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Farrer LM, Jackson HM, Gulliver A, Calear AL, Leach L, Hasking P, Katruss N, Batterham PJ. A Transdiagnostic Video-Based Internet Intervention (Uni Virtual Clinic-Lite) to Improve the Mental Health of University Students: Randomized Controlled Trial. J Med Internet Res 2024; 26:e53598. [PMID: 39137012 DOI: 10.2196/53598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/27/2024] [Accepted: 05/24/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Numerous studies have demonstrated the effectiveness of digital interventions for improving the mental health of university students. However, low rates of engagement with these interventions are an ongoing challenge and can compromise effectiveness. Brief, transdiagnostic, web-based video interventions are capable of targeting key mental health and related issues affecting university students and may be more engaging and accessible for this population. OBJECTIVE This study used a 2-arm randomized controlled trial to evaluate the effectiveness of Uni Virtual Clinic-Lite (UVC-Lite), a fully automated, transdiagnostic, web-based video intervention, relative to an attention-control condition. The primary outcomes were symptoms of depression and generalized anxiety disorder. The secondary outcomes included psychological distress, social anxiety symptoms, body appreciation, quality of life, well-being, functioning, general self-efficacy, academic self-efficacy, and help seeking. Program use (intervention uptake and engagement) and satisfaction were also assessed. METHODS University students (n=487) with mild to moderate symptoms of distress were recruited from universities across Australia and randomly allocated to receive access to the UVC-Lite intervention or an attention-control condition targeting general health for a period of 6 weeks. UVC-Lite includes 12 modules, each comprising a brief animated video and an accompanying exercise. Of the 12 modules, 7 also included a brief symptom screening quiz. Outcomes were assessed at baseline, postintervention, and 3- and 6-months postintervention. RESULTS The primary and secondary outcomes were analyzed on an intention-to-treat basis using mixed models repeated measures ANOVA. The intervention was not found to be effective relative to the control condition on any of the primary or secondary outcomes. While 67.9% (114/168) of participants accessed at least 1 module of the intervention, module completion was extremely low. Subgroup analyses among those who engaged with the program (completed at least 1 video) and those with higher baseline distress (Distress Questionnaire-5 score ≥15) did not reveal any differences between the conditions over time. However, uptake (accessing at least 1 video) and engagement (completing at least 1 video) were higher among those with higher baseline symptoms. Satisfaction with the intervention was high. CONCLUSIONS The UVC-Lite intervention was not effective relative to a control program, although it was associated with high satisfaction among students and was not associated with symptom deterioration. Given the challenges faced by universities in meeting demand for mental health services, flexible and accessible interventions such as UVC-Lite have the potential to assist students to manage symptoms of mental health problems. However, low uptake and engagement (particularly among students with lower levels of symptomatology) are significant challenges that require further attention. Future studies should examine the effectiveness of the intervention in a more highly symptomatic sample, as well as implementation pathways to optimize effective engagement with the intervention. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12621000375853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380146.
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Affiliation(s)
- Louise M Farrer
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Hayley M Jackson
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Amelia Gulliver
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Alison L Calear
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Liana Leach
- Department of Health Economics Wellbeing and Society, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Penelope Hasking
- Curtin enAble Institute and School of Population Health, Faculty of Health Sciences, Curtin University, Curtin, Australia
| | - Natasha Katruss
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
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Koelen J, Klein A, Wolters N, Bol E, De Koning L, Roetink S, Van Blom J, Boutin B, Schaaf J, Grasman R, Van der Heijde CM, Salemink E, Riper H, Karyotaki E, Cuijpers P, Schneider S, Rapee R, Vonk P, Wiers R. Web-Based, Human-Guided, or Computer-Guided Transdiagnostic Cognitive Behavioral Therapy in University Students With Anxiety and Depression: Randomized Controlled Trial. JMIR Ment Health 2024; 11:e50503. [PMID: 38896474 PMCID: PMC11222767 DOI: 10.2196/50503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Internet-based cognitive behavioral interventions (iCBTs) are efficacious treatments for depression and anxiety. However, it is unknown whether adding human guidance is feasible and beneficial within a large educational setting. OBJECTIVE This study aims to potentially demonstrate the superiority of 2 variants of a transdiagnostic iCBT program (human-guided and computer-guided iCBT) over care as usual (CAU) in a large sample of university students and the superiority of human-guided iCBT over computer-guided iCBT. METHODS A total of 801 students with elevated levels of anxiety, depression, or both from a large university in the Netherlands were recruited as participants and randomized to 1 of 3 conditions: human-guided iCBT, computer-guided iCBT, and CAU. The primary outcome measures were depression (Patient Health Questionnaire) and anxiety (Generalized Anxiety Disorder scale). Secondary outcomes included substance use-related problems (Alcohol Use Disorder Identification Test and Drug Abuse Screening Test-10 items). Linear mixed models were used to estimate the effects of time, treatment group, and their interactions (slopes). The primary research question was whether the 3 conditions differed in improvement over 3 time points (baseline, midtreatment, and after treatment) in terms of depression and anxiety symptoms. Results were analyzed according to the intention-to-treat principle using multiple imputation. Patients were followed exploratively from baseline to 6 and 12 months. RESULTS In both short-term and long-term analyses, the slopes for the 3 conditions did not differ significantly in terms of depression and anxiety, although both web-based interventions were marginally more efficacious than CAU over 6 months (P values between .02 and .03). All groups showed significant improvement over time (P<.001). For the secondary outcomes, only significant improvements over time (across and not between groups) were found for drug use (P<.001). Significant differences were found in terms of adherence, indicating that participants in the human-guided condition did more sessions than those in the computer-guided condition (P=.002). CONCLUSIONS The transdiagnostic iCBT program offers a practical, feasible, and efficacious alternative to usual care to tackle mental health problems in a large university setting. There is no indication that human guidance should be preferred over technological guidance. The potential preference of human support also depends on the scale of implementation and cost-effectiveness, which need to be addressed in future trials. TRIAL REGISTRATION International Clinical Trials Registry Platform NL7328/NTR7544; https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON26795.
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Affiliation(s)
- Jurrijn Koelen
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Anke Klein
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Nine Wolters
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Eline Bol
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Lisa De Koning
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Samantha Roetink
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Jorien Van Blom
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Bruno Boutin
- Technical Support Psychology Department, University of Amsterdam, Amsterdam, Netherlands
| | - Jessica Schaaf
- Cognitive Neuroscience Department, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Raoul Grasman
- Department of Psychological Methods, University of Amsterdam, Amsterdam, Netherlands
| | - Claudia Maria Van der Heijde
- Department of Research, Development and Prevention, Student Health Service, University of Amsterdam, Amsterdam, Netherlands
| | - Elske Salemink
- Experimental Psychopathology and Clinical Psychology Lab, Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
| | - Heleen Riper
- Amsterdam Public Health Research Institute, Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Eirini Karyotaki
- Amsterdam Public Health Research Institute, Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Pim Cuijpers
- Amsterdam Public Health Research Institute, Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Silvia Schneider
- Mental Health Research and Treatment Center, Department of Clinical Child and Adolescent Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Ronald Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Peter Vonk
- Department of Research, Development and Prevention, Student Health Service, University of Amsterdam, Amsterdam, Netherlands
| | - Reinout Wiers
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
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Harith H, Nik Farid ND, Yahya A, Mohd Shuib NL. The Effectiveness of EduMind for Mental Health Promotion Among Youths. Cureus 2024; 16:e61462. [PMID: 38826914 PMCID: PMC11143080 DOI: 10.7759/cureus.61462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 06/04/2024] Open
Abstract
Introduction The global surge in mental health issues, particularly among the youth, is evident. Despite the proliferation of digital mental health services, their adoption remains limited, hindered by various barriers. To address this issue, an evidence-based, validated digital mental health intervention is necessary. Although much research has explored the effectiveness of such interventions, there was limited evidence supporting those within the youth population. The objective of this research is to assess the effects of an interventional module on depression, anxiety, and stress symptoms among youths. Methods The EduMind online mental health intervention contents were developed from a needs assessment and a scoping review of effective psychotherapies, achieving a high content validation index (CVI) of 0.96. The contents were integrated into a web application to assess its effectiveness among the target population which consisted of university students of a local institution. A quasi-experimental study compared the intervention group (n=264) to a waitlist-control group (n=200), evaluating changes in mental health status with the Depression, Anxiety and Stress Scale 21 (DASS-21) questionnaire using analysis of covariance (ANCOVA) to analyse mean differences. Results Participants in the intervention group indicated a significant decrease (p < 0.001) in depression, anxiety, and stress. The pre-test and post-test mean scores in the intervention group were 15.81 and 8.97 for depression, 11.46 and 7.02 for anxiety and 14.64 and 6.33 for stress, respectively. In the control group, there was no significant difference between the pre-test and post-test mean scores for depression. However, there was a slight significant reduction for anxiety with pre- and post-test scores of 13.31 and 12.95. Stress mean scores exhibited a slight increase, rising from 13.55 to 14.24. The final phase revealed significant improvements in mental health status between groups, with significant effect sizes for stress (ƞp2 = 0.57, p < 0.001), depression (ƞp2 = 0.71, p < 0.001), and anxiety (ƞp2 = 0.27, p < 0.001). Conclusion The findings contribute to the advancement of technology-assisted health services, facilitating greater uptake among the population. This study utilized a comprehensive module development framework and demonstrated the effectiveness of the expert-guided mental health intervention module. Furthermore, the study suggests potential integration with the National Strategic Plan for Mental Health 2020-2025 and the National Mental Health Policy, proposing the web application as a potential compulsory student screening tool administered by universities. The information gathered by this application could inform future research directions, propelling technological-assisted mental health services to new heights.
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Affiliation(s)
- Hazwa Harith
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
| | - Nik Daliana Nik Farid
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
| | - Abqariyah Yahya
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
| | - Nor Liyana Mohd Shuib
- Department of Information Systems, Faculty of Computer Science and Information Technology, Universiti Malaya, Kuala Lumpur, MYS
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Kaufman A, Nemeroff R. Motivation to change predicts college students' utilization of self-help resources. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-9. [PMID: 38592799 DOI: 10.1080/07448481.2024.2334082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
Background: Stress and mental health difficulties are common burdens on college students. College counseling centers have been overrun by demand. Thus, self-help interventions may offer a promising alternative to traditional college counseling services. Methods: The current study examined the influence of perceived stress, motivation to change, and self-efficacy beliefs on college students' use of self-help resources, to determine whether these factors would predict follow-up with self-help recommendations. Results: Results of stepwise linear regression models suggest that perceived stress and self-efficacy did not predict self-help resource utilization. Different types of self-help recommendations did not predict different levels of follow-up. However, motivation to change was a significant predictor college students' self-help resource use, and this variable was particularly important when self-help recommendations were less structured. Conclusions: These findings can help to predict which college students are likely to make use of self-help resources, and inform targeted individual treatment.
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Affiliation(s)
- Alyson Kaufman
- Department of Psychology, William Paterson University, Wayne, New Jersey, USA
| | - Robin Nemeroff
- Department of Psychology, William Paterson University, Wayne, New Jersey, USA
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Berman AH, Topooco N, Lindfors P, Bendtsen M, Lindner P, Molander O, Kraepelien M, Sundström C, Talebizadeh N, Engström K, Vlaescu G, Andersson G, Andersson C. Transdiagnostic and tailored internet intervention to improve mental health among university students: Research protocol for a randomized controlled trial. Trials 2024; 25:158. [PMID: 38429834 PMCID: PMC10908025 DOI: 10.1186/s13063-024-07986-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/15/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Emerging adulthood is often associated with mental health problems. About one in three university students report symptoms of depression and anxiety that can negatively affect their developmental trajectory concerning work, intimate relationships, and health. This can interfere with academic performance, as mood and anxiety disorders are key predictors of dropout from higher education. A treatment gap exists, where a considerable proportion of students do not seek help for mood and anxiety symptoms. Offering internet interventions to students with mental health problems could reduce the treatment gap, increase mental health, and improve academic performance. A meta-analysis on internet interventions for university students showed small effects for depression and none for anxiety. Larger trials are recommended to further explore effects of guidance, transdiagnostic approaches, and individual treatment components. METHODS This study will offer 1200 university students in Sweden participation in a three-armed randomized controlled trial (RCT) evaluating a guided or unguided transdiagnostic internet intervention for mild to moderate depression and anxiety, where the waitlist control group accesses the intervention at 6-month follow-up. Students reporting suicidal ideation/behaviors will be excluded and referred to treatment within the existing healthcare system. An embedded study within the trial (SWAT) will assess at week 3 of 8 whether participants in the guided and unguided groups are at higher risk of failing to benefit from treatment. Those at risk will be randomized to an adaptive treatment strategy, or to continue the treatment as originally randomized. Primary outcomes are symptoms of depression and anxiety. Follow-ups will occur at post-treatment and at 6-, 12-, and 24-month post-randomization. Between-group outcome analyses will be reported, and qualitative interviews about treatment experiences are planned. DISCUSSION This study investigates the effects of a transdiagnostic internet intervention among university students in Sweden, with an adaptive treatment strategy employed during the course of treatment to minimize the risk of treatment failure. The study will contribute knowledge about longitudinal trajectories of mental health and well-being following treatment, taking into account possible gender differences in responsiveness to treatment. With time, effective internet interventions could make treatment for mental health issues more widely accessible to the student group.
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Affiliation(s)
- Anne H Berman
- Department of Psychology, Uppsala University, Uppsala, Sweden.
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Naira Topooco
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Petra Lindfors
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Philip Lindner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Olof Molander
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Martin Kraepelien
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Christopher Sundström
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | | | - Karin Engström
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - George Vlaescu
- Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Gerhard Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Claes Andersson
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Department of Criminology, Malmö University, Malmö, Sweden
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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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Ciharova M, Cuijpers P, Amanvermez Y, Riper H, Klein AM, Bolinski F, de Wit LM, van der Heijde CM, Bruffaerts R, Struijs S, Wiers RW, Karyotaki E. Use of tailoring features and reasons for dropout in a guided internet-based transdiagnostic individually-tailored cognitive behavioral therapy for symptoms of depression and/or anxiety in college students. Internet Interv 2023; 34:100646. [PMID: 38099094 PMCID: PMC10719529 DOI: 10.1016/j.invent.2023.100646] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/01/2023] [Accepted: 07/07/2023] [Indexed: 12/17/2023] Open
Abstract
Transdiagnostic individually-tailored digital interventions reduce symptoms of depression and anxiety in adults with moderate effects. However, research into these approaches for college students is scarce and contradicting. In addition, the exact reasons for intervention dropout in this target group are not well known, and the use of individually-tailored intervention features, such as optional modules, has not yet been explored. The current study aimed to (1) investigate reasons for dropout from a guided internet-based transdiagnostic individually-tailored intervention for college students assessed in a randomized controlled trial (RCT) and (2) evaluate whether participants used tailoring features intended for their baseline symptoms. A sample of college students with mild to moderate depression and/or anxiety symptoms (n = 48) in the Netherlands (partially) followed a guided internet-based transdiagnostic individually-tailored intervention. We contacted those who did not complete the entire intervention (n = 29) by phone to report the reasons for intervention dropout. Further, we descriptively explored the use of tailoring features (i.e., depression versus anxiety trajectory) and optional modules of the intervention in the whole sample. We identified a range of person- and intervention-related reasons for intervention dropout, most commonly busy schedules, needs for different kinds of help, or absence of personal contact. Furthermore, only less than half of the participants used the individually-tailoring features to address the symptoms they reported as predominant. In conclusion, digital interventions clear about the content and targeted symptoms, tested in user research could prevent dropout and create reasonable expectations of the intervention. Participants would benefit from additional guidance when using tailoring features of digital interventions, as they often do not choose the tailoring features targeting their baseline symptoms.
