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Balasooriya Lekamge R, Gasevic D, Karim MN, Ilic D. Mindfulness for academic performance in health professions students: a systematic review. BMJ Evid Based Med 2023; 28:341-347. [PMID: 35760452 DOI: 10.1136/bmjebm-2021-111853] [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] [Accepted: 05/31/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To systematically review the impact of mindfulness-based interventions (MBIs) on the academic performance of undergraduate medicine, nursing and allied health students. METHODS Randomised controlled trials that examined the effects of MBIs in medicine, nursing and allied health students on academic performance were eligible for inclusion. Electronic database searches were conducted across Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus), PsycINFO and ERIC databases. Two authors independently reviewed citations, extracted data and assessed the quality of evidence using the Cochrane Collaboration's risk of bias tool. A descriptive analysis of included studies and a meta-analysis using a random-effects model of standardised mean difference were performed. RESULTS A total of 267 studies were returned from the search, of which 2 met the inclusion criteria. The overall risk of bias was assessed as unclear risk of bias for one study and high risk of bias for second included study. A meta-analysis of MBIs on student academic performance as measured by marks in written examination indicated no statistical difference between interventions (Standardised Mean Difference (SMD)=0.43, 95% CI -1.77 to 2.62, I2=96%). DISCUSSION Our systematic review highlights a lack of evidence to either support, or refute, the use of mindfulness interventions on the academic performance of undergraduate medical students. We encourage that future randomised controlled trials pay heed to the dosing of mindfulness and include a measurement of mindfulness to enable us to draw a clearer causal relationship.
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Affiliation(s)
- Roshini Balasooriya Lekamge
- Medical Education Research & Quality (MERQ) Unit, School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Danijela Gasevic
- Medical Education Research & Quality (MERQ) Unit, School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Md Nazmul Karim
- Medical Education Research & Quality (MERQ) Unit, School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dragan Ilic
- Medical Education Research & Quality (MERQ) Unit, School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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2
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Asfar T, Alcaide ML, Jones DL, McClure LA, Brewer J, Lee DJ, Carrico A. HIV patients’ perceptions of a potential multi-component mindfulness-based smoking cessation smartphone application intervention. PLoS One 2022; 17:e0271946. [PMID: 36006893 PMCID: PMC9409537 DOI: 10.1371/journal.pone.0271946] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/14/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives Cigarette smoking rates among people living with HIV (PLWH) in the US is triple that of the general population. PLWH smokers are a high-risk group for smoking-related health disparities and should be a prime focus for smoking cessation efforts. Our team has developed a novel evidence-based Mindfulness Training (MT) smoking cessation smartphone application (app), “Craving-to-Quit.” Using qualitative focus groups among PLWH smokers, this study aims to tailor and optimize the app’s content and design to PLWH’s unique psychosocial profile and needs. Methods We conducted 8 focus groups among PLWH smokers (n = 59; 47.5% females; ≥18 years) to gain insight into participants’ perceptions about the app, MT, and the feasibility and acceptability of adding two additional strategies (CM: Contingency Management; self-monitoring of anti-retroviral therapies intake [ART]) to further optimize the app. Participants were asked to practice MTs and watch videos from the app presented on a screen in the conference room to discuss their experience. Sessions were audio-taped, transcribed verbatim, and analyzed thematically using NVivo. Results Most participants were non-Hispanic black (67.8%), on a federal health insurance program (61.0%). Participants considered it easy to learn the app and thought that MT is helpful in reducing stress and motivating quit attempts and were supportive of adding CM and recommended providing $20-$50 weekly cash incentives to help in quitting. Participants felt that adding self-monitoring of ART is helpful but were concerned about confidentiality in case they lost their phone. Participants recommended making the app cost-free and adding information about smoking cessation medications and the negative effects of smoking among PLWH. Conclusions Findings will guide the development of a novel multi-component smoking cessation intervention app integrating MT, CM, and ART self-monitoring strategies. This intervention has the potential to address several barriers to quitting in PLWH. Further clinical research is needed to test this intervention.
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Affiliation(s)
- Taghrid Asfar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States of America
- * E-mail:
| | - Maria Luisa Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Internal Medicine, Jackson Memorial Hospital, Miami, FL, United States of America
| | - Deborah L. Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Laura A. McClure
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Judson Brewer
- Department of Behavioral and Social Sciences, Brown Mindfulness Center, Brown University School of Public Health, Providence, RI, United States of America
| | - David J. Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Adam Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
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3
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Tam CC, Zhou Y, Qiao S, Li X, Shen Z. Mindfulness, psychological distress, and somatic symptoms among women engaged in sex work in China. Appl Psychol Health Well Being 2022; 14:967-986. [PMID: 35419932 PMCID: PMC9544246 DOI: 10.1111/aphw.12362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/04/2022] [Indexed: 11/26/2022]
Abstract
Women engaged in sex work (WSW) in China encounter numerous disadvantages (e.g., exposure to violence) and have substantial risk for psychological distress and somatic symptoms. Intervention literature has attended to mindfulness, which is a protective factor for psychological outcomes, and its influences can further improve physical health. However, mindfulness has not been well studied in WSW. We aimed to examine the association among mindfulness, psychological distress, and somatic symptoms among Chinese WSW. Data were collected from 410 WSW in Guangxi, China, using an anonymous, self‐administered survey evaluating demographics, mindfulness, psychological distress (i.e., depression, loneliness, and perceived stress), and somatic symptoms (i.e., pain, cardiopulmonary, and gastrointestinal/fatigue symptoms). Structural equation modeling was utilized for data analyses. Mindfulness was negatively associated with psychological distress and somatic symptoms. Psychological distress was positively associated with somatic symptoms. Psychological distress mediated the association between mindfulness and somatic symptoms. Mindfulness appears to be a protective factor for psychological distress among WSW, and such an effect is further influential to their somatic symptoms. Our findings add to the growing literature on mindfulness, suggesting that mindfulness‐based interventions could be beneficial for WSW. Future research should explore other cognitive factors underlying the psychosomatic mechanism of mindfulness.
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Affiliation(s)
- Cheuk Chi Tam
- South Carolina SmartState Center for Healthcare Quality, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Yuejiao Zhou
- Guangxi Zhuang Autonomous Region Center for Diseases Prevention and Control, Nanning, China
| | - Shan Qiao
- South Carolina SmartState Center for Healthcare Quality, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Zhiyong Shen
- Guangxi Zhuang Autonomous Region Center for Diseases Prevention and Control, Nanning, China
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4
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The effect of mindfulness-based interventions on immunity-related biomarkers: a comprehensive meta-analysis of randomised controlled trials. Clin Psychol Rev 2022; 92:102124. [DOI: 10.1016/j.cpr.2022.102124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 12/17/2021] [Accepted: 01/09/2022] [Indexed: 11/21/2022]
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5
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Nielsen EG, Minda JP. The Mindful Lawyer: Investigating the Effects of Two Online Mindfulness Programs on Self-Reported Well-Being in the Legal Profession. J Occup Environ Med 2021; 63:e871-e882. [PMID: 34860207 DOI: 10.1097/jom.0000000000002393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Two studies were conducted to determine whether mindfulness meditation could be an effective tool for improving well-being among legal professionals-a population plagued by high rates of depression, anxiety, and stress. METHODS Study 1. Legal professionals completed questionnaires before and after an 8-week mindfulness program. Study 2. Lawyers were randomly assigned to either an experimental or waitlist condition. Questionnaires were administered at the beginning of the study and after experimental participants had completed a 30-day intervention. RESULTS Study 1. Participants reported significant improvements in mood, resilience, trait mindfulness, stress, anxiety, and depression over time. Study 2. Post-intervention, experimental participants reported better mood, lower levels of stress, and higher levels of non-reactivity and observing than waitlist participants. CONCLUSIONS Mindfulness and meditation may effectively improve well-being among legal professionals.
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Affiliation(s)
- Emily G Nielsen
- Department of Psychology & The Brain and Mind Institute, Western University, London, Ontario, Canada
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6
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Brody LR, Firpo-Perretti Y, Bruck-Segal D, Dale SK, Ruffing EG, Cassiello-Robbins C, Weber KM, Cohen MH. Positive Psychological Factors and Life Themes in Relation to Health Outcomes in Women Living with HIV. Int J Behav Med 2021; 29:469-479. [PMID: 34713412 PMCID: PMC9046468 DOI: 10.1007/s12529-021-10032-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] [Subscribe] [Scholar Register] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND This mixed methods study identified positive psychological factors and life themes expressed in autobiographical narratives of predominantly Black women living with HIV (WLWH) and investigated these in relation to depressive symptoms, antiretroviral therapy (ART) adherence (≥ 95% of time), and undetectable HIV viral load (VL) (< 80 copies/ml). METHOD Ninety-eight WLWH from the Women's Interagency HIV Study Chicago site (M age = 45.3; 91% Black) narrated three autobiographical life turning points, reliably coded for positive factors and life themes. ART adherence, VL and depressive symptoms, assessed with Center for Epidemiologic Studies Depression Scale total score (TOT) including its four factors (negative affect (NA), positive affect (PA), somatic symptoms (SS), and interpersonal problems (IP)), were collected over two time points: concurrently with narratives and 6 months later. Composite scores across the two time points were used in all analyses. RESULTS Ten positive psychological factors (gratitude, insight, compassion, meaning-making, acceptance, mindfulness, generativity, optimism, self-reliance, and benevolent God beliefs) and three positive life themes (health improvements, positive relationships, and accomplishments) were identified in narratives. Higher accomplishments, overall positive factors, insight, mindfulness, self-reliance, optimism, meaning-making, and acceptance related to lower depressive symptoms (TOT, NA, SS, or IP). Positive factors and life themes did not significantly relate to PA. Higher compassion related to higher ART adherence. Higher accomplishments related to undetectable VL independent of ART adherence. CONCLUSION Findings that positive psychological factors and life accomplishments may relate to better health, especially to lower depression, potentially contribute to developing positive psychology interventions for Black WLWH.
