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Willems L, Rasing SPA, Heijs DAM, Vermulst AA, Huvenaars MJ, Onrust SA, Creemers DHM. Mental health app boost my mood (BMM) as preventive early intervention for adolescents with (sub)clinical depressive symptoms. BMC Public Health 2024; 24:2118. [PMID: 39103796 DOI: 10.1186/s12889-024-19666-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 07/31/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Depression is a common mental disorder. Detecting (sub)clinical depressive symptoms in adolescents at an early stage and offering a low-threshold early intervention can minimize the risk of serious and/or long-term depression. As such, a digital intervention can be a low-threshold preventive and early intervention. This study aims to examine whether the Boost My Mood (BMM)-app is a suitable preventive early intervention for adolescents with (sub)clinical depressive symptoms. METHODS This naturalistic single-arm evaluation study (N = 50) was conducted in adolescents aged 16-21 with (sub)clinical depressive symptoms. Furthermore, the BMM-app was studied in relation to anxiety, worrying, stress, and sleeping problems. An exploratory objective was to determine whether positive expectations and social support are related to app use. RESULTS The study showed a significant decrease in not only depressive symptoms, but also anxiety, worrying and stress while using the BMM-app. Sleeping problems did not significantly decrease over time while using the BMM-app. The degree of use of the BMM-app and telling significant others about using the BMM-app were both not related to a decrease in depressive symptoms. The BMM-app was used significantly more when the adolescent had told relatives about their depressive symptoms. CONCLUSIONS A digital intervention, such as the BMM-app, can be a low-threshold preventive and early intervention for adolescents with (sub)clinical depressive symptoms. Beneficial effects of the BMM-app were reported on depressive symptoms as well as other aspects of quality of life, such as anxiety, worrying, and stress. Whereas several factors may have played a role in the current findings on depressive symptoms, there are reasons to assume that part of the reduction in symptoms could be attributed to the BMM-app. Although no causality can be assumed, this study is a first step in the implementation of preventive apps in mental health care.
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Affiliation(s)
- Linda Willems
- GGZ Oost Brabant, P.O. Box 3, Boekel, 5427 ZG, The Netherlands.
| | - Sanne P A Rasing
- GGZ Oost Brabant, P.O. Box 3, Boekel, 5427 ZG, The Netherlands
- Behavioural Science Institute, Radboud University, P.O. Box 9104, Nijmegen, 6500 HE, The Netherlands
| | - Dewi A M Heijs
- GGZ Oost Brabant, P.O. Box 3, Boekel, 5427 ZG, The Netherlands
| | - Ad A Vermulst
- GGZ Oost Brabant, P.O. Box 3, Boekel, 5427 ZG, The Netherlands
| | | | - Simone A Onrust
- Trimbos-Instituut, P.O. Box 725, Utrecht, 3500 AS, The Netherlands
| | - Daan H M Creemers
- GGZ Oost Brabant, P.O. Box 3, Boekel, 5427 ZG, The Netherlands
- Behavioural Science Institute, Radboud University, P.O. Box 9104, Nijmegen, 6500 HE, The Netherlands
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Gordon AM, Magruder ML, Schwartz J, Ng MK, Erez O, Mont MA. Preoperative Depression Screening for Primary Total Knee Arthroplasty: An Evaluation of Its Modifiability on Outcomes in Patients Who Have Depression. J Arthroplasty 2024; 39:2040-2046. [PMID: 38382629 DOI: 10.1016/j.arth.2024.02.035] [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: 06/12/2023] [Revised: 01/24/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Few studies have evaluated preoperative depression screenings in patients who have depression. We studied whether depression screenings before total knee arthroplasty (TKA) were associated with lower: 1) medical complications; 2) emergency department (ED) utilizations and readmissions; 3) implant complications; and 4) costs. METHODS A nationwide sample from January 1, 2010, to April 30, 2021, was collected using an insurance database. Depression patients were 1:1 propensity-score matched based on those who had (n = 29,009) and did not have (n = 29,009) preoperative depression screenings or psychotherapy visits within 3 months of TKA. A case-matched population who did not have depression was compared (n = 144,994). A 90-day period was used to compare complications and health-care utilization and 2-year follow-up for periprosthetic joint infections (PJIs) and implant survivorship. Costs were 90-day reimbursements. Logistic regression models computed odds ratios (ORs) of depression screening on dependent variables. P values less than .001 were significant. RESULTS Patients who did not receive preoperative screening were associated with higher medical complications (18.7 versus 5.2%, OR: 4.15, P < .0001) and ED utilizations (11.5 versus 3.2%, OR: 3.93, P < .0001) than depressed patients who received screening. Patients who had screening had lower medical complications (5.2 versus 5.9%, OR: 0.88, P < .0001) and ED utilizations compared to patients who did not have depression (3.2 versus 3.8%, OR: 0.87, P = .0001). Two-year PJI incidences (3.0 versus 1.3%, OR: 2.63, P < .0001) and TKA revisions (4.3 versus 2.1%, OR: 2.46, P < .0001) were greater in depression patients who were not screened preoperatively versus screened patients. Depression patients who had screening had lower PJIs (1.3 versus 1.8%, OR: 0.74, P < .0001) compared to nondepressed patients. Reimbursements ($13,949 versus $11,982; P < .0001) were higher in depression patients who did not have screening. CONCLUSIONS Preoperative screening was associated with improved outcomes in depression patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Adam M Gordon
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, New York; Questrom School of Business, Boston University, Boston, Massachusetts
| | - Matthew L Magruder
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, New York
| | - Jake Schwartz
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, New York
| | - Mitchell K Ng
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, New York
| | - Orry Erez
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, New York
| | - Michael A Mont
- Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
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Ermita KC, Rosenthal DM. Exploring Mental Health Services for Youth Experiencing Homelessness in East Asian Pacific Regions: A Systematic Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:864. [PMID: 39062313 PMCID: PMC11275148 DOI: 10.3390/children11070864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/30/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Youth experiencing homelessness (YEH) in East Asian Pacific (EAP) regions represent one of the most at-risk populations due to cultural and geographical factors. Effective mental health interventions, primarily researched in Western contexts, may not fully apply to YEH in EAP. Their lack of stable shelter, disrupted social networks, and limited access to mental health services elevate their susceptibility to adverse mental health, making urgent interventions essential to address their needs. OBJECTIVE The objective of this study is to explore and systematically search the types of mental health services and interventions available for YEH in EAP and their impact on overall quality of life and wellbeing. METHODS Electronic databases (e.g., Medline, PsycINFO, PubMed, Scopus) were systematically searched (publication dates between 1 January 1990 and 13 May 2023), as well as additional online resources specific to homelessness. Articles were screened, and a critical appraisal assessed the quality of the included studies. RESULTS Eight studies with different interventions were identified in Indonesia (n = 2), Malaysia (n = 1), South Korea (n = 3), and the Philippines (n = 1). These were thematically clustered into six categories: art, cognitive behavioural therapy, life skills education, resilience enhancement, family strengthening, and government interventions/services. CONCLUSIONS This review highlights effective mental health interventions' positive impact on YEH mental health outcomes and quality of life in EAP, stressing the urgent need to implement socio-culturally sensitive services. Future research should address knowledge gaps through comprehensive studies covering diverse EAP regions and populations, prioritising socio-culturally specific psychological measures.
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Affiliation(s)
- Kimberley Cortez Ermita
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK;
| | - Diana Margot Rosenthal
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK;
- UCL Collaborative Centre for Inclusion Health, University College London, London WC1E 7HB, UK
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY 10003, USA
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Miller K, McKean A, Hand J, Rackley S, Leung JG, LeMahieu A, Geske J, Bostwick JM. The occurrence of mental health symptoms in isotretinoin-treated adolescents. Pediatr Dermatol 2024; 41:635-640. [PMID: 38500340 PMCID: PMC11262976 DOI: 10.1111/pde.15595] [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: 11/03/2023] [Accepted: 02/24/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Isotretinoin treatment for acne can reduce adverse psychiatric outcomes in adults, but there has been little investigation of the incidence of psychiatric outcomes in treated adolescents. METHODS This retrospective cohort study using the Rochester Epidemiology Project identified 606 patients aged 12-18 prescribed isotretinoin over a 10-year period between January 1, 2008 and December 31, 2017. Medical records were reviewed to identify psychiatric diagnoses before and during isotretinoin therapy, as well as psychiatric symptoms not captured by formal diagnoses and changes to isotretinoin dosing because of psychiatric diagnoses or symptoms. RESULTS One hundred seventy-seven (29.2%) had a psychiatric diagnosis prior to isotretinoin initiation, but 98 (16.2%) had a new psychiatric diagnosis or psychiatric symptom while taking isotretinoin. Patients with a psychiatric history were no more likely than those without to receive a new psychiatric diagnosis during treatment (4.5% vs. 3.7%; p = .650), but did experience more psychiatric symptoms, primarily low mood and mood swings (23.7% vs. 7.7%; p < .001). Only 25.5% of the 98 with a new psychiatric diagnosis or psychiatric symptom had a subsequent dose change. A dose change was more likely if patients received a new psychiatric diagnosis (41.7% vs. 20.3%; p = .037) or patients did not have a psychosocial explanation for psychiatric symptoms (34.4% vs. 10.8%; p = .009). CONCLUSIONS A substantial proportion of adolescent patients prescribed isotretinoin had a prior psychiatric diagnosis. This predicts more psychiatric symptoms during isotretinoin treatment. Adolescents with a psychiatric history who have worsening symptoms and those with new-onset psychiatric symptoms would benefit from close monitoring while taking isotretinoin.
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Affiliation(s)
- Keith Miller
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN USA
| | - Alastair McKean
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN USA
| | - Jennifer Hand
- Department of Pediatrics, Jacobs School of Medicine & Biomedical Sciences, Buffalo, NY USA
| | - Sandra Rackley
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN USA
| | - Jonathan G. Leung
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN USA
- Department of Pharmacy, Mayo Clinic, Rochester, MN USA
| | - Allison LeMahieu
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
| | - Jennifer Geske
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
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Chang G, Lin X, Qin M, Wang L, Cai S. Symptom cluster study undergoing chemotherapy in breast cancer patients: Latent class analysis and contemporaneous network analysis. Asia Pac J Oncol Nurs 2024; 11:100499. [PMID: 38975611 PMCID: PMC11225815 DOI: 10.1016/j.apjon.2024.100499] [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: 02/21/2024] [Accepted: 04/27/2024] [Indexed: 07/09/2024] Open
Abstract
Objective This study aims to explore the subgroups and networks of symptom clusters in breast cancer patients undergoing chemotherapy, and to provide effective interventions for the core symptoms. Methods A cross-sectional survey was conducted at four comprehensive hospitals in Foshan City, China, from August to November 2023. A total of 292 participants completed the social determinants of health questionnaire, the numerical rating scale (NRS), the Pittsburgh sleep quality index (PSQI), the Chinese version of the cancer fatigue scale (CFS), and the hospital anxiety and depression Scale (HADS). Latent class analysis (LCA) was utilized to distinguish subgroups, and network analysis was utilized to identify core symptoms among different subgroups. Results Breast cancer patients undergoing chemotherapy exhibit symptoms were divided into two subgroups: the high burden group of symptoms (72.3%, Class 1) and the low burden group of symptoms (27.7%, Class 2). Education attainment, work status, family monthly income per capita, and daily sleep duration (hours) were associated with subgroup membership. "Panic feelings" (# HADS-A11) were the core symptom in both the full sample and Class 2, while "tension or pain" (# HADS-A1) was the core symptom in Class 1. Conclusions The core symptoms of fear, enjoyment, nervousness, and pain varied across subgroups of patients and could inform the current strategies for symptom management in breast cancer chemotherapy patients.
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Affiliation(s)
| | | | - Meijiao Qin
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Lixia Wang
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Shu Cai
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
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Metaxa AM, Clarke M. Efficacy of psilocybin for treating symptoms of depression: systematic review and meta-analysis. BMJ 2024; 385:e078084. [PMID: 38692686 PMCID: PMC11062320 DOI: 10.1136/bmj-2023-078084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE To determine the efficacy of psilocybin as an antidepressant compared with placebo or non-psychoactive drugs. DESIGN Systematic review and meta-analysis. DATA SOURCES Five electronic databases of published literature (Cochrane Central Register of Controlled Trials, Medline, Embase, Science Citation Index and Conference Proceedings Citation Index, and PsycInfo) and four databases of unpublished and international literature (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, ProQuest Dissertations and Theses Global, and PsycEXTRA), and handsearching of reference lists, conference proceedings, and abstracts. DATA SYNTHESIS AND STUDY QUALITY Information on potential treatment effect moderators was extracted, including depression type (primary or secondary), previous use of psychedelics, psilocybin dosage, type of outcome measure (clinician rated or self-reported), and personal characteristics (eg, age, sex). Data were synthesised using a random effects meta-analysis model, and observed heterogeneity and the effect of covariates were investigated with subgroup analyses and metaregression. Hedges' g was used as a measure of treatment effect size, to account for small sample effects and substantial differences between the included studies' sample sizes. Study quality was appraised using Cochrane's Risk of Bias 2 tool, and the quality of the aggregated evidence was evaluated using GRADE guidelines. ELIGIBILITY CRITERIA Randomised trials in which psilocybin was administered as a standalone treatment for adults with clinically significant symptoms of depression and change in symptoms was measured using a validated clinician rated or self-report scale. Studies with directive psychotherapy were included if the psychotherapeutic component was present in both experimental and control conditions. Participants with depression regardless of comorbidities (eg, cancer) were eligible. RESULTS Meta-analysis on 436 participants (228 female participants), average age 36-60 years, from seven of the nine included studies showed a significant benefit of psilocybin (Hedges' g=1.64, 95% confidence interval (CI) 0.55 to 2.73, P<0.001) on change in depression scores compared with comparator treatment. Subgroup analyses and metaregressions indicated that having secondary depression (Hedges' g=3.25, 95% CI 0.97 to 5.53), being assessed with self-report depression scales such as the Beck depression inventory (3.25, 0.97 to 5.53), and older age and previous use of psychedelics (metaregression coefficient 0.16, 95% CI 0.08 to 0.24 and 4.2, 1.5 to 6.9, respectively) were correlated with greater improvements in symptoms. All studies had a low risk of bias, but the change from baseline metric was associated with high heterogeneity and a statistically significant risk of small study bias, resulting in a low certainty of evidence rating. CONCLUSION Treatment effects of psilocybin were significantly larger among patients with secondary depression, when self-report scales were used to measure symptoms of depression, and when participants had previously used psychedelics. Further research is thus required to delineate the influence of expectancy effects, moderating factors, and treatment delivery on the efficacy of psilocybin as an antidepressant. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023388065.