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Affiliation(s)
- Marketa Ciharova
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- Faculty of Medicine, Dept. of Psychiatry, University of Turku, FI-20014 Turun yliopisto, Finland
- Babeș-Bolyai University, International Institute for Psychotherapy, No.37, Republicii Street 400015, Cluj-Napoca, Romania
| | - Yagmur Amanvermez
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- Faculty of Medicine, Dept. of Psychiatry, University of Turku, FI-20014 Turun yliopisto, Finland
- Research Unit for Telepsychiatry and e-Mental Health, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, 5000 Odense, Denmark
- Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands
| | - Anke M. Klein
- Developmental and Educational Psychology of the Institute of Psychology, Leiden University, Rapenburg 70, 2311 EZ Leiden, the Netherlands
- Addiction, Development, and Psychopathology Lab, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129, 1001NK Amsterdam, the Netherlands
| | - Felix Bolinski
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- Department of Mental Health and Prevention, Trimbos Institute, Da Costakade 45, 3521 VS Utrecht, the Netherlands
| | - Leonore M. de Wit
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
| | - Claudia M. van der Heijde
- Department of Research, Development and Prevention, Student Health Service, University of Amsterdam, Oude Turfmarkt 151, 1012 GC Amsterdam, the Netherlands
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum, Centre for Public Health Psychiatry, Katholieke Universiteit Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Sascha Struijs
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
| | - Reinout W. Wiers
- Addiction, Development, and Psychopathology Lab, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129, 1001NK Amsterdam, the Netherlands
- Center for Urban Mental Health, Oude Turfmarkt 145-147, 1012 GC Amsterdam, the Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
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8
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Wang Q, Zhang W, An S. A systematic review and meta-analysis of Internet-based self-help interventions for mental health among adolescents and college students. Internet Interv 2023; 34:100690. [PMID: 38023965 PMCID: PMC10654252 DOI: 10.1016/j.invent.2023.100690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 10/24/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose This meta-analysis aims to evaluate the impact of Internet-based self-help interventions on the mental health of adolescents and college students. Methods We conducted a systematic review of randomized controlled trials (RCTs) that investigated Internet-based self-help interventions aiming to mitigate mental health symptoms such as anxiety and depression, as well as managing high levels of stress, among adolescents and college students. Our search spanned databases including Web of Science, PubMed, Cochrane Library, and Embase, up until November 1st, 2022. It is essential to emphasize that our focus was the evaluation of symptoms (continuous outcomes), rather than the diagnosis of specific mental disorders. The meta-analysis was performed using the R version 4.3.1. The effect size measure was the standardized mean difference (SMD), and random-effects models were used to pool data from eligible RCTs. Subgroup analyses were carried out to examine variations in intervention effects based on factors such as sample type, intervention modality, guidance type, and intervention duration. Results The meta-analysis was based on 25 comparisons involving a total of 4480 participants. In comparison to the control group (n = 2125), participants receiving interventions (n = 2355) reported significant reductions in symptoms of anxiety, depression, and stress, along with a significant improvement in quality of life. Specifically, for depression, we observed moderate intervention effects (SMD = -0.42, 95 % CI: -0.56, -0.27), and a similar pattern was seen for quality of life (SMD = 0.36, 95%CI: 0.22, 0.49). Small intervention effects were found for anxiety (SMD = -0.35, 95 % CI [-0.48, -0.22]) and stress (SMD = -0.35, 95 % CI [-0.51, -0.20]). Given significant heterogeneity, subgroup analyses were conducted for anxiety and depression, considering factors such as sample type, intervention method, and intervention duration. Notably, college students experienced more significant benefits in both anxiety and depression alleviation compared to adolescents. Longer interventions (>8 weeks) were particularly effective in reducing anxiety and depression. Additionally, third-wave cognitive-behavioral therapy (CBT) showed pronounced intervention effects in both outcome measures, while the presence of guidance did not notably influence results. Conclusion This meta-analysis underscores the positive impact of Internet-based self-help programs in alleviating the symptoms of psychological disorders among adolescents and college students. However, it is crucial to acknowledge that the available evidence exhibits inconsistencies and limitations. Therefore, further research utilizing rigorous methodologies is necessary to verify and broaden the findings of this meta-analysis.
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Affiliation(s)
- Qing Wang
- Nanjing Normal University, School of Education Science, Jiangsu, Nanjing 210000, PR China
| | - Weixin Zhang
- Department of Traditional Chinese Medical Orthopedic Surgery, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, PR China
| | - Senbo An
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, PR China
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9
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Lukenga MP, Billonnet L, Gaugue J, Denis J. Exploring female students' perceptions of the use of digital technologies in managing academic stress. Front Psychol 2023; 14:1199038. [PMID: 37333588 PMCID: PMC10274148 DOI: 10.3389/fpsyg.2023.1199038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Objective The purpose of this research is to explore the perceptions of female students regarding the implementation of digital technologies for academic stress management. We aim to determine if the contribution of these technologies could offer to female students a better management of the stress related to their studies and thus, a better deployment of strategies to cope with academic difficulties. Method A qualitative study using the focus group methodology was conducted. Our inductive and exploratory approach allowed us to focus on the experience and perception of eleven female students from the University of Mons. The cohort was divided into two groups according to their score on the Perceived Stress Scale-10. Results The data collected was analyzed using the thematic analysis of which allowed us to identify fourteen sub-themes divided into three axes: coping strategies used to manage academic stress, students' needs to improve their management of academic stress, and the implementation of technology for managing academic stress. Conclusion Our results show that the issues present in the academic context lead students to use various coping strategies, some of which are harmful to their physical and mental health. The implementation of digital technologies and biofeedback seems to be an approach that could help students adopt more functional coping strategies and alleviate their daily difficulties in managing academic stress.
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Affiliation(s)
| | | | - Justine Gaugue
- Department of Clinical Psychology, University of Mons, Mons, Belgium
| | - Jennifer Denis
- Department of Clinical Psychology, University of Mons, Mons, Belgium
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10
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D’Adamo L, Paraboschi L, Grammer AC, Fennig M, Graham AK, Yaeger LH, Newman MG, Wilfley DE, Taylor CB, Eisenberg D, Fitzsimmons-Craft EE. Reach and uptake of digital mental health interventions based on cognitive-behavioral therapy for college students: A systematic review. JOURNAL OF BEHAVIORAL AND COGNITIVE THERAPY 2023; 33:97-117. [PMID: 37724304 PMCID: PMC10506850 DOI: 10.1016/j.jbct.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Background Mental health problems are increasing in prevalence among college students, yet few students receive treatment due to barriers such as insufficient resources in college counseling centers. Digital mental health interventions (DMHIs) have potential to overcome barriers and offer accessible, evidence-based care to college students. However, to evaluate the true public health impact of evidence-based DMHIs, it is important to assess the reach and uptake rates of DMHIs on college campuses. Objectives We conducted a systematic review to examine the reach (i.e., % of invited students who express interest) and uptake (i.e., % of enrolled participants who initiate an intervention) of DMHIs based on cognitive-behavioral therapy (CBT) for college students. Methods Eight databases were searched. Inclusion criteria included: (1) college population; (2) experimental design; (3) CBT-based intervention; (4) intervention targeting specific mental health conditions; and (5) digital intervention. Reach and uptake rates were calculated from data reported. A systematic narrative review framework was used to synthesize results. Results Of 10,315 articles screened, 90 were included. Seventeen studies (19%) reported sufficient data to calculate reach; 35 studies (39%) reported uptake rates. Of studies that reported reach or uptake, most evaluated unguided (n = 20) or guided (n = 16) self-help programs. Measurement methods varied widely. Overall reach was low, whereas uptake was high among enrolled participants. Discussion Despite evidence that improving reach and uptake can increase the public health impact of DMHIs, most studies did not report on either outcome. Suggested practices to improve these outcomes, and their reporting, are discussed.
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Affiliation(s)
- Laura D’Adamo
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
- Department of Psychological and Brain Sciences and Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, 3201 Chestnut St. Philadelphia, PA 19104, USA
| | - Layna Paraboschi
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Anne Claire Grammer
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Molly Fennig
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N St Clair St, Chicago, IL 60611, USA
| | - Lauren H. Yaeger
- Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, USA
| | - Michelle G. Newman
- Department of Psychology, The Pennsylvania State University, 371 Moore Building, University Park, PA 16801, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA
- Center for m Health, Palo Alto University, 5150 El Camino Real, Los Altos, CA 94022, USA
| | - Daniel Eisenberg
- Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Ellen E. Fitzsimmons-Craft
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
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11
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Kosasih FR, Yee VTS, Toh SHY, Sündermann O. Efficacy of Intellect's self-guided anxiety and worry mobile health programme: A randomized controlled trial with an active control and a 2-week follow-up. PLOS DIGITAL HEALTH 2023; 2:e0000095. [PMID: 37224139 DOI: 10.1371/journal.pdig.0000095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 03/24/2023] [Indexed: 05/26/2023]
Abstract
Digital self-guided mobile health [mHealth] applications are cost-effective, accessible, and well-suited to improve mental health at scale. This randomized controlled trial [RCT] evaluated the efficacy of a recently developed mHealth programme based on cognitive-behavioral therapy [CBT] principles in improving worry and anxiety. We also examined psychological mindedness [PM] as a mediator by which app engagement is thought to improve outcomes. The Intervention group completed a 2-week "Anxiety and Worry" programme with daily CBT-informed activities, while the active waitlist-control completed a matched 2-week mHealth programme on procrastination. Participants filled out the Generalized Anxiety Disorder [GAD-7], Patient Health Questionnaire [PHQ-9], and Psychological Mindedness Scale [PMS] at baseline, post-intervention, and 2-week follow-up. App engagement was measured at post-intervention only. Contrary to prediction, the Intervention group did not perform better than the Active Control group; both groups showed significant improvements on anxiety and depressive symptoms from baseline to follow-up. From post-intervention to follow-up, only the Intervention group showed further improvements for anxiety symptoms. Higher engagement with the mHealth app predicted lower anxiety and depressive symptoms at follow-up, and this relationship was fully mediated by psychological mindedness. This study provides evidence that [a] engaging in a CBT mHealth programme can reduce anxiety and worry, and [b] Psychological mindedness is a potential pathway by which engaging with a mHealth app improves anxiety and depressive symptoms. While overall effect sizes were small, at the population level, these can make significant contributions to public mental health.
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Affiliation(s)
| | | | | | - Oliver Sündermann
- Research Department, Intellect Co Pte Ltd, Singapore
- Department of Psychology, National University of Singapore
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12
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Hagberg T, Manhem P, Oscarsson M, Michel F, Andersson G, Carlbring P. Efficacy of transdiagnostic cognitive-behavioral therapy for assertiveness: A randomized controlled trial. Internet Interv 2023; 32:100629. [PMID: 37273933 PMCID: PMC10235435 DOI: 10.1016/j.invent.2023.100629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 06/06/2023] Open
Abstract
Assertiveness training has been an essential component in cognitive-behavioral therapy (CBT), for example, in the treatment of social anxiety and in dialectical behavioral therapy. However, the assertiveness construct has garnered little attention in recent clinical research. The objective of this study was to investigate the efficacy of an eight-week transdiagnostic stand-alone internet-based CBT intervention specifically aimed at increasing levels of assertive behavior. Following inclusion, we randomized N = 210 participants into three groups: therapist-guided self-help, unguided self-help, and a wait-list control condition. After a one-year follow-up, we employed a linear mixed model to estimate the effects at both post-test and follow-up for the primary outcome measures of assertiveness, Adaptive and Aggressive Assertiveness Scales, the Rathus Assertiveness Schedule, and secondary outcome measures of anxiety, depression, and general well-being. We also assessed reliable clinical change. Compared to the wait list at the post-treatment, estimated between-group effect sizes on self-rated adaptive assertiveness were statistically equivalent for the two treatment groups both at the post and at the one-year follow-up time points, ranging from ES = 0.95 to 1.73, with reliable clinical recovery proportions from 19 % to 36 %. The increase in aggressive assertiveness ranged from ES = 0.62 to 0.90 compared to the wait-list condition at post. For social anxiety symptoms, the effects compared to the wait list at post-treatment ranged from ES = 0.67 to 0.93, with a reliable clinical recovery rate from 16 % to 26 %. For self-assessed well-being, the effects compared to the wait list at post ranged from ES = 0.70 to 1.05. No effects were observed for generalized anxiety, although within-group evidence was found for a medium effect on depression one year after treatment. Overall, the two treatment conditions produced similar effects. In general, participation increased healthy assertive expressions regardless of treatment condition, all the while reducing self-assessed social anxiety and, over time, possibly also depression. Participation also improved general well-being. The findings demonstrate that the assertiveness construct can be a suitable target for intervention, with reductions of both psychiatric symptoms and non-syndromal problems in daily life. The study was preregistered at ClinicalTrials.gov (NCT04240249).
