Effectiveness of taking in the good based-bibliotherapy intervention program among depressed Filipino female adolescents

Research Review: Psychological and psychosocial interventions for children and adolescents with depression, anxiety, and post-traumatic stress disorder in low- and middle-income countries - a systematic review and meta-analysis

BACKGROUND

The incidence of depression, anxiety, and post-traumatic stress disorder (PTSD) among children and adolescents residing in low- and middle-income countries (LMICs) poses a significant public health concern. However, there is variation in the evidence of effective psychological interventions. This meta-analysis aims to provide a complete overview of the current body of evidence in this rapidly evolving field.

METHODS

We conducted searches on PubMed, Embase.com, and EBSCO/APA PsycInfo databases up to June 23, 2022, identify randomized controlled trials (RCTs) investigating the effectiveness of psychological interventions in LMICs that targeted children and adolescents with elevated symptoms above a cut-off score for depression, anxiety, and PTSD, comparing a psychological or psychosocial intervention with other control conditions. We conducted random effects meta-analyses for depression, anxiety, and PTSD symptoms. Sensitivity analysis for outliers and high-risk studies, and analyses for the publication bias were carried out. Subgroup analyses investigated how the intervention type, intervention format, the facilitator, study design, and age group of the participant predicted effect sizes.

RESULTS

Thirty-one RCTs (6,123 participants) were included. We found a moderate effect of interventions on depression outcomes compared to the control conditions (g = 0.53; 95% CI: 0.06-0.99; NNT = 6.09) with a broad prediction interval (PI) (-1.8 to 2.86). We found a moderate to large effect for interventions on anxiety outcomes (g = 0.88; 95% CI: -0.03 to 1.79; NNT = 3.32) with a broad PI (-3.14 to 4.9). Additionally, a moderate effect was observed on PTSD outcomes (g = 0.54; 95% CI: 0.19-0.9; NNT = 5.86) with a broad PI (-0.64 to 1.72).

CONCLUSIONS

Psychological and psychosocial interventions aimed at addressing depression, anxiety, and PTSD among children and adolescents in LMICs have demonstrated promising results. However, future studies should consider the variation in evidence and incorporate long-term outcomes to better understand the effectiveness of these interventions.

Estimation of Effect Heterogeneity in Rare Events Meta-Analysis

The paper outlines several approaches for dealing with meta-analyses of count outcome data. These counts are the accumulation of occurred events, and these events might be rare, so a special feature of the meta-analysis is dealing with low counts including zero-count studies. Emphasis is put on approaches which are state of the art for count data modelling including mixed log-linear (Poisson) and mixed logistic (binomial) regression as well as nonparametric mixture models for count data of Poisson and binomial type. A simulation study investigates the performance and capability of discrete mixture models in estimating effect heterogeneity. The approaches are exemplified on a meta-analytic case study investigating the acceptance of bibliotherapy.

Mental health literacy amongst children with common mental health problems and their parents in Java, Indonesia: a qualitative study

Background

Optimising mental health literacy (MHL) at the individual and population level can be an effective mental health improvement and prevention tool. However, concepts of MHL are largely based on evidence from high-income countries. Little is known about the manifestation and role of MHL in countries where collectivist health and social cultures are dominant.

Aim

This study aimed to examine the MHL of Indonesian children and young people (CYP) with experience of common mental health problems and their parents.

Methods

Semi-structured interviews with 40 participants (19 CYP aged 11-15 with experience of common mental health problems and 21 parents) from three areas of Java, Indonesia. Data were analysed using framework analysis, informed by Jorm's 1997 Mental Health Literacy Framework.

Results

Parents and CYP demonstrated relatively low levels of MHL defined from a conventional perspective. Religiosity and spirituality were salient in participants' accounts, particularly parents, as were narratives about personal responsibility. These beliefs appeared to contribute to a high level of self-blame for mental illness, self-reliance for symptom management, the foregrounding of support from spiritual/traditional healers and a reduced propensity to access professional help. CYP were heavily reliant on family support, but parents often felt they were not best placed to communicate with their children about mental health. Providing trusted, technology-based sources of mental health information were advocated by CYP.

