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Burnett J, Hoyumpa GM, Beauchamp JES, Hernandez-Tejada MA, Acierno R, Perissinotto C. Social connection and self-neglect: A case for broader exploration. Int J Psychiatry Med 2024:912174241240619. [PMID: 38896807 DOI: 10.1177/00912174241240619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Self-neglect (SN) is the most common report to Adult Protective Services (APS) and is associated with significant morbidity and mortality risks for older adults. Lack of instrumental support is a well-evidenced etiologic factor in the development and continuation of SN, but little is known about other modifiable social connection characteristics. The social connection framework, provides a host of evidence-based characteristics across structure, function, quality missing from SN studies that could be identified if explored. These factors could provide prevention and intervention targets related to poor health. We present a narrative case study using quantitative and qualitative data to explore social connection across structure, function, and quality in the context of SN. The findings highlight the complexity of social connection that may be frequently observed in SN cases reported to APS. Strategic utilization of direct and indirect social interventions to support social connection in this case is presented and provides general considerations that may be generalizable to other SN cases. Thoughts for future research on social connection in this population are provided.
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Affiliation(s)
- Jason Burnett
- Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, McGovern Medical School, The University of Texas Health Science Center, Houston, TX, USA
| | - Gabrielle M Hoyumpa
- McGovern Medical School, The University of Texas Health Science Center, Houston, TX, USA
| | - Jennifer E S Beauchamp
- Cizik School of Nursing, The University of Texas Health Science Center, Houston, TX, USA
| | - Melba A Hernandez-Tejada
- Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center, Houston, TX, USA
| | - Ronald Acierno
- Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center, Houston, TX, USA
| | - Carla Perissinotto
- School of Medicine, The University of California San Francisco, San Francisco, CA, USA
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2
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Ross EJ, Jimenez DE, Ghanooni D, Mendez A, Hirshfield S, Horvath KJ, DeVries B, Dilworth SE, Carrico AW, Martinez CA. Loneliness, Methamphetamine Use, and Cardiovascular Risk Factors Among Sexual Minority Men in the COVID-19 Era. Int J Behav Med 2024:10.1007/s12529-024-10288-0. [PMID: 38684565 DOI: 10.1007/s12529-024-10288-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Important gaps exist in our understanding of loneliness and biobehavioral outcomes among sexual minority men (SMM), such as faster HIV disease progression. At the same time, SMM who use methamphetamine are approximately one-third more likely than non-users to develop cardiovascular disease. This study examined associations of loneliness, stimulant use, and cardiovascular risk in SMM with and without HIV. METHOD Participants were enrolled from August 2020 to February 2022 in a 6-month prospective cohort study. The study leveraged self-report baseline data from 103 SMM, with a subset of 56 SMM that provided a blood sample to measure markers of cardiovascular risk. RESULTS Loneliness showed negative bivariate associations with total cholesterol and LDL cholesterol in the cardiometabolic subsample (n = 56). SMM with methamphetamine use (t(101) = 2.03, p < .05; d = .42) and those that screened positive for a stimulant use disorder (t(101) = 2.07, p < .05; d = .46) had significantly higher mean loneliness scores. In linear regression analyses, negative associations of loneliness with LDL and total cholesterol were observed only among SMM who used methamphetamine. CONCLUSION We observed lower cholesterol in SMM reporting loneliness and methamphetamine use. Thus, in addition to the observed associations of loneliness with cholesterol, there are important medical consequences of methamphetamine use including cardiovascular risk, higher HIV acquisition risk and progression, as well as stimulant overdose death. This cross-sectional study underscores the need for clinical research to develop and test interventions targeting loneliness among SMM with stimulant use disorders.
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Affiliation(s)
- Emily J Ross
- Department of Public Health Sciences, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Daniel E Jimenez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1436, Miami, FL, 33136, USA
| | - Delaram Ghanooni
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Armando Mendez
- Division of Endocrinology, Diabetes and Metabolism and the Diabetes Research Institute, Department of Medicine, University of Miami Miller School of Medicine, 1450 NW 10 Ave, Miami, FL, 33136, USA
| | - Sabina Hirshfield
- Department of Medicine, STAR Program, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - Keith J Horvath
- Department of Psychology, San Diego State University, Alvarado Court, San Diego, 6363, CA, USA
| | - Britt DeVries
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Samantha E Dilworth
- Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, 550 16 Street, San Francisco, CA, 94158, USA
| | - Adam W Carrico
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Claudia A Martinez
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA.
