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Rassaby M, Shakya HB, Fowler JH, Oveis C, Sieber WJ, Jain S, Stein MB, Taylor CT. Application of an egocentric social network approach to examine changes in social connections following treatment for anxiety and depression: A novel measurement tool for clinical trials research? Soc Sci Med 2024; 350:116914. [PMID: 38696938 DOI: 10.1016/j.socscimed.2024.116914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/02/2024] [Accepted: 04/23/2024] [Indexed: 05/04/2024]
Abstract
The epidemic of loneliness and social isolation has been recognized as a public health crisis warranting the same prioritization as other public health issues today, such as obesity, substance use disorders, and tobacco use. Social disconnection is particularly prevalent and disabling among individuals with anxiety and depression, yet it is inadequately evaluated and addressed in most clinical psychology treatment research. Studies generally employ global measures of perceived connectedness, loneliness, or relationship satisfaction, limiting understanding about elements of one's social network that may change with treatment. This study examined changes in the degree (number of people nominated) and quality of one's social network from pre-to post-treatment using an egocentric social network approach in 59 adults (mean age = 30.8 years, range = 18 to 54) with clinically elevated anxiety or depression who were randomized to a cognitive and behavioral positive valence treatment versus waitlist. Participants (egos) named people in their lives (alters) with whom they discussed important issues or spent free time. For each alter, participants rated how close they felt, how close they thought the alter felt to them, and how frequently they communicated. Linear regressions, which included treatment group as a predictor, revealed no group differences in changes in network degree, perceived alter feelings of closeness, or communication frequency, despite prior findings from this sample indicating larger increases in perceived global connectedness in the treatment group. Unexpectedly, the control group reported a greater increase in perceived closeness to alters. Post-hoc analyses revealed this was explained by the treatment group identifying more distal social ties (e.g., extended family, colleagues, roommates) as alters following treatment - an outcome positively associated with global improvements in connectedness. This proof-of-concept study suggests egocentric social network surveys may provide unique information on treatment-related changes in social functioning. Suggestions are provided for adaptations to facilitate application of social network surveys to mental health treatment research.
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Affiliation(s)
- Madeleine Rassaby
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, United States
| | | | | | | | | | - Sonia Jain
- University of California San Diego, United States
| | - Murray B Stein
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, United States; University of California San Diego, United States
| | - Charles T Taylor
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, United States; University of California San Diego, United States.
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Taylor CT, Stein MB, Simmons AN, He F, Oveis C, Shakya HB, Sieber WJ, Fowler JH, Jain S. Amplification of Positivity Treatment for Anxiety and Depression: A Randomized Experimental Therapeutics Trial Targeting Social Reward Sensitivity to Enhance Social Connectedness. Biol Psychiatry 2024; 95:434-443. [PMID: 37607657 DOI: 10.1016/j.biopsych.2023.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/04/2023] [Accepted: 07/25/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Social disconnection is common and causes significant impairment in anxiety and depressive disorders, and it does not respond sufficiently to available treatments. The positive valence system supports social bond formation and maintenance but is often hyporesponsive in people with anxiety or depression. We conducted an experimental therapeutics trial to test the hypothesis that targeting positive valence processes through cognitive and behavioral strategies would enhance responsivity to social rewards, a core mechanism underlying social connectedness. METHODS Sixty-eight adults who endorsed clinically elevated anxiety and/or depression with social impairment were randomized 1:1:1 to 5 (n = 23) or 10 (n = 22) sessions of amplification of positivity (AMP) treatment or waitlist (n = 23). Pre- to posttreatment change in striatal activity (primary outcome) during social reward anticipation was measured using functional magnetic resonance imaging, and reactivity to a social affiliation task (secondary) and self-reported social connectedness (exploratory) were examined. Primary analyses compared AMP (doses combined) versus waitlist. A second aim was to compare the effects of different doses. RESULTS AMP engaged the hypothesized treatment target, leading to greater striatal activation during anticipation of social rewards versus waitlist (d = 1.01 [95% CI = 0.42-1.61]; largest striatal volume). AMP yielded larger improvements in positive affect and approach behavior during the affiliation task (but not other outcomes) and social connectedness. Larger striatal and social connectedness increases were observed for 5-session versus 10-session AMP (d range = 0.08-1.03). CONCLUSIONS Teaching people with anxiety or depression strategies to increase positive thoughts, behaviors, and emotions enhances activity in brain regions that govern social reward processing and promotes social connectedness. Social reward sensitivity may be a transdiagnostic target for remediating social disconnection.
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Affiliation(s)
- Charles T Taylor
- Department of Psychiatry, University of California San Diego, San Diego, California.
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, San Diego, California; VA San Diego Healthcare System, San Diego, California
| | - Alan N Simmons
- Department of Psychiatry, University of California San Diego, San Diego, California; VA San Diego Healthcare System, San Diego, California
| | - Feng He
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, San Diego, California
| | - Christopher Oveis
- Rady School of Management, University of California San Diego, San Diego, California
| | - Holly B Shakya
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, San Diego, California
| | - William J Sieber
- Department of Family Medicine, University of California San Diego, San Diego, California
| | - James H Fowler
- Department of Political Science, University of California San Diego, San Diego, California
| | - Sonia Jain
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, San Diego, California
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Gallagher AG, Washburn D, Jacobson JA, Harkness KL. Negative feedback-seeking in depression: The moderating roles of rumination and interpersonal life stress. J Clin Psychol 2024; 80:471-489. [PMID: 38010741 DOI: 10.1002/jclp.23624] [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: 02/01/2023] [Revised: 10/13/2023] [Accepted: 11/05/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES Swann's self-verification theory proposes that negative feedback seeking (NFS)-the solicitation of negative feedback from others that confirms one's self-views-works in a negative cycle to maintain and exacerbate depression in the face of interpersonal stress. We propose a cognitive-interpersonal integration account of NFS such that this maladaptive behavior prospectively predicts depression only among those with a trait tendency to ruminate on the causes and consequences of depressed mood and stress. METHOD Participants included 91 young adults who were over-sampled for a lifetime history of a unipolar depressive disorder (age 17-33; 69% women; 67% lifetime depressive disorder). At baseline, participants completed a structured diagnostic interview and self-report measures of NFS, rumination, and depression symptoms. In addition, participants engaged in an interpersonal rejection task (the Yale Interpersonal Stressor) followed by a behavioral measure of NFS. At a 3-month follow-up, depression symptoms were again assessed by self-report and exposure to stressful interpersonal life events in the intervening period were assessed with a rigorous contextual interview and independent rating system. RESULTS Controlling for baseline depression severity, greater self-reported, and behaviorally assessed NFS predicted greater follow-up depression severity, but only among those with higher trait tendency to ruminate. For self-reported NFS, this association was further moderated by level of interpersonal, but not noninterpersonal, life events experienced over follow-up. CONCLUSION These findings suggest that rumination may represent a modifiable intervention target that could break the vicious interpersonal cycle of depression and, thus, mitigate the depressogenic effects of NFS.
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Affiliation(s)
- Anna G Gallagher
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Dustin Washburn
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Jill A Jacobson
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Kate L Harkness
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
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Kilian HM, Schiller B, Meyer-Doll DM, Heinrichs M, Schläpfer TE. Normalized affective responsiveness following deep brain stimulation of the medial forebrain bundle in depression. Transl Psychiatry 2024; 14:6. [PMID: 38191528 PMCID: PMC10774255 DOI: 10.1038/s41398-023-02712-y] [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: 03/12/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024] Open
Abstract
Deep brain stimulation (DBS) of the supero-lateral medial forebrain bundle (slMFB) is associated with rapid and sustained antidepressant effects in treatment-resistant depression (TRD). Beyond that, improvements in social functioning have been reported. However, it is unclear whether social skills, the basis of successful social functioning, are systematically altered following slMFB DBS. Therefore, the current study investigated specific social skills (affective empathy, compassion, and theory of mind) in patients with TRD undergoing slMFB DBS in comparison to healthy subjects. 12 patients with TRD and 12 age- and gender-matched healthy subjects (5 females) performed the EmpaToM, a video-based naturalistic paradigm differentiating between affective empathy, compassion, and theory of mind. Patients were assessed before and three months after DBS onset and compared to an age- and gender-matched sample of healthy controls. All data were analyzed using non-parametric Mann-Whitney U tests. DBS treatment significantly affected patients' affective responsiveness towards emotional versus neutral situations (i.e. affective empathy): While their affective responsiveness was reduced compared to healthy subjects at baseline, they showed normalized affective responsiveness three months after slMFB DBS onset. No effects occurred in other domains with persisting deficits in compassion and intact socio-cognitive skills. Active slMFB DBS resulted in a normalized affective responsiveness in patients with TRD. This specific effect might represent one factor supporting the resumption of social activities after recovery from chronic depression. Considering the small size of this unique sample as well as the explorative nature of this study, future studies are needed to investigate the robustness of these effects.
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Affiliation(s)
- Hannah Marlene Kilian
- Division of Interventional Biological Psychiatry, Department of Psychiatry and Psychotherapy Medical Center - University of Freiburg, Faculty of Medicine, DE-79104, Freiburg, Germany.
| | - Bastian Schiller
- Department of Psychology, Laboratory for Biological Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, DE-79104, Freiburg, Germany
| | - Dora Margarete Meyer-Doll
- Division of Interventional Biological Psychiatry, Department of Psychiatry and Psychotherapy Medical Center - University of Freiburg, Faculty of Medicine, DE-79104, Freiburg, Germany
| | - Markus Heinrichs
- Department of Psychology, Laboratory for Biological Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, DE-79104, Freiburg, Germany
| | - Thomas Eduard Schläpfer
- Division of Interventional Biological Psychiatry, Department of Psychiatry and Psychotherapy Medical Center - University of Freiburg, Faculty of Medicine, DE-79104, Freiburg, Germany
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Shang W, Guo L, Liu Y, Li Y, Wei Q, Guo K, Yang M, Wei L, Xu Z, Niu J, Li X, Yang K. PROTOCOL: Non-pharmacological interventions for older people with a diagnosis of depression: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1354. [PMID: 37771463 PMCID: PMC10523358 DOI: 10.1002/cl2.1354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 08/11/2023] [Accepted: 08/23/2023] [Indexed: 09/30/2023]
Abstract
This is the protocol for an evidence and gap map. The objectives are as follows: To map available randomized control trials, economic evaluations, and systematic reviews that assess the effectiveness and cost-effectiveness of non-pharmacological interventions for older people with a diagnosis of depression and identify any existing gaps in the evidence that can inform future research.
