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Pandey AR, Adhikari B, Bista B, Lamichhane B, Joshi D, K C SP, Sharma S, Baral S. Prevalence, determinants and care-seeking behaviour for anxiety and depression in Nepalese population: a secondary analysis of data from Nepal Demographic and Health Survey 2022. BMJ Open 2024; 14:e078582. [PMID: 39107021 PMCID: PMC11308907 DOI: 10.1136/bmjopen-2023-078582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 07/07/2024] [Indexed: 08/09/2024] Open
Abstract
OBJECTIVE To determine the prevalence and factors associated with anxiety and depression and the care-seeking behaviour among Nepalese population. DESIGN AND SETTINGS Secondary analysis of the data from nationally representative Nepal Demographic and Health Survey 2022. PARTICIPANTS Analysed data of 12 355 participants (7442 females and 4913 males) aged 15-49 years. OUTCOME MEASURES Depression and anxiety were assessed using Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder Assessment (GAD-7) tools, respectively. STATISTICAL ANALYSIS We performed weighted analysis to account for the complex survey design. We presented categorical variables as frequency, per cent and 95% confidence interval (CI), whereas numerical variables were presented as median, inter-quartile range (IQR) and 95% CI. We performed univariate and multivariable logistic regression to determine factors associated with anxiety and depression, and results were presented as crude OR (COR), adjusted OR (AOR) and their 95% CI. RESULTS The prevalence of depression and anxiety were 4.0% (95% CI 3.5 to 4.5) and 17.7% (95% CI 16.5 to 18.9), respectively. Divorced or separated participants were found to have higher odds of developing anxiety (AOR 2.40, 95% CI 1.74 to 3.31) and depression (AOR 3.16, 95% CI 1.84 to 5.42). Among ethnic groups, Janajati had lower odds of developing anxiety (AOR 0.77, 95% CI 0.65 to 0.92) and depression (AOR 0.67, 95% CI 0.49 to 0.93) compared with Brahmin/Chhetri. Regarding disability, participants with some difficulty had higher odds of developing anxiety (AOR 1.81, 95% CI 1.56 to 2.10) and depression (AOR 1.94, 95% CI 1.51 to 2.49), and those with a lot of difficulty had higher odds of anxiety (AOR 2.09, 95% CI 1.48 to 2.96) and depression (AOR 2.04, 95% CI 1.06 to 3.90) compared with those without any disability. Among those who had symptoms of anxiety or depression, only 32.9% (95% CI 30.4 to 34.4) sought help for the conditions. CONCLUSIONS Marital status and disability status were positively associated with anxiety and depression, whereas Janajati ethnicity had relatively lower odds of experiencing anxiety and depression. It is essential to develop interventions and policies targeting females and divorced individuals to help reduce the burden of anxiety and depression in Nepal.
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Affiliation(s)
- Achyut Raj Pandey
- HERD International, Kathmandu, Nepal
- Nepal Health Economics Association, Kathmandu, Nepal
- University of Bergen, Bergen, Norway
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Ecker AH, Shivaji S, Plasencia M, Kauth MR, Hundt NE, Fletcher TL, Sansgiry S, Cully JA. The role of symptom reduction in improving health-related quality of life through brief cognitive behavioral therapy. Psychother Res 2024:1-9. [PMID: 38861659 DOI: 10.1080/10503307.2024.2349992] [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: 04/04/2023] [Accepted: 04/25/2024] [Indexed: 06/13/2024] Open
Abstract
Brief cognitive behavior therapy (bCBT) is effective in reducing symptoms of depression and anxiety disorders and improving health-related quality of life (HRQoL). However, the mechanisms through which cognitive behavior therapy impact HRQoL are not well understood. This study evaluated whether anxiety and depression symptom reduction is a mechanism of treatment for HRQoL outcomes. METHOD Using secondary data from a multisite, pragmatic, randomized trial, this study evaluated bCBT vs enhanced usual care in 16 VA community-based outpatient clinics. Ordinary least-squares path analysis testing multiple mediators was used to evaluate the role of change in depression and anxiety symptoms in the relationship between treatment condition and HRQoL. RESULTS Receiving bCBT (vs. enhanced usual care) was significantly negatively associated with change (reduction) in depression and anxiety scores. The indirect effect of treatment on mental HRQoL was significant with change in depression scores as mediator. A similar pattern was observed for physical HRQoL and change in anxiety scores as mediator. CONCLUSION Findings suggest reduction of depression and anxiety symptoms as a mechanism through which bCBT for depression promoted improvements in HRQoL, with important implications for understanding how CBT impacts functioning, as well as the utility of bCBT in nontraditional mental health settings. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02466126.
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Affiliation(s)
- Anthony H Ecker
- Houston VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Maribel Plasencia
- Houston VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Michael R Kauth
- Houston VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- LGBTQ+ Health Program, Office of Patient Care Services, Department of Veterans Affairs, Washington, DC, USA
| | - Natalie E Hundt
- Houston VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Terri L Fletcher
- Houston VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Shubhada Sansgiry
- Houston VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey A Cully
- Houston VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Kemp JM, Taylor VH, Kanagasabai T. Access to healthcare and depression severity in vulnerable groups the US: NHANES 2013-2018. J Affect Disord 2024; 352:473-478. [PMID: 38401808 DOI: 10.1016/j.jad.2024.02.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/17/2024] [Accepted: 02/21/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Access to healthcare is essential for managing chronic diseases, yet it often poses a barrier, contributing to a significant burden of conditions like depression. This study aimed to investigate the association between healthcare access and depression severity in contemporary free-living adults in the US, with a focus on identifying vulnerable populations. METHOD Data from the National Health and Nutrition Examination Survey cycles 2013-2018 were utilized, involving 13,689 participants aged 20 years or older. Multivariable multinomial logistic regression models were conducted, adjusting for various confounding variables. RESULTS Approximately 17 % of US adults lacked access to healthcare, while 24 % experienced varying levels of depression severity, with 8 % having moderate-to-severe depression. More males faced challenges accessing healthcare, while more females reported diverse levels of depression. Both healthcare access and depression severity were associated with low educational attainment, low familial income, lacking spousal support, lacking health insurance coverage, and worse self-reported overall health. We found a higher vulnerability to moderate-to-severe depression among females (OR (95 % CI): 1.20 (0.91, 1.59)), individuals identifying as the Other ethnic group (1.69 (1.02, 2.79)), and those living without a spouse (1.57 (1.10, 2.26)). LIMITATIONS Our cross-sectional study cannot establish causality, and potential biases related to self-reported data exist. CONCLUSIONS Access to healthcare emerged as a crucial predictor of moderate-to-severe depression among females, individuals of the Other ethnic group, and those without a spouse. Longitudinal research is needed to confirm and enhance our understanding of factors that shape the relationship between healthcare access and depression in free-living US adults.
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Affiliation(s)
- James M Kemp
- Department of Public Health, St. Lawrence University, Canton, NY, USA
| | - Valerie H Taylor
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Torabynasab K, Shahinfar H, Zeraattalab-Motlagh S, Jazayeri S, Effatpanah M, Azadbakht L. The association of major dietary patterns with odds and severity of anxiety disorders: a case-control study. Nutr Neurosci 2024:1-10. [PMID: 38593065 DOI: 10.1080/1028415x.2024.2333688] [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: 04/11/2024]
Abstract
Background: In the present study, we explored the association between major dietary patterns, odds, and severity of anxiety disorders, which has not been clarified to date.Methods: This case-control study was conducted on 85 patients who were group-matched by gender with 170 healthy subjects. Dietary intakes were evaluated applying a 147-item validated food frequency questionnaire (FFQ). Anthropometric data collection was accomplished based on precise clinical assessments. Major dietary patterns were identified using principal component analysis (PCA). Multivariate odds ratios (OR) with 95% confidence intervals (CI) were used to investigate the association of the identified dietary patterns with anxiety disorders. Multiple linear regression analysis was used to evaluate the association between the GAD-7 score and major dietary pattern scores.Results: Three major dietary patterns were derived through PCA labeled as 'healthy', 'Western', and 'Mixed'. Those in the top tertile of the healthy dietary pattern were less likely to have anxiety disorders (OR = 0.26; 95%CI: 0.10, 0.66), while no significant relationship was found between Western and mixed dietary patterns and the odds of anxiety disorders. The severity of anxiety disorders, assessed by the GAD-7 score, was reduced by higher adherence to healthy dietary pattern (P = 0.003), and increased by greater adherence to mixed (P = 0.002) and Western (P = 0.001) dietary patterns.Conclusion: We provided evidence demonstrating an inverse association of healthy dietary pattern with odds, and severity of anxiety disorders. Also, higher adherence to Western and mixed dietary patterns resulted in greater GAD-7 scores.
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Affiliation(s)
- Kimia Torabynasab
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Shahinfar
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | | | - Shima Jazayeri
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Effatpanah
- School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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Gómez-Gómez I, Barquero-Jiménez C, Johnson E, Conejo-Cerón S, Moreno-Peral P, Bellón JÁ, Motrico E. Effectiveness of multiple health behavior change interventions in reducing symptoms of anxiety in the adult population: A systematic review and meta-analysis of randomized controlled trials. Prev Med 2024; 180:107847. [PMID: 38199592 DOI: 10.1016/j.ypmed.2024.107847] [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: 02/02/2023] [Revised: 11/30/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
There is limited evidence regarding the effectiveness of preventive interventions for anxiety disorders. We aim to test the effectiveness of multiple health behavior change (MHBC) interventions in the reduction of symptoms of anxiety in the adult population. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted by searching the most relevant databases and registry platforms in the area. Reference lists of included articles and relevant systematic reviews and meta-analyses of MHBC interventions that examined anxiety or depression as outcomes were also manually searched. To identify RCTs that evaluated preventive interventions, we excluded studies in which the target population included only patients meeting the diagnostic criteria for anxiety disorders. To pool results, the standardized mean difference (SMD) was calculated using the random effects model. Sensitivity, subgroup and meta-regression analyses were performed. Forty-six RCTs were included in the qualitative synthesis, and 34 RCTs were included in the meta-analysis. Thirty RCTs were focused on promoting healthy diet and physical activity, whereas the other 16 studies also focused on smoking cessation. The pooled SMD was small (-0.183; 95% CI -0.276 to -0.091) but significant (p < 0.001). The effect became non-significant when only studies with a low risk of bias were included. There was substantial and significant heterogeneity between the studies. There is currently insufficient evidence regarding the effectiveness of MHBC interventions to reduce symptoms of anxiety in the adult population.
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Affiliation(s)
- Irene Gómez-Gómez
- Department of Psychology, Universidad Loyola Andalucía, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | | | - Emma Johnson
- Centre for Applied Psychology, School of Psychology, University of Birmingham, UK
| | - Sonia Conejo-Cerón
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain; Research Unit of the Health District of Primary Care Málaga-Guadalhorce, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | - Patricia Moreno-Peral
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain; Research Unit of the Health District of Primary Care Málaga-Guadalhorce, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Spain; Department of Personality, Assessment and Psychological Treatment, University of Malaga (UMA), Spain
| | - Juan Ángel Bellón
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain; Research Unit of the Health District of Primary Care Málaga-Guadalhorce, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Spain; El Palo Health Centre, Andalusian Health Service (SAS), Spain; Department of Public Health and Psychiatry, University of Málaga (UMA), Spain
| | - Emma Motrico
- Department of Psychology, Universidad Loyola Andalucía, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain.
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Wols A, Pingel M, Lichtwarck-Aschoff A, Granic I. Effectiveness of applied and casual games for young people's mental health: A systematic review of randomised controlled studies. Clin Psychol Rev 2024; 108:102396. [PMID: 38320420 DOI: 10.1016/j.cpr.2024.102396] [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: 05/12/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
Many youth experience mental health problems and digital games hold potential as mental health interventions. This systematic review provides an overview of randomised controlled studies assessing the effectiveness of digital applied and casual games for improving mental health in youth aged 6-24 years. A systematic search of PsycINFO, Web of Science and Pubmed yielded 145 eligible studies. Studies on (sub)clinical participant samples (n = 75) most often focused on attention-deficit/hyperactivity disorder (ADHD), autism and anxiety. Applied games were found most effective for improving social skills, verbal memory and anxiety, whereas casual games were found most effective for improving depression, anxiety and ADHD. Studies involving healthy youth (n = 70) were grouped into papers examining anxiety in medical settings, momentary effects on positive and negative affect, and papers employing a longitudinal design measuring mental health trait outcomes. Promising results were found for the use of games as distraction tools in medical settings, and for applied and casual games for improving momentary affect. Overall, our findings demonstrate the potential of digital games for improving mental health. Implications and recommendations for future research are discussed, such as developing evaluation guidelines, clearly defining applied games, harmonising outcome measures, including positive outcomes, and examining nonspecific factors that may influence symptom improvement as well.
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Affiliation(s)
- Aniek Wols
- Radboud University, Behavioural Science Institute, Nijmegen, the Netherlands.
| | - Michelle Pingel
- Radboud University, Behavioural Science Institute, Nijmegen, the Netherlands
| | - Anna Lichtwarck-Aschoff
- Rijksuniversiteit Groningen, Department of Pedagogical & Educational Sciences, Groningen, the Netherlands
| | - Isabela Granic
- McMaster University, Health, Aging & Society, Hamilton, Ontario, Canada
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Farrand P, Raue PJ, Ward E, Repper D, Areán P. Use and Engagement With Low-Intensity Cognitive Behavioral Therapy Techniques Used Within an App to Support Worry Management: Content Analysis of Log Data. JMIR Mhealth Uhealth 2024; 12:e47321. [PMID: 38029300 PMCID: PMC10809068 DOI: 10.2196/47321] [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: 03/21/2023] [Revised: 06/19/2023] [Accepted: 11/28/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Low-intensity cognitive behavioral therapy (LICBT) has been implemented by the Improving Access to Psychological Therapies services across England to manage excessive worry associated with generalized anxiety disorder and support emotional well-being. However, barriers to access limit scalability. A solution has been to incorporate LICBT techniques derived from an evidence-based protocol within the Iona Mind Well-being app for Worry management (IMWW) with support provided through an algorithmically driven conversational agent. OBJECTIVE This study aims to examine engagement with a mobile phone app to support worry management with specific attention directed toward interaction with specific LICBT techniques and examine the potential to reduce symptoms of anxiety. METHODS Log data were examined with respect to a sample of "engaged" users who had completed at least 1 lesson related to the Worry Time and Problem Solving in-app modules that represented the "minimum dose." Paired sample 2-tailed t tests were undertaken to examine the potential for IMWW to reduce worry and anxiety, with multivariate linear regressions examining the extent to which completion of each of the techniques led to reductions in worry and anxiety. RESULTS There was good engagement with the range of specific LICBT techniques included within IMWW. The vast majority of engaged users were able to interact with the cognitive behavioral therapy model and successfully record types of worry. When working through Problem Solving, the conversational agent was successfully used to support the user with lower levels of engagement. Several users engaged with Worry Time outside of the app. Forgetting to use the app was the most common reason for lack of engagement, with features of the app such as completion of routine outcome measures and weekly reflections having lower levels of engagement. Despite difficulties in the collection of end point data, there was a significant reduction in severity for both anxiety (t53=5.5; P<.001; 95% CI 2.4-5.2) and low mood (t53=2.3; P=.03; 95% CI 0.2-3.3). A statistically significant linear model was also fitted to the Generalized Anxiety Disorder-7 (F2,51=6.73; P<.001), while the model predicting changes in the Patient Health Questionnaire-8 did not reach significance (F2,51=2.33; P=.11). This indicates that the reduction in these measures was affected by in-app engagement with Worry Time and Problem Solving. CONCLUSIONS Engaged users were able to successfully interact with the LICBT-specific techniques informed by an evidence-based protocol although there were lower completion rates of routine outcome measures and weekly reflections. Successful interaction with the specific techniques potentially contributes to promising data, indicating that IMWW may be effective in the management of excessive worry. A relationship between dose and improvement justifies the use of log data to inform future developments. However, attention needs to be directed toward enhancing interaction with wider features of the app given that larger improvements were associated with greater engagement.
