1
|
Zachariae R, Christiansen P, Amidi A, Wu L, Ventzel L, Tauber N, Von Heymann A, Skjødt Rafn B, Fassov J, Juul T, Christensen P, Johansen C. The time has come for national clinical practice guidelines for managing late effects after cancer and cancer treatment. Acta Oncol 2024; 63:491-493. [PMID: 38910334 PMCID: PMC11332514 DOI: 10.2340/1651-226x.2024.40787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 05/23/2024] [Indexed: 06/25/2024]
Affiliation(s)
- Robert Zachariae
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark; Danish Breast Cancer Group Center for Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark.
| | - Peer Christiansen
- Danish Breast Cancer Group Center for Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark; Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Ali Amidi
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Lisa Wu
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Lise Ventzel
- Department of Oncology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Nina Tauber
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Annika Von Heymann
- Center for Cancer Late Effects (CASTLE), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bolette Skjødt Rafn
- Center for Cancer Late Effects (CASTLE), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Janne Fassov
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Therese Juul
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Christensen
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Christoffer Johansen
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
2
|
Sayer NA, Maieritsch KP, Yamokoski CA, Orazem RJ, Clothier BA, Noorbaloochi S. Evaluation of implementation facilitation integrated into a national mentoring programme to improve access to evidence-based psychotherapy for post-traumatic stress disorder within the veterans health administration: a quality improvement report. BMJ Open Qual 2024; 13:e002449. [PMID: 38216294 PMCID: PMC10806576 DOI: 10.1136/bmjoq-2023-002449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/07/2023] [Indexed: 01/14/2024] Open
Abstract
Despite the resources dedicated to specialised mental healthcare for patients with post-traumatic stress disorder (PTSD) within the US Veterans Health Administration, evidence-based psychotherapies (EBPs) for PTSD have been underutilised, as evidenced by low EBP reach to patients. A research-operation collaboration evaluated whether implementation facilitation delivered by regional PTSD mentors as part of a national mentoring programme improved EBP reach compared with less-intensive quality improvement interventions. We used a non-equivalent comparison-group design that included all PTSD clinics with low EBP reach at baseline (n=51). Clinics were grouped into one of four quality improvement conditions according to self-selection by regional PTSD mentors: facilitation (n=6), learning collaborative (n=15), mentoring as usual in the regions that had facilitation-target clinics (n=15) and mentoring as usual in other regions (n=15). The primary outcome was EBP reach among therapy patients with PTSD at preintervention baseline and postintervention sustainment periods. We used the ratio of odds ratios (ROR) between the two time periods to evaluate the effectiveness of facilitation compared with the other conditions, adjusting for patient-level and clinic-level confounders. 26 126 veterans with PTSD received psychotherapy in one of 51 low-reach PTSD clinics during preintervention baseline and postintervention sustainment periods. The odds of a patient receiving an EBP increased over time across conditions. The adjusted ORs of a patient receiving an EBP from baseline to sustainment were 1.35-1.69 times larger in clinics that received facilitation compared with the three comparison conditions (adjusted RORs of comparison condition versus facilitation ranged from 0.59 (95% CI 0.47 to 0.75) to 0.74 (95% CI 0.58 to 0.94)). Implementation facilitation can be integrated into a national programme for quality improvement for PTSD specialty care and may be particularly useful when less-intensive approaches are not sufficiently effective.
Collapse
Affiliation(s)
- Nina A Sayer
- CCDOR, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Kelly P Maieritsch
- Executive Division, National Center for PTSD, White River Junction VA Medical Center, White River Junction, Vermont, USA
| | - Cynthia A Yamokoski
- Executive Division, National Center for PTSD, White River Junction VA Medical Center, White River Junction, Vermont, USA
| | - Robert J Orazem
- CCDOR, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | | | - Siamak Noorbaloochi
- CCDOR, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
3
|
Kruzan KP, Ng A, Stiles-Shields C, Lattie EG, Mohr DC, Reddy M. The Perceived Utility of Smartphone and Wearable Sensor Data in Digital Self-tracking Technologies for Mental Health. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2023; 2023:88. [PMID: 38873656 PMCID: PMC11174977 DOI: 10.1145/3544548.3581209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Mental health symptoms are commonly discovered in primary care. Yet, these settings are not set up to provide psychological treatment. Digital interventions can play a crucial role in stepped care management of patients' symptoms where patients are offered a low intensity intervention, and treatment evolves to incorporate providers if needed. Though digital interventions often use smartphone and wearable sensor data, little is known about patients' desires to use these data to manage mental health symptoms. In 10 interviews with patients with symptoms of depression and anxiety, we explored their: symptom self-management, current and desired use of sensor data, and comfort sharing such data with providers. Findings support the use digital interventions to manage mental health, yet they also highlight a misalignment in patient needs and current efforts to use sensors. We outline considerations for future research, including extending design thinking to wraparound services that may be necessary to truly reduce healthcare burden.
Collapse
Affiliation(s)
| | - Ada Ng
- Northwestern University, Illinois, USA
| | | | | | | | - Madhu Reddy
- University of California Irvine, Irvine, USA
| |
Collapse
|
4
|
Friesen L, Gaine G, Klaver E, Burback L, Agyapong V. Key stakeholders’ experiences and expectations of the care system for individuals affected by borderline personality disorder: An interpretative phenomenological analysis towards co-production of care. PLoS One 2022; 17:e0274197. [PMID: 36137103 PMCID: PMC9499299 DOI: 10.1371/journal.pone.0274197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background The diagnosis of borderline personality disorder (BPD) consists of extreme emotional dysregulation and long-term disability when left untreated. It is associated with ineffective use of health care systems and mismanaged care in emergency departments, which can result in a revolving door phenomenon of urgent system usage, poor treatment outcomes, or patients falling out of care entirely–all of which primarily affect patients with BPD as well as their caregivers and clinicians. This crisis must be addressed with a comprehensive understanding of key stakeholder perspectives on the challenges of the system and potential solutions. Objective This study explored the perspectives of three key stakeholder groups (i.e., patients, clinicians, and caregivers) in relation to their experiences with and future expectations of the care system for those affected by BPD. Methods Four patients with BPD, three generalist clinicians with experience treating BPD, and three caregivers of individuals with BPD participated in individual semi-structured interviews. Participants were asked about their experiences with the current healthcare system and their suggestions for improvement. Responses were analyzed using interpretative phenomenological analysis. Findings In-depth analysis of the qualitative data revealed twelve shared themes and three themes that were unique to each key stakeholder group. These themes are discussed and used to inform recommendations for promising practices, policies, and training in this area. Conclusion Findings support the importance of a comprehensive mental health system approach for improving the accessibility, effectiveness, and acceptability of the management and treatment of BPD.
Collapse
Affiliation(s)
- Laura Friesen
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
- Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
- * E-mail:
| | - Graham Gaine
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
- Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ellen Klaver
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
- Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
| | - Lisa Burback
- Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Vincent Agyapong
- Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
5
|
Batista J, Marinai JC, Gouveia M, Oliveira JT, Gonçalves MM. Write and Let Go: An Online Writing Program for University Students. Front Psychol 2022; 13:874600. [PMID: 35874340 PMCID: PMC9301038 DOI: 10.3389/fpsyg.2022.874600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background There are a plethora of studies on expressive writing and positive writing interventions, but few have addressed the combination of both paradigms. Additionally, research on the role of ambivalence toward change in the context of writing-based interventions is lacking. Ambivalence toward change is a natural movement of approaching and avoiding change that may occur in various situations. In psychotherapy, its resolution is associated with successful outcomes. Aim This study tested the efficacy of a combination of expressive and positive writing paradigms in an internet-based intervention to improve university students' mental health. Additionally, focusing participants on a current, unresolved problem allowed us to explore the possible role of ambivalence toward change as a mediator of the intervention's results. Methods We recruited 172 participants who were randomly divided into experimental (n = 85) and control (n = 87) groups. The intervention consisted of the identification of a current problem and four writing tasks on consecutive days. Assessment was conducted at baseline and posttest in both groups and at follow-up in the experimental group. Participants in the experimental condition were also assessed after each task. Measures of anxiety, depression, rumination, ambivalence toward change, distress, and wellbeing (optimism, affect, and satisfaction with life) were collected. Results Multivariate analysis of variance (MANOVA) showed that participants in the experimental group had a significant decrease from baseline to posttest in ambivalence toward change and rumination when compared with the control group. These results were maintained at follow-up. No differences were found in the remaining measures. Within the experimental group, ambivalence toward change, rumination, and distress significantly decreased throughout the intervention and the exploratory mediation analysis indicated that ambivalence toward change partially mediated the improvements in rumination and distress. Discussion Considering different perspectives about a current problem and using a combination of expressive and positive writing fostered the reduction of ambivalence toward change and rumination. Ambivalence toward change reduction after the second writing task may have created optimal conditions for the subsequent decrease in rumination and distress. Future studies should replicate this finding and dismantle the components that are more adequate in changing these variables.
Collapse
|
6
|
Kaufman BG, Allen KD, Coffman CJ, Woolson S, Caves K, Hall K, Hoenig HM, Huffman KM, Morey MC, Hodges NJ, Ramasunder S, van Houtven CH. Cost and Quality of Life Outcomes of the STepped Exercise Program for Patients With Knee OsteoArthritis Trial. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:614-621. [PMID: 35365305 DOI: 10.1016/j.jval.2021.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/31/2021] [Accepted: 09/30/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to evaluate the cost-effectiveness of the randomized clinical trial STEP-KOA (STepped Exercise Program for patients with Knee OsteoArthritis). METHODS The trial included 230 intervention and 115 control participants from 2 Veterans Affairs (VA) medical centers. A decision tree simulated outcomes for cohorts of patients receiving arthritis education (control) or STEP-KOA (intervention), which consisted of an internet-based exercise training program (step 1), phone counseling (step 2), and physical therapy (step 3) according to patient's response. Intervention costs were assessed from the VA perspective. Quality of life (QOL) was measured using 5-level EQ-5D US utility weights. Incremental cost-effectiveness ratios (ICERs) were calculated as the difference in costs divided by the difference in quality-adjusted life-years (QALYs) between arms at 9 months. A Monte Carlo probabilistic sensitivity analysis was used to generate a cost-effectiveness acceptability curve. RESULTS The adjusted model found differential improvement in QOL utility weights of 0.042 (95% confidence interval 0.003-0.080; P=.03) for STEP-KOA versus control at 9 months. In the base case, STEP-KOA resulted in an incremental gain of 0.028 QALYs and an incremental cost of $279 per patient for an ICER of $10 076. One-way sensitivity analyses found the largest sources of variation in the ICER were the impact on QOL and the need for a VA-owned tablet. The probabilistic sensitivity analysis found a 98% probability of cost-effectiveness at $50 000 willingness-to-pay per QALY. CONCLUSIONS STEP-KOA improves QOL and has a high probability of cost-effectiveness. Resources needed to implement the program will decline as ownership of mobile health devices increases.