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Affiliation(s)
- Wenru Shang
- School of Basic Medical Sciences, Evidence‐Based Medicine CenterLanzhou UniversityLanzhouChina
- Collaborative Innovation Center of First Hospital of Lanzhou UniversityLanzhouChina
- School of Public Health, Evidence‐Based Social Science Research CenterLanzhou UniversityLanzhouChina
| | - Liping Guo
- School of Basic Medical Sciences, Evidence‐Based Medicine CenterLanzhou UniversityLanzhouChina
| | - Yujia Liu
- Gansu University of Traditional Chinese MedicineLanzhouChina
| | - Yanfei Li
- School of Basic Medical Sciences, Evidence‐Based Medicine CenterLanzhou UniversityLanzhouChina
- School of Public Health, Evidence‐Based Social Science Research CenterLanzhou UniversityLanzhouChina
| | - Qian Wei
- Key Laboratory of Public Health Safety, Ministry of Education, School of Public HealthFudan UniversityShanghaiChina
| | - Ke Guo
- School of Basic Medical Sciences, Evidence‐Based Medicine CenterLanzhou UniversityLanzhouChina
- School of Public Health, Evidence‐Based Social Science Research CenterLanzhou UniversityLanzhouChina
| | - Minyan Yang
- School of Basic Medical Sciences, Evidence‐Based Medicine CenterLanzhou UniversityLanzhouChina
- School of Public Health, Evidence‐Based Social Science Research CenterLanzhou UniversityLanzhouChina
| | - Lili Wei
- Gansu University of Traditional Chinese MedicineLanzhouChina
| | - Zheng Xu
- School of Basic Medical Sciences, Evidence‐Based Medicine CenterLanzhou UniversityLanzhouChina
| | - Junqiang Niu
- School of Basic Medical Sciences, Evidence‐Based Medicine CenterLanzhou UniversityLanzhouChina
- Collaborative Innovation Center of First Hospital of Lanzhou UniversityLanzhouChina
- Lanzhou University First Affiliated HospitalLanzhouChina
| | - Xiuxia Li
- School of Basic Medical Sciences, Evidence‐Based Medicine CenterLanzhou UniversityLanzhouChina
- Collaborative Innovation Center of First Hospital of Lanzhou UniversityLanzhouChina
- School of Public Health, Evidence‐Based Social Science Research CenterLanzhou UniversityLanzhouChina
| | - Kehu Yang
- School of Basic Medical Sciences, Evidence‐Based Medicine CenterLanzhou UniversityLanzhouChina
- Collaborative Innovation Center of First Hospital of Lanzhou UniversityLanzhouChina
- School of Public Health, Evidence‐Based Social Science Research CenterLanzhou UniversityLanzhouChina
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Aguilar-Raab C, Winter F, Warth M, Stoffel M, Moessner M, Hernández C, Pace TWW, Harrison T, Negi LT, Jarczok MN, Ditzen B. A compassion-based treatment for couples with the female partner suffering from current depressive disorder: A randomized-controlled trial. J Affect Disord 2023; 342:127-138. [PMID: 37661057 DOI: 10.1016/j.jad.2023.08.136] [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: 03/30/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Studies have shown that depression and interpersonal relationships are interdependently connected and that including the intimate partner in treatment for depression has beneficial effects. Given evidence that compassion is both an interpersonal quality and a promising treatment target, the goal of this study was to examine the effects of a compassion-based, contemplative treatment for couples employing a multi-method approach for evaluation. METHODS In a pre-post-follow-up design, n = 53 different-sex couples including women with current depression were randomly assigned to a 10-week-long CBCT®-fC (Cognitively-Based Compassion Training/intervention for couples) or treatment-as-usual (TAU) condition. Multi-level linear regression models and post-hoc contrasts were calculated to determine changes in depressive symptoms, mindfulness and self-compassion, interpersonal functioning and neuroendocrine markers collected during a partnership appreciation task (PAT) in the laboratory before and after CBCT-fC treatment. RESULTS While CBCT-fC led to a comparable decrease of depressive symptoms as TAU, the training specifically increased self-compassion and mindfulness versus TAU. Interestingly, interpersonal functioning did not improve, which was also reflected in participants' preferred self-focus in-between-session practices, instead of practices with interpersonal focus. There were no group-specific changes in psychobiological stress-marker reactivity. CONCLUSIONS CBCT-fC was effective in decreasing current depressive symptomatology and increasing mindfulness, and self-compassion. Especially the motivation to participate, such as improving interpersonal functioning, should be addressed and intrinsic motives of the partners to be involved. In highly burdened individuals, self-regulation may need to be improved before co-regulation can be addressed, which would requiring longer treatments. Facilitating factors for engaging in the practice between-sessions seem meaningful.
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Affiliation(s)
- Corina Aguilar-Raab
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.
| | - Friederike Winter
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Marco Warth
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
| | - Martin Stoffel
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Markus Moessner
- Institute of Psychosocial Prevention, Center for Psychotherapy Research, Center for Psychosocial Medicine, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Cristóbal Hernández
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Escuela de Psicología - Universidad Adolfo Ibáñez, Chile
| | | | - Timothy Harrison
- Center for Contemplative Science and Compassion-Based Ethics, Emory University, Atlanta, GA, USA
| | - Lobsang Tenzin Negi
- Center for Contemplative Science and Compassion-Based Ethics, Emory University, Atlanta, GA, USA
| | - Marc N Jarczok
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
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Ridout N, Dritschel B, Morjaria M, Yankey C. The influence of induced dysphoria on autobiographical memory specificity and social problem solving: Examining the role of executive function. Behav Res Ther 2023; 169:104404. [PMID: 37742525 DOI: 10.1016/j.brat.2023.104404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023]
Abstract
Negative mood induction leads to reductions in autobiographical memory specificity (AMS) and social problem-solving (SPS). The aim was to establish if executive function contributes to changes in AMS and SPS following negative mood induction. Forty-four participants (study 1) completed the autobiographical memory test and measures of executive function (letter & category fluency) before and after a positive or negative mood induction (MI). Forty participants (study 2) completed the means-end problem solving task (MEPS) and (letter & category) fluency tasks before and after a positive or negative MI. In study 1, participants exhibited impaired AMS and fluency performance following a sad MI. Decrease in memory specificity pre-to post-MI was related to reductions in happy mood and letter fluency. In study 2, participants exhibited poorer performance on the MEPS and fluency tasks following a sad MI. Decreases in the number of relevant solutions generated on the MEPS pre-to post-MI was linked to increases in sad mood and decreases in letter fluency. In both studies, the influence of mood became non-significant once the effect of executive function was accounted for, which suggests that changes in AMS and SPS in response to induced mood were related to concomitant changes in executive function.
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Affiliation(s)
- Nathan Ridout
- School of Psychology, College of Health & Life Sciences, Aston University, Birmingham, B4 7ET, UK.
| | - Barbara Dritschel
- School of Psychology & Neuroscience, University of St Andrews, St Andrews, UK
| | - Meera Morjaria
- School of Psychology, College of Health & Life Sciences, Aston University, Birmingham, B4 7ET, UK
| | - Chanelle Yankey
- School of Psychology, College of Health & Life Sciences, Aston University, Birmingham, B4 7ET, UK
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Cuijpers P, Miguel C, Harrer M, Plessen CY, Ciharova M, Papola D, Ebert D, Karyotaki E. Psychological treatment of depression: A systematic overview of a 'Meta-Analytic Research Domain'. J Affect Disord 2023; 335:141-151. [PMID: 37178828 DOI: 10.1016/j.jad.2023.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Over the past 16 years, we have developed a 'Meta-analytic Research Domain' (MARD) of all randomized trials of psychological treatments of depression. A MARD is a living systematic review of a research field, that cannot be otherwise covered by one (network) meta-analysis and includes multiple PICOs. In this paper we give an overview of the findings of this MARD. METHODS A narrative review of the results of the 118 meta-analyses on psychotherapies for depression that were published within our MARD. RESULTS Most research has been conducted on cognitive-behavioral therapy (CBT), but several other psychotherapies are also effective, with few differences between therapies. They can be effectively delivered in individual, group, telephone and guided self-help format and are effective in many different target groups and across different age groups, although the effects are significantly smaller in children and adolescents. Psychotherapies have comparable effects as pharmacotherapy at the short term but are probably more effective at the longer term. Combined treatment is more effective than either psychotherapy or pharmacotherapy alone at the short, but also at the longer term. LIMITATIONS We did not summarize all published meta-analyses (protocols, methodological studies) and have not compared our results to those found in other meta-analyses on comparable subjects. CONCLUSION Psychotherapies can contribute considerably to a reduction of the disease burden of depression. MARDs are an important next step in the aggregation of knowledge from randomized controlled trials in psychological treatments of depression as well as in other healthcare sectors.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands; Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania.
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Department of Health Sciences, Technical University Munich, Munich, Germany; Department of Clinical Psychology & Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Constantin Yves Plessen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands; Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Davide Papola
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Italy; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - David Ebert
- Psychology & Digital Mental Health Care, Department of Health Sciences, Technical University Munich, Munich, Germany
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
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Cuijpers P, Franco P, Ciharova M, Miguel C, Segre L, Quero S, Karyotaki E. Psychological treatment of perinatal depression: a meta-analysis. Psychol Med 2023; 53:2596-2608. [PMID: 37310303 PMCID: PMC10123831 DOI: 10.1017/s0033291721004529] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 06/08/2021] [Accepted: 10/18/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Depression during pregnancy and after the birth of a child is highly prevalent and an important public health problem. Psychological interventions are the first-line treatment and, although a considerable number of randomized trials have been conducted, no recent comprehensive meta-analysis has evaluated treatment effects. METHODS We used an existing database of randomized controlled trials of psychotherapies for adult depression and included studies aimed at perinatal depression. Random effects models were used in all analyses. We examined the effects of the interventions in the short and long term, and also examined secondary outcomes. RESULTS Forty-three studies with 49 comparisons and 6270 participants between an intervention and control group were included. The overall effect size was g = 0.67 [95% confidence interval (CI) 0.45~0.89; numbers needed-to-be-treated = 4.39] with high heterogeneity (I2 = 80%; 95% CI 75~85). This effect size remained largely unchanged and significant in a series of sensitivity analyses, although some publication bias was found. The effects remained significant at 6-12 months follow-up. Significant effects were also found for social support, anxiety, functional limitations, parental stress and marital stress, although the number of studies for each outcome was low. All results should be considered with caution because of the high levels of heterogeneity in most analyses. CONCLUSIONS Psychological interventions are probably effective in the treatment of perinatal depression, with effects that last at least up to 6-12 months and probably also have effects on social support, anxiety, functional impairment, parental stress, and marital stress.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pamela Franco
- Department of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lisa Segre
- College of Nursing, University of Iowa, Iowa City, USA
| | - Soledad Quero
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
- CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Swerdlow BA, Baker SN, Leifker FR, Straud CL, Rozek DC, Sippel LM. The impact of trauma-focused psychotherapy for posttraumatic stress disorder on interpersonal functioning: A systematic review and meta-analysis of randomized clinical trials. J Trauma Stress 2023. [PMID: 36628929 DOI: 10.1002/jts.22906] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/27/2022] [Accepted: 11/14/2022] [Indexed: 01/12/2023]
Abstract
Interpersonal functioning is a common concern for people with postttraumatic stress disorder (PTSD) but is not a key target of most trauma-focused psychotherapies (TFPs). We preregistered and undertook a systematic review and meta-analysis of randomized clinical trials (RCTs) examining the efficacy of TFPs for improving interpersonal functioning. Studies were identified through the PTSD Trials Standardized Data Repository, scholarly databases, and the solicitation of unpublished data from the PTSD research community following current PRISMA guidelines. We used random effects meta-analysis to estimate within-group change (i.e., pre- to posttreatment) in interpersonal functioning. Meta-analytic findings yielded a medium total effect of TFP on interpersonal functioning, g = 0.54, 95% CI [0.37, 0.72], with high between-study heterogeneity. Sensitivity analyses yielded substantively equivalent point estimates when outliers were excluded, g = 0.55, and when only the most well-established individual TFPs were included, g = 0.57. In contrast, allocation to a control condition was associated with little average change in interpersonal functioning, g = 0.04 [-0.12, 0.21]. Formal tests did not yield clear evidence of publication bias. Bias-corrected estimates varied but centered around a medium effect, gs = 0.41-1.11. There was a medium-to-large association between change in interpersonal functioning and change in PTSD symptoms, rs = -.35--.44. The extant literature on TFPs and interpersonal functioning is small and heterogeneous, indicating the need for more focused attention on this outcome. Results suggest that, on average, TFPs are moderately efficacious for improving interpersonal functioning; however, additional treatment may be needed to meet the desired level of improvement.
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Affiliation(s)
| | - Shelby N Baker
- Department of Psychology, University of Central Florida, Orlando, Florida, USA
| | - Feea R Leifker
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Casey L Straud
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA.,South Texas Veterans Healthcare System, San Antonio, Texas, USA
| | - David C Rozek
- Department of Psychology, University of Central Florida, Orlando, Florida, USA.,Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Lauren M Sippel
- Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Department of Veterans Affairs National Center for PTSD, West Haven, Connecticut, USA
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11
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Freidl M, Wegerer M, Litvan Z, König D, Alexandrowicz RW, Portela-Millinger F, Gruber M. Determinants of quality of life improvements in anxiety and depressive disorders-A longitudinal study of inpatient psychotherapy. Front Psychiatry 2022; 13:937194. [PMID: 36590609 PMCID: PMC9798124 DOI: 10.3389/fpsyt.2022.937194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
Background Quality of life (QoL) is substantially impaired in patients with anxiety disorders (AD) and depressive disorders (DD) and improvements in symptom burden after psychotherapy are not always paralleled by similar improvements in QoL. So far, little is known about treatment outcome in terms of QoL and predictors of QoL improvements following inpatient psychotherapy with a focus on cognitive behavior therapy (CBT). The current study aimed at investigating the relationship between changes in symptoms and QoL across different life domains. Additionally, predictors of a positive treatment outcome were evaluated. Methods 122 patients with AD and/or DD undergoing an 8-weeks inpatient CBT program completed self-report measures of psychopathological symptoms and QoL at pre- and post-treatment. Mixed effects models were used to investigate changes, a confirmatory factor analysis was applied to analyze the latent factor structure of the anxiety sensitivity index and binary logistic regression analyses were performed for predictors of QoL improvements. Results Patients showed moderate to strong decreases in anxious and depressive symptoms and moderate to strong improvements in general QoL, particularly in the psychological and physical QoL subdomains. Changes in symptom burden correlated most strongly with psychological and physical QoL. In addition, poor QoL before treatment and low levels of specific anxiety sensitivity symptoms (items 1 and 5) significantly predicted improvement in QoL. Conclusion Patients with poor QoL who are not as inhibited to openly express their anxious feelings particularly benefit from inpatient psychotherapy (individual and group) to improve their QoL. In contrast, our research suggests that patients who are too anxious to openly express their nervousness should receive additional social skills training, more focused treatment to build sufficient self-confidence to better engage in the treatment program.
