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Jurado-González F, García-Torres F, Contreras A, Muñoz-Navarro R, González-Blanch C, Adrián Medrano L, Ruiz-Rodríguez P, Moreno EM, Pérez-Dueñas C, Cano-Vindel A, Moriana JA. Comparing psychological versus pharmacological treatment in emotional disorders: A network analysis. PLoS One 2024; 19:e0301675. [PMID: 38568925 PMCID: PMC10990220 DOI: 10.1371/journal.pone.0301675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 03/11/2024] [Indexed: 04/05/2024] Open
Abstract
Transdiagnostic group cognitive behavioural therapy (TD-GCBT) is more effective in improving symptoms and severity of emotional disorders (EDs) than treatment as usual (TAU; usually pharmacological treatment). However, there is little research that has examined the effects of these treatments on specific symptoms. This study used Network Intervention Analysis (NIA) to investigate the direct and differential effects of TD-GCBT + TAU and TAU on specific symptoms of anxiety and depression. Data are from a multicentre randomised clinical trial (N = 1061) comparing TD-GCBT + TAU versus TAU alone for EDs. The networks included items from the PHQ-9 (depression) and GAD-7 (anxiety) questionnaire and mixed graphical models were estimated at pre-treatment, post-treatment and 3-, 6- and 12-month follow-up. Results revealed that TD-GCBT + TAU was associated with direct effects, mainly on several anxiety symptoms and depressed mood after treatment. New direct effects on other depressive symptoms emerged during the follow-up period promoted by TD-GCBT compared to TAU. Our results suggest that the improvement of anxiety symptoms after treatment might precipitate a wave of changes that favour a decrease in depressive symptomatology. NIA is a methodology that can provide fine-grained insight into the likely pathways through which treatments exert their effects.
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Affiliation(s)
- Francisco Jurado-González
- Department of Psychology, University of Cordoba/Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofia University Hospital, Cordoba, Spain
| | - Francisco García-Torres
- Department of Psychology, University of Cordoba/Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofia University Hospital, Cordoba, Spain
| | - Alba Contreras
- University Catholique San Antonio of Murcia, Murcia, Spain
| | - Roger Muñoz-Navarro
- Department of Psychology and Sociology, Faculty of Social and Human Sciences, University of Zaragoza, Teruel, Spain
| | - César González-Blanch
- Mental Health Centre, Marqués de Valdecilla University Hospital—IDIVAL, Santander, Cantabria, Spain
| | | | - Paloma Ruiz-Rodríguez
- Castilla La Nueva Primary Care Centre, Health Service of Madrid, Fuenlabrada, Madrid, Spain
| | - Eliana M. Moreno
- Department of Psychology, University of Cordoba/Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofia University Hospital, Cordoba, Spain
| | - Carolina Pérez-Dueñas
- Department of Psychology, University of Cordoba/Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofia University Hospital, Cordoba, Spain
| | | | - Juan A. Moriana
- Department of Psychology, University of Cordoba/Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofia University Hospital, Cordoba, Spain
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García-Batista ZE, Cantisano-Guzmán LM, Guerra-Peña K, Alvarez A, Moretti L, Cano-Vindel A, Muñoz-Navarro R, Medrano LA, Baltra RA. PsicAP transdiagnostic protocol of group cognitive-behavioral training for emotional disorders in Dominican Republic: a randomized controlled trial protocol. BMC Psychiatry 2023; 23:363. [PMID: 37226144 DOI: 10.1186/s12888-023-04771-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/11/2023] [Indexed: 05/26/2023] Open
Abstract
Emotional disorders (ED) such as anxiety, depression and somatization are extremely prevalent disorders that can affect an individual's quality of life and functionality. Primary Health Care (PHC) is the first place to identify most patients with these conditions. Mental health services in the Dominican Republic, as well as in Latin America and the Caribbean in general, are unable to provide appropriate care for most people with mental disorders. Using evidence-based treatment protocols is also crucial to make progress in helping people with ED. The PsicAP project is a group intervention that uses a transdiagnostic approach and is grounded in cognitive-behavioral techniques. The program is implemented in 7 group sessions, each lasting for one and a half hours. The program has been shown to be effective in reducing clinical symptoms, dysfunction, and in improving quality of life. It is also a non-time-intensive, low-cost treatment that is helpful for addressing EDs in a PHC context. The objective is to bring psychological treatments into PHC facilities of Dominican Republic, making them more accessible for a larger amount of the population.