- Department of Cardiology and Interventional Cardiology, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA.
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Kennedy MA, Stevens CJ, Pepin R, Lyons KD. Behavioral Activation: Values-Aligned Activity Engagement as a Transdiagnostic Intervention for Common Geriatric Conditions. THE GERONTOLOGIST 2024; 64:gnad046. [PMID: 37068017 PMCID: PMC10943502 DOI: 10.1093/geront/gnad046] [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] [Indexed: 04/18/2023] Open
Abstract
Scalable, transdiagnostic interventions are needed to meet the needs of a growing population of older adults experiencing multimorbidity and functional decline. Behavioral activation (BA) is a pragmatic, empirically supported treatment for depression that focuses on increasing engagement in values-aligned activities. We propose BA is an ideal transdiagnostic intervention approach for older adults because it (a) specifically targets activity restriction, a shared characteristic of common conditions of aging; and (b) has strong potential for scalability through delivery by a broad range of clinician and nonclinician interventionists and via telehealth. We describe the history of BA and review recent literature demonstrating impacts beyond depression including on cognition, social isolation, and disability. We also describe the feasibility of delivering BA across interventionists, settings, and modalities. Our approach advances scholarship by proposing BA as a scalable, transdiagnostic behavioral intervention to address functional decline in older adults with common geriatric conditions.
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Affiliation(s)
- Meaghan A Kennedy
- New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Courtney J Stevens
- Department of Psychiatry, Dartmouth-Hitchcock Medicine Center, Lebanon, New Hampshire, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Renée Pepin
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Kathleen D Lyons
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, Massachusetts, USA
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4
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Brinkhof LP, Ridderinkhof KR, Murre JMJ, Krugers HJ, de Wit S. Improving goal striving and resilience in older adults through a personalized metacognitive self-help intervention: a protocol paper. BMC Psychol 2023; 11:223. [PMID: 37542308 PMCID: PMC10403928 DOI: 10.1186/s40359-023-01259-3] [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: 04/26/2023] [Accepted: 07/21/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Successful aging is often linked to individual's ability to demonstrate resilience: the maintenance or quick recovery of functional ability, well-being, and quality of life despite losses or adversity. A crucial element of resilience is behavioral adaptability, which refers to the adaptive changes in behavior in accordance with internal or external demands. Age-related degradation of executive functions can, however, lead to volition problems that compromise flexible adjustment of behavior. In contrast, the reliance on habitual control has been shown to remain relatively intact in later life and may therefore provide an expedient route to goal attainment among older adults. In the current study, we examine whether a metacognitive self-help intervention (MCSI), aimed at facilitating goal striving through the gradual automatization of efficient routines, could effectively support behavioral adaptability in favor of resilience among older adults with and without (sub-clinical) mental health problems. METHODS This metacognitive strategy draws on principles from health and social psychology, as well as clinical psychology, and incorporates elements of established behavioral change and activation techniques from both fields. Additionally, the intervention will be tailored to personal needs and challenges, recognizing the significant diversity that exist among aging individuals. DISCUSSION Despite some challenges that may limit the generalizability of the results, our MCSI program offers a promising means to empower older adults with tools and strategies to take control of their goals and challenges. This can promote autonomy and independent functioning, and thereby contribute to adaptability and resilience in later life. TRIAL REGISTRATION Pre-registered, partly retrospectively. This study was pre-registered before the major part of the data was collected, created, and realized. Only a small part of the data of some participants (comprising the baseline and other pre-intervention measures), and the full dataset of the first few participants, was collected prior to registration, but it was not accessed yet. See: https://osf.io/5b9xz.
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Affiliation(s)
- Lotte P Brinkhof
- Department of Psychology, Faculty of Behavioral and Social Sciences, University of Amsterdam, Amsterdam, Netherlands.
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands.