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Affiliation(s)
- Marion Freidl
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Melanie Wegerer
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Zsuzsa Litvan
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Daniel König
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Filipe Portela-Millinger
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Maria Gruber
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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12
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Cregg DR, Cheavens JS. Healing through helping: an experimental investigation of kindness, social activities, and reappraisal as well-being interventions. THE JOURNAL OF POSITIVE PSYCHOLOGY 2022. [DOI: 10.1080/17439760.2022.2154695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- David R. Cregg
- Department of Psychology, The Ohio State University, Columbus, OH, USA
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13
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Winter F, Jarczok MN, Warth M, Hembd-Peuse S, Ditzen B, Aguilar-Raab C. A new way to measure partner burden in depression: Construction, validation, and sensitivity to change of the partner burden in depression questionnaire. JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:1111-1127. [PMID: 35253231 DOI: 10.1111/jmft.12584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/15/2021] [Accepted: 01/27/2022] [Indexed: 06/14/2023]
Abstract
Depression occurs in an interpersonal dynamic and living with a depressed person can lead to a significant burden on the partner. Instruments measuring burden do not address couples and often measure caregiving for individuals with schizophrenic disorders. The partner burden in depression (PBD) questionnaire is a new instrument measuring PBD by asking individuals, (1) which symptoms they can observe in their depressed partners and (2) to which degree this burdens them. Hence, PBD combines measuring the awareness of observed depressive symptoms and the resulting burden. Additionally, it addresses aspects unique to couple relationships. Our German validation confirmed a one-factor model with 12 items. The PBD had good psychometric properties and was sensitive to change. Partner burden predicted self-reported depressive symptoms (PHQ-9) over time. PBD is short, easily applicable in research and practice and can add to the understanding of partner effects in depression.
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Affiliation(s)
- Friederike Winter
- Institute of Medical Psychology, Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Marc N Jarczok
- Department of Psychosomatic Medicine and Psychotherapy, University Clinic Ulm, Ulm, Germany
| | - Marco Warth
- Institute of Medical Psychology, Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Susanne Hembd-Peuse
- Institute of Medical Psychology, Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Corina Aguilar-Raab
- Institute of Medical Psychology, Medical Faculty, Heidelberg University, Heidelberg, Germany
- Department of Psychology, University of Kassel, Kassel, Germany
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14
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Jayasinghe A, Wrobel A, Filia K, Byrne LK, Melvin G, Berk L, Berk M, Cotton S. Psychological distress in siblings of people with mental illness: A systematic review and meta-analysis. Aust N Z J Psychiatry 2022; 57:642-660. [PMID: 36113083 DOI: 10.1177/00048674221123481] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to characterise the prevalence and/or severity of psychological distress (namely, depression and anxiety symptoms) in siblings of people with mental illness (MI) and to examine correlates of distress in siblings of people with MI. METHOD Studies comparing distress in individuals with and without a sibling with MI were eligible. Studies reporting on correlates of distress in siblings were also eligible. A search of MEDLINE Complete, PsycINFO and Embase was conducted up until 17 March 2022. RESULTS Fifteen studies comprising 2304 siblings and 2263 comparison individuals were included. Meta-analyses indicated individuals with a sibling with MI experience significantly greater depressive symptoms (Hedges's g = 0.53, 95% CI = [0.32, 0.73], siblings n = 1962, comparison individuals n = 2248) and anxiety symptoms (Hedges's g = 0.40, 95% CI = [0.19, 0.61], siblings n = 653, comparison individuals n = 533) than those without. The sibling relationship, siblings' locus of control, interpersonal functioning and their appraisal of the impacts of MI were identified as important and potentially modifiable correlates. CONCLUSION Individuals with a sibling with MI experience greater depressive and anxiety symptoms than those without and would likely benefit from support. Future studies are required to elucidate the mechanisms underlying distress in siblings.
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Affiliation(s)
- Anuradhi Jayasinghe
- School of Psychology, Deakin University, Geelong, VIC, Australia.,Orygen, Parkville, VIC, Australia
| | - Anna Wrobel
- Orygen, Parkville, VIC, Australia.,Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Kate Filia
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Linda K Byrne
- School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Glenn Melvin
- School of Psychology, Deakin University, Geelong, VIC, Australia.,Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
| | - Lesley Berk
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Michael Berk
- Orygen, Parkville, VIC, Australia.,Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Sue Cotton
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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15
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A systematic review of digital and face-to-face cognitive behavioral therapy for depression. NPJ Digit Med 2022; 5:144. [PMID: 36109583 PMCID: PMC9476400 DOI: 10.1038/s41746-022-00677-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/12/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractCognitive behavioral therapy (CBT) represents one of the major treatment options for depressive disorders besides pharmacological interventions. While newly developed digital CBT approaches hold important advantages due to higher accessibility, their relative effectiveness compared to traditional CBT remains unclear. We conducted a systematic literature search to identify all studies that conducted a CBT-based intervention (face-to-face or digital) in patients with major depression. Random-effects meta-analytic models of the standardized mean change using raw score standardization (SMCR) were computed. In 106 studies including n = 11854 patients face-to-face CBT shows superior clinical effectiveness compared to digital CBT when investigating depressive symptoms (p < 0.001, face-to-face CBT: SMCR = 1.97, 95%-CI: 1.74–2.13, digital CBT: SMCR = 1.20, 95%-CI: 1.08–1.32) and adherence (p = 0.014, face-to-face CBT: 82.4%, digital CBT: 72.9%). However, after accounting for differences between face-to-face and digital CBT studies, both approaches indicate similar effectiveness. Important variables with significant moderation effects include duration of the intervention, baseline severity, adherence and the level of human guidance in digital CBT interventions. After accounting for potential confounders our analysis indicates comparable effectiveness of face-to-face and digital CBT approaches. These findings underline the importance of moderators of clinical effects and provide a basis for the future personalization of CBT treatment in depression.
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16
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Kilian HM, Schiller B, Schläpfer TE, Heinrichs M. Impaired socio-affective, but intact socio-cognitive skills in patients with treatment-resistant, recurrent depression. J Psychiatr Res 2022; 153:206-212. [PMID: 35841816 DOI: 10.1016/j.jpsychires.2022.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/03/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Social withdrawal is a key symptom of depression. The resulting loss of social reinforcement in turn contributes to chronic, recurrent courses of the disease. However, it is not clear whether depressed patients have less motivation to socially interact, or whether their skills in doing so are impaired. The current study investigates potential skill deficits in patients with treatment-resistant depression (TRD). METHODS 15 TRD patients and 19 age- and sex-matched healthy controls performed the EmpaToM, a paradigm which includes naturalistic video stimuli of either neutral or emotional valence and which differentiates between socio-affective (affective empathy, compassion) and socio-cognitive (theory of mind) skills. RESULTS Controlling for the baseline affective state in neutral situations, TRD patients displayed significantly reduced affective empathy towards emotional situations compared to healthy controls. Furthermore, TRD patients were less compassionate in both neutral and emotional situations. In contrast, socio-cognitive skill performances did not differ between patients and healthy controls. LIMITATIONS Further studies might explore socio-affective and socio-cognitive skills in TRD patients using socio-affective/-cognitive tasks involving face-to-face social interactions. CONCLUSION Our study revealed a specific socio-affective deficit in TRD patients, while showing intact socio-cognitive skills. Patients were less able to affectively resonate with others (affective empathy) and exhibited generally reduced feelings of compassion. These deficits might interfere with providing and receiving social support. Our study contributes to a better understanding of the underlying causes of social withdrawal and stresses the need to specifically address pervasive socio-affective deficits in psychotherapy of TRD patients.
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Affiliation(s)
- Hannah M Kilian
- Division of Interventional Biological Psychiatry, Department of Psychiatry and Psychotherapy Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Bastian Schiller
- Department of Psychology, Laboratory for Biological Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, DE, 79104, Freiburg, Germany.
| | - Thomas E Schläpfer
- Division of Interventional Biological Psychiatry, Department of Psychiatry and Psychotherapy Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; Johns Hopkins University, Baltimore, MD, USA
| | - Markus Heinrichs
- Department of Psychology, Laboratory for Biological Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, DE, 79104, Freiburg, Germany
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17
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Wei D, Tsheringla S, McPartland JC, Allsop AZASA. Combinatorial approaches for treating neuropsychiatric social impairment. Philos Trans R Soc Lond B Biol Sci 2022; 377:20210051. [PMID: 35858103 PMCID: PMC9274330 DOI: 10.1098/rstb.2021.0051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 05/13/2022] [Indexed: 01/30/2023] Open
Abstract
Social behaviour is an essential component of human life and deficits in social function are seen across multiple psychiatric conditions with high morbidity. However, there are currently no FDA-approved treatments for social dysfunction. Since social cognition and behaviour rely on multiple signalling processes acting in concert across various neural networks, treatments aimed at social function may inherently require a combinatorial approach. Here, we describe the social neurobiology of the oxytocin and endocannabinoid signalling systems as well as translational evidence for their use in treating symptoms in the social domain. We leverage this systems neurobiology to propose a network-based framework that involves pharmacology, psychotherapy, non-invasive brain stimulation and social skills training to combinatorially target trans-diagnostic social impairment. Lastly, we discuss the combined use of oxytocin and endocannabinoids within our proposed framework as an illustrative strategy to treat specific aspects of social function. Using this framework provides a roadmap for actionable treatment strategies for neuropsychiatric social impairment. This article is part of the theme issue 'Interplays between oxytocin and other neuromodulators in shaping complex social behaviours'.
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Affiliation(s)
- Don Wei
- Department of Psychiatry, UCLA, Los Angeles, CA, USA
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18
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Bozzatello P, Giordano B, Montemagni C, Rocca P, Bellino S. Real-World Functioning in Psychiatric Outpatients: Predictive Factors. J Clin Med 2022; 11:jcm11154400. [PMID: 35956015 PMCID: PMC9369214 DOI: 10.3390/jcm11154400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/17/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: Investigations on predictors of real-world functioning were mainly performed in patients with schizophrenia, while fewer studies have been conducted in other psychiatric disorders. Objective: Our objective was to identify clinical, socio-demographic, and illness-related predictors of real-world functioning during 12 months of standard treatments in outpatients with different diagnoses. Methods: Outpatients (n = 1019) with schizophrenia (SZ), major depressive disorder (MDD), bipolar disorder (BD), and borderline personality disorder (BPD) were evaluated with the following tools: SCID-5-CV and SCID-5-PD, CGI-S, SAT-P, DAI-10, and PSP. Change of PSP (ΔPSP) between baseline and 12 months was used as the dependent variable in multiple regression analysis. Results: Higher PSP score at baseline and the achievement of main milestones predicted better functioning after follow-up in all subgroups of patients, with the exception of BD. In the total sample, ΔPSP was related to age of onset, treatments, and quality of life, and inversely related to psychiatric anamnesis, antidepressants, and global symptoms. In SZ, ΔPSP was related to adherence and quality of life. In MDD, ΔPSP was related to psychotherapy and quality of life, and inversely related to antidepressants and global symptoms. In BD, ΔPSP was related to age of onset, antipsychotics, and quality of life, while it was inversely related to psychiatric anamnesis. In BPD, antipsychotics, mood stabilizers, psychotherapy, and quality of life were directly related to ΔPSP, while suicidal attempts and global symptoms had an inverse relation. Conclusions: Several socio-demographic and illness-related variables predicted improvement of real-world functioning, besides psychopathology and severity of the disease.