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Affiliation(s)
- Zoilo Emilio García-Batista
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic.
- Escuela de Psicología, Pontificia Universidad Católica Madre y Maestra, Av. Autopista Duarte Km. 1 1/2, Santiago, 51000, Dominican Republic.
| | | | - Kiero Guerra-Peña
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Adriana Alvarez
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Luciana Moretti
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
- Universidad Siglo 21, Córdoba, Argentina
| | | | | | - Leonardo Adrián Medrano
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
- Universidad Siglo 21, Córdoba, Argentina
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Barrio-Martínez S, Cano-Vindel A, Muñoz-Navarro R, Moriana JA, Ruíz-Rodríguez P, Medrano LA, Ventura L, González-Blanch C. Factors differentiating panic disorder with and without comorbid symptoms of depression. Psychol Psychother 2021; 94:523-540. [PMID: 33993636 DOI: 10.1111/papt.12327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/17/2021] [Indexed: 11/29/2022]
Abstract
The aim of this study was to examine the sociodemographic and clinical differences between people with a probable diagnosis of panic disorder (PD) and those with PD and a probable comorbid diagnosis major depressive disorder (PD + MDD). We also sought to explore the potential contribution of cognitive variables to help differentiate between PD and PD + MDD. This was a subgroup analysis of 331 patients with PD symptoms who were included in the PsicAP clinical trial. All participants completed scales to evaluate panic, depression, somatization, cognitive and performance variables. A univariate analysis showed significant differences (p < .01) between the groups (PD vs PD + MDD) in clinical variables. Somatization was the best predictor of comorbid PD + MDD (β = .346; p < .01). Cognitive variables do not appear to play an essential role in predicting the presence of depressive symptoms in people with a screen positive for PD. These findings appear to support a transdiagnostic treatment approach for PD, which may be useful regardless of whether comorbid depression is present or not. PRACTITIONER POINTS: Somatic symptoms were associated with a higher probability of be in the PD + MDD group. Cognitive variables do not play a relevant role in the differentiation of both groups. A transdiagnostic approach can be useful for the treatment of PD or PD + MDD group.
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Affiliation(s)
| | | | - Roger Muñoz-Navarro
- Department of Psychology and Sociology, Faculty of Human and Social Sciences, University of Zaragoza, Spain
| | - Juan Antonio Moriana
- Department of Psychology, Universidad de Córdoba/Maimónides Institute for Research in Biomedicine of Cordoba (IMIBIC), Spain
| | | | - Leonardo Adrián Medrano
- Pontificia Universidad Católica Madre y Maestra, Santiago De Los Caballeros, Dominican Republic
| | - Ludovica Ventura
- Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | - César González-Blanch
- Mental Health Centre, Marqués de Valdecilla University Hospital - IDIVAL, Santander, Spain.,Faculty of Health Sciences, Universidad Europea del Atlántico, Santander, Spain
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Luo MS, Chui EWT, Li LW. The Longitudinal Associations between Physical Health and Mental Health among Older Adults. Aging Ment Health 2020; 24:1990-1998. [PMID: 31429303 DOI: 10.1080/13607863.2019.1655706] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study examines the lead-lag relationship between physical and mental health among older adults. METHOD Data are collected from 16,417 older adults aged 50 years and older participating in the biannual Health and Retirement Study (HRS). Participants were assessed on up to 11 measurement points over a 21-year period from 1994 to 2014. Physical health was measured as a composite of chronic diseases, functional limitations, and difficulties in basic and instrumental activities of daily living. Mental health was measured with the modified CES-D. Bivariate latent change score models (BLCSM) were estimated. RESULTS Both physical and mental health declined in the observed years, with slower declining rates over time. A reciprocal relationship emerged, with the prior level of physical health acting as the leading indicator of subsequent change in mental health, and the prior mental health state acting as the leading indicator of subsequent changes in physical health. Additionally, the influence of physical health on mental health changes was larger than the corresponding effect of mental health on subsequent physical health. CONCLUSION This study demonstrates the reciprocal relationship between physical and mental health in later adulthood and highlights the need to pay attention to the mental health of older people with physical health problems.
