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Bjornstad G, Sonthalia S, Rouse B, Freeman L, Hessami N, Dunne JH, Axford N. A comparison of the effectiveness of cognitive behavioural interventions based on delivery features for elevated symptoms of depression in adolescents: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1376. [PMID: 38188230 PMCID: PMC10771715 DOI: 10.1002/cl2.1376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/03/2023] [Indexed: 01/09/2024]
Abstract
Background Depression is a public health problem and common amongst adolescents. Cognitive behavioural therapy (CBT) is widely used to treat adolescent depression but existing research does not provide clear conclusions regarding the relative effectiveness of different delivery modalities. Objectives The primary aim is to estimate the relative efficacy of different modes of CBT delivery compared with each other and control conditions for reducing depressive symptoms in adolescents. The secondary aim is to compare the different modes of delivery with regard to intervention completion/attrition (a proxy for intervention acceptability). Search Methods The Cochrane Depression, Anxiety and Neurosis Clinical Trials Register was searched in April 2020. MEDLINE, PsycInfo, EMBASE, four other electronic databases, the CENTRAL trial registry, Google Scholar and Google were searched in November 2020, together with reference checking, citation searching and hand-searching of two databases. Selection Criteria Randomised controlled trials (RCTs) of CBT interventions (irrespective of delivery mode) to reduce symptoms of depression in young people aged 10-19 years with clinically relevant symptoms or diagnosis of depression were included. Data Collection and Analysis Screening and data extraction were completed by two authors independently, with discrepancies addressed by a third author. CBT interventions were categorised as follows: group CBT, individual CBT, remote CBT, guided self-help, and unguided self-help. Effect on depressive symptom score was estimated across validated self-report measures using Hedges' g standardised mean difference. Acceptability was estimated based on loss to follow-up as an odds ratio. Treatment rankings were developed using the surface under the cumulative ranking curve (SUCRA). Pairwise meta-analyses were conducted using random effects models where there were two or more head-to-head trials. Network analyses were conducted using random effects models. Main Results Sixty-eight studies were included in the review. The mean age of participants ranged from 10 to 19.5 years, and on average 60% of participants were female. The majority of studies were conducted in schools (28) or universities (6); other settings included primary care, clinical settings and the home. The number of CBT sessions ranged from 1 to 16, the frequency of delivery from once every 2 weeks to twice a week and the duration of each session from 20 min to 2 h. The risk of bias was low across all domains for 23 studies, 24 studies had some concerns and the remaining 21 were assessed to be at high risk of bias. Sixty-two RCTs (representing 6435 participants) were included in the pairwise and network meta-analyses for post-intervention depressive symptom score at post-intervention. All pre-specified treatment and control categories were represented by at least one RCT. Although most CBT approaches, except remote CBT, demonstrated superiority over no intervention, no approaches performed clearly better than or equivalent to another. The highest and lowest ranking interventions were guided self-help (SUCRA 83%) and unguided self-help (SUCRA 51%), respectively (very low certainty in treatment ranking). Nineteen RCTs (3260 participants) were included in the pairwise and network meta-analyses for 6 to 12 month follow-up depressive symptom score. Neither guided self-help nor remote CBT were evaluated in the RCTs for this time point. Effects were generally attenuated for 6- to 12-month outcomes compared to posttest. No interventions demonstrated superiority to no intervention, although unguided self-help and group CBT both demonstrated superiority compared to TAU. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking approaches were unguided self-help and individual CBT, respectively. Sixty-two RCTs (7347 participants) were included in the pairwise and network meta-analyses for intervention acceptability. All pre-specified treatment and control categories were represented by at least one RCT. Although point estimates tended to favour no intervention, no active treatments were clearly inferior. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking active interventions were individual CBT and group CBT respectively. Pairwise meta-analytic findings were similar to those of the network meta-analysis for all analyses. There may be age-based subgroup effects on post-intervention depressive symptoms. Using the no intervention control group as the reference, the magnitudes of effects appear to be larger for the oldest age categories compared to the other subgroups for each given comparison. However, they were generally less precise and formal testing only indicated a significant difference for group CBT. Findings were robust to pre-specified sensitivity analyses separating out the type of placebo and excluding cluster-RCTs, as well as an additional analysis excluding studies where we had imputed standard deviations. Authors' Conclusions At posttreatment, all active treatments (group CBT, individual CBT, guided self-help, and unguided self-help) except for remote CBT were more effective than no treatment. Guided self-help was the most highly ranked intervention but only evaluated in trials with the oldest adolescents (16-19 years). Moreover, the studies of guided self-help vary in the type and amount of therapist support provided and longer-term results are needed to determine whether effects persist. The magnitude of effects was generally attenuated for 6- to 12-month outcomes. Although unguided self-help was the lowest-ranked active intervention at post-intervention, it was the highest ranked at follow-up. This suggests the need for further research into whether interventions with self-directed elements enable young people to maintain effects by continuing or revisiting the intervention independently, and whether therapist support would improve long-term outcomes. There was no clear evidence that any active treatments were more acceptable to participants than any others. The relative effectiveness of intervention delivery modes must be taken into account in the context of the needs and preferences of individual young people, particularly as the differences between effect sizes were relatively small. Further research into the type and amount of therapist support that is most acceptable to young people and most cost-effective would be particularly useful.