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19
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Emotion-Based Interventions for Clinicians. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2022. [DOI: 10.1007/s10879-022-09546-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Groot M, Laceulle OM, Cissen H, Tiemens B, Heijden PT. Symptom distress and disability: Different sides of the same coin? An investigation of the relationship between symptom distress and disability over time in patients receiving treatment for internalizing disorders. J Clin Psychol 2022; 78:2446-2455. [DOI: 10.1002/jclp.23361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 02/21/2022] [Accepted: 03/24/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Marlies Groot
- Reinier van Arkel Mental Health Institute The Netherlands 's‐Hertogenbosch
| | - Odilia M. Laceulle
- Department of Developmental Psychology Utrecht University Utrecht The Netherlands
| | - Helma Cissen
- Reinier van Arkel Mental Health Institute The Netherlands 's‐Hertogenbosch
| | - Bea Tiemens
- Behavioural Science Institute Radboud University Nijmegen Nijmegen The Netherlands
- Pro Persona Mental Health Institute Wolfheze The Netherlands
| | - Paul T. Heijden
- Reinier van Arkel Mental Health Institute The Netherlands 's‐Hertogenbosch
- Behavioural Science Institute Radboud University Nijmegen Nijmegen The Netherlands
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21
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Moeller SB, Gbyl K, Hjorthøj C, Andreasen M, Austin SF, Buchholtz PE, Fønss L, Hjerrild S, Hogervorst L, Jørgensen MB, Ladegaard N, Martiny K, Meile J, Packness A, Sigaard KR, Straarup K, Straszek SPV, Soerensen CH, Welcher B, Videbech P. Treatment of difficult-to-treat depression - clinical guideline for selected interventions. Nord J Psychiatry 2022; 76:177-188. [PMID: 34455900 DOI: 10.1080/08039488.2021.1952303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Difficult-to-treat-depression (DTD) is a clinical challenge. The interventions that are well-established for DTD are not suitable or effective for all the patients. Therefore, more treatment options are highly warranted. We formulated an evidence-based guideline concerning six interventions not well-established for DTD in Denmark. METHODS Selected review questions were formulated according to the PICO principle with specific definitions of the patient population (P), the intervention (I), the comparison (C), and the outcomes of interest (O), and systematic literature searches were performed stepwise for each review question to identify relevant systematic reviews/meta-analyses, and randomized controlled trials. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the methodological quality of the included studies. Clinical recommendations were formulated based on the evidence, the risk-benefit ratio, and perceived patient preferences. RESULTS We found sufficient evidence for a weak recommendation of repetitive transcranial magnetic stimulation (rTMS) and cognitive behavioural analysis system of psychotherapy (CBASP). The use of bright light therapy in DTD was not sufficiently supported by the evidence, but should be considered as good clinical practice. The interventions should be considered in addition to ongoing antidepressant treatment. We did not find sufficient evidence to recommend intravenous ketamine/esketamine, rumination-focused psychotherapy, or cognitive remediation to patients with DTD. CONCLUSION The evidence supported two of the six reviewed interventions, however it was generally weak which emphasizes the need for more good quality studies. This guideline does not cover all treatment options and should be regarded as a supplement to relevant DTD-guidelines.
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Affiliation(s)
- Stine Bjerrum Moeller
- Psychotherapy Research Unit, Mental Health Centre Stolpegaard, Capital Region Psychiatry, Gentofte, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Krzysztof Gbyl
- Center for Neuropsychiatric Depression Research (CNDR), Psychiatric Center Glostrup, Capital Region Psychiatry, Glostrup, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - Core, Mental Health Center Copenhagen, Section of Epidemiology, Department of Public Health, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Maike Andreasen
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
| | - Stephen F Austin
- Psychiatric Research Unit, Psychiatry Region Zealand, Department of Psychology, University of Southern Denmark, Slagelse, Denmark
| | - Poul Erik Buchholtz
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
| | - Line Fønss
- Center for Neuropsychiatric Depression Research (CNDR), Psychiatric Center Glostrup, Capital Region Psychiatry, Glostrup, Denmark
| | - Simon Hjerrild
- Department for Affective Disorders, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Martin Balslev Jørgensen
- Mental Health Center Copenhagen, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai Ladegaard
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark.,Psychiatric Centre Copenhagen and Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Jonas Meile
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
| | - Aake Packness
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,The Royal Danish Library, Aarhus University Library, Health Sciences, Aarhus, Denmark
| | | | - Krista Straarup
- Research and Treatment Program for Bipolar Disorder, Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Birgitte Welcher
- Mental health Center Psychiatry Vest, Region Zealand Psychiatry, Slagelse, Denmark
| | - Poul Videbech
- Center for Neuropsychiatric Depression Research (CNDR), Psychiatric Center Glostrup, Capital Region Psychiatry, Glostrup, Denmark
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22
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Herrman H, Patel V, Kieling C, Berk M, Buchweitz C, Cuijpers P, Furukawa TA, Kessler RC, Kohrt BA, Maj M, McGorry P, Reynolds CF, Weissman MM, Chibanda D, Dowrick C, Howard LM, Hoven CW, Knapp M, Mayberg HS, Penninx BWJH, Xiao S, Trivedi M, Uher R, Vijayakumar L, Wolpert M. Time for united action on depression: a Lancet-World Psychiatric Association Commission. Lancet 2022; 399:957-1022. [PMID: 35180424 DOI: 10.1016/s0140-6736(21)02141-3] [Citation(s) in RCA: 266] [Impact Index Per Article: 133.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Sangath, Goa, India; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Christian Kieling
- Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Michael Berk
- Deakin University, IMPACT Institute, Geelong, VIC, Australia
| | - Claudia Buchweitz
- Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Mario Maj
- Department of Psychiatry, University of Campania L Vanvitelli, Naples, Italy
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Myrna M Weissman
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Dixon Chibanda
- Department of Psychiatry, University of Zimbabwe, Harare, Zimbabwe; Centre for Global Mental Health, The London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Louise M Howard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christina W Hoven
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Helen S Mayberg
- Departments of Neurology, Neurosurgery, Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Shuiyuan Xiao
- Central South University Xiangya School of Public Health, Changsha, China
| | - Madhukar Trivedi
- Peter O'Donnell Jr Brain Institute and the Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Lakshmi Vijayakumar
- Sneha, Suicide Prevention Centre and Voluntary Health Services, Chennai, India
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23
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Relationship between workplace violence and work-related depression/anxiety, separating the types of perpetrators: a cross-sectional study using data from the fourth and fifth Korean Working Conditions Surveys (KWCS). Ann Occup Environ Med 2022; 34:e13. [PMID: 35923792 PMCID: PMC9300452 DOI: 10.35371/aoem.2022.34.e13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/27/2022] [Accepted: 05/24/2022] [Indexed: 11/24/2022] Open
Abstract
Background Work is an inseparable element of a person’s life, and violence in the workplace has various effects on individual workers and companies. While most studies have focused on specific industries, very few studies have investigated the influence of workplace violence by co-workers. Therefore, this study aimed to evaluate the association between workplace violence and work-related depression/anxiety in various occupations by differentiating the perpetrators of violence as co-workers and clients. Methods This study was conducted based on data from the 4th and 5th Korean Working Conditions Surveys (KWCS). The experience of workplace violence was classified in terms of the perpetrator: workplace violence by co-workers and that by clients. Work-related depression and anxiety were assessed using questions about health problems related to depression and anxiety and whether the problems were related to work. Descriptive statistics, χ2 tests, and multiple logistic regression analyses were performed using the SPSS 26.0. Results After adjusting for sociodemographic characteristics (age, education, income, subjective health status) and occupational characteristics (occupation, weekly working hours, type of employment, size of workplace, and shift work), male workers with experience of workplace violence by co-workers were found to be at a higher risk of work-related depression/anxiety (odds ratio [OR], 11.52; 95% confidence interval [CI], 8.65–15.36). The same was confirmed for female workers (OR, 10.89; 95% CI, 7.90–15.02). Conclusions Employees who experienced workplace violence from co-workers were found to be more vulnerable to work-related depression/anxiety. Continuous contact between the victim and the perpetrator may occur, and the possibility of a secondary assault can frighten the victim. Appropriate prevention and intervention measures that focus on the perpetrators of violence are needed.
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Yang H, Gao S, Li J, Yu H, Xu J, Lin C, Yang H, Teng C, Ma H, Zhang N. Remission of symptoms is not equal to functional recovery: Psychosocial functioning impairment in major depression. Front Psychiatry 2022; 13:915689. [PMID: 35958633 PMCID: PMC9360322 DOI: 10.3389/fpsyt.2022.915689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
The ultimate goal of depression treatment is to achieve functional recovery. Psychosocial functioning is the main component of functional impairment in depressed patients. The concept of psychosocial functioning has an early origin; however, its concept and connotation are still ambiguous, which is the basic and key problem faced by the relevant research and clinical application. In this study, we start from the paradox of symptoms remission and functional recovery, describe the concept, connotation, and characteristics of psychosocial functioning impairment in depressed patients, and re-emphasize its importance in depression treatment to promote research and clinical applications related to psychosocial functioning impairment in depressed patients to achieve functional recovery.
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Affiliation(s)
- Hao Yang
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Shuzhan Gao
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jiawei Li
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Haoran Yu
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jingren Xu
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Chenchen Lin
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Hua Yang
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Changjun Teng
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Ma
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Ning Zhang
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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Brooks H, Oughli HA, Kamel L, Subramanian S, Morgan G, Blumberger DM, Kloeckner J, Kumar S, Mulsant BH, Lenze EJ, Rajji TK. Enhancing Cognition in Older Persons with Depression or Anxiety with a Combination of Mindfulness-Based Stress Reduction (MBSR) and Transcranial Direct Current Stimulation (tDCS): Results of a Pilot Randomized Clinical Trial. Mindfulness (N Y) 2021; 12:3047-3059. [PMID: 34630733 PMCID: PMC8491443 DOI: 10.1007/s12671-021-01764-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2021] [Indexed: 11/30/2022]
Abstract
Objectives Individuals with subjective memory complaints and symptoms of depression and/or anxiety are at high risk for further cognitive decline, and possible progression to dementia. Low-burden interventions to help slow or prevent cognitive decline in this high-risk group are needed. The objective of this study is to assess the feasibility of combining Mindfulness-Based Stress Reduction (MBSR) with transcranial direct current stimulation (tDCS) to increase putative benefits of MBSR for cognitive function and everyday mindfulness in depressed or anxious older adults with subjective cognitive decline. Methods We conducted a two-site pilot double-blind randomized sham-controlled trial, combining active MBSR with either active or sham tDCS. The intervention included weekly in-class group sessions at the local university hospital and daily at-home practice. Anodal tDCS was applied for 30 min during MBSR meditative practice, both in-class and at-home. Results Twenty-six individuals with subjective cognitive complaints and symptoms of depression and/or anxiety were randomized to active (n = 12) or sham tDCS (n = 14). The combination of MBSR and tDCS was safe and well tolerated, though at-home adherence and in-class attendance were variable. While they were not statistically significant, the largest effect sizes for active vs. sham tDCS were for everyday mindfulness (d = 0.6) and social functioning (d = 0.9) (F(1,21) = 3.68, p = 0.07 and F(1,21) = 3.9, p = 0.06, respectively). Conclusions Our findings suggest that it is feasible and safe to combine tDCS with MBSR in older depressed and anxious adults, including during remote, at-home use. Furthermore, tDCS may enhance MBSR via transferring its meditative learning and practice into increases in everyday mindfulness. Future studies need to improve adherence to MBSR with tDCS. Trial Registration ClinicalTrials.gov (NCT03653351 and NCT03680664). Supplementary Information The online version contains supplementary material available at 10.1007/s12671-021-01764-9.
