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Munsif M, Sajjad M, Ullah M, Tarekegn AN, Cheikh FA, Tsakanikas P, Muhammad K. Optimized efficient attention-based network for facial expressions analysis in neurological health care. Comput Biol Med 2024; 179:108822. [PMID: 38986286 DOI: 10.1016/j.compbiomed.2024.108822] [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: 01/24/2024] [Revised: 06/25/2024] [Accepted: 06/25/2024] [Indexed: 07/12/2024]
Abstract
Facial Expression Analysis (FEA) plays a vital role in diagnosing and treating early-stage neurological disorders (NDs) like Alzheimer's and Parkinson's. Manual FEA is hindered by expertise, time, and training requirements, while automatic methods confront difficulties with real patient data unavailability, high computations, and irrelevant feature extraction. To address these challenges, this paper proposes a novel approach: an efficient, lightweight convolutional block attention module (CBAM) based deep learning network (DLN) to aid doctors in diagnosing ND patients. The method comprises two stages: data collection of real ND patients, and pre-processing, involving face detection and an attention-enhanced DLN for feature extraction and refinement. Extensive experiments with validation on real patient data showcase compelling performance, achieving an accuracy of up to 73.2%. Despite its efficacy, the proposed model is lightweight, occupying only 3MB, making it suitable for deployment on resource-constrained mobile healthcare devices. Moreover, the method exhibits significant advancements over existing FEA approaches, holding tremendous promise in effectively diagnosing and treating ND patients. By accurately recognizing emotions and extracting relevant features, this approach empowers medical professionals in early ND detection and management, overcoming the challenges of manual analysis and heavy models. In conclusion, this research presents a significant leap in FEA, promising to enhance ND diagnosis and care.The code and data used in this work are available at: https://github.com/munsif200/Neurological-Health-Care.
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Affiliation(s)
| | - Muhammad Sajjad
- Digital Image Processing Lab, Department of Computer Science, Islamia College, Peshawar, 25000, Pakistan; Department of Computer Science, Norwegian University for Science and Technology, 2815, Gjøvik, Norway
| | - Mohib Ullah
- Intelligent Systems and Analytics Research Group (ISA), Department of Computer Science, Norwegian University for Science and Technology, 2815, Gjøvik, Norway
| | - Adane Nega Tarekegn
- Department of Computer Science, Norwegian University for Science and Technology, 2815, Gjøvik, Norway
| | - Faouzi Alaya Cheikh
- Department of Computer Science, Norwegian University for Science and Technology, 2815, Gjøvik, Norway
| | - Panagiotis Tsakanikas
- Institute of Communication and Computer Systems, National Technical University of Athens, 15773 Athens, Greece
| | - Khan Muhammad
- Visual Analytics for Knowledge Laboratory (VIS2KNOW Lab), Department of Applied Artificial Intelligence, School of Convergence, College of Computing and Informatics, Sungkyunkwan University, Seoul 03063, Republic of Korea.
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Kuut TA, Buffart LM, Braamse AMJ, Müller F, Knoop H. Is the effect of cognitive behaviour therapy for chronic fatigue syndrome (ME/CFS) moderated by the presence of comorbid depressive symptoms? A meta-analysis of three treatment delivery formats. J Psychosom Res 2024; 184:111850. [PMID: 38970879 DOI: 10.1016/j.jpsychores.2024.111850] [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: 03/11/2024] [Revised: 06/04/2024] [Accepted: 06/21/2024] [Indexed: 07/08/2024]
Abstract
OBJECTIVE Cognitive behaviour therapy (CBT) for fatigue in chronic fatigue syndrome (ME/CFS) leads to a significant reduction of fatigue and disability and is available in different treatment delivery formats, i.e. internet-based, individual face-to-face and group face-to-face. The aim of this study was to investigate whether moderation of the effects of CBT by clinically relevant depressive symptoms varies between CBT delivery formats. METHODS Data from six randomised controlled trials (n = 1084 patients) were pooled. Moderation of clinically relevant depressive symptoms (Brief Depression Inventory for Primary Care) in different treatment formats on fatigue severity (Checklist Individual Strength, subscale fatigue severity), functional impairment (Sickness Impact Profile-8) and physical functioning (Short Form-36, subscale physical functioning) was investigated using linear mixed model analyses and interaction tests. Differences in percentages of patients no longer severely fatigued post-CBT were studied by calculating relative risks. RESULTS The moderator effect of depressive symptoms on fatigue severity varied by delivery format. In internet-based CBT, ME/CFS patients with depressive symptoms showed less reduction in fatigue, and were more often still severely fatigued post-treatment than patients without depressive symptoms. In individual and group face-to-face CBT, no significant difference in treatment effect on fatigue severity was found between patients with and without depressive symptoms. No moderation was found for the other outcomes. CONCLUSION In internet-based CBT, ME/CFS patients with comorbid depressive symptoms benefit less, making face-to-face CBT currently the first-choice delivery format for these patients. Internet-based CBT should be further developed to improve its effectiveness for ME/CFS patients with depressive symptoms.
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Affiliation(s)
- T A Kuut
- Amsterdam UMC Location University of Amsterdam, Department of Medical Psychology, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands.
| | - L M Buffart
- Radboud University Medical Center, Department of Medical BioSciences, Nijmegen, the Netherlands
| | - A M J Braamse
- Amsterdam UMC Location University of Amsterdam, Department of Medical Psychology, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands
| | - F Müller
- Amsterdam UMC Location University of Amsterdam, Department of Medical Psychology, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands
| | - H Knoop
- Amsterdam UMC Location University of Amsterdam, Department of Medical Psychology, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands
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Guo W, Nazari N, Sadeghi M. Cognitive-behavioral treatment for insomnia and mindfulness-based stress reduction in nurses with insomnia: a non-inferiority internet delivered randomized controlled trial. PeerJ 2024; 12:e17491. [PMID: 39071123 PMCID: PMC11283175 DOI: 10.7717/peerj.17491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/09/2024] [Indexed: 07/30/2024] Open
Abstract
Background Insomnia is a highly prevalent sleep disorder frequently comorbid with mental health conditions in nurses. Despite the effectiveness of evidence-based cognitive behavioral therapy for insomnia (CBT-I), there is a critical need for alternative approaches. This study investigated whether internet-delivered mindfulness-based stress reduction (IMBSR) for insomnia could be an alternative to internet-delivered CBT-I (ICBT-I). Objective The hypothesis was that the IMBSR would be noninferior to the ICBT-I in reducing the severity of insomnia among nurses with insomnia. Additionally, it was expected that ICBT-I would produce a greater reduction in the severity of insomnia and depression than IMBSR. Method Among 240 screened nurses, 134 with insomnia were randomly allocated (IMBSR, n = 67; ICBT-I, n = 67). The assessment protocol comprised clinical interviews and self-reported outcome measures, including the Insomnia Severity Index (ISI), Patient Health Questionnaire-9 (PHQ-9), the 15-item Five Facet Mindfulness Questionnaire (FFMQ), and the Client Satisfaction Questionnaire (CSQ-I). Results The retention rate was 55% with 77.6% (n = 104) of participants completing the study. At post-intervention, the noninferiority analysis of the ISI score showed that the upper limit of the 95% confidence interval was 4.88 (P = 0.46), surpassing the pre-specified noninferiority margin of 4 points. Analysis of covariance revealed that the ICBT-I group had significantly lower ISI (Cohen's d = 1.37) and PHQ-9 (Cohen's d = 0.71) scores than did the IMBSR group. In contrast, the IMBSR group showed a statistically significant increase in the FFMQ-15 score (Cohen's d = 0.67). Within-group differences showed that both the IMBSR and ICBT-I were effective at reducing insomnia severity and depression severity and improving mindfulness. Conclusion Overall, nurses demonstrated high levels of satisfaction and adherence to both interventions. The IMBSR significantly reduced insomnia severity and depression, but the findings of this study do not provide strong evidence that the IMBSR is at least as effective as the ICBT-I in reducing insomnia symptoms among nurses with insomnia. The ICBT-I was found to be significantly superior to the IMBSR in reducing insomnia severity, making it a recommended treatment option for nurses with insomnia.
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Affiliation(s)
- Wanran Guo
- School of Public Policy and Administration, Nanchang University, Nanchang, Nanchang, China
| | - Nabi Nazari
- Department of Psychology, Faculty of Human Sciences, University of Lorestan, Khorramabad, Lorestan, Iran
| | - Masoud Sadeghi
- Department of Psychology, Faculty of Human Sciences, University of Lorestan, Khorramabad, Lorestan, Iran
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Stover CS, Holland ML, Martin E, Modanesi E, Fish MC, Beebe R. Comparing in Person to Telehealth Delivery of a Family Violence Intervention. Clin Psychol Psychother 2024; 31:e3034. [PMID: 39089327 DOI: 10.1002/cpp.3034] [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: 01/15/2024] [Revised: 07/03/2024] [Accepted: 07/04/2024] [Indexed: 08/03/2024]
Abstract
There is increasing evidence that therapy and intervention services delivered by telehealth are effective at reducing a variety of mental health symptoms. Limited studies have indicated online services can reduce intimate partner violence (IPV), but none have tested in-person compared to telehealth-delivered interventions for men who have used IPV. Clinical outcome data from 311 parents (192 fathers and 119 linked coparent mothers) engaged in the Fathers for Change (F4C) intervention following referral by child protective services for IPV were examined to determine if in-person delivery of the intervention differed in terms of client treatment engagement and retention or outcomes. Parents who enrolled during a 1-year period prior to the COVID pandemic received their F4C therapy in person, while those who enrolled during the pandemic received their intake and most of their sessions via telehealth delivery. Parents reported significantly greater symptoms of depression, anxiety, and stress prior to treatment if they enrolled prior to COVID than if they enrolled during the pandemic. There were few differences in completion rates or outcomes based on in-person compared to telehealth delivery. Fathers were slightly more likely to complete treatment and attended a significantly higher percentage of their sessions when it was delivered by telehealth during COVID. Fathers reported significantly lower stress scores posttreatment when they received COVID telehealth delivery compared to prior to COVID in-person delivery of F4C. These findings suggest that telehealth may be an appropriate and viable option for the delivery of IPV interventions for families.
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Affiliation(s)
- Carla Smith Stover
- Child Study Center, Yale University School of Medicine Child Study Center, New Haven, CT, USA
| | - Margaret L Holland
- Child Study Center, Yale University School of Medicine Child Study Center, New Haven, CT, USA
- Department of Population Health & Leadership, University of New Haven, West Haven, CT, USA
| | - Ellen Martin
- Child Study Center, Yale University School of Medicine Child Study Center, New Haven, CT, USA
| | - Edoardo Modanesi
- Child Study Center, Yale University School of Medicine Child Study Center, New Haven, CT, USA
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
| | - Meghan Clough Fish
- Injury Prevention Center, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Rebecca Beebe
- Injury Prevention Center, Connecticut Children's Medical Center, Hartford, CT, USA
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Roshanghalb A, Hansen B, Rudoler D, Best MW. Predicting CBT modality, treatment participation, and reliable improvements for individuals with anxiety and depression in a specialized mental health centre: a retrospective population-based cohort study. BMC Psychiatry 2024; 24:390. [PMID: 38783227 PMCID: PMC11112857 DOI: 10.1186/s12888-024-05817-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: 07/19/2023] [Accepted: 05/05/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Cognitive Behaviour Therapy (CBT) is one of the most successful therapeutic approaches for treating anxiety and depression. Clinical trials show that for some clients, internet-based CBT (eCBT) is as effective as other CBT delivery modes. However, the fidelity of these effects may be weakened in real-world settings where clients and providers have the freedom to choose a CBT delivery mode and switch treatments at any time. The purpose of this study is to measure the CBT attendance rate and identify client-level characteristics associated with delivery mode selection and having reliable and clinically significant improvement (RCSI) of treatment in each delivery mode in a real-world CBT outpatient program. METHODS This is a retrospective cohort analysis of electronic medical records collected between May 1, 2019, and March 31, 2022, at Ontario Shores Centre for Mental Health Sciences. Regression models were used to investigate the impact of individual client characteristics on participation and achieving RCSI of different CBT delivery modes. RESULTS Our data show a high attendance rate for two and more CBT sessions across all modalities (98% of electronic, 94% of group, 100% of individual, and 99% of mixed CBT). Individuals were more likely to enter mixed and group CBT modality if they were younger, reported being employed, and reported higher depression severity at the baseline. Among the four modalities of CBT delivery, group CBT clients were least likely to have RCSI. Of those who started sessions, clients were significantly more likely to experience RCSI on the Patient Health Questionnaire (PHQ)-9 and the Generalized Anxiety Disorder (GAD)-7 if they were employed, reported more severe symptoms at baseline, and were living in the most deprived neighborhoods. CONCLUSIONS This study will contribute to the body of knowledge about the implementation and treatment planning of different CBT delivery modes in real-world settings. With the changing clinical environment, it is possible to advocate for the adoption of the eCBT intervention to improve therapy practices and achieve better treatment success. The findings can help guide future CBT program planning based on client socio-demographic characteristics, allowing the optimal therapy type to be targeted to the right client at the right time.
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Affiliation(s)
- Afsaneh Roshanghalb
- Faculty of Health Sciences, The University of Ontario Institute of Technology, Oshawa, Ontario, Canada.
