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Sextl-Plötz T, Steinhoff M, Baumeister H, Cuijpers P, Ebert DD, Zarski AC. A systematic review of predictors and moderators of treatment outcomes in internet- and mobile-based interventions for depression. Internet Interv 2024; 37:100760. [PMID: 39139716 PMCID: PMC11320424 DOI: 10.1016/j.invent.2024.100760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/08/2024] [Accepted: 07/19/2024] [Indexed: 08/15/2024] Open
Abstract
This systematic review aimed to synthesize evidence on predictors and moderators of treatment outcomes in internet- and mobile-based interventions (IMIs) for depression, informing personalized care. A systematic search across PubMed, PsycInfo, and Cochrane yielded 33,002 results. Two reviewers independently performed screening, data extraction, risk of bias assessment, and methodological quality evaluation. Fifty-eight single studies (m = 466 analyses) focusing on baseline-predictors (59.7 %, m = 278), process-predictors (16.5 %, m = 77), and moderators (21.9 %, m = 102), and six individual patient data meta-analyses (m = 93) were included. Only 24.0 % (m = 112/466) of analyses in single studies and 15.1 % (m = 14/93) in individual patient data meta-analyses were significant. Evidence from single studies was rated as insufficient for all variable categories with only 2 out of 40 categories showing >50 % significant results. Baseline depression severity had the strongest predictive value with higher scores linked to better outcomes followed by variables indicative for the course-of-change. Other frequently analyzed and potentially relevant variables with significant results were adherence, age, educational level, ethnicity, relationship status, treatment history, and behavioral variables. More high quality quantitative studies with sufficient power are essential to validate and expand findings, identifying predictors and moderators specifically relevant in IMIs to explain differential treatment effects.
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Affiliation(s)
- Theresa Sextl-Plötz
- Professorship for Psychology & Digital Mental Health Care, Technical University of Munich, Germany
- Department of Clinical Psychology, Division of eHealth in Clinical Psychology, Philipps University of Marburg, Marburg, Germany
| | - Maria Steinhoff
- Department of Clinical Psychology and Psychotherapy, University of Ulm, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, University of Ulm, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Netherlands
- Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
| | - David D. Ebert
- Professorship for Psychology & Digital Mental Health Care, Technical University of Munich, Germany
| | - Anna-Carlotta Zarski
- Department of Clinical Psychology, Division of eHealth in Clinical Psychology, Philipps University of Marburg, Marburg, Germany
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Hallford DJ, Austin DW, Takano K, Yeow JJ, Rusanov D, Fuller-Tyszkiewicz M, Raes F. Improving usual care outcomes in major depression in youth by targeting memory specificity: A randomized controlled trial of adjunct computerized memory specificity training (c-MeST). J Affect Disord 2024; 358:500-512. [PMID: 38663556 DOI: 10.1016/j.jad.2024.04.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 02/11/2024] [Accepted: 04/21/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE Extending on previous findings that computerized Memory Specificity Training (c-MeST) improves memory specificity and depressive symptoms in Major Depressive Disorder (MDD) in adults, this study aimed to assess the effects of c-MeST in youth with MDD on memory specificity and depression in addition to other treatment. METHODS Participants aged 15-25 (N = 359, 76 % female; M age = 19.2, SD = 3.1), receiving predominantly psychological therapy or counseling (85 %) and/or antidepressants (52 %) were randomized to usual care and c-MeST or usual care. Cognitive and clinical outcomes were assessed at baseline and at one, three, and six-month follow-ups. RESULTS The usual care and c-MeST group reported higher memory specificity at one-month (d = 0.42, p = .022), but not at three or six months (d's < 0.15, p's > 0.05). The rate of MDE was numerically lower in the c-MeST group at each follow-up time-point, but group was not a statistically significant predictor at one month (64 % usual care and c-MeST vs. 68 % usual care, OR = 0.81, p = .606), three months (67 % usual care and c-MeST vs. 72 % usual care, OR = 0.64, p = .327) or six months (55 % usual care and c-MeST vs. 68 % usual care, OR = 0.56, p = .266). The usual care and c-MeST group did report lower depressive symptoms at one month (d = 0.42, p = .023) and six-months (d = 0.84, p = .001), but not three-months (d = 0.13, p > .05). CONCLUSIONS c-MeST may reduce symptoms in youth with MDD when provided alongside other treatments. However, there are significant limitations to this inference, including high attrition in the study and a need for more data on the acceptability of the intervention.
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Affiliation(s)
- David John Hallford
- School of Psychology, 1 Gheringhap Street, Deakin University, Geelong, Victoria 3220, Melbourne, Australia.
| | - David W Austin
- School of Psychology, 1 Gheringhap Street, Deakin University, Geelong, Victoria 3220, Melbourne, Australia
| | - Keisuke Takano
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Ludwig-Maximilians-University Munich, Leopoldstr. 13, Munich, Germany
| | - Joesph J Yeow
- School of Psychology, 1 Gheringhap Street, Deakin University, Geelong, Victoria 3220, Melbourne, Australia
| | - Danielle Rusanov
- School of Psychology, 1 Gheringhap Street, Deakin University, Geelong, Victoria 3220, Melbourne, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, 1 Gheringhap Street, Deakin University, Geelong, Victoria 3220, Melbourne, Australia
| | - Filip Raes
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, Box 3712, 3000 Leuven, Belgium
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Yi L, Chen J, Li S, Cui W, Li J, Peng L, Peng C. Efficacy and safety of Chinese patent medicines combined with antidepressants for treatment of depression in adults: A multiple-treatment meta-analysis. J Psychiatr Res 2024; 176:205-212. [PMID: 38878648 DOI: 10.1016/j.jpsychires.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 06/03/2024] [Accepted: 06/10/2024] [Indexed: 07/29/2024]
Abstract
BACKGROUND Combinations of Chinese patent medicines (CPM) with antidepressants (including selective serotonin reuptake inhibitors (SSRI), selective serotonin-norepinephrine reuptake inhibitors (SNRI), tricyclic antidepressants (TCA), and noradrenergic and specific serotonergic antidepressants (NaSSA)) are frequently utilized for treating depression in adults. However, the efficacy and safety of these combination treatments remain to be established. METHODS Systematic search was conducted in seven electronic databases, regulatory websites and international registers of trials from 1994 to 2023 that included adult patients with depressive disorders who received CPM combined with antidepressants. The Multiple-Treatment Meta-Analysis (MTMA) was conducted using a random effects model with Stata/MP17 and R4.3.5 software. Primary outcomes were total efficacy rate, Hamilton Depression Scale (HAMD) score, and Treatment Emergency Symptom Scale (TESS) score. Secondary outcomes included brain-derived neurotrophic factor (BDNF) levels. RESULTS A total of 146 randomized controlled trials (13,754 participants: 6929 in intervention and 6825 in control groups) were included. For total effective rate, Multiple-Treatment Meta-Analysis results showed that the overall effect of combined intervention was better compared with antidepressants alone, where Jieyuanshenkeli (JYASKL) presented the optimal option for improving total efficacy (OR = 5.39, 95% CI [2.60, 11.18], SUCRA = 84.50%). In reduding the HAMD, Shuganjieyujiaonang (SGJYJN) was most likely to reduce the HAMD score (SMD = -2.20, 95% CI [-3.06, -1.33], SUCRA = 86.10%), Jieyuanshenkeli (JYASKL),Tianewangbuxindan (TWBXD), Shuyukeli (SYKL), Anshenbuxinwan (ASBXW) combination intervention did not appear to be statistically superior to antidepressants alone. In theTreatment Emergency Symptom Scale (TESS), Wulinjiaonang induced the most significant reduction in TESS score (SMD = -1.98, 95% CI [-3.59, -0.36], SUCRA = 90.40%). Tianmengjiaonang (TMJN) + Antidepressants(AD) (SUCRA = 88.30%) displayed the highest scores in increasing the levels of BDNF, although not statistically significant compared to Antidepressants(AD) alone (SMD = 1.23, 95% CI [0.90, 1.55]). CONCLUSION Combinations of CPM and antidepressants showed superior efficacy over antidepressants alone. The optimal combinations were determined as Shuganjieyu Jiaonang (SGJYJN)/SSRIs and Jieyuanshenkeli (JYASKL)/SSRIs. In terms of safety, results showed that combination therapy did not show better TESS efficacy than antidepressants alone.Although some of the combination interventions were not superior than antidepressants alone in reducing HAMD scores,our findings provide a potentially significant alternative option for clinical complementary therapy. However, these results require further validation through larger sample sizes, multicenter randomized controlled trials, and real-world data.
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Affiliation(s)
- Lidan Yi
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Jing Chen
- Department of Pharmacy, The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, 410011, China
| | - Sini Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Wei Cui
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Jianhe Li
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Liubao Peng
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Ciyan Peng
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, 410011, China.
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Sackeim HA, Aaronson ST, Bunker MT, Conway CR, George MS, McAlister-Williams RH, Prudic J, Thase ME, Young AH, Rush AJ. Update on the assessment of resistance to antidepressant treatment: Rationale for the Antidepressant Treatment History Form: Short Form-2 (ATHF-SF2). J Psychiatr Res 2024; 176:325-337. [PMID: 38917723 DOI: 10.1016/j.jpsychires.2024.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/09/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024]
Abstract
All definitions of treatment-resistant depression (TRD) require that patients have experienced insufficient benefit from one or more adequate antidepressant trials. Thus, identifying "failed, adequate trials" is key to the assessment of TRD. The Antidepressant Treatment History Form (ATHF) was one of the first and most widely used instruments that provided objective criteria in making these assessments. The original ATHF was updated in 2018 to the ATHF-SF, changing to a checklist format for scoring, and including specific pharmacotherapy, brain stimulation, and psychotherapy interventions as potentially adequate antidepressant treatments. The ATHF-SF2, presented here, is based on the consensus of the ATHF workgroup about the novel interventions introduced since the last revision and which should/should not be considered effective treatments for major depressive episodes. This document describes the rationale for these choices and, for each intervention, the minimal criteria for determining the adequacy of treatment administration. The Supplementary Material that accompanies this article provide the Scoring Checklist, Data Collection Forms (current episode and composite of previous episodes), and Instruction Manual for the ATHF-SF2.
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Affiliation(s)
- Harold A Sackeim
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, USA.
| | - Scott T Aaronson
- Sheppard Pratt Health System and Department of Psychiatry, University of Maryland, Baltimore, MD, USA
| | | | - Charles R Conway
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | - Mark S George
- Departments of Psychiatry,Neurology,and Neuroscience, Medical University of South Carolina and Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - R Hamish McAlister-Williams
- Northern Centre for Mood Disorders, Translational and Clinical Research Institute, Newcastle University, UK; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Joan Prudic
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY, USA
| | - Michael E Thase
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - A John Rush
- Duke-NUS Medical School, Singapore; Duke University, Durham, NC, USA; Texas Tech University, Permian Basin, TX, USA
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Meng Y, Liu S, Yu M, Liang H, Tong Y, Song J, Shi J, Cai W, Wu Q, Wen Z, Wang J, Guo F. The Changes of Blood and CSF Ion Levels in Depressed Patients: a Systematic Review and Meta-analysis. Mol Neurobiol 2024; 61:5369-5403. [PMID: 38191692 DOI: 10.1007/s12035-023-03891-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 12/19/2023] [Indexed: 01/10/2024]
Abstract
Micronutrient deficiencies and excesses are closely related to developing and treating depression. Traditional and effective antidepressants include tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and lithium. There is no consensus on the fluctuation of zinc (Zn2+), magnesium (Mg2+), calcium (Ca2+), copper (Cu2+), iron (Fe2+), and manganese (Mn2+) ion levels in depressed individuals before and after therapy. In order to determine whether there were changes in blood and cerebrospinal fluid (CSF) levels of these ions in depressed patients compared with healthy controls and depressed patients treated with TCAs, SSRIs, or lithium, we applied a systematic review and meta-analysis. Using the Stata 17.0 software, we performed a systematic review and meta-analysis of the changes in ion levels in human samples from healthy controls, depressive patients, and patients treated with TCAs, SSRIs, and lithium, respectively. By searching the PubMed, EMBASE, Google Scholar, Web of Science, China National Knowledge Infrastructure (CNKI), and WAN FANG databases, 75 published analyzable papers were chosen. In the blood, the levels of Zn2+ and Mg2+ in depressed patients had decreased while the Ca2+ and Cu2+ levels had increased compared to healthy controls, Fe2+ and Mn2+ levels have not significantly changed. After treatment with SSRIs, the levels of Zn2+ and Ca2+ in depressed patients increased while Cu2+ levels decreased. Mg2+ and Ca2+ levels were increased in depressed patients after Lithium treatment. The findings of the meta-analysis revealed that micronutrient levels were closely associated with the onset of depression and prompted more research into the underlying mechanisms as well as the pathophysiological and therapeutic implications.
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Affiliation(s)
- Yulu Meng
- Department of Pharmacy, The Fourth Affiliated Hospital of China Medical University, Shenyang, 110032, China
- Department of Pharmaceutical Toxicology, School of Pharmacy, China Medical University, Shenyang, 110122, China
| | - Shuangshuang Liu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Miao Yu
- Science Experiment Center, China Medical University, Shenyang, 110122, China
| | - Hongyue Liang
- Department of Pharmaceutical Toxicology, School of Pharmacy, China Medical University, Shenyang, 110122, China
| | - Yu Tong
- Department of Pharmaceutical Toxicology, School of Pharmacy, China Medical University, Shenyang, 110122, China
| | - Ji Song
- Department of Pharmaceutical Toxicology, School of Pharmacy, China Medical University, Shenyang, 110122, China
| | - Jian Shi
- Department of Pharmaceutical Toxicology, School of Pharmacy, China Medical University, Shenyang, 110122, China
| | - Wen Cai
- Department of Pharmaceutical Toxicology, School of Pharmacy, China Medical University, Shenyang, 110122, China
| | - Qiong Wu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Zhifeng Wen
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, China.
| | - Jialu Wang
- Department of Neurology, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, China.
| | - Feng Guo
- Department of Pharmacy, The Fourth Affiliated Hospital of China Medical University, Shenyang, 110032, China.