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Affiliation(s)
- Paul Farrand
- Clinical Education, Development and Research, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
- Department of Psychology, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Patrick J Raue
- AIMS CENTER, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Earlise Ward
- School of Medicine and Public Health, Carbone Comprehensive Cancer Center, University of Wisconsin-Madison, Madison, WI, United States
| | - Dean Repper
- Trent PTS, Improving Access to Psychological Therapies, Derby, United Kingdom
| | - Patricia Areán
- AIMS CENTER, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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Kandola A, Edwards K, Muller MAE, Dührkoop B, Hein B, Straatman J, Hayes JF. Digitally managing depression: A fully remote randomised attention-placebo controlled trial. Digit Health 2024; 10:20552076241260409. [PMID: 38854919 PMCID: PMC11162123 DOI: 10.1177/20552076241260409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/11/2024] Open
Abstract
Background Depression is a common and disabling condition. Digital apps may augment or facilitate care, particularly in under-served populations. We tested the efficacy of juli, a digital self-management app for depression in a fully remote randomised controlled trial. Methods A pragmatic randomised controlled trial that included participants aged > 18 who self-identified as having depression and scored > 5 on the Patient Health Questionnaire-8. Participants were randomly assigned (1:1) to receive juli for 8 weeks or a limited attention-placebo control app. Our primary outcome was the difference in Patient Health Questionnaire-8 scores at 8 weeks. Secondary outcomes were remission, minimal clinically important difference, worsening of depression, and health-related quality of life. Analyses were per-protocol (primary), and modified and full intention-to-treat (secondary). The trial was registered at ISRCTN (ISRCTN12329547). Results Between May 2021 and January 2023, we randomised 908 participants. 662 completed the week 2 outcome assessment and were included in the modified intention-to-treat analysis, and 456 completed the week 8 outcome assessments (per-protocol). In the per-protocol analysis, the juli group had a greater reduction in Patient Health Questionnaire-8 score (10.78, standard deviation 6.26) than the control group (11.88, standard deviation 5.73) by week 8 (baseline adjusted β-coefficient -0.94, 95% CI: -1.87 to -0.22, p = 0.045). Achieving remission and a minimal clinically important difference was more likely in the juli group at 8 weeks (adjusted odds ratios 2.22, 95% CI: 1.45-3.39, p < 0.001 and 1.56, 95% CI: 1.08-2.27, p = 0.018, respectively). There were no between-group differences in health-related quality of life or worsening of depression. Modified and full intention-to-treat analyses found similar results, but the primary outcome was non-significant. Conclusion The use of juli for 8 weeks resulted in a small reduction in symptoms of depression compared with an attention-placebo control. The juli app is a digital self-management tool that could increase the accessibility of evidence-based depression treatments.
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Affiliation(s)
- Aaron Kandola
- MRC Unit of Lifelong Health and Aging, University College London - UCL, UK
- juli Health, Hull, MA, USA
| | - Kyra Edwards
- Division of Psychiatry, University College London - UCL, UK
| | | | | | | | | | - Joseph F Hayes
- juli Health, Hull, MA, USA
- Division of Psychiatry, University College London - UCL, UK
- Camden and Islington NHS Foundation Trust, London, UK
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Svedin F, Blomberg O, Farrand P, Brantnell A, von Essen L, Åberg AC, Woodford J. Effectiveness, acceptability, and completeness and quality of intervention reporting of psychological interventions for people with dementia or mild cognitive impairment: protocol for a mixed-methods systematic review. BMJ Open 2023; 13:e077180. [PMID: 38086581 PMCID: PMC10729069 DOI: 10.1136/bmjopen-2023-077180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/25/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Mental health difficulties such as anxiety and depression have negative impacts on psychological well-being and are common in people with dementia and mild cognitive impairment. However, access to psychological treatments is limited. This mixed-method systematic review will: (1) examine the effectiveness of psychological interventions to improve mental health and psychological well-being in people with dementia or mild cognitive impairment; (2) examine the effectiveness of these psychological interventions to improve mental health and psychological well-being in informal caregivers; (3) examine potential clinical and methodological moderators associated with effectiveness; (4) explore factors associated with the acceptability of psychological interventions from the perspective of key stakeholders; and (5) examine the completeness and quality of intervention reporting. METHODS AND ANALYSIS Electronic databases (ASSIA, CENTRAL, CINAHL, EMBASE, PsycINFO and MEDLINE) will be systematically searched and supplemented with expert contact, reference and citation checking, and grey literature searches. If possible, we will conduct a meta-analysis to examine the overall effectiveness of psychological interventions to improve mental health and psychological well-being in people with dementia or mild cognitive impairment and their informal caregivers; and examine potential clinical and methodological moderators associated with effectiveness. We will conduct a deductive framework synthesis, informed by the theoretical framework of acceptability, to explore factors associated with the acceptability of psychological interventions from the perspective of key stakeholders. In accordance with Joanna Briggs Institute guidance, we will adopt a convergent segregated approach to data synthesis and integration of quantitative and qualitative findings. We will examine the completeness and quality of intervention reporting according to the Template for Intervention Description and Replication checklist and guide. ETHICS AND DISSEMINATION No primary data will be collected, and therefore, ethical approval is not required. Results will be disseminated through a peer-reviewed publication, academic conferences, and plain language summaries. PROSPERO REGISTRATION NUMBER CRD42023400514.
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Affiliation(s)
- Frida Svedin
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Oscar Blomberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Paul Farrand
- Clinical Education Development and Research (CEDAR), University of Exeter, Exeter, UK
| | - Anders Brantnell
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Civil and Industrial Engineering, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna Cristina Åberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Dalarna University, Falun, Sweden
| | - Joanne Woodford
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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alHarbi H, Farrand P, Laidlaw K. Understanding the beliefs and attitudes towards mental health problems held by Muslim communities and acceptability of Cognitive Behavioral Therapy as a treatment: systematic review and thematic synthesis. DISCOVER MENTAL HEALTH 2023; 3:26. [PMID: 37995058 PMCID: PMC10667170 DOI: 10.1007/s44192-023-00053-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Muslims experience the lowest recovery rate from mental health difficulties across all religious groups. The aim of this research is to understand the barriers that prevent Muslims from accessing Cognitive Behavioral Therapy (CBT) and the extent to which these may vary across country of residence. METHODS Systematic review and thematic synthesis for quantitative, qualitative, and mixed methods studies published in English and Arabic informed by the SPIDER search tool. Methodological quality and risk of bias of included papers were critically appraised independently according to the Mixed Methods Appraisal Tool. RESULTS A search of seven databases in the Arabic and English language yielded 3836 studies with 210 studies assessed for eligibility. Employing the Mixed Methods Appraisal Tool resulted in 14 studies included in the thematic synthesis. Seven studies adopted a qualitative methodology employing semi-structured interviews and seven were quantitative descriptive studies. CONCLUSIONS Muslim communities experience barriers accessing Cognitive Behavioral Therapy at the level of the individual, culture, provider and management. The main barriers were experienced at the individual level which was dominated by the influence of Islam regarding the cause of mental health difficulties, which also influenced the way in which difficulties were managed. SYSTEMATIC REVIEW REGISTRATION PROSPERO and registration number: CRD42020192854.
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Affiliation(s)
- Hind alHarbi
- Clinical Education, Development and Research (CEDAR), Psychology, Faculty of Health and Life Sciences, University of Exeter, Perry Road, Exeter, EX4 4QG, UK.
| | - Paul Farrand
- Clinical Education, Development and Research (CEDAR), Psychology, Faculty of Health and Life Sciences, University of Exeter, Perry Road, Exeter, EX4 4QG, UK
| | - Ken Laidlaw
- School of Psychology, Faculty of Health and Life Sciences, University of Exeter, Perry Road, Exeter, EX4 4QG, UK
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11
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Aucoin M, LaChance L, van der Wurff I, Miller S, Naidoo U, Jenkins A, Cooley K. Dietary counselling plus omega-3 supplementation in the treatment of generalized anxiety disorder: protocol for a randomized wait-list controlled pilot trial (the "EASe-GAD Trial"). Pilot Feasibility Stud 2023; 9:186. [PMID: 37950301 PMCID: PMC10636887 DOI: 10.1186/s40814-023-01414-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Anxiety disorders are prevalent and disabling conditions involving excessive worry and tension. Generalized anxiety disorder (GAD), the most common anxiety disorder, affects 5% of individuals from high-income countries and many individuals report that treatment options are not accessible, effective, or tolerable. Clinical evidence suggests that nutrition interventions, based on the Mediterranean diet and supplementation of omega-3 fatty acids, can significantly improve symptoms of depression; however, the effect of nutrition interventions on anxiety symptoms has not been studied in a clinical population. The primary objective of the present study is to assess the feasibility and acceptability of a dietary counselling and omega-3 fatty acid supplementation intervention delivered to adult women with GAD. The secondary objectives include assessing changes in anxiety symptom severity, assessing changes in quality of life, assessing changes in biomarkers, and evaluating the components of the program. METHODS This study is a randomized, wait-list controlled pilot trial delivering a 12-week, dietary counselling intervention and omega-3 supplementation to 50 adult women with GAD. Participants will complete seven individual counselling sessions which include education, personalized recommendations, mindful eating techniques, motivational interviewing, and goal setting. They will be provided with recipes, instructional videos, and food items. The intervention is designed based on the Social Cognitive Theory and previous research that has been done by the author team to identify dietary constituents with the most evidence to support their use in the treatment of anxiety disorders. Questionnaires and blood work will be completed at baseline, after the waiting period (for those in the waitlist group), and after the intervention. DISCUSSION Results from this study will lay the foundation for future large-scale studies in this area and may provide preliminary evidence of the role of diet counselling and omega-3 supplementation in the management of GAD. Research on the role of nutrition in psychiatric care has been identified as a priority by a number of international organizations. The present trial directly addresses the call for the research that is most needed to advance the field. TRIAL REGISTRATION This protocol was registered at ClinicalTrials.gov on October 10, 2022; NCT05573672 . Trial sponsor: The Canadian College of Naturopathic Medicine, 1255 Sheppard Ave E, Toronto, ON M2K 1E2, 416-498-1255. Steering committee: Composed of MA, LL, KC, IvdW, SM, UN, AJ. The committee meets monthly to oversee the trial. Protocol identifier: CCNM_EASe-GADCT_2201v4.
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Affiliation(s)
- Monique Aucoin
- Canadian College of Naturopathic Medicine, Toronto, Canada.
- University of Guelph, Guelph, Canada.
| | - Laura LaChance
- McGill University, Montreal, Canada
- St. Mary's Hospital, Montreal, Canada
| | - Inge van der Wurff
- Health Psychology, Faculty of Psychology, Open University of the Netherlands, Utrecht, Netherlands
| | | | - Umadevi Naidoo
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | | | - Kieran Cooley
- Canadian College of Naturopathic Medicine, Toronto, Canada
- Southern Cross University, Lismore, Australia
- University of Technology Sydney, Ultimo, Australia
- Pacific College of Health and Science, San Diego, USA
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12
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Harty S, Enrique A, Akkol-Solakoglu S, Adegoke A, Farrell H, Connon G, Ward F, Kennedy C, Chambers D, Richards D. Implementing digital mental health interventions at scale: one-year evaluation of a national digital CBT service in Ireland. Int J Ment Health Syst 2023; 17:29. [PMID: 37817270 PMCID: PMC10563351 DOI: 10.1186/s13033-023-00592-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 07/31/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND In recent years, exponential growth in digital innovations and internet access has provided opportunities to deliver health services at a much greater scale than previously possible. Evidence-based technology-enabled interventions can provide cost-effective, accessible, and resource-efficient solutions for addressing mental health issues. This study evaluated the first year of a supported digital cognitive behavioral therapy (CBT) service provided by the national health service in Ireland, which has been accessible to individuals who receive a referral from one of five referring groups: General Practitioners, Primary Care Psychology, Counselling Primary Care, Community Mental Health, and Jigsaw (a nationwide youth mental health service). METHODS A retrospective, observational study examining data from the service between April 2021 to April 2022 was conducted. Descriptive statistics on referrals, account activations, user demographics, program usage, and user satisfaction were extracted, and pre-to-post clinical outcomes for depression measured by the Patient Health Questionnaire-9 and for anxiety measured by the Generalised Anxiety Disorder-7 were analysed using linear mixed effect models. RESULTS There were 5,298 referrals and 3,236 (61%) account activations within the year. Most users were female (72.9%) and aged between 18 and 44 years (75.4%). The CBT programs were associated with significant reductions in both depression (β = 3.34, 95% CI [3.03, 3.65], p < 0.001) and anxiety (β = 3.64, 95% CI [3.36, 3.93], p < 0.001), with large effect sizes (Cohen's d > 0.8). Time spent using the programs was also found to be a predictor of the variability in these clinical outcomes (p < 0.001), and accounting for this resulted in significantly better model fits (p < 0.001). User satisfaction ratings were also very high, exceeding 94%. CONCLUSIONS Efforts to improve the representation of male and older adult users are warranted. However, overall, the results demonstrate how digital CBT can be provided at scale and lead to symptom reductions with large effect sizes for patients seeking help for depression and anxiety. The findings substantiate the continued use and expansion of this service in Ireland and the more widespread implementation of similar services in other international public healthcare settings.