Conclusion

Robust efforts are needed to improve MHL in low- and middle-income countries drawing on culturally appropriate approaches to reduce stigma and optimise timely, effective help-seeking for CYP. Enhancing parental and family level literacy may be efficacious, especially when combined with mechanisms to facilitate open communication, as may the development of standalone interventions directly developed to reach younger generations. Future research may usefully establish the comparative efficacy and acceptability of these different approaches.

Psychological Treatments for Depression in Adolescents: More Than Three Decades Later

Depression is a common and impairing disorder which is a serious public health problem. For some individuals, depression has a chronic course and is recurrent, particularly when its onset is during adolescence. The purpose of the current paper was to review the clinical trials conducted between 1980 and 2020 in adolescents with a primary diagnosis of a depressive disorder, excluding indicated prevention trials for depressive symptomatology. Cognitive behavioral therapy (CBT) is the pre-eminent treatment and is well established from an evidence-based treatment perspective. The body of research on the remaining treatments is smaller and the status of these treatments is varied: interpersonal therapy (IPT) is well established; family therapy (FT) is possibly effective; and short-term psychoanalytic therapy (PT) is experimental treatment. Implementation of the two treatments that work well-CBT and IPT-has more support when provided individually as compared to in groups. Research on depression treatments has been expanding through using transdiagnostic and modular protocols, implementation through information and communication technologies, and indicated prevention programs. Despite significant progress, however, questions remain regarding the rate of non-response to treatment, the fading of specific treatment effects over time, and the contribution of parental involvement in therapy.

Therapeutic Factors in Adolescents' Groups With and Without Movies

The study explores the therapeutic factors in two types of group interventions--film therapy (n = 69) and affective support therapy (n = 48) for Arab adolescents (ages 13-14) in Israel. Film therapy is a relatively new method for groups, aimed at enhancing adolescents' engagement in the process of group counseling. Six-hundred students from 11 schools were screened for the level of parent-adolescent conflict, based on a self-report measure. The 117 students who met the cutoff point constituted our sample. They were randomly divided into 12 small groups (6 in each type of intervention). A previous study reported the outcomes of these two interventions, showing equal progress in both groups (compared to control). The current study explores process variables, specifically therapeutic factors, in an attempt to enhance our understanding of those outcomes. Results indicated common therapeutic factors across both types of intervention. The factors of relationship-climate and other- versus self-focus were ranked the highest and, contrary to expectations, were significantly higher in affective support therapy than in film therapy.

Psychological and Psychosocial Interventions for PTSD, Depression and Anxiety Among Children and Adolescents in Low- and Middle-Income Countries: A Meta-Analysis

BACKGROUND

In low- and middle-income countries, rates of common mental health disorders are found to be very high among children and adolescents while individuals, particularly in these countries, face barriers to mental health care. In the recent years, randomized controlled trials (RCTs) have been conducted that implemented and tested different psychological and psychosocial treatment approaches to treat common mental disorders. This review aims to analyze psychological interventions among children and adolescents in low- and middle-income countries.

METHODS

RCTs carried out in low- and middle-income countries on psychological and psychosocial interventions for children and adolescents with symptoms of trauma- and stressor related disorders, depression or anxiety were identified in bibliographic databases. Databases were systematically searched until December 14, 2018. Effect sizes indicating differences between treatment and control groups at post-test were computed using a random-effects model. Outcomes were symptoms of depression, anxiety and posttraumatic stress disorder (PTSD).

RESULTS

Thirteen studies with a total of 2,626 participants aged between 5 and 18 years were included. Treatments varied between studies and number of treatment sessions ranged from 1 to 16. The pooled effect size, combining outcomes of depression, anxiety and PTSD of psychological or psychosocial intervention versus care-as-usual or a control conditions yielded a medium effect (g = 0.62; 95% CI: 0.27-0.98). Heterogeneity was very high (I2 = 94.41; 95% CI = 80-91). The beneficial effect of interventions increased after excluding outliers (g = 0.72; 95% CI: 0.37-1.07), while heterogeneity remained high (I2 = 86.12; 95% CI = 87-94).