- Department of Pharmaceutical Toxicology, School of Pharmacy, China Medical University, Shenyang, 110122, China.
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Dou J, Zhang H, Fu X, Yang Y, Gao X. Optimal dose and type of non-pharmacological treatments to improve cognitive function in people with Alzheimer's disease: a systematic review and network meta-analysis. Aging Ment Health 2024:1-10. [PMID: 39028199 DOI: 10.1080/13607863.2024.2379427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/06/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVES To evaluate and rank the effectiveness of specific non-pharmacological treatments (NPTs) in improving the global cognitive function in individuals with Alzheimer's disease (AD) and to examine the dose-response relationship. METHOD We conducted a systematic search in PubMed, MEDLINE, Embase, PsycINFO, CENTRAL, WOS, and CNKI from their inception to 15 February 2023. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for outcomes using random effects models. RESULTS We included 68 studies involving 5053 participants in this meta-analysis. The treatments with the highest cumulative probabilities for improving global cognitive function were transcranial direct current stimulation (tDCS), followed by physical exercise (PE), and repetitive transcranial magnetic stimulation (rTMS). Additionally, cognitive stimulation (CS), cognitive training CT), multidisciplinary program (MD), and reminiscence treatment (RT) also significantly improve the global cognitive function of people with AD. A non-linear dose-response association was observed for tDCS, PE, rTMS, CS, and CT with global cognitive improvement. Notably, no minimal threshold was identified for the beneficial effects of PE on cognition. The estimated minimal doses for clinically relevant changes in cognition were 33 min per week for tDCS, 330 MET-min per week for PE, and 8000 pulses per week for rTMS. CONCLUSION tDCS, PE, and rTMS are the better effective NPTs for enhancing global cognitive function in individuals with AD. Properly dosing these treatments can yield significant clinical benefits. Our findings support the clinical utility of low-dose exercise in improving cognition in people with AD.
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Affiliation(s)
- Jiejie Dou
- College of Education, Lishui University, Lishui, China
| | - Haoyang Zhang
- Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Henan University, Kaifeng, China
| | - Xueying Fu
- Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Henan University, Kaifeng, China
| | - Yong Yang
- Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Henan University, Kaifeng, China
- School of Life Sciences, Institute for Brain Sciences Research, Henan University, Kaifeng, China
| | - Xianqi Gao
- Department of Medicine, Lishui University, Lishui, China
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Hendriks GJ, Janssen N, Robertson L, van Balkom AJ, van Zelst WH, Wolfe S, Oude Voshaar RC, Uphoff E. Cognitive behavioural therapy and third-wave approaches for anxiety and related disorders in older people. Cochrane Database Syst Rev 2024; 7:CD007674. [PMID: 38973756 PMCID: PMC11229394 DOI: 10.1002/14651858.cd007674.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is the most researched psychological therapy for anxiety disorders in adults, and known to be effective in this population. However, it remains unclear whether these results apply to older adults, as most studies include participants between 18 and 55 years of age. This systematic review aims to provide a comprehensive and up-to-date synthesis of the available evidence on CBT and third wave approaches for older adults with anxiety and related disorders. OBJECTIVES To assess the effects of Cognitive Behavioural Therapy (CT, BT, CBT and third-wave CBT interventions) on severity of anxiety symptoms compared with minimal management (not providing therapy) for anxiety and related disorders in older adults, aged 55 years or over. To assess the effects of CBT and related therapies on severity of anxiety symptoms compared with other psychological therapies for anxiety and related disorders in older adults, aged 55 years or over. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled studies Register (CCMDCTR), CENTRAL, Ovid MEDLINE, Ovid Embase and Ovid PsycINFO to 21 July 2022. These searches were updated on 2 February 2024. We also searched the international studies registries, including Clinicalstudies.gov and the WHO International Clinical Trials Registry Platform (ICTRP), to identify additional ongoing and unpublished studies. These sources were manually searched for studies up to 12 February 2024. SELECTION CRITERIA We included randomised controlled trials (RCTs) in older adults (≥ 55 years) with an anxiety disorder, or a related disorder, including obsessive compulsive disorder (OCD), acute stress disorder and post-traumatic stress disorder (PTSD), that compared CBT to either minimal management or an active (non-CBT) psychological therapy. Eligible studies had to have an anxiety-related outcome. DATA COLLECTION AND ANALYSIS Several authors independently screened all titles identified by the searches. All full texts were screened for eligibility according to our prespecified selection criteria. Data were extracted and the risk of bias was assessed using the Cochrane tool for RCTs. The certainty of evidence was evaluated using GRADE. Meta-analyses were performed for outcomes with quantitative data from more than one study. MAIN RESULTS We included 21 RCTs on 1234 older people allocated to either CBT or control conditions. Ten studies focused on generalised anxiety disorder; others mostly included a mix of clinical diagnoses. Nineteen studies focused on the comparison between CBT and minimal management. Key issues relating to risk of bias were lack of blinding of participants and personnel, and participants dropping out of studies, potentially due to treatment preference and allocation. CBT may result in a small-to-moderate reduction of anxiety post-treatment (SMD -0.51, 95% CI -0.66 to -0.36, low-certainty evidence). However, compared to this benefit with CBT immediately after treatment, at three to six months post-treatment, there was little to no difference between CBT and minimal management (SMD -0.29, 95% CI -0.59 to 0.01, low-certainty evidence). CBT may have little or no effect on clinical recovery/ improvement post-treatment compared to minimal management, but the evidence is very uncertain (RR 1.56, 95% CI 1.20 to 2.03, very low-certainty evidence). Results indicate that five people would need to receive treatment for one additional person to benefit (NNTB = 5). Compared to minimal management, CBT may result in a reduction of comorbid depression symptoms post-treatment (SMD -0.57, 95% CI -0.74 to -0.40, low-certainty evidence). There was no difference in dropout rates post-treatment, although the certainty of the evidence was low (RR 1.19, 95% CI 0.80 to 1.78). Two studies reported adverse events, both of which related to medication in the control groups (very low-certainty evidence, no quantitative estimate). Only two studies compared CBT to other psychological therapies, both of which only included participants with post-traumatic stress disorder. Low-certainty evidence showed no difference in anxiety severity post-treatment and at four to six months post-treatment, symptoms of depression post-treatment, and dropout rates post-treatment. Other outcomes and time points are reported in the results section of the manuscript. AUTHORS' CONCLUSIONS CBT may be more effective than minimal management in reducing anxiety and symptoms of worry and depression post-treatment in older adults with anxiety disorders. The evidence is less certain longer-term and for other outcomes including clinical recovery/improvement. There is not enough evidence to determine whether CBT is more effective than alternative psychological therapies for anxiety in older adults.
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Affiliation(s)
- Gert-Jan Hendriks
- "Overwaal" Centre of Expertise for Anxiety Disorders, OCD and PTSD, Institute for Integrated Mental Health Care "Pro Persona, Nijmegen, Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Noortje Janssen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | | | - Anton J van Balkom
- Department of Psychiatry, Amsterdam University Medical Centre Vrije Universiteit, Amsterdam Public Health Institute and GGZ inGeest, Amsterdam, Netherlands
| | - Willeke H van Zelst
- Department of Psychiatry, University Medical Centre Groningen, Groningen, Netherlands
| | - Samantha Wolfe
- Tees, Esk and Wear Valleys NHS Foundation Trust, Durham, UK
| | | | - Eleonora Uphoff
- Centre for Reviews and Dissemination, University of York, York, UK
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Frederick J, Ng MY, Valente MJ, Venturo-Conerly K, Weisz JR. What CBT Modules Work Best for Whom? Identifying Subgroups of Depressed Youths by Their Differential Response to Specific Modules. Behav Ther 2024; 55:898-911. [PMID: 38937058 PMCID: PMC11211639 DOI: 10.1016/j.beth.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 12/30/2023] [Accepted: 01/11/2024] [Indexed: 06/29/2024]
Abstract
Prior research suggests that the effects of specific cognitive-behavioral therapy (CBT) modules on symptom outcomes can be estimated. We conducted a study utilizing idiographic and nomothetic methods to clarify which CBT modules are most effective for youth depression, and for whom they are most effective. Thirty-five youths received modular CBT for depression. Interrupted time series models estimated whether the introduction of each module was associated with changes in internalizing symptoms, whereby significant symptom reduction would suggest a therapeutic response to the module. Regression models were used to explore whether participant characteristics predicted subgroups of youths based on their estimated response to certain types (e.g., cognitive) of modules, and whether group membership was associated with posttreatment outcomes. Thirty youths (86%) had at least one module associated with a significant change in internalizing symptoms from premodule delivery to postmodule delivery. The specific modules associated with these changes varied across youths. Behavioral activation was most frequently associated with symptom decreases (34% of youths). No participant characteristics predicted estimated response to module type, and group membership was not significantly associated with posttreatment outcomes. Youths display highly heterogeneous responses to treatment modules, indicating multiple pathways to symptom improvement for depressed youths.
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Qin N, Luo Y, Wang S, Li Y, Li J, Luo J, Zhou J, Zhang Q, Xie J, Cheng ASK. Effectiveness of a modified behavioural activation treatment training program for primary medical staff to manage depressive symptoms among rural elderly in Hunan Province, China: study protocol for a cluster randomised controlled trial. BMJ Open 2024; 14:e086489. [PMID: 38925704 PMCID: PMC11202641 DOI: 10.1136/bmjopen-2024-086489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Depression is a major global health problem, with high prevalence rates of depressive symptoms observed among the elderly population in China, particularly exacerbating in rural areas. Due to a lack of professional mental health training and inadequate psychotherapy capacity within primary medical staff, rural elderly individuals grappling with depressive symptoms often encounter challenges in receiving timely diagnosis and treatment. In this landscape, the modified behavioural activation treatment (MBAT) emerges as a promising approach due to its practicality, ease of therapist training and application, patient acceptability, and broad applicability. However, existing evidence for MBAT mainly hails from developed countries, leaving a gap in its adaptation and implementation within rural China. This study aims to develop an MBAT training programme for primary medical staff to manage depressive symptoms among rural elderly and evaluate its effectiveness. METHODS AND ANALYSIS A cluster randomised controlled trial will be conducted in 10 randomly selected township hospitals in Lengshuijiang and Lianyuan, Hunan Province. We aim to recruit 150 participants, with 5 township hospitals selected for each group, each consisting of 15 participants. The intervention group will implement the MBAT training programme, while the control group will receive usual care training programme. Depressive symptoms, psychosocial functioning, quality of life and satisfaction will be measured at baseline, immediately post-intervention, and at 3 and 6 months post-intervention. Effectiveness will be assessed using linear or generalised linear mixed models. ETHICS AND DISSEMINATION This study has obtained approval from the Institutional Review Board of the Third Xiangya Hospital, Centre South University (No.: 2022-S261). Results will be disseminated through publication in international peer-reviewed journals and presentations at national and international conferences. TRIAL REGISTRATION NUMBER ChiCTR2300074544.
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Affiliation(s)
- Ning Qin
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Yating Luo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Sha Wang
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuxuan Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jing Li
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Juan Luo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jian Zhou
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, Hunan, China
| | - Qiuxiang Zhang
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jianfei Xie
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Andy S K Cheng
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
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10
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Huang X, Chen Y, Luo J, Wang D, Yang C, Luo W, Zhou Y. The effect of behavioral activation play therapy in adolescents with depression: A study protocol for a randomized controlled trial. PLoS One 2024; 19:e0304084. [PMID: 38900751 PMCID: PMC11189190 DOI: 10.1371/journal.pone.0304084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/30/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Depression is a common psychological problem in adolescents worldwide. Although the World Health Organization recommends that members of this population engage in physical activity to reduce depressive symptoms, compliance with this recommendation is often low. Furthermore, although behavioral activation (BA) is recommended as a treatment for adolescents with depression, the reported effect size is small. Compared with traditional exercises, gamified physical activity (GPA) can be particularly appealing to adolescents because it is perceived as an enjoyable experience. In this study, we integrated BA and GPA to create behavioral activation play therapy (BAPT). We designed a clinical trial to investigate the feasibility, acceptability, and effectiveness of this treatment in adolescents with depression. METHODS This study is a randomized controlled trial (RCT) with a three-arm, assessor-blinded design, conducted to validate the effectiveness and applicability of BAPT for treating adolescent with depression. We will recruit 258 participants and randomly assign them to a BAPT group, BA group, or GPA group using a ratio of 1:1:1. Based on conventional strategies for treatment and care, the three groups will receive nine BAPT sessions, nine BA sessions, or nine GPA sessions, respectively. We will compare the outcomes of the BAPT with those of the BA and GPA interventions. DISCUSSION This is the first RCT to explore the effectiveness and applicability of BAPT in adolescents with depression. This study will provide evidence that may help to decrease depressive symptoms in adolescents, and will demonstrate the treatment effectiveness in terms of increasing levels of physical activity, reducing the rate of non-suicidal self-injury behaviors, and improving sleep quality. We will also assess the presence of side effects and the treatment adherence of patients receiving BAPT. TRIAL REGISTRATION Trial registration: Chinese Clinical Trial Registry, ChiCTR2300072671. Registered on 20 June 2023.
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Affiliation(s)
- Xiaolong Huang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Yuqi Chen
- Southern Medical University, Guangzhou, China
| | | | - Dongdong Wang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Chanjuan Yang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Wei Luo
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Yanling Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
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11
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Cyrkler M, Czerwiak KZ, Drabik A, Soroka E. A New Pandemic of the XXIst Century: The Growing Crisis of Adolescent Depression in the Digital Age. Med Sci Monit 2024; 30:e944838. [PMID: 38900715 PMCID: PMC11305108 DOI: 10.12659/msm.944838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/17/2024] [Indexed: 06/22/2024] Open
Abstract
In a reality dominated by social media and affected by the recent COVID-19 pandemic, the mental health of people in various age groups has undoubtedly suffered, especially among young people. Statistics confirm that adolescent depression is a significant health problem and is the most common cause of disability in this age group. Research shows the multifactorial basis of this disease entity, placing particular emphasis on the genetic, environmental, and biological background. A family history of depression can increase the risk of developing depression by 4-fold. A teenager, being part of many systems, such as family, school community, and social media co-user, is exposed to many stressors. Maturing youth have a very demanding educational plan to implement, and depression causes a decline in cognitive functions, which are so important in acquiring knowledge. Among many patients, an additional risk is self-harm and suicide, which are part of the clinical picture of depressive disorders. Suicide accounts for about one-third of mortality among youth. We draw attention to the need to increase educational and psychoeducational impacts on adolescent depression, as it is a huge health problem that has an impact on all areas of a young person's life. The trend of depression among adolescents is constantly increasing. The aim of this article is to review the global causes and consequences of the growing number of cases of depression, self-harm, and suicide among children and adolescents, as well as contemporary approaches to management.