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Affiliation(s)
- Gretchen Bjornstad
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
- Dartington Service Design LabBuckfastleighUK
| | - Shreya Sonthalia
- Dartington Service Design LabBuckfastleighUK
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - Benjamin Rouse
- Center for Clinical Evidence and Guidelines, ECRI InstitutePlymouth MeetingPennsylvaniaUSA
| | | | | | - Jo Hickman Dunne
- The Centre for Youth ImpactLondonUK
- University of ManchesterManchesterUK
| | - Nick Axford
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of PlymouthPlymouthUK
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Llistosella M, Goni-Fuste B, Martín-Delgado L, Miranda-Mendizabal A, Franch Martinez B, Pérez-Ventana C, Castellvi P. Effectiveness of resilience-based interventions in schools for adolescents: a systematic review and meta-analysis. Front Psychol 2023; 14:1211113. [PMID: 37868613 PMCID: PMC10587685 DOI: 10.3389/fpsyg.2023.1211113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/22/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Resilience has been identified as a dynamic process that provides capabilities to face adversity. Considering the many protective factors involved in resilience and that the school is a key context to promote resilience, this review aimed to examine the effect of school-based interventions on resilience in adolescents. Methods A systematic literature review and meta-analysis were conducted in July 2021 on four databases. The risk of bias was assessed using the Cochrane risk of bias tool. Random-effects meta-analysis was used to obtain pooled estimates. Stratified analyses were done according to population type (general, at risk), intervention type, and follow-up assessments. Results Of the 1,667 articles obtained, 27 were included in the systematic review and 16 in the meta-analysis. The random effects indicated a significant increase in resilience after the intervention [SMD = 0.58, 95% CI (0.29-0.87)]. Subgroup analysis showed effectiveness only in the population at risk [SMD = 1.28, 95% CI (0.53-2.03)] and early adolescence [SMD = 1.28, 95% CI (0.42-2.14), PI (-7.44 to 10.33)]. Multicomponent intervention [SMD = 1.45, 95% CI (0.11-2.80)] and Cognitive Behavioural Therapy (CBT) [SMD = 0.20, 95% CI (0.06-0.34)] demonstrated substantial effectiveness. Significant results were observed within 8-week follow-ups or less [SMD = 1.55, 95% CI (0.61-2.48)]. Discussion These findings provide evidence that multicomponent and CBT interventions increase resilience in early at-risk adolescents only in the short term. Developing resilience interventions is useful in schools exposed to unfavourable socioeconomic contexts. Furthermore, long-term interventions should be redesigned to improve their effectiveness. Systematic review registration PROSPERO [CRD42021277493].
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Affiliation(s)
- Maria Llistosella
- Primary Health Care, Consorci Sanitari de Terrasa, Terrassa, Spain
- Department of Nursing, Universitat International de Catalunya, Sant Cugat del Vallés, Spain
| | - Blanca Goni-Fuste
- Department of Nursing, Universitat International de Catalunya, Sant Cugat del Vallés, Spain
| | - Leandra Martín-Delgado
- Department of Nursing, Universitat International de Catalunya, Sant Cugat del Vallés, Spain
| | - Andrea Miranda-Mendizabal
- Teaching, Research and Innovation Unit, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Mental Health Networking Biomedical Research Centre (CIBERSAM), Madrid, Spain
- Department of Medicine, Universitat International de Catalunya, Sant Cugat del Vallés, Spain
| | - Berta Franch Martinez
- Department of Medicine, Universitat International de Catalunya, Sant Cugat del Vallés, Spain
| | | | - Pere Castellvi
- Department of Medicine, Universitat International de Catalunya, Sant Cugat del Vallés, Spain
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Chen XL, Deng XT, Sun FG, Huang QJ. Effect of cognitive behavioral group therapy on rehabilitation of community patients with schizophrenia: A short-term randomized control trial. World J Psychiatry 2023; 13:583-592. [PMID: 37701538 PMCID: PMC10494774 DOI: 10.5498/wjp.v13.i8.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND The efficacy of cognitive behavioral group therapy (CBGT) for cognitive dys-function and negative symptoms of schizophrenia is established, but more evidence is required. AIM To assess the effectiveness of CBGT combined with mental health education as a treatment for schizophrenia compared with mental health education alone. METHODS In all, 120 schizophrenia out-patients were randomized into CBGT combined with mental health education or single mental health education. The primary outcomes were positive and negative symptoms, cognitive function, excitatory factor, anxiety and depression symptom improvements on the positive and negative syndrome scale score. Secondary outcome measures included social function and drug compliance. RESULTS There were significant differences between CBGT combined with mental health education and single mental health education on measures of positive and negative symptoms, cognitive functions, excitatory factor, anxiety and depression symptoms, and social functions. No other significant difference in outcomes was observed. CONCLUSION CBGT combined with mental health education may be relevant beneficial treatment method in reducing symptoms, cognitive and social functions of patients with schizophrenia.