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Affiliation(s)
- Siobhán Harty
- Amwell Science, Amwell, One Stephen Street Upper, Dublin 8, Dublin, Ireland.
| | - Angel Enrique
- Amwell Science, Amwell, One Stephen Street Upper, Dublin 8, Dublin, Ireland
| | | | - Adedeji Adegoke
- Amwell Science, Amwell, One Stephen Street Upper, Dublin 8, Dublin, Ireland
| | - Hannah Farrell
- Amwell Clinical Operations, Amwell, One Stephen Street Upper, Dublin 8, Dublin, Ireland
| | - Graham Connon
- Community Health Organization, Health Service Executive (HSE), Dublin, Ireland
| | - Fiona Ward
- National Counselling Service, Health Service Executive (HSE), Dublin, Ireland
| | - Conor Kennedy
- Health Service Executive (HSE), National Mental Health Operations, Dublin, Ireland
| | - Derek Chambers
- Health Service Executive (HSE), National Mental Health Operations, Dublin, Ireland
| | - Derek Richards
- Amwell Science, Amwell, One Stephen Street Upper, Dublin 8, Dublin, Ireland
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13
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Dold M, Bartova L, Volz HP, Seifritz E, Möller HJ, Schläfke S, Kasper S. Efficacy of Silexan in patients with anxiety disorders: a meta-analysis of randomized, placebo-controlled trials. Eur Arch Psychiatry Clin Neurosci 2023; 273:1615-1628. [PMID: 36717399 PMCID: PMC10465640 DOI: 10.1007/s00406-022-01547-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/19/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION We report on a meta-analysis of Silexan, a proprietary active substance produced from Lavandula angustifolia, in subthreshold anxiety, mixed anxiety and depressive disorder (MADD), and generalized anxiety disorder (GAD). METHODS The present analyses are based on all currently completed 5 double-blind, randomized, placebo-controlled trials investigating Silexan in adult out-patients who received Silexan 1 × 80 mg/day or placebo for ten weeks according to random assignment (n = 1213). Efficacy was assessed based on the Hamilton Anxiety Rating Scale (HAMA), several anxiety self-rating scales, the Clinical Global Impression (CGI) scale, and the Short Form-36 (SF-36) health status questionnaire. RESULTS After ten weeks' treatment, Silexan was significantly superior to placebo in reducing the HAMA total score (including the psychic and somatic anxiety sub-scores) and self-rated anxiety. Based on a ≥ 50% HAMA total score reduction, the responder rate ratio was 1.34 favoring Silexan, and the rate ratio of subjects much or very much improved according to the CGI was 1.51. Silexan was also significantly superior in improving the physical and mental health summary scores of the SF-36. There were no significant between-group differences concerning the occurrence of adverse events (AEs), serious AEs, and premature withdrawal due to AEs. CONCLUSIONS This meta-analysis demonstrates that Silexan exerts significant anxiolytic effects in subthreshold anxiety, GAD and MADD that were consistently reflected in investigator ratings and patient-reported outcomes, including improvement of health-related life-quality, while showing favorable tolerability and safety.
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Affiliation(s)
- Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Balthasar-Neumann-Platz 1, 97440, Werneck, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Sandra Schläfke
- Dr. Willmar Schwabe GmbH & Co. KG, Willmar-Schwabe-Straße 4, 76227, Karlsruhe, Germany
| | - Siegfried Kasper
- Center of Brain Research, Medical University of Vienna, Spitalgasse 4, 1090, Vienna, Austria.
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14
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Olthuis JV, Kaltenbach E, Giberson E, Saryeddine T, Asmundson GJG, Carleton RN, Cramm H, Crombach A, Devlin J, Mack J, Lingley-Pottie P, Rao S, Sullivan M, Wozney L, McGrath PJ. Paraprofessional delivery of online narrative exposure therapy for firefighters. J Trauma Stress 2023; 36:772-784. [PMID: 37291963 DOI: 10.1002/jts.22941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/21/2023] [Accepted: 04/08/2023] [Indexed: 06/10/2023]
Abstract
Firefighters are at increased risk for developing posttraumatic stress disorder (PTSD) and face numerous barriers to accessing mental health care. Innovative ways to increase access to evidence-based interventions are needed. This study was a case series testing the acceptability, feasibility, and preliminary effectiveness of a paraprofessional-delivered, virtual narrative exposure therapy (eNET) intervention for PTSD. Participants were 21 firefighters who met the criteria for clinical or subclinical probable PTSD and completed 10-12 sessions of eNET via videoconference. Participants completed self-report measures pre- and postintervention and at 2- and 6-month follow-ups as well as a postintervention qualitative interview. Paired samples t tests evidenced statistically significant decreases in PTSD, anxiety, and depressive symptom severity and functional impairment from pre- to postintervention, ds = 1.08-1.33, and in PTSD and anxiety symptom severity and functional impairment from preintervention to 6-month follow-up, ds = 0.69-1.10. The average PTSD symptom severity score fell from above to below the clinical cutoff for probable PTSD at postintervention and follow-ups. Qualitative interviews indicated that paraprofessionals were considered central to participants' success and experience with the intervention. No adverse events or safety concerns were raised. This study is an important step in demonstrating that appropriately trained and supervised paraprofessionals can effectively deliver eNET to firefighters with PTSD.
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Affiliation(s)
- Janine V Olthuis
- Department of Psychology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | | | - Emma Giberson
- Department of Psychology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Tina Saryeddine
- Canadian Association of Fire Chiefs, Ottawa, Ontario, Canada
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | | | - R Nicholas Carleton
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Heidi Cramm
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Anselm Crombach
- Department of Psychology, Universität des Saarlandes, Saarbrücken, Germany
| | - Julie Devlin
- Conservation and Protection, Fisheries and Oceans Canada, Ottawa, Ontario, Canada
| | - Jeff Mack
- Fredericton Fire Department, Fredericton, New Brunswick, Canada
| | - Patricia Lingley-Pottie
- IWK Health Centre, Halifax, Nova Scotia, Canada
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sanjay Rao
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Sullivan
- Department of Psychology, McGill University, Montreal, Québec, Canada
| | - Lori Wozney
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Patrick J McGrath
- IWK Health Centre, Halifax, Nova Scotia, Canada
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
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15
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Ma SON, McCallum SM, Pasalich D, Batterham PJ, Calear AL. Understanding parental knowledge, attitudes and self-efficacy in professional help-seeking for child anxiety. J Affect Disord 2023:S0165-0327(23)00720-6. [PMID: 37245548 DOI: 10.1016/j.jad.2023.05.079] [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: 02/11/2023] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Child anxiety disorders are highly prevalent yet undertreated. As parents are often 'gatekeepers' to children receiving treatment and support, this study aimed to investigate modifiable parental factors affecting professional help-seeking for their children from general practitioners (GPs), psychologists, and paediatricians. METHODS In this study, 257 Australian parents of children aged 5-12 years with elevated anxiety symptoms completed a cross-sectional online survey. The survey assessed help-seeking from a GP, psychologist, and paediatrician (General Help Seeking Questionnaire), as well as anxiety knowledge (Anxiety Literacy Scale), help-seeking attitudes (Attitudes Toward Seeking Professional Psychological Help), personal stigma (Generalised Anxiety Stigma Scale) and self-efficacy (Self-Efficacy in Seeking Mental Health Care). RESULTS 66.9 % of participants had sought help from a GP, 61.1 % from a psychologist, and 33.9 % from a paediatrician. Help-seeking from a GP or psychologist was associated with lower personal stigma (p = .02 and p = .03 respectively). Participants who sought help from a psychologist also had more positive attitudes toward seeking professional support (p = .01). Conversely, knowledge of anxiety disorders and self-efficacy were not associated with help-seeking from any source. LIMITATIONS Limitations of the study include the representativeness of our sample (female gender, higher education level); unexplained variance potentially accounted for by other factors (e.g., structural barriers); lack of prior validation of measures in a parent sample. CONCLUSIONS This research will inform the development of public health policy and psychoeducation interventions for parents, to reduce personal stigma and increase positive attitudes toward professional help-seeking, in turn improving help-seeking for child anxiety.
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Affiliation(s)
- Samuel O N Ma
- Research School of Psychology, The Australian National University, Canberra, Australia
| | - Sonia M McCallum
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Dave Pasalich
- Research School of Psychology, 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
| | - Alison L Calear
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia.
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16
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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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17
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Biagianti B, Foti G, Di Liberto A, Bressi C, Brambilla P. CBT-informed psychological interventions for adult patients with anxiety and depression symptoms: A narrative review of digital treatment options. J Affect Disord 2023; 325:682-694. [PMID: 36690081 DOI: 10.1016/j.jad.2023.01.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/03/2023] [Accepted: 01/13/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Across a range of age, educational and clinical characteristics, adults experiencing depression and anxiety already use digital technology to manage their symptoms. Although several reviews and meta-analyses indicated feasibility and efficacy for adults with depression and anxiety, digital treatments are poorly accessed and disseminated. This review illustrates potentials and limitations of interventions that specifically leveraged unique features of digital technology and were grounded in the principles of Cognitive Behavioral Therapy (CBT). METHODS This systematic review followed the PRISMA guidelines. An electronic database search was conducted in October 2021. Peer-reviewed, English-language studies were included if i) they reported data from RCTs for adults aged 18+ who engaged with CBT-informed digital interventions targeting primarily depression and anxiety; ii) they used at least PHQ-9 or GAD-7 as standardized and validated assessment self-report measures for depression and anxiety. RESULTS Findings from 35 RCTs examining 33 interventions (25 internet-based, 6 mobile-based, a2 mobile/web) are discussed. The quality of the evidence differed widely as many small-scale RCTs reported only short-term feasibility and preliminary efficacy. Effects of CBT-informed digital interventions were substantially larger when compared to waitlist than active control conditions. Greater therapeutic benefits were observed for interventions that offered clinical assistance or were used in combination with other treatments. CONCLUSIONS CBT-informed digital interventions have accumulated enough scientific evidence to be positioned today as: i) a low-intensity tool for those with subclinical levels of symptoms; ii) a first step in a stepped-care approach to service delivery iii) a low-cost, easily accessible option for targeted preventive programs.
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Affiliation(s)
- Bruno Biagianti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.
| | | | | | - Cinzia Bressi
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
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18
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Deng H, Vu KQ, Franco JR, Shepler LJ, Abouzeid CA, Hamner JW, Mercier HW, Taylor JA, Kazis LE, Slavin MD, Ryan CM, Schneider JC. Digital Interventions for Social Participation in Adults with Long-term Physical Conditions: A Systematic Review. J Med Syst 2023; 47:26. [PMID: 36792791 PMCID: PMC9931567 DOI: 10.1007/s10916-023-01914-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 01/20/2023] [Indexed: 02/17/2023]
Abstract
This review aims to identify and evaluate digital interventions for social participation in the growing population of adults with long-term physical conditions. Articles were sourced from MEDLINE, EMBASE, CINAHL and PsycINFO databases using subject headings and keywords related to "social participation" and "digital technology". Studies that adopted digital technology interventions to improve social participation in adults with long-term physical conditions were included. Data on study methodology, participant and digital intervention characteristics, and findings related to social participation were extracted. The search yielded a total of 4646 articles and 14 articles met criteria for final review with five randomized controlled trials, two non-randomized clinical trials and seven one-group pretest-posttest clinical trials. Studies were organized based on the digital intervention strategy implemented to improve social participation: group support (n = 4), individual skill training or counseling (n = 6), education and support (n = 3), and mixed intervention (n = 1). The group support interventions developed a social network among participants through videoconference, app, or virtual reality platform. Three studies reported positive improvements in different aspects of social participation. Individual skill training or counseling mainly utilized phone calls to help participants cope with activity participation and interpersonal relationship issues. Only two studies demonstrated benefits for social participation. The education and support intervention, which used messages and website information to increase participants' knowledge and provide support, showed positive findings in three studies. This review suggests digital interventions for improving social participation in adults with long-term physical conditions are feasible and the effectiveness of different strategies may vary.Registration: This review was prospectively registered on the International Prospective Register of Systematic Reviews (PROSPERO) (registry number: CRD42021254105).
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Affiliation(s)
- Huan Deng
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Kevin Q Vu
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Jessie R Franco
- Department of Rehabilitation Services, Brigham and Women's Hospital, Boston, MA, USA
| | - Lauren J Shepler
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA
| | - Cailin A Abouzeid
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA
| | - J W Hamner
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA
| | - Hannah W Mercier
- Occupational Therapy Program, Stony Brook University, Stony Brook, NY, USA
| | - J Andrew Taylor
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Lewis E Kazis
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Mary D Slavin
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Colleen M Ryan
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Shriners Hospitals for Children-Boston®, Boston, MA, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA.
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.
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Gittins Stone DI, Elkins RM, Gardner M, Boger K, Sperling J. Examining the Effectiveness of an Intensive Telemental Health Treatment for Pediatric Anxiety and OCD During the COVID-19 Pandemic and Pediatric Mental Health Crisis. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01500-5. [PMID: 36749490 PMCID: PMC9902833 DOI: 10.1007/s10578-023-01500-5] [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] [Accepted: 01/23/2023] [Indexed: 02/08/2023]
Abstract
Despite research supporting the efficacy of weekly outpatient videoconferencing-based cognitive behavioral therapy (VCBT), limited evidence exists about the benefits of leveraging VCBT for brief intensive formats. We examined the effectiveness of an intensive outpatient VCBT targeting pediatric anxiety and OCD. Quasi-experimental design was used to compare outcomes of intensive, in-person, group-based cognitive-behavioral therapy with medication management and caregiver guidance pre-pandemic, to a similar VCBT peri-pandemic (n = 130). Pretreatment and posttreatment assessments included patient- and caregiver-report of anxiety and functional impairment. Analyses of covariance were conducted, examining changes in anxiety and impairment between treatment groups, controlling for admission levels. No significant differences in posttreatment anxiety or impairment were observed between conditions. This study illustrates that intensive, group-based treatment for pediatric anxiety and OCD using VCBT is associated with comparable reductions in anxiety and impairment. It marks a crucial step toward providing broader access to quality care for youth in need.
