Randomized controlled trial study of the effects of an online divorce platform on anxiety, depression, and somatization

Association between vegetable intake and major depressive disorder: results from National Health and Nutrition Examination Survey 2005-2018 and bidirectional two-sample Mendelian randomisation

OBJECTIVE

This study aimed to evaluate the association between vegetable intake and major depressive disorder (MDD) through cross-sectional analysis and bidirectional two-sample Mendelian randomisation (MR).

DESIGN

Cross-sectional analysis was conducted on National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2018 and the corresponding Food Patterns Equivalents Database (FPED). Genome-wide association study (GWAS) data were obtained from UK Biobank and Psychiatric Genomics Consortium (PGC) dataset. Logistic regression analysis was performed after calculating the weights of the samples. Inverse variance weighted, MR-Egger and weighted median methods were used to evaluate the causal effects.

SETTING

A Patient Health Questionnaire-9 score ≥ 10 was considered to indicate MDD. Low vegetable intake was defined as < 2 cups of vegetables per day.

PARTICIPANTS

30 861 U.S. adults from NHANES. The GWAS data sample size related to vegetable intake were comprised 448 651 and 435 435 cases respectively, while the GWAS data sample size associated with MDD encompassed 500 199 cases.

RESULTS

There were 23 249 (75·33 %) participants with low vegetable intake. The relationship between vegetable intake and MDD was nonlinear. In the multivariate model adjusted for sex, age, education, marital status, poverty income ratio, ethnicity and BMI, participants with low vegetable intake were associated with an increased risk of MDD (OR = 1·53, 95 % CI (1·32, 1·77), P < 0·001). Bidirectional MR showed no causal effects between vegetable intake and MDD.

CONCLUSIONS

Cross-sectional analysis identified a significant relationship between vegetable intake and MDD, whereas the results from bidirectional two-sample MR did not support a causal role.

Digital Psychotherapies for Adults Experiencing Depressive Symptoms: Systematic Review and Meta-Analysis

BACKGROUND

Depression affects 5% of adults and it is a major cause of disability worldwide. Digital psychotherapies offer an accessible solution addressing this issue. This systematic review examines a spectrum of digital psychotherapies for depression, considering both their effectiveness and user perspectives.

OBJECTIVE

This review focuses on identifying (1) the most common types of digital psychotherapies, (2) clients' and practitioners' perspectives on helpful and unhelpful aspects, and (3) the effectiveness of digital psychotherapies for adults with depression.

METHODS

A mixed methods protocol was developed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search strategy used the Population, Intervention, Comparison, Outcomes, and Study Design (PICOS) framework covering 2010 to 2024 and 7 databases were searched. Overall, 13 authors extracted data, and all aspects of the review were checked by >1 reviewer to minimize biases. Quality appraisal was conducted for all studies. The clients' and therapists' perceptions on helpful and unhelpful factors were identified using qualitative narrative synthesis. Meta-analyses of depression outcomes were conducted using the standardized mean difference (calculated as Hedges g) of the postintervention change between digital psychotherapy and control groups.

RESULTS

Of 3303 initial records, 186 records (5.63%; 160 studies) were included in the review. Quantitative studies (131/160, 81.8%) with a randomized controlled trial design (88/160, 55%) were most common. The overall sample size included 70,720 participants (female: n=51,677, 73.07%; male: n=16,779, 23.73%). Digital interventions included "stand-alone" or non-human contact interventions (58/160, 36.2%), "human contact" interventions (11/160, 6.8%), and "blended" including stand-alone and human contact interventions (91/160, 56.8%). What clients and practitioners perceived as helpful in digital interventions included support with motivation and accessibility, explanation of task reminders, resources, and learning skills to manage symptoms. What was perceived as unhelpful included problems with usability and a lack of direction or explanation. A total of 80 studies with 16,072 participants were included in the meta-analysis, revealing a moderate to large effect in favor of digital psychotherapies for depression (Hedges g=-0.61, 95% CI -0.75 to -0.47; Z=-8.58; P<.001). Subgroup analyses of the studies with different intervention delivery formats and session frequency did not have a statistically significant effect on the results (P=.48 and P=.97, respectively). However, blended approaches revealed a large effect size (Hedges g=-0.793), while interventions involving human contact (Hedges g=-0.42) or no human contact (Hedges g=-0.40) had slightly smaller effect sizes.