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Affiliation(s)
- Xue-Lian Chen
- Medical College of Shantou University, Shantou 515041, Guangdong Province, China
- Chronic Disease Prevention and Control Center (Mental Health Center) of Longhua District, Shenzhen 518110, Guangdong Province, China
| | - Xiao-Ting Deng
- Chronic Disease Prevention and Control Center (Mental Health Center) of Longhua District, Shenzhen 518110, Guangdong Province, China
| | - Fu-Gang Sun
- Chronic Disease Prevention and Control Center (Mental Health Center) of Longhua District, Shenzhen 518110, Guangdong Province, China
| | - Qing-Jun Huang
- Mental Health Center, Shantou University, Shantou 515041, Guangdong Province, China
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Omkarappa DB, Rentala S, Nattala P. Effectiveness of psychosocial intervention for internalizing behavior problems among children of parents with alcohol dependence: Randomized controlled trial. World J Clin Cases 2022; 10:5306-5316. [PMID: 35812678 PMCID: PMC9210892 DOI: 10.12998/wjcc.v10.i16.5306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 08/23/2021] [Accepted: 04/30/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Parental drinking has a direct bearing on children. Behavioral problems such as anxiety and depression are common problems among children whose parents drink heavily. Psychosocial interventions have shown promising results for anxiety and depression among children; however, few studies have been conducted in the context of children of parents with alcohol dependence in India.
AIM To evaluate the efficacy of psychosocial intervention for internalizing behavioral problems among children of parents with alcohol dependence.
METHODS A randomized controlled trial with a 2 × 4 factorial design was adopted with longitudinal measurement of outcomes for 6 mo. Two-hundred and eleven children who met the eligibility criteria (at least one parent with alcohol dependence) at government high schools in Bangalore, India, were randomized to the experimental (n = 97) or control group (n = 98). The psychosocial intervention was administered to the experimental group in eight sessions (biweekly) over 4 wk after baseline assessment. The intervention focused on identifying and modifying negative thoughts, replacing thinking errors with realistic alternatives, modification of maladaptive behavior, developing adaptive coping skills and building self-esteem. The data was collected pre-intervention and at 1, 3 and 6 mo after the intervention. Data were analyzed using SPSS 28.0 version.
RESULTS Mean age of the children was 14.68 ± 0.58 years, 60.5% were male, 56% were studying in 9th standard, 70.75% were from nuclear families, and mean family monthly income was 9588.1 ± 3135.2 INR. Mean duration of parental alcohol dependence was 7.52 ± 2.94 years and the father was the alcohol-consuming parent. The findings showed that there were significant psychosocial intervention effects in terms of decreasing anxiety and depression scores, and increasing self-esteem level among experimental group subjects over the 6-mo interval, when compared with the control group (P < 0.001).
CONCLUSION The present study demonstrated that the psychosocial intervention was effective in reducing anxiety and depression, and increasing self-esteem among children of parents with alcohol dependence. The study recommends the need for ongoing psychosocial intervention for these children.
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Affiliation(s)
| | - Sreevani Rentala
- Department of Psychiatric Nursing, Dharwad Institute of Mental Health and Neurosciences, Dharwad 580008, Karnataka, India
| | - Prasanthi Nattala
- Department of Nursing, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, Karnataka, India
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Pinto TM, Laurence PG, Macedo CR, Macedo EC. Resilience Programs for Children and Adolescents: A Systematic Review and Meta-Analysis. Front Psychol 2021; 12:754115. [PMID: 34880812 PMCID: PMC8645691 DOI: 10.3389/fpsyg.2021.754115] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Resilience may be defined as the ability to recover and adapt to adverse situations. Given that resilience involves cognitive and behavioral aspects, it could be promoted based on strategies that favor them, especially during childhood and adolescence. As a result, several resilience-focused programs have been developed and studied. This systematic review of Randomized Controlled Trials (RCTs) aimed to assess resilience-focused programs for children (<12 years old) and adolescents (12-22 years old) compared to active (treatment as usual, other program modalities, and educational curriculum at school) or inactive (waiting list, no treatment) control groups. We performed a systematic review of meta-analyses of RCTs. The following databases were searched: Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, and PsycINFO. Two authors independently selected the studies, extracted the data, and assessed the studies' risk of bias. Meta-analyses of random effects were conducted to calculate the standard mean differences (SMD) and 95% confidence interval (CI) of program effectiveness. Of the 17 RCTs that met the inclusion criteria, 13 provided sufficient data to assess the effectiveness of the programs after their implementation. Meta-analyses indicated overall effectiveness of the programs in promoting resilience (SMD = 0.48, 95% CI [0.15, 0.81], p = 0.0077). The subgroup analysis indicated effectiveness only among adolescents' resilience (SMD = 0.48, 95% CI [0.08, 0.88], p = 0.02). The follow-up analysis also indicated evidence of continuation of results within a period of up to 6 months up (SMD = 0.12, 95% CI [-0.44, 0.69], p = 0.02). These results indicated the effectiveness of promoting resilience, especially in adolescents, and its continuation in follow-up analyses. These findings are promising in the field of resilience programs; however, further studies are necessary to analyze the different possible characteristics of programs and their results. Clinical Trial Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020179874], [CRD42020179874].