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Affiliation(s)
- Athina-Marina Metaxa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Mike Clarke
- Northern Ireland Methodology Hub, Centre for Public Health, ICS-A Royal Hospitals, Belfast, Ireland, UK
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Stecher C, Cloonan S, Domino ME. The Economics of Treatment for Depression. Annu Rev Public Health 2024; 45:527-551. [PMID: 38100648 DOI: 10.1146/annurev-publhealth-061022-040533] [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] [Indexed: 12/17/2023]
Abstract
The global prevalence of depression has risen over the past three decades across all socioeconomic groups and geographic regions, with a particularly rapid increase in prevalence among adolescents (aged 12-17 years) in the United States. Depression imposes large health, economic, and societal costs, including reduced life span and quality of life, medical costs, and reduced educational attainment and workplace productivity. A wide range of treatment modalities for depression are available, but socioeconomic disparities in treatment access are driven by treatment costs, lack of culturally tailored options, stigma, and provider shortages, among other barriers. This review highlights the need for comparative research to better understand treatments' relative efficacy, cost-effectiveness, scalability, and potential heterogeneity in efficacy across socioeconomic groups and country and cultural contexts. To address the growing burden of depression, mental health policy could consider reducing restrictions on the supply of providers, implementing digital interventions, reducing stigma, and promoting healthy lifestyles.
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Affiliation(s)
- Chad Stecher
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA;
- The Center for Health Information and Research, Arizona State University, Phoenix, Arizona, USA
| | - Sara Cloonan
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Marisa Elena Domino
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA;
- The Center for Health Information and Research, Arizona State University, Phoenix, Arizona, USA
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Wilhelm M, Bauer S, Feldhege J, Wolf M, Moessner M. Alleviating the burden of depression: a simulation study on the impact of mental health services. Epidemiol Psychiatr Sci 2024; 33:e19. [PMID: 38563188 PMCID: PMC11022261 DOI: 10.1017/s204579602400012x] [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: 08/18/2023] [Revised: 12/21/2023] [Accepted: 02/02/2024] [Indexed: 04/04/2024] Open
Abstract
AIMS Depressive disorders are ranked as the single leading cause of disability worldwide. Despite immense efforts, there is no evidence of a global reduction in the disease burden in recent decades. The aim of the study was to determine the public health impact of the current service system (status quo), to quantify its effects on the depression-related disease burden and to identify the most promising strategies for improving healthcare for depression on the population level. METHODS A Markov model was developed to quantify the impact of current services for depression (including prevention, treatment and aftercare interventions) on the total disease burden and to investigate the potential of alternative scenarios (e.g., improved reach or improved treatment effectiveness). Parameter settings were derived from epidemiological information and treatment data from the literature. Based on the model parameters, 10,000,000 individual lives were simulated for each of the models, based on monthly transition rates between dichotomous health states (healthy vs. diseased). Outcome (depression-related disease burden) was operationalized as the proportion of months spent in depression. RESULTS The current healthcare system alleviates about 9.5% (95% confidence interval [CI]: 9.2%-9.7%) of the total disease burden related to depression. Chronic cases cause the majority (83.2%) of depression-related burden. From a public health perspective, improving the reach of services holds the largest potential: Maximum dissemination of prevention (26.9%; CI: 26.7%-27.1%) and treatment (26.5%; CI: 26.3%-26.7%) would result in significant improvements on the population level. CONCLUSIONS The results confirm an urgent need for action in healthcare for depression. Extending the reach of services is not only more promising but also probably more achievable than increasing their effectiveness. Currently, the system fails to address the prevention and treatment of chronic cases. The large proportion of the disease burden associated with chronic courses highlights the need for improved treatment policies and clinical strategies for this group (e.g., disease management and adaptive or personalized interventions). The model complements the existing literature by providing a new perspective on the depression-related disease burden and the complex interactions between healthcare services and the lifetime course.
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Affiliation(s)
- M. Wilhelm
- Center for Psychotherapy Research, Heidelberg University Hospital, Heidelberg, Germany
- Institute of Psychology, Heidelberg University, Heidelberg, Germany
- German Center for Mental Health (DZPG), Partner site Mannheim/Heidelberg/Ulm, Germany
| | - S. Bauer
- Center for Psychotherapy Research, Heidelberg University Hospital, Heidelberg, Germany
- German Center for Mental Health (DZPG), Partner site Mannheim/Heidelberg/Ulm, Germany
| | - J. Feldhege
- Asklepios Science & Research, Research Institute, Hamburg, Germany
| | - M. Wolf
- Department of Psychology, University of Zurich, Zürich, Switzerland
| | - M. Moessner
- Center for Psychotherapy Research, Heidelberg University Hospital, Heidelberg, Germany
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Vander Zwalmen Y, Liebaert E, Hoorelbeke K, de Mévergnies CN, Baeken C, Verhaeghe N, Koster EHW. Treatment Response Following Adaptive PASAT Training for Depression Vulnerability: a Systematic Review and Meta-Analysis. Neuropsychol Rev 2024; 34:232-249. [PMID: 36853526 DOI: 10.1007/s11065-023-09581-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 12/27/2022] [Indexed: 03/01/2023]
Abstract
In recent years, cognitive control training (CCT) has gained momentum as an intervention to remediate cognitive impairments and decrease depressive symptoms. One promising operationalization to train cognitive control is the adaptive Paced Auditory Serial Addition Task (aPASAT). In this systematic review and meta-analysis of aPASAT training, the efficacy of the intervention and potential moderators were examined. The PsycINFO, MEDLINE, Embase, Web of Science and Cochrane Library electronic databases were searched for studies examining aPASAT training for depressive symptomatology or rumination. Nineteen studies (n = 1255) were included, comprising of depressed patients, remitted depressed patients, at-risk, and healthy participants. We found small significant effects directly after training for both depressive symptomatology and rumination, with similar effect sizes at follow-up. Subgroup analyses suggest a significantly higher mean effect of aPASAT training in non-healthy populations for rumination immediately following training, but not for depressive symptomatology. The amount of training sessions did not moderate effects of CCT. aPASAT has a small but significant effect on depressive symptoms, with direct effects immediately after training, as well as sustained long-term effects. It is currently unclear how many sessions are required for sustained effects due to heterogeneity in training dosage and absence of sufficient trials. Our results suggest that aPASAT training may be most effective for at-risk, remitted- and clinically depressed populations. The effect sizes resulting from this meta-analysis could be used to adequately power future research, which could investigate a dose-response relationship and examine potential treatment gains when combining CCT with other antidepressant interventions.
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Affiliation(s)
- Yannick Vander Zwalmen
- Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium.
| | - Eveline Liebaert
- Department of Head and Skin, Ghent University Hospital, Ghent, Belgium
| | - Kristof Hoorelbeke
- Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
| | - Constance Nève de Mévergnies
- Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Chris Baeken
- Department of Head and Skin, Ghent University Hospital, Ghent, Belgium
| | - Nick Verhaeghe
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Research Group Social and Economic Policy and Social Inclusion, HIVA, KU Leuven, Leuven, Belgium
| | - Ernst H W Koster
- Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
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Zhou J, Zhou J, Feng Z, Feng L, Xiao L, Chen X, Yang J, Feng Y, Wang G. Identifying the core residual symptom in patients with major depressive disorder using network analysis and illustrating its association with prognosis: A study based on the national cohorts in China. Gen Hosp Psychiatry 2024; 87:68-76. [PMID: 38325144 DOI: 10.1016/j.genhosppsych.2024.01.012] [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: 11/15/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To identify the core residual symptom of MDD and assess its relationship with patients' long-term outcomes. METHOD All patients were administered antidepressants during the acute phase and treated continuously. The 521 patients remitted at month 6 of a multicenter prospective project were included. Remission was defined as a Quick Inventory of Depressive Symptoms-Self-Report total score of ≤5. Functional impairments were measured with the Sheehan Disability Scale, quality of life with the Quality of Life Enjoyment and Satisfaction Questionnaire - short form, and family burden with the Family Burden Scale of Disease. Visits were scheduled at baseline, weeks 2, 8, 12, and month 6. RESULTS Difficulty with concentration/decision making was the core residual symptom of MDD, determined with the centrality measure of network analysis. It was positively associated with functional impairments and family burden (r = 0.35, P < 0.01 and r = 0.31, P < 0.01, respectively) and negatively associated with life satisfaction (r = -0.29, P < 0.01). The exhibition of this residual symptom was associated with a family history of psychiatric disorders (OR = 2.610 [1.242-5.485]). CONCLUSIONS The core residual symptom of MDD, difficulty with concentration/decision making, is associated with poorer social functioning, heavier family burden, and lower life satisfaction. Early detection and intervention of this symptom may be beneficial. CLINICAL TRIALS REGISTRATION NUMBER (Chinese Clinical Trials.gov identifier) ChiCTR-OOC-17012566 and ChiCTR-INR-17012574.
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Affiliation(s)
- Jingjing Zhou
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jia Zhou
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Zizhao Feng
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Lei Feng
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Le Xiao
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xu Chen
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jian Yang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yuan Feng
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Gang Wang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
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11
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Gumuchian ST, Boyle A, Hazel LH, Ellenbogen MA. Fear of depression recurrence among individuals with remitted depression: a qualitative interview study. BMC Psychiatry 2024; 24:152. [PMID: 38383311 PMCID: PMC10882790 DOI: 10.1186/s12888-024-05588-4] [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: 08/02/2023] [Accepted: 02/05/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Major Depressive Disorder (MDD) is a prevalent psychiatric condition and the largest contributor to disability worldwide. MDD is highly recurrent, yet little is known about the mechanisms that occur following a Major Depressive Episode (MDE) and underlie recurrence. We explored the concept of fear of depression recurrence (FoDR) and its impact on daily functioning among individuals in remission from MDD. METHODS 30 participants (83% female; 37% White; Mage = 27.7, SD = 8.96) underwent semi-structured qualitative interviews. The interviews explored participants' experiences of FoDR including the frequency, severity, content, triggers, and impact of fears and associated coping strategies. We used content analysis to analyze the transcriptions. RESULTS Most participants (73%) reported having FoDR, with varying frequency, severity, and duration of fears. The triggers and content of participants' fears often mirrored the symptoms (e.g., low mood, anhedonia) and consequences (e.g., job loss, social withdrawal) endured during past MDEs. Some participants reported a minimal impact of FoDR on daily functioning, whereas others reported a positive (e.g., personal growth) or negative (e.g., increased anxiety) influence. LIMITATIONS Our sample size did not allow for explorations of differences in FoDR across unique MDD subtypes or sociocultural factors. CONCLUSIONS The concept of FoDR may present a window into understanding the unique cognitive and behavioural changes that occur following MDD remission and underlie depression recurrence. Future research should aim to identify underlying individual differences and characteristics of the disorder that may influence the presence and impact of FoDR. Finally, a FoDR measure should be developed so that associations between FoDR and recurrence risk, depressive symptoms, and other indices of functioning can be determined.
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Affiliation(s)
- Stephanie T Gumuchian
- Department of Psychology, Concordia University, 7141 Sherbrooke Street West, H4B 1R6, Montréal, Québec, Canada.
| | - Ariel Boyle
- Department of Psychology, Concordia University, 7141 Sherbrooke Street West, H4B 1R6, Montréal, Québec, Canada
| | - Lori H Hazel
- Department of Psychology, Concordia University, 7141 Sherbrooke Street West, H4B 1R6, Montréal, Québec, Canada
| | - Mark A Ellenbogen
- Department of Psychology, Concordia University, 7141 Sherbrooke Street West, H4B 1R6, Montréal, Québec, Canada
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12
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Bruijniks SJE, Hollon SD, Lemmens LHJM, Peeters FPML, Arntz A, Cuijpers P, Twisk J, Dingemanse P, Willems L, van Oppen P, van den Boogaard M, Spijker J, Huibers MJH. Long-term outcomes of once weekly v. twice weekly sessions of cognitive behavioral therapy and interpersonal psychotherapy for depression. Psychol Med 2024; 54:517-526. [PMID: 37665012 DOI: 10.1017/s0033291723002143] [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] [Indexed: 09/05/2023]
Abstract
BACKGROUND Twice weekly sessions of cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) for major depressive disorder (MDD) lead to less drop-out and quicker and better response compared to once weekly sessions at posttreatment, but it is unclear whether these effects hold over the long run. AIMS Compare the effects of twice weekly v. weekly sessions of CBT and IPT for depression up to 24 months since the start of treatment. METHODS Using a 2 × 2 factorial design, this multicentre study randomized 200 adults with MDD to once or twice weekly sessions of CBT or IPT over 16-24 weeks, up to a maximum of 20 sessions. Main outcome measures were depression severity, measured with the Beck Depression Inventory-II and the Longitudinal Interval Follow-up Evaluation. Intention-to-treat analyses were conducted. RESULTS Compared with patients who received once weekly sessions, patients who received twice weekly sessions showed a significant decrease in depressive symptoms up through month 9, but this effect was no longer apparent at month 24. Patients who received CBT showed a significantly larger decrease in depressive symptoms up to month 24 compared to patients who received IPT, but the between-group effect size at month 24 was small. No differential effects between session frequencies or treatment modalities were found in response or relapse rates. CONCLUSIONS Although a higher session frequency leads to better outcomes in the acute phase of treatment, the difference in depression severity dissipated over time and there was no significant difference in relapse.