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada.
| | - Bojay Hansen
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
| | - David Rudoler
- Faculty of Health Sciences, The University of Ontario Institute of Technology, Oshawa, Ontario, Canada
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
| | - Michael W Best
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
- Departments of Psychology and Psychological Clinical Science, University of Toronto, Scarborough, Ontario, Canada
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Zandieh S, Abdollahzadeh SM, Sadeghirad B, Wang L, McCabe RE, Yao L, Inness BE, Pathak A, Couban RJ, Crandon H, Torabiardakani K, Bieling P, Busse JW. Therapist-guided remote versus in-person cognitive behavioural therapy: a systematic review and meta-analysis of randomized controlled trials. CMAJ 2024; 196:E327-E340. [PMID: 38499303 PMCID: PMC10948182 DOI: 10.1503/cmaj.230274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) has been shown to be effective for several psychiatric and somatic conditions; however, most randomized controlled trials (RCTs) have administered treatment in person and whether remote delivery is similarly effective remains uncertain. We sought to compare the effectiveness of therapist-guided remote CBT and in-person CBT. METHODS We systematically searched MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials from inception to July 4, 2023, for RCTs that enrolled adults (aged ≥ 18 yr) presenting with any clinical condition and that randomized participants to either therapist-guided remote CBT (e.g., teleconference, videoconference) or in-person CBT. Paired reviewers assessed risk of bias and extracted data independently and in duplicate. We performed random-effects model meta-analyses to pool patient-important primary outcomes across eligible RCTs as standardized mean differences (SMDs). We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance to assess the certainty of evidence and used the Instrument to Assess the Credibility of Effect Modification Analyses (ICEMAN) to rate the credibility of subgroup effects. RESULTS We included 54 RCTs that enrolled a total of 5463 patients. Seventeen studies focused on treatment of anxiety and related disorders, 14 on depressive symptoms, 7 on insomnia, 6 on chronic pain or fatigue syndromes, 5 on body image or eating disorders, 3 on tinnitus, 1 on alcohol use disorder, and 1 on mood and anxiety disorders. Moderate-certainty evidence showed little to no difference in the effectiveness of therapist-guided remote and in-person CBT on primary outcomes (SMD -0.02, 95% confidence interval -0.12 to 0.07). INTERPRETATION Moderate-certainty evidence showed little to no difference in the effectiveness of in-person and therapist-guided remote CBT across a range of mental health and somatic disorders, suggesting potential for the use of therapist-guided remote CBT to facilitate greater access to evidence-based care. Systematic review registration: Open Science Framework (https://osf.io/7asrc).
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Affiliation(s)
- Sara Zandieh
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Seyedeh Maryam Abdollahzadeh
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Behnam Sadeghirad
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Li Wang
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Randi E McCabe
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Liam Yao
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Briar E Inness
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Ananya Pathak
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Rachel J Couban
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Holly Crandon
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Kian Torabiardakani
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Peter Bieling
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Jason W Busse
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont.
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7
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Wang C, Si H, Bian Y, Qiao X, Ji L, Liu Q, Wang W, Yu J, Li Y, Zhou W, Yue W, Liu J, Jin Y. Effectiveness of subjective support-focused cognitive behavioral therapy on depressive symptoms among (pre)frail community-dwelling older adults: A randomized controlled trial. J Affect Disord 2024; 347:92-100. [PMID: 37992773 DOI: 10.1016/j.jad.2023.11.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/26/2023] [Accepted: 11/17/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Subjective support could ameliorate the adverse effect of (pre)frailty on depressive symptoms. However, there is scarce evidence regarding subjective support-focused intervention in preventing depression among (pre)frail community-dwelling older adults. This study aims to explore the effectiveness of subjective support-focused cognitive behavioral therapy (SS-CBT) in preventing depression among this group of population. METHODS A total of 100 community-dwelling (pre)frail older adults were recruited from six communities in a Chinese city and were randomized to an 8-week SS-CBT group or a wait-list control group. Depressive symptoms and subjective support were assessed at baseline (T0), and at 8 week (T1), 12 week (T2), 16 week (T3) after randomization. Generalized estimating equation was used to examine the effectiveness of SS-CBT on depressive symptoms and subjective support. Hierarchical linear regression models and Bootstrapping method were used to examine whether subjective support mediated the effectiveness of SS-CBT on depressive symptoms. RESULTS Participants in SS-CBT group reported significant reduction in depressive symptoms (Wald χ2 = 20.800, p < 0.001) and improvement in subjective support (Wald χ2 = 92.855, p < 0.001) compared to those in wait-list control group. Changes in subjective support mediated the effectiveness of SS-CBT on changes in depressive symptoms. LIMITATIONS Restricted regions to recruit participants, inclusion of the most motivated participants, lack of diagnosis of depression, potential experimenter bias and contamination, short follow-up period, and lack of an active control group. CONCLUSIONS The findings support the benefits of SS-CBT in preventing depression among (pre)frail community-dwelling older adults, and provide insight into possible mechanisms.
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Affiliation(s)
- Cuili Wang
- Peking University, No. 38 Xueyuan Road, Beijing 100191, PR China
| | - Huaxin Si
- Peking University, No. 38 Xueyuan Road, Beijing 100191, PR China
| | - Yanhui Bian
- Peking University, No. 38 Xueyuan Road, Beijing 100191, PR China
| | - Xiaoxia Qiao
- Peking University, No. 38 Xueyuan Road, Beijing 100191, PR China
| | - Lili Ji
- Peking University, No. 38 Xueyuan Road, Beijing 100191, PR China
| | - Qinqin Liu
- Peking University, No. 38 Xueyuan Road, Beijing 100191, PR China
| | - Wenyu Wang
- Peking University, No. 38 Xueyuan Road, Beijing 100191, PR China
| | - Jiaqi Yu
- Peking University, No. 38 Xueyuan Road, Beijing 100191, PR China
| | - Yanyan Li
- Peking University, No. 38 Xueyuan Road, Beijing 100191, PR China
| | - Wendie Zhou
- Peking University, No. 38 Xueyuan Road, Beijing 100191, PR China
| | - Weihua Yue
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing 100191, PR China
| | - Jiajia Liu
- Peking University, No. 38 Xueyuan Road, Beijing 100191, PR China
| | - Yaru Jin
- Peking University, No. 38 Xueyuan Road, Beijing 100191, PR China.
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8
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Akdemir A, Smith AB, Wu VS, Rincones O, Russell H, Lyhne JD, Kemp E, David M, Bamgboje-Ayodele A. Guided versus non-guided digital psychological interventions for cancer patients: A systematic review and meta-analysis of engagement and efficacy. Psychooncology 2024; 33:e6290. [PMID: 38282223 DOI: 10.1002/pon.6290] [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: 12/19/2022] [Revised: 12/29/2023] [Accepted: 12/29/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE To evaluate engagement with and efficacy of guided versus non-guided digital interventions targeting psychological symptoms of cancer via a systematic review of current evidence. METHODS PubMed, Scopus, PsychINFO, MEDLINE, and CINAHL databases were searched. Eligible publications were randomised controlled trials of guided or non-guided digital psychological interventions used in cancer settings reporting intervention efficacy and/or engagement. Study methodological quality was assessed using the Cochrane risk of bias (RoB) tool. Random effects meta-analyses were performed on outcomes with sufficient data, with sub-group analyses of intervention type and follow-up period. RESULTS Forty-three studies were included. Studies varied by level of guidance, type of technology used, duration, and outcomes assessed. Most studies had a high overall RoB. Meta-analysis indicated that guided interventions significantly reduced distress, anxiety, and fatigue, while non-guided did not. For depression and quality of life, both guided and non-guided interventions produced significant improvements. Guided interventions reported higher levels of intervention engagement than non-guided. CONCLUSIONS Guided digital psychological interventions were likely to be more effective than non-guided ones for cancer patients, particularly in reducing distress, anxiety, and fatigue. Whilst both types were found to improve depression and life quality, guided interventions were associated with higher patient engagement. These findings suggest digital interventions could supplement traditional cancer care, warranting further research concerning long-term effects and cost-efficiency.
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Affiliation(s)
- Aleyna Akdemir
- Ingham Institute for Applied Medical Research, South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, Liverpool, New South Wales, Australia
| | - Allan Ben Smith
- Ingham Institute for Applied Medical Research, South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, Liverpool, New South Wales, Australia
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Verena Shuwen Wu
- Ingham Institute for Applied Medical Research, South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, Liverpool, New South Wales, Australia
| | - Orlando Rincones
- Ingham Institute for Applied Medical Research, South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, Liverpool, New South Wales, Australia
| | - Hayley Russell
- Ovarian Cancer Australia, Melbourne, Victoria, Australia
| | - Johanne Dam Lyhne
- Department of Clinical Oncology, University Hospital of Southern Denmark, Vejle, Denmark
| | - Emma Kemp
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Michael David
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
- School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Adeola Bamgboje-Ayodele
- Ingham Institute for Applied Medical Research, South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, Liverpool, New South Wales, Australia
- Biomedical Informatics and Digital Health, School of Medical Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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9
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Garner K, Thabrew H, Lim D, Hofman P, Jefferies C, Serlachius A. Exploring the Usability and Acceptability of a Well-Being App for Adolescents Living With Type 1 Diabetes: Qualitative Study. JMIR Pediatr Parent 2023; 6:e52364. [PMID: 38153804 PMCID: PMC10766165 DOI: 10.2196/52364] [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: 08/31/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 12/30/2023] Open
Abstract
Background Adolescents living with either type 1 diabetes (T1D) or type 2 diabetes (T2D) have an increased risk of psychological disorders due to the demands of managing a chronic illness and the challenges of adolescence. Psychological disorders during adolescence increase the risk of suboptimal glycemic outcomes and may lead to serious diabetes-related complications. Research shows that digital health interventions may increase access to psychological support for adolescents and improve physical and mental health outcomes for youth with diabetes. To our knowledge, there are no evidence-based, publicly available mental health apps with a focus on improving the psychological well-being of adolescents with diabetes. Objective This study aimed to explore the acceptability and usability of our evidence-based well-being app for New Zealand adolescents, Whitu: 7 Ways in 7 Days (Whitu), to allow us to further tailor it for youth with diabetes. We interviewed adolescents with T1D and T2D, their parents, and health care professionals to explore their views on the Whitu app and suggestions for tailoring the app for adolescent with diabetes. We also explored the cultural acceptability of the Whitu app for Māori and Pacific adolescents. Methods A total of 34 participants, comprising 13 adolescents aged 12-16 years (11 with T1D and 2 with T2D), 10 parents, and 11 health care professionals, were recruited from a specialist diabetes outpatient clinic and Facebook diabetes groups. Each participant attended one 1-hour focus group on Zoom, in person, or via phone. Researchers gathered general feedback on what makes an effective and engaging app for adolescents with diabetes, as well as specific feedback about Whitu. Transcribed audio recordings of the focus groups were analyzed using directed content analysis. Results Adolescents with T1D, their parents, and health care professionals found Whitu to be acceptable and usable. Adolescents with T1D and their parents signaled a preference for more diabetes-specific content. Health care professionals expressed less awareness and trust of digital health interventions and, as such, recommended that they be used with external support. Due to challenges in recruitment and retention, we were unable to include the views of adolescents with T2D in this qualitative study. Conclusions There appears to be sufficient openness to the use of an app such as Whitu for supporting the well-being of adolescents with T1D, albeit with modifications to make its content more diabetes specific. Based on this qualitative study, we have recently developed a diabetes-specific version of Whitu (called LIFT: Thriving with Diabetes). We are also planning a qualitative study to explore the views of youth with T2D and their perspectives on the new LIFT app, where we are using alternative research approaches to recruit and engage adolescents with T2D and their families.
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Affiliation(s)
- Katie Garner
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Hiran Thabrew
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - David Lim
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Paul Hofman
- Liggins Institute and Department of Pediatrics, University of Auckland, Auckland, New Zealand
| | - Craig Jefferies
- Liggins Institute and Department of Pediatrics, University of Auckland, Auckland, New Zealand
- Starship Child Health, Te Whatu Ora – Health New Zealand, Te Toka Tumai Auckland, Auckland, New Zealand
| | - Anna Serlachius
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
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10
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Stephenson C, Jagayat J, Kumar A, Khamooshi P, Eadie J, Pannu A, Meartsi D, Danaee E, Gutierrez G, Khan F, Gizzarelli T, Patel C, Moghimi E, Yang M, Shirazi A, Omrani M, Patel A, Alavi N. Comparing clinical decision-making of AI technology to a multi-professional care team in an electronic cognitive behavioural therapy program for depression: protocol. Front Psychiatry 2023; 14:1220607. [PMID: 38188047 PMCID: PMC10768033 DOI: 10.3389/fpsyt.2023.1220607] [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: 05/12/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Depression is a leading cause of disability worldwide, affecting up to 300 million people globally. Despite its high prevalence and debilitating effects, only one-third of patients newly diagnosed with depression initiate treatment. Electronic cognitive behavioural therapy (e-CBT) is an effective treatment for depression and is a feasible solution to make mental health care more accessible. Due to its online format, e-CBT can be combined with variable therapist engagement to address different care needs. Typically, a multi-professional care team determines which combination therapy most benefits the patient. However, this process can add to the costs of these programs. Artificial intelligence (AI) has been proposed to offset these costs. Methods This study is a double-blinded randomized controlled trial recruiting individuals experiencing depression. The degree of care intensity a participant will receive will be randomly decided by either: (1) a machine learning algorithm, or (2) an assessment made by a group of healthcare professionals. Subsequently, participants will receive depression-specific e-CBT treatment through the secure online platform. There will be three available intensities of therapist interaction: (1) e-CBT; (2) e-CBT with a 15-20-min phone/video call; and (3) e-CBT with pharmacotherapy. This approach aims to accurately allocate care tailored to each patient's needs, allowing for more efficient use of resources. Discussion Artificial intelligence and providing patients with varying intensities of care can increase the efficiency of mental health care services. This study aims to determine a cost-effective method to decrease depressive symptoms and increase treatment adherence to online psychotherapy by allocating the correct intensity of therapist care for individuals diagnosed with depression. This will be done by comparing a decision-making machine learning algorithm to a multi-professional care team. This approach aims to accurately allocate care tailored to each patient's needs, allowing for more efficient use of resources with the convergence of technologies and healthcare. Ethics The study received ethics approval and began participant recruitment in December 2022. Participant recruitment has been conducted through targeted advertisements and physician referrals. Complete data collection and analysis are expected to conclude by August 2024. Clinical trial registration ClinicalTrials.Gov, identifier NCT04747873.