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Affiliation(s)
- Tatiana Matheus Pinto
- Social and Cognitive Neuroscience Laboratory and Developmental Disorders Program, Center for Health and Biological Sciences, Mackenzie Presbyterian University, São Paulo, Brazil
| | - Paulo Guirro Laurence
- Social and Cognitive Neuroscience Laboratory and Developmental Disorders Program, Center for Health and Biological Sciences, Mackenzie Presbyterian University, São Paulo, Brazil
| | - Cristiane Rufino Macedo
- Brazilian Cochrane Center, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Elizeu Coutinho Macedo
- Social and Cognitive Neuroscience Laboratory and Developmental Disorders Program, Center for Health and Biological Sciences, Mackenzie Presbyterian University, São Paulo, Brazil
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Konradt CE, Cardoso TDA, Mondin TC, Souza LDDM, Kapczinski F, da Silva RA, Jansen K. Impact of resilience on the improvement of depressive symptoms after cognitive therapies for depression in a sample of young adults. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2018; 40:226-231. [PMID: 30304118 DOI: 10.1590/2237-6089-2017-0047] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 01/03/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Few studies have evaluated positive measures for therapeutic response. Thus, the objective of this study was to assess the effects of resilience on severity of depressive and anxious symptoms after brief cognitive psychotherapy for depression. METHODS This was a clinical follow-up study nested in a randomized clinical trial of cognitive therapies. The Resilience Scale was applied at baseline. The Hamilton Anxiety Rating Scale (HARS) and the Hamilton Depression Rating Scale (HDRS) were used at baseline, post-intervention, and at six-month follow-up. RESULTS Sixty-one patients were assessed at baseline, post-intervention and at six-month follow-up. Resilience scores were significantly different between baseline and post-intervention assessments (p<0.001), as well as at baseline and at six-month follow-up (p<0.001). We observed a weak negative correlation between baseline resilience scores and HDRS scores at post-intervention (r=-0.295, p=0.015) and at six-month follow-up (r=-0.354, p=0.005). Furthermore, we observed a weak negative correlation between resilience scores and HARS scores at post-intervention (r=-0.292, p=0.016). CONCLUSION Subjects with higher resilience scores at baseline showed a lower severity of symptoms at post-intervention and at six-month follow-up.
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Affiliation(s)
- Caroline Elizabeth Konradt
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas (UCPel), Pelotas, RS, Brazil
| | - Taiane de Azevedo Cardoso
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas (UCPel), Pelotas, RS, Brazil.,Mood Disorders Program, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Thaíse Campos Mondin
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas (UCPel), Pelotas, RS, Brazil
| | - Luciano Dias de Mattos Souza
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas (UCPel), Pelotas, RS, Brazil
| | - Flavio Kapczinski
- Mood Disorders Program, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Programa de Pós-Graduação em Psiquiatria, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Ricardo Azevedo da Silva
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas (UCPel), Pelotas, RS, Brazil
| | - Karen Jansen
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas (UCPel), Pelotas, RS, Brazil
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Howells FM, Kingdon DG, Baldwin DS. Current and potential pharmacological and psychosocial interventions for anxiety symptoms and disorders in patients with schizophrenia: structured review. Hum Psychopharmacol 2017; 32. [PMID: 28812313 DOI: 10.1002/hup.2628] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/30/2017] [Accepted: 07/11/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Between 30% and 62% of patients with schizophrenia present with co-morbid anxiety disorders that are associated with increased overall burden. Our aim was to summarize current and potential interventions for anxiety in schizophrenia. DESIGN Structured review, summarizing pharmacological and psychosocial interventions used to reduce anxiety in schizophrenia and psychosis. RESULTS Antipsychotics have been shown to reduce anxiety, increase anxiety, or have no effect. These may be augmented with another antipsychotic, anxiolytic, or antidepressant. Novel agents, such as L-theanine, pregabalin, and cycloserine, show promise in attenuating anxiety in schizophrenia. Psychosocial therapies have been developed to reduce the distress of schizophrenia. Cognitive behavioural therapy (CBT) has shown that benefit and refinements in the therapy have been successful, for example, for managing worry in schizophrenia. CBT usually involves more than 16 sessions, as short courses of CBT do not attenuate the presentation of anxiety in schizophrenia. To address time and cost, the development of manualized CBT to address anxiety in schizophrenia is being developed. CONCLUSIONS The presence of coexisting anxiety symptoms and co-morbid anxiety disorders should be ascertained when assessing patients with schizophrenia or other psychoses as a range of pharmacological and psychosocial treatments are available.