CONCLUSIONS

Digital interventions for depression were found to be effective regardless of format and frequency. Blended interventions have larger effect size than those involving human contact or no human contact. Digital interventions were helpful especially for diverse ethnic groups and young women. Future research should focus on understanding the sources of heterogeneity based on intervention and population characteristics.

TRIAL REGISTRATION

PROSPERO CRD42021238462; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=238462.

Can Online Parent Education Meet the Needs of the Courts and Improve the Well-Being of Children? The Critical Roles of Goal, Program, and Evidence Alignment

Parent education in family courts can significantly impact children's well-being after divorce if programs are (1) widely accessible, (2) acceptable to parents, (3) feasible to implement by courts, and (4) have evidence of effectiveness in improving key outcomes for children. In light of recently raised concerns about whether court-ordered/court-mandated parent education is justified; it is critical to identify effective parent education programs. Online parent education programs have the potential to be widely accessible, acceptable to parents and courts, and effectively promote children's well-being. However, few effective online parent education programs are being widely adopted by family courts. There is some controversy about whether online parent education meets the needs of family courts in being cost-effective programs that offer ways to hold parents accountable for their participation. We articulate the wide array of goals for parent education programs and present a framework to identify and select programs that meet specific goals. We discuss access, cost, evidence of effectiveness, acceptability, credibility, and compliance tracking. We highlight two online parent education programs to illustrate differences in contexts and goals and to show that online programs have great potential to be effective in accomplishing goals valued by the courts.

A call for early, effective, and scalable parent education programs for high-conflict separated/divorcing parents: A synthesized perspective from prevention science and family law

Conflict between parents is stressful and disruptive to children living in the midst of parental separation or divorce. Although some level of post-separation/divorce conflict is understandable in an emotionally-charged separation/divorce, it undermines the extent to which parents protect their children from short- and long-term problems. In this article, we weave together a synthesized perspective informed by our respective training and experience in prevention science and family law on the role of parent education programs for high-conflict separating/divorcing parents. To do so, we first describe the research on the effects of high interparental conflict on children's outcomes and then discuss current approaches and challenges to reducing these negative effects by offering parent education programs for high-conflict separating/divorcing parents. Then, we propose and describe a new model for early, effective, and scalable parent education programs with the ultimate goal of protecting children after separation/divorce.

Mental health trajectories after juridical divorce: Does personality matter?

INTRODUCTION

This study investigated whether the Big Five personality dimensions were associated with mental health trajectories and/or intervention effects of a digital divorce intervention from juridical divorce to 12 months following juridical divorce. The study utilized a randomized controlled trial study design (N = 676) and measured mental health outcomes (anxiety, depression, somatization, and stress) at study inclusion (i.e., at juridical divorce) and 3-, 6-, and 12 months after juridical divorce. Big Five personality dimensions were measured 1 month post study inclusion.

RESULTS

The study found that neuroticism is the personality dimension most predictive of post-divorce mental health outcomes. Specifically, divorcees with higher neuroticism scores indicated worse mental health immediately following divorce, but their symptom levels decreased more rapidly over a 12 months period after juridical divorce compared with lower neuroticism divorcees. It is also notable that their mean scores for the mental health outcomes remained higher at all time points (3, 6, and 12 months post baseline), relative to those lower in neuroticism.

CONCLUSION

Findings are discussed in light of divorce-adjustment-theory and the stress-buffering model.

The future of divorce support: Is "digital" enough in presence of conflict?

Divorce conflict is the main driver of adverse postdivorce health adjustments among divorcing families. Despite the growing potential of online divorce support programs, there is concern that such solutions might not be sufficient to impact health-related disparities among high-conflict divorcees. The present study examined the effectiveness of the digital "Cooperation after Divorce" intervention as a function of conflict among 1856 recently divorced Danish residents. Linear mixed-effect regression modeling suggested that, although higher levels of divorce conflict at judicial divorce predicted worse health outcomes up to 1 year following divorce, the effectiveness of the digital divorce intervention did not vary as a function of the initial level of divorce conflict. Individuals in the intervention group with higher conflict in divorce still reported worse health at 12 months follow-up than those with lower levels of divorce conflict; however, much lower than the control group.