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Affiliation(s)
- Callum Stephenson
- Department of Psychiatry, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Jasleen Jagayat
- Department of Psychiatry, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Anchan Kumar
- Department of Psychiatry, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Paniz Khamooshi
- Department of Psychiatry, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Jazmin Eadie
- Department of Psychiatry, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
- Department of Psychology, Faculty of Arts and Sciences, Queen’s University, Kingston, ON, Canada
| | - Amrita Pannu
- Department of Psychiatry, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Dekel Meartsi
- Department of Psychiatry, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Eileen Danaee
- Department of Psychiatry, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Gilmar Gutierrez
- Department of Psychiatry, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Ferwa Khan
- Department of Psychiatry, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Tessa Gizzarelli
- Department of Psychiatry, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Charmy Patel
- Department of Psychiatry, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Elnaz Moghimi
- Department of Psychiatry, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Megan Yang
- Department of Psychiatry, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | | | - Mohsen Omrani
- Department of Psychiatry, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
- OPTT Inc., Toronto, ON, Canada
| | - Archana Patel
- Department of Psychiatry, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Nazanin Alavi
- Department of Psychiatry, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
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11
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Marsden AM, Hann M, Barron E, McGough B, Murray E, Valabhji J, Cotterill S. The effectiveness of digital delivery versus group-based face-to-face delivery of the English National Health Service Type 2 Diabetes Prevention Programme: a non-inferiority retrospective cohort comparison study. BMC Health Serv Res 2023; 23:1434. [PMID: 38110926 PMCID: PMC10729322 DOI: 10.1186/s12913-023-10365-2] [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: 05/17/2023] [Accepted: 11/22/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Face-to-face group-based diabetes prevention programmes have been shown to be effective in many settings. Digital delivery may suit some patients, but research comparing the effectiveness of digital with face-to-face delivery is scarce. The aim was to assess if digital delivery of the English National Health Service Diabetes Prevention Programme (NHS DPP) is non-inferior to group-based face-to-face delivery in terms of weight change, and evaluate factors associated with differential change. METHODS The study included those recruited to the NHS DPP in 2017-2018. Individual-level data from a face-to-face cohort was compared to two cohorts on a digital pilot who (i) were offered no choice of delivery mode, or (ii) chose digital over face-to-face. Changes in weight at 6 and 12 months were analysed using mixed effects linear regression, having matched participants from the digital pilot to similar participants from face-to-face. RESULTS Weight change on the digital pilot was non-inferior to face-to-face at both time points: it was similar in the comparison of those with no choice (difference in weight change: -0.284 kg [95% CI: -0.712, 0.144] at 6 months) and greater in digital when participants were offered a choice (-1.165 kg [95% CI: -1.841, -0.489]). Interactions between delivery mode and sex, ethnicity, age and deprivation were observed. CONCLUSIONS Digital delivery of the NHS DPP achieved weight loss at least as good as face-to-face. Patients who were offered a choice and opted for digital experienced better weight loss, compared to patients offered face-to-face only.
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Affiliation(s)
- Antonia M Marsden
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Mark Hann
- Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
| | | | | | - Elizabeth Murray
- Institute of Epidemiology & Health Care, University College London, London, UK
| | - Jonathan Valabhji
- NHS England, London, UK
- Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | - Sarah Cotterill
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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12
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Schreiter S, Mascarell-Maricic L, Rakitzis O, Volkmann C, Kaminski J, Daniels MA. Digital Health Applications in the Area of Mental Health. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:797-803. [PMID: 37732500 PMCID: PMC10777310 DOI: 10.3238/arztebl.m2023.0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/06/2023] [Accepted: 09/06/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND The introduction of digital health applications (DiGA) is a fundamental innovation in Germany. In the field of mental health, numerous applications are already available whose efficacy has been tested in clinical trials. We investigated whether, and to what extent, the use of DiGA can be recommended on the basis of the available evidence. METHODS In this scoping review, we summarize the evidence supporting the use of DiGA in the mental health field through an examination of relevant publications that were retrieved by a systematic literature search. We provide an annotated tabular listing and discuss the current advantages of, and obstacles to, the care of mentally ill patients with the aid of DiGA. RESULTS We identified 17 DiGA for use in depression, anxiety disorders, addiction disorders, sleep disorders, stress/burnout, vaginismus, and chronic pain. These DiGA have been evaluated to date in 3 meta-analyses, 39 randomized controlled trials (RCTs), and two single-armed intervention trials. 23 of the 36 published trials were carried out with the direct participation of the manufacturers. 29 of the 39 RCTs were not blinded or contained no information regarding blinding. Active controls were used in 6 of the 39 RCTs. The reported effect sizes, with the exclusion of pre-post analyses, ranged from 0.16 to 1.79. CONCLUSION Most of the published studies display a high risk of bias, both because of the manufacturers' participation and because of methodological deficiencies. DiGA are an increasingly important therapeutic modality in psychiatry. The available evidence indicates that treatment effects are indeed present, but prospective comparisons with established treatments are still entirely lacking.
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Affiliation(s)
- Stefanie Schreiter
- Department of Psychiatry and Neurosciences, CCM, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Lea Mascarell-Maricic
- Department of Psychiatry and Neurosciences, CCM, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Orestis Rakitzis
- Department of Psychiatry and Neurosciences, CCM, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Constantin Volkmann
- Department of Psychiatry and Neurosciences, CCM, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jakob Kaminski
- * These authors share last authorship
- Department of Psychiatry and Neurosciences, CCM, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Martin André Daniels
- * These authors share last authorship
- Department of Psychiatry and Neurosciences, CCM, Charité – Universitätsmedizin Berlin, Berlin, Germany
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13
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Owusu E, Shalaby R, Elgendy H, Mao W, Shalaby N, Agyapong B, Nichols A, Eboreime E, Nkire N, Lawal MA, Agyapong VIO. Comparison of Resilience, Personal Recovery, and Quality of Life Measures Pre- and Post-Discharge from Inpatient Mental Health Units in Alberta: Analysis of Control Group Data from a Randomized Trial. Healthcare (Basel) 2023; 11:2958. [PMID: 37998451 PMCID: PMC10670919 DOI: 10.3390/healthcare11222958] [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: 08/15/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023] Open
Abstract
Background: The transition from hospital to community settings for most mental health service users is often hindered by challenges that affect community adjustment and continuity of care. The first few weeks and days after discharge from mental health inpatient units represent a critical phase for many service users. This paper aims to evaluate the changes in the resilience, personal recovery, and quality of life status of individuals with mental health challenges recently discharged from acute mental health care into the community. Methods: Data for this study were collected as part of a pragmatic stepped-wedge cluster-randomized, longitudinal approach in Alberta. A paired sample t-test and Chi-squared/Fisher test were deployed to assess changes from baseline to six weeks in the recovery assessment scale (RAS), brief resilience scale (BRS), and EuroQol-5d (EQ-5D), using an online questionnaire. Results: A total of 306 service users were recruited and 88 completed both baseline and six weeks, giving a response rate of 28.8%. There was no statistically significant change in the level of resilience, recovery and quality of life as measured with the brief resilience scale, recovery assessment scale and EQ-5D from baseline to six weeks (p > 0.05). Conclusions: The study showed that there was neither an improvement nor deterioration in resilience, recovery, or quality of life status of service users six weeks post-discharge from inpatient mental health care. The lack of further progress calls into question whether the support available in the community when patient's leave inpatient care is adequate to promote full recovery. The results justify investigations into the effectiveness of innovative and cost-effective programs such as peer and text-based supportive interventions for service users discharged from inpatient psychiatric care.
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Affiliation(s)
- Ernest Owusu
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Hossam Elgendy
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Wanying Mao
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Nermin Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Belinda Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Angel Nichols
- Queen Elizabeth II Hospital, Alberta Health Services, Grande Prairie, AB T5J 3E4, Canada
| | - Ejemai Eboreime
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Nnamdi Nkire
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Mobolaji A. Lawal
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Vincent I. O. Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 4R2, Canada
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14
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Fundoiano-Hershcovitz Y, Breuer Asher I, Ritholz MD, Feniger E, Manejwala O, Goldstein P. Specifying the Efficacy of Digital Therapeutic Tools for Depression and Anxiety: Retrospective, 2-Cohort, Real-World Analysis. J Med Internet Res 2023; 25:e47350. [PMID: 37738076 PMCID: PMC10559191 DOI: 10.2196/47350] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 08/01/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Depression and anxiety are the main sources of work and social disabilities as well as health-related problems around the world. Digital therapeutic solutions using cognitive behavioral therapy have demonstrated efficacy in depression and anxiety. A common goal of digital health apps is to increase user digital engagement to improve outcomes. However, there is a limited understanding of the association between digital platform components and clinical outcomes. OBJECTIVE The aim of the study is to investigate the contribution of specific digital engagement tools to mental health conditions. We hypothesized that participation in coaching sessions and breathing exercises would be associated with a reduction in depression and anxiety. METHODS Depression and general anxiety symptoms were evaluated in real-world data cohorts using the digital health platform for digital intervention and monitoring change. This retrospective real-world analysis of users on a mobile platform-based treatment followed two cohorts of people: (1) users who started with moderate levels of depression and completed at least 2 depression assessments (n=519) and (2) users who started with moderate levels of anxiety and completed at least 2 anxiety assessments (n=474). Levels of depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7) were tracked throughout the first 16 weeks. A piecewise mixed-effects model was applied to model the trajectories of the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7 mean scores in 2 segments (1-6 weeks and 7-16 weeks). Finally, simple slope analysis was used for the interpretation of the interactions probing the moderators: coaching sessions and breathing exercises in both depression and anxiety cohorts. RESULTS Analysis revealed a significant decrease in depression symptoms (β=-.37, 95% CI -0.46 to 0.28; P≤.001) during the period of weeks 1-6 of app use, which was maintained during the period of 7-16 weeks. Coach interaction significantly moderated the reduction in depression symptoms during the period of weeks 1-6 (β=-.03, 95% CI -0.05 to -0.001; P=.02). A significant decrease in anxiety symptoms (β=-.41, 95% CI -0.50 to -0.33; P≤.001) was revealed during the period of 1-6 weeks, which was maintained during the period of 7-16 weeks. Breathing exercises significantly moderated the reduction in anxiety symptoms during the period of 1-6 weeks (β=-.07, 95% CI -0.14 to -0.01; P=.04). CONCLUSIONS This study demonstrated general improvement followed by a period of stability of depression and anxiety symptoms associated with cognitive behavioral therapy-based digital intervention. Interestingly, engagement with a coaching session but not a breathing exercise was associated with a reduction in depression symptoms. Moreover, breathing exercise but not engagement with a coaching session was associated with a reduction of anxiety symptoms. These findings emphasize the importance of using a personalized approach to behavioral health during digital health interventions.
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Affiliation(s)
| | | | - Marilyn D Ritholz
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
| | | | | | - Pavel Goldstein
- Integrative Pain Laboratory (iPainLab), School of Public Health, University of Haifa, Haifa, Israel
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15
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Xiang X, Kayser J, Ash S, Zheng C, Sun Y, Weaver A, Dunkle R, Blackburn JA, Halavanau A, Xue J, Himle JA. Web-Based Cognitive Behavioral Therapy for Depression Among Homebound Older Adults: Development and Usability Study. JMIR Aging 2023; 6:e47691. [PMID: 37725423 PMCID: PMC10548322 DOI: 10.2196/47691] [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: 03/30/2023] [Revised: 07/05/2023] [Accepted: 08/17/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Homebound older adults are a high-risk group for depression. However, many of them face barriers to accessing evidence-supported mental health treatments. Digital mental health interventions can potentially improve treatment access, but few web-based interventions are explicitly tailored for depression in older adults. OBJECTIVE This paper describes the development process of Empower@Home, a web-delivered intervention for depression in homebound older adults that is based on cognitive behavioral therapy, and reports on the outcomes of usability studies. METHODS Empower@Home was developed in collaboration with community agencies, stakeholders, and older adults, guided by user-centered design principles. User needs were assessed through secondary data analysis, demographic and health profiles from administrative data, and interviews and surveys of community partners. A comparative usability evaluation was conducted with 10 older adults to assess the usability of Empower@Home compared to 2 similar programs. Field testing was conducted with 4 end users to detect additional usability issues. RESULTS Feedback and recommendations from community partners heavily influenced the content and design of Empower@Home. The intervention consists of 9 sessions, including psychoeducation and an introduction to cognitive behavioral therapy skills and tools through short video clips, in-session exercises, an animated storyline, and weekly out-of-session home practice. A printed workbook accompanies the web-based lessons. In comparative usability testing (N=10), Empower@Home received a System Usability Scale score of 78 (SD 7.4), which was significantly higher than the 2 comparator programs (t9=3.28; P=.005 and t9=2.78; P=.011). Most participants, 80% (n=8), preferred Empower@Home over the comparators. In the longitudinal field test (n=4), all participants reported liking the program procedures and feeling confident in performing program-related tasks. The single-subject line graph showed an overall downward trend in their depression scores over time, offering an encouraging indication of the intervention's potential effects. CONCLUSIONS Collaboration with community stakeholders and careful consideration of potential implementation issues during the design process can result in more usable, engaging, and effective digital mental health interventions.