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Affiliation(s)
- Heather Brooks
- Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | | | - Lojine Kamel
- Washington University School of Medicine, St. Louis, MO USA
| | | | - Gwen Morgan
- Centre for Mindfulness Studies, Toronto, Canada
| | - Daniel M Blumberger
- Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | | | - Sanjeev Kumar
- Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Eric J Lenze
- Washington University School of Medicine, St. Louis, MO USA
| | - Tarek K Rajji
- Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto, ON Canada.,Toronto Dementia Research Alliance, University of Toronto, Toronto, Canada
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Monferrer M, Ricarte JJ, Montes MJ, Fernández-Caballero A, Fernández-Sotos P. Psychosocial remediation in depressive disorders: A systematic review. J Affect Disord 2021; 290:40-51. [PMID: 33991945 DOI: 10.1016/j.jad.2021.04.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/16/2021] [Accepted: 04/25/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Social functioning impairment has been described in several psychiatric illness, including depressive disorders. It is associated with a deterioration in global functioning and quality of life, thus there is a growing interest in psychosocial functioning remediation interventions. This systematic review aims to review all psychotherapeutic, pharmacological and biological social functioning interventions in depressive disorders. METHODS A systematic search was conducted on PubMed, PsycINFO and Scopus from the first articles to 2019 following the PRISMA guidelines. 72 original papers were extracted from an initial number of 1827, based on the selected eligibility criteria. RESULTS A growing body of research was observed in the last 10 years, with most studies showing a low level of scientific evidence. The main diagnosis found was major depressive disorder and the principal social cognition domains assessed were emotional processing and attributional style. The type of intervention most found was the pharmacological one, followed by psychotherapeutic interventions classified as "non-specific. The efficacy of treatments showed an improvement in depressive symptoms and positive results for emotional processing and attributional style. LIMITATIONS Because there is a lack of well-controlled designs and really few interventions focusing on its remediation, and low homogeneity on the assessment of social aspects across, a comparison of results and the extraction of general conclusions is quite difficult. CONCLUSIONS Although a promising body of literature has been developed in recent years on the improvement of psychosocial functioning in patients with depressive disorders, more studies are needed to clarify relevant aspects in this area.
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Affiliation(s)
- Marta Monferrer
- Mental Health Service, Complejo Hospitalario Universitario de Albacete (CHUA), Albacete, Spain
| | - Jorge J Ricarte
- Department of Psychology, Faculty of Medicine, Universidad de Castilla La Mancha, Albacete, Spain
| | - María J Montes
- Mental Health Service, Complejo Hospitalario Universitario de Albacete (CHUA), Albacete, Spain
| | - Antonio Fernández-Caballero
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; Departamento de Sistemas Informáticos, Universidad de Castilla-La Mancha, Albacete, Spain; Instituto de Investigación en Informática de Albacete, Albacete, Spain
| | - Patricia Fernández-Sotos
- Mental Health Service, Complejo Hospitalario Universitario de Albacete (CHUA), Albacete, Spain; CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; Mental Health Service, Hospital Virgen de la Luz, Cuenca, Spain.
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The Correlations Among Severity of Depression, Level of Observed Expressed Emotions, Perceived Social Support and Psychosocial Functioning in Patients with Unipolar Depression. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2020-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
The aims of the study were to examine the correlations among severity of depression, level of psychosocial functioning, level of observed expressed emotions and perceived social support in patients diagnosed with unipolar depression. The sample included 61 patients. The following study instruments were applied: the Beck Depression Inventory II, the Functioning Assessment Short Test, the Level of Expressed Emotion scale and the Multidimensional Scale of Perceived Social Support. Descriptive statistics of the sample have shown the mean age of 42.39years (SD=13.387), moderate severity of depression (AS=22.7, SD=11.984), moderate level of observed expressed emotions (AS=74.70, SD=17.959), moderate level of psychosocial difficulties (AS=26.33, SD=17.207) and high level of perceived social support (AS=5.24, SD=1.395). There were significant positive correlations between severity of depression and psychosocial difficulties (r=0.69) and perceived social support (r=-0.42), as well as between psychosocial difficulties and both levels of observed expressed emotions (r=0.31) and perceived social support (r=- 0.53). Hierarchical multiple regression analysis showed that 47.1% of the psychosocial functioning variance can be predicted by severity of depressive symptoms, and perceived social support explained the additional 7% of variance. The level of observed expressed emotion didn’t show an additional explanation of the psychosocial functioning variance. Our research showed that the severity of depressive symptoms and perceived social support predict difficulties in psychosocial functioning, while the level of observed expressed emotion was not an important predictor.
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Milner A, Disney G, Byars S, King TL, Kavanagh AM, Aitken Z. The effect of gender on mental health service use: an examination of mediation through material, social and health-related pathways. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1311-1321. [PMID: 32055895 DOI: 10.1007/s00127-020-01844-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 02/03/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE We aimed to understand how much of the gender difference in mental health service use could be due to the joint mediation of employment, behavioural and material factors, social support and mental health need. METHODS We used data from employed individuals aged 18-65 years who participated in the 2015-2017 waves of the Household, Income and Labour Dynamics in Australia survey. The exposure (male, female) and confounders were measured in 2015, mediators in 2016 and the outcome-whether a person had seen a mental health professional in the previous year-was measured in 2017. We estimated natural mediation effects using weighted counterfactual predictions from a logistic regression model. RESULTS Men were less likely to see a mental health care provider than women. The total causal effect on the risk difference scale was - 0.045 (95% CI - 0.056, - 0,034). The counterfactual of men taking the mediator values of women explained 28% (95% CI 1.7%, 54%) of the total effect, with the natural direct effect estimated to represent an absolute risk difference of - 0.033 (95% CI - 0.048, - 0.018) and the natural indirect effect - 0.012 (95% CI - 0.022, - 0.0027). CONCLUSION Gendered differences in the use of mental health services could be reduced by addressing inequalities in health, employment, material and behavioural factors, and social support.
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Affiliation(s)
- Allison Milner
- Disability and Health Unit, Melbourne School Population and Global Health, Centre for Health Equity, The University of Melbourne, Victoria, 3010, Australia
| | - George Disney
- Disability and Health Unit, Melbourne School Population and Global Health, Centre for Health Equity, The University of Melbourne, Victoria, 3010, Australia
| | - Sean Byars
- Disability and Health Unit, Melbourne School Population and Global Health, Centre for Health Equity, The University of Melbourne, Victoria, 3010, Australia.,Melbourne Disability Institute, The University of Melbourne, Victoria, 3010, Australia
| | - Tania L King
- Disability and Health Unit, Melbourne School Population and Global Health, Centre for Health Equity, The University of Melbourne, Victoria, 3010, Australia
| | - Anne M Kavanagh
- Disability and Health Unit, Melbourne School Population and Global Health, Centre for Health Equity, The University of Melbourne, Victoria, 3010, Australia
| | - Zoe Aitken
- Disability and Health Unit, Melbourne School Population and Global Health, Centre for Health Equity, The University of Melbourne, Victoria, 3010, Australia.
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Taylor CT, Pearlstein SL, Kakaria S, Lyubomirsky S, Stein MB. Enhancing Social Connectedness in Anxiety and Depression Through Amplification of Positivity: Preliminary Treatment Outcomes and Process of Change. COGNITIVE THERAPY AND RESEARCH 2020; 44:788-800. [PMID: 32661447 DOI: 10.1007/s10608-020-10102-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Anxiety and depressive disorders are often characterized by perceived social disconnection, yet evidence-based treatments produce only modest improvements in this domain. The well-established link between positive affect (PA) and social connectedness suggests that directly targeting PA in treatment may be valuable. Method A secondary analysis of a waitlist-controlled trial (N=29) was conducted to evaluate treatment response and process of change in social connectedness within a 10-session positive activity intervention protocol-Amplification of Positivity (AMP)-designed to increase PA in individuals seeking treatment for anxiety or depression (ClinicalTrials.gov Identifier: NCT02330627). Perceived social connectedness and PA/negative affect (NA) were assessed throughout treatment. Time-lagged multilevel mediation models examined the process of change in affect and connectedness throughout treatment. Results The AMP group displayed significantly larger improvements in social connectedness from pre- to post-treatment compared to waitlist; improvements were maintained through 6-month follow-up. Within the AMP group, increases in PA and decreases in NA both uniquely predicted subsequent increases in connectedness throughout treatment. However, experiencing heightened NA throughout treatment attenuated the effect of changes in PA on connectedness. Improvements in connectedness predicted subsequent increases in PA, but not changes in NA. Conclusions These preliminary findings suggest that positive activity interventions may be valuable for enhancing social connectedness in individuals with clinically impairing anxiety or depression, possibly through both increasing positive emotions and decreasing negative emotions.
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Ota M, Takeda S, Pu S, Matsumura H, Araki T, Hosoda N, Yamamoto Y, Sakakihara A, Kaneko K. The relationship between cognitive distortion, depressive symptoms, and social adaptation: A survey in Japan. J Affect Disord 2020; 265:453-459. [PMID: 32090772 DOI: 10.1016/j.jad.2020.01.094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 11/18/2019] [Accepted: 01/20/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND In the treatment of depression, improvements in both clinical symptoms and social adaptation are important. Previous studies have shown that cognitive distortion and depressive symptoms are mutually related, and that depressive symptoms and social adaptation are related to each other. However, it is unknown how these three factors interrelate. Therefore, this study examined the relationship between cognitive distortion, depressive symptoms, and social adaptation. METHODS The final analyzed sample consisted of 430 employees of a manufacturing company in Japan (74.2% male, 24.7% female, 1.2% unknown). Participants completed the Worker's Cognitive Distortion Scale (WCDS), Beck Depression Inventory-Second Edition (BDI-II), and Social Adaptation Self-Evaluation Scale (SASS). The WCDS was further divided into two subscales: self-contained cognitive distortion (WCDS-S) and environment-dependent cognitive distortion (WCDS-E). We used a covariance structure analysis for the main analysis and examined the relationship between these three variables' scores. RESULTS The results revealed that both the WCDS-S and WCDS-E affected social adaptation indirectly via depressive symptoms, and that the WCDS-S additionally affected social adaptation directly. It was further revealed that the WCDS-S exerted a greater effect on depressive symptoms than the WCDS-E. LIMITATIONS The participants were healthy cases. As such, one must be cautious about applying the results of healthy cases to clinical cases. CONCLUSIONS This study indicates that cognitive distortion affects social adaptation directly and that it is indirectly mediated by depressive symptoms. Thus, professionals are required to attempt to treat depressive symptoms and improve social adaptation by considering that interventions in cognitive distortion may be effective.
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Affiliation(s)
- Maki Ota
- Division of Neuropsychiatry, Department of Clinical Medicine, Tottori University Graduate School of Medical Sciences, Yonago, Tottori 683-8503, Japan; National Hospital Organization, Tottori Medical Center, Tottori-shi, Tottori 689-0203, Japan.
| | - Shinya Takeda
- Department of Clinical Psychology, Tottori University Graduate School of Medical Sciences, Yonago, Tottori 683-8503, Japan
| | - Shenghong Pu
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine, Yonago, Tottori 683-8503, Japan
| | | | - Takayuki Araki
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine, Yonago, Tottori 683-8503, Japan
| | - Naoko Hosoda
- Division of Neuropsychiatry, Yowa Hospital, Yonago, Tottori 683-0841, Japan
| | - Yoko Yamamoto
- Department of Fundamental Nursing, School of Health Science, Tottori University Faculty of Medicine, Yonago, Tottori 683-8503, Japan
| | - Aya Sakakihara
- Community Health Nursing, Faculty of Medicine, Shimane University, Izumo, Shimane 693-8501, Japan
| | - Koichi Kaneko
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine, Yonago, Tottori 683-8503, Japan
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Knapstad M, Lervik LV, Sæther SMM, Aarø LE, Smith ORF. Effectiveness of Prompt Mental Health Care, the Norwegian Version of Improving Access to Psychological Therapies: A Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 89:90-105. [PMID: 31794968 PMCID: PMC7158231 DOI: 10.1159/000504453] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 09/23/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The innovative treatment model Improving Access to Psychological Therapies (IAPT) and its Norwegian adaptation, Prompt Mental Health Care (PMHC), have been evaluated by cohort studies only. Albeit yielding promising results, the extent to which these are attributable to the treatment thus remains unsettled. OBJECTIVE To investigate the effectiveness of the PMHC treatment compared to treatment as usual (TAU) at 6-month follow-up. METHODS A randomized controlled trial with parallel assignment was performed in two PMHC sites (Sandnes and Kristiansand) and enrolled clients between November 9, 2015 and August 31, 2017. Participants were 681 adults (aged ≥18 years) considered for admission to PMHC due to anxiety and/or mild to moderate depression (Patient Health Questionnaire [PHQ-9]/Generalized Anxiety Disorder scale [GAD-7] scores above cutoff). These were randomly assigned (70:30 ratio; n = 463 to PMHC, n = 218 to TAU) with simple randomization within each site with no further constraints. The main outcomes were recovery rates and changes in symptoms of depression (PHQ-9) and anxiety (GAD-7) between baseline and follow-up. Primary outcome data were available for 73/67% in PMHC/TAU. Sensitivity analyses based on observed patterns of missingness were also conducted. Secondary outcomes were work participation, functional status, health-related quality of life, and mental well-being. RESULTS A reliable recovery rate of 58.5% was observed in the PMHC group and of 31.9% in the TAU group, equaling a between-group effect size of 0.61 (95% CI 0.37 to 0.85, p < 0.001). The differences in degree of improvement between PMHC and TAU yielded an effect size of -0.88 (95% CI -1.23 to -0.43, p < 0.001) for PHQ-9 and -0.60 (95% CI -0.90 to -0.30, p < 0.001) for GAD-7 in favor of PMHC. All sensitivity analyses pointed in the same direction, with small variations in point estimates. Findings were slightly more robust for depressive than anxiety symptoms. PMHC was also more effective than TAU in improving all secondary outcomes, except for work participation (z = 0.415, p = 0.69). CONCLUSIONS The PMHC treatment was substantially more effective than TAU in alleviating the burden of anxiety and depression. This adaptation of IAPT is considered a viable supplement to existing health services to increase access to effective treatment for adults who suffer from anxiety and mild to moderate depression. A potential effect on work participation needs further examination.
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Affiliation(s)
- Marit Knapstad
- Faculty of Psychology, Department of Clinical Psychology, University of Bergen, Bergen, Norway, .,Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway,
| | - Linn Vathne Lervik
- Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | | | - Leif Edvard Aarø
- Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Otto Robert F. Smith
- Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
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Crowe M, Inder M, Douglas K, Carlyle D, Wells H, Jordan J, Lacey C, Mulder R, Beaglehole B, Porter R. Interpersonal and Social Rhythm Therapy for Patients With Major Depressive Disorder. Am J Psychother 2020; 73:29-34. [DOI: 10.1176/appi.psychotherapy.20190024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Marie Crowe
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand (all authors)
| | - Maree Inder
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand (all authors)
| | - Katie Douglas
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand (all authors)
| | - Dave Carlyle
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand (all authors)
| | - Hayley Wells
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand (all authors)
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand (all authors)
| | - Cameron Lacey
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand (all authors)
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand (all authors)
| | - Ben Beaglehole
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand (all authors)
| | - Richard Porter
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand (all authors)
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Tan M, Shallis A, Barkus E. Social anhedonia and social functioning: Loneliness as a mediator. Psych J 2020; 9:280-289. [DOI: 10.1002/pchj.344] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Melody Tan
- Cognitive Basis of Atypical Behaviour Initiative (CBABi)School of Psychology, University of Wollongong Wollongong Australia
| | - Amy Shallis
- Cognitive Basis of Atypical Behaviour Initiative (CBABi)School of Psychology, University of Wollongong Wollongong Australia
| | - Emma Barkus
- Cognitive Basis of Atypical Behaviour Initiative (CBABi)School of Psychology, University of Wollongong Wollongong Australia
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Cuijpers P. Measuring success in the treatment of depression: what is most important to patients? Expert Rev Neurother 2020; 20:123-125. [DOI: 10.1080/14737175.2020.1712807] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Sayegh L, Touré EH, Farquhar E, Beaulieu S, Renaud S, Rej S, Perreault M. Group Cognitive Behavioral Analysis System of Psychotherapy (CBASP): A Pilot Study for Bipolar Depression. Front Psychiatry 2020; 11:565681. [PMID: 33173513 PMCID: PMC7538805 DOI: 10.3389/fpsyt.2020.565681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/03/2020] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is an individually administered treatment model designed specifically for Persistent Depression however bipolar patients have traditionally been excluded from CBASP studies. There is a perception that bipolar depression will be harder to treat and requires a unique psychological approach. This pilot study reports on the feasibility of administering the same 20-week manualized group CBASP therapy with bipolar patients currently in a depressive episode. METHODS This non-randomized, single-arm prospective pilot study, reports on an a posteriori exploration of benefits to bipolar depressed patients (n=26) of the same 20-week group CBASP intervention administered to unipolar depressed patients (n=81). The clinical trial for the initial phase examining benefits of the manualized 20-week group CBASP intervention with unipolar patients was registered with the ISRCTN registry, study ID: ISRCTN95149444. Results reported here include mixed ANOVA analyses, across group treatment models and diagnostic categories. Changes over time in self-reported depressive symptoms (Inventory of Depressive Symptoms -IDS-SR), self-reported social functioning, interpersonal problems and interpersonal dispositions are documented for all patients. An exploratory longitudinal latent class analysis was used to examine patients' trajectories of improvement in depressive symptoms. Finally, the best predictors of change in reported depressive symptoms were explored with a logistic regression for all patients. RESULTS Improvements in depressive symptoms and in social functioning over time were significant for all patients with bipolar patients trending towards a greater improvement in depressive symptoms after controlling for baseline differences. An exploratory Latent Class Analysis identified two different treatment trajectories for the entire sample: 1) moderate to severely depressed patients who improved significantly (49%) and 2) severely depressed patients who did not improve (51%). The best predictors of non-response to group therapy include high baseline problems in social functioning and low rates of self-reported Perceived Improvements in overall health. CONCLUSION Bipolar patients in a depressive episode appear to benefit from the same 20-week group CBASP model designed originally for the treatment of Persistent Depressive Disorder. Bipolar patients seem more easily mobilized both during and outside of group therapy sessions and report more interpersonal confidence and more agency than unipolar depressed patients.
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Affiliation(s)
- Liliane Sayegh
- Bipolar Disorders Program, Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychology, McGill University, Montreal, QC, Canada
| | - El Hadj Touré
- Department of Sociology, University of Montreal, Montreal, QC, Canada.,Douglas Research Center, Douglas Mental Health University Institute, Montreal, QC, Canada
| | | | - Serge Beaulieu
- Bipolar Disorders Program, Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Suzane Renaud
- Bipolar Disorders Program, Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada.,Complex Mood, Comorbid and Personality Disorders Program, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Soham Rej
- Bipolar Disorders Program, Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada.,GeriPARTy Research Group, Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada
| | - Michel Perreault
- Douglas Research Center, Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
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Abstract
It is not yet clear what mental disorders are and what are the causal pathways that lead to them. That makes it difficult to decide what the targets and outcomes of psychotherapies should be. In this paper, the main types of targets and outcomes of psychotherapies are described, and a brief overview is provided of some of the main results of research on these types. These include symptom reduction, personal targets and outcomes from the patient's perspective, improvement of quality of life, intermediate outcomes depending on the theoretical framework of the therapist, negative outcomes to be avoided, and economic outcomes. In line with the dominance of the DSM and ICD systems for diagnoses, most research has been focused on symptom reduction. This considerable body of research, with hundreds of randomized trials, has shown that for most mental disorders effective psychotherapies are available. There is also research showing that psychotherapies can result in improvement of quality of life in most mental disorders. However, relatively little research is available on patient-defined outcomes, intermediate outcomes, negative outcomes and economic outcomes. Patients, relatives, therapists, employers, health care providers and society at large each have their own perspectives on targets and outcomes of psychotherapies. The perspective of patients should have more priority in research, and a standardization of outcome measures across trials is much needed.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
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Engel S, Laufer S, Knaevelsrud C, Schumacher S. The endogenous oxytocin system in depressive disorders: A systematic review and meta-analysis. Psychoneuroendocrinology 2019; 101:138-149. [PMID: 30458371 DOI: 10.1016/j.psyneuen.2018.11.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/10/2018] [Accepted: 11/06/2018] [Indexed: 11/26/2022]
Abstract
The oxytocin system is involved in psychological functions and interacts with biological systems that are altered in patients suffering from depressive disorders. This suggests a possible role of oxytocin in the development and maintenance of depression. We provide the first systematic review and meta-analysis that specifically addresses differences in basal endogenous oxytocin concentrations between patients with depressive disorders and healthy controls. A systematic literature search was conducted to identify studies that measured basal endogenous oxytocin concentrations in depressive patients and healthy controls. We included k = 13 studies (n = 368 patients and n = 346 healthy controls) in the qualitative review and k = 9 studies (n = 273 patients and n = 273 healthy controls) in the meta-analytic procedure. Standardized mean group differences were non-significant (g = -0.02, CI = [-0.41; 0.36]), indicating that depressive patients and healthy controls did not differ in basal endogenous oxytocin concentrations. The overall effect was heterogeneous. Effects within studies showing comparable risks of biases, as rated according to the Newcastle-Ottawa Quality Assessment Scale, were non-significant as well, but homogeneous. The findings suggest that more complex research designs and methodological approaches should be employed to detect and understand a possible role of the oxytocin system in depressive disorders. We provide recommendations for subsequent promising study designs, involving the consideration of illness phase, comorbidities and correlations with psychological functions or symptoms. We point out the strengths of reactivity designs and multidimensional measurement approaches and recommend to linking future research questions to theories of depression.
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Affiliation(s)
- Sinha Engel
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Sebastian Laufer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Sarah Schumacher
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
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Chu C, Nota JA, Silverman AL, Beard C, Björgvinsson T. Pathways among sleep onset latency, relationship functioning, and negative affect differentiate patients with suicide attempt history from patients with suicidal ideation. Psychiatry Res 2019; 273:788-797. [PMID: 31207867 DOI: 10.1016/j.psychres.2018.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/28/2018] [Accepted: 11/06/2018] [Indexed: 01/27/2023]
Abstract
Depression, anxiety, sleep disturbances and poor relationship functioning often co-occur with the confluence of these factors contributing to greater suicide risk. This study investigated whether the pathways between depression, anxiety, sleep disturbances, and relationship functioning differentiated patients with suicide attempt history from those with suicidal ideation history. Patients seeking partial hospital treatment for severe psychiatric symptoms (N = 180) completed interviews assessing psychiatric and suicidal symptom histories, and self-report measures of sleep behaviors, anxiety, depression, and relationship functioning. Multiple sleep behaviors were examined: duration, sleep onset latency, and bedtime. Bias-corrected bootstrap mediation and moderated mediation analyses with suicide attempt as the moderator were used to evaluate pathways between variables. Among patients with ideation and attempt history, (1) sleep onset latency significantly mediated the association between depression and relationship functioning and that between anxiety and relationship functioning; (2) relationship functioning significantly mediated the association between depression and sleep onset latency and that between anxiety and sleep onset latency. These pathways were not significant among patients with suicidal ideation only. No other sleep behaviors were related to study variables. The reciprocal relationship between disrupted sleep onset latency and poor relationship functioning was specifically linked to more severe psychiatric symptoms among acute patients with suicide attempt histories.
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Affiliation(s)
- Carol Chu
- McLean Hospital/Harvard Medical School, Belmont, MA, United States; Department of Psychology, Harvard University, Cambridge, MA, United States.
| | - Jacob A Nota
- McLean Hospital/Harvard Medical School, Belmont, MA, United States
| | - Alexandra L Silverman
- Department of Psychology, University of Virginia, Charlottesville, VA, United States
| | - Courtney Beard
- McLean Hospital/Harvard Medical School, Belmont, MA, United States
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Knapstad M, Nordgreen T, Smith ORF. Prompt mental health care, the Norwegian version of IAPT: clinical outcomes and predictors of change in a multicenter cohort study. BMC Psychiatry 2018; 18:260. [PMID: 30115041 PMCID: PMC6097447 DOI: 10.1186/s12888-018-1838-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 08/07/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Prompt mental health care (PMHC) is a Norwegian initiative, inspired by the English 'Improving Access to Psychological Therapy' (IAPT), aimed to provide low-threshold access to primary care treatment for persons with symptoms of anxiety and depression. The objectives of the present study are to describe the PMHC service, to examine changes in symptoms of anxiety and depression following treatment and to identify predictors of change, using data from the 12 first pilot sites. METHODS A prospective cohort design was used. All participants were asked to complete questionnaires at baseline, before each treatment session and at the end of treatment. Effect sizes (ES) for pre-post changes and recovery rates were calculated based on the Patient Health Questionnaire and the Generalized Anxiety Disorder scale. Multiple imputation (MI) was used in order to handle missing data. We examined predictors through latent difference score models and reported the contribution of each predictor level in terms of ES. RESULTS In total, N = 2512 clients received treatment at PMHC between October 2014 and December 2016, whereof 61% consented to participate. The changes from pre- to post-treatment were large for symptoms of both depression (ES = 1.1) and anxiety (ES = 1.0), with an MI-based reliable recovery rate of 58%. The reliable recovery rate comparable to IAPT based on last-observation-carried-forward was 48%. The strongest predictors for less improvement were having immigrant background (ES change depression - 0.27, ES change anxiety - 0.26), being out of work at baseline (ES change depression - 0.18, ES change anxiety - 0.35), taking antidepressants (ES change anxiety - 0.36) and reporting bullying as cause of problems (ES change depression - 0.29). Taking sleep medication did on the other hand predict more improvement (ES change depression 0.23, ES change anxiety 0.45). CONCLUSIONS Results in terms of clinical outcomes were promising, compared to both the IAPT pilots and other benchmark samples. Though all groups of clients showed substantial improvements, having immigrant background, being out of work, taking antidepressant medication and reporting bullying as cause stood out as predictors of poorer treatment response. Altogether, PMHC was successfully implemented in Norway. Areas for improvement of the service are discussed.
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Affiliation(s)
- Marit Knapstad
- Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes gate 7, 5018, Bergen, Norway. .,Department of Clinical Psychology, University of Bergen, Bergen, Norway.
| | - Tine Nordgreen
- 0000 0004 1936 7443grid.7914.bDepartment of Clinical Psychology, University of Bergen, Bergen, Norway ,0000 0000 9753 1393grid.412008.fDivision of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Otto R. F. Smith
- 0000 0001 1541 4204grid.418193.6Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes gate 7, 5018 Bergen, Norway
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40
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Saeri AK, Cruwys T, Barlow FK, Stronge S, Sibley CG. Social connectedness improves public mental health: Investigating bidirectional relationships in the New Zealand attitudes and values survey. Aust N Z J Psychiatry 2018; 52:365-374. [PMID: 28803484 DOI: 10.1177/0004867417723990] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The importance of social connectedness in supporting public mental health is well established. However, the reverse causal pathway (that psychological ill-health leads to reduced social connectedness) remains a dominant perspective among mental health practitioners. Our analysis aimed to provide a rigorous test of the directionality of this relationship. METHOD A cross-lagged panel analysis of a large longitudinal national probability sample ( N ≈ 21,227), the New Zealand Attitudes and Values Survey, was used to assess the bidirectional longitudinal relationship between social connectedness and mental health, controlling for baseline levels of both variables and demographics. RESULTS Social connectedness was found to be a stronger and more consistent predictor of mental health year-on-year than mental health was of social connectedness. CONCLUSION These results further demonstrate how the psychological resources conferred by social connectedness can act as a 'social cure' for psychological ill-health, and provide the strongest evidence to date for the direction of this relationship in the general community.
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Affiliation(s)
- Alexander K Saeri
- 1 School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Tegan Cruwys
- 1 School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Fiona Kate Barlow
- 1 School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Samantha Stronge
- 2 School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Chris G Sibley
- 2 School of Psychology, The University of Auckland, Auckland, New Zealand
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41
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Cuijpers P, Gentili C. Psychological treatments are as effective as pharmacotherapies in the treatment of adult depression: a summary from Randomized Clinical Trials and neuroscience evidence. ACTA ACUST UNITED AC 2017; 20:273. [PMID: 32913741 PMCID: PMC7451304 DOI: 10.4081/ripppo.2017.273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/28/2017] [Accepted: 06/28/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Claudio Gentili
- Department of General Psychology, University of Padua, Italy
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42
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Saleh C, Hasler G. Deep brain stimulation for psychiatric disorders: Is there an impact on social functioning? Surg Neurol Int 2017; 8:134. [PMID: 28781911 PMCID: PMC5523473 DOI: 10.4103/sni.sni_15_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 05/06/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) for refractory psychiatric disorders shows promising effects on symptom-reduction, however, little is known regarding the effects of DBS on social outcome. METHODS A PubMed search based on original studies of DBS for psychiatric disorders [treatment resistant depression (TRD), Gilles de la Tourette's syndrome (GTS), and obsessive compulsive disorder (OCD)] was conducted. Data on social outcome following surgery were extracted and analyzed. RESULTS Social functioning was not a primary outcome measure in the reviewed article. The literature is incomplete and inconclusive on this variable, however from the reported data, there is some evidence that DBS has the potential to improve social functioning. CONCLUSIONS More systematic and detailed data gathering and reporting on social outcome with longer follow-ups are needed to evaluate more exhaustively the role of DBS in refractory psychiatric disorders.
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Affiliation(s)
- Christian Saleh
- Division of Molecular Psychiatry, Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Gregor Hasler
- Division of Molecular Psychiatry, Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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43
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Lin CH, Yang WC. The Relationship between Symptom Relief and Psychosocial Functional Improvement during Acute Electroconvulsive Therapy for Patients with Major Depressive Disorder. Int J Neuropsychopharmacol 2017; 20:538-545. [PMID: 28430980 PMCID: PMC5492785 DOI: 10.1093/ijnp/pyx022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/17/2017] [Indexed: 11/13/2022] Open
Abstract
Background We aimed to compare the degree of symptom relief to psychosocial functional (abbreviated as "functional") improvement and explore the relationships between symptom relief and functional improvement during acute electroconvulsive therapy for patients with major depressive disorder. Methods Major depressive disorder inpatients (n=130) requiring electroconvulsive therapy were recruited. Electroconvulsive therapy was generally performed for a maximum of 12 treatments. Symptom severity, using the 17-item Hamilton Depression Rating Scale, and psychosocial functioning (abbreviated as "functioning"), using the Modified Work and Social Adjustment Scale, were assessed before electroconvulsive therapy, after every 3 electroconvulsive therapy treatments, and after the final electroconvulsive therapy. Both 17-item Hamilton Depression Rating Scale and Modified Work and Social Adjustment Scale scores were converted to T-score units to compare the degrees of changes between depressive symptoms and functioning after electroconvulsive therapy. Structural equation modeling was used to test the relationships between 17-item Hamilton Depression Rating Scale and Modified Work and Social Adjustment Scale during acute electroconvulsive therapy. Results One hundred sixteen patients who completed at least the first 3 electroconvulsive therapy treatments entered the analysis. Reduction of 17-item Hamilton Depression Rating Scale T-scores was significantly greater than that of Modified Work and Social Adjustment Scale T-scores at assessments 2, 3, 4, and 5. The model analyzed by structural equation modeling satisfied all indices of goodness-of-fit (chi-square = 32.882, P =.107, TLI = 0.92, CFI = 0.984, RMSEA = 0.057). The 17-item Hamilton Depression Rating Scale change did not predict subsequent Modified Work and Social Adjustment Scale change. Conclusions Functioning improved less than depressive symptoms during acute electroconvulsive therapy. Symptom reduction did not predict subsequent functional improvement. Depressive symptoms and functional impairment are distinct domains and should be assessed independently to accurately reflect the effectiveness of electroconvulsive therapy.
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Affiliation(s)
- Ching-Hua Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Cheng Yang
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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44
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Factors Related to the Changes in Quality of Life for Patients With Depression After an Acute Course of Electroconvulsive Therapy. J ECT 2017; 33:126-133. [PMID: 27668944 DOI: 10.1097/yct.0000000000000358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to examine the effect of electroconvulsive therapy (ECT) on quality of life (QOL), depressive symptoms, and functioning for patients with depression, and to explore the variables related to QOL changes. METHODS Ninety-five inpatients with depression receiving at least 6 ECT sessions and completed all measures were included. Quality of life, symptom severity, and functioning were assessed using Short Form 36 (SF-36), the 17-item Hamilton Rating Scale for Depression (HAMD-17), and the Modified Work and Social Adjustment Scale (MWSAS), before and after ECT. The SF-36 includes 8 subscales, physical component summary (PCS), and mental component summary (MCS). Adverse effects after ECT, including headache, muscle pain, and nausea/vomiting, were also recorded. RESULTS All 8 SF-36 subscales, PCS, MCS, HAMD-17, and MWSAS improved significantly after treatment. Using multiple linear regression analysis, MWSAS changes predicted PCS changes significantly after adjusting for baseline PCS. Similarly, using multiple linear regression analysis, MWSAS changes were significant variables associated with MCS changes after adjusting for ECT frequency, HAMD-17 changes, and baseline MCS. The ECT improved QOL, depressive symptoms, and functioning. CONCLUSIONS Whether strategies to enhance functioning during an acute course of ECT could improve QOL is needed to be examined in a further study.
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Wingo AP, Briscione M, Norrholm SD, Jovanovic T, McCullough SA, Skelton K, Bradley B. Psychological resilience is associated with more intact social functioning in veterans with post-traumatic stress disorder and depression. Psychiatry Res 2017; 249:206-211. [PMID: 28119173 DOI: 10.1016/j.psychres.2017.01.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 01/03/2017] [Accepted: 01/08/2017] [Indexed: 10/20/2022]
Abstract
Patients with depression or post-traumatic stress disorder (PTSD), common sequelae among individuals exposed to stressful or traumatic events, often report impairment in social functioning. Resilience is a multidimensional construct that enables adaptive coping with life adversity. Relationship between resilience and social functioning among veterans with depression and PTSD is not entirely clear and is the focus of this report. Resilience was assessed in 264 veterans using the Connor-Davidson Resilience Scale, PTSD with the PTSD Symptom Scale, depression with the Beck Depression Inventory, and social functioning with the Short Form Health Survey. Higher resilience was associated with more intact social functioning after PTSD and depression severity, childhood maltreatment, physical health, gender, education, marital status, and employment were simultaneously adjusted for. Childhood maltreatment, gender, marital status, education, and employment did not predict social functioning; however, greater severity of PTSD, depression, or physical health problems was each significantly associated with more impaired social functioning. Our findings suggest that higher resilience was associated with more intact social functioning regardless of the severity of PTSD and depression. Given the importance of social functioning in depression and/or PTSD recovery, studies are needed to examine if enhancing resilience presents a complementary approach to alleviating impaired social functioning.
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Affiliation(s)
- Aliza P Wingo
- Atlanta VA Medical Center, Trauma Recovery Program, 1670 Clairmont Road Decatur, GA 30033, USA; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 101 Woodruff Circle, Room 4339, Atlanta, GA 30322, USA
| | - Maria Briscione
- Atlanta VA Medical Center, Trauma Recovery Program, 1670 Clairmont Road Decatur, GA 30033, USA; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 101 Woodruff Circle, Room 4339, Atlanta, GA 30322, USA
| | - Seth D Norrholm
- Atlanta VA Medical Center, Trauma Recovery Program, 1670 Clairmont Road Decatur, GA 30033, USA; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 101 Woodruff Circle, Room 4339, Atlanta, GA 30322, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 101 Woodruff Circle, Room 4339, Atlanta, GA 30322, USA
| | - S Ashley McCullough
- Atlanta VA Medical Center, Trauma Recovery Program, 1670 Clairmont Road Decatur, GA 30033, USA
| | - Kelly Skelton
- Atlanta VA Medical Center, Trauma Recovery Program, 1670 Clairmont Road Decatur, GA 30033, USA; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 101 Woodruff Circle, Room 4339, Atlanta, GA 30322, USA
| | - Bekh Bradley
- Atlanta VA Medical Center, Trauma Recovery Program, 1670 Clairmont Road Decatur, GA 30033, USA; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 101 Woodruff Circle, Room 4339, Atlanta, GA 30322, USA.
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Kamenov K, Twomey C, Cabello M, Prina AM, Ayuso-Mateos JL. The efficacy of psychotherapy, pharmacotherapy and their combination on functioning and quality of life in depression: a meta-analysis. Psychol Med 2017; 47:414-425. [PMID: 27780478 PMCID: PMC5244449 DOI: 10.1017/s0033291716002774] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 09/30/2016] [Accepted: 10/04/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is growing recognition of the importance of both functioning and quality of life (QoL) outcomes in the treatment of depressive disorders, but the meta-analytic evidence is scarce. The objective of this meta-analysis of randomized controlled trials (RCTs) was to determine the absolute and relative effects of psychotherapy, pharmacotherapy and their combination on functioning and QoL in patients with depression. METHOD One hundred and fifty-three outcome trials involving 29 879 participants with depressive disorders were identified through database searches in Pubmed, PsycINFO and the Cochrane Central Register of Controlled Trials. RESULTS Compared to control conditions, psychotherapy and pharmacotherapy yielded small to moderate effect sizes for functioning and QoL, ranging from g = 0.31 to g = 0.43. When compared directly, initial analysis yielded no evidence that one of them was superior. After adjusting for publication bias, psychotherapy was more efficacious than pharmacotherapy (g = 0.21) for QoL. The combination of psychotherapy and medication performed significantly better for both outcomes compared to each treatment alone yielding small effect sizes (g = 0.32 to g = 0.39). Both interventions improved depression symptom severity more than functioning and QoL. CONCLUSION Despite the small number of comparative trials for some of the analyses, this study reveals that combined treatment is superior, but psychotherapy and pharmacotherapy alone are also efficacious for improving functioning and QoL. The overall relatively modest effects suggest that future tailoring of therapies could be warranted to better meet the needs of individuals with functioning and QoL problems.