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Affiliation(s)
- Sanne J E Bruijniks
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Steven D Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Lotte H J M Lemmens
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Frenk P M L Peeters
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jos Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Pieter Dingemanse
- Department of Mood Disorders, Altrecht Mental Health Institute, Utrecht, The Netherlands
| | - Linda Willems
- Department of Mood Disorders, GGZ Oost Brabant, Oss, The Netherlands
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit/GGZ inGeest and Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Jan Spijker
- Center of Depression Expertise, Pro Persona Mental Health Care; and Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Marcus J H Huibers
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- NPI Center for Personality Disorders/ARKIN, Amsterdam, The Netherlands
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13
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Pettitt AK, Nelson BW, Forman-Hoffman VL, Goldin PR, Peiper NC. Longitudinal outcomes of a therapist-supported digital mental health intervention for depression and anxiety symptoms: A retrospective cohort study. Psychol Psychother 2024. [PMID: 38270220 DOI: 10.1111/papt.12517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE This study examined treatment outcomes (depression and anxiety symptoms) up to 24 months after completion of a therapist-supported digital mental health intervention (DMHI). METHODS The sample consisted of 380 participants who participated in an eight-week DMHI from February 6, 2017 to May 20, 2019. Participants reported depression and anxiety symptoms at eight timepoints from baseline to 24 months. Mixed-effects modelling was used to investigate symptom changes over time. The proportion of participants meeting criteria for treatment response, clinically significant change, and remission of depression and anxiety symptoms were calculated, including proportions demonstrating each outcome sustained up to each timepoint. RESULTS Multivariate analyses yielded statistically significant reductions in depression (β = -5.40) and anxiety (β = -3.31) symptoms from baseline to end of treatment (8 weeks). Symptom levels remained significantly reduced from baseline through 24 months. The proportion of participants meeting criteria for clinical treatment outcomes remained constant over 24 months, although there were linear decreases in the proportions experiencing sustained clinical outcomes. CONCLUSIONS Treatment gains were made for depression and anxiety symptoms at the end of treatment and up to 24 months. Future studies should determine the feasibility of integrating post-treatment programmes into DMHIs to address symptom deterioration.
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Affiliation(s)
- Adam K Pettitt
- Meru Health, San Mateo, California, USA
- Center for Digital Mental Health, University of Oregon, Eugene, Oregon, USA
| | - Benjamin W Nelson
- Meru Health, San Mateo, California, USA
- Department of Psychology and Neuroscience, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Valerie L Forman-Hoffman
- Meru Health, San Mateo, California, USA
- Department of Epidemiology, The University of Iowa, Iowa City, Iowa, USA
| | - Philippe R Goldin
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California, USA
| | - Nicholas C Peiper
- Meru Health, San Mateo, California, USA
- Department of Epidemiology and Population Health, University of Louisville, Louisville, Kentucky, USA
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14
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de Jonge M, Blankers M, Bockting CLH, van Dijk MK, Kikkert MJ, Dekker JJM. Economic evaluation of preventive cognitive therapy versus care as usual in cognitive behavioral therapy responders. Front Psychiatry 2024; 14:1134071. [PMID: 38268558 PMCID: PMC10806131 DOI: 10.3389/fpsyt.2023.1134071] [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: 12/29/2022] [Accepted: 12/11/2023] [Indexed: 01/26/2024] Open
Abstract
Background The highly recurrent nature of Major Depressive Disorder is a major contributor to disability and health care costs. Several studies indicate that recurrence may be prevented with Preventive Cognitive Therapy (PCT). This study is the first to perform an economic evaluation of PCT in comparison with care as usual for recurrently depressed patients who experienced two or more depressive episodes and remitted after receiving Cognitive Behavioural Therapy. Methods An economic evaluation from the societal perspective was performed alongside a randomized trial (N = 214). Health-related quality of life (QALYs), depression-free days, health care utilization, and productivity losses were measured between randomization and 15 months follow-up. The costs were indexed to the reference year 2014. Results QALY gains did not differ significantly between the groups (p = 0.69). Depression-free days were higher after PCT (p = 0.02). Societal costs of PCT were 10,417 euro and for care as usual 9,545 euro per person. We found a 47% likelihood that PCT led to additional QALYs at higher costs, and there was a 26% likelihood that PCT led to fewer QALYs at higher costs. When depression-free days was used as an outcome, we found PCT had a 72% likelihood of leading to more depression-free days at higher costs than care as usual and a 27% likelihood of leading to more depression-free days at lower societal costs. Limitations The 15-month follow-up might be too short to draw long-term conclusions about the cost-effectiveness of the PCT. The data collected for this study is part of an RCT to examine the effectiveness of adding PCT to care as usual. Therefore, the study was powered primarily to detect an effect in time to relapse/recurrences. Conclusion The economic evaluation is slightly in favour of the PCT condition when depression-free days is used as an outcome. PCT is not cost-effective given the high costs per additional QALYs from the societal perspective when QALYs are the effect measure. Clinical trial registration https://www.onderzoekmetmensen.nl/en, identifier NL2482.
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Affiliation(s)
- Margo de Jonge
- Department of Research, Arkin, Amsterdam, Netherlands
- Novarum, Amstelveen, Netherlands
| | - Matthijs Blankers
- Department of Research, Arkin, Amsterdam, Netherlands
- Trimbos, Utrecht, Netherlands
| | | | | | | | - Jack J. M. Dekker
- Department of Research, Arkin, Amsterdam, Netherlands
- Department of Clinical Psychology, Vrije Universiteit, Amsterdam, Netherlands
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15
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Dunlop BW, Cha J, Choi KS, Nemeroff CB, Craighead WE, Mayberg HS. Functional connectivity of salience and affective networks among remitted depressed patients predicts episode recurrence. Neuropsychopharmacology 2023; 48:1901-1909. [PMID: 37491672 PMCID: PMC10584833 DOI: 10.1038/s41386-023-01653-w] [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: 04/03/2023] [Revised: 06/09/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023]
Abstract
Recurrent episodes in major depressive disorder (MDD) are common but the neuroimaging features predictive of recurrence are not established. Participants in the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) study who achieved remission after 12 weeks of treatment withcognitive behavior therapy, duloxetine, or escitalopram were prospectively monitored for up to 21 months for recurrence. Neuroimaging markers predictive of recurrence were identified from week 12 functional magnetic resonance imaging scans by analyzing whole-brain resting state functional connectivity (RSFC) using seeds for four brain networks that are altered in MDD. Neuroimaging correlates of established clinical predictors of recurrence, including the magnitude of depressive (Hamilton Depression Rating Scale), anxiety (Hamilton Anxiety Rating Scale) symptom severity at time of remission, and a comorbid anxiety disorder were examined for their similarity to the neuroimaging predictors of recurrence. Of the 344 patients randomized in PReDICT, 61 achieved remission and had usable scans for analysis, 9 of whom experienced recurrence during follow-up. Recurrence was predicted by: 1) increased RSFC between subcallosal cingulate cortex (SCC) and right anterior insula, 2) decreased RSFC between SCC and bilateral primary visual cortex, and 3) decreased RSFC between insula and bilateral caudate. Week 12 depression and anxiety scores were negatively correlated with RSFC strength between executive control and default mode networks, but they were not correlated with the three RSFC patterns predicting recurrence. We conclude that altered RSFC in SCC and anterior insula networks are prospective risk factors associated with MDD recurrence, reflecting additional sources of risk beyond clinical measures.
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Affiliation(s)
- Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA.
| | - Jungho Cha
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ki Sueng Choi
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, Institute for Early Life Adversity Research, University of Texas at Austin Dell Medical School, Austin, USA
| | - W Edward Craighead
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA
- Department of Psychology, Emory University, Atlanta, USA
| | - Helen S Mayberg
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
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16
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Böttcher L, Breedvelt JJF, Warren FC, Segal Z, Kuyken W, Bockting CLH. Identifying relapse predictors in individual participant data with decision trees. BMC Psychiatry 2023; 23:835. [PMID: 37957596 PMCID: PMC10644580 DOI: 10.1186/s12888-023-05214-9] [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: 11/10/2022] [Accepted: 09/22/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Depression is a highly common and recurrent condition. Predicting who is at most risk of relapse or recurrence can inform clinical practice. Applying machine-learning methods to Individual Participant Data (IPD) can be promising to improve the accuracy of risk predictions. METHODS Individual data of four Randomized Controlled Trials (RCTs) evaluating antidepressant treatment compared to psychological interventions with tapering ([Formula: see text]) were used to identify predictors of relapse and/or recurrence. Ten baseline predictors were assessed. Decision trees with and without gradient boosting were applied. To study the robustness of decision-tree classifications, we also performed a complementary logistic regression analysis. RESULTS The combination of age, age of onset of depression, and depression severity significantly enhances the prediction of relapse risk when compared to classifiers solely based on depression severity. The studied decision trees can (i) identify relapse patients at intake with an accuracy, specificity, and sensitivity of about 55% (without gradient boosting) and 58% (with gradient boosting), and (ii) slightly outperform classifiers that are based on logistic regression. CONCLUSIONS Decision tree classifiers based on multiple-rather than single-risk indicators may be useful for developing treatment stratification strategies. These classification models have the potential to contribute to the development of methods aimed at effectively prioritizing treatment for those individuals who require it the most. Our results also underline the existing gaps in understanding how to accurately predict depressive relapse.
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Affiliation(s)
- Lucas Böttcher
- Frankfurt School of Finance and Management, Frankfurt am Main, Germany.
- Department of Medicine, University of Florida, Gainesville, FL, USA.
| | - Josefien J F Breedvelt
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- NatCen Social Research, London, UK
| | - Fiona C Warren
- Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Zindel Segal
- Department of Clinical Psychological Science, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Claudi L H Bockting
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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17
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Barton SB, Armstrong PV, Robinson LJ, Bromley EHC. CBT for difficult-to-treat depression: self-regulation model. Behav Cogn Psychother 2023; 51:543-558. [PMID: 37170824 DOI: 10.1017/s1352465822000273] [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] [Indexed: 05/13/2023]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is an effective treatment for depression but a significant minority of clients do not complete therapy, do not respond to it, or subsequently relapse. Non-responders, and those at risk of relapse, are more likely to have adverse childhood experiences, early-onset depression, co-morbidities, interpersonal problems and heightened risk. This is a heterogeneous group of clients who are currently difficult to treat. AIM The aim was to develop a CBT model of depression that will be effective for difficult-to-treat clients who have not responded to standard CBT. METHOD The method was to unify theory, evidence and clinical strategies within the field of CBT to develop an integrated CBT model. Single case methods were used to develop the treatment components. RESULTS A self-regulation model of depression has been developed. It proposes that depression is maintained by repeated interactions of self-identity disruption, impaired motivation, disengagement, rumination, intrusive memories and passive life goals. Depression is more difficult to treat when these processes become interlocked. Treatment based on the model builds self-regulation skills and restructures self-identity, rather than target negative beliefs. A bespoke therapy plan is formed out of ten treatment components, based on an individual case formulation. CONCLUSIONS A self-regulation model of depression is proposed that integrates theory, evidence and practice within the field of CBT. It has been developed with difficult-to-treat cases as its primary purpose. A case example is described in a concurrent article (Barton et al., 2022) and further empirical tests are on-going.
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Affiliation(s)
- Stephen B Barton
- School of Psychology, Newcastle University, Dame Margaret Barbour Building, Newcastle upon TyneNE2 4DR, UK
- Centre for Specialist Psychological Therapies, Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Benfield House, Newcastle upon TyneNE6 4PF, UK
| | - Peter V Armstrong
- School of Psychology, Newcastle University, Dame Margaret Barbour Building, Newcastle upon TyneNE2 4DR, UK
| | - Lucy J Robinson
- School of Psychology, Newcastle University, Dame Margaret Barbour Building, Newcastle upon TyneNE2 4DR, UK
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18
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Arco L. Toward a synthesis of cognitive behaviour therapy via component analysis of self-regulation. Clin Psychol Psychother 2023. [PMID: 37855427 DOI: 10.1002/cpp.2918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/15/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023]
Abstract
The cognitive behavioural therapies (CBTs) are the choice psychotherapies for many clinicians treating a wide range of adult psychological disorders including various anxieties, mood, substance use, eating, schizophrenia and personality-related. Empirical research in the CBTs is ever increasing, and the accumulating evidence supporting efficacious treatments is substantial and well documented. However, with prolific research comes a seemingly accelerating and worrying trend of purportedly different therapies, and numerous hybrids and combinations of therapies and techniques. For many clinicians this is increasingly confusing and not helpful in clinical practice. This article is a critique of current trends and directions in clinical research, which show signs of limited effectiveness, fragmentation, and obfuscation. An alternative strategy is proposed-examining transdiagnostic therapeutic effects, which appear related to treating pervasive dysregulated emotions, with component analyses of four principal self-regulation components (viz., self-monitoring; functional analysis; identifying values, goals and treatment-plans; and feedback). Such a strategy is likely to lead to a more coherently synthesized and effective CBT.