CONCLUSION

High quality RCTs investigating the effect of psychological and psychosocial interventions on PTSD, depression and anxiety among children and adolescents in low- and middle-income countries are scarce. Results of the available studies may suggest that psychological and psychosocial interventions might be more effective in reducing symptoms of anxiety, depression and PTSD compared to control conditions. Due to very high heterogeneity, this evidence must be considered with caution.

Validation of the Kutcher Adolescent Depression Scale in a Caribbean student sample

BACKGROUND

Research on depression among Caribbean children has been limited by a lack of valid and reliable measures. We addressed this problem by exploring the internal consistency reliability and the concurrent and discriminant validity of the Kutcher Adolescent Depression Rating Scale (KADS) among a wide cross-section of the student population attending elementary schools in Jamaica and Barbados.

METHODS

Students enrolled in grade 6 in a cross-section of schools in Jamaica and Barbados were invited to participate in the study. Schools included a balance of government-funded public schools and privately funded preparatory schools. All schools that were invited to participate accepted, and all grade 6 classrooms in each school were sampled. The following instruments were administered to the students during the fall semester of 2015: KADS, Adolescent Depression Rating Scale (ADRS), major depression disorder subscale of the Revised Children's Anxiety and Depression Scale (RCADS), and state and trait anxiety visual analogue scales.

RESULTS

In total, 759 children (376 girls [49.5%] and 363 boys [47.8%]; in 20 cases [2.6%], sex was missing) with a mean age of 10.7 (standard deviation 0.66) years (median 11.0 yr) took part in the study. Overall, the KADS had an acceptable degree of reliability (α = 0.76). The instrument had reasonably good concurrent validity, as evidenced by strong correlations with scores on the ADRS (r = 0.62) and the major depression disorder subscale of the RCADS (r = -0.61). It had acceptable discriminant validity, as shown through low correlations with the state and trait anxiety visual analogue scales (r = 0.21 and 0.18, respectively). This pattern of results suggests that a large part (37%) of the variance underlying the KADS assesses depression, and a smaller degree of the variance (3%-4%) measures a conceptually similar but distinct concept.

INTERPRETATION

The KADS is a reliable and valid measure for assessing depressive symptoms among Jamaican and Barbadian elementary school students. The sample may not be representative of all Caribbean children.

Comparative efficacy and acceptability of bibliotherapy for depression and anxiety disorders in children and adolescents: a meta-analysis of randomized clinical trials

BACKGROUND

Depression and anxiety are the most common mental disorders in children and adolescents. Bibliotherapy is a treatment using written materials for mental health problems. Its main advantages are ease of use, low cost, low staffing demands, and greater privacy. Yet few meta-analyses have focused on the effect of bibliotherapy on depression and anxiety disorders in children and adolescents.

METHODS

We included randomized controlled trials comparing bibliotherapy with control conditions for depression and anxiety in children and adolescents (aged ≤18 years). Five electronic databases (PubMed, Embase, Cochrane, Web of Science, and PsycINFO) were searched from inception to January 2017. Efficacy was defined as mean change scores in depression and anxiety symptoms. Acceptability was defined as the proportion of participants who discontinued the treatment. Random effects model was used. An intention-to-treat analysis was conducted.

RESULTS

Eight studies with 979 participants were selected. At posttreatment, bibliotherapy was significantly more effective than the control conditions in reducing the symptoms of depression or anxiety (standardized mean difference, -0.52; 95% confidence interval [CI], -0.89 to -0.15). Bibliotherapy did not have statistically significantly more all-cause discontinuations than controls (risk ratios, 1.66; 95% CI, 0.93 to 2.95). We also performed subgroup analyses for efficacy outcomes in different categories (types of disorder, mean age, control conditions, and parental involvement) of studies and found that bibliotherapy has been more effective in depressive adolescents.

LIMITATIONS

Limited studies were eligible in this review and hence there was potential publication bias.

CONCLUSION

According to the findings in this review, bibliotherapy may be more beneficial in treating depression in adolescents, but shows less robust effects for anxiety in children. Further well-defined clinical studies should be performed to confirm these outcomes.