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Özer Ö, Uyhan O, Devrilmez E, Orhan İ, Bilgiç M, Uğurlu A, Tabak EY, Yüksel O, Şentürk A, Karakullukçu A, Eler N, Özcan K, Akpınar S. The relationship between attitude toward physical activity and weight gain in children and young adolescence. Front Pediatr 2024; 12:1300613. [PMID: 38774299 PMCID: PMC11106473 DOI: 10.3389/fped.2024.1300613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 04/23/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction The purpose of this study was to investigate the association between attitudes toward physical activity and weight gain among children and young adolescents with an additional focus on the impact of gender on these attitudes. Methods Employing a descriptive survey method, data were systematically gathered via purposive sampling from 11 specific cities in Türkiye, ensuring representation from all seven regions. A total of 3,138 students, aged between 9 and 14 years, participated in this study, with a distribution of 46% girls and 54% boys. To assess the attitudes of children and young adolescents toward physical activity, the Youth Physical Activity Attitude Scale was utilized. Height and body weight measurements were taken to determine the body mass index of participants. SPSS 26.0 software facilitated the statistical analyses, including Pearson correlation analysis to explore relationships between variables. Multivariate Analysis of Variance was employed to evaluate the impact of age, BMI, and gender on attitudes toward physical activity. Results Participants classified as normal weight exhibited a more positive attitude towards physical activity compared to their obese and overweight counterparts. Moreover, a significant gender difference emerged, with boys demonstrating significantly higher positive attitudes toward physical activity than girls. However, no significant difference was observed in negative attitudes based on gender. The study also revealed that an escalation in negative attitudes towards physical activity correlated with students being categorized as underweight, overweight, or obese, as opposed to having a normal weight status. Additionally, a statistically significant divergence in both positive and negative attitudes towards physical activity was found based on age. Specifically, the results indicated that students aged 9 and 14 exhibited lower levels of positive attitude when contrasted with their counterparts of different age groups. Conversely, in the domain of negative attitudes, students at the age of 9 scored higher than their peers in other age categories. Discussion Attitudes towards physical activity can serve as a convenient indicator and guide for assessing the effectiveness of various practices or interventions aimed at promoting physical activity, with recognition of the significant gender difference in positive attitudes among children and young adolescents.
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Affiliation(s)
- Ömer Özer
- Faculty of Sport Science, Department of Physical Education and Sport, Bandırma Onyedi Eylül University, Balıkesir, Türkiye
| | - Osman Uyhan
- Institute of Health Science, Bandırma Onyedi Eylül University, Balıkesir, Türkiye
| | - Erhan Devrilmez
- Faculty of Sport Science, Department of Physical Education and Sport, Karamanoğlu Mehmetbey University, Karaman, Türkiye
| | - İlkay Orhan
- Faculty of Sport Science, Department of Physical Education and Sport, Akdeniz University, Antalya, Türkiye
| | - Mert Bilgiç
- Faculty of Sport Science, Department of Coaching Education, Akdeniz University, Antalya, Türkiye
| | - Alkan Uğurlu
- Faculty of Sport Science, Department of Physical Education and Sport, Akdeniz University, Antalya, Türkiye
| | - Ekrem Yasin Tabak
- Institute of Social Science, Karamanoğlu Mehmetbey University, Karaman, Türkiye
| | - Oğuzhan Yüksel
- Faculty of Sport Science, Department of Recreation, Dumlupınar University, Kütahya, Türkiye
| | - Aydın Şentürk
- Faculty of Sport Science, Department of Coaching Education, Dumlupınar University, Kütahya, Türkiye
| | - Ayla Karakullukçu
- Faculty of Sport Science, Department of Sport Management, Kırıkkale University, Kırkkale, Türkiye
| | - Nebahat Eler
- School of Physical Education and Sport, Department of Coaching Education, Bülent Ecevit University, Zonguldak, Türkiye
| | - Kürşat Özcan
- Faculty of Sport Science, Department of Physical Education and Sport, Nevşehir Hacı Bektaş Veli University, Nevşehir, Türkiye
| | - Selçuk Akpınar
- Faculty of Sport Science, Department of Physical Education and Sport, Nevşehir Hacı Bektaş Veli University, Nevşehir, Türkiye