Collapse
Affiliation(s)
- Brystana G Kaufman
- Duke University, Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA.
| | - Kelli D Allen
- Durham VA Medical Center, Durham, NC, USA; University of North Carolina, Chapel Hill, NC
| | - Cynthia J Coffman
- Durham VA Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | | | - Kevin Caves
- Durham VA Medical Center, Durham, NC, USA; Duke Older Americans Independence Center, Duke University Medical Center, Durham, NC, USA
| | - Katherine Hall
- Durham VA Medical Center, Durham, NC, USA; Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Older Americans Independence Center, Duke University Medical Center, Durham, NC, USA
| | - Helen M Hoenig
- Durham VA Medical Center, Durham, NC, USA; Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Older Americans Independence Center, Duke University Medical Center, Durham, NC, USA
| | - Kim M Huffman
- Duke University, Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA; Duke Older Americans Independence Center, Duke University Medical Center, Durham, NC, USA
| | - Miriam C Morey
- Durham VA Medical Center, Durham, NC, USA; Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Older Americans Independence Center, Duke University Medical Center, Durham, NC, USA
| | | | | | | |
Collapse
|
7
|
Tracing the missteps of stepped care: Improving the implementation of stepped care through contextual behavioral science. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
8
|
Do MT, Nguyen TT, Tran HTT. Preliminary results of adapting the stepped care model for depression management in Vietnam. Front Psychiatry 2022; 13:922911. [PMID: 36061295 PMCID: PMC9433669 DOI: 10.3389/fpsyt.2022.922911] [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: 04/18/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Depression is the leading burden of mental disease, especially in low-and-middle-income countries like Vietnam. The Stepped Care Model is a promising approach to managing depression in the community with low resources. This is the first study that implemented the adapted Stepped Care Model for depression management in the Vietnamese context and evaluated the initial effectiveness of this community-based intervention in the Thai Nguyen community. MATERIALS AND METHODS A quasi-experimental study with a 3-month follow-up was conducted in 10 selected communes in Thai Nguyen province. The most important modifications in the Stepped Care Model for depression management were the screening focused on the high-risk individuals living in the community; the combination of 8-session group psychotherapy with animation activities at commune health stations (CHS); and using psychotherapy as first-line treatment. From August 2020 to January 2021, quantitative data were collected using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form. The descriptive analyses were performed to describe the demographic characteristics and the change in the questionnaires' mean score at the baseline and 3-month follow-up. RESULTS A total of 1,891 people were approached in the community, of which 359 voluntary people met the study criteria and attended group psychotherapy. During group psychotherapy, the average PHQ-9 scores gradually decreased, and after the 8th session, this figure dropped by 2.65 times compared to the beginning. After 3 months, the percentage of the group with mild-moderate depression shrank from 95.5 to 9.3%, and there were no more severe cases. Moreover, life satisfaction increased by 32% and the anxiety level significantly dropped according to Q-LES-Q-SF and GAD-7 accordingly. CONCLUSION The preliminary results after 3-month follow-up showed that the Stepped Care Model with group psychotherapy at the CHS was promising to manage the depression in the community. This task shifting approach with limited resources should be further disseminated and studied for long-term effectiveness in low-and-middle-income countries like Vietnam.
Collapse
Affiliation(s)
| | | | - Huong Thi Thanh Tran
- Hanoi Medical University, Hanoi, Vietnam.,Vietnam National Cancer Institute, Hanoi, Vietnam
| |
Collapse
|
9
|
Mediavilla R, McGreevy KR, Felez-Nobrega M, Monistrol-Mula A, Bravo-Ortiz MF, Bayón C, Rodríguez-Vega B, Nicaise P, Delaire A, Sijbrandij M, Witteveen AB, Purgato M, Barbui C, Tedeschi F, Melchior M, van der Waerden J, McDaid D, Park AL, Kalisch R, Petri-Romão P, Underhill J, Bryant RA, Haro JM, Ayuso-Mateos JL. Effectiveness of a stepped-care programme of internet-based psychological interventions for healthcare workers with psychological distress: Study protocol for the RESPOND healthcare workers randomised controlled trial. Digit Health 2022; 8:20552076221129084. [PMID: 36211795 PMCID: PMC9537484 DOI: 10.1177/20552076221129084] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 09/11/2022] [Indexed: 11/05/2022] Open
Abstract
Background and aims The coronavirus disease 2019 pandemic has challenged health services worldwide, with a worsening of healthcare workers' mental health within initial pandemic hotspots. In early 2022, the Omicron variant is spreading rapidly around the world. This study explores the effectiveness and cost-effectiveness of a stepped-care programme of scalable, internet-based psychological interventions for distressed health workers on self-reported anxiety and depression symptoms. Methods We present the study protocol for a multicentre (two sites), parallel-group (1:1 allocation ratio), analyst-blinded, superiority, randomised controlled trial. Healthcare workers with psychological distress will be allocated either to care as usual only or to care as usual plus a stepped-care programme that includes two scalable psychological interventions developed by the World Health Organization: A guided self-help stress management guide (Doing What Matters in Times of Stress) and a five-session cognitive behavioural intervention (Problem Management Plus). All participants will receive a single-session emotional support intervention, namely psychological first aid. We will include 212 participants. An intention-to-treat analysis using linear mixed models will be conducted to explore the programme's effect on anxiety and depression symptoms, as measured by the Patient Health Questionnaire - Anxiety and Depression Scale summary score at 21 weeks from baseline. Secondary outcomes include post-traumatic stress disorder symptoms, resilience, quality of life, cost impact and cost-effectiveness. Conclusions This study is the first randomised trial that combines two World Health Organization psychological interventions tailored for health workers into one stepped-care programme. Results will inform occupational and mental health prevention, treatment, and recovery strategies. Registration details ClinicalTrials.gov Identifier: NCT04980326.
Collapse
Affiliation(s)
- Roberto Mediavilla
- Department of Psychiatry, Universidad Autónoma de Madrid
(UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Instituto de Salud Carlos III, Madrid, Spain
| | - Kerry R McGreevy
- Department of Psychiatry, Universidad Autónoma de Madrid
(UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Instituto de Salud Carlos III, Madrid, Spain
| | - Mireia Felez-Nobrega
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Instituto de Salud Carlos III, Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de
Déu, Barcelona, Spain
| | - Anna Monistrol-Mula
- Research and Development Unit, Parc Sanitari Sant Joan de
Déu, Barcelona, Spain
| | - María-Fe Bravo-Ortiz
- Department of Psychiatry, Universidad Autónoma de Madrid
(UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, Clinical Psychology and Mental Health,
Hospital Univeristario La Paz, Madrid, Spain
- Instituto de Investigación del Hospital
Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Carmen Bayón
- Department of Psychiatry, Universidad Autónoma de Madrid
(UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, Clinical Psychology and Mental Health,
Hospital Univeristario La Paz, Madrid, Spain
- Instituto de Investigación del Hospital
Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Beatriz Rodríguez-Vega
- Department of Psychiatry, Universidad Autónoma de Madrid
(UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, Clinical Psychology and Mental Health,
Hospital Univeristario La Paz, Madrid, Spain
- Instituto de Investigación del Hospital
Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Pablo Nicaise
- Institute of Health & Society (IRSS), Université Catholique de
Louvain, Brussels, Belgium
| | - Audrey Delaire
- Institute of Health & Society (IRSS), Université Catholique de
Louvain, Brussels, Belgium
| | - Marit Sijbrandij
- Clinical, Neuro- and Developmental Psychology, WHO Collaborating
Centre for Research and Dissemination of Psychological Interventions, Amsterdam
Public Health Institute, Vrije Universiteit
Amsterdam, Amsterdam, the Netherlands
| | - Anke B. Witteveen
- Clinical, Neuro- and Developmental Psychology, WHO Collaborating
Centre for Research and Dissemination of Psychological Interventions, Amsterdam
Public Health Institute, Vrije Universiteit
Amsterdam, Amsterdam, the Netherlands
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health
and Service Evaluation, Department of Neuroscience, Biomedicine, and Movement
Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health
and Service Evaluation, Department of Neuroscience, Biomedicine, and Movement
Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health
and Service Evaluation, Department of Neuroscience, Biomedicine, and Movement
Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé
Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Faculté de
Médecine St Antoine, , Paris, France
| | - Judith van der Waerden
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé
Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Faculté de
Médecine St Antoine, , Paris, France
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political
Science, London, UK
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political
Science, London, UK
| | - Raffael Kalisch
- Leibniz Institute for Resilience Research
(LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience
(FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | | | | | - Richard A. Bryant
- School of Psychology, University of New
South Wales, Sydney, NSW, Australia
| | - Josep Maria Haro
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Instituto de Salud Carlos III, Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de
Déu, Barcelona, Spain
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid
(UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, La Princesa University
Hospital, Instituto de Investigación Sanitaria Princesa (IIS-Princesa),
Madrid, Spain
| | | |
Collapse
|
10
|
Darling Rasmussen P, Ribeiro JP, Storebø OJ. Mothers of Children Diagnosed with ADHD: A Descriptive Study of Maternal Experience during the First Three Years of Treatment. Pediatr Rep 2021; 13:450-462. [PMID: 34449712 PMCID: PMC8396042 DOI: 10.3390/pediatric13030052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Attention deficit hyperactivity disorder is the most common childhood psychiatric disorder. Current treatment strategies do not provide a convincing improvement on overall functioning, and further, reciprocity between ADHD and attachment has been suggested. This suggests that we do not fully comprehend the mechanisms of the disorder. This study was part of a larger project investigating factors of potential importance when a child is diagnosed with ADHD. Aim: In this current study we aimed to gain a clearer understanding about whether the mothers experienced the diagnostic process and treatment as helpful. Method: Sixty children newly diagnosed with ADHD and their mothers were included three years prior to this study. Fifty-two (87%) completed a survey about their experience with the diagnostic process and the years after in the psychiatric system and the secondary healthcare sector. Forty-three had also participated in an attachment interview in the original study and answered questions about this. Discussion: The follow-up questionnaire was based on conversations with the mothers was not meant to be used as a quantitative measure. However, one point to take is that the mothers did often not feel the help offered to be sufficient. In our opinion, this underlines that we are still far from understanding what ADHD is and what causes the differences in developmental trajectories as well as how differences in etiological factors may call for more customized approaches in treatment strategies.
Collapse
Affiliation(s)
- Pernille Darling Rasmussen
- Center for Evidence-Based Psychiatry, Psychiatric Research Unit, Psychiatry Region Zealand, 4200 Slagelse, Denmark; (J.P.R.); (O.J.S.)
- Private Hospital Hejmdal, 2000 Frederiksberg, Denmark
- Correspondence:
| | - Johanne Pereira Ribeiro
- Center for Evidence-Based Psychiatry, Psychiatric Research Unit, Psychiatry Region Zealand, 4200 Slagelse, Denmark; (J.P.R.); (O.J.S.)
| | - Ole Jakob Storebø
- Center for Evidence-Based Psychiatry, Psychiatric Research Unit, Psychiatry Region Zealand, 4200 Slagelse, Denmark; (J.P.R.); (O.J.S.)
- Department of Psychology, University of Southern Denmark, 5000 Odense, Denmark
- Department of Child and Adolescent Psychiatry, Psychiatry Region Zealand, 4000 Roskilde, Denmark
| |
Collapse
|
11
|
Hurley MV, Irwin S, Erwin J, Gibney A, Hallett R, Carter A, Woolf A. Delivering NICE Joint Pain Advice in the workplace. Musculoskeletal Care 2021; 19:555-563. [PMID: 33650771 PMCID: PMC9290526 DOI: 10.1002/msc.1539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 11/19/2022]
Abstract
Background Chronic joint pain is extremely prevalent, but its impact can be mitigated if people receive self‐management/lifestyle advice, especially about the importance of physical activity and maintaining a healthy weight. To reach the large number of people who needs support, we devised Joint Pain Advice (JPA), an intervention that can be delivered in a variety of health and community settings by a range of healthcare and non‐healthcare professionals. Here we extend JPA delivery into workplace settings. Method In each workplace, an advisor was trained to deliver JPA. This involved an initial assessment of participant's pain, musculoskeletal health and function (MSK‐HQ), number of days/week active for >30 min, and physical function. Participants were taught simple self‐management strategies, encouraged to adopt healthier lifestyles using motivational interviewing, goal‐settings and personalised action/coping plans. Participants were reviewed three times over 6 months, baseline outcomes reassessed, progress highlighted, health messages reinforced and action plans revised, if necessary. Results Twenty large public organisations or small/medium enterprises delivered JPA to 481 people. Satisfaction with the service was high; people found it acceptable, valued advice tailored to their individual needs and experienced tangible benefits—MSK‐HQ (9.5 points; CI 8.3 to 10.6), pain (−1.7; −2.2 to −1.7), physical function (−2.0; −2.2 to −1.7), activity levels and self‐confidence improved, whilst absenteeism and healthcare utilisation reduced. Conclusion Delivering advice about self‐management for chronic knee, hip and back pain in workplace settings using local health promotion or occupational health professionals and is practicable, beneficial and valued. JPA could benefit small, medium and large employers.
