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Jahoda A, Dagnan D, Hastings R, Gillooly A, Miller J, Baines S, Hatton C. Adapting psychological interventions for people with severe and profound intellectual disabilities: A behavioural activation exemplar. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13199. [PMID: 38361369 DOI: 10.1111/jar.13199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 11/06/2023] [Accepted: 01/01/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND People with severe to profound intellectual disabilities experience similar or higher levels of depression than those with more mild intellectual disabilities. Yet, there is an absence of evidence about how to adapt existing psychological therapies for this population. METHOD A behavioural activation intervention (BeatIt) for people with mild to moderate intellectual disabilities was adapted for people with severe to profound intellectual disabilities and depression. Key considerations include: (i) beginning with a more in-depth assessment process; (ii) including the person in session activities and developing a relationship with them; (iii) formulation and the use of film to document the link between activity and mood; and (iv) addressing barriers to change at an individual and inter-personal level and considering how the carer could support the person's engagement in activity. RESULTS Successfully adapting BeatIt represents a first step towards gathering evidence about the effectiveness of behavioural activation for people with severe to profound intellectual disabilities.
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Affiliation(s)
- Andrew Jahoda
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Dave Dagnan
- Community Learning Disability Services, Cumbria Northumberland, Tyne and Wear NHS Foundation Trust, Workington, UK
| | - Richard Hastings
- Centre for Research in Intellectual and Developmental Disabilities, University of Warwick, Coventry, UK
| | - Amanda Gillooly
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jenny Miller
- Promoting A More Inclusive Society (PAMIS), Dundee, UK
| | - Susie Baines
- Division of Health Research, University of Lancaster, Lancaster, UK
| | - Chris Hatton
- Department of Social Care and Social Work, Manchester Metropolitan University, Manchester, UK
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Tapp K, Vereenooghe L, Hewitt O, Scripps E, Gray KM, Langdon PE. Psychological therapies for people with intellectual disabilities: An updated systematic review and meta-analysis. Compr Psychiatry 2023; 122:152372. [PMID: 36724728 DOI: 10.1016/j.comppsych.2023.152372] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/22/2022] [Accepted: 01/24/2023] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis (PROSPERO 2020 CRD42020169323) was to evaluate the efficacy of psychological therapy for people with intellectual disabilities. METHOD A comprehensive literature search yielded 22,444 studies which were screened for eligibility. Studies were eligible for inclusion if a psychological therapy was delivered to people with intellectual disabilities compared to a group who did not receive the therapy. Thirty-three controlled trials were eligible for inclusion in the review, with 19 included within a DerSimonian-Laird random effects meta-analysis. Subgroup analysis was completed by clinical presentation, and by comparing randomised trials to non-randomised trials, and group-based to individually delivered psychotherapy. RESULTS Following the removal of outliers, psychological therapy for a range of mental health problems was associated with a small and significant effect size, g = 0.43, 95% CI [0.20, 0.67], N = 698. There was evidence of heterogeneity and bias due to studies with small sample sizes and a lack of randomisation. Non-randomised studies were associated with a large effect size, g = 0.90, 95% CI [0.47, 1.32], N = 174, while randomised studies were associated with a small effect size, g = 0.36, 95% CI [0.17, 0.55], N = 438, excluding outliers. Individually delivered psychological therapy was associated with a small and non-significant effect size, g = 0.32, 95% CI [-0.01, 0.65], N = 146, while group-based interventions were associated with a small and significant effect size, g = 0.37, 95% CI [0.05, 0.68], N = 361, again, excluding outliers. Psychological therapy for anger was associated with a moderate effect size, g = 0.60, 95% CI [0.26, 0.93], N = 324, while treatment for depression and anxiety was associated with a small and non-significant effect size, g = 0.38, 95% CI [-0.10, 0.85], N = 216, after outliers were removed. CONCLUSIONS Studies are fraught with methodological weaknesses limiting the ability to make firm conclusions about the effectiveness of psychological therapy for people with intellectual disabilities. Improved reporting standards, appropriately powered and well-designed trials, and greater consideration of the nature and degree of adaptations to therapy are needed to minimise bias and increase the certainty of conclusions.
