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Davison TE, Bhar S, Wells Y, Owen PJ, You E, Doyle C, Bowe SJ, Flicker L. Psychological therapies for depression in older adults residing in long-term care settings. Cochrane Database Syst Rev 2024; 3:CD013059. [PMID: 38501686 PMCID: PMC10949416 DOI: 10.1002/14651858.cd013059.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Depression is common amongst older people residing in long-term care (LTC) facilities. Currently, most residents treated for depression are prescribed antidepressant medications, despite the potential availability of psychological therapies that are suitable for older people and a preference amongst many older people for non-pharmacological treatment approaches. OBJECTIVES To assess the effect of psychological therapies for depression in older people living in LTC settings, in comparison with treatment as usual, waiting list control, and non-specific attentional control; and to compare the effectiveness of different types of psychological therapies in this setting. SEARCH METHODS We searched the Cochrane Common Mental Disorders Group Controlled Trials Register, CENTRAL, MEDLINE, Embase, five other databases, five grey literature sources, and two trial registers. We performed reference checking and citation searching, and contacted study authors to identify additional studies. The latest search was 31 October 2021. SELECTION CRITERIA We included randomized controlled trials (RCTs) and cluster-RCTs of any type of psychological therapy for the treatment of depression in adults aged 65 years and over residing in a LTC facility. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles/abstracts and full-text manuscripts for inclusion. Two review authors independently performed data extraction and risk of bias assessments using the Cochrane RoB 1 tool. We contacted study authors for additional information where required. Primary outcomes were level of depressive symptomatology and treatment non-acceptability; secondary outcomes included depression remission, quality of life or psychological well-being, and level of anxious symptomatology. We used Review Manager 5 to conduct meta-analyses, using pairwise random-effects models. For continuous data, we calculated standardized mean differences and 95% confidence intervals (CIs), using endpoint data, and for dichotomous data, we used odds ratios and 95% CIs. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included 19 RCTs with 873 participants; 16 parallel group RCTs and three cluster-RCTs. Most studies compared psychological therapy (typically including elements of cognitive behavioural therapy, behavioural therapy, reminiscence therapy, or a combination of these) to treatment as usual or to a condition controlling for the effects of attention. We found very low-certainty evidence that psychological therapies were more effective than non-therapy control conditions in reducing symptoms of depression, with a large effect size at end-of-intervention (SMD -1.04, 95% CI -1.49 to -0.58; 18 RCTs, 644 participants) and at short-term (up to three months) follow-up (SMD -1.03, 95% CI -1.49 to -0.56; 16 RCTs, 512 participants). In addition, very low-certainty evidence from a single study with 82 participants indicated that psychological therapy was associated with a greater reduction in the number of participants presenting with major depressive disorder compared to treatment as usual control, at end-of-intervention and short-term follow-up. However, given the limited data on the effect of psychological therapies on remission of major depressive disorder, caution is advised in interpreting this result. Participants receiving psychological therapy were more likely to drop out of the trial than participants receiving a non-therapy control (odds ratio 3.44, 95% CI 1.19 to 9.93), which may indicate higher treatment non-acceptability. However, analyses were restricted due to limited dropout case data and imprecise reporting, and the finding should be interpreted with caution. There was very low-certainty evidence that psychological therapy was more effective than non-therapy control conditions in improving quality of life and psychological well-being at short-term follow-up, with a medium effect size (SMD 0.51, 95% CI 0.19 to 0.82; 5 RCTs, 170 participants), but the effect size was small at postintervention (SMD 0.40, 95% CI -0.02 to 0.82; 6 RCTs, 195 participants). There was very low-certainty evidence of no effect of psychological therapy on anxiety symptoms postintervention (SMD -0.68, 95% CI -2.50 to 1.14; 2 RCTs, 115 participants), although results lacked precision, and there was insufficient data to determine short-term outcomes. AUTHORS' CONCLUSIONS This systematic review suggests that cognitive behavioural therapy, behavioural therapy, and reminiscence therapy may reduce depressive symptoms compared with usual care for LTC residents, but the evidence is very uncertain. Psychological therapies may also improve quality of life and psychological well-being amongst depressed LTC residents in the short term, but may have no effect on symptoms of anxiety in depressed LTC residents, compared to control conditions. However, the evidence for these effects is very uncertain, limiting our confidence in the findings. The evidence could be strengthened by better reporting and higher-quality RCTs of psychological therapies in LTC, including trials with larger samples, reporting results separately for those with and without cognitive impairment and dementia, and longer-term outcomes to determine when effects wane.
