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O'Connor EA, Henninger ML, Perdue LA, Coppola EL, Thomas RG, Gaynes BN. Anxiety Screening: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2023; 329:2171-2184. [PMID: 37338868 DOI: 10.1001/jama.2023.6369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Importance Anxiety is commonly seen in primary care and associated with substantial burden. Objective To review the benefits and harms of screening and treatment for anxiety and the accuracy of instruments to detect anxiety among primary care patients. Data Sources MEDLINE, PsychINFO, Cochrane library through September 7, 2022; references of existing reviews; ongoing surveillance for relevant literature through November 25, 2022. Study Selection English-language original studies and systematic reviews of screening or treatment compared with control conditions and test accuracy studies of a priori-selected screening instruments were included. Two investigators independently reviewed abstracts and full-text articles for inclusion. Two investigators independently rated study quality. Data Extraction and Synthesis One investigator abstracted data; a second checked accuracy. Meta-analysis results were included from existing systematic reviews where available; meta-analyses were conducted on original research when evidence was sufficient. Main Outcomes and Measures Anxiety and depression outcomes; global quality of life and functioning; sensitivity and specificity of screening tools. Results Of the 59 publications included, 40 were original studies (N = 275 489) and 19 were systematic reviews (including ≈483 studies [N≈81 507]). Two screening studies found no benefit for screening for anxiety. Among test accuracy studies, only the Generalized Anxiety Disorder (GAD) GAD-2 and GAD-7 screening instruments were evaluated by more than 1 study. Both screening instruments had adequate accuracy for detecting generalized anxiety disorder (eg, across 3 studies the GAD-7 at a cutoff of 10 had a pooled sensitivity of 0.79 [95% CI, 0.69 to 0.94] and specificity of 0.89 [95% CI, 0.83 to 0.94]). Evidence was limited for other instruments and other anxiety disorders. A large body of evidence supported the benefit of treatment for anxiety. For example, psychological interventions were associated with a small pooled standardized mean difference of -0.41 in anxiety symptom severity in primary care patients with anxiety (95% CI, -0.58 to -0.23]; 10 RCTs [n = 2075]; I2 = 40.2%); larger effects were found in general adult populations. Conclusions and Relevance Evidence was insufficient to draw conclusions about the benefits or harms of anxiety screening programs. However, clear evidence exists that treatment for anxiety is beneficial, and more limited evidence indicates that some anxiety screening instruments have acceptable accuracy to detect generalized anxiety disorder.
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Affiliation(s)
- Elizabeth A O'Connor
- Kaiser Permanente Evidence-based Practice Center, Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Michelle L Henninger
- Kaiser Permanente Evidence-based Practice Center, Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Leslie A Perdue
- Kaiser Permanente Evidence-based Practice Center, Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Erin L Coppola
- Kaiser Permanente Evidence-based Practice Center, Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Rachel G Thomas
- Kaiser Permanente Evidence-based Practice Center, Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Bradley N Gaynes
- Gillings School of Global Public Health, University of North Carolina School of Medicine, Chapel Hill
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Sasseville M, LeBlanc A, Tchuente J, Boucher M, Dugas M, Gisèle M, Barony R, Chouinard MC, Beaulieu M, Beaudet N, Skidmore B, Cholette P, Aspiros C, Larouche A, Chabot G, Gagnon MP. The impact of technology systems and level of support in digital mental health interventions: a secondary meta-analysis. Syst Rev 2023; 12:78. [PMID: 37143171 PMCID: PMC10157597 DOI: 10.1186/s13643-023-02241-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 04/20/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND The majority of people with a chronic disease (e.g., diabetes, hypertension, COPD) have more than one concurrent condition and are also at higher risk for developing comorbidities in mental health, including anxiety and depression. There is an urgent need for more relevant and accurate data on digital interventions in this area to prepare for an increase demand for mental health services. The aim of this study was to conduct a meta-analysis of the digital mental health interventions for people with comorbid physical and mental chronic diseases to compare the effect of technology systems and level of support. METHODS This secondary meta-analysis follows a rapid review of systematic reviews, a virtual workshop with knowledge users to identify research questions and a modified Delphi study to guide research methods: What types of digital health interventions (according to a recognized categorization) are the most effective for the management of concomitant mental health and chronic disease conditions in adults? We conducted a secondary analysis of the primary studies identified in the rapid review. Two reviewers independently screened the titles and abstracts and applied inclusion criteria: RCT design using a digital mental health intervention in a population of adults with another chronic condition, published after 2010 in French or English, and including an outcome measurement of anxiety or depression. RESULTS Seven hundred eight primary studies were extracted from the systematic reviews and 84 primary studies met the inclusion criteria Digital mental health interventions were significantly more effective than in-person care for both anxiety and depression outcomes. Online messaging was the most effective technology to improve anxiety and depression scores; however, all technology types were effective. Interventions partially supported by healthcare professionals were more effective than self-administered. CONCLUSIONS While our meta-analysis identifies digital intervention's characteristics are associated with better effectiveness, all technologies and levels of support could be used considering implementation context and population. TRIAL REGISTRATION The protocol for this review is registered in the National Collaborating Centre for Methods and Tools (NCCMT) COVID-19 Rapid Evidence Service (ID 75).