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Affiliation(s)
- Lucius Arco
- Praxis Research, Perth, Western Australia, Australia
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19
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Malekizadeh H, Saed O, Rashtbari A, Sajjadi M, Ahmadi D, Ronold EH. Deficits in specific executive functions manifest by severity in major depressive disorder: a comparison of antidepressant naïve inpatient, outpatient, subclinical, and healthy control groups. Front Psychiatry 2023; 14:1225062. [PMID: 37854445 PMCID: PMC10580982 DOI: 10.3389/fpsyt.2023.1225062] [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: 05/18/2023] [Accepted: 09/12/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction Previous research has highlighted the executive function (EF) deficits present in depressed patients; however, conflicting results exist regarding the impact of depression severity on the size of these deficits. This study aimed to compare deficits in EF between antidepressant naïve inpatient and outpatient depressed, a group with subclinical depression symptoms, and a healthy control group while controlling for education, sex, and age. Methods In cross-sectional research, 245 antidepressant naive participants (46 inpatient, 68 outpatient, 65 subclinical, and 67 healthy control individuals) were recruited by convenience sampling. The Structured Clinical Interview for DSM-5 Disorders (SCID-5) and Beck Depression Inventory-II (BDI-II) were used to assess depression. EF was measured using several neuropsychological tests, including the Stroop Color-Word Test, the Wisconsin Card Sorting Test, and the N-back Test, which assessed the components of Inhibition, Shifting, and Updating, respectively. Multivariate analysis of covariance revealed a significant difference between the groups in EF components (p < 0.001). Pairwise comparisons further showed that inpatient and outpatient patients had more depressive symptoms and worse EF performance than subclinical and healthy control groups (p < 0.05). Results In the analysis of EF measures, a significant difference was found among the four groups, with post-hoc tests revealing variations in specific EF components. Overall, patients with more severe depressive symptoms show more deficits in EF. Additionally, correlations between clinical characteristics and EF measures varied across patient groups, but many correlations became non-significant after adjusting for the false discovery rate (FDR). Discussion This study emphasizes the impact of depression severity on deficits in the EF of depressed patients and at-risk populations. Consequently, it is important to consider executive dysfunctions as an underlying vulnerability in the development and persistence of depressive disorder.
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Affiliation(s)
- Hossein Malekizadeh
- Department of Clinical Psychology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Omid Saed
- Department of Clinical Psychology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Alireza Rashtbari
- Department of Clinical Psychology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mozhdeh Sajjadi
- Faculty of Psychology and Education, University of Tehran, Tehran, Iran
| | - Davoud Ahmadi
- Department of Clinical Psychology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Eivind Haga Ronold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
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20
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Kooiman BEAM, Robberegt SJ, Albers CJ, Bockting CLH, Stikkelbroek YAJ, Nauta MH. Congruency of multimodal data-driven personalization with shared decision-making for StayFine: individualized app-based relapse prevention for anxiety and depression in young people. Front Psychiatry 2023; 14:1229713. [PMID: 37840790 PMCID: PMC10570515 DOI: 10.3389/fpsyt.2023.1229713] [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: 05/26/2023] [Accepted: 08/31/2023] [Indexed: 10/17/2023] Open
Abstract
Tailoring interventions to the individual has been hypothesized to improve treatment efficacy. Personalization of target-specific underlying mechanisms might improve treatment effects as well as adherence. Data-driven personalization of treatment, however, is still in its infancy, especially concerning the integration of multiple sources of data-driven advice with shared decision-making. This study describes an innovative type of data-driven personalization in the context of StayFine, a guided app-based relapse prevention intervention for 13- to 21-year-olds in remission of anxiety or depressive disorders (n = 74). Participants receive six modules, of which three are chosen from five optional modules. Optional modules are Enhancing Positive Affect, Behavioral Activation, Exposure, Sleep, and Wellness. All participants receive Psycho-Education, Cognitive Restructuring, and a Relapse Prevention Plan. The personalization approach is based on four sources: (1) prior diagnoses (diagnostic interview), (2) transdiagnostic psychological factors (online self-report questionnaires), (3) individual symptom networks (ecological momentary assessment, based on a two-week diary with six time points per day), and subsequently, (4) patient preference based on shared decision-making with a trained expert by experience. This study details and evaluates this innovative type of personalization approach, comparing the congruency of advised modules between the data-driven sources (1-3) with one another and with the chosen modules during the shared decision-making process (4). The results show that sources of data-driven personalization provide complementary advice rather than a confirmatory one. The indications of the modules Exposure and Behavioral Activation were mostly based on the diagnostic interview, Sleep on the questionnaires, and Enhancing Positive Affect on the network model. Shared decision-making showed a preference for modules improving positive concepts rather than combating negative ones, as an addition to the data-driven advice. Future studies need to test whether treatment outcomes and dropout rates are improved through personalization.
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Affiliation(s)
- Bas E. A. M. Kooiman
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, Netherlands
- Depression Expertise Centre-Youth, GGZ Oost Brabant, Boekel, Netherlands
| | - Suzanne J. Robberegt
- Depression Expertise Centre-Youth, GGZ Oost Brabant, Boekel, Netherlands
- Department of Psychiatry, Amsterdam University Medical Centres–Location AMC, Amsterdam Public Health, University of Amsterdam, Amsterdam, Netherlands
| | - Casper J. Albers
- Department of Psychometrics and Statistics, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Claudi L. H. Bockting
- Department of Psychiatry, Amsterdam University Medical Centres–Location AMC, Amsterdam Public Health, University of Amsterdam, Amsterdam, Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
| | - Yvonne A. J. Stikkelbroek
- Depression Expertise Centre-Youth, GGZ Oost Brabant, Boekel, Netherlands
- Department of Clinical Child and Family Studies, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, Netherlands
| | - Maaike H. Nauta
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, Netherlands
- Accare Child Study Centre, Groningen, Netherlands
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21
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Zhou Y, Zhao D, Zhu X, Liu L, Meng M, Shao X, Zhu X, Xiang J, He J, Zhao Y, Yuan Y, Gao R, Jiang L, Zhu G. Psychological interventions for the prevention of depression relapse: systematic review and network meta-analysis. Transl Psychiatry 2023; 13:300. [PMID: 37770471 PMCID: PMC10539522 DOI: 10.1038/s41398-023-02604-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 09/16/2023] [Accepted: 09/20/2023] [Indexed: 09/30/2023] Open
Abstract
Depression is highly prevalent and easily relapses. Psychological interventions are effective for the prevention of depression relapse. This systematic review and network meta-analysis aimed to compare the efficacy at the same follow-up time points of psychological interventions in depression. We searched PubMed, Embase, and PsycINFO via OVID, and the Cochrane Library published up to December 12, 2021, and PubMed up to July 1, 2022. The primary outcome was depression relapse, considering the same time points that were extracted on survival curves or relapse curves. The study protocol was registered with PROSPERO, CRD42022343327. A total of 2,871 patients were included from 25 RCTs. Mindfulness-based cognitive therapy (MBCT) was significantly better than placebo at the 3 months, the 6 months, and the 9 months at follow-up. Cognitive behavioral therapy (CBT) was significantly better than treatment as usual at the 3 months, the 9 months, the 12 months, and the 15 months at follow-up. CBT was significantly better than placebo at the 21 months and the 24 months at follow-up. Behavioral activation therapy was significantly better than placebo at the 21 months and the 24 months at follow-up. Interpersonal psychotherapy was significantly better than placebo at the 24-month follow-up. All psychological interventions included in the study were significantly better than supportive counseling most of the time. The results were robust in various sensitivity and subgroup analyses. In conclusion, MBCT had a continuous effect in preventing relapse of depression. CBT had the longest but not continuous effect in preventing relapse of depression. The effects of behavioral activation therapy and interpersonal therapy for the prevention of depression appeared late. All psychological interventions included in the study were more effective than supportive counseling. More evidence is needed from large comparative trials that provide long-term follow-up data.
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Affiliation(s)
- Yurong Zhou
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Defeng Zhao
- Clinical Medicine (5 + 3), China Medical University, Shenyang, 110122, China
| | - Xiaotong Zhu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
- Department of Psychiatry, The Fourth Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Lu Liu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
- Department of Psychiatry, The Fourth Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Ming Meng
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
- Shenyang Mental Health Center, Shenyang, 110168, China
| | - Xiaojun Shao
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Xueyan Zhu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Jing Xiang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Jiali He
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Yimeng Zhao
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Yuman Yuan
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Rui Gao
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Lin Jiang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Gang Zhu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China.
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22
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Schricker IF, Nayman S, Reinhard I, Kuehner C. Reactivity toward daily events: Intraindividual variability and change in recurrent depression - A measurement burst study. Behav Res Ther 2023; 168:104383. [PMID: 37586185 DOI: 10.1016/j.brat.2023.104383] [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: 12/20/2022] [Revised: 06/29/2023] [Accepted: 07/31/2023] [Indexed: 08/18/2023]
Abstract
In Major Depressive Disorder, first evidence shows heightened mood-reactivity toward daily events. Related longitudinal studies in remitted patients with recurrent major depression are lacking. Long-term changes in such short-term within-person associations can be analysed via measurement burst designs. Two bursts, separated by approximately 4.4 years, consisted of a baseline session and an Ambulatory Assessment (burst-1: 3 days, burst-2: 5 days). Via smartphone, 54 initially remitted patients with recurrent major depression indicated their negative and positive affect, rumination, self-acceptance, and the occurrence of negative and positive daily events ten times and collected saliva cortisol samples five times per day. In bursts with higher depression levels, patients showed blunted negative affect- and cortisol-reactivity and stronger decreases in positive affect and self-acceptance toward negative daily events, as well as stronger increases in self-acceptance following positive daily events. However, patients with higher depression levels demonstrated stronger ruminative stress-reactivity within bursts. Furthermore, patients with higher depression levels showed an increase of affective stress-reactivity over bursts, such that negative affect more strongly increased and positive affect more strongly decreased following negative daily events over bursts. Following positive daily events, patients with higher depression levels showed stronger decreases in negative affect within bursts and a decrease of self-acceptance-reactivity over bursts. To conclude, measurement burst designs enable to examine intraindividual variability and change of micro-level processes, and possible moderators thereof, potentially providing prognostic information for the course of recurrent major depression.
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Affiliation(s)
- Isabelle Florence Schricker
- Research Group Longitudinal and Intervention Research, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Sibel Nayman
- Research Group Longitudinal and Intervention Research, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Iris Reinhard
- Department of Biostatistics, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Christine Kuehner
- Research Group Longitudinal and Intervention Research, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany.
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23
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Godara M, Sanchez-Lopez A, De Raedt R. The contextual goal dependent attentional flexibility (CoGoDAF) framework: A new approach to attention bias in depression. Behav Res Ther 2023; 167:104354. [PMID: 37343329 DOI: 10.1016/j.brat.2023.104354] [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: 08/21/2022] [Revised: 05/30/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023]
Abstract
Successful adaptation to the environment requires attentional prioritization of emotional information relevant to the current situational demands. Accordingly, the presence of an attention bias (AB) for both positive and negative information may allow preferential processing of stimuli in line with the current situational goals. However, AB for negative information sometimes becomes maladaptive, being antithetical to the current adaptive needs and goals of an individual, such as in the case of affective disorders such as depression. Although difficulties in flexible shifting between emotional stimuli in depression have increasingly become a topic of discussion in the field, an integrative approach towards biased versus flexible emotional attentional processes remains absent. In the present paper, we advance a novel and integrative view of conceptualizing potentially aberrant affective attention patterns in depression as a function of the current contextual features. We propose that flexible emotional attention takes place as a result of attention prioritization towards goal-relevant emotional stimuli depending upon the current context of the individual. Specifically, the roles of context, distal and proximal goals, and approach and avoidance motivation processes are considered in a unified manner. The empirical, clinical, and interventional implications of this integrative framework provide a roadmap for future psychological and neurobiological experimental and translational research.
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Affiliation(s)
- Malvika Godara
- Department of Experimental Clinical & Health Psychology, Ghent University, Belgium.
| | | | - Rudi De Raedt
- Department of Experimental Clinical & Health Psychology, Ghent University, Belgium
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24
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Lorenzo-Luaces L, Howard J. Efficacy of an Unguided, Digital Single-Session Intervention for Internalizing Symptoms in Web-Based Workers: Randomized Controlled Trial. J Med Internet Res 2023; 25:e45411. [PMID: 37418303 PMCID: PMC10362424 DOI: 10.2196/45411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/31/2023] [Accepted: 05/10/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND The Common Elements Toolbox (COMET) is an unguided digital single-session intervention (SSI) based on principles of cognitive behavioral therapy and positive psychology. Although unguided digital SSIs have shown promise in the treatment of youth psychopathology, the data are more mixed regarding their efficacy in adults. OBJECTIVE This study aimed to investigate the efficacy of COMET-SSI versus a waiting list control in depression and other transdiagnostic mental health outcomes for Prolific participants with a history of psychopathology. METHODS We conducted an investigator-blinded, preregistered randomized controlled trial comparing COMET-SSI (n=409) with an 8-week waiting list control (n=419). Participants were recruited from the web-based workspace Prolific and assessed for depression, anxiety, work and social functioning, psychological well-being, and emotion regulation at baseline and at 2, 4, and 8 weeks after the intervention. The main outcomes were short-term (2 weeks) and long-term (8 weeks) changes in depression and anxiety. The secondary outcomes were the 8-week changes in work and social functioning, well-being, and emotion regulation. Analyses were conducted according to the intent-to-treat principle with imputation, without imputation, and using a per-protocol sample. In addition, we conducted sensitivity analyses to identify inattentive responders. RESULTS The sample comprised 61.9% (513/828) of women, with a mean age of 35.75 (SD 11.93) years. Most participants (732/828, 88.3%) met the criteria for screening for depression or anxiety using at least one validated screening scale. A review of the text data suggested that adherence to the COMET-SSI was near perfect, there were very few inattentive respondents, and satisfaction with the intervention was high. However, despite being powered to detect small effects, there were negligible differences between the conditions in the various outcomes at the various time points, even when focusing on subsets of individuals with more severe symptoms. CONCLUSIONS Our results do not support the use of the COMET-SSI in adult Prolific participants. Future work should explore alternate ways of intervening with paid web-based participants, including matching individuals to SSIs they may be most responsive to. TRIAL REGISTRATION ClinicalTrials.gov NCT05379881, https://clinicaltrials.gov/ct2/show/NCT05379881.
