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Qin N, Luo Y, Wang S, Li Y, Li J, Luo J, Zhou J, Zhang Q, Xie J, Cheng ASK. Effectiveness of a modified behavioural activation treatment training program for primary medical staff to manage depressive symptoms among rural elderly in Hunan Province, China: study protocol for a cluster randomised controlled trial. BMJ Open 2024; 14:e086489. [PMID: 38925704 PMCID: PMC11202641 DOI: 10.1136/bmjopen-2024-086489] [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: 03/15/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Depression is a major global health problem, with high prevalence rates of depressive symptoms observed among the elderly population in China, particularly exacerbating in rural areas. Due to a lack of professional mental health training and inadequate psychotherapy capacity within primary medical staff, rural elderly individuals grappling with depressive symptoms often encounter challenges in receiving timely diagnosis and treatment. In this landscape, the modified behavioural activation treatment (MBAT) emerges as a promising approach due to its practicality, ease of therapist training and application, patient acceptability, and broad applicability. However, existing evidence for MBAT mainly hails from developed countries, leaving a gap in its adaptation and implementation within rural China. This study aims to develop an MBAT training programme for primary medical staff to manage depressive symptoms among rural elderly and evaluate its effectiveness. METHODS AND ANALYSIS A cluster randomised controlled trial will be conducted in 10 randomly selected township hospitals in Lengshuijiang and Lianyuan, Hunan Province. We aim to recruit 150 participants, with 5 township hospitals selected for each group, each consisting of 15 participants. The intervention group will implement the MBAT training programme, while the control group will receive usual care training programme. Depressive symptoms, psychosocial functioning, quality of life and satisfaction will be measured at baseline, immediately post-intervention, and at 3 and 6 months post-intervention. Effectiveness will be assessed using linear or generalised linear mixed models. ETHICS AND DISSEMINATION This study has obtained approval from the Institutional Review Board of the Third Xiangya Hospital, Centre South University (No.: 2022-S261). Results will be disseminated through publication in international peer-reviewed journals and presentations at national and international conferences. TRIAL REGISTRATION NUMBER ChiCTR2300074544.
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Affiliation(s)
- Ning Qin
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Yating Luo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Sha Wang
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuxuan Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jing Li
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Juan Luo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jian Zhou
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, Hunan, China
| | - Qiuxiang Zhang
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jianfei Xie
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Andy S K Cheng
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
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Berna F, Mengin AC, Huguelet P, Urbach M, Evrard R, Fond G. Is mindfulness practice "at risk" of increasing spirituality? Systematic review and critical analysis of a claimed effect. L'ENCEPHALE 2024:S0013-7006(24)00003-4. [PMID: 38311475 DOI: 10.1016/j.encep.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 02/06/2024]
Abstract
INTRODUCTION Mindfulness meditation has gained prominence in somatic and psychiatric care in several countries including France. Studies have shown its effectiveness in various conditions, in particular the prevention of depressive relapses. However, there are criticisms and concerns about its potential links to Buddhism and spirituality, raising issues of secularism and sectarianism. This issue is particularly conflicting in France with regard its historical and political relationship with secularism. OBJECTIVES This study aims to assess quantitative data regarding the impact of mindfulness meditation on spirituality and religiosity using quantitative validated scales. METHODS A systematic review was conducted. PubMed was searched for relevant studies using keywords related to mindfulness and spirituality/religiosity scales. Four scales assessing spirituality were identified: FACIT-sp, INSPIRIT, DSES, and DUREL. Qualitative analysis determined if scale items pertained to spirituality or other topics considered by opponents to mindfulness as "at risk" for deviances or sectarian aberrations. Quantitative analysis assessed the effect size of changes in scale scores before and after mindfulness meditation interventions. RESULTS Eighteen studies were analyzed, with varying scales and program durations including 1272 participants. Qualitative analysis showed that most scales contained items related to spirituality as well as "at risk" elements like religion and mysticism. Quantitative analysis revealed that a few studies reported significant increases in spirituality scores following mindfulness meditation, but the clinical relevance of these changes was questioned. In general, control groups had smaller score changes. INTERPRETATION While some studies suggest a potential increase in spirituality due to mindfulness meditation, the clinical significance of these findings remains uncertain. Moreover, mindfulness meditation's ties to Buddhism are disputed, and its roots are intertwined with various psychotherapy traditions that incorporate spirituality. The role of secularism in psychotherapy is also debated in France, emphasizing the need for proper use and regulation policy rather than prohibition of mindfulness-based approaches. This study highlights the complexity of assessing the impact of mindfulness meditation on spirituality and religiosity. It suggests that a pragmatic approach focusing on risk and harm reduction may be more suitable than labeling the practice as "at risk". Further research is needed to clarify these issues in the specific cultural context of France.