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Affiliation(s)
- Katherine Tapp
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Leen Vereenooghe
- v. Bodelschwinghsche Stiftungen Bethel, Psychologischer Dienst, proWerk, Nazarethweg 4, 33617 Bielefeld, Germany
| | - Olivia Hewitt
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, United Kingdom; Berkshire Healthcare NHS Foundation Trust, Learning Disabilities Service, Erlegh House, Earley Gate, Whiteknights Road, Reading, Berkshire RG6 6BZ, United Kingdom
| | - Emma Scripps
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Kylie M Gray
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, United Kingdom; Department of Psychiatry, School of Clinical Health Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; Centre for Mental Health and Wellbeing Research, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Peter E Langdon
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, United Kingdom; Brooklands Hospital, Coventry and Warwickshire Partnership NHS Trust, Birmingham B37 5RY, United Kingdom; Herefordshire and Worcestershire Health and Care NHS Trust, 2 Kings Way, Charles Hastings Way, Worcester WE5 1JR, United Kingdom; Centre for Mental Health and Wellbeing Research, University of Warwick, Coventry CV4 7AL, United Kingdom.
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Pouls KP, Koks-Leensen MC, Mastebroek M, Leusink GL, Assendelft WJ. Adults with intellectual disabilities and mental health disorders in primary care: a scoping review. Br J Gen Pract 2022; 72:e168-e178. [PMID: 34903519 PMCID: PMC8884443 DOI: 10.3399/bjgp.2021.0164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 09/02/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND GPs are increasingly confronted with patients with both intellectual disabilities (ID) and mental health disorders (MHD). Currently, the care provided to these patients is found to be insufficient, putting them at risk of developing more severe MHD. Improving the quality of GP care will improve the whole of mental health care for this patient group. Therefore, an overview of the content and quality of care provided to them by the GP may be helpful. AIM To provide an up-to-date literature overview of the care provided by GPs to patients with ID and MHD, identify knowledge gaps, and inform research, practice, and policy about opportunities to improve care. DESIGN AND SETTING Scoping review. METHOD PubMed, PsycINFO, EMBASE, and grey literature were searched for publications concerning primary care and patients with ID and MHD. Selected publications were analysed qualitatively. RESULTS One hundred publications met the inclusion criteria. Five overarching themes were identified: GP roles, knowledge and experience, caregiver roles, collaboration, and a standardised approach. The results show GPs' vital, diverse, and demanding roles in caring for patients with both ID and MHD. GPs experience problems in fulfilling their roles, and gaps are identified regarding effective GP training programmes, applicable guidelines and tools, optimal collaborative mental health care, and corresponding payment models. CONCLUSION The improvement required in the current quality of GP care to patients with ID and MHD can be achieved by bridging the identified gaps and initiating close collaborations between care professionals, policymakers, and organisational managers.
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Affiliation(s)
- Katrien Pm Pouls
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Monique Cj Koks-Leensen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mathilde Mastebroek
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Geraline L Leusink
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Willem Jj Assendelft
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
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Temizkan E, Davutoğlu C, Aran OT, Kayıhan H. Effects of vocational rehabilitation group intervention on motivation and occupational self-awareness in individuals with intellectual disabilities: A single blind, randomised control study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:196-204. [PMID: 34582077 DOI: 10.1111/jar.12939] [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: 03/10/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study was to investigate the effects of a vocational rehabilitation group intervention on motivation and occupational self-competence in individuals with intellectual disability. METHODS A single-blind, randomised controlled study design was used. The intervention group (IG) received the group-based intervention alongside the individualised vocational rehabilitation (IVR) and the control group (CG) continued receiving only the IVR for 8 weeks. In order to assess motivation and occupational self-competence, Objective Achievement Motivation Test (OLMT) and Occupational Self-Assessment (OSA) were used. RESULTS Forty-nine individuals were enrolled to the study and randomised into IG (n = 24) and CG (n = 25). Two groups were similar at baseline in terms of demographic qualities, OLMT and OSA scores (p > 0.05). After the intervention, the IG showed significant improvements in all assessments (p < 0.05), however the CG showed improvements only in OLMT sub-tests (p < 0.05). CONCLUSIONS The group-based intervention program was effective in increasing occupational self-competence and motivation.