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Affiliation(s)
- Tanya E Davison
- Research and Innovation, Silverchain, Melbourne, Australia
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
- Health and Innovation Transformation Centre, Federation University, Ballarat, Australia
| | - Sunil Bhar
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Yvonne Wells
- Australian Institute for Primary Care & Ageing, La Trobe University, Melbourne, Australia
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, Australia
| | - Emily You
- Academic Unit for Psychiatry of Old Age (AUPOA), Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Colleen Doyle
- National Ageing Research Institute, Melbourne, Australia
| | - Steven J Bowe
- Deakin Biostatistics Unit, Faculty of Health, Deakin University, Burwood, Australia
- School of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Leon Flicker
- Western Australian Centre for Health and Ageing (WACHA), University of Western Australia, Perth, Australia
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2
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Gao P, Cao G, Liu J, Yang F, Liu M. Global, regional, and national trends in incidence of depression among women, 1990-2019: An analysis of the global burden of disease study. Psychiatry Res 2024; 331:115668. [PMID: 38101074 DOI: 10.1016/j.psychres.2023.115668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 08/30/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
Depression is a common mental disorder and more women are affected by depression than men. In this study, we aimed to analyze the trends in the incidence of depression among women from 1990 to 2019 and their associations with sociodemographic and universal health coverage indices based on data from the Global Burden of Disease study 2019. It was observed that while the incidence rate of depression among women decreased by an average of 0.35% per year at the global level, the incidence rate increased at the regional level for the high sociodemographic index region by an average of 0.39% per year from 1990 to 2019. And the global downward trend in incidence rate from 1990 to 2019 was contributed by the downward trend from 2000 to 2009. In Spearman correlation analyzes at the level of country/territory, a negative correlation between the estimated annual percentage change in the incidence rate and the universal health coverage index was found (ρ=-0.15).
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Affiliation(s)
- Peng Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China, Address: No.38, Xueyuan Road, Haidian District, Beijing 100191, China
| | - Guiying Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China, Address: No.38, Xueyuan Road, Haidian District, Beijing 100191, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China, Address: No.38, Xueyuan Road, Haidian District, Beijing 100191, China; Institute for Global Health and Development, Peking University, Beijing, China, Address: No.5, Yiheyuan Road, Haidian District, Beijing 100871, China
| | - Fude Yang
- Beijing Huilongguan Hospital, Peking University Huilonguan Clinical Medical School, Beijing, China, Address: No.7 Huilongguan Nandian Road, Changping District, Beijing 100096, China.
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China, Address: No.38, Xueyuan Road, Haidian District, Beijing 100191, China.
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3
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Li LY, Meng X, Hu WT, Geng JS, Cheng TH, Luo JC, Hu MY, Li HY, Wang Y, Wang YY. A meta-analysis of the association between mindfulness and motivation. Front Public Health 2023; 11:1159902. [PMID: 37614448 PMCID: PMC10442577 DOI: 10.3389/fpubh.2023.1159902] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/17/2023] [Indexed: 08/25/2023] Open
Abstract
Introduction Mindfulness reflects attention to the present moment in a non-judgmental way and has been linked to individual autonomy and motivation, but conclusions are inconsistent. The purpose of this review was to summarize previous studies to explore the relationship between mindfulness and motivation and its intervention effects. Methods Literature searches were conducted in five electronic databases. Both correlational studies assessing the association between motivation and mindfulness and experimental studies to verify the effect of intervention were included. Results Six papers with seven intervention studies and twenty-three papers with twenty-seven correlational studies met the inclusion criteria. Meta-analysis showed that mindfulness was positively correlated with intrinsic motivation (r = 0.28, p < 0.0001) and total motivation (r = 0.37, p < 0.0001) but had no significant correlation with extrinsic motivation (r = 0.01, p = 0.93) or amotivation (r = -0.17, p = 0.14). Effect-size estimates suggested that mindfulness intervention was beneficial to motivation promotion, but the effect was at a low level (g = 0.12). Conclusion We found consistent support for mindfulness practice relating to motivation promotion, especially on intrinsic motivation development. However, there was still a portion of heterogeneity that could not be explained and needed to be identified in future studies.