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Affiliation(s)
- Meng Sha Luo
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ernest Wing Tak Chui
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Lydia W Li
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
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Yang R, Wang J, Wang H, Tracy EL, Tracy CT. A cross-lagged model of depressive symptoms and mobility disability among middle-aged and older Chinese adults with arthritis. Geriatr Gerontol Int 2020; 20:873-877. [PMID: 32827228 DOI: 10.1111/ggi.13993] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 06/15/2020] [Accepted: 07/02/2020] [Indexed: 12/27/2022]
Abstract
AIM To examine the reciprocal and longitudinal associations between depressive symptoms and mobility disability in middle-aged and older Chinese adults with arthritis. METHODS We used three waves of the China Health and Retirement Longitudinal Study. The analytic sample included 4682 community-dwelling adults aged ≥45 years with arthritis who completed the self-report measurement of depressive symptoms and mobility disability every 2 years over a 4-year study period. Analysis involved an autoregressive cross-lagged model. RESULTS The prevalence rates of comorbid depressive symptoms and mobility disability were 38.9%, 33.2% and 38.9%, respectively across three waves. There was a significant bidirectional and longitudinal relationship between depressive symptoms and mobility disability among middle-aged and older Chinese adults with arthritis. A higher level of depressive symptoms in previous waves was associated with a subsequent increase in mobility disability over time. A similar pattern was also shown in the opposite direction from mobility disability to depressive symptoms over time. CONCLUSIONS This study demonstrates that depressive symptoms and mobility disability are reciprocally related in Chinese adults with arthritis over time. In addition, it highlights the importance of early interventions aimed at reversing the downward spiral of depressive symptoms and mobility disability to improve the health of Chinese adults with arthritis. Geriatr Gerontol Int 2020; 20: 873-877.
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Affiliation(s)
- Rumei Yang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Jingxia Wang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Haocen Wang
- Department of Health and Kinesiology, Texas A&M University, College Station, Texas, USA
| | - Eunjin Lee Tracy
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Cory T Tracy
- Independent Researcher, Salt Lake City, Utah, USA
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Clinical Psychology in Spain: History, Regulation and Future Challenges. CLINICAL PSYCHOLOGY IN EUROPE 2019. [DOI: 10.32872/cpe.v1i4.38158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The heterogeneity of national regulations in clinical psychology and psychological treatment across Europe requires a detailed description of every regulation to start a shared discussion. In the current paper, we describe the history, legal regulations, a specialized training program, the current status and some future challenges for clinical psychology in Spain. The evolution of clinical psychology in the Spanish National Health System (NHS) towards a health specialty regulated by law, exemplifies a balanced process of expansion, social recognition and professional settlement. Overall, the growth of clinical psychology in Spain may depend on access to leadership and management positions in the NHS that would allow a better organization of care resources to improve citizens’ access to psychological treatment.
Spanish regulation of clinical psychology is mediated by socio-cultural and political changes that occurred in the late 70's and 80’s in the country.
Recognition as a licensed clinical psychologist is obtained through a 4-year training system as an intern resident psychologist (PIR).
PIR is a training system of supervised internships, with increasing autonomy in various healthcare departments in the National Health System (NHS).
Achieving independent Clinical Psychology Services within the NHS in order to organize, implement and deliver evidence-based practices is currently one of our biggest challenges in the near future.