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Affiliation(s)
- Ege Temizkan
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Ceren Davutoğlu
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Orkun Tahir Aran
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Hülya Kayıhan
- Department of Occupational Therapy, Faculty of Health Sciences, Biruni University, Istanbul, Turkey
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Syed AA, Neelofur S, Moran A, O'Reilly G. Investigating the potential clinical utility of therapeutic techniques based on eidetic imagery as adapted by the Eidetic Model of Growth (EMG) for people with intellectual disability (ID). Heliyon 2020; 6:e05115. [PMID: 33033764 PMCID: PMC7533367 DOI: 10.1016/j.heliyon.2020.e05115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/07/2020] [Accepted: 09/25/2020] [Indexed: 11/03/2022] Open
Abstract
Eidetic model of growth (EMG) is a form of psychotherapy developed for people with intellectual disabilities (ID). EMG is based on the theoretical tenets of eidetic psychotherapy of Akhter Ahsen, which uses eidetic imagery as its major therapeutic tool. The literature review did not find any empirical study on eidetic imagery-based psychotherapy for people with ID except reviews and case histories. This study investigates the clinical utility of therapeutic techniques based on eidetic imagery as developed by Ahsen and Syed. In this study thirty participants with mild and moderate ID were recruited. Participants were recruited from the services for people with ID. These services were contacted to recruit participants who had experiential (i.e., abuse, trauma etc.), emotional (i.e., bereavement, attachment problems), psychiatric (i.e., anxiety, depression) and behavioural (i.e., anger, aggression) problems and to seek consent from the potential participants. The Anxiety Depression and Mood Scale (ADAMS) was administered to the participants before the therapy started, after every 5th session and once the therapy was terminated. The statistical analysis of the pre-therapy and post-therapy scores of participants on the ADAMS was carried out to measure the therapeutic outcome. Paired-sample t-test revealed a significant difference between the pre-therapy and post-therapy scores of participants on ADAMS, with a large effect size (d = 1.54). The result indicates existence of eidetic imagery in people with ID and its promising therapeutic utility.
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Graser J, Menge E, Lyons N, Willutzki U, Michalak J. Verhaltenstherapie bei Erwachsenen mit intellektueller Beeinträchtigung: Eine systematische Review. VERHALTENSTHERAPIE 2020. [DOI: 10.1159/000508955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Hintergrund:</i></b> Menschen mit intellektueller Beeinträchtigung (IB) sind häufig von psychischen Störungen betroffen. Gleichzeitig ist die psychotherapeutische Versorgung in diesem Bereich bisher unzureichend, und die Evidenz bezüglich der Wirksamkeit verhaltenstherapeutischer Interventionen bei Erwachsenen mit IB ist unklar. <b><i>Ziele:</i></b> Eine systematische Literaturrecherche in den Datenbanken PubMed, PsycINFO und Google Scholar wurde durchgeführt, um die aktuelle Studienlage zu verhaltenstherapeutischen Interventionen bei Menschen mit IB zu evaluieren. Ausgewählt wurden Studien zu verhaltenstherapeutischen Verfahren bei psychischen Störungen und Problemverhalten im Erwachsenenalter. <b><i>Ergebnisse:</i></b> Zweiunddreißig Studien entsprachen den Einschlusskriterien; es wurden sowohl einzeltherapeutische als auch gruppentherapeutische Interventionen eingeschlossen. Für Menschen mit leichter IB (IQ 50–69) und teilweise auch bei mittlerer IB (IQ 35–49) konnten in einigen Studien Hinweise auf effektive und gut umsetzbare Verfahren gefunden werden. Deutliche positive Effekte aus verschiedenen Studien zeigten sich bei depressiven Symptomen und bei aggressivem Verhalten sowohl im ambulanten wie auch im forensischen Setting. Für Angstsymptome und bei Raucherentwöhnung liegen ebenfalls positive Befunde vor. Bei psychotischen Störungen und bei pathologischem Horten muss die Wirksamkeit von verhaltenstherapeutischen Interventionen noch als unklar eingeschätzt werden. <b><i>Schlussfolgerungen:</i></b> Es bedarf weiterer Forschung (insbesondere randomisierter kontrollierter Studien mit aktiven Kontrollbedingungen), in der differenzierter überprüft wird, welche Aspekte der Therapien/welche Settingbedingungen die Effektivität bei den verschiedenen Graden der IB beeinflussen.
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Jahoda A, Hastings R, Hatton C, Cooper SA, McMeekin N, Dagnan D, Appleton K, Scott K, Fulton L, Jones R, McConnachie A, Zhang R, Knight R, Knowles D, Williams C, Briggs A, Melville C. Behavioural activation versus guided self-help for depression in adults with learning disabilities: the BeatIt RCT. Health Technol Assess 2019; 22:1-130. [PMID: 30265239 DOI: 10.3310/hta22530] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Depression is the most prevalent mental health problem among people with learning disabilities. OBJECTIVE The trial investigated the clinical effectiveness and cost-effectiveness of behavioural activation for depression experienced by people with mild to moderate learning disabilities. The intervention was compared with a guided self-help intervention. DESIGN A multicentre, single-blind, randomised controlled trial, with follow-up at 4, 8 and 12 months post randomisation. There was a nested qualitative study. SETTING Participants were recruited from community learning disability teams and services and from Improving Access to Psychological Therapies services in Scotland, England and Wales. PARTICIPANTS Participants were aged ≥ 18 years, with clinically significant depression, assessed using the Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities. Participants had to be able to give informed consent and a supporter could accompany them to therapy. INTERVENTIONS BeatIt was a manualised behavioural activation intervention, adapted for people with learning disabilities and depression. StepUp was an adapted guided self-help intervention. MAIN OUTCOME MEASURES The primary outcome measure was the Glasgow Depression Scale for people with a Learning Disability (GDS-LD). Secondary outcomes included carer ratings of depressive symptoms and aggressiveness, self-reporting of anxiety symptoms, social support, activity and adaptive behaviour, relationships, quality of life (QoL) and life events, and resource and medication use. RESULTS There were 161 participants randomised (BeatIt, n = 84; StepUp, n = 77). Participant retention was strong, with 141 completing the trial. Most completed therapy (BeatIt: 86%; StepUp: 82%). At baseline, 63% of BeatIt participants and 66% of StepUp participants were prescribed antidepressants. There was no statistically significant difference in GDS-LD scores between the StepUp (12.94 points) and BeatIt (11.91 points) groups at the 12-month primary outcome point. However, both groups improved during the trial. Other psychological and QoL outcomes followed a similar pattern. There were no treatment group differences, but there was improvement in both groups. There was no economic evidence suggesting that BeatIt may be more cost-effective than StepUp. However, treatment costs for both groups were approximately only 4-6.5% of the total support costs. Results of the qualitative research with participants, supporters and therapists were in concert with the quantitative findings. Both treatments were perceived as active interventions and were valued in terms of their structure, content and perceived impact. LIMITATIONS A significant limitation was the absence of a treatment-as-usual (TAU) comparison. CONCLUSIONS Primary and secondary outcomes, economic data and qualitative results all clearly demonstrate that there was no evidence for BeatIt being more effective than StepUp. FUTURE WORK Comparisons against TAU are required to determine whether or not these interventions had any effect. TRIAL REGISTRATION Current Controlled Trials ISRCTN09753005. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 53. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Andrew Jahoda
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Richard Hastings
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK.,Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Chris Hatton
- Department of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sally-Ann Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola McMeekin
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Dave Dagnan
- Department of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.,Cumbria Partnership NHS Foundation Trust, Penrith, UK
| | - Kim Appleton
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Katie Scott
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lauren Fulton
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Robert Jones
- School of Psychology, Bangor University, Bangor, UK
| | - Alex McConnachie
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rachel Zhang
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rosie Knight