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Affiliation(s)
- Lorenzo Lorenzo-Luaces
- Department of Psychological and Brain Sciences, Indiana University-Bloomington, Bloomington, IN, United States
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25
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Gumport NB, Dong L, Lee JY, Zhao X, Harvey AG. Development and preliminary validation of the treatment adherence rating scale. J Behav Ther Exp Psychiatry 2023; 79:101832. [PMID: 36584414 PMCID: PMC10013098 DOI: 10.1016/j.jbtep.2022.101832] [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: 09/15/2021] [Revised: 08/12/2022] [Accepted: 12/17/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Patient adherence to treatment is an important barrier to the implementation of evidence-based psychological treatments (EBPTs). There is a need for simple and deployable measures of patient adherence to treatment for use across EBPTs. The Treatment Adherence Rating Scale (TARS) was developed and validated in two samples. METHODS This study includes two samples: adults with Major Depressive Disorder who received Cognitive Therapy for depression (Sample 1; N = 48, mean age = 44.27 years), and at-risk adolescents who received either the Transdiagnostic Sleep and Circadian Intervention or Psychoeducation (Sample 2; N = 176, mean age = 14.77 years). Factor structure of the TARS scores was examined via Exploratory Factor Analyses (EFA) in Sample 1 and Confirmatory Factor Analyses (CFA) in Sample 2. Internal consistency, predictive validity, and construct validity of the TARS scores were examined. RESULTS Results from EFA in Sample 1 supported a one-factor model. Results from CFA in Sample 2 suggested that a two-factor model (i.e., agreement and compliance) fit better than a one-factor model. TARS scores from both samples demonstrated adequate predictive validity with primary clinical outcomes and construct validity with treatment expectations. LIMITATIONS The sample was small with two specific populations. Future research should focus on other patient populations, a larger population, and other EBPTs. Future research examining patient ratings of these items are needed for further validation of the TARS. CONCLUSIONS Preliminary findings support the use of a two-factor model and highlight the potential utility of a simple measure of patient adherence to treatment across age and diagnostic groups.
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Affiliation(s)
| | | | | | - Xin Zhao
- University of California, Berkeley, USA.
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26
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Sałaciak K, Koszałka A, Lustyk K, Żmudzka E, Jagielska A, Pytka K. Memory impairments in rodent depression models: A link with depression theories. Prog Neuropsychopharmacol Biol Psychiatry 2023; 125:110774. [PMID: 37088171 DOI: 10.1016/j.pnpbp.2023.110774] [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: 01/13/2023] [Revised: 04/11/2023] [Accepted: 04/20/2023] [Indexed: 04/25/2023]
Abstract
More than 80% of depressed patients struggle with learning new tasks, remembering positive events, or concentrating on a single topic. These neurocognitive deficits accompanying depression may be linked to functional and structural changes in the prefrontal cortex and hippocampus. However, their mechanisms are not yet completely understood. We conducted a narrative review of articles regarding animal studies to assess the state of knowledge. First, we argue the contribution of changes in neurotransmitters and hormone levels in the pathomechanism of cognitive dysfunction in animal depression models. Then, we used numerous neuroinflammation studies to explore its possible implication in cognitive decline. Encouragingly, we also observed a positive correlation between increased oxidative stress and a depressive-like state with concomitant memory deficits. Finally, we discuss the undeniable role of neurotrophin deficits in developing cognitive decline in animal models of depression. This review reveals the complexity of depression-related memory impairments and highlights the potential clinical importance of gathered findings for developing more reliable animal models and designing novel antidepressants with procognitive properties.
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Affiliation(s)
- Kinga Sałaciak
- Department of Pharmacodynamics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, Krakow 30-688, Poland
| | - Aleksandra Koszałka
- Department of Pharmacodynamics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, Krakow 30-688, Poland
| | - Klaudia Lustyk
- Department of Pharmacodynamics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, Krakow 30-688, Poland
| | - Elżbieta Żmudzka
- Department of Social Pharmacy, Faculty of Pharmacy, Jagiellonian University Medical College Medyczna, 9 Street, Kraków 30-688, Poland
| | - Angelika Jagielska
- Department of Pharmacodynamics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, Krakow 30-688, Poland
| | - Karolina Pytka
- Department of Pharmacodynamics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, Krakow 30-688, Poland.
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27
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Reciprocal Prospective Effects of Momentary Cognitions and Affect in Daily Life and Mood Reactivity Toward Daily Events in Remitted Recurrent Depression. Behav Ther 2023; 54:274-289. [PMID: 36858759 DOI: 10.1016/j.beth.2022.09.001] [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: 02/10/2022] [Revised: 09/05/2022] [Accepted: 09/09/2022] [Indexed: 11/20/2022]
Abstract
Major depressive disorder is a recurrent condition. Potential risk factors for future episodes are maladaptive cognitions, such as rumination and unfavorable reactivity toward negative daily events. Positive thoughts and positive daily events, in contrast, could act as a buffer against mood deterioration. The aim of the present study is to (a) examine differences in daily affect and cognitions in remitted depressed patients with a history of recurrent episodes (rMDD) and healthy controls, (b) analyze reciprocal prospective effects of momentary cognitions and affect, and (c) investigate effects of daily events on affect and cognitions in both groups. A sample of N = 102 participants underwent an ecological momentary assessment (EMA) phase of 5 consecutive days, where rMDD patients (n = 51) and healthy controls (n = 51) indicated their momentary rumination, positive thoughts, affect, and the occurrence of daily events 10 times per day. Via multilevel lag models, we found higher rumination to predict a decrease of positive affect (PA) in the rMDD group, but no effect of rumination on subsequent negative affect (NA) in either group. Higher positive thoughts predicted an increase in PA and a decrease in NA, similarly strong in both groups. Regarding daily events, rMDD patients reported a stronger increase in NA and rumination following negative daily events compared to controls, whereas an observed subsequent decrease of PA and positive thoughts was not moderated by group. Following positive daily events, rMDD patients showed a stronger increase in PA and positive thoughts and a stronger decrease in NA and rumination than controls. For interventions targeting relapse prevention, our results indicate the implementation of strategies fostering the responsiveness to positive events and the up-regulation of positive affect.
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28
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Robberegt SJ, Brouwer ME, Kooiman BEAM, Stikkelbroek YAJ, Nauta MH, Bockting CLH. Meta-Analysis: Relapse Prevention Strategies for Depression and Anxiety in Remitted Adolescents and Young Adults. J Am Acad Child Adolesc Psychiatry 2023; 62:306-317. [PMID: 35513189 DOI: 10.1016/j.jaac.2022.04.014] [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: 11/12/2021] [Revised: 04/06/2022] [Accepted: 04/21/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Depression and anxiety cause a high burden of disease and have high relapse rates (39%-72%). This meta-analysis systematically examined effectiveness of relapse prevention strategies on risk of and time to relapse in youth who remitted. METHOD PubMed, PsycInfo, Embase, Cochrane, and ERIC databases were searched up to June 15, 2021. Eligible studies compared relapse prevention strategies to control conditions among youth (mean age 13-25 years) who were previously depressed or anxious or with ≥30% improvement in symptoms. Two reviewers independently assessed titles, abstracts, and full texts; extracted study data; and assessed risk of bias and overall strength of evidence. Random-effects models were used to pool results, and mixed-effects models were used for subgroup analyses. Main outcome was relapse rate at last follow-up (PROSPERO ID: CRD42020149326). RESULTS Of 10 randomized controlled trials (RCTs) that examined depression, 9 were eligible for analysis: 4 included psychological interventions (n = 370), 3 included antidepressants (n = 80), and 2 included combinations (n = 132). No RCTs for anxiety were identified. Over 6 to 75 months, relapse was half as likely following psychological treatment compared with care as usual conditions (k = 6; odds ratio 0.56, 95% CI 0.31 to 1.00). Sensitivity analyses including only studies with ≥50 participants (k = 3), showed similar results. Over 6 to 12 months, relapse was less likely in youth receiving antidepressants compared with youth receiving pill placebo (k = 3; OR 0.29, 95% CI 0.10 to 0.82). Quality of studies was suboptimal. CONCLUSION Relapse prevention strategies for youth depression reduce risk of relapse, although adequately powered, high-quality RCTs are needed. This finding, together with the lack of RCTs on anxiety, underscores the need to examine relapse prevention in youth facing these common mental health conditions.
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Affiliation(s)
- Suzanne J Robberegt
- Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Depression Expertise Centre-Youth, GGZ Oost Brabant, the Netherlands
| | - Marlies E Brouwer
- Amsterdam University Medical Centers, University of Amsterdam, the Netherlands
| | - Bas E A M Kooiman
- Depression Expertise Centre-Youth, GGZ Oost Brabant, the Netherlands; University of Groningen, the Netherlands
| | - Yvonne A J Stikkelbroek
- Depression Expertise Centre-Youth, GGZ Oost Brabant, the Netherlands; Utrecht University, the Netherlands
| | - Maaike H Nauta
- University of Groningen, the Netherlands; Accare Child Study Centre, the Netherlands
| | - Claudi L H Bockting
- Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Centre for Urban Mental Health, University of Amsterdam, the Netherlands.
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29
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Parallel latent trajectories of mental health and personal earnings among 16- to 20 year-old US labor force participants: a 20-year longitudinal study. Soc Psychiatry Psychiatr Epidemiol 2022; 58:805-821. [PMID: 36566466 DOI: 10.1007/s00127-022-02398-5] [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] [Received: 11/09/2021] [Accepted: 12/12/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE Determine the number of latent parallel trajectories of mental health and employment earnings over two decades among American youth entering the workforce and estimate the association between baseline sociodemographic and health factors on latent trajectory class membership. METHODS This study used data of 8173 participants from the National Longitudinal Survey of Youth 1997 who were 13-17 years old in 1997. Surveys occurred annually until 2011 then biennially until 2017, when participants were 33-37 years old. The Mental Health Inventory-5 measured mental health at eight survey cycles between 2000 and 2017. Employment earnings were measured annually between 1998 and 2017. Latent parallel trajectories were estimated using latent growth modeling. Multinomial logistic regression explored the association between baseline factors and trajectory membership. RESULTS Four parallel latent classes were identified; all showed stable mental health and increasing earnings. Three percent of the sample showed a good mental health, steep increasing earnings trajectory (average 2017 earnings ~ $196,000); 23% followed a good mental health, medium increasing earnings trajectory (average 2017 earnings ~ $78,100); 50% followed a good mental health, low increasing earnings trajectory (average 2017 earnings ~ $39,500); and 24% followed a poor mental, lowest increasing earnings trajectory (average 2017 earnings ~ $32,000). Participants who were younger, women, Black or Hispanic, from lower socioeconomic households, and reported poorer health behaviors had higher odds of belonging to the poor mental health, low earnings class. CONCLUSION Findings highlight the parallel courses of mental health and labor market earnings, and the influence of gender, race/ethnicity, and adolescent circumstances on these processes.
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30
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Wijnen J, Van 't Hullenaar G, Gordon NL, Pont ML, Geijselaers MWH, Van Oosterwijck J, De Jong J. An interdisciplinary multimodal integrative healthcare program for somatic symptom disorder, with predominant (spinal) pain. Psychother Res 2022; 33:581-594. [PMID: 36525631 DOI: 10.1080/10503307.2022.2144528] [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: 12/23/2022] Open
Abstract
OBJECTIVE Although multimodal interventions are generally recommended in patients with long-term somatic symptom disorders (SSD), available evidence is limited. The current study evaluates the effectiveness of an outpatient secondary care interdisciplinary multimodal integrative healthcare program for patients with SSD and predominant (spinal) pain. METHOD The healthcare program consisted of two active treatment phases: main 20-week program and a 12-month relapse prevention program. Participants were 4453 patients diagnosed with SSD. The primary outcome was health-related quality of life (HRQoL) assessed using the RAND-36 (i.e., mental/physical component summary) and secondary outcomes included physical and psychological symptoms assessed using the Brief Symptom Inventory (BSI) and RAND-36 subscales. Mixed linear models were used to examine the effects of the multimodal healthcare program on primary/secondary outcomes over four time points: before start 20-week program (T0), halfway 20-week program (T1), end of 20-week program (T2) and end of relapse prevention program (T3). RESULTS Significant improvements were found from T0 to T2 for all primary variables (i.e., mental/physical component summary) and secondary variables (i.e., BSI/RAND-36 subscales), which were maintained until the end of the relapse prevention program (T3). CONCLUSION An interdisciplinary multimodal integrative treatment for SSD is effective for improving HRQoL and reducing physical and psychological symptoms.