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Affiliation(s)
- Fleur M Howells
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - David G Kingdon
- Department of Psychiatry Faculty of Medicine, University of Southampton, Southampton, UK
| | - David S Baldwin
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry Faculty of Medicine, University of Southampton, Southampton, UK
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Do preventive interventions for children of mentally ill parents work? Results of a systematic review and meta-analysis. Curr Opin Psychiatry 2017; 30:283-299. [PMID: 28505032 DOI: 10.1097/yco.0000000000000342] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The transgenerational transmission of mental disorders is one of the most significant causes of psychiatric morbidity. Several risk factors for children of parents with mental illness (COPMI) have been identified in numerous studies and meta-analyses. RECENT FINDINGS Many interventions have been developed for this high-risk group, but data about their efficacy are heterogeneous. SUMMARY The current meta-analysis reports on 96 articles including 50 independent samples from randomized controlled trials quantifying effects of preventive interventions for COPMI. Random effect models resulted in small, though significant Effect Sizes (ES) for programs enhancing the mother-infant interaction (ES = 0.26) as well as mothers' (ES = 0.33) and children's (ES = 0.31) behavior that proved to be stable over the 12-month follow-up, except for infants' behavior. Interventions for children/adolescents resulted in significant small effects for global psychopathology (ES = 0.13), as well as internalizing symptoms (ES = 0.17), and increased significantly over time, with externalizing symptoms reaching significance in the follow-up assessments as well (ES = 0.17). Interventions addressing parents and children jointly produced overall larger effects. Higher study quality was associated with smaller effects. There is a dearth of high quality studies that effectively reduce the high risk of COPMI for the development of mental disorders.
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Orkibi H, Azoulay B, Snir S, Regev D. In-session behaviours and adolescents' self-concept and loneliness: A psychodrama process-outcome study. Clin Psychol Psychother 2017; 24:O1455-O1463. [PMID: 28653318 DOI: 10.1002/cpp.2103] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/16/2017] [Accepted: 05/23/2017] [Indexed: 11/07/2022]
Abstract
As adolescents spend many hours a day in school, it is crucial to examine the ways in which therapeutic practices in schools promote their well-being. This longitudinal pilot study examined the contribution of school-based psychodrama group therapy to the self-concept dimensions and perceived loneliness of 40 Israeli adolescents (aged 13-16, 60% boys) in public middle schools. From a process-outcome perspective, we also examined the understudied trajectory of adolescents' in-session behaviours (process variables) and its associations with changes in their self-concepts and loneliness (outcome variables). Psychodrama participants reported increases in global, social, and behavioural self-concepts and a decrease in loneliness compared to the control group. In-session productive behaviours increased and resistance decreased throughout the therapy, but varied process-outcome relationships were found. The study suggests that conducting further research into the process-outcome relationships in psychodrama group therapy is warranted to pinpoint specific mechanisms of change. Suggestions for future studies are provided.
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Affiliation(s)
- Hod Orkibi
- School of Creative Arts Therapies, University of Haifa, Haifa, Israel
| | - Bracha Azoulay
- School of Creative Arts Therapies, University of Haifa, Haifa, Israel
| | - Sharon Snir
- Education and Drama Therapy, Tel Hai College, Kiryat Shmona, Israel
| | - Dafna Regev
- School of Creative Arts Therapies, University of Haifa, Haifa, Israel
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van Genugten L, Dusseldorp E, Massey EK, van Empelen P. Effective self-regulation change techniques to promote mental wellbeing among adolescents: a meta-analysis. Health Psychol Rev 2016; 11:53-71. [PMID: 27796160 DOI: 10.1080/17437199.2016.1252934] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Mental wellbeing is influenced by self-regulation processes. However, little is known on the efficacy of change techniques based on self-regulation to promote mental wellbeing. The aim of this meta-analysis is to identify effective self-regulation techniques (SRTs) in primary and secondary prevention interventions on mental wellbeing in adolescents. Forty interventions were included in the analyses. Techniques were coded into nine categories of SRTs. Meta-analyses were conducted to identify the effectiveness of SRTs, examining three different outcomes: internalising behaviour, externalising behaviour, and self-esteem. Primary interventions had a small-to-medium ([Formula: see text] = 0.16-0.29) on self-esteem and internalising behaviour. Secondary interventions had a medium-to-large short-term effect (average [Formula: see text] = 0.56) on internalising behaviour and self-esteem. In secondary interventions, interventions including asking for social support [Formula: see text] 95% confidence interval, CI = 1.11-1.98) had a great effect on internalising behaviour. Interventions including monitoring and evaluation had a greater effect on self-esteem [Formula: see text] 95% CI = 0.21-0.57). For primary interventions, there was not a single SRT that was associated with a greater intervention effect on internalising behaviour or self-esteem. No effects were found for externalising behaviours. Self-regulation interventions are moderately effective at improving mental wellbeing among adolescents. Secondary interventions promoting 'asking for social support' and promoting 'monitoring and evaluation' were associated with improved outcomes. More research is needed to identify other SRTs or combinations of SRTs that could improve understanding or optimise mental wellbeing interventions.
