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Schmaling KB, Kaplan RM. Depression trial results: A cross-sectional study of ClinicalTrials.gov. J Psychiatr Res 2023; 161:461-466. [PMID: 37059031 DOI: 10.1016/j.jpsychires.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/24/2023] [Accepted: 04/05/2023] [Indexed: 04/16/2023]
Abstract
Published clinical trials represent a subsample of the objective information needed to appraise treatments for depression. We characterize the extent of selective and delayed reporting in a systematic review (PROSPERO #CRD42020173606) of depression trial results registered on ClinicalTrials.gov. Inclusion criteria were studies registered on ClinicalTrials.gov with depression as the condition, had enrolled ages 18 and over, were completed between January 1, 2008 and May 1, 2019, and had posted results by February 1, 2022. Cox regression analyses of time to result posting from registration and from study completion included enrollment as a covariate. Among 442 protocols, median result posting occurred over two years after study completion and five years after registration. Among protocols with incomplete results, effect sizes (d or W) were calculated for 134 protocols. Median effect sizes for protocols with incomplete results were small (0.16, 95% CI 0.08, 0.21). For 28% of protocols, observed effects were contrary to the expected direction. Between-group effect size calculations were based on post-treatment data as pre-treatment data were inconsistently provided. Although drug and device trials in the U.S. are required to register on ClinicalTrials.gov, compliance is imperfect, and submissions are not peer reviewed. For depression treatment trials, long intervals between study completion and posting of results are common. Further, investigators often fail to report the results of statistical tests. Failure to post trial results in a timely manner and omission of statistical test reporting may lead to overestimates of treatment effects in systematic literature reviews.
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Affiliation(s)
| | - Robert M Kaplan
- Clinical Excellence Research Center, Stanford University School of Medicine, USA
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2
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Dehn LB, Driessen M, Steinhart I, Beblo T. Participating in Longitudinal Observational Research on Psychiatric Rehabilitation: Quantitative Results From a Patient Perspective Study. Front Psychiatry 2022; 13:834389. [PMID: 35185660 PMCID: PMC8854761 DOI: 10.3389/fpsyt.2022.834389] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Longitudinal observational studies play on an important role for evidence-based research on health services and psychiatric rehabilitation. However, information is missing about the reasons, why patients participate in such studies, and how they evaluate their participation experience. METHODS Subsequently to their final assessment in a 2-year follow-up study on supported housing for persons with severe mental illness, n = 182 patients answered a short questionnaire on their study participation experience (prior experiences, participation reasons, burden due to study assessments, intention to participate in studies again). Basic respondent characteristics as well as symptom severity (SCL-K9) were also included in the descriptive and analytical statistics. RESULTS To help other people and curiosity were cited as the main initial reasons for study participation (>85%). Further motives were significantly associated with demographic and/or clinical variables. For instance, "relieve from boredom" was more frequently reported by men and patients with substance use disorders (compared to mood disorders), and participants 'motive" to talk about illness" was associated with higher symptom severity at study entry. Furthermore, only a small proportion of respondents indicated significant burdens by study participation and about 87% would also participate in future studies. CONCLUSIONS The respondents gave an overall positive evaluation regarding their participation experience in an observational study on psychiatric rehabilitation. The results additionally suggest that health and social care professionals should be responsive to the expectations and needs of patients with mental illness regarding participation in research.