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK
| | - Dawn Knowles
- Department of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | | | - Andy Briggs
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Craig Melville
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Hamers PCM, Festen DAM, Hermans H. Non-pharmacological interventions for adults with intellectual disabilities and depression: a systematic review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:684-700. [PMID: 29797730 DOI: 10.1111/jir.12502] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/29/2018] [Accepted: 04/04/2018] [Indexed: 05/20/2023]
Abstract
BACKGROUND Although high rates of depression symptoms are reported in adults with intellectual disabilities (IDs), there is a lack of knowledge about non-pharmacological treatment options for depression in this population. The first research question of this paper is: Which non-pharmacological interventions have been studied in adults with ID and depression? The second research question is: What were the results of these non-pharmacological interventions? METHOD Systematic review of the literature with an electronic search in six databases has been completed with hand searches. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines have been followed. Selected studies met predefined inclusion criteria. RESULTS Literature search resulted in 4267 papers of which 15 met the inclusion criteria. Five different types of non-pharmacological interventions have been studied: cognitive behavioural therapy, behavioural therapy, exercise intervention, social problem-solving skills programme and bright light therapy. CONCLUSION There are only a few studies of good quality evaluating non-pharmacological interventions for adults with ID and depression. Some of these studies, especially studies on cognitive behavioural therapy, show good results in decreasing depressive symptoms. High-quality randomised controlled trials evaluating non-pharmacological interventions with follow-up are needed.
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Affiliation(s)
- P C M Hamers
- Intellectual Disability Medicine, Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
- Amarant Group, Healthcare Organization for People with Intellectual Disabilities, Tilburg, The Netherlands
| | - D A M Festen
- Intellectual Disability Medicine, Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H Hermans
- Intellectual Disability Medicine, Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
- Amarant Group, Healthcare Organization for People with Intellectual Disabilities, Tilburg, The Netherlands
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Jahoda A, Hastings R, Hatton C, Cooper SA, Dagnan D, Zhang R, McConnachie A, McMeekin N, Appleton K, Jones R, Scott K, Fulton L, Knight R, Knowles D, Williams C, Briggs A, MacMahon K, Lynn H, Smith I, Thomas G, Melville C. Comparison of behavioural activation with guided self-help for treatment of depression in adults with intellectual disabilities: a randomised controlled trial. Lancet Psychiatry 2017; 4:909-919. [PMID: 29153873 PMCID: PMC5714593 DOI: 10.1016/s2215-0366(17)30426-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/01/2017] [Accepted: 10/06/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Psychological therapies are first-line interventions for depression, but existing provision is not accessible for many adults with intellectual disabilities. We investigated the clinical and cost-effectiveness of a behavioural activation intervention (BeatIt) for people with intellectual disabilities and depression. BeatIt was compared with a guided self-help intervention (StepUp). METHODS We did a multicentre, single-blind, randomised, controlled trial with follow-up at 4 months and 12 months after randomisation. Participants aged 18 years or older, with mild to moderate intellectual disabilities and clinically significant depression were recruited from health and social care services in the UK. The primary outcome was the Glasgow Depression Scale for people with a Learning Disability (GDS-LD) score at 12 months. Analyses were done on an intention-to-treat basis. This trial is registered with ISCRTN, number ISRCTN09753005. FINDINGS Between Aug 8, 2013, and Sept 1, 2015, 161 participants were randomly assigned (84 to BeatIt; 77 to StepUp); 141 (88%) participants completed the trial. No group differences were found in the effects of BeatIt and StepUp based on GDS-LD scores at 12 months (12·03 [SD 7·99] GDS-LD points for BeatIt vs 12·43 [SD 7·64] GDS-LD points for StepUp; mean difference 0·26 GDS-LD points [95% CI -2·18 to 2·70]; p=0·833). Within-group improvements in GDS-LD scores occurred in both groups at 12 months (BeatIt, mean change -4·2 GDS-LD points [95% CI -6·0 to -2·4], p<0·0001; StepUp, mean change -4·5 GDS-LD points [-6·2 to -2·7], p<0·0001), with large effect sizes (BeatIt, 0·590 [95% CI 0·337-0·844]; StepUp, 0·627 [0·380-0·873]). BeatIt was not cost-effective when compared with StepUp, although the economic analyses indicated substantial uncertainty. Treatment costs were only approximately 3·6-6·8% of participants' total support costs. No treatment-related or trial-related adverse events were reported. INTERPRETATION This study is, to our knowledge, the first large randomised controlled trial assessing individual psychological interventions for people with intellectual disabilities and mental health problems. These findings show that there is no evidence that BeatIt is more effective than StepUp; both are active and potentially effective interventions. FUNDING National Institute for Health Research.
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Affiliation(s)
- Andrew Jahoda
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Richard Hastings
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK; Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Chris Hatton
- Faculty of Health and Medicine, University of Lancaster, Lancaster, UK
| | - Sally-Ann Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Dave Dagnan
- Cumbria Partnership NHS Foundation Trust and University of Lancaster, Lancaster, UK
| | - Ruiqi Zhang
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola McMeekin
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kim Appleton
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rob Jones
- School of Psychology, Bangor University, Bangor, UK
| | - Katie Scott
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lauren Fulton
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rosie Knight
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
| | - Dawn Knowles
- Faculty of Health and Medicine, University of Lancaster, Lancaster, UK
| | - Chris Williams
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Andrew Briggs
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ken MacMahon
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Helen Lynn
- Learning Disability Services, NHS Ayrshire and Arran, Ayrshire, UK
| | - Ian Smith
- Faculty of Health and Medicine, University of Lancaster, Lancaster, UK
| | - Gail Thomas
- Specialist Learning Disability Psychological Services, South Staffordshire and Shropshire Healthcare NHS Foundation Trust, Stafford, UK
| | - Craig Melville
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Osugo M, Cooper SA. Interventions for adults with mild intellectual disabilities and mental ill-health: a systematic review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:615-622. [PMID: 27109143 DOI: 10.1111/jir.12285] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 03/02/2016] [Accepted: 03/09/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND People with intellectual disabilities have very high rates of mental ill health. Standard psychosocial interventions designed for the general population may not be accessible for people with mild intellectual disabilities, and drug usage tends to be modified - 'start low and go slow'. This systematic review aims to synthesise the evidence on psychological, pharmacological and electroconvulsive therapy (ECT) interventions for adults with mild intellectual disabilities and mental ill health. METHOD PRISMA guidelines were followed. Medline, Embase, PsycINFO and CINAHL were searched, as was grey literature and reference lists of selected papers. Papers were selected based on pre-defined inclusion and exclusion criteria. A proportion of papers were double reviewed. Data was extracted using a structured table. STUDY REGISTRATION PROSPERO 2015:CRD42015015218. RESULTS Initially, 18 949 records were identified. Sixteen studies were finally selected for inclusion; seven on psychological therapies, two on group exercise, five on antipsychotics and two on antidepressants. They do not provide definitive evidence for effectiveness of psychosocial interventions, nor address whether starting low and going slow is wise, or causes sub-optimum therapy. CONCLUSIONS There are few evidence-based interventions for people with mild intellectual disabilities and mental ill-health; existing literature is limited in quantity and quality. Group cognitive-behavioural therapies have some supporting evidence - however, further randomised control trials are required, with longer-term follow-up, and larger sample sizes.