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Affiliation(s)
| | - Patrik Manhem
- Department of Psychology, Stockholm University, Sweden
| | | | | | - Gerhard Andersson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Behavioral Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Sweden
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13
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Laufer S, Schulze L, Engel S, Klusmann H, Skoluda N, Nater UM, Knaevelsrud C, Schumacher S. The effect of an internet-based intervention for depression on cortisol and alpha-amylase. Psychoneuroendocrinology 2023; 152:106082. [PMID: 36989562 DOI: 10.1016/j.psyneuen.2023.106082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/13/2023] [Accepted: 03/11/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION Psychotherapeutic interventions for major depressive disorder (MDD) have been suggested to be associated with a normalization of biological stress system (i.e., the hypothalamic-pituitary-adrenal axis and the autonomic nervous system) dysregulation. Furthermore, pre-intervention cortisol parameters have been identified as prescriptive biological markers of treatment success. However, evidence of treatment effects on the biological stress systems is still sparse, and results are heterogeneous. The current study examined the effect of an internet-based intervention for MDD on salivary cortisol and alpha-amylase as well as hair cortisol concentrations. Moreover, the prescriptive capacity of pre-intervention cortisol and alpha-amylase concentrations on treatment response was explored. METHODS Thirty-eight participants suffering from mild to moderate MDD collected saliva and hair samples throughout the intervention. Biological outcome parameters were salivary cortisol and alpha-amylase (awakening response, total diurnal output, diurnal slope) and hair cortisol concentrations. Treatment response was indicated by change in depression severity and perceived chronic stress. RESULTS Treatment response on depression scores or chronic stress was not associated with changes in any of the cortisol or alpha-amylase parameters. Exploratory analysis indicated that non-responders showed a steeper alpha-amylase slope pre-intervention. DISCUSSION The results indicate that changes in depressive symptoms did not correspond to changes of the biological stress systems, contradicting the suggested normalization of dysregulated hypothalamic-pituitary-adrenal axis or autonomic nervous system activity through a psychotherapeutic intervention. However, the results point to a potential role of pre-intervention alpha-amylase slope as a prescriptive marker of treatment response for depression.
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Affiliation(s)
- Sebastian Laufer
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendener Straße 27, 14195 Berlin, Germany; Clinical Psychology and Psychotherapy, Institute for Mental Health and Behavioral Medicine, Faculty of Health, HMU Health and Medical University, Olympischer Weg 1, 14471 Potsdam, Germany.
| | - Lars Schulze
- Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - Sinha Engel
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendener Straße 27, 14195 Berlin, Germany
| | - Hannah Klusmann
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendener Straße 27, 14195 Berlin, Germany
| | - Nadine Skoluda
- Department of Clinical Psychology and Health Psychology, Faculty of Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria; Research Platform the Stress of Life (SOLE) - Processes and Mechanisms underlying Everyday Life Stress, Austria
| | - Urs M Nater
- Department of Clinical Psychology and Health Psychology, Faculty of Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria; Research Platform the Stress of Life (SOLE) - Processes and Mechanisms underlying Everyday Life Stress, Austria
| | - Christine Knaevelsrud
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendener Straße 27, 14195 Berlin, Germany
| | - Sarah Schumacher
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendener Straße 27, 14195 Berlin, Germany; Clinical Psychology and Psychotherapy, Institute for Mental Health and Behavioral Medicine, Faculty of Health, HMU Health and Medical University, Olympischer Weg 1, 14471 Potsdam, Germany
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14
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Oliveira C, Pacheco M, Borges J, Meira L, Santos A. Internet-delivered cognitive behavioral therapy for anxiety among university students: A systematic review and meta-analysis. Internet Interv 2023; 31:100609. [PMID: 36873307 PMCID: PMC9982642 DOI: 10.1016/j.invent.2023.100609] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 02/14/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
University years are marked by multiple stressors. Consequently, university students often report anxiety symptoms or disorders, but most remain untreated. Internet-delivered cognitive behavioral therapy (ICBT) has been proposed as an alternative to address known help-seeking barriers, which were aggravated during the COVID-19 pandemic. This meta-analysis aims to evaluate the efficacy of ICBT for university students with anxiety. A systematic search on three databases, EBSCOhost, PubMed, and Web of Science, and a manual search were performed. Fifteen studies were identified, including a total of 1619 participants. Seven studies evaluated ICBT treatment for both anxiety and depression, three for social anxiety, two for generalized anxiety, while the remaining (k = 3) only targeted anxiety, test anxiety, and comorbidity between anxiety and insomnia. Analyses were performed based on a random-effects model using the metafor package in R. The results indicated that ICBT had a significant and positive effect on university students with anxiety compared to controls at post-test (g = -0.48; 95 % CI: -0.63, -0.27; p < .001, I 2 = 67.30 %). Nevertheless, more research is required to determine the intervention components that are more relevant for therapeutic change, how much guidance is required to produce better outcomes, and how patient engagement can be improved.
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Affiliation(s)
- Cláudia Oliveira
- University of Maia, Av. Carlos Oliveira Campos, 4475-690 Maia, Portugal.,Center for Psychology at University of Porto, 4200-135 Porto, Portugal
| | - Mara Pacheco
- University of Maia, Av. Carlos Oliveira Campos, 4475-690 Maia, Portugal
| | - Janete Borges
- University of Maia, Av. Carlos Oliveira Campos, 4475-690 Maia, Portugal
| | - Liliana Meira
- University of Maia, Av. Carlos Oliveira Campos, 4475-690 Maia, Portugal.,Center for Psychology at University of Porto, 4200-135 Porto, Portugal
| | - Anita Santos
- University of Maia, Av. Carlos Oliveira Campos, 4475-690 Maia, Portugal.,Center for Psychology at University of Porto, 4200-135 Porto, Portugal
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15
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Chang C, Palermo E, Deswert S, Brown A, Nuske HJ. Money can't buy happiness: A randomized controlled trial of a digital mental health app with versus without financial incentives. Digit Health 2023; 9:20552076231170693. [PMID: 37361441 PMCID: PMC10286537 DOI: 10.1177/20552076231170693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 04/03/2023] [Indexed: 06/28/2023] Open
Abstract
Mental health disorders are prevalent among college students and increasing in frequency and severity. However, there is a significant gap between those who need treatment and those who engage in treatment. Given the documented efficacy of financial incentives for promoting health behavior change and engagement in treatment, financial incentives may help, along with nonfinancial behavioral incentives such as motivational messaging, gamification, and loss aversion techniques. We compared brief (28-day) use of two versions of a behavioral economics-inspired digital mental health app, NeuroFlow: (1) the full app including financial incentives and nonfinancial behavioral incentives (treatment group) and (2) a version of the app with nonfinancial behavioral incentives only (control group). In our intent-to-treat analyses, in order to examine the primary outcome of app engagement, a one-way analysis of variance (ANOVA) (treatment vs. control) was conducted, and to examine the secondary outcomes (depression, anxiety, emotion dysregulation, and wellbeing), a two-way repeated measures ANOVAs (treatment vs. control × baseline vs. post-trial) were conducted. We found that there were no differences between treatment groups on app engagement or the change in the mental health/wellness outcome measures. There was a main effect of timepoint on symptoms of anxiety and emotion dysregulation, such that there were significantly lower self-reported symptoms at post-trial relative to baseline. Our results suggest that financial incentives in digital mental health apps over and above nonfinancial behavioral incentives do not have an impact on app engagement or mental health/wellness outcomes.
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Affiliation(s)
- Cheryl Chang
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Emma Palermo
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Penn Center for Mental Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sky Deswert
- Department of Psychiatry, Penn Center for Mental Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Alyssa Brown
- Department of Psychiatry, Penn Center for Mental Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Heather J Nuske
- Department of Psychiatry, Penn Center for Mental Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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16
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Mavragani A, Strowger M, Shipley JL, Ortman J, MacIntyre RI, Bauer EA. Data Quality and Study Compliance Among College Students Across 2 Recruitment Sources: Two Study Investigation. JMIR Form Res 2022; 6:e39488. [PMID: 36485020 PMCID: PMC9789498 DOI: 10.2196/39488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/03/2022] [Accepted: 10/20/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Models of satisficing suggest that study participants may not fully process survey items and provide accurate responses when survey burden is higher and when participant motivation is lower. Participants who do not fully process survey instructions can reduce a study's power and hinder generalizability. Common concerns among researchers using self-report measures are data quality and participant compliance. Similarly, attrition can hurt the power and generalizability of a study. OBJECTIVE Given that college students comprise most samples in psychological studies, especially examinations of student issues and psychological health, it is critical to understand how college student recruitment sources impact data quality (operationalized as attention check items with directive instructions and correct answers) and retention (operationalized as the completion of follow-up surveys over time). This examination aimed to examine the following: whether data quality varies across recruitment sources, whether study retention varies across recruitment sources, the impact of data quality on study variable associations, the impact of data quality on measures of internal consistency, and whether the demographic qualities of participants significantly vary across those who failed attention checks versus those who did not. METHODS This examination was a follow-up analysis of 2 previously published studies to explore data quality and study compliance. Study 1 was a cross-sectional, web-based survey examining college stressors and psychological health (282/407, 69.3% female; 230/407, 56.5% White, 113/407, 27.8% Black; mean age 22.65, SD 6.73 years). Study 2 was a longitudinal college drinking intervention trial with an in-person baseline session and 2 web-based follow-up surveys (378/528, 71.6% female; 213/528, 40.3% White, 277/528, 52.5% Black; mean age 19.85, SD 1.65 years). Attention checks were included in both studies to assess data quality. Participants for both studies were recruited from a psychology participation pool (a pull-in method; for course credit) and the general student body (a push-out method; for monetary payment or raffle entry). RESULTS A greater proportion of participants recruited through the psychology pool failed attention checks in both studies, suggesting poorer data quality. The psychology pool was also associated with lower retention rates over time. After screening out those who failed attention checks, some correlations among the study variables were stronger, some were weaker, and some were fairly similar, potentially suggesting bias introduced by including these participants. Differences among the indicators of internal consistency for the study measures were negligible. Finally, attention check failure was not significantly associated with most demographic characteristics but varied across some racial identities. This suggests that filtering out data from participants who failed attention checks may not limit sample diversity. CONCLUSIONS Investigators conducting college student research should carefully consider recruitment and include attention checks or other means of detecting poor quality data. Recommendations for researchers are discussed.
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Affiliation(s)
| | - Megan Strowger
- Department of Psychology, Old Dominion University, Norfolk, VA, United States
| | - Jennifer L Shipley
- Department of Psychology, Old Dominion University, Norfolk, VA, United States
| | - Jordan Ortman
- Department of Psychology, Old Dominion University, Norfolk, VA, United States
| | - Rachel I MacIntyre
- Department of Psychology, Old Dominion University, Norfolk, VA, United States.,Department of Psychology, Millersville University, Millersville, PA, United States
| | - Elizabeth A Bauer
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
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17
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Rom S, Miskovic‐Wheatley J, Barakat S, Aouad P, Fuller‐Tyszkiewicz M, Maguire S. Evaluating the feasibility and potential efficacy of a brief eTherapy for binge-eating disorder: A pilot study. Int J Eat Disord 2022; 55:1614-1620. [PMID: 35986579 PMCID: PMC9804415 DOI: 10.1002/eat.23803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE For those with binge-eating disorder (BED), access to evidence-based, face-to-face treatment is often constrained by clinician availability and high treatment costs. Emerging evidence suggests online therapy (eTherapy) may navigate these barriers and reduce binge-eating symptomatology; however, less evaluation has been done in those with BED, particularly with briefer programs targeting early change. This study investigated the feasibility and potential efficacy of a brief, supported eTherapy in those with BED or subthreshold BED. METHOD Participants were 19 women with BED who completed a four-session eTherapy. This was a single-arm, pre-post intervention study, with participants completing weekly content and attending telehealth sessions. Key outcomes were assessed by the Eating Disorder Examination Questionnaire-Short (EDE-QS): objective binge episode days, loss of control over eating days, and eating disorder (ED) psychopathology via a total EDE-QS score. RESULTS Generalized and linear mixed models showed significantly reduced loss of control over eating days and ED psychopathology. Program feasibility was high, with strong program adherence and a below average attrition rate. DISCUSSION Pilot results support the feasibility and potential efficacy of a brief, behavioral-focused eTherapy program in reducing ED pathology in those with BED. Future research should further investigate findings in an adequately powered randomized controlled trial. PUBLIC SIGNIFICANCE This study suggests that a brief, behavioral-focused online therapy, guided by non-expert clinicians, can be successfully administered to those with binge-eating disorder (BED) and may be efficacious at reducing eating disorder and other related symptomatology. Brief eTherapies that are effective, accessible, and rapidly available may facilitate earlier intervention in illness and improve treatment outcomes for individuals who experience this common and distressing disorder.
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Affiliation(s)
- Sean Rom
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia,InsideOut Institute, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Jane Miskovic‐Wheatley
- InsideOut Institute, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Sarah Barakat
- InsideOut Institute, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia,School of PsychologyThe University of SydneySydneyNew South WalesAustralia
| | - Phillip Aouad
- InsideOut Institute, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | | | - Sarah Maguire
- InsideOut Institute, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia,Sydney Local Health DistrictSydneyNew South WalesAustralia
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18
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McKee PC, Budnick CJ, Walters KS, Antonios I. College student Fear of Missing Out (FoMO) and maladaptive behavior: Traditional statistical modeling and predictive analysis using machine learning. PLoS One 2022; 17:e0274698. [PMID: 36197889 PMCID: PMC9534387 DOI: 10.1371/journal.pone.0274698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 09/01/2022] [Indexed: 12/02/2022] Open
Abstract
This paper reports a two-part study examining the relationship between fear of missing out (FoMO) and maladaptive behaviors in college students. This project used a cross-sectional study to examine whether college student FoMO predicts maladaptive behaviors across a range of domains (e.g., alcohol and drug use, academic misconduct, illegal behavior). Participants (N = 472) completed hard copy questionnaire packets assessing trait FoMO levels and questions pertaining to unethical and illegal behavior while in college. Part 1 utilized traditional statistical analyses (i.e., hierarchical regression modeling) to identify any relationships between FoMO, demographic variables (socioeconomic status, living situation, and gender) and the behavioral outcomes of interest. Part 2 looked to quantify the predictive power of FoMO, and demographic variables used in Part 1 through the convergent approach of supervised machine learning. Results from Part 1 indicate that college student FoMO is indeed related to many diverse maladaptive behaviors spanning the legal and illegal spectrum. Part 2, using various techniques such as recursive feature elimination (RFE) and principal component analysis (PCA) and models such as logistic regression, random forest, and Support Vector Machine (SVM), showcased the predictive power of implementing machine learning. Class membership for these behaviors (offender vs. non-offender) was predicted at rates well above baseline (e.g., 50% at baseline vs 87% accuracy for academic misconduct with just three input variables). This study demonstrated FoMO's relationships with these behaviors as well as how machine learning can provide additional predictive insights that would not be possible through inferential statistical modeling approaches typically employed in psychology, and more broadly, the social sciences. Research in the social sciences stands to gain from regularly utilizing the more traditional statistical approaches in tandem with machine learning.