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Affiliation(s)
| | - R Meredith Elkins
- McLean Hospital Belmont, Belmont, MA, USA
- Harvard Medical School, Cambridge, MA, USA
| | | | - Kathryn Boger
- McLean Hospital Belmont, Belmont, MA, USA
- Harvard Medical School, Cambridge, MA, USA
| | - Jacqueline Sperling
- McLean Hospital Belmont, Belmont, MA, USA
- Harvard Medical School, Cambridge, MA, USA
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20
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Balaskas A, Schueller SM, Cox AL, Rashleigh C, Doherty G. Examining young adults daily perspectives on usage of anxiety apps: A user study. PLOS DIGITAL HEALTH 2023; 2:e0000185. [PMID: 36812622 PMCID: PMC9931254 DOI: 10.1371/journal.pdig.0000185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/14/2022] [Indexed: 01/27/2023]
Abstract
The growing number of mental health smartphone applications has led to increased interest in how these tools might support users in different models of care. However, research on the use of these interventions in real-world settings has been scarce. It is important to understand how apps are used in a deployment setting, especially among populations where such tools might add value to current models of care. The objective of this study is to explore the daily use of commercially-available mobile apps for anxiety that integrate CBT, with a focus on understanding reasons for and barriers for app use and engagement. This study recruited 17 young adults (age M = 24.17 years) while on a waiting list to receive therapy in a Student Counselling Service. Participants were asked to select up to two of a list of three selected apps (Wysa, Woebot, and Sanvello) and instructed to use the apps for two weeks. Apps were selected because they used techniques from cognitive behavioral therapy, and offer diverse functionality for anxiety management. Qualitative and quantitative data were gathered through daily questionnaires to capture participants' experiences with the mobile apps. In addition, eleven semi-structured interviews were conducted at the end of the study. We used descriptive statistics to analyze participants' interaction with different app features and used a general inductive approach to analyze the collected qualitative data. The results highlight that users form opinions about the apps during the first days of app use. A number of barriers to sustained use are identified including cost-related issues, inadequate content to support long-term use, and a lack of customization options for different app functions. The app features used differ among participants with self-monitoring and treatment elements being the most used features.
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Affiliation(s)
- Andreas Balaskas
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
- * E-mail:
| | - Stephen M. Schueller
- Department of Psychological Science, University of California, Irvine, Irvine, California, United States of America
| | - Anna L. Cox
- UCLIC, University College London, London, United Kingdom
| | - Chuck Rashleigh
- Student Counselling Services, Trinity College Dublin, Dublin, Ireland
| | - Gavin Doherty
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
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21
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Grudin R, Ahlen J, Mataix-Cols D, Lenhard F, Henje E, Månsson C, Sahlin H, Beckman M, Serlachius E, Vigerland S. Therapist-guided and self-guided internet-delivered behavioural activation for adolescents with depression: a randomised feasibility trial. BMJ Open 2022; 12:e066357. [PMID: 36572500 PMCID: PMC9806095 DOI: 10.1136/bmjopen-2022-066357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Access to effective treatments for adolescents with depression needs to improve. Few studies have evaluated behavioural activation (BA) for adolescent depression, and none remotely delivered BA. This study explored the feasibility and acceptability of therapist-guided and self-guided internet-delivered BA (I-BA) in preparation for a future randomised controlled trial (RCT). DESIGN A single-blinded randomised controlled feasibility trial. SETTING A specialist outpatient clinic in Sweden. PARTICIPANTS Thirty-two adolescents with mild-to-moderate major depression, aged 13-17 years. INTERVENTIONS Ten weeks of therapist-guided I-BA or self-guided I-BA, or treatment as usual (TAU). Both versions of I-BA included parental support. TAU included referral to usual care within child and youth psychiatry or primary care. OUTCOMES Feasibility measures included study take-up, participant retention, acceptability, safety and satisfaction. The primary outcome measure was the blinded assessor-rated Children's Depression Rating Scale, Revised. The primary endpoint was the 3-month follow-up. RESULTS 154 adolescents were screened and 32 were randomised to therapist-guided I-BA (n=11), self-guided I-BA (n=10) or TAU (n=11). Participant retention was acceptable, with two drop-outs in TAU. Most participants in TAU had been offered interventions by the primary endpoint. The mean number of completed chapters (total of 8) for adolescents was 7.5 in therapist-guided I-BA and 5.4 in self-guided I-BA. No serious adverse events were recorded. Satisfaction was acceptable in both I-BA groups. Following an intent-to-treat approach, the linear mixed-effects model revealed that both therapist-guided and self-guided I-BA (Cohen's d=2.43 and 2.23, respectively), but not TAU (Cohen's d=0.95), showed statistically significant changes on the primary outcome measure with large within-group effect sizes. CONCLUSIONS Both therapist-guided and self-guided I-BA are acceptable and potentially efficacious treatments for adolescents with depression. It is feasible to conduct a large-scale RCT to establish the efficacy and cost-effectiveness of I-BA versus TAU. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04117789).
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Affiliation(s)
- Rebecca Grudin
- Centre for Psychiatry Research,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Johan Ahlen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- The Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Fabian Lenhard
- Centre for Psychiatry Research,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Eva Henje
- Department of Clinical Science, Child and Adolescent Psychiatry, Umeå Universitet, Umea, Sweden
| | - Cecilia Månsson
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Hanna Sahlin
- Centre for Psychiatry Research,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Maria Beckman
- Centre for Psychiatry Research,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Eva Serlachius
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Sarah Vigerland
- Centre for Psychiatry Research,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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22
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Bazzano AN, Sun Y, Chavez-Gray V, Akintimehin T, Gustat J, Barrera D, Roi C. Effect of Yoga and Mindfulness Intervention on Symptoms of Anxiety and Depression in Young Adolescents Attending Middle School: A Pragmatic Community-Based Cluster Randomized Controlled Trial in a Racially Diverse Urban Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12076. [PMID: 36231378 PMCID: PMC9564597 DOI: 10.3390/ijerph191912076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
Mental health conditions in childhood and adolescence are increasing in the U.S. population and require early intervention, as highlighted by a recent Surgeon General's Advisory on Protecting Youth Mental Health. These health issues, which have been exacerbated by the COVID-19 pandemic, impair functioning, and may lead to longer term reductions in quality of life. Young adolescents are likely to experience stressors including academic pressure, feelings of loneliness and isolation, and excessive exposure to social media, all of which have been made worse by the pandemic and associated disruptions. Universal preventive programs at school serve as an important strategy for equipping youth with coping skills to address current and future social and emotional challenges. Yoga and mindfulness programs have emerged as a promising preventive approach for schools and have proven feasible and acceptable. The current study evaluated a universal, school-based mindfulness and yoga program among youth aged 11-14 in a racially diverse, urban setting in the United States. Outcomes of interest included symptoms of anxiety and depression. Anxiety and depression symptoms decreased in the intervention group, although these differences were not statistically significant. In the control group, anxiety symptoms decreased but depression symptoms increased. The resulting time effect indicated a significant decrease in anxiety symptoms, while the time by group effect revealed a strong trend in depression symptoms. Future research should investigate the utility of yoga and mindfulness interventions for early adolescents in a larger population, and the differences in intervention effect among subgroups, with attention to longer term outcomes.
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Affiliation(s)
- Alessandra N. Bazzano
- Center of Excellence in Maternal Child Health, Department of Social, Behavioral and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Yaoyao Sun
- Institute of Mental Health, Peking University Sixth Hospital, Beijing 100191, China
| | - Vaughne Chavez-Gray
- Center of Excellence in Maternal Child Health, Department of Social, Behavioral and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Temitope Akintimehin
- Center of Excellence in Maternal Child Health, Department of Social, Behavioral and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Jeanette Gustat
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Denise Barrera
- Center of Excellence in Maternal Child Health, Department of Social, Behavioral and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Cody Roi
- Department of Child and Adolescent Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
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23
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Burger F, Neerincx MA, Brinkman WP. Using a conversational agent for thought recording as a cognitive therapy task: Feasibility, content, and feedback. Front Digit Health 2022; 4:930874. [PMID: 35928046 PMCID: PMC9343632 DOI: 10.3389/fdgth.2022.930874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
E-mental health for depression is increasingly used in clinical practice, but patient adherence suffers as therapist involvement decreases. One reason may be the low responsiveness of existing programs: especially autonomous systems are lacking in their input interpretation and feedback-giving capabilities. Here, we explore (a) to what extent a more socially intelligent and, therefore, technologically advanced solution, namely a conversational agent, is a feasible means of collecting thought record data in dialog, (b) what people write about in their thought records, (c) whether providing content-based feedback increases motivation for thought recording, a core technique of cognitive therapy that helps patients gain an understanding of how their thoughts cause their feelings. Using the crowd-sourcing platform Prolific, 308 participants with subclinical depression symptoms were recruited and split into three conditions of varying feedback richness using the minimization method of randomization. They completed two thought recording sessions with the conversational agent: one practice session with scenarios and one open session using situations from their own lives. All participants were able to complete thought records with the agent such that the thoughts could be interpreted by the machine learning algorithm, rendering the completion of thought records with the agent feasible. Participants chose interpersonal situations nearly three times as often as achievement-related situations in the open chat session. The three most common underlying schemas were the Attachment, Competence, and Global Self-evaluation schemas. No support was found for a motivational effect of providing richer feedback. In addition to our findings, we publish the dataset of thought records for interested researchers and developers.
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Affiliation(s)
- Franziska Burger
- Department of Intelligent Systems, Delft University of Technology, Delft, Netherlands
| | - Mark A. Neerincx
- Department of Intelligent Systems, Delft University of Technology, Delft, Netherlands
- Department of Perceptual and Cognitive Systems, Netherlands Organisation of Applied Scientific Research (TNO), Soesterberg, Netherlands
| | - Willem-Paul Brinkman
- Department of Intelligent Systems, Delft University of Technology, Delft, Netherlands
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24
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O’Callaghan E, Sullivan S, Gupta C, Belanger HG, Winsberg M. Feasibility and acceptability of a novel telepsychiatry-delivered precision prescribing intervention for anxiety and depression. BMC Psychiatry 2022; 22:483. [PMID: 35854281 PMCID: PMC9297585 DOI: 10.1186/s12888-022-04113-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/05/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Major Depressive Disorder and Generalized Anxiety Disorder are pervasive and debilitating conditions, though treatment is often inaccessible and based on trial-and-error prescribing methods. The present observational study seeks to describe the use of a proprietary precision prescribing algorithm piloted during routine clinical practice as part of Brightside's telepsychiatry services. The primary aim is to determine the feasibility and acceptability of implementing this intervention. Secondary aims include exploring remission and symptom improvement rates. METHODS Participants were adult patients enrolled in Brightside who completed at least 12 weeks of treatment for depression and/or anxiety and received a prescription for at least one psychiatric medication. A prescription recommendation was made by Brightside's algorithm at treatment onset and was utilized for clinical decision support. Participants received baseline screening surveys of the PHQ-9 and GAD-7, and at weeks 2,4,6,8,10 and 12. Intent-to-treat (ITT) sensitivity analyses were conducted. Feasibility of the implementation was measured by the platform's ability to enroll and engage participants in timely psychiatric care, as well as offer high touch-point treatment options. Acceptability was measured by patient responses to a 5-star satisfaction rating. RESULTS Brightside accessed and treated 6248 patients from October 2018 to April 2021, treating a majority of patients within 4-days of enrollment. The average plan cost was $115/month. 89% of participants utilized Brightside's core medication plan at a cost of $95/month. 13.4% of patients in the study rated Brightside's services as highly satisfactory, averaging a 4.6-star rating. Furthermore, 90% of 6248 patients experienced a MCID in PHQ-9 or GAD-7 score. Remission rates were 75% (final PHQ-9 or GAD-7 score < 10) for the study sample and 59% for the ITT sample. 69.3% of Brightside patients were treated with the medication initially prescribed at intake. CONCLUSIONS Results suggest that the present intervention may be feasible and acceptable within the assessed population. Exploratory analyses suggest that Brightside's course of treatment, guided by precision recommendations, improved patients' symptoms of anxiety and depression.
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Affiliation(s)
- Erin O’Callaghan
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA 94607-1703 USA
| | - Scott Sullivan
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA 94607-1703 USA
| | - Carina Gupta
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA, 94607-1703, USA.
| | - Heather G. Belanger
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA 94607-1703 USA ,grid.170693.a0000 0001 2353 285XDepartments of Psychology and Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL USA
| | - Mirène Winsberg
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA 94607-1703 USA
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25
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Staeck R, Drüge M, Albisser S, Watzke B. Acceptance of E-mental health interventions and its determinants among psychotherapists-in-training during the first phase of COVID-19. Internet Interv 2022; 29:100555. [PMID: 35789691 PMCID: PMC9242936 DOI: 10.1016/j.invent.2022.100555] [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: 01/28/2022] [Revised: 06/07/2022] [Accepted: 06/22/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Although E-mental health (EMH) interventions have been shown to be effective in the treatment of mental health problems and empirical knowledge regarding EMH acceptance for different occupations in health care is established, little is known regarding EMH and psychotherapists-in-training. This seems particularly relevant as psychotherapists-in-training will shape the future health care system since they are as being the next generation of psychotherapists. With social distancing measures in place, COVID-19 has led to an increased demand for EMH, which is broadening the way psychological treatments are delivered. OBJECTIVE The present study aims to assess the acceptance of EMH and its determinants among psychotherapists-in-training of different EMH modalities and to retrospectively compare current acceptance with pre-COVID-19 times. METHODS Altogether, 29 training institutions in Switzerland and 232 training institutions in Germany were contacted, resulting in a sample of N = 216 psychotherapists-in-training (88.4 % female) who filled out the self-administered web-based questionnaire in summer 2020. The acceptance of EMH was assessed considering several different modalities (e.g., videoconference, guided self-help programs) as well as further possible predictors of EMH acceptance based on the Unified Theory of Acceptance and Use of Technology. Acceptance scores were categorized as low, moderate or high based on prior research and predicted using multiple regression. RESULTS Acceptance of EMH was moderate (M = 3.40, SD = 1.11) and increased significantly (t(215) = 12.03, p < .01; d = 0.88) compared to pre-COVID-19 (M = 2.67, SD = 1.11); however, acceptance varied significantly between modalities (F(2.6, 561.7) = 62.93, p < .01, partial η2 = 0.23), with videoconferencing being the most accepted and unguided programs the least. Stepwise regression including three of 14 variables (R2 = 0.55, F (14, 201) = 17.68, p < .001) identified performance expectancy, social influence and concerns about the therapeutic alliance as significant determinants of EMH acceptance. DISCUSSION Acceptance by psychotherapists-in-training was moderate and in line with prior research and comparable with other clinicians' acceptance scores. Performance expectancy, social influence and concerns about the therapeutic alliance were predictive of EMH acceptance, indicating their significance in the implementation of EMH in health care. CONCLUSION These findings underline the importance of the aforementioned determinants of EMH acceptance and the need for further studies investigating EMH acceptance in order to derive adequate educational programs and to facilitate dissemination among psychotherapists-in-training.