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Affiliation(s)
- K. Kamenov
- Instituto de Salud Carlos III, Centro de
Investigación Biomédica en Red, CIBERSAM, Madrid,
Spain
- Department of Psychiatry,
UniversityAutónoma de Madrid, Madrid,
Spain
| | - C. Twomey
- Faculty of Social and Human Sciences,
University of Southampton, Southampton,
UK
| | - M. Cabello
- Instituto de Salud Carlos III, Centro de
Investigación Biomédica en Red, CIBERSAM, Madrid,
Spain
- Department of Psychiatry,
UniversityAutónoma de Madrid, Madrid,
Spain
| | - A. M. Prina
- Health Service and Population Research
Department, Centre for Global Mental Health, Institute of
Psychiatry, Psychology and Neuroscience, King's College London,
London, UK
| | - J. L. Ayuso-Mateos
- Instituto de Salud Carlos III, Centro de
Investigación Biomédica en Red, CIBERSAM, Madrid,
Spain
- Department of Psychiatry,
UniversityAutónoma de Madrid, Madrid,
Spain
- Instituto de investigación de la Princesa,
(IIS-IP), Hospital Universitario de la Princesa,
Madrid, Spain
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Kolovos S, Kleiboer A, Cuijpers P. Effect of psychotherapy for depression on quality of life: meta-analysis. Br J Psychiatry 2016; 209:460-468. [PMID: 27539296 DOI: 10.1192/bjp.bp.115.175059] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 01/14/2016] [Accepted: 04/27/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Several meta-analyses have shown that psychotherapy is effective for reducing depressive symptom severity. However, the impact on quality of life (QoL) is as yet unknown. AIMS To investigate the effectiveness of psychotherapy for depression on global QoL and on the mental health and physical health components of QoL. METHOD We conducted a meta-analysis of 44 randomised clinical trials comparing psychotherapy for adults experiencing clinical depression or elevated depressive symptoms with a control group. We used subgroup analyses to explore the influence of various study characteristics on the effectiveness of treatment. RESULTS We detected a small to moderate effect size (Hedges' g = 0.33, 95% CI 0.24-0.42) for global QoL, a moderate effect size for the mental health component (g = 0.42, 95% CI 0.33-0.51) and, after removing an outlier, a small but statistically significant effect size for the physical health component (g = 0.16, 95% CI 0.05-0.27). Multivariate meta-regression analyses showed that the effect size of depressive symptoms was significantly related to the effect size of the mental health component of QoL. The effect size of depressive symptoms was not related to global QoL or the physical health component. CONCLUSIONS Psychotherapy for depression has a positive impact on the QoL of patients with depression. Improvements in QoL are not fully explained by improvements in depressive symptom severity.
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Affiliation(s)
- Spyros Kolovos
- Spyros Kolovos, MSc, Department of Health Sciences, VU University Amsterdam, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands; Annet Kleiboer, PhD, Department of Clinical Psychology, VU University Amsterdam, EMGO Institute for Health and Care Research, VU University, Department of Clinical and Health Psychology, Utrecht University, The Netherlands; Pim Cuijpers, PhD, Department of Clinical Psychology, VU University Amsterdam, EMGO Institute for Health and Care Research, VU University and VU University Medical Centre Amsterdam, The Netherlands, and Leuphana University, Lunebrug, Germany
| | - Annet Kleiboer
- Spyros Kolovos, MSc, Department of Health Sciences, VU University Amsterdam, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands; Annet Kleiboer, PhD, Department of Clinical Psychology, VU University Amsterdam, EMGO Institute for Health and Care Research, VU University, Department of Clinical and Health Psychology, Utrecht University, The Netherlands; Pim Cuijpers, PhD, Department of Clinical Psychology, VU University Amsterdam, EMGO Institute for Health and Care Research, VU University and VU University Medical Centre Amsterdam, The Netherlands, and Leuphana University, Lunebrug, Germany
| | - Pim Cuijpers
- Spyros Kolovos, MSc, Department of Health Sciences, VU University Amsterdam, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands; Annet Kleiboer, PhD, Department of Clinical Psychology, VU University Amsterdam, EMGO Institute for Health and Care Research, VU University, Department of Clinical and Health Psychology, Utrecht University, The Netherlands; Pim Cuijpers, PhD, Department of Clinical Psychology, VU University Amsterdam, EMGO Institute for Health and Care Research, VU University and VU University Medical Centre Amsterdam, The Netherlands, and Leuphana University, Lunebrug, Germany
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Kamenov K, Caballero FF, Miret M, Leonardi M, Sainio P, Tobiasz-Adamczyk B, Haro JM, Chatterji S, Ayuso-Mateos JL, Cabello M. Which Are the Most Burdensome Functioning Areas in Depression? A Cross-National Study. Front Psychol 2016; 7:1342. [PMID: 27630609 PMCID: PMC5005959 DOI: 10.3389/fpsyg.2016.01342] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 08/22/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The study aimed to identify the most burdensome functioning domains in depression and their differential impact on the quality of life (QoL) of individuals from nine countries in Asia, Africa, Europe, and Latin America. MATERIALS AND METHODS Data from two multi-country projects-the World Health Organization's Study on Global Ageing and Adult Health (SAGE) and the Collaborative Research on Ageing in Europe (COURAGE)-were analyzed. Eight functioning domains (pain, mobility, self-care, cognition, interpersonal activities, domestic life, and work, sleep and energy, and affect) and QoL were assessed in 4051 individuals with depression. RESULTS The analyses of the pooled sample showed that affect (ß = -0.21, p < 0.001), domestic life and work (ß = -0.16, p < 0.001) and interpersonal activities (ß = -0.15, p < 0.001) were the most affected functioning domains. When the analysis was stratified by gender, women showed similar patterns to the total sample, whereas mobility, self-care, cognition and pain were not significant amongst men. The cross-national analysis revealed that difficulties in affect and interpersonal activities were common across countries, whereas the rest of the domains showed country variability. In addition, being a woman (ß = -0.05), being older (ß = 0.07), being married (ß = 0.05), not having a comorbid condition (ß = -0.03) and having a higher education (ß = 0.04) were all factors associated with higher levels of QoL. CONCLUSION There was a variation in the level of decrements in different functioning domains across countries. This is in line with the growing evidence that reporting functioning sum-scores obscures potential differences among people. Functioning tools should capture the distinctiveness among individuals in order to provide tailored responses.
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Affiliation(s)
- Kaloyan Kamenov
- Centro Investigación Biomédica en Red, Instituto de Salud Carlos IIIMadrid, Spain
- Department of Psychiatry, Universidad Autónoma de MadridMadrid, Spain
| | - Francisco Felix Caballero
- Centro Investigación Biomédica en Red, Instituto de Salud Carlos IIIMadrid, Spain
- Department of Psychiatry, Universidad Autónoma de MadridMadrid, Spain
- Instituto de Investigación Sanitaria del Hospital de La Princesa, Hospital Universitario de la PrincesaMadrid, Spain
| | - Marta Miret
- Centro Investigación Biomédica en Red, Instituto de Salud Carlos IIIMadrid, Spain
- Department of Psychiatry, Universidad Autónoma de MadridMadrid, Spain
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Neurological Institute “C. Besta” IRCCS FoundationMilan, Italy
| | - Päivi Sainio
- National Institute for Health and WelfareHelsinki, Finland
| | | | - Josep Maria Haro
- Centro de Investigación Biomédica en Red de Salud Mental, Parc Sanitari Sant Joan de DéuBarcelona, Spain
| | - Somnath Chatterji
- Department of Health Statistics and Information Systems, World Health OrganizationGeneva, Switzerland
| | - José Luis Ayuso-Mateos
- Centro Investigación Biomédica en Red, Instituto de Salud Carlos IIIMadrid, Spain
- Department of Psychiatry, Universidad Autónoma de MadridMadrid, Spain
- Instituto de Investigación Sanitaria del Hospital de La Princesa, Hospital Universitario de la PrincesaMadrid, Spain
| | - Maria Cabello
- Centro Investigación Biomédica en Red, Instituto de Salud Carlos IIIMadrid, Spain
- Department of Psychiatry, Universidad Autónoma de MadridMadrid, Spain
- Instituto de Investigación Sanitaria del Hospital de La Princesa, Hospital Universitario de la PrincesaMadrid, Spain
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Vittengl JR, Clark LA, Thase ME, Jarrett RB. Longitudinal social-interpersonal functioning among higher-risk responders to acute-phase cognitive therapy for recurrent major depressive disorder. J Affect Disord 2016; 199:148-56. [PMID: 27104803 PMCID: PMC4862892 DOI: 10.1016/j.jad.2016.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/18/2016] [Accepted: 04/11/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Social-interpersonal dysfunction increases disability in major depressive disorder (MDD). Here we clarified the durability of improvements in social-interpersonal functioning made during acute-phase cognitive therapy (CT), whether continuation CT (C-CT) or fluoxetine (FLX) further improved functioning, and relations of functioning with depressive symptoms and relapse/recurrence. METHOD Adult outpatients (N=241) with recurrent MDD who responded to acute-phase CT with higher risk of relapse (due to unstable or partial remission) were randomized to 8 months of C-CT, FLX, or pill placebo plus clinical management (PBO) and followed 24 additional months. We analyzed repeated measures of patients' social adjustment, interpersonal problems, dyadic adjustment, depressive symptoms, and major depressive relapse/recurrence. RESULTS Large improvements in social-interpersonal functioning occurring during acute-phase CT (median d=1.4) were maintained, with many patients (median=66%) scoring in normal ranges for 32 months. Social-interpersonal functioning did not differ significantly among C-CT, FLX, and PBO arms. Beyond concurrently measured residual symptoms, deterioration in social-interpersonal functioning preceded and predicted upticks in depressive symptoms and major depressive relapse/recurrence. LIMITATIONS Results may not generalize to other patient populations, treatment protocols, or measures of social-interpersonal functioning. Mechanisms of risk connecting poorer social-interpersonal functioning with depression were not studied. CONCLUSIONS Average improvements in social-interpersonal functioning among higher-risk responders to acute phase CT are durable for 32 months. After acute-phase CT, C-CT or FLX may not further improve social-interpersonal functioning. Among acute-phase CT responders, deteriorating social-interpersonal functioning provides a clear, measurable signal of risk for impending major depressive relapse/recurrence and opportunity for preemptive intervention.
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Affiliation(s)
- Jeffrey R. Vittengl
- Address correspondence to either author: Jeffrey R. Vittengl, Department of Psychology, Truman State University, 100 East Normal Street, Kirksville, MO 63501-4221, USA. Telephone: 1-660-785-6041. FAX: 1-660-785-7128. . Robin B. Jarrett, Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9149, USA.
| | | | - Michael E. Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Robin B. Jarrett
- Address correspondence to either author: Jeffrey R. Vittengl, Department of Psychology, Truman State University, 100 East Normal Street, Kirksville, MO 63501-4221, USA. Telephone: 1-660-785-6041. FAX: 1-660-785-7128. . Robin B. Jarrett, Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9149, USA.
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50
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Social functioning in major depressive disorder. Neurosci Biobehav Rev 2016; 69:313-32. [PMID: 27395342 DOI: 10.1016/j.neubiorev.2016.07.002] [Citation(s) in RCA: 353] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 06/15/2016] [Accepted: 07/05/2016] [Indexed: 12/18/2022]
Abstract
Depression is associated with social risk factors, social impairments and poor social functioning. This paper gives an overview of these social aspects using the NIMH Research and Domain Criteria 'Systems for Social Processes' as a framework. In particular, it describes the bio-psycho-social interplay regarding impaired affiliation and attachment (social anhedonia, hyper-sensitivity to social rejection, competition avoidance, increased altruistic punishment), impaired social communication (impaired emotion recognition, diminished cooperativeness), impaired social perception (reduced empathy, theory-of-mind deficits) and their impact on social networks and the use of social media. It describes these dysfunctional social processes at the behavioural, neuroanatomical, neurochemical and genetic levels, and with respect to animal models of social stress. We discuss the diagnostic specificity of these social deficit constructs for depression and in relation to depression severity. Since social factors are importantly involved in the pathogenesis and the consequences of depression, such research will likely contribute to better diagnostic assessments and concepts, treatments and preventative strategies both at the diagnostic and transdiagnostic level.
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