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van den Hout WJ, Mook-Kanamori DO, van Peet PG, Büchner FL, Elzinga BM, Rosendaal FR, de Mutsert R, Numans ME. Association of mental health and negative life events with weight change in patients with overweight: A cohort study. J Affect Disord 2023; 334:325-331. [PMID: 37160236 DOI: 10.1016/j.jad.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND It is unclear to what extent mental health and negative life events (NLEs) contribute to weight change in patients with overweight. This study aimed to evaluate the association of anxiety, depression, NLEs and quality of life (QoL) with weight change over ten years in middle-aged individuals with overweight. METHODS Population-based cohort study of 2889 middle-aged men and women with a body mass index ≥27 kg/m2. Relative weight change over ten years was defined as weight loss (≤- 5 %), stable weight (between >- 5 % and <5 %) or weight gain (≥5 %). At baseline, participants reported anxiety symptoms, depressive symptoms, recent (last year) and distant (lifetime) NLEs, and a mental component summary of QoL. With multinomial logistic regression adjusting for potential confounding, we examined the association of mental health and NLEs with weight change after a median (25th, 75th percentiles) follow-up of 9.7 (9.0-10.5) years. RESULTS In 51 % participants weight was stable, 33 % participants lost weight and 17 % gained weight. Mild (odds ratio 1.36; 95 % confidence interval 1.05-1.75), and moderate to very severe depressive symptoms (1.43; 0.97-2.12) and four or more distant NLEs (1.35; 1.10-1.67) were associated with weight gain. Anxiety symptoms, the mental component summary of QoL were not associated with either weight gain or weight loss. LIMITATIONS Due to the observational design residual confounding cannot be excluded. CONCLUSION Our study suggests that depressive symptoms or having experienced distant NLEs are associated with weight gain over time in middle-aged individuals with overweight. These subgroups might benefit from proactive attention from their health care providers.
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Affiliation(s)
- Willemijn J van den Hout
- Department of Public Health and Primary Care, Leiden University Medical Center, the Netherlands.
| | - Dennis O Mook-Kanamori
- Department of Public Health and Primary Care, Leiden University Medical Center, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, the Netherlands
| | - Petra G van Peet
- Department of Public Health and Primary Care, Leiden University Medical Center, the Netherlands
| | - Frederike L Büchner
- Department of Public Health and Primary Care, Leiden University Medical Center, the Netherlands
| | - Bernet M Elzinga
- Section of Clinical and Health Psychology, University of Leiden, the Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, the Netherlands
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, the Netherlands
| | - Mattijs E Numans
- Department of Public Health and Primary Care, Leiden University Medical Center, the Netherlands
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Kringle EA, Tucker D, Wu Y, Lv N, Kannampallil T, Barve A, Dosala S, Wittels N, Dai R, Ma J. Associations between daily step count trajectories and clinical outcomes among adults with comorbid obesity and depression. Ment Health Phys Act 2023; 24:100512. [PMID: 37206660 PMCID: PMC10191421 DOI: 10.1016/j.mhpa.2023.100512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Purpose To examine the relationship between features of daily measured step count trajectories and clinical outcomes among people with comorbid obesity and depression in the ENGAGE-2 Trial. Methods This post hoc analysis used data from the ENGAGE-2 trial where adults (n=106) with comorbid obesity (BMI ≥30.0 or 27.0 if Asian) and depressive symptoms (Patient Health Questionnaire-9 score ≥10) were randomized (2:1) to receive the experimental intervention or usual care. Daily step count trajectories over the first 60 days (Fitbit Alta HR) were characterized using functional principal component analyses. 7-day and 30-day trajectories were also explored. Functional principal component scores that described features of step count trajectories were entered into linear mixed models to predict weight (kg), depression (Symptom Checklist-20), and anxiety (Generalized Anxiety Disorder Questionnaire-7) at 2-months (2M) and 6-months (6M). Results Features of 60-day step count trajectories were interpreted as overall sustained high, continuous decline, and disrupted decline. Overall sustained high step count was associated with low anxiety (2M, β=-0.78, p<.05; 6M, β=-0.80, p<.05) and low depressive symptoms (6M, β=-0.15, p<.05). Continuous decline in step count was associated with high weight (2M, β=0.58, p<.05). Disrupted decline was not associated with clinical outcomes at 2M or 6M. Features of 30-day step count trajectories were also associated with weight (2M, 6M), depression (6M), and anxiety (2M, 6M); Features of 7-day step count trajectories were not associated with weight, depression, or anxiety at 2M or 6M. Conclusions Features of step count trajectories identified using functional principal component analysis were associated with depression, anxiety, and weight outcomes among adults with comorbid obesity and depression. Functional principal component analysis may be a useful analytic method that leverages daily measured physical activity levels to allow for precise tailoring of future behavioral interventions.
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Affiliation(s)
| | - Danielle Tucker
- Department of Mathematics, Statistics, and Computer Science, University of Illinois at Chicago
| | - Yichao Wu
- Department of Mathematics, Statistics, and Computer Science, University of Illinois at Chicago
| | - Nan Lv
- Department of Medicine, University of Illinois at Chicago
| | - Thomas Kannampallil
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis
| | - Amruta Barve
- Department of Medicine, University of Illinois at Chicago
| | | | - Nancy Wittels
- Department of Medicine, University of Illinois at Chicago
| | - Ruixuan Dai
- Department of Computer Science and Engineering, McKelvey School of Engineering, Washington University in St. Louis
| | - Jun Ma
- Department of Medicine, University of Illinois at Chicago
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Lv N, Kringle EA, Ma J. Integrated Behavioral Interventions for Adults with Comorbid Obesity and Depression: a Systematic Review. Curr Diab Rep 2022; 22:157-168. [PMID: 35304703 PMCID: PMC8930483 DOI: 10.1007/s11892-022-01458-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To synthesize evidence from randomized controlled trials on the effects of integrated behavioral interventions for comorbid obesity and depression in adults. RECENT FINDINGS Seven trials (n = 33 to 409) were included. The quality of evidence was mixed. In 2 trials, integrated interventions led to greater improvements in both obesity and depression over 12 months, compared with usual care. Of 4 trials comparing integrated interventions with a standalone obesity intervention, 2 showed incremental effects on depression only, and 2 did not detect a significant effect for either outcome. One 3-arm trial compared an integrated intervention with standalone obesity and depression interventions and only detected incremental effects on obesity when compared with a standalone depression intervention. The effects of integrated interventions for comorbid obesity and depression are varied but promising. Implications for future research to guide intervention optimization and implement integrated interventions in clinical practice are provided.
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Affiliation(s)
- Nan Lv
- Department of Medicine, University of Illinois at Chicago, 1747 W. Roosevelt Rd, Room 586 (MC 275), Chicago, IL 60608 USA
| | - Emily A. Kringle
- Department of Medicine, University of Illinois at Chicago, 1747 W. Roosevelt Rd, Room 586 (MC 275), Chicago, IL 60608 USA
| | - Jun Ma
- Department of Medicine, University of Illinois at Chicago, 1747 W. Roosevelt Rd, Room 586 (MC 275), Chicago, IL 60608 USA
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Venditti EM, Steinman LE, Lewis MA, Weiner BJ, Ma J. Seeking a pot of gold with integrated behavior therapy and research to improve health equity: insights from the RAINBOW trial for obesity and depression. Transl Behav Med 2021; 11:1691-1698. [PMID: 34244787 PMCID: PMC8344914 DOI: 10.1093/tbm/ibab069] [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: 11/25/2022] Open
Abstract
More than one third of adults in the United States (U.S.) live with multiple chronic conditions that affect their physical and mental health, functional outcomes, independence, and mortality. The COVID-19 pandemic has exposed not only an increased risk for infection, morbidity, and mortality among those with chronic conditions but long-standing health inequities by age, race, sex, and other social determinants. Obesity plus depression represent one such prevalent comorbidity for which few effective integrated interventions exist, prompting concern about the potential for secondary physical and mental health pandemics post COVID-19. Translational behavioral medicine research can play an important role in studying integrated collaborative healthcare approaches and advancing scientific understanding on how to engage and more effectively treat diverse populations with physical and mental health comorbidities. The RAINBOW (Research Aimed at Improving Both Mood and Weight) clinical trial experience offers a wealth of insights into the potential of collaborative care interventions to advance behavior therapy research and practice. Primary care patients with co-occurring obesity and depression were assigned to either Integrated Coaching for Mood and Weight (I-CARE), which blended Group Lifestyle Balance (GLB) for weight management and the Program to Encourage Active Rewarding Lives (PEARLS) for depression, or usual care, to examine clinical, cost-effectiveness, and implementation outcomes. This commentary highlights the empirical findings of eight RAINBOW research papers and discusses implications for future studies, including their relevance in the U.S. COVID-19 context. Organized by key principles of translational behavioral medicine research, the commentary aims to examine and embrace the heterogeneity of baseline and intervention response differences among those living with multiple chronic conditions. We conclude that to prevent health and healthcare disparities from widening further, tailored engagement, dissemination, and implementation strategies and flexible delivery formats are essential to improve treatment access and outcomes among underrepresented populations.
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Affiliation(s)
- Elizabeth M Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lesley E Steinman
- Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | | | - Bryan J Weiner
- Departments of Global Health and Health Services, University of Washington, Seattle, WA, USA
| | - Jun Ma
- Department of Medicine and Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
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Lv N, Xiao L, Rosas LG, Venditti EM, Smyth JM, Lewis MA, Snowden MB, Ronneberg CR, Williams LM, Gerber BS, Ajilore OA, Patel AS, Ma J. Sex Moderates Treatment Effects of Integrated Collaborative Care for Comorbid Obesity and Depression: The RAINBOW RCT. Ann Behav Med 2021; 55:1157-1167. [PMID: 33616188 DOI: 10.1093/abm/kaaa125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Sex influences health and related behaviors due to biological and psychosocial/socioeconomic factors. Assessing sex-specific responses to integrated treatment for comorbid obesity and depression could inform intervention targeting. PURPOSE To test (a) whether sex moderates the effects of integrated collaborative care on weight and depression outcomes through 24 months and (b) whether treatment response at 6 months predicts 12 and 24 month outcomes by sex. METHODS Secondary data analyses on weight and depression severity (SCL-20) measured over 24 months among 409 adults with obesity and depression in the Research Aimed at Improving Both Mood and Weight trial. RESULTS Men achieved significantly greater weight reductions in intervention versus usual care than women, whereas women achieved significantly greater percentage reductions in SCL-20 than men at both 12 and 24 months. In logistic models, at 80% specificity for correctly identifying participants not achieving clinically significant long-term outcomes, women who lost <3.0% weight and men who lost <4.1% weight at 6 months had ≥84% probability of not meeting 5% weight loss at 24 months. Similarly, at 80% specificity, women who reduced SCL-20 by <39.5% and men who reduced by <53.0% at 6 months had ≥82% probability of not meeting 50% decrease in SCL-20 at 24 months. CONCLUSIONS Sex modified the integrated treatment effects for obesity and depression. Sex-specific responses at 6 months predicted clinically significant weight loss and depression outcomes through 24 months. Based on early responses, interventions may need to be tailored to address sex-specific barriers and facilitators to achieving healthy weight and depression outcomes at later time points. CLINICAL TRIAL REGISTRATION NCT02246413 (https://clinicaltrials.gov/ct2/show/NCT02246413).
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Affiliation(s)
- Nan Lv
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Lan Xiao
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, USA
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, USA
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Elizabeth M Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joshua M Smyth
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Megan A Lewis
- Center for Communication Science, RTI International, Seattle, WA, USA
| | - Mark B Snowden
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Corina R Ronneberg
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Ben S Gerber
- Division of Academic Internal Medicine and Geriatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Olusola A Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Aashutos S Patel
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Jun Ma
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
- Department of Medicine, College of Medicine, University of Illinois at Chicago, 1747 W. Roosevelt Rd, Room 586 (MC 275), Chicago, IL 60608, USA
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Zhuo C, Ji F, Tian H, Wang L, Jia F, Jiang D, Chen C, Zhou C, Lin X, Zhu J. Transient effects of multi-infusion ketamine augmentation on treatment-resistant depressive symptoms in patients with treatment-resistant bipolar depression - An open-label three-week pilot study. Brain Behav 2020; 10:e01674. [PMID: 32621379 PMCID: PMC7428494 DOI: 10.1002/brb3.1674] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/29/2020] [Accepted: 05/08/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION While the psychiatric benefits of ketamine have been verified through clinical trials, there is limited information about ketamine augmentation in patients with treatment-resistant bipolar depression (TRBPD). Hence, in the present study, we investigate the therapeutic efficacy and functional brain alterations associated with multi-infusion ketamine augmentation in patients with TRBPD. METHODS The present three-week study included 38 patients with TRBPD, all of whom received a series of nine ketamine injections over the study period. The Hamilton Depression Rating Scale (HAMD) was used to assess the effects of multi-infusion ketamine combined with mood stabilizers. Brain function was evaluated by global functional connectivity density (gFCD). RESULTS Adjunctive treatment with multiple infusions of ketamine, when combined with a mood stabilizer, could effectively alleviate depressive symptoms for one week, yet the symptoms began to relapse during the second week. Functional brain alterations were detected via gFCD. Specifically, gFCD reductions were mainly found in the bilateral insula, right caudate nucleus, and bilateral inferior frontal gyrus, while increased gFCD was mainly located in the bilateral postcentral gyrus, subgenual anterior cingulate cortex, bilateral thalamus, and cerebellum. Although gFCD alterations were sustained for up to three weeks after the first ketamine infusion, the antidepressant effects of ketamine augmentation sharply declined from the end of the second week of treatment. CONCLUSIONS Multi-infusion ketamine augmentation can rapidly alleviate depressive symptoms in patients with TRBPD. The clinical effects were primarily visible in the first week after treatment and partially sustained for two weeks; however, the therapeutic effects and related functional brain alterations sharply decreased from the end of the second week. Based on these findings, we demonstrated that the clinical efficacy and functional brain alterations induced by ketamine augmentation are transient.
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Affiliation(s)
- Chuanjun Zhuo
- Department of Psychiatry, School of Mental Health, Jining Medical University, Jining, China.,Department of Psychiatry and Imaging-Genetics and Co-morbidity (PNGC-Lab), Tianjin Anding Hospital, Tianjin Mental Health Center, Mental Health Teaching Hospital, Tianjin Medical University, Tianjin, China.,Department of Psychiatry Wenzhou Seventh People's Hospital, Wenzhou, China
| | - Feng Ji
- Department of Psychiatry, School of Mental Health, Jining Medical University, Jining, China
| | - Hongjun Tian
- Department of Psychiatry and Imaging-Genetics and Co-morbidity (PNGC-Lab), Tianjin Anding Hospital, Tianjin Mental Health Center, Mental Health Teaching Hospital, Tianjin Medical University, Tianjin, China
| | - Lina Wang
- Department of Psychiatry and Imaging-Genetics and Co-morbidity (PNGC-Lab), Tianjin Anding Hospital, Tianjin Mental Health Center, Mental Health Teaching Hospital, Tianjin Medical University, Tianjin, China
| | - Feng Jia
- Department of Psychiatry and Imaging-Genetics and Co-morbidity (PNGC-Lab), Tianjin Anding Hospital, Tianjin Mental Health Center, Mental Health Teaching Hospital, Tianjin Medical University, Tianjin, China
| | - Deguo Jiang
- Department of Psychiatry Wenzhou Seventh People's Hospital, Wenzhou, China
| | - Ce Chen
- Department of Psychiatry Wenzhou Seventh People's Hospital, Wenzhou, China
| | - Chunhua Zhou
- Department of Pharmacy, First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaodong Lin
- Department of Psychiatry Wenzhou Seventh People's Hospital, Wenzhou, China
| | - Jingjing Zhu
- Department of Psychiatry Wenzhou Seventh People's Hospital, Wenzhou, China
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Goldhaber-Fiebert JD, Prince L, Xiao L, Lv N, Rosas LG, Venditti EM, Lewis MA, Snowden MB, Ma J. First-Year Economic and Quality of Life Effects of the RAINBOW Intervention to Treat Comorbid Obesity and Depression. Obesity (Silver Spring) 2020; 28:1031-1039. [PMID: 32320533 PMCID: PMC7245568 DOI: 10.1002/oby.22805] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/21/2020] [Accepted: 02/23/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Obesity and depression are prevalent and often co-occurring conditions in the United States. The Research Aimed at Improving Both Mood and Weight (RAINBOW) randomized trial demonstrated the effectiveness of an integrated intervention for adults with both conditions. Characterizing the intervention's economic effects is important for broader dissemination and implementation. METHODS This study evaluated the cost (2018 US dollars) and health-related quality of life (HRQoL) impacts during RAINBOW's first year, comparing intervention (n = 204) and usual-care groups (n = 205). Outcomes included intervention delivery costs, differential changes in antidepressant medication spending compared with the pretrial year, differential changes in medical services spending compared with the pretrial year, and HRQoL changes from baseline using Euroqol-5D US utility weights. RESULTS RAINBOW's 1-year delivery cost per person was $2,251. Compared with usual care, annual antidepressant medication days increased more (38 days [95% CI: 4 to 72]; P = 0.027). Annual antidepressant medication spending had a larger, nonsignificant increase ($89 [95% CI: -$20 to $197]; P = 0.109). Annual spending on medical care services had a smaller, nonsignificant decrease (-$54 [95% CI: -$832 to $941]; P = 0.905). HRQoL had a nonsignificant increase (0.011 [95% CI: -0.025 to 0.047]; P = 0.546). CONCLUSIONS The RAINBOW intervention's economic value will depend on how its 1-year improvements in obesity and depression translate into long-term reduced morbidity, delayed mortality, or averted costs.
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Affiliation(s)
- Jeremy D Goldhaber-Fiebert
- Stanford Health Policy Group, Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, California, USA
| | - Lea Prince
- Stanford Health Policy Group, Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, California, USA
| | - Lan Xiao
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California, USA
| | - Nan Lv
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California, USA
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Elizabeth M Venditti
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Megan A Lewis
- Center for Communications Science, RTI International, Seattle, Washington, USA
| | - Mark B Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Jun Ma
- Division of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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Sternheim L, Danner U, van Elburg A, Harrison A. Do anxiety, depression, and intolerance of uncertainty contribute to social problem solving in adult women with anorexia nervosa? Brain Behav 2020; 10:e01588. [PMID: 32270602 PMCID: PMC7303378 DOI: 10.1002/brb3.1588] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/09/2019] [Accepted: 01/18/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Inefficient problem solving in the social domain may be one of the difficulties underlying the interpersonal challenges thought to maintain anorexia nervosa (AN). However, past studies have neglected to control for depression, anxiety, and intolerance of uncertainty (IU), which are known to contribute to social problem solving. METHODS This study aimed to investigate whether adults with AN would show differences in social problem solving on an experimental task (Means-End Problem Solving; MEPS) and report differences in their attitudes (positive, negative) toward social problem solving and their use of social problem-solving styles (rational, impulsive-careless, avoidant) on the Social Problem-Solving Inventory Revised (SPSRI) compared to a non-AN control group. RESULTS Seventy-four adult women took part (30 with AN and 44 non-AN controls), and data show that those with AN generated significantly less effective solutions on the MEPS (d = 1.96) reported overall poorer social problem solving on the SPSRI (d = 0.58), reporting more negative and less positive attitudes toward social problem solving, and less impulsive and more avoidant social problem-solving styles. However, those with AN did not differ from controls in being able to rationalize social problems. Once depression (Beck Depression Inventory: BDI), state anxiety (State-Trait Anxiety Inventory: STAI), and IU (Intolerance of Uncertainty Scale-12; IUS-12) were included as covariates, these differences were no longer significant, suggesting that comorbid depression, anxiety, and IU symptoms may contribute to social problem solving in AN. CONCLUSIONS There was no specific effect of depression. Treating anxiety and IU might help to improve social problem solving and enable people with AN to be able to better access social support to aid their recovery.
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Affiliation(s)
- Lot Sternheim
- Department of Clinical PsychologyUniversiteit UtrechtUtrechtThe Netherlands
| | - Unna Danner
- Department of Clinical PsychologyUniversiteit UtrechtUtrechtThe Netherlands
- Altrecht Eating Disorders RintveldZeistThe Netherlands
| | - Annemarie van Elburg
- Department of Clinical PsychologyUniversiteit UtrechtUtrechtThe Netherlands
- Altrecht Eating Disorders RintveldZeistThe Netherlands
- Trimbos Institute NetherlandsUtrechtThe Netherlands
| | - Amy Harrison
- Department of Psychology and Human DevelopmentInstitute of EducationUniversity College LondonLondonUK
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Ma J, Rosas LG, Lv N, Xiao L, Snowden MB, Venditti EM, Lewis MA, Goldhaber-Fiebert JD, Lavori PW. Effect of Integrated Behavioral Weight Loss Treatment and Problem-Solving Therapy on Body Mass Index and Depressive Symptoms Among Patients With Obesity and Depression: The RAINBOW Randomized Clinical Trial. JAMA 2019; 321:869-879. [PMID: 30835308 PMCID: PMC6439596 DOI: 10.1001/jama.2019.0557] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/01/2019] [Indexed: 12/14/2022]
Abstract
Importance Coexisting obesity and depression exacerbate morbidity and disability, but effective treatments remain elusive. Objective To test the hypothesis that an integrated collaborative care intervention would significantly improve both obesity and depression at 12 months compared with usual care. Design, Setting, and Participants The Research Aimed at Improving Both Mood and Weight (RAINBOW) randomized clinical trial enrolled 409 adults with body mass indices (BMIs) of 30 or greater (≥27 for Asian adults) and 9-item Patient Health Questionnaire (PHQ-9) scores of 10 or greater. Primary care patients at a health system in Northern California were recruited from September 30, 2014, to January 12, 2017; the date of final 12-month follow-up was January 17, 2018. Interventions All participants randomly assigned to the intervention (n = 204) or the usual care control group (n = 205) received medical care from their personal physicians as usual, received information on routine services for obesity and depression at their clinic, and received wireless physical activity trackers. Intervention participants also received a 12-month intervention that integrated a Diabetes Prevention Program-based behavioral weight loss treatment with problem-solving therapy for depression and, if indicated, antidepressant medications. Main Outcomes and Measures The co-primary outcome measures were BMI and 20-item Depression Symptom Checklist (SCL-20) scores (range, 0 [best] to 4 [worst]) at 12 months. Results Among 409 participants randomized (mean age of 51.0 years [SD, 12.1 years]; 70% were women; mean BMI of 36.7 [SD, 6.4]; mean PHQ-9 score of 13.8 [SD, 3.1]; and mean SCL-20 score of 1.5 [SD, 0.5]), 344 (84.1%) completed 12-month follow-up. At 12 months, mean BMI declined from 36.7 (SD, 6.9) to 35.9 (SD, 7.1) among intervention participants compared with a change in mean BMI from 36.6 (SD, 5.8) to 36.6 (SD, 6.0) among usual care participants (between-group mean difference, -0.7 [95% CI, -1.1 to -0.2]; P = .01). Mean SCL-20 score declined from 1.5 (SD, 0.5) to 1.1 (SD, 1.0) at 12 months among intervention participants compared with a change in mean SCL-20 score from 1.5 (SD, 0.6) to 1.4 (SD, 1.3) among usual care participants (between-group mean difference, -0.2 [95% CI, -0.4 to 0]; P = .01). There were 47 adverse events or serious adverse events that involved musculoskeletal injuries (27 in the intervention group and 20 in the usual care group). Conclusions and Relevance Among adults with obesity and depression, a collaborative care intervention integrating behavioral weight loss treatment, problem-solving therapy, and as-needed antidepressant medications significantly improved weight loss and depressive symptoms at 12 months compared with usual care; however, the effect sizes were modest and of uncertain clinical importance. Trial Registration ClinicalTrials.gov Identifier: NCT02246413.
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Affiliation(s)
- Jun Ma
- Department of Medicine and Institute of Health Research and Policy, University of Illinois, Chicago
| | - Lisa Goldman Rosas
- Department of Health Research and Policy and Medicine, Stanford University, Palo Alto, California
| | - Nan Lv
- Department of Medicine and Institute of Health Research and Policy, University of Illinois, Chicago
| | - Lan Xiao
- Department of Medicine, Stanford University, Palo Alto, California
| | - Mark B. Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Elizabeth M. Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Megan A. Lewis
- Center for Communications Science, RTI International, Seattle, Washington
| | | | - Philip W. Lavori
- Department of Biomedical Data Science, Stanford University, Stanford, California
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Cooper DC, Bates MJ. Military Health Provider Training and Evaluation of a Problem-Solving Intervention to Reduce Distress and Enhance Readiness Among Service Members. Mil Med 2018; 184:e303-e311. [DOI: 10.1093/milmed/usy229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/14/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Denise C Cooper
- Psychological Health Center of Excellence (PHCoE), Defense Health Headquarters, 7700 Arlington Blvd, Suite 5101, Box #22 (Silver Spring Office), Falls Church, VA
| | - Mark J Bates
- Psychological Health Center of Excellence (PHCoE), Defense Health Headquarters, 7700 Arlington Blvd, Suite 5101, Box #22 (Silver Spring Office), Falls Church, VA
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Ahmed HO, Hama Marif MA, sabah abid abdulhakim, Ali Omer MA, majeed nuri DA, Hamasur AF, Ahmed SH, Abddalqadir KM. The life styles causing overweight or obesity: Based on 5 years of experience in two centers in Sulaimani Governorate, Kurdistan Region/Iraq. INTERNATIONAL JOURNAL OF SURGERY OPEN 2018. [DOI: 10.1016/j.ijso.2018.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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