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Affiliation(s)
- Leslie R Brody
- Department of Psychological and Brain Sciences, Boston University, Boston, USA.
| | | | - Dana Bruck-Segal
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
| | | | - Elizabeth G Ruffing
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
| | | | - Kathleen M Weber
- Hektoen Institute of Medicine, Cook County Health and Hospitals System, Chicago, USA
| | - Mardge H Cohen
- Departments of Medicine, Stroger Hospital, Cook County Health and Hospitals System and Rush Medical School, Chicago, USA
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7
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Razzera BN, Adamoli AN, Ranheiri MF, Oliveira MDS, Feoli AMP. Impacts of mindfulness-based interventions in people undergoing hemodialysis: a systematic review. ACTA ACUST UNITED AC 2021; 44:84-96. [PMID: 34643641 PMCID: PMC8943880 DOI: 10.1590/2175-8239-jbn-2021-0116] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/01/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Chronic kidney disease (CKD) is a serious public health problem worldwide, leading to a series of physical and psychological comorbidities, in addition to costly treatments, lifestyle and dietary restrictions. There is evidence that mindfulness-based interventions (MBIs) offer complementary treatment for people with chronic illnesses, including CKD, with the aim of improving overall health, reducing side effects and treatment costs. This review aims to investigate the MBIs impact on people with CKD undergoing hemodialysis, and to identify the methodological quality of the current literature in order to support future studies. METHODS We ran searches in five databases (MEDLINE via PubMed, PsycINFO, Embase, Web of Science and Scopus) in July 2020. The papers were selected and evaluated by two reviewers independently, using predefined criteria, including the Cochrane Group's risk of bias tool and its recommendations (CRD42020192936). RESULTS Of the 175 studies found, 6 randomized controlled trials met the inclusion criteria, and ranged from 2014 to 2019. There were significant improvements in symptoms of anxiety, depression, self-efficacy, sleep quality, and quality of life (n=3) in the groups submitted to the intervention, in addition to physical measures such as blood pressure, heart rate and respiratory rate (n=1). CONCLUSIONS MBIs can offer a promising and safe complementary therapy for people with CKD undergoing hemodialysis, acting on quality of life and physical aspects of the disease.
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Affiliation(s)
- Bruno Nunes Razzera
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências da Saúde e da Vida, Programa de Pós-Graduação em Psicologia, Porto Alegre, RS, Brasil
| | - Angélica Nickel Adamoli
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências da Saúde e da Vida, Programa de Pós-Graduação em Psicologia, Porto Alegre, RS, Brasil.,Hospital de Clínicas de Porto Alegre, Serviço de Educação Física e Terapia Ocupacional de Nefrologia, Porto Alegre, RS, Brasil
| | - Maitê Freitas Ranheiri
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências da Saúde e da Vida, Programa de Pós-Graduação em Psicologia, Porto Alegre, RS, Brasil
| | - Margareth da Silva Oliveira
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências da Saúde e da Vida, Programa de Pós-Graduação em Psicologia, Porto Alegre, RS, Brasil
| | - Ana Maria Pandolfo Feoli
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências da Saúde e da Vida, Programa de Pós-Graduação em Psicologia, Porto Alegre, RS, Brasil
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8
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Castle RD, Williams MA, Bushell WC, Rindfleisch JA, Peterson CT, Marzolf J, Brouwer K, Mills PJ. Implications for Systemic Approaches to COVID-19: Effect Sizes of Remdesivir, Tocilizumab, Melatonin, Vitamin D3, and Meditation. J Inflamm Res 2021; 14:4859-4876. [PMID: 34588793 PMCID: PMC8473718 DOI: 10.2147/jir.s323356] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/28/2021] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION COVID-19 poses a chronic threat to inflammatory systems, reinforcing the need for efficient anti-inflammatory strategies. The purpose of this review and analysis was to determine the efficacy of various interventions upon the inflammatory markers most affected by COVID-19. The focus was on the markers associated with COVID-19, not the etiology of the virus itself. METHODS Based on 27 reviewed papers, information was extracted on the effects of COVID-19 upon inflammatory markers, then the effects of standard treatments (Remdesivir, Tocilizumab) and adjunctive interventions (vitamin D3, melatonin, and meditation) were extracted for those markers. These data were used to approximate effect sizes for the disease or interventions via standardized mean differences (SMD). RESULTS The data that were available indicated that adjunctive interventions affected 68.4% of the inflammatory markers impacted by COVID-19, while standard pharmaceutical medication affected 26.3%. DISCUSSION Nonstandard adjunctive care appeared to have comparable or superior effects in comparison to Remdesivir and Tocilizumab on the inflammatory markers most impacted by COVID-19. Alongside standards of care, melatonin, vitamin D3, and meditation should be considered for treatment of SARS-COV-2 infection and COVID-19 disease.
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Affiliation(s)
- Ryan D Castle
- Science Division, Whole Health Institute, Bentonville, AR, USA
| | - Michelle A Williams
- Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Harvard University, Boston, MA, USA
| | | | - J Adam Rindfleisch
- Education Department, Whole Health School of Medicine and Health Sciences, Bentonville, AR, USA
| | - Christine Tara Peterson
- Center of Excellence for Research and Training in Integrative Health, Department of Family Medicine, School of Medicine, University of California, San Diego, CA, USA
| | - James Marzolf
- Health Sector Finance & Policy, Whole Health Institute, Bentonville, AR, USA
| | - Kimberly Brouwer
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA
| | - Paul J Mills
- Herbert Wertheim School of Public Health and Human Longevity Science, Center of Excellence for Research and Training in Integrative Health, University of California, San Diego, CA, USA
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Kerrigan D, Karver TS, Barrington C, Donastorg Y, Perez M, Gomez H, Mbwambo J, Likindikoki S, Davis W, Wilson Beckham S, Mantsios A, Galai N, Sibinga E. Mindfulness, Mental Health and HIV Outcomes Among Female Sex Workers in the Dominican Republic and Tanzania. AIDS Behav 2021; 25:2941-2950. [PMID: 33511496 DOI: 10.1007/s10461-021-03168-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 10/22/2022]
Abstract
We examined the relationship between mindfulness, mental health and HIV outcomes among female sex workers (FSW) from the Dominican Republic (DR) (n = 201) and Tanzania (n = 208) using cross-sectional survey and biologic data. We employed stratified multivariate linear and logistic regression. Depression was associated with lower odds of ART adherence in the DR (AOR 0.25, 95% CI: 0.08-0.78) and of viral suppression in Tanzania (AOR 0.49, 95% CI: 0.24-0.97). In both countries, mindfulness was associated with lower odds of moderate to severe depression (AOR 0.82, 95% CI: 0.76-0.88 for the DR; AOR 0.85, 95% CI: 0.77-0.95 for Tanzania). In the DR, mindfulness was associated with lower odds of anxiety (AOR 0.83, 95% CI: 0.77-0.89), lower HIV stigma (β = - 0.28 per unit change, 95% CI: - 0.37 to - 0.19) and greater odds of viral suppression (AOR 1.09, 95% CI: 1.02-1.15). Findings demonstrate the potential of tailored mindfulness interventions to improve mental health and HIV outcomes among FSW.
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10
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Mendez NA, Mayo D, Safren SA. Interventions Addressing Depression and HIV-Related Outcomes in People with HIV. Curr HIV/AIDS Rep 2021; 18:377-390. [PMID: 34014446 PMCID: PMC8136266 DOI: 10.1007/s11904-021-00559-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW People with HIV (PWH) are more likely to experience depression than those without HIV. Depression is not only distressing and interfering in and of itself, but it is also consistently associated with non-adherence to antiretroviral treatment (ART). Accordingly, research and clinical priorities require updated knowledge about interventions that address depression in PWH. RECENT FINDINGS Twenty efficacy trials and nine pilot studies since a 2009 review emerged in the literature review search. Of these, 11 and 6 respectively had a depression-related inclusion criterion. The intervention strategies included individual psychotherapy (n=6), group therapy (n=6), telehealth (n=3), and antidepressant medication (n=5). Generally, these interventions demonstrated acute efficacy for improving depression symptoms in PWH, with some also addressing ART non-adherence. However, not all studies collected follow-up data. Furthermore, trials that addressed depression but did not specifically address non-adherence did not also show adherence improvements. Existing interventions for depression have demonstrated efficacy in PWH, and these may have both positive mental and physical health outcomes. Future trials should measure and boost longer-term effects. It would be useful to incorporate adherence interventions into depression treatment to improve self-care behaviors and health outcomes.
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Affiliation(s)
- Noelle A. Mendez
- Department of Psychology, University of Miami, Coral Gables, FL USA
| | - Daniel Mayo
- Department of Psychology, University of Miami, Coral Gables, FL USA
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, FL USA
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11
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Hunter-Jones J, Gilliam S, Davis C, Brown D, Green D, Hunter C, Carswell A, Hansen N. Process and Outcome Evaluation of a Mindfulness-Based Cognitive Therapy Intervention for Cisgender and Transgender African American Women Living with HIV/AIDS. AIDS Behav 2021; 25:592-603. [PMID: 32886219 DOI: 10.1007/s10461-020-03017-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
There is a need for evidence-based contextualized mental health interventions for persons living with HIV/AIDS. In the current study, the primary researcher conducted open trials with African American women living with HIV/AIDS (AAWLWHA) to examine the acceptability and feasibility of Project UPLIFT, a mindfulness-based cognitive therapy intervention that has demonstrated effectiveness in persons living with epilepsy. Women were recruited for a tele-delivered phone intervention group separated by gender identity, as well as participated in pre- and post-test assessments. Additionally, data on acceptability was collected. Both cis- and transgender women were highly satisfied with the intervention and demonstrated improvement in depressive and stress symptoms. The intervention seemed to be particularly feasible for cisgender women, though more qualitative mental health research may be warranted with transgender women. The current research has implications for the utility of mindfulness-based interventions such as UPLIFT, with AAWLWHA.