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26
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Spagnuolo R, Basile A, Corea A, Iaquinta FS, Milić N, Doldo P, Luzza F, Abenavoli L. Measuring Mood and Anxiety Disorders by Patient Reported Outcomes in Inflammatory Bowel Disease: A Literature Review Update. Rev Recent Clin Trials 2022; 17:RRCT-EPUB-124855. [PMID: 35770406 DOI: 10.2174/1574887117666220628151256] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 06/15/2023]
Abstract
Background Anxiety and depression are the most common psychological disorders found in Inflammatory Bowel Disease (IBD) patients. Accurate measuring of these disorders should be proposed for a prompt management. Patient-reported outcome measurements (PROMs) allow patients to self-report their psychological symptoms. Objective To highlight the presence of PROMs measuring anxiety and depression in IBD setting evaluating the most used psychometric tools. Methods We reviewed the literature from 2010 up to September 2021. Articles on adult IBD patients assessing depression and anxiety by PROMs in English language were included. Results Thirty-six studies, including 11 psychometric tools were found. Hospital Anxiety and Depression Scale (21 studies), Beck Depression Inventory II (5 studies), Spielberg State-Trait Anxiety Inventory (3 studies), Patient-Reported Outcomes Measurement Information System (3 studies), Symptom Checklist-90 (2 studies), Euro Quality of Life (2 studies) mostly used psychometric tools for anxiety and depression in IBD settings. Conclusion Our review analyzed psychometric tools used for PROMs evaluating anxiety and depression in IBD setting. No chronological differences have emerged, all have been used in the last ten years, highlighting a lack of specificity. The strong association between IBD and mood disorders suggests that clinicians should consider the evaluation of depression and anxiety as integral parts of IBD clinical care. It is essential to identify tools enabling these items to be detected better. A global view of IBD patients, accounting not only for physical but also for psychical symptoms with an early and feasible assessment of unrecognized psychiatric disorders, can have a strong impact on their management strategy.
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Affiliation(s)
- Rocco Spagnuolo
- Department of Clinical and Experimental Medicine, Magna Graecia, University of Catanzaro, Calabria, Catanzaro, Italy
| | - Antonio Basile
- Department of Health Sciences, Magna Graecia University of Catanzaro, Calabria, Catanzaro, Italy
| | - Alessandro Corea
- Department of Health Sciences, Magna Graecia University of Catanzaro, Calabria, Catanzaro, Italy
| | | | - Nataša Milić
- Department of Pharmacy, University of Novi Sad, Novi Sad, Serbia
| | - Patrizia Doldo
- Department of Health Sciences, Magna Graecia University of Catanzaro, Calabria, Catanzaro, Italy
| | - Francesco Luzza
- Department of Health Sciences, Magna Graecia University of Catanzaro, Calabria, Catanzaro, Italy
| | - Ludovico Abenavoli
- Department of Health Sciences, Magna Graecia University of Catanzaro, Calabria, Catanzaro, Italy
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Maharaj SS, Nuhu JM. Effect of treadmill walking for anxiety, depression and social well-being in women with diabetes type 2: A randomized controlled trial. Health Care Women Int 2022; 44:734-752. [PMID: 35763045 DOI: 10.1080/07399332.2022.2090566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Anxiety and depression are higher in persons with diabetes leading to poor glycaemic control and diabetes-related emotional distress. Some diabetic women do not engage in exercises perceiving it to make their diabetes worse. The researchers' objective of this treadmill walking program was to determine its effect on anxiety, depression and social well-being in women with diabetes type 2 (DT2). We randomized 49 sedentary women with DT2 into treadmill walking at moderate intensity of 40-60% of their age-adjusted maximal heart rate, three times per week on alternate days for 12 weeks. The control attended electronic lectures on diet, diabetes and mental health. The treadmill group had no adverse effects and their anxiety, depression and social well-being scores improved with no significant changes for the control. We offer women with DT2 an easy, safe indoors exercise preventing them from abuse from men, erratic drivers and extreme weather conditions with positive physiological responses.
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Affiliation(s)
- Sonill S. Maharaj
- Department of Physiotherapy, University of KwaZulu-Natal, Durban, South Africa
| | - Jibril M. Nuhu
- UKZN and Faculty of Allied Health Sciences, Department of Physiotherapy, Bayero University, Kano, Nigeria
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The effective delivery of digital CBT: a service evaluation exploring the outcomes of young people who completed video conferencing therapy in 2020. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Despite its impressive evidence base, there is a widening access gap to receiving cognitive behavioural therapy (CBT). Video conferencing therapy (VCT) offers an effective solution for logistical barriers to treatment, which has been salient throughout the Coronavirus pandemic. However, research concerning the delivery of CBT via VCT for children and young people (CYP) is in its infancy, and clinical outcome data are limited. The aim of this service evaluation was to explore the effectiveness of a VCT CBT intervention for CYP referred from Child and Adolescent Mental Health Services (CAMHS) in the UK. A total of 989 records of CYP who had completed CBT via VCT in 2020 with Healios, a digital mental health company commissioned by the National Health Service (NHS), were examined to determine changes in anxiety, depression and progress towards personalised goals. Routine outcome measures (ROMs) were completed at baseline and endpoint, as well as session by session. Feedback was collected from CYP and their families at the end of treatment. There was a significant reduction in symptoms of anxiety and depression and significant progress towards goals, with pre- to post-effect sizes (Cohen’s d) demonstrating medium to large effects (d=.45 to d=−1.39). Reliable improvement ranged from 31 to 80%, clinical improvement ranged from 33 to 50%, and 25% clinically and reliably improved on at least one measure; 92% reported that they would recommend Healios. This service evaluation demonstrates that Healios’ CBT delivered via VCT is effective for CYP receiving it as part of routine mental health care.
Key learning aims
(1)
To consider whether CBT can be effectively delivered in routine care via VCT.
(2)
To explore whether CBT delivered in routine care via VCT is acceptable to children, young people and their families.
(3)
To reflect on the benefits of VCT and the collection of a variety of ROMs via digital platforms.
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Paul M, Bullock K, Bailenson J. Virtual Reality Behavioral Activation for Adults With Major Depressive Disorder: Feasibility Randomized Controlled Trial. JMIR Ment Health 2022; 9:e35526. [PMID: 35404830 PMCID: PMC9123544 DOI: 10.2196/35526] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a global crisis with increasing incidence and prevalence. There are many established evidence-based psychotherapies (EBPs) for depression, but numerous barriers still exist; most notably, access and dissemination. Virtual reality (VR) may offer some solutions to existing constraints of EBPs for MDD. OBJECTIVE We aimed to examine the feasibility, acceptability, and tolerability of using VR as a method of delivering behavioral activation (BA) for adults diagnosed with MDD during a global pandemic and to explore for signs of clinical efficacy by comparing VR-enhanced BA (VR BA) to a standard BA treatment and a treatment as usual control group for individuals diagnosed with MDD. METHODS A feasibility trial using a 3-armed, unblinded, randomized controlled pilot design was conducted. The study took place remotely via Zoom telehealth visits between April 8, 2020, and January 15, 2021. This study used a 3-week, 4-session protocol in which VR BA participants used a VR headset to complete their BA homework. Feasibility was measured using dropout rates, serious adverse events, completion of homework, an adapted telepresence scale, the Simulator Sickness Questionnaire, the Brief Agitation Measure, and an adapted Technology Acceptance Model. Efficacy was assessed using the Patient Health Questionnaire-9. RESULTS Of the 35 participants assessed for eligibility, 13 (37%) were randomized into VR BA (n=5, 38%), traditional BA (n=4, 31%), or a treatment as usual control (n=4, 31%). The mean age of the 13 participants (5/13, 38% male; 7/13, 54% female; and 1/13, 8% nonbinary or third gender) was 35.4 (SD 12.3) years. This study demonstrated VR BA feasibility in participants with MDD through documented high levels of acceptability and tolerability while engaging in VR-induced pleasurable activities in conjunction with a brief BA protocol. No adverse events were reported. This study also illustrated that VR BA may have potential clinical utility for treating MDD, as the average VR BA participant's clinical severity decreased by 5.67 points, signifying a clinically meaningful change in severity from a moderate to a mild level of depression as per the Patient Health Questionnaire-9 score. CONCLUSIONS The findings of this study demonstrate that VR BA is safe and feasible to explore for the treatment of MDD. This study documented evidence that VR BA may be efficacious and justifies further examination in an adequately powered randomized controlled trial. This pilot study highlights the potential utility that VR technology may offer patients with MDD, especially those who have difficulty accessing real-world pleasant activities. In addition, for those having difficulty accessing care, VR BA could be adapted as a first step to help people improve their mood and increase their motivation while waiting to connect with a health care professional for other EBPs. TRIAL REGISTRATION ClinicalTrials.gov NCT04268316; https://clinicaltrials.gov/ct2/show/NCT04268316. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/24331.
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Affiliation(s)
- Margot Paul
- PGSP-Stanford PsyD Consortium, Palo Alto University, Palo Alto, CA, United States.,Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, United States
| | - Kim Bullock
- Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, United States
| | - Jeremy Bailenson
- Department of Communication, Stanford University, Stanford, CA, United States
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Wiegersma S, Hidajat M, Schrieken B, Veldkamp B, Olff M. Improving Web-Based Treatment Intake for Multiple Mental and Substance Use Disorders by Text Mining and Machine Learning: Algorithm Development and Validation. JMIR Ment Health 2022; 9:e21111. [PMID: 35404261 PMCID: PMC9039807 DOI: 10.2196/21111] [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: 06/05/2020] [Revised: 11/01/2020] [Accepted: 09/28/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Text mining and machine learning are increasingly used in mental health care practice and research, potentially saving time and effort in the diagnosis and monitoring of patients. Previous studies showed that mental disorders can be detected based on text, but they focused on screening for a single predefined disorder instead of multiple disorders simultaneously. OBJECTIVE The aim of this study is to develop a Dutch multi-class text-classification model to screen for a range of mental disorders to refer new patients to the most suitable treatment. METHODS On the basis of textual responses of patients (N=5863) to a questionnaire currently used for intake and referral, a 7-class classifier was developed to distinguish among anxiety, panic, posttraumatic stress, mood, eating, substance use, and somatic symptom disorders. A linear support vector machine was fitted using nested cross-validation grid search. RESULTS The highest classification rate was found for eating disorders (82%). The scores for panic (55%), posttraumatic stress (52%), mood (50%), somatic symptom (50%), anxiety (35%), and substance use disorders (33%) were lower, likely because of overlapping symptoms. The overall classification accuracy (49%) was reasonable for a 7-class classifier. CONCLUSIONS A classification model was developed that could screen text for multiple mental health disorders. The screener resulted in an additional outcome score that may serve as input for a formal diagnostic interview and referral. This may lead to a more efficient and standardized intake process.
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Affiliation(s)
- Sytske Wiegersma
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, Netherlands
| | | | | | - Bernard Veldkamp
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, Netherlands
| | - Miranda Olff
- Department of Psychiatry, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, Netherlands.,ARQ National Psychotrauma Centre, Diemen, Netherlands
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Kim HW, Kim J, Kang SY. Intentions of preventive depression management for a healthy pregnancy by gender among unmarried college students in Korea: a cross-sectional study. Reprod Health 2022; 19:75. [PMID: 35331282 PMCID: PMC8943979 DOI: 10.1186/s12978-022-01380-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background Early adulthood is a significant period for preventive depression management for a healthy pregnancy. However, previous public health initiatives have not yet emphasized preparation for a healthy pregnancy in this population. In addition, pregnancy planning has traditionally been regarded as women’s responsibility, so intervention strategies may differ by gender. This study explored intentions of preventive depression management for a healthy pregnancy among unmarried college students, as well as factors influencing those intentions, by applying the Theory of Planned Behavior (TPB) model. Methods For this cross-sectional survey, 828 unmarried college students aged 18–29 were recruited from a national university in Korea from July to September 2019. The chi-square test and t-test were used to compare gender differences in general characteristics, the current level of depression, and constructs of the extended TPB. Hierarchical regression was performed to identify factors influencing the intention of preventive depression management for a healthy pregnancy. Results The intention to manage depression was significantly higher in men than in women (t = 2.36, p = 0.019). The factors affecting the intention of preventive depression management for a healthy pregnancy were components of TPB in both women and men, of which self-efficacy had the greatest effect (female: β = 0.34, p < 0.001, male: β = 0.30, p < 0.001). The current level of depression was a significant factor for women only (β = 0.10, p = 0.014). Conclusions Our study results underscore the need for nurses to perform preventive interventions and provide directions to develop interventions to improve the intention of depression management for unmarried college students. It is necessary to intervene with all the constructs of the TPB, especially self-efficacy, for both men and women. It is also important to check and address the current depression status of unmarried female college students. Starting in early adulthood, such as college students in the preconception stage, it is necessary to take care of one’s mental health (including depression) in order to have a healthy pregnancy in the future. The early identification of adults needing depression management is also a major challenge. In this study, an online survey was conducted to investigate levels of depression among Korean college students and their intention to manage depression for a healthy future pregnancy, as well as to identify the influencing factors. Convenience recruitment was conducted by e-mail at one university in Korea, and 828 male and female college students responded to the survey. An analysis of the factors affecting the intention to manage depression for a healthy future pregnancy identified the components of the Theory of Planned Behavior as influencing factors in both men and women. In particular, self-efficacy had the greatest influence. However, the current level of depression was only a significant factor among women. These findings could help nurses recognize differences in gender characteristics for the intention of preventive depression management for a healthy pregnancy, and provide evidence to develop and implement the intervention. These efforts will ultimately reduce high-risk pregnancies due to poor mental health.
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Affiliation(s)
- Hae Won Kim
- Research Institute of Nursing Science, Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project, College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Jieun Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Saem Yi Kang
- College of Nursing, Institute of Health Sciences, Gyeongsang National University, 816-15 Jinju-daero, Jinju, 52727, Republic of Korea.