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Affiliation(s)
- Maxime Sasseville
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada.
| | - Annie LeBlanc
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada
| | - Jack Tchuente
- VITAM Research Center on Sustainable Health, Quebec City, Canada
| | | | - Michèle Dugas
- VITAM Research Center on Sustainable Health, Quebec City, Canada
| | | | | | | | | | - Nicolas Beaudet
- Université de Sherbrooke, Omnimed, Sherbrooke, Quebec, Canada
| | - Becky Skidmore
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada
| | - Pascale Cholette
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale, Quebec City, Canada
| | - Christine Aspiros
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada
| | - Alain Larouche
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada
| | - Guylaine Chabot
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada
| | - Marie-Pierre Gagnon
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada
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3
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Cobb SJ, Vaughn BV, Sagherian K. Nonpharmacologic Interventions and Seizure Frequency in Patients With Psychogenic Nonepileptic Seizures: An Integrative Review. J Am Psychiatr Nurses Assoc 2022:10783903221107637. [PMID: 35801259 DOI: 10.1177/10783903221107637] [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: 11/15/2022]
Abstract
BACKGROUND Psychogenic nonepileptic seizures (PNES) pose a heavy burden on patients' lives and the health care system. The symptoms of PNES are often debilitating and cause high rates of disability and poor quality of life. Many treatment options are available, but there is no clear consensus on best practices. AIM To critique and synthesize the current literature on nonpharmacologic interventions and effects on seizure frequency in patients with PNES. METHODS An integrative review guided by the Whittemore and Knafl approach. RESULTS The review included 24 studies published from 2010 to 2020. Interventions for PNES included individualized psychotherapies, group therapies, multimodal psychotherapies, self-help therapies, and complementary and alternative medicine therapies. Individual psychotherapies such as cognitive behavioral therapy and psychoeducation were the most used treatment modalities. The most effective treatments for seizure frequency reduction were those that included multiple psychotherapy sessions with a health care provider and covered multiple domains (e.g., understanding of diagnosis, identifying triggers, and developing effective coping strategies). CONCLUSIONS Seizure frequency can be reduced in patients with PNES with multiple nonpharmacologic interventions. However, seizure frequency is not considered a comprehensive outcome measure and provides little insight into other important life domains. Further research is needed on nonpharmacologic interventions for PNES and effects on other areas of life such as sleep, employment status, global functioning, and self-efficacy.
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Affiliation(s)
- Sandra J Cobb
- Sandra J. Cobb, MSN, FNP-C, RN, REEGT, PhD in nursing candidate, University of Tennessee Knoxville, College of Nursing, Knoxville, TN, USA
| | - Bradley V Vaughn
- Bradley V. Vaughn, MD, Professor, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Knar Sagherian
- Knar Sagherian, PhD, RN, Assistant Professor, University of Tennessee Knoxville College of Nursing, Knoxville, TN, USA
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4
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McQuillin SD, Hagler MA, Werntz A, Rhodes JE. Paraprofessional Youth Mentoring: A Framework for Integrating Youth Mentoring with Helping Institutions and Professions. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 69:201-220. [PMID: 34318526 DOI: 10.1002/ajcp.12546] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The demand for child mental health services, including those provided by psychologists, counselors, and social workers, exceeds the supply. This trend is expected to continue or worsen unless there are substantial structural changes in how mental health services are provided. We propose a framework for paraprofessional youth mentors, defined as a subgroup of professionally supervised, non-expert volunteer or paid mentors to whom aspects of professional helping tasks are delegated. Our proposal is aligned with historical and modern solutions to scaling mental health services, and this framework could simultaneously increase the number of youth receiving evidence-based mental health services and reduce the burden on existing systems of care. The framework defines three plausible tasks for paraprofessional mentors: (1) reducing barriers to mental health service, (2) increasing engagement in services, and (3) providing direct services. The safety and effectiveness of these task-shifting efforts will hinge on competency-based training and evaluation, supervision by professionals, and documentation of services rendered, all of which the field of youth mentoring currently lacks. We describe several requisite scientific, institutional, and regulatory advances that will be necessary to realize this variant of youth mentoring for a subgroup of youth who are presenting for assistance with mental health problems.