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12
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Wang C, Wang Q, Liu M, Tang S, Huang X, Huang C. Effectiveness of psychological interventions among community-dwelling older adults with subthreshold depression: A systematic review and meta-analysis. J Affect Disord 2024; 354:368-375. [PMID: 38479506 DOI: 10.1016/j.jad.2024.03.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 02/22/2024] [Accepted: 03/09/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Little is known about the effectiveness of psychological interventions among older adults with subthreshold depression in the community. This systematic review and meta-analysis aimed to examine the effectiveness of psychological interventions on depressive symptoms, anxiety symptoms and quality of life. METHODS We searched five databases from inception to 20th September 2022 and included RCTs that evaluated the effectiveness of psychological interventions among older adults with subthreshold depression in the community. Standardized mean difference (SMD) and 95 % confidence intervals (CI) were used to calculate the effect sizes of treatment outcomes in the meta-analysis, using RevMan 5.4.1 and Stata 16.0. RESULTS This meta-analysis included thirteen RCT studies involving 2079 participants. Psychological interventions could significantly reduce depressive symptoms (post-intervention time: SMD = -0.58, 95 % CI = -0.76 to -0.40; follow-up time: SMD = -0.31, 95 % CI = -0.41 to -0.22) and anxiety symptoms (post-intervention time: SMD = -0.33, 95 % CI = -0.49 to -0.17; follow-up time: SMD = -0.24, 95 % CI = -0.36 to -0.12) and improve quality of life (post-intervention time: SMD = 0.30, 95 % CI = 0.05 to 0.55; follow-up time: SMD = 0.15, 95 % CI = 0.01 to 0.28). CONCLUSION Evidence suggests that psychological interventions could significantly reduce depressive symptoms and anxiety symptoms, and improve quality of life among community-dwelling older adults with subthreshold depression.
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Affiliation(s)
- Chunyu Wang
- School of Nursing, University of California, Los Angeles, CA 90024, USA
| | - Qing Wang
- Xiangya School of Nursing, Central South University, Changsha, Hunan 410013, China
| | - Minhui Liu
- School of Nursing, Ningxia Medical University, Yinchuan, Ningxia 750101, China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan 410013, China
| | - Xiaoting Huang
- Xiangya School of Nursing, Central South University, Changsha, Hunan 410013, China.
| | - Chongmei Huang
- School of Nursing, Ningxia Medical University, Yinchuan, Ningxia 750101, China.
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13
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Wei YD, Wang Y, Curtis DS, Shin S, Wen M. Built Environment, Natural Environment, and Mental Health. GEOHEALTH 2024; 8:e2024GH001047. [PMID: 38912227 PMCID: PMC11193151 DOI: 10.1029/2024gh001047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/03/2024] [Accepted: 06/13/2024] [Indexed: 06/25/2024]
Abstract
Mental health disorders have become a global problem, garnering considerable attention. However, the root causes of deteriorating mental health remain poorly understood, with existing literature predominantly concentrating on socioeconomic conditions and psychological factors. This study uses multi-linear and geographically weighted regressions (GWR) to examine the associations between built and natural environmental attributes and the prevalence of depression in US counties. The findings reveal that job sprawl and land mixed use are highly correlated with a lower risk of depression. Additionally, the presence of green spaces, especially in urban area, is associated with improved mental health. Conversely, higher concentrations of air pollutants, such as PM2.5 and CO, along with increased precipitation, are linked to elevated depression rates. When considering spatial correlation through GWR, the impact of population density and social capital on mental health displays substantial spatial heterogeneity. Further analysis, focused on two high depression risk clustering regions (northwestern and southeastern counties), reveals nuanced determinants. In northwestern counties, depression rates are more influenced by factors like precipitation and socioeconomic conditions, including unemployment and income segregation. In southeastern counties, population demographic characteristics, particularly racial composition, are associated with high depression prevalence, followed by built environment factors. Interestingly, job growth and crime rates only emerge as significant factors in the context of high depression risks in southeastern counties. This study underscores the robust linkages and spatial variations between built and natural environments and mental health, emphasizing the need for effective depression treatment to incorporate these multifaceted factors.
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Affiliation(s)
| | - Yu Wang
- Department of GeographyUniversity of UtahSalt Lake CityUTUSA
| | - David S. Curtis
- Department of Family and Consumer StudiesUniversity of UtahSalt Lake CityUTUSA
| | - Sungeun Shin
- Department of GeographyUniversity of UtahSalt Lake CityUTUSA
| | - Ming Wen
- Faculty of Social SciencesUniversity of Hong KongHong KongChina
- Department of SociologyUniversity of UtahSalt Lake CityUTUSA
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Gellert P, Lech S, Hoppmann F, O'Sullivan JL, Kessler EM. Effectiveness of Psychotherapy for Community-Dwelling Vulnerable Older Adults with Depression and Care Needs: Findings from the PSY-CARE Trial. Clin Gerontol 2024:1-15. [PMID: 38773916 DOI: 10.1080/07317115.2024.2353702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
BACKGROUND For older adults with care needs, evidence for the effectiveness of psychotherapy on depression is scarce. METHODS In PSY-CARE, a pragmatic randomized controlled trial, N = 197 home-living older adults with depression and care needs were randomized into outpatient psychotherapy or an active control condition. Residential psychotherapists offered age-sensitive cognitive-behavioral psychotherapy (at-home if needed). Control group participants received telephone counseling and a self-help guide. Outcomes were assessed at baseline (T1), after (T2), 3 months after (T3), and 12 months after the intervention (T4). RESULTS There was a significant decrease in depressive symptoms across both arms with Cohen's d T4-T1 = .52 in the psychotherapy and .55 in the control group. Mixed models revealed no statistically significant difference in primary and secondary outcomes between interventions. Posthoc, we found control group participants with greater ADL limitations experienced significantly increased depressive symptoms compared to those reporting lower limitations. CONCLUSIONS Interventions were successful in reducing depressive symptoms, even though treatment fidelity was decreased due to the COVID-19 pandemic. We could not demonstrate superior effectiveness of psychotherapy for older adults with care needs. CLINICAL IMPLICATIONS Findings suggest that psychotherapy may be an important and superior treatment to circumvent aggravation of depression in older patients with high functional limitations. TRIAL REGISTRATION The trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN55646265, February 15, 2019).
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Affiliation(s)
- Paul Gellert
- Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Mental Health (DZPG), partner site Berlin/Potsdam, Berlin, Germany
| | - Sonia Lech
- Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felicia Hoppmann
- Department of Psychology MSB Medical School Berlin, Berlin, Germany
| | - Julie Lorraine O'Sullivan
- Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Mental Health (DZPG), partner site Berlin/Potsdam, Berlin, Germany
| | - Eva-Marie Kessler
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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15
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Luo G, Wang S, Gou L, Li C, Yao C, Jing Y, Xuekelaiti Z, Li J, Zhang XY. Sex differences and risk factors of self-reported suicide attempts in middle-aged Chinese Han patients with first-episode drug-naïve anxious depression: a large-scale cross-sectional study. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02779-x. [PMID: 38743092 DOI: 10.1007/s00702-024-02779-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 04/08/2024] [Indexed: 05/16/2024]
Abstract
This study aims to investigate sex differences and risk factors for self-reported suicide attempts among Chinese Han middle-aged patients with first-episode drug-naïve (FEDN) anxious depression (AD). A total of 1796 patients with FEDN major depressive disorder were enrolled in this study, including 341 middle-aged patients with AD. We compared the prevalence, demographics, and clinical characteristics of suicide attempts between male and female patients with FEDN middle-aged AD. We also explored the risk factors for self-reported suicide attempts in this population using binary logistic regression analysis. The male/female ratio was 91/250 and the age of onset was 51.50 ± 4.13. Our results showed that there were no significant sex differences in the prevalence of self-reported suicide attempts in middle-aged patients with FEDN AD. However, we did find significant differences in several demographic and clinical characteristics between self-reported suicide attempters and non-suicide attempters. Moreover, severe anxiety, measured by the Hamilton Anxiety Rating Scale score, was identified as a risk factor for self-reported suicide attempts in female middle-aged AD patients. Additionally, elevated thyroid peroxidase antibody (TPOAb) levels were linked to self-reported suicide attempts in male AD patients. Our findings suggest that there are no significant sex differences in the prevalence of self-reported suicide attempts in this population, but there may be sex-specific risk factors for self-reported suicide attempts in middle-aged AD. Clinical psychiatrists need to pay attention to thyroid hormone levels in middle-aged anxious depression.
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Affiliation(s)
- Guoshuai Luo
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, 300222, China
| | - Shuo Wang
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, 300222, China
| | - Lei Gou
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, 300222, China
| | - Cui Li
- Department of Civil Engineering, Nanjing Technical Vocational College, 58 Huangshan Rd, Nanjing, 210019, China
| | - Cong Yao
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, 300222, China
| | - Yifan Jing
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, 300222, China
| | - Zaimina Xuekelaiti
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, 300222, China
| | - Jie Li
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, 300222, China.
| | - Xiang-Yang Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Beijing, 100101, China.
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16
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Moreno X, Moreno F. Attitudes towards seeking psychological help among community dwelling older adults enrolled in primary care in Chile. BMC Geriatr 2024; 24:386. [PMID: 38693485 PMCID: PMC11064339 DOI: 10.1186/s12877-024-04986-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Depression and anxiety are common mental disorders among older adults, but they are frequently underdiagnosed. Attitudes towards seeking professional mental health care is one of the barriers to access to treatment. This study was aimed at assessing the attitudes towards seeking psychological help among older adults who are enrolled in primary care in Chile, and to determine the associated factors. METHODS This cross-sectional study recruited 233 primary care users aged 65 or more years. The Attitudes Towards Seeking Professional Psychological Help was used. Reliability and factor analysis of this scale were carried out. The average scores of the scale and factors were calculated and compared, by selected variables. Multivariate linear regression was estimated to determine factors associated with attitudes towards seeking psychological help. RESULTS Three factors were identified in the attitudes towards seeking psychological help: confidence in psychologists, coping alone with emotional problems, and predisposition to seek psychological help. On average, participants had a favorable attitude towards seeking psychological help, compared with previous research. Lower level of education, and risk of social isolation were inversely associated with these attitudes. CONCLUSION Strategies to improve mental health literacy and social connection among older adults, could have an impact on factors that mediate the access to mental health care, such as attitudes towards seeking psychological help, among people who have a lower level of education or are at risk of social isolation.
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Affiliation(s)
- Ximena Moreno
- Facultad de Psicología y Humanidades, Universidad San Sebastián, Lota 2465 Providencia, Santiago, Chile.
| | - Francisco Moreno
- Department of Mathematics and Computer Science, University of Santiago, Las Sophoras 175, Oficina 420, Estación Central, Santiago, Chile
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17
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Nissen ER, Neumann H, Knutzen SM, Henriksen EN, Amidi A, Johansen C, von Heymann A, Christiansen P, Zachariae R. Interventions for insomnia in cancer patients and survivors-a comprehensive systematic review and meta-analysis. JNCI Cancer Spectr 2024; 8:pkae041. [PMID: 38781520 PMCID: PMC11188797 DOI: 10.1093/jncics/pkae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/19/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Considering the persistent nature and higher prevalence of insomnia in cancer patients and survivors compared with the general population, there is a need for effective management strategies. This systematic review and meta-analysis aimed to comprehensively evaluate the available evidence for the efficacy of pharmacological and nonpharmacological interventions for insomnia in adult cancer patients and survivors. METHODS Following the PRISMA guidelines, we analyzed data from 61 randomized controlled trials involving 6528 participants. Interventions included pharmacological, physical, and psychological treatments, with a focus on insomnia severity and secondary sleep and non-sleep outcomes. Frequentist and Bayesian analytical strategies were employed for data synthesis and interpretation. RESULTS Cognitive-Behavioral Therapy for Insomnia (CBT-I) emerged as the most efficacious intervention for reducing insomnia severity in cancer survivors and further demonstrated significant improvements in fatigue, depressive symptoms, and anxiety. CBT-I showed a large postintervention effect (g = 0.86; 95% confidence interval [CI] = 0.57 to 1.15) and a medium effect at follow-up (g = 0.55; 95% CI = 0.18 to 0.92). Other interventions such as bright white light therapy, sleep medication, melatonin, exercise, mind-body therapies, and mindfulness-based therapies showed benefits, but the evidence for their efficacy was less convincing compared with CBT-I. Brief Behavioral Therapy for Insomnia showed promise as a less burdensome alternative for patients in active cancer treatment. CONCLUSIONS CBT-I is supported as a first-line treatment for insomnia in cancer survivors, with significant benefits observed across sleep and non-sleep outcomes. The findings also highlight the potential of less intensive alternatives. The research contributes valuable insights for clinical practice and underscores the need for further exploration into the complexities of sleep disturbances in cancer patients and survivors.