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32
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Feinstein JS, Gould D, Khalsa SS. Amygdala-driven apnea and the chemoreceptive origin of anxiety. Biol Psychol 2022; 170:108305. [PMID: 35271957 DOI: 10.1016/j.biopsycho.2022.108305] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 02/09/2022] [Accepted: 03/03/2022] [Indexed: 12/13/2022]
Abstract
Although the amygdala plays an important part in the pathogenesis of anxiety and generation of exteroceptive fear, recent discoveries have challenged the directionality of this brain-behavior relationship with respect to interoceptive fear. Here we highlight several paradoxical findings including: (1) amygdala lesion patients who experience excessive fear and panic following inhalation of carbon dioxide (CO2), (2) clinically anxious patients who have significantly smaller (rather than larger) amygdalae and a pronounced hypersensitivity toward CO2, and (3) epilepsy patients who exhibit apnea immediately following stimulation of their amygdala yet have no awareness that their breathing has stopped. The above findings elucidate an entirely novel role for the amygdala in the induction of apnea and inhibition of CO2-induced fear. Such a role is plausible given the strong inhibitory connections linking the central nucleus of the amygdala with respiratory and chemoreceptive centers in the brainstem. Based on this anatomical arrangement, we propose a model of Apnea-induced Anxiety (AiA) which predicts that recurring episodes of apnea are being unconsciously elicited by amygdala activation, resulting in transient spikes in CO2 that provoke fear and anxiety, and lead to characteristic patterns of escape and avoidance behavior in patients spanning the spectrum of anxiety. If this new conception of AiA proves to be true, and activation of the amygdala can repeatedly trigger states of apnea outside of one's awareness, then it remains possible that the chronicity of anxiety disorders is being interoceptively driven by a chemoreceptive system struggling to maintain homeostasis in the midst of these breathless states.
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Affiliation(s)
- Justin S Feinstein
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA, 74136; University of Tulsa, Oxley College of Health Sciences, Tulsa, Oklahoma, USA, 74104; University of Iowa, Department of Neurology, Iowa City, Iowa, USA, 52242.
| | - Dylan Gould
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA, 74136
| | - Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA, 74136; University of Tulsa, Oxley College of Health Sciences, Tulsa, Oklahoma, USA, 74104
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33
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Belanger HG, Winsberg M. Do older adults benefit from telepsychiatric care: Comparison to younger adults. Front Psychiatry 2022; 13:998401. [PMID: 36072453 PMCID: PMC9441623 DOI: 10.3389/fpsyt.2022.998401] [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: 07/19/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Telemental health platforms may increase access to care for older adults. Historically, older adults have tended to adopt new technologies at a slower rate which creates a perception that they may not be able to benefit from them. The purpose of this study was to determine whether or not older adult patients receiving psychiatric care for depression via a telemental health platform achieve the same outcomes as younger adults. METHOD Participant data utilized in the current investigation were obtained from a national mental health telehealth company (i.e., Brightside) and consisted of 12,908 U.S.-based adult patients receiving psychiatric care for depression between October, 2018 and January, 2022. Propensity matching was used to create an older and younger sample (n = 141 in each) using 23 covariates. These samples were then compared using repeated measures ANOVA on Patient Health Questionnaire-9 (PHQ-9) scores at start of treatment, 6 weeks, 8 weeks, 10 weeks, 12 weeks, 14 weeks, and 16 weeks. RESULTS Despite matching, the groups still significantly differed on prior mental health treatment, such that more older adults reported having had prior mental health treatment. There were no other differences between the groups on assessed variables. Both younger and older adults had decreasing scores over time with no significant differences between them. CONCLUSION Older adults have similar improvement in depression symptom severity over time following initiation of psychiatric treatment via a telehealth platform. These findings suggest that age is not a barrier to benefitting from telepsychiatric care.
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Affiliation(s)
- Heather G Belanger
- Brightside Health Inc., Oakland, CA, United States.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States
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Damme KS, Park JS, Vargas T, Walther S, Shankman SA, Mittal VA. Motor abnormalities, depression risk, and clinical course in adolescence. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2022; 2:61-69. [PMID: 35419552 PMCID: PMC9000199 DOI: 10.1016/j.bpsgos.2021.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 02/02/2023] Open
Abstract
Background Motor abnormalities, such as psychomotor agitation and retardation, are widely recognized as core features of depression. However, it is not currently known if motor abnormalities connote risk for depression. Methods Using data from the Adolescent Brain Cognitive Development (ABCD) Study, a nationally representative sample of youth (n=10,835, 9-11 years old), the present paper examines whether motor abnormalities are associated with (a) depression symptoms in early adolescence, (b) familial risk for depression (familial risk loading), and (c) future depression symptoms. Motor abnormalities measures included traditional (DSM) motor signs such as psychomotor agitation and retardation as well as other motor domains such as developmental motor delays and dyscoordination. Results Traditional motor abnormalities were less prevalent (agitation=3.2%, retardation=0.3%) than non-traditional domains (delays=13.79%, coordination=35.5%) among adolescents. Motor dysfunction was associated with depression symptoms (Cohen's ds=0.02 to 0.12). Familial risk for depression was related to motor abnormalities (Cohen's ds=0.08 to 0.27), with the exception of motor retardation. Family vulnerability varied in sensitivity to depression risk (e.g., retardation: .53%; dyscoordination: 32.05%). Baseline endorsement of motor abnormalities predicted future depression symptoms at one-year follow-up. Conclusions These findings suggest that motor signs reflect a novel, promising future direction for examining vulnerability to depression risk in early adolescence.
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Affiliation(s)
- Katherine S.F. Damme
- Department of Psychology, Northwestern University, Evanston, Illinois
- Institute for Innovations in Developmental Sciences, Northwestern University, Evanston and Chicago, Illinois
| | - Jadyn S. Park
- Department of Psychology, Northwestern University, Evanston, Illinois
- Department of Psychiatry, Northwestern University, Chicago, Illinois
| | - Teresa Vargas
- Department of Psychology, Northwestern University, Evanston, Illinois
- Institute for Innovations in Developmental Sciences, Northwestern University, Evanston and Chicago, Illinois
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Stewart A. Shankman
- Department of Psychology, Northwestern University, Evanston, Illinois
- Institute for Innovations in Developmental Sciences, Northwestern University, Evanston and Chicago, Illinois
- Department of Psychiatry, Northwestern University, Chicago, Illinois
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University, Evanston, Illinois
- Institute for Innovations in Developmental Sciences, Northwestern University, Evanston and Chicago, Illinois
- Medical Social Sciences, Northwestern University, Chicago, Illinois
- Institute for Policy Research, Northwestern University, Chicago, Illinois
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35
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Monteiro S, Nejad YS, Aucoin M. Perinatal diet and offspring anxiety: A scoping review. Transl Neurosci 2022; 13:275-290. [PMID: 36128579 PMCID: PMC9449687 DOI: 10.1515/tnsci-2022-0242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/04/2022] [Accepted: 08/12/2022] [Indexed: 11/15/2022] Open
Abstract
Health behaviors during pregnancy have an impact on the developing offspring. Dietary factors play a role in the development of mental illness: however, less is known about the impact of diet factors during pre-conception, gestation, and lactation on anxiety levels in offspring. This scoping review sought to systematically map the available research involving human and animal subjects to identify nutritional interventions which may have a harmful or protective effect, as well as identify gaps. Studies investigating an association between any perinatal diet pattern or diet constituent and offspring anxiety were included. The number of studies reporting an association with increased or decreased levels of anxiety were counted and presented in figures. A total of 55,914 results were identified as part of a larger scoping review, and 120 articles met the criteria for inclusion. A greater intake of phytochemicals and vitamins were associated with decreased offspring anxiety whereas maternal caloric restriction, protein restriction, reduced omega-3 consumption, and exposure to a high fat diet were associated with higher levels of offspring anxiety. Results were limited by a very large proportion of animal studies. High quality intervention studies involving human subjects are warranted to elucidate the precise dietary factors or constituents that modulate the risk of anxiety in offspring.
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Affiliation(s)
- Sasha Monteiro
- Department of Research and Clinical Epidemiology, Canadian College of Naturopathic Medicine, 1255 Sheppard Ave E, Toronto, ON, M2K 1E2, Canada
| | - Yousef Sadat Nejad
- Department of Research and Clinical Epidemiology, Canadian College of Naturopathic Medicine, 1255 Sheppard Ave E, Toronto, ON, M2K 1E2, Canada
| | - Monique Aucoin
- Department of Research and Clinical Epidemiology, Canadian College of Naturopathic Medicine, 1255 Sheppard Ave E, Toronto, ON, M2K 1E2, Canada
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36
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Brandley ET, Kirkland AE, Baron M, Baraniuk JN, Holton KF. The Effect of the Low Glutamate Diet on the Reduction of Psychiatric Symptoms in Veterans With Gulf War Illness: A Pilot Randomized-Controlled Trial. Front Psychiatry 2022; 13:926688. [PMID: 35795023 PMCID: PMC9251130 DOI: 10.3389/fpsyt.2022.926688] [Citation(s) in RCA: 4] [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: 04/22/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
The objective of this pilot study was to examine the effects of the low glutamate diet on anxiety, post-traumatic stress disorder (PTSD), and depression in veterans with Gulf War Illness (GWI). The low glutamate diet removes dietary excitotoxins and increases consumption of micronutrients which are protective against glutamatergic excitotoxicity. This study was registered at ClinicalTrials.gov (NCT#03342482). Forty veterans with GWI completed psychiatric questionnaires at baseline and after 1-month following the low glutamate diet. Participants were then randomized into a double-blind, placebo-controlled crossover challenge with monosodium glutamate (MSG; a dietary excitotoxin) vs. placebo over three consecutive days per week, with assessments on day three. Data were analyzed across the full sample and with participants categorized by baseline symptom severity. Pre-post-dietary intervention change scores were analyzed with Wilcoxon signed-rank tests and paired sample t-tests across the full sample, and changes across symptom severity categories were analyzed using ANOVA. Crossover challenge results were analyzed with linear mixed modeling accounting for challenge material (MSG v. placebo), sequence (MSG/placebo v. placebo/MSG), period (challenge week 1 v. week 2), pre-diet baseline symptom severity category (minimal/mild, moderate, or severe), and the challenge material*symptom severity category interaction. A random effect of ID (sequence) was also included. All three measures showed significant improvement after 1 month on the diet, with significant differences between baseline severity categories. Individuals with severe psychological symptoms at baseline showed the most improvement after 1 month on the diet, while those with minimal/mild symptoms showed little to no change. Modeling results from the challenge period demonstrated a significant worsening of anxiety from MSG in only the most severe group, with no significant effects of MSG challenge on depression nor PTSD symptoms. These results suggest that the low glutamate diet may be an effective treatment for depression, anxiety, and PTSD, but that either (a) glutamate is only a direct cause of symptoms in anxiety, or (b) underlying nutrient intake may prevent negative psychiatric effects from glutamate exposure. Future, larger scale clinical trials are needed to confirm these findings and to further explore the potential influence of increased micronutrient intake on the improvements observed across anxiety, PTSD, and depression.
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Affiliation(s)
- Elizabeth T Brandley
- Department of Health Studies, American University, Washington, DC, United States
| | - Anna E Kirkland
- Medical University of South Carolina, Charleston, SC, United States
| | - Michael Baron
- Department of Mathematics and Statistics, American University, Washington, DC, United States
| | - James N Baraniuk
- Department of Medicine, Georgetown University, Washington, DC, United States
| | - Kathleen F Holton
- Department of Health Studies, American University, Washington, DC, United States.,Department of Neuroscience, American University, Washington, DC, United States.,Center for Neuroscience and Behavior, American University, Washington, DC, United States
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37
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Pérez JC, Fernández O, Cáceres C, Carrasco ÁE, Moessner M, Bauer S, Espinosa-Duque D, Gloger S, Krause M. An Adjunctive Internet-Based Intervention to Enhance Treatment for Depression in Adults: Randomized Controlled Trial. JMIR Ment Health 2021; 8:e26814. [PMID: 34927594 PMCID: PMC8726028 DOI: 10.2196/26814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/23/2021] [Accepted: 07/07/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Internet-based interventions promise to enhance the accessibility of mental health care for a greater number of people and in more remote places. Their effectiveness has been shown for the prevention and treatment of various mental disorders. However, their potential when delivered as add-on to conventional treatment (ie, blended care) is less clear. OBJECTIVE The aim of this study is to study the effectiveness of an internet intervention (ASCENSO) implemented in addition to face-to-face treatment as usual (TAU) for depression. METHODS A 2-arm, parallel-group, randomized controlled trial was conducted in an outpatient private mental health care center in Chile. In all, 167 adults, diagnosed with major depressive disorder, without severe comorbidities, and with internet access, were included. Eighty-four participants were assigned to the intervention group and received medical and psychological TAU from the mental health center plus access to the ASCENSO online platform. The control group (n=83) received only TAU. The ASCENSO platform includes psycho-educational information, depressive symptom monitoring and feedback, and managing emergencies based on the principles of cognitive behavioral therapy. Emergency management was mental health provider-assisted. TAU includes access to primary care physicians and psychiatrists, to a brief individual psychotherapy, and to medication when needed. The baseline questionnaires were administered in person, and 6- and 9-months assessments were conducted online. Depression symptoms and quality of life were measured by self-administered questionnaires, and treatment adherence was determined via the Mental Health Center's internal records. The usage of ASCENSO was assessed by server logs. Reduction on depressive symptomatology was considered as the primary outcome of the intervention and quality of life as a secondary outcome. RESULTS Of the 84 participants in the intervention group, 5 participants (6%) never accessed the online platform. Of the remaining 79 participants who accessed ASCENSO, 1 (1%, 1/79) did not answer any of the symptom questionnaire, and most participants (72/79, 91%) answered the monitoring questionnaires irregularly. The ASCENSO intervention implemented in addition to face-to-face care did not improve the outcome of the usual care delivered at the mental health center, either in terms of reduction of depressive symptoms (F2,6087= 0.48; P=.62) or in the improvement of quality of life (EQ-5D-3L: F2,7678=0.24; P=.79 and EQ-VAS: F2,6670= 0.13; P=.88). In contrast, for the primary (F2,850=78.25; P<.001) and secondary outcomes (EQ-5D-3L: F2,1067=37.87; EQ-VAS: F2,4390= 51.69; P<.001) in both groups, there was an improvement from baseline to 6 months (P<.001), but there was no change at 9 months. In addition, no effects on adherence to or use of TAU were found. Finally, the dropout rate for the face-to-face treatment component was 54% (45/84) for the intervention group versus 39% (32/83) for the control group (P=.07). CONCLUSIONS The fact that the adjunctive access to ASCENSO did not improve outcome could be due to both the rather high effectiveness of TAU and to patients' limited use of the online platform. TRIAL REGISTRATION ClinicalTrials.gov NCT03093467; https://clinicaltrials.gov/ct2/show/NCT03093467.