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Affiliation(s)
- Paul C. McKee
- Department of Psychology, Southern Connecticut State University, New Haven, CT, United States of America
- * E-mail:
| | - Christopher J. Budnick
- Department of Psychology, Southern Connecticut State University, New Haven, CT, United States of America
| | - Kenneth S. Walters
- Department of Psychology, Southern Connecticut State University, New Haven, CT, United States of America
| | - Imad Antonios
- Department of Computer Science, Southern Connecticut State University, New Haven, CT, United States of America
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19
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Børtveit L, Dechsling A, Sütterlin S, Nordgreen T, Nordahl-Hansen A. Guided Internet-Delivered Treatment for Depression: Scoping Review. JMIR Ment Health 2022; 9:e37342. [PMID: 36194467 PMCID: PMC9579933 DOI: 10.2196/37342] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/01/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies on guided internet-delivered treatment have demonstrated promising results for patients with depressive disorder. OBJECTIVE The aim of this study was to provide an overview of this research area and identify potential gaps in the research. METHODS In this scoping review, web-based databases were used to identify research papers published between 2010 and 2022 where guided internet-delivered treatment was administered to participants with depressive disorders, a standardized rating scale of depressive symptoms was used as the primary outcome measure, and the treatment was compared with a control condition. RESULTS A total of 111 studies were included, and an overview of the studies was provided. Several gaps in the research were identified regarding the design of the studies, treatments delivered, participant representation, and treatment completion. CONCLUSIONS This review provides a comprehensive overview of the research area, and several research gaps were identified. The use of other designs and active control conditions is recommended. Future studies should provide access to treatment manuals, and more replications should be conducted. Researchers should aim to include underrepresented populations and provide reports of comorbidities. Definitions of adequate dosage, reports of completion rates, and reasons for treatment dropout are recommended for future studies.
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Affiliation(s)
- Line Børtveit
- Faculty of Health, Welfare and Organisation, Østfold University College, Halden, Norway.,Faculty of Health Sciences, Department of Behavioral Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Anders Dechsling
- Department of Education, ICT, and Learning, Østfold University College, Halden, Norway
| | - Stefan Sütterlin
- Faculty of Health, Welfare and Organisation, Østfold University College, Halden, Norway.,Faculty of Computer Science, Albstadt-Sigmaringen University, Sigmaringen, Germany
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Departement of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Anders Nordahl-Hansen
- Department of Education, ICT, and Learning, Østfold University College, Halden, Norway
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20
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Tomoiagă C, David O. The Efficacy of Guided and Unguided Game-Based Cognitive-Behavioral Therapy in Reducing Distress in College Students. Games Health J 2022; 11:403-413. [PMID: 36067336 DOI: 10.1089/g4h.2021.0195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: College students` mental health is an international prioritized research subject. Dedicated interventions are constantly developed to be more suited, attractive, and effective and to reach as many students as possible. Our study aims to investigate the efficacy of an online game-based cognitive-behavioral therapy transdiagnostic intervention (REThink game) in reducing psychology students' distress. Method: Our sample consisted of 139 students (mean age 26.27; 17 male students and 122 female students) who voluntarily enrolled in our study, and they were randomly assigned to 1 of our 3 groups (REThink game without guidance n = 44; REThink game with guidance n = 46; or care-as-usual control group n = 49). They completed the pretest questionnaires (distress [negative functional and dysfunctional emotions], rational, and irrational cognitions), then they were offered to play the trial version of the REThink game, and after that, two specific levels focused on relaxation with mindfulness abilities, and on cognitive change emotion-regulation abilities. After completing the game, students in the REThink game with guidance received email support aimed to help them implement the skills learned in the game. Results: Results showed medium effect size improvements for the REThink game without guidance group compared to the control group in terms of dysfunctional negative emotions and improvements in irrational cognitions for both experimental groups compared to the control group. Conclusion: So far, the REThink therapeutic game proved to be a promising innovative, efficient, and highly accessible intervention for helping students manage distress. Trial Registration: ClinicalTrials.gov NCT04763954.
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Affiliation(s)
- Cristina Tomoiagă
- Evidence-Based Psychological Assessment and Interventions Doctoral School, Babes-Bolyai University of Cluj-Napoca, Cluj-Napoca, Romania
| | - Oana David
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University of Cluj-Napoca, Cluj-Napoca, Romania
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21
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Lambert SD, Grover S, Laizner AM, McCusker J, Belzile E, Moodie EEM, Kayser JW, Lowensteyn I, Vallis M, Walker M, Da Costa D, Pilote L, Ibberson C, Sabetti J, de Raad M. Adaptive web-based stress management programs among adults with a cardiovascular disease: A pilot Sequential Multiple Assignment Randomized Trial (SMART). PATIENT EDUCATION AND COUNSELING 2022; 105:1587-1597. [PMID: 34753612 DOI: 10.1016/j.pec.2021.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/13/2021] [Accepted: 10/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To assess the feasibility and acceptability of using a Sequential Multiple Assignment Randomized Trial (SMART) to optimize the delivery of a web-based, stress management intervention for patients with a cardiovascular disease (CVD). METHODS 59 patients with a CVD and moderate stress were randomized to a self-directed web-based stress management program (n = 30) or the same intervention plus lay telephone coaching (n = 29). After 6 weeks, non-responders were re-randomized to continue with their initial intervention or switched to motivational interviewing (MI). Feasibility, acceptability, and clinical significance were assessed. RESULTS SMART procedures were feasible. Attrition rates were almost twice as high in the web-only group than the lay coach group. This might be because of the low satisfaction (47%) in the web-only group. On average, 1.7/5 modules were completed. Effect sizes for stress and quality of life generally exceeded 0.2 (clinical benchmark), except for the group that initially received lay coaching and then switched to MI. CONCLUSIONS Results suggest that a larger trial would be feasible. Issues pertaining to attrition and satisfaction for non-responders need to be addressed. PRACTICE IMPLICATIONS Findings contribute to the evidence on how best to develop and deliver e-Health interventions to maximize their efficacy while remaining cost-effective.
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Affiliation(s)
- Sylvie D Lambert
- Ingram School of Nursing, McGill University, 80 Sherbrooke St W, Suite 1800, Montreal, Quebec, Canada H3A 2M7; St. Mary's Research Centre, 3830 Lacombe Ave., Hayes Pavilion, Suite 4720, Montreal, Quebec, Canada H3T 1M5.
| | - Steven Grover
- Department of Medicine, McGill University, 845 Rue Sherbrooke St W, Montreal, Quebec, Canada H3A 0G4
| | - Andrea Maria Laizner
- Ingram School of Nursing, McGill University, 80 Sherbrooke St W, Suite 1800, Montreal, Quebec, Canada H3A 2M7; McGill University Health Centre, 1001 Decarie Blvd, Montreal, Quebec, Canada H4A 3J1; Research Institute of the McGill University Health Centre, 2155 Guy St, Suite 500, Montreal, Quebec, Canada H3H 2R9
| | - Jane McCusker
- St. Mary's Research Centre, 3830 Lacombe Ave., Hayes Pavilion, Suite 4720, Montreal, Quebec, Canada H3T 1M5; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave, Montreal, Quebec, Canada H3A 1A2
| | - Eric Belzile
- St. Mary's Research Centre, 3830 Lacombe Ave., Hayes Pavilion, Suite 4720, Montreal, Quebec, Canada H3T 1M5; Montreal West Island Integrated University Health and Social Services Centre (CIUSSS-ODIM), 3830 Lacombe Ave., Montreal, Quebec, Canada H3T 1M5
| | - Erica E M Moodie
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave, Montreal, Quebec, Canada H3A 1A2
| | - John William Kayser
- Montreal West Island Integrated University Health and Social Services Centre (CIUSSS-ODIM), 3830 Lacombe Ave., Montreal, Quebec, Canada H3T 1M5
| | - Ilka Lowensteyn
- Clinimetrica, 430 Saint-Pierre St, Suite 200, Montreal, Quebec, Canada H2Y 2M5; Research Institute of the McGill University Health Centre, 2155 Guy St, Suite 500, Montreal, Quebec, Canada H3H 2R9
| | - Michael Vallis
- Department of Family Medicine, Dalhousie University, 1465 Brenton St, Suite 402, Halifax, Nova Scotia, Canada B3J 3T4
| | - Mathieu Walker
- Division of Cardiology, St Mary's Hospital Centre, 3830 Lacombe Ave., Montreal, Quebec, Canada H3T 1M5
| | - Deborah Da Costa
- Center for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, 2155 Guy St, Suite 500, Montreal, Quebec, Canada H3H 2R9; Department of Medicine, McGill University, 845 Rue Sherbrooke St W, Montreal, Quebec, Canada H3A 0G4
| | - Louise Pilote
- Center for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, 2155 Guy St, Suite 500, Montreal, Quebec, Canada H3H 2R9; Department of Medicine, McGill University, 845 Rue Sherbrooke St W, Montreal, Quebec, Canada H3A 0G4
| | - Cindy Ibberson
- St. Mary's Research Centre, 3830 Lacombe Ave., Hayes Pavilion, Suite 4720, Montreal, Quebec, Canada H3T 1M5
| | - Judith Sabetti
- St. Mary's Research Centre, 3830 Lacombe Ave., Hayes Pavilion, Suite 4720, Montreal, Quebec, Canada H3T 1M5
| | - Manon de Raad
- St. Mary's Research Centre, 3830 Lacombe Ave., Hayes Pavilion, Suite 4720, Montreal, Quebec, Canada H3T 1M5; Montreal West Island Integrated University Health and Social Services Centre (CIUSSS-ODIM), 3830 Lacombe Ave., Montreal, Quebec, Canada H3T 1M5
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22
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Rogers CB, Webb JB, Bauert L, Carelock J. Feasibility and Acceptability of a Guided Self-Help, Text-Messaging Intervention to Promote Positive Body Image of Emerging Adult Women. Front Glob Womens Health 2022; 3:849836. [PMID: 35572213 PMCID: PMC9099092 DOI: 10.3389/fgwh.2022.849836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/11/2022] [Indexed: 11/15/2022] Open
Abstract
The predominant approach of existing eating disorder prevention programs targets risk factors for development; furthermore, burgeoning evidence suggests that promotion of protective factors against eating disorders (e.g., positive body image) is also a worthy avenue for prevention efforts. The present study considered existing literature gaps in the design of an 8-week guided self-help intervention meant to address the risk for disordered eating through the improvement of positive body image and enhancement of current adaptive functioning. The intervention incorporated elements of weight-inclusive health promotion (e.g., Health at Every Size; HAES) alongside positive psychology and third-wave behavioral interventions [e.g., self-compassion, mindful eating, Acceptance and Commitment Therapy (ACT)] to promote engagement in mindful-self-care. This mixed-methods study evaluated the feasibility and acceptability of the text-messaging based intervention in a diverse sample of cisgender college women (N = 30; 30% Black; 30% bisexual) at risk for disordered eating. Results indicated a high level of engagement and satisfaction with the intervention. Proof of concept was preliminarily supported by the observed significant changes in variables of interest (i.e., body appreciation, positive embodiment, mindful self-care, intuitive eating, self-compassion, disordered eating, and body image dissatisfaction) across the intervention. Overall, results of this study suggest that the use of a guided self-help program based in technology which seeks to reduce risk factors for disordered eating while also supporting adaptive functioning may be indicated for emerging adult women. This article will discuss how the present study provides the groundwork for continued development of innovative and remotely accessible interventions which promote positive body image.
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Affiliation(s)
- Courtney B. Rogers
- Cherokee Health Systems, Knoxville, TN, United States
- *Correspondence: Courtney B. Rogers
| | - Jennifer B. Webb
- Health Psychology PhD Program, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Lia Bauert
- Health Psychology PhD Program, University of North Carolina at Charlotte, Charlotte, NC, United States
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23
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LeBlanc J, Talbot F, Fournier V, Titov N, Dear BF. Lessons learned from two feasibility trials of a translated and minimally monitored iCBT program for young adults among community and university samples. Internet Interv 2022; 28:100529. [PMID: 35371925 PMCID: PMC8971854 DOI: 10.1016/j.invent.2022.100529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 11/27/2022] Open
Abstract
Young adults are less likely to use traditional mental health services than adults. iCBT may be more youth friendly, but its access remains limited in several countries. This study aims to evaluate the feasibility of a minimally monitored transdiagnostic iCBT program translated from English to French and offered in Canada for the treatment of anxiety and depression among young adults. The impact of the program on resilience was also assessed. Twenty-five participants from community and university samples were included in the analyses in two separate single-group feasibility trials with a 3-month follow-up. Feasibility outcomes were attrition, adherence, treatment acceptability and treatment gains. Outcome measures included the Patient Health Questionnaire 9-item (PHQ-9), Generalized Anxiety Disorder 7-item (GAD-7) and Connor-Davidson Resilience Scale (CD-RISC). In Trial 1 (N = 10), recruiting among the general population proved to be challenging. Low adherence (20%) and high attrition (80%) rates were observed. Methodological changes to recruitment were made and a second trial was conducted among university students using incentives (N = 15). About half of the participants completed treatment (55%, n = 8/15), 12/15 provided post-treatment data and 8/15 provided 3-month follow-up data. All study completers (100%; n = 14) reported they would recommend the program. Mixed effects model analyses revealed significant and large pre-post treatment reductions on the PHQ-9 and GAD-7 (Cohen's d = 1.09 and 1.64 respectively) with treatment gains maintained at follow-up. Moderate improvements were found on the CD-RISC post-treatment with further gains at follow-up (ds = 0.55 and 1.10 respectively). These finding suggest that future research on this French-Canadian version of the Mood Mechanic Course is feasible with appropriate attention to recruitment. Translating existing iCBT interventions and using minimal monitoring may be an optimal first step to initiate the cross-cultural dissemination of iCBT while increasing access to treatments among young adults. Lessons learned are discussed.
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Affiliation(s)
| | - France Talbot
- Université de Moncton, Canada,Corresponding author at: Université de Moncton, Moncton E1A 3E9, N.-B., Canada.
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24
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Feasibility, Acceptability, and Clinical Significance of a Dyadic, Web-Based, Psychosocial and Physical Activity Self-Management Program (TEMPO) Tailored to the Needs of Men with Prostate Cancer and Their Caregivers: A Multi-Center Randomized Pilot Trial. Curr Oncol 2022; 29:785-804. [PMID: 35200566 PMCID: PMC8871005 DOI: 10.3390/curroncol29020067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Prostate cancer is the most common cancer diagnosis among men. Family caregivers (often female spouses) play a key role in ensuring patients’ needs are met, frequently assuming their role with no formal training, which can contribute to a high burden. The purpose of this study was to pilot TEMPO—the first dyadic, Tailored, wEb-based, psychosocial and physical activity self-Management PrOgram for men with prostate cancer and their caregivers. Methods: 49 men with prostate cancer and their caregivers were randomized to TEMPO or usual care. Baseline and follow-up questionnaires were completed to assess feasibility, acceptability, and clinical significance. A priori benchmarks for these outcomes were set. Thirteen exit interviews were conducted to further explore acceptability. Results: Feasibility benchmarks were met with the exception for recruitment with on average 6.1 dyads recruited/month (benchmark: 8 dyads/month). Benchmarks of acceptability focused on attrition (<25%) and system usability, which were met. Using the strict criteria for adherence of 100% of the module viewed and participants spending at least 15 min on the module, 45% of participants were adherent. The clinical significance on anxiety and quality of life was supported for caregivers, and mostly supported for the men with prostate cancer. Conclusion: This pilot trial was successful, with minor modifications needed prior to a large trial.