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Affiliation(s)
- Xiaoling Xiang
- School of Social Work, University of Michigan-Ann Arbor, Ann Arbor, MI, United States
| | - Jay Kayser
- School of Social Work, University of Michigan-Ann Arbor, Ann Arbor, MI, United States
| | - Samson Ash
- School of Social Work, University of Michigan-Ann Arbor, Ann Arbor, MI, United States
| | - Chuxuan Zheng
- Department of Psychology, University of Michigan-Ann Arbor, Ann Arbor, MI, United States
| | - Yihang Sun
- School of Social Work, Columbia University, New York City, NY, United States
| | - Addie Weaver
- School of Social Work, University of Michigan-Ann Arbor, Ann Arbor, MI, United States
| | - Ruth Dunkle
- School of Social Work, University of Michigan-Ann Arbor, Ann Arbor, MI, United States
| | - James A Blackburn
- School of Social Work, University of Michigan-Ann Arbor, Ann Arbor, MI, United States
| | - Alex Halavanau
- SLAC National Accelerator Laboratory, Stanford University, Menlo Park, CA, United States
| | - Jia Xue
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Faculty of Information, University of Toronto, Toronto, ON, Canada
| | - Joseph A Himle
- School of Social Work, University of Michigan-Ann Arbor, Ann Arbor, MI, United States
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16
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Lisi DM, Hawley LL, McCabe RE, Rowa K, Cameron DH, Richter MA, Rector NA. Online versus in-person delivery of cognitive behaviour therapy for obsessive compulsive disorder: An examination of effectiveness. Clin Psychol Psychother 2023. [PMID: 37699581 DOI: 10.1002/cpp.2908] [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: 04/11/2023] [Revised: 06/13/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
Cognitive behavioural therapy (CBT) including exposure and response prevention is the first-line psychological treatment for obsessive compulsive disorder (OCD). Given changes in the clinical landscape, there are increasing efforts to evaluate its effectiveness in online contexts. Mirroring the traditional in-person delivery, few studies have assessed the role of therapist-guided, manual-based CBT for OCD delivered in real-time via videoconferencing methods. The present study sought to fill this gap by comparing in-person and online delivery of group-based CBT for the treatment of OCD. A convenience sample of participants with moderate to severe OCD (n = 144) were recruited from a naturalistic database from two large OCD specialty assessment and treatment centres. Patients received group-based CBT that was provided in-person (pre-COVID-19 pandemic; March 2018 to March 2020) or online via videoconferencing (during the COVID-19 pandemic; March 2020 to April 2021). In both delivery methods, treatment consisted of 2-h weekly sessions led by trained clinicians. Analyses revealed that, regardless of treatment modality, both in-person and online groups demonstrated significant, reliable, and statistically equivalent improvements in OCD symptoms post-treatment. Videoconferenced, clinician-led CBT may be a promising alternative to in-person delivery for those with moderate to severe OCD symptoms.
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Affiliation(s)
- Diana M Lisi
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lance L Hawley
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Karen Rowa
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Duncan H Cameron
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Margaret A Richter
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Neil A Rector
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Rutkowska E, Furmańska J, Lane H, Marques CC, Martins MJ, Sahar NU, Meixner J, Tullio V, Argo A, Bermeo Barros DM. Determinants of psychotherapists' attitudes to online psychotherapy. Front Psychiatry 2023; 14:1196907. [PMID: 37426099 PMCID: PMC10324565 DOI: 10.3389/fpsyt.2023.1196907] [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: 03/30/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Online psychotherapy is a form of work that is becoming more and more popular. Public health problems, such as COVID-19, forced mental health professionals and patients to incorporate new methodologies such as the use of electronic media and internet to provide follow-up, treatment and also supervision. The aim of this study was to investigate which factors shape the therapists' attitudes toward online psychotherapy during a pandemic taking into account: (1) attitudes toward the COVID-19 pandemic (fear of contagion, pandemic fatigue, etc.), (2) personal characteristics of the psychotherapists (age, gender, feeling of efficacy, anxiety, depression, etc.), and (3) characteristics of the psychotherapeutic practice (guideline procedure, client age group, professional experience, etc). Materials and methods Study participants were 177 psychotherapists from four European countries: Poland (n = 48), Germany (n = 44), Sweden (n = 49), and Portugal (n = 36). Data were collected by means of an individual online survey through the original questionnaire and the standardized scales: a modified version of the Attitudes toward Psychological Online Interventions Scale (APOI), Fear of Contagion by COVID-19 Scale (FCS COVID-19), Pandemic Fatigue Scale (PFS), Hospital Anxiety and Depression Scale (HADS), Social Support Questionnaire (F-SozU K-14), and the Sense of Efficiency Test (SET). Results Determinants that impacted psychotherapists' attitudes toward online therapy were: COVID-19 belief in prevention-keeping distance and hand disinfection, pandemic behavioral fatigue, previous online therapy experience (including voice call), working with youth and adults. Our study showed that belief in the sense of prevention in the form of taking care of hand disinfection before the session, pandemic behavioral fatigue and experience in working with adults were significant predictors of negative attitudes of therapists toward online psychological interventions. On the other hand, belief in the sense of prevention in the form of keeping distance during the session had a positive effect on general attitudes toward therapy conducted via the internet. Discussion The online therapy boom during the COVID-19 pandemic has spawned a powerful tool for psychotherapists. More research in this area and training of psychotherapists are needed for online psychological interventions to become an effective therapy format that is accepted by patients and therapists alike.
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Affiliation(s)
- Emilia Rutkowska
- Institute of Psychology, University of Szczecin, Szczecin, Poland
| | - Joanna Furmańska
- Institute of Psychology, University of Szczecin, Szczecin, Poland
| | - Hakan Lane
- Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Brandenburg, Germany
| | - Cristiana C. Marques
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Maria João Martins
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
- University of Coimbra Health Services, University of Coimbra, Coimbra, Portugal
| | - Najam us Sahar
- Fatima Jinnah Women University, Rawalpindi, Punjab, Pakistan
| | - Johannes Meixner
- Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Brandenburg, Germany
| | - Valeria Tullio
- Department of Health Promotion, Maternal and Child Care, “G. D’Alessandro”, University of Palermo, Palermo, Sicily, Italy
| | - Antonina Argo
- Department of Health Promotion, Maternal and Child Care, “G. D’Alessandro”, University of Palermo, Palermo, Italy, University of Palermo, Palermo, Sicily, Italy
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18
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Owen K, Laphan A, Gee B, Lince K. Evaluating cognitive analytic therapy within a primary care psychological therapy service. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023. [PMID: 37317047 DOI: 10.1111/bjc.12430] [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: 04/21/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Cognitive analytic therapy (CAT) is used within UK mental health settings as a treatment for transdiagnostic complex psychological presentations. However, it is not routinely offered by the NHS Talking Therapies, for anxiety and depression (NHS Talking Therapies) programme which provides psychological treatments for common mental health difficulties. We aimed to evaluate the outcomes of providing CAT treatment to patients presenting with depression and/or anxiety, within the context of relational difficulties, adverse childhood experience or difficulty managing emotions, returning for further psychological treatment within NHS Talking Therapies. METHODS This was a pragmatic, real-world evaluation, involving routinely collected self-report measures of depression and anxiety, to examine the treatment outcomes of NHS Talking Therapies patients offered CAT over an 18-month period. Quantitative validated measures of depression and anxiety were administered at the beginning and end of CAT treatment, and at follow up. Within-group change in depression and anxiety scores were examined statistically, and rates of reliable improvement and recovery calculated. RESULTS Statistically significant decreases in depression and anxiety scores were observed during the CAT active treatment phase. The recovery rate was 46.4%, and 71.4% of patients showed a reliable improvement post-treatment. Positive outcomes continued to be observed at follow-up, with a recovery rate of 50% and a reliable improvement rate of 79.4%. CONCLUSIONS CAT shows promise as a treatment option for NHS Talking Therapies patients re-presenting with depression and/or anxiety. More research is required to determine if CAT should be offered more widely within NHS Talking Therapies services.
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Affiliation(s)
- Kiri Owen
- Norfolk & Waveney Wellbeing Service, Norwich, UK
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Andrew Laphan
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Brioney Gee
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Karen Lince
- Norfolk & Waveney Wellbeing Service, Norwich, UK
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
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19
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Koivu AM, Näsänen-Gilmore PK, Hunter PJ, Muthiani Y, Isojärvi J, Heimonen O, Bastola K, Csonka L, Ashorn P, Ashorn U. Antenatal interventions to address harmful behaviors and psychosocial risk factors in the prevention of low birth weight. Am J Clin Nutr 2023; 117 Suppl 2:S148-S159. [PMID: 37331761 DOI: 10.1016/j.ajcnut.2022.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/11/2022] [Accepted: 11/08/2022] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Risk factors related to the harmful behaviors, psychosocial wellbeing, and socio-economic circumstances in the lives of pregnant women can lead to adverse birth outcomes, including low birth weight (LBW). OBJECTIVE This systematic search and review aims to provide a comparative evidence synthesis on the effect of eleven antenatal interventions targeted to address psychosocial risk factors on adverse birth outcomes. METHODS We searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials and CINAHL Complete between March 2020 and May 2020. We included randomized controlled trials (RCTs) and reviews of RCTs of eleven antenatal interventions for pregnant females reporting LBW, preterm birth (PTB), small-for-gestational-age or stillbirth as outcomes. For interventions where randomization was either not feasible or unethical, we accepted non-randomized controlled studies. RESULTS Seven records contributed data to the quantitative estimates of the effect sizes and 23 contributed to narrative analysis. Psychosocial interventions for reducing smoking in pregnancy likely reduced the risk of LBW, and professionally provided psychosocial support for at-risk women possibly reduced the risk of PTB. Financial incentives or nicotine replacement therapy as smoking cessation aids, or virtually delivered psychosocial support did not appear to reduce the risk of adverse birth outcomes. The available evidence on these interventions was primarily from high-income countries. For other reviewed interventions (psychosocial interventions to reduce alcohol use, group based psychosocial support programs, intimate partner violence prevention interventions, antidepressant medication, and cash transfers) there was little evidence in any direction regarding the efficacy or the data was conflicting. CONCLUSIONS Professionally provided psychosocial support during pregnancy in general and specifically as a means to reduce smoking can potentially contribute to improved newborn health. The gaps in the investments for research and implementation of psychosocial interventions should be addressed to better meet the global targets in LBW reduction.
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Affiliation(s)
- Annariina M Koivu
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Pieta K Näsänen-Gilmore
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Finnish Institute for Health and Welfare, FI-00271, Helsinki, Finland
| | | | - Yvonne Muthiani
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jaana Isojärvi
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Otto Heimonen
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Kalpana Bastola
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Leon Csonka
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Słoczyńska K, Orzeł J, Murzyn A, Popiół J, Gunia-Krzyżak A, Koczurkiewicz-Adamczyk P, Pękala E. Antidepressant pharmaceuticals in aquatic systems, individual-level ecotoxicological effects: growth, survival and behavior. AQUATIC TOXICOLOGY (AMSTERDAM, NETHERLANDS) 2023; 260:106554. [PMID: 37167880 DOI: 10.1016/j.aquatox.2023.106554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/18/2023] [Accepted: 05/05/2023] [Indexed: 05/13/2023]
Abstract
The growing consumption of antidepressant pharmaceuticals has resulted in their widespread occurrence in the environment, particularly in waterways with a typical concentration range from ng L-1 to μg L-1. An increasing number of studies have confirmed the ecotoxic potency of antidepressants, not only at high concentrations but also at environmentally relevant levels. The present review covers literature from the last decade on the individual-level ecotoxicological effects of the most commonly used antidepressants, including their impact on behavior, growth, and survival. We focus on the relationship between antidepressants physico-chemical properties and dynamics in the environment. Furthermore, we discuss the advantages of considering behavioral changes as sensitive endpoints in ecotoxicology, as well as some current methodological shortcomings in the field, including low standardization, reproducibility and context-dependency.
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Affiliation(s)
- Karolina Słoczyńska
- Department of Pharmaceutical Biochemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland.
| | - Justyna Orzeł
- Department of Pharmaceutical Biochemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Aleksandra Murzyn
- Department of Pharmaceutical Biochemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Justyna Popiół
- Department of Pharmaceutical Biochemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Agnieszka Gunia-Krzyżak
- Department of Bioorganic Chemistry, Chair of Organic Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Paulina Koczurkiewicz-Adamczyk
- Department of Pharmaceutical Biochemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Elżbieta Pękala
- Department of Pharmaceutical Biochemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
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21
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Cox WTL. Developing scientifically validated bias and diversity trainings that work: empowering agents of change to reduce bias, create inclusion, and promote equity. MANAGEMENT DECISION 2023; 61:1038-1061. [PMID: 37090785 PMCID: PMC10120861 DOI: 10.1108/md-06-2021-0839] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Purpose – Research consistently shows that non-scientific bias, equity, and diversity trainings do not work, and often make bias and diversity problems worse. Despite these widespread failures, there is considerable reason for hope that effective, meaningful DEI efforts can be developed. One approach in particular, the bias habit-breaking training, has 15 years of experimental evidence demonstrating its widespread effectiveness and efficacy. Design/methodology/approach – This article discusses bias, diversity, equity, and inclusion (DEI) efforts from the author's perspective as a scientist-practitioner - the author draws primarily on the scientific literature, but also integrates insights from practical experiences working in DEI. The author provides a roadmap for adapting effective, evidence-based approaches from other disciplines (e.g. cognitive-behavioral therapy) into the DEI context and reviews evidence related to the bias habit-breaking training as one prominent demonstration of a scientifically-validated approach that effects lasting, meaningful improvements on DEI issues within both individuals and institutions. Findings – DEI trainings fail due to widespread adoption of the information deficit model, which is well-known as a highly ineffective approach. Empowerment-based approaches, in contrast, are highly promising for making meaningful, lasting changes in the DEI realm. Evidence indicates that the bias habit-breaking training is effective at empowering individuals as agents of change to reduce bias, create inclusion, and promote equity, both within themselves and the social contexts they inhabit. Originality/value – In contrast to the considerable despair and pessimism around DEI efforts, the present analysis provides hope and optimism, and an empirically-validated path forward, to develop and test DEI approaches that empower individuals as agents of change.