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Affiliation(s)
- J Carola Pérez
- Facultad de Psicología, Universidad del Desarrollo, Santiago, Chile
| | - Olga Fernández
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | | | - Álvaro E Carrasco
- Instituto Milenio para la Investigación en Depresión y Personalidad, Santiago, Chile
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital, Heidelberg, Germany
| | - Stephanie Bauer
- Center for Psychotherapy Research, University Hospital, Heidelberg, Germany
| | | | - Sergio Gloger
- Psicomedica, Clincal & Research Group, Santiago, Chile.,Departamento de Psiquiatría y Salud Mental, Campus Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Mariane Krause
- Escuela de Psicología, Facultad de Ciencias Sociales, Pontificia Universidad Católica de Chile, Santiago, Chile
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Aucoin M, LaChance L, Naidoo U, Remy D, Shekdar T, Sayar N, Cardozo V, Rawana T, Chan I, Cooley K. Diet and Anxiety: A Scoping Review. Nutrients 2021; 13:nu13124418. [PMID: 34959972 PMCID: PMC8706568 DOI: 10.3390/nu13124418] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/23/2021] [Accepted: 12/04/2021] [Indexed: 12/22/2022] Open
Abstract
Anxiety disorders are the most common group of mental disorders. There is mounting evidence demonstrating the importance of nutrition in the development and progression of mental disorders such as depression; however, less is known about the role of nutrition in anxiety disorders. This scoping review sought to systematically map the existing literature on anxiety disorders and nutrition in order to identify associations between dietary factors and anxiety symptoms or disorder prevalence as well as identify gaps and opportunities for further research. The review followed established methodological approaches for scoping reviews. Due to the large volume of results, an online program (Abstrackr) with artificial intelligence features was used. Studies reporting an association between a dietary constituent and anxiety symptoms or disorders were counted and presented in figures. A total of 55,914 unique results were identified. After a full-text review, 1541 articles met criteria for inclusion. Analysis revealed an association between less anxiety and more fruits and vegetables, omega-3 fatty acids, “healthy” dietary patterns, caloric restriction, breakfast consumption, ketogenic diet, broad-spectrum micronutrient supplementation, zinc, magnesium and selenium, probiotics, and a range of phytochemicals. Analysis revealed an association between higher levels of anxiety and high-fat diet, inadequate tryptophan and dietary protein, high intake of sugar and refined carbohydrates, and “unhealthy” dietary patterns. Results are limited by a large percentage of animal and observational studies. Only 10% of intervention studies involved participants with anxiety disorders, limiting the applicability of the findings. High quality intervention studies involving participants with anxiety disorders are warranted.
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Affiliation(s)
- Monique Aucoin
- Canadian College of Naturopathic Medicine, Toronto, ON M2K 1E2, Canada
| | - Laura LaChance
- Department of Psychiatry, McGill University, Montreal, QC H3A 0G4, Canada
- St. Mary's Hospital Centre, Montreal, QC H3T 1M5, Canada
| | - Umadevi Naidoo
- Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Daniella Remy
- Canadian College of Naturopathic Medicine, Toronto, ON M2K 1E2, Canada
- Anthrophi Technologies, Toronto, ON M6H1W2, Canada
| | - Tanisha Shekdar
- Canadian College of Naturopathic Medicine, Toronto, ON M2K 1E2, Canada
| | - Negin Sayar
- Canadian College of Naturopathic Medicine, Toronto, ON M2K 1E2, Canada
| | - Valentina Cardozo
- Canadian College of Naturopathic Medicine, Toronto, ON M2K 1E2, Canada
| | - Tara Rawana
- Canadian College of Naturopathic Medicine, Toronto, ON M2K 1E2, Canada
| | - Irina Chan
- Canadian College of Naturopathic Medicine, Toronto, ON M2K 1E2, Canada
| | - Kieran Cooley
- Canadian College of Naturopathic Medicine, Toronto, ON M2K 1E2, Canada
- School of Public Health, Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Ultimo 2007, Australia
- Pacific College of Health Sciences, San Diego, CA 92108, USA
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore 2480, Australia
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Cronin TJ, Pepping CA, Halford WK, Lyons A. Minority Stress and Psychological Outcomes in Sexual Minorities: The Role of Barriers to Accessing Services. JOURNAL OF HOMOSEXUALITY 2021; 68:2417-2429. [PMID: 32815799 DOI: 10.1080/00918369.2020.1804264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Lesbian, gay, and bisexual (LGB) individuals are at higher risk for poor mental health than their heterosexual counterparts, and these disparities are largely accounted for by minority stressors. Less is known about the mechanisms underlying associations between minority stress and mental health. In a sample of 592 LGB adults (Mage = 29.39), we tested a model in which minority stress (internalized stigma, stigma consciousness, and lived discrimination) was associated with poor mental health when mediated by stigma-related barriers to accessing psychological services. Structural equation modeling revealed that minority stressors predicted more barriers to service use which, in turn, predicted poorer mental health outcomes. Internalized stigma was also directly associated with poor mental health. Results suggest that links between minority stress and poorer mental health in LGB individuals are at least partly explained by stigma-related barriers to accessing services. Future research is needed to investigate methods which may ameliorate these barriers.
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Affiliation(s)
- Timothy J Cronin
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | | | - W Kim Halford
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health, and Society, La Trobe University, Melbourne, Australia
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40
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Balaskas A, Schueller SM, Cox AL, Doherty G. The Functionality of Mobile Apps for Anxiety: Systematic Search and Analysis of Engagement and Tailoring Features. JMIR Mhealth Uhealth 2021; 9:e26712. [PMID: 34612833 PMCID: PMC8529472 DOI: 10.2196/26712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/02/2021] [Accepted: 07/15/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND A range of mobile apps for anxiety have been developed in response to the high prevalence of anxiety disorders. Although the number of publicly available apps for anxiety is increasing, attrition rates among mobile apps are high. These apps must be engaging and relevant to end users to be effective; thus, engagement features and the ability to tailor delivery to the needs of individual users are key. However, our understanding of the functionality of these apps concerning engagement and tailoring features is limited. OBJECTIVE The aim of this study is to review how cognitive behavioral elements are delivered by anxiety apps and their functionalities to support user engagement and tailoring based on user needs. METHODS A systematic search for anxiety apps described as being based on cognitive behavioral therapy (CBT) was conducted on Android and iPhone marketplaces. Apps were included if they mentioned the use of CBT for anxiety-related disorders. We identified 597 apps, of which 36 met the inclusion criteria and were reviewed through direct use. RESULTS Cognitive behavioral apps for anxiety incorporate a variety of functionalities, offer several engagement features, and integrate low-intensity CBT exercises. However, the provision of features to support engagement is highly uneven, and support is provided only for low-intensity CBT treatment. Cognitive behavioral elements combine various modalities to deliver intervention content and support the interactive delivery of these elements. Options for personalization are limited and restricted to goal selection upon beginning use or based on self-monitoring entries. Apps do not appear to provide individualized content to users based on their input. CONCLUSIONS Engagement and tailoring features can be significantly expanded in existing apps, which make limited use of social features and clinical support and do not use sophisticated features such as personalization based on sensor data. To guide the evolution of these interventions, further research is needed to explore the effectiveness of different types of engagement features and approaches to tailoring therapeutic content.
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Affiliation(s)
- Andreas Balaskas
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Stephen M Schueller
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States.,Department of Informatics, University of California, Irvine, Irvine, CA, United States
| | - Anna L Cox
- UCL Interaction Centre, University College London, London, United Kingdom
| | - Gavin Doherty
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
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Leffler JM, Zelic KJ, Kruser AF, Lange HJ. Youth and parent report of sleep-based interventions and utilization of technology resources in the treatment of pediatric mood disorders. Clin Child Psychol Psychiatry 2021; 26:924-937. [PMID: 33736503 DOI: 10.1177/13591045211000104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Mood disorders in youth are associated with social and academic impairment, and difficulties within the family system. Engagement in sleep hygiene, and family- and technology-based treatment models can address these impairments. The current study evaluates changes in functioning for youth who participated in a family-based partial hospitalization program (PHP) for mood disorders. Child and parent views of the importance and application of sleep hygiene and utilization of technology-based interventions were also evaluated. METHODS 474 youth diagnosed with a primary mood disorder and their caregivers participated in a family-based PHP that addressed the role of sleep hygiene, technology use for symptom management, and components of evidence-based treatments in ameliorating mood disorders. Participants were evaluated 1-, 3-, and 6-month following treatment. RESULTS Participants demonstrated improved functioning in social, home, and school domains. The majority of participants and parents found the sleep hygiene content and application important or very important as a component of treatment. Parents were significantly more likely than youth to be interested in using technology to access after care resources. CONCLUSIONS Findings revealed significantly less impairment in functioning at follow-up. Parents and youth reported interest in sleep hygiene strategies as part of a comprehensive treatment for mood disorders as well as the use of technology-based resources to assist with treatment. Limitations include sample demographics and follow-up sample size.
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Affiliation(s)
- Jarrod M Leffler
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Kate J Zelic
- Psychological Services, Children's Hospitals and Clinics of Minnesota, St. Paul, USA
| | - Amelia F Kruser
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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Martinengo L, Stona AC, Griva K, Dazzan P, Pariante CM, von Wangenheim F, Car J. Self-guided Cognitive Behavioral Therapy Apps for Depression: Systematic Assessment of Features, Functionality, and Congruence With Evidence. J Med Internet Res 2021; 23:e27619. [PMID: 34328431 PMCID: PMC8367167 DOI: 10.2196/27619] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/13/2021] [Accepted: 04/23/2021] [Indexed: 12/16/2022] Open
Abstract
Background Mental health disorders affect 1 in 10 people globally, of whom approximately 300 million are affected by depression. At least half of the people affected by depression remain untreated. Although cognitive behavioral therapy (CBT) is an effective treatment, access to mental health specialists, habitually challenging, has worsened because of the COVID-19 pandemic. Internet-based CBT is an effective and feasible strategy to increase access to treatment for people with depression. Mental health apps may further assist in facilitating self-management for people affected by depression; however, accessing the correct app may be cumbersome given the large number and wide variety of apps offered by public app marketplaces. Objective This study aims to systematically assess the features, functionality, data security, and congruence with evidence of self-guided CBT-based apps targeting users affected by depression that are available in major app stores. Methods We conducted a systematic assessment of self-guided CBT-based apps available in Google Play and the Apple App Store. Apps launched or updated since August 2018 were identified through a systematic search in the 42matters database using CBT-related terms. Apps meeting the inclusion criteria were downloaded and assessed using a Samsung Galaxy J7 Pro (Android 9) and iPhone 7 (iOS 13.3.1). Apps were appraised using a 182-question checklist developed by the research team, assessing their general characteristics, technical aspects and quality assurance, and CBT-related features, including 6 evidence-based CBT techniques (ie, psychoeducation, behavioral activation, cognitive restructuring, problem solving, relaxation, and exposure for comorbid anxiety) as informed by a CBT manual, CBT competence framework, and a literature review of internet-based CBT clinical trial protocols. The results were reported as a narrative review using descriptive statistics. Results The initial search yielded 3006 apps, of which 98 met the inclusion criteria and were systematically assessed. There were 20 well-being apps; 65 mental health apps, targeting two or more common mental health disorders, including depression; and 13 depression apps. A total of 28 apps offered at least four evidence-based CBT techniques, particularly depression apps. Cognitive restructuring was the most common technique, offered by 79% (77/98) of the apps. Only one-third of the apps offered suicide risk management resources, whereas 17% (17/98) of the apps offered COVID-19–related information. Although most apps included a privacy policy, only a third of the apps presented it before account creation. In total, 82% (74/90) of privacy policies stated sharing data with third-party service providers. Half of the app development teams included academic institutions or health care providers. Conclusions Only a few self-guided CBT-based apps offer comprehensive CBT programs or suicide risk management resources. Sharing of users’ data is widespread, highlighting shortcomings in health app market governance. To fulfill their potential, self-guided CBT-based apps should follow evidence-based clinical guidelines, be patient centered, and enhance users’ data security.
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Affiliation(s)
- Laura Martinengo
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Anne-Claire Stona
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Konstadina Griva
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,National Institute for Health Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Carmine Maria Pariante
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Florian von Wangenheim
- Professor of Technology Marketing, Department of Management, Technology & Economics, ETH Zurich, Zurich, Switzerland
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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43
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Woodford J, Farrand P, Hagström J, Hedenmalm L, von Essen L. Internet-Administered Cognitive Behavioral Therapy for Common Mental Health Difficulties in Parents of Children Treated for Cancer: Intervention Development and Description Study. JMIR Form Res 2021; 5:e22709. [PMID: 34142662 PMCID: PMC8367173 DOI: 10.2196/22709] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/08/2021] [Accepted: 06/17/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Following the end of a child's treatment for cancer, parents may report psychological distress. However, there is a lack of evidence-based interventions that are tailored to the population, and psychological support needs are commonly unmet. An internet-administered low-intensity cognitive behavioral therapy (LICBT)-based intervention (EJDeR [internetbaserad självhjälp för föräldrar till barn som avslutat en behandling mot cancer]) may provide a solution. OBJECTIVE The first objective is to provide an overview of a multimethod approach that was used to inform the development of the EJDeR intervention. The second objective is to provide a detailed description of the EJDeR intervention in accordance with the Template for Intervention Description and Replication (TIDieR) checklist. METHODS EJDeR was developed through a multimethod approach, which included the use of existing evidence, the conceptualization of distress, participatory action research, a cross-sectional survey, and professional and public involvement. Depending on the main presenting difficulty identified during assessment, LICBT behavioral activation or worry management treatment protocols are adopted for the treatment of depression or generalized anxiety disorder when experienced individually or when comorbid. EJDeR is delivered via the Uppsala University Psychosocial Care Programme (U-CARE) portal, a web-based platform that is designed to deliver internet-administered LICBT interventions and includes secure videoconferencing. To guide parents in the use of EJDeR, weekly written messages via the portal are provided by e-therapists comprising final year psychology program students with training in cognitive behavioral therapy. RESULTS An overview of the development process and a description of EJDeR, which was informed by the TIDieR checklist, are presented. Adaptations that were made in response to public involvement are highlighted. CONCLUSIONS EJDeR represents a novel, guided, internet-administered LICBT intervention for supporting parents of children treated for cancer. Adopting the TIDieR checklist offers the potential to enhance fidelity to the intervention protocol and facilitate later implementation. The intervention is currently being tested in a feasibility study (the ENGAGE study). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2018-023708.
