile health (mHealth) gamification provides a potential solution to improve cognitive behavioral therapy efficacy by delivering more engaging and interactive strategies to facilitate cognitive behavioral therapy skills practice in everyday lives (in vivo). Objective The goal of this project was to redesign an existing mHealth system called SmartCAT (Smartphone-enhanced Child Anxiety Treatment) so as to increase user engagement, retention, and learning facilitation by integrating gamification techniques and interactive features. Furthermore, this project assessed the effectiveness of gamification in improving user engagement and retention throughout posttreatment. Methods We redesigned and implemented the SmartCAT system consisting of a smartphone app for children and an integrated clinician portal. The gamified app contains (1) a series of interactive games and activities to reinforce skill understanding, (2) an in vivo skills coach that cues the participant to use cognitive behavioral therapy skills during real-world emotional experiences, (3) a home challenge module to encourage home-based exposure tasks, (4) a digital reward system that contains digital points and trophies, and (5) a therapist-patient messaging interface. Therapists used a secure Web-based portal connected to the app to set up required activities for each session, receive or send messages, manage participant rewards and challenges, and view data and figures summarizing the app usage. The system was implemented as an adjunctive component to brief cognitive behavioral therapy in an open clinical trial. To evaluate the effectiveness of gamification, we compared the app usage data at posttreatment with the earlier version of SmartCAT without gamification. Results Gamified SmartCAT was used frequently throughout treatment. On average, patients spent 35.59 min on the app (SD 64.18) completing 13.00 activities between each therapy session (SD 12.61). At the 0.10 significance level, the app usage of the gamified system (median 68.00) was higher than that of the earlier, nongamified SmartCAT version (median 37.00, U=76.00, P<.01). The amount of time spent on the gamified system (median 173.15) was significantly different from that of the earlier version (median 120.73, U=173.00, P=.06). Conclusions The gamified system showed good acceptability, usefulness, and engagement among anxious children receiving brief cognitive behavioral therapy treatment. Integrating an mHealth gamification platform within treatment for anxious children seems to increase involvement in shorter treatment. Further study is needed to evaluate increase in involvement in full-length treatment.
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Affiliation(s)
- Gede Pramana
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bambang Parmanto
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA, United States
| | - James Lomas
- The Design Lab, University of California, San Diego, CA, United States
| | - Oliver Lindhiem
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, United States
| | - Jennifer Silk
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
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Stjerneklar S, Hougaard E, Nielsen AD, Gaardsvig MM, Thastum M. Internet-based cognitive behavioral therapy for adolescents with anxiety disorders: A feasibility study. Internet Interv 2018; 11:30-40. [PMID: 30135757 PMCID: PMC6084871 DOI: 10.1016/j.invent.2018.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/21/2017] [Accepted: 01/04/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) is a well-documented effective method for the treatment of anxiety disorders in children and adolescents. While internet based CBT (ICBT) programs for adults have been widely investigated, research on ICBT programs for anxiety disorders in youth is still in an early phase: To date, no such program has been developed or evaluated in Denmark. AIM As preparation for a randomized controlled efficacy trial, this study aimed at evaluating the feasibility of a translated and adapted version of the ICBT program 'Chilled Out' for adolescents with anxiety disorders, developed at Macquarie University, Australia. METHODS At the University Clinic in Aarhus, Denmark, we conducted a feasibility study with six adolescents with a primary anxiety disorder. The 12-week ICBT intervention consisted of eight online modules. Participants received weekly phone calls from a clinical psychologist. Semi-structured interviews on participant's experiences of the program were administered post-treatment and at three-month follow-up. Outcome was evaluated post-treatment and at follow-up using diagnostic interview and questionnaires. RESULTS Five of the six participants completed the program. Participants were generally satisfied with the program and the majority would recommend it to others. Preliminary clinical outcome results indicated moderate to large improvements (e.g., a standardized mean difference from pre- to post-treatment of d = 1.54 on the clinical severity rating of their primary anxiety disorder). CONCLUSION Results from this study indicate that a translated and revised version of the Chilled Out program could be a feasible psychological intervention for Danish adolescents with anxiety disorders.
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Affiliation(s)
- Silke Stjerneklar
- Department of Psychology and Behavioral Sciences, Aarhus BSS, Aarhus University, Bartholins Allé 9, 8000 Aarhus C, Denmark
| | - Esben Hougaard
- Department of Psychology and Behavioral Sciences, Aarhus BSS, Aarhus University, Bartholins Allé 9, 8000 Aarhus C, Denmark
| | | | - Majken M. Gaardsvig
- Department of Psychology and Behavioral Sciences, Aarhus BSS, Aarhus University, Bartholins Allé 9, 8000 Aarhus C, Denmark
| | - Mikael Thastum
- Department of Psychology and Behavioral Sciences, Aarhus BSS, Aarhus University, Bartholins Allé 9, 8000 Aarhus C, Denmark
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Barnes S, Prescott J. Empirical Evidence for the Outcomes of Therapeutic Video Games for Adolescents With Anxiety Disorders: Systematic Review. JMIR Serious Games 2018; 6:e3. [PMID: 29490893 PMCID: PMC5852274 DOI: 10.2196/games.9530] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/12/2018] [Accepted: 01/17/2018] [Indexed: 11/13/2022] Open
Abstract
Background Extant evidence suggests that the proportion of adolescents suffering from anxiety disorders (ADs) has increased by up to 70% since the mid-1980s, with experience of anxiety at this stage associated with significant negative short- and long-term life outcomes. The existing therapeutic interventions (eg, cognitive behavioral therapy, CBT; attention bias modification, ABM) have proven to have clinically measurable benefits in reducing anxiety, but their efficacy is often compromised by social and practical barriers. The growing discrepancy between demand for, and access to, clinical interventions for anxiety has led to the development of a range of eHealth (health care practice supported by electronic processes and communication) and mHealth (versions of eHealth using mobile devices) interventions. One such protocol is therapeutic games, which aim to provide clinical frameworks in dynamic, adaptable, and personalized virtual environments. Although some evidence exists to suggest therapeutic games are associated with reductions in subjective anxiety and observed stress reactivity, there is currently, to our knowledge, no systematic review of the adherence to, and effectiveness of, therapeutic games for adolescent anxiety. Objective The aim of this review was to establish the effectiveness of therapeutic games in making clinically measurable reductions in anxiety symptoms in adolescent samples. Methods A systematic search of the existing academic literature published between 1990 and July 2017 was conducted using the databases Journal of Medical Internet Research, Journal Storage, Psychology Articles, Psychology Info, ScienceDIRECT, and Scopus. Records linked to empirical papers on therapeutic games for anxiety using adolescent samples were evaluated. Results A total of 5 studies (N=410 participants) met the inclusion criteria, and 3 gamified anxiety interventions for adolescents were identified. The papers included a mixture of randomized controlled trials, quasi-experimental studies, and usability studies comprising quantitative and qualitative measures, with varying degrees of mixed methods. Extant evidence shows potential for therapeutic games to create clinically measurable reductions in symptoms of anxiety in adolescent samples, though findings are complicated in some cases by a low sample size, and in other cases by research design and methodological complications, including anxiety reductions in control groups caused by a control-game selection. Conclusions Although research in this field appears to be extremely limited, as demonstrated by the small number of papers meeting the inclusion criteria for this review, early findings suggest that therapeutic games have potential in helping to engage adolescents with anxiety and lead to clinically measurable reductions in symptoms.
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Affiliation(s)
| | - Julie Prescott
- Department of Education and Psychology, University of Bolton, Bolton, United Kingdom
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Quinn C, Denman K, Smithson P, Owens C, Sheaff R, Campbell J, Porter I, Annison J, Byng R. General practitioner contributions to achieving sustained healthcare for offenders: a qualitative study. BMC FAMILY PRACTICE 2018; 19:22. [PMID: 29390968 PMCID: PMC5796354 DOI: 10.1186/s12875-018-0708-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 01/24/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Offenders frequently have substantial healthcare needs and, like many other socially marginalised groups, often receive healthcare in inverse proportion to their needs. Improved continuity of healthcare over time could contribute to addressing these needs. General Practitioners need to be able to support people with complex social and medical problems, even in systems that are not specifically designed to manage individuals with such degrees of complexity. We aimed to examine offenders' perspectives on factors that contributed to, or worked against, creating and sustaining their access to healthcare. METHODS From a sample of 200 participants serving community or prison sentences in South West (SW) and South East (SE) England, who were interviewed about their health care experiences as part of the Care for Offenders: Continuity of Access (COCOA) study, we purposively sampled 22 participants for this sub-study, based on service use. These interviews were transcribed verbatim. A thematic analytic approach initially applied 5 a priori codes based on access and different components of continuity. Data were then examined for factors that contributed to achieving and disrupting access and continuity. RESULTS Participants described how their own life situations and behaviours contributed to their problems in accessing healthcare and also identified barriers created by existing access arrangements. They also highlighted how some General Practitioners used their initiative and skills to 'workaround' the system, and build positive relationships with them; feeling listened to and building trust were particularly valued, as was clear communication. Limitations faced by General Practitioners included a lack of appropriate services to refer people to, where the offender patients would meet the access criteria, and disagreements regarding medication prescriptions. CONCLUSIONS General Practitioners can make a positive contribution to supporting access to healthcare for an under-served population by facilitating more flexible and less formal access arrangements, by using their relationship skills, and by problem-solving. General Practitioners should recognise their potential to transform people's experience of healthcare whilst working in imperfect systems, particularly with vulnerable and marginalised groups who have complex medical and social needs.