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Affiliation(s)
- Samuel D McQuillin
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Matthew A Hagler
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Alexandra Werntz
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Jean E Rhodes
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
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5
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Parker EL, Banfield M, Fassnacht DB, Hatfield T, Kyrios M. Contemporary treatment of anxiety in primary care: a systematic review and meta-analysis of outcomes in countries with universal healthcare. BMC FAMILY PRACTICE 2021; 22:92. [PMID: 33992082 PMCID: PMC8126070 DOI: 10.1186/s12875-021-01445-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 04/26/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND Anxiety disorders are highly prevalent mental health conditions and are managed predominantly in primary care. We conducted a systematic review and meta-analysis of psychological and pharmacological treatments in countries with universal healthcare, and investigated the influence of treatment provider on the efficacy of psychological treatment. METHOD PubMed, Cochrane, PsycINFO, CINAHL, and Scopus were searched in April 2017 for controlled studies of evidence-based anxiety treatment in adults in primary care, published in English since 1997. Searches were repeated in April 2020. We synthesised results using a combination of meta-analysis and narrative methods. Meta-analysis was conducted using a random-effects multi-level model to account for intercorrelation between effects contributed different treatment arms of the same study. Moderator variables were explored using meta-regression analyses. RESULTS In total, 19 articles (from an initial 2,247) reporting 18 studies were included. Meta-analysis including ten studies (n = 1,308) found a pooled effect size of g = 1.16 (95%CI = 0.63 - 1.69) for psychological treatment compared to waitlist control, and no significant effect compared to care as usual (p = .225). Substantial heterogeneity was present (I2 = 81.25). Specialist treatment produced large effects compared to both waitlist control (g = 1.46, 95%CI = 0.96 - 1.96) and care as usual (g = 0.76, 95%CI = 0.27 - 1.25). Treatment provided by non-specialists was only superior to waitlist control (g = 0.80, 95%CI = 0.31 - 1.28). We identified relatively few studies (n = 4) of medications, which reported small to moderate effects for SSRI/SNRI medications and hydroxyzine. The quality of included studies was variable and most studies had at least "unclear" risk of bias in one or more key domains. CONCLUSIONS Psychological treatments for anxiety are effective in primary care and are more effective when provided by a specialist (psychologist or clinical psychologist) than a non-specialist (GP, nurse, trainee). However, non-specialists provide effective treatment compared with no care at all. Limited research into the efficacy of pharmacological treatments in primary care needs to be considered carefully by prescribers TRIAL REGISTRATION: PROSPERO registration number CRD42018050659.
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Affiliation(s)
- Erin L Parker
- Research School of Psychology, Australian National University, Canberra, ACT, 2601, Australia.
| | - Michelle Banfield
- Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - Daniel B Fassnacht
- Research School of Psychology, Australian National University, Canberra, ACT, 2601, Australia
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Timothy Hatfield
- Research School of Psychology, Australian National University, Canberra, ACT, 2601, Australia
| | - Michael Kyrios
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
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Evans K, Spiby H, Morrell CJ. Developing a complex intervention to support pregnant women with mild to moderate anxiety: application of the Medical Research Council framework. BMC Pregnancy Childbirth 2020; 20:777. [PMID: 33317463 PMCID: PMC7734709 DOI: 10.1186/s12884-020-03469-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/01/2020] [Indexed: 11/24/2022] Open
Abstract
Background To design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy. Methods The development followed the MRC framework for complex interventions, utilising psychological theory, review level evidence and professional and public involvement. Two systematic reviews were completed which helped identify potentially beneficial intervention components. The theory underpinning the components was explored to consider the potential benefit for women with mild to moderate anxiety symptoms in pregnancy. Methods of delivering the intervention within maternity services were explored. The intervention comprised: group discussions, one to one support and assisted self-help resources. Midwives were identified as ideally placed to facilitate the intervention supported by midwifery support workers. A bespoke training package was provided by subject experts to prepare the facilitators. Results The absence of established interventions and a paucity of evidence based approaches for pregnant women with symptoms of mild to moderate anxiety indicated the need for a rigorous and systematic approach to the intervention design. This approach led to the development of an intervention feasible for implementation in maternity care systems tailored to the needs of pregnant women. The involvement of a multi-professional advisory team and active engagement of service users helped to consider the acceptability of the intervention for women and the feasibility of delivering the intervention in the context of maternity care. Conclusion The MRC Framework provided useful overarching guidance to develop a midwife facilitated intervention for women with symptoms of anxiety in pregnancy. The framework assisted the development of a robust rationale for each intervention component and considered the processes of evaluation and implementation into maternity care systems.