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Affiliation(s)
- Eva Rames Nissen
- Unit for Psychooncology and Health Psychology, Department of Oncology Aarhus University Hospital, and Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Henrike Neumann
- Unit for Psychooncology and Health Psychology, Department of Oncology Aarhus University Hospital, and Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Sofie Møgelberg Knutzen
- Unit for Psychooncology and Health Psychology, Department of Oncology Aarhus University Hospital, and Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Emilie Nørholm Henriksen
- Centre for Involvement of Relatives, Mental Health Services, Region of Southern Denmark, Odense, Denmark
| | - Ali Amidi
- Unit for Psychooncology and Health Psychology, Department of Oncology Aarhus University Hospital, and Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Christoffer Johansen
- Cancer Survivorship and Treatment Late Effects (CASTLE) – a Danish Cancer Society National Research Center, Department of Oncology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Annika von Heymann
- Cancer Survivorship and Treatment Late Effects (CASTLE) – a Danish Cancer Society National Research Center, Department of Oncology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Peer Christiansen
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
- Danish Breast Cancer Group Center and Clinic for Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark
| | - Robert Zachariae
- Unit for Psychooncology and Health Psychology, Department of Oncology Aarhus University Hospital, and Department of Psychology, Aarhus University, Aarhus, Denmark
- Danish Breast Cancer Group Center and Clinic for Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark
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Guo J, Zhang T, Chen W, Tan J, Li X, Zheng A, Fu Y, Qiu T. The relationship between serum resolvin D1, NLRP3, cytokine levels, and adolescents with first-episode medication-naïve major depressive disorder. BMC Psychiatry 2024; 24:285. [PMID: 38627683 PMCID: PMC11020182 DOI: 10.1186/s12888-024-05724-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/27/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Inflammation has become a critical pathological mechanism of Major Depressive Disorder (MDD). NLRP3 is a critical inflammatory pathway to maintain the immune balance. Recently, preclinical evidence showed that Resolvin D1 might potentially offer a new option for antidepressant treatment due to its protective effects through the inhibition of neuroinflammation. However, whether they have clinical value in the diagnosis and treatment evaluation of adolescent depression was unclear. METHODS Forty-eight untreated first-episode adolescent patients with moderate to severe major depressive disorder, as well as 30 healthy adolescents (HCs, age and gender-matched), were enrolled for this study. Their ages ranged from 13 to 18 (15.75 ± 1.36) years. The patients were treated with fluoxetine for 6-8 weeks. HDRS-17 was used to evaluate the severity of depressive symptoms. Venous blood samples were collected at baseline for the two groups and at the time-point of post-antidepressant treatment for the patients. Serum concentrations of RvD1, NLRP3, IL-1β, IL-18, and IL-4 were measured by enzyme-linked immunosorbent assays (ELISA) pre- and post-fluoxetine treatment. RESULTS Serum levels of RvD1 and anti-inflammatory cytokine IL-4 were significantly elevated in adolescents with MDD compared to healthy adolescents, but no significant difference in NLRP3, IL-1β, and IL-18 between the two groups. Meanwhile, RvD1 (positively) and IL-4 (negatively) were correlated with the severity of symptoms (HDRS-17 scores) after adjusting age, gender, and BMI. Interestingly, fluoxetine treatment significantly reduced the serum levels of RvD1, NLRP3, IL-1β, and IL-18 in MDD adolescents but increased the levels of IL-4 relative to baseline. Furthermore, we observed that serum levels of RvD1 might be an excellent distinguishing indicator for depression and healthy adolescents. CONCLUSIONS Our study is the first to compare RvD1 and NLRP3 between adolescent MDD and HCs. Our findings of reactive increase of RvD1 in adolescent MDD comprised a novel and critical contribution. Our results showed the presence of inflammation resolution unbalanced in adolescents with MDD and indicated that RvD1 might be an ideal biomarker for diagnosing and treating adolescent MDD.
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Affiliation(s)
- Jiamei Guo
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, P.R. China
| | - Tanwei Zhang
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, P.R. China
| | - Wanjun Chen
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, P.R. China
| | - Jianyu Tan
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, P.R. China
| | - Xiao Li
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, P.R. China
| | - Anhai Zheng
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, P.R. China
| | - Yixiao Fu
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, P.R. China
| | - Tian Qiu
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, P.R. China.
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Hejase R, Saleh AM, Abdel-Aziz HR, Vellaiyan A, Al Omari AK, Al Omari AA. Analyzing Depressive Symptoms Among Elderly Cancer Patients: A Comprehensive Examination of Demographic and Medical Correlates. Asian Pac J Cancer Prev 2024; 25:1271-1276. [PMID: 38679987 PMCID: PMC11162703 DOI: 10.31557/apjcp.2024.25.4.1271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/20/2024] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVE This study aimed to explore the relationship between depressive symptoms and demographic as well as health-related variables in elderly individuals diagnosed with cancer. METHODS A cohort of 50 elderly cancer patients participated in the study. Data collection involved the completion of surveys and assessments encompassing demographic characteristics, medical profiles, levels of depression, cognitive functioning, activities of daily living, and perceived social support. RESULTS Findings revealed that among the elderly participants, 45% experienced mild depression, 20% exhibited moderate depression, and 5% showed severe depression. Depression levels were found to be linked to marital status (P = 0.03), with widowed individuals reporting the highest depression rates (80%) and single individuals reporting the lowest (4%). Living arrangements were significantly associated with depression (P = 0.012), with participants cohabiting with their partner and children showing lower depression rates (6%) compared to those living solely with their children (40%). Additionally, depression showed a significant correlation with income (P = 0.01), as individuals reporting insufficient income for living expenses displayed higher levels of depression (58%). Furthermore, depression was notably linked to chronic health conditions like diabetes and respiratory ailments (P = .023), with individuals grappling with respiratory issues reporting the highest depression scores. CONCLUSION Recognizing and addressing factors such as marital status, living situation, income level, and the presence of chronic illnesses hold the potential for healthcare professionals to tailor interventions effectively to meet the specific requirements of this vulnerable demographic. This tailored approach has the capability to contribute significantly to enhancing the overall well-being and mental health outcomes of elderly cancer patients.
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Affiliation(s)
- Rami Hejase
- Faculty of Sciences, Al Maaref University, Beirut, Lebanon.
| | - Ahmad Mahmoud Saleh
- Department of Nursing, College of Applied Medical Sciences, to be Nursing College, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia.
| | - Hassanat R. Abdel-Aziz
- Department of Nursing, College of Applied Medical Sciences, to be Nursing College, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia.
| | - Arul Vellaiyan
- Department of Nursing, College of Applied Medical Sciences, to be Nursing College, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia.
| | - Ahmad Khaleel Al Omari
- Department of Biomedical Technology, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Riyadh, Saudi Arabia.
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20
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Selinheimo S, Gluschkoff K, Kausto J, Turunen J, Koskinen A, Väänänen A. The association of sociodemographic characteristics with work disability trajectories during and following long-term psychotherapy: a longitudinal register study. Soc Psychiatry Psychiatr Epidemiol 2024; 59:621-630. [PMID: 37432409 PMCID: PMC10960900 DOI: 10.1007/s00127-023-02523-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/30/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE This register-based study examined the trajectories of depression or anxiety disorder-related work disability during and following long-term psychotherapy and identified sociodemographic factors that indicate membership in different trajectory groups. METHODS Data were drawn from national registers (Statistics Finland, Social Insurance Institution of Finland). Participants included a random sample of Finnish working-age individuals (18-55 years) who started psychotherapy treatment between 2011 and 2014 and were followed for 5 years: 1 year before and 4 years after the onset of psychotherapy (N = 3 605 individuals; 18 025 person-observations across five time points). Group-based trajectory modeling was applied to assign individuals to work disability trajectories by the number of annual mental health-related work disability months. Multinomial logistic regression was used to examine the associations between trajectory group membership and baseline sociodemographic factors of age, gender, occupational status, and geographical area of residence. RESULTS Four mental health-related work disability trajectories were identified: stable very low (72%), decrease (11%), persistent low (9%) and persistent high (7%). Those with older age, female gender, lower occupational status, and living in sparsely populated geographical areas were more likely to belong to the most unfavorable trajectory group of persistent high work disability. The presence of multiple risk characteristics substantially increased the probability of belonging to the most adverse trajectory group. CONCLUSIONS Sociodemographic factors were associated with the course of mental health-related work disability in association with psychotherapy. Rehabilitative psychotherapy does not function as an equal support resource for work ability in all parts of the population.
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Affiliation(s)
- Sanna Selinheimo
- Finnish Institute of Occupational Health, Työterveyslaitos, PO Box 18, 00032, Helsinki, Finland.
| | - Kia Gluschkoff
- Finnish Institute of Occupational Health, Työterveyslaitos, PO Box 18, 00032, Helsinki, Finland
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Johanna Kausto
- Finnish Institute of Occupational Health, Työterveyslaitos, PO Box 18, 00032, Helsinki, Finland
| | - Jarno Turunen
- Finnish Institute of Occupational Health, Työterveyslaitos, PO Box 18, 00032, Helsinki, Finland
| | - Aki Koskinen
- Finnish Institute of Occupational Health, Työterveyslaitos, PO Box 18, 00032, Helsinki, Finland
| | - Ari Väänänen
- Finnish Institute of Occupational Health, Työterveyslaitos, PO Box 18, 00032, Helsinki, Finland
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21
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Janssen NP, Hendriks GJ, Sens R, Lucassen P, Oude Voshaar RC, Ekers D, van Marwijk H, Spijker J, Bosmans JE. Cost-effectiveness of behavioral activation compared to treatment as usual for depressed older adults in primary care: A cluster randomized controlled trial. J Affect Disord 2024; 350:665-672. [PMID: 38244792 DOI: 10.1016/j.jad.2024.01.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 12/23/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024]
Abstract
INTRODUCTION Depression in older adults is associated with decreased quality of life and increased utilization of healthcare services. Behavioral activation (BA) is an effective treatment for late-life depression, but the cost-effectiveness compared to treatment as usual (TAU) is unknown. METHODS An economic evaluation was performed alongside a cluster randomized controlled multicenter trial including 161 older adults (≥65 years) with moderate to severe depressive symptoms (PHQ-9 ≥ 10). Outcome measures were depression (response on the QIDS-SR), quality-adjusted life-years (QALYs) and societal costs. Missing data were imputed using multiple imputation. Cost and effect differences were estimated using bivariate linear regression models, and statistical uncertainty was estimated with bootstrapping. Cost-effectiveness acceptability curves showed the probability of cost-effectiveness at different ceiling ratios. RESULTS Societal costs were statistically non-significantly lower in BA compared to TAU (mean difference (MD) -€485, 95 % CI -3861 to 2792). There were no significant differences in response on the QIDS-SR (MD 0.085, 95 % CI -0.015 to 0.19), and QALYs (MD 0.026, 95 % CI -0.0037 to 0.055). On average, BA was dominant over TAU (i.e., more effective and less expensive), although the probability of dominance was only 0.60 from the societal perspective and 0.85 from the health care perspective for both QIDS-SR response and QALYs. DISCUSSION Although the results suggest that BA is dominant over TAU, there was considerable uncertainty surrounding the cost-effectiveness estimates which precludes firm conclusions.
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Affiliation(s)
- Noortje P Janssen
- Behavioural Science Institute, Radboud University, 6525 XZ Nijmegen, the Netherlands; Department of Primary and Community Care, Research Institute of Health Sciences, Radboud University Medical Centre Nijmegen, 6525 EZ Nijmegen, the Netherlands; Institute for Integrated Mental Health Care Pro Persona, 6525 DX Nijmegen, the Netherlands.
| | - Gert-Jan Hendriks
- Behavioural Science Institute, Radboud University, 6525 XZ Nijmegen, the Netherlands; Institute for Integrated Mental Health Care Pro Persona, 6525 DX Nijmegen, the Netherlands
| | - Renate Sens
- Department of Health Sciences, VU University, 1081 HV Amsterdam, the Netherlands
| | - Peter Lucassen
- Department of Primary and Community Care, Research Institute of Health Sciences, Radboud University Medical Centre Nijmegen, 6525 EZ Nijmegen, the Netherlands
| | - Richard C Oude Voshaar
- University of Groningen, Department of Psychiatry, University Medical Centre Groningen, 9713 GZ Groningen, the Netherlands
| | - David Ekers
- Mental Health and Addictions Research Group, Tees Esk and Wear Valleys NHS FT/University of York, TS60SZ York, UK
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, BN1 9PH Brighton, United Kingdom
| | - Jan Spijker
- Behavioural Science Institute, Radboud University, 6525 XZ Nijmegen, the Netherlands; Institute for Integrated Mental Health Care Pro Persona, 6525 DX Nijmegen, the Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, VU University, 1081 HV Amsterdam, the Netherlands
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22
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Isometsä E. Schema therapy for older adults? THE LANCET. HEALTHY LONGEVITY 2024; 5:e237-e238. [PMID: 38555917 DOI: 10.1016/s2666-7568(24)00027-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 04/02/2024] Open
Affiliation(s)
- Erkki Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki FI-00014, Finland.
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23
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Wang N, Kong JQ, Bai N, Zhang HY, Yin M. Psychological interventions for depression in children and adolescents: A bibliometric analysis. World J Psychiatry 2024; 14:467-483. [PMID: 38617982 PMCID: PMC11008384 DOI: 10.5498/wjp.v14.i3.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/20/2023] [Accepted: 02/02/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Depression has gradually become a common psychological disorder among children and adolescents. Depression in children and adolescents affects their physical and mental development. Psychotherapy is considered to be one of the main treatment options for depressed children and adolescents. However, our understanding of the global performance and progress of psychological interventions for depression in children and adolescents (PIDCA) research is limited. AIM To identify collaborative research networks in this field and explore the current research status and hotspots through bibliometrics. METHODS Articles and reviews related to PIDCA from January 2010 to April 2023 were identified from the Web of Science Core Collection database. The Charticulator website, CiteSpace and VOSviewer software were used to visualize the trends in publications and citations, the collaborative research networks (countries, institutions, and authors), and the current research status and hotspots. RESULTS Until April 16, 2023, 1482 publications were identified. The number of documents published each year and citations had increased rapidly in this field. The United States had the highest productivity in this field. The most prolific institution was the University of London. Pim Cuijpers was the most prolific author. In the context of research related to PIDCA, both reference co-citation analysis and keywords co-occurrence analysis identified 10 research hotspots, including third-wave cognitive behavior therapy, short-term psychoanalytic psychotherapy, cognitive behavioral analysis system of psychotherapy, family element in psychotherapy, modular treatment, mobile-health, emotion-regulation-based transdiagnostic intervention program, dementia risk in later life, predictors of the efficacy of psychological intervention, and risks of psychological intervention. CONCLUSION This bibliometric study provides a comprehensive overview of PIDCA from 2010 to present. Psychological intervention characterized as psychological-process-focused, short, family-involved, modular, internet-based, emotion-regulation-based, and personalized may benefit more young people.