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Affiliation(s)
- Lorenz B Dehn
- Department of Psychiatry and Psychotherapy, Evangelische Klinikum Bethel, Universitätsklinikum OWL of Bielefeld University, Bielefeld, Germany
| | - Martin Driessen
- Department of Psychiatry and Psychotherapy, Evangelische Klinikum Bethel, Universitätsklinikum OWL of Bielefeld University, Bielefeld, Germany.,Department of Psychology, University of Bielefeld, Bielefeld, Germany
| | - Ingmar Steinhart
- von Bodelschwinghsche Stiftungen Bethel, Bielefeld, Germany.,Institut für Sozialpsychiatrie Mecklenburg-Vorpommern e. V., University of Greifswald, Greifswald, Germany
| | - Thomas Beblo
- Department of Psychiatry and Psychotherapy, Evangelische Klinikum Bethel, Universitätsklinikum OWL of Bielefeld University, Bielefeld, Germany.,Department of Psychology, University of Bielefeld, Bielefeld, Germany
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Smilan LE. The Revised Common Rule and Mental Illness: Enduring Gaps in Protections. AMERICAN JOURNAL OF LAW & MEDICINE 2020; 46:413-444. [PMID: 33413011 DOI: 10.1177/0098858820975532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Lisa E Smilan
- Lisa E. Smilan, Visiting Scholar, Institute of Law, Psychiatry, and Public Policy, University of Virginia, Charlottesville, VA; J.D., George Washington University Law School, Washington, D.C.; LL.M., specialization in health law, University of Maryland Francis King Carey School of Law, Baltimore, MD; Member, National Institutes of Health Intramural Institutional Review Board, Bethesda, MD. The opinions here expressed are those of the Author and completely independent of the National Institutes of Health. The Author thanks Ellen Wright Clayton for supporting this scholarship and for comments on earlier drafts. Thanks, also, to Leslie Meltzer Henry for her guidance and encouragement, and both Richard Bonnie and Xuemei Ding for their hospitality at the University of Virginia and for facilitating access to university libraries. Finally, thanks to the anonymous peer reviewers for their observations, probing questions, and helpful suggestions, and AJLM editors Jessa Boubker and Sharon Jaquez for their dedication and meticulous care in preparing this Article for publication
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Nugent AC, Ballard ED, Park LT, Zarate CA. Research on the pathophysiology, treatment, and prevention of suicide: practical and ethical issues. BMC Psychiatry 2019; 19:332. [PMID: 31675949 PMCID: PMC6824024 DOI: 10.1186/s12888-019-2301-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/20/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Despite decades of research, the rate of death from suicide is rising in the United States. Suicide is a complex and multifactorial phenomenon and, to date, no validated biomarkers that predict suicidal behavior have been identified. Only one FDA-approved drug to prevent suicide exists, and it is approved only for patients with schizophrenia. Although anti-suicide psychotherapeutic techniques exist, treatment takes time, and only preliminary data exist for rapid-acting therapies. DISCUSSION While more research into suicidal ideation and acute suicidal behavior is clearly needed, this research is fraught with both practical and ethical concerns. As a result, many investigators and bioethicists have called for restrictions on the types of research that individuals with suicidal behavior can participate in, despite the fact that the available empirical evidence suggests that this research can be done safely. This manuscript presents background information on the phenomenology of suicide, discusses the current state of treatment and prevention strategies, and reviews the practical and ethical issues surrounding suicide research in the context of available empirical data. Currently, the causes of suicide are poorly understood, in part due to the fact that very few studies have investigated the acute suicidal crisis. Although some biomarkers for predicting risk have been developed, none have been sufficiently validated. The most successful current interventions involve means restriction. However, while numerous hurdles face researchers, these are not insurmountable. The available evidence suggests that research into suicide can be conducted both safely and ethically.
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Affiliation(s)
- Allison C. Nugent
- 0000 0004 0464 0574grid.416868.5Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA ,0000 0004 0464 0574grid.416868.5Magnetoencephalography Core Facility, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth D. Ballard
- 0000 0004 0464 0574grid.416868.5Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA
| | - Lawrence T. Park
- 0000 0004 0464 0574grid.416868.5Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA
| | - Carlos A. Zarate
- 0000 0004 0464 0574grid.416868.5Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA
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Laine A, Välimäki M, Pekurinen V, Löyttyniemi E, Marttunen M, Anttila M. Feasibility, Acceptability, and Preliminary Impacts of Web-Based Patient Education on Patients With Schizophrenia Spectrum Disorder: Quasi-Experimental Cluster Study. J Med Internet Res 2019; 21:e13073. [PMID: 31625952 PMCID: PMC6913382 DOI: 10.2196/13073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 06/25/2019] [Accepted: 08/19/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Web-based interventions are promising tools for increasing the understanding of illness and treatment among patients with serious mental disorders. OBJECTIVE This study aimed to test the feasibility and acceptability of a Web-based patient education intervention using a quasi-experimental cluster design to report feedback on patient education sessions and the website used and to report preliminary evidence of the intervention's impact on patients with schizophrenia spectrum disorder. METHODS A single-blind, parallel, quasi-experimental cluster study over a 6-month period comparing Web-based education (n=33) with a nonequivalent control group (treatment as usual, n=24) for people with schizophrenia spectrum disorder was conducted. Participants (N=57) were recruited from one psychiatric hospital (6 wards). Feasibility was assessed by participants' commitment (refusal rate, dropout rate) to the study. Acceptability was assessed as participants' commitment to the intervention. Patient education sessions and website feedback were assessed by the patients and health care professionals. The preliminary impact of the sessions on patients' self-efficacy, self-esteem, illness cognition, and knowledge level was measured at baseline and follow-ups (8 weeks, 6 months) with self-rated questionnaires. RESULTS The refusal rate among patients was high with no statistically significant difference (69% [74/107] in the intervention group, 76% [76/100] in the control group; P=.21). The same result was found for the dropout rates (48% [16/33] vs 58% [14/24]; P=.46). The acceptability of the intervention was good; 31 participants out of 33 (94%) completed all five sessions. Feedback on the intervention was mainly positive; three out of four subscales of session were rated above the midpoint of 4.0. Feedback on the website was also positive, with a grade of good for content (69%, 20/29 patients; 75%, 21/28 professionals), layout (62%, 18/29 patients; 61%, 17/28 professionals), and usability (62%, 18/29 patients; and 68%, 19/28 professionals). The patients using the intervention had significantly higher scores 6 months after the sessions in self-efficacy (baseline mean 26.12, SD 5.64 vs 6-month mean 29.24, SD 6.05; P=.003) and regarding knowledge level about schizophrenia (mean 11.39, SD 4.65 vs 6-month mean 15.06, SD 5.26; P=.002), and lower scores in the subscale of helplessness in illness cognition (mean 2.26, SD 0.96 vs 6-month mean 1.85, SD 0.59; P=.03). Differences from the control group were not significant. No differences were found in patients' self-esteem or other subscales in illness cognition. CONCLUSIONS The patients were reluctant to participate in the study and tended to drop out before the follow-ups. Once they had participated, their acceptance of the intervention was high. A more effective recruitment strategy and monitoring method will be needed in future studies. To assess the impact of the intervention, a more rigorous study design with an adequately powered sample size will be used in cooperation with outpatient mental health services.
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Affiliation(s)
- Anna Laine
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Virve Pekurinen
- Department of Nursing Science, University of Turku, Turku, Finland
| | | | - Mauri Marttunen
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Helsinki, Finland
| | - Minna Anttila
- Department of Nursing Science, University of Turku, Turku, Finland
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Bixo L, Cunningham JL, Ekselius L, Öster C, Ramklint M. 'Sick and tired': Patients reported reasons for not participating in clinical psychiatric research. Health Expect 2019; 24 Suppl 1:20-29. [PMID: 31605443 PMCID: PMC8137497 DOI: 10.1111/hex.12977] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 01/04/2023] Open
Abstract
Background Meaningful and generalizable research depends on patients' willingness to participate. Studies often fail to reach satisfactory representativeness. Objective This paper aims to investigate reasons for not participating in research among young adult patients with psychiatric illness. Method A quantitative cross‐sectional study was performed based on questionnaires reported on by 51 psychiatric patients (14 males, 35 females and two unspecified) who had previously declined participation in an ongoing research project. Thereafter, a qualitative interview with subsequent content analysis was conducted with ten additional patients (five males, five females). Results The questionnaires indicate being ‘too tired/too sick to participate’ as the most common barrier. Lack of time and fear of needles were other common barriers. Lack of trust or belief in the value of research was less inhibitive. In the interviews, disabling psychiatric symptoms were confirmed as the main reason for not participating. Several potential ways to increase participation were identified, such as simplification of procedures and information as well as providing rewards and feedback, and building relationships before asking. Conclusion This study is unusual as it focuses on the group of young people attending psychiatry outpatient clinics we know very little about – those who do not partake in research. Our results indicate that fatigue and sickness reduce research participation and identify factors that may facilitate enrolment of this important group.