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Affiliation(s)
- Joanne Woodford
- Uppsala University, Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala, Sweden
| | - Paul Farrand
- Clinical Education, Development, and Research (CEDAR), Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Josefin Hagström
- Uppsala University, Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala, Sweden
| | - Li Hedenmalm
- Uppsala University, Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala, Sweden
| | - Louise von Essen
- Uppsala University, Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala, Sweden
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44
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Alharbi H, Farrand P, Laidlaw K. Understanding the beliefs and attitudes towards mental health problems held by Muslim communities and acceptability of cognitive behavioural therapy as a treatment: systematic review and thematic synthesis protocol. BMJ Open 2021; 11:e044865. [PMID: 34145011 PMCID: PMC8215244 DOI: 10.1136/bmjopen-2020-044865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Many barriers prevent Muslims' accessing mental health services, the aim of this systematic review is to gain an understanding regarding these barriers and consider how they vary across different Muslim communities resident in different countries. METHODS AND ANALYSIS Systematic review of PubMed/MEDLINE, CINAHL, PsycINFO, Ovid MEDLINE, Embase and Index Islamicus databases for studies published in English in addition to the Saudi Digital Library for studies published in Arabic. The review will include quantitative, qualitative and mixed methods studies published in peer-review journals since 1980. Methodological quality and risk of bias of included papers will be critically appraised independently according to the Mixed Methods Appraisal Tool. Thematic synthesis will be used to extract outcome and analyse data from studies included in the review. ETHICS AND DISSEMINATION There are considered to be no ethical issues. Findings will be disseminated in both English and Arabic to clinicians and researchers via journal publication and conference presentation(s). TRIAL REGISTRATION NUMBER CRD42020192854.
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Affiliation(s)
- Hind Alharbi
- Clinical Education Development and Research (CEDAR) Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Paul Farrand
- Clinical Education Development and Research (CEDAR) Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Ken Laidlaw
- Clinical Education Development and Research (CEDAR) Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
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45
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Bantjes J, Kazdin AE, Cuijpers P, Breet E, Dunn-Coetzee M, Davids C, Stein DJ, Kessler RC. A Web-Based Group Cognitive Behavioral Therapy Intervention for Symptoms of Anxiety and Depression Among University Students: Open-Label, Pragmatic Trial. JMIR Ment Health 2021; 8:e27400. [PMID: 34042598 PMCID: PMC8193479 DOI: 10.2196/27400] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/02/2021] [Accepted: 03/15/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Anxiety and depression are common among university students, and university counseling centers are under pressure to develop effective, novel, and sustainable interventions that engage and retain students. Group interventions delivered via the internet could be a novel and effective way to promote student mental health. OBJECTIVE We conducted a pragmatic open trial to investigate the uptake, retention, treatment response, and level of satisfaction with a remote group cognitive behavioral therapy intervention designed to reduce symptoms of anxiety and depression delivered on the web to university students during the COVID-19 pandemic. METHODS Preintervention and postintervention self-reported data on anxiety and depression were collected using the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9. Satisfaction was assessed postintervention using the Client Satisfaction with Treatment Questionnaire. RESULTS A total of 175 students were enrolled, 158 (90.3%) of whom initiated treatment. Among those initiating treatment, 86.1% (135/158) identified as female, and the mean age was 22.4 (SD 4.9) years. The mean number of sessions attended was 6.4 (SD 2.8) out of 10. Among participants with clinically significant symptoms at baseline, mean symptom scores decreased significantly for anxiety (t56=11.6; P<.001), depression (t61=7.8; P<.001), and composite anxiety and depression (t60=10.7; P<.001), with large effect sizes (d=1-1.5). Remission rates among participants with clinically significant baseline symptoms were 67.7%-78.9% and were not associated with baseline symptom severity. High overall levels of satisfaction with treatment were reported. CONCLUSIONS The results of this study serve as a proof of concept for the use of web-based group cognitive behavioral therapy to promote the mental health of university students.
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Affiliation(s)
- Jason Bantjes
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Alan E Kazdin
- Department of Psychology, Yale University, New Haven, CT, United States
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, Netherlands
| | - Elsie Breet
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Munita Dunn-Coetzee
- Centre for Student Counselling and Development, Student Affairs, Stellenbosch University, Stellenbosch, South Africa
| | - Charl Davids
- Centre for Student Counselling and Development, Student Affairs, Stellenbosch University, Stellenbosch, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, South African Medical Research Council Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
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46
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Strodl E, Yang J. Motivational Interviewing Enhances Group Cognitive Behavioral Therapy for Anxiety Disorders. J Cogn Psychother 2021; 35:JCPSY-D-20-00025. [PMID: 33833090 DOI: 10.1891/jcpsy-d-20-00025] [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: 11/25/2022]
Abstract
This pilot study tested whether the addition of motivational interviewing (MI) prior to group cognitive behavioral therapy (CBT) for anxiety may improve the effectiveness of the treatment. Prior to group CBT, 40 individuals with a principal diagnosis of an anxiety disorder (40% panic disorder, 25% generalized anxiety disorder, 22.5% social phobia, and 12.5% others) were randomly assigned to receive either three individual sessions of MI or were assigned to a control group that did not receive MI. The pretreatment MI group, compared to the control group, experienced significantly greater reduction in anxiety symptoms post-CBT. These results suggest that brief MI pretreatment enhances the efficacy of CBT on anxiety. A combination of MI and CBT may be particularly promising for the treatment of anxiety, with MI directed at increasing motivation and commitment to change, and CBT directed at helping the client achieve the desired changes.
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Affiliation(s)
- Esben Strodl
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Joel Yang
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
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47
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Agin-Liebes G, Haas TF, Lancelotta R, Uthaug MV, Ramaekers JG, Davis AK. Naturalistic Use of Mescaline Is Associated with Self-Reported Psychiatric Improvements and Enduring Positive Life Changes. ACS Pharmacol Transl Sci 2021; 4:543-552. [PMID: 33860184 PMCID: PMC8033766 DOI: 10.1021/acsptsci.1c00018] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Indexed: 12/20/2022]
Abstract
Mescaline is a naturally occurring psychoactive alkaloid that has been used as a sacrament by Indigenous populations in spiritual ritual and healing ceremonies for millennia. Despite promising early preliminary research and favorable anecdotal reports, there is limited research investigating mescaline's psychotherapeutic potential. We administered an anonymous online questionnaire to adults (N = 452) reporting use of mescaline in naturalistic settings about mental health benefits attributed to mescaline. We assessed respondents' self-reported improvements in depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol and drug use disorders (AUD and DUD). Of the respondents reporting histories of these clinical conditions, most (68-86%) reported subjective improvement following their most memorable mescaline experience. Respondents who reported an improvement in their psychiatric conditions reported significantly higher ratings of acute psychological factors including mystical-type, psychological insight, and ego dissolution effects compared to those who did not report improvements (Cohen's d range 0.7 - 1.5). Many respondents (35-50%) rated the mescaline experience as the single or top five most spiritually significant or meaningful experience(s) of their lives. Acute experiences of psychological insight during their mescaline experience were associated with increased odds of reporting improvement in depression, anxiety, AUD and DUD. Additional research is needed to corroborate these preliminary findings and to rigorously examine the efficacy of mescaline for psychiatric treatment in controlled, longitudinal clinical trials.
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Affiliation(s)
- Gabrielle Agin-Liebes
- Department
of Psychiatry, University of California,
San Francisco, 1001 Potrero
Ave., San Francisco, California 94110, United States,Zuckerberg
San Francisco General Hospital, 1001 Potrero Ave., Bldg. 80, San Francisco, California 94110, United States,Tel.: 646-641-2000.
| | - Trevor F. Haas
- University
of California, Davis, School of Medicine, 4610 X Street, Sacramento, California 95817, United States,Department
of Psychiatry and Behavioral Sciences, University
of Southern California, 3620 McClintock Ave., Los Angeles, California 90089-0001, United States
| | - Rafael Lancelotta
- Habituating
to Wholeness, LLC, 6500 W 13th Ave, Lakewood, Colorado 80214, United States
| | - Malin V. Uthaug
- Department
of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, 6229, Maastricht, Limburg 6200
MD, The Netherlands
| | - Johannes G. Ramaekers
- Department
of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, 6229, Maastricht, Limburg 6200
MD, The Netherlands
| | - Alan K. Davis
- College
of Social Work, The Ohio State University, 1947 College Road, Columbus, Ohio 43210, United States,Center
for Psychedelic and Consciousness Research, Johns Hopkins University, 5510 Nathan Shock Drive, Baltimore, Maryland 21224, United
States,Tel.: 614-292-5251.
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48
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Cronin TJ, Pepping CA, Halford WK, Lyons A. Mental health help-seeking and barriers to service access among lesbian, gay, and bisexual Australians. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1080/00050067.2021.1890981] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Timothy J. Cronin
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | | | - W. Kim Halford
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health, and Society, La Trobe University, Melbourne, Australia
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49
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Kaltenbach E, Chisholm M, Xiong T, Thomson D, Crombach A, McGrath PJ. Online narrative exposure therapy for parents of children with neurodevelopmental disabilities suffering from posttraumatic stress symptoms - study protocol of a randomized controlled trial. Eur J Psychotraumatol 2021; 12:1991650. [PMID: 34868484 PMCID: PMC8635605 DOI: 10.1080/20008198.2021.1991650] [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] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Parents of children with intellectual and neurodevelopmental disorders (IDD) often experience traumatic events in the care of their children. This leads to comparatively high numbers of mental health problems such as posttraumatic stress disorder (PTSD) in those parents. Intervention approaches for parents of children with IDD are scarce and many parents remain without support. OBJECTIVE This study aims to test the feasibility and efficacy of online Narrative Exposure Therapy (eNET) with parents of children with IDD. METHODS The study follows a randomized waitlist-control design. eNET is an exposure-based PTSD intervention and includes 8-12 90-minute sessions. All sessions will be conducted via video calls with trained paraprofessionals. We aim to include 50 parents, approximately 25 in the immediate intervention group and 25 in the waitlist group. Waitlist participants will receive the same intervention after a three-month wait period. All participants need to either fulfill full or subclinical PTSD symptoms according to DSM-5. Feasibility and efficacy of the intervention will be measured with pre, post, and 2 and 6 months follow-up surveys focusing on PTSD symptoms. Secondary outcomes include other health-related outcomes such as physical symptoms, depression symptoms, anxiety symptoms and functionality. CONCLUSIONS The proposed study allows us to test the feasibility and efficacy of eNET in a sample of parents of children with IDD. There are so far no published studies on the evidence of eNET; this study is one of the first randomized controlled trials investigating the feasibility and efficacy of eNET and therefore will have implications on further research and practice.Clinical trial registration: NCT04385927Date and version identifier: 22 July 2021.
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Affiliation(s)
- Elisa Kaltenbach
- Centre for Research in Family Health, IWK Health Centre, Halifax, Canada
| | - Michelle Chisholm
- Centre for Research in Family Health, IWK Health Centre, Halifax, Canada
| | - Ting Xiong
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | | | - Anselm Crombach
- Department of Clinical Psychology in Childhood and Adolescence, University of Konstanz, Konstanz, Germany.,Department of Psychology, Clinical Psychology and Psychotherapy for Children and Adolescents at the University of Saarland, Saarbrücken, Germany
| | - Patrick J McGrath
- Centre for Research in Family Health, IWK Health Centre, Halifax, Canada.,Department of Psychiatry, Dalhousie University, Halifax, Canada
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50
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Brinkmann B, Payne CF, Kohler I, Harling G, Davies J, Witham M, Siedner MJ, Sie A, Bountogo M, Ouermi L, Coulibaly B, Bärnighausen T. Depressive symptoms and cardiovascular disease: a population-based study of older adults in rural Burkina Faso. BMJ Open 2020; 10:e038199. [PMID: 33371016 PMCID: PMC7757460 DOI: 10.1136/bmjopen-2020-038199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 08/03/2020] [Accepted: 08/19/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To contribute to the current understanding of depressive disorders in sub-Saharan African (SSA) countries by examining the association of depressive symptoms with cardiovascular and cardiometabolic conditions in a population-based study of middle-aged and older adults in rural Burkina Faso. SETTING This study was conducted in the Nouna Health and Demographic Surveillance System in north-western Burkina Faso, in a mixed rural and small-town environment. The data were obtained between May and July 2018. PARTICIPANTS Consenting adults over 40 years of age (n=3026). PRIMARY AND SECONDARY OUTCOME MEASURES Depressive symptoms were assessed using the Patient Health Questionnaire depression module (PHQ-9). Chronic cardiometabolic conditions were assessed via a lipid panel and glycated haemoglobin measures from serum, alongside anthropometry and blood pressure measurements and a self-reported questionnaire. Multivariable linear regression was used to test the relationship between depressive symptoms and cardiovascular/cardiometabolic conditions after controlling for sociodemographic factors. RESULTS Depressive symptoms were not associated with the metabolic syndrome (standardised beta coefficient=0.00 (95% CI -0.04 to 0.03)), hypertension (beta=0.01 (95% CI -0.02 to 0.05)), diabetes mellitus (beta=0.00 (95% CI -0.04 to 0.04)) and past diagnosis of elevated blood pressure or blood sugar. Prior stroke diagnosis (beta=0.04 (95% CI 0.01 to 0.07)) or heart disease (beta=0.08 (95% CI 0.05 to 0.11)) was positively associated with the standardised PHQ-9 score as were self-reported stroke symptoms. CONCLUSION Objectively measured cardiometabolic conditions had no significant association with depressive symptoms in an older, poor, rural SSA population, in contrast to observations in high income countries. However, consequences of cardiovascular disease such as stroke and heart attack were associated with depressive symptoms in older adults in Burkina Faso.
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Affiliation(s)
- Ben Brinkmann
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Collin F Payne
- School of Demography, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Iliana Kohler
- Population Studies Center (PSC) and Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Guy Harling
- Institute for Global Health, University College London, London, UK
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USA
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Miles Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Mark J Siedner
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Sie
- Centre de Recherche en Sante de Nouna, Nouna, Boucle du Mouhoun, Burkina Faso
| | - Mamadou Bountogo
- Centre de Recherche en Sante de Nouna, Nouna, Boucle du Mouhoun, Burkina Faso
| | - Lucienne Ouermi
- Centre de Recherche en Sante de Nouna, Nouna, Boucle du Mouhoun, Burkina Faso
| | - Boubacar Coulibaly
- Centre de Recherche en Sante de Nouna, Nouna, Boucle du Mouhoun, Burkina Faso
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Africa Health Research Institute, KwaZulu-Natal, South Africa
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