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Affiliation(s)
- Nan Wang
- School of Nursing, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Jia-Qi Kong
- School of Nursing, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Nan Bai
- School of Nursing, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Hui-Yue Zhang
- School of Nursing, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Min Yin
- School of Nursing, Lanzhou University, Lanzhou 730000, Gansu Province, China
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24
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Cuijpers P, Miguel C, Ciharova M, Harrer M, Karyotaki E. Non-directive supportive therapy for depression: A meta-analytic review. J Affect Disord 2024; 349:452-461. [PMID: 38211757 DOI: 10.1016/j.jad.2024.01.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/24/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Non-directive supportive therapy (NDST) is an important treatment of adult depression, but no recent meta-analysis has integrated the randomized trials examining its effects. METHODS We conducted a meta-analysis comparing NDST to control conditions and to other therapies, by using an existing database of randomized trials of psychological treatments of depression in adults. This database was built through searches in PubMed, PsycINFO, Embase and the Cochrane Library. RESULTS 48 randomized controlled trials (5075 participants), with 20 comparisons between NDST and a control group and 49 comparisons between NDST and another psychotherapy were included. Random effects meta-analyses found an effect size of NDST compared with control conditions of g = 0.53 (95 % CI, 0.34; 0.72) with moderate heterogeneity (I2 = 51; 95 % CI: 18; 71; PI = -0.02 to 1.09). NDST was less effective than other therapies (g = -0.21; 95 % CI: -0.31; -0.11). The difference with other therapies was significantly larger in studies in which NDST was used as a control group (p = .003). There was no significant difference between NDST and other therapies in which NDST was not used as a control group (k = 14; g = -0.05; 95 % CI: -0.17; 0.07). CONCLUSIONS NDST probably is an effective treatment of depression. The effects may be somewhat smaller than those of other therapies, but that may also be an artefact, because NDST is often used as a control group and may be designed as an "intent-to-fail" intervention in some studies.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands; Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania.
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Department of Health Sciences, Technical University of Munich, Munich, Germany
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
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25
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Poetar CR, Dobrean A, Andersson G. Preliminary efficacy of a transdiagnostic parent-led internet-delivered intervention for children with anxiety and depressive symptoms: a pilot randomized controlled trial. Child Adolesc Psychiatry Ment Health 2024; 18:31. [PMID: 38448874 PMCID: PMC10918968 DOI: 10.1186/s13034-024-00721-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/21/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND There is extensive research indicating that transdiagnostic interventions are effective for adults and children with anxiety and depressive disorders; however, limited research has been conducted on the efficacy of such programs targeting parents of children with anxiety and depressive symptoms delivered via the Internet. This study aims to investigate the preliminary efficacy of a transdiagnostic Internet-delivered intervention for Romanian parents of children with elevated anxiety and depressive symptoms. METHODS We conducted a single-blinded pilot randomized controlled trial. Forty-two parents of children with anxiety and depressive symptoms (Mage = 39.79, 78.6% women) from Romania were randomly assigned to one of the two groups, to ParentKIT, an Internet-delivered intervention based on Rational Emotive and Behavioral Therapy (n = 21), or to a delayed treatment condition (waitlist group) (n = 21). ParentKIT consisted of a brief transdiagnostic intervention delivered through nine modules with therapist guidance. RESULTS A significant Group by Time effect was found for child emotional problems as reported by parents (Cohen's d = - 0.85) and for parental self-efficacy (Cohen's d = 0.71). CONCLUSION A transdiagnostic Internet-delivered intervention addressed to parents of children with elevated anxiety and depressive symptoms is a promising approach. Future research should include blind assessments as well as multiple outcome assessors and investigate the long-term efficacy of the intervention. TRIAL REGISTRATION NCT05341297.
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Affiliation(s)
- Costina-Ruxandra Poetar
- Department of Clinical Psychology and Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania.
- The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania.
| | - Anca Dobrean
- Department of Clinical Psychology and Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
- The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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26
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Wang X, Cao X, Yu J, Jin S, Li S, Chen L, Liu Z, Ge X, Lu Y. Associations of perceived stress with loneliness and depressive symptoms: the mediating role of sleep quality. BMC Psychiatry 2024; 24:172. [PMID: 38429635 PMCID: PMC10905934 DOI: 10.1186/s12888-024-05609-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/14/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Whether perceived stress is associated with loneliness and depressive symptoms in general adults, and to what extent sleep quality mediates the associations, remains unknown. The aim of this study was to estimate the associations of perceived stress with loneliness and depressive symptoms, and the mediating role of sleep quality in these associations. METHODS Cross-sectional data on 734 participants (aged 18-87 years) were analyzed. Perceived stress was assessed using the 10-item Perceived Stress Scale (PSS-10; range 0-40). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI; range 0-21). Loneliness was assessed using the three-item short form of the Revised University of California, Los Angeles (UCLA) loneliness scale (range 3-9). Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression (CESD-10) Scale (range 0-30). General linear regression models, multivariable logistic regression models, and formal mediation analysis were performed. RESULTS After adjustment for age and sex, we found that with each 1-point increment in the perceived stress score, both the loneliness score (β = 0.07; 95% confidence interval [CI]: 0.06, 0.08) and depression score (β = 0.45; 95% CI: 0.40, 0.49) increased significantly. Robust results were observed when adjusting for more confounders. Furthermore, sleep quality mediated 5.3% (95% CI: 1.3%, 10.0%; P = 0.014) and 9.7% (95% CI: 6.2%, 14.0%; P < 0.001) of the associations of perceived stress score with loneliness score and depression score, respectively. CONCLUSIONS In general Chinese adults, perceived stress was positively associated with loneliness and depressive symptoms, and sleep quality partially mediated these associations. The findings reveal a potential pathway from perceived stress to mental health through sleep behaviors, and highlight the importance of implementing sleep intervention programs for promoting mental health among those who feel highly stressed.
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Affiliation(s)
- Xiao Wang
- Department of General Practice, Dongyang People's Hospital, 322100, Jinhua, Zhejiang, China
| | - Xingqi Cao
- Center for Clinical Big Data and Analytics Second Affiliated Hospital, Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, 310058, Hangzhou, Zhejiang, China
| | - Jiening Yu
- Center for Clinical Big Data and Analytics Second Affiliated Hospital, Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, 310058, Hangzhou, Zhejiang, China
| | - Shuyi Jin
- Center for Clinical Big Data and Analytics Second Affiliated Hospital, Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, 310058, Hangzhou, Zhejiang, China
| | - Shengyi Li
- School of Mathematical Sciences, University of Nottingham, University Park, NG7 2RD, Nottingham, UK
| | - Liying Chen
- Department of General Practice, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 310016, Hangzhou, Zhejiang, China
| | - Zuyun Liu
- Center for Clinical Big Data and Analytics Second Affiliated Hospital, Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, 310058, Hangzhou, Zhejiang, China.
| | - Xuan Ge
- Health Management Center, Dongyang People's Hospital, 322100, Jinhua, Zhejiang, China.
| | - Yangzhen Lu
- Department of General Practice, Dongyang People's Hospital, 322100, Jinhua, Zhejiang, China.
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27
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Vollbehr NK, Stant AD, Hoenders HJR, Bartels-Velthuis AA, Nauta MH, Castelein S, Schroevers MJ, de Jong PJ, Ostafin BD. Cost-effectiveness of a mindful yoga intervention added to treatment as usual for young women with major depressive disorder versus treatment as usual only: Cost-effectiveness of yoga for young women with depression. Psychiatry Res 2024; 333:115692. [PMID: 38309011 DOI: 10.1016/j.psychres.2023.115692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 02/05/2024]
Abstract
In a randomized controlled trial in the Netherlands, we studied the (cost)effectiveness of adding a mindful yoga intervention (MYI+TAU) to treatment as usual (TAU) for young women with major depressive disorder (MDD). In this paper, we present the results of the economic analyses. Societal costs and health outcomes were prospectively assessed during 15 months for all randomized participants (n = 171). Symptoms of depression (Depression Anxiety and Stress Scales; DASS) and quality adjusted life years (QALYs) were used as health outcomes in the economic analyses. Mean total societal costs during the 15 months of the study were €11.966 for the MYI+TAU group and €13.818 for the TAU group, differences in mean total societal costs were not statistically significant. Health outcomes (DASS and QALY) were slightly in favour of MYI+TAU, but differences between groups were not statistically significant. Combining costs and health outcomes in cost-effectiveness analyses indicated that MYI+TAU is likely to be cost-effective compared to TAU which was confirmed by sensitivity analyses. Although there were limitations in the cost-effectiveness analysis, findings from this study suggest that MYI+TAU warrants future attention for the potential to be cost-effective compared to TAU for young women with MDD.
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Affiliation(s)
- Nina K Vollbehr
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Hereweg 80, 9725 AG, Groningen, the Netherlands; University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands.
| | | | - H J Rogier Hoenders
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Hereweg 80, 9725 AG, Groningen, the Netherlands; University of Groningen, Faculty of Religion, Culture and Society, Groningen, the Netherlands
| | - Agna A Bartels-Velthuis
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research center, Groningen, the Netherlands
| | - Maaike H Nauta
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
| | - Stynke Castelein
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Hereweg 80, 9725 AG, Groningen, the Netherlands; University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands; Lentis Psychiatric Institute, Lentis Research, Groningen, the Netherlands
| | - Maya J Schroevers
- University of Groningen, University Medical Center Groningen, Faculty of Medical Sciences, Groningen, the Netherlands
| | - Peter J de Jong
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
| | - Brian D Ostafin
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
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28
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Specka M, Bonnet U, Schmidberg L, Wichmann J, Keller M, Scholze C, Scherbaum N. Effectiveness of Medical Cannabis for the Treatment of Depression: A Naturalistic Outpatient Study. PHARMACOPSYCHIATRY 2024; 57:61-68. [PMID: 38211630 DOI: 10.1055/a-2215-6114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND There is a lack of studies on the course and effectiveness of medical cannabis in the treatment of major depressive disorder (MDD). METHODS Retrospective longitudinal (18 weeks) study of n=59 outpatients with MDD, treated with medical cannabis via a telemedical platform. Previous treatment with antidepressant medication was required for inclusion into the study. Standardized data collection was carried out at entry and during monthly consultations. Severity of depression was measured on a 0-10 point rating scale. Side-effects were assessed by a checklist. RESULTS Patients were 20-54 years old; 72.9% were male; one third reported times of regular cannabis consumption within the previous five years. Drop-out rate was 22% after 18 weeks. Mean severity of depression decreased from 6.9 points (SD 1.5) at entry to 3.8 points (2.7) at week 18 (baseline observation carried forward; 95% CI for the mean difference: 2.4 to 3.8; p<0.001). A treatment response (>50% reduction of the initial score) was seen in 50.8% at week 18. One third of patients complained about side effects, none was considered as severe. Concomitant antidepressant medication (31% of patients) was not associated with outcome. CONCLUSIONS Medical cannabis was well tolerated and dropout rate was comparable to those in clinical trials of antidepressant medication. Patients reported a clinically significant reduction of depression severity. Further research on the effectiveness of medical cannabis for MDD seems warranted. Risks of this medication, such as sustaining or inducing a cannabis use disorder, or side effects such as poor concentration, must be taken into consideration.
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Affiliation(s)
- Michael Specka
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Udo Bonnet
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Essen, Germany
| | | | | | - Martin Keller
- Algea Care GmbH, Frankfurt am Main, Germany
- Department of Global Development and Health, The University of Gothenburg, Gothenburg, Sweden
| | | | - Norbert Scherbaum
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Long Y, Li X, Cao H, Zhang M, Lu B, Huang Y, Liu M, Xu M, Liu Z, Yan C, Sui J, Ouyang X, Zhou X. Common and distinct functional brain network abnormalities in adolescent, early-middle adult, and late adult major depressive disorders. Psychol Med 2024; 54:582-591. [PMID: 37553976 DOI: 10.1017/s0033291723002234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
BACKGROUND The age-related heterogeneity in major depressive disorder (MDD) has received significant attention. However, the neural mechanisms underlying such heterogeneity still need further investigation. This study aimed to explore the common and distinct functional brain abnormalities across different age groups of MDD patients from a large-sample, multicenter analysis. METHODS The analyzed sample consisted of a total of 1238 individuals including 617 MDD patients (108 adolescents, 12-17 years old; 411 early-middle adults, 18-54 years old; and 98 late adults, > = 55 years old) and 621 demographically matched healthy controls (60 adolescents, 449 early-middle adults, and 112 late adults). MDD-related abnormalities in brain functional connectivity (FC) patterns were investigated in each age group separately and using the whole pooled sample, respectively. RESULTS We found shared FC reductions among the sensorimotor, visual, and auditory networks across all three age groups of MDD patients. Furthermore, adolescent patients uniquely exhibited increased sensorimotor-subcortical FC; early-middle adult patients uniquely exhibited decreased visual-subcortical FC; and late adult patients uniquely exhibited wide FC reductions within the subcortical, default-mode, cingulo-opercular, and attention networks. Analysis of covariance models using the whole pooled sample further revealed: (1) significant main effects of age group on FCs within most brain networks, suggesting that they are decreased with aging; and (2) a significant age group × MDD diagnosis interaction on FC within the default-mode network, which may be reflective of an accelerated aging-related decline in default-mode FCs. CONCLUSIONS To summarize, these findings may deepen our understanding of the age-related biological and clinical heterogeneity in MDD.