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Affiliation(s)
- Fabrice Berna
- Psychiatry, Inserm U1329, université de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
| | - Amaury C Mengin
- Psychiatry, Inserm U1329, université de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | | | - Mathieu Urbach
- Service universitaire de psychiatrie et d'addictologie, centre hospitalier de Versailles, Versailles, France
| | - Renaud Evrard
- Laboratories Inters (EA 4432), université de Lorraine, Nancy, France
| | - Guillaume Fond
- Assistance publique des Hôpitaux de Marseille, Marseille, France
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Sun Q, Xu H, Zhang W, Zhou Y, Lv Y. Behavioral Activation Therapy for Subthreshold Depression in Stroke Patients: An Exploratory Randomized Controlled Trial. Neuropsychiatr Dis Treat 2022; 18:2795-2805. [PMID: 36471746 PMCID: PMC9719268 DOI: 10.2147/ndt.s392403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Subthreshold depression (SD) is known to be a major risk factor for the development of post-stroke depression (PSD). Appropriate intervention to prevent the transition from SD to PSD is thus imperative. As a form of short-term psychotherapy adapted for individuals with cognitive and communication impairments, behavioral activation therapy (BAT) may be a suitable choice. However, the effects of BAT on psychological outcomes in stroke patients with SD has not been established. This study investigated the feasibility and effectiveness of BAT in reducing the development of depressive symptoms in this patient population. METHODS A double-blind, randomized controlled trial was performed. Seventy participants were randomized to either a BAT group (n=35) or a control group (n=35). Participants in the BAT group received a six-week BAT intervention. The feasibility of BAT was assessed by the number of sessions attended by participants, and the acceptability of BAT to participants and the incidence of adverse events were recorded. The primary clinical outcome measure was the Center for Epidemiological Studies Depression Scale (CES-D) and the 17-item Hamilton Depression Scale (HAMD-17) at baseline, six weeks, and three months after the group allocation. Secondary outcomes included behavioral activation and the incidence of depression. RESULTS The intervention was feasible and acceptable, with 94.3% of participants in the BAT group (33 of 35) attending at least five sessions. No adverse events were reported in either group. Compared with the control group, the BAT group showed significant improvements in the CES-D (F=67.689, P<0.05), HAMD-17 (F=4.170, P<0.05), and behavioral activation (F=25.355, P<0.05) scores after intervention, and these differences were maintained at the three-month assessment. CONCLUSION BAT appears to be feasible and efficacious for reducing depressive symptoms and increasing behavioral activation among stroke patients with SD. The findings of this study may contribute to the primary prevention of PSD.
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Affiliation(s)
- Qiuxue Sun
- School of Nursing, Harbin Medical University (Daqing), Daqing, People's Republic of China
| | - Hailian Xu
- School of Medical, Quzhou College of Technology, Quzhou, People's Republic of China
| | - Wenyue Zhang
- Department of Rehabilitation, People's Hospital of Daqing, Daqing, People's Republic of China
| | - Yuqiu Zhou
- School of Nursing, Harbin Medical University (Daqing), Daqing, People's Republic of China
| | - Yumei Lv
- School of Nursing, Harbin Medical University (Daqing), Daqing, People's Republic of China
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Dondé C, Vignaud P, Poulet E, Brunelin J, Haesebaert F. Management of depression in patients with schizophrenia spectrum disorders: a critical review of international guidelines. Acta Psychiatr Scand 2018; 138:289-299. [PMID: 29974451 DOI: 10.1111/acps.12939] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Depression is a frequent but potentially treatable clinical dimension in patients with schizophrenia spectrum disorders (PWS). However, there is a lack of consensual recommendations regarding the optimal strategy to manage depression in PWS. In this study, we aimed to compare the various proposed strategies to define a core set of valid care recommendations for depression management in PWS. METHODS After a systematic search of the literature, the methodological quality of 10 international guidelines from four continents was compared using a validated guideline appraisal instrument (AGREE II). Key recommendations for the management of depression in PWS were subsequently reviewed and discussed. RESULTS The methodological quality of the guidelines was heterogeneous. Although all guidelines proposed pharmacotherapy, psychosocial interventions were a minor concern. Waiting for antipsychotic effects mostly was recommended during the acute phase of schizophrenia. During the postpsychotic phase of the illness, a switch to a second-generation antipsychotic and/or the adjunction of an antidepressant were the primary recommendations. Cognitive behavioural therapy and other medications were considered with strong variations. CONCLUSIONS Further studies are needed to strengthen the level of evidence for antidepressive approaches in PWS. The inclusion of PWS as stakeholders is also considered to be a major issue for future guideline development.
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Affiliation(s)
- C Dondé
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: From Resistance to Response Team, Lyon, France.,University Lyon 1, Villeurbanne, France.,Centre Hospitalier Le Vinatier, Bron, France
| | - P Vignaud
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: From Resistance to Response Team, Lyon, France.,University Lyon 1, Villeurbanne, France.,Centre Hospitalier Le Vinatier, Bron, France
| | - E Poulet
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: From Resistance to Response Team, Lyon, France.,University Lyon 1, Villeurbanne, France.,Centre Hospitalier Le Vinatier, Bron, France.,Department of Psychiatry Emergencies, CHU Lyon, Hôpital Edouard Herriot, Lyon, France
| | - J Brunelin
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: From Resistance to Response Team, Lyon, France.,University Lyon 1, Villeurbanne, France.,Centre Hospitalier Le Vinatier, Bron, France
| | - F Haesebaert
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: From Resistance to Response Team, Lyon, France.,University Lyon 1, Villeurbanne, France.,Centre Hospitalier Le Vinatier, Bron, France.,CERVO Brain Research Center, Québec, QC, Canada.,Département de Psychiatrie et Neurosciences, Faculté de Médecine, Université Laval, Québec, QC, Canada
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