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Affiliation(s)
- Lenneke van Genugten
- a Department of Public Health , Erasmus MC, University Medical Centre Rotterdam , Rotterdam , The Netherlands.,b Expertise Group Life Style , Netherlands Organization for Applied Scientific Research (TNO) , Leiden , The Netherlands
| | - Elise Dusseldorp
- b Expertise Group Life Style , Netherlands Organization for Applied Scientific Research (TNO) , Leiden , The Netherlands.,d Institute of Psychology, Methodology & Statistics, Leiden University , Leiden , The Netherlands
| | - Emma K Massey
- c Department of Internal Medicine, Section Nephrology & Transplantation , Erasmus MC, University Medical Centre Rotterdam , Rotterdam , The Netherlands
| | - Pepijn van Empelen
- b Expertise Group Life Style , Netherlands Organization for Applied Scientific Research (TNO) , Leiden , The Netherlands
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Hetrick SE, Cox GR, Witt KG, Bir JJ, Merry SN. Cognitive behavioural therapy (CBT), third-wave CBT and interpersonal therapy (IPT) based interventions for preventing depression in children and adolescents. Cochrane Database Syst Rev 2016; 2016:CD003380. [PMID: 27501438 PMCID: PMC8407360 DOI: 10.1002/14651858.cd003380.pub4] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Depression is common in young people. It has a marked negative impact and is associated with self-harm and suicide. Preventing its onset would be an important advance in public health. This is an update of a Cochrane review that was last updated in 2011. OBJECTIVES To determine whether evidence-based psychological interventions (including cognitive behavioural therapy (CBT), interpersonal therapy (IPT) and third wave CBT)) are effective in preventing the onset of depressive disorder in children and adolescents. SEARCH METHODS We searched the specialised register of the Cochrane Common Mental Disorders Group (CCMDCTR to 11 September 2015), which includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). We searched conference abstracts and reference lists of included trials and reviews, and contacted experts in the field. SELECTION CRITERIA We included randomised controlled trials of an evidence-based psychological prevention programme compared with any comparison control for young people aged 5 to 19 years, who did not currently meet diagnostic criteria for depression. DATA COLLECTION AND ANALYSIS Two authors independently assessed trials for inclusion and rated their risk of bias. We adjusted sample sizes to take account of cluster designs and multiple comparisons. We contacted trial authors for additional information where needed. We assessed the quality of evidence for the primary outcomes using GRADE. MAIN RESULTS We included 83 trials in this review. The majority of trials (67) were carried out in school settings with eight in colleges or universities, four in clinical settings, three in the community and four in mixed settings. Twenty-nine trials were carried out in unselected populations and 53 in targeted populations.For the primary outcome of depression diagnosis at medium-term follow-up (up to 12 months), there were 32 trials with 5965 participants and the risk of having a diagnosis of depression was reduced for participants receiving an intervention compared to those receiving no intervention (risk difference (RD) -0.03, 95% confidence interval (CI) -0.05 to -0.01; P value = 0.01). We rated this evidence as moderate quality according to the GRADE criteria. There were 70 trials (73 trial arms) with 13,829 participants that contributed to the analysis for the primary outcome of depression symptoms (self-rated) at the post-intervention time point, with results showing a small but statistically significant effect (standardised mean difference (SMD) -0.21, 95% CI -0.27 to -0.15; P value < 0.0001). This effect persisted to the short-term assessment point (up to three months) (SMD -0.31, 95% CI -0.45 to -0.17; P value < 0.0001; 16 studies; 1558 participants) and medium-term (4 to 12 months) assessment point (SMD -0.12, 95% CI -0.18 to -0.05; P value = 0.0002; 53 studies; 11,913 participants); however, the effect was no longer evident at the long-term follow-up. We rated this evidence as low to moderate quality according to the GRADE criteria.The evidence from this review is unclear with regard to whether the type of population modified the overall effects; there was statistically significant moderation of the overall effect for depression symptoms (P value = 0.0002), but not for depressive disorder (P value = 0.08). For trials implemented in universal populations there was no effect for depression diagnosis (RD -0.01, 95% CI -0.03 to 0.01) and a small effect for depression symptoms (SMD -0.11, 95% CI -0.17 to -0.05). For trials implemented in targeted populations there was a statistically significantly beneficial effect of intervention (depression diagnosis RD -0.04, 95% CI -0.07 to -0.01; depression symptoms SMD -0.32, 95% CI -0.42 to -0.23). Of note were the lack of attention placebo-controlled trials in targeted populations (none for depression diagnosis and four for depression symptoms). Among trials implemented in universal populations a number used an attention placebo comparison in which the intervention consistently showed no effect. AUTHORS' CONCLUSIONS Overall the results show small positive benefits of depression prevention, for both the primary outcomes of self-rated depressive symptoms post-intervention and depression diagnosis up to 12 months (but not beyond). Estimates of numbers needed to treat to benefit (NNTB = 11) compare well with other public health interventions. However, the evidence was of moderate to low quality using the GRADE framework and the results were heterogeneous. Prevention programmes delivered to universal populations showed a sobering lack of effect when compared with an attention placebo control. Interventions delivered to targeted populations, particularly those selected on the basis of depression symptoms, had larger effect sizes, but these seldom used an attention placebo comparison and there are practical difficulties inherent in the implementation of targeted programmes. We conclude that there is still not enough evidence to support the implementation of depression prevention programmes.Future research should focus on current gaps in our knowledge. Given the relative lack of evidence for universal interventions compared with attention placebo controls and the poor results from well-conducted effectiveness trials of universal interventions, in our opinion any future such trials should test a depression prevention programme in an indicated targeted population using a credible attention placebo comparison group. Depressive disorder as the primary outcome should be measured over the longer term, as well as clinician-rated depression. Such a trial should consider scalability as well as the potential for the intervention to do harm.