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Affiliation(s)
- Jaap Wijnen
- Intergrin Academy, Geleen, Netherlands.,Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group, Belgium
| | | | | | | | | | - Jessica Van Oosterwijck
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group, Belgium.,Center for InterProfessional Collaboration in Education Research and Practice (IPC-ERP UGent), Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jeroen De Jong
- Intergrin Academy, Geleen, Netherlands.,Department of Rehabilitation Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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31
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Robberegt SJ, Kooiman BEAM, Albers CJ, Nauta MH, Bockting C, Stikkelbroek Y. Personalised app-based relapse prevention of depressive and anxiety disorders in remitted adolescents and young adults: a protocol of the StayFine RCT. BMJ Open 2022; 12:e058560. [PMID: 36521888 PMCID: PMC9756181 DOI: 10.1136/bmjopen-2021-058560] [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] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Youth in remission of depression or anxiety have high risks of relapse. Relapse prevention interventions may prevent chronicity. Aim of the study is therefore to (1) examine efficacy of the personalised StayFine app for remitted youth and (2) identify high-risk groups for relapse and resilience. METHOD AND ANALYSIS In this Dutch single-blind parallel-group randomised controlled trial, efficacy of app-based monitoring combined with guided app-based personalised StayFine intervention modules is assessed compared with monitoring only. In both conditions, care as usual is allowed. StayFine modules plus monitoring is hypothesised to be superior to monitoring only in preventing relapse over 36 months. Participants (N=254) are 13-21 years and in remission of depression or anxiety for >2 months. Randomisation (1:1) is stratified by previous treatment (no treatment vs treatment) and previous episodes (1, 2 or >3 episodes). Assessments include diagnostic interviews, online questionnaires and monitoring (ecological momentary assessment with optional wearable) after 0, 4, 12, 24 and 36 months. The StayFine modules are guided by certified experts by experience and based on preventive cognitive therapy and ingredients of cognitive behavioural therapy. Personalisation is based on shared decision-making informed by baseline assessments and individual symptom networks. Time to relapse (primary outcome) is assessed by the Kiddie Schedule for Affective Disorders and Schizophrenia-lifetime version diagnostic interview. Intention-to-treat survival analyses will be used to examine the data. Secondary outcomes are symptoms of depression and anxiety, number and duration of relapses, global functioning, and quality of life. Mediators and moderators will be explored. Exploratory endpoints are monitoring and wearable outcomes. ETHICS, FUNDING AND DISSEMINATION The study was approved by METC Utrecht and is funded by the Netherlands Organisation for Health Research and Development (636310007). Results will be submitted to peer-reviewed scientific journals and presented at (inter)national conferences. TRIAL REGISTRATION NUMBER NCT05551468; NL8237.
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Affiliation(s)
- Suzanne J Robberegt
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Depression Expertise Centre-Youth, GGZ Oost Brabant, Boekel, The Netherlands
| | - Bas E A M Kooiman
- Depression Expertise Centre-Youth, GGZ Oost Brabant, Boekel, The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Casper J Albers
- Department of Psychometrics and Statistics, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Maaike H Nauta
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
- Child Study Centre, Accare, Groningen, The Netherlands
| | - Claudi Bockting
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Yvonne Stikkelbroek
- Depression Expertise Centre-Youth, GGZ Oost Brabant, Boekel, The Netherlands
- Department of Clinical Child and Family Studies, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
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The Italian consensus conference on psychological therapies for anxiety and depressive disorders: findings and recommendations. Epidemiol Psychiatr Sci 2022; 31:e89. [PMID: 36511136 PMCID: PMC9762139 DOI: 10.1017/s2045796022000713] [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: 12/15/2022] Open
Abstract
A Consensus Conference of clinicians, researchers, public health specialists and users was convened in Italy to review efficacy, effectiveness, treatment appropriateness and access to care for anxiety and depression, and to consider the role of psychological therapies. Expert opinion was sought concerning identification of people requiring psychological therapies according to levels of symptom severity matched to corresponding levels of treatment intensity, suitability of psychological therapies for subclinical anxiety or depression, definition of a minimum level of information on evidence-based psychotherapies to be provided by university medical and psychology courses, initiatives to raise awareness among potential users and decision makers on the role and effectiveness of psychological therapies in healthcare. The expert jury concluded that a number of psychological therapy models endorsed by most authoritative guidelines are supported by research showing their effectiveness at least equal to the drugs used in common mental disorders (CMDs). Such therapies are under-represented in the Italian public health system, leading many people to resort to the private sector, resulting in unacceptable wealth discrimination. The difficulty of accessing psychological treatments often entails the use of drug therapies in cases where they are not indicated. Starting from these assumptions, the experts recommended the promotion of better and timely recognition of anxiety and depressive disorders and their classification in terms of symptom intensity and functional impairment, differentiating subthreshold mood swings from clinical forms, to foster outcome studies of psychotherapies in CMDs in Italy, to introduce a stepped care model structured according to levels of intensity of treatment, based on wellbeing support strategies in nonmedical contexts for subthreshold situations, self-help, support and psychoeducation as frontline interventions in mild clinical forms, evidence-based psychotherapies in moderate and severe forms, with the option of combining psychological treatment and appropriate drug therapy in the most severe cases.
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Eielsen M, Ulvenes PG, Røssberg JI, Høstmælingen A, Soma CS, Wampold BE. The Effectiveness of an Intensive Inpatient Psychotherapy Program for Chronic Depression: A naturalistic comparison with wait list. BMC Psychiatry 2022; 22:745. [PMID: 36451114 PMCID: PMC9710086 DOI: 10.1186/s12888-022-04381-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 11/09/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Patients with chronic depression (CD) typically have an early symptom onset, more psychiatric comorbidities, more treatment attempts, and more frequent and longer inpatient hospitalizations than patients with major depressive disorders. The main purpose of this study was to investigate the effectiveness of an intensive inpatient psychotherapy program for patients with chronic depression (CD). The primary research question was whether two intensive psychodynamic inpatient treatments, affect phobia therapy (APT) and VITA, were superior to an outpatient wait list condition, receiving treatment as usual (TAU), at completion of treatment. To investigate if a potential difference between the intensive treatment and the wait list control group was dependent on a specific psychotherapeutic model, the study contrasted two therapies with similar intensity, but different theoretical rationales. METHODS Two hundred eighty patients with CD were included in a naturalistic study. Patients were assessed at four time points; assessment, start of therapy, end of therapy and 1-year follow-up. Three comparisons were performed with patients matched across groups; Intensive inpatient treatment program (APT + VITA) vs wait list during treatment, APT vs VITA during treatment and APT vs VITA during follow-up. The outcome measure was the BDI-II. RESULTS Intensive inpatient treatment program vs. wait list showed a significant difference in favor of the intensive treatment. No significant differences were found between APT and VITA during therapy or follow-up; but both groups had large effect sizes during treatment, which were maintained during follow-up. CONCLUSIONS The intensive inpatient psychotherapy program showed superior effect on chronic depression over an outpatient wait list condition receiving treatment as usual (TAU), but no significant differences were found between the two intensive inpatient psychodynamic treatments. The results provide support for the effectiveness of an intensive inpatient psychotherapy program in treatment of chronic and severe disorders, such as CD, which could be of benefit for policymakers and the health care sector as they are allocating recourses efficiently. TRIAL REGISTRATION This study has been retrospectively registered on ClinicalTrials.gov (NCT05221567) on February 3rd, 2022.
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Affiliation(s)
- Mikkel Eielsen
- Institute of Clinical Medicine, University of Oslo, Sognsvanssveien 21, 0372, Oslo, Norway. .,Research Institute, Modum Bad Psychiatric Center, Modum Bad Research Institute, Badeveien 287, 3370, Vikersund, Norway.
| | - Pål Gunnar Ulvenes
- grid.5510.10000 0004 1936 8921Research Institute, Modum Bad Psychiatric Center, Modum Bad Research Institute, Badeveien 287, 3370 Vikersund, Norway ,grid.5510.10000 0004 1936 8921Department of Psychology, University of Oslo, Forskningsveien 3a, 0373 Oslo, Norway
| | - Jan Ivar Røssberg
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Sognsvanssveien 21, 0372 Oslo, Norway
| | - Andreas Høstmælingen
- grid.5510.10000 0004 1936 8921Department of Psychology, University of Oslo, Forskningsveien 3a, 0373 Oslo, Norway
| | - Christina S. Soma
- grid.223827.e0000 0001 2193 0096Department of Educational Psychology, University of Utah, 1721 Campus Center Dr., SAEC Room 3220, Salt Lake City, UT 84109 USA
| | - Bruce E. Wampold
- grid.5510.10000 0004 1936 8921Research Institute, Modum Bad Psychiatric Center, Modum Bad Research Institute, Badeveien 287, 3370 Vikersund, Norway ,grid.14003.360000 0001 2167 3675Department of Counseling Psychology, University of Wisconsin–Madison, 317 Education Building, 1000 Bascom Mall, Madison, WI 53706-1326 USA
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Strege MV, Richey JA, Siegle GJ. What does "staying well" after depression mean? Chronic low grade symptomatology after treatment for depression is common. J Affect Disord 2022; 317:228-235. [PMID: 36029878 PMCID: PMC10012845 DOI: 10.1016/j.jad.2022.08.075] [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: 11/06/2021] [Revised: 05/25/2022] [Accepted: 08/22/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Persistent low grade depression symptoms are common and impairing in major depressive disorder (MDD) yet rarely reported in treatment follow-up studies (Judd et al., 1998a; Kennedy et al., 2004), suggesting that extant sustained remission rates may not reflect this important clinical feature. Furthermore, no long-term MDD treatment follow-up study has reported on quality of life ratings across functioning levels and years throughout the follow-up period, thus the severity, breadth, and persistence of functional impairment remain unclear. Accordingly, the current study evaluated the course of MDD with consideration of low grade depressive symptomatology and holistic features (e.g., quality of life). METHODS We report long-term (9-14 years) follow-up data from individuals with MDD (N = 37) who underwent either Cognitive Therapy (CBT) or a course of selective serotonin reuptake inhibitor (SSRI) treatment. Patients provided retrospective reports of depression symptoms and quality of life in the years following treatment. RESULTS Chronic depression symptoms (most often mild in severity) and decreased quality of life in multiple domains are frequent and suggest poorer sustained remission rates than previously observed in the literature. LIMITATIONS Study limitations include small sample size recruited via convenience sampling methods. CONCLUSIONS Findings support a conceptualization of depression recovery that entails persistent symptoms and vulnerabilities. Clinical recommendations are provided for discussing these features of depression recovery with patients.
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Affiliation(s)
- Marlene V Strege
- University of Pittsburgh, Department of Psychiatry, United States of America.
| | - John A Richey
- Virginia Polytechnic Institute and State University, Department of Psychology, United States of America
| | - Greg J Siegle
- University of Pittsburgh, Department of Psychiatry, United States of America
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Identifying high-risk population of depression: association between metabolic syndrome and depression using a health checkup and claims database. Sci Rep 2022; 12:18577. [PMID: 36329095 PMCID: PMC9633757 DOI: 10.1038/s41598-022-22048-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
Depression and metabolic syndrome (MetS) are correlated, leading to an increased healthcare burden and decreased productivity. We aimed to investigate the association between MetS-related factors and depression using a health checkup and claims database. Individuals aged 18-75 years who underwent health examinations between 2014 and 2019 were enrolled in the study. Among 76,277 participants, "ever" and "incident" antidepressant users exhibited worse metabolic profiles and were more likely to be prescribed hypnotics and anxiolytics than "never" users. In a nested case-control study with a 1:10 ratio of incident users to controls, MetS was associated with incident antidepressant use (odds ratio, 1.53 [95% confidence interval 1.24-1.88]) adjusted for lifestyle information obtained from a self-administered questionnaire, medical history, and medications. Other metabolic traits also showed significant associations: body mass index (1.04 [1.02-1.06]), abdominal circumference per 10 cm (1.17 [1.08-1.27]), high blood pressure (1.17 [1.00-1.37]), glucose intolerance (1.29 [1.05-1.58]), and dyslipidemia (1.27 [1.08-1.51]). A bodyweight increase > 10 kg from age 20 years (1.46 [1.25-1.70]) was also significantly associated with incident antidepressant use. In conclusion, metabolic abnormalities were associated with incident antidepressant use and can be useful in identifying populations at high risk of depression.
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Moriarty AS, Meader N, Snell KIE, Riley RD, Paton LW, Dawson S, Hendon J, Chew-Graham CA, Gilbody S, Churchill R, Phillips RS, Ali S, McMillan D. Predicting relapse or recurrence of depression: systematic review of prognostic models. Br J Psychiatry 2022; 221:448-458. [PMID: 35048843 DOI: 10.1192/bjp.2021.218] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Relapse and recurrence of depression are common, contributing to the overall burden of depression globally. Accurate prediction of relapse or recurrence while patients are well would allow the identification of high-risk individuals and may effectively guide the allocation of interventions to prevent relapse and recurrence. AIMS To review prognostic models developed to predict the risk of relapse, recurrence, sustained remission, or recovery in adults with remitted major depressive disorder. METHOD We searched the Cochrane Library (current issue); Ovid MEDLINE (1946 onwards); Ovid Embase (1980 onwards); Ovid PsycINFO (1806 onwards); and Web of Science (1900 onwards) up to May 2021. We included development and external validation studies of multivariable prognostic models. We assessed risk of bias of included studies using the Prediction model risk of bias assessment tool (PROBAST). RESULTS We identified 12 eligible prognostic model studies (11 unique prognostic models): 8 model development-only studies, 3 model development and external validation studies and 1 external validation-only study. Multiple estimates of performance measures were not available and meta-analysis was therefore not necessary. Eleven out of the 12 included studies were assessed as being at high overall risk of bias and none examined clinical utility. CONCLUSIONS Due to high risk of bias of the included studies, poor predictive performance and limited external validation of the models identified, presently available clinical prediction models for relapse and recurrence of depression are not yet sufficiently developed for deploying in clinical settings. There is a need for improved prognosis research in this clinical area and future studies should conform to best practice methodological and reporting guidelines.