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Affiliation(s)
- Kerry Evans
- University of Nottingham, 12th Floor Tower Building, Nottingham, NG7 2RD, UK.
| | - Helen Spiby
- University of Nottingham, 12th Floor Tower Building, Nottingham, NG7 2RD, UK.,School of Nursing and Midwifery, University of Queensland, Brisbane, Australia
| | - C Jane Morrell
- University of Nottingham, 12th Floor Tower Building, Nottingham, NG7 2RD, UK
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Lukaschek K, Mergenthal K, Heider D, Hanke A, Munski K, Moschner A, Emig M, van den Akker M, Zapf A, Wegscheider K, König HH, Gensichen J. eHealth-supported case management for patients with panic disorder or depression in primary care: Study protocol for a cRCT (PREMA). Trials 2019; 20:662. [PMID: 31791389 PMCID: PMC6889733 DOI: 10.1186/s13063-019-3751-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/23/2019] [Indexed: 12/03/2022] Open
Abstract
Background Panic disorder (PD), frequently occurring with agoraphobia (AG), and depression are common mental disorders in primary care and associated with considerable individual and societal costs. Early detection and effective treatment of depression and PD/AG are of major importance. Cognitive behavioural exposure exercises have been shown to be effective in reducing anxiety and depressive symptoms. Practice team-based case management can improve clinical outcomes for patients with chronic diseases in primary care. The present study aims at evaluating the effects and cost-effectiveness of a primary care team-based intervention using behavioural therapy elements and case management supported by eHealth components in patients with PD/AG or depression compared to treatment as usual. Methods/design This is a two-arm cluster-randomized, controlled trial (cRCT). General practices represent the units of randomisation. General practitioners recruit adult patients with depression and PD ± AG according to the International Classification of Diseases, version 10 (ICD-10). In the intervention group, patients receive cognitive behaviour therapy-oriented psychoeducation and instructions to self-managed exposure exercises in four manual-based appointments with the general practitioner. A trained health care assistant from the practice team delivers case management and is continuously monitoring symptoms and treatment progress in ten protocol-based telephone contacts with patients. Practice teams and patients are supported by eHealth components. In the control group, patients receive usual care from general practitioners. Outcomes are measured at baseline (T0), at follow-up after 6 months (T1), and at follow-up after 12 months (T2). The primary outcome is the mental health status of patients as measured by the Mental Health Index (MHI-5). Effect sizes of 0.2 standard deviation (SD) are regarded as relevant. Assuming a drop-out rate of 20% of practices and patients each, we aim at recruiting 1844 patients in 148 primary care practices. This corresponds to 12.5 patients on average per primary care practice. Secondary outcomes include depression and anxiety-related clinical parameters and health-economic costs. Discussion If the intervention is more effective than treatment as usual, the three-component (cognitive behaviour therapy, case-management, eHealth) primary care-based intervention for patients suffering from PD/AG or depression could be a valuable low-threshold option that benefits patients and primary care practice teams. Trial registration German clinical trials register, DRKS00016622. Registered on February 22nd, 2019.
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Affiliation(s)
- Karoline Lukaschek
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians University of Munich, Pettenkoferstr 8a, 80336, Munich, Germany
| | - Karola Mergenthal
- Institute of General Practice, Goethe-University, Frankfurt am Main, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Michelle Emig
- Association of Statutory Health Insurance Physicians Hesse, Frankfurt am Main, Germany
| | - Marjan van den Akker
- Institute of General Practice, Goethe-University, Frankfurt am Main, Germany.,Department of Family Medicine, Maastricht University, Maastricht, the Netherlands.,Academic Centre of General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Wegscheider
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians University of Munich, Pettenkoferstr 8a, 80336, Munich, Germany.
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McDevitt-Petrovic O, Shevlin M, Kirby K. Modelling changes in anxiety and depression during low-intensity cognitive behavioural therapy: An application of growth mixture models. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2019; 59:169-185. [PMID: 31696972 DOI: 10.1111/bjc.12237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 10/05/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Research largely supports the clinical effectiveness of low-intensity cognitive behavioural therapy (LICBT) for mild-to-moderate anxiety and depression, delivered by psychological well-being practitioners (PWPs). Knowledge regarding the predictors of treatment response, however, is relatively limited. The primary aim of this study was to model the heterogeneity in longitudinal changes in anxiety and depression throughout LICBT provided by PWPs in Northern Ireland (NI), and to explore associations between pre-treatment variables and differences in treatment response. METHODS Growth mixture modelling (GMM) techniques were employed to examine changes in psychological status in clients (N = 253) over the first six sessions of treatment, to identify divergent early response trajectories. A series of pre-treatment variables were used to predict class membership using chi-square tests and binary logistic regression models. RESULTS There was one class representing improvement and one representing no improvement for both anxiety and depression. Class membership was predictive of treatment outcome. Pre-treatment variables associated with less improvement included unemployment, risk of suicide, neglect of self or others, using medication, receiving previous or concurrent treatments, a longer duration of difficulties, and comorbidities. CONCLUSIONS Findings indicate most of the sample populated an 'improvers' class for both depression and anxiety. Pre-treatment variables identified as predictive of poor treatment response may need to be considered by practitioners in potential triage referral decision policies, supporting cost-effective and efficient services. Further research around predictors of clinical outcome is recommended. PRACTITIONER POINTS Most of the sample belonged to an 'improvers' class. Several pre-treatment variables predicted poor treatment response (unemployment, suicide risk, neglect, medication, previous or concurrent treatments, longer duration of difficulties, and comorbidities). Few studies have utilized GMM to determine predictors of outcome following LICBT Regarding pre-treatment variables, the possibility of self-report bias cannot be excluded. The time period was relatively short, although represented the optimum number of sessions recommended for LICBT. The lack of a control group and random allocation were the main limitations.