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Affiliation(s)
- Sarah E Hetrick
- The National Centre of Excellence in Youth Mental HealthOrygen35 Poplar RoadParkvilleMelbourneVictoriaAustralia3054
| | - Georgina R Cox
- The National Centre of Excellence in Youth Mental HealthOrygen35 Poplar RoadParkvilleMelbourneVictoriaAustralia3054
| | | | - Julliet J Bir
- University of AucklandDepartment of PsychiatryPrivate Bag 92109AucklandNew Zealand
| | - Sally N Merry
- University of AucklandDepartment of Psychological MedicinePrivate Bag 92019AucklandNew Zealand
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Tian X, Gao Q, Li G, Zou G, Liu C, Kong L, Li P. Resilience is associated with low psychological distress in renal transplant recipients. Gen Hosp Psychiatry 2016; 39:86-90. [PMID: 26805002 DOI: 10.1016/j.genhosppsych.2015.12.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/17/2015] [Accepted: 12/23/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Renal transplantation (RT) is a significant life event; its subsequent challenges often lead to psychological distress, which substantially lowers patients' quality of life. The purpose of this study was to screen psychological distress and examine the relationships between resilience and psychological distress in RT recipients. METHODS Participants were 139 RT recipients from the RT follow-up clinic and ward in the departments of nephrology of three general hospitals in Jinan, China. They were assessed using the Connor-Davidson Resilience Scale, Perceived Social Support Scale and Kessler Psychological Distress Scale. Logistic regression analyses were used to evaluate the relationships between resilience and psychological distress after adjusting for perceived social support. RESULTS Fifty-nine (42.4%) RT recipients were considered as experiencing "psychological distress" (K10 score ≥ 22). Resilience was associated with psychological distress after controlling for perceived social support and sociodemographic variables: a one-point increase in resilience decreased the likelihood of having possible psychological distress (odds ratio=0.945, 95% confidence interval=0.914-0.976, P<.01). CONCLUSIONS The present study suggests that resilience was significantly associated with low psychological distress in RT recipients. Psychosocial interventions focused on resilience might provide useful approaches to overcome psychological distress in RT recipients.
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Affiliation(s)
- Xiaohong Tian
- School of Nursing, Shandong University, Jinan, China
| | - Qingling Gao
- School of Nursing, Shandong University, Jinan, China
| | - Guopeng Li
- School of Nursing, Shandong University, Jinan, China
| | - Guiyuan Zou
- School of Nursing, Shandong University, Jinan, China
| | - Chunqin Liu
- School of Nursing, Shandong University, Jinan, China
| | - Linghua Kong
- School of Nursing, Shandong University, Jinan, China
| | - Ping Li
- School of Nursing, Shandong University, Jinan, China.
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Hirschtritt ME, Ordóñez AE, Rico YC, LeWinn KZ. Internal resilience, peer victimization, and suicidal ideation among adolescents. Int J Adolesc Med Health 2015; 27:415-423. [PMID: 25719294 DOI: 10.1515/ijamh-2014-0060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 11/22/2014] [Indexed: 06/04/2023]
Abstract
PURPOSE Our goal was to examine the association between peer victimization (PV) and suicidal ideation (SI), and the degree to which internal resilience moderates this association. MATERIALS AND METHODS We examined the independent associations between PV frequency and type (verbal, cyber, physical, and relational), internal resilience, and the risk of SI within the last 12 months among 9th and 11th grade students participating in the California Healthy Kids Survey (CHKS) (n=42,594; 55.2% female; 72.2% non-white). RESULTS Odds ratios (OR) of SI associated with very low- (at least 1 PV type 1 time, but none more than 1 time), low- (at least 1 PV type 2-3 times, but none more than 2-3 times), and moderate/high- (at least 1 PV type 4 times or more) frequency PV compared with no PV were 1.30 (95% CI=1.15-1.45), 1.70 (95% CI=1.51-1.90) and 2.47 (95% CI=1.23-2.73), respectively. Any exposure to physical (OR=1.31; 95% CI=1.19-1.44), relational (OR=1.26; 95% CI=1.15-1.38), verbal (OR=1.38; 95% CI=1.27-1.50), or cyber (OR=1.26; 95% CI=1.15-1.39) PV was associated with increased odds of SI compared with no PV. Internal resilience was associated with lower odds of SI (OR=0.98, 95% CI=0.98-0.99), regardless of PV exposure. The slope between internal resilience and SI was significantly steeper for those subjects who experienced verbal PV (OR interaction=0.99; 95% CI=0.98-1.00). CONCLUSION Even infrequent PV was found to be associated with increased risk for SI. Internal resilience was associated with reduced SI, particularly for verbal forms of PV. Our results suggested that efforts to decrease SI among adolescents should be directed toward both preventing PV and strengthening internal resilience.