- Amsterdam Brain & Cognition (ABC), University of Amsterdam, Amsterdam, Netherlands.
| | - K Richard Ridderinkhof
- Department of Psychology, Faculty of Behavioral and Social Sciences, University of Amsterdam, Amsterdam, Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Brain & Cognition (ABC), University of Amsterdam, Amsterdam, Netherlands
| | - Jaap M J Murre
- Department of Psychology, Faculty of Behavioral and Social Sciences, University of Amsterdam, Amsterdam, Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Brain & Cognition (ABC), University of Amsterdam, Amsterdam, Netherlands
| | - Harm J Krugers
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Brain & Cognition (ABC), University of Amsterdam, Amsterdam, Netherlands
- Faculty of Science, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Sanne de Wit
- Department of Psychology, Faculty of Behavioral and Social Sciences, University of Amsterdam, Amsterdam, Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Brain & Cognition (ABC), University of Amsterdam, Amsterdam, Netherlands
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5
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Bhardwaj T, Donovan NJ. Loneliness and Dementia in Context. Am J Geriatr Psychiatry 2023; 31:487-490. [PMID: 37032257 DOI: 10.1016/j.jagp.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 04/11/2023]
Affiliation(s)
- Twisha Bhardwaj
- Division of Geriatric Psychiatry, Department of Psychiatry, Brigham and Women's Hospital (T.B., N.J.D.), Boston, MA
| | - Nancy J Donovan
- Division of Geriatric Psychiatry, Department of Psychiatry, Brigham and Women's Hospital (T.B., N.J.D.), Boston, MA; Harvard Medical School (N.J.D.), Boston, MA.
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Thompson S, Deaner K, Franco MG. How to Help Clients Make Friends. JOURNAL OF HEALTH SERVICE PSYCHOLOGY 2023; 49:1-9. [PMID: 37360221 PMCID: PMC10237073 DOI: 10.1007/s42843-023-00085-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Friendships have been declining for the past 30 years, resulting in severe mental and physical health consequences. However, multiple barriers prevent individuals from initiating and maintaining connections. This paper highlights the individual and societal-level challenges that limit social connection including fear of rejection, insecure attachment style, structural racism, and increased use of technology. To help clients make friends, we recommend clinicians assess loneliness, social competency, and attachment style; administer cognitive behavioral or behavioral activation therapies; and guide clients to assume others like them and be self-compassionate.
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Fortuna KL, Cosco TD, Bohm AR. The Intersection of Business Innovation and Scientific Exploration to Address Early Mortality in People With Serious Mental Illness. JAMA Psychiatry 2023; 80:5-6. [PMID: 36322080 PMCID: PMC9812855 DOI: 10.1001/jamapsychiatry.2022.3327] [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] [Indexed: 11/07/2022]
Abstract
This Viewpoint describes how open innovation has been used by communities to support individual and community health and discusses how scientists and clinicians could apply this idea- and resource-sharing strategy to generate breakthrough advances that may extend the life span of people with serious mental illness (SMI).
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Affiliation(s)
- Karen L. Fortuna
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; and Collaborative Design for Recovery and Health, Nashua, New Hampshire
| | - Theodore D. Cosco
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada; and Oxford Institute of Population Ageing, University of Oxford, Oxford, United Kingdom
| | - Andrew R. Bohm
- Collaborative Design for Recovery and Health, Nashua, New Hampshire; and The Dartmouth Institute for Health Policy & Clinical Practice, Hanover, New Hampshire
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Van Orden KA, Heffner KL. Promoting Social Connection in Dementia Caregivers: A Call for Empirical Development of Targeted Interventions. THE GERONTOLOGIST 2022; 62:1258-1265. [PMID: 35235943 PMCID: PMC9579462 DOI: 10.1093/geront/gnac032] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Indexed: 11/13/2022] Open
Abstract
Social connection is an understudied target of intervention for the health of individuals providing care for a family member with Alzheimer's disease and related dementias (ADRD). To guide future research, we discuss considerations for interventions to promote social connection, with a particular focus on reducing loneliness: (a) include caregiver perspectives in designing and delivering interventions; (b) adapt to stages of dementia; (c) consider caregiving demands, including the use of brief interventions; (d) specify and measure mechanisms of action and principles of interventions; (e) consider dissemination and implementation at all stages of research. With support from the National Institute on Aging for a Roybal Center for Translational Research in the Behavioral and Social Sciences of Aging, we are developing a portfolio of mechanism-informed and principle-driven behavioral interventions to promote social connection in ADRD caregivers that can be flexibly applied to meet a diverse set of needs while maximizing resources and reducing demands on caregivers.