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Affiliation(s)
- Yicheng Long
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xuemei Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hengyi Cao
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Manqi Zhang
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
| | - Bing Lu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yang Huang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mengqi Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ming Xu
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Zhening Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chaogan Yan
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Jing Sui
- IDG/McGovern Institute for Brain Research, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Xuan Ouyang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xinyu Zhou
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Schneider BC, Veckenstedt R, Karamatskos E, Ahlf-Schumacher J, Gehlenborg J, Schultz J, Moritz S, Jelinek L. Efficacy and moderators of metacognitive training for depression in older adults (MCT-Silver): A randomized controlled trial. J Affect Disord 2024; 345:320-334. [PMID: 37865342 DOI: 10.1016/j.jad.2023.10.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/28/2023] [Accepted: 10/16/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Up to 79 % of older adults with depression do not receive treatments commensurate with guideline recommendations. Metacognitive Training-Silver (MCT-Silver) is a low-intensity group training, which aims to reduce depressive symptoms by targeting (meta)cognitive beliefs. METHODS A randomized controlled trial comparing MCT-Silver (n = 41) to cognitive remediation (n = 39) was conducted with older adults with major depressive disorder and/or dysthymia. Clinician-rated depression (Hamilton Depression Rating Scale [HDRS, primary outcome]), self-reported depression (Beck Depression Inventory-II [BDI-II]), negative cognitive beliefs, positive metacognitive beliefs, rumination, health status, quality of life, and neurocognitive functioning were assessed at baseline, eight weeks (post) and three months (follow-up). RESULTS Both groups demonstrated moderate to large reductions in depression. No superior effects of MCT-Silver on clinician-rated depression (HDRS) were detected. MCT-Silver led to greater reductions in self-reported depression and rumination at post- and follow-up. Despite this, scores at post- and follow-up assessments were similar for both groups. MCT-Silver's effect on depressive symptoms was moderated by baseline rumination, positive metacognitive beliefs and previous treatment experience. MCT-Silver was evaluated as superior according to patient appraisals. LIMITATIONS Conclusions are limited by divergent findings on measures of depression and that the study was conducted during the COVID-19 pandemic. CONCLUSIONS Whereas no superior effect of MCT-Silver was found for the primary outcome, there was a significant effect of MCT-Silver for self-reported depression and rumination. Patients endorsing rumination and positive metacognitive beliefs as well as those without previous psychological treatment may benefit more from MCT-Silver.
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Affiliation(s)
- Brooke C Schneider
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
| | - Ruth Veckenstedt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Evangelos Karamatskos
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Jana Ahlf-Schumacher
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Josefine Gehlenborg
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Josephine Schultz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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Yang H, Qi L, Pei D. Effect of psychosocial interventions for depression in adults with chronic kidney disease: a systematic review and meta-analysis. BMC Nephrol 2024; 25:17. [PMID: 38200465 PMCID: PMC10782786 DOI: 10.1186/s12882-023-03447-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND People with chronic kidney disease (CKD) treated with dialysis are frequently affected by depression. Psychotherapy has been reported to decrease depressive symptoms in various chronic diseases and is a potential treatment option for depression. We aimed to perform a systematic review and meta-analysis to evaluate the effect of psychotherapy on depression in adults with CKD. METHODS We searched MEDLINE, Embase, Web of Science, and Cochrane for published studies up to October 31, 2023. Two investigators independently reviewed the included studies and extracted relevant data. Randomized controlled trials (RCTs) assessing the impact of interventions that provide psychological, emotional, or social support without the use of pharmacological substances on depressive symptoms in people with CKD were included and summarized. Scores on different tools for depressive assessment and quality of life were pooled. RESULTS A total of 19 RCTs published between 2004 and 2023 were included and analyzed. The weighted mean difference (WMD) for all included studies with regard to depression was - 2.32 (95%CI=-3.83, -0.80, P = 0.003). The WMD for Beck Depression Inventory (BDI) score of depression was - 3.27 (95%CI=-7.81, 1.27, P = 0.158) with significant heterogeneity (I2 = 95.1%). Significant WMD was detected for the Hospital Anxiety and Depression Scale (HADS) tool: WMD=-1.90, 95%CI=-2.91, -0.90, P < 0.001. The WMD for all included studies regarding quality of life was 1.21 (95%CI=-0.51, 2.93, P = 0.168). The WMD for Kidney Disease Quality of Life Short Form (KDQOL-SF) score was 4.55 (95%CI = 0.50, 8.60, P = 0.028). The WMD for SF-36 score was 0.02 (95%CI=-10.33, 10.36, P = 0.998). Significant difference on outcomes of S-PRT scale was observed (WMD = 2.42, 95%CI = 1.07, 3.76, P < 0.001). CONCLUSIONS Psychosocial interventions probably reduce the depression level among CKD patients. Preliminary evidence suggests that psychosocial interventions might be beneficial for the quality of life in CKD patients. Our results provide medical facilities with an evidence-based basis for establishing psychosocial interventions in kidney care settings.
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Affiliation(s)
- Hui Yang
- Department of Health Management, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, China
| | - Li Qi
- Department of Health Management, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, China
| | - Dongmei Pei
- Department of Health Management, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, China.
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Li JL, Lin L, Wu MM, Zhang JY, Zhang YX, Cao MR, Wang L. A meta-analysis of the efficacy and safety of the traditional Chinese medicine formula Kaixinsan decoction for depression. Medicine (Baltimore) 2024; 103:e36719. [PMID: 38181245 PMCID: PMC10766321 DOI: 10.1097/md.0000000000036719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/28/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Kaixinsan (KXS) decoction is a traditional Chinese herbal formulation commonly used to treat depression. This study aimed to evaluate the efficacy and safety of KXS, which is widely used, alone and in combination with other therapies, for the treatment of depression. The main objective was to assess the efficacy and safety of KXS in the treatment of depression as a single agent or in combination with other methods. METHODS Randomized controlled trials of KXS in the treatment of depression were systematically searched from several Chinese and English databases with no language restriction. Patients in these studies met the relevant diagnostic criteria for depression. Data on HAMD, SDS, practical situations, and occurrence of side effects in the studies were extracted. Finally, the methodological quality and risk of bias of the included studies were assessed using the Jadad scale and Cochrane bias evaluation tool. RESULTS Twelve studies with 1034 patients were included after screening. The Jadad scale and Cochrane bias evaluation tool indicated that the quality of the studies ranged from fair to good, with 41.7% categorized as good and 58.3% as poor. Egger test and funnel plots showed that the publication bias remain low. CONCLUSION The results showed that the frequency of side effects in the control group was higher than that in the treatment group, and there was a statistically significant difference. KXS was comparable or superior to antidepressants in treating depression and has fewer side effects. The data analysis showed that effectiveness and other indicators differed significantly by geographic area and dosage form, which has implications for future clinical work.
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Affiliation(s)
- Jia-liang Li
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Lin Lin
- Department of Gynecology and Obstetrics, First Hospital of Harbin Medical University, Harbin, China
| | - Min-min Wu
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Jing-yu Zhang
- Fujian University of Chinese Medicine, Fuzhou, China
| | - Yi-xin Zhang
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Meng-ru Cao
- The Second Department of Mammary Gland, Harbin Medical University Cancer Hospital, Harbin, China
| | - Long Wang
- The Third Department of Acupuncture, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
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Thomas JE, Pasch KE, Nathan Marti C, Loukas A. Depressive symptoms prospectively increase risk for new onset cigarette and ENDS dependence symptoms. Addict Behav 2024; 148:107870. [PMID: 37776758 PMCID: PMC11212675 DOI: 10.1016/j.addbeh.2023.107870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/30/2023] [Accepted: 09/24/2023] [Indexed: 10/02/2023]
Abstract
Little research has examined the new onset of cigarette and Electronic Nicotine Delivery System (ENDS) dependence symptoms among young adults. This study aims to 1) examine new onset cigarette and ENDS dependence symptoms over a 4.5-year period and 2) examine how depressive symptoms impact new onset dependence symptoms among young adults. Participants were drawn from 24 colleges in Texas who were participating in a multi-wave cohort study (2014-2019). The present study included 4536 participants aged 18-25 who did not report cigarette or ENDS dependence symptoms at wave 1 (64.1% female; 65.2% non-white; m age = 20.62 [SD = 1.80] at wave 1). Cox's regression models were employed to determine the hazard of new onset cigarette and ENDS dependence symptoms overall and the impact of depressive symptoms. Models controlled for sociodemographic factors and other tobacco product use. 14.4% of participants reported new onset cigarette dependence symptoms and 14.6% reported new onset ENDS dependence symptoms over the 4.5 years of the study. Depressive symptoms significantly predicted increased risk for new onset cigarette (HR = 1.30, CI = [1.21, 1.39]) and ENDS (HR = 1.20, CI = [1.12, 1.29]) dependence symptoms. Young adults exhibited dependence symptoms for cigarettes and ENDS products at similar rates across the 4.5 years of the study. Elevated depressive symptoms increased risk of new onset cigarette and ENDS dependence symptoms, advancing evidence for the self-medication hypothesis. Tobacco and nicotine prevention and cessation programs and messaging are needed particularly among young adults who experience depressive symptoms.
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Affiliation(s)
- Jacob E Thomas
- Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd D3700, Austin, TX 78712, USA.
| | - Keryn E Pasch
- Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd D3700, Austin, TX 78712, USA.
| | - C Nathan Marti
- Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd D3700, Austin, TX 78712, USA.
| | - Alexandra Loukas
- Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd D3700, Austin, TX 78712, USA.
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Ye J, Pan Y, Wu C, Hu Z, Wu S, Wang W, Guo J, Xiao A. Effects of Mindfulness-Based Cognitive Therapy on Depression and Anxiety in Late Life: A Meta-Analysis. ALPHA PSYCHIATRY 2024; 25:1-8. [PMID: 38799491 PMCID: PMC11114204 DOI: 10.5152/alphapsychiatry.2024.231379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/04/2023] [Indexed: 05/29/2024]
Abstract
Objective This study aims to assess the efficacy of mindfulness-based cognitive therapy (MBCT) in alleviating depression in older adults. Methods A comprehensive search was conducted in 4 electronic databases and 1 registered database from inception up to July 2021 to identify relevant trials. The meta-analysis employed Hedge's g, along with its 95% CI, and associated z and P-values for the included studies, utilizing Comprehensive Meta-Analysis software. Results Qualitative synthesis was performed on 5 eligible studies. Evaluation of methodological quality and bias risk across the papers involved scrutiny of key variables due to the heterogeneous research formats. Our findings indicated a significant moderating effect of MBCT against current depressive symptoms in older adults (g = 0.53, 95% Confidence Intervals (CI) = 0.31-0.75) and a similar effect size for anxiety (g = 0.43, 95% CI = 0.20-0.65). However, caution is warranted due to the limited number of studies and potential publication bias. Further extensive research with longer follow-up measures and larger sample sizes is essential. Conclusion This study underscores the effectiveness of MBCT as a treatment for anxiety and despair in older individuals. Mindfulness-based cognitive therapy should be recommended for its positive impact on older adults with depression, and the involvement of authorized psychiatric nurses is crucial for conducting successful MBCT interventions. However, caution is warranted due to the limited number of studies and potential publication bias. Further extensive research with longer follow-up measures and larger sample sizes is essential.
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Affiliation(s)
- Junrong Ye
- Geriatric Neuroscience Center, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuanxin Pan
- Geriatric Neuroscience Center, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou Medical University, School of Nursing, Guangzhou, China
| | - Chenxin Wu
- Geriatric Neuroscience Center, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou Medical University, School of Nursing, Guangzhou, China
| | - Zhanhua Hu
- Sun Yat-sen University, School of Pharmaceutical Sciences, Guangzhou, China
| | - Shengwei Wu
- Department of Traditional Chinese Medicine, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wen Wang
- Geriatric Neuroscience Center, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou Medical University, School of Nursing, Guangzhou, China
| | - Jianxiong Guo
- Department of Chronic Diseases, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Aixiang Xiao
- Geriatric Neuroscience Center, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou Medical University, School of Nursing, Guangzhou, China
- Department of Nursing Administration, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
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Nordahl-Hansen A, Cogo-Moreira H, Panjeh S, Quintana DS. Redefining effect size interpretations for psychotherapy RCTs in depression. J Psychiatr Res 2024; 169:38-41. [PMID: 38000182 DOI: 10.1016/j.jpsychires.2023.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 10/27/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Effect sizes are often used to interpret the magnitude of a result and in power calculations when planning research studies. However, as effect size interpretations are context-dependent, Jacob Cohen's suggested guidelines for what represents a small, medium, and large effect are unlikely to be suitable for a diverse range of research populations and interventions. Our objective here is to determine empirically-derived effect size thresholds associated with psychotherapy randomized controlled trials (RCTs) in depression by calculating the effect size distribution. METHODS We extracted effect sizes from 366 RCTs provided by the systematic review of Cuijpers and colleagues (2020) on psychotherapy for depressive disorders across all age groups. The 50th percentile effect size, as this represents a medium effect size, and the 25th (small) and 75th (large) percentile effect sizes were calculated to determine empirically-derived effect size thresholds. RESULTS After adjusting for publication bias, 0.27, 0.53, and 0.86 represent small, medium, and large effect sizes, respectively, for psychotherapy treatment for depressive disorders. DISCUSSION The effect size distribution for psychotherapy treatment of depression indicates that observed effect size thresholds are larger than Cohen's suggested effect size thresholds (0.2, 0.5, and 0.8). These results have implications for the interpretation of study effects and the planning of future studies via power analyses, which often use effect size thresholds.
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Affiliation(s)
- Anders Nordahl-Hansen
- Department of Education, ICT and Learning, Østfold University College, Halden, Norway
| | - Hugo Cogo-Moreira
- Department of Education, ICT and Learning, Østfold University College, Halden, Norway
| | - Sareh Panjeh
- Department of Psychiatry and Medical Psychology, Federal University of São Paulo, São Paulo, Brazil
| | - Daniel S Quintana
- Department of Psychology, University of Oslo, Oslo, Norway; NevSom, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway; KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway; NORMENT Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Oslo, Norway.
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Sylvester CM, Luby JL, Pine DS. Novel mechanism-based treatments for pediatric anxiety and depressive disorders. Neuropsychopharmacology 2024; 49:262-275. [PMID: 37608220 PMCID: PMC10700626 DOI: 10.1038/s41386-023-01709-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023]
Abstract
Pediatric anxiety and depressive disorders are common, can be highly impairing, and can persist despite the best available treatments. Here, we review research into novel treatments for childhood anxiety and depressive disorders designed to target underlying cognitive, emotional, and neural circuit mechanisms. We highlight three novel treatments lying along a continuum relating to clinical impact of the disorder and the intensity of clinical management required. We review cognitive training, which involves the lowest risk and may be applicable for problems with mild to moderate impact; psychotherapy, which includes a higher level of clinical involvement and may be sufficient for problems with moderate impact; and brain stimulation, which has the highest potential risks and is therefore most appropriate for problems with high impact. For each treatment, we review the specific underlying cognitive, emotional, and brain circuit mechanisms that are being targeted, whether treatments modify those underlying mechanisms, and efficacy in reducing symptoms. We conclude by highlighting future directions, including the importance of work that leverages developmental windows of high brain plasticity to time interventions to the specific epochs in childhood that have the largest and most enduring life-long impact.