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10
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Siller H, Renner W, Juen B. Turkish Migrant Women with Recurrent Depression: Results from Community-based Self-help Groups. Behav Med 2017; 43:129-141. [PMID: 26651367 DOI: 10.1080/08964289.2015.1111858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The study focuses on psychosocial functioning of female Turkish immigrants in Austria with recurrent depressive disorder participating in self-help groups. Self-help groups guided by group leaders of Turkish descent should increase autonomy in participants, providing the opportunity to follow their ethnic health beliefs. Turkish immigrant women (n = 43) with recurrent depressive disorder participated in self-help groups over four months. Qualitative data of participants and group leaders, containing interviews, group protocols and supervision protocols of group leaders were analyzed using the qualitative content analysis for effects on psychosocial function, such as interaction with others, illness beliefs and benefit from self-help group. Women reported feelings of being neglected and violated by their husbands. They stated that they had gained strength and had emancipated themselves from their husbands. Self-help groups functioned as social resources and support for changes in participants' lives. Further interventions should integrate the functional value of depressive symptoms and focus on social support systems and social networks.
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Affiliation(s)
- Heidi Siller
- a Women's Health Centre , Medical University of Innsbruck
| | | | - Barbara Juen
- c Department of Psychology , University of Innsbruck
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11
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Zhang Y, Wang P. Interactions and user-perceived helpfulness in diet information social questions & answers. Health Info Libr J 2016; 33:295-307. [PMID: 27870318 DOI: 10.1111/hir.12158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Online health information seeking using social questions and answers (Social Q&A) sites has been increasingly popular in recent years. It calls for better understanding of health information seeking behaviour and interactions between information seekers and information providers. OBJECTIVES The study investigates how diet information seekers interact with information providers on WebMD Answers, which is a Social Q&A site devoted to health-related topics, and examines the factors that constitute a 'helpful' answer from an information seeker's perspective. METHODS Bales' interaction process analysis was applied as the framework to analyse 568 diet-related Q&As from WebMD Answers to identify interaction patterns. RESULTS Most diet information seekers post questions anonymously and without any detailed description. Individual experts or health organisations provide most answers. Overall, answers are positively received and had a high satisfaction rating. It was also found that information seeker-perceived helpfulness does not depend on who answered the question but to how an information seeker posted the question. CONCLUSIONS This study indicates that answers at WebMD Answers are helpful for diet information seekers. It sheds new light on the interactions during the Q&A process, preferred site functions and important factors that contribute to perceived helpful answers.
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Affiliation(s)
- Yin Zhang
- School of Library and Information Science, Kent State University, Kent, OH, USA
| | - Peilin Wang
- School of Management, Anhui University, Hefei, China
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12
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Krebber AMH, van Uden-Kraan CF, Melissant HC, Cuijpers P, van Straten A, Becker-Commissaris A, Leemans CR, Verdonck-de Leeuw IM. A guided self-help intervention targeting psychological distress among head and neck cancer and lung cancer patients: motivation to start, experiences and perceived outcomes. Support Care Cancer 2016; 25:127-135. [PMID: 27585808 PMCID: PMC5127860 DOI: 10.1007/s00520-016-3393-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/23/2016] [Indexed: 12/16/2022]
Abstract
Background Recent results of a randomized clinical trial showed that a guided self-help intervention (based on problem-solving therapy) targeting psychological distress among head and neck cancer and lung cancer patients is effective. This study qualitatively explored motivation to start, experiences with and perceived outcomes of this intervention. Methods Data were collected from semi-structured interviews of 16 patients. All interviews were audio-recorded and transcribed verbatim. Data were analyzed individually by two coders and coded into key issues and themes. Results Patients participated in the intervention for intrinsic (e.g. to help oneself) and for extrinsic reasons (e.g. being asked by a care professional or to help improve health care). Participants indicated positive and negative experiences with the intervention. Several participants appreciated participating as being a pleasant way to work on oneself, while others described participating as too confrontational. Some expressed their disappointment as they felt the intervention had brought them nothing or indicated that they felt worse temporarily, but most participants perceived positive outcomes of the intervention (e.g. feeling less distressed and having learned what matters in life). Conclusions Cancer patients have various reasons to start a guided self-help intervention. Participants appreciated the guided self-help as intervention to address psychological distress, but there were also concerns. Most participants reported the intervention to be beneficial. The results suggest the need to identify patients who might benefit most from guided self-help targeting psychological distress and that interventions should be further tailored to individual cancer patients’ requirements.