The "In It Together" digital intervention to treat distress among older adults with sensory loss and their spouses: Study protocol for a randomized controlled trial study

Sensory impairment is common in older age and may be associated with intra- and interpersonal struggles. Treatment and intervention efforts may be hampered by functional difficulties or unwillingness to receive face-to-face mental health services. The current study seeks to assess the efficacy of an online psychological intervention for older adults with sensory loss and their spouses in Denmark, using a two-arm, parallel-group, randomized controlled trial study design. Participants will be randomly assigned to the intervention group or waiting list control group. The intervention consists of four digital, sequential modules that contain psychoeducation and Acceptance and Commitment Therapy inspired therapeutic activities. Individuals will be assessed at baseline, 6 weeks, and 10 weeks post-baseline, and for the intervention group only, at 18-weeks. The outcomes are well-being (primary), relationship satisfaction (secondary), and depressive symptoms (tertiary). The data will be analyzed using multilevel modeling to account for non-independence of data (nesting within participant and within couple). This is the first randomized controlled trial study of an online psychological intervention for older adults with sensory loss and their spouses and it will provide valuable knowledge regarding whether internet-delivered intervention is effective for this population group.

Temporal Associations between Depression and Hostility in the Context of a Divorce Intervention

Divorce interventions have been found effective in reducing negative outcomes for newly divorced people, including depression and hostility. Typically, divorce interventions cover a variety of issues that may influence people's level of depression and hostility. However, it is unclear whether the interventions differentially affect the outcomes. That is, it may be that intervention participation leads to a reduction in depression, which is associated with a prospective reduction in hostility - or vice versa. The current study used a sample of 1,856 recently divorced Danes, who completed questionnaires at baseline, 3-, 6-, and 12-month post-divorce. Structural equation modeling revealed that while depression and hostility were concurrently associated, there were no prospective associations, except for baseline depression predicting 3-month hostility. Moreover, the associations did not differ by gender. The results suggest that the intervention content may have influenced both depression and hostility. These findings may be useful in guiding future divorce intervention developments.

Prevalence and related factors of depression and anxiety in a cohort of Chinese elderly caregivers in the nursing home

BACKGROUND

The heavy care burden, the long-term dependence of the disabled elderly, and the changing social roles can put elderly caregivers at high risk for mental disorders. This study aimed to explore the prevalence and related factors of depression and anxiety among elderly caregivers and examine the role of resilience in depression and anxiety.

METHODS

A multicentre cross-sectional survey was designed. A total of 953 elderly caregivers in nursing homes were recruited in three provinces in China using convenience sampling. Depression and anxiety were measured by self-rating depression scale (SDS) and self-rating anxiety scale (SAS). Multivariate logistic regression analysis was used to explore the key factors associated with depression and anxiety.

RESULTS

The median SDS score was 40 (interquartile interval 34-48), and the median SAS score was 48 (interquartile interval 38-56). In this cohort, 19.4% reported depression and 44.0% anxiety. Working hours, sensitive personality and health status were related factors for depression symptom. In terms of anxiety symptoms, its related factors included working hours, health status and higher monthly income. Furthermore, resilience was associated with depression and anxiety among caregivers.

LIMITATIONS

A selection bias may be caused by convenience sampling and voluntary participation.

CONCLUSION

Depression and anxiety symptoms were common in the cohort of Chinese elderly caregivers in the nursing home. The factors explored in this study may contribute to the development of individualized interventions for depression and anxiety symptoms.

When Love Hurts - Mental and Physical Health Among Recently Divorced Danes

The last decades of research have consistently found strong associations between divorce and adverse health outcomes among adults. However, limitations of a majority of this research include (a) lack of “real-time” research, i.e., research employing data collected very shortly after juridical divorce where little or no separation periods have been effectuated, (b) research employing thoroughly validated and population-normed measures against which study results can be compared, and (c) research including a comprehensive array of previously researched sociodemographic- and divorce-related variables. The current cross-sectional study, including 1,856 recently divorced Danes, was designed to bridge these important gaps in the literature. Mental and physical health were measured using the Short Form 36 (SF-36)-2. Analyses included correlational analyses, t-test comparisons, and hierarchical multiple regression analyses. The study found that the health-related quality of life of Danish divorcees was significantly worse than the comparative background population immediately following divorce. Across gender, higher levels of divorce conflict were found to predict worse mental health, and worse physical health for women, even when controlling for other socio-demographic variables and divorce characteristics. Among men, lower age and higher income predicted better physical health, while more children, more previous divorces, participant divorce initiation, new partner status, and lower levels of divorce conflict predicted better mental health. Among women, higher income, fewer previous divorces, new partner status, and lower levels of divorce conflict predicted better physical health while higher income, participant divorce initiation, new partner status, and lower levels of divorce conflict predicted better mental health. The findings underscore the relevance of providing assistance to divorcees who experience higher levels of divorce conflict immediately following divorce, in seeking to reduce potential long-term negative health effects of divorce.