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Affiliation(s)
- Chad M Sylvester
- Washington University Department of Psychiatry, St. Louis, MO, USA.
- Washington University Department of Radiology, St. Louis, MO, USA.
| | - Joan L Luby
- Washington University Department of Psychiatry, St. Louis, MO, USA
| | - Daniel S Pine
- National Institute of Mental Health, Emotion and Development Branch, St. Louis, MO, USA
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Li H, Zhang R, Lee YC, Kraut RE, Mohr DC. Systematic review and meta-analysis of AI-based conversational agents for promoting mental health and well-being. NPJ Digit Med 2023; 6:236. [PMID: 38114588 PMCID: PMC10730549 DOI: 10.1038/s41746-023-00979-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023] Open
Abstract
Conversational artificial intelligence (AI), particularly AI-based conversational agents (CAs), is gaining traction in mental health care. Despite their growing usage, there is a scarcity of comprehensive evaluations of their impact on mental health and well-being. This systematic review and meta-analysis aims to fill this gap by synthesizing evidence on the effectiveness of AI-based CAs in improving mental health and factors influencing their effectiveness and user experience. Twelve databases were searched for experimental studies of AI-based CAs' effects on mental illnesses and psychological well-being published before May 26, 2023. Out of 7834 records, 35 eligible studies were identified for systematic review, out of which 15 randomized controlled trials were included for meta-analysis. The meta-analysis revealed that AI-based CAs significantly reduce symptoms of depression (Hedge's g 0.64 [95% CI 0.17-1.12]) and distress (Hedge's g 0.7 [95% CI 0.18-1.22]). These effects were more pronounced in CAs that are multimodal, generative AI-based, integrated with mobile/instant messaging apps, and targeting clinical/subclinical and elderly populations. However, CA-based interventions showed no significant improvement in overall psychological well-being (Hedge's g 0.32 [95% CI -0.13 to 0.78]). User experience with AI-based CAs was largely shaped by the quality of human-AI therapeutic relationships, content engagement, and effective communication. These findings underscore the potential of AI-based CAs in addressing mental health issues. Future research should investigate the underlying mechanisms of their effectiveness, assess long-term effects across various mental health outcomes, and evaluate the safe integration of large language models (LLMs) in mental health care.
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Affiliation(s)
- Han Li
- Department of Communications and New Media, National University of Singapore, Singapore, 117416, Singapore
| | - Renwen Zhang
- Department of Communications and New Media, National University of Singapore, Singapore, 117416, Singapore.
| | - Yi-Chieh Lee
- Department of Computer Science, National University of Singapore, Singapore, 117416, Singapore
| | - Robert E Kraut
- Human-Computer Interaction Institute Carnegie Mellon University, Pittsburgh, PA, 15213, USA
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL, 60611, USA
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van Aswegen T, Samartzi E, Morris L, van der Spek N, de Vries R, Seedat S, van Straten A. Effectiveness of family-based therapy for depressive symptoms in children and adolescents: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2023; 58:499-511. [PMID: 37409629 PMCID: PMC10946719 DOI: 10.1002/ijop.12926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/06/2023] [Indexed: 07/07/2023]
Abstract
Early-onset depression contributes significantly to the global health burden and has long-term negative effects. This meta-analysis collates and examines the effectiveness of family-based interventions, where family members are involved in the treatment of depression in children and adolescents. A literature search was performed up to 8th March 2023. Randomised controlled trials of family-based interventions were included for participants aged 3-18 years with a diagnosis of major depressive disorder or dysthymia, according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) or with a score above a cut-off on a standardised self-report depression measure. The overall effect size for treatment versus active control was g = 0.22 (95% confidence interval [CI]: -0.05-0.50) (nine studies; 659 participants), and for treatment versus non-active control it was g = 0.46 (95% CI: -0.09-1.01) (four studies; 385 participants). Effect sizes were not statistically significant, and heterogeneity was high, ranging between I2 = 64.3-81.1%. Subgroup analysis comparing attachment-based family therapy with family therapy using other theoretical frameworks did not yield a significant difference between the two. The effects of family-based therapies were larger than those in the comparison groups, but family-based therapy did not demonstrate a significant treatment benefit compared to the controls. More randomised controlled trials are warranted, considering that evidence for other psychotherapies for depression in children and adolescents, indicates modest effects. Family-based therapy may be an alternative for children and adolescents whose needs are not addressed by these treatments.
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Affiliation(s)
- Tanya van Aswegen
- Department of Psychiatry, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioral and Movement SciencesVrije Universiteit Amsterdam & Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Eleonora Samartzi
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioral and Movement SciencesVrije Universiteit Amsterdam & Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Linzette Morris
- Department of Physical Therapy and Rehabilitation Science, College of Health Sciences, QU HealthQatar UniversityDohaQatar
| | - Nadia van der Spek
- Department of Clinical, Neuro and Developmental PsychologyAmsterdam Public Health Research Institute (APH), Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Ralph de Vries
- Medical LibraryVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioral and Movement SciencesVrije Universiteit Amsterdam & Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
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Oude Voshaar RC. The 'discontinuity hypothesis' of depression in later life-clinical and research implications. Age Ageing 2023; 52:afad239. [PMID: 38156879 PMCID: PMC10756079 DOI: 10.1093/ageing/afad239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 01/08/2023] [Indexed: 01/03/2024] Open
Abstract
The term depression is overused as an umbrella term for a variety of conditions, including depressed mood and various psychiatric disorders. According to psychiatric diagnostic criteria, depressive disorders impact nearly all aspects of human life and are a leading cause of disability worldwide. The widespread assumption that different types of depression lie on a continuum of severity has stimulated important research on subthreshold depression in later life. This view assumes that depressed mood is a precursor of a depressive disorder. The present narrative review argues why in later life depressed mood might either (i) lie on a continuum with depressive disorders among people vulnerable for a depressive disorder or (ii) be an ageing-related epiphenomenon of underlying physical illnesses in people who are resilient to depressive disorders ('discontinuity hypothesis'). Three arguments are discussed. First, the course of depressed mood and depressive disorders differs across the life span. Second, screening instruments for depression have low predictive value for depressive disorders in later life. Third, a dose-response relationship has not been consistently found across different types of depression and detrimental health outcomes. Using the umbrella term depression may partly explain why pharmacological treatment is less effective with increasing age, and negative health-related outcomes might be overestimated. The discontinuity hypothesis may prevent pharmacological overtreatment of milder subtypes of depression and may stimulate comprehensive multidisciplinary assessment as well as the development of separate treatment algorithms for depressed mood and depressive disorders.
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Affiliation(s)
- Richard C Oude Voshaar
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherland
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40
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Thoma MV, Salas Castillo AN, Maercker A. [Psychotherapy for elderly patients]. Psychother Psychosom Med Psychol 2023; 73:516-528. [PMID: 38048814 DOI: 10.1055/a-1993-9570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
A particular feature of the demographic change is the growing proportion of elderly and very elderly people. In Western countries, this is largely due to improved medical care for age-associated diseases. There is still comparatively little knowledge about mental health disorders in old age, their age-typical clinical presentation and specific psychotherapeutic treatment.
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Eckshtain D, Horn R, Weisz JR. Family-Based Interventions for Youth Depression: Meta-Analysis of Randomized Clinical Trials. Child Psychiatry Hum Dev 2023; 54:1737-1748. [PMID: 35616765 DOI: 10.1007/s10578-022-01375-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/26/2022]
Abstract
Youth depression is an impairing pediatric condition for which psychotherapy effects are modest. Can outcomes be improved by treatments that address the family context, as proposed in practice parameters of the American Academy of Child and Adolescent Psychiatry? To find out, we searched five decades of research for randomized controlled trials testing family-based interventions; 11 trials were found for ages 4-18 years. Using robust variance estimation, we obtained estimates of effect size (ES) and tested candidate moderators that might explain variation in ES. Overall pooled ES of the studies was 0.33 at posttreatment, similar to that reported for all youth depression treatments in three prior meta-analyses (i.e., 0.36, 0.30, and 0.29), but higher for adolescents (ages ≥ 13, 0.50) than children (0.04). Taken together, our findings do not show superior outcomes for family-based interventions, and raise questions about how much confidence can be placed in the evidence base to date. The small number of relevant studies in more than five decades, together with the publication bias and risk of bias concerns, highlights the need for more trials testing family-based treatment, and for pre-registered reports, publicly-available preprints, and other mechanisms for improving the dissemination of completed research.
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Affiliation(s)
- Dikla Eckshtain
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 02114, Boston, MA, United States.
| | - Rachel Horn
- Department of Psychology, Harvard University, 1030 William James Hall, 33 Kirkland Street, 02138, Cambridge, MA, United States
| | - John R Weisz
- Department of Psychology, Harvard University, 1030 William James Hall, 33 Kirkland Street, 02138, Cambridge, MA, United States
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Weisz JR, Fitzpatrick OM, Venturo-Conerly KE, Sternberg A, Steinberg JS, Ng MY. Research Review: The internalizing paradox - youth anxiety and depression symptoms, psychotherapy outcomes, and implications for research and practice. J Child Psychol Psychiatry 2023; 64:1720-1734. [PMID: 37222162 PMCID: PMC10667566 DOI: 10.1111/jcpp.13820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Youth anxiety and depression have long been combined within the empirically derived internalizing syndrome. The two conditions show substantial comorbidity, symptom co-occurrence, and overlap in treatment procedures, but paradoxically diverge in psychotherapy outcomes: strong, positive effects for anxiety and weak effects for depression. METHODS Drawing on recent research, we examine candidate explanations for this paradox to help identify strategies for addressing it by improving outcomes for youth depression. RESULTS Candidate explanations include that youth depression, compared with youth anxiety, has more varied comorbidities and more heterogeneous symptom combinations, has greater uncertainty regarding mediators and mechanisms of change, is treated with more complex and potentially confusing protocols, and has characteristics that may impede client engagement. Candidate strategies for shrinking the psychotherapy effectiveness gap include personalizing through transdiagnostic modular treatment, simplifying therapy by focusing on empirically supported principles of change, developing effective strategies for engaging family members as intervention allies, using shared decision-making to inform clinical decisions and boost client engagement, capitalizing on youth-friendly technological advances, and shortening and digitizing treatments to enhance their accessibility and appeal. CONCLUSIONS Recent advances suggest explanations for the internalizing paradox, which in turn suggest strategies for shrinking the youth anxiety-depression psychotherapy outcome gap; these form an agenda for a promising new era of research.
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Affiliation(s)
- John R. Weisz
- Department of Psychology, Harvard University, Cambridge, MA 02138 USA
| | | | | | - Ariel Sternberg
- Department of Psychology, Harvard University, Cambridge, MA 02138 USA
| | | | - Mei Yi Ng
- Department of Psychology, Florida International University, Miami, FL 33199 USA
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Liwinski T, Lang UE, Brühl AB, Schneider E. Exploring the Therapeutic Potential of Gamma-Aminobutyric Acid in Stress and Depressive Disorders through the Gut-Brain Axis. Biomedicines 2023; 11:3128. [PMID: 38137351 PMCID: PMC10741010 DOI: 10.3390/biomedicines11123128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Research conducted on individuals with depression reveals that major depressive disorders (MDDs) coincide with diminished levels of the inhibitory neurotransmitter γ-aminobutyric acid (GABA) in the brain, as well as modifications in the subunit composition of the primary receptors (GABAA receptors) responsible for mediating GABAergic inhibition. Furthermore, there is substantial evidence supporting the significant role of GABA in regulating stress within the brain, which is a pivotal vulnerability factor in mood disorders. GABA is readily available and approved as a food supplement in many countries. Although there is substantial evidence indicating that orally ingested GABA may affect GABA receptors in peripheral tissues, there is comparatively less evidence supporting its direct action within the brain. Emerging evidence highlights that oral GABA intake may exert beneficial effects on the brain and psyche through the gut-brain axis. While GABA enjoys wide consumer acceptance in Eastern Asian markets, with many consumers reporting favorable effects on stress regulation, mood, and sleep, rigorous independent research is still largely lacking. Basic research, coupled with initial clinical findings, makes GABA an intriguing neuro-nutritional compound deserving of clinical studies in individuals with depression and other psychological problems.
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Affiliation(s)
| | | | | | - Else Schneider
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, CH-4002 Basel, Switzerland; (T.L.); (U.E.L.); (A.B.B.)
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Fiorini G, Bai Y, Fonagy P, Consortium TI, Midgley N. Short-term psychoanalytic psychotherapy with depressed adolescents: Comparing in-session interactions in good and poor outcome cases. Psychother Res 2023:1-14. [PMID: 37946369 DOI: 10.1080/10503307.2023.2270140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 10/06/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE To identify and describe in-session interaction patterns between psychoanalytic therapists and adolescents diagnosed with major depressive disorder, comparing good and poor outcome cases. METHOD Audio recordings for 100 psychotherapy sessions from 10 Short-Term Psychoanalytic Psychotherapies were analysed using the Adolescent Psychotherapy Q-Set (APQ). The cases and sessions were evenly divided into two groups (poor outcome and good outcome, 5 patients and 50 sessions per group). Interaction patterns were analysed with an Exploratory Factor Analysis (EFA), while group differences were assessed through t-tests. RESULTS The EFA revealed three factors: (1) "Open, engaged young person working collaboratively with a therapist to make sense of their experiences", (2) "Directive therapist with a young person fluctuating in emotional state and unwilling to explore", (3) "Young person expressing anger and irritation and challenging the therapist". Factor 1 was significantly more prominent in the good outcome cases, while factor 3, on the contrary, was more significantly related to the poor outcome cases. Factor 2 was equally present in both groups. CONCLUSION Besides reinforcing to researchers and clinicians the association between a collaborative psychotherapy process with good outcomes, our findings also provide empirical data regarding the role of anger in adolescent depression and the psychotherapy process.