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Affiliation(s)
- Andrew S Moriarty
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, UK and Hull York Medical School, University of York, UK
| | - Nicholas Meader
- Centre for Reviews and Dissemination, University of York, UK and Cochrane Common Mental Disorders, University of York, UK
| | - Kym I E Snell
- Centre for Prognosis Research, School of Medicine, Keele University, UK
| | - Richard D Riley
- Centre for Prognosis Research, School of Medicine, Keele University, UK
| | - Lewis W Paton
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, UK
| | - Sarah Dawson
- Cochrane Common Mental Disorders, University of York, UK and Bristol Medical School, University of Bristol, UK
| | - Jessica Hendon
- Centre for Reviews and Dissemination, University of York, UK and Cochrane Common Mental Disorders, University of York, UK
| | | | - Simon Gilbody
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, UK and Hull York Medical School, University of York, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, UK and Cochrane Common Mental Disorders, University of York, UK
| | | | - Shehzad Ali
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, UK and Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, Canada
| | - Dean McMillan
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, UK and Hull York Medical School, University of York, UK
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Can integrating the Memory Support Intervention into cognitive therapy improve depression outcome? A randomized controlled trial. Behav Res Ther 2022; 157:104167. [DOI: 10.1016/j.brat.2022.104167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/12/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022]
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Lokman JC, Bockting CL. Pathways to depressive and anxiety disorders during and after the COVID-19 pandemic. Lancet Psychiatry 2022; 9:531-533. [PMID: 35717953 PMCID: PMC9212978 DOI: 10.1016/s2215-0366(22)00152-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
Affiliation(s)
- J C Lokman
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - C L Bockting
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
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Gjengedal RGH, Osnes K, Reme SE, Lagerveld SE, Johnson SU, Lending HD, Sandin K, Bjørndal MT, Hjemdal O. Changes in depression domains as predictors of return to work in common mental disorders. J Affect Disord 2022; 308:520-527. [PMID: 35460747 DOI: 10.1016/j.jad.2022.04.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/06/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Depression highly impairs function and reduces quality of life. Therefore, both symptomatic and functional recovery are important treatment goals. Depression consists of several cognitive, somatic, and affective symptom factors that differently affect function. However, it is unclear whether changes in these domains predict return to work (RTW) after treatment. METHODS Data were collected during treatment from patients on full or partial sick leave reporting depression symptoms (N = 300) at an out-patient clinic. Information on work status was assessed pre- and post-treatment and at 6 months follow-up. Multiple logistic regression was used to investigate if residualized changes in symptom factors predicted full RTW, controlling for gender, education level, and age. RESULTS Changes (as symptom improvement) in the cognitive, somatic, and affective factor scores each significantly predicted full RTW post-treatment and at follow-up for patients on full and partial sick leave, even after controlling for gender, education level, and age. The change in the somatic factor explained the largest proportion of variance for full work post-treatment in patients on full sick-leave, while change in the cognitive factor explained most unique variance for patients on graded sick leave. LIMITATIONS The sample consisted of a majority of women with a relatively high level of education. This study should be replicated in more heterogeneous samples. CONCLUSION Changes in depression symptom domains are significant predictors for RTW work post-treatment. The change in the somatic factor explained the largest proportion of variance in patients on full sick leave and thus may particularly influence RTW after treatment.
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Affiliation(s)
- Ragne G H Gjengedal
- Diakonhjemmet Hospital, Oslo, Norway; Norwegian University of Science and Technology, Trondheim, Norway.
| | | | - Silje E Reme
- Diakonhjemmet Hospital, Oslo, Norway; University of Oslo, Norway
| | | | - Sverre U Johnson
- Diakonhjemmet Hospital, Oslo, Norway; University of Oslo, Norway
| | | | - Kenneth Sandin
- Diakonhjemmet Hospital, Oslo, Norway; Norwegian University of Science and Technology, Trondheim, Norway
| | - Marianne T Bjørndal
- Diakonhjemmet Hospital, Oslo, Norway; Norwegian University of Science and Technology, Trondheim, Norway
| | - Odin Hjemdal
- Diakonhjemmet Hospital, Oslo, Norway; Norwegian University of Science and Technology, Trondheim, Norway
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Heuschen CBBCM, Mocking RJT, Zantvoord JB, Figueroa CA, Schene AH, Denys DAJP, Ruhé HG, Bockting CLH, Lok A. Suicidal ideation in remitted major depressive disorder predicts recurrence. J Psychiatr Res 2022; 151:65-72. [PMID: 35461004 DOI: 10.1016/j.jpsychires.2022.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/21/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Each year almost 800.000 people die from suicide, of which up to 87% are affected by major depressive disorder (MDD). Despite the strong association between suicidality and MDD, it remains unknown if suicidal symptoms during remission put remitted recurrent MDD patients (rrMDD) at risk for recurrence. METHODS At baseline we compared sociodemographic characteristics and suicidal symptoms in un-medicated rrMDD participants to matched never-depressed controls. We used the HDRS17 and IDS-SR30 to assess suicidal symptoms and depressive symptomatology. Next, we studied the longitudinal association between baseline suicidal symptoms and time to recurrence(s) in rrMDD during a 2.5-year follow-up period using cox regression analyses. Further, we studied with longitudinal data whether suicidal symptoms and depressive symptomatology were cross-sectionally associated using mixed model analysis. RESULTS At baseline, rrMDD participants (N = 73) had higher self-reported suicidal symptoms than matched never-depressed controls (N = 45) (χ2 = 12.09 p < .002). Self-reported suicidal symptoms were almost four times higher (27.9% versus 6.9%) compared to clinician-rated suicidal symptoms in rrMDD at baseline. Self-reported baseline suicidal symptoms, but not clinician-rated symptoms, predicted earlier MDD-recurrence during follow-up, independent of other residual depressive symptoms (χ2 = 7.26, p < .026). Higher suicidal symptoms were longitudinally related to higher depressive symptoms (HDRS17; F = 49.87, p < .001), IDS-SR30; (F = 22.36, p < .001). CONCLUSION This study showed that self-reported - but not clinician-rated - suicidal symptoms persist during remission in rrMDD and predict recurrence, independent from residual symptoms. We recommend to monitor both suicidal and depressive symptomatology during remission in rrMDD, preferably also including self-reported questionnaires apart from clinician-rated. It would be beneficial for future research to assess suicidality using questionnaires primarily designed for measuring suicidal ideation.
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Affiliation(s)
- Caroline B B C M Heuschen
- Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands.
| | - Roel J T Mocking
- Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands
| | - Jasper B Zantvoord
- Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands
| | - Caroline A Figueroa
- School of Social Welfare, University of California, Berkeley, United States; University Medical Centre Utrecht, Heidelberglaan, 100 3584 CX, Utrecht
| | - Aart H Schene
- Dept. of Psychiatry, Radboudumc, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Damiaan A J P Denys
- Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands
| | - Henricus G Ruhé
- Dept. of Psychiatry, Radboudumc, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Claudi L H Bockting
- Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands; Amsterdam Public Health Institute, Amsterdam UMC, Amsterdam, the Netherlands; Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
| | - Anja Lok
- Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands; Amsterdam Public Health Institute, Amsterdam UMC, Amsterdam, the Netherlands; Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
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Zemplényi A, Józwiak-Hagymásy J, Kovács S, Erdősi D, Boncz I, Tényi T, Osváth P, Voros V. Repetitive transcranial magnetic stimulation may be a cost-effective alternative to antidepressant therapy after two treatment failures in patients with major depressive disorder. BMC Psychiatry 2022; 22:437. [PMID: 35764989 PMCID: PMC9238085 DOI: 10.1186/s12888-022-04078-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/20/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The cost-effectiveness of treatment strategies for patients with Major Depressive Disorder (MDD) who have not responded to two adequate treatments with antidepressants (TRD) are still unclear. The aim of this analysis was to evaluate the cost-effectiveness of add-on repetitive Transcranial Magnetic Stimulation (rTMS) compared with standard treatment. METHODS A Markov-model simulated clinical events over one year from the perspective of healthcare payer. Third- and fourth-line treatment pathways (augmentation, antidepressant switch or combination, and Electro-Convulsive Therapy (ECT)) were defined based on medical practice guidelines. Transition probabilities were derived from a recent meta-analysis and scientific publications. Resource utilization and cost estimates were based on the patient-level database of a large university hospital. RESULTS Incremental Quality-Adjusted Life Years (QALYs) and costs were 0.053 and 785 €, respectively, corresponding to an Incremental Cost-Effectiveness Ratio (ICER) of 14,670 € per QALY. The difference in cost between standard treatment and rTMS is explained by the rTMS sessions used in acute (€660) and maintenance (€57/month) treatments, partly offset by lower hospital costs due to higher remission rates in the rTMS arm. Key parameters driving the ICER were incremental utility of remission, unit cost of rTMS treatment and remission rate. At a threshold of €22,243 add-on rTMS is a cost-effective alternative to pharmacotherapy. Evidence on long-term effectiveness is not yet available, so results are estimated for a one-year period. CONCLUSION Not only does rTMS treatment have beneficial clinical effects compared with drug therapy in TRD, but it also appears to offer good value-for-money, especially in centres with larger numbers of patients where unit costs can be kept low.
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Affiliation(s)
- Antal Zemplényi
- Centre for Health Technology Assessment and Pharmacoeconomic Research, Faculty of Pharmacy, University of Pécs, Rákóczi street 2, Pécs, H-7623, Hungary.
| | - Judit Józwiak-Hagymásy
- grid.9679.10000 0001 0663 9479Centre for Health Technology Assessment and Pharmacoeconomic Research, Faculty of Pharmacy, University of Pécs, Rákóczi street 2, Pécs, H-7623 Hungary
| | - Sándor Kovács
- grid.9679.10000 0001 0663 9479Centre for Health Technology Assessment and Pharmacoeconomic Research, Faculty of Pharmacy, University of Pécs, Rákóczi street 2, Pécs, H-7623 Hungary
| | - Dalma Erdősi
- grid.9679.10000 0001 0663 9479Centre for Health Technology Assessment and Pharmacoeconomic Research, Faculty of Pharmacy, University of Pécs, Rákóczi street 2, Pécs, H-7623 Hungary
| | - Imre Boncz
- grid.9679.10000 0001 0663 9479Institute for Health Insurance, Faculty of Health Sciences, University of Pecs, Pécs, Hungary
| | - Tamás Tényi
- grid.9679.10000 0001 0663 9479Department of Psychiatry and Psychotherapy, Medical School, University of Pecs, Pecs, Hungary
| | - Péter Osváth
- grid.9679.10000 0001 0663 9479Department of Psychiatry and Psychotherapy, Medical School, University of Pecs, Pecs, Hungary
| | - Viktor Voros
- grid.9679.10000 0001 0663 9479Department of Psychiatry and Psychotherapy, Medical School, University of Pecs, Pecs, Hungary
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Bockting C, Legemaat AM, van der Stappen JGJ, Geurtsen GJ, Semkovska M, Burger H, Bergfeld IO, Lous N, Denys DAJP, Brouwer M. Augmenting neurocognitive remediation therapy to Preventive Cognitive Therapy for partially remitted depressed patients: protocol of a pragmatic multicentre randomised controlled trial. BMJ Open 2022; 12:e063407. [PMID: 35738653 PMCID: PMC9226921 DOI: 10.1136/bmjopen-2022-063407] [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: 11/23/2022] Open
Abstract
INTRODUCTION Major depressive disorder (MDD) affects 163 million people globally every year. Individuals who experience subsyndromal depressive symptoms during remission (ie, partial remission of MDD) are especially at risk for a return to a depressive episode within an average of 4 months. Simultaneously, partial remission of MDD is associated with work and (psycho)social impairment and a lower quality of life. Brief psychological interventions such as preventive cognitive therapy (PCT) can reduce depressive symptoms or relapse for patients in partial remission, although achieving full remission with treatment is still a clinical challenge. Treatment might be more effective if cognitive functioning of patients is targeted as well since cognitive problems are the most persisting symptom in partial remission and predict poor treatment response and worse functioning. Studies show that cognitive functioning of patients with (remitted) MDD can be improved by online neurocognitive remediation therapy (oNCRT). Augmenting oNCRT to PCT might improve treatment effects for these patients by strengthening their cognitive functioning alongside a psychological intervention. METHODS AND ANALYSIS This study will examine the effectiveness of augmenting oNCRT to PCT in a pragmatic national multicentre superiority randomised controlled trial. We will include 115 adults partially remitted from MDD with subsyndromal depressive symptoms defined as a Hamilton Depression Rating Scale score between 8 and 15. Participants will be randomly allocated to PCT with oNCRT, or PCT only. Primary outcome measure is the effect on depressive symptomatology over 1 year. Secondary outcomes include time to relapse, cognitive functioning, quality of life and healthcare costs. This first dual approach study of augmenting oNCRT to PCT might facilitate full remission in partially remitted individuals as well as prevent relapse over time. ETHICS AND DISSEMINATION Ethical approval was obtained by Academic Medical Center, Amsterdam. Outcomes will be made publicly available. TRIAL REGISTRATION NUMBER NL9582.
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Affiliation(s)
- Claudi Bockting
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Amanda M Legemaat
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Gert J Geurtsen
- Department of Medical Psychology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Maria Semkovska
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Huibert Burger
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Isidoor O Bergfeld
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Damiaan A J P Denys
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Marlies Brouwer
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
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Sorge A, Borrelli G, Saita E, Perrella R. Violence Risk Assessment and Risk Management: Case-Study of Filicide in an Italian Woman. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6967. [PMID: 35742216 PMCID: PMC9223206 DOI: 10.3390/ijerph19126967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND At an international level, the risk assessment and management process of violent offenders follows a standard method that implies well-defined theoretical models and the use of scientifically validated tools. In Italy, this process is still highly discretionary. The aim of this study is to highlight the advantages deriving from the use of risk assessment tools within the framework of a single case study; Methods: Recidivism risk and social dangerousness of an Italian woman perpetrator of filicide were assessed through the administration of the Level of Service/Case Management Inventory (LS/CMI) instrument supported by Historical Clinical Risk-20 Version 3 (HCR-20 V3); Results: The administration of LS/CMI showed that, in this single case, the subcomponents represent a criminogenic risk/need factor are: Family/Marital, Companions, Alcohol and Drug Problem and Leisure; while constituting strengths: employment and the absence of a Pro-criminal Orientation and an Antisocial Pattern; Conclusions: Data collected through LS/CMI indicated life areas of a single case, which should be emphasised not only to assess the risk of re-offending and social dangerousness but also for a social rehabilitation programme more suited to the subject. This study demonstrates that the LS/CMI assessment tool is suitable for the Italian context.