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Affiliation(s)
- William Taylor Laimaka Cox
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Inequity Agents of Change, Madison, Wisconsin, USA
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22
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Comparison of weight change between face-to-face and digital delivery of the English National Health service diabetes prevention programme: An exploratory non-inferiority study with imputation of plausible weight outcomes. Prev Med Rep 2023; 32:102161. [PMID: 36926593 PMCID: PMC10011422 DOI: 10.1016/j.pmedr.2023.102161] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 02/22/2023] Open
Abstract
Worldwide evidence suggests face-to-face diabetes prevention programmes are effective in preventing and delaying the onset of type 2 diabetes by encouraging behaviour change towards weight loss, healthy eating, and increased exercise. There is an absence of evidence on whether digital delivery is as effective as face-to-face. During 2017-18 patients in England were offered the National Health Service Diabetes Prevention Programme as group-based face-to-face delivery, digital delivery ('digital-only') or a choice between digital and face-to-face ('digital-choice'). The contemporaneous delivery allowed for a robust non-inferiority study, comparing face-to-face with digital only and digital choice cohorts. Changes in weight at 6 months were missing for around half of participants. Here we take a novel approach, estimating the average effect in all 65,741 individuals who enrolled in the programme, by making a range of plausible assumptions about weight change in individuals who did not provide outcome data. The benefit of this approach is that it includes everyone who enrolled in the programme, not restricted to those who completed. We analysed the data using multiple linear regression models. Under all scenarios explored, enrolment in the digital diabetes prevention programme was associated with clinically significant reductions in weight which were at least equivalent to weight loss in the face-to-face programme. Digital services can be just as effective as face-to-face in delivering a population-based approach to the prevention of type 2 diabetes. Imputation of plausible outcomes is a feasible methodological approach, suitable for analysis of routine data in settings where outcomes are missing for non-attenders.
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Key Words
- (BMI), Body Mass Index
- CCG, Clinical Commissioning Group
- CI, Confidence interval
- Cohort studies
- DIPLOMA, Diabetes Prevention – Long Term Multimethod Assessment
- Diabetes mellitus, Type 2
- Diet, healthy
- FPG, Fasting Blood Glucose (a test for diagnosing diabetes and the risk of diabetes)
- HbA1c, Haemoglobin A1c (a test for diagnosing diabetes and the risk of diabetes)
- IMD, Index of Multiple deprivation
- Method for dealing with missing data
- NHS DPP, National Health Service Diabetes Prevention Programme
- National health programs
- Non-inferiority
- Preventive health services
- STP, Sustainability and Transformation Partnership
- Self-management
- Weight loss
- eHealth: Telemedicine
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Ando M, Kao YC, Lee YC, Tai SA, Mendez SR, Sasaki K, Tang W, Papatheodorou S. Remote cognitive behavioral therapy for older adults with anxiety symptoms: A systematic review and meta-analysis. J Telemed Telecare 2023:1357633X231151788. [PMID: 36794548 DOI: 10.1177/1357633x231151788] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
INTRODUCTION In-person cognitive behavioral therapy (CBT) can reduce self-reported anxiety in older adults. However, studies are limited for remote CBT. We assessed the effectiveness of remote CBT in mitigating self-reported anxiety in older adults. METHODS We conducted a systematic review and meta-analysis based on a literature search of PubMed, Embase, PsycInfo, and Cochrane databases up to March 31, 2021, for randomized controlled clinical trials comparing the effectiveness of remote CBT versus non-CBT controls on mitigating self-reported anxiety in older adults. We calculated within-group pre-to-post-treatment standardized mean difference using Cohen's d, obtained the difference between a remote CBT group and a non-CBT control group as our effect size for cross-study comparison, and conducted a random-effects meta-analysis. Changes in scores on self-reported anxiety symptoms (Generalized Anxiety Disorder-7 item Scale, Penn State Worry Questionnaire, or Penn State Worry Questionnaire - Abbreviated), and self-reported depressive symptoms (Patient Health Questionnaire-9 item Scale or Beck Depression Inventory) were primary and secondary outcomes, respectively. RESULTS Six eligible studies, containing 633 participants with a pooled mean age of 66.6 years, were included in the systematic review and meta-analysis. There was a significant mitigating effect of intervention on self-reported anxiety, favoring remote CBT over non-CBT controls (between-group effect size: -0.63; 95% CI: -0.99 to -0.28). We also found a significant mitigating effect of intervention on self-reported depressive symptoms (between-group effect size: -0.74; 95% CI: -1.24 to -0.25). DISCUSSION Remote CBT is more effective in reducing self-reported anxiety and depressive symptoms than non-CBT control in older adults.
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Affiliation(s)
- Mariko Ando
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ying-Chia Kao
- Department of Occupational Therapy, 38023Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Chien Lee
- Department of Family Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Sung-An Tai
- Department of Otolaryngology-Head and Neck Surgery, 40293Taichung Veterans General Hospital, Taichung, Taiwan
| | - Samuel R Mendez
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kosuke Sasaki
- Department of Mathematics and Statistics, 1846Boston University, Boston, MA, USA
| | - Wenze Tang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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24
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Management of Bipolar Disorder During the Perinatal Period. Nurs Womens Health 2023; 27:42-52. [PMID: 36528074 DOI: 10.1016/j.nwh.2022.11.001] [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: 04/15/2022] [Revised: 07/13/2022] [Accepted: 11/05/2022] [Indexed: 12/15/2022]
Abstract
Bipolar disorder (BPD) is a lifelong mental health condition characterized by symptoms of mania, depression, and often anxiety. BPD can have detrimental consequences for individuals during pregnancy and the postpartum period, as well as for their offspring. This is often due to underdiagnosis and/or misdiagnosis as unipolar depression. There is a high incidence of first episodes of BPD in pregnant and postpartum persons. Perinatal care providers need to routinely screen for BPD and assess for relapse among those with a previous diagnosis during the pregnancy and postpartum periods. Medication management is complex and must be considered in the context of an individual's risk factors and perceptions about treatment as well as the limited evidence regarding fetal safety, using a shared decision-making model. Collaboration, consultation, and/or referral to mental health care providers are essential for managing acute and chronic BPD symptoms.
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25
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Winter S, Jesser A, Probst T, Schaffler Y, Kisler IM, Haid B, Pieh C, Humer E. How the COVID-19 Pandemic Affects the Provision of Psychotherapy: Results from Three Online Surveys on Austrian Psychotherapists. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1961. [PMID: 36767327 PMCID: PMC9915415 DOI: 10.3390/ijerph20031961] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
This study aimed to assess patient numbers and the format in which psychotherapy was delivered by Austrian psychotherapists during different time points of the COVID-19 pandemic and to explore psychotherapists` experiences on pandemic-associated changes in their psychotherapeutic work as well as their wishes for support in their professional activities. Three cross-sectional online surveys were conducted between March 2020 and May 2022. The total number of participating psychotherapists was n = 1547 in 2020, n = 238 in 2021, and n = 510 in 2022. The number of patients treated was highest in 2022 and lowest at the beginning of the pandemic (p < 0.001). During the lockdown in 2020, only 25.0% of patients were treated in personal contact. This proportion increased in the following years, reaching 86.9% in 2022 (p < 0.001). After a substantial increase in the proportion of patients treated via the telephone and internet during the first lockdown, both proportions decreased during the pandemics' second and third year (p < 0.001). However, a larger proportion of patients were treated via the internet in 2022 compared to pre-pandemic times (p < 0.001). Psychotherapists reported that the pandemic affected mainly the setting in which psychotherapy was provided (29.6%), the working conditions and workload (27.1%), as well as the demand for psychotherapy (26.9%). About one-third of psychotherapists expressed support wishes for their psychotherapeutic work. Results suggest that the pandemic went along with a partial shift in the provision of psychotherapy towards psychotherapy via the internet but not the telephone. The increase in patient numbers and psychotherapists` reports of increased workload suggest a rise in the demand for mental health care during and in the aftermath of the pandemic.
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Affiliation(s)
- Stefanie Winter
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, 3500 Krems, Austria
| | - Andrea Jesser
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, 3500 Krems, Austria
| | - Thomas Probst
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, 3500 Krems, Austria
| | - Yvonne Schaffler
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, 3500 Krems, Austria
| | | | - Barbara Haid
- Austrian Federal Association for Psychotherapy, 1030 Vienna, Austria
| | - Christoph Pieh
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, 3500 Krems, Austria
| | - Elke Humer
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, 3500 Krems, Austria
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26
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Konkolÿ Thege B, Emmanuel T, Callanan J, Askland KD. Trans-diagnostic determinants of psychotherapeutic treatment response: The pressing need and new opportunities for a more systematic way of selecting psychotherapeutic treatment in the age of virtual service delivery. Front Public Health 2023; 11:1102434. [PMID: 36926171 PMCID: PMC10013819 DOI: 10.3389/fpubh.2023.1102434] [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: 11/18/2022] [Accepted: 02/08/2023] [Indexed: 03/08/2023] Open
Abstract
Numerous forms of psychotherapy have demonstrated effectiveness for individuals with specific mental disorders. It is, therefore, the task of the clinician to choose the most appropriate therapeutic approach for any given client to maximize effectiveness. This can prove to be a difficult task due to at least three considerations: (1) there is no treatment approach, method or model that works well on all patients, even within a particular diagnostic class; (2) several treatments are equally efficacious (i.e., more likely to be effective than no treatment at all) when considered only in terms of the patient's diagnosis; and (3) effectiveness in the real-world therapeutic setting is determined by a host of non-diagnostic factors. Typically, consideration of these latter, trans-diagnostic factors is unmethodical or altogether excluded from treatment planning - often resulting in suboptimal patient care, inappropriate clinic resource utilization, patient dissatisfaction with care, patient demoralization/hopelessness, and treatment failure. In this perspective article, we argue that a more systematic research on and clinical consideration of trans-diagnostic factors determining psychotherapeutic treatment outcome (i.e., treatment moderators) would be beneficial and - with the seismic shift toward online service delivery - is more feasible than it used to be. Such a transition toward more client-centered care - systematically considering variables such as sociodemographic characteristics, patient motivation for change, self-efficacy, illness acuity, character pathology, trauma history when making treatment choices - would result in not only decreased symptom burden and improved quality of life but also better resource utilization in mental health care and improved staff morale reducing staff burnout and turnover.
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Affiliation(s)
- Barna Konkolÿ Thege
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Talia Emmanuel
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
| | | | - Kathleen D Askland
- Askland Medicine Professional Corporation, Midland, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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Piloting Group-Based Behavioral Activation Therapy for Families of Deceased COVID-19 Patients. Crit Care Explor 2022; 4:e0803. [PMID: 36506831 PMCID: PMC9726309 DOI: 10.1097/cce.0000000000000803] [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] [Indexed: 12/12/2022] Open
Abstract
Surrogate decision-making is a stressful process for many family members of critically ill patients. The COVID-19 pandemic may have amplified the risk for anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms in ICU surrogates. OBJECTIVES This study piloted an online group-based behavioral intervention with family members of deceased COVID-19 patients. Participant engagement, perceptions, and responses related to the intervention were assessed. DESIGN A single-arm pilot study was conducted with bereaved families. Quantitative analysis of measures of anxiety, depression, and PTSD symptoms was conducted with mixed models. Qualitative data were analyzed to identify themes in surrogates' experiences with the intervention. SETTING Participants were recruited from ICUs at a tertiary academic medical center. Participants completed the intervention, measures, and interviews online. SUBJECTS Participants were family members of patients who died from COVID-19. INTERVENTIONS The intervention involved six online group-based behavioral activation sessions. Sessions covered topics pertinent to grieving and engagement in personally meaningful activities. MEASUREMENTS AND MAIN RESULTS Semi-structured interviews explored participants' experiences with the intervention. Surrogates also completed measures of anxiety, depression, and PTSD symptoms before and after the intervention. Nineteen of 26 participants (73.1%) completed the study. Thematic analysis suggested that surrogates found the group helpful for overcoming perceived isolation, receiving validation, and developing coping skills. Significant pre-to-post reductions were observed in symptoms of Hospital and Anxiety Disorder Scale (HADS) anxiety (pre-mean = 9.27, sd = 5.30 vs post-mean = 6.80, sd = 4.16; p = 0.0271), HADS depression (pre-mean =6 .65, sd = 4.58 vs post- mean = 4.89, sd = 3.40; p = 0.0436), and Impact of Events Scale-Revised PTSD (pre-mean = 36.86, sd = 16.97 vs post-mean = 24.14, sd = 13.49; p = 0.0008). LIMITATIONS This was a preliminary study based on qualitative and self-report measures. Future studies should include a control group. CONCLUSIONS Online group-based behavioral activation therapy appears to be a potentially useful intervention for family members of ICU patients who died from COVID-19.