Friend or foe? Postdivorce hostility among recently divorced individuals

High levels of hostility often occur during and postdivorce and may significantly affect the quality of life, parent-child relationships, and social functioning of divorcees. Moreover, hostility may predict aggressive and violent behavior. This study sought to (a) compare average general hostility levels of a large sample of Danish divorcees to the norms of the general adult Danish population, (b) compare general hostility levels between male and female divorcees, and (c) investigate the explanatory value of various sociodemographic and divorce-related factors on postdivorce general hostility and whether these factors differ across gender. Cross-sectional baseline data (N = 1,856) from a larger randomized controlled trial study was used in this study. Normative data from a general sample of Danish adults (N = 2,040) was used for comparisons of hostility levels between our study sample and the Danish background population. This study found that male and female divorcees did not report significantly different hostility levels. However, participants reported significantly higher hostility levels postdivorce than the comparative Danish norm sample. Significant predictors of postdivorce hostility were lower age, lower educational level, infidelity as a reason for divorce, higher degree of postdivorce conflict, worse communication with the former spouse, the former spouse as the initiator of the divorce, and new partner status with neither divorcees having a new partner, or only the former spouse having a new partner. The predictive strength of the factors did not differ across gender. The findings may be especially relevant for interventions targeting problematic outcomes postdivorce (e.g., preventing aggressive behavior).

"Divorce burnout" among recently divorced individuals

Traditionally, the concept of burnout has been applied to the workspace but recent research suggests its applicability to more general contexts such as the family sphere. The present study applies burnout to the divorce context and (a) proposes and statistically tests the Divorce Burnout Model (DBM), (b) investigates the contribution of sociodemographic variables and divorce characteristics to burnout scores, and (c) investigates the relationship between burnout scores and the number of sick days and days of absence from work. Using a cross-sectional design and a sample of 1,856 recently divorced Danish citizens, multigroup confirmatory factor analysis verified the DBM´s good fit to data. Using this model, for men, it was found that fewer previous divorces, former spouse initiation of divorce, not having a new partner and a higher degree of conflict significantly predicted higher levels of divorce burnout. For women, lower income, former spouse divorce initiation, not having a new partner, and a higher level of conflict significantly predicted higher levels of divorce burnout. Across gender, burnout scores were found to significantly predict number of sick days and days of absence from work in the past 3 months over and above sociodemographic variables, divorce related characteristics, and depressive symptoms.

A Randomised Controlled Trial Study of the Effects of a Digital Divorce Platform on Mental and Physical Health

BACKGROUND

Two decades of divorce research has consistently documented adverse mental and physical health effects of divorce. Responding to calls for evidence-based online divorce interventions, this study tests effects of the "Cooperation after Divorce" (CAD) digital intervention platform on divorcees' mental and physical health.

METHODS

Randomised control trial 12-month longitudinal study using a sample of 1,856 newly divorced Danes. Mental and physical health were measured using the SF-36 at baseline and 3, 6, and 12 months from baseline. Intervention effects were investigated using linear mixed effect models and Cohen's (d) for effect sizes.

RESULTS

The study found significant treatment effects of the CAD intervention on mental and physical health. These effects were evident across all eight health domains constituting the mental and physical health components. The study also found that the intervention group had significantly better mental health than the control group at subsequent 6- and 12-month assessments from baseline while for physical health, the intervention group had significantly better physical health at the 6-month assessment from baseline only.

CONCLUSION

The results indicate that digital solutions allowing for individually tailored user experiences may hold great potential in reducing well-known adverse health effects of divorce.

PRACTITIONER'S POINTS

The study finds highly significant treatment effects of the "CAD" digital divorce intervention on mental and physical health indicating that online interventions may be successfully integrated into help offered to divorcees post-divorce.