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Chermahini MB, Eadie J, Agarwal A, Stephenson C, Malakouti N, Nikjoo N, Jagayat J, Jarabana V, Shirazi A, Kumar A, Gizzarelli T, Gutierrez G, Khan F, Patel C, Yang M, Omrani M, Alavi N. Comparing the Efficacy of Electronically Delivered Cognitive Behavioral Therapy (e-CBT) to Weekly Online Mental Health Check-Ins for Generalized Anxiety Disorder-A Randomized Controlled Trial: Comparaison de l'efficacité de la thérapie cognitivo-comportementale délivrée par voie électronique (e-TCC) aux contrôles hebdomadaires en ligne de santé mentale pour le trouble d'anxiété généralisée - un essai randomisé contrôlé. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024:7067437241261933. [PMID: 39033431 DOI: 10.1177/07067437241261933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
BACKGROUND Generalized anxiety disorder (GAD) is a prevalent anxiety disorder characterized by uncontrollable worry, trouble sleeping, muscle tension, and irritability. Cognitive behavioural therapy (CBT) is one of the first-line treatments that has demonstrated high efficacy in reducing symptoms of anxiety. Electronically delivered CBT (e-CBT) has been a promising adaptation of in-person treatment, showing comparable efficacy with increased accessibility and scalability. Finding further scalable interventions that can offer benefits to patients requiring less intensive interventions can allow for better resource allocation. Some studies have indicated that weekly check-ins can also lead to improvements in GAD symptoms. However, there is a lack of research exploring the potential benefits of online check-ins for patients with GAD. OBJECTIVE This study aims to investigate the effects of weekly online asynchronous check-ins on patients diagnosed with GAD and compare it with a group receiving e-CBT. METHODS Participants (n e-CBT = 45; n check-in = 51) with GAD were randomized into either an e-CBT or a mental health check-in program for 12 weeks. Participants in the e-CBT program completed pre-designed modules and homework assignments through a secure online delivery platform where they received personalized feedback from a trained care provider. Participants in the mental health check-in condition had weekly asynchronous messaging communication with a care provider where they were asked structured questions with a different weekly theme to encourage conversation. RESULTS Both treatments demonstrated statistically significant reductions in GAD-7-item questionnaire (GAD-7) scores over time, but when comparing the groups there was no significant difference between the treatments. The number of participants who dropped out and baseline scores on all questionnaires were comparable for both groups. CONCLUSIONS The findings support the effectiveness of e-CBT and mental health check-ins for the treatment of GAD.
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Affiliation(s)
- Melinaz Barati Chermahini
- Department of Public Health Sciences, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Jazmin Eadie
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
- Department of Psychology, Faculty of Arts and Sciences, Queen's University, Kingston, Ontario, Canada
| | - Anika Agarwal
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Callum Stephenson
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Niloufar Malakouti
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Niloofar Nikjoo
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Jasleen Jagayat
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Vineeth Jarabana
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | | | - Anchan Kumar
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Tessa Gizzarelli
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Gilmar Gutierrez
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Ferwa Khan
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Charmy Patel
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Megan Yang
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Mohsen Omrani
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
- OPTT Inc., Toronto, Ontario, Canada
| | - Nazanin Alavi
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
- OPTT Inc., Toronto, Ontario, Canada
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Wadsworth DP, Cash B, Tulloch K, Couper R, Robson K, Fitzpatrick S. Conducting mental health research with rural and regional older Australians: Reflections and recommendations. Aust J Rural Health 2024. [PMID: 39003641 DOI: 10.1111/ajr.13165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/27/2024] [Accepted: 06/30/2024] [Indexed: 07/15/2024] Open
Abstract
AIMS This commentary aims to assist emerging leaders of mental health research with older rural Australians through (i) affirmation that others share the barriers, pitfalls and challenges being faced; (ii) reinforcing the rationale making this a pertinent area for research; and (iii) opening a dialogue for best practice to engage older rural Australians in mental health research. CONTEXT Supporting the mental health of older adults is a pertinent global challenge, none more so than in rural Australia where restricted access to services and supports are compounded by limited help-seeking behaviours and capacity to engage with support. Paradoxically, such limitations also extend to impact researchers' ability to engage rural older Australians in mental health research, particularly when combined with the stoicism and stigma that often envelopes mental health, and the contemporary challenges posed by the emergence of technology. Such challenges are however not often discussed, more-often sidelined in favour of reporting positive research outcomes, or seeing emerging researchers eschew such focus entirely. APPROACH Through this paper, the authors utilised critical self-appraisal and iterative reflection to identify four recommendations for undertaking contemporary mental health research with rural older Australians, namely to: plan realistically through a collaborative, authentic and respectful approach; identify community champions and build/maintain trust; diversify thought, approaches and methodology; and cast the research net far, wide and often. CONCLUSION By adopting recommendations, researchers can maximise accessibility to and possible participation in mental health research, providing foundations for older rural Australians' contributions to inform the development of policies and strategies to promote their health and well-being.
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Affiliation(s)
- Daniel P Wadsworth
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Manna Institute for Rural and Regional Mental Health, Albury, New South Wales, Australia
- Sunshine Coast Health Institute, Birtinya, Queensland, Australia
| | - Belinda Cash
- Manna Institute for Rural and Regional Mental Health, Albury, New South Wales, Australia
- Charles Sturt University, Albury, New South Wales, Australia
| | - Kristen Tulloch
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Rebekah Couper
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Kristy Robson
- Manna Institute for Rural and Regional Mental Health, Albury, New South Wales, Australia
- Three Rivers Department of Rural Health, Charles Sturt University, Albury, New South Wales, Australia
| | - Sally Fitzpatrick
- Manna Institute for Rural and Regional Mental Health, Albury, New South Wales, Australia
- Everymind, Newcastle, New South Wales, Australia
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Vakkalanka JP, Gadag K, Lavin L, Ternes S, Healy HS, Merchant KAS, Scott W, Wiggins W, Ward MM, Mohr NM. Telehealth Use and Health Equity for Mental Health and Substance Use Disorder During the COVID-19 Pandemic: A Systematic Review. Telemed J E Health 2024; 30:1205-1220. [PMID: 38227387 DOI: 10.1089/tmj.2023.0588] [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] [Indexed: 01/17/2024] Open
Abstract
Background: As a result of the COVID-19 public health emergency (PHE), telehealth utilization accelerated to facilitate health care management and minimize risk. However, those with mental health conditions and substance use disorders (SUD)-who represent a vulnerable population, and members of underrepresented minorities (e.g., rural, racial/ethnic minorities, the elderly)-may not benefit from telehealth equally. Objective: To evaluate health equality in clinical effectiveness and utilization measures associated with telehealth for clinical management of mental health disorders and SUD to identify emerging patterns for underrepresented groups stratified by race/ethnicity, gender, age, rural status, insurance, sexual minorities, and social vulnerability. Methods: We performed a systematic review in PubMed, Embase, Cochrane Central Register of Controlled Trials, and CINAHL through November 2022. Studies included those with telehealth, COVID-19, health equity, and mental health or SUD treatment/care concepts. Our outcomes included general clinical measures, mental health or SUD clinical measures, and operational measures. Results: Of the 2,740 studies screened, 25 met eligibility criteria. The majority of studies (n = 20) evaluated telehealth for mental health conditions, while the remaining five studies evaluated telehealth for opioid use disorder/dependence. The most common study outcomes were utilization measures (n = 19) or demographic predictors of telehealth utilization (n = 3). Groups that consistently demonstrated less telehealth utilization during the PHE included rural residents, older populations, and Black/African American minorities. Conclusions: We observed evidence of inequities in telehealth utilization among several underrepresented groups. Future efforts should focus on measuring the contribution of utilization disparities on outcomes and strategies to mitigate disparities in implementation.
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Affiliation(s)
- J Priyanka Vakkalanka
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Khyathi Gadag
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Lauren Lavin
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Sara Ternes
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Heather S Healy
- Hardin Library for the Health Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Kimberly A S Merchant
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Wakina Scott
- Office for the Advancement of Telehealth, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland, USA
| | - Whitney Wiggins
- Office for the Advancement of Telehealth, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland, USA
| | - Marcia M Ward
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
- Department of Anesthesia and Critical Care, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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Janssen NP, Guineau MG, Lucassen P, Hendriks GJ, Ikani N. Depressive symptomatology in older adults treated with behavioral activation: A network perspective. J Affect Disord 2024; 352:445-453. [PMID: 38387671 DOI: 10.1016/j.jad.2024.02.073] [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: 12/27/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Late-life depression is a serious mental health problem. Behavioral Activation (BA) is an effective, accessible psychotherapeutic treatment for older adults. However, little is known about which symptoms decrease and how associations between depressive symptoms change during BA treatment. METHODS Using data from a cluster-randomized trial for older adults with late-life depression, we estimated a partial correlation network and a relative importance network of depressive symptoms before and after 8 weeks of BA treatment in primary care (n = 96). Networks were examined with measures of network structure, connectivity, centrality as well as stability. RESULTS The most central symptoms at baseline and post-treatment were anhedonia, fatigue, and feeling depressed. In contrast, sleeping problems had the lowest centrality. The post-treatment network was significantly more interconnected than at baseline. Moreover, all symptoms were significantly more central at post-treatment. CONCLUSION Our findings highlight the utility of the network approach to better understand symptom networks of depressed older adults before and after BA treatment. Results show that network connectivity and centrality of all symptoms increased after treatment. Future studies should investigate longitudinal idiographic networks to explore symptom dynamics within individuals over time.
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Affiliation(s)
- Noortje P Janssen
- Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, 6525 GD Nijmegen, the Netherlands; Department of Primary and Community Care, Research Institute of Health Sciences, Radboud University Medical Centre Nijmegen, Nijmegen, the Netherlands; Institute for Integrated Mental Health Care Pro Persona, Nijmeegsebaan 61, 6525 DX Nijmegen, the Netherlands.
| | - Melissa G Guineau
- Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, 6525 GD Nijmegen, the Netherlands; Institute for Integrated Mental Health Care Pro Persona, Nijmeegsebaan 61, 6525 DX Nijmegen, the Netherlands.
| | - Peter Lucassen
- Department of Primary and Community Care, Research Institute of Health Sciences, Radboud University Medical Centre Nijmegen, Nijmegen, the Netherlands.
| | - Gert-Jan Hendriks
- Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, 6525 GD Nijmegen, the Netherlands; Institute for Integrated Mental Health Care Pro Persona, Nijmeegsebaan 61, 6525 DX Nijmegen, the Netherlands.
| | - Nessa Ikani
- Institute for Integrated Mental Health Care Pro Persona, Nijmeegsebaan 61, 6525 DX Nijmegen, the Netherlands; Department of Developmental Psychology, Tilburg University, Warandelaan 2, 5037 AB Tilburg, the Netherlands.
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Fischer S, Nilsen C. ADHD in older adults - a scoping review. Aging Ment Health 2024:1-8. [PMID: 38622905 DOI: 10.1080/13607863.2024.2339994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 03/30/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES This scoping review presents an overview of the available research on symptoms, comorbidities, and associated challenges among older adults with ADHD. METHOD The literature study followed Arksey and O'Malley's five-stage framework. The search was conducted in ProQuest Central, Scopus, PsycInfo, CINAHL, and PubMed. Articles were included if they were peer-reviewed, ethically approved primary studies, written in the English language, concerning ADHD, and including people 60 years of age and older. RESULTS The review included 17 articles. Symptoms of ADHD persist throughout life. Older adults with ADHD experience similar core symptoms as younger individuals, but their manifestation and intensity may differ. The most common comorbidity found was mental illness, for example depression and anxiety. ADHD in older adults is linked to several challenges, such as difficulty with relationships and social isolation. CONCLUSION Older adults with ADHD face various symptoms, comorbidities, and challenges that affect their quality of life. Age-related changes can amplify ADHD symptoms and increase the perceived burden of illness. More research is needed to understand the complex relationship between these factors and enable tailored interventions to improve their quality of life and well-being.