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Affiliation(s)
- Kimberly A Van Orden
- Address correspondence to: Kimberly A. Van Orden, PhD, Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Box Psych Research, Rochester, NY 14642, USA. E-mail:
| | - Kathi L Heffner
- School of Nursing, University of Rochester Medical Center, Rochester, New York, USA
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9
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Lutz J, Van Orden KA, Bruce ML, Conwell Y. Social Disconnection in Late Life Suicide: An NIMH Workshop on State of the Research in Identifying Mechanisms, Treatment Targets, and Interventions. Am J Geriatr Psychiatry 2021; 29:731-744. [PMID: 33622593 PMCID: PMC8286287 DOI: 10.1016/j.jagp.2021.01.137] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 12/13/2022]
Abstract
Both social disconnection and suicide are significant public health concerns among older adults, and social disconnection is associated with greater risk for suicide-related thoughts and behaviors in late life. We present a synthesis of research discussed during a workshop hosted by the National Institute of Mental Health on social disconnection and late-life suicide. Social disconnection is related to suicide risk in late life via a variety of mechanisms, including biological, behavioral, and psychological correlates. Researchers in several scientific fields have begun to establish these connections and identify targets for interventions to reduce risk in late life. While research has demonstrated that social connection is amenable to change, there is little research to date on the most evidence-based interventions to mitigate social disconnection or the related risks. However, there are several promising biological, behavioral, and psychological interventions that may target various mechanisms, as well as social disconnection itself. With a relative paucity of research in this area, these lines of study are ripe for innovative investigation. In order to most effectively advance the field, we must establish more consistent definitions of social connection and disconnection; more accurately measure and assess older adults' social needs; examine the most effective approaches and modalities for assessment and intervention; take into account important contextual factors; and apply a translational, convergent scientific approach.
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Affiliation(s)
- Julie Lutz
- Center for the Study and Prevention of Suicide, Department of Psychiatry (JL), University of Rochester Medical Center, Rochester, NY.
| | - Kimberly A Van Orden
- Center for the Study and Prevention of Suicide, Department of Psychiatry (KAVO), University of Rochester Medical Center, Rochester, NY
| | - Martha L Bruce
- Department of Psychiatry (MLB), Geisel School of Medicine, Dartmouth, NH
| | - Yeates Conwell
- Center for the Study and Prevention of Suicide, Department of Psychiatry (YC), University of Rochester Medical Center, Rochester, NY
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10
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Bruce ML, Pepin R, Marti CN, Stevens CJ, Choi NG. One Year Impact on Social Connectedness for Homebound Older Adults: Randomized Controlled Trial of Tele-delivered Behavioral Activation Versus Tele-delivered Friendly Visits. Am J Geriatr Psychiatry 2021; 29:771-776. [PMID: 34130906 PMCID: PMC8286332 DOI: 10.1016/j.jagp.2021.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Lonely and socially isolated homebound older participants of a randomized trial comparing behavioral activation (BA) versus friendly visiting, both delivered by lay counselors using tele-videoconferencing, were reassessed at 1-year to determine whether benefits at 12 weeks were maintained over time. METHODS The study reinterviewed 64/89 (71.9%) participants. RESULTS The positive 12-week impact of tailored BA on 3 indicators of social connectedness (loneliness, social interaction and satisfactions with social support) was maintained, albeit to a lesser degree, over 1 year. The positive impact on depressive symptoms and disability was also maintained. CONCLUSIONS The intervention's potential reach and scalability are suggested by several factors: participants were recruited by home delivered meals programs during routine assessments; the intervention was brief and delivered by lay counselors; care delivery by tele-videoconferencing is increasingly common. The 1 year outcomes indicate that brief BA delivered by tele-video conferencing can have an enduring impact on social connectedness.
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Affiliation(s)
- Martha L Bruce
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Health (MLB, RP, CJS).