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Affiliation(s)
- Anne-Marie H Krebber
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.,EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.,VUmc Cancer Center, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Cornelia F van Uden-Kraan
- EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.,VUmc Cancer Center, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.,Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, the Netherlands
| | - Heleen C Melissant
- EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.,VUmc Cancer Center, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.,Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, the Netherlands
| | - Pim Cuijpers
- EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.,Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, the Netherlands
| | - Annemieke van Straten
- EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.,Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, the Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - C René Leemans
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.,VUmc Cancer Center, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands. .,EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands. .,VUmc Cancer Center, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands. .,Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, the Netherlands.
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13
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Beshai S, Wallace LM, Mcdougall KH, Waldmann K, Stea JN. Reduced Contact Cognitive-Behavioral Interventions for Adult Depression: A Review. THE JOURNAL OF PSYCHOLOGY 2015; 150:252-79. [PMID: 26606161 DOI: 10.1080/00223980.2015.1087376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Depression is a highly prevalent and debilitating mental health condition. Evidence suggests that there is a widening gap between the demand for and availability of effective treatments. As such, there is a vast need for the development and dissemination of accessible and affordable treatments for depression. In the past decade, there has been a proliferation of reduced client-therapist contact protocols for depression. In this article, the authors review and compare the efficacy of reduced contact cognitive-behavioral interventions for adult depression across two degrees of therapist-client contact (i.e., no therapist-client contact versus minimal therapist-client contact interventions). The authors also discuss the methodological and theoretical limitations of this research base. The present review suggests that a) reduced contact interventions for depression can be effective in remediating the symptoms of depression; b) the effect sizes of some reduced contact protocols may approximate those reported in traditional protocols involving significantly greater client-therapist contact; and c) protocols which employ some form of client-therapist contact, on average, generate higher effect sizes than those that are purely self-help in nature. A discussion of the theoretical and applied implications of such findings, as well as areas in need of further research, is provided.
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Abstract
This article addresses four major challenges for efforts to create synergy between the global mental health movement and cultural psychiatry. First, although they appear to share domains of mutual interest, the worlds of global mental health and cultural psychiatry have distinct lineages. Expanding their horizons by learning from adjacent disciplines would be mutually beneficial. A second challenge concerns the conceptualization of a new classification system for mental health problems. Adopting a classification system that integrates new insights from socio-neurobiology and from a networks perspective could bring cultural psychiatry and global mental health closer and change the way each field addresses the mental health gap, which constitutes the third challenge. I summarize attempts to achieve comprehensive mental health coverage around the globe and question whether the strategies employed to achieve these goals have been successful, both in high- (HIC) and low- and middle-income countries (LMIC). In LMIC, the dominant strategy needs to be complemented by mobilization of other community resources including local practitioners. A fourth challenge is the lack of mathematical models to guide action and research and solve major preoccupations such as access to care or multi-level analyses in complex ecological or health systems.