Collapse
Affiliation(s)
- Michael V Hurley
- Faculty of Health, Social Care and Education, St George's University of London and Kingston University, London, UK.,Musculoskeletal Programme, Health Innovation Network, London, UK
| | - Sally Irwin
- Musculoskeletal Programme, Health Innovation Network, London, UK
| | - Jo Erwin
- Bone & Joint Research Group, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Amber Gibney
- Musculoskeletal Programme, Health Innovation Network, London, UK
| | - Rachel Hallett
- Faculty of Health, Social Care and Education, St George's University of London and Kingston University, London, UK
| | - Andrea Carter
- Musculoskeletal Programme, Health Innovation Network, London, UK
| | - Anthony Woolf
- Bone & Joint Research Group, Royal Cornwall Hospitals NHS Trust, Truro, UK
| |
Collapse
|
12
|
Allen KD, Woolson S, Hoenig HM, Bongiorni D, Byrd J, Caves K, Hall KS, Heiderscheit B, Hodges NJ, Huffman KM, Morey MC, Ramasunder S, Severson H, Van Houtven C, Abbate LM, Coffman CJ. Stepped Exercise Program for Patients With Knee Osteoarthritis : A Randomized Controlled Trial. Ann Intern Med 2021; 174:298-307. [PMID: 33370174 PMCID: PMC10405203 DOI: 10.7326/m20-4447] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Evidence-based models are needed to deliver exercise-related services for knee osteoarthritis efficiently and according to patient needs. OBJECTIVE To examine a stepped exercise program for patients with knee osteoarthritis (STEP-KOA). DESIGN Randomized controlled trial. (ClinicalTrials.gov: NCT02653768). SETTING 2 U.S. Department of Veterans Affairs sites. PARTICIPANTS 345 patients (mean age, 60 years; 15% female; 67% people of color) with symptomatic knee osteoarthritis. INTERVENTION Participants were randomly assigned in a 2:1 ratio to STEP-KOA or an arthritis education (AE) control group, respectively. The STEP-KOA intervention began with 3 months of an internet-based exercise program (step 1). Participants who did not meet response criteria for improvement in pain and function after step 1 progressed to step 2, which involved 3 months of biweekly physical activity coaching calls. Participants who did not meet response criteria after step 2 went on to in-person physical therapy visits (step 3). The AE group received educational materials via mail every 2 weeks. MEASUREMENTS Primary outcome was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Scores for the STEP-KOA and AE groups at 9 months were compared by using linear mixed models. RESULTS In the STEP-KOA group, 65% of participants (150 of 230) progressed to step 2 and 35% (81 of 230) to step 3. The estimated baseline WOMAC score for the full sample was 47.5 (95% CI, 45.7 to 49.2). At 9-month follow-up, the estimated mean WOMAC score was 6.8 points (CI, -10.5 to -3.2 points) lower in the STEP-KOA than the AE group, indicating greater improvement. LIMITATION Participants were mostly male veterans, and follow-up was limited. CONCLUSION Veterans in STEP-KOA reported modest improvements in knee osteoarthritis symptoms compared with the control group. The STEP-KOA strategy may be efficient for delivering exercise therapies for knee osteoarthritis. PRIMARY FUNDING SOURCE Department of Veterans Affairs, Health Services Research and Development Service.
Collapse
Affiliation(s)
- Kelli D Allen
- Durham VA Health Care System, Durham, and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (K.D.A.)
| | - Sandra Woolson
- Durham VA Health Care System, Durham, North Carolina (S.W., D.B., N.J.H.)
| | - Helen M Hoenig
- Durham VA Health Care System and Duke University, Durham, North Carolina (H.M.H., K.S.H., K.M.H., M.C.M., S.R.)
| | - Dennis Bongiorni
- Durham VA Health Care System, Durham, North Carolina (S.W., D.B., N.J.H.)
| | - James Byrd
- Greenville VA Health Care Center, Greenville, North Carolina (J.B.)
| | - Kevin Caves
- Duke University, Durham, North Carolina (K.C.)
| | - Katherine S Hall
- Durham VA Health Care System and Duke University, Durham, North Carolina (H.M.H., K.S.H., K.M.H., M.C.M., S.R.)
| | | | - Nancy Jo Hodges
- Durham VA Health Care System, Durham, North Carolina (S.W., D.B., N.J.H.)
| | - Kim M Huffman
- Durham VA Health Care System and Duke University, Durham, North Carolina (H.M.H., K.S.H., K.M.H., M.C.M., S.R.)
| | - Miriam C Morey
- Durham VA Health Care System and Duke University, Durham, North Carolina (H.M.H., K.S.H., K.M.H., M.C.M., S.R.)
| | - Shalini Ramasunder
- Durham VA Health Care System and Duke University, Durham, North Carolina (H.M.H., K.S.H., K.M.H., M.C.M., S.R.)
| | | | - Courtney Van Houtven
- Durham VA Health Care System and Duke University School of Medicine, Durham, North Carolina (C.V.)
| | - Lauren M Abbate
- VA Eastern Colorado Health Care System and University of Colorado School of Medicine, Aurora, Colorado (L.M.A.)
| | - Cynthia J Coffman
- Durham VA Health Care System and Duke University Medical Center, Durham, North Carolina (C.J.C.)
| |
Collapse
|
13
|
Knudsen SV, Hermansen SB, Holmskov J, Johnsen SP, Mainz J. Patient Inventory: a quality improvement method. Int J Qual Health Care 2021; 32:300-305. [PMID: 32412058 DOI: 10.1093/intqhc/mzaa038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/16/2020] [Accepted: 04/03/2020] [Indexed: 11/14/2022] Open
Abstract
Providing high quality care requires that patient care pathways are organized according to the needs of the patient. The organization of high-quality integrated patient care requires methods to assess 'appropriateness' of the care pathways to identify challenges in delivering the right procedure, for the right person at the right time and setting and with the most appropriate use of resources. There is a need for methods to assess appropriateness that can easily be implemented in daily clinical practice. The Patient Inventory method is such a method. Patient Inventory is a special type of audit that provides a 'snapshot' of the patient population in an entire hospital, a ward or another clinical unit. It maps the bed occupancy situation, as well as coordination, continuity and communication associated with the individual patient pathway. The aim is to identify inappropriate or wasteful events and to facilitate reflections on the underlying causes. These reflections are used to identify focus areas for quality improvement efforts. The method answers the question: 'Is it the right patient in the right place at the right time, and is the correct pathway for the patient organized with the most appropriate use of resources?' The aim of this method paper is to describe the background, definitions and methodologies for Patient Inventory, to offer a practical guidance for application of the method and to describe the current experiences with the method.
Collapse
Affiliation(s)
- Søren Valgreen Knudsen
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Mølleparkvej 10, 9000 Aalborg, Denmark.,Psychiatric Management, Psychiatry in Region North Jutland, North Denmark Region, Mølleparkvej 10, 9000 Aalborg, Denmark
| | - Sabina Bay Hermansen
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Mølleparkvej 10, 9000 Aalborg, Denmark
| | - Jens Holmskov
- Psychiatric Management, Psychiatry in Region North Jutland, North Denmark Region, Mølleparkvej 10, 9000 Aalborg, Denmark.,Department of Psychiatry, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Mølleparkvej 10, 9000 Aalborg, Denmark
| | - Jan Mainz
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Mølleparkvej 10, 9000 Aalborg, Denmark.,Psychiatric Management, Psychiatry in Region North Jutland, North Denmark Region, Mølleparkvej 10, 9000 Aalborg, Denmark.,Department of Health Economics, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark.,Department for Community Mental Health, University of Haifa, Abba Khoushy Ave 199, Haifa, 3498838, Israel
| |
Collapse
|
14
|
Bell L, Cornish P, Gauthier R, Kargus C, Rash J, Robbins R, Ward S, Poulin PA. Implementation of the Ottawa Hospital Pain Clinic stepped care program: A preliminary report. Can J Pain 2020; 4:168-178. [PMID: 33987496 PMCID: PMC7951149 DOI: 10.1080/24740527.2020.1768059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 10/31/2022]
Abstract
BACKGROUND Access to multidisciplinary pain management treatment in Canada is limited, with wait times up to 4 years. Stepped care approaches to mental health treatment have led to substantial reduction and elimination of wait times and may be applicable to chronic pain settings. There is no unifying framework for stepped care chronic pain programs. A systematic review of the efficacy of stepped care in chronic pain management conducted by the Canadian Agency for Drugs and Technologies reported varied results that may be due to heterogeneous stepped care models across facilities. AIM We propose a unifying framework for multidisciplinary stepped care chronic pain programs and present its application at The Ottawa Hospital Pain Clinic. The Ottawa Hospital stepped care framework is an eight-tiered approach that allows patients the opportunity to decide collaboratively with a health care professional which treatment program will best suit their needs for the management of chronic pain. As levels of stepped care increase, the time and resource commitment to each step will also increase. Treatment is stepped up or down, depending on patient needs. METHOD This is a descriptive case study. RESULTS Implementing the interprofessional model of care with the stepped care program has eliminated wait times for access to The Ottawa Hospital Pain Clinic Interprofessional Chronic Pain Management Program and has improved communication between professions of the interprofessional team, resulting in better care for patients. CONCLUSION More research is needed to further develop and evaluate the clinical efficacy of stepped care to manage chronic pain.
Collapse
Affiliation(s)
- Louise Bell
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Peter Cornish
- Student Wellness & Counselling Centre, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Renée Gauthier
- The Ottawa Hospital Pain Clinic, Ottawa, Ontario, Canada
| | - Cristin Kargus
- The Ottawa Hospital Pain Clinic, Ottawa, Ontario, Canada
| | - Joshua Rash
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Rose Robbins
- The Ottawa Hospital Pain Clinic, Ottawa, Ontario, Canada
| | - Susan Ward
- The Ottawa Hospital Pain Clinic, Ottawa, Ontario, Canada
| | - Patricia A. Poulin
- The Ottawa Hospital Pain Clinic, Ottawa, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
15
|
Cognitive-Affective Change Mechanisms in Personalized Normative Feedback via the Articulated Thoughts in Simulated Situations Paradigm. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030690. [PMID: 31973094 PMCID: PMC7038020 DOI: 10.3390/ijerph17030690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/14/2020] [Accepted: 01/18/2020] [Indexed: 11/25/2022]
Abstract
The research explored explanatory mechanisms of change for a personalized normative feedback (PNF) intervention, through an adapted application of the Articulated Thoughts in Simulated Situation (ATSS) cognitive think-aloud paradigm. A sample of 70 (51% female) U.S. adjudicated students were randomly assigned to one of three conditions: a PNF-ATSS condition, a PNF-Only condition (without ATSS), and an active Control+ATSS condition which received psychoeducation about alcohol use. Students in both the PNF-Only and PNF-ATSS conditions reported significant reductions in their misperceived peer drinking norms and alcohol-related consequences at the 30-day follow-up, relative to students in the control condition. Participants in the PNF-ATSS condition drank significantly fewer drinks per week at follow-up than participants in the PNF-Only condition, but not less than participants in the control condition. Significant indirect effects were found for the ATSS codes of participants’ neutrality and believability toward PNF content. This study presents a proof of concept for an adapted ATSS think-aloud methodology as a clinical science intervention tool to specify the cognitive-affective processes of change linked to complex intervention for particular problems, persons, and contexts.
Collapse
|
16
|
Ching TH, Jelinek L, Hauschildt M, Williams MT. Association Splitting for Obsessive-Compulsive Disorder: A Systematic Review. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2352096512666190912143311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Association splitting is a cognitive technique that targets obsessions in
obsessive-compulsive disorder (OCD) by weakening biased semantic associations among OCDrelevant
concepts.
Objective:
In this systematic review, we examine studies on the efficacy of association splitting for
reducing OCD symptoms.
Methods:
Following PRISMA guidelines, six studies were included, with diversity in sample characteristics,
mode of administration (i.e., self-help vs therapist-assisted), language of administration,
comparator groups, etc.
Results:
Results indicated that association splitting, as a self-help intervention, was efficacious in
reducing overall OCD symptom severity, specific OCD symptoms (i.e., sexual obsessions), subclinical
unwanted intrusions, and thought suppression, with small-to-large effect sizes (e.g., across
relevant studies, ds = .28-1.07). Findings were less clear when association splitting was administered
on a therapist-assisted basis as an add-on to standard cognitive-behavior therapy (CBT). Nonetheless,
across studies, the majority of participants reported high acceptability, ease of comprehension,
and adherence to daily association splitting practice.
Conclusion:
Although association splitting is an efficacious and acceptable self-help intervention
for OCD symptoms, future studies should include appropriate comparison groups, conduct longitudinal
assessments, examine efficacy for different symptom dimensions, and assess changes in semantic
networks as proof of mechanistic change. There should also be greater representation of
marginalized groups in future studies to assess association splitting’s utility in circumventing barriers
to face-to-face CBT. Ethical considerations are also discussed.