| | - Renee Pepin
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Health (MLB, RP, CJS)
| | - C Nathan Marti
- The University of Texas at Austin Steve Hicks School of Social Work (CNM, NGC)
| | - Courtney J Stevens
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Health (MLB, RP, CJS)
| | - Namkee G Choi
- The University of Texas at Austin Steve Hicks School of Social Work (CNM, NGC)
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Van Orden KA, Areán PA, Conwell Y. A Pilot Randomized Trial of Engage Psychotherapy to Increase Social Connection and Reduce Suicide Risk in Later Life. Am J Geriatr Psychiatry 2021; 29:789-800. [PMID: 33952416 PMCID: PMC8286301 DOI: 10.1016/j.jagp.2021.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/09/2021] [Accepted: 03/29/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Targeting social connection to prevent suicide in later life shows promise but requires additional study to identify the most effective and acceptable interventions. This study examines acceptability, feasibility, and efficacy of Engage Psychotherapy to improve subjective disconnection (target mechanisms: low belonging and perceived burden), and improve clinical and functional outcomes (depression, suicide ideation, quality of life). METHODS Pilot randomized trial with adults age 60 and older who reported feeling lonely and/or like a burden. Participants were randomly assigned to 10 sessions of 'Social Engage' (S-ENG; n = 32) or care-as-usual (CAU; n = 30), with follow-up assessments at 3 weeks, 6 weeks, and 10 weeks. RESULTS S-ENG is feasible to deliver over 10 sessions and acceptable to older adults who report social disconnection-a population at risk for suicide. Participants were willing and able to focus each session on social engagement and demonstrated high levels of compliance. Social Engage did not show preliminary evidence of impact on belonging or perceived burden but was effective in reducing depressive symptoms and improving social-emotional quality of life. DISCUSSION S-ENG holds promise for improving social-emotional quality of life and depressive symptoms. Future research is needed to identify and measure target mechanisms that account for clinical and functional improvement.
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Affiliation(s)
- Kimberly A Van Orden
- Department of Psychiatry (KAO, YC), University of Rochester Medical Center, Rochester, NY.
| | - Patricia A Areán
- Department of Psychiatry & Behavioral Sciences (PAA), University of Washington, WA
| | - Yeates Conwell
- Department of Psychiatry (KAO, YC), University of Rochester Medical Center, Rochester, NY
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12
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Gould CE, Carlson C, Alfaro AJ, Chick CF, Bruce ML, Forman-Hoffman VL. Changes in Quality of Life and Loneliness Among Middle-Aged and Older Adults Participating in Therapist-Guided Digital Mental Health Intervention. Front Public Health 2021; 9:746904. [PMID: 34957011 PMCID: PMC8695684 DOI: 10.3389/fpubh.2021.746904] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This study aimed to examine the effects of a 12-week multicomponent mobile app-delivered intervention, the Meru Health Program (MHP), on mental health quality of life (QoL) and loneliness among the middle-aged and older adults with depression symptoms. Methods: The eligible participants (M age = 57.06, SD = 11.26 years) were enrolled in the MHP, a therapist-supported mobile intervention. Using a non-randomized pre-post design, change in mental health QoL [WHO QoL Brief (WHOQOL-BREF) psychological health] and loneliness (UCLA Loneliness Scale) from baseline to post-treatment were examined. Time of enrollment [pre- vs. post-coronavirus disease 2019 (COVID-19)] was included as a between-subjects factor in the repeated measures analyses. Results: Forty-two participants enrolled prior to the COVID-19 pandemic; eight enrolled after the pandemic began. Among the pre-COVID-19 enrollees, increase in mental health QoL, F(1, 38) = 12.61, p = 0.001, η2 = 0.25 and decreases in loneliness emerged, F(1, 38) = 5.42, p = 0.025, η2 = 0.13. The changes in mental health QoL, but not loneliness, held for the combined sample, such as post-COVID-19 enrollees, F(1, 44) = 6.02, p = 0.018, η2 = 0.12. The regression analyses showed that increases in mindfulness were associated with the increased mental health QoL and decreased loneliness. Conclusion: Therapist-supported digital mental health interventions, such as the MHP, have the potential to improve mental health QoL and decrease loneliness among the middle-aged and older adults. The findings for loneliness may not hold during the periods of mandated isolation. Instead, therapists supporting digital interventions may need to tailor their approach to target loneliness.
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Affiliation(s)
- Christine E Gould
- VA Palo Alto Health Care System, Geriatric Research, Education and Clinical Center, Palo Alto, CA, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Chalise Carlson
- VA Palo Alto Health Care System, Geriatric Research, Education and Clinical Center, Palo Alto, CA, United States
| | - Ana Jessica Alfaro
- VA Palo Alto Health Care System, Geriatric Research, Education and Clinical Center, Palo Alto, CA, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Christina F Chick
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States.,VA Palo Alto Health Care System, Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, United States
| | - Martha L Bruce
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Health, Hanover, NH, United States
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