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Affiliation(s)
- J Hunter-Jones
- School of Social Work, University of North Carolina Wilmington, 601 S. College Rd, Wilmington, NC, 28403, USA.
| | - S Gilliam
- College of Public Health, University of Georgia, Athens, GA, USA
| | - C Davis
- School of Medicine, Emory University, Atlanta, GA, USA
| | - D Brown
- College of Public Health, University of Georgia, Athens, GA, USA
| | - D Green
- Counselor Education and Supervision, University of Holy Cross, New Orleans, LA, USA
| | - C Hunter
- Student Support Services, Mercer University, Macon, GA, USA
| | | | - N Hansen
- College of Public Health, University of Georgia, Athens, GA, USA
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12
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Jiang T, Hou J, Sun R, Dai L, Wang W, Wu H, Zhang T, Su B. Immunological and Psychological Efficacy of Meditation/Yoga Intervention Among People Living With HIV (PLWH): A Systematic Review and Meta-analyses of 19 Randomized Controlled Trials. Ann Behav Med 2020; 55:505-519. [PMID: 33119732 DOI: 10.1093/abm/kaaa084] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND An expanding number of mind-body therapies are being used to reduce the psychological burden of peoples living with human immunodeficiency virus (HIV). However, the effects on the immune system and mental health varied among studies. PURPOSE This meta-analysis was conducted to summarize the randomized controlled trials to draw comprehensive conclusions regarding the psycho-immunological efficacy. METHODS Random-effects models were used to assess the outcome of interest. Egger's tests were used to identify publication bias. Subgroup and meta-regression were used to explore potential moderators. This review was registered on the PROSPERO database (CRD42019148118). RESULTS Nineteen randomized controlled trials with a total sample size of 1,300 were included in this meta-analysis. Regarding immune system outcome, mind-body therapy significantly improved CD4 T-cell counts (Cohen's d = 0.214, p = .027) and maintained (0.427, p = .049). In addition, baseline CD4 T-cell counts and years since HIV diagnosis significantly moderated the efficacy of mind-body practices on CD4 improvement (all ps < .001). Regarding mental health outcome, mind-body therapy significantly reduced stress, depression, and anxiety symptoms (0.422, p < .001; 0.506, p < .001, and 0.709, p < .001, respectively) while improving quality of life (0.67, p < .001). CONCLUSIONS Meditation/yoga intervention could result in potential benefits with regard to improved CD4 T-cell counts immediately after the intervention and at long-term follow-up, while also improving their mental health. The cost-effective meditation/yoga intervention should be integrated into routine care for people living with HIV, especially for those with lower CD4 baseline and fewer years since diagnosis.
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Affiliation(s)
- Taiyi Jiang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Jianhua Hou
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Runsong Sun
- Department of Sociology and Social Work, School of Sociology, Beijing Normal University, Beijing, China
| | - Lili Dai
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wen Wang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Hao Wu
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Tong Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Bin Su
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
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13
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Shields GS, Spahr CM, Slavich GM. Psychosocial Interventions and Immune System Function: A Systematic Review and Meta-analysis of Randomized Clinical Trials. JAMA Psychiatry 2020; 77:1031-1043. [PMID: 32492090 PMCID: PMC7272116 DOI: 10.1001/jamapsychiatry.2020.0431] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Recent estimates suggest that more than 50% of all deaths worldwide are currently attributable to inflammation-related diseases. Psychosocial interventions may represent a potentially useful strategy for addressing this global public health problem, but which types of interventions reliably improve immune system function, under what conditions, and for whom are unknown. OBJECTIVE To address this issue, we conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) in which we estimated associations between 8 different psychosocial interventions and 7 markers of immune system function, and examined 9 potential moderating factors. DATA SOURCES PubMed, Scopus, PsycInfo, and ClinicalTrials.gov databases were systematically searched from February 1, 2017, to December 31, 2018, for all relevant RCTs published through December 31, 2018. STUDY SELECTION Eligible RCTs included a psychosocial intervention, immune outcome, and preintervention and postintervention immunologic assessments. Studies were independently examined by 2 investigators. Of 4621 studies identified, 62 were eligible and 56 included. DATA EXTRACTION AND SYNTHESIS Data were extracted and analyzed from January 1, 2019, to July 29, 2019. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed. Data were extracted by 2 investigators who were blind to study hypotheses and analyses, and were then analyzed using robust variance estimation. Analysis included 8 psychosocial interventions (behavior therapy, cognitive therapy, cognitive behavior therapy [CBT], CBT plus additive treatment or mode of delivery that augmented the CBT, bereavement or supportive therapy, multiple or combined interventions, other psychotherapy, and psychoeducation), 7 immune outcomes (proinflammatory cytokine or marker levels, anti-inflammatory cytokine levels, antibody levels, immune cell counts, natural killer cell activity, viral load, and other immune outcomes), and 9 moderating factors (intervention type, intervention format, intervention length, immune marker type, basal vs stimulated markers, immune marker measurement timing, disease state or reason for treatment, age, and sex). MAIN OUTCOMES AND MEASURES The primary a priori outcomes were pretest-posttest-control (ppc) group effect sizes (ppc g) for the 7 immunologic outcomes investigated. RESULTS Across 56 RCTs and 4060 participants, psychosocial interventions were associated with enhanced immune system function (ppc g = 0.30, 95% CI, 0.21-0.40; t50.9 = 6.22; P < .001). Overall, being randomly assigned to a psychosocial intervention condition vs a control condition was associated with a 14.7% (95% CI, 5.7%-23.8%) improvement in beneficial immune system function and an 18.0% (95% CI, 7.2%-28.8%) decrease in harmful immune system function over time. These associations persisted for at least 6 months following treatment and were robust across age, sex, and intervention duration. These associations were most reliable for CBT (ppc g = 0.33, 95% CI, 0.19-0.47; t27.2 = 4.82; P < .001) and multiple or combined interventions (ppc g = 0.52, 95% CI, 0.17-0.88; t5.7 = 3.63; P = .01), and for studies that assessed proinflammatory cytokines or markers (ppc g = 0.33, 95% CI, 0.19-0.48; t25.6 = 4.70; P < .001). CONCLUSIONS AND RELEVANCE These findings suggest that psychosocial interventions are reliably associated with enhanced immune system function and may therefore represent a viable strategy for improving immune-related health.
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Affiliation(s)
| | - Chandler M. Spahr
- Department of Psychology, San Diego State University, San Diego, California
| | - George M. Slavich
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
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14
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Positively Mindful: A Mixed Method Feasibility Study of Mindfulness Meditation for People Living with HIV in the UK. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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Carey MP, Dunne EM, Norris A, Dunsiger S, Rich C, Rosen RK, Chan P, Salmoirago-Blotcher E. Telephone-Delivered Mindfulness Training to Promote Medication Adherence and Reduce Sexual Risk Behavior Among Persons Living with HIV: An Exploratory Clinical Trial. AIDS Behav 2020; 24:1912-1928. [PMID: 31848765 PMCID: PMC9707639 DOI: 10.1007/s10461-019-02768-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This study explored whether telephone-delivered mindfulness training (MT) to promote medication adherence and reduce sexual risk behavior was feasible for and acceptable to people living with HIV. Participants (N = 42; 50% female; M age = 47.5 years) were randomized to MT or health coaching (HC). Pre- and post-intervention, and at 3-month follow-up, we assessed adherence to ART, sexual risk behavior, and hypothesized mediators; we also conducted individual interviews to obtain qualitative data. Results showed that 55% of patients assigned to MT completed ≥ 50% of the training calls compared with 86% of HC patients (p < .05). Most patients reported satisfaction with their intervention (MT = 88%, HC = 87%). Patients in MT and HC reported improvements in medication adherence, mindfulness, and sexual risk reduction as well as reductions in anxiety, depressive symptoms, perceived stress, and impulsivity over time; however, no between-groups differences were observed.
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Affiliation(s)
- Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02903, USA.
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, USA.
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, USA.
| | - Eugene M Dunne
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, USA
| | - Alyssa Norris
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, USA
| | - Shira Dunsiger
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02903, USA
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, USA
| | - Carla Rich
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02903, USA
| | - Rochelle K Rosen
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02903, USA
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, USA
| | - Philip Chan
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, USA
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, USA
| | - Elena Salmoirago-Blotcher
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02903, USA
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, USA
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16
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Testing Mindful Awareness as a Moderator in the Association Between HIV-Related Stress and Drug and Alcohol Use Problems Among People Living with HIV. Mindfulness (N Y) 2020; 11:1159-1169. [PMID: 34306246 DOI: 10.1007/s12671-020-01315-8] [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: 10/25/2022]
Abstract
Objectives People living with HIV (PLWH) are disproportionately affected by stressful life events. HIV-related stress adds to general life stressors to increase health risks among this population. Stress has not only been associated with HIV progression but it is also linked to HIV transmission risk behavior (e.g., substance use). Older adults living with HIV (OALWH) experience additional age-related stress and are at increased risk for substance use. Mindfulness buffers against stress for PLWH; however, research has yet to examine mindfulness as a buffer between HIV-related stress and substance use for OALWH. Methods Participants were 130 OALWH (M age = 54.65, SD = 4.20) and 74.6% were Black. The majority were male (69.2%), and nearly half identified as heterosexual (48.5%). A hierarchical linear regression examined the main and interactive effects of mindful awareness and two types of HIV-related stress (e.g., stigma and rumination) on alcohol and drug use problems. Results In step one of the model, we examined HIV stigma (β = .231, p = .015) and found no significant interaction with mindful awareness. In step two, HIV rumination (β = .288, p = .001) was added. We found a significant interaction (β = .196, p = .020), indicating those with low mindful awareness and high rumination reported the greatest substance use problems. Exploratory analyses revealed an indirect effect of HIV stigma on substance use through HIV rumination as well as a significant effect for second-stage moderated mediation. Conclusions These findings support mindful awareness as a buffer against HIV rumination for OALWH. Further, our results have important implications for the utility of mindfulness-based interventions (MBIs) with OALWH and comorbid substance use disorders.
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Valikhani A, Kashani VO, Rahmanian M, Sattarian R, Rahmati Kankat L, Mills PJ. Examining the mediating role of perceived stress in the relationship between mindfulness and quality of life and mental health: testing the mindfulness stress buffering model. ANXIETY STRESS AND COPING 2020; 33:311-325. [DOI: 10.1080/10615806.2020.1723006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Ahmad Valikhani
- Department of Clinical Psychology, School of Education and Psychology, Shiraz University, Shiraz, Iran
| | - Vali Ollah Kashani
- Faculty of Human Sciences, Department of Physical Education, Semnan University, Semnan, Iran
| | | | - Rafat Sattarian
- Department of Psychology, School of Humanities, Urmia University, Urmia, Iran
| | - Leila Rahmati Kankat
- Faculty of Humanities, Department of Clinical Psychology, Islamic Azad University of Arak, Arak, Iran
| | - Paul J. Mills
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
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18
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Asensio-Martínez Á, Oliván-Blázquez B, Montero-Marín J, Masluk B, Fueyo-Díaz R, Gascón-Santos S, Gudé F, Gónzalez-Quintela A, García-Campayo J, Magallón-Botaya R. Relation of the Psychological Constructs of Resilience, Mindfulness, and Self-Compassion on the Perception of Physical and Mental Health. Psychol Res Behav Manag 2019; 12:1155-1166. [PMID: 31920412 PMCID: PMC6939394 DOI: 10.2147/prbm.s225169] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/13/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose Health factors that enhance an individual’s ability to perceive and maintain health and well-being are referred to as “health assets”. Of these assets, resilience, mindfulness and self-compassion are considered to be of special importance. The objective of this study was to analyze the association between these psychological constructs on the perception of physical and mental health in a general population. Patients and methods A descriptive and analytical cross-sectional study was conducted with 845 participating subjects. The outcome variable was the individual´s perception of physical and mental health, measured using the SF-36 questionnaire. The independent variables were: sociodemographic variables, medical information, physical activity performance (using the International Physical Activity Questionnaire), tobacco and alcohol consumption, anxiety and/or depression (using the Goldberg Anxiety and Depression Scale), resilience (using the Connor-Davidson Resilience Scale), mindfulness (with the Five Facets of Mindfulness Questionnaire Short Form) and self-compassion (using the Self-compassion scale-short form). A correlation analysis, simple linear regression and multiple linear regression were carried out, controlling for the influence of the distinct independent variables. Results The constructs of resilience, mindfulness and self-compassion are significant, in the perception of both physical and mental health. Other factors appearing in the multiple regression are gender, age, educational level, physical activity and tobacco consumption, in a positive or negative sense. Conclusion The study of these associations is fundamental for the understanding of underlying regulation processes of healthy lifestyles in the general population.
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Affiliation(s)
- Ángela Asensio-Martínez
- Research Network on Preventive Activities and Health Promotion (RedIAPP), Zaragoza 50009, Spain.,Health Research Institute of Aragon, Zaragoza 50009, Spain.,Department of Psychology and Sociology, University of Zaragoza, Zaragoza 50005, Spain
| | - Bárbara Oliván-Blázquez
- Research Network on Preventive Activities and Health Promotion (RedIAPP), Zaragoza 50009, Spain.,Health Research Institute of Aragon, Zaragoza 50009, Spain.,Department of Psychology and Sociology, University of Zaragoza, Zaragoza 50005, Spain
| | - Jesús Montero-Marín
- Research Network on Preventive Activities and Health Promotion (RedIAPP), Zaragoza 50009, Spain.,Health Research Institute of Aragon, Zaragoza 50009, Spain
| | - Bárbara Masluk
- Research Network on Preventive Activities and Health Promotion (RedIAPP), Zaragoza 50009, Spain.,Health Research Institute of Aragon, Zaragoza 50009, Spain.,Department of Psychology and Sociology, University of Zaragoza, Zaragoza 50005, Spain
| | - Ricardo Fueyo-Díaz
- Health Research Institute of Aragon, Zaragoza 50009, Spain.,Department of Psychology and Sociology, University of Zaragoza, Zaragoza 50005, Spain
| | - Santiago Gascón-Santos
- Research Network on Preventive Activities and Health Promotion (RedIAPP), Zaragoza 50009, Spain.,Health Research Institute of Aragon, Zaragoza 50009, Spain.,Department of Psychology and Sociology, University of Zaragoza, Zaragoza 50005, Spain
| | - Francisco Gudé
- Research Network on Preventive Activities and Health Promotion (RedIAPP), Zaragoza 50009, Spain.,Clinical Epidemiology Unit, Santiago de Compostela Hospital, Santiago de Compostela 15706, Spain
| | - Arturo Gónzalez-Quintela
- Research Network on Preventive Activities and Health Promotion (RedIAPP), Zaragoza 50009, Spain.,Departamento de Medicina Interna, Santiago de Compostela Hospital, Santiago de Compostela 15706, Spain
| | - Javier García-Campayo
- Research Network on Preventive Activities and Health Promotion (RedIAPP), Zaragoza 50009, Spain.,Health Research Institute of Aragon, Zaragoza 50009, Spain.,Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza 50009, Spain
| | - Rosa Magallón-Botaya
- Research Network on Preventive Activities and Health Promotion (RedIAPP), Zaragoza 50009, Spain.,Health Research Institute of Aragon, Zaragoza 50009, Spain.,Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza 50009, Spain
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19
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Depressive symptoms, physical symptoms, and health-related quality of life among older adults with HIV. Qual Life Res 2019; 28:3313-3322. [PMID: 31446515 DOI: 10.1007/s11136-019-02271-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE In the United States, approximately 45% of persons living with HIV (PLHIV) are ≥ 50 years of age. Many older PLHIV have multi-morbidities that complicate HIV infection and/or interfere with, or are exacerbated by, antiretroviral treatment. Physical health symptoms and psychiatric disorders, particularly depression, can worsen life quality in older PLHIV. METHODS This study assessed associations among physical symptoms, indicators of HIV-related health status (i.e., time since diagnosis; ever diagnosed with AIDS; having attained viral suppression), depressive symptoms, and health-related quality of life (HRQoL) in older PLHIV. Regression analyses examined data from 296 PLHIV ≥ 50 years of age living in Cincinnati, OH, Columbus, OH, and New York City. RESULTS Depressive symptoms and physical symptoms, particularly those related to appearance and sexual functioning, most strongly predicted HRQoL. Indicators of HIV health status did not significantly predict HRQoL. Depressive symptoms were a particularly robust predictor of HRQoL, even when accounting for physical health symptoms. CONCLUSION Findings suggest that symptom management is critical to HRQoL in older PLHIV, and symptoms related to physical appearance and sexual functioning should not be overlooked in this growing population.
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20
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Hunter-Jones JJ, Gilliam SM, Carswell AL, Hansen NB. Assessing the Acceptability of a Mindfulness-Based Cognitive Therapy Intervention for African-American Women Living with HIV/AIDS. J Racial Ethn Health Disparities 2019; 6:1157-1166. [PMID: 31332688 DOI: 10.1007/s40615-019-00617-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/01/2019] [Accepted: 07/11/2019] [Indexed: 11/24/2022]
Abstract
African-American HIV-seropositive women are at elevated risk for depressive symptoms compared to their seropositive counterparts. Depressive symptoms have been linked to HIV/AIDS-related health predictors and outcomes such as medication and care adherence, and viral load. Project UPLIFT, a mindfulness-based cognitive therapy intervention originally designed for persons with epilepsy has been shown effective to reduce depressive and anxiety symptoms. Focus groups were conducted to assess the appropriateness and acceptability of UPLIFT for African-American HIV-seropositive women and to obtain feedback on needed modifications. The focus groups, including cisgender and transgender African-American HIV-seropositive women, revealed, while well received, modifications should include lowering the reading level of content and altering specific mindfulness-based exercises to make them relevant and acceptable to the target population. This qualitative work demonstrates UPLIFT could be a promising avenue to improve the mental health of African-American HIV-seropositive women, a group for which mindfulness interventions had not been previously considered. SIGNIFICANCE: Mindfulness-based interventions have been found effective in reducing depression, anxiety, and chronic pain. Further, it has been used for groups living with chronic illness, particularly HIV/AIDS. It has helped to improve mental and behavioral health, as well as increase CD4 count and reduce viral load for some samples of people living with HIV/AIDS. African-American women living with HIV/AIDS are especially vulnerable to poor mental and behavioral health given their experience of mental illness and hesitancy to engage mental healthcare. Though used for other groups of people living with HIV/AIDS, mindfulness-based cognitive therapy has not previously been considered for this population. This study explored the acceptability and feasibility of an MBCT intervention for this group. The data suggests that this intervention could be potentially useful in improving the mental health of this population, and includes suggestions for making the intervention culturally relevant.
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Affiliation(s)
- Josalin J Hunter-Jones
- SSchool of Social Work, College of Health and Human Sciences, University of North Carolina Wilmington, Wilmington, NC, USA.
| | - Shantesica M Gilliam
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA, USA
| | | | - Nathan B Hansen
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA, USA
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Asensio-Martínez Á, Masluk B, Montero-Marin J, Olivan-Blázquez B, Navarro-Gil MT, García-Campayo J, Magallón-Botaya R. Validation of Five Facets Mindfulness Questionnaire - Short form, in Spanish, general health care services patients sample: Prediction of depression through mindfulness scale. PLoS One 2019; 14:e0214503. [PMID: 30939151 PMCID: PMC6445454 DOI: 10.1371/journal.pone.0214503] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 03/14/2019] [Indexed: 01/22/2023] Open
Abstract
The validation of Five Facets Mindfulness Questionnaire (FFMQ)-short version was performed in a general population of a city in a region of Galicia (Spain), the sample was composed of randomly selected Spanish Health Care patients (N = 845). The results on the goodness of fit of the non-hierarchical, five-dimensional factorial model met the criteria for good and acceptable model adjustment (after eliminating item 18 and despite the correlations detected among the errors included in the model), explaining a 55.5%.of the variance. As the second objective has been analysed the association between the scores obtained in the different facets of the FFMQ-SF and the risk of suffering an episode of depression. (The Odd Ratio, the Hosmer-Lemeshow test and the ROC curve were calculated.) Participants who were currently suffering from an episode of depression were more likely to have low scores in "describing" facet of Mindfulness (adjusted OR = 1.58, 95% CI = 1.04-2.40, linear trend: χ2 = 3.74, df = 1, p = 0.053) as well as low scores on "acting with awareness" (adjusted OR = 2.19, 95% CI = 1.461-3.30, linear trend: χ2 = 9.52, df = 1; = 0.002) and "non judging" (adjusted OR = 2.05, 95% CI = 1.36-3.09, linear trend: χ2 = 143.21, df = 1; p <0.001). Participants with a previous episode of depression were more likely to have low scores on the subscale "acting with awareness" (adjusted OR = 2.37, 95% CI = 1.43-3.93, linear trend: χ2 = 9.62, df = 1, p = 0.002) and "non-reactivity" (adjusted OR = 2.14, 95% CI = 1.28-3.56, linear trend: χ2 = 8.30; df = 1; p = 0.004. Questionnaire FFMQ-SF is an adequate questionnaire for the evaluation of mindfulness in non-clinical multi- occupational population.
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Affiliation(s)
- Ángela Asensio-Martínez
- Research Network in preventive activities and health promotion RedIAPP, Barcelona, Spain
- Health Research Institute of Aragon, Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Barbara Masluk
- Research Network in preventive activities and health promotion RedIAPP, Barcelona, Spain
- Health Research Institute of Aragon, Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Jesus Montero-Marin
- Research Network in preventive activities and health promotion RedIAPP, Barcelona, Spain
- Health Research Institute of Aragon, Zaragoza, Spain
- * E-mail:
| | - Bárbara Olivan-Blázquez
- Research Network in preventive activities and health promotion RedIAPP, Barcelona, Spain
- Health Research Institute of Aragon, Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Maria Teresa Navarro-Gil
- Research Network in preventive activities and health promotion RedIAPP, Barcelona, Spain
- Health Research Institute of Aragon, Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Javier García-Campayo
- Research Network in preventive activities and health promotion RedIAPP, Barcelona, Spain
- Health Research Institute of Aragon, Zaragoza, Spain
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
| | - Rosa Magallón-Botaya
- Research Network in preventive activities and health promotion RedIAPP, Barcelona, Spain
- Health Research Institute of Aragon, Zaragoza, Spain
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
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Abstract
OBJECTIVE There has been substantial research and public interest in mindfulness interventions, biological pathways, and health for the past two decades. This article reviews recent developments in understanding relationships between mindfulness interventions and physical health. METHODS A selective review was conducted with the goal of synthesizing conceptual and empirical relationships between mindfulness interventions and physical health outcomes. RESULTS Initial randomized controlled trials in this area suggest that mindfulness interventions can improve pain management outcomes among chronic pain populations, and there is preliminary evidence for mindfulness interventions improving specific stress-related disease outcomes in some patient populations (i.e., clinical colds, psoriasis, irritable bowel syndrome, posttraumatic stress disorder, diabetes, HIV). We offer a stress-buffering framework for the observed beneficial effects of mindfulness interventions and summarize supporting biobehavioral and neuroimaging studies that provide plausible mechanistic pathways linking mindfulness interventions with positive physical health outcomes. CONCLUSIONS We conclude with new opportunities for research and clinical implementations to consider in the next two decades.
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Thomas KH, McDaniel JT, Diehr AJ, Hunter K. Mindful Living with Human Immunodeficiency Virus and AIDS: Behavioral Medicine for Patient Resilience and Improved Screening Practices. Nurs Clin North Am 2019; 53:35-46. [PMID: 29362059 DOI: 10.1016/j.cnur.2017.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Complementary techniques are useful in treating adverse symptoms of human immunodeficiency virus (HIV) and AIDS, and in preventing disease spread by encouraging screening. This study indicates that HIV diagnosis rates are higher in states where behavioral medicine is practiced; participation in such activities may influence the extent to which someone might closely monitor personal health. A strong evidence-base exists for the recommendation of mindfulness practices that improve rates of primary preventive practices and self-reported quality of life for participants living with chronic conditions such as HIV and AIDS. Access to such programs is an area for future research and practice.
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Affiliation(s)
- Kate Hendricks Thomas
- Charleston Southern University, CSU College of Health Sciences, 9200 University Boulevard, Charleston, SC 29410, USA.
| | - Justin T McDaniel
- Southern Illinois University, 475 Clocktower Drive Mail Code #4632, Carbondale, IL 62901, USA
| | - Aaron J Diehr
- HIV/AIDS Section, American Public Health Association, Public Health and Recreation Professions, Southern Illinois University, 475 Clocktower Drive Mail Code #4632, Carbondale, IL 62901, USA
| | - Kyleanne Hunter
- Josef Korbel School of International Studies, University of Denver, 2199 S University Boulevard, Denver, CO 80208, USA
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Schneiderman N, McIntosh RC, Antoni MH. Psychosocial risk and management of physical diseases. J Behav Med 2019; 42:16-33. [PMID: 30632000 PMCID: PMC6941845 DOI: 10.1007/s10865-018-00007-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 12/18/2018] [Indexed: 12/24/2022]
Abstract
During the 40 years since the Yale conference on Behavioral Medicine and the founding of the Journal of Behavioral Medicine considerable progress has been made in understanding the role of psychosocial risk and management of physical diseases. We here describe the development of these fundamental concepts from early research on stress through studies of the Type A behavior pattern to more contemporary approaches to the relationship between psychosocial risks and benefits in relation to disease processes. This includes the relationship of psychosocial risk to cancers, cardiovascular diseases (CVD), cardiometabolic disorders, Human Immunodeficiency Virus (HIV)/Acquired Human Immune Deficiency Syndrome. During the past 40 years the effects of prolonged distress responses in the pathogenesis of some cancers and CVD have been well-established and modifiable behavioral, cognitive and social factors have been shown to produce favorable outcome components in the management of such diseases as breast cancer, coronary heart disease and HIV.
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Affiliation(s)
- Neil Schneiderman
- Health Division, Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL, 33124, USA.
| | - Roger C McIntosh
- Health Division, Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL, 33124, USA
| | - Michael H Antoni
- Health Division, Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL, 33124, USA
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Rubtsova AA, Marquine MJ, Depp C, Holstad M, Ellis RJ, Letendre S, Jeste DV, Moore DJ. Psychosocial Correlates of Frailty Among HIV-Infected and HIV-Uninfected Adults. Behav Med 2019; 45:210-220. [PMID: 30431403 PMCID: PMC6612538 DOI: 10.1080/08964289.2018.1509053] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Frailty is a geriatric condition characterized by increased vulnerability to physical impairments and limitations that may lead to disabilities and mortality. Although studies in the general population suggest that psychosocial factors affect frailty, less is known about whether similar associations exist among people living with HIV (PLWH). The purpose of this study was to examine psychosocial correlates of frailty among PLWH and HIV-uninfected adults. Our sample included 127 adults (51% PLWH) participating in the Multi-Dimensional Successful Aging among HIV-Infected Adults study at the University of California San Diego (average age 51 years, 80% male, 53% White). Frailty was assessed via the Fried Frailty Index. Psychosocial variables significant in bivariate models were included in principal component analysis to generate factor variables summarizing psychosocial correlates. Multivariate logistic regression models were fit to examine the independent effects of factor variables and their interaction terms with HIV status. In bivariate models, frailty was associated with multiple psychosocial variables, for example, grit, optimism, personal mastery, social support, emotional support. Factor analysis revealed that psychosocial variables loaded on two factors-Positive Resources/Outlook and Support by Others. The multivariate model showed significant main effects of Support by Others and HIV status, and interactive effects HIV X Positive Resources/Outlook, such that Positive Resources/Outlook was negatively associated with frailty for PLWH but not for HIV-uninfected individuals. These analyses indicate that psychosocial factors may be associated with frailty among PLWH. Positive resources and outlook may play a role in frailty prevention. Future longitudinal studies are needed to establish causal links.
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Affiliation(s)
- Anna A. Rubtsova
- Department of Behavioral Sciences and Health Education,
Emory University Rollins School of Public Health, Atlanta, GA
| | - María J. Marquine
- Department of Psychiatry, University of California, San
Diego, CA,Sam and Rose Stein Institute for Research on Aging,
University of California, San Diego, CA,HIV Neurobehavioral Research Program, University of
California, San Diego
| | - Colin Depp
- Department of Psychiatry, University of California, San
Diego, CA,Sam and Rose Stein Institute for Research on Aging,
University of California, San Diego, CA
| | - Marcia Holstad
- Emory University Nell Hodgson Woodruff School of Nursing,
Atlanta, GA
| | - Ronald J. Ellis
- Department of Neuroscience, University of California, San
Diego, CA,HIV Neurobehavioral Research Program, University of
California, San Diego
| | - Scott Letendre
- Department of Medicine, University of California, San
Diego, CA,HIV Neurobehavioral Research Program, University of
California, San Diego
| | - Dilip V. Jeste
- Department of Psychiatry, University of California, San
Diego, CA,Department of Neuroscience, University of California, San
Diego, CA,Sam and Rose Stein Institute for Research on Aging,
University of California, San Diego, CA
| | - David J. Moore
- Department of Psychiatry, University of California, San
Diego, CA,HIV Neurobehavioral Research Program, University of
California, San Diego
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26
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Vance DE, Blake BJ, Brennan-Ing M, DeMarco RF, Fazeli PL, Relf MV. Revisiting Successful Aging With HIV Through a Revised Biopsychosocial Model: An Update of the Literature. J Assoc Nurses AIDS Care 2019; 30:5-14. [PMID: 30586079 DOI: 10.1097/jnc.0000000000000029] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The concept of successful aging was recognized only recently by HIV researchers because people living with HIV (PLWH) in the early epidemic were not expected to survive. With the introduction of antiretrovirals that block viral replication, PLWH are now aging with HIV. Given the complex nature of HIV within the social, economic, and political climates in which it occurs, a holistic model of successful aging is needed to guide researchers and clinicians. Several overarching models exist, but must be updated for rapidly advancing HIV and aging research agendas. We provide an updated, adapted, and integrated biopsychosocial model of successful aging with HIV based on the principles of Baltes and Baltes (1998) on 8 essential components of successful aging: (a) length of life, (b) biological health, (c) mental health, (d) cognitive efficiency, (e) social competence, (f) productivity, (g) personal control, and (h) life satisfaction. Clinical practice and research implications are highlighted.
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27
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Scott-Sheldon LAJ, Balletto BL, Donahue ML, Feulner MM, Cruess DG, Salmoirago-Blotcher E, Wing RR, Carey MP. Mindfulness-Based Interventions for Adults Living with HIV/AIDS: A Systematic Review and Meta-analysis. AIDS Behav 2019; 23:60-75. [PMID: 30054765 PMCID: PMC6344266 DOI: 10.1007/s10461-018-2236-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This meta-analysis examined the effects of mindfulness-based interventions (MBIs) on stress, psychological symptoms, and biomarkers of disease among people living with HIV/AIDS (PLWHA). Comprehensive searches identified 16 studies that met the inclusion criteria (N = 1059; M age = 42 years; 20% women). Participants had been living with HIV for an average of 8 years (range = < 1-20 years); 65% were currently on antiretroviral therapy. Between-group analyses indicated that depressive symptoms were reduced among participants receiving the MBIs compared to controls (d+ = 0.37, 95% CI 0.03, 0.71). Within-group analyses showed reductions in psychological symptoms (i.e., less anxiety, fewer depressive symptoms) and improved quality of life over time among MBI participants (d+s = 0.40-0.85). No significant changes were observed for immunological outcomes (i.e., CD4 counts) between- or within-groups. MBIs may be a promising approach for reducing psychological symptoms and improving quality of life among PLWHA. Studies using stronger designs (i.e., randomized controlled trials) with larger sample sizes and longer follow-ups are needed to clarify the potential benefits of MBIs for PLWHA.
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Affiliation(s)
- Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA.
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
| | - Brittany L Balletto
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Marissa L Donahue
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Melissa M Feulner
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Dean G Cruess
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Elena Salmoirago-Blotcher
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
- Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Rena R Wing
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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Mindfulness-based intervention among People living with HIV/AIDS: A Systematic Review. Complement Ther Clin Pract 2018; 33:12-19. [PMID: 30396609 DOI: 10.1016/j.ctcp.2018.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/10/2018] [Indexed: 12/11/2022]
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Knight L, Mukumbang FC, Schatz E. Behavioral and cognitive interventions to improve treatment adherence and access to HIV care among older adults in sub-Saharan Africa: an updated systematic review. Syst Rev 2018; 7:114. [PMID: 30071903 PMCID: PMC6090879 DOI: 10.1186/s13643-018-0759-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 06/24/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Approximately 14% of Africans infected with HIV are over the age of 50, yet few intervention studies focus on improving access to care, retention in care, and adherence to antiretroviral therapy (ART) in this population. A review of the published literature until 2012, found no relevant ART management and care interventions for older people living with HIV (OPLHIV) in sub-Saharan Africa. The aim of this systematic review is to update the original systematic review of intervention studies on OPLHIV, with a focus on evidence from sub-Saharan Africa. METHODS We conducted a systematic review of the available published literature from 2012 to 2017 to explore behavioral and cognitive interventions addressing access to ART, retention in HIV care and adherence to ART in sub-Saharan Africa that include older adults (50+). We searched three databases (MEDLINE, EMBASE, and Education Resources Information Center) using relevant Medical Subject Headings (MeSH) terms as well as a manual search of the reference lists. No language restrictions were placed. We identified eight articles which were analyzed using content analysis with additional information obtained directly from the corresponding authors. RESULTS AND DISCUSSION There were no studies that exclusively focused on OPLHIV. Three studies referred only to participants being over 18 years and did not specify age categories. Therefore, it is unclear whether these studies actively considered people living with HIV over the age of 50. Although the studies sampled older adults, they lacked sufficient data to draw conclusions about the relevance of the outcomes of this group. CONCLUSIONS These findings underscore the need to increase the evidence-base of which interventions will work for older Africans on ART.
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Affiliation(s)
- Lucia Knight
- School of Public Health, University of the Western Cape, P Bag X17, Bellville, 7535, South Africa
| | - Ferdinand C Mukumbang
- School of Public Health, University of the Western Cape, P Bag X17, Bellville, 7535, South Africa.
| | - Enid Schatz
- Department of Health Sciences and Department of Women's and Gender Studies, University of Missouri, Columbia, USA
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30
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McIntyre TL, Elkonin D, de Kooker M, Magidson JF. The application of mindfulness for individuals living with HIV in South Africa: A hybrid effectiveness-implementation pilot study. Mindfulness (N Y) 2018; 9:871-883. [PMID: 30079121 PMCID: PMC6070157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Despite the recent growth of mindfulness research worldwide, there remains little research examining the application of mindfulness-based interventions in resource-limited, international settings. This study examined the application of Mindfulness Based Stress Reduction (MBSR) for HIV-infected individuals in South Africa, where rates of HIV are highest in the world. Mixed methods were used to examine the following over a three-month follow up: (1) feasibility, acceptability, and preliminary adaptation of MBSR for this new context; and (2) effects of MBSR on immune functioning, self-reported mindfulness (MAAS, FFMQ), depression, anxiety, and stress (DASS-21). Ten individuals initiated MBSR, and seven completed all eight sessions. Results indicated medium effect size improvements in immune functioning (CD4 count and t-cell count; d = .5) through the three-month follow up, though the small sample size limited power to detect a statistically significant effect. From baseline to post-treatment, improvements in "Observing" and "Non-reactivity" (FFMQ) approached statistical significance with large effect sizes (observing: d = 1.5; p = .08; non-reactivity: d = .7; p = .07). There were no statistically significant changes in depression, anxiety, or stress throughout the study period. Primary areas for adaptation of MBSR included emphasis on informal practice, ways to create "space" without much privacy, and ways to concretize the concepts and definitions of mindfulness. Feedback from participants can shape future adaptations to MBSR for this and similar populations. Findings provide preliminary evidence regarding the implementation of MBSR for individuals living with HIV in South Africa. A future randomized clinical trial with a larger sample size is warranted.
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Affiliation(s)
- Tracy-Leigh McIntyre
- Department of Psychology, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - Diane Elkonin
- Department of Psychology, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - Margo de Kooker
- Department of Psychology, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - Jessica F. Magidson
- Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
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31
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Webb L, Perry-Parrish C, Ellen J, Sibinga E. Mindfulness instruction for HIV-infected youth: a randomized controlled trial. AIDS Care 2017; 30:688-695. [PMID: 29067834 DOI: 10.1080/09540121.2017.1394434] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
HIV-infected youth experience many stressors, including stress related to their illness, which can negatively impact their mental and physical health. Therefore, there is a significant need to identify potentially effective interventions to improve stress management, coping, and self-regulation. The object of the study was to assess the effect of a mindfulness-based stress reduction (MBSR) program compared to an active control group on psychological symptoms and HIV disease management in youth utilizing a randomized controlled trial. Seventy-two HIV-infected adolescents, ages 14-22 (mean age 18.71 years), were enrolled from two urban clinics and randomized to MBSR or an active control. Data were collected on mindfulness, stress, self-regulation, psychological symptoms, medication adherence, and cognitive flexibility at baseline, post-program, and 3-month follow-up. CD4+ T lymphocyte and HIV viral load (HIV VL) counts were also pulled from medical records. HIV-infected youth in the MBSR group reported higher levels of mindfulness (P = .03), problem-solving coping (P = .03), and life satisfaction (P = .047), and lower aggression (P = .002) than those in the control group at the 3-month follow-up. At post-program, MBSR participants had higher cognitive accuracy when faced with negative emotion stimuli (P = .02). Also, those in the MBSR study arm were more likely to have or maintain reductions in HIV VL at 3-month follow-up than those in the control group (P = .04). In our sample, MBSR instruction proved beneficial for important psychological and HIV-disease outcomes, even when compared with an active control condition. Lower HIV VL levels suggest improved HIV disease control, possibly due to higher levels of HIV medication adherence, which is of great significance in both HIV treatment and prevention. Additional research is needed to explore further the role of MBSR for improving the psychological and physical health of HIV-positive youth.
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Affiliation(s)
- Lindsey Webb
- a Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Carisa Perry-Parrish
- b Child and Adolescent Psychiatry , Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Jonathan Ellen
- c Pediatrics , Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Erica Sibinga
- c Pediatrics , Johns Hopkins School of Medicine , Baltimore , MD , USA
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32
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Salmoirago-Blotcher E, Rich C, Rosen RK, Dunsiger S, Rana A, Carey MP. Phone-delivered mindfulness training to promote medication adherence and reduce sexual risk behavior among persons living with HIV: Design and methods. Contemp Clin Trials 2016; 53:162-170. [PMID: 28017907 DOI: 10.1016/j.cct.2016.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 12/14/2016] [Accepted: 12/18/2016] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Two-thirds of people living with HIV (PLWH) show sub-optimal adherence to antiretroviral therapy (ART) and one-third engages in risky sex. Both non-adherence and risky sex have been associated with emotional distress and impulsivity. To allay distress and lessen impulsivity, mindfulness training (MT) can be helpful. In this trial, we will investigate the utility of phone-delivered MT for PWLH. The primary outcomes comprise feasibility and acceptability of phone-delivery; secondary outcomes are estimates of efficacy of MT on adherence to ART and safer sexual practices as well as on their hypothesized antecedents. METHODS/DESIGN Fifty participants will be enrolled in this parallel-group randomized clinical trial (RCT). Outpatients recruited from an HIV treatment clinic will be randomized (1:1 ratio) to either MT or to an attention-control intervention; both interventions will be administered during 8 weekly phone calls. ART adherence (self-reported measure and unannounced phone pill counts), sexual behavior (self-reports and biomarkers), mindfulness, depression, stress, and impulsivity will be measured at baseline, post-intervention, and 3months post-intervention. CONCLUSIONS MT has great potential to help PLWH to manage stress, depressive symptoms, and impulsivity. Positive changes in these antecedents are expected to improve safer sex practices and ART adherence. If results from this exploratory trial support our hypotheses, we will conduct a large RCT to test (a) the efficacy of MT on ART adherence and safer sex practices and (b) the hypothesis that improved ART adherence and safer sex will reduce viral load, and decrease the incidence of sexually transmitted infections, respectively.
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Affiliation(s)
- Elena Salmoirago-Blotcher
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02903, United States; Department of Medicine, The Warren Alpert Medical School of Brown University, United States.
| | - Carla Rich
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02903, United States
| | - Rochelle K Rosen
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02903, United States; Department of Behavioral and Social Science, School of Public Health, Brown University, United States
| | - Shira Dunsiger
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02903, United States; Department of Behavioral and Social Science, School of Public Health, Brown University, United States
| | - Aadia Rana
- Department of Medicine, The Warren Alpert Medical School of Brown University, United States
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02903, United States; Department of Behavioral and Social Science, School of Public Health, Brown University, United States; Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, United States
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33
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Abstract
Mindfulness interventions aim to foster greater attention to and awareness of present moment experience. There has been a dramatic increase in randomized controlled trials (RCTs) of mindfulness interventions over the past two decades. This article evaluates the growing evidence of mindfulness intervention RCTs by reviewing and discussing (a) the effects of mindfulness interventions on health, cognitive, affective, and interpersonal outcomes; (b) evidence-based applications of mindfulness interventions to new settings and populations (e.g., the workplace, military, schools); (c) psychological and neurobiological mechanisms of mindfulness interventions; (d) mindfulness intervention dosing considerations; and (e) potential risks of mindfulness interventions. Methodologically rigorous RCTs have demonstrated that mindfulness interventions improve outcomes in multiple domains (e.g., chronic pain, depression relapse, addiction). Discussion focuses on opportunities and challenges for mindfulness intervention research and on community applications.
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Affiliation(s)
- J David Creswell
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213;
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34
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Fumaz CR, Ayestaran A, Perez-Alvarez N, Muñoz-Moreno JA, Ferrer MJ, Negredo E, Clotet B. Clinical and Emotional Factors Related to Erectile Dysfunction in HIV-Infected Men. Am J Mens Health 2016; 11:647-653. [PMID: 27645512 PMCID: PMC5675217 DOI: 10.1177/1557988316669041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The prevalence and associated factors of erectile dysfunction (ED) in Human Immunodeficiency Virus (HIV)–infected men remain controversial. The authors evaluated ED, clinical, and emotional variables in a group of 501 HIV-infected men in a cross-sectional 4-month observational study. ED was assessed using the International Index of Erectile Function–5 and emotional status using the Hospital Anxiety and Depression (HAD) questionnaire. Median age (interquartile range) was 42 (35, 48) years. Time since HIV diagnosis was 6.3 (2.6, 17.1) years, 92% were taking antiretroviral treatment and 81.8% had an HIV-RNA viral load <50 copies. The prevalence of ED was 58.5%. ED was mild in 30.1%, mild to moderate in 19.5%, moderate in 6.1%, and severe in 2.5%. ED medications were used by 19% of men. In the univariate analysis, the variables associated with all degrees of ED were older age, longer time since HIV diagnosis, higher scores in HAD, not taking efavirenz, taking etravirine, taking ritonavir, HIV/Hepatitis C Virus coinfection, and taking a protease inhibitor-containing regimen. For mild to moderate, moderate, and severe ED, the same variables were significant, as were lower nadir CD4 cell count, lower social support, taking atazanavir, concomitant conditions, and concomitant treatments. The variables that remained significant in the multivariate analyses, considering all degrees of ED or excluding mild ED were the following: older age and higher scores in HAD total. In summary, ED affected more than half of this cohort of well controlled HIV-infected men. Age and emotional status seemed to play a fundamental role in its presence.
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Affiliation(s)
- Carmina R Fumaz
- 1 HIV Unit- Lluita contra la Sida Foundation- Germans Trias i Pujol University Hospital- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Aintzane Ayestaran
- 2 Lluita contra la Sida Foundation- Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Nuria Perez-Alvarez
- 2 Lluita contra la Sida Foundation- Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Jose A Muñoz-Moreno
- 1 HIV Unit- Lluita contra la Sida Foundation- Germans Trias i Pujol University Hospital- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Jose Ferrer
- 1 HIV Unit- Lluita contra la Sida Foundation- Germans Trias i Pujol University Hospital- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eugenia Negredo
- 1 HIV Unit- Lluita contra la Sida Foundation- Germans Trias i Pujol University Hospital- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Bonaventura Clotet
- 1 HIV Unit- Lluita contra la Sida Foundation- Germans Trias i Pujol University Hospital- Universitat Autònoma de Barcelona, Barcelona, Spain
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35
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Brody LR, Jack DC, Bruck-Segal DL, Ruffing EG, Firpo-Perretti YM, Dale SK, Weber KM, Cohen MH. Life Lessons from Women with HIV: Mutuality, Self-Awareness, and Self-Efficacy. AIDS Patient Care STDS 2016; 30:261-73. [PMID: 27214648 PMCID: PMC4913488 DOI: 10.1089/apc.2016.0031] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Women with HIV in the United States cope with multiple traumas that influence adherence to antiretroviral therapy (ART) and well-being. Narrative themes from three life turning points and a projective story task were compared for two groups of women with HIV (HIV well-managed vs. HIV not well-managed, matched on demographics and narrative word count) to understand predictors of successful outcomes. The well-managed group (n = 10) was virally suppressed and reported ≥95% ART adherence; the not well-managed group (n = 10) had detectable viral load and reported <95% ART adherence. Women were predominantly African American with low socioeconomic status and averaged 46.51 years. A three-stage coding process (with coders blind to group status in stages 1 and 2) involved (1) line by line thematic analyses that generated 155 subthemes reflecting six content areas (interpersonal relationships; culture and community; sense of self; relationship to past, present, and future experiences; self-care; and motivators for change); (2) absence/presence of the 155 subthemes was compared for the two groups; the frequency of 37 subthemes was found to significantly differ; and (3) the 37 differentiating subthemes were conceptually integrated, revealing that the well-managed group's narratives more frequently reflected (a) mutuality (growth-fostering relationships involving reciprocal care and empathy); (b) self-awareness (recognition of personal strengths and weaknesses and multiple factors contributing to life choices and trajectories); and (c) self-efficacy (active coping, self-advocacy, and utilizing resources). Implications for treatment and interconnections among themes are discussed, emphasizing the factors that enable women to care for themselves and others.
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Affiliation(s)
- Leslie R. Brody
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Dana C. Jack
- Fairhaven College of Interdisciplinary Studies, Western Washington University, Bellingham, Washington
| | - Dana L. Bruck-Segal
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Elizabeth G. Ruffing
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | | | - Sannisha K. Dale
- Behavioral Medicine Service, Massachusetts General Hospital, Boston, Massachusetts
| | - Kathleen M. Weber
- Cook County Health and Hospitals System, Hektoen Institute of Medicine, Chicago, Illinois
| | - Mardge H. Cohen
- Department of Medicine, Stroger Hospital, Cook County Health & Hospitals System, and Rush University, Chicago, Illinois
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Cherry CL, Wadley AL, Kamerman PR. Diagnosing and treating HIV-associated sensory neuropathy: a global perspective. Pain Manag 2016; 6:191-9. [PMID: 26988147 DOI: 10.2217/pmt.15.65] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
HIV-associated sensory neuropathy (HIV-SN) is a common complication of HIV and remains highly prevalent even with modern HIV management strategies, causing debilitating pain in millions globally. We review HIV-SN diagnosis and management. We suggest most HIV-SN cases are easily recognized using clinical screening tools, with physician assessment and/or specialized testing prioritized for atypical cases. Management aims to prevent further nerve damage and optimize symptom control. Symptom relief is difficult and rarely complete, with a lack of proven pharmacological strategies. Work is needed to clarify optimal use of available medications. This includes understanding the marked placebo effect in HIV-SN analgesic trials and exploring 'responder phenotypes'. Limited data support nondrug strategies including hypnosis, meditation, psychology, physical activity and a positive therapeutic relationship.
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Affiliation(s)
- Catherine L Cherry
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Infectious Diseases Unit, Department of Infectious Diseases, The Alfred Hospital & Burnet Institute, Monash University, Commercial Rd, Melbourne, Victoria 3004, Australia
| | - Antonia L Wadley
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter R Kamerman
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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37
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Feliu-Soler A, Borràs X, Peñarrubia-María MT, Rozadilla-Sacanell A, D'Amico F, Moss-Morris R, Howard MA, Fayed N, Soriano-Mas C, Puebla-Guedea M, Serrano-Blanco A, Pérez-Aranda A, Tuccillo R, Luciano JV. Cost-utility and biological underpinnings of Mindfulness-Based Stress Reduction (MBSR) versus a psychoeducational programme (FibroQoL) for fibromyalgia: a 12-month randomised controlled trial (EUDAIMON study). BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:81. [PMID: 26921267 PMCID: PMC4769528 DOI: 10.1186/s12906-016-1068-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 02/23/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The EUDAIMON study focuses on fibromyalgia syndrome (FMS), a prevalent chronic condition characterized by pain, fatigue, cognitive problems and distress. According to recent reviews and meta-analyses, Mindfulness-Based Stress Reduction (MBSR) is a promising therapeutic approach for patients with FMS. The measurement of biomarkers as part of the analysis of MBSR effects would help to identify the neurobiological underpinnings of MBSR and increase our knowledge of FMS pathophysiology. The main objectives of this 12-month RCT are: firstly, to examine the effectiveness and cost-utility for FMS patients of MBSR as an add-on to treatment as usual (TAU) versus TAU + the psychoeducational programme FibroQoL, and versus TAU only; secondly, to examine pre-post differences in brain structure and function, as well as levels of specific inflammatory markers in the three study arms and; thirdly, to analyse the role of some psychological variables as mediators of 12-month clinical outcomes. METHODS Effectiveness, cost-utility, and neurobiological analyses performed alongside a 12-month RCT. The participants will be 180 adult patients with FMS recruited at the Sant Joan de Déu hospital (St. Boi de Llobregat, Spain), randomly allocated to one of the three study arms: TAU + MBSR vs. TAU + FibroQol vs. TAU. A comprehensive assessment to collect functional, quality of life, distress, costs, and psychological variables will be conducted pre-, post-intervention, and at 12-month post-intervention. Fifty per cent of study participants will be evaluated at pre- and post-treatment using Voxel-Based Morphometry, Diffusion Tensor Imaging, pseudo-continuous Arterial Spin Labeling, and resting state fMRI. A cytokine multiplex kit of high-sensitivity will be applied (cytokines IL-6, IL-8, IL-10 + high-sensitivity CRP test). DISCUSSION The findings obtained from this RCT will indicate whether MBSR is potentially cost-effective for FMS and contribute to knowledge of any brain and inflammatory changes associated with MBSR in FMS patients. Specifically, we will determine whether there are morphometric and functional changes associated with participation in MBSR in brain regions related to meta-awareness, body awareness, memory consolidation-reconsolidation, emotion regulation and in networks postulated to underpin the sensory-discriminative, cognitive-evaluative and affective-motivational aspects of the pain experience. TRIAL REGISTRATION NCT02561416 . Registered 23 September 2015.
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Affiliation(s)
- Albert Feliu-Soler
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, C/Dr. Antoni Pujadas 42, 08830, Sant Boi de Llobregat, Barcelona, Spain.
- Centre for Biomedical Research in Mental Health, CIBERSAM, Madrid, Spain.
| | - Xavier Borràs
- Stress and Health Research Group, Faculty of Psychology, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.
| | - María T Peñarrubia-María
- Primary Health Centre Bartomeu Fabrés Anglada, DAP Delta Llobregat, Unitat Docent Costa de Ponent, Institut Català de la Salut, Gavà, Spain.
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Madrid, Spain.
| | | | - Francesco D'Amico
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK. F.D'
| | - Rona Moss-Morris
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK.
| | - Matthew A Howard
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Nicolás Fayed
- Magnetic Resonance Unit, Department of Radiology, Hospital Quironsalud Zaragoza, Zaragoza, Spain.
| | - Carles Soriano-Mas
- Centre for Biomedical Research in Mental Health, CIBERSAM, Madrid, Spain.
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
- Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Marta Puebla-Guedea
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Madrid, Spain.
- Aragon Institute of Health Sciences (I+CS), Zaragoza, Spain.
| | - Antoni Serrano-Blanco
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, C/Dr. Antoni Pujadas 42, 08830, Sant Boi de Llobregat, Barcelona, Spain.
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Madrid, Spain.
| | - Adrián Pérez-Aranda
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, C/Dr. Antoni Pujadas 42, 08830, Sant Boi de Llobregat, Barcelona, Spain.
| | | | - Juan V Luciano
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, C/Dr. Antoni Pujadas 42, 08830, Sant Boi de Llobregat, Barcelona, Spain.
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Madrid, Spain.
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Black DS, Slavich GM. Mindfulness meditation and the immune system: a systematic review of randomized controlled trials. Ann N Y Acad Sci 2016; 1373:13-24. [PMID: 26799456 DOI: 10.1111/nyas.12998] [Citation(s) in RCA: 275] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Mindfulness meditation represents a mental training framework for cultivating the state of mindful awareness in daily life. Recently, there has been a surge of interest in how mindfulness meditation improves human health and well-being. Although studies have shown that mindfulness meditation can improve self-reported measures of disease symptomatology, the effect that mindfulness meditation has on biological mechanisms underlying human aging and disease is less clear. To address this issue, we conducted the first comprehensive review of randomized controlled trials examining the effects of mindfulness meditation on immune system parameters, with a specific focus on five outcomes: (1) circulating and stimulated inflammatory proteins, (2) cellular transcription factors and gene expression, (3) immune cell count, (4) immune cell aging, and (5) antibody response. This analysis revealed substantial heterogeneity across studies with respect to patient population, study design, and assay procedures. The findings suggest possible effects of mindfulness meditation on specific markers of inflammation, cell-mediated immunity, and biological aging, but these results are tentative and require further replication. On the basis of this analysis, we describe the limitations of existing work and suggest possible avenues for future research. Mindfulness meditation may be salutogenic for immune system dynamics, but additional work is needed to examine these effects.
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Affiliation(s)
- David S Black
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - George M Slavich
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California
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Gotink RA, Chu P, Busschbach JJV, Benson H, Fricchione GL, Hunink MGM. Standardised mindfulness-based interventions in healthcare: an overview of systematic reviews and meta-analyses of RCTs. PLoS One 2015; 10:e0124344. [PMID: 25881019 PMCID: PMC4400080 DOI: 10.1371/journal.pone.0124344] [Citation(s) in RCA: 264] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 02/27/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mindfulness-based therapies are being used in a wide range of common chronic conditions in both treatment and prevention despite lack of consensus about their effectiveness in different patient categories. OBJECTIVE To systematically review the evidence of effectiveness MBSR and MBCT in different patient categories. METHODS A systematic review and meta-analysis of systematic reviews of RCTs, using the standardized MBSR or MBCT programs. We used PRISMA guidelines to assess the quality of the included reviews and performed a random effects meta-analysis with main outcome measure Cohen's d. All types of participants were considered. RESULTS The search produced 187 reviews: 23 were included, covering 115 unique RCTs and 8,683 unique individuals with various conditions. Compared to wait list control and compared to treatment as usual, MBSR and MBCT significantly improved depressive symptoms (d=0.37; 95%CI 0.28 to 0.45, based on 5 reviews, N=2814), anxiety (d=0.49; 95%CI 0.37 to 0.61, based on 4 reviews, N=2525), stress (d=0.51; 95%CI 0.36 to 0.67, based on 2 reviews, N=1570), quality of life (d=0.39; 95%CI 0.08 to 0.70, based on 2 reviews, N=511) and physical functioning (d=0.27; 95%CI 0.12 to 0.42, based on 3 reviews, N=1015). Limitations include heterogeneity within patient categories, risk of publication bias and limited long-term follow-up in several studies. CONCLUSION The evidence supports the use of MBSR and MBCT to alleviate symptoms, both mental and physical, in the adjunct treatment of cancer, cardiovascular disease, chronic pain, depression, anxiety disorders and in prevention in healthy adults and children.
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Affiliation(s)
- Rinske A. Gotink
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
- Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, the Netherlands
- Department of Radiology, Erasmus MC, Rotterdam, the Netherlands
| | - Paula Chu
- Department of Health Policy, Harvard University, Cambridge, United States of America
| | - Jan J. V. Busschbach
- Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, the Netherlands
| | - Herbert Benson
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America
| | - Gregory L. Fricchione
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America
| | - M. G. Myriam Hunink
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
- Department of Radiology, Erasmus MC, Rotterdam, the Netherlands
- Department of Health Policy and Management, Harvard School of Public Health, Boston, United States of America
- * E-mail:
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Improving mental health among people living with HIV: a review of intervention trials in low- and middle-income countries. Glob Ment Health (Camb) 2015; 2:e19. [PMID: 26435843 PMCID: PMC4589870 DOI: 10.1017/gmh.2015.17] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
People living with HIV (PLWH) experience greater psychological distress than the general population. Evidence from high-incomes countries suggests that psychological interventions for PLWH can improve mental health symptoms, quality of life, and HIV care engagement. However, little is known about the effectiveness of mental health interventions for PLWH in low and middle-income countries (LMICs), where the large majority of PLWH reside. This systematized review aims to synthesize findings from mental health intervention trials with PLWH in LMICs to inform the delivery of mental health services in these settings. A systematic search strategy was undertaken to identify peer-reviewed published papers of intervention trials addressing negative psychological states or disorders (e.g., depression, anxiety) among PLWH in LMIC settings. Search results were assessed against pre-established inclusion and exclusion criteria. Data from papers meeting criteria were extracted for synthesis. Twenty-six papers, published between 2000 and 2014, describing 22 unique interventions were identified. Trials were implemented in sub-Saharan Africa (n=13), Asia (n=7), and the Middle East (n=2), and addressed mental health using a variety of approaches, including cognitive-behavioral (n=18), family-level (n=2), and pharmacological (n=2) treatments. Four randomized controlled trials reported significant intervention effects in mental health outcomes, and eleven preliminary studies demonstrated promising findings. Among the limited mental health intervention trials with PLWH in LMICs, few demonstrated efficacy. Mental health interventions for PLWH in LMICs must be further developed and adapted for resource-limited settings to improve effectiveness.
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Abstract
Asia is seeing a rise in noncommunicable diseases in their general population and among people living with HIV. Many Asians have low body weight, which can lead to higher plasma concentrations of antiretrovirals and, as a result, their toxicities. Examples are metabolic complications from protease inhibitors, chronic kidney disease from tenofovir, and hepatotoxicity from nevirapine. Asia has not only the highest burden of hepatitis B viral infection than any other continent but also a predominance of genotypes B and C, the latter associated with higher risk for hepatocellular carcinoma. HIV-associated neurocognitive disorders are equally common among Asians as other populations. Diastolic dysfunction and asymptomatic myocardial ischemia are not infrequent. Non-Hodgkin lymphoma is the most common AIDS-related cancer, whereas Kaposi sarcoma is relatively infrequent. Emerging data show high prevalence of human papillomavirus-associated anal dysplasia in men who have sex with men. Resource-limited countries in Asia suffer from lack of resources for national screening programs of noncommunicable diseases, which, in turn, limits the epidemiologic data that exist to guide the use of national health resources.
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