Collapse
Affiliation(s)
- Terence H.W. Ching
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269- 1020, United States
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Marit Hauschildt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Monnica T. Williams
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269- 1020, United States
| |
Collapse
|
17
|
Bischof A, Bischof G, Meyer C, John U, Hodgins DC, Rumpf HJ. Untreated pathological gamblers: who recovers and who does not? INTERNATIONAL GAMBLING STUDIES 2019. [DOI: 10.1080/14459795.2019.1703201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Anja Bischof
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Gallus Bischof
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Christian Meyer
- Institute of Social Medicine and Prevention, University Medicine of Greifswald, Greifswald, Germany
| | - Ulrich John
- Institute of Social Medicine and Prevention, University Medicine of Greifswald, Greifswald, Germany
| | - David C. Hodgins
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Hans-Jürgen Rumpf
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| |
Collapse
|
18
|
Huxley E, Lewis KL, Coates AD, Borg WM, Miller CE, Townsend ML, Grenyer BFS. Evaluation of a brief intervention within a stepped care whole of service model for personality disorder. BMC Psychiatry 2019; 19:341. [PMID: 31694681 PMCID: PMC6836372 DOI: 10.1186/s12888-019-2308-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although there is growing evidence that stepped models of care are useful for providing appropriate, person centered care, there are very few studies applied to personality disorders. A brief, four session, psychological treatment intervention for personality disorder within a whole of service stepped care model was evaluated. The intervention stepped between acute emergency crisis mental health services and longer-term outpatient treatments. METHODS Study 1 used service utilization data from 191 individuals referred to the brief intervention at a single community health site in a metropolitan health service. Proportions of individuals retained across the intervention and the referral pathways accessed following the intervention were examined. Study 2 examined 67 individuals referred to the brief intervention across 4 different sites in metropolitan health services. A range of measures of symptoms and quality of life were administered at the first and last session of the intervention. Effect sizes were calculated to examine mean changes across the course of the intervention. RESULTS Study 1 found that 84.29% of individuals referred to the intervention attended at least 1 session, 60.21% attended 2 sessions or more and 41.89% attended 3 or more sessions. 13.61% of the sample required their care to be "stepped up" within the service, whereas 29.31% were referred to other treatment providers following referral to the intervention. Study 2 found a significant reduction in borderline personality disorder symptom severity and distress following the intervention, and an increase in quality of life. The largest reduction was found for suicidal ideation (d = 1.01). CONCLUSIONS Brief psychological intervention was a useful step between acute services and longer-term treatments in this stepped model of care for personality disorder. Suicide risk and symptom severity reduced and quality of life improved, with only a small proportion of individuals requiring ongoing support from the health service following the intervention.
Collapse
Affiliation(s)
- Elizabeth Huxley
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Kate L Lewis
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Adam D Coates
- South East Sydney Local Health District, Sydney, Australia
| | - Wayne M Borg
- South East Sydney Local Health District, Sydney, Australia
| | - Caitlin E Miller
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Michelle L Townsend
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Brin F S Grenyer
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia.
| |
Collapse
|
19
|
Meuldijk D, Wuthrich VM. Stepped‐care treatment of anxiety and depression in older adults: A narrative review. Aust J Rural Health 2019; 27:275-280. [DOI: 10.1111/ajr.12524] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
- Denise Meuldijk
- Centre for Emotional Health Department of Psychology Macquarie University Sydney New South Wales Australia
| | - Viviana M. Wuthrich
- Centre for Emotional Health Department of Psychology Macquarie University Sydney New South Wales Australia
| |
Collapse
|
20
|
Kopelovich SL, Strachan E, Sivec H, Kreider V. Stepped Care as an Implementation and Service Delivery Model for Cognitive Behavioral Therapy for Psychosis. Community Ment Health J 2019; 55:755-767. [PMID: 30623294 DOI: 10.1007/s10597-018-00365-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 12/29/2018] [Indexed: 10/27/2022]
Abstract
Cognitive behavioral therapy for schizophrenia spectrum disorders is an evidence-based treatment that is recommended by United States schizophrenia treatment guidelines. Based on recent estimates, only 0.3% of individuals with a primary psychotic disorder are able to access this treatment in the United States. Stepped care interventions have shown promise as an applied treatment delivery model in other settings and for other psychotherapeutic interventions. The current paper describes how the stepped care model can be applied to CBT for psychosis in the US to increase access to the intervention in community mental health settings by leveraging the multidisciplinary team.
Collapse
Affiliation(s)
- Sarah L Kopelovich
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 9th Avenue, Box 359911, 98104, Seattle, WA, USA.
| | - Eric Strachan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 9th Avenue, Box 359911, 98104, Seattle, WA, USA
| | - Harry Sivec
- Best Practices in Schizophrenia Treatment (BeST) Center, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Valerie Kreider
- Best Practices in Schizophrenia Treatment (BeST) Center, Northeast Ohio Medical University, Rootstown, OH, USA
| |
Collapse
|
21
|
Wong MHM, Keng SL, Buck PJ, Suthendran S, Wessels A, Østbye T. Effects of Mental Health Paraprofessional Training for Filipina Foreign Domestic Workers in Singapore. J Immigr Minor Health 2019; 22:571-579. [PMID: 31183593 DOI: 10.1007/s10903-019-00907-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Research has found that 24% of foreign domestic workers (FDWs) in Singapore have poor mental health (24%), with depressive symptoms being identified as the second most severe psychological symptoms [1]. The study assessed the acceptability and effectiveness of a 4-week cognitive behavioral therapy (CBT)-based paraprofessional training program for FDWs in Singapore on depression literacy and CBT knowledge (primary outcomes), depression-related stigma, as well as attitudes towards seeking professional help (secondary outcomes) immediately and 2 months following the training. Forty female Filipino FDWs were recruited and randomized into either a CBT-based paraprofessional training program or wait-list (WL) group. Participants completed outcome measures before, after, and 2 months following their training. No significant difference was found on changes on any of the outcome variables in the intervention group as compared to the WL group. Following training, both groups showed significantly improved depression literacy, CBT knowledge, and attitudes towards seeking professional help. These changes were sustained at 2-month follow-up. All participants indicated a high level of satisfaction with the training program. While findings from between-group analyses do not support the efficacy of the CBT-based paraprofessional training program in improving depression literacy and related outcomes, participation in the program was associated with improvements in several outcomes within the training group. Future research should explore adaptations to the program (e.g., in terms of training duration and modes of delivery) that would increase its efficacy in improving depression literacy and CBT knowledge among FDWs.
Collapse
Affiliation(s)
- M H M Wong
- Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Shian-Ling Keng
- Division of Social Science, Yale-NUS College, 16 College Avenue West, Singapore, 138527, Singapore.
| | - P J Buck
- Portland Dialectical Behavior Therapy Institute, Portland, OR, USA
| | - S Suthendran
- Humanitarian Organization for Migration Economics, Singapore, Singapore
| | - A Wessels
- Research Across Borders, Sydney, NSW, Australia
| | - T Østbye
- Center for Aging Research and Education, Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
22
|
Allen KD, Bongiorni D, Caves K, Coffman CJ, Floegel TA, Greysen HM, Hall KS, Heiderscheit B, Hoenig HM, Huffman KM, Morey MC, Ramasunder S, Severson H, Smith B, Van Houtven C, Woolson S. STepped exercise program for patients with knee OsteoArthritis (STEP-KOA): protocol for a randomized controlled trial. BMC Musculoskelet Disord 2019; 20:254. [PMID: 31138256 PMCID: PMC6540433 DOI: 10.1186/s12891-019-2627-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/14/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Physical therapy (PT) and other exercise-based interventions are core components of care for knee osteoarthritis (OA), but both are underutilized, and some patients have limited access to PT services. This clinical trial is examining a STepped Exercise Program for patients with Knee OsteoArthritis (STEP-KOA). This model of care can help to tailor exercise-based interventions to patient needs and also conserve higher resource services (such as PT) for patients who do not make clinically relevant improvements after receiving less costly interventions. METHODS / DESIGN Step-KOA is a randomized trial of 345 patients with symptomatic knee OA from two Department of Veterans Affairs sites. Participants are randomized to STEP-KOA and Arthritis Education (AE) Control groups with a 2:1 ratio, respectively. STEP-KOA begins with 3 months of access to an internet-based exercise program (Step 1). Participants not meeting response criteria for clinically meaningful improvement in pain and function after Step 1 progress to Step 2, which involves bi-weekly physical activity coaching calls for 3 months. Participants not meeting response criteria after Step 2 progress to in-person PT visits (Step 3). Outcomes will be assessed at baseline, 3, 6 and 9 months (primary outcome time point). The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), and secondary outcomes are objective measures of physical function. Linear mixed models will compare outcomes between the STEP-KOA and AE control groups at follow-up. We will also evaluate patient characteristics associated with treatment response and conduct a cost-effectiveness analysis of STEP-KOA. DISCUSSION STEP-KOA is a novel, efficient and patient-centered approach to delivering exercise-based interventions to patients with knee OA, one of the most prevalent and disabling health conditions. This trial will provide information on the effectiveness of STEP-KOA as a novel potential model of care for treatment of OA. TRIAL REGISTRATION Clinicaltrials.gov, NCT02653768 (STepped Exercise Program for Knee OsteoArthritis (STEP-KOA)), Registered January 12, 2016.
Collapse
Affiliation(s)
- Kelli D. Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System HSRD (152), 508 Fulton Street, Durham, NC 27705 USA
- Department of Medicine & Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Dennis Bongiorni
- Physical Medicine & Rehabilitation Service, Durham VA Healthcare System, Durham, USA
| | - Kevin Caves
- Department of Biomedical Engineering, Duke University, Durham, USA
| | - Cynthia J. Coffman
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System HSRD (152), 508 Fulton Street, Durham, NC 27705 USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, USA
| | | | | | - Katherine S. Hall
- Department of Medicine, Division of Geriatrics, Duke University, Durham, USA
- Claude D Pepper Older Americans Independence Center, Duke University, Durham, USA
- Geriatric Research, Education and Clinical Center, Durham VA Healthcare System, Durham, USA
| | - Bryan Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, USA
| | - Helen M. Hoenig
- Physical Medicine & Rehabilitation Service, Durham VA Healthcare System, Durham, USA
- Department of Medicine, Division of Geriatrics, Duke University, Durham, USA
- Claude D Pepper Older Americans Independence Center, Duke University, Durham, USA
| | - Kim M. Huffman
- Physical Medicine & Rehabilitation Service, Durham VA Healthcare System, Durham, USA
- Department of Medicine, Division of Rheumatology, Duke University, Durham, USA
| | - Miriam C. Morey
- Department of Medicine, Division of Geriatrics, Duke University, Durham, USA
- Claude D Pepper Older Americans Independence Center, Duke University, Durham, USA
- Geriatric Research, Education and Clinical Center, Durham VA Healthcare System, Durham, USA
| | | | | | - Battista Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System HSRD (152), 508 Fulton Street, Durham, NC 27705 USA
| | - Courtney Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System HSRD (152), 508 Fulton Street, Durham, NC 27705 USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, USA
| | - Sandra Woolson
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System HSRD (152), 508 Fulton Street, Durham, NC 27705 USA
| |
Collapse
|
23
|
Singh NN, Lancioni GE, Karazsia BT, Myers RE, Hwang YS, Anālayo B. Effects of Mindfulness-Based Positive Behavior Support (MBPBS) Training Are Equally Beneficial for Mothers and Their Children With Autism Spectrum Disorder or With Intellectual Disabilities. Front Psychol 2019; 10:385. [PMID: 30894823 PMCID: PMC6414461 DOI: 10.3389/fpsyg.2019.00385] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/07/2019] [Indexed: 01/10/2023] Open
Abstract
Parenting a child with autism spectrum disorder (ASD) or intellectual disabilities (IDs) can be stressful for many parents. Mindfulness-Based Positive Behavior Support (MBPBS) is a customized mindfulness program that enables parents and other caregivers to reduce their perceived psychological stress to normative levels through mindfulness procedures and to support children with ASD or ID to self-manage their challenging behaviors through positive behavior support (PBS). In this study, we evaluated whether MBPBS would have differential effects on the stress levels of mothers of adolescents with ASD (n = 47) or with ID (n = 45) and the effects of the program on the aggressive, disruptive, and compliance behaviors of their children. Both groups of mothers participated in the 40-week study (10 weeks control and 30 weeks MBPBS program), rated their own stress levels, and collected daily observational data on the adolescents' behavior. Results showed significant reductions in the level of stress in both groups of mothers, but no differential effects on mothers of children with ASD or with ID. In addition, significant reductions in aggression and disruptive behavior and increases in compliance behaviors were observed in the adolescents in both groups. The results suggest that MBPBS is equally beneficial for mothers of adolescents with ASD or ID. In the present study, although the mothers of children with ID had slightly higher levels of stress at baseline and mothers of children with ASD had lower levels of stress following the MBPBS program, the program can be considered equally effective in reducing the stress levels of both groups of mothers. This suggests that the program may be effective regardless of baseline levels of mothers' stress.