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25
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Krifa I, van Zyl LE, Braham A, Ben Nasr S, Shankland R. Mental Health during COVID-19 Pandemic: The Role of Optimism and Emotional Regulation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1413. [PMID: 35162435 PMCID: PMC8835172 DOI: 10.3390/ijerph19031413] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/17/2022] [Accepted: 01/22/2022] [Indexed: 12/16/2022]
Abstract
In light of different challenges associated with the COVID-19 pandemic, university students are considered a particularly vulnerable population to mental health and study engagement issues. The first years at university represent a crucial period for students and are associated with an increase in mental health problems, particularly in healthcare studies. This study aimed (1) to document the current levels of mental health and study engagement among healthcare students in Tunisia, and (2) to investigate the relationships between emotional regulation, optimism, study engagement and common mental health problems (stress, anxiety and depression) among this population. A cross-sectional, electronic survey-based research design was used to draw a sample of 366 health care students from a University in Tunisia. Participants mostly reported mild (34.7%) or moderate (44.3%) levels of depression, moderate (44.7%) or severe (33.6%) levels of anxiety, average (50.8%) or mild (33.8%) levels of stress, and high levels of study engagement (>85%). Through structural equation modelling, the results showed that emotional regulation negatively affected stress, anxiety, and depression. Optimism partially mediated the relationship between emotional regulation, anxiety and depression and fully mediated the relationship between emotional regulation and study engagement. The findings indicated a high prevalence of psychological distress among healthcare university students in Tunisia, and specific protective factors that may be targeted to reduce mental health problems.
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Affiliation(s)
- Imen Krifa
- Université de Sousse, Faculty of Medicine of Sousse, Mental illness Epidemiology Research Laboratory LR12ES04, Screening and Early Management, Sousse 4000, Tunisia; (I.K.); (A.B.); (S.B.N.)
- Université de Sousse, Higher School of Sciences and Techniques of Health of Sousse, Sousse 4054, Tunisia
| | - Llewellyn Ellardus van Zyl
- Department of Industrial Engineering & Innovation Sciences, University of Eindhoven, 5612 Eindhoven, The Netherlands;
- Optentia Research Focus Area, North-West University (VTC), Vanderbijlpark 1900, South Africa
- Department of Human Resource Management, University of Twente, 7522 Enschede, The Netherlands
- Department of Social Psychology, InstitutfürPsychologie, Goethe University, 60323 Frankfurt, Germany
| | - Amel Braham
- Université de Sousse, Faculty of Medicine of Sousse, Mental illness Epidemiology Research Laboratory LR12ES04, Screening and Early Management, Sousse 4000, Tunisia; (I.K.); (A.B.); (S.B.N.)
- Farhat Hached University Hospital of Sousse, Department of Psychiatry, Sousse 4000, Tunisia
| | - Selma Ben Nasr
- Université de Sousse, Faculty of Medicine of Sousse, Mental illness Epidemiology Research Laboratory LR12ES04, Screening and Early Management, Sousse 4000, Tunisia; (I.K.); (A.B.); (S.B.N.)
- Farhat Hached University Hospital of Sousse, Department of Psychiatry, Sousse 4000, Tunisia
| | - Rebecca Shankland
- Laboratory DIPHE (Development, Individual, Personality, Handicap, Education), Department of Psychology of Development, Education and Vulnerabilities, University Lumière Lyon 2, 69676 Bron, France
- Laboratory LIP/PC2S, Department of Psychology, University Grenoble Alpes/Savoie-Mont-Blanc, 38000 Grenoble, France
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26
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Rosenberg BM, Kodish T, Cohen ZD, Gong-Guy E, Craske MG. A Novel Peer-to-Peer Coaching Program to Support Digital Mental Health: Design and Implementation. JMIR Ment Health 2022; 9:e32430. [PMID: 35080504 PMCID: PMC8829693 DOI: 10.2196/32430] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 01/09/2023] Open
Abstract
Many individuals in need of mental health services do not currently receive care. Scalable programs are needed to reduce the burden of mental illness among those without access to existing providers. Digital interventions present an avenue for increasing the reach of mental health services. These interventions often rely on paraprofessionals, or coaches, to support the treatment. Although existing programs hold immense promise, providers must ensure that treatments are delivered with high fidelity and adherence to the treatment model. In this paper, we first highlight the tension between the scalability and fidelity of mental health services. We then describe the design and implementation of a peer-to-peer coach training program to support a digital mental health intervention for undergraduate students within a university setting. We specifically note strategies for emphasizing fidelity within our scalable framework, including principles of learning theory and competency-based supervision. Finally, we discuss future applications of this work, including the potential adaptability of our model for use within other contexts.
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Affiliation(s)
- Benjamin M Rosenberg
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Tamar Kodish
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Zachary D Cohen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Elizabeth Gong-Guy
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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27
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Karyotaki E, Klein AM, Ciharova M, Bolinski F, Krijnen L, de Koning L, de Wit L, van der Heijde CM, Ebert DD, Riper H, Batelaan N, Vonk P, Auerbach RP, Kessler RC, Bruffaerts R, Struijs S, Wiers RW, Cuijpers P. Guided internet-based transdiagnostic individually tailored Cognitive Behavioral Therapy for symptoms of depression and/or anxiety in college students: A randomized controlled trial. Behav Res Ther 2022; 150:104028. [DOI: 10.1016/j.brat.2021.104028] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 12/17/2021] [Accepted: 12/27/2021] [Indexed: 12/22/2022]
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Leung C, Pei J, Hudec K, Shams F, Munthali R, Vigo D. The effects of non-clinician guidance on effectiveness and process outcomes of digital mental health interventions: A systematic review and meta-analysis (Preprint). J Med Internet Res 2021; 24:e36004. [PMID: 35511463 PMCID: PMC9244656 DOI: 10.2196/36004] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/15/2022] [Accepted: 04/25/2022] [Indexed: 01/22/2023] Open
Abstract
Background Digital mental health interventions are increasingly prevalent in the current context of rapidly evolving technology, and research indicates that they yield effectiveness outcomes comparable to in-person treatment. Integrating professionals (ie, psychologists and physicians) into digital mental health interventions has become common, and the inclusion of guidance within programs can increase adherence to interventions. However, employing professionals to enhance mental health programs may undermine the scalability of digital interventions. Therefore, delegating guidance tasks to paraprofessionals (peer supporters, technicians, lay counsellors, or other nonclinicians) can help reduce costs and increase accessibility. Objective This systematic review and meta-analysis evaluates the effectiveness, adherence, and other process outcomes of nonclinician-guided digital mental health interventions. Methods Four databases (MEDLINE, Embase, CINAHL, and PsycINFO) were searched for randomized controlled trials published between 2010 and 2020 examining digital mental health interventions. Three journals that focus on digital intervention were hand searched; gray literature was searched using ProQuest and the Cochrane Central Register of Control Trials (CENTRAL). Two researchers independently assessed risk of bias using the Cochrane risk-of-bias tool version 2. Data were collected on effectiveness, adherence, and other process outcomes, and meta-analyses were conducted for effectiveness and adherence outcomes. Nonclinician-guided interventions were compared with treatment as usual, clinician-guided interventions, and unguided interventions. Results Thirteen studies qualified for inclusion. Nonclinician-guided interventions yielded higher posttreatment effectiveness outcomes when compared to conditions involving control programs (eg, online psychoeducation and monitored attention control) or wait-list controls (k=7, Hedges g=–0.73; 95% CI –1.08 to –0.38). There were also significant differences between nonclinician-guided interventions and unguided interventions (k=6, Hedges g=–0.17; 95% CI –0.23 to –0.11). In addition, nonclinician-guided interventions did not differ in effectiveness from clinician-guided interventions (k=3, Hedges g=0.08; 95% CI –0.01 to 0.17). These results suggest that guided digital mental health interventions are helpful to improve mental health outcomes regardless of the qualifications of the individual performing the intervention, and that the presence of a nonclinician guide improves effectiveness outcomes compared to having no guide. Nonclinician-guided interventions did not yield significantly different adherence outcomes when compared with unguided interventions (k=3, odds ratio 1.58; 95% CI 0.51 to 4.92), although a general trend of improved adherence was observed within nonclinician-guided interventions. Conclusions Integrating paraprofessionals and nonclinicians appears to improve the outcomes of digital mental health interventions, and may also enhance adherence outcomes (though this trend was nonsignificant). Further research should focus on the specific types of tasks these paraprofessionals can successfully provide (ie, psychosocial support, therapeutic alliance, and technical augmentation) and their associated outcomes. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020191226; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=191226
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Affiliation(s)
- Calista Leung
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julia Pei
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kristen Hudec
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Farhud Shams
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Richard Munthali
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Vigo
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Celia G, Cavicchiolo E, Girelli L, Limone P, Cozzolino M. Effect of online counselling on emotional outcomes during the COVID‐19 pandemic: An innovative group intervention for university students using the Brain Wave Modulation Technique. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021; 22:889-901. [PMID: 35465356 PMCID: PMC9015604 DOI: 10.1002/capr.12512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 01/08/2023]
Abstract
Young people's mental health problems are a matter of concern during the COVID‐19 pandemic. Counselling services for university students by means of telemental support can help them to deal with psychological issues that they may be facing due to the pandemic. The present study investigated the effects of four once‐weekly online counselling sessions based on a mind‐body technique (the Brain Wave Modulation Technique; BWM‐T) on enhancing positive affect and on reducing negative affect and anxiety in a sample of 54 university students (96.3% females; Mage = 21.31 years, SD = 2.09). An experimental design was conducted: the participants were randomly assigned to the intervention group, which received 15 min of a guided online BWM‐T session, or to the control group, which watched a 15‐min video on how to sustain their psychological well‐being. The results of a two‐factor mixed‐design analysis of variance (ANOVA) showed that the participants in the intervention group reported a significant increase in positive affect and a decrease in negative affect over time compared to those in the control group. They also reported a slight decrease in state anxiety compared to the control group, although this was just short of statistical significance. The information provided by this study, regarding emotional outcomes among university students after four brief online counselling sessions, suggests that such interventions could be an effective and sustainable way to reinforce young people's mental health during the COVID‐19 pandemic, as well as later in their university careers and adult lives.
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Affiliation(s)
- Giovanna Celia
- Department of Economics, Management and Territory University of Foggia Foggia Italy
| | - Elisa Cavicchiolo
- Department of Human, Philosophical and Educational Sciences University of Salerno Fisciano Italy
| | - Laura Girelli
- Department of Human, Philosophical and Educational Sciences University of Salerno Fisciano Italy
| | - Pierpaolo Limone
- Department of Humanities, Literature and Cultural Heritage University of Foggia Foggia Italy
| | - Mauro Cozzolino
- Department of Human, Philosophical and Educational Sciences University of Salerno Fisciano Italy
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30
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Krifa I, Hallez Q, van Zyl LE, Braham A, Sahli J, Ben Nasr S, Shankland R. Effectiveness of an online positive psychology intervention among Tunisian healthcare students on mental health and study engagement during the Covid-19 pandemic. Appl Psychol Health Well Being 2021; 14:1228-1254. [PMID: 34939332 DOI: 10.1111/aphw.12332] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 12/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Imen Krifa
- Mental illness Epidemiology Research Laboratory, University of Sousse, Sousse, Tunisia.,Higher School of Sciences and Techniques of Health of Sousse, Department of Psychiatry LR12ES04, Farhat Hached University Hospital, Sousse, Tunisia
| | - Quentin Hallez
- Laboratory DIPHE, Department of Psychology, Education and Vulnerabilities, Université Lumière Lyon 2, Lyon, France
| | - Llewellyn Ellardus van Zyl
- Department of Industrial Engineering and Innovation Sciences, University of Eindhoven, Eindhoven, Netherlands.,Optentia Research Unit, North-West University, South Africa.,Department of Human Resource Management, University of Twente, the Netherlands.,Department of Social Psychology, Goethe University, Frankfurt am Main, Germany
| | - Amel Braham
- Mental illness Epidemiology Research Laboratory, University of Sousse, Sousse, Tunisia.,Faculty of Medicine of Sousse, Department of Psychiatry LR12ES04, Farhat Hached University Hospital, Sousse, Tunisia
| | - Jihene Sahli
- Laboratory of Research Quality of Care and Management of Maternal Health Services, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Selma Ben Nasr
- Mental illness Epidemiology Research Laboratory, University of Sousse, Sousse, Tunisia.,Faculty of Medicine of Sousse, Department of Psychiatry LR12ES04, Farhat Hached University Hospital, Sousse, Tunisia
| | - Rebecca Shankland
- Laboratory DIPHE, Department of Psychology, Education and Vulnerabilities, Université Lumière Lyon 2, Lyon, France
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31
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Zhou X, Edirippulige S, Bai X, Bambling M. Are online mental health interventions for youth effective? A systematic review. J Telemed Telecare 2021; 27:638-666. [PMID: 34726992 DOI: 10.1177/1357633x211047285] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This systematic review aims to examine the effectiveness of online mental health interventions for youth. METHODS We searched seven electronic databases (PubMed, PsycINFO, Medline, Embase, CINAHL, Web of Science and SCOPUS) for the past 10 years to identify randomized controlled trials which have evaluated the use of telehealth interventions for young people with mental health problems. The included studies were assessed for quality and risk of bias. RESULTS Forty-five randomized controlled trials (n = 13,291 participants) were eligible for this review. Most studies (35 trials) evaluated the use of web-based self-help platforms to deliver cognitive behavioural therapy (14 trials), mindfulness (four trials), acceptance commitment therapy (five trials) and positive psychology (two trials). Mobile/computer applications were used to deliver cognitive behavioural therapy (four trials) and coping strategies training (two trials). Web-based synchronous chat (one trial) was used to assist communication between counsellors and participants. Three studies used artificial intelligence-based conversational agents to deliver cognitive behavioural therapy (two trials) and problem-solving-strategy training (one trial). Eighty-two percent (n = 37) identified the participants as student population (i.e. university students, high school students). Sixty-four percent (n = 29) of the telehealth interventions were found to be effective in managing depression, anxiety, stress, insomnia and improving quality of life when compared with control conditions. CONCLUSIONS Online mental health interventions were found to be effective in managing diverse mental health conditions among youth. Online self-help platforms were the most frequently used modality and artificial intelligence-based chatbots are merging as potential solutions. Future research is warranted to investigate the solutions to improve the retention rate and satisfaction of telehealth interventions among this population.
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Affiliation(s)
- Xiaoyun Zhou
- Centre for Online Health, 1974The University of Queensland, Australia
- Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Sisira Edirippulige
- Centre for Online Health, 1974The University of Queensland, Australia
- Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Xuejun Bai
- Academy of Psychology and Behavior, 205359Tianjin Normal University, China
| | - Matthew Bambling
- Centre for Online Health, 1974The University of Queensland, Australia
- Navitas ACAP School of Psychology, Australia
- School of Psychology, Queensland University of Technology, Australia
- Brisbane Central Medical School, 1974The University of Queensland, Australia
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32
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A qualitative study of patients’ experiences and acceptance of computerised cognitive behavioural therapy in primary care, Scotland. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x21000210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Computerised cognitive behavioural therapy (CCBT) has been made available within the National Health Service (NHS) across Scotland as an alternative treatment for mild to moderate anxiety and depression. However, the provision of CCBT services is still limited in the NHS, possibly affecting delivery of this computer-aided therapy to patients and inhibiting acceptance and uptake of this intervention. This paper reports on the qualitative exploration of patients’ experiences and acceptance of one CCBT programme delivering computer-assisted therapy (Beating the Blues: BTB), examining particularly the point of referral, access to treatment, and support. Thematic analysis was conducted on semi-structured face-to-face and email interviews with 33 patients at different NHS organisations across Scotland. Data analysis generated six key themes which illustrated patients’ experiences relating to referral and access to the treatment, and the challenges they faced: (1) information dissemination; (2) expectations and the impact of waiting for BTB; (3) impact of locations on experience of BTB; (4) preference for home access; (5) desire for better human support; and (6) desire for additional application support features. The findings highlighted that better methods of implementing and delivering such CCBT services together with the design of the technological interventions are vital to the success of these services.
Key learning aims
(1)
To understand the service models and methods of implementing and delivering one CCBT programme (BTB) in routine care;
(2)
To learn about user experiences of accessing and using BTB; and
(3)
To learn about the implications and factors that might have influenced uptake and understand the implications.
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33
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Ma L, Huang C, Tao R, Cui Z, Schluter P. Meta-analytic review of online guided self-help interventions for depressive symptoms among college students. Internet Interv 2021; 25:100427. [PMID: 34401386 PMCID: PMC8350612 DOI: 10.1016/j.invent.2021.100427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 05/18/2021] [Accepted: 07/05/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE This meta-analysis examines the effect of online guided self-help interventions for depressive symptoms among college students. METHODS We searched studies through PubMed, Embase, Web of Science, PsycINFO, and Cochrane Central. Effect estimates were reported as standardized mean differences (SMD) and data were pooled using random-effects models. Subgroup analyses were conducted to investigate the differential effects of these interventions by sample type, level of contact, use of incentive, length of intervention, and program content. RESULTS 24 comparisons (n = 3074) deriving from 19 trials were included in the meta-analysis. Intervention participants (n = 1620) indicated significant reductions in depressive symptoms at post-intervention compared to non-active control conditions (n = 1454). The weighted effect size was 0.46 (95% CI: 0.28-0.64), which dropped to 0.36 (95% CI: 0.26-0.45) after an outlier was removed. Subgroup analyses showed that the effects were significant among interventions using both selective and universal samples; among interventions of shorter (≤4 weeks), moderate (4-8 weeks), and greater length (≥8 weeks); among interventions with high, moderate, and low levels of contact; among interventions with and without incentive; and among interventions employing cognitive-behavioral therapy (CBT) and third-wave CBT. CONCLUSION This meta-analysis reinforces evidence to support the effectiveness of online guided self-help interventions in reducing depressive symptoms among college students. However, because of the generally variable and limited quality of current evidence, further research applying rigorous methods is needed to confirm and extend the findings of this meta-analysis.
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Affiliation(s)
- Liang Ma
- The First Hospital of China Medical University, Shenyang, China
| | - Cong Huang
- Department of Sports and Exercise Science, Zhejiang University, Hangzhou, China
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Rimeng Tao
- The First Hospital of China Medical University, Shenyang, China
| | - Zeshi Cui
- School of Pharmacy, China Medical University, Shenyang, China
| | - Philip Schluter
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
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34
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Orsolini L, Pompili S, Salvi V, Volpe U. A Systematic Review on TeleMental Health in Youth Mental Health: Focus on Anxiety, Depression and Obsessive-Compulsive Disorder. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:793. [PMID: 34440999 PMCID: PMC8398756 DOI: 10.3390/medicina57080793] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 01/17/2023]
Abstract
Background and Objectives: The Internet is widely used and disseminated amongst youngsters and many web-based applications may serve to improve mental health care access, particularly in remote and distant sites or in settings where there is a shortage of mental health practitioners. However, in recent years, specific digital psychiatry interventions have been developed and implemented for special populations such as children and adolescents. Materials and Methods: Hereby, we describe the current state-of-the-art in the field of TMH application for young mental health, focusing on recent studies concerning anxiety, obsessive-compulsive disorder and affective disorders. Results: After screening and selection process, a total of 56 studies focusing on TMH applied to youth depression (n = 29), to only youth anxiety (n = 12) or mixed youth anxiety/depression (n = 7) and youth OCD (n = 8) were selected and retrieved. Conclusions: Telemental Health (TMH; i.e., the use of telecommunications and information technology to provide access to mental health assessment, diagnosis, intervention, consultation, supervision across distance) may offer an effective and efficacious tool to overcome many of the barriers encountering in the delivery of young mental health care.
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Affiliation(s)
- Laura Orsolini
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Via Tronto 10/A, 60126 Ancona, Italy; (S.P.); (V.S.); (U.V.)
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35
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Prior K, Salemink E, Wiers RW, Teachman BA, Piggott M, Newton NC, Teesson M, Baillie AJ, Manning V, McLellan LF, Mahoney A, Stapinski LA. A Web-Based Cognitive Bias Modification Intervention (Re-train Your Brain) for Emerging Adults With Co-occurring Social Anxiety and Hazardous Alcohol Use: Protocol for a Multiarm Randomized Controlled Pilot Trial. JMIR Res Protoc 2021; 10:e28667. [PMID: 34255726 PMCID: PMC8295835 DOI: 10.2196/28667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Alcohol use and anxiety disorders commonly co-occur, resulting in a more severe clinical presentation and poorer response to treatment. Research has shown that approach bias modification (ApBM) and interpretation bias modification (IBM) cognitive retraining interventions can be efficacious adjunctive treatments that improve outcomes for alcohol use and social anxiety, respectively. However, the acceptability, feasibility, and clinical utility of combining ApBM and IBM programs to optimize treatments among comorbid samples are unknown. It is also unclear whether integrating ApBM and IBM within each training session or alternating them between each session is more acceptable and efficacious. OBJECTIVE This paper describes the protocol for a randomized controlled pilot trial investigating the feasibility, acceptability, and preliminary efficacy of the Re-train Your Brain intervention-an adjunct web-based ApBM+IBM program-among a clinical sample of emerging adults with hazardous alcohol use and social anxiety. METHODS The study involves a three-arm randomized controlled pilot trial in which treatment-seeking emerging adults (18-30 years) with co-occurring hazardous alcohol use and social anxiety will be individually randomized to receive the Re-train Your Brain integrated program, delivered with 10 biweekly sessions focusing on both social anxiety and alcohol each week, plus treatment as usual (TAU; ie, the model of care provided in accordance with standard practice at their service; n=30); the Re-train Your Brain alternating program, delivered with 10 biweekly sessions focusing on social anxiety one week and alcohol the next week, plus TAU (n=30); or TAU only (n=30). Primary outcomes include feasibility (uptake, follow-up rates, treatment adherence, attrition, and adverse events) and acceptability (system usability, client satisfaction, user experience, and training format preference). Secondary efficacy outcomes include changes in alcohol approach and interpretation biases, social anxiety, and alcohol use (eg, drinks per day, binge drinking, drinking motives, severity of dependence, and cravings). The primary end point will be posttreatment (6 weeks postbaseline), with a secondary end point at 3 months postbaseline. Descriptive statistics will be conducted for primary outcomes, whereas intention-to-treat, multilevel mixed effects analysis for repeated measures will be performed for secondary outcomes. RESULTS This study is funded from 2019 to 2023 by Australian Rotary Health. Recruitment is expected to be completed by mid-2022 to late 2022, with follow-ups completed by early 2023. CONCLUSIONS This study will be the first to evaluate whether an ApBM+IBM program is acceptable to treatment-seeking, emerging adults and whether it can be feasibly delivered via the web, in settings where it will ultimately be used (eg, at home). The findings will broaden our understanding of the types of programs that emerging adults will engage with and whether the program may be an efficacious treatment option for this comorbidity. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12620001273976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364131. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/28667.
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Affiliation(s)
- Katrina Prior
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Elske Salemink
- Experimental Psychopathology Lab, Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
| | - Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands.,Center for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
| | - Bethany A Teachman
- Department of Psychology, School of Arts and Sciences, University of Virginia, Virginia, VA, United States
| | - Monique Piggott
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Nicola C Newton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Andrew J Baillie
- Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Victoria Manning
- Eastern Health Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - Lauren F McLellan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Alison Mahoney
- Clinical Research Unit for Anxiety and Depression, St Vincent's Public Hospital, Sydney, Australia
| | - Lexine A Stapinski
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
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36
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Furukawa TA, Suganuma A, Ostinelli EG, Andersson G, Beevers CG, Shumake J, Berger T, Boele FW, Buntrock C, Carlbring P, Choi I, Christensen H, Mackinnon A, Dahne J, Huibers MJH, Ebert DD, Farrer L, Forand NR, Strunk DR, Ezawa ID, Forsell E, Kaldo V, Geraedts A, Gilbody S, Littlewood E, Brabyn S, Hadjistavropoulos HD, Schneider LH, Johansson R, Kenter R, Kivi M, Björkelund C, Kleiboer A, Riper H, Klein JP, Schröder J, Meyer B, Moritz S, Bücker L, Lintvedt O, Johansson P, Lundgren J, Milgrom J, Gemmill AW, Mohr DC, Montero-Marin J, Garcia-Campayo J, Nobis S, Zarski AC, O'Moore K, Williams AD, Newby JM, Perini S, Phillips R, Schneider J, Pots W, Pugh NE, Richards D, Rosso IM, Rauch SL, Sheeber LB, Smith J, Spek V, Pop VJ, Ünlü B, van Bastelaar KMP, van Luenen S, Garnefski N, Kraaij V, Vernmark K, Warmerdam L, van Straten A, Zagorscak P, Knaevelsrud C, Heinrich M, Miguel C, Cipriani A, Efthimiou O, Karyotaki E, Cuijpers P. Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data. Lancet Psychiatry 2021; 8:500-511. [PMID: 33957075 PMCID: PMC8838916 DOI: 10.1016/s2215-0366(21)00077-8] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/12/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Internet cognitive behavioural therapy (iCBT) is a viable delivery format of CBT for depression. However, iCBT programmes include training in a wide array of cognitive and behavioural skills via different delivery methods, and it remains unclear which of these components are more efficacious and for whom. METHODS We did a systematic review and individual participant data component network meta-analysis (cNMA) of iCBT trials for depression. We searched PubMed, PsycINFO, Embase, and the Cochrane Library for randomised controlled trials (RCTs) published from database inception to Jan 1, 2019, that compared any form of iCBT against another or a control condition in the acute treatment of adults (aged ≥18 years) with depression. Studies with inpatients or patients with bipolar depression were excluded. We sought individual participant data from the original authors. When these data were unavailable, we used aggregate data. Two independent researchers identified the included components. The primary outcome was depression severity, expressed as incremental mean difference (iMD) in the Patient Health Questionnaire-9 (PHQ-9) scores when a component is added to a treatment. We developed a web app that estimates relative efficacies between any two combinations of components, given baseline patient characteristics. This study is registered in PROSPERO, CRD42018104683. FINDINGS We identified 76 RCTs, including 48 trials contributing individual participant data (11 704 participants) and 28 trials with aggregate data (6474 participants). The participants' weighted mean age was 42·0 years and 12 406 (71%) of 17 521 reported were women. There was suggestive evidence that behavioural activation might be beneficial (iMD -1·83 [95% credible interval (CrI) -2·90 to -0·80]) and that relaxation might be harmful (1·20 [95% CrI 0·17 to 2·27]). Baseline severity emerged as the strongest prognostic factor for endpoint depression. Combining human and automated encouragement reduced dropouts from treatment (incremental odds ratio, 0·32 [95% CrI 0·13 to 0·93]). The risk of bias was low for the randomisation process, missing outcome data, or selection of reported results in most of the included studies, uncertain for deviation from intended interventions, and high for measurement of outcomes. There was moderate to high heterogeneity among the studies and their components. INTERPRETATION The individual patient data cNMA revealed potentially helpful, less helpful, or harmful components and delivery formats for iCBT packages. iCBT packages aiming to be effective and efficient might choose to include beneficial components and exclude ones that are potentially detrimental. Our web app can facilitate shared decision making by therapist and patient in choosing their preferred iCBT package. FUNDING Japan Society for the Promotion of Science.
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Affiliation(s)
- Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.
| | - Aya Suganuma
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Edoardo G Ostinelli
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Christopher G Beevers
- Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, Austin, TX, USA
| | - Jason Shumake
- Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, Austin, TX, USA
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Florien Willemijn Boele
- Patient Centred Outcomes Research Group, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Isabella Choi
- Central Clinical School, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Helen Christensen
- Black Dog Institute and University of New South Wales, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Andrew Mackinnon
- Black Dog Institute and University of New South Wales, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Marcus J H Huibers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - David D Ebert
- Department for Sport and Health Sciences, Chair for Psychology & Digital Mental Health Care, Technical University Munich, Germany
| | - Louise Farrer
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Nicholas R Forand
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Daniel R Strunk
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Iony D Ezawa
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Erik Forsell
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Viktor Kaldo
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | | | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | | | - Sally Brabyn
- Department of Health Sciences, University of York, York, UK
| | | | - Luke H Schneider
- Anxiety Treatment and Research Clinic, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Robert Johansson
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Robin Kenter
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Marie Kivi
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Björkelund
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Annet Kleiboer
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, Luebeck University, Luebeck, Germany
| | - Johanna Schröder
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Björn Meyer
- Research Department, GAIA AG, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lara Bücker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ove Lintvedt
- Norwegian Center for E-health research, Tromsø, Norway
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Johan Lundgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Jeannette Milgrom
- Parent-Infant Research Institute and Austin Health, Melbourne School of Psychological Sciences, University of Melbourne, VIC, Australia
| | - Alan W Gemmill
- Parent-Infant Research Institute and Austin Health, Melbourne School of Psychological Sciences, University of Melbourne, VIC, Australia
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Jesus Montero-Marin
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Javier Garcia-Campayo
- Aragon Institute for Health Research, Miguel Servet University Hospital, Zaragoza, Spain; Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain
| | | | - Anna-Carlotta Zarski
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Kathleen O'Moore
- Black Dog Institute and University of New South Wales, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Alishia D Williams
- Department of Psychology, Faculty of Science, The University of New South Wales, Sydney, NSW, Australia
| | - Jill M Newby
- School of Psychology, University of New South Wales at the Black Dog Institute, Sydney, NSW, Australia
| | - Sarah Perini
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW, Australia
| | - Rachel Phillips
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Justine Schneider
- School of Sociology & Social Policy and Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Wendy Pots
- Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands
| | | | - Derek Richards
- University of Dublin, Trinity College, School of Psychology, E-mental Health Research Group, Dublin, Ireland; SilverCloud Health, Clinical Research & Innovation, Dublin, Ireland
| | | | | | | | - Jessica Smith
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Viola Spek
- School of Applied Psychology, Fontys University of Applied Science, Eindhoven, Netherlands
| | - Victor J Pop
- Department of Medical & Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | | | | | - Sanne van Luenen
- Department of Clinical Psychology, Leiden University, Leiden, Netherlands
| | - Nadia Garnefski
- Department of Clinical Psychology, Leiden University, Leiden, Netherlands
| | - Vivian Kraaij
- Department of Clinical Psychology, Leiden University, Leiden, Netherlands
| | - Kristofer Vernmark
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | | | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pavle Zagorscak
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | | | - Manuel Heinrich
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Andrea Cipriani
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Orestis Efthimiou
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Eirini Karyotaki
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Harrer M, Apolinário-Hagen J, Fritsche L, Salewski C, Zarski AC, Lehr D, Baumeister H, Cuijpers P, Ebert DD. Effect of an internet- and app-based stress intervention compared to online psychoeducation in university students with depressive symptoms: Results of a randomized controlled trial. Internet Interv 2021; 24:100374. [PMID: 33718001 PMCID: PMC7932886 DOI: 10.1016/j.invent.2021.100374] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 01/18/2021] [Accepted: 02/08/2021] [Indexed: 02/07/2023] Open
Abstract
Depression is highly prevalent among university students. Internet-based interventions have been found to be effective in addressing depressive symptoms, but it is open if this also applies to interventions directed at academic stress. It is also largely unclear if the techniques employed in such programs provide significant additional benefits when controlling for non-specific intervention effects. A sample of N = 200 students with elevated levels of depression (CES-D ≥ 16) of a large distance-learning university were randomly assigned to either an Internet- and App-based stress intervention group (IG; n = 100) or an active control group (CG; n = 100) receiving an Internet-based psychoeducational program of equal length. Self-report data was assessed at baseline, post-treatment (7 weeks) and three-month follow-up. The primary outcome was depression (CES-D) post-treatment. Secondary outcomes included mental health outcomes, modifiable risk factors, and academic outcomes. We found significant between-group effects on depressive symptom severity (d = 0.36; 95% CI: 0.08-0.64), as well as behavioral activation (d = 0.61; 95% CI: 0.30-0.91), perceived stress (d = 0.45; 95% CI: 0.18-0.73), anxiety (d = 0.35; 95% CI: 0.03-0.67) and other secondary outcomes post-treatment. Effects on depression were sustained at three-month follow-up. Response rates for depressive symptoms were significantly higher in the IG (26%) than the CG (14%) at post-test (χ 2=4.5, p = 0.04), but not at three-month follow-up (p = 0.454). We also found significant effects on relevant academic outcomes, including work impairment (follow-up; d = 0.36), work output (post-treatment; d = 0.27) and work cutback (follow-up; d = 0.36). The intervention was more effective for depressive symptoms compared to the CG, and so controlling for unspecific intervention effects. This suggests that specific techniques of the intervention may provide significant additional benefits on depressive symptoms. Trial registration: German Clinical Trial Registration (DRKS): DRKS00011800 (https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011800).
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Affiliation(s)
- Mathias Harrer
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Jennifer Apolinário-Hagen
- Institute of Occupational, Social and Environmental Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Lara Fritsche
- Department of Health Psychology, Institute for Psychology, University of Hagen, Hagen, Germany
| | - Christel Salewski
- Department of Health Psychology, Institute for Psychology, University of Hagen, Hagen, Germany
| | - Anna-Carlotta Zarski
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Dirk Lehr
- Division of Online Health Trainings, Innovation Incubator, Leuphana University, Lüneburg, Germany
| | - Harald Baumeister
- Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - David Daniel Ebert
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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38
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Rahmadiana M, Karyotaki E, Schulte M, Ebert DD, Passchier J, Cuijpers P, Berger T, van Ballegooijen W, Wimbarti S, Riper H. Transdiagnostic Internet Intervention for Indonesian University Students With Depression and Anxiety: Evaluation of Feasibility and Acceptability. JMIR Ment Health 2021; 8:e20036. [PMID: 33666553 PMCID: PMC7980121 DOI: 10.2196/20036] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 11/12/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND University students with depression and anxiety do not easily receive or seek treatment; therefore, internet-based interventions have been suggested to be a promising way to improve treatment accessibility and availability. However, it has not been examined whether a guided, culturally adapted, transdiagnostic, internet-based intervention is effective for treating symptoms of depression, anxiety, or both among university students in Indonesia. OBJECTIVE This study aims to investigate the feasibility (acceptability and satisfaction, usability, and uptake) of a guided, culturally adapted, transdiagnostic, internet-based intervention among university students with symptoms of depression, anxiety, or both in Indonesia. METHODS Students from Universitas Gadjah Mada, Yogyakarta, Indonesia, were screened for symptoms of depression, anxiety, or both, and filled online informed consent, demographic questionnaires, and a quality of life measure at pretreatment assessment (T0). Subsequently, the participants started the intervention. Seven weeks after T0, the primary outcomes of this feasibility study were analyzed at posttreatment assessment (T1) using the 8-item Client Satisfaction Questionnaire (CSQ-8) and the System Usability Scale (SUS). Mean and SDs for the CSQ-8 and SUS were calculated to examine feasibility. Within-group secondary outcomes (depression, anxiety, and quality of life) were inspected for outliers and normal distribution. Paired-sample t tests were used to investigate differences between time points of secondary outcomes. A mixed-method approach of quantitative and qualitative analyses was adopted. Both the primary and secondary outcomes were additionally explored with an individual semistructured interview and synthesized descriptively. RESULTS A total of 50 participants completed the intervention. We found a moderate to high level of satisfaction and acceptability, a slightly below-average level of desirable usability (≥70), and an adherence rate of 52% which was higher than expected given the novelty of the intervention. Results for the secondary outcomes indicated a decrease in depression and anxiety. For depression, the overall mean difference between the 2 time points for depression was 3.92 (95% CI 2.75-5.1; Hedges g 1.15; P<.001). For anxiety, the overall mean difference between the 2 time points was 3.34 (95% CI 2.06-4.61; Hedges g 1.02; P<.001). Further, a moderate effect in improving quality of life was found (g=0.50). Overall, participants were positive about the online intervention and ECoaches (online guidance), and they found the intervention to be culturally appropriate. CONCLUSIONS A culturally adapted, transdiagnostic, internet-based intervention appears to be acceptable and feasible for reducing symptoms of depression, anxiety, or both, and increasing quality of life in university students in Indonesia. Future studies should include a randomized controlled trial to assess the effectiveness of such interventions as they may supplement existing counseling services in universities, reduce the treatment costs, and maximize treatment accessibility in low-resourced settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1016/j.invent.2018.11.002.
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Affiliation(s)
- Metta Rahmadiana
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Mieke Schulte
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - David Daniel Ebert
- Division of Online Health Training, Innovation Incubator, Leuphana University of Lueneburg, Lueneburg, Germany.,Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Department of Clinical Psychology and EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jan Passchier
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Wouter van Ballegooijen
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Department of Psychiatry, Vrije Universiteit Medical Centre/GGZ inGeest, Amsterdam, Netherlands
| | - Supra Wimbarti
- Faculty of Psychology, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Department of Psychiatry, Vrije Universiteit Medical Centre/GGZ inGeest, Amsterdam, Netherlands
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Sharif-Sidi Z, Shen C, Wong W, Hanson R, Miller L, Fickel K, Green E, Burns J, Dunn C, Somai M, Crotty BH. Addressing depression and behavioral health needs through a digital program at scale. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2021; 9:100521. [PMID: 33601212 DOI: 10.1016/j.hjdsi.2021.100521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/28/2020] [Accepted: 01/17/2021] [Indexed: 11/19/2022]
Abstract
Depression and anxiety disorders are prevalent mental health conditions; yet they are often unrecognized, under-addressed and/or under-treated, and specialty treatment for these conditions is oftentimes difficult to access. By acting either as a bridge to therapy or as a form of therapy, digital tools, such as those that provide internet-based cognitive behavioral therapy (iCBT), may help clinicians support their patients' mental health needs. At one academic health system, a digital mental health program was deployed in primary care and outpatient behavioral health programs to help patients meet needs identified through screening or clinical visits. Over the first two years of operation, 138 clinicians (40% of eligible clinicians) prescribed the program to 2,228 unique patients, from which 1,117 (48.9%) enrolled. Patients who enrolled tended to be younger and healthier than non-enrollees. On average, enrolled patients spent 114.6 minutes within the iCBT program. Clinical improvement was assessed using pre- and post PHQ-9 and GAD-7 scores for depression and anxiety, respectively. Pre/Post scores were compared using Wilcoxon Rank Sum test. Patients with at least moderate depression had an average 23% reduction in PHQ-9 scores (median change -3(interquartile range 7), p<0.001) and those with at least moderate anxiety had a 26% reduction in GAD-7 scores (-4(7), p<0.001). Improvements were clinically and statistically significant. Future steps include performing a cost analysis to understand whether models utilizing iCBT are net cost-saving for health systems.
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Affiliation(s)
- Zakariyah Sharif-Sidi
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, United States
| | - Christine Shen
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, United States
| | - William Wong
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, United States
| | - Ryan Hanson
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, United States; Froedtert & Medical College of Wisconsin Health Network, United States
| | - Lawrence Miller
- Department of Psychiatry, Medical College of Wisconsin, United States; Froedtert & Medical College of Wisconsin Health Network, United States
| | - Karen Fickel
- Froedtert & Medical College of Wisconsin Health Network, United States
| | - Erin Green
- Froedtert & Medical College of Wisconsin Health Network, United States
| | - Jaymes Burns
- Froedtert & Medical College of Wisconsin Health Network, United States
| | - Caitlin Dunn
- Froedtert & Medical College of Wisconsin Health Network, United States
| | - Melek Somai
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, United States; Froedtert & Medical College of Wisconsin Health Network, United States
| | - Bradley H Crotty
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, United States; Froedtert & Medical College of Wisconsin Health Network, United States.
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Calero Elvira A, Santacreu Ivars M, Marchena Giráldez C, Shih PC. Internet-based cognitive behavioural therapy programme with and without videoconference guidance sessions: A randomized controlled trial to treat work-related symptoms of anxiety and depression. Clin Psychol Psychother 2021; 28:1230-1242. [PMID: 33586819 DOI: 10.1002/cpp.2571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 11/10/2022]
Abstract
This study provides the results from the implementation of a highly structured therapist-guided iCBT programme for people with work-related anxiety and depression, in terms of programme efficacy, participants' adherence and satisfaction. Seventy-seven national police workers were randomly allocated to one of two groups: without additional videoconference sessions (web platform with guidance of therapist) and with additional videoconference sessions (same intervention as the previous group, plus two videoconference guidance sessions with a psychologist). The intervention was composed of 12 sessions and took place for 17-20 weeks. We found an adherence rate of 36.4%, with no differences between groups. All participants endorsed lower depression (BDI-II F(1) = 36.98, p < .001; ATQ F(1) = 24.22, p < .001), and anxiety (STAI-State F(1) = 76.62, p < .001) after the programme. As a variable related to anxiety and depression in workplace, participants also showed higher assertiveness levels (RAS F(1) = 8.96, p < .001). A significant reduction of the mean level of anxiety perceived by participants as the intervention programme progressed was observed in both groups (F(2) = 7.44; p = .003). Participants were satisfied with the therapists' intervention and with the programme. No significant group effects were found for any of the measures. Reduction in depression levels was maintained in the 12-month follow-up, but levels of anxiety increased. This study is innovative, as it is the first controlled trial to analyse the effect of two added videoconference sessions, and it includes short- and long-term measures, which is not usual. The results are discussed to clarify the role of the contact with the therapist to improve treatment adherence.
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Affiliation(s)
- Ana Calero Elvira
- Department of Biological and Health Psychology, Autonomous University of Madrid, Madrid, Spain
| | - Marta Santacreu Ivars
- Faculty of Biomedical Sciences, European University of Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Carlos Marchena Giráldez
- Faculty of Education and Psychology, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain
| | - Pei-Chun Shih
- Department of Biological and Health Psychology, Autonomous University of Madrid, Madrid, Spain
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Lutz-Kopp C, Luka-Krausgrill U, Honsbrok B, Meinhardt-Injac B, Gropalis M. Development, Implementation and First Evaluation of an Online Portal to Promote the Mental Health of University Students (me@JGU). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1179. [PMID: 33525749 PMCID: PMC7908504 DOI: 10.3390/ijerph18031179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND University students encounter various stressors such as exam preparation, workload and economic concerns. Having to deal with a multitude of stressors can lead to mental health problems and have a negative impact on academic outcomes in students attending university. This paper describes the development and usability evaluation of an open and easily accessible online portal (me@JGU) designed to help students build skills they need to cope with common stressors and manage their own mental health. METHODS We developed a website that addresses the most common stressors among university students and offers strategies for dealing with difficult situations. Initial evaluation results were collected using website statistics and a short anonymous survey regarding the attractiveness and usability of the website. RESULTS Over an eight-month period, there were 5739 visitors, a total of 16,495 page views and 3748 downloads. The survey results indicate that me@JGU covers relevant topics and that the students like the layout. CONCLUSIONS Online interventions promoting mental health of university populations are easily accessible and cost effective for large populations. They may prevent study difficulties, inform students about mental health and offer possible solutions. In addition, at-risk students can receive information about other relevant resources, and feel encouraged to access support and treatment.