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Affiliation(s)
- Li-ying Li
- School of Psychology, Weifang Medical University, Weifang, China
| | - Xue Meng
- School of Psychology, Weifang Medical University, Weifang, China
| | - Wen-ting Hu
- School of Psychology, Weifang Medical University, Weifang, China
| | - Jia-sen Geng
- School of Psychology, Weifang Medical University, Weifang, China
| | - Tian-hua Cheng
- School of Psychology, Weifang Medical University, Weifang, China
| | - Jia-cheng Luo
- School of Psychology, Weifang Medical University, Weifang, China
| | - Ming-yu Hu
- School of Psychology, Weifang Medical University, Weifang, China
| | - Hai-yue Li
- School of Psychology, Weifang Medical University, Weifang, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yan-yu Wang
- School of Psychology, Weifang Medical University, Weifang, China
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4
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Gartlehner G, Dobrescu A, Chapman A, Toromanova A, Emprechtinger R, Persad E, Affengruber L, Pieh C, Klerings I, Wagner G. Nonpharmacologic and Pharmacologic Treatments of Adult Patients With Major Depressive Disorder: A Systematic Review and Network Meta-analysis for a Clinical Guideline by the American College of Physicians. Ann Intern Med 2023; 176:196-211. [PMID: 36689750 DOI: 10.7326/m22-1845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Primary care patients and clinicians may prefer alternative options to second-generation antidepressants for major depressive disorder (MDD). PURPOSE To compare the benefits and harms of nonpharmacologic treatments with second-generation antidepressants as first-step interventions for acute MDD, and to compare second-step treatment strategies for patients who did not achieve remission after an initial attempt with antidepressants. DATA SOURCES English-language studies from several electronic databases from 1 January 1990 to 8 August 2022, trial registries, gray literature databases, and reference lists to identify unpublished research. STUDY SELECTION 2 investigators independently selected randomized trials of at least 6 weeks' duration. DATA EXTRACTION Reviewers abstracted data about study design and conduct, participants, interventions, and outcomes. They dually rated the risk of bias of studies and the certainty of evidence for outcomes of interest. DATA SYNTHESIS 65 randomized trials met the inclusion criteria; eligible data from nonrandomized studies were not found. Meta-analyses and network meta-analyses indicated similar benefits of most nonpharmacologic treatments and antidepressants as first-step treatments. Antidepressants had higher risks for discontinuation because of adverse events than most other treatments. For second-step therapies, different switching and augmentation strategies provided similar symptomatic relief. The certainty of evidence for most comparisons is low; findings should be interpreted cautiously. LIMITATIONS Many studies had methodological limitations or dosing inequalities; publication bias might have affected some comparisons. In some cases, conclusions could not be drawn because of insufficient evidence. CONCLUSION Although benefits seem to be similar among first- and second-step MDD treatments, the certainty of evidence is low for most comparisons. Clinicians and patients should focus on options with the most reliable evidence and take adverse event profiles and patient preferences into consideration. PRIMARY FUNDING SOURCE American College of Physicians. (PROSPERO: CRD42020204703).
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Affiliation(s)
- Gerald Gartlehner
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University of Krems, Krems, Austria, and RTI International, Research Triangle Park, North Carolina (G.G.)
| | - Andreea Dobrescu
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University of Krems, Krems, Austria (A.D., A.C., A.T., E.P., I.K., G.W.)
| | - Andrea Chapman
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University of Krems, Krems, Austria (A.D., A.C., A.T., E.P., I.K., G.W.)
| | - Ana Toromanova
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University of Krems, Krems, Austria (A.D., A.C., A.T., E.P., I.K., G.W.)
| | | | - Emma Persad
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University of Krems, Krems, Austria (A.D., A.C., A.T., E.P., I.K., G.W.)
| | - Lisa Affengruber
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University of Krems, Krems, Austria, and Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands (L.A.)
| | - Christoph Pieh
- Department for Psychotherapy and Biopsychosocial Health, University of Krems, Krems, Austria (C.P.)
| | - Irma Klerings
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University of Krems, Krems, Austria (A.D., A.C., A.T., E.P., I.K., G.W.)
| | - Gernot Wagner
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University of Krems, Krems, Austria (A.D., A.C., A.T., E.P., I.K., G.W.)