Collapse
Affiliation(s)
- Nirbhay N. Singh
- Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Giulio E. Lancioni
- Department of Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Bryan T. Karazsia
- Department of Psychology, The College of Wooster, Wooster, OH, United States
| | - Rachel E. Myers
- WellStar School of Nursing, Kennesaw State University, Kennesaw, GA, United States
| | - Yoon-Suk Hwang
- Institute For Learning Sciences and Teacher Education, Australian Catholic University, Brisbane, QLD, Australia
| | - Bhikkhu Anālayo
- Numata Center for Buddhist Studies, University of Hamburg, Hamburg, Germany
| |
Collapse
|
24
|
Yeguez CE, Page TF, Rey Y, Silverman WK, Pettit JW. A Cost Analysis of a Stepped Care Treatment Approach for Anxiety Disorders in Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 49:549-555. [PMID: 30644757 DOI: 10.1080/15374416.2018.1539913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To address the high demand for youth anxiety treatment, researchers have begun to evaluate stepped care approaches to use limited resources efficiently. Quantifying cost savings can inform policy decisions about optimal ways to use limited resources. This study presents a cost analysis of a stepped care treatment approach for anxiety disorders in youth. Youths (N = 112) completed an 8-session computer-administered attention bias modification treatment (Step 1), and families were given the option to "step up" to cognitive behavioral therapy (CBT; Step 2). Stepped care treatment cost estimates were based on (a) resources used in treatment (i.e., clinician/paraprofessional time, equipment/materials) and (b) Medicaid reimbursement rates for clinician and paraprofessional time. We compared these two cost estimates with a hypothetical standard treatment approach for youth anxiety disorders: CBT only. We also tested predictive models to determine whether they could guide decisions about which youths, based on baseline characteristics, should be assigned to stepped care or directly to CBT only to avoid the costs associated with Step 1. Compared to a hypothetical standard CBT approach, the stepped care treatment was associated with an overall cost savings of 44.4% for the Medicaid reimbursement model and 47.7% for the resource cost model. The predictive models indicated that assigning all youths to stepped care would be more cost-effective than assigning certain youths directly to CBT only. This study provides the first evidence that a stepped care treatment approach for youth anxiety is associated with substantial cost savings compared with a standard CBT.
Collapse
Affiliation(s)
| | - Timothy F Page
- Department of Health Policy and Management, Florida International University
| | - Yasmin Rey
- Department of Psychology, Florida International University
| | | | - Jeremy W Pettit
- Department of Health Policy and Management, Florida International University
| |
Collapse
|
25
|
Arving C, Assmus J, Thormodsen I, Berntsen S, Nordin K. Early rehabilitation of cancer patients—An individual randomized stepped‐care stress‐management intervention. Psychooncology 2018; 28:301-308. [DOI: 10.1002/pon.4940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 10/31/2018] [Accepted: 11/05/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Cecilia Arving
- Department of Oncology and Medical PhysicsHaukeland University Hospital Bergen Norway
- Department of Public Health and Caring SciencesUppsala University Uppsala Sweden
| | - Jörg Assmus
- Centre for Clinical ResearchHaukeland University Hospital Bergen Norway
| | - Inger Thormodsen
- Department of Oncology and Medical PhysicsHaukeland University Hospital Bergen Norway
| | - Sveinung Berntsen
- Department of Public Health and Caring SciencesUppsala University Uppsala Sweden
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport SciencesUniversity of Agder Kristiansand Norway
| | - Karin Nordin
- Department of Public Health and Caring SciencesUppsala University Uppsala Sweden
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport SciencesUniversity of Agder Kristiansand Norway
| |
Collapse
|
26
|
Vijverberg R, Ferdinand R, Beekman A, van Meijel B. Factors associated with treatment intensification in child and adolescent psychiatry: a cross-sectional study. BMC Psychiatry 2018; 18:291. [PMID: 30200911 PMCID: PMC6131781 DOI: 10.1186/s12888-018-1874-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 08/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More knowledge about characteristics of children and adolescents who need intensive levels of psychiatric treatment is important to improve treatment approaches. These characteristics were investigated in those who need youth Assertive Community Treatment (youth-ACT). METHOD A cross-sectional study among children/adolescents and their parents treated in either a regular outpatient clinic or a youth-ACT setting in a specialized mental health treatment center in the Netherlands. RESULTS Child, parent and family/social context factors were associated with treatment intensification from regular outpatient care to youth-ACT. The combination of the child, parent, and family/social context factors adds substantially to the predictive power of the model (Nagelkerke R2 increasing from 36 to 45% for the three domains separately, to 61% when all domains are combined). The strongest predictors are the severity of psychiatric disorders of the child, parental stress, and domestic violence. CONCLUSIONS Using a wide variety of variables that are potentially associated with treatment intensification from regular outpatient clinic to youth-ACT, we constructed a regression model illustrating a relatively strong relation between the predictor variables and the outcome (Nagelkerke R2 = 0.61), with three strong predictors, i.e. severity of psychiatric disorders of the child, parental stress, and domestic violence. This emphasizes the importance of a system-oriented approach with primary attention for problem solving and stress reduction within the system, in addition to the psychiatric treatment of the child, and possibly also the parents.
Collapse
Affiliation(s)
- Richard Vijverberg
- Department of Child and Adolescent Psychiatry, GGZ Delfland, PO-box 5016, 2600, GA, Delft, The Netherlands. .,Amsterdam UMC, location VUmc and GGZ inGeest, Department of psychiatry, Amsterdam, The Netherlands. .,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Robert Ferdinand
- Department of Child and Adolescent Psychiatry, GGZ Delfland, PO-box 5016, 2600 GA Delft, The Netherlands
| | - Aartjan Beekman
- Amsterdam UMC, location VUmc and GGZ inGeest, Department of psychiatry, Amsterdam, The Netherlands ,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Berno van Meijel
- Amsterdam UMC, location VUmc and GGZ inGeest, Department of psychiatry, Amsterdam, The Netherlands ,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.448984.dInholland University of Applied Sciences, Amsterdam, The Netherlands ,GGZ-VS, Academy for Masters in Advanced Nursing Practice, Utrecht, The Netherlands ,Parnassia Psychiatric Institute, The Hague, The Netherlands
| |
Collapse
|
27
|
Granek L, Nakash O, Ben-David M, Shapira S, Ariad S. Oncologists' Treatment Responses to Mental Health Distress in Their Cancer Patients. QUALITATIVE HEALTH RESEARCH 2018; 28:1735-1745. [PMID: 29973126 DOI: 10.1177/1049732318786479] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The objectives of this study were to identify how oncologists respond to mental health distress in their patients, what specific strategies they use in treating this distress, and what barriers they report responding to their patients' emotional distress. Twenty-three oncologists at two cancer centers were interviewed. The grounded theory method of data collection and analysis was used. Oncologists varied in their response to patients' emotional distress. Strategies used in responding to patients' distress included creating supportive relationships and prescribing medications, while barriers included patient reluctance, a lack of protocol on how to respond to patients, limited psychosocial resources, and a lack of time. Developing and adopting clear guidelines to addressing mental health distress among cancer patients is critical in assuring quality care for the whole patient and reduce the risk for poor quality of life and potential disease-related morbidity and mortality.
Collapse
Affiliation(s)
- Leeat Granek
- 1 Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ora Nakash
- 2 Smith College, Northampton, Massachusetts, USA
- 3 Interdisciplinary Center Herzliya, Herzliya, Israel
| | - Merav Ben-David
- 4 Tel Aviv University, Tel Aviv, Israel
- 5 Sheba Medical Center, Ramat-Gan, Israel
| | - Shahar Shapira
- 1 Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Samuel Ariad
- 1 Ben-Gurion University of the Negev, Beer-Sheva, Israel
- 6 Soroka University Medical Center, Beer-Sheva, Israel
| |
Collapse
|
28
|
Shepardson RL, Buchholz LJ, Weisberg RB, Funderburk JS. Psychological interventions for anxiety in adult primary care patients: A review and recommendations for future research. J Anxiety Disord 2018; 54:71-86. [PMID: 29427898 PMCID: PMC7909724 DOI: 10.1016/j.janxdis.2017.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/07/2017] [Accepted: 12/23/2017] [Indexed: 10/18/2022]
Abstract
Anxiety symptoms are prevalent in primary care, yet treatment rates are low. The integration of behavioral health providers into primary care via the Primary Care Behavioral Health (PCBH) model offers a promising way to improve treatment options by adding a team member with the necessary skillset to deliver evidence-based psychological interventions for anxiety. We conducted a narrative review of psychological interventions for anxiety applied within adult primary care settings (k = 44) to update the literature and evaluate the fit of existing interventions with the PCBH model. The majority of studies were randomized controlled trials (RCTs; 70.5%). Most interventions utilized cognitive-behavioral therapy (68.2%) and were delivered individually, face-to-face (52.3%). Overall, 65.9% of interventions (58.6% of RCTs, 91.7% of pre-post) were effective in reducing anxiety symptoms, and 83.3% maintained the gains at follow-up. Although it is encouraging that most interventions significantly reduced anxiety, their longer formats (i.e., number and duration of sessions) and narrow symptom targets make translation into practice difficult. Methodological limitations of the research included homogenous samples, failure to report key procedural details, pre-post designs, and restrictive eligibility criteria. We offer recommendations to guide future research to improve the likelihood of successful translation of anxiety interventions into clinical practice.
Collapse
Affiliation(s)
- Robyn L Shepardson
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, United States; Department of Psychology, Syracuse University, Syracuse, NY, United States.
| | - Laura J Buchholz
- Center for Integrated Healthcare, VA Western New York Healthcare System at Buffalo, Buffalo, NY, United States; Department of Psychology, University at Buffalo/State University of New York, Buffalo, NY, United States; Department of Psychology, University of Tampa, Tampa, FL, United States.
| | - Risa B Weisberg
- VA Boston Healthcare System, Boston, MA, United States; Boston University School of Medicine, Boston, MA, United States; Alpert Medical School of Brown University, Providence, RI, United States.
| | - Jennifer S Funderburk
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, United States; Department of Psychology, Syracuse University, Syracuse, NY, United States; Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States.
| |
Collapse
|
29
|
Walker A, Williams R, Sibley F, Stamp D, Carter A, Hurley M. Improving access to better care for people with knee and/or hip pain: service evaluation of allied health professional-led primary care. Musculoskeletal Care 2018; 16:222-232. [PMID: 28401656 DOI: 10.1002/msc.1189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Chronic knee and hip pain is prevalent, impairing mobility, function and quality of life. Allied health professions (AHPs) are better trained and have more time than general practitioners in primary care to advise and support people to adopt healthier lifestyles (maintain healthy weight, increase physical activity) that reduce joint pain. We evaluated whether AHP-led primary care delivering person-centred, practical lifestyle coaching was a feasible, effective way to manage chronic knee and/or hip pain. METHODS At initial assessment the 'Joint Pain Advisor' assessed pain, function, quality of life, physical activity, waist circumference and body mass, taught simple self-management strategies and used behaviour change techniques (motivational interviewing, goal setting, action/coping planning) to alter participants' lifestyles. Participants were invited for 6-week and 6-month reviews, when the Advisor reassessed clinical outcomes, fed back progress and reinforced health messages. Feasibility and effectiveness of the service was evaluated using quantitative and qualitative methods. RESULTS Uptake of the service was good: 498 people used the service. Between initial assessment and reviews, participants' pain, function, quality of life, weight, waist circumference and physical activity improved (p < 0.005). Service user satisfaction was high; they reported easier access to advice and support tailored to their needs that translated into clinical benefits and a more efficient pathway reducing unnecessary consultations and investigations. Relatively few people returned for a 6-month review as they considered they had received sufficient advice. CONCLUSIONS AHP-led care is a popular, effective, efficient and sustainable way to manage joint pain, without compromising safety or quality of care.
Collapse
Affiliation(s)
- A Walker
- St George's, University of London and Kingston University, UK
- Health Innovation Network, London, UK
| | - R Williams
- Lewisham NHS Clinical Commissioning Group, UK
| | - F Sibley
- Health Innovation Network, London, UK
| | - D Stamp
- Lewisham and Greenwich NHS Trust, UK
| | - A Carter
- Health Innovation Network, London, UK
| | - M Hurley
- St George's, University of London and Kingston University, UK
- Health Innovation Network, London, UK
| |
Collapse
|
30
|
Lovell K, Bower P, Gellatly J, Byford S, Bee P, McMillan D, Arundel C, Gilbody S, Gega L, Hardy G, Reynolds S, Barkham M, Mottram P, Lidbetter N, Pedley R, Molle J, Peckham E, Knopp-Hoffer J, Price O, Connell J, Heslin M, Foley C, Plummer F, Roberts C. Clinical effectiveness, cost-effectiveness and acceptability of low-intensity interventions in the management of obsessive-compulsive disorder: the Obsessive-Compulsive Treatment Efficacy randomised controlled Trial (OCTET). Health Technol Assess 2018; 21:1-132. [PMID: 28681717 DOI: 10.3310/hta21370] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The Obsessive-Compulsive Treatment Efficacy randomised controlled Trial emerged from a research recommendation in National Institute for Health and Care Excellence obsessive-compulsive disorder (OCD) guidelines, which specified the need to evaluate cognitive-behavioural therapy (CBT) treatment intensity formats. OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of two low-intensity CBT interventions [supported computerised cognitive-behavioural therapy (cCBT) and guided self-help]: (1) compared with waiting list for high-intensity CBT in adults with OCD at 3 months; and (2) plus high-intensity CBT compared with waiting list plus high-intensity CBT in adults with OCD at 12 months. To determine patient and professional acceptability of low-intensity CBT interventions. DESIGN A three-arm, multicentre, randomised controlled trial. SETTING Improving Access to Psychological Therapies services and primary/secondary care mental health services in 15 NHS trusts. PARTICIPANTS Patients aged ≥ 18 years meeting Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition criteria for OCD, on a waiting list for high-intensity CBT and scoring ≥ 16 on the Yale-Brown Obsessive Compulsive Scale (indicative of at least moderate severity OCD) and able to read English. INTERVENTIONS Participants were randomised to (1) supported cCBT, (2) guided self-help or (3) a waiting list for high-intensity CBT. MAIN OUTCOME MEASURES The primary outcome was OCD symptoms using the Yale-Brown Obsessive Compulsive Scale - Observer Rated. RESULTS Patients were recruited from 14 NHS trusts between February 2011 and May 2014. Follow-up data collection was complete by May 2015. There were 475 patients randomised: supported cCBT (n = 158); guided self-help (n = 158) and waiting list for high-intensity CBT (n = 159). Two patients were excluded post randomisation (one supported cCBT and one waiting list for high-intensity CBT); therefore, data were analysed for 473 patients. In the short term, prior to accessing high-intensity CBT, guided self-help demonstrated statistically significant benefits over waiting list, but these benefits did not meet the prespecified criterion for clinical significance [adjusted mean difference -1.91, 95% confidence interval (CI) -3.27 to -0.55; p = 0.006]. Supported cCBT did not demonstrate any significant benefit (adjusted mean difference -0.71, 95% CI -2.12 to 0.70). In the longer term, access to guided self-help and supported cCBT, prior to high-intensity CBT, did not lead to differences in outcomes compared with access to high-intensity CBT alone. Access to guided self-help and supported cCBT led to significant reductions in the uptake of high-intensity CBT; this did not seem to compromise patient outcomes at 12 months. Taking a decision-making approach, which focuses on which decision has a higher probability of being cost-effective, rather than the statistical significance of the results, there was little evidence that supported cCBT and guided self-help are cost-effective at the 3-month follow-up compared with a waiting list. However, by the 12-month follow-up, data suggested a greater probability of guided self-help being cost-effective than a waiting list from the health- and social-care perspective (60%) and the societal perspective (80%), and of supported cCBT being cost-effective compared with a waiting list from both perspectives (70%). Qualitative interviews found that guided self-help was more acceptable to patients than supported cCBT. Professionals acknowledged the advantages of low intensity interventions at a population level. No adverse events occurred during the trial that were deemed to be suspected or unexpected serious events. LIMITATIONS A significant issue in the interpretation of the results concerns the high level of access to high-intensity CBT during the waiting list period. CONCLUSIONS Although low-intensity interventions are not associated with clinically significant improvements in OCD symptoms, economic analysis over 12 months suggests that low-intensity interventions are cost-effective and may have an important role in OCD care pathways. Further research to enhance the clinical effectiveness of these interventions may be warranted, alongside research on how best to incorporate them into care pathways. TRIAL REGISTRATION Current Controlled Trials ISRCTN73535163. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 37. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Peter Bower
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Judith Gellatly
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Sarah Byford
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Dean McMillan
- Hull York Medical School and Department of Health Sciences, University of York, York, UK
| | | | - Simon Gilbody
- Hull York Medical School and Department of Health Sciences, University of York, York, UK
| | - Lina Gega
- Social Work and Communities, Northumbria University, Newcastle, UK
| | - Gillian Hardy
- Department of Psychology, University of Sheffield, Sheffield, UK
| | | | - Michael Barkham
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Patricia Mottram
- Cheshire & Wirral Partnership, NHS Foundation Trust, Wallasey, UK
| | | | - Rebecca Pedley
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Jo Molle
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Emily Peckham
- Department of Health Sciences, University of York, York, UK
| | | | - Owen Price
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Janice Connell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Margaret Heslin
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christopher Foley
- Centre for Biostatistics in the Institute of Population Health, University of Manchester, Manchester, UK
| | - Faye Plummer
- Department of Health Sciences, University of York, York, UK
| | - Christopher Roberts
- Centre for Biostatistics in the Institute of Population Health, University of Manchester, Manchester, UK
| |
Collapse
|
31
|
Tolin DF. Can Cognitive Behavioral Therapy for Anxiety and Depression Be Improved with Pharmacotherapy? A Meta-analysis. Psychiatr Clin North Am 2017; 40:715-738. [PMID: 29080596 DOI: 10.1016/j.psc.2017.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The present meta-analysis examined controlled trials of pharmacologic augmentation of cognitive-behavioral therapy (CBT) for patients with anxiety or depressive disorders. The additive effect of medications was small for both anxiety and depressive disorders at posttreatment, and there was no additive benefit after medications were discontinued. A small body of evidence suggested that antidepressant medications are an efficacious second-line treatment for patients failing to respond to CBT alone. In anxiety disorders, novel agents thought to potentiate the biological mechanisms of CBT showed small effects at posttreatment; after discontinuation, some of these agents were associated with an increasing effect.
Collapse
Affiliation(s)
- David F Tolin
- The Institute of Living, Anxiety Disorders Center, 200 Retreat Avenue, Hartford, CT 06106, USA.
| |
Collapse
|
32
|
Can less be more? Open trial of a stepped care approach for child and adolescent anxiety disorders. J Anxiety Disord 2017; 51:7-13. [PMID: 28843575 PMCID: PMC5610647 DOI: 10.1016/j.janxdis.2017.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 05/10/2017] [Accepted: 08/13/2017] [Indexed: 11/22/2022]
Abstract
This open trial presents a stepped care treatment approach for youths with anxiety disorders. In Step 1, 124 youths (65 girls; M age=9.7years) participated in a low intensity computer administered attention bias modification (ABM) protocol. Statistically significant reductions in youth anxiety severity were found following Step 1. Youths and parents were then given the option to not continue with further treatment or step up to a higher intensity cognitive behavioral therapy (CBT) protocol (Step 2). Of 112 youths who completed Step 1, 67 (59.8%) discontinued treatment and 45 (40.2%) stepped up. Co-occurring ADHD and higher anxiety severity at baseline were significantly associated with the decision to step up. Of those youths who completed Step 2, additional statistically significant reductions in youth anxiety severity were found. Across the entire protocol, 68.6% of youths were rated as either very much improved or much improved on the Clinical Global Impressions-Improvement scale. In a hypothetical comparison in which all youths received CBT alone, the stepped care protocol resulted in approximately 50% less time in treatment sessions. These findings support the promise of initiating youth anxiety disorder treatment with low intensity treatment and then stepping up to higher intensity treatment as needed.
Collapse
|
33
|
Rushton A, Heneghan NR, Heap A, White L, Calvert M, Goodwin PC. Patient and physiotherapist perceptions of rehabilitation following primary lumbar discectomy: a qualitative focus group study embedded within an external pilot and feasibility trial. BMJ Open 2017; 7:e015878. [PMID: 28473522 PMCID: PMC5623354 DOI: 10.1136/bmjopen-2017-015878] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/10/2017] [Accepted: 03/23/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate patients' and physiotherapists' perceptions, preferences and feelings about rehabilitation following lumbar discectomy surgery. DESIGN A qualitative focus group study, informed from the theoretical perspective of phenomenology, of patients' and physiotherapists' experiences of rehabilitation following lumbar discectomy was conducted. The focus groups were used to explore patients' and physiotherapists' perceptions and their preferences and feelings about different approaches to rehabilitation. The focus groups were facilitated and observed by experienced researchers and were informed by a topic guide that had been piloted previously. SETTING The study was embedded within an external pilot and feasibility trial that randomised patients across two secondary care spinal surgery sites in the UK to receive either 1:1 physiotherapy and leaflet or leaflet-only interventions. PARTICIPANTS Five focus groups took place between April and July 2014. A framework analysis of thematic coding (deductive and inductive components) by two researchers captured identified themes common to both patients and physiotherapists. Data from three focus groups with patients and carers (n=11) and two with physiotherapists (n=15) contributed to the analytic framework. RESULTS Emerging themes included: the value of patient leaflets with or without physiotherapy interventions; the importance of self-motivation in the recovery pathway; benefits of group physiotherapy for some patient groups and patient preference influencing rehabilitation. CONCLUSION Patients and physiotherapists perceived the study patient leaflet and 1:1 physiotherapy interventions as high quality and valuable. Patients' personal priorities, for example, their need to return to work, influenced their preferences for rehabilitation interventions following surgery.
Collapse
Affiliation(s)
- Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Nicola R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Alison Heap
- Physiotherapy, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Louise White
- Physiotherapy, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Melanie Calvert
- Institute of Applied Health Research, The University of Birmingham, Birmingham, UK
| | - Peter C Goodwin
- Health Professions Department (Physiotherapy), Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
34
|
Abstract
This case study details limitations encountered while providing indirect and direct clinical services to children in applied settings through a behavioral mental health consultation model. Specifically, the case of AB, a 13-year-old male residing at a foster care facility, who demonstrates oppositional and defiant behavior problems and symptoms of both retentive encopresis and posttraumatic stress, is presented to illustrate potential pitfalls faced by a consultant providing multiple forms of intervention in applied settings. Although the provision of supportive, individual psychotherapy is reviewed, an emphasis is placed on the difficulties of implementing a behavior modification plan to treat AB's encopresis at his residential foster care facility. The challenges associated with providing individual psychotherapy to AB while serving as the behavioral consultant at his residence are highlighted. Finally, recommendations are presented regarding how mental health consultants can work with applied service agencies to promote effective therapeutic interventions within frameworks established by those agencies.
Collapse
|
35
|
Silverman WK, Pettit JW, Lebowitz ER. Stepping Toward Making Less More for Concerning Anxiety in Children and Adolescents. ACTA ACUST UNITED AC 2016; 23:234-238. [PMID: 28025591 DOI: 10.1111/cpsp.12158] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
36
|
Versluis A, Verkuil B, Spinhoven P, van der Ploeg MM, Brosschot JF. Changing Mental Health and Positive Psychological Well-Being Using Ecological Momentary Interventions: A Systematic Review and Meta-analysis. J Med Internet Res 2016; 18:e152. [PMID: 27349305 PMCID: PMC4940607 DOI: 10.2196/jmir.5642] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/04/2016] [Accepted: 04/21/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Mental health problems are highly prevalent, and there is need for the self-management of (mental) health. Ecological momentary interventions (EMIs) can be used to deliver interventions in the daily life of individuals using mobile devices. OBJECTIVES The aim of this study was to systematically assess and meta-analyze the effect of EMI on 3 highly prevalent mental health outcomes (anxiety, depression, and perceived stress) and positive psychological outcomes (eg, acceptance). METHODS PsycINFO and Web of Science were searched for relevant publications, and the last search was done in September 2015. Three concepts were used to find publications: (1) mental health, (2) mobile phones, and (3) interventions. A total of 33 studies (using either a within- or between-subject design) including 43 samples that received an EMI were identified (n=1301), and relevant study characteristics were coded using a standardized form. Quality assessment was done with the Cochrane Collaboration tool. RESULTS Most of the EMIs focused on a clinical sample, used an active intervention (that offered exercises), and in over half of the studies, additional support by a mental health professional (MHP) was given. The EMI lasted on average 7.48 weeks (SD=6.46), with 2.80 training episodes per day (SD=2.12) and 108.25 total training episodes (SD=123.00). Overall, 27 studies were included in the meta-analysis, and after removing 6 outliers, a medium effect was found on mental health in the within-subject analyses (n=1008), with g=0.57 and 95% CI (0.45-0.70). This effect did not differ as function of outcome type (ie, anxiety, depression, perceived stress, acceptance, relaxation, and quality of life). The only moderator for which the effect varied significantly was additional support by an MHP (MHP-supported EMI, g=0.73, 95% CI: 0.57-0.88; stand-alone EMI, g=0.45, 95% CI: 0.22-0.69; stand-alone EMI with access to care as usual, g=0.38, 95% CI: 0.11-0.64). In the between-subject studies, 13 studies were included, and a small to medium effect was found (g=0.40, 95% CI: 0.22-0.57). Yet, these between-subject analyses were at risk for publication bias and were not suited for moderator analyses. Furthermore, the overall quality of the studies was relatively low. CONCLUSIONS Results showed that there was a small to medium effect of EMIs on mental health and positive psychological well-being and that the effect was not different between outcome types. Moreover, the effect was larger with additional support by an MHP. Future randomized controlled trials are needed to further strengthen the results and to determine potential moderator variables. Overall, EMIs offer great potential for providing easy and cost-effective interventions to improve mental health and increase positive psychological well-being.
Collapse
Affiliation(s)
- Anke Versluis
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, Netherlands.
| | | | | | | | | |
Collapse
|
37
|
Castelnuovo G, Pietrabissa G, Cattivelli R, Manzoni GM, Molinari E. Not Only Clinical Efficacy in Psychological Treatments: Clinical Psychology Must Promote Cost-Benefit, Cost-Effectiveness, and Cost-Utility Analysis. Front Psychol 2016; 7:563. [PMID: 27242562 PMCID: PMC4860399 DOI: 10.3389/fpsyg.2016.00563] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/05/2016] [Indexed: 01/17/2023] Open
Affiliation(s)
- Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilano, Italy
| | - Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilano, Italy
| | - Roberto Cattivelli
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilano, Italy
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Faculty of Psychology, eCampus UniversityNovedrate, Italy
| | - Enrico Molinari
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilano, Italy
| |
Collapse
|
38
|
Abstract
Children exposed to disasters are a vulnerable population, making the assessment of children post-disaster an important issue. Utilizing a Multiple Gating Stepped Care framework, we highlight recent literature related to post-disaster assessment and intervention for children. In particular, we focus on screening, clinical evaluation, and feedback-informed service delivery. Screening allows large populations of children to be assessed at a relatively low cost. Children identified by screening as being at risk may then be assessed through more in-depth clinical evaluations, in order to assess clinical symptoms, strengths, and stressors, and to make determinations about appropriate interventions. Continued assessment during therapy provides important feedback for the delivery of appropriate care. New formats for assessment, as well as issues related to identifying sources for assessment, are discussed. Recommendations for future directions are provided.
Collapse
|
39
|
Bee P, Lovell K, Airnes Z, Pruszynska A. Embedding telephone therapy in statutory mental health services: a qualitative, theory-driven analysis. BMC Psychiatry 2016; 16:56. [PMID: 26932326 PMCID: PMC4774117 DOI: 10.1186/s12888-016-0761-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 02/22/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Telephone-administered cognitive behavioural therapy (T-CBT) has attracted international recognition as a potential means of providing effective psychological treatment whilst simultaneously lowering costs, maximizing service efficiency and improving patient access to care. A lack of rigorous exploration of therapist perspectives means that little is known about professional readiness to adopt such delivery models, or the work that may be involved in ensuring successful implementation. METHODS This paper reports on a qualitative exploration of professional views of high intensity T-CBT. Semi-structured interviews with 18 UK accredited Cognitive Behavioural Therapists with nursing or allied health backgrounds were collected and analysed according to Normalisation Process Theory, a contemporary and empirically-derived theory of health technology implementation. RESULTS Despite increasing research effort seeking to determine the effectiveness of T-CBT, the clinical rationale for its use remains insecure. Professional perceptions of T-CBT as a high risk delivery strategy emerge as a key factor delaying T-CBT routinisation in practice. T-CBT champions draw on experiential knowledge to demonstrate that remote services can add value, a key factor being the recognition that telephone-mediated services can provide viable access for hard to reach populations. T-CBT uptake will be facilitated by i) the modification of existing protocols to address new methods of exchanging information and data, and (ii) greater clarification of the reach and span of telephone therapies, including the most appropriate division of labour across different service levels and settings. CONCLUSIONS The integration and normalisation of high intensity T-CBT into mental health services demands greater recognition and redress of the existing socio-technical matrices within which nursing and allied health practitioners work. The future spread of higher intensity T-CBT is contingent upon the willingness of service managers to support staff in the delivery and governance of non-face-to-face therapy models. Clear delineation of the role and scope of T-CBT and the extent to which it will extend or replace existing provision is required.
Collapse
Affiliation(s)
- Penny Bee
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Zerena Airnes
- Primary Care Psychological Therapies Service, NHS Tameside and Glossop, Glossop, UK
| | - Anna Pruszynska
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| |
Collapse
|
40
|
Meuldijk D, Carlier I, van Vliet I, van Veen T, Wolterbeek R, van Hemert A, Zitman F. The clinical effectiveness of concise cognitive behavioral therapy with or without pharmacotherapy for depressive and anxiety disorders; a pragmatic randomized controlled equivalence trial in clinical practice. Contemp Clin Trials 2016; 47:131-8. [DOI: 10.1016/j.cct.2015.12.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 12/29/2015] [Accepted: 12/31/2015] [Indexed: 12/28/2022]
|
41
|
|
42
|
Jensen CG, Lansner J, Petersen A, Vangkilde SA, Ringkøbing SP, Frokjaer VG, Adamsen D, Knudsen GM, Denninger JW, Hasselbalch SG. Open and Calm--a randomized controlled trial evaluating a public stress reduction program in Denmark. BMC Public Health 2015; 15:1245. [PMID: 26673225 PMCID: PMC4682248 DOI: 10.1186/s12889-015-2588-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 12/09/2015] [Indexed: 12/17/2022] Open
Abstract
Background Prolonged psychological stress is a risk factor for illness and constitutes an increasing public health challenge creating a need to develop public interventions specifically targeting stress and promoting mental health. The present randomized controlled trial evaluated health effects of a novel program: Relaxation-Response-based Mental Health Promotion (RR-MHP). Methods The multimodal, meditation-based course was publicly entitled “Open and Calm” (OC) because it consistently trained relaxed and receptive (“Open”) attention, and consciously non-intervening (“Calm”) witnessing, in two standardized formats (individual or group) over nine weeks. Seventy-two participants who complained to their general practitioner about reduced daily functioning due to prolonged stress or who responded to an online health survey on stress were randomly assigned to OC formats or treatment as usual, involving e.g., unstandardized consultations with their general practitioner. Outcomes included perceived stress, depressive symptoms, quality of life, sleep disturbances, mental health, salivary cortisol, and visual perception. Control variables comprised a genetic stress-resiliency factor (serotonergic transporter genotype; 5-HTTLPR), demographics, personality, self-reported inattentiveness, and course format. Results Intent-to-treat analyses showed significantly larger improvements in OC than in controls on all outcomes. Treatment effects on self-reported outcomes were sustained after 3 months and were not related to age, gender, education, or course format. The dropout rate was only 6 %. Conclusions The standardized OC program reduced stress and improved mental health for a period of 3 months. Further testing of the OC program for public mental health promotion and reduction of stress-related illnesses is therefore warranted. A larger implementation is in progress. Trial registration: ClinicalTrials.gov.: NCT02140307. Registered May 14 2014. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2588-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Christian G Jensen
- Neurobiology Research Unit (NRU) and Center for Integrated Molecular Brain Imaging (Cimbi), The Neuroscience Centre, Rigshospitalet and University of Copenhagen, Juliane Maries Vej 28, 3rd floor, 2100, Copenhagen OE, Denmark.
| | - Jon Lansner
- Neurobiology Research Unit (NRU) and Center for Integrated Molecular Brain Imaging (Cimbi), The Neuroscience Centre, Rigshospitalet and University of Copenhagen, Juliane Maries Vej 28, 3rd floor, 2100, Copenhagen OE, Denmark.
| | - Anders Petersen
- Center for Visual Cognition, Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen K, Denmark.
| | - Signe A Vangkilde
- Center for Visual Cognition, Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen K, Denmark.
| | - Signe P Ringkøbing
- Neurobiology Research Unit (NRU) and Center for Integrated Molecular Brain Imaging (Cimbi), The Neuroscience Centre, Rigshospitalet and University of Copenhagen, Juliane Maries Vej 28, 3rd floor, 2100, Copenhagen OE, Denmark.
| | - Vibe G Frokjaer
- Neurobiology Research Unit (NRU) and Center for Integrated Molecular Brain Imaging (Cimbi), The Neuroscience Centre, Rigshospitalet and University of Copenhagen, Juliane Maries Vej 28, 3rd floor, 2100, Copenhagen OE, Denmark.
| | - Dea Adamsen
- Neurobiology Research Unit (NRU) and Center for Integrated Molecular Brain Imaging (Cimbi), The Neuroscience Centre, Rigshospitalet and University of Copenhagen, Juliane Maries Vej 28, 3rd floor, 2100, Copenhagen OE, Denmark.
| | - Gitte M Knudsen
- Neurobiology Research Unit (NRU) and Center for Integrated Molecular Brain Imaging (Cimbi), The Neuroscience Centre, Rigshospitalet and University of Copenhagen, Juliane Maries Vej 28, 3rd floor, 2100, Copenhagen OE, Denmark.
| | - John W Denninger
- Benson-Henry Institute of Mind-Body Medicine, Massachusetts General Hospital, Boston, USA.
| | - Steen G Hasselbalch
- Neurobiology Research Unit (NRU) and Center for Integrated Molecular Brain Imaging (Cimbi), The Neuroscience Centre, Rigshospitalet and University of Copenhagen, Juliane Maries Vej 28, 3rd floor, 2100, Copenhagen OE, Denmark. .,Danish Dementia Center, Copenhagen University Hospital, Copenhagen, Denmark.
| |
Collapse
|
43
|
Rushton A, Heneghan NR, Calvert M, Heap A, White L, Goodwin PC. Physiotherapy Post Lumbar Discectomy: Prospective Feasibility and Pilot Randomised Controlled Trial. PLoS One 2015; 10:e0142013. [PMID: 26562660 PMCID: PMC4642943 DOI: 10.1371/journal.pone.0142013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 10/12/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To evaluate: acceptability and feasibility of trial procedures; distribution of scores on the Roland Morris Disability Questionnaire (RMDQ, planned primary outcome); and efficient working of trial components. DESIGN AND SETTING A feasibility and external pilot randomised controlled trial (ISRCTN33808269, assigned 10/12/2012) was conducted across 2 UK secondary care outpatient physiotherapy departments associated with regional spinal surgery centres. PARTICIPANTS Consecutive consenting patients aged >18 years; post primary, single level, lumbar discectomy. INTERVENTIONS Participants were randomised to either 1:1 physiotherapy outpatient management including patient leaflet, or patient leaflet alone. MAIN OUTCOME MEASURES Blinded assessments were made at 4 weeks post surgery (baseline) and 12 weeks post baseline (proposed primary end point). Secondary outcomes included: Global Perceived Effect, back/leg pain, straight leg raise, return to work/function, quality of life, fear avoidance, range of movement, medication, re-operation. RESULTS At discharge, 110 (44%) eligible patients gave consent to be contacted. 59 (54%) patients were recruited. Loss to follow up was 39% at 12 weeks, with one site contributing 83% losses. Mean (SD) RMDQ was 10.07 (5.58) leaflet and 10.52 (5.94) physiotherapy/leaflet at baseline; and 5.37 (4.91) leaflet and 5.53 (4.49) physiotherapy/leaflet at 12 weeks. 5.1% zero scores at 12 weeks illustrated no floor effect. Sensitivity to change was assessed at 12 weeks with mean (SD) change -4.53 (6.41), 95%CI -7.61 to -1.44 for leaflet; and -6.18 (5.59), 95%CI -9.01 to -3.30 for physiotherapy/leaflet. RMDQ mean difference (95%CI) between change from baseline to twelve weeks was 1.65(-2.46 to 5.75). Mean difference (95%CI) between groups at 12 weeks was -0.16 (-3.36 to 3.04). Participant adherence with treatment was good. No adverse events were reported. CONCLUSIONS Both interventions were acceptable, and it is promising that they both demonstrated a trend in reducing disability in this population. A randomised controlled trial, using a different trial design, is needed to ascertain the effectiveness of combining the interventions into a stepped care intervention and comparing to a no intervention arm. Findings will guide design changes for an adequately powered randomised controlled trial, using RMDQ as the primary outcome. TRIAL REGISTRATION ISRCTN registry 33808269.
Collapse
Affiliation(s)
- Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Nicola R Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Melanie Calvert
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Alison Heap
- Physiotherapy Department, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Louise White
- Physiotherapy Department, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Peter C Goodwin
- Health Professions Department (Physiotherapy), Manchester Metropolitan University, Birley Fields, Manchester, United Kingdom
| |
Collapse
|
44
|
Stepped Care and Rehabilitation for Patients Recovering From Borderline Personality Disorder. J Clin Psychol 2015; 71:747-52. [DOI: 10.1002/jclp.22202] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
45
|
Pugh M. A narrative review of schemas and schema therapy outcomes in the eating disorders. Clin Psychol Rev 2015; 39:30-41. [PMID: 25932958 DOI: 10.1016/j.cpr.2015.04.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 03/02/2015] [Accepted: 04/15/2015] [Indexed: 12/25/2022]
Abstract
Whilst cognitive-behavioural therapy has demonstrated efficacy in the treatment of eating disorders, therapy outcomes and current conceptualizations still remain inadequate. In light of these shortcomings there has been growing interest in the utility of schema therapy applied to eating pathology. The present article first provides a narrative review of empirical literature exploring schemas and schema processes in eating disorders. Secondly, it critically evaluates outcome studies assessing schema therapy applied to eating disorders. Current evidence lends support to schema-focused conceptualizations of eating pathology and confirms that eating disorders are characterised by pronounced maladaptive schemas. Treatment outcomes also indicate that schema therapy, the schema-mode approach, and associated techniques are promising interventions for complex eating disorders. Implications for clinical practice and future directions for research are discussed.
Collapse
Affiliation(s)
- Matthew Pugh
- Vincent Square Eating Disorders Service, Central and North West London NHS Foundation Trust, Royal Holloway, University of London, London, England, United Kingdom.
| |
Collapse
|
46
|
Magor-Blatch LE, Ingham L. Youth with mental illness: attitudes towards and therapeutic benefits of residential stepped care. Community Ment Health J 2015; 51:338-46. [PMID: 25319877 DOI: 10.1007/s10597-014-9778-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 10/07/2014] [Indexed: 11/30/2022]
Abstract
There is little research reporting the "lived experience" of young people undertaking treatment for mental health conditions. This pilot study explores the phenomenological experiences of a small group of six young people aged 14-18 years who were resident of a youth stepped-care mental health program in the Australian Capital Territory. Using semi-structured interviews, data were collected and two main themes emerged: (a) "Life engagement" and (b) "Relationships." Participants also provided responses on self-report measures at baseline and follow-up and feedback on aspects of the program. Further research is suggested to build on this study to increase research outcomes.
Collapse
Affiliation(s)
- Lynne E Magor-Blatch
- Faculty of Health, Centre for Applied Psychology, University of Canberra, Canberra, ACT, 2601, Australia,
| | | |
Collapse
|
47
|
Montero-Marín J, Prado-Abril J, Botella C, Mayoral-Cleries F, Baños R, Herrera-Mercadal P, Romero-Sanchiz P, Gili M, Castro A, Nogueira R, García-Campayo J. Expectations among patients and health professionals regarding Web-based interventions for depression in primary care: a qualitative study. J Med Internet Res 2015; 17:e67. [PMID: 25757358 PMCID: PMC4376189 DOI: 10.2196/jmir.3985] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/26/2015] [Accepted: 02/12/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND One-quarter of the world's population will suffer from depression symptoms at some point in their lives. Mental health services in developed countries are overburdened. Therefore, cost-effective interventions that provide mental health care solutions such as Web-based psychotherapy programs have been proposed. OBJECTIVE The intent of the study was to identify expectations regarding Web-based psychotherapy for the treatment of depression in primary care among patients and health professionals that might facilitate or hinder its effects. METHODS The expectations of untreated patients and health professionals were examined by means of interviews and focus groups. There were 43 participants (20 patients with mild and moderate levels of depression, 11 primary care physicians, and 12 managers; 22 of them for interviews and 21 for groups). A thematic content analysis from the grounded theory for interviews, and an analysis of the discursive positions of participants based on the sociological model for groups were performed. Interpretations were achieved by agreement between three independent analysts. RESULTS All participants showed a good general acceptance of Web-based psychotherapy, appreciating possible advantages and improvements. Patients, physicians, and managers shared the same conceptualization of their expectations, although highlighting different aspects. Patients focused on the need for individualized and personalized interaction, while professionals highlighted the need for the standardization of the program. Physicians were concerned with extra workload, while managers were worried about optimizing cost-effectiveness. CONCLUSIONS Expectations of the different participants can conflict with each other. Finding a balanced position among them is needed if we are to harmoniously implement effective Web-based interventions for depression in routine clinical practice.
Collapse
|
48
|
Rissanen R, Nordin K, Ahlgren J, Arving C. A stepped care stress management intervention on cancer-related traumatic stress symptoms among breast cancer patients—a randomized study in group vs. individual setting. Psychooncology 2015; 24:1028-35. [PMID: 25631707 DOI: 10.1002/pon.3763] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 11/10/2014] [Accepted: 12/30/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate the mode of delivery of a stress management intervention, in a group or individual setting, on self-reported cancer-related traumatic stress symptoms. A secondary aim was to evaluate a stepped care approach. METHODS All study participants (n = 425), who were female, newly diagnosed with breast cancer and receiving standard oncological care were offered Step I of the stepped care approach, a stress management education (SME). Thereafter, they were screened for cancer-related traumatic stress symptoms, and, if present (n = 304), were invited to join Step II, a more intense intervention, derived from cognitive behavioral therapy, to which they were randomized to either a group (n = 77) or individual (n = 78) setting. To assess cancer-related traumatic stress symptoms, participants completed the Impact of Event Scale and the Hospital Anxiety and Depression Scale at the time of inclusion, three-months post-inclusion and approximately 12-months post-inclusion. RESULTS The SME did not significantly decrease any of the cancer-related traumatic stress symptoms. No statistically significant differences were found between the group and the individual setting interventions. However, only 54% of the participants attended the group setting compared to 91% for the individual setting. CONCLUSION The mode of delivery had no effect on the cancer-related traumatic stress symptoms; however, the individual setting was preferred. In future studies, a preference-based RCT design will be recommended for evaluating the different treatment effects.
Collapse
Affiliation(s)
- Ritva Rissanen
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Karin Nordin
- Department of Public Health and Caring Sciences, Uppsala University, Sweden.,Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Johan Ahlgren
- Department of Oncology, University of Örebro, Sweden
| | - Cecilia Arving
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
| |
Collapse
|
49
|
The clinical effectiveness of stepped care systems for depression in working age adults: a systematic review. J Affect Disord 2015; 170:119-30. [PMID: 25240141 DOI: 10.1016/j.jad.2014.08.030] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 07/13/2014] [Accepted: 08/19/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Stepped care service delivery models involve treatments that become increasingly intense through successive steps, with patients re-assigned via pre-defined decision criteria. This article reviews the clinical effectiveness of stepped care systems for depression in working age adults. METHODS Systematic literature review of quantitative clinical outcome evidence comprising 14 controlled and uncontrolled studies meeting specified criteria. Principal outcomes were (a) recovery rates, defined as patients no longer meeting clinical cut-off criteria for the specific outcome measure and (b) treatment response rates, defined as a 50% decrease in outcome measure score. RESULTS Stepped care systems had recovery rates ranging predominantly between 40% and 60% and response rates approximating 60%. Studies comparing stepped care with usual/enhanced usual care tended to find significant differences favouring stepped care. The median recovery odds ratio was 1.31 (interquartile intervals of 1.05 and 1.66; k=7 studies). The median comparative Cohen's d effect size estimate was 0.41 (interquartile intervals 0.25 and 0.45; k=5 studies). LIMITATIONS The inclusion of uncontrolled studies could be seen as reducing the overall quality of evidence and a meta-analysis was not included due to limitations with the available data. CONCLUSIONS Evidence suggested that stepped care interventions for depression are at least as effective as usual care. However, the clinical and organisational superiority of stepped care is yet to be scientifically verified. Differential benefits of stepped care may ultimately depend on service quality. Further research investigating and comparing the specific components and configurations of stepped care interventions are indicated.
Collapse
|
50
|
Hill JJ, Kuyken W, Richards DA. Developing stepped care treatment for depression (STEPS): study protocol for a pilot randomised controlled trial. Trials 2014; 15:452. [PMID: 25409886 PMCID: PMC4247766 DOI: 10.1186/1745-6215-15-452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/30/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stepped care is recommended and implemented as a means to organise depression treatment. Compared with alternative systems, it is assumed to achieve equivalent clinical effects and greater efficiency. However, no trials have examined these assumptions. A fully powered trial of stepped care compared with intensive psychological therapy is required but a number of methodological and procedural uncertainties associated with the conduct of a large trial need to be addressed first. METHODS/DESIGN STEPS (Developing stepped care treatment for depression) is a mixed methods study to address uncertainties associated with a large-scale evaluation of stepped care compared with high-intensity psychological therapy alone for the treatment of depression. We will conduct a pilot randomised controlled trial with an embedded process study. Quantitative trial data on recruitment, retention and the pathway of patients through treatment will be used to assess feasibility. Outcome data on the effects of stepped care compared with high-intensity therapy alone will inform a sample size calculation for a definitive trial. Qualitative interviews will be undertaken to explore what people think of our trial methods and procedures and the stepped care intervention. A minimum of 60 patients with Major Depressive Disorder will be recruited from an Improving Access to Psychological Therapies service and randomly allocated to receive stepped care or intensive psychological therapy alone. All treatments will be delivered at clinic facilities within the University of Exeter. Quantitative patient-related data on depressive symptoms, worry and anxiety and quality of life will be collected at baseline and 6 months. The pilot trial and interviews will be undertaken concurrently. Quantitative and qualitative data will be analysed separately and then integrated. DISCUSSION The outcomes of this study will inform the design of a fully powered randomised controlled trial to evaluate the effectiveness and efficiency of stepped care. Qualitative data on stepped care will be of immediate interest to patients, clinicians, service managers, policy makers and guideline developers. A more informed understanding of the feasibility of a large trial will be obtained than would be possible from a purely quantitative (or qualitative) design. TRIAL REGISTRATION Current Controlled Trials ISRCTN66346646 registered on 2 July 2014.
Collapse
Affiliation(s)
- Jacqueline J Hill
- />Mood Disorders Centre, School of Psychology, University of Exeter, Queen’s Drive, Exeter, UK
| | - Willem Kuyken
- />Mood Disorders Centre, School of Psychology, University of Exeter, Queen’s Drive, Exeter, UK
| | - David A Richards
- />University of Exeter Medical School, University of Exeter, Exeter, UK
| |
Collapse
|