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15
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Terluin B, Oosterbaan DB, Brouwers EPM, van Straten A, van de Ven PM, Langerak W, van Marwijk HWJ. To what extent does the anxiety scale of the Four-Dimensional Symptom Questionnaire (4DSQ) detect specific types of anxiety disorder in primary care? A psychometric study. BMC Psychiatry 2014; 14:121. [PMID: 24761829 PMCID: PMC4006959 DOI: 10.1186/1471-244x-14-121] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 04/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anxiety scales may help primary care physicians to detect specific anxiety disorders among the many emotionally distressed patients presenting in primary care. The anxiety scale of the Four-Dimensional Symptom Questionnaire (4DSQ) consists of an admixture of symptoms of specific anxiety disorders. The research questions were: (1) Is the anxiety scale unidimensional or multidimensional? (2) To what extent does the anxiety scale detect specific DSM-IV anxiety disorders? (3) Which cut-off points are suitable to rule out or to rule in (which) anxiety disorders? METHODS We analyzed 5 primary care datasets with standardized psychiatric diagnoses and 4DSQ scores. Unidimensionality was assessed through confirmatory factor analysis (CFA). We examined mean scores and anxiety score distributions per disorder. Receiver operating characteristic (ROC) analysis was used to determine optimal cut-off points. RESULTS Total n was 969. CFA supported unidimensionality. The anxiety scale performed slightly better in detecting patients with panic disorder, agoraphobia, social phobia, obsessive compulsive disorder (OCD) and post traumatic stress disorder (PTSD) than patients with generalized anxiety disorder (GAD) and specific phobia. ROC-analysis suggested that ≥4 was the optimal cut-off point to rule out and ≥10 the cut-off point to rule in anxiety disorders. CONCLUSIONS The 4DSQ anxiety scale measures a common trait of pathological anxiety that is characteristic of anxiety disorders, in particular panic disorder, agoraphobia, social phobia, OCD and PTSD. The anxiety score detects the latter anxiety disorders to a slightly greater extent than GAD and specific phobia, without being able to distinguish between the different anxiety disorder types. The cut-off points ≥4 and ≥10 can be used to separate distressed patients in three groups with a relatively low, moderate and high probability of having one or more anxiety disorders.
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Affiliation(s)
- Berend Terluin
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
| | - Desiree B Oosterbaan
- Overwaal Centre for Anxiety Disorders, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Evelien PM Brouwers
- Scientific Centre for Care and Welfare (Tranzo), Tilburg University, Tilburg, The Netherlands
| | - Annemieke van Straten
- Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Wendy Langerak
- Dutch Institute for Employee Benefit Schemes (UWV), Almere, The Netherlands
| | - Harm WJ van Marwijk
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
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16
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Mayo-Wilson E, Montgomery P. Media-delivered cognitive behavioural therapy and behavioural therapy (self-help) for anxiety disorders in adults. Cochrane Database Syst Rev 2013:CD005330. [PMID: 24018460 DOI: 10.1002/14651858.cd005330.pub4] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Anxiety disorders are the most common mental health problems. They are chronic and unremitting. Effective treatments are available, but access to services is limited. Media-delivered behavioural and cognitive behavioural interventions (self-help) aim to deliver treatment with less input from professionals compared with traditional therapies. OBJECTIVES To assess the effects of media-delivered behavioural and cognitive behavioural therapies for anxiety disorders in adults. SEARCH METHODS Published and unpublished studies were considered without restriction by language or date. The Cochrane Depression, Anxiety and Neurosis Review Group's Specialized Register (CCDANCTR) was searched all years to 1 January 2013. The CCDANCTR includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). Complementary searches were carried out on Ovid MEDLINE (1950 to 23 February 2013) and PsycINFO (1987 to February, Week 2, 2013), together with International trial registries (the trials portal of the World Health Organization (ICTRP) and ClinicalTrials.gov). Reference lists from previous meta-analyses and reports of randomised controlled trials were checked, and authors were contacted for unpublished data. SELECTION CRITERIA Randomised controlled trials of media-delivered behavioural or cognitive behavioural therapy in adults with anxiety disorders (other than post-traumatic stress disorder) compared with no intervention (including attention/relaxation controls) or compared with face-to-face therapy. DATA COLLECTION AND ANALYSIS Both review authors independently screened titles and abstracts. Study characteristics and outcomes were extracted in duplicate. Outcomes were combined using random-effects models, and tests for heterogeneity and for small study bias were conducted. We examined subgroup differences by type of disorder, type of intervention provided, type of media, and recruitment methods used. MAIN RESULTS One hundred and one studies with 8403 participants were included; 92 studies were included in the quantitative synthesis. These trials compared several types of media-delivered interventions (with varying levels of support) with no treatment and with face-to-face interventions. Inconsistency and risk of bias reduced our confidence in the overall results. For the primary outcome of symptoms of anxiety, moderate-quality evidence showed medium effects compared with no intervention (standardised mean difference (SMD) 0.67, 95% confidence interval (CI) 0.55 to 0.80; 72 studies, 4537 participants), and low-quality evidence of small effects favoured face-to-face therapy (SMD -0.23, 95% CI -0.36 to -0.09; 24 studies, 1360 participants). The intervention was associated with greater response than was seen with no treatment (risk ratio (RR) 2.34, 95% CI 1.81 to 3.03; 21 studies, 1547 participants) and was not significantly inferior to face-to-face therapy in these studies (RR 0.78, 95 % CI 0.56 to 1.09; 10 studies, 575 participants), but the latter comparison included versions of therapies that were not as comprehensive as those provided in routine clinical practice. Evidence suggested benefit for secondary outcome measures (depression, mental-health related disability, quality of life and dropout), but this evidence was of low to moderate quality. Evidence regarding harm was lacking. AUTHORS' CONCLUSIONS Self-help may be useful for people who are not able or are not willing to use other services for people with anxiety disorders; for people who can access it, face-to-face cognitive behavioural therapy is probably clinically superior. Economic analyses were beyond the scope of this review.Important heterogeneity was noted across trials. Recent interventions for specific problems that incorporate clinician support may be more effective than transdiagnostic interventions (i.e. interventions for multiple disorders) provided with no guidance, but these issues are confounded in the available trials.Although many small trials have been conducted, the generalisability of their findings is limited. Most interventions tested are not available to consumers. Self-help has been recommended as the first step in the treatment of some anxiety disorders, but the short-term and long-term effectiveness of media-delivered interventions has not been established. Large, pragmatic trials are needed to evaluate and to maximise the benefits of self-help interventions.