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5
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Cuijpers P, Miguel C, Ciharova M, Quero S, Plessen CY, Ebert D, Harrer M, van Straten A, Karyotaki E. Psychological treatment of depression with other comorbid mental disorders: systematic review and meta-analysis. Cogn Behav Ther 2023; 52:246-268. [PMID: 36718645 DOI: 10.1080/16506073.2023.2166578] [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: 02/01/2023]
Abstract
Most people with a mental disorder meet criteria for multiple disorders. We conducted a systematic review and meta-analysis of randomized trials comparing psychotherapies for people with depression and comorbid other mental disorders with non-active control conditions. We identified studies through an existing database of randomized trials on psychotherapies for depression. Thirty-five trials (3,157 patients) met inclusion criteria. Twenty-seven of the 41 interventions in the 35 trials (66%) were based on CBT. The overall effect on depression was large (g = 0.65; 95% CI: 0.40 ~ 0.90), with high heterogeneity (I2 = 78%; 95% CI: 70 ~ 83). The ten studies in comorbid anxiety showed large effects on depression (g = 0.90; 95% CI: 0.30 ~ 1.51) and anxiety (g = 1.01; 95% CI: 0.28 ~ 1.74). For comorbid insomnia (11 comparisons) a large and significant effect on depression (g = 0.99; 95% CI: 0.16 ~ 1.82) and insomnia (g = 1.38; 95% CI: 0.38 ~ 2.38) were found. For comorbid substance use problems (12 comparisons) effects on depression (g = 0.25; 95% CI: 0.06 ~ 0.43) and on substance use problems (g = 0.25; 95% CI: 0.01 ~ 0.50) were significant. Most effects were no longer significant after adjustment for publication bias and when limited to studies with low risk of bias. Therapies are probably effective in the treatment of depression with comorbid anxiety, insomnia, and substance use problems.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands.,WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands
| | - Soledad Quero
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Avda. Vicente Sos Baynat s/n, Castellón de la Plana 12071, Spain.,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, C/Monforte de Lemos 3, Pb 11, Madrid 28029, Spain
| | - Constantin Yves Plessen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands
| | - David Ebert
- Psychology & Digital Mental Health Care, Technische Universität München, Connollystraße 32, Munich 80809, Germany
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Technische Universität München, Connollystraße 32, Munich 80809, Germany.,Clinical Psychology & Psychotherapy, Universität Erlangen-Nürnberg, Nägelsbachstr. 25a, Erlangen 91052, Germany
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands.,WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands
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6
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Abstract
The number of older women are increasing more rapidly and it is estimated that by 2050, the number of elderly women over 60 years old will be 3.2 times that of 2000. Moreover, the number and rate of elderly women in cities where widowed life alone has increased. The study pays attention to the fragile and vulnerable group of urban elderly women. Hence, the purpose of the study to suggest psychological adjustment and guidance for ageing urban women. The study suggests that by adopting protective policies and measures in a targeted manner this problem can be resolved. It is not only a critical responsibility of the state and the government, but also the social responsibility of all sectors of society, including enterprises and non-profit sectors of society, and even every ordinary citizen to support the elderly women for making their rest of lives happier and enjoyable.
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7
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Lwi SJ, Paulraj SR, Schendel K, Dempsey DG, Curran BC, Herron TJ, Baldo JV. A Randomized, Controlled Pilot Study of Mindfulness-Based Stress Reduction in Healthy Older Adults. Clin Gerontol 2022; 46:330-345. [PMID: 36398589 DOI: 10.1080/07317115.2022.2137075] [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: 11/19/2022]
Abstract
OBJECTIVES As the aging population increases, it is critical to find ways to sustain older adults' health and well-being. Mindfulness-Based Stress Reduction (MBSR) may be one approach, but its effects are difficult to discern because few studies have conducted randomized controlled trials with an active control group and blinded examiners. We begin to address these gaps with a pilot study examining the feasibility of conducting an MBSR intervention with an active control condition in healthy older adults. METHODS Participants were randomly assigned to one of two classes, MBSR or Brain Health education. Classes were matched for time, format, and instructor. The study examined acceptability, practicality, implementation, and preliminary efficacy using a range of participant questionnaires, instructor ratings, cognitive measures assessed by blinded examiners, and attendance. RESULTS Both MBSR and the Brain Health class evidenced high rates of recruitment, participant satisfaction, and retention. Implementation procedures were successful, and preliminary results revealed similar levels of efficacy across both classes. CONCLUSIONS This study demonstrates the feasibility of an MBSR intervention in healthy older adults. CLINICAL IMPLICATIONS MBSR, with its focus on improving stress and self-awareness, has the potential to be an approach that can improve aging adults' health and coping skills.
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Affiliation(s)
- Sandy J Lwi
- VA Northern California Health Care System, Martinez, California, USA
| | - Selvi R Paulraj
- VA Northern California Health Care System, Martinez, California, USA
| | - Krista Schendel
- VA Northern California Health Care System, Martinez, California, USA
| | - Denise G Dempsey
- VA Northern California Health Care System, Martinez, California, USA
| | - Brian C Curran
- VA Northern California Health Care System, Martinez, California, USA
| | - Timothy J Herron
- VA Northern California Health Care System, Martinez, California, USA
| | - Juliana V Baldo
- VA Northern California Health Care System, Martinez, California, USA
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8
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Espirito-Santo H, Costa-Santos H, Simões-Cunha L, Lemos L, Grasina A, Daniel F. Does emotional dysregulation mediate the relationship between disability and depressive symptoms in older people? Rev Esp Geriatr Gerontol 2022; 57:312-319. [PMID: 36283905 DOI: 10.1016/j.regg.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 08/18/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Emotion dysregulation has been consistently linked to psychopathology, and the relationship between disability and depressive symptomatology in old age is well-known. OBJECTIVE To examine the mediational role of emotional dysregulation in the relationship between perceived disability and depressive symptomatology in older adults. METHODS Two hundred eighty-three participants, aged 60-96 years (M±SD=74.22±8.69; 62.9% women; 29.0% with long-term care support [LTC-S] and 71.0% community residents without LTC-S), were assessed with the Geriatric Depression Scale-8 (GDS-8), the World Health Organization Disability Assessment Schedule-2 (WHODAS-2), and the Difficulties in Emotion Regulation Scale-16 (DERS-16). RESULTS A mediation model was established, which revealed: (1) a moderate association between WHODAS-2 and GDS-8 (β=0.20; p<.001); (2) DERS-16 partially and weakly mediated the relationship between WHODAS-2 and GDS-8 (β=0.003; p<.01). The model explained 31.9% of the variance of depressive symptoms. An inconsistent mediation model was obtained in the LTC-S group. CONCLUSIONS Globally, our findings indicate that disability has an indirect relationship with depressive symptomatology through emotional dysregulation (except for those in the LTC-S). Accordingly, we present suggestions for the treatment of depressive symptoms and for the inclusion of other emotion regulation variables in the study of the disability-depressive symptom link in future studies with older people in the LTC-S.
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Affiliation(s)
- Helena Espirito-Santo
- Miguel Torga Higher Education Institute, Coimbra, Portugal; Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Coimbra, Portugal.
| | | | - Luís Simões-Cunha
- Miguel Torga Higher Education Institute, Coimbra, Portugal; Centro de Investigação e Desenvolvimento do Instituto Universitário Militar, Lisboa, Portugal
| | - Laura Lemos
- Miguel Torga Higher Education Institute, Coimbra, Portugal
| | | | - Fernanda Daniel
- Miguel Torga Higher Education Institute, Coimbra, Portugal; Centro de Estudos e Investigação em Saúde da Universidade de Coimbra, Portugal
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9
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Sadeghi-Bahmani D, Esmaeili L, Mokhtari F, Sadeghi L, Afsharzadeh M, Shaygannejad V, Mirmosayyeb O, Goldstein-Piekarski AN, Gross JJ. Effects of Acceptance and Commitment Therapy (ACT) and Mindfulness-Based Stress Reduction (MBSR) on Symptoms and Emotional Competencies in Individuals with Multiple Sclerosis. Mult Scler Relat Disord 2022; 67:104029. [DOI: 10.1016/j.msard.2022.104029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/15/2022] [Accepted: 07/03/2022] [Indexed: 10/31/2022]
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10
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Reangsing C, Rittiwong T, Schneider JK. Effects of mindfulness meditation interventions on depression in older adults: A meta-analysis. Aging Ment Health 2021; 25:1181-1190. [PMID: 32666805 DOI: 10.1080/13607863.2020.1793901] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We examined the effects of MMIs on depression in older adults and explored the moderating effects of participant, methods, and intervention characteristics. METHODS We systematically searched 15 databases through June 2019 without date restrictions using the following search terms: (mindful* OR meditat*) AND depress* AND (older adult* OR elder OR aging OR senior OR geriatric*). Inclusion criteria were primary studies evaluating MMIs with adults ≥65 years old with depression measured as an outcome, a control group, and written in English. Two researchers independently coded each study and compared for discrepancies and consulted a third researcher in cases of disagreement. We used random-effects model to compute effect sizes (ESs) using Hedges' g, a forest plot, and Q and I2 statistics as measures of heterogeneity; we also examined moderator analyses. RESULTS Nineteen studies included 1,076 participants (71.8 ± 5.2 years old). Overall, MMIs showed significantly improved depression (ES=.65, 95%CI 0.35, 0.94) compared to controls. With regards to moderators, Asians had a greater improvement in depression (1.28) than Europeans (.59) and North Americans (.32). Less than 5 weeks of MMIs showed greater improvement in depression (1.47) than longer periods (.55). MMIs with guided meditation reduced depression (.91) more than MMIs without (.42). Only one quality indicator, a priori power analysis, showed greater effects on depression (g = 1.0) than no power analysis (g=.35). CONCLUSION MMIs improved depressive symptoms in older adults. MMIs might be used as adjunctive or alternative to conventional treatment for depressed older adults.
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Affiliation(s)
- Chuntana Reangsing
- Trudy Busch Valentine School of Nursing, Saint Louis University, St Louis, MO, USA
| | - Tanapa Rittiwong
- Trudy Busch Valentine School of Nursing, Saint Louis University, St Louis, MO, USA
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11
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Wuthrich VM, Meuldijk D, Jagiello T, Robles AG, Jones MP, Cuijpers P. Efficacy and effectiveness of psychological interventions on co-occurring mood and anxiety disorders in older adults: A systematic review and meta-analysis. Int J Geriatr Psychiatry 2021; 36:858-872. [PMID: 33368598 DOI: 10.1002/gps.5486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/19/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Co-occurring mood and anxiety disorders are common in older adult populations and are associated with worse long-term outcomes and poorer treatment response than either disorder alone. This systematic review and meta-analysis aimed to examine the efficacy and effectiveness of psychological interventions for treating co-occurring mood and anxiety disorders in older adults. METHOD The study was registered (PROSPERO CRD4201603834), databases systematically searched (MEDLINE, PSYCINFO, PubMed and Cochrane Reviews) and articles screened according to PRISMA guidelines. INCLUSION Participants aged ≥60 years with clinically significant anxiety and depression, psychological intervention evaluated against control in randomised controlled trial, changes in both anxiety and depression reported at post-treatment. ResultsFour studies were included (total n = 255, mean age range 67-71 years). Overall, psychological interventions (cognitive behavioural therapy, mindfulness) resulted in significant benefits over control conditions (active, waitlist) for treating depression in the presence of co-occurring anxiety (Hedges' g = -0.44), and treating anxiety in the presence of depression (Hedges' g = -0.55). However, conclusions are limited; the meta-analysis was non-significant, few studies were included, several were low quality and there was high heterogeneity between studies. Benefits at follow-up were not established. CONCLUSION Co-occurring anxiety and mood disorders can probably be treated simultaneously with psychological interventions in older adults with moderate effect sizes, however, more research is needed. Given comorbidity is common and associated with worse clinical outcomes, more high-quality clinical trials are needed that target the treatment of co-occurring anxiety and mood disorders, and report changes in diagnostic remission for both anxiety and mood disorders independently.
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Affiliation(s)
- Viviana M Wuthrich
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia.,Department of Psychology, Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, Australia
| | - Denise Meuldijk
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia.,Department of Psychology, Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, Australia
| | - Tess Jagiello
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Alberto González Robles
- Department of Basic, Clinical Psychology, and Neuropsychology, Universitat Jaume I, Castellón, Spain
| | - Michael P Jones
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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12
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Shanok NA, Reive C, Mize KD, Jones NA. Mindfulness Meditation Intervention Alters Neurophysiological Symptoms of Anxiety and Depression in Preadolescents. J PSYCHOPHYSIOL 2020. [DOI: 10.1027/0269-8803/a000244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Mindfulness meditation interventions (MMIs) are formal training programs which utilize mindfulness techniques to improve attentional control and reduce stress and anxiety. Past investigations have shown that mindfulness-based interventions are effective in improving symptoms of anxiety and depression in both adolescents and adults, making this a promising natural approach to treating mood disorders. The current study sought to examine the neurophysiological effects of a 10-week MMI, in a relatively unexplored age-range (7–10 years). The non-clinical participants demonstrated increases in interhemispheric alpha coherence, as well as increased theta, alpha, and beta power particularly in frontal and central areas; reflecting a lower neurological risk for anxiety development. However, two common measures linked to anxiety, frontal and posterior alpha asymmetry remained largely unchanged following the training period. Still, these preliminary results exemplify the potentially positive effects of mindfulness meditation on preadolescents; this time on neurophysiological functioning.
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Affiliation(s)
- Nathaniel A. Shanok
- Developmental Neuroscience Lab, Charles E. Schmidt College of Science, Florida Atlantic University, Boca Raton, FL, USA
| | - Carol Reive
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Krystal D. Mize
- Developmental Neuroscience Lab, Charles E. Schmidt College of Science, Florida Atlantic University, Boca Raton, FL, USA
| | - Nancy Aaron Jones
- Developmental Neuroscience Lab, Charles E. Schmidt College of Science, Florida Atlantic University, Boca Raton, FL, USA
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13
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Krause M, Gutsmiedl K, Bighelli I, Schneider-Thoma J, Chaimani A, Leucht S. Efficacy and tolerability of pharmacological and non-pharmacological interventions in older patients with major depressive disorder: A systematic review, pairwise and network meta-analysis. Eur Neuropsychopharmacol 2019; 29:1003-1022. [PMID: 31327506 DOI: 10.1016/j.euroneuro.2019.07.130] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/25/2019] [Accepted: 07/09/2019] [Indexed: 01/01/2023]
Abstract
As there is currently no comprehensive evaluation about the efficacy and safety of interventions in elderly patients with major depressive disorder, we did a systematic review and network meta-analysis about all interventions in this population. We searched the specialised register of the Cochrane common mental disorders group, MEDLINE, EMBASE, PsycINFO, CochraneLibrary, ClinicalTrials.gov and the WHO registry until Dec 12, 2017 to identify all randomized controlled trials about the treatment of major depressive disorder in patients over an age of 65. The primary outcome was response defined as reduction of at least 50% on the Hamilton Depression Scale or any other validated depression scale. Secondary outcomes were remission, depressive symptoms, dropouts total, dropouts owing to inefficacy and dropouts due to adverse events, quality of life and social functioning. Additionally, we analysed 116 adverse events. We identified 129 references from 53 RCTs with 9274 participants published from 1990 to 2017. The mean participant age was 73.7 years. In terms of the primary outcome response to treatment the network-meta-analysis showed significant superiority compared to placebo for quetiapine and duloxetine; in addition, agomelatine, imipramine and vortioxetine outperformed placebo in pairwise meta-analyses, and there were also significant superiorities of several antidepressants compared to placebo in secondary efficacy outcomes. Very limited evidence suggests that competitive memory training, geriatric home treatment group and detached mindfulness condition reduce depressive symptoms. Several antidepressants and quetiapine have been shown to be efficacious in elderly patients with major depressive disorder, but due to the comparably few available data, the results are not robust. Differences in the multiple side-effects analysed should also be considered in drug choice. Although there were significant effects for some non-pharmacological treatments, the overall evidence for non-pharmacological treatments in major depressive disorder is insufficient, because it is based on a few trials with usually small sample sizes.
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Affiliation(s)
- Marc Krause
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstraße 22, 81675 Munich, Germany; Faculty of Medicine, Institute for Evidence in Medicine (for Cochrane Germany Foundation) Medical Center, University of Freiburg, Germany.
| | - Katharina Gutsmiedl
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstraße 22, 81675 Munich, Germany
| | - Irene Bighelli
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstraße 22, 81675 Munich, Germany
| | - Johannes Schneider-Thoma
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstraße 22, 81675 Munich, Germany
| | - Anna Chaimani
- Paris Descartes University, Paris, France; INSERM, UMR1153 Epidemiology and Statistics, Sorbonne Paris Cité Research Center (CRESS), METHODS Team, Paris, France; Cochrane France, Paris, France
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstraße 22, 81675 Munich, Germany
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14
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Jahangard L, Sadeghi A, Ahmadpanah M, Holsboer-Trachsler E, Sadeghi Bahmani D, Haghighi M, Brand S. Influence of adjuvant omega-3-polyunsaturated fatty acids on depression, sleep, and emotion regulation among outpatients with major depressive disorders - Results from a double-blind, randomized and placebo-controlled clinical trial. J Psychiatr Res 2018; 107:48-56. [PMID: 30317101 DOI: 10.1016/j.jpsychires.2018.09.016] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/20/2018] [Accepted: 09/28/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Extant literature shows that adjuvant omega-3-polyunsaturated fatty acids (O3PUFAs) to a standard antidepressant medication impacts favorably on symptoms of depression in participants with major depressive disorders (MDD). The aim of the present study was to investigate, if and to what extent compared to placebo adjuvant O3PUFAs had a favorable impact on symptoms of depression, anxiety, sleep and emotion regulation among outpatients with MDD. METHOD A total of 50 outpatients (mean age: M = 42.46; 68% females) took part in this randomized, double-blind and placebo-controlled study. They were randomly assigned either to the O3PUFA- or to the placebo-condition. Standard medication was sertraline at therapeutic dosages. At baseline, six weeks and 12 weeks later at study completion participants completed questionnaires covering symptoms of depression, anxiety sensitivity, intolerance of uncertainty, sleep disturbances, and emotion regulation. In parallel, experts blind to participants' group assignment rated participants' depression with the Montgomery-Asberg Depression Scale. RESULTS Symptoms of depression (self- and experts' ratings) decreased over time, but more so in the O3PUFA condition, compared to the placebo condition. Likewise, anxiety sensitivity, intolerance of uncertainty and sleep disturbances improved, but again more so in the O3PUFA condition. Further, regulation and control of emotions and perception of other's emotions improved over time, but more so in the O3PUFA condition. CONCLUSIONS Among outpatients with MDD, and compared to placebo, adjuvant O3PUFAs to a standard medication improved not only symptoms of depression, but also dimensions of anxiety and sleep, and above all patients' competencies to regulate their emotions.
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Affiliation(s)
- Leila Jahangard
- Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Sadeghi
- Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Ahmadpanah
- Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Edith Holsboer-Trachsler
- University of Basel, Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland
| | - Dena Sadeghi Bahmani
- University of Basel, Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland; Kermanshah University of Medical Sciences (KUMS), Sleep Disorders Research Center, Kermanshah, Iran; Kermanshah University of Medical Sciences (KUMS), Substance Abuse Prevention Research Center, Kermanshah, Iran; Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Haghighi
- Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Serge Brand
- University of Basel, Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland; Kermanshah University of Medical Sciences (KUMS), Sleep Disorders Research Center, Kermanshah, Iran; Kermanshah University of Medical Sciences (KUMS), Substance Abuse Prevention Research Center, Kermanshah, Iran; University of Basel, Department of Sport, Exercise and Health, Division of Sport Sciences and Psychosocial Health, Basel, Switzerland.
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15
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Bottaccioli AG, Bottaccioli F, Minelli A. Stress and the psyche-brain-immune network in psychiatric diseases based on psychoneuroendocrineimmunology: a concise review. Ann N Y Acad Sci 2018; 1437:31-42. [PMID: 29762862 DOI: 10.1111/nyas.13728] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/14/2018] [Accepted: 03/20/2018] [Indexed: 12/12/2022]
Abstract
In the last decades, psychoneuroendocrineimmunology research has made relevant contributions to the fields of neuroscience, psychobiology, epigenetics, molecular biology, and clinical research by studying the effect of stress on human health and highlighting the close interrelations between psyche, brain, and bodily systems. It is now well recognized that chronic stress can alter the physiological cross-talk between brain and biological systems, leading to long-lasting maladaptive effects (allostatic overload) on the nervous, immune, endocrine, and metabolic systems, which compromises stress resiliency and health. Stressful conditions in early life have been associated with profound alterations in cortical and subcortical brain regions involved in emotion regulation and the salience network, showing relevant overlap with different psychiatric conditions. This paper provides a summary of the available literature concerning the notable effects of stress on the brain and immune system. We highlight the role of epigenetics as a mechanistic pathway mediating the influences of the social and physical environment on brain structure and connectivity, the immune system, and psycho-physical health in psychiatric diseases. We also summarize the evidence regarding the effects of stress management techniques (mainly psychotherapy and meditation practice) on clinical outcomes, brain neurocircuitry, and immune-inflammatory network in major psychiatric diseases.
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Affiliation(s)
- Anna Giulia Bottaccioli
- Dipartimento di Scienze e Biotecnologie Medico-Chirurgiche, Università degli Studi di Roma La Sapienza, Internal Medicine Unit, ICOT Hospital, Latina, Italy
| | - Francesco Bottaccioli
- Dipartimento di Medicina Clinica, Università degli Studi dell'Aquila, Sanita Pubblica Scienze della Vita e dell'Ambiente, L'Aquila, Italy
| | - Andrea Minelli
- Dipartimento di Scienze Biomolecolari, Università degli Studi di Urbino Carlo Bo, Urbino, Italy
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16
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Brand S, Colledge F, Ludyga S, Emmenegger R, Kalak N, Sadeghi Bahmani D, Holsboer-Trachsler E, Pühse U, Gerber M. Acute Bouts of Exercising Improved Mood, Rumination and Social Interaction in Inpatients With Mental Disorders. Front Psychol 2018; 9:249. [PMID: 29593592 PMCID: PMC5859016 DOI: 10.3389/fpsyg.2018.00249] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/15/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Studies at the macro level (such as longer-term interventions) showed that physical activity impacts positively on cognitive-emotional processes of patients with mental disorders. However, research focusing on the immediate impact of acute bouts of exercise (micro level) are missing. The aim of the present study was therefore to investigate whether and to what extent single bouts of moderately intense exercise can influence dimensions of psychological functioning in inpatients with mental disorders. Method: 129 inpatients (mean age: 38.16 years; 50.4% females) took part and completed a questionnaire both immediately before and immediately after exercising. Thirty inpatients completed the questionnaires a second time in the same week. The questionnaire covered socio-demographic and illness-related information. Further, the questionnaire asked about current psychological states such as mood, rumination, social interactions, and attention, tiredness, and physical strengths as a proxy of physiological states. Results: Psychological states improved from pre- to post-session. Improvements were observed for mood, social interactions, attention, and physical strengths. Likewise, rumination and tiredness decreased. Mood, rumination, and tiredness further improved, when patients completed the questionnaires the second time in the same week. Conclusion: At micro level, single bouts of exercise impacted positively on cognitive-emotional processes such as mood, rumination, attention and social interactions, and physiological states of tiredness and physical strengths among inpatients with mental disorders. In addition, further improvements were observed, if patients participated in physical activities a second time.
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Affiliation(s)
- Serge Brand
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
- Center for Affective, Stress and Sleep Disorders, Psychiatric Clinics, University of Basel, Basel, Switzerland
- Substance Abuse Prevention Research Center and Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Flora Colledge
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Sebastian Ludyga
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Raphael Emmenegger
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Nadeem Kalak
- Center for Affective, Stress and Sleep Disorders, Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Dena Sadeghi Bahmani
- Center for Affective, Stress and Sleep Disorders, Psychiatric Clinics, University of Basel, Basel, Switzerland
- Substance Abuse Prevention Research Center and Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Edith Holsboer-Trachsler
- Center for Affective, Stress and Sleep Disorders, Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Uwe Pühse
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Markus Gerber
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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