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Affiliation(s)
- Caroline Lutz-Kopp
- Mental Health Services for Students, Johannes Gutenberg University, 55122 Mainz, Germany; (U.L.-K.); (B.H.); (M.G.)
| | - Ursula Luka-Krausgrill
- Mental Health Services for Students, Johannes Gutenberg University, 55122 Mainz, Germany; (U.L.-K.); (B.H.); (M.G.)
| | - Bettina Honsbrok
- Mental Health Services for Students, Johannes Gutenberg University, 55122 Mainz, Germany; (U.L.-K.); (B.H.); (M.G.)
| | - Bozana Meinhardt-Injac
- Department of Psychology, Catholic University of Applied Sciences Berlin, 10318 Berlin, Germany;
| | - Maria Gropalis
- Mental Health Services for Students, Johannes Gutenberg University, 55122 Mainz, Germany; (U.L.-K.); (B.H.); (M.G.)
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Yang T, Liu J, Zhang Y, Zhang Q, Shangguan L, Li Z, Luo X, Gong J. Coping style predicts sense of security and mediates the relationship between autistic traits and social anxiety: Moderation by a polymorphism of the FKBP5 gene. Behav Brain Res 2021; 404:113142. [PMID: 33508350 DOI: 10.1016/j.bbr.2021.113142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 12/28/2020] [Accepted: 01/19/2021] [Indexed: 12/28/2022]
Abstract
The mechanism underlying the relationship between autistic traits and social anxiety still remains unknown. It is therefore necessary to investigate potential psychological and biological mechanisms. A total of 2695 college students were samples for this research during 2017-2018. The assessed variables included demographic characteristics and measures of autistic traits, sense of security, coping styles, and social anxiety. Blood samples were collected from which DNA was extracted. Regression analysis indicated that autistic traits and negative coping were positively associated with social anxiety; furthermore, positive coping, interpersonal security, and sense of control were negatively associated with social anxiety. Further analyses demonstrated that the relationship between autistic traits and social anxiety was mediated by coping styles (both positive coping and negative coping) and sense of security (both interpersonal security and sense of control), and coping style predicted the sense of security. The FK506 binding protein 5 (FKBP5) gene rs3800373 moderated the association between autistic traits and social anxiety. The present study is the first to demonstrate that both coping style and sense of security play an intermediate role between autistic traits and social anxiety in a sample of Chinese college students; moreover, the FKBP5 gene moderates this association between autistic traits and social anxiety.
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Affiliation(s)
- Tingyu Yang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Jianbo Liu
- Department of Child Psychiatry of Shenzhen Kangning Hospital, Shenzhen Mental Health Center, School of Mental Health, Shenzhen University, Shenzhen, 518003, China
| | - Yaru Zhang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Qin Zhang
- Department of Applied Psychology, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Lizhi Shangguan
- Department of Applied Psychology, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Zun Li
- Department of Applied Psychology, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Xuerong Luo
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.
| | - Jingbo Gong
- Department of Applied Psychology, Hunan University of Chinese Medicine, Changsha, 410208, China.
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Christ C, Schouten MJ, Blankers M, van Schaik DJ, Beekman AT, Wisman MA, Stikkelbroek YA, Dekker JJ. Internet and Computer-Based Cognitive Behavioral Therapy for Anxiety and Depression in Adolescents and Young Adults: Systematic Review and Meta-Analysis. J Med Internet Res 2020; 22:e17831. [PMID: 32673212 PMCID: PMC7547394 DOI: 10.2196/17831] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/23/2020] [Accepted: 06/21/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Anxiety and depressive disorders are prevalent in adolescents and young adults. However, most young people with mental health problems do not receive treatment. Computerized cognitive behavior therapy (cCBT) may provide an accessible alternative to face-to-face treatment, but the evidence base in young people is limited. OBJECTIVE The objective was to perform an up-to-date comprehensive systematic review and meta-analysis of the effectiveness of cCBT in treating anxiety and depression in adolescents and young adults compared with active treatment and passive controls. We aimed to examine posttreatment and follow-up effects and explore the moderators of treatment effects. METHODS We conducted systematic searches in the following six electronic databases: PubMed, EMBASE, PsycINFO, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials. We included randomized controlled trials comparing cCBT with any control group in adolescents or young adults (age 12-25 years) with anxiety or depressive symptoms. The quality of included studies was assessed using the Cochrane risk-of-bias tool for randomized trials, version 2.0. Overall quality of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Posttreatment means and SDs were compared between intervention and control groups, and pooled effect sizes (Hedges g) were calculated. Random-effects meta-analyses were conducted using Comprehensive Meta-Analysis software. Subgroup analyses and meta-regression analyses were conducted to explore whether age, guidance level, and adherence rate were associated with treatment outcome. RESULTS The search identified 7670 papers, of which 24 studies met the inclusion criteria. Most included studies (22/24) had a high risk of bias owing to self-report measures and/or inappropriate handling of missing data. Compared with passive controls, cCBT yielded small to medium posttreatment pooled effect sizes regarding depressive symptoms (g=0.51, 95% CI 0.30-0.72, number needed to treat [NNT]=3.55) and anxiety symptoms (g=0.44, 95% CI 0.23-0.65, NNT=4.10). cCBT yielded effects similar to those of active treatment controls regarding anxiety symptoms (g=0.04, 95% CI -0.23 to 0.31). For depressive symptoms, the nonsignificant pooled effect size favored active treatment controls (g=-0.70, 95% CI -1.51 to 0.11, P=.09), but heterogeneity was very high (I2=90.63%). No moderators of treatment effects were identified. At long-term follow-up, cCBT yielded a small pooled effect size regarding depressive symptoms compared with passive controls (g=0.27, 95% CI 0.09-0.45, NNT=6.58). No other follow-up effects were found; however, power was limited owing to the small number of studies. CONCLUSIONS cCBT is beneficial for reducing posttreatment anxiety and depressive symptoms in adolescents and young adults compared with passive controls. Compared with active treatment controls, cCBT yielded similar effects regarding anxiety symptoms. Regarding depressive symptoms, however, the results remain unclear. More high-quality research involving active controls and long-term follow-up assessments is needed in this population. TRIAL REGISTRATION PROSPERO CRD42019119725; https://tinyurl.com/y5acfgd9.
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Affiliation(s)
- Carolien Christ
- Department of Psychiatry, GGZ inGeest, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Research, Arkin Mental Health Care, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Maria Je Schouten
- Department of Research, Arkin Mental Health Care, Amsterdam, Netherlands
| | - Matthijs Blankers
- Department of Research, Arkin Mental Health Care, Amsterdam, Netherlands
- Trimbos institute-The Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Digna Jf van Schaik
- Department of Psychiatry, GGZ inGeest, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Aartjan Tf Beekman
- Department of Psychiatry, GGZ inGeest, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marike A Wisman
- Department of Youth and Family, Arkin Mental Health Care, Amsterdam, Netherlands
| | - Yvonne Aj Stikkelbroek
- Department of Child and Adolescent Studies, Universiteit Utrecht, Utrecht, Netherlands
- Depression Expert Center for Youth, Mental Health Care Oost-Brabant, Boekel, Netherlands
| | - Jack Jm Dekker
- Department of Research, Arkin Mental Health Care, Amsterdam, Netherlands
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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The Process of Developing a Sleep Health Improvement Plan: a Lab-Based Model of Self-Help Behavior. Int J Behav Med 2020; 28:96-106. [PMID: 32488792 DOI: 10.1007/s12529-020-09904-6] [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: 10/24/2022]
Abstract
BACKGROUND Although self-help strategies to improve sleep are widely accessible, little is known about the ways in which individuals interact with these resources and the extent to which people are successful at improving their own sleep based on sleep health recommendations. The present study developed a lab-based model of self-help behavior by observing the development of sleep health improvement plans (SHIPs) and examining factors that may influence SHIP development. METHOD Sixty healthy, young adults were identified as poor sleepers during one week of actigraphy baseline and recruited to develop and implement a SHIP. Participants viewed a list of sleep health recommendations through an eye tracker and provided information on their current sleep health habits. Each participant implemented their SHIP for 1 week during which sleep was assessed with actigraphy. RESULTS Current sleep health habits, but not patterns of visual attention, predicted SHIP goal selection. Sleep duration increased significantly during the week of SHIP implementation. CONCLUSIONS Findings indicate that the SHIP protocol is an effective strategy for observing self-help behavior and examining factors that influence goal selection. The increase in sleep duration suggests that individuals may be successful at extending their own sleep, though causal mechanisms have not yet been established. This study presents a lab-based protocol for studying self-help sleep improvement behavior and takes an initial step toward gaining knowledge required to improve sleep health recommendations.
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Amanvermez Y, Rahmadiana M, Karyotaki E, de Wit L, Ebert DD, Kessler RC, Cuijpers P. Stress management interventions for college students: A systematic review and meta-analysis. ACTA ACUST UNITED AC 2020. [DOI: 10.1111/cpsp.12342] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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46
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Linden B, Stuart H. Post-Secondary Stress and Mental Well-Being: A Scoping Review of the Academic Literature. ACTA ACUST UNITED AC 2020. [DOI: 10.7870/cjcmh-2020-002] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Post-secondary students have been identified as an at-risk population for chronic stress and poor mental health. We conducted a scoping review of the academic literature surrounding student stress and mental well-being as the first phase of research in the development of Canada’s National Standard for the Psychological Health and Safety of Post-Secondary Students. Major thematic findings included student stress, resilience through effective coping and help-seeking, and programs or strategies to improve campus mental health. Recommendations include a call for increased mental health promotion and mental illness prevention activities that are sensitive to diverse cultures, ethnicities, religions, and sexualities.
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Palma-Gómez A, Herrero R, Baños R, García-Palacios A, Castañeiras C, Fernandez GL, Llull DM, Torres LC, Barranco LA, Cárdenas-Gómez L, Botella C. Efficacy of a self-applied online program to promote resilience and coping skills in university students in four Spanish-speaking countries: study protocol for a randomized controlled trial. BMC Psychiatry 2020; 20:148. [PMID: 32248795 PMCID: PMC7133009 DOI: 10.1186/s12888-020-02536-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 03/06/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND There is evidence of a high prevalence of depression and anxiety in university students. Therefore, college time is a key period where prevention of mental disorders through interventions that promote resilience and mental health can be relevant. Currently, there are interventions available, but these are insufficient for those who need them. Online interventions are tools that can facilitate global accessibility and are easy for young people to use. CORE (Cultivating Our Resilience) is a self-administered online program, based on Ryff's psychological well-being model, to promote resilience and coping skills in university students at risk of developing symptoms of depression or anxiety. The objective is to evaluate the effectiveness of this intervention protocol in comparison with an active control condition targeting healthy lifestyle, and a waiting list control condition. The study will be conducted in four populations of Spanish-speaking university students (Spain, Argentina, Colombia, and Mexico). METHODS The study design is a randomized controlled trial (RCT). At least 324 university students will be randomly assigned to three conditions: 1) CORE, a 6-week training program to improve resilience; 2) HLP, a 6-week training to promote a healthy lifestyle; and 3) WL, waiting list control condition. The primary outcome measure will be the Connor-Davidson resilience scale. Additionally, measures of anxiety, depression, quality of life and socio-demographic variables (age, sex, incomes, marital status, among others) will be collected. Participants will be evaluated at pre-treatment, after each module, 6 weeks after allocation, and at 3-month follow-up. Intention-to-treat and per-protocol analyses will be performed. DISCUSSION The results of this study will contribute to research on Internet-administered interventions and the implementation of a protocol that includes a series of components designed to improve resilience and coping skills, increase psychological well-being, and prevent depression and anxiety disorders in Spanish-speaking university students. In addition, avenues will be opened up for new research on the effectiveness of these interventions focused on the prevention and promotion of mental health in Spanish-speaking countries. TRIAL REGISTRATION Registered at ClinicalTrials.gov NCT03903978 on April 2, 2019.
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Affiliation(s)
| | - Rocío Herrero
- CIBER of Physiopathology of Obesity and Nutrition (CB06/03) Instituto Salud Carlos III, Madrid, Spain
- Universidad de Valencia, Av. Blasco Ibañez, 21, 46021 Valencia, Spain
| | - Rosa Baños
- CIBER of Physiopathology of Obesity and Nutrition (CB06/03) Instituto Salud Carlos III, Madrid, Spain
- Universidad de Valencia, Av. Blasco Ibañez, 21, 46021 Valencia, Spain
| | - Azucena García-Palacios
- Universitat Jaume I, Castellón, Spain
- CIBER of Physiopathology of Obesity and Nutrition (CB06/03) Instituto Salud Carlos III, Madrid, Spain
| | | | | | | | | | | | | | - Cristina Botella
- Universitat Jaume I, Castellón, Spain
- CIBER of Physiopathology of Obesity and Nutrition (CB06/03) Instituto Salud Carlos III, Madrid, Spain
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Henriques Wollach CA, Cardaciotto L, Levin M, Lee Armstrong S. Implementing a Web-Based Cognitive Defusion Program to Target Negative Self-Referential Thoughts in College Students: A Pilot Study. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Petersen D, Salazar B, Kertz SJ. Therapist and Treatment-Seeking Students’ Perceptions of Telemental Health. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s41347-019-00116-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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50
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Rith-Najarian LR, Boustani MM, Chorpita BF. A systematic review of prevention programs targeting depression, anxiety, and stress in university students. J Affect Disord 2019; 257:568-584. [PMID: 31326690 DOI: 10.1016/j.jad.2019.06.035] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 05/05/2019] [Accepted: 06/29/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Given the prevalence of anxiety, depression, and stress among university students, it is important to assess the effectiveness of prevention programs for these problems. Beyond examining effect sizes, applying a common elements approach can enhance our understanding of which practice elements are most frequently included in symptom-reducing programs. METHOD This review examined effective (i.e., outcome-producing) prevention programs targeting depression, anxiety, and/or stress in university students. Programs could be delivered in a group-based, online/computer-delivered, or self-administered format and at the universal, selective, or indicated prevention level. RESULTS The resulting sample of 62 articles covered 68 prevention programs for college, graduate, or professional students across 15 countries. Average effect sizes for programs were moderate (overall g = 0.65), regardless of delivery format or prevention level. The most common practice elements (overall and for programs producing large effects) were: psychoeducation (72%), relaxation (69%), and cognitive monitoring/restructuring (47%). Many programs were limited by: (a) symptom target-outcome mismatches, (b) disproportionately female samples, and (c) inconsistently reported adherence data. LIMITATIONS Commonness of practice elements across outcome-producing interventions does not imply their extensiveness nor unique contribution to effectiveness. Coding was based on information in articles rather than manuals, and inter-rater reliability was moderate for some practice elements. CONCLUSION The outcome-producing prevention programs in our sample had common practice elements and produced moderate reduction in symptoms overall. Future research of depression, anxiety, and stress prevention programs for university students can investigate practice elements' unique and combined impact on outcomes, further explore under-tested practice elements, and use findings to inform intervention design.
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Affiliation(s)
| | - Maya M Boustani
- Department of Psychology, Loma Linda University, United States
| | - Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles, United States
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