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Affiliation(s)
- Antonia Sorge
- Department of Psychology, Catholic University of the Sacred Heart, 20123 Milan, Italy;
| | - Giovanni Borrelli
- Department of Psychology, University of Campania Luigi Vanvitelli, 81100 Caserta, Italy; (G.B.); (R.P.)
| | - Emanuela Saita
- Department of Psychology, Catholic University of the Sacred Heart, 20123 Milan, Italy;
| | - Raffaella Perrella
- Department of Psychology, University of Campania Luigi Vanvitelli, 81100 Caserta, Italy; (G.B.); (R.P.)
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La Marca R, Pallich G, Holtforth MG, Hochstrasser B. Higher Resting Cardiovagal Activity Predicts Larger Decrease of Depressive Symptoms in Inpatients Treated for Stress-Related Depression. J PSYCHOPHYSIOL 2022. [DOI: 10.1027/0269-8803/a000299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Depression is one of the most prevalent mental disorders, with treatment outcomes generally being unsatisfactory. The identification of outcome predictors could contribute to improving diagnosis, treatment, and outcome. Heart rate variability (HRV), an index of cardiovagal activity, has been proposed as a potential correlate of depression as well as a predictor of treatment effectiveness. The aim of the present study was to examine if HRV at baseline could predict the outcome of inpatient treatment for stress-related depressive disorder (SRDD). Depressive symptoms of n = 57 inpatients with an SRDD, who were treated in a specialized burnout ward, were assessed using the Beck Depression Inventory (BDI) at the beginning, the end of treatment, and at 3-month follow-up. HRV (i.e., RMSSD, the root mean square of successive RR interval differences) was determined from a five-minute measurement in the supine position. RMSSD was not significantly associated with the BDI score at the beginning, end, and follow-up. Higher RMSSD was revealed to be a significant predictor of a stronger decrease in depressive severity from the beginning to the end of the treatment. Thereby, the regression model explained 7.6% of the total variance in the BDI decrease. The results revealed initial HRV to predict a larger decrease in depressive severity. Therefore, resting HRV represents a physiological resource and index of successful neurovisceral interaction, which supports inpatients in benefitting from specialized treatment.
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Affiliation(s)
- Roberto La Marca
- Centre for Stress-Related Disorders, Clinica Holistica Engiadina SA, Susch, Switzerland
- Clinical Psychology and Psychotherapy, University of Zurich, Switzerland
| | - Gianandrea Pallich
- Clinical Psychology and Psychotherapy, University of Zurich, Switzerland
- Clinical Psychology and Psychotherapy, University of Bern, Switzerland
- Private Hospital Meiringen, Switzerland
| | - Martin grosse Holtforth
- Clinical Psychology and Psychotherapy, University of Bern, Switzerland
- Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
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Karyotaki E, Araya R, Kessler RC, Waqas A, Bhana A, Rahman A, Matsuzaka CT, Miguel C, Lund C, Garman EC, Nakimuli-Mpungu E, Petersen I, Naslund JA, Schneider M, Sikander S, Jordans MJD, Abas M, Slade P, Walters S, Brugha TS, Furukawa TA, Amanvermez Y, Mello MF, Wainberg ML, Cuijpers P, Patel V. Association of Task-Shared Psychological Interventions With Depression Outcomes in Low- and Middle-Income Countries: A Systematic Review and Individual Patient Data Meta-analysis. JAMA Psychiatry 2022; 79:430-443. [PMID: 35319740 PMCID: PMC8943620 DOI: 10.1001/jamapsychiatry.2022.0301] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/02/2022] [Indexed: 01/14/2023]
Abstract
Importance Task sharing, the training of nonspecialist workers with no formal experience in counseling, is a promising strategy for addressing the large gap in treatment for depression in low- and middle-income countries (LMICs). Objective To examine the outcomes and moderators of task-shared psychological interventions associated with depression severity, response, and remission. Data Sources Systematic literature searches in PubMed, Embase, PsycINFO, and Cochrane Library up to January 1, 2021. Study Selection Randomized clinical trials (RCTs) of task-shared psychological interventions compared with control conditions for adults with depressive symptoms in LMICs were included. Data Extraction and Synthesis Two researchers independently reviewed the titles, abstracts, and full text of articles from an existing generic meta-analytic database that includes all RCTs on psychotherapy for depression. A systematic review and individual patient data (IPD) meta-analysis was used to estimate the outcomes of task-shared psychological interventions across patient characteristics using mixed-effects models. Procedures for abstracting data and assessing data quality and validity followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Main Outcomes and Measures Primary outcome was reduction in depression symptom severity measured by the 9-item Patient Health Questionnaire (PHQ-9). Response and remission rates were also estimated. Results Of 13 eligible trials, 11 (4145 participants) contributed IPD. Task-shared psychological interventions were associated with a greater decrease in depressive symptom severity than control conditions (Hedges g, 0.32; 95% CI, -0.26 to -0.38). Participants in the intervention groups had a higher chance of responding (odds ratio, 2.11; 95% CI, 1.60 to 2.80) and remitting (odds ratio, 1.87; 95% CI, 1.20 to 1.99). The presence of psychomotor symptoms was significantly associated with the outcomes of task-shared psychological interventions (β [SE], -1.21 [0.39]; P = .002). No other significant associations were identified. Heterogeneity among the trials with IPD was 74% (95% CI, 53%-86%). Conclusions and Relevance In this meta-analysis of IPD, task-shared psychological interventions were associated with a larger reduction in depressive symptom severity and a greater chance of response and remission than control conditions. These findings show potential for the use of task-sharing of psychological interventions across different groups of patients with depression. Further research would help identify which people are most likely to benefit and strengthen larger-scale implementation of this strategy to address the burden of depression in LMICs.
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Affiliation(s)
- Eirini Karyotaki
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Ricardo Araya
- Center for Global Mental Health and Primary Care Research, Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Ahmed Waqas
- Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Arvin Bhana
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Atif Rahman
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Camila T. Matsuzaka
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Clara Miguel
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Crick Lund
- Center for Global Mental Health and Primary Care Research, Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Emily C. Garman
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Marguerite Schneider
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Siham Sikander
- Human Development Research Foundation, Islamabad, Pakistan
- Health Services Academy, Islamabad, Pakistan
| | - Mark J. D. Jordans
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Melanie Abas
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Pauline Slade
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Stephen Walters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Traolach S. Brugha
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Toshi A. Furukawa
- Departments of Health Promotion and Human Behaviour and of Clinical Epidemiology, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Yagmur Amanvermez
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Marcelo F. Mello
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
- Albert Einstein Israelite Hospital, Medicine School, São Paulo, Brazil
| | - Milton L. Wainberg
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York
| | - Pim Cuijpers
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
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Otto MW, Birk JL, Fitzgerald HE, Chauvin GV, Gold AK, Carl JR. Stage models for major depression: Cognitive behavior therapy, mechanistic treatment targets, and the prevention of stage transition. Clin Psychol Rev 2022; 95:102172. [DOI: 10.1016/j.cpr.2022.102172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/12/2022] [Accepted: 05/18/2022] [Indexed: 11/17/2022]
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Krings A, Simon J, Carré A, Blairy S. Can Cognitive Control and Attentional Biases Explain More of the Variance in Depressive Symptoms Than Behavioral Processes? A Path Analysis Approach. Front Psychol 2022; 13:809387. [PMID: 35401370 PMCID: PMC8985875 DOI: 10.3389/fpsyg.2022.809387] [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] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/09/2022] [Indexed: 12/26/2022] Open
Abstract
Background This study explored the proportion of variance in depressive symptoms explained by processes targeted by BA (activation, behavioral avoidance, anticipatory pleasure, and brooding), and processes targeted by cognitive control training (cognitive control, attentional biases, and brooding). Methods Five hundred and twenty adults were recruited. They completed a spatial cueing task as a measure of attentional biases and a cognitive task as a measure of cognitive control and completed self-report measures of activation, behavioral avoidance, anticipatory pleasure, brooding, and depressive symptoms. With path analysis models, we explored the relationships between these predictors and depressive symptoms. Results BA processes were significant predictors of depressive symptoms, and activation partially predicted anticipatory pleasure, which in turn predicted depressive symptoms. However, cognitive control and attentional biases predicted neither brooding nor depressive symptoms. A comprehensive model including all processes fit the data but did not explain more of the variance in brooding or depressive symptoms than a model including only BA processes. Limitations The spatial cueing task was associated with low reliability and the use of a non-clinical sample limited the generalizability of the conclusions. Conclusion Activation, behavioral avoidance, brooding, and anticipatory pleasure are relevant processes to target in order to reduce depressive symptoms, while cognitive control and attentional biases are not.
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Affiliation(s)
- Audrey Krings
- Psychology and Neuroscience of Cognition Research Unit (PsyNCog), Université de Liège, Liège, Belgium
| | - Jessica Simon
- Psychology and Neuroscience of Cognition Research Unit (PsyNCog), Université de Liège, Liège, Belgium
| | - Arnaud Carré
- LIP/PC2S, Université Savoie Mont Blanc, Université de Grenoble Alpes, Chambéry, France
| | - Sylvie Blairy
- Psychology and Neuroscience of Cognition Research Unit (PsyNCog), Université de Liège, Liège, Belgium
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48
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Initial Severity and Depressive Relapse in Cognitive Behavioral Therapy and Antidepressant Medications: An Individual Patient Data Meta-analysis. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-021-10281-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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49
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Pietrek A, Kangas M, Kliegl R, Rapp MA, Heinzel S, van der Kaap-Deeder J, Heissel A. Basic psychological need satisfaction and frustration in major depressive disorder. Front Psychiatry 2022; 13:962501. [PMID: 36203824 PMCID: PMC9530199 DOI: 10.3389/fpsyt.2022.962501] [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: 06/06/2022] [Accepted: 08/19/2022] [Indexed: 11/15/2022] Open
Abstract
Basic psychological needs theory postulates that a social environment that satisfies individuals' three basic psychological needs of autonomy, competence, and relatedness leads to optimal growth and well-being. On the other hand, the frustration of these needs is associated with ill-being and depressive symptoms foremost investigated in non-clinical samples; yet, there is a paucity of research on need frustration in clinical samples. Survey data were compared between adult individuals with major depressive disorder (MDD; n = 115; 48.69% female; 38.46 years, SD = 10.46) with those of a non-depressed comparison sample (n = 201; 53.23% female; 30.16 years, SD = 12.81). Need profiles were examined with a linear mixed model (LMM). Individuals with depression reported higher levels of frustration and lower levels of satisfaction in relation to the three basic psychological needs when compared to non-depressed adults. The difference between depressed and non-depressed groups was significantly larger for frustration than satisfaction regarding the needs for relatedness and competence. LMM correlation parameters confirmed the expected positive correlation between the three needs. This is the first study showing substantial differences in need-based experiences between depressed and non-depressed adults. The results confirm basic assumptions of the self-determination theory and have preliminary implications in tailoring therapy for depression.
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Affiliation(s)
- Anou Pietrek
- Social and Preventive Medicine, Department of Sports and Health Sciences, Faculty of Human Science, University of Potsdam, Potsdam, Germany
| | - Maria Kangas
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Reinhold Kliegl
- Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany
| | - Michael A Rapp
- Social and Preventive Medicine, Department of Sports and Health Science, Intra-Faculty Unit "Cognitive Sciences", Faculty of Human Science, and Faculty of Health Sciences Brandenburg, Research Area Services Research and e-Health, University of Potsdam, Potsdam, Germany
| | - Stephan Heinzel
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | | | - Andreas Heissel
- Social and Preventive Medicine, Department of Sports and Health Science, Intra-Faculty Unit "Cognitive Sciences", Faculty of Human Science, and Faculty of Health Sciences Brandenburg, Research Area Services Research and e-Health, University of Potsdam, Potsdam, Germany
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50
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Vittengl JR, Clark LA, Thase ME, Jarrett RB. Levels of depressed mood and low interest for two years after response to cognitive therapy for recurrent depression. Behav Res Ther 2022; 148:103996. [PMID: 34775120 PMCID: PMC8712398 DOI: 10.1016/j.brat.2021.103996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/13/2021] [Accepted: 11/07/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) involves depressed mood (high negative affect, predominantly) and low interest/pleasure (low positive affect). In past research, negative affect has improved more than positive affect during acute-phase antidepressant medication or cognitive therapy (CT). We extended this literature by differentiating depressed mood and two dimensions of low interest (general and sexual), assessing persistence of symptom differences after acute-phase CT response, and testing whether continuation treatment acted differently on depressed mood versus low interest. METHODS We analyzed data from two randomized controlled trials. Patients with recurrent MDD first received acute-phase CT. Then, responders were randomized to 8-month continuation treatments and assessed for 16-24 additional months. RESULTS Depressed mood and low general interest improved more than low sexual interest during acute-phase CT. Among responders, these symptom differences persisted for at least 2 years and were not changed by continuation CT or antidepressant medication. LIMITATIONS Generalization of findings to other patient populations and treatments is uncertain. Depressed mood and low interest scales were constructed from standard symptom measures and overlapped empirically. CONCLUSIONS Less improvement during CT, and persistent low sexual interest despite continuation treatment, highlights the need for MDD treatments more effectively targeting this positive affective symptom.
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Affiliation(s)
| | - Lee Anna Clark
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Michael E Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robin B Jarrett
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
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