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Affiliation(s)
- Evan Mayo-Wilson
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, UK, WC1E 7HB
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Collaborative research: a case example of dissemination of CBT in primary care. COGNITIVE BEHAVIOUR THERAPIST 2013. [DOI: 10.1017/s1754470x13000093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractWhile we now have a strong evidence base for cognitive behaviour therapy in managing mental health problems, the challenge is to disseminate it into real-world settings. Two dissemination approaches exist: the dominant ‘research to practice’ model, a linear sequence, taking interventions from the research laboratory and overcoming barriers so as to apply them in the real world and a more collaborative approach, in which researchers work together with clinicians and patients to adapt existing treatments for real-world settings. This article provides a detailed example of a collaborative approach to adapting cognitive behaviour therapy, by developing a very brief mental health intervention for patients in a primary-care (family doctor) setting.
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Fledderus M, Bohlmeijer ET, Pieterse ME, Schreurs KMG. Acceptance and commitment therapy as guided self-help for psychological distress and positive mental health: a randomized controlled trial. Psychol Med 2012; 42:485-495. [PMID: 21740624 DOI: 10.1017/s0033291711001206] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In order to reduce the high prevalence of depression, early interventions for people at risk of depression are warranted. This study evaluated the effectiveness of an early guided self-help programme based on acceptance and commitment therapy (ACT) for reducing depressive symptomatology. METHOD Participants with mild to moderate depressive symptomatology were recruited from the general population and randomized to the self-help programme with extensive email support (n=125), the self-help programme with minimal email support (n=125) or to a waiting list control group (n=126). Participants completed measures before and after the intervention to assess depression, anxiety, fatigue, experiential avoidance, positive mental health and mindfulness. Participants in the experimental conditions also completed these measures at a 3-month follow-up. RESULTS In the experimental conditions significant reductions in depression, anxiety, fatigue, experiential avoidance and improvements in positive mental health and mindfulness were found, compared with the waiting list condition (effect sizes Cohen's d=0.51-1.00). These effects were sustained at the 3-month follow-up. There were no significant differences between the experimental conditions on the outcome measures. CONCLUSIONS The ACT-based self-help programme with minimal email support is effective for people with mild to moderate depressive symptomatology.
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Affiliation(s)
- M Fledderus
- University of Twente, Faculty of Behavioural Sciences, Department of Psychology, Health and Technology, Enschede, The Netherlands.
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Seekles W, van Straten A, Beekman A, van Marwijk H, Cuijpers P. Stepped care treatment for depression and anxiety in primary care. a randomized controlled trial. Trials 2011; 12:171. [PMID: 21736720 PMCID: PMC3152524 DOI: 10.1186/1745-6215-12-171] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 07/07/2011] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Depressive and anxiety disorders are common in general practice but not always treated adequately. Introducing stepped care might improve this. In this randomized trial we examined the effectiveness of such a stepped care model. METHODS The study population consisted of primary care attendees aged 18-65 years with minor or major DSM-IV depressive and/or anxiety disorders, recruited through screening. We randomized 120 patients to either stepped care or care as usual. The stepped care program consisted of (1) watchful waiting, (2) guided self-help, (3) short face-to-face problem solving treatment and (4) pharmacotherapy and/or specialized mental health care. Patients were assessed at baseline and after 8, 16 and 24 weeks. RESULTS Symptoms of depression and anxiety decreased significantly over time for both groups. However, there was no statistically significant difference between the two groups (IDS: P = 0.35 and HADS: P = 0.64). The largest, but not significant, effect (d = -0.21) was found for anxiety on T3. In both groups approximately 48% of the patients were recovered from their DSM-IV diagnosis at the final 6 months assessment. CONCLUSIONS In summary we could not demonstrate that stepped care for depression and anxiety in general practice was more effective than care as usual. Possible reasons are discussed. TRIAL REGISTRATION Current Controlled Trails: ISRCTN17831610.
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Affiliation(s)
- Wike Seekles
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands.
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