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Affiliation(s)
- Guilherme Fiorini
- Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Yushi Bai
- Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | | | - Nick Midgley
- Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
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45
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Kahlon MK, Aksan N, Aubrey R. Effect of a Layperson-Delivered Telephone Program for People With Depressive Symptoms. Psychiatr Serv 2023; 74:1176-1179. [PMID: 37042110 DOI: 10.1176/appi.ps.20220440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
OBJECTIVE This study investigated whether a layperson-delivered telephone program focusing on empathy could improve depressive symptoms among adults. METHODS Data for a subset of participants from a randomized controlled trial (July 6-September 24, 2020) were analyzed to assess the impact of a telephone program on mental health. Participants in this post hoc analysis had baseline depressive symptoms and were assessed for depression, anxiety, loneliness, and isolation. RESULTS Of the 240 people in the original sample, 58 had depressive symptoms (i.e., baseline scores of ≥10 on the eight-item Patient Health Questionnaire [PHQ-8]); 56 of the 58 were reassessed 4 weeks later. Participants in the intervention arm had greater improvements in PHQ-8 scores (baseline mean±SD=13.0±2.6, postintervention mean=9.2±3.0; mean difference=3.8, 95% CI=2.9-4.7) than participants in the control arm (mean difference=1.3, 95% CI=0.1-2.5) (p=0.013). CONCLUSIONS This telephone intervention, delivered by a lay workforce, holds promise for reducing the burden on the clinical care system.
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Affiliation(s)
- Maninder K Kahlon
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin
| | - Nazan Aksan
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin
| | - Rhonda Aubrey
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin
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McIntyre RS, Alsuwaidan M, Baune BT, Berk M, Demyttenaere K, Goldberg JF, Gorwood P, Ho R, Kasper S, Kennedy SH, Ly-Uson J, Mansur RB, McAllister-Williams RH, Murrough JW, Nemeroff CB, Nierenberg AA, Rosenblat JD, Sanacora G, Schatzberg AF, Shelton R, Stahl SM, Trivedi MH, Vieta E, Vinberg M, Williams N, Young AH, Maj M. Treatment-resistant depression: definition, prevalence, detection, management, and investigational interventions. World Psychiatry 2023; 22:394-412. [PMID: 37713549 PMCID: PMC10503923 DOI: 10.1002/wps.21120] [Citation(s) in RCA: 83] [Impact Index Per Article: 83.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
Treatment-resistant depression (TRD) is common and associated with multiple serious public health implications. A consensus definition of TRD with demonstrated predictive utility in terms of clinical decision-making and health outcomes does not currently exist. Instead, a plethora of definitions have been proposed, which vary significantly in their conceptual framework. The absence of a consensus definition hampers precise estimates of the prevalence of TRD, and also belies efforts to identify risk factors, prevention opportunities, and effective interventions. In addition, it results in heterogeneity in clinical practice decision-making, adversely affecting quality of care. The US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have adopted the most used definition of TRD (i.e., inadequate response to a minimum of two antidepressants despite adequacy of the treatment trial and adherence to treatment). It is currently estimated that at least 30% of persons with depression meet this definition. A significant percentage of persons with TRD are actually pseudo-resistant (e.g., due to inadequacy of treatment trials or non-adherence to treatment). Although multiple sociodemographic, clinical, treatment and contextual factors are known to negatively moderate response in persons with depression, very few factors are regarded as predictive of non-response across multiple modalities of treatment. Intravenous ketamine and intranasal esketamine (co-administered with an antidepressant) are established as efficacious in the management of TRD. Some second-generation antipsychotics (e.g., aripiprazole, brexpiprazole, cariprazine, quetiapine XR) are proven effective as adjunctive treatments to antidepressants in partial responders, but only the olanzapine-fluoxetine combination has been studied in FDA-defined TRD. Repetitive transcranial magnetic stimulation (TMS) is established as effective and FDA-approved for individuals with TRD, with accelerated theta-burst TMS also recently showing efficacy. Electroconvulsive therapy is regarded as an effective acute and maintenance intervention in TRD, with preliminary evidence suggesting non-inferiority to acute intravenous ketamine. Evidence for extending antidepressant trial, medication switching and combining antidepressants is mixed. Manual-based psychotherapies are not established as efficacious on their own in TRD, but offer significant symptomatic relief when added to conventional antidepressants. Digital therapeutics are under study and represent a potential future clinical vista in this population.
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Affiliation(s)
- Roger S McIntyre
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Mohammad Alsuwaidan
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Bernhard T Baune
- Department of Psychiatry, University of Münster, Münster, Germany
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Michael Berk
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
- Deakin University IMPACT Institute, Geelong, VIC, Australia
| | - Koen Demyttenaere
- Department of Psychiatry, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Joseph F Goldberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Philip Gorwood
- Department of Psychiatry, Sainte-Anne Hospital, Paris, France
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Institute for Health Innovation and Technology, National University of Singapore, Singapore
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy and Center of Brain Research, Molecular Neuroscience Branch, Medical University of Vienna, Vienna, Austria
| | - Sidney H Kennedy
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Josefina Ly-Uson
- Department of Psychiatry and Behavioral Medicine, University of The Philippines College of Medicine, Manila, The Philippines
| | - Rodrigo B Mansur
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - R Hamish McAllister-Williams
- Northern Center for Mood Disorders, Translational and Clinical Research Institute, Newcastle University, and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - James W Murrough
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Andrew A Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA, USA
| | - Joshua D Rosenblat
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Gerard Sanacora
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Alan F Schatzberg
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA
| | - Richard Shelton
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephen M Stahl
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, USA
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Maj Vinberg
- Mental Health Centre, Northern Zealand, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Nolan Williams
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA
| | - Allan H Young
- Department of Psychological Medicine, King's College London, London, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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Roest AM, de Vries YA, Wienen AW, de Jonge P. Commentary: The evidence base regarding the long-term effects of childhood mental disorder treatments needs to be strengthened - reply to Dekkers et al. (2023). J Child Psychol Psychiatry 2023; 64:1520-1521. [PMID: 37452754 DOI: 10.1111/jcpp.13861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2023] [Indexed: 07/18/2023]
Abstract
In their reply to our editorial (Journal of Child Psychology and Psychiatry, 2023, 64, 464), Dekkers et al. (Journal of Child Psychology and Psychiatry, 2023, 64, 470) argue that treatment is the best choice for children with mental disorders because there is 'sound evidence' that interventions are effective, also in the long term. We agree that there is sound evidence for treatment effectiveness in the short-term and there is some evidence for longer-term effects of certain specific treatments, such as behavioral parent training in children with behavioral disorders, as acknowledged in our editorial. However, we strongly disagree that there is sound evidence for long-term effectiveness.
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Affiliation(s)
- Annelieke M Roest
- Department of Developmental Psychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - Ymkje Anna de Vries
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Albert W Wienen
- Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Peter de Jonge
- Department of Developmental Psychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
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Gliske K, Berry KR, Ballard J, Schmidt C, Kroll E, Kohlmeier J, Killian M, Fenkel C. Predicting Youth and Young Adult Treatment Engagement in a Transdiagnostic Remote Intensive Outpatient Program: Latent Profile Analysis. JMIR Form Res 2023; 7:e47917. [PMID: 37676700 PMCID: PMC10514771 DOI: 10.2196/47917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/20/2023] [Accepted: 07/31/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The youth mental health crisis in the United States continues to worsen, and research has shown poor mental health treatment engagement. Despite the need for personalized engagement strategies, there is a lack of research involving youth. Due to complex youth developmental milestones, there is a need to better understand clinical presentation and factors associated with treatment engagement to effectively identify and tailor beneficial treatments. OBJECTIVE This quality improvement investigation sought to identify subgroups of clients attending a remote intensive outpatient program (IOP) based on clinical acuity data at intake, to determine the factors associated with engagement outcomes for clients who present in complex developmental periods and with cooccurring conditions. The identification of these subgroups was used to inform programmatic decisions within this remote IOP system. METHODS Data were collected as part of ongoing quality improvement initiatives at a remote IOP for youth and young adults. Participants included clients (N=2924) discharged between July 2021 and February 2023. A latent profile analysis was conducted using 5 indicators of clinical acuity at treatment entry, and the resulting profiles were assessed for associations with demographic factors and treatment engagement outcomes. RESULTS Among the 2924 participants, 4 profiles of clinical acuity were identified: a low-acuity profile (n=943, 32.25%), characterized by minimal anxiety, depression, and self-harm, and 3 high-acuity profiles defined by moderately severe depression and anxiety but differentiated by rates of self-harm (high acuity+low self-harm: n=1452, 49.66%; high acuity+moderate self-harm: n=203, 6.94%; high acuity+high self-harm: n=326, 11.15%). Age, gender, transgender identity, and sexual orientation were significantly associated with profile membership. Clients identified as sexually and gender-marginalized populations were more likely to be classified into high-acuity profiles than into the low-acuity profile (eg, for clients who identified as transgender, high acuity+low self-harm: odds ratio [OR] 2.07, 95% CI 1.35-3.18; P<.001; high acuity+moderate self-harm: OR 2.85, 95% CI 1.66-4.90; P<.001; high acuity+high self-harm: OR 3.67, 95% CI 2.45-5.51; P<.001). Race was unrelated to the profile membership. Profile membership was significantly associated with treatment engagement: youth and young adults in the low-acuity and high-acuity+low-self-harm profiles attended an average of 4 fewer treatment sessions compared with youth in the high-acuity+moderate-self-harm and high-acuity+high-self-harm profiles (ꭓ23=27.6, P<.001). Individuals in the high-acuity+low-self-harm profile completed treatment at a significantly lower rate relative to the other 2 high-acuity profiles (ꭓ23=13.4, P=.004). Finally, those in the high-acuity+high-self-harm profile were significantly less likely to disengage early relative to youth in all other profiles (ꭓ23=71.12, P<.001). CONCLUSIONS This investigation represents a novel application for identifying subgroups of adolescents and young adults based on clinical acuity data at intake to identify patterns in treatment engagement outcomes. Identifying subgroups that differentially engage in treatment is a critical first step toward targeting engagement strategies for complex populations.
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Affiliation(s)
- Kate Gliske
- Charlie Health Inc, Bozeman, MT, United States
| | | | - Jaime Ballard
- Center For Applied Research and Educational Improvement, University of Minnesota, St. Paul, MN, United States
| | | | | | | | - Michael Killian
- College of Social Work, Florida State University, Tallahassee, FL, United States
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Cuijpers P, Miguel C, Harrer M, Plessen CY, Ciharova M, Papola D, Ebert D, Karyotaki E. Psychological treatment of depression: A systematic overview of a 'Meta-Analytic Research Domain'. J Affect Disord 2023; 335:141-151. [PMID: 37178828 DOI: 10.1016/j.jad.2023.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Over the past 16 years, we have developed a 'Meta-analytic Research Domain' (MARD) of all randomized trials of psychological treatments of depression. A MARD is a living systematic review of a research field, that cannot be otherwise covered by one (network) meta-analysis and includes multiple PICOs. In this paper we give an overview of the findings of this MARD. METHODS A narrative review of the results of the 118 meta-analyses on psychotherapies for depression that were published within our MARD. RESULTS Most research has been conducted on cognitive-behavioral therapy (CBT), but several other psychotherapies are also effective, with few differences between therapies. They can be effectively delivered in individual, group, telephone and guided self-help format and are effective in many different target groups and across different age groups, although the effects are significantly smaller in children and adolescents. Psychotherapies have comparable effects as pharmacotherapy at the short term but are probably more effective at the longer term. Combined treatment is more effective than either psychotherapy or pharmacotherapy alone at the short, but also at the longer term. LIMITATIONS We did not summarize all published meta-analyses (protocols, methodological studies) and have not compared our results to those found in other meta-analyses on comparable subjects. CONCLUSION Psychotherapies can contribute considerably to a reduction of the disease burden of depression. MARDs are an important next step in the aggregation of knowledge from randomized controlled trials in psychological treatments of depression as well as in other healthcare sectors.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands; Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania.
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Department of Health Sciences, Technical University Munich, Munich, Germany; Department of Clinical Psychology & Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Constantin Yves Plessen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands; Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Davide Papola
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Italy; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - David Ebert
- Psychology & Digital Mental Health Care, Department of Health Sciences, Technical University Munich, Munich, Germany
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
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Cuijpers P, Miguel C, Harrer M, Ciharova M, Karyotaki E. Does the use of pharmacotherapy interact with the effects of psychotherapy? A meta-analytic review. Eur Psychiatry 2023; 66:e63. [PMID: 37534407 PMCID: PMC10594340 DOI: 10.1192/j.eurpsy.2023.2437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND It is not clear if there is an interaction between psychotherapy and pharmacotherapy. First, there may be no interaction at all, meaning that the effects of both are independent of each other. Second, antidepressants may reduce the effects of psychotherapy, and third, antidepressants may increase the effects of psychotherapy. We examined which of the three is correct. METHODS We conducted random effects meta-analyses of randomized trials comparing psychotherapies for adult depression with control conditions. The proportion of users of antidepressants was used as a predictor of the effect size in a series of meta-regression analyses, while adjusting for relevant moderators, such as type of control group and baseline severity. RESULTS We included 300 randomized controlled trials (353 comparisons between treatment and control; 32,852 participants). The main effect size of psychotherapy was g = 0.71 (95% CI: 0.64; 0.79) with high heterogeneity (I2 = 82; 95% CI: 80; 84). We found no significant association between the proportion of antidepressants users and effect size (p = .07). We did find a significant association with some other predictors, including the type of control group and risk of bias. The use of antidepressants was associated with higher response rates within the control conditions, but not with the relative effects of the treatments compared to the control groups. DISCUSSION We found support for the independent effects of psychotherapy and pharmacotherapy, which is good news from a clinical perspective. Apparently, patients can start with psychotherapy and do not have to be afraid that this will reduce the effects of the therapy.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Department of Health Sciences, Technical University Munich, Munich, Germany
- Department of Clinical Psychology & Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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