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Affiliation(s)
- Liv Bixo
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Janet L Cunningham
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Lisa Ekselius
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Caisa Öster
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Mia Ramklint
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
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Stratta P, Rossi A, Rocca P, Bucci P, Prescenzo S, Patriarca S, Serrone D, Galderisi S, Maj M. Questionnaire on Attitude towards Research and Care (QuARC): a survey of patients with psychosis. J Ment Health 2019; 29:590-596. [PMID: 30862214 DOI: 10.1080/09638237.2019.1581341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: The patients' appraisal, satisfaction and attitude toward research is crucial to obtain reliable information, in psychiatry frequently not objective.Aim: We operationalised the information derived from studies on satisfaction and attitude towards research and developed a standardized measure, whose internal consistency and factor structure was investigated.Method: The Questionnaire on Attitude towards Research and health Care (QuARC) is a 10-item self-report scale, administered to 116 patients with psychotic disorders participating in research protocols. Exploratory factor analysis was conducted and internal consistency evaluated.Results: Two factors have been identified: one labelled External Factor, including items related to information on the received treatment, relationship with third parties, and one labelled Internal Factor with items related to the disorder, perceived well-being and contribution to scientific knowledge. Cronbach's alpha internal consistencies were good.Conclusions: The QuARC is easy to use, well accepted, with good psychometric properties. The constructs identified are different from the original issues addressed (i.e. attitude and satisfaction), prevailing different constructs closer to the patient opinion on the research and personal condition. These constructs identify dimensions useful to delineate and understand the patients' experience of participating in a scientific project as well as their satisfaction.
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Affiliation(s)
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L'Aquila, L'Aquila, Italy
| | - Paola Rocca
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Paola Bucci
- Department of Psychiatry, University of Campania, Naples, Italy
| | - Samanta Prescenzo
- Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L'Aquila, L'Aquila, Italy
| | - Sara Patriarca
- Department of Psychiatry, University of Campania, Naples, Italy
| | - Dario Serrone
- Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L'Aquila, L'Aquila, Italy
| | | | - Mario Maj
- Department of Psychiatry, University of Campania, Naples, Italy
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McDonald KE, Conroy NE, Kim CI, LoBraico EJ, Prather EM, Olick RS. Is Safety in the Eye of the Beholder? Safeguards in Research With Adults With Intellectual Disability. J Empir Res Hum Res Ethics 2016; 11:424-438. [PMID: 27307420 DOI: 10.1177/1556264616651182] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Human subjects research has a core commitment to participant well-being. This obligation is accentuated for once exploited populations such as adults with intellectual disability. Yet we know little about the public's views on appropriate safeguards for this population. We surveyed adults with intellectual disability, family members and friends, disability service providers, researchers, and Institutional Review Board (IRB) members to compare views on safeguards. We found many points of convergence of views, particularly for decision-making and participation. One trend is that adults with intellectual disability perceive greater safety in being engaged directly in recruitment, and recruitment by specific individuals. Researchers and IRB members need to consider community views to facilitate the safe and respectful inclusion of adults with intellectual disability.
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Affiliation(s)
| | | | | | | | | | - Robert S Olick
- 2 SUNY Upstate Medical University, Syracuse, New York City, USA
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Perceptions of PTSD research participation among patients with severe mental illness. Psychiatry Res 2012; 200:1071-3. [PMID: 22884217 DOI: 10.1016/j.psychres.2012.07.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Revised: 07/23/2012] [Accepted: 07/26/2012] [Indexed: 11/22/2022]
Abstract
Due to concerns that individuals with severe mental illness (SMI) are too fragile to participate in trauma/PTSD research, we examined reactions to PTSD research participation among these patients. Most patients viewed their participation favorably and were not significantly distressed, suggesting an adequate benefit of trauma/PTSD research participation in this population.
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