Spanish regulation of clinical psychology is mediated by socio-cultural and political changes that occurred in the late 70's and 80’s in the country.
Recognition as a licensed clinical psychologist is obtained through a 4-year training system as an intern resident psychologist (PIR).
PIR is a training system of supervised internships, with increasing autonomy in various healthcare departments in the National Health System (NHS).
Achieving independent Clinical Psychology Services within the NHS in order to organize, implement and deliver evidence-based practices is currently one of our biggest challenges in the near future.
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Moreno E, Muñoz-Navarro R, Medrano LA, González-Blanch C, Ruiz-Rodríguez P, Limonero JT, Moretti LS, Cano-Vindel A, Moriana JA. Factorial invariance of a computerized version of the GAD-7 across various demographic groups and over time in primary care patients. J Affect Disord 2019; 252:114-121. [PMID: 30981054 DOI: 10.1016/j.jad.2019.04.032] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 03/07/2019] [Accepted: 04/07/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Generalized Anxiety Disorder 7-item scale (GAD-7) is commonly used by clinicians and researchers to screen for anxiety disorders and to monitor anxiety symptoms in primary care. However, findings regarding its factor structure are mixed, with most studies reporting a best-fitting for a one-factor structure, whereas others indicate a two-factor model. To be valid for comparisons, the GAD-7 should measure the same latent construct with the same structure across groups and over time. We aimed to examine the best-fit factor structure model of the GAD-7 among primary care patients and to evaluate its measurement invariance. METHODS A total of 1255 patients completed the computerized version of GAD-7 and a subsample of 238 cases was assessed at the 3-month follow-up. A confirmatory factor analysis (CFA) was performed and analyses of multiple-group invariance were also conducted to determine the extent to which the factor structure was comparable across various sociodemographic groups and over time. RESULTS The results showed that both a one- and two-factor structure (representing somatic and cognitive-affective components) were invariant across sociodemographic groups and over time. The two-factor structure provided the best model fit. LIMITATIONS Results cannot be generalized to all primary care patients, as only patients whose general practitioners consider them to suffer emotional disorders were included. CONCLUSIONS Our study supports the reliability and validity of the one- and two-factor model of the GAD-7, both for screening purposes and for monitoring response to treatment.
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Affiliation(s)
- Eliana Moreno
- Department of Psychology, Maimónides Institute for Research in Biomedicine of Cordoba-IMIBIC, Reina Sofía University Hospital, University of Córdoba, Av. Menéndez Pidal, s/n, 14004 Córdoba, Spain.
| | - Roger Muñoz-Navarro
- Department of Basic Psychology, Faculty of Psychology, University of Valencia, Avd. Blasco Ibañez, 21, 46010, Valencia, Spain.
| | | | - César González-Blanch
- Mental Health Centre, University Hospital "Marqués de Valdecilla"- IDIVAL, Av. Valdecilla 25, 39008 Santander, Cantabria, Spain.
| | - Paloma Ruiz-Rodríguez
- Castilla La Nueva Primary Care Centre, Health Service of Madrid, Calle Teruel, 4, 28941 Fuenlabrada, Madrid, Spain.
| | - Joaquín T Limonero
- Department of Basic Psychology, Autonomous University of Barcelona, Campus de la UAB, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.
| | - Luciana Sofía Moretti
- Faculty of Psychology, University Siglo 21, De los Latinos 8555, 5008 Córdoba, Argentina.
| | - Antonio Cano-Vindel
- Department of Basic Psychology, Faculty of Psychology, Complutense University of Madrid, Campus de Somosaguas, s/n, 28223 Madrid, Spain.
| | - Juan A Moriana
- Department of Psychology, Maimónides Institute for Research in Biomedicine of Cordoba-IMIBIC, Reina Sofía University Hospital, University of Córdoba, Av. Menéndez Pidal, s/n, 14004 Córdoba, Spain.
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