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Clinical Change Mechanisms in the Treatment of College Students with ADHD: Trajectories and Associations with Outcomes. Behav Ther 2022; 54:444-460. [PMID: 37088503 DOI: 10.1016/j.beth.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/10/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
The purpose of this study was to evaluate trajectories of response for the three theorized mechanisms of clinical change (knowledge, behavioral strategies, and adaptive thinking) associated with the Accessing Campus Connections and Empowering Student Success (ACCESS) intervention for college students with attention-deficit/hyperactivity disorder (ADHD) and their association with treatment outcomes. Participants included 250 college students comprehensively diagnosed with ADHD randomly assigned to ACCESS or to a delayed-treatment control who completed ratings at baseline, end of active treatment, and end of the maintenance phase of treatment (after two semesters). Growth mixture models (GMMs) were used to evaluate trajectories. Participants in ACCESS made significant gains in the use of behavioral strategies and trajectories were associated with large effect size improvements in measures of symptoms and functioning. Participants also made improvements in ADHD knowledge. However, only the knowledge trajectory with rapid improvement displayed significantly better outcomes. Only one trajectory group showed improvement in adaptive thinking with most ACCESS participants remaining stable across time. However, adaptive thinking trajectories were strongly related to both symptom and functional outcomes. ACCESS is associated with large gains in two of the three theorized clinical mechanisms of change, behavioral strategies and ADHD knowledge. Rapid improvement in behavioral strategies was associated with robust improvement in symptoms and functioning. Although improvements in the third mechanism, adaptive thinking, were small, they were strongly associated with outcomes demonstrating the importance of a cognitive-behavioral approach in treating college students with ADHD.
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Kriston L, Liebherz S, Köhnen M. Concerns about 'A comparison of electronically-delivered and face to face cognitive behavioural therapies in depressive disorders: A systematic review and meta-analysis'. EClinicalMedicine 2022; 54:101763. [PMID: 36471730 PMCID: PMC9719072 DOI: 10.1016/j.eclinm.2022.101763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
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Dufour R, Novack K, Picard L, Chadi N, Booij L. The use of technology in the treatment of youth with eating disorders: A scoping review. J Eat Disord 2022; 10:182. [PMID: 36434657 PMCID: PMC9700893 DOI: 10.1186/s40337-022-00697-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Adolescence and young adulthood is a high-risk period for the development of eating disorders. In recent years, there has been an increase in use of technology-based interventions (TBIs) for the treatment of eating disorders. The objective of this study was to determine the types of technology used for eating disorder treatment in youth and their effectiveness. METHODS A scoping review was conducted according to PRISMA-ScR guidelines. Four databases were searched. Eligible articles included: (1) a TBI (2) participants with a mean age between 10- and 25-years and meeting DSM-IV or DSM-5 criteria for any eating disorder and (3) qualitative or quantitative designs. Quantitative and qualitative studies were assessed for quality. RESULTS The search identified 1621 articles. After screening of titles and abstracts, 130 articles were read in full and assessed for eligibility by two raters. Forty-nine (29 quantitative and 20 qualitative, observational, or mixed methods studies) met inclusion criteria. Quality ratings indicated that 78% of quantitative studies had a low risk of bias and 22% had a moderate risk. Technologies reviewed in our study included videoconference therapy, mobile applications, and online self-help. We considered interventions used both within sessions with clinicians as well as those used in between sessions by patients alone. Fifteen of 18 (83%) quantitative studies found that TBIs reduce eating disorder symptomatology, with nine of those reporting medium-to-large effect sizes. Qualitative data was of high quality and suggested that virtual interventions are acceptable in this population. CONCLUSIONS Although identified studies are of high quality, they are limited in number. More research is needed, particularly regarding videoconferencing and mobile applications. Nonetheless, TBIs show promise for the treatment of eating disorders in youth. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Rachel Dufour
- Sainte-Justine Hospital Research Centre, Montreal, Canada.,Department of Psychology, Concordia University, Montreal, Canada
| | - Kaylee Novack
- Sainte-Justine Hospital Research Centre, Montreal, Canada.,Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Louis Picard
- Division of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Centre, 3175 Chemin de La Côte-Ste-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Nicholas Chadi
- Sainte-Justine Hospital Research Centre, Montreal, Canada. .,Division of Adolescent Medicine, Department of Pediatrics, Université de Montréal, Montreal, Canada. .,Division of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Centre, 3175 Chemin de La Côte-Ste-Catherine, Montreal, QC, H3T 1C5, Canada.
| | - Linda Booij
- Sainte-Justine Hospital Research Centre, Montreal, Canada.,Department of Psychology, Concordia University, Montreal, Canada.,Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
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Harvey E, Mutanda D, Jones AM, Hayward M. How should psychological interventions for distressing voices be delivered: a comparison of outcomes for patients who received interventions remotely or face-to-face within routine clinical practice? PSYCHOSIS 2022. [DOI: 10.1080/17522439.2022.2128860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Edward Harvey
- School of Psychology, University of Sussex, Brighton, UK
| | | | | | - Mark Hayward
- Research and Development Department, University of Sussex and Sussex Partnership NHS Foundation Trust, Hove, UK
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A systematic review of digital and face-to-face cognitive behavioral therapy for depression. NPJ Digit Med 2022; 5:144. [PMID: 36109583 PMCID: PMC9476400 DOI: 10.1038/s41746-022-00677-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/12/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractCognitive behavioral therapy (CBT) represents one of the major treatment options for depressive disorders besides pharmacological interventions. While newly developed digital CBT approaches hold important advantages due to higher accessibility, their relative effectiveness compared to traditional CBT remains unclear. We conducted a systematic literature search to identify all studies that conducted a CBT-based intervention (face-to-face or digital) in patients with major depression. Random-effects meta-analytic models of the standardized mean change using raw score standardization (SMCR) were computed. In 106 studies including n = 11854 patients face-to-face CBT shows superior clinical effectiveness compared to digital CBT when investigating depressive symptoms (p < 0.001, face-to-face CBT: SMCR = 1.97, 95%-CI: 1.74–2.13, digital CBT: SMCR = 1.20, 95%-CI: 1.08–1.32) and adherence (p = 0.014, face-to-face CBT: 82.4%, digital CBT: 72.9%). However, after accounting for differences between face-to-face and digital CBT studies, both approaches indicate similar effectiveness. Important variables with significant moderation effects include duration of the intervention, baseline severity, adherence and the level of human guidance in digital CBT interventions. After accounting for potential confounders our analysis indicates comparable effectiveness of face-to-face and digital CBT approaches. These findings underline the importance of moderators of clinical effects and provide a basis for the future personalization of CBT treatment in depression.
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Szőllősi GJ, Boruzs K, Karcagi-Kováts A, Kalas N, Bányai G, Bíró K. Investigation of the relationship between incidence of mental disorders and economic growth among the Visegrad countries. Front Public Health 2022; 10:982716. [PMID: 36159231 PMCID: PMC9490257 DOI: 10.3389/fpubh.2022.982716] [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: 06/30/2022] [Accepted: 08/18/2022] [Indexed: 01/25/2023] Open
Abstract
Prevention and care for mental disorders represent an important public health task in achieving global development goals. Proper access to adequate healthcare and social services is an important step related to care for mental disorders, which is presumably strongly related to economic growth. The main aim of the study was to investigate the relationship between the economic growth and the incidence of mental disorders in the V4 countries. An ecological correlation study was conducted regarding the four Visegrad countries. Indicators were derived from the World Health Organization (WHO) 'Health for All' (HFA) online database and Penn World Table version 10. The incidence of mental disorders increased in the V4 countries throughout the years between 2000-2018 except in Hungary, where a decreasing trend was observed. The prevalence of mental disorders increased in all countries as well, but it stagnated in Hungary. At the same time standardized death rate due to mental disorders increased in all Visegrad countries. According to the Hungarian data, while the prevalence of the disease did not change remarkably, the incidence decreased and the mortality increased as well as the prescription of drugs used in the treatment of mental disorders. This could indicate a serious hidden morbidity.
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Affiliation(s)
- Gergő József Szőllősi
- Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary,*Correspondence: Gergő József Szőllősi
| | - Klára Boruzs
- Faculty of Economics and Business, Institute of Health Economics and Management, University of Debrecen, Debrecen, Hungary
| | - Andrea Karcagi-Kováts
- Faculty of Economics and Business, Department of Environmental Economics, University of Debrecen, Debrecen, Hungary
| | - Nándor Kalas
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Gábor Bányai
- Faculty of Economics and Business, Institute of Health Economics and Management, University of Debrecen, Debrecen, Hungary
| | - Klára Bíró
- Faculty of Economics and Business, Institute of Health Economics and Management, University of Debrecen, Debrecen, Hungary
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Corbière M, Lachance JP, Jean-Baptiste F, Hache-Labelle C, Riopel G, Lecomte T. Healthy Minds: Group Cognitive-Behavioral Intervention for Sustainable Return to Work After a Sick Leave Due to Depression. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:505-514. [PMID: 34279759 PMCID: PMC8287279 DOI: 10.1007/s10926-021-09991-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 06/13/2023]
Abstract
Background Depression is one of the major causes for sick leave and loss of productivity at work. Many studies have investigated return to work (RTW) interventions for people with common mental disorders. However, a paucity of studies has targeted depressive symptoms in the workplace, as well as work productivity. Objectives This study presents preliminary results on a novel group intervention based on cognitive behavioral principles in order to optimize sustainable RTW, by reducing clinical symptoms (anxiety and depression) and improving work productivity. Method This pilot study followed a quasi-experimental design, with participants randomly receiving the group intervention (N = 19) or only receiving usual services (N = 11, control group). The group intervention called Healthy Minds for Sustainable RTW consists of eight sessions based on cognitive behavioral therapy principles and techniques. Outcome measures on depressive and anxiety symptoms and work productivity were administered at baseline (i.e. the start of return-to-work or gradual RTW), as well 2 months later (post-intervention), and at 6-month follow-up. Results The results did not show a time × group interaction for symptoms of depression or anxiety (p = 0.07). Those who received the group intervention however did see a within-group reduction in anxiety and depressive symptoms over time, clinically significant for the group intervention only. A significant time × group interaction for work productivity was found, with those in the intervention group improving over time compared to the control condition. Conclusion Although replication is needed, these results suggest that a brief group cognitive-behavioral intervention specifically tailored to work-related issues is promising. Future studies are warranted, particularly with larger samples and remote webconferencing delivery.
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Affiliation(s)
- Marc Corbière
- Faculty of Educational Sciences, Université of Québec à Montréal, 1205, Rue Saint-Denis, Montréal, QC, H2X 3R9, Canada.
- Research Center of the Institut universitaire en santé mentale de Montréal, Montreal, Canada.
| | - Jean-Philippe Lachance
- Research Center of the Institut universitaire en santé mentale de Montréal, Montreal, Canada
- Health and Society Institute, Université du Québec à Montréal, Montreal, Canada
| | | | - Catherine Hache-Labelle
- Research Center of the Institut universitaire en santé mentale de Montréal, Montreal, Canada
- Department of Psychology, Université de Montréal, Montreal, Canada
| | - Gabrielle Riopel
- Research Center of the Institut universitaire en santé mentale de Montréal, Montreal, Canada
- Department of Psychology, Université de Montréal, Montreal, Canada
| | - Tania Lecomte
- Research Center of the Institut universitaire en santé mentale de Montréal, Montreal, Canada
- Department of Psychology, Université de Montréal, Montreal, Canada
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Zou P, D'Souza D, Luo Y, Sun W, Zhang H, Yang Y. Potential effects of virtual interventions for menopause management: a systematic review. Menopause 2022; 29:1101-1117. [PMID: 35944249 DOI: 10.1097/gme.0000000000002020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPORTANCE Menopausal women are one of the fastest growing demographic groups globally. Virtual interventions have emerged as alternate avenues for menopausal women to manage and cope with their symptoms. OBJECTIVE The purpose of this review is to summarize existing research on the potential effects of virtual interventions for menopause management. EVIDENCE REVIEW This systematic review was written in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, PsychINFO, CINAHL, AgeLine, ERIC, ProQuest, Nursing and Allied Health Database, PsychARTICLES, and Sociology Database were used for literature search and searched from conception to December 2021. Original studies, including randomized controlled trials and quasi-experimental studies, were included if they evaluated a virtual intervention for menopause management and investigated the effects of these interventions on physical and psychosocial outcomes and/or the feasibility of these interventions among menopausal women. Included studies were published in peer-reviewed journals and assessed for quality using the Critical Appraisal Skills Program Checklists. FINDINGS A total of 16 articles were included in this review. Virtual interventions have the potential to improve physical health outcomes including body weight/body mass index/waist circumference, pain, blood pressure, and cholesterol. However, conflicting results were identified for the outcomes of vasomotor and endocrine symptoms, sleep, and sexual functioning. Virtual interventions might also improve psychosocial outcomes, including knowledge and patient-physician communication, although conflicting results were again identified for treatment decision-making ability, quality of life, and anxiety and depression. Virtual interventions were feasible in terms of being usable and cost-effective, and eliciting satisfaction and compliance among menopausal women. CONCLUSIONS AND RELEVANCE Virtual interventions might have the potential to improve the physical and psychosocial health outcomes of menopausal women, although some conflicting findings arose. Future studies should focus on including diverse menopausal women and ethnic minorities, conducting research within low- to middle-income countries and communities, further exploring intervention design to incorporate features that are age and culture sensitive, and conducting full randomized controlled trials to evaluate the effects of the interventions.
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Affiliation(s)
- Ping Zou
- From the School of Nursing, Nipissing University, Toronto, Ontario, Canada
| | - Daniel D'Souza
- Faculty of Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Yan Luo
- Faculty of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, P.R. China
| | - Winnie Sun
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Hui Zhang
- Department of Cardiology, Guizhou Provincial People's Hospital Guiyang, China
| | - Yeqin Yang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
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Yan K, Yusufi MH, Nazari N. Application of unified protocol as a transdiagnostic treatment for emotional disorders during COVID-19: An internet-delivered randomized controlled trial. World J Clin Cases 2022; 10:8599-8614. [PMID: 36157826 PMCID: PMC9453349 DOI: 10.12998/wjcc.v10.i24.8599] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/02/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has been an emotionally challenging time, especially for young adults. It is associated with a substantial increase in the prevalence of mental health problems, negative symptoms, and stressful experiences that compromise well-being. In low-income countries, internet-delivered psychological services could have a remarkable impact on the population’s mental health, given the lack of mental health professionals.