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Affiliation(s)
- Silke Fischer
- Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden
| | - Charlotta Nilsen
- Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden
- Stress Research Institute, Department of Psychology, Stockholm University, Sweden
- Aging Research Center, Karolinska Institutet/Stockholm University, Sweden
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Janssen NP, Hendriks GJ, Sens R, Lucassen P, Oude Voshaar RC, Ekers D, van Marwijk H, Spijker J, Bosmans JE. Cost-effectiveness of behavioral activation compared to treatment as usual for depressed older adults in primary care: A cluster randomized controlled trial. J Affect Disord 2024; 350:665-672. [PMID: 38244792 DOI: 10.1016/j.jad.2024.01.109] [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: 05/23/2023] [Revised: 12/23/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024]
Abstract
INTRODUCTION Depression in older adults is associated with decreased quality of life and increased utilization of healthcare services. Behavioral activation (BA) is an effective treatment for late-life depression, but the cost-effectiveness compared to treatment as usual (TAU) is unknown. METHODS An economic evaluation was performed alongside a cluster randomized controlled multicenter trial including 161 older adults (≥65 years) with moderate to severe depressive symptoms (PHQ-9 ≥ 10). Outcome measures were depression (response on the QIDS-SR), quality-adjusted life-years (QALYs) and societal costs. Missing data were imputed using multiple imputation. Cost and effect differences were estimated using bivariate linear regression models, and statistical uncertainty was estimated with bootstrapping. Cost-effectiveness acceptability curves showed the probability of cost-effectiveness at different ceiling ratios. RESULTS Societal costs were statistically non-significantly lower in BA compared to TAU (mean difference (MD) -€485, 95 % CI -3861 to 2792). There were no significant differences in response on the QIDS-SR (MD 0.085, 95 % CI -0.015 to 0.19), and QALYs (MD 0.026, 95 % CI -0.0037 to 0.055). On average, BA was dominant over TAU (i.e., more effective and less expensive), although the probability of dominance was only 0.60 from the societal perspective and 0.85 from the health care perspective for both QIDS-SR response and QALYs. DISCUSSION Although the results suggest that BA is dominant over TAU, there was considerable uncertainty surrounding the cost-effectiveness estimates which precludes firm conclusions.
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Affiliation(s)
- Noortje P Janssen
- Behavioural Science Institute, Radboud University, 6525 XZ Nijmegen, the Netherlands; Department of Primary and Community Care, Research Institute of Health Sciences, Radboud University Medical Centre Nijmegen, 6525 EZ Nijmegen, the Netherlands; Institute for Integrated Mental Health Care Pro Persona, 6525 DX Nijmegen, the Netherlands.
| | - Gert-Jan Hendriks
- Behavioural Science Institute, Radboud University, 6525 XZ Nijmegen, the Netherlands; Institute for Integrated Mental Health Care Pro Persona, 6525 DX Nijmegen, the Netherlands
| | - Renate Sens
- Department of Health Sciences, VU University, 1081 HV Amsterdam, the Netherlands
| | - Peter Lucassen
- Department of Primary and Community Care, Research Institute of Health Sciences, Radboud University Medical Centre Nijmegen, 6525 EZ Nijmegen, the Netherlands
| | - Richard C Oude Voshaar
- University of Groningen, Department of Psychiatry, University Medical Centre Groningen, 9713 GZ Groningen, the Netherlands
| | - David Ekers
- Mental Health and Addictions Research Group, Tees Esk and Wear Valleys NHS FT/University of York, TS60SZ York, UK
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, BN1 9PH Brighton, United Kingdom
| | - Jan Spijker
- Behavioural Science Institute, Radboud University, 6525 XZ Nijmegen, the Netherlands; Institute for Integrated Mental Health Care Pro Persona, 6525 DX Nijmegen, the Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, VU University, 1081 HV Amsterdam, the Netherlands
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Nagel LC, Tesky VA, Schall A, Müller T, König J, Pantel J, Stangier U. Compliance with CBT referral in nursing home residents diagnosed with depression: Results from a feasibility study. Heliyon 2024; 10:e23379. [PMID: 38148800 PMCID: PMC10750160 DOI: 10.1016/j.heliyon.2023.e23379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/27/2023] [Accepted: 12/01/2023] [Indexed: 12/28/2023] Open
Abstract
Objectives Patient-level factors that influence compliance with a recommendation for CBT in nursing home residents diagnosed with depression were identified. Methods Within a cluster-randomized trial on stepped care for depression in nursing homes (DAVOS-study, Trial registration: DRKS00015686), participants received an intake interview administered by a licensed psychotherapist. If psychotherapy was required, patients were offered a referral for CBT. Sociodemographic characteristics, severity of depression, loneliness, physical health, antidepressant medication, prior experience with psychotherapy, and attitudes towards own aging were assessed. A binary regression determined predictors of compliance with referral. Results Of 123 residents receiving an intake interview, 80 were recommended a CBT. Forty-seven patients (58.8 %) followed the recommendation. The binary logistic regression model on compliance with recommended CBT was significant, χ2(9) = 21.64, p = .010. Significant predictors were age (Odds Ratio (OR) = 0.9; 95 % Confidence Interval (CI) = 0.82, 0.99; p = .024) and depression (OR = 1.33; 95 % CI = 1.08, 1.65; p = .008). Conclusion Within the implemented setting compliance rate was comparable to other age groups. Future interventions should include detailed psychoeducation on the benefits of psychotherapy on mild depressive symptoms in older age and evidence-based interventions to address the stigma of depression. Interventions such as reminiscence-based methods or problem-solving could be useful to increase compliance with referral, especially in very old patients (80+). Language barriers and a culturally sensitive approach should be considered when screening residents.
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Affiliation(s)
| | | | - Arthur Schall
- Department of General Medicine, Goethe University, Frankfurt, Germany
| | - Tanja Müller
- Frankfurt Forum for Interdisciplinary Ageing Research, Goethe University, Frankfurt, Germany
| | - Jochem König
- Department of Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Johannes Pantel
- Department of General Medicine, Goethe University, Frankfurt, Germany
| | - Ulrich Stangier
- Department of Clinical Psychology, Goethe University, Frankfurt, Germany
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Wuthrich VM, Dickson SJ, Pehlivan M, Chen JTH, Zagic D, Ghai I, Neelakandan A, Johnco C. Efficacy of low intensity interventions for geriatric depression and anxiety - A systematic review and meta-analysis. J Affect Disord 2024; 344:592-599. [PMID: 37858732 DOI: 10.1016/j.jad.2023.10.093] [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: 03/08/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND This systematic review and meta-analysis examined the efficacy of low intensity psychological interventions for older adults (60+ years) with clinical anxiety and/or depressive disorders. METHOD Systematic review and meta-analysis of randomised control trials of low-intensity psychological interventions for anxiety and/or depression with an active or passive control condition (e.g., waitlist, treatment-as-usual or active control) in any setting. Low intensity psychological interventions (e.g., cognitive behaviour therapy [CBT]) targeted anxiety and/or depression as primary outcomes, were primarily self-help, and included support from trained practitioners/facilitators with <6 h total contact time (typically <30 min p/contact). RESULTS Seven studies consisting of 304 older adults (65-78 years, Mage = 70, SD = 4) were identified and six included in the meta-analysis of depression outcomes and three for anxiety. A random effects meta-analysis of group differences in symptom change from pre-post treatment found evidence favouring low intensity psychological interventions over passive control groups for the treatment of depressive and anxiety symptoms, with moderate effect sizes for depression (Cohen's d = -0.62) and large effect sizes for anxiety (Cohen's d = -0.84) at post-treatment. LIMITATIONS Results are limited by study design of included studies such that the efficacy of interventions compared to treatment-as-usual, non-CBT approaches, in adults >80 years and long-term effects are unknown. CONCLUSIONS There is some evidence supporting the clinical benefits of low intensity psychological interventions for depressive and anxiety symptoms in older adults compared to passive controls. More research is needed to examine efficacy compared to active control conditions, and among those over 80 years.
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Affiliation(s)
- Viviana M Wuthrich
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia.
| | - Sophie J Dickson
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Melissa Pehlivan
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Jessamine T-H Chen
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Dino Zagic
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Ishaan Ghai
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Aswathi Neelakandan
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Carly Johnco
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
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Parsons CE, Purves KL, Davies MR, Mundy J, Bristow S, Eley TC, Breen G, Hirsch CR, Young KS. Seeking help for mental health during the COVID-19 pandemic: A longitudinal analysis of adults' experiences with digital technologies and services. PLOS DIGITAL HEALTH 2023; 2:e0000402. [PMID: 38055730 DOI: 10.1371/journal.pdig.0000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 11/04/2023] [Indexed: 12/08/2023]
Abstract
The COVID-19 pandemic brought about dramatic changes in how patients access healthcare from its outset. Lockdown restrictions and remote working led to a proliferation of digital technologies and services, which also impacted mental health provisions. Against the backdrop of new and changing support services, along with an unprecedented emphasis on mental health, relatively little is known about how adults sought out and received support for their mental health during this period. With a sample of 27,574 adults assessed longitudinally online over 12 months of the pandemic in the UK, we analysed reports of help-seeking for mental health, as well as sources of treatment or support and the perceived helpfulness of treatments received. We observed that the proportions of participants who reported seeking help remained relatively consistent throughout the 12-month period (ranging from 12.6% to 17.0%). Online talking therapies were among the most frequently sought sources (15.3%), whereas online self-guided treatments were among the least frequently sought sources (5%). Telephone lines, both NHS and non-governmental, had marked treatment 'gaps'. These treatment gaps, where individuals sought treatment but did not receive it, were especially evident for men and older adults. Our findings underscore online talking therapies as being a widely-sought and helpful source of mental health support. This is important given the current global need for accessible treatment options.
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Affiliation(s)
- Christine E Parsons
- Department of Clinical Medicine, Interacting Minds Center, Aarhus University, Aarhus, Denmark
| | - Kirstin L Purves
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- NIHR Maudsley Biomedical Research Centre, King's College London, United Kingdom
| | - Molly R Davies
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- NIHR Maudsley Biomedical Research Centre, King's College London, United Kingdom
| | - Jessica Mundy
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Shannon Bristow
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- NIHR Maudsley Biomedical Research Centre, King's College London, United Kingdom
| | - Thalia C Eley
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- NIHR Maudsley Biomedical Research Centre, King's College London, United Kingdom
| | - Gerome Breen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- NIHR Maudsley Biomedical Research Centre, King's College London, United Kingdom
| | - Colette R Hirsch
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Katherine S Young
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- NIHR Maudsley Biomedical Research Centre, King's College London, United Kingdom
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Lee YJ, Palmer J, Cline AC, Lee H. Factors Influencing the Health Care Utilization Among People With Depression and/or Anxiety Symptoms. J Am Psychiatr Nurses Assoc 2023:10783903231197655. [PMID: 37724452 PMCID: PMC10988633 DOI: 10.1177/10783903231197655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
BACKGROUND This analysis aimed to examine the factors predictive of service utilization among patients with anxiety and/or depression. Quick and appropriate treatment for anxiety and depression can reduce disease burden and improve social functioning. Currently, less than half of the population with comorbid anxiety and depression receives the recommended treatment. AIMS This analysis aims to identify factors predictive of utilizing mental health treatment for those with anxiety and/or depression by analyzing intrinsic, patient-centered factors. METHOD This study is a cross-sectional cohort analysis using National Health Interview Survey (NHIS) 2019 data. The sample size is 7,156 adults aged 18 to 64 with family incomes ≤100% of the federal poverty level. We used multivariate logistic regression analysis to identify factors predictive of care utilization in this population. Variables of interest include scores on Patient Health Questionnaire-8 (PHQ-8) and Generalized Anxiety Disorder-7 (GAD-7), service utilization, level of social functioning, having a usual source for care, and previous mental health care utilization. Additional covariates were age, gender, race, country of origin, education, marital status, and insurance coverage. RESULTS Twenty-one percent of respondents reported using mental health services. Factors predictive of care utilization were older age, female gender, limited social functioning, having a usual source of care, and insurance coverage. CONCLUSION There are significant barriers to receiving quick and appropriate care for anxiety and/or depression. Strategies should focus on reducing barriers for young adults, men, and the uninsured/underinsured. Strategies for integrating mental health services into primary care could increase the percentage of people with anxiety and/or depression who receive services.
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Affiliation(s)
- Young Ji Lee
- Young Ji Lee, PhD, MSN, RN, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Josh Palmer
- Joshua Palmer, DNP, PMHNP-BC, RN, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Alice Curtis Cline
- Alice Curtis Cline, MSN, CNM. PhD, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Heeyoung Lee
- Heeyoung Lee, PhD, PMHNP-BC, FAAN, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
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11
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Janssen NP, Lucassen P, Huibers MJH, Ekers D, Broekman T, Bosmans JE, Van Marwijk H, Spijker J, Oude Voshaar R, Hendriks GJ. Behavioural Activation versus Treatment as Usual for Depressed Older Adults in Primary Care: A Pragmatic Cluster-Randomised Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2023; 92:255-266. [PMID: 37385226 DOI: 10.1159/000531201] [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: 02/02/2023] [Accepted: 05/19/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION Effective non-pharmacological treatment options for depression in older adults are lacking. OBJECTIVE The effectiveness of behavioural activation (BA) by mental health nurses (MHNs) for depressed older adults in primary care compared with treatment as usual (TAU) was evaluated. METHODS In this multicentre cluster-randomised controlled trial, 59 primary care centres (PCCs) were randomised to BA and TAU. Consenting older (≥65 years) adults (n = 161) with clinically relevant symptoms of depression (PHQ-9 ≥ 10) participated. Interventions were an 8-week individual MHN-led BA programme and unrestricted TAU in which general practitioners followed national guidelines. The primary outcome was self-reported depression (QIDS-SR16) at 9 weeks and 3, 6, 9, and 12-month follow-up. RESULTS Data of 96 participants from 21 PCCs in BA and 65 participants from 16 PCCs in TAU, recruited between July 4, 2016, and September 21, 2020, were included in the intention-to-treat analyses. At post-treatment, BA participants reported significantly lower severity of depressive symptoms than TAU participants (QIDS-SR16 difference = -2.77, 95% CI = -4.19 to -1.35), p < 0.001; between-group effect size = 0.90; 95% CI = 0.42-1.38). This difference persisted up to the 3-month follow-up (QIDS-SR16 difference = -1.53, 95% CI = -2.81 to -0.26, p = 0.02; between-group effect size = 0.50; 95% CI = 0.07-0.92) but not up to the 12-month follow-up [QIDS-SR16 difference = -0.89 (-2.49 to 0.71)], p = 0.28; between-group effect size = 0.29 (95% CI = -0.82 to 0.24). CONCLUSIONS BA led to a greater symptom reduction of depressive symptoms in older adults, compared to TAU in primary care, at post-treatment and 3-month follow-up, but not at 6- to 12-month follow-up.
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Affiliation(s)
- Noortje P Janssen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Department of Primary and Community Care, Research Institute of Health Sciences, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
- Institute for Integrated Mental Health Care Pro Persona, Nijmegen, The Netherlands
| | - Peter Lucassen
- Department of Primary and Community Care, Research Institute of Health Sciences, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Marcus J H Huibers
- NPI Centre for Personality Disorders/Arkin Amsterdam, Amsterdam, The Netherlands
| | - David Ekers
- Mental Health and Addictions Research Group, Tees Esk and Wear Valleys NHS FT/University of York, York, UK
| | | | - Judith E Bosmans
- Department of Health Sciences, VU University, Amsterdam, The Netherlands
| | - Harm Van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Jan Spijker
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Institute for Integrated Mental Health Care Pro Persona, Nijmegen, The Netherlands
| | - Richard Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Gert-Jan Hendriks
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Institute for Integrated Mental Health Care Pro Persona, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
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12
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Efficacy of virtual interventions for reducing symptoms of depression in community-dwelling older adults: a systematic review. Int Psychogeriatr 2023; 35:131-141. [PMID: 35603891 DOI: 10.1017/s1041610222000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Older adults experience symptoms of depression, leading to suffering and increased morbidity and mortality. Although we have effective depression therapies, physical distancing and other public health measures have severely limited access to in-person interventions. OBJECTIVE To describe the efficacy of virtual interventions for reducing symptoms of depression in community-dwelling older adults. DESIGN Systematic review. SETTING We searched MEDLINE, EMBASE, Cochrane Libraries, PsycINFO, and gray literature from inception to July 5, 2021. PARTICIPANTS AND INTERVENTIONS We included randomized trials (RCTs) comparing the efficacy of virtual interventions to any other virtual intervention or usual care in community-dwelling adults ≥60 years old experiencing symptoms of depression or depression as an outcome. MEASUREMENTS The primary outcome was change in symptoms of depression measured by any depression scale. RESULTS We screened 12,290 abstracts and 830 full text papers. We included 15 RCTs (3100 participants). Five RCTs examined persons with depression symptoms at baseline and ten examined depression as an outcome only. Included studies demonstrated feasibility of interventions such as internet or telephone cognitive behavioral therapy with some papers showing statistically significant improvement in depressive symptoms. CONCLUSIONS There is a paucity of studies examining virtual interventions in older adults with depression. Given difficulty in accessing in-person therapies in a pandemic and poor access for people living in rural and remote regions, there is an urgent need to explore efficacy, effectiveness, and implementation of virtual therapies.
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13
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Tan J, Ma C, Zhu C, Wang Y, Zou X, Li H, Li J, He Y, Wu C. Prediction models for depression risk among older adults: systematic review and critical appraisal. Ageing Res Rev 2023; 83:101803. [PMID: 36410622 DOI: 10.1016/j.arr.2022.101803] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To provide an overview of prediction models for the risk of major depressive disorder (MDD) among older adults. METHODS We conducted a systematic review combined with a meta-analysis and critical appraisal of published studies on existing geriatric depression risk models. RESULTS The systematic search screened 23,378 titles and abstracts; 14 studies including 20 prediction models were included. A total of 16 predictors were selected in the final model at least twice. Age, physical health, and cognitive function were the most common predictors. Only one model was externally validated, two models were presented with a complete equation, and five models examined the calibration. We found substantial heterogeneity in predictor and outcome definitions across models; important methodological information was often missing. All models were rated at high or unclear risk of bias, primarily due to methodological limitations. The pooled C-statistics of 12 prediction models was 0.83 (95%CI=0.77-0.89). CONCLUSION The usefulness of all models remains unclear due to several methodological limitations. Future studies should focus on methodological quality and external validation of depression risk prediction models.
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Affiliation(s)
- Jie Tan
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China; School of Public Health, Wuhan University, Wuhan, Hubei, China
| | - Chenxinan Ma
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Chonglin Zhu
- College of Pharmacy, Southwest Medical University, Luzhou, Sichuang, China
| | - Yin Wang
- College of Management Science, Chengdu University of Technology, Chengdu, Sichuan, China
| | - Xiaoshuang Zou
- College of Basic Medicine Science, Shenyang Medical College, Shenyang, Liaoning, China
| | - Han Li
- School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
| | - Jiarun Li
- School of Basic Medicine, Guizhou Medical University, Guiyang, Guizhou, China
| | - Yanxuan He
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China.
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14
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Miyawaki CE, McClellan A, Bouldin ED, Brohard C, Spencer H, Tahija N, Kunik ME. Feasibility and Efficacy of Life Review Delivered by Virtually-Trained Family Caregivers. J Alzheimers Dis 2023; 95:573-583. [PMID: 37545241 DOI: 10.3233/jad-230371] [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] [Indexed: 08/08/2023]
Abstract
BACKGROUND Due to the high prevalence of depressive symptoms and Alzheimer's disease and related dementias in older Americans (≥65 years), we developed a six-week depression intervention, Caregiver-Provided Life Review (C-PLR) for care recipients (CRs) with early-stage dementia and mild depression. OBJECTIVE The objective of the study was to examine the feasibility and efficacy of C-PLR delivered by virtually-trained caregivers (CGs) on CRs who live with dementia and depression in community and long-term care settings (N = 25 CG-CR dyads). METHODS We used fidelity scores as a measure of CG's feasibility to provide C-PLR. We collected the pre- and post-measures on CRs' depression (primary outcome), life satisfaction, CGs' burden, positive aspects of caregiving, and CG-CR relationship quality (secondary outcomes) and compared them using paired t-tests. We evaluated if the effect differed by race/ethnicity, residential setting, or living alone. RESULTS The average fidelity check-in score was 14.8±0.78 indicating high feasibility. CGs were 52 years old (mean), 88% female, 64% working, 72% college-educated, and 72% in good-excellent health. CRs were 81 years old (mean), 84% female, and 56% in poor-fair health. CRs' depression significantly improved (p < 0.001), and this effect was found in CRs who were Asian (p = 0.017), White (p = 0.040), community-dwelling (p < 0.001), lived alone (p = 0.045), or with others (p = 0.002). CONCLUSION This study demonstrated that the C-PLR can be successfully taught to CGs virtually and is effective in reducing CR's depressive symptoms. C-PLR could be implemented more broadly to improve symptoms among CRs in community and residential settings, as well as among a diverse population of CRs.
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Affiliation(s)
| | - Angela McClellan
- Baylor University Diana R. Garland School of Social Work, Waco, TX, USA
| | - Erin D Bouldin
- Health Services Research & Development, Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
- University of Utah, Department of Internal Medicine, Salt Lake City, UT, USA
| | - Cheryl Brohard
- University of Houston College of Nursing, Sugar Land, TX, USA
| | - Helen Spencer
- University of Houston Graduate College of Social Work, Houston, TX, USA
| | | | - Mark E Kunik
- VA South Central Mental Illness Research, Education and Clinical Center & Baylor College of Medicine, Houston, TX, USA
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15
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Gluckman NS, Eagle A, Michalitsi M, Reynolds N. Adapting to the COVID-19 Pandemic: A Psychological Crisis Support Call Service Within a Community Mental Health Team. Community Ment Health J 2023; 59:25-34. [PMID: 35737200 PMCID: PMC9219371 DOI: 10.1007/s10597-022-00985-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/06/2022] [Indexed: 01/07/2023]
Abstract
To mitigate potential mental health crises within a Community Mental Health Team (CMHT) the psychology department implemented a short-term, rapid access, crisis telephone support service for clients during the COVID-19 pandemic. We aimed to evaluate the feasibility and acceptability. Data was collected on who the service was offered to and whom engaged. Demographic information, referral and crisis support call information was collected from the service's electronic database. Forty-four participants were referred to the service. Seventy seven percent of participants engaged in one or more telephone sessions. Participants rated the service as highly useful, with simply 'talking to someone' seen as the most important aspect of the calls. A number of age differences were noted regarding the content that was discussed in sessions. The psychological crisis telephone support service was feasible and acceptable to service users during the COVID-19 pandemic.
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Affiliation(s)
- Nicole S Gluckman
- North Kensington and Chelsea Community Mental Health Team, Central and North West London NHS Trust, Pall Mall Mental Health Centre, 150 Barlby Road, London, W10 6BS, UK.,Department of Clinical Psychology, University of East London, London, UK
| | - Andrew Eagle
- North Kensington and Chelsea Community Mental Health Team, Central and North West London NHS Trust, Pall Mall Mental Health Centre, 150 Barlby Road, London, W10 6BS, UK
| | - Maria Michalitsi
- North Kensington and Chelsea Community Mental Health Team, Central and North West London NHS Trust, Pall Mall Mental Health Centre, 150 Barlby Road, London, W10 6BS, UK
| | - Nicola Reynolds
- North Kensington and Chelsea Community Mental Health Team, Central and North West London NHS Trust, Pall Mall Mental Health Centre, 150 Barlby Road, London, W10 6BS, UK. .,Department of Clinical Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK.
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16
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Häger M, Boman E, Forsman AK. Meeting the Needs of Older Adults with Mental Ill-Health in Non-Psychiatric Care Settings: Self-Rated Confidence in Helping and its Co-Variates within a Multiprofessional Study Sample. Gerontol Geriatr Med 2023; 9:23337214231179819. [PMID: 37457398 PMCID: PMC10338893 DOI: 10.1177/23337214231179819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/14/2023] [Accepted: 05/15/2023] [Indexed: 07/18/2023] Open
Abstract
In this paper we sought to explore health and social care professionals' self-rated confidence in helping older adults with mental ill-health in non-psychiatric care settings. A cross-sectional survey study was performed exploring the participants' (n = 480) confidence in helping. Confidence in helping was analyzed together with background characteristics and selected explanatory variables, such as the workplace and work experience of the participants, their personal experiences of and attitudes to mental ill-health, as well as their knowledge in mental ill-health among older adults, by means of descriptive statistics and logistic regression analysis. We found that approximately half (55%) of the participants were confident in helping older adults with mental ill-health. The odds ratios for being confident in helping were significantly associated to the workplace of the professionals, professionals' attitude to and experience of mental ill-health, and knowledge of mental health among older adults. To increase confidence in helping older adults with mental ill-health, we recommend confidence-building interventions, for example, educational programs, through which knowledge of mental health among older adults is increased and negative attitudes are challenged, especially within the context of specialist somatic healthcare.
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Affiliation(s)
- Magdalena Häger
- Åland University of Applied Sciences, Mariehamn, Finland
- Åbo Akademi University, Vaasa, Finland
| | - Erika Boman
- Åland University of Applied Sciences, Mariehamn, Finland
- Umeå University, Sweden
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17
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Adams C, Gringart E, McAullay D, Sim M, Scarfe B, Budrikis A, Strobel N. Older adults access to mental health and social care services during COVID-19 restrictions in Western Australia. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2022. [DOI: 10.1080/00049530.2022.2139196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Claire Adams
- Kurongkurl Katitjin, Edith Cowan University, Perth, Australia
- School of Arts and Humanities, Edith Cowan University, Perth, Australia
| | - Eyal Gringart
- School of Arts and Humanities, Edith Cowan University, Perth, Australia
| | - Daniel McAullay
- Kurongkurl Katitjin, Edith Cowan University, Perth, Australia
| | - Moira Sim
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Brigitta Scarfe
- Kurongkurl Katitjin, Edith Cowan University, Perth, Australia
| | - Amy Budrikis
- Kurongkurl Katitjin, Edith Cowan University, Perth, Australia
| | - Natalie Strobel
- Kurongkurl Katitjin, Edith Cowan University, Perth, Australia
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18
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Chen JTH, Wuthrich VM, Zagic D. Practitioners’ use of exposure therapy in older adults with anxiety disorders. AUSTRALIAN PSYCHOLOGIST 2022. [DOI: 10.1080/00050067.2022.2134757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Jessamine T.-H. Chen
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia
- Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
| | - Viviana M. Wuthrich
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia
- Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
| | - Dino Zagic
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia
- Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
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19
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Getting Connected: a Retrospective Cohort Investigation of Video-to-Home Telehealth for Mental Health Care Utilization Among Women Veterans. J Gen Intern Med 2022; 37:778-785. [PMID: 36042096 PMCID: PMC9427431 DOI: 10.1007/s11606-022-07594-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 04/01/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Increasingly, women are serving in the military and seeking care at the Veterans Health Administration (VHA). Women veterans face unique challenges and barriers in seeking mental health (MH) care within VHA. VA Video Connect (VVC), which facilitates video-based teleconferencing between patients and providers, can reduce barriers while maintaining clinical effectiveness. OBJECTIVE Primary aims were to examine gender differences in VVC use, describe changes in VVC use over time (including pre-COVID and 6 months following the beginning of COVID), and determine whether changes over time differed by gender. DESIGN A retrospective cohort investigation of video-to-home telehealth for MH care utilization among veterans having at least 1 MH visit from October 2019 to September 2020. PARTICIPANTS Veterans (236,268 women; 1,318,024 men). INTERVENTIONS (IF APPLICABLE) VVC involves face-to-face, synchronous, video-based teleconferencing between patients and providers, enabling care at home or another private location. MAIN MEASURES Percentage of MH encounters delivered via VA Video Connect. KEY RESULTS Women veterans were more likely than men to have at least 1 VVC encounter and had a greater percentage of MH care delivered via VVC in FY20. There was an increase in the percentage of MH encounters that were VVC over FY20, and this increase was greater for women than men. Women veterans who were younger than 55 (compared to those 55 and older), lived in urban areas (compared to those in rural areas), or were Asian (compared to other races) had a greater percentage of MH encounters that were VVC since the start of the pandemic, controlling for the mean percentage of VVC MH encounters in the 6 months pre-pandemic. CONCLUSIONS VVC use for MH care is greater in women veterans compared to male veterans and may reduce gender-specific access barriers. Future research and VVC implementation efforts should emphasize maximizing patient choice and satisfaction.
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20
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Kapeloni A, Glover R. Encountering older adults in psychotherapy: The lived experience of therapists working with older adults in Ireland. EUROPEAN JOURNAL OF PSYCHOTHERAPY & COUNSELLING 2022. [DOI: 10.1080/13642537.2022.2070231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Agapi Kapeloni
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Rita Glover
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
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Psychological distress, multimorbidity and health services among older adults in rural South Australia. J Affect Disord 2022; 309:453-460. [PMID: 35490879 DOI: 10.1016/j.jad.2022.04.140] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Psychological distress may relate to higher health services use. However, data on psychological distress and health services use among rural older adults are limited. This study investigates psychological distress in older adults (aged ≥60) and evaluates the relationship between psychological distress, multimorbidity and health services utilization. DESIGN A cross-sectional design was adopted using data on older adults (≥60) (n = 5920) from the South Australia's 2013-2017 population health survey. The Modified Monash Model MM2-7 was used to designate rural areas. The dataset provides information on reported physical health conditions, psychological distress, and patterns of health services use. The Kessler Psychological Distress Scale (K10) was used to compute scores for reported mental health disorders in this population. RESULTS The mean (SD) age of the study participants was 72.1 (8.1) years. Women constituted 58.8% of the sample. The mean (SD) score for psychological distress was 12.5 (3.6). One-fourth (33.7%) report one-chronic condition, 20.4% reported 2 chronic conditions and 13% had more than 3 chronic conditions. High psychological distress was associated with female gender (χ2 = 14.4, p < 0.001), <80 years (χ2 = 11.7, p = 0.019), lower education (χ2 = 10.9, p = 0.027). Similarly, multimorbidity was associated with female gender (χ2 = 51.1, p < 001), increasing age (χ2 = 173.6, p < 0.001) and lower education (χ2 = 28.8 p < 0.001). Psychological distress and multimorbidity were independently associated with health service use. High psychological distress was associated with general practitioner (GP) visit (odds ratio 3.6 (95% CI 2.6-5.1), p < 0.001), emergency department (ED) visit (odds ratio 2.5 (95% CI 1.2-5.0), p < 0.001) and hospital admission (odds ratio 2.3 (95% CI 1.3-4.3), p < 0.001). Multimorbidity was associated with general practitioner (GP) visit (odds ratio 6.8 (95% CI 5.6-8.3), p < 0.001), emergency department (ED) visit (odds ratio 2.5 (95% CI 1.4-4.3), p < 0.001) and hospital admission (odds ratio 3.1 (95% CI 1.9-5.1), p < 0.001). Model included age, gender, education, number of chronic condition and psychological distress. CONCLUSION/IMPLICATION Psychological distress and multimorbidity were independently associated with health services use. Thus, psychological distress, particularly in the presence of multimorbidity, presents an opportunity for intervention by clinicians that may reduce the demand on rural health services.
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22
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Mulalint T, Seeherunwong A, Wanitkun N, Tongsai S. Determinants of continuing mental health service use among older persons diagnosed with depressive disorders in general hospitals: latent class analysis and GEE. BMC Health Serv Res 2022; 22:899. [PMID: 35818042 PMCID: PMC9275052 DOI: 10.1186/s12913-022-08250-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Prevalence of depression in older persons was a leading cause of disability. This group has the lowest access to service and retention in care compared to other age groups. This study aimed to explore continuing mental health service use and examined the predictive power of the mental health service delivery system and individual factors on mental health service use among older persons diagnosed with depressive disorders. Methods We employed an analytic cross-sectional study design of individual and organizational variables in 12 general hospitals selected using multi-stratified sampling. There were 3 clusters comprising community hospitals, advanced and standard hospitals, and university hospitals. Participants in each group were 150 persons selected by purposive sampling. We included older persons with a first or recurring diagnosis of a depressive disorder in the last 6 to 12 months of the data collection date. Data at the individual level included socio-demographic characteristics, Charlson Comorbidity Index, Attitude toward Depression and its treatment, and perceived social support. Data at the organizational level had hospital level, nurse competency, nurse-patient ratio, and appointment reminders. Descriptive statistics, Pearson chi-square test, latent class analysis (LCA), and marginal logistic regression model using generalized estimating equation (GEE) were used to analyze the data. Results The continuing mental health service use among older persons diagnosed with depressive disorders was 54%. The latent class analysis of four variables in the mental health services delivery organization yielded distinct and interpretable findings in two groups: high and low resource organization. The marginal logistic multivariable regression model using GEE found that organizational group and attitude toward depression and its treatment were significantly associated with mental health service use (p-value = 0.046; p-value = 0.003). Conclusions The findings suggest that improving continuing mental health services use in older persons diagnosed with depressive disorders should emphasize specialty resources of the mental health services delivery system and attitude toward depression and its treatment.
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Affiliation(s)
- Thida Mulalint
- D.N.S. Candidate, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Acharaporn Seeherunwong
- Department of Mental Health and Psychiatric Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand.
| | - Napaporn Wanitkun
- Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Sasima Tongsai
- Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Rens E, Michielsen J, Dom G, Remmen R, Van den Broeck K. Clinically assessed and perceived unmet mental health needs, health care use and barriers to care for mental health problems in a Belgian general population sample. BMC Psychiatry 2022; 22:455. [PMID: 35799153 PMCID: PMC9263045 DOI: 10.1186/s12888-022-04094-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/21/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Mental health problems often remain undetected and untreated. Prior research suggests that this is mainly due to a lack of need-perception and attitudinal barriers. The aim of this study is to examine unmet mental health needs using both a clinically assessed and a self-perceived approach in a Belgian province. METHODS A cross-sectional survey study with a weighted representative sample of 1208 individuals aged 15 - 80 years old was carried out in 2021 in the province of Antwerp (Belgium). Mental health needs were defined as a positive symptom screening for depression (PHQ-9), anxiety (GAD-7) or alcohol abuse (AUDIT-C and CAGE), combined with experiencing significant dysfunction in daily life. Also 12-month health care use for mental health problems, self-perceived unmet mental health needs and reasons for not seeking (extra) help were assessed. Logistic regression analyses were used to explore the predictors of mental health problems, health care use, and objective and subjective unmet mental health needs. RESULTS One in five participants had a positive screening on one of the scales, of whom half experienced dysfunction, leading to a prevalence of 10.4% mental health needs. Among those, only half used health care for their mental health, resulting in a population prevalence of 5.5% clinically assessed unmet mental health needs. Fourteen percent of the total sample perceived an unmet mental health need. However, more women and younger people perceived unmet needs, while clinically assessed unmet needs were higher among men and older people. One in six of the total sample used health care for their mental health, most of whom did not have a clinically assessed mental health need. Motivational reasons were most often endorsed for not seeking any help, while a financial barrier was the most important reason for not seeking extra help. CONCLUSIONS The prevalence of unmet mental health needs is high. Assessed and perceived (unmet) mental health needs are both relevant and complementary, but are predicted by different factors. More research is needed on this discrepancy.
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Affiliation(s)
- Eva Rens
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium. .,Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium. .,University of Antwerp, Gouverneur Kinsbergencentrum Room 00.56, Doornstraat 331, 2610, Wilrijk, Belgium.
| | - Joris Michielsen
- grid.11505.300000 0001 2153 5088Institute of Tropical Medicine (ITM), Antwerp, Belgium
| | - Geert Dom
- grid.5284.b0000 0001 0790 3681Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Roy Remmen
- grid.5284.b0000 0001 0790 3681Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
| | - Kris Van den Broeck
- grid.5284.b0000 0001 0790 3681Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium ,grid.5284.b0000 0001 0790 3681Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
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Cations M, Collier LR, Caughey G, Bartholomaeus J, Lang C, Crotty M, Harvey G, Wesselingh S, Corlis M, Inacio MC. Government-subsidised mental health services are underused in Australian residential aged care facilities. AUST HEALTH REV 2022; 46:432-441. [PMID: 35772928 DOI: 10.1071/ah22049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/15/2022] [Indexed: 11/23/2022]
Abstract
ObjectiveTo describe patterns of use of the available Government-subsidised mental health services among people living in Australian residential aged care facilities.MethodsA retrospective population-based trend analysis was conducted, including all non-Indigenous people living in an Australian facility between 2012 and 2017. Adjusted incidence proportions and trends were estimated for four groups of mental health services.ResultsThe use of Medicare-subsidised mental health services was very low overall. The proportion of residents who accessed primary care mental health services increased from 1.3% in 2012/2013 to 2.4% in 2016/2017, while psychiatry service use increased from 1.9 to 2.3%. Claims for clinical psychology increased from 0.18 to 0.26%, and claims for a registered psychologist, occupational therapist or social worker rose from 0.45 to 1.2%. People with dementia were less likely than people without dementia to access all services aside from psychiatry services.ConclusionsLess than 3% of residents accessed funding subsidies for mental health services and people with dementia experienced pronounced barriers to service access. Mental health care is a pillar of the publicly-funded health system in Australia, and low use of these services among aged care residents indicates a need for organisational and policy changes to improve access.
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Affiliation(s)
- Monica Cations
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia; and College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Luke R Collier
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia
| | - Gillian Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia; and Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Jonathan Bartholomaeus
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia
| | - Catherine Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Steven Wesselingh
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia
| | - Megan Corlis
- Aged Care and Research, Australian Nursing and Midwifery Foundation, Adelaide, SA, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia; and Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
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Aprahamian I, Borges MK, Hanssen DJC, Jeuring HW, Oude Voshaar RC. The Frail Depressed Patient: A Narrative Review on Treatment Challenges. Clin Interv Aging 2022; 17:979-990. [PMID: 35770239 PMCID: PMC9234191 DOI: 10.2147/cia.s328432] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/16/2022] [Indexed: 12/15/2022] Open
Abstract
Although the public importance of frailty is widely acknowledged by the World Health Organization, physical frailty is still largely neglected in geriatric mental health care. Firstly in this narrative review, we summarize the knowledge on the epidemiology of the association between depression and frailty, whereafter implications for treatment will be discussed. Even though frailty and depression have overlapping diagnostic criteria, epidemiological studies provide evidence for distinct constructs which are bidirectionally associated. Among depressed patients, frailty has predictive validity being associated with increased mortality rates and an exponentially higher fall risk due to antidepressants. Nonetheless, guidelines on the treatment of depression neither consider frailty for risk stratification nor for treatment selection. We argue that frailty assessment enables clinicians to better target the pharmacological and psychological treatment of depression as well as the need for interventions targeting primarily frailty, for instance, lifestyle interventions and reduction of polypharmacy. Applying a frailty informed framework of depression treatment studies included in a meta-analysis reveals that the benefit–harm ratio of antidepressants given to frail depressed patients can be questioned. Nonetheless, frail-depressed patients should not withhold antidepressants as formal studies are not available yet, but potential adverse effects should be closely monitored. Dopaminergic antidepressants might be preferable when slowness is a prominent clinical feature. Psychotherapy is an important alternative for pharmacological treatment, especially psychotherapeutic approaches within the movement of positive psychology, but this approach needs further study. Finally, geriatric rehabilitation, including physical exercise and nutritional advice, should also be considered. In this regard, targeting ageing-related abnormalities underlying frailty that may also be involved in late-life depression such as low-grade inflammation might be a promising target for future studies. The lack of treatment studies precludes firm recommendations, but more awareness for frailty in mental health care will open a plethora of alternative treatment options to be considered.
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Affiliation(s)
- Ivan Aprahamian
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Department of Internal Medicine, Jundiaí Medical School, Jundiaí, Brazil
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
- Correspondence: Ivan Aprahamian, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Division of Geriatrics, Department of Internal Medicine, Jundiaí Medical School, Jundiaí, Brazil, Email
| | - Marcus K Borges
- Federal University of Paraná, Department of Psychiatry, Curitiba, Brazil
| | - Denise J C Hanssen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
| | - Hans W Jeuring
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
| | - Richard C Oude Voshaar
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
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Choi NG, Vences K, Caamano J. Reasons for refusing referrals and challenges to effectual engagement in tele-treatment for depression among low-income homebound older adults. Aging Ment Health 2022; 26:1127-1135. [PMID: 33843370 PMCID: PMC8853830 DOI: 10.1080/13607863.2021.1910789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives: To describe reasons for refusal to be referred to or enroll in a depression treatment study and post-enrollment challenges to treatment engagement and technology-related problems among low-income homebound individuals aged 50+ years with depression.Methods: Data came from a 3-arm randomized clinical trial that evaluated real-world effectiveness of lay counselor-delivered behavioral activation (BA) versus clinician-delivered problem-solving therapy (PST). Interventionists were embedded in a large home-delivered meals program and treatment sessions were videoconferenced; hence Tele-BA and Tele-PST. We described refusal reasons of those who refused initial case manager referrals (n = 279), telephone screening (n = 64), enrollment (n = 47), or post-enrollment baseline assessments (n = 18). We used inductive thematic analysis to explore challenges to effectual treatment engagement and tele-delivery-related problems among Tele-PST or Tele-BA participants (n = 183) from the interventionists' tele-session process recordings.Results: More than a third of potentially eligible older adults refused their case managers' referral, and a quarter of those who accepted referral refused further screening or enrollment. Three quarters of those who refused reported no interest or need or declined to talk about depression. Others refused given their busy schedule with medical appointments and caregiving. Nearly 80% of Tele-BA or Tele-PST participants had some challenges to effectual engagement in treatment sessions due to environmental and health-related conditions and other life stressors including financial distress. Though many tele-sessions had connectivity and other technology-related problems, these did not affect depression outcomes.Conclusion: Mental health service providers for low-income older adults need to be aware of these challenges when adopting best practice strategies for them.
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Affiliation(s)
- Namkee G. Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Kelly Vences
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Julieta Caamano
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
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27
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Schuster JP, Strippoli MPF, Hoertel N, Marques-Vidal P, Vandeleur CL, Limosin F, Preisig M, von Gunten A. Healthcare use for major depressive disorders among middle-aged and older adults in the community. Soc Psychiatry Psychiatr Epidemiol 2022; 57:953-961. [PMID: 34842964 DOI: 10.1007/s00127-021-02193-8] [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] [Received: 05/19/2021] [Accepted: 10/31/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE There is a substantial gap between people having a mental disorder and those treated for this disorder. Studies that assessed the influence of age on healthcare use for major depressive disorder (MDD) have provided inconsistent results. We aimed to assess healthcare use in terms of treatment-seeking and psychotropic medication use in four age groups of 45- to 85-year-old community dwellers meeting criteria for MDD. METHODS Data stemmed from CoLaus|PsyCoLaus, a population-based prospective cohort study. Diagnostic information on mental disorders, utilization of professional healthcare and psychotropic drugs was elicited using a semi-structured interview. Associations between age groups and healthcare use were established using logistic regression models with serial adjustments for socio-demographic and depression characteristics as well as comorbid mental disorders and cardio-metabolic features. RESULTS Compared to participants of the youngest age group (ages 45 to 54 years), (1) those older than 75 years were less likely to use healthcare from psychiatrists or psychologists (OR: 0.4 [95% CI 0.17-0.96]), although the frequency of using any professional health care did not vary across age groups; (2) those older than 55 years used any psychotropic medication more frequently; and (3) those aged 55-64 years used antidepressants more frequently (OR: 1.61 [95% CI 1.07-2.44]), whereas those aged 65-74 years used anxiolytics more frequently (OR: 2.30 [95% CI 1.15-4.58]). CONCLUSION Age is a complex biological and social factor that influences healthcare use.
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Affiliation(s)
- Jean-Pierre Schuster
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV) and University of Lausanne, Prilly, Switzerland.
| | - Marie-Pierre F Strippoli
- Centre for Research in Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nicolas Hoertel
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France.,Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.,Centre Psychiatrie Et Neurosciences, Inserm Umr 894, Paris, France
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Caroline L Vandeleur
- Centre for Research in Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Frédéric Limosin
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France.,Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.,Centre Psychiatrie Et Neurosciences, Inserm Umr 894, Paris, France
| | - Martin Preisig
- Centre for Research in Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV) and University of Lausanne, Prilly, Switzerland
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Cremers G, Taylor E, Hodge L, Quigley A. Effectiveness and Acceptability of Low-intensity Psychological Interventions on the Well-being of Older Adults: A Systematic Review. Clin Gerontol 2022; 45:214-234. [PMID: 31507251 DOI: 10.1080/07317115.2019.1662867] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Growth in the older adult population and healthcare inequities mean there is a global need to increase access to early intervention in mental healthcare for older adults. This systematic review synthesized the evidence for the efficacy and acceptability of low-intensity psychological interventions (self-help, psychoeducation, bibliotherapy, internet cognitive-behavioral therapy: iCBT) for older adults with mild-to-moderate mental health problems.Methods: Ovid, EBSCOhost and ProQuest were searched for articles describing low-intensity psychological interventions. Pre and post outcome measures and a mean age of at least 50 (age range ≥40) were required for inclusion.Results: 26 articles (23 studies) described various interventions. Most studies were good quality and reported improvements in participant's mental health scores post intervention. Participants were more likely to be female, aged 60-70 and to be highly educated. Eight studies reported obtaining participant satisfaction ratings. Three studies included participants from rural areas.Conclusions: Low-intensity psychological interventions can be effective for older adults with mild-to-moderate mental health problems, but generalizability is constrained.Clinical Implications: Guided iCBT and bibliotherapy may be beneficial for adults in their 60s and 70s experiencing mild-to-moderate levels of depression. CBT may also be beneficial for reducing symptoms of mild-to-moderate anxiety. Providing the option of low-intensity psychological intervention, particularly iCBT, may help increase engagement with treatment.
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Affiliation(s)
- Gwendolyn Cremers
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK.,Psychological Services, NHS Borders, Melrose, UK
| | - Emily Taylor
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Lorna Hodge
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
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Mohlman J, Tsang W, Magee SA, Dalokay L, Basch C. Which Variant of Anxiety Is Associated with Smartphone Expertise in Community Dwelling Older Adults? Clin Gerontol 2022; 45:403-413. [PMID: 34928188 DOI: 10.1080/07317115.2021.2013382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Older adults vary greatly in their mastery of state-of-the-art smartphones. Anxiety may function as a barrier to technological expertise. This study characterizes an older community-dwelling sample (n = 71) in terms of their levels of demonstrated smartphone expertise relative to variants of anxiety (e.g., trait, social, tech-related). METHODS A 20-step behavioral smartphone challenge task, the Smartphone Task for Older Adults (STOA), was used to evaluate older adults' knowledge of a range of smartphone functions. Self-report measures of anxiety symptoms and perceived digital proficiency were also administered. RESULTS STOA scores were relatively low (x = 8.26, s.d. = 5.65) and showed negative relations with tech-anxiety and in-vivo frustration, but not social or trait anxiety. A hierarchical regression model indicated that tech-related anxiety and in-vivo frustration contributed significantly to STOA scores, above and beyond established predictors such as education. CONCLUSIONS Tech-anxiety and frustration while learning new smartphone functions may characterize the next cohort of older adults who have not effectively mastered the use of smartphones. CLINICAL IMPLICATIONS Anxiety management skills derived from cognitive behavior therapy and other self-regulation tools could help those who experience tech-anxiety or frustration during smartphone training, facilitating the development of expertise.
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Affiliation(s)
- Jan Mohlman
- Department of Psychology, William Paterson University, Wayne, New Jersey, USA
| | - William Tsang
- Department of Psychology, William Paterson University, Wayne, New Jersey, USA
| | - Sofia Alba Magee
- Department of Psychology, William Paterson University, Wayne, New Jersey, USA
| | - Lauren Dalokay
- Department of Psychology, William Paterson University, Wayne, New Jersey, USA
| | - Corey Basch
- Department of Public Health,William Paterson University, Wayne, New Jersey, USA
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30
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More evidence for problem-solving therapy: improving access is still a problem in need of solving. Int Psychogeriatr 2022; 34:105-107. [PMID: 34044902 DOI: 10.1017/s1041610221000077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Perkins L, Fisher E, Felstead C, Rooney C, Wong GHY, Dai R, Vaitheswaran S, Natarajan N, Mograbi DC, Ferri CP, Stott J, Spector A. Delivering Cognitive Stimulation Therapy (CST) Virtually: Developing and Field-Testing a New Framework. Clin Interv Aging 2022; 17:97-116. [PMID: 35173425 PMCID: PMC8841739 DOI: 10.2147/cia.s348906] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/28/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose This feasibility and pilot study aimed to develop and field-test a 14-session virtual Cognitive Stimulation Therapy (vCST) programme for people living with dementia, developed as a result of services moving online during the COVID-19 pandemic. Methods The vCST protocol was developed using the existing group CST manual, through stakeholder consultation with people living with dementia, caregivers, CST group facilitators and dementia service managers. This protocol was then field-tested with 10 groups of people living with dementia in the Brazil, China (Hong Kong), India, Ireland and the UK, and feedback on the protocol was gathered from 14 facilitators. Results Field testing in five countries indicated acceptability to group facilitators and participants. Feedback from these groups was used to refine the developed protocol. The final vCST protocol is proposed, including session materials for delivery of CST over videoconferencing and a framework for offering CST virtually in global settings. Conclusion vCST is a feasible online intervention for many people living with dementia. We recommend that it is offered to those unable to access traditional in-person CST for health reasons, lack of transport or COVID-19 restrictions. Further research is needed to explore if participant outcomes are comparable to in-person CST groups.
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Affiliation(s)
- Luke Perkins
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Emily Fisher
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Correspondence: Emily Fisher, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK, Tel +44 20 7679 5770, Email
| | - Cerne Felstead
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Claire Rooney
- Occupational Therapy Department, Older Persons Services, Our Lady’s Hospice and Care Services, Harold’s Cross, Dublin, Ireland
| | - Gloria H Y Wong
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong
| | - Ruizhi Dai
- Faculty of Social Sciences, University of Hong Kong, Hong Kong, Hong Kong
| | - Sridhar Vaitheswaran
- Dementia Care in Schizophrenia Research Foundation (DEMCARES), Chennai, Tamil Nadu, India
| | - Nirupama Natarajan
- Dementia Care in Schizophrenia Research Foundation (DEMCARES), Chennai, Tamil Nadu, India
| | - Daniel C Mograbi
- Department of Psychology, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Cleusa P Ferri
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Health Technology Assessment Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Joshua Stott
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Aimee Spector
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Podlipski PL, Tran E, Chrusciel J, Kaladjian A, Sanchez S. [Management of suicidal crisis in general practice: evaluation of care practices according to patient age]. Soins Psychiatr 2022; 43:42-48. [PMID: 35598914 DOI: 10.1016/j.spsy.2022.01.010] [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] [Indexed: 06/15/2023]
Abstract
Nearly 800,000 people die by suicide each year worldwide. Up to 75% of suicidal patients consulted their general practitioner in the months preceding their attempt. A study, conducted among 167 practitioners in Champagne-Ardenne in 2016-2017, aims to evaluate the practices of general practitioners in the management of suicidal crisis, particularly according to the age of the patient. It provides elements for reflection on their role in suicide prevention.
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Affiliation(s)
- Pierre-Luc Podlipski
- Pôle de psychiatrie des adultes, centre hospitalier universitaire de Reims, faculté de médecine de Reims, rue du Général-Koenig, 51100 Reims, France
| | - Eric Tran
- Pôle territorial santé publique et performance, unité de recherche clinique et de recherche en soins, Hôpitaux Champagne Sud, 101 avenue Anatole-France, 10000 Troyes, France
| | - Jan Chrusciel
- Pôle territorial santé publique et performance, unité de recherche clinique et de recherche en soins, Hôpitaux Champagne Sud, 101 avenue Anatole-France, 10000 Troyes, France
| | - Arthur Kaladjian
- Pôle de psychiatrie des adultes, centre hospitalier universitaire de Reims, faculté de médecine de Reims, rue du Général-Koenig, 51100 Reims, France
| | - Stéphane Sanchez
- Pôle territorial santé publique et performance, unité de recherche clinique et de recherche en soins, Hôpitaux Champagne Sud, 101 avenue Anatole-France, 10000 Troyes, France.
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Exploring the relationships between income and emotional/practical concerns and help-seeking by older adult cancer survivors: A secondary analysis. J Geriatr Oncol 2021; 13:337-345. [PMID: 34776383 DOI: 10.1016/j.jgo.2021.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/21/2021] [Accepted: 11/03/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE The number of older cancer survivors is growing rapidly and expected to double through the next decade. Survivors can face challenges from treatment as well as other co-morbid conditions which may influence quality of living and generate distress. Understanding more about factors influencing whether older cancer survivors receive the help they desire is important for cancer program planning. The purpose of this analysis was to understand relationships between income and emotional/practical concerns, help-seeking experiences and unmet needs of adults 65+ years one to three years following cancer treatment. MATERIALS AND METHODS A survey was conducted with randomly selected Canadian cancer survivors about their survivorship care. Drawing from these publicly available data, this secondary analysis examines prevalence of concerns, help-seeking, receipt of help, reasons for not seeking help, responses to information questions, and overall unmet needs for trends across income groups. RESULTS 7975 respondents 65+ years responded, of which the 5891 (73.9%) indicating annual household income were analyzed. Over 80% responded to questions regarding emotional/practical concerns following treatment with the largest proportions reporting emotional concerns for anxiety/fear of cancer returning (63%) and depression (49%), and practical concerns regarding transportation for appointments (33%) and paying healthcare bills (31%). Individuals with household incomes <$25,000 reported higher levels of concern than other income groups and higher proportions sought assistance for their concerns. Across income levels, 20% reported difficulty finding assistance to address their concerns. DISCUSSION Older cancer survivors across all income categories reported emotional/practical concerns, lack of information about these issues, and unmet needs regarding both emotional and practical concerns. Many encountered challenges obtaining help with those in lower income categories more severely affected despite Canada's universal health care system. Financial burden ought to be assessed with older survivors on an on-going basis to ensure relevant intervention.
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Liu Y, Gellatly J. Barriers and facilitators of engagement in psychological therapies among older adults with depression: A systematic review and thematic synthesis. J Psychiatr Ment Health Nurs 2021; 28:509-520. [PMID: 33043526 DOI: 10.1111/jpm.12697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/20/2020] [Accepted: 09/27/2020] [Indexed: 12/26/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: The utilization rate of psychological therapies is low in older adults with depression. The barriers and facilitators to engaging in psychological therapies experienced by older adults with depression are unclear. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Personal suitability for therapy engagement, practical abilities, personal therapy preferences, and familiarity with psychological therapies are associated with psychological therapy engagement. Psychological therapists can also impact psychological therapy engagement among older adults with depression. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Proving the effectiveness and suitability of chosen psychological therapies is important for improving therapy engagement. Strategies for handling functional impairments among older adults with depression are necessary for engaging this population in psychological therapies. Although in-home psychological therapies are accessible, barriers to handling the technologies used for delivering the therapies should be addressed. More methods of accessing information about psychological therapies should be available to older adults in order for them to increase their knowledge on the topic. Psychological therapists should have positive attitudes and the competence to treat depression in older adults. ABSTRACT INTRODUCTION: Although psychological therapies are preferred by older adults, the utilization rate of these therapies is significantly low in older adults with depression. Understanding the barriers and facilitators to engaging in psychological therapies experienced by older adults is important for improving utilization rates. AIM This review aimed to explore the barriers and facilitators to engaging in psychological therapies experienced by older adults with depression. METHODS A systematic review of qualitative studies on psychological therapy engagement among older adults with depression. Relevant published studies and grey literature were searched. The Critical Appraisal Skills Programme tool was used to assess the quality of the included studies. The results of the included studies were synthesized using thematic synthesis. RESULTS Personal suitability for therapy engagement, practical abilities, personal therapy preferences and familiarity with psychological therapies was associated with therapy engagement. Therapists' competencies also affected therapy engagement. DISCUSSION Older adult's personal health status and requirements for psychological therapy should be considered. IMPLICATIONS FOR PRACTICE Mental health practitioners should consider whether specific psychological therapies are beneficial and acceptable for older adults. Improvements are needed in older adult's familiarity with psychological therapies and the ability of therapists to address the mental problems of older adults.
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Affiliation(s)
- Yuan Liu
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Judith Gellatly
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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An Overview of Anxiety, Trauma-Related and Obsessive-Compulsive Disorders. CURRENT GERIATRICS REPORTS 2021. [DOI: 10.1007/s13670-021-00361-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Adams C, Gringart E, Strobel N, Masterman P. Help-seeking for mental health problems among older adults with chronic disease: an application of the theory of planned behaviour. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2021. [DOI: 10.1080/00049530.2021.1952850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Claire Adams
- School of Arts and Humanities, Edith Cowan University, Perth, Australia
| | - Eyal Gringart
- School of Arts and Humanities, Edith Cowan University, Perth, Australia
| | - Natalie Strobel
- Kurongkurl Katitjin, Edith Cowan University, Perth, Australia
| | - Paul Masterman
- School of Arts and Humanities, Edith Cowan University, Perth, Australia
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Lauderdale SA, Martin KJ, Oakes KR, Moore JM, Balotti RJ. Pragmatic Screening of Anxiety, Depression, Suicidal Ideation, and Substance Misuse in Older Adults. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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O’Donnell J, Pybis J, Bacon J. Counselling in the third sector: to what extent are older adults accessing these services and how complete are the data third sector services collect measuring client psychological distress? COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Jennifer O’Donnell
- British Association for Counselling and Psychotherapy (BACP) Lutterworth UK
| | - Joanne Pybis
- British Association for Counselling and Psychotherapy (BACP) Lutterworth UK
| | - Jeremy Bacon
- British Association for Counselling and Psychotherapy (BACP) Lutterworth UK
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Temple JB, Brijnath B, Enticott J, Utomo A, Williams R, Kelaher M. Discrimination reported by older adults living with mental health conditions: types, contexts and association with healthcare barriers. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1003-1014. [PMID: 32696302 DOI: 10.1007/s00127-020-01914-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 06/30/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Australian policy-making needs better information on the prevalence, context and types of discrimination reported by people living with mental health conditions and the association of exposure to discrimination with experiencing a barrier to accessing healthcare. METHODS Secondary data analysis using the national representative General Social Survey 2014 to examine discrimination and healthcare barriers. Multivariable logistic regression was used to examine the association between discrimination and barriers to healthcare. RESULTS Around 10% of older adults without mental health conditions reported an instance of discrimination in the last 12 months, compared to 22-25% of those with mental health conditions. Approximately 20% with mental health conditions attributed discrimination to their health conditions, along with other characteristics including age. Discrimination was reported in settings important to human capital (e.g., healthcare, workplace), but also in general social and public contexts. Everyday discrimination (OR = 2.11 p < 0.001), discrimination in healthcare (OR = 2.92 p < 0.001), and discrimination attributed to the person's health condition (OR = 1.99 p < 0.05) increased the odds of experiencing a barrier to care two-to-three-fold. For each type of discrimination reported (e.g., racism, ageism etc.), the odds of experiencing a barrier to care increased 1.3 times (OR = 1.29 p < 0.01). CONCLUSION This new population-level evidence shows older adults with mental health conditions are experiencing discrimination at more than twofold compared to those without mental health conditions. Discrimination was associated with preventing or delaying healthcare access. These findings indicate that future strategies to promote mental healthcare in underserved groups of older people will need to be multidimensional and consideration given to address discrimination.
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Affiliation(s)
- Jeromey B Temple
- Demography and Ageing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Bianca Brijnath
- Social Gerontology, National Ageing Research Institute (NARI), Parkville, Australia.
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
- Southern Synergy, Department of Psychiatry, Monash University, Melbourne, Australia
| | - Ariane Utomo
- School of Geography, Faculty of Science, University of Melbourne, Melbourne, Australia
| | - Ruth Williams
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Wuthrich VM, Meuldijk D, Jagiello T, Robles AG, Jones MP, Cuijpers P. Efficacy and effectiveness of psychological interventions on co-occurring mood and anxiety disorders in older adults: A systematic review and meta-analysis. Int J Geriatr Psychiatry 2021; 36:858-872. [PMID: 33368598 DOI: 10.1002/gps.5486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/19/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Co-occurring mood and anxiety disorders are common in older adult populations and are associated with worse long-term outcomes and poorer treatment response than either disorder alone. This systematic review and meta-analysis aimed to examine the efficacy and effectiveness of psychological interventions for treating co-occurring mood and anxiety disorders in older adults. METHOD The study was registered (PROSPERO CRD4201603834), databases systematically searched (MEDLINE, PSYCINFO, PubMed and Cochrane Reviews) and articles screened according to PRISMA guidelines. INCLUSION Participants aged ≥60 years with clinically significant anxiety and depression, psychological intervention evaluated against control in randomised controlled trial, changes in both anxiety and depression reported at post-treatment. ResultsFour studies were included (total n = 255, mean age range 67-71 years). Overall, psychological interventions (cognitive behavioural therapy, mindfulness) resulted in significant benefits over control conditions (active, waitlist) for treating depression in the presence of co-occurring anxiety (Hedges' g = -0.44), and treating anxiety in the presence of depression (Hedges' g = -0.55). However, conclusions are limited; the meta-analysis was non-significant, few studies were included, several were low quality and there was high heterogeneity between studies. Benefits at follow-up were not established. CONCLUSION Co-occurring anxiety and mood disorders can probably be treated simultaneously with psychological interventions in older adults with moderate effect sizes, however, more research is needed. Given comorbidity is common and associated with worse clinical outcomes, more high-quality clinical trials are needed that target the treatment of co-occurring anxiety and mood disorders, and report changes in diagnostic remission for both anxiety and mood disorders independently.
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Affiliation(s)
- Viviana M Wuthrich
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia.,Department of Psychology, Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, Australia
| | - Denise Meuldijk
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia.,Department of Psychology, Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, Australia
| | - Tess Jagiello
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Alberto González Robles
- Department of Basic, Clinical Psychology, and Neuropsychology, Universitat Jaume I, Castellón, Spain
| | - Michael P Jones
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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van Poelgeest EP, Pronk AC, Rhebergen D, van der Velde N. Depression, antidepressants and fall risk: therapeutic dilemmas-a clinical review. Eur Geriatr Med 2021; 12:585-596. [PMID: 33721264 PMCID: PMC8149338 DOI: 10.1007/s41999-021-00475-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/18/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE The aim of this clinical review was to summarize the existing knowledge on fall risk associated with antidepressant use in older adults, describe underlying mechanisms, and assist clinicians in decision-making with regard to (de-) prescribing antidepressants in older persons. METHODOLOGY We comprehensively examined the literature based on a literature search in Pubmed and Google Scholar, and identified additional relevant articles from reference lists, with an emphasis on the most commonly prescribed drugs in depression in geriatric patients. We discuss use of antidepressants, potential fall-related side effects, and deprescribing of antidepressants in older persons. RESULTS Untreated depression and antidepressant use both contribute to fall risk. Antidepressants are equally effective, but differ in fall-related side effect profile. They contribute to (or cause) falling through orthostatic hypotension, sedation/impaired attention, hyponatremia, movement disorder and cardiac toxicity. Falling is an important driver of morbidity and mortality and, therefore, requires prevention. If clinical condition allows, withdrawal of antidepressants is recommended in fall-prone elderly persons. An important barrier is reluctance of prescribers to deprescribe antidepressants resulting from fear of withdrawal symptoms or disease relapse/recurrence, and the level of complexity of deprescribing antidepressants in older persons with multiple comorbidities and medications. Practical resources and algorithms are available that guide and assist clinicians in deprescribing antidepressants. CONCLUSIONS (De-) prescribing antidepressants in fall-prone older adults is often challenging, but detailed insight in fall-related side effect profile of the different antidepressants and a recently developed expert-based decision aid STOPPFalls assists prescribers in clinical decision-making.
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Affiliation(s)
- E P van Poelgeest
- Department of Internal Medicine, Geriatrics, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands.
| | - A C Pronk
- Department of Internal Medicine, Geriatrics, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - D Rhebergen
- Amsterdam University Medical Center, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Mental Health Care Institute GGZ Centraal, Amersfoort, The Netherlands
| | - N van der Velde
- Department of Internal Medicine, Geriatrics, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Hohls JK, König HH, Eisele M, Mallon T, Mamone S, Wiese B, Weyerer S, Fuchs A, Pentzek M, Roehr S, Welzel F, Mösch E, Weeg D, Heser K, Wagner M, Scherer M, Maier W, Riedel-Heller SG, Hajek A. Help-seeking for psychological distress and its association with anxiety in the oldest old - results from the AgeQualiDe cohort study. Aging Ment Health 2021; 25:923-929. [PMID: 32081021 DOI: 10.1080/13607863.2020.1725737] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: This study aimed to examine aspects of help-seeking for psychological distress and its association with increased anxiety symptoms in the oldest old.Method: Baseline data from AgeQualiDe, a multicenter cohort study of people aged 85 and over recruited in primary care, were analyzed. Help-seeking for psychological distress (items from the Camberwell Assessment of Need for the Elderly) was analyzed using ordinal and logistic regression models as a function of increased anxiety symptoms (Geriatric Anxiety Inventory-Short Form ≥ 3), as well as relevant socio-demographic and health-related covariates.Results:N = 155 (18.1% of the sample) reported having experienced psychological distress recently and were thus included in the analysis. Among those, 26.5% reported experiencing increased anxiety symptoms. On a descriptive level, 76.8% sought informal, 29.0% sought formal, and 18.1% sought no help for psychological distress. In covariate-adjusted regression models, increased anxiety was significantly associated with increased use of informal support (OR: 2.92, 95% CI: 1.31-6.48), but was neither associated with formal (OR: 0.72, 95% CI: 0.26-1.97) nor no help-seeking (OR: 0.28, 95% CI: 0.08-1.05).Conclusion: A large proportion of those experiencing psychological distress sought support from informal sources in this study. Anxiety symptoms in the oldest old were associated with the increased use of informal support, but not formal support or no help-seeking. Training and support for people providing informal help to those with mental health problems should be promoted to reduce a possible burden. However, future research addressing underlying mechanisms is needed.
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Affiliation(s)
- Johanna Katharina Hohls
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marion Eisele
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tina Mallon
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Silke Mamone
- Hannover Medical School, Institute of General Practice, Hannover, Germany
| | - Birgitt Wiese
- Hannover Medical School, Institute of General Practice, Hannover, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Angela Fuchs
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Michael Pentzek
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Susanne Roehr
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Franziska Welzel
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Edelgard Mösch
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Dagmar Weeg
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Kathrin Heser
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Bonn, Germany
| | - Michael Wagner
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Martin Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Maier
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Smart EL, Berry K, Palmier-Claus J, Brown LJE. Aging well with psychosis. J Aging Stud 2021; 57:100925. [PMID: 34082995 DOI: 10.1016/j.jaging.2021.100925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 03/05/2021] [Accepted: 03/22/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite the unique challenges faced by people living with a severe mental illness, little work has been done to understand how these populations can age well. This study therefore aimed to explore the views of mid to older aged adults living with a psychosis on what it means to age well, and how they might be supported in this endeavor. RESEARCH DESIGN AND METHODS Semi-structured interviews were conducted with sixteen individuals (age 50-74 years) diagnosed with psychosis-related disorders (e.g. schizophrenia). Inductive thematic analysis was used to analyze the data. RESULTS Four themes were identified: (i) Engagement with Life - referring to participating in, and maintaining, activities that bring satisfaction and value; (ii) Attitude to Life and Aging - referring to a positive attitude and outlook, and accepting aging-related challenges; (iii) Health and Wellbeing - relating to keeping as physically and mentally fit as possible and (iv) Social Connections - referring to both personal and professional relationships, and feeling heard and understood by others. DISCUSSION AND IMPLICATIONS Whilst there were clear parallels between these results and those reported from other populations, participants aging with a psychosis revealed challenges, perceptions, and nuances that were unique to their situation. The importance of relationships with professionals, developing a mastery over their mental health difficulties, and the continued impact of stigma on aging well were highlighted. This suggests that approaches that target external societal factors, as well as therapeutic interventions focused on the individual, may help this population to age well.
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Affiliation(s)
- Emily L Smart
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Salford Royal Hospital Foundation NHS Trust, Salford, UK.
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | - Jasper Palmier-Claus
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK; Lancashire Care NHS Foundation Trust, UK.
| | - Laura J E Brown
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
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Witlox M, Garnefski N, Kraaij V, de Waal MWM, Smit F, Bohlmeijer E, Spinhoven P. Blended Acceptance and Commitment Therapy Versus Face-to-face Cognitive Behavioral Therapy for Older Adults With Anxiety Symptoms in Primary Care: Pragmatic Single-blind Cluster Randomized Trial. J Med Internet Res 2021; 23:e24366. [PMID: 33769293 PMCID: PMC8088844 DOI: 10.2196/24366] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/23/2020] [Accepted: 01/20/2021] [Indexed: 01/16/2023] Open
Abstract
Background Anxiety symptoms in older adults are prevalent and disabling but often go untreated. Most trials on psychological interventions for anxiety in later life have examined the effectiveness of face-to-face cognitive behavioral therapy (CBT). To bridge the current treatment gap, other treatment approaches and delivery formats should also be evaluated. Objective This study is the first to examine the effectiveness of a brief blended acceptance and commitment therapy (ACT) intervention for older adults with anxiety symptoms, compared with a face-to-face CBT intervention. Methods Adults aged between 55-75 years (n=314) with mild to moderately severe anxiety symptoms were recruited from general practices and cluster randomized to either blended ACT or face-to-face CBT. Assessments were performed at baseline (T0), posttreatment (T1), and at 6- and 12-month follow-ups (T2 and T3, respectively). The primary outcome was anxiety symptom severity (Generalized Anxiety Disorder-7). Secondary outcomes were positive mental health, depression symptom severity, functional impairment, presence of Diagnostic and Statistical Manual of Mental Disorders V anxiety disorders, and treatment satisfaction. Results Conditions did not differ significantly regarding changes in anxiety symptom severity during the study period (T0-T1: B=.18, P=.73; T1-T2: B=−.63, P=.26; T1-T3: B=−.33, P=.59). Large reductions in anxiety symptom severity (Cohen d≥0.96) were found in both conditions post treatment, and these were maintained at the 12-month follow-up. The rates of clinically significant changes in anxiety symptoms were also not different for the blended ACT group and CBT group (χ21=0.2, P=.68). Regarding secondary outcomes, long-term effects on positive mental health were significantly stronger in the blended ACT group (B=.27, P=.03, Cohen d=0.29), and treatment satisfaction was significantly higher for blended ACT than CBT (B=3.19, P<.001, Cohen d=0.78). No other differences between the conditions were observed in the secondary outcomes. Conclusions The results show that blended ACT is a valuable treatment alternative to CBT for anxiety in later life. Trial Registration Netherlands Trial Register TRIAL NL6131 (NTR6270); https://www.trialregister.nl/trial/6131
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Affiliation(s)
- Maartje Witlox
- Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Nadia Garnefski
- Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Vivian Kraaij
- Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Margot W M de Waal
- Department Public Health & Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Filip Smit
- Department of Mental Health & Prevention, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands.,Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands.,Department of Epidemiology & Biostatistics, Amsterdam University Medical Centers, VU University Medical Center, Amsterdam, Netherlands
| | - Ernst Bohlmeijer
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Philip Spinhoven
- Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands
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Translating evidence-based psychological interventions for older adults with depression and anxiety into public and private mental health settings using a stepped care framework: Study protocol. Contemp Clin Trials 2021; 104:106360. [PMID: 33766760 DOI: 10.1016/j.cct.2021.106360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND With expected increases in the number of older adults worldwide, the delivery of stepped psychological care for depression and anxiety in older populations may improve both treatment and allocative efficiency for individual patients and the health system. DESIGN A multisite pragmatic randomised controlled trial evaluating the clinical and cost-effectiveness of a stepped care model of care for treating depression and anxiety among older adults compared to treatment as usual (TAU) will be conducted. Eligible participants (n = 666) with clinically interfering anxiety and/or depression symptoms will be recruited from and treated within six Australian mental health services. The intervention group will complete a low intensity cognitive behavioural therapy (CBT) program: Internet-delivered or using a work-at-home book with brief therapist calls (STEP 1). Following STEP 1 a higher intensity face-to-face CBT (STEP 2) will then be offered if needed. Intention-to-treat analyses will be used to examine changes in primary outcomes (e.g. clinician-rated symptom severity changes) and secondary outcomes (e.g. self-reported symptoms severity, health related quality of life and service utilisation costs). An economic evaluation will be conducted using a cost-utility analysis to derive the incremental cost-effectiveness ratio for the stepped care intervention. DISCUSSION This study will demonstrate the relative clinical and economic benefits of stepped care model of psychological care for older adults experiencing anxiety and/or depression compared to TAU. The evaluation of the intervention within existing mental health services means that results will have significant implications for the translation of evidence-based interventions in older adult services across urban and rural settings. TRAIL REGISTRATION Prospectively registered on anzctr.org.au (ACTRN12619000219189) and isrctn.com (ISRCTN37503850).
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Abstract
As the number of older adults is expected to increase exponentially within the next few decades, loneliness, social isolation, and depression among seniors are growing public health concerns. Although formal treatment options, such as therapy and medication, can be helpful for depression, they can also be expensive and sometimes ineffective. It is therefore important to consider other potential treatment options and social interventions. Alternative methods for addressing mental health issues are especially important for older adults, as they may encounter barriers associated with aging such as limited mobility and decreased social networks. In these circumstances, online social networking may offer a potential "social cure" to alleviate loneliness, social isolation, and depression. The purpose of this scoping review was to gather and summarize the current literature on associations between online social networking and mental health outcomes (e.g., depression, life satisfaction, loneliness) among older adults. An initial search of 3,699 articles resulted in 52 articles that met criteria for inclusion. Five common themes were identified: (1) enhanced communication with family and friends, (2) greater independence and self-efficacy, (3) creation of online communities, (4) positive associations with well-being and life satisfaction, and (5) decreased depressive symptoms. Implications for older adults' mental health, social connectedness, programs and policies are discussed.
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Choi NG, Sullivan JE, Marti CN, Kunik ME. Religious coping and acceptability and outcome of short-term psychotherapeutic treatments for depression among low-income homebound older adults. Aging Ment Health 2021; 25:431-438. [PMID: 31791141 PMCID: PMC7694875 DOI: 10.1080/13607863.2019.1697204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To examine (1) correlates of religious coping, and (2) associations of religious coping at baseline with evaluation of treatment acceptability and depressive symptom severity outcomes of short-term psychotherapeutic depression treatments among 277 low-income homebound older adults (70% female; 41% non-Hispanic White, 30% African American, and 29% Hispanic) who participated in a treatment effectiveness trial. METHOD Religious coping was measured with a 2-item subscale of the Brief COPE. Treatment acceptability was measured with the 11-item Treatment Evaluation Inventory (TEI). Depressive symptoms were measured with the 24-item Hamilton Rating Scale for Depression (HAMD). We used linear regression modeling to examine correlates of religious coping at baseline and to examine associations of religious coping with treatment acceptability and depression outcome at 12 weeks. RESULTS Being female and being African American predicted higher religious coping. Additionally, active coping, emotional support coping, and clergy consultation on depression were significantly associated with higher religious coping. Religious coping was not significantly associated with TEI and HAMD scores at 12 weeks. CONCLUSION The findings show that once these older adults participate in depression treatment, they find it highly acceptable and benefit from treatment, regardless of their religious coping, and that psychotherapeutic treatment is a highly acceptable and effective addition to those with religious-oriented coping.
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Affiliation(s)
- Namkee G. Choi
- Corresponding author: 1925 San Jacinto Blvd, Austin, TX 78712; ; 512-232-9590
| | | | | | - Mark E Kunik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. Debakey VA Medical Center, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Baylor College of Medicine, Houston, TX, USA
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Banerjee D, Mukhopadhyay S. Relevance of the Indian telemedicine guidelines 2020 in psychogeriatric care: A critical appraisal. JOURNAL OF GERIATRIC MENTAL HEALTH 2021. [DOI: 10.4103/jgmh.jgmh_24_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Buczak-Stec E, Hajek A, van den Bussche H, Eisele M, Wiese B, Mamone S, Weyerer S, Werle J, Fuchs A, Pentzek M, Röhr S, Welzel F, Weeg D, Mösch E, Heser K, Wagner M, Riedel-Heller SG, Maier W, Scherer M, König HH. Frequent attendance in primary care in the oldest old: evidence from the AgeCoDe-AgeQualiDe study. Aging Clin Exp Res 2020; 32:2629-2638. [PMID: 32108287 DOI: 10.1007/s40520-020-01495-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND There are very few studies examining the determinants of frequent attendance in primary care among the oldest old. AIMS The purpose of this study was to determine the characteristics of frequent attendance among individuals aged 85 years or older. METHODS Cross-sectional data stem from the multicenter prospective cohort "Study on needs, health service use, costs and health-related quality of life in a large sample of oldest old primary care patients (85 +)" (AgeQualiDe). This study covers very old primary care patients (n = 861, mean age of 89.0 years ± 2.9; 85-100 years). The number of self-reported GP visits in the preceding 3 months was used to quantify frequent attenders. We defined patients in the top decile as frequent attenders. RESULTS Multiple logistic regressions showed that frequent attendance was associated with more chronic diseases (adjusted OR 1.12, 95% CI 1.01-1.23), worse functioning (OR 0.97, 95% CI 0.95-0.99), worries about one's financial situation (OR 2.20, 95% CI 1.07-4.53) and it was inversely associated with depression (OR 0.26, 95% CI 0.08-0.80). DISCUSSION In contrast to studies based on younger samples, different factors were associated with frequent users in our study, showing that it is important to study the determinants of frequent attendance among the oldest old. CONCLUSION In Germany, among the group of the oldest old, frequent attendance was positively associated with worse physical health status (e.g., number of chronic diseases), but negatively with depression. This might indicate that the German health care system is responsive to the physical, but not psychological needs of the oldest old.
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Hannaford S, Shaw R, Walker R. Older Adults’ Perceptions of Psychotherapy: What Is It and Who Is Responsible? AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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