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Booster Sessions after Cognitive-Behavioural Group Therapy for Panic Disorder: Impact on Resilience, Coping, and Quality of Life. Behav Cogn Psychother 2014; 43:513-25. [PMID: 24914489 DOI: 10.1017/s1352465814000289] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Panic disorder (PD) has a chronic nature, especially as a result of maladaptive coping strategies to deal with stressful events. AIMS To evaluate the impact of booster sessions with cognitive techniques on coping strategies, resilience, and quality of life (QoL) in patients previously submitted to standard cognitive-behavioural group therapy (CBGT) for PD. METHOD A controlled clinical trial with 44 patients with PD (intervention = 20; control = 24) who had previously completed a 12-week CBGT protocol. PD, anxiety, and depression severity symptoms were assessed at baseline and 1, 6, and 12 months after the booster sessions. Coping strategies, resilience, and QoL were assessed by Coping Strategies Inventory (CSI), Resilience Scale, and WHOQOL-BREF respectively. RESULTS Over time, a significant improvement in PD and depression symptoms was observed in both groups. A significant increase in the QoL social relations domain was found in the booster group, considering a time/group interaction. Coping and other QoL domains did not change after the booster sessions. Changes in resilience were dependent on the intensity of symptoms, with negative but non-significant correlations. CONCLUSIONS The improvement in PD and depression symptoms for both groups may be a result of the group format of the intervention. Group booster sessions after CBGT are useful to maintain the benefits obtained with CBGT.
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Hyun MS, Chung HIC, De Gagne JC, Kang HS. The Effects of Cognitive-Behavioral Therapy on Depression, Anger, and Self-Control for Korean Soldiers. J Psychosoc Nurs Ment Health Serv 2014; 52:22-8. [DOI: 10.3928/02793695-20130930-05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 08/05/2013] [Indexed: 11/20/2022]
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Songprakun W, McCann TV. Effectiveness of a self-help manual on the promotion of resilience in individuals with depression in Thailand: a randomised controlled trial. BMC Psychiatry 2012; 12:12. [PMID: 22339984 PMCID: PMC3298500 DOI: 10.1186/1471-244x-12-12] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 02/16/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The prevalence of depression is increasing markedly in Thailand. One way of helping people with depression is to increase their resilience; good resilience is associated with positive outcomes in depression. The purpose of this study was to examine the effectiveness of a self-help manual on the resilience levels of individuals with depression living in the community in Chiang Mai Province in northern Thailand. METHODS Fifty-six participants with a diagnosis of moderate depression were assigned randomly to either an intervention (n = 27) or control (n = 29) group by means of independent random allocation, using computer generated random numbers. Fifty-four completed the study (two were excluded shortly after baseline data collection), so an available case analysis was undertaken. The intervention group were given a self-help manual and continued to receive standard care and treatment, while the control group continued to receive standard care and treatment. Both groups were also given a short weekly telephone call from a researcher. Participants were assessed at three time points: baseline (Week 0), immediate post-test (Week 8), and follow-up (Week 12). Data were collected between October 2007 and April 2008. RESULTS The findings showed statistically significant differences between the intervention and the control group, and within the intervention group, in their resilience levels. Simple main effects analyses of group within time showed a significant difference between both groups at follow-up (p = 0.001), with the intervention group having a higher resilience score than the control group. Simple main effect of time within the intervention group showed a significant increase in resilience scores from baseline to post-test time points (p < 0.001), from baseline to follow-up (p < 0.001), but not from post-test to follow-up (p = 0.298). CONCLUSIONS The findings provide preliminary evidence supporting the use of bibliotherapy for increasing resilience in people with moderate depression in a Thai context. Bibliotherapy is straightforward to use, and an easily accessible addition to the standard approach to promoting recovery. It is incorporated readily as an adjunct to the work of mental health nurses and other professionals in promoting resilience and enhancing recovery in people with moderate depression in the community. TRIAL REGISTRATION http://www.ANZCTR.org.au/ACTRN12611000905965.aspx.
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Affiliation(s)
- Wallapa Songprakun
- McCormick Faculty of Nursing, Payup University, 131 Kaewnawarat Road, T. Watgate A. Muang, Chiang Mai 50000, Thailand
| | - Terence V McCann
- School of Nursing and Midwifery, Victoria University, PO Box 1428, Melbourne, Victoria, Australia
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