AIM To investigate the efficacy of internet-delivered cognitive-behavior therapy (CBT)-transdiagnostic intervention for adults with emotional disorders.
METHODS In this internet-delivered randomized controlled trial, 102 students with an emotional disorder (mean age = 28.20 years, standard deviation = 5.07) were randomly allocated to receive unified protocol (UP) (n = 51) or treatment as the usual intervention. Following a semi-structured clinical interview, participants completed an online survey including the Overall Anxiety Severity and Impairment Scale, Overall Depression Severity and Impairment Scale, Difficulties in Emotion Regulation Scale, Positive and Negative Affect Schedule, and Emotional Style Questionnaire.
RESULTS The participants showed a high degree of adherence. In total, 78% (n = 40) of the experimental group participants completed the UP treatment. Considering the intention to treat procedure, the results of the analysis of covariance indicated that participants who received UP showed statistically significant changes in depression symptoms [Cohen’s d = -1.50 with 95% confidence interval (CI): -1.90 to -1.10], anxiety (Cohen’s d = -1.06 with 95%CI: -1.48 to -0.65), difficulties with emotion regulation (Cohen’s d = -0.33 with 95%CI: -0.7 to -0.06), positive affect (Cohen's d = 1.27 with 95%CI: 0.85 to 1.68), negative affect (Cohen’s d= -1.04 with 95%CI: -1.46 to -0.63), and healthy emotionality (Cohen’s d = 0.53 with 95%CI: 0.09 to 0.13) compared with the control group.
CONCLUSION This study’s findings highlight the potential value of transdiagnostic internet-delivered programs for young adults with an emotional disorder during the COVID-19 pandemic, and expand the research examining emotional well-being improvements resulting from CBT-transdiagnostic interventions. The findings suggest that UP, which generally concentrates on reducing negative effects, can increase positive effects.
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Affiliation(s)
- Kou Yan
- School of Humanities and Education, Xi'an Eurasia University, Xi'an 710065, Shaanxi Province, China
| | | | - Nabi Nazari
- Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Lorestan, Iran
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Ramshaw G, McKeown A, Lee R, Conlon A, Brown D, Kennedy PJ. Introduction of Technology to Support Young People’s Care and Mental Health—A Rapid Evidence Review. CHILD & YOUTH CARE FORUM 2022; 52:509-531. [PMID: 35966643 PMCID: PMC9362215 DOI: 10.1007/s10566-022-09700-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/23/2022]
Abstract
Background Technology and its use within mental health services has advanced dramatically over recent years. Opportunities for mental health services to utilise technology to introduce novel, effective, and more efficient means of delivering assessment, and treatment are increasing. Objective The current rapid-evidence paper reviews evidence regarding the introduction of novel technology to support young people’s mental health and psychological well-being. Methods A rapid evidence review was conducted. PSYCHINFO and CINAHL were searched for research articles between 2016 and 2021 that were specific to young people, mental health, and technology developments within this domain. N = 27 studies which explored the introduction, feasibility, and value of technology for mental health purposes were included in a narrative synthesis. Quality or risk of bias analyses were not completed. Results Overall, technological advancements in young people’s care were considered positive and engaging for young people. Factors including resources, efficiency of care, engagement, therapeutic effectiveness, ethical considerations, therapeutic alliance, and flexibility were considered within this review. Nevertheless, potential barriers include clinician concerns, socioeconomic factors, and motivation. Conclusion Effective and sustained use of technology within young people’s mental health services will depend on the technology’s usability, efficiency, and ability to engage young people. This paper expands on existing research by reviewing a broader range of technology proposed to support young people’s mental health and well-being. This will assist in the application of novel technological advancements by indicating effectiveness, preferences, potential barriers, and recommendations for the feasibility and efficacy of introducing technology into young people’s services.
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Chow DYW, Jiang X, You JHS. Information technology-based versus face-to-face cognitive-behavioural therapy for anxiety and depression: A systematic review and meta-analysis. J Affect Disord 2022; 310:429-440. [PMID: 35577156 DOI: 10.1016/j.jad.2022.05.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 12/06/2021] [Accepted: 05/08/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aimed to systematically review the efficacy of information technology-based cognitive behavioural therapy (ICBT) versus face-to-face cognitive behavioural therapy (FCBT) for management of anxiety and depression in adult patients. METHODS Systematic literature search for clinical trials comparing ICBT to FCBT in adults diagnosed with anxiety or depression was conducted. Quantitative analyses were performed to examine the efficacy of ICBT versus FCBT. Primacy outcome was change in symptom severity. RESULTS A total of 11 publications (10 studies and 896 participants) were included. The pooled effect size of ICBT versus FCBT did not find significant difference for post-treatment anxiety or depressive symptoms severity (Hedges' g = -0.07; 95% CI = -0.20 to 0.06), and ICBT was non-inferior to FCBT (at Cohen's d = 0.3). Maintenance of treatment efficacy also showed no significant difference between ICBT and FCBT at 6 months (g = -0.14, 95% CI = -0.42 to 0.14) and 12 months (g = -0.05, 95% CI = -0.41 to 0.32) post-treatment. Adherence rate was lower in ICBT than FCBT but did not achieve statistically significance (61% vs 88%; RR = 0.86, 95% CI = 0.74 to1.00). Results were not affected by study quality. LIMITATIONS The examination of study heterogeneity was limited by the small number of studies. CONCLUSIONS We found non-inferior performance of ICBT versus FCBT in reducing symptoms in patients diagnosed of anxiety or depressive disorders. With the social-distancing measures amid COVID-19 pandemic, service providers should give serious consideration with great caution in the decision-making process of offering ICBT to patients.
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Affiliation(s)
- Dilys Yan-Wing Chow
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xinchan Jiang
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Joyce H S You
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Venkatesan A, Forster B, Rao P, Miller M, Scahill M. Improvements in Depression Outcomes Following a Digital Cognitive Behavioral Therapy Intervention in a Polychronic Population: Retrospective Study. JMIR Form Res 2022; 6:e38005. [PMID: 35788442 PMCID: PMC9297139 DOI: 10.2196/38005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/27/2022] [Accepted: 06/08/2022] [Indexed: 02/06/2023] Open
Abstract
Background Digital mental health interventions have shown promise in reducing barriers to effective care for depression. Depression and related mental disorders are known to be highly comorbid with common chronic physical conditions, such as obesity and type 2 diabetes. While some research has explored the interaction dynamics of treating populations living with both mental and physical disorders, very little is known about such dynamics in digital care. Objective We aimed to examine the effectiveness of a 12-week, therapist-supported, app-based cognitive behavioral therapy program in improving symptoms of depression and anxiety. The studied population included adults with a heavy burden of chronic physical disease, including obesity and type 2 diabetes. Methods A total of 1512 participants with at least moderate depression were enrolled. The treatment cohort consisted of 831 (54.96%) participants who completed a follow-up assessment. The program included structured lessons and tools (ie, exercises and practices) and offered one-on-one weekly video counseling sessions with a licensed therapist for 12 weeks and monthly sessions thereafter. The clinically validated 8-item Patient Health Questionnaire (PHQ-8) and the 7-item Generalized Anxiety Disorder scale (GAD-7) were used to assess depression and anxiety, respectively. Linear mixed-effects modeling was employed to examine changes in depression and anxiety over time. Given correlation among various measures of program usage, a composite variable for depth of usage was used to analyze the correlation between usage and changes in depressive symptoms. Body weight changes from baseline were assessed primarily with digitally connected scales. Results Out of 831 participants in the treatment cohort, 74.5% (n=619) showed a clinically significant reduction in depressive symptom severity after 12 weeks, where follow-up PHQ-8 scores had shifted downward by at least one diagnostic category. In total, 67.5% (n=561) of the participants showed a reliable improvement in PHQ-8 scores as measured by the reliable change index. There was an average reduction of 5.9 (SD 5.2) points (P<.001) between baseline and follow-up. Greater program usage was correlated with greater likelihood of reliable improvement in depressive symptoms (odds ratio 1.3, 95% CI 1.1-1.5; P=.002). An exploratory analysis of body weight changes with a multilevel, mixed-effect model suggested that reliable improvement in depressive symptoms at follow-up was associated with significantly greater weight loss at 9 months (β=–1.11, P=.002). Conclusions The results provide further support that digital interventions can support clinically meaningful improvements in depression. Some form of synergy in treatment of comorbid depression and obesity or diabetes could be studied in future research. The study was limited by postintervention participant attrition as well as the retrospective observational study design.
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Dörttepe ZÜ, Duman ZÇ. Examination of Telemental Health Practices in Caregivers of Children and Adolescents with Mental Illnesses: A Systematic Review. Issues Ment Health Nurs 2022; 43:625-637. [PMID: 35021018 DOI: 10.1080/01612840.2021.2013366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In this systematic review, effects of telemental health (TMH) practices' on caregivers of children/adolescents with mental illnesses were investigated. The literature review included databases, and reference lists of published studies. All studies published until September 2021 were reviewed. Eleven studies were included. Several services were provided via TMH: education, cognitive behavioral therapy (CBT), parent training, caregiver behavior training, family CBT. The effectiveness of TMH interventions on caregivers varied from low to high. Most reproducible findings were on caregivers' satisfaction, stress, therapeutic alliance and caregiver burden. Studies had a low to high bias risk. Most studies had small samples. Results built on the small but growing literature support TMH interventions' promising role in caregivers of children with mental illness. Future studies should estimate outcomes with medium to low effect size. Other caregiver groups, rarely considered in previous studies, should be included. Bias risk should be minimized. Larger, more methodologically rigorous studies should be conducted.
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Affiliation(s)
- Zümra Ülker Dörttepe
- Medical Services and Techniques Department, Vocational School of Health Sciences, Uşak University, Uşak, Turkey
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41
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Carr A, Toloza C, Li Z, Nazar BP, Himmerich H. Therapy outcome of day treatment for people with anorexia nervosa before and during the COVID-19 pandemic. Brain Behav 2022; 12:e2604. [PMID: 35588369 PMCID: PMC9226813 DOI: 10.1002/brb3.2604] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE The current research aimed to compare clinical outcome measures of two National Eating Disorder (ED) Day Services at the Maudsley Hospital from before the COVID-19 lockdown, when treatment was face to face, with after the lockdown when treatment moved online. METHOD Clinical outcome measures collected as part of the admission and discharge process were compared from the beginning and end of treatment for patients treated either via face-to-face or online delivery. Twenty-nine patients' data were analyzed (89% of them female, 11% male, 89% from White ethnic backgrounds, 11% from BAME ethnic backgrounds and a mean age of 25.99 years). Additionally, the mean change in outcome measures was also compared between the two groups (pre-lockdown face to face and during lockdown online). RESULTS Treatment delivered face to face led to significant improvements in body mass index (BMI) but not in Eating Disorder Examination Questionnaire (EDEQ) Global and Work and Social Adjustment Scale (WSAS) Total scores. In contrast, treatment delivered online led to significant improvements in EDEQ Global and WSAS Total scores but not in BMI. Neither one of the delivery modalities created significantly larger mean changes in any of the clinical outcome measures than the other. CONCLUSIONS Both face-to-face and online delivery of eating disorder day treatment show some success. Suggested improvements for using online delivery of treatment include implementing additional support opportunities, adapting the online format to improve communication and commitment and using a hybrid model of specific face-to-face elements with some online treatment.
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Affiliation(s)
- Anna Carr
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Cindy Toloza
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Zhuo Li
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Hubertus Himmerich
- South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Duan W, Kong Y, Bu H, Guan Q, Chen Z, Luo Q, Zhang J. The Online Strength-Informed Acceptance and Commitment Therapy Among COVID-19-Affected Adolescents. RESEARCH ON SOCIAL WORK PRACTICE 2022; 32:465-474. [PMID: 38603081 PMCID: PMC8841394 DOI: 10.1177/10497315211067270] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Purpose: This study develops and investigates the changes in anxiety symptoms and quality of life (QoL) among participants of the online Strength-informed Acceptance and Commitment Therapy (SACT) across three tests. METHODS A small-scale, quasi-experiment with no control group was conducted. Repeated-measures analysis was employed to assess the changes of the three tests, which were the pre-experimental, post-test, and 3-month follow-up test. A total of 47 adolescents (ages 10-12) completed the 45-min intervention that lasted 10 weeks. RESULTS Compared with the pre-experimental, the post-test indicated significant anxiety symptoms reduction but not a statistically significant increase in QoL. The 3-month follow-up test indicated reduced anxiety symptoms and improved QoL compared with the pre-experimental. The with-in subject changes were substantial. CONCLUSIONS The online SACT is a promising model to reduce anxiety symptoms and promote QoL among adolescents during the current COVID-19 pandemic, which show both short- and long-term benefit to the participants.
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Affiliation(s)
- Wenjie Duan
- School of Social and Public Administration, East China University of Science and Technology, Shanghai, China
| | - Yansi Kong
- School of Social and Public Administration, East China University of Science and Technology, Shanghai, China
| | - He Bu
- Department of Social & Behavioural Sciences, City University of Hong Kong, Hong Kong, China
| | - Qiujie Guan
- School of Social Development and Public Policy, Fudan University, Shanghai, China
| | - Zheng Chen
- Institute of Education, Wuhan University, Wuhan, China
| | - Qiansheng Luo
- Wuhan Economic and Technological Development Zone Huangling Primary School, Wuhan, China
| | - Jing Zhang
- Wuhan Economic and Technological Development Zone Huangling Primary School, Wuhan, China
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43
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Milosevic I, Cameron DH, Milanovic M, McCabe RE, Rowa K. Face-to-face versus Video Teleconference Group Cognitive Behavioural Therapy for Anxiety and Related Disorders: A Preliminary Comparison. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:391-402. [PMID: 34159838 PMCID: PMC9065489 DOI: 10.1177/07067437211027319] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Telehealth is being increasingly incorporated into the delivery of mental health care and has received widespread attention during the COVID-19 pandemic for its ability to facilitate care during physical distancing restrictions. Videoconferencing is a common telehealth modality for delivering psychotherapy and has demonstrated similar outcomes to those of face-to-face therapy. Cognitive behavioural therapy (CBT) is the most common psychotherapy evaluated across various telehealth modalities; however, studies on CBT delivered via videoconference, particularly in a group therapy format, are lacking. Further, little research exists on videoconference group CBT for anxiety disorders. Accordingly, the present study compared the outcomes of group CBT for anxiety and related disorders delivered via videoconference versus face-to-face. METHOD Using a non-randomized design, data on attendance, dropout, clinical outcomes, and functional impairment were collected from 413 adult outpatients of a tertiary care anxiety disorders clinic who attended a CBT group for panic disorder/agoraphobia, social anxiety disorder, generalized anxiety disorder (GAD), or obsessive-compulsive disorder delivered either face-to-face (pre-COVID-19 pandemic) or via videoconference (since the onset of COVID-19 pandemic). Outcomes were assessed using well-validated self-report measures. Data were collected pre-treatment, across 12 weekly sessions, and post-treatment. Intent-to-treat analyses were applied to symptom outcome measures. RESULTS Face-to-face CBT conferred only a slight benefit over videoconference CBT for symptom outcomes across all groups, but when assessed individually, only the GAD group showed greater symptom improvement in the face-to-face format. Effect sizes for significant differences between the delivery formats were small. Participants in videoconference groups tended to have slightly higher attendance rates in some instances, whereas functional improvement and treatment dropout were comparable across the delivery formats. CONCLUSIONS Results provide preliminary evidence that videoconference group CBT for anxiety and related disorders may be a promising and effective alternative to face-to-face CBT. Additional research is needed to establish equivalence between these delivery formats.
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Affiliation(s)
- Irena Milosevic
- Anxiety Treatment and Research Clinic, 25479St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Duncan H Cameron
- Anxiety Treatment and Research Clinic, 25479St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Melissa Milanovic
- Anxiety Treatment and Research Clinic, 25479St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, 25479St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Karen Rowa
- Anxiety Treatment and Research Clinic, 25479St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Dean R. Can improving quality of sleep reduce the symptoms of cancer-related fatigue in adults?: A systematic review. Eur J Cancer Care (Engl) 2022; 31:e13597. [PMID: 35474359 PMCID: PMC9541520 DOI: 10.1111/ecc.13597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/03/2021] [Accepted: 12/02/2021] [Indexed: 12/01/2022]
Abstract
Purpose Cancer‐related fatigue (CRF) results in reduced quality of life for cancer patients. The relationship between tiredness and fatigue has been established in cancer patients and has been shown to be reciprocal, meaning the relationship is somewhat ‘chicken or the egg’ with tiredness influencing fatigue and vice versa. The aim of this study is to determine whether an improvement in sleep quality can ease the symptoms of CRF and whether this can support the theory that CRF symptoms stem from the effect of tiredness. Method Three databases were searched producing 259 papers. The papers were filtered using several inclusion criteria, resulting in a final list of 20 papers for analysis. The remaining papers (20) were critically appraised using the Critical Appraisals Skills Programme (CASP) randomised control trial checklist and assessed for bias using the Cochrane Collaboration's tool for assessing risk of bias in randomised trials. Results Fourteen papers showed an increase in sleep quality that also resulted in an improvement in fatigue symptoms. Cognitive behavioural therapy was shown to be the most effective intervention with a statistically significant decrease in fatigue alongside significant improvement in sleep quality shown in six of the papers (p < 0.05). Sleep education also had a positive impact on both sleep and fatigue scores with three papers showing significant improvements. Three papers focusing on exercise interventions produced a significant improvement in fatigue symptoms and quality of sleep. Conclusion Improving quality of sleep does ease the symptoms of CRF; however, the ‘chicken or the egg’ question regarding CRF and tiredness cannot be answered at this stage.
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Affiliation(s)
- Rogan Dean
- Warwick Medical School, University of Warwick, Coventry, UK
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45
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Feinstein D. Uses of Energy Psychology Following Catastrophic Events. Front Psychol 2022; 13:856209. [PMID: 35548526 PMCID: PMC9084314 DOI: 10.3389/fpsyg.2022.856209] [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: 01/16/2022] [Accepted: 02/14/2022] [Indexed: 12/15/2022] Open
Abstract
Energy psychology, as most widely practiced, integrates the manual stimulation of acupuncture points with imaginal exposure, cognitive restructuring, and other evidence-based psychotherapeutic procedures. Efficacy for energy psychology protocols has been established in more than 120 clinical trials, with meta-analyses showing strong effect sizes for PTSD, anxiety, and depression. The approach has been applied in the wake of natural and human-made disasters in more than 30 countries. Four tiers of energy psychology interventions following the establishment of safety, trust, and rapport are described, including (1) immediate relief/stabilization, (2) reducing limbic arousal to trauma-based triggers, (3) overcoming complex psychological difficulties, and (4) promoting optimal functioning. The first tier is most pertinent in psychological first aid immediately following a disaster, with the subsequent tiers progressively being introduced over time with complex stress reactions and chronic disorders. Advantages of adding the stimulation of acupuncture points to a conventional exposure approach are identified, and challenges around cultural sensitivities and unintended effects are discussed. After establishing a framework for introducing energy psychology in disaster relief efforts, reports from a sampling of settings are presented, based on interviews with this paper's author. These include accounts of relief work with survivors of mass shootings, genocide, ethnic warfare, earthquakes, hurricanes, tornadoes, floods, wildfires, and the COVID-19 pandemic. Hundreds of other reports from the field show a pattern of strong outcomes following the use of energy psychology in the days or weeks after a disaster and in the subsequent treatment of trauma-based psychological problems. Many of these accounts corroborate one another in terms of rapid relief and long-term benefits. Finally, examples of more efficient delivery methods utilizing large groups, lay counselors, digital technology, and cultivating community resilience are presented.
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Patients’ and therapists’ experiences of CBT videoconferencing in anxiety disorders. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Cognitive behavioural therapy (CBT) videoconferencing has been demonstrated to be an effective treatment for anxiety disorders and an equal alternative to face-to-face CBT. However, qualitative patient and therapist experiences of CBT videoconferencing have been less researched. Due to COVID-19, mental health services have shifted to remote therapy methods; thus, understanding patient and therapist experiences are crucial to better inform service policies and best practices. The current study focused on patient and therapist experiences of CBT videoconferencing at the Centre for Anxiety Disorders and Trauma (CADAT). Researchers used qualitative content analysis to explore patients’ (n = 54) and therapists’ (n = 15) responses to an online survey. Results yielded four themes: behavioural experiments work well if the problem lends itself to videoconferencing, overall practicalities but some home environment implications, privacy and technical issues, high telepresence and the negative impact on the therapeutic alliance, and COVID-19 influences attitude positively. The findings have clinical implications for CBT videoconferencing, including a need for specific training in assessment and intervention for therapists using videoconferencing.
Key learning aims
Readers of this paper will be able to:
(1)
Describe patient and therapist qualitative experiences of CBT videoconferencing.
(2)
Identify areas to consider when delivering CBT videoconferencing in anxiety disorders.
(3)
Understand therapist training needs for CBT videoconferencing in anxiety disorders.
(4)
Inform own service protocols and best practices for the delivery of CBT videoconferencing.
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Cuthbert K, Parsons EM, Smith L, Otto MW. Acceptability of telehealth CBT during the time of COVID-19: Evidence from patient treatment initiation and attendance records. JOURNAL OF BEHAVIORAL AND COGNITIVE THERAPY 2022; 32:67-72. [PMID: 35018352 PMCID: PMC8739019 DOI: 10.1016/j.jbct.2022.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/31/2021] [Accepted: 01/03/2022] [Indexed: 05/22/2023]
Abstract
The COVID-19 pandemic provided unique conditions for examining outpatient psychotherapy clinics' rapid transition to telehealth. The current study utilized data from a large, specialty CBT clinic to investigate attendance and treatment engagement changes when services were provided via telehealth versus in-person. Results indicate that, following a complete transition to telehealth services, clinic referrals were maintained. Further, telehealth treatment appeared to be entirely acceptable as assessed by a decreased missed visit rate of telehealth appointments compared to in-person appointments. Given the elimination of commuting times, telehealth has the potential to address disparities in care linked to physical distance from the clinic and/or differential ability to take time off work for appointments.
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Affiliation(s)
- Kristy Cuthbert
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215, USA
| | - E Marie Parsons
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215, USA
| | - Lisa Smith
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215, USA
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215, USA
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Garner K, Boggiss A, Jefferies C, Serlachius A. Digital health interventions for improving mental health outcomes and wellbeing for youth with type 1 diabetes: A systematic review. Pediatr Diabetes 2022; 23:258-269. [PMID: 34913548 DOI: 10.1111/pedi.13304] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/04/2021] [Accepted: 12/09/2021] [Indexed: 01/20/2023] Open
Abstract
Digital health interventions are a promising alternative to face-to-face psychosocial interventions that may improve psychological outcomes in youth with diabetes. Several reviews have explored the efficacy of digital health interventions for adults and youth with some chronic health conditions; however, their efficacy among youth with type 1 diabetes is not known. This systematic review aims to assess digital health interventions targeting both psychological and physical health outcomes in youth with type 1 diabetes as well as to evaluate study quality and efficacy, and provide directions for future research in this area. Relevant studies were identified through searches conducted in MEDLINE, Embase, APA PsycInfo, Scopus, Cochrane Central, and CINAHL Plus up until February 2021. Studies were included if they were randomized; reported at least one psychological outcome that was assessed at ≥2 time points; included a digital health intervention; and were conducted in youth aged 5 to 25 years with type 1 diabetes. The revised Cochrane risk-of-bias (RoB 2) tool was used to assess risk of bias. Of the 5159 articles found, 15 met the inclusion criteria and were included in the review. Self-efficacy improved in 2 of the 3 studies which assessed self-efficacy; however, no consistent improvements were found for other psychological, behavioral, or physical outcomes. All studies showed some risk of bias concerns. More research is needed to make firm conclusions on the efficacy of digital health interventions for youth with diabetes. More specifically, interventions based on psychological theories are needed and studies of higher quality methodologies.
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Affiliation(s)
- Katie Garner
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Anna Boggiss
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Craig Jefferies
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
| | - Anna Serlachius
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
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Aemissegger V, Lopez-Alcalde J, Witt CM, Barth J. Comparability of Patients in Trials of E-Health and Face-To-Face Psychotherapeutic Interventions for Depression: a Meta-Synthesis (Preprint). J Med Internet Res 2022; 24:e36978. [PMID: 36103217 PMCID: PMC9520399 DOI: 10.2196/36978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/16/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vera Aemissegger
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Jesus Lopez-Alcalde
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Madrid, Spain
- Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Madrid, Spain
| | - Claudia M Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Lau Y, Yen KY, Wong SH, Cheng JY, Cheng LJ. Effect of digital cognitive behavioral therapy on psychological symptoms among perinatal women in high income-countries: A systematic review and meta-regression. J Psychiatr Res 2022; 146:234-248. [PMID: 34774299 DOI: 10.1016/j.jpsychires.2021.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/11/2021] [Accepted: 11/04/2021] [Indexed: 10/19/2022]
Abstract
Several reviews focused on the use of digital cognitive behavioral therapy (CBT) across different populations. This review synthesized randomized controlled trials (RCTs) that evaluated the effectiveness of digital CBT on psychological symptoms (depression, anxiety, and stress symptoms). An extensive search was conducted in 10 databases from inception until August 29, 2021. A meta-analysis using a random-effects model was performed using Hedges' g. The potential sources of heterogeneity were explored through subgroup analyses and meta-regression analysis. A total of 18 RCTs in 2514 perinatal women were identified from over 23 countries. The sample size ranged from 25 to 910. Meta-analyses showed that digital CBT significantly reduced depression (g = -0.56, 95% CI: -0.85, -0.27, I2 = 84.81%, p < 0.001), anxiety (g = -0.30, 95% CI: -0.44, -0.17, I2 = 0%, p < 0.001), and stress (g = -0.75, 95% CI: -0.95, -0.56, I2 = 0%, p < 0.001) symptoms at post-intervention and stress symptoms at follow-up (g = -0.52, 95% CI: -0.93, -0.11, I2 = 0%, p = 0.01) compared with those in the control group. Subgroup analyses highlighted that the intervention was effective when CBT was combined with other therapeutic components which delivered via a mobile application. Preferable features of intervention should be more than eight sessions and conducted for than 6 weeks among postnatal women. Multivariable meta-regression showed that age was a significant covariate on depression symptoms. The sample size in the selected RCTs was small, and the overall quality of the evidence was very low. Digital CBT is a potential intervention for alleviating psychological outcomes in perinatal women. This review suggests the essential features to optimize the intervention effect. Further well-designed RCTs with large sample sizes are necessary.
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Affiliation(s)
- Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Kai Yoong Yen
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Sai Ho Wong
- Alexandra Hospital, National University Health System, Singapore.
| | - Jing Ying Cheng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Ling Jie Cheng
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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