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Affiliation(s)
- M Osugo
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - S-A Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Wieland J, Zitman FG. Brief Symptom Inventory symptom profiles of outpatients with borderline intellectual functioning and major depressive disorder or posttraumatic stress disorder: Comparison with patients from regular mental health care and patients with Mild Intellectual Disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 51-52:153-159. [PMID: 26827151 DOI: 10.1016/j.ridd.2016.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/30/2015] [Accepted: 01/07/2016] [Indexed: 06/05/2023]
Abstract
INTRODUCTION In most countries, people with borderline intellectual functioning (BIF) are not considered a separate group in mental health care. There is little to no research on the impact of BIF on the presentation, nature and severity of mental health problems. The aim of the present exploratory study was to compare, in a naturalistic setting of patients referred to secondary care, symptom profiles of patients with BIF diagnosed with either major depressive disorder (MDD) or posttraumatic stress disorder (PTSD) to patients from regular mental health care (RMHC) and patients with Mild ID diagnosed with the same disorders. METHODS We used a cohort of adolescent and adult outpatients (aged 16-88) with or without BIF diagnosed with a primary diagnosis MDD or PTSD. Primary outcome was the nature and severity of psychopathological symptoms assessed at baseline using the Brief Symptom Inventory. All outcomes were adjusted for gender and age. RESULTS Results showed that BIF patients with a primary diagnosis MDD reported less severe symptoms on BSI Total and the subscales Depression, Obsession-Compulsion and Psychoticism than patients from regular mental health care (RMHC). There were no statistically significant differences in reported symptom severity on BSI Total and the different BSI subscales between BIF patients with PTSD and either patients from RMHC or patients with Mild ID. Patients Mild ID, did report significantly less severe symptoms on the subscale Depression and on the subscale Psychoticism than patients from RMHC. DISCUSSION Since there were no other published studies into symptom profiles in patients with BIF compared to either patients with higher or lower levels of cognitive functioning, the study was mainly exploratory in nature, providing direction for future research. Results indicate that symptom profiles did not widely differ, but that there might be some characteristics unique to patients BIF separating them as a group from both patients from RMHC and patients with Mild ID.
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Affiliation(s)
- Jannelien Wieland
- Kristal Centre for Psychiatry and Intellectual Disability, Rivierduinen, Postbus 582, 2300 AN Leiden, The Netherlands.
| | - Frans G Zitman
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
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McGillivray JA, Kershaw M. Do we need both cognitive and behavioural components in interventions for depressed mood in people with mild intellectual disability? JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:105-115. [PMID: 24372867 DOI: 10.1111/jir.12110] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND A growing literature suggests that people with mild intellectual disability (ID) who have depressed mood may benefit from cognitive-behavioural interventions. There has been some speculation regarding the relative merit of the components of this approach. The aim of this study was to compare (i) cognitive strategies; (ii) behavioural strategies; and (iii) combined cognitive-behavioural (CB) strategies on depressed mood among a sample of 70 individuals with mild ID. METHODS Staff from three participating agencies received training in how to screen individuals with mild ID for depressive symptoms and risk factors for depression. Depressive symptoms and negative automatic thoughts were assessed prior to and at the conclusion of the intervention, and at 6-month follow-up. The interventions were run in groups by the same therapist. RESULTS A post-intervention reduction in depression scores was evident in participants of all three interventions, with no significant difference between groups. A significant reduction in negative automatic thoughts post-intervention was evident in the CB combination group and was maintained at follow-up. Examination of clinical effectiveness suggests some advantage of the CB combination in terms of improvement and highlights the possible short term impact of behavioural strategies in comparison with the longer-term potential of cognitive strategies. CONCLUSIONS The findings support the use of group cognitive-behavioural interventions for addressing symptoms of depression among people with ID. Further research is necessary to determine the effectiveness of components.
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Affiliation(s)
- J A McGillivray
- School of Psychology, Deakin University, Burwood, Vic., Australia
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