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Affiliation(s)
- Cath Quinn
- Plymouth University, Drake Circus, Plymouth, Devon PL4 8AA UK
| | - Katie Denman
- Plymouth University, Drake Circus, Plymouth, Devon PL4 8AA UK
| | | | - Christabel Owens
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Rod Sheaff
- Plymouth University, Drake Circus, Plymouth, Devon PL4 8AA UK
| | - John Campbell
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Ian Porter
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Jill Annison
- Plymouth University, Drake Circus, Plymouth, Devon PL4 8AA UK
| | - Richard Byng
- Plymouth University, Drake Circus, Plymouth, Devon PL4 8AA UK
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Examining the short-term anxiolytic and antidepressant effect of Floatation-REST. PLoS One 2018; 13:e0190292. [PMID: 29394251 PMCID: PMC5796691 DOI: 10.1371/journal.pone.0190292] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/04/2017] [Indexed: 11/19/2022] Open
Abstract
Floatation-REST (Reduced Environmental Stimulation Therapy) reduces sensory input to the nervous system through the act of floating supine in a pool of water saturated with Epsom salt. The float experience is calibrated so that sensory signals from visual, auditory, olfactory, gustatory, thermal, tactile, vestibular, gravitational and proprioceptive channels are minimized, as is most movement and speech. This open-label study aimed to examine whether Floatation-REST would attenuate symptoms of anxiety, stress, and depression in a clinical sample. Fifty participants were recruited across a spectrum of anxiety and stress-related disorders (posttraumatic stress, generalized anxiety, panic, agoraphobia, and social anxiety), most (n = 46) with comorbid unipolar depression. Measures of self-reported affect were collected immediately before and after a 1-hour float session, with the primary outcome measure being the pre- to post-float change score on the Spielberger State Anxiety Inventory. Irrespective of diagnosis, Floatation-REST substantially reduced state anxiety (estimated Cohen’s d > 2). Moreover, participants reported significant reductions in stress, muscle tension, pain, depression and negative affect, accompanied by a significant improvement in mood characterized by increases in serenity, relaxation, happiness and overall well-being (p < .0001 for all variables). In reference to a group of 30 non-anxious participants, the effects were found to be more robust in the anxious sample and approaching non-anxious levels during the post-float period. Further analysis revealed that the most severely anxious participants reported the largest effects. Overall, the procedure was well-tolerated, with no major safety concerns stemming from this single session. The findings from this initial study need to be replicated in larger controlled trials, but suggest that Floatation-REST may be a promising technique for transiently reducing the suffering in those with anxiety and depression. Trial registration: ClinicalTrials.gov NCT03051074
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Meyer TD, Casarez R, Mohite SS, La Rosa N, Iyengar MS. Novel technology as platform for interventions for caregivers and individuals with severe mental health illnesses: A systematic review. J Affect Disord 2018; 226:169-177. [PMID: 28987999 DOI: 10.1016/j.jad.2017.09.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 09/11/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Severe mental illnesses (SMIs) have been found to be associated with both increases in morbidity-mortality, need for treatment care in patients themselves, and burden for relatives as caregivers. A growing number of web-based and mobile software applications have appeared that aim to address various barriers with respect to access to care. Our objective was to review and summarize recent advancements in such interventions for caregivers of individuals with a SMI. METHODS We conducted a systematic search for papers evaluating interactive mobile or web-based software (using no or only minimal support from a professional) specifically aimed at supporting informal caregivers. We also searched for those supporting patients with SMI so as to not to miss any which might include relatives. RESULTS Out of a total of 1673 initial hits, we identified 11 articles reporting on 9 different mobile or web-based software programs. The main result is that none of those studies focused on caregivers, and the ones we identified using mobile or web-based applications were just for patients and not their relatives. LIMITATIONS Differentiating between online and offline available software might not always have been totally reliable, and we might have therefore missed some studies. CONCLUSIONS In summary, the studies provided evidence that remotely accessible interventions for patients with SMI are feasible and acceptable to patients. No such empirically evaluated program was available for informal caregivers such as relatives. Keeping in mind the influential role of those informal caregivers in the process of treatment and self-management, this is highly relevant for public health. Supporting informal caregivers can improve well-being of both caregivers and patients.
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Affiliation(s)
- Thomas D Meyer
- McGovern Medical School, Department of Psychiatry and Behavioral Sciences, University of Texas HSC at Houston, Houston, TX, USA.
| | - Rebecca Casarez
- School of Nursing, University of Texas HSC at Houston, Houston, TX, USA
| | - Satyajit S Mohite
- McGovern Medical School, Department of Psychiatry and Behavioral Sciences, University of Texas HSC at Houston, Houston, TX, USA; School of Public Health, University of Texas HSC at Houston, Houston, TX, USA
| | - Nikki La Rosa
- McGovern Medical School, Department of Psychiatry and Behavioral Sciences, University of Texas HSC at Houston, Houston, TX, USA
| | - M Sriram Iyengar
- Biomedical Informatics Core, Clinical Science & Translational Research, Texas A & M University, Houston, TX, USA
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