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Chirinos DA, Kershaw KN, Allen NB, Carroll AJ, Lewis TT, Schreiner PJ, Lewis CE, Kiefe CI, Mezuk B, Carnethon MR. Depressive Symptom Subgroups and Their Association with Prevalent and Incident Cardiovascular Risk Factors in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Int J Behav Med 2023; 30:891-903. [PMID: 36670342 DOI: 10.1007/s12529-022-10144-z] [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] [Accepted: 12/06/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND We sought to identify depressive symptom subgroups in a community sample of young adults, investigate their stability over time, and determine their association with prevalent and incident cardiovascular disease (CVD) risk factors. METHOD Participants were 3377 adults from the Coronary Artery Risk Development in Young Adults study. Using latent class and latent transition analysis, we derived subgroups based on items of the 20-item version of the Center for Epidemiologic Studies Depression Scale in 1990, and examined patterns of change over a 10-year period (1990-2000). Cox regression models were used to examine associations between subgroup membership and prevalent (2000) and incident (2000 to 2016) obesity, hypertension, and diabetes. RESULTS Three baseline subgroups were identified and labeled: "No Symptoms" (63.5%), "Lack of Positive Affect" (PA, 25.6%), and "Depressed Mood" (10.9%). At 10-year follow-up, individuals in "No Symptoms" subgroup had the highest probability (0.84) of being classified within the same subgroup. Participants classified as "Lack of PA" were likely (0.46) to remain in the same subgroup or be classified as "No Symptoms." Participants in the "Depressed Mood" were most likely to transition to the "Lack of PA" subgroup (0.38). Overall, 30.5% of participants transitioned between subgroups, with 11.4% classified as "Worsening" and 19.1% as "Improving." Relative to the "No Symptoms Stable," other subgroups ("Depressed Stable," "Worsening," and "Improving") were associated with prevalent obesity and hypertension. CONCLUSION We identified distinct depressive symptom subgroups that are variably stable over time, and their change patterns were differentially associated with CVD risk factor prevalence.
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Affiliation(s)
- Diana A Chirinos
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lakeshore Drive, Suite 1400, Chicago, IL, 60611, USA.
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lakeshore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lakeshore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Allison J Carroll
- Department of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Cora E Lewis
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Briana Mezuk
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lakeshore Drive, Suite 1400, Chicago, IL, 60611, USA
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Singh VK, Muralidhar D, Malo PK, Bhaskarapillai B, Muralidharan K. Effectiveness of Short-Term Lifestyle Modification on Reducing Body- Weight-Related Parameters in Persons with Severe Mental Illness: A Randomized Controlled Trial. Indian J Psychol Med 2023; 45:352-359. [PMID: 37483568 PMCID: PMC10357896 DOI: 10.1177/02537176231155039] [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] [Indexed: 07/25/2023] Open
Abstract
Background Persons with severe mental illness (SMI) reportedly have a high mortality rate due to metabolic syndrome (MS). However, lifestyle modification (LM) offers effective management of some components of MS. This study aimed to evaluate the effectiveness of LM in reducing body-weight-related parameters in SMIs. Method Eighty participants with SMI were assigned randomly to either LM (n = 40) or treatment as usual (TAU; n = 40) groups using block randomization (eight blocks of n = 10). The LM group and their caregivers received a structured LM package that included nutrition counselling, recommendations on a balanced diet, and physical activity. The two groups were assessed on body weight, body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), and quality of life (QOL) at baseline and after three months. Thirty-one LM and 33 TAU participants completed the study. Results The LM and TAU groups were comparable on sociodemographic and clinical characteristics and baseline variables of body weight, BMI, WC, and WHR (all P > 0.08). Repeated-measures analysis of variance (RM ANOVA) showed that the LM group had significantly reduced body weight, BMI, WC, and WHR (all P < 0.001) than the TAU group. Similarly, the LM group also showed improvement in their QOL (P < 0.001), whereas TAU showed no improvement. Conclusions LM is an effective way to reduce body-weight-related parameters of MS and improves the QOL among persons with SMI in the short term. The caregivers' inclusion during LM contributed to the weight reduction. However, the long-term effect of the intervention could not be assessed.
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Affiliation(s)
- Vinit Kumar Singh
- Dept. of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (INI), Bengaluru, Karnataka, India
| | - Daliboina Muralidhar
- Dept. of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (INI), Bengaluru, Karnataka, India
| | - Palash Kumar Malo
- Dept. of Biostatistics, National Institute of Mental Health and Neurosciences (INI), Bengaluru, Karnataka, India
| | - Binukumar Bhaskarapillai
- Dept. of Biostatistics, National Institute of Mental Health and Neurosciences (INI), Bengaluru, Karnataka, India
| | - Kesavan Muralidharan
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (INI), Bengaluru, Karnataka, India
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3
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Chae WR, Baumert J, Nübel J, Brasanac J, Gold SM, Hapke U, Otte C. Associations between individual depressive symptoms and immunometabolic characteristics in major depression. Eur Neuropsychopharmacol 2023; 71:25-40. [PMID: 36966710 DOI: 10.1016/j.euroneuro.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 05/29/2023]
Abstract
Inflammation and metabolic dysregulations are likely to underlie atypical, energy-related depressive symptoms such as appetite and sleep alterations. Indeed, increased appetite was previously identified as a core symptom of an immunometabolic subtype of depression. The aim of this study was 1) to replicate the associations between individual depressive symptoms and immunometabolic markers, 2) to extend previous findings with additional markers, and 3) to evaluate the relative contribution of these markers to depressive symptoms. We analyzed data from 266 persons with major depressive disorder (MDD) in the last 12 months from the German Health Interview and Examination Survey for Adults and its mental health module. Diagnosis of MDD and individual depressive symptoms were determined by the Composite International Diagnostic Interview. Associations were analyzed using multivariable regression models, adjusting for depression severity, sociodemographic/behavioral variables, and medication use. Increased appetite was associated with higher body mass index (BMI), waist circumference (WC), insulin, and lower high-density lipoprotein. In contrast, decreased appetite was associated with lower BMI, WC, and fewer metabolic syndrome (MetS) components. Insomnia was associated with higher BMI, WC, number of MetS components, triglycerides, insulin, and lower albumin, while hypersomnia was associated with higher insulin. Suicidal ideation was associated with higher number of MetS components, glucose, and insulin. None of the symptoms were associated with C-reactive protein after adjustment. Appetite alterations and insomnia were most important symptoms associated with metabolic markers. Longitudinal studies should investigate whether the candidate symptoms identified here are predicted by or predict the development of metabolic pathology in MDD.
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Affiliation(s)
- Woo Ri Chae
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Berlin, Germany.
| | - Jens Baumert
- Robert-Koch Institute, Department of Epidemiology and Health Monitoring, Berlin, Germany
| | - Julia Nübel
- Robert-Koch Institute, Department of Epidemiology and Health Monitoring, Berlin, Germany
| | - Jelena Brasanac
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Berlin, Germany
| | - Stefan M Gold
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Berlin, Germany; Charité - Universitätsmedizin Berlin, Medical Department, Section Psychosomatic Medicine, Hindenburgdamm 30, 12203 Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulfert Hapke
- Robert-Koch Institute, Department of Epidemiology and Health Monitoring, Berlin, Germany
| | - Christian Otte
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Berlin, Germany
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4
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Mayhew M, Smith N, Fortmann SP, Fitzpatrick SL. Mental health diagnosis attenuates weight loss among older adults in a digital diabetes prevention program. Obes Sci Pract 2023; 9:320-326. [PMID: 37287521 PMCID: PMC10242247 DOI: 10.1002/osp4.644] [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: 05/06/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 06/09/2023] Open
Abstract
Objective Diabetes Prevention Programs (DPP) are effective at reducing diabetes incidence via clinically significant weight loss. Co-morbid mental health condition(s) may reduce the effect of DPP administered in-person and telephonically but this has not been assessed for digital DPP. This report examines the moderating effect of mental health diagnosis on weight change among individuals who enrolled in digital DPP (enrollees) at 12 and 24 months. Methods Secondary analysis of prospective, electronic health record data from a study of digital DPP among adults (N = 3904) aged 65-75 with prediabetes (HbA1c 5.7%-6.4%) and obesity (BMI ≥30 kg/m2). Results Mental health diagnosis only moderated the effect of digital DPP on weight change during the first 7 months (p = 0.003) and the effect attenuated at 12 and 24 months. Results were unchanged after adjusting for psychotropic medication use. Among those without a mental health diagnosis, digital DPP enrollees lost more weight than non-enrollees: -4.17 kg (95% CI, -5.22 to -3.13) at 12 months and -1.88 kg (95% CI, -3.00 to -0.76) at 24 months, whereas among individuals with a mental health diagnosis, there was no difference in weight loss between enrollees and non-enrollees at 12 and 24 months (-1.25 kg [95% CI, -2.77 to 0.26] and 0.02 kg [95% CI, -1.69-1.73], respectively). Conclusions Digital DPP appears less effective for weight loss among individuals with a mental health condition, similar to prior findings for in-person and telephonic modalities. Findings suggest a need for tailoring DPP to address mental health conditions.
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Affiliation(s)
- Meghan Mayhew
- Kaiser Permanente Center for Health Research Northwest in PortlandPortlandOregonUSA
| | - Ning Smith
- Kaiser Permanente Center for Health Research Northwest in PortlandPortlandOregonUSA
| | - Stephen P. Fortmann
- Kaiser Permanente Center for Health Research Northwest in PortlandPortlandOregonUSA
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Adkins-Hempel M, Japuntich SJ, Chrastek M, Dunsiger S, Breault CE, Ayenew W, Everson-Rose SA, Nijjar PS, Bock BC, Wu WC, Miedema MD, Carlson BM, Busch AM. Integrated smoking cessation and mood management following acute coronary syndrome: Protocol for the post-acute cardiac event smoking (PACES) trial. Addict Sci Clin Pract 2023; 18:29. [PMID: 37173792 PMCID: PMC10175930 DOI: 10.1186/s13722-023-00388-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Approximately 400,000 people who smoke cigarettes survive Acute Coronary Syndrome (ACS; unstable angina, ST and non-ST elevation myocardial infarction) each year in the US. Continued smoking following ACS is an independent predictor of mortality. Depressed mood post-ACS is also predictive of mortality, and smokers with depressed mood are less likely to abstain from smoking following an ACS. A single, integrated treatment targeting depressed mood and smoking could be effective in reducing post-ACS mortality. METHOD/DESIGN The overall aim of the current study is to conduct a fully powered efficacy trial enrolling 324 smokers with ACS and randomizing them to 12 weeks of an integrated smoking cessation and mood management treatment [Behavioral Activation Treatment for Cardiac Smokers (BAT-CS)] or control (smoking cessation and general health education). Both groups will be offered 8 weeks of the nicotine patch if medically cleared. Counseling in both arms will be provided by tobacco treatment specialists. Follow-up assessments will be conducted at end-of-treatment (12-weeks) and 6, 9, and 12 months after hospital discharge. We will track major adverse cardiac events and all-cause mortality for 36 months post-discharge. Primary outcomes are depressed mood and biochemically validated 7-day point prevalence abstinence from smoking over 12 months. DISCUSSION Results of this study will inform smoking cessation treatments post-ACS and provide unique data on the impact of depressed mood on success of post-ACS health behavior change attempts. TRIAL REGISTRATION ClinicalTrials.gov, NCT03413423. Registered 29 January 2018. https://beta. CLINICALTRIALS gov/study/NCT03413423 .
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Affiliation(s)
- Melissa Adkins-Hempel
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, 701 Park Ave. S9.104, Minneapolis, MN, 55415, USA
| | - Sandra J Japuntich
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, 701 Park Ave. S9.104, Minneapolis, MN, 55415, USA
- Division of Clinical Pharmacology, Department of Medicine, Hennepin Healthcare, 900 S. 8th St., G5, Minneapolis, MN, 55415, USA
- Division of General Internal Medicine, Department of Medicine, University of Minnesota, 401 East River Parkway, Suite 131, Minneapolis, MN, 55455, USA
| | - Michelle Chrastek
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, 701 Park Ave. S9.104, Minneapolis, MN, 55415, USA
| | - Shira Dunsiger
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity, School of Public Health, Brown University, 121 South Main St., Providence, RI, 02903, USA
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main St., Providence, RI, 02903, USA
| | - Christopher E Breault
- Center for Behavioral and Preventative Medicine, Lifespan, 1 Hoppin St., Suite 309, Providence, RI, 02903, USA
| | - Woubeshet Ayenew
- Division of Cardiology, Department of Medicine, Hennepin Healthcare, 900 South 8th St., O5, Minneapolis, MN, 55415, USA
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA
| | - Susan A Everson-Rose
- Division of General Internal Medicine, Department of Medicine, University of Minnesota, 401 East River Parkway, Suite 131, Minneapolis, MN, 55455, USA
- Program in Health Disparities Research, University of Minnesota, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA
| | - Prabhjot S Nijjar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA
| | - Beth C Bock
- Center for Behavioral and Preventative Medicine, Lifespan, 1 Hoppin St., Suite 309, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, 700 Butler Drive, Providence, RI, 02906, USA
| | - Wen-Chih Wu
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main St., Providence, RI, 02903, USA
- Center of Innovation in Long Term Services and Support, Providence VA Medical Center, 830 Chalkstone Ave., Providence, RI, 02908, USA
- Cardiovascular Rehab Center, Lifespan, 208 Collyer St., Providence, RI, 02904, USA
| | - Michael D Miedema
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, 920 East 28th St., Suite 480, Minneapolis, MN, 55407, USA
| | - Brett M Carlson
- North Memorial Health Heart and Vascular Center, 3300 Oakdale Ave. N., Suite 200, Robbinsdale, MN, 55422, USA
| | - Andrew M Busch
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, 701 Park Ave. S9.104, Minneapolis, MN, 55415, USA.
- Division of Clinical Pharmacology, Department of Medicine, Hennepin Healthcare, 900 S. 8th St., G5, Minneapolis, MN, 55415, USA.
- Division of General Internal Medicine, Department of Medicine, University of Minnesota, 401 East River Parkway, Suite 131, Minneapolis, MN, 55455, USA.
- Program in Health Disparities Research, University of Minnesota, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA.
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Cuijpers P, Karyotaki E, Harrer M, Stikkelbroek Y. Individual behavioral activation in the treatment of depression: A meta analysis. Psychother Res 2023:1-12. [PMID: 37068380 DOI: 10.1080/10503307.2023.2197630] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVE Behavioral activation (BA) is an extensively examined treatment for depression which is relatively simple to apply in comparison to other psychotherapies. BA aims to increase positive interactions between a person and the environment. All previous meta-analyses focused on BA in groups and guided self-help, but none focused on BA in individual psychotherapy. The goal of the current meta-analysis is to examine the pooled effects of trials comparing individual BA to control conditions. METHODS We conducted systematic searches and conducted random effects meta-analyses to examine the effects of BA. RESULTS We included 22 randomized controlled trials (with 819 patients) comparing individual behavioral activation with waitlist, usual care, or other control conditions on distal treatment outcomes. Nine studies were rated as low risk of bias. We found a large effect (Hedges' g = 0.85; 95% CI: 0.57; 1.1) with high heterogeneity (75%; 95% CI: 62; 83). When only studies with low risk of bias were considered, the effect size was still significant (g = 0.56; 95% CI: 0.09; 1.03), with high heterogeneity (I2 = 80%; 95% CI: 66; 89; prediction interval: -0.85; 1.98). CONCLUSION BA is an effective, relatively simple type of therapy that can be applied broadly in differing populations/.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Mathias Harrer
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Yvonne Stikkelbroek
- Depression Expertise Centre-Youth, GGZ Oost Brabant, Boekel, Netherlands
- Department of Clinical Child and Family Studies, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, Netherlands
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Audrain-McGovern J, Wileyto EP, Ashare R, Albelda B, Manikandan D, Perkins KA. Behavioral activation for smoking cessation and the prevention of smoking cessation-related weight gain: A randomized trial. Drug Alcohol Depend 2023; 244:109792. [PMID: 36739753 PMCID: PMC10024937 DOI: 10.1016/j.drugalcdep.2023.109792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Post-cessation weight gain (PCWG) is an obstacle to smoking cessation. This trial evaluated a behavioral intervention targeting alternative rewards to smoking and high calorie snacking to promote smoking cessation while mitigating PCWG. METHODS Adult smokers (n = 288; 119 females, 169 males) received eight weeks of transdermal nicotine and were randomized to eight sessions of behavioral activation for smoking cessation and the mitigation of PCWG (BAS+) or standard smoking cessation counseling (SC). Primary outcomes were 7-day point prevalence abstinence and PCWG 26 weeks after the target quit date. Change in caloric intake from pre-treatment through the 26-week follow-up was a secondary outcome. Data were collected from September 2016 to February 2021, and analyses were completed in July 2022. RESULTS BAS+ and SC did not differ in smoking abstinence rates at the 26-week follow-up (OR=0.80, 95%CI 0.50-1.27, p = 0.34; 18% versus 23%). There were no significant differences in PCWG between BAS+ and SC who were 7-day point prevalence abstinent (β = -0.29, 95%CI -2.13 to 1.65, p = 0.77; 2.60 versus 2.20 pounds, respectively) or among those continuously abstinent (5.78 versus 5.34 pounds, respectively). There were no significant differences in caloric intake between BAS+ and SC from baseline to the 26-week follow-up (β = 110.65, 95%CI -96.72 to 318.02, p = 0.30; -19.1 versus -116.9 kcals/day, respectively). CONCLUSIONS The results do not support the efficacy of BAS+ for smoking cessation and the prevention of PCWG. These findings join a growing body of research highlighting the challenge of minimizing PCWG and promoting smoking abstinence.
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Affiliation(s)
- Janet Audrain-McGovern
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - E Paul Wileyto
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca Ashare
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Benjamin Albelda
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Divya Manikandan
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kenneth A Perkins
- University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
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8
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Cao B, Xu J, Li R, Teopiz KM, McIntyre RS, Chen H. Interventions targeting comorbid depression and overweight/obesity: A systematic review. J Affect Disord 2022; 314:222-232. [PMID: 35878825 DOI: 10.1016/j.jad.2022.07.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/18/2022] [Accepted: 07/17/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Overweight/obesity and depression are highly co-occurring conditions with shared pathophysiology as well as social and economic determinants. To our knowledge, this is the first systematic review aims to comprehensively synthesize extant literature with a focus on the effectiveness of interventions targeting obesity and depression comorbidity. METHODS We searched databases including MEDLINE, ProQuest Central, Web of Science, PsycINFO, Cochrane Library, from inception of the databases until Nov 12, 2021. Articles were included if they reported on the effects of pharmacological, psychological or dietary interventions on comorbid depression and overweight/obesity as their primary or secondary outcome. RESULTS Of the 5480 identified records, 19 eligible researches comprising 15 RCTs and 4 uncontrolled longitudinal studies for 3408 participants with comorbid depression and overweight/obesity. The available literature is not sufficient to inform evidence-based treatments targeting obesity and comorbid depression contemporaneously. Notwithstanding, the combination of CBT and lifestyle intervention show efficacy targeting obesity and comorbid depression as do some nutritional supplements, antidepressants and anti-diabetic agents. LIMITATIONS The high heterogeneity of various interventions in the included studies may cause a lack of comparability between different studies. CONCLUSIONS Concurrent management of depression and overweight/obesity is suggested by available data. There is a pressing need for studies that evaluate the effectiveness in real world samples of persons experiencing multiple co-occurring chronic diseases including but not limited to depression and overweight/obesity.
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Affiliation(s)
- Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing 400715, PR China; National Demonstration Center for Experimental Psychology Education, Southwest University, Chongqing 400715, PR China.
| | - Jiatong Xu
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing 400715, PR China
| | - Ruonan Li
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing 400715, PR China
| | - Kayla M Teopiz
- Mood Disorders Psychopharmacology Unit, University of Toronto, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University of Toronto, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, Canada
| | - Hong Chen
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing 400715, PR China; National Demonstration Center for Experimental Psychology Education, Southwest University, Chongqing 400715, PR China.
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9
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Reinosa Segovia FA, Benuto LT. A Systematic Review of Ethnoracial Participation in Randomized Clinical Trials of Behavioral Activation. Behav Ther 2022; 53:927-943. [PMID: 35987549 DOI: 10.1016/j.beth.2022.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 02/18/2022] [Accepted: 03/25/2022] [Indexed: 11/27/2022]
Abstract
As of the last available NIH report, people of color (POC) constituted 28.1% of enrollment across all U.S. domestic clinical trials. The literature on prevalence rates of depression among POC is mixed. While the prevalence rates of depression may vary across POC, it remains unknown to what degree POC have been included in outcome clinical trials of depression since NIH's mandates for inclusion of minorities in clinical outcome research. Following PRISMA guidelines, the present review identified randomized controlled trials of behavioral activation from 1989 to 2021 using the following search engines: PsycINFO, EMBASE, and Cochrane Central Register of Controlled Trials. We reviewed 5,247 articles and included 28 articles that met full inclusion criteria (n = 5,169 participants). Across studies included in this review, 70% were non-Latinx White, 14.1% were African American, 8.9% were Latinx, 0.5% were Asian, 2.9% were other, and 3.7% were unknown. Results indicated an increase in representation of ethnoracial inclusion rates across time and that recruitment method was not associated with adequate inclusion of POC. However, the university setting was associated with inadequate representation of POC.
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10
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Berman MI, Park J, Kragenbrink ME, Hegel MT. Accept Yourself! A Pilot Randomized Controlled Trial of a Self-Acceptance-Based Treatment for Large-Bodied Women With Depression. Behav Ther 2022; 53:913-926. [PMID: 35987548 DOI: 10.1016/j.beth.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 03/04/2022] [Accepted: 03/16/2022] [Indexed: 11/15/2022]
Abstract
A pilot parallel randomized controlled trial compared a self-acceptance, non-weight-loss intervention, Accept Yourself! (AY), to a weight loss program, Weight Watchers (WW), in order to provide preliminary safety, feasibility, and efficacy data in preparation for a definitive RCT of AY as an intervention to enhance the mental and physical health of larger-bodied women with Major Depressive Disorder (MDD). Adult women with MDD and a Body Mass Index ≥30 were eligible. Nineteen women were randomized by random number table into AY (n = 9) or WW (n = 10). Intake, pretreatment, posttreatment, 3-, 6-, 9-, and 12-month follow-up assessments occurred at a rural academic medical center. Primary outcomes included depression severity and cardiovascular fitness. Chi-square and t-tests assessed attrition and participant preferences for treatment; other analyses used intention-to-treat, linear mixed-effects models for repeated measures, including all participants' available data. Both groups improved in self-reported, F(5, 43.81) = 7.45, p < .001, partial η2 = .38, and blinded-clinician-rated depression, F(6, 62.03) = 10.41, p < .001, partial η2 = .5. AY was superior to WW in self-reported depression, F(5, 43.81) = 2.72, p = .03, partial η2 = .11. Neither group improved in fitness. Eating disorder symptoms and weight gain worsened in WW. AY appeared safe, feasible, and offered initial evidence of efficacy for depression; it should be investigated in a definitive RCT, with modifications to increase potency. WW may not be suitable as a comparator intervention for AY because of risk to participants.
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Affiliation(s)
| | - John Park
- Geisel School of Medicine at Dartmouth
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11
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Benuto LT, Reinosa-Segovia F. Acceptability of Behavioral Activation for Depression Among Latinas: A Mixed Methods Study. Behav Ther 2022; 53:858-868. [PMID: 35987544 DOI: 10.1016/j.beth.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 11/25/2022]
Abstract
Latinxs represent the largest ethnoracial minority population in the United States. Despite having significant rates of depression, Latinxs underutilize behavioral health services. This, combined with the association between gender and depression (women have higher rates of depression than men), underscores the importance of developing an improved understanding of how Latinas view behavioral activation (BA), an empirically supported treatment for depression. In this mixed methods study, participants consisted of 77 Latinas; participants were provided with a vignette depicting a fictional character that underwent BA for depression. Participants in the quantitative study completed a measure of treatment acceptability of BA (n = 60); participants in the qualitative study completed a semistructured interview assessing their views on BA (n = 17). Latinas had generally positive attitudes about BA, although they also identified some elements that they perceived might act as barriers to treatment success. Because we were interested in the interplay of cultural factors and treatment acceptability, we also examined enculturation and acculturation as predictors of treatment acceptability-enculturation only was a significant predictor treatment acceptability. Our sample was relatively small, social desirability may have influenced our responses, and it is not known to what extent our results generalize to Latinx men. Latina women find BA to be an acceptable treatment for depression, which suggests promise with regard to clinical outcomes for depressed Latinas receiving BA. Addressing potential barriers to treatment engagement may improve outcomes for depressed Latinas receiving BA.
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Lv N, Kringle EA, Ma J. Integrated Behavioral Interventions for Adults with Comorbid Obesity and Depression: a Systematic Review. Curr Diab Rep 2022; 22:157-168. [PMID: 35304703 PMCID: PMC8930483 DOI: 10.1007/s11892-022-01458-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To synthesize evidence from randomized controlled trials on the effects of integrated behavioral interventions for comorbid obesity and depression in adults. RECENT FINDINGS Seven trials (n = 33 to 409) were included. The quality of evidence was mixed. In 2 trials, integrated interventions led to greater improvements in both obesity and depression over 12 months, compared with usual care. Of 4 trials comparing integrated interventions with a standalone obesity intervention, 2 showed incremental effects on depression only, and 2 did not detect a significant effect for either outcome. One 3-arm trial compared an integrated intervention with standalone obesity and depression interventions and only detected incremental effects on obesity when compared with a standalone depression intervention. The effects of integrated interventions for comorbid obesity and depression are varied but promising. Implications for future research to guide intervention optimization and implement integrated interventions in clinical practice are provided.
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Affiliation(s)
- Nan Lv
- Department of Medicine, University of Illinois at Chicago, 1747 W. Roosevelt Rd, Room 586 (MC 275), Chicago, IL 60608 USA
| | - Emily A. Kringle
- Department of Medicine, University of Illinois at Chicago, 1747 W. Roosevelt Rd, Room 586 (MC 275), Chicago, IL 60608 USA
| | - Jun Ma
- Department of Medicine, University of Illinois at Chicago, 1747 W. Roosevelt Rd, Room 586 (MC 275), Chicago, IL 60608 USA
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Developing weight navigation program to support personalized and effective obesity management in primary care settings: protocol for a quality improvement program with an embedded single-arm pilot study. Prim Health Care Res Dev 2022; 23:e14. [PMID: 35234116 PMCID: PMC8919179 DOI: 10.1017/s1463423621000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Primary care providers (PCPs) are expected to help patients with obesity to lose weight through behavior change counseling and patient-centered use of available weight management resources. Yet, many PCPs face knowledge gaps and clinical time constraints that hinder their ability to successfully support patients' weight loss. Fortunately, a small and growing number of physicians are now certified in obesity medicine through the American Board of Obesity Medicine (ABOM) and can provide personalized and effective obesity treatment to individual patients. Little is known, however, about how to extend the expertise of ABOM-certified physicians to support PCPs and their many patients with obesity. AIM To develop and pilot test an innovative care model - the Weight Navigation Program (WNP) - to integrate ABOM-certified physicians into primary care settings and to enhance the delivery of personalized, effective obesity care. METHODS Quality improvement program with an embedded, 12-month, single-arm pilot study. Patients with obesity and ≥1 weight-related co-morbidity may be referred to the WNP by PCPs. All patients seen within the WNP during the first 12 months of clinical operations will be compared to a matched cohort of patients from another primary care site. We will recruit a subset of WNP patients (n = 30) to participate in a remote weight monitoring pilot program, which will include surveys at 0, 6, and 12 months, qualitative interviews at 0 and 6 months, and use of an electronic health record (EHR)-based text messaging program for remote weight monitoring. DISCUSSION Obesity is a complex chronic condition that requires evidence-based, personalized, and longitudinal care. To deliver such care in general practice, the WNP leverages the expertise of ABOM-certified physicians, health system and community weight management resources, and EHR-based population health management tools. The WNP is an innovative model with the potential to be implemented, scaled, and sustained in diverse primary care settings.
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Drew RJ, Morgan PJ, Young MD. Mechanisms of an eHealth program targeting depression in men with overweight or obesity: A randomised trial. J Affect Disord 2022; 299:309-317. [PMID: 34871640 DOI: 10.1016/j.jad.2021.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The SHED-IT: Recharge study demonstrated that a gender-tailored eHealth program could improve the depressive symptoms of men with overweight or obesity and low mood. This study examined whether changes in key behaviours and cognitions acted as significant mediators of this treatment effect. METHODS The study was a randomised controlled trial (RCT) including 125 men with overweight or obesity (mean (SD) weight 103.8 (15.8) kg), and current depressive symptoms (Patient Health Questionnaire (PHQ-9) ≥ 5; mean (SD) 9.2 (4.1) units). Assessments were held at baseline, 3 months (post-intervention), and 6 months (follow-up). Depressive symptoms were assessed using the validated PHQ-9 and Masculine Depressive Risk Scale (MDRS-22). Behavioural and cognitive mediators were assessed with validated measures. Intention-to-treat mediation analyses were conducted using the PROCESS macro in SPSS. RESULTS Single mediation analyses demonstrated that the intervention effect on both PHQ-9 and MDRS-22 scores was significantly mediated by changes in MVPA, energy-dense nutrient-poor foods, cognitive flexibility, and behavioural activation. In addition, changes in sleep quality mediated improvements in MDRS-22 scores. No mediation effects were observed for light physical activity, sedentary behaviour, fruit and vegetable intake, risky alcohol consumption or mindfulness. LIMITATIONS The study was a secondary analysis with power to detect moderate-to-large mediation effects only. CONCLUSION To prevent or treat depression in men with overweight or obesity, early evidence suggests MVPA, sleep quality, energy-dense nutrient-poor food intake, cognitive flexibility, and behavioural activation are important intervention targets.
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Affiliation(s)
- Ryan J Drew
- Priority Research Centre for Physical Activity and Nutrition, School of Education, College of Human and Social Futures, University of Newcastle, Australia
| | - Philip J Morgan
- Priority Research Centre for Physical Activity and Nutrition, School of Education, College of Human and Social Futures, University of Newcastle, Australia
| | - Myles D Young
- Priority Research Centre for Physical Activity and Nutrition, School of Psychological Sciences, College of Engineering, Science and Environment, University of Newcastle, NSW, Australia.
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15
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Chae WR, Schienkiewitz A, Du Y, Hapke U, Otte C, Michalski N. Comorbid depression and obesity among adults in Germany: Effects of age, sex, and socioeconomic status. J Affect Disord 2022; 299:383-392. [PMID: 34910960 DOI: 10.1016/j.jad.2021.12.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Depression and obesity are common health problems with major public health implications. These conditions frequently co-occur, adversely affecting the course of the other. The sociodemographic and socioeconomic risk factors for comorbid depression and obesity in the German adult population have not yet been reported. METHODS We analyzed the prevalence and sociodemographic and socioeconomic correlates of comorbid depression and obesity using cross-sectional data from the national German health interview and examination survey for adults (DEGS1; n = 7987) and its mental health module (DEGS1-MH; n = 4493). The Composite International Diagnostic Interview was used to diagnose major depressive disorder (CIDI-MDD). Sensitivity was analyzed using the self-reported depression measure and current depressive symptoms measured by Patient Health Questionnaire-9 (PHQ-9). Obesity was defined by body mass index calculated from measured data. RESULTS Prevalence of comorbid depression and obesity was 1.3% (95% CI 0.8-2.0) in men and 2.0% (95% CI 1.3-3.0) in women. We found significant sex differences in results from the self-reported depression measure and the PHQ-9, but not from the CIDI-MDD. Low socioeconomic status and poor social support were linked to a higher prevalence of comorbid depression and obesity among women. LIMITATIONS Severe depression may have been underreported. CONCLUSIONS Depression is statistically more prevalent in women than in men, which accounts for many of the sex differences in the prevalence of comorbid depression and obesity in our models. Targeted public health strategies need to be developed to prevent and treat comorbid depression and obesity in women with a low socioeconomic position.
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Affiliation(s)
- Woo Ri Chae
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Berlin, Germany.
| | - Anja Schienkiewitz
- Department of Epidemiology and Health Monitoring, Division of Health Behaviour, Robert Koch Institute, Berlin, Germany
| | - Yong Du
- Department of Epidemiology and Health Monitoring, Physical Health Unit, Robert Koch Institute, Berlin, Germany
| | - Ulfert Hapke
- Department of Epidemiology and Health Monitoring, Mental Health Unit, Robert Koch Institute, Berlin, Germany
| | - Christian Otte
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Berlin, Germany
| | - Niels Michalski
- Department of Epidemiology and Health Monitoring, Unit of Social Determinants of Health, Robert Koch Institute, Berlin, Germany
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Wang X, Hu Y, Qin LQ, Dong JY. Combined association of central obesity and depressive symptoms with risk of heart disease: A prospective cohort study. J Affect Disord 2022; 297:360-365. [PMID: 34715187 DOI: 10.1016/j.jad.2021.10.096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/14/2021] [Accepted: 10/23/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine the combined association of central obesity and depressive symptoms with risk of heart disease in a national prospective cohort study of the Chinese population. METHODS Data came from 10,722 community-dwelling adults aged over 45 years, from the China Health and Retirement Longitudinal Study during 2011-2018. Central obesity was assessed with waist circumference (WC) in physical examinations (men with a WC of ≥ 90 cm and women with a WC of ≥ 80 cm). Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (score ≥ 10). Participants were assigned to four groups according to central obesity (yes/no) and depressive symptoms (yes/no). Cox proportional hazard regression was used after adjusting for covariates. RESULTS During 7 years of follow-up, we identified 1080 heart disease cases. Compared with people without central obesity and depressive symptoms, the multivariable-adjusted hazard ratios (95% confidence intervals) were 1.39 (1.18, 1.64) for those who had central obesity alone, 1.44 (1.18, 1.77) for those who had depressive symptoms alone, and 1.88 (1.55, 2.30) for those who had both central obesity and depressive symptoms. The combined association in men was more evident than that in women. CONCLUSIONS Our study provided evidence that the coexistence of central obesity and depressive symptoms were associated with a substantially increased risk of heart disease compared to those without these two conditions.
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Affiliation(s)
- Xiaowen Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka 5650871, Japan
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; Medical Informatics Center, Peking University Health Science Center, Beijing 100191, China
| | - Li-Qiang Qin
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou 215000, China
| | - Jia-Yi Dong
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka 5650871, Japan.
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Castro A, Roca M, Ricci-Cabello I, García-Toro M, Riera-Serra P, Coronado-Simsic V, Pérez-Ara MÁ, Gili M. Adherence to Lifestyle Interventions for Treatment of Adults with Depression: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413268. [PMID: 34948874 PMCID: PMC8702100 DOI: 10.3390/ijerph182413268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 11/18/2022]
Abstract
The aim of this systematic review was to determine the adherence to lifestyle interventions for adults with depression and to estimate the dropout rates in trials examining the impact of these interventions. A bibliographic search was conducted in PubMed, Embase, PsycINFO, the Cochrane library, and several sources of grey literature. We included randomised controlled trials examining the impact of multiple lifestyle interventions on depressive symptomatology in adults when compared to control or other active treatments. Two reviewers independently screened citations, extracted the relevant data, and assessed the risk of bias using Cochrane tools. A random effects meta-analysis of proportions was used to summarise the proportion of participants who completed the intervention and to determine the proportion of dropouts at post-treatment assessment. Multiple subgroup analyses were also carried out. We identified six trials. The meta-analysis of proportions showed that 53% (95%CI 49% to 58%) of the participants assigned to the intervention group fully adhered to the intervention program. The weighted mean proportion of completed intervention sessions was 66%. The pooled trial dropout rate was 22% (95%CI 20% to 24%). Around half of adults with depression adhere to lifestyle interventions. Future research is needed to develop interventions to support adherence to lifestyle interventions in depressive patients.
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Affiliation(s)
- Adoración Castro
- Health Research Institute of the Balearic Islands (IdiSBa), Hospital Universitario Son Espases, Edificio S, 07120 Palma de Mallorca, Spain; (M.R.); (I.R.-C.); (M.G.-T.); (P.R.-S.); (M.Á.P.-A.); (M.G.)
- Research Institute of Health Sciences (IUNICS), University of Balearic Islands, 07122 Palma de Mallorca, Spain;
- Correspondence: ; Tel.: +34-971259888
| | - Miquel Roca
- Health Research Institute of the Balearic Islands (IdiSBa), Hospital Universitario Son Espases, Edificio S, 07120 Palma de Mallorca, Spain; (M.R.); (I.R.-C.); (M.G.-T.); (P.R.-S.); (M.Á.P.-A.); (M.G.)
- Research Institute of Health Sciences (IUNICS), University of Balearic Islands, 07122 Palma de Mallorca, Spain;
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), 28029 Madrid, Spain
| | - Ignacio Ricci-Cabello
- Health Research Institute of the Balearic Islands (IdiSBa), Hospital Universitario Son Espases, Edificio S, 07120 Palma de Mallorca, Spain; (M.R.); (I.R.-C.); (M.G.-T.); (P.R.-S.); (M.Á.P.-A.); (M.G.)
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, 07002 Palma, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Mauro García-Toro
- Health Research Institute of the Balearic Islands (IdiSBa), Hospital Universitario Son Espases, Edificio S, 07120 Palma de Mallorca, Spain; (M.R.); (I.R.-C.); (M.G.-T.); (P.R.-S.); (M.Á.P.-A.); (M.G.)
- Research Institute of Health Sciences (IUNICS), University of Balearic Islands, 07122 Palma de Mallorca, Spain;
| | - Pau Riera-Serra
- Health Research Institute of the Balearic Islands (IdiSBa), Hospital Universitario Son Espases, Edificio S, 07120 Palma de Mallorca, Spain; (M.R.); (I.R.-C.); (M.G.-T.); (P.R.-S.); (M.Á.P.-A.); (M.G.)
- Research Institute of Health Sciences (IUNICS), University of Balearic Islands, 07122 Palma de Mallorca, Spain;
| | - Victoria Coronado-Simsic
- Research Institute of Health Sciences (IUNICS), University of Balearic Islands, 07122 Palma de Mallorca, Spain;
| | - María Ángeles Pérez-Ara
- Health Research Institute of the Balearic Islands (IdiSBa), Hospital Universitario Son Espases, Edificio S, 07120 Palma de Mallorca, Spain; (M.R.); (I.R.-C.); (M.G.-T.); (P.R.-S.); (M.Á.P.-A.); (M.G.)
- Research Institute of Health Sciences (IUNICS), University of Balearic Islands, 07122 Palma de Mallorca, Spain;
| | - Margalida Gili
- Health Research Institute of the Balearic Islands (IdiSBa), Hospital Universitario Son Espases, Edificio S, 07120 Palma de Mallorca, Spain; (M.R.); (I.R.-C.); (M.G.-T.); (P.R.-S.); (M.Á.P.-A.); (M.G.)
- Research Institute of Health Sciences (IUNICS), University of Balearic Islands, 07122 Palma de Mallorca, Spain;
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), 28029 Madrid, Spain
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Drew RJ, Morgan PJ, Kay-Lambkin F, Collins CE, Callister R, Kelly BJ, Hansen V, Young MD. Men's Perceptions of a Gender-Tailored eHealth Program Targeting Physical and Mental Health: Qualitative Findings from the SHED-IT Recharge Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12878. [PMID: 34948488 PMCID: PMC8702011 DOI: 10.3390/ijerph182412878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022]
Abstract
Despite increasing rates of co-morbid depression and obesity, few interventions target both conditions simultaneously, particularly in men. The SHED-IT: Recharge trial, conducted in 125 men with depressive symptoms and overweight or obesity, tested the efficacy of a gender-tailored eHealth program with integrated mental health support. The aims of this study were to examine the perceptions of men who received the SHED-IT: Recharge intervention in relation to recruitment, satisfaction with the program, and suggestions to improve the program. Individual semi-structured interviews were conducted in a random sub-sample, stratified by baseline depression and weight status (n = 19, mean (SD) age 49.6 years (11.6), PHQ-9 score 9.0 (3.7), BMI 32.5 kg/m2 (4.6)). Transcripts were analyzed using an inductive process by an independent qualitative researcher. Four themes emerged, namely, (i) specific circumstances determined men's motivation to enroll, (ii) unique opportunity to implement sustained physical and mental health changes compared to previous experiences, (iii) salience of the program elements, and (iv) further opportunities that build accountability could help maintain focus. Gender-tailored, self-directed lifestyle interventions incorporating mental health support are acceptable and satisfying for men experiencing depressive symptoms. These findings provide important insights for future self-guided lifestyle interventions for men with poor physical and mental health.
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Affiliation(s)
- Ryan J. Drew
- School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, NSW 2308, Australia; (R.J.D.); (P.J.M.)
| | - Philip J. Morgan
- School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, NSW 2308, Australia; (R.J.D.); (P.J.M.)
| | - Frances Kay-Lambkin
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (F.K.-L.); (B.J.K.)
| | - Clare E. Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Robin Callister
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Brian J. Kelly
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (F.K.-L.); (B.J.K.)
| | - Vibeke Hansen
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, NSW 2450, Australia;
| | - Myles D. Young
- School of Psychological Sciences, College of Engineering, Science and Environment, University of Newcastle, Callaghan, NSW 2308, Australia
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Depression and obesity among females, are sex specificities considered? Arch Womens Ment Health 2021; 24:851-866. [PMID: 33880649 DOI: 10.1007/s00737-021-01123-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 03/21/2021] [Indexed: 12/13/2022]
Abstract
This study aimed to systematically review the relationship of obesity-depression in the female sex. We carried out a systematic search (PubMed, MEDLINE, Embase) to quantify the articles (controlled trials and randomized controlled trials) regarding obesity and depression on a female population or a mixed sample. Successively, we established whether the sex specificities were studied by the authors and if they reported on collecting data regarding factors that may contribute to the evolution of obesity and depression and that could be responsible for the greater susceptibility of females to those conditions. After applying the inclusion and exclusion criteria, we found a total of 20 articles with a female sample and 54 articles with a mixed sample. More than half of all articles (51.35%, n = 38) evaluated the relationship between depression and obesity, but only 20 (27.03%) evaluated this relationship among females; still, 80% of those (n = 16) presented supporting results. However, few articles considered confounding factors related to female hormones (12.16%, n = 9) and none of the articles focused on factors responsible for the binomial obesity-depression in the female sex. The resulting articles also supported that depression (and related impairments) influencing obesity (and related impairments) is a two-way road. This systematic review supports the concurrency of obesity-depression in females but also shows how sex specificities are ultimately under-investigated. Female sex specificity is not being actively considered when studying the binomial obesity-depression, even within a female sample. Future studies should focus on trying to understand how the female sex and normal hormonal variations influence these conditions.
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20
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Jones BDM, Levitan RD, Wang W, Uher R, Rotzinger S, Foster JA, Kennedy SH, Farzan F, Quilty LC, Kloiber S. Metabolic variables associated with response to cognitive behavioural therapy for depression in females: A Canadian biomarker integration network for depression (CAN-BIND) study. J Psychiatr Res 2021; 142:321-327. [PMID: 34419752 DOI: 10.1016/j.jpsychires.2021.07.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/13/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Cognitive behavioural therapy (CBT) is an established first-line treatment for depression; however, it remains unclear which factors predict a positive outcome with this approach. Prior work suggests that co-morbid obesity predicts a poorer response to antidepressant medication. The current study examined whether there is an association between weight parameters and improvement of depressive symptoms with CBT. METHODS This was a secondary analysis of data from the "Clinical and Biological Markers of Response to Cognitive Behavioural Therapy for Depression - 6" (CANBIND-6; https://clinicaltrials.gov/ct2/show/NCT02883257) study. Adult participants (n = 41) with a diagnosis of Major Depressive Disorder (MDD) or Persistent Depressive Disorder (PDD) were recruited from an outpatient tertiary psychiatric centre in Canada. Participants completed 20 individual sessions of CBT over 16 weeks. The primary measure for treatment outcome was the Montgomery-Åsberg Depression Rating Scale (MADRS) total score at week 16. RESULTS Thirty-seven participants completed assessments pre and post CBT. Baseline weight parameters were not correlated with treatment response to CBT in the entire group. There was a significant sex*waist circumference (WC) (B:-1.34; p = 0.004) and sex*body mass index (BMI) interaction (B:-2.03; p:0.009). In female participants, baseline waist circumference, but not BMI, significantly predicted week 16 MADRS after controlling for age and baseline MADRS (B:0.422 p:0.049). LIMITATIONS The major limitation of our preliminary finding is the small sample size. CONCLUSION Our preliminary findings suggest that higher waist circumference may be associated with a better treatment response to CBT for depression in females. This result could be of clinical relevance and warrants further investigation in larger and independent samples.
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Affiliation(s)
- Brett D M Jones
- Centre for Addiction and Mental Health and Campbell Family Mental Health Research Institute, 1000 Queen St West, Toronto, Canada; Department of Psychiatry, University of Toronto, 250 College St, Toronto, Canada
| | - Robert D Levitan
- Centre for Addiction and Mental Health and Campbell Family Mental Health Research Institute, 1000 Queen St West, Toronto, Canada; Department of Psychiatry, University of Toronto, 250 College St, Toronto, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health and Campbell Family Mental Health Research Institute, 1000 Queen St West, Toronto, Canada; Department of Psychiatry, University of Toronto, 250 College St, Toronto, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, 5909 Veteran Memorial Lane, Halifax, NS, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University Health Network, University of Toronto, 200 Elizabeth St, Toronto, Ontario, Canada
| | - Jane A Foster
- Psychiatry and Behavioural Neuroscience, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada; Department of Psychiatry, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University Health Network, University of Toronto, 200 Elizabeth St, Toronto, Ontario, Canada
| | - Faranak Farzan
- Brain Lab, School of Mechatronic Systems Engineering, Simon Fraser University, 250-13450, 102 Avenue, Surrey, BC, Canada
| | - Lena C Quilty
- Centre for Addiction and Mental Health and Campbell Family Mental Health Research Institute, 1000 Queen St West, Toronto, Canada; Department of Psychiatry, University of Toronto, 250 College St, Toronto, Canada
| | - Stefan Kloiber
- Centre for Addiction and Mental Health and Campbell Family Mental Health Research Institute, 1000 Queen St West, Toronto, Canada; Department of Psychiatry, University of Toronto, 250 College St, Toronto, Canada.
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Fang CM, McMahon K, Miller ML, Rosenthal MZ. A pilot study investigating the efficacy of brief, phone-based, behavioral interventions for burnout in graduate students. J Clin Psychol 2021; 77:2725-2745. [PMID: 34517431 DOI: 10.1002/jclp.23245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 07/20/2021] [Accepted: 08/15/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This pilot study tested the efficacy of two brief, phone-administered, behavioral interventions derived from behavioral activation in reducing burnout among doctoral students. METHODS Sixty-six doctoral students demonstrating current high burnout were randomly assigned to one of three intervention conditions: (1) Reward: increasing pleasant, rewarding behaviors, (2) Approach: approaching important goals that they have been avoiding, or (3) Control: monitoring only. RESULTS Results indicated that doctoral students treated with the approach intervention reported significantly lower burnout compared to participants in the control condition immediately after the intervention and at a 1-week follow-up. Results also suggested that students in the approach intervention also reported higher well-being compared to students in the control condition. CONCLUSION These findings suggest that this approach intervention is an effective treatment for school burnout for doctoral students that can be delivered remotely through phone and web technology.
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Affiliation(s)
- Caitlin M Fang
- Department of Psychiatry and Behavioral Sciences, Cognitive-Behavioral Research and Therapy Program, Duke University Medical Center, Durham, North Carolina, USA
| | - Kibby McMahon
- Department of Psychiatry and Behavioral Sciences, Cognitive-Behavioral Research and Therapy Program, Duke University Medical Center, Durham, North Carolina, USA
| | - Melissa L Miller
- Department of Psychiatry and Behavioral Sciences, Cognitive-Behavioral Research and Therapy Program, Duke University Medical Center, Durham, North Carolina, USA
| | - Mark Zachary Rosenthal
- Department of Psychiatry and Behavioral Sciences, Cognitive-Behavioral Research and Therapy Program, Duke University Medical Center, Durham, North Carolina, USA
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22
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Huang YQ, Wang Y, Hu K, Lin S, Lin XH. Hippocampal Glycerol-3-Phosphate Acyltransferases 4 and BDNF in the Progress of Obesity-Induced Depression. Front Endocrinol (Lausanne) 2021; 12:667773. [PMID: 34054732 PMCID: PMC8158158 DOI: 10.3389/fendo.2021.667773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/19/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Obesity has been reported to lead to increased incidence of depression. Glycerol-3-phosphate acyltransferases 4 (GPAT4) is involved in triacylglycerol synthesis and plays an important role in the occurrence of obesity. GPAT4 is the only one of GPAT family expressed in the brain. The aim of this study is to investigate if central GPAT4 is associated with obesity-related depression and its underlying mechanism. RESULTS A high-fat diet resulted in increased body weight and blood lipid. HFD induced depression like behavior in the force swimming test, tail suspension test and sucrose preference test. HFD significantly up-regulated the expression of GPAT4 in hippocampus, IL-1β, IL-6, TNF-α and NF-κB, accompanied with down-regulation of BDNF expression in hippocampus and ventromedical hypothalamus, which was attributed to AMP-activated protein kinase (AMPK) and cAMP-response element binding protein (CREB). CONCLUSION Our findings suggest that hippocampal GPAT4 may participate in HFD induced depression through AMPK/CREB/BDNF pathway, which provides insights into a clinical target for obesity-associated depression intervention.
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Affiliation(s)
- Yin-qiong Huang
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yaofeng Wang
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Keyue Hu
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Shu Lin
- Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Diabetes and Metabolism Division, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney, NSW, Australia
- *Correspondence: Xia-hong Lin, ; Shu Lin,
| | - Xia-hong Lin
- Department of Endocrinology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
- *Correspondence: Xia-hong Lin, ; Shu Lin,
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23
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Nepper MJ, McAtee JR, Chai W. Effect of a Workplace Weight-Loss Program for Overweight and Obese Healthcare Workers. Am J Health Promot 2020; 35:352-361. [PMID: 32969262 DOI: 10.1177/0890117120960393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Examining the effect of a workplace weight-loss program on weight loss, and physical, behavioral and mental well-being among overweight/obese healthcare workers. DESIGN Quasi experimental design. SETTING Single healthcare setting. PARTICIPANTS Forty-one (48.0 ± 11.2 years) day-time shift healthcare employees with body mass index [BMI] >29 kg/m2. INTERVENTION Sixteen-week program with weekly group meetings/activities and individual appointments with nutrition/health experts. MEASURES Objective (weight, BMI, blood pressure) and self-reported measures were collected at baseline, conclusion of the intervention and 3 to 6 months post-intervention. ANALYSIS Repeated measure analysis accounting for confounders. RESULTS Participants had an average of 13 pounds (5.6%) weight loss (224.2 ± 6.4 vs. 211.6 ± 6.4 lbs.; P < 0.0001) upon program completion with significant decreases in BMI (37.7 ± 1.0 vs. 35.1 ± 1.0 kg/m2; P < 0.0001). Extreme obesity (BMI≥40 kg/m2) rate was reduced from 36.6% to 17.1% (P < 0.0001). There were decreases in diastolic blood pressure (76.0 ± 1.4 vs. 68.7 ± 1.5 mmHg; P = 0.001) and self-reported blood glucose (119.9 ± 4.4 vs. 105.5 ± 4.6 mg/dL; P = 0.03). Participants had improvements in weekly physical activity (25% change; P = 0.01), nutrition behavior (33% change, P < 0.0001), sleep quality (23% change, P = 0.005), and depression (72% change, P < 0.0001). Twenty-seven participants had post-intervention follow-up data. On average participants regained 8 pounds, which was less than the initial weight loss (16 lbs., N = 27). CONCLUSION The results suggest the program may benefit healthcare employees. Further emphasis should be placed on post-intervention weight management to prevent weight regain.
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Affiliation(s)
| | - Jennifer R McAtee
- Department of Nutrition and Health Sciences, 14719University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Weiwen Chai
- Department of Nutrition and Health Sciences, 14719University of Nebraska-Lincoln, Lincoln, NE, USA
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24
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Hayes JF, Hoggatt KJ, Breland JY. Mental Health Diagnostic Patterns in Behavioral Weight Loss Program Attendees. Mil Med 2020; 185:e1263-e1270. [PMID: 32328624 DOI: 10.1093/milmed/usaa046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/28/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Individuals with obesity have higher rates of mental health disorders, both singly and in combination, than individuals of normal weight. Mental health disorders may negatively impact weight loss treatment outcomes; however, little is known about the mental health burden of individuals using weight loss programs. The current study identifies common mental health diagnostic profiles among participants of MOVE!-the Veterans Health Administration's behavioral weight loss program. MATERIAL AND METHODS We used national VHA administrative data from fiscal year 2014 to identify veteran primary care patients who participated in at least one MOVE! session the previous year (n = 110,830). Using latent class analysis, we identified patient types (classes) characterized by the presence or absence of mental health diagnoses, both overall and stratified by age and gender. RESULTS There were several patient types (classes), including psychologically healthy, predominantly depressed, depressed with co-occurring mental disorders, and co-occurring mental disorders with no predominant psychological condition. Additional patient types were found in men of different ages. The majority of patients had at least one psychiatric disorder, particularly younger patients. CONCLUSIONS Efforts to improve patients' engagement in the MOVE! program may need to address barriers to care associated with mental health disorders or incorporate care for both obesity and mental health diagnoses in MOVE! A holistic approach may be particularly important for younger patients who have a higher comorbidity burden and longer care horizons. Future work may address if patient types found in the current study extend to non-VHA obesity treatment seekers.
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Affiliation(s)
- Jacqueline F Hayes
- VA HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA 94025.,Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond Street, Providence, RI 02903
| | - Katherine J Hoggatt
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA San Francisco Healthcare System, San Francisco, CA, 94121.,Department of Medicine, University of California, San Francisco, CA, 94143
| | - Jessica Y Breland
- VA HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA 94025
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25
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Owens M, Watkins E, Bot M, Brouwer IA, Roca M, Kohls E, Penninx BWJH, Grootheest G, Hegerl U, Gili M, Visser M. Nutrition and depression: Summary of findings from the EU‐funded MooDFOOD depression prevention randomised controlled trial and a critical review of the literature. NUTR BULL 2020. [DOI: 10.1111/nbu.12447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- M. Owens
- Department of Psychology University of Exeter Exeter UK
| | - E. Watkins
- Department of Psychology University of Exeter Exeter UK
| | - M. Bot
- Amsterdam UMC Vrije Universiteit, Psychiatry Amsterdam Public Health Research Institute GGZ in Geest Specialized Mental Health Care Amsterdam The Netherlands
| | - I. A. Brouwer
- Department of Health Sciences Faculty of Science Amsterdam Public Health Research Institute Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - M. Roca
- Institut Universitari d’ Investigació en Ciències de la Salut (IUNICS/IDISBA) Rediapp University of Balearic Islands Palma de Mallorca Spain
| | - E. Kohls
- Department of Psychiatry and Psychotherapy Medical Faculty University Leipzig Leipzig Germany
| | - B. W. J. H. Penninx
- Amsterdam UMC Vrije Universiteit, Psychiatry Amsterdam Public Health Research Institute GGZ in Geest Specialized Mental Health Care Amsterdam The Netherlands
| | - G. Grootheest
- Amsterdam UMC Vrije Universiteit, Psychiatry Amsterdam Public Health Research Institute GGZ in Geest Specialized Mental Health Care Amsterdam The Netherlands
| | - U. Hegerl
- Department of Psychiatry, Psychosomatics and Psychotherapy Goethe‐University Frankfurt Germany
| | - M. Gili
- Institut Universitari d’ Investigació en Ciències de la Salut (IUNICS/IDISBA) Rediapp University of Balearic Islands Palma de Mallorca Spain
| | - M. Visser
- Department of Health Sciences Faculty of Science Amsterdam Public Health Research Institute Vrije Universiteit Amsterdam Amsterdam The Netherlands
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26
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Lv N, Xiao L, Majd M, Lavori PW, Smyth JM, Rosas LG, Venditti EM, Snowden MB, Lewis MA, Ward E, Lesser L, Williams LM, Azar KMJ, Ma J. Variability in engagement and progress in efficacious integrated collaborative care for primary care patients with obesity and depression: Within-treatment analysis in the RAINBOW trial. PLoS One 2020; 15:e0231743. [PMID: 32315362 PMCID: PMC7173791 DOI: 10.1371/journal.pone.0231743] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 03/27/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The RAINBOW randomized clinical trial validated the efficacy of an integrated collaborative care intervention for obesity and depression in primary care, although the effect was modest. To inform intervention optimization, this study investigated within-treatment variability in participant engagement and progress. METHODS Data were collected in 2014-2017 and analyzed post hoc in 2018. Cluster analysis evaluated patterns of change in weekly self-monitored weight from week 6 up to week 52 and depression scores on the Patient Health Questionnaire-9 (PHQ-9) from up to 15 individual sessions during the 12-month intervention. Chi-square tests and ANOVA compared weight loss and depression outcomes objectively measured by blinded assessors to validate differences among categories of treatment engagement and progress defined based on cluster analysis results. RESULTS Among 204 intervention participants (50.9 [SD, 12.2] years, 71% female, 72% non-Hispanic White, BMI 36.7 [6.9], PHQ-9 14.1 [3.2]), 31% (n = 63) had poor engagement, on average completing self-monitored weight in <3 of 46 weeks and <5 of 15 sessions. Among them, 50 (79%) discontinued the intervention by session 6 (week 8). Engaged participants (n = 141; 69%) self-monitored weight for 11-22 weeks, attended almost all 15 sessions, but showed variable treatment progress based on patterns of change in self-monitored weight and PHQ-9 scores over 12 months. Three patterns of weight change (%) represented minimal weight loss (n = 50, linear β1 = -0.06, quadratic β2 = 0.001), moderate weight loss (n = 61, β1 = -0.28, β2 = 0.002), and substantial weight loss (n = 12, β1 = -0.53, β2 = 0.005). Three patterns of change in PHQ-9 scores represented moderate depression without treatment progress (n = 40, intercept β0 = 11.05, β1 = -0.11, β2 = 0.002), moderate depression with treatment progress (n = 20, β0 = 12.90, β1 = -0.42, β2 = 0.006), and milder depression with treatment progress (n = 81, β0 = 7.41, β1 = -0.23, β2 = 0.003). The patterns diverged within 6-8 weeks and persisted throughout the intervention. Objectively measured weight loss and depression outcomes were significantly worse among participants with poor engagement or poor progress on either weight or PHQ-9 than those showing progress on both. CONCLUSIONS Participants demonstrating poor engagement or poor progress could be identified early during the intervention and were more likely to fail treatment at the end of the intervention. This insight could inform individualized and timely optimization to enhance treatment efficacy. TRIAL REGISTRATION ClinicalTrials.gov# NCT02246413.
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Affiliation(s)
- Nan Lv
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Lan Xiao
- Department of Medicine, Stanford University, Palo Alto, California, United States of America
| | - Marzieh Majd
- Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Philip W. Lavori
- Department of Biomedical Data Science, Stanford University, Stanford, California, United States of America
| | - Joshua M. Smyth
- Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Lisa G. Rosas
- Department of Health Research and Policy and Medicine, Stanford University, Palo Alto, California, United States of America
| | - Elizabeth M. Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Mark B. Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, United States of America
| | - Megan A. Lewis
- Center for Communications Science, RTI International, Seattle, Washington, United States of America
| | - Elizabeth Ward
- Pacific Coast Psychiatric Associates, San Francisco, California, United States of America
| | - Lenard Lesser
- One Medical, San Francisco, California, United States of America
| | - Leanne M. Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States of America
| | - Kristen M. J. Azar
- Sutter Health Research Enterprise, Center for Health Systems Research, Walnut Creek, California, United States of America
| | - Jun Ma
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
- * E-mail:
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27
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Rosas LG, Azar KMJ, Lv N, Xiao L, Goldhaber-Fiebert JD, Snowden MB, Venditti EM, Lewis MM, Goldstein-Piekarski AN, Ma J. Effect of an Intervention for Obesity and Depression on Patient-Centered Outcomes: An RCT. Am J Prev Med 2020; 58:496-505. [PMID: 32067873 PMCID: PMC7089815 DOI: 10.1016/j.amepre.2019.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 01/06/2023]
Abstract
INTRODUCTION An integrated collaborative care intervention was successful for treating comorbid obesity and depression. The effect of the integrated intervention on secondary outcomes of quality of life and psychosocial functioning were examined, as well as whether improvements in these secondary outcomes were correlated with improvements in the primary outcomes of weight and depressive symptoms. STUDY DESIGN This RCT compared an integrated collaborative care intervention for obesity and depression to usual care. Data were analyzed in 2018. SETTING/PARTICIPANTS Adult primary care patients (n=409) with a BMI ≥30 (≥27 if Asian) and 9-Item Patient Health Questionnaire score ≥10 were recruited from September 30, 2014 to January 12, 2017 from primary care clinics in Northern California. INTERVENTION The 12-month intervention integrated a behavioral weight loss program and problem-solving therapy with as-needed antidepressant medications for depression. MAIN OUTCOME MEASURES A priori secondary outcomes included health-related quality of life (Short Form-8 Health Survey), obesity-specific quality of life (Obesity-Related Problems Scale), sleep disturbance and sleep-related impairment (Patient-Reported Outcomes Measurement Information System), and functional disability (Sheehan Disability Scale) at baseline and 6 and 12 months. RESULTS Participants randomized to the intervention experienced significantly greater improvements in obesity-specific problems, mental health-related quality of life, sleep disturbance, sleep-related impairment, and functional disability at 6 months but not 12 months. Improvements in obesity-related problems (β=0.01, 95% CI=0.01, 0.02) and sleep disturbance (β= -0.02, 95% CI= -0.04, 0) were associated with lower BMI. Improvements in the physical (β= -0.01, 95% CI= -0.01, 0) and mental health components (β= -0.02, 95% CI= -0.03, -0.02) of the Short Form-8 Health Survey as well as sleep disturbance (β=0.01, 95% CI=0.01, 0.02) and sleep-related impairment (β=0.01, 95% CI=0, 0.01) were associated with fewer depressive symptoms. CONCLUSIONS An integrated collaborative care intervention for obesity and depression that was shown previously to improve weight and depressive symptoms may also confer benefits for quality of life and psychosocial functioning over 6 months. TRIAL REGISTRATION This study is registered at clinicaltrials.gov NCT02246413.
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Affiliation(s)
- Lisa G Rosas
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California; Department of Medicine, Stanford University, Palo Alto, California
| | | | - Nan Lv
- Department of Medicine and Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Lan Xiao
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California
| | | | - Mark B Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Elizabeth M Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Megan M Lewis
- Center for Communications Science, RTI International, Seattle, Washington
| | | | - Jun Ma
- Department of Medicine and Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois.
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Arnott B, Kitchen CEW, Ekers D, Gega L, Tiffin PA. Behavioural activation for overweight and obese adolescents with low mood delivered in a community setting: feasibility study. BMJ Paediatr Open 2020; 4:e000624. [PMID: 32399504 PMCID: PMC7204816 DOI: 10.1136/bmjpo-2019-000624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Mood and weight problems are common in young people, yet few treatments address both conditions concurrently. Behavioural activation (BA) has shown promise as a treatment for adults with comorbid obesity and depression. This study aimed to examine the feasibility and acceptability of a manualised BA treatment targeting weight and mood problems in young people. METHODS Young people with low mood and weight difficulties were identified via a school-based screening process. Following a diagnostic interview, young people with clinically significant mood problems and concurrent overweight/obesity were invited to participate. A total of 8-12 sessions of BA were delivered by a graduate therapist to eight adolescents (four male) aged 12-15 years. Weight, mood and functioning were assessed before, during and after treatment, and a semistructured qualitative interview was conducted, along with selected outcome measures at 4 months' follow-up. RESULTS Low attrition and positive qualitative feedback suggested the intervention was acceptable. Trends towards a reduction in reported depression symptoms and improved functioning scores were observed at follow-up, with more mixed results for change in body mass index. Of those attending the 4-month follow-up, 57% (4/7) no longer met the screening threshold for major depressive disorder. However, low screening and baseline recruitment rates would pose challenges to executing a larger trial. CONCLUSIONS BA delivered by a graduate therapist in a British community setting is an acceptable, feasible treatment for comorbid mood and weight problems in adolescence, and its effectiveness should be evaluated in an adequately powered randomised controlled trial.
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Affiliation(s)
- Bronia Arnott
- Population Health Sciences Institute Newcastle University, Newcastle upon Tyne, UK
| | | | - David Ekers
- Department of Health Sciences, University of York, York, North Yorkshire, UK.,Tees Esk and Wear Valleys NHS Foundation Trust, Durham, UK
| | - Lina Gega
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Paul Alexander Tiffin
- Department of Health Sciences & the Hull York Medical School, University of York, York, North Yorkshire, UK.,Tees Esk and Wear Valleys NHS Foundation Trust, Teesside, UK
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29
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Fitzpatrick SL, Brooks N, Bray B, Stevens VJ. Adherence to behavioral recommendations for weight loss and associated psychosocial factors among African American adults. J Behav Med 2019; 43:859-864. [PMID: 31617048 DOI: 10.1007/s10865-019-00108-2] [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] [Received: 12/19/2018] [Accepted: 10/03/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To identify patterns of behavioral adherence among 388 African Americans who participated in the Weight Loss Maintenance trial and examine associated psychosocial factors. METHODS Using repeated measures latent class analysis, we modeled patterns of adherence to recommendations regarding fruit and vegetable, total fat, and saturated fat intake and physical activity at baseline, 6, and 18 months. Latent classes were compared on the SF-36 (mental health composite and vitality subscale), Perceived Stress Scale, and PHQ-8 at each time point. RESULTS Three distinct latent classes emerged: Nutrition Adherers (n = 96); Physical Activity Adherers (n = 61); and Non-Adherers (n = 231). All groups showed initial improvement in psychosocial measures followed by relapse. Non-Adherers had significantly lower mean mental health and vitality scores and higher depression scores than adherers at 6 and 18 months. CONCLUSION Psychological well-being should be addressed with African Americans in weight loss treatment to enhance behavior change and improve weight loss outcomes.
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Affiliation(s)
- Stephanie L Fitzpatrick
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave, Portland, OR, 97227, USA.
| | - Neon Brooks
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Bethany Bray
- The Methodology Center, Penn State University, State College, PA, USA
| | - Victor J Stevens
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave, Portland, OR, 97227, USA
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30
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Affiliation(s)
- Richard Parker
- Leeds Liver Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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31
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Simmonds-Buckley M, Kellett S, Waller G. Acceptability and Efficacy of Group Behavioral Activation for Depression Among Adults: A Meta-Analysis. Behav Ther 2019; 50:864-885. [PMID: 31422844 DOI: 10.1016/j.beth.2019.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/29/2018] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
Abstract
The evidence base for behavioral activation (BA) as a front-line treatment for depression is grounded in individual delivery. No valid previous meta-analytic reviews of BA delivered in groups have been conducted. This study therefore examined the efficacy and acceptability of group BA drawn from clinical trial evidence. Randomized controlled trials of group BA were identified using a comprehensive literature search. Depression outcomes at posttreatment/follow-up, recovery and dropout rates were extracted and analyzed using a random-effects meta-analysis. Treatment moderators were analyzed using meta-regression and subgroup analyses. Nineteen trials were quantitatively synthesized. Depression outcomes postgroup BA treatment were superior to controls (SMD 0.72, CI 0.34 to 1.10, k=13, N=461) and were equivalent to other active therapies (SMD 0.14, CI -0.18 to 0.46, k=15, N=526). Outcomes were maintained at follow-up for group BA and moderators of treatment outcome were limited. The dropout rate for group BA (14%) was no different from other active treatments for depression (17%). Further research is required to refine the conditions for optimum delivery of group BA and define robust moderators and mediators of outcome. However, BA delivered in groups produces a moderate to large effect on depressive symptoms and should be considered an appropriate front-line treatment option.
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Affiliation(s)
| | - Stephen Kellett
- University of Sheffield, and Sheffield Health and Social Care NHS Foundation Trust
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Restrepo Moreno S, García Valencia J, Vargas C, López-Jaramillo C. Cognitive Development in Patients with Bipolar Disorder and Metabolic Syndrome. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2019; 48:149-155. [PMID: 31426917 DOI: 10.1016/j.rcp.2017.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/21/2017] [Accepted: 10/22/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To describe and discuss current evidence on the relationship between cognitive performance, Bipolar Affective Disorder (BAD) and Metabolic Syndrome (MS). METHODS We searched for related articles in different bibliographic databases (MEDLINE, EMBASE, Scielo) and performed a narrative review of the literature with the selected articles. RESULTS To date, evidence has not been conclusive and the effect of MS on BD has not been widely studied, but important correlations have been observed with individual metabolic variables. It is suggested that obesity in patients with BAD is associated wotj worse performance in verbal memory, psychomotor processing speed, and sustained attention. Hypertriglyceridemia in patients with BAD appears to be associated with a lower score in executive function tasks; hypertension appears to be associated with impairment in overall cognitive function. CONCLUSIONS Despite the associations between MS and poor cognitive performance in patients suffering from BAD, more studies are required to precisely determine how these variables are related to each other.
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Affiliation(s)
- Sebastián Restrepo Moreno
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Grupo de Investigación en Psiquiatría GIPSI, Medellín, Colombia
| | - Jenny García Valencia
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Grupo de Investigación en Psiquiatría GIPSI, Medellín, Colombia
| | - Cristian Vargas
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Grupo de Investigación en Psiquiatría GIPSI, Medellín, Colombia.
| | - Carlos López-Jaramillo
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Grupo de Investigación en Psiquiatría GIPSI, Medellín, Colombia
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Cristea IA, Karyotaki E, Hollon SD, Cuijpers P, Gentili C. Biological markers evaluated in randomized trials of psychological treatments for depression: a systematic review and meta-analysis. Neurosci Biobehav Rev 2019; 101:32-44. [DOI: 10.1016/j.neubiorev.2019.03.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/05/2019] [Accepted: 03/24/2019] [Indexed: 12/15/2022]
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34
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Affiliation(s)
- Michael Berk
- IMPACT Strategic Research Centre, Deakin University, Geelong, Victoria, Australia
- Food & Mood Centre, Deakin University, Geelong, Victoria, Australia
- Orygen, the National Centre of Excellence in Youth Mental Health, Department of Psychiatry, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Felice N Jacka
- IMPACT Strategic Research Centre, Deakin University, Geelong, Victoria, Australia
- Food & Mood Centre, Deakin University, Geelong, Victoria, Australia
- Black Dog Institute, Randwick, New South Wales, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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35
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Ma J, Rosas LG, Lv N, Xiao L, Snowden MB, Venditti EM, Lewis MA, Goldhaber-Fiebert JD, Lavori PW. Effect of Integrated Behavioral Weight Loss Treatment and Problem-Solving Therapy on Body Mass Index and Depressive Symptoms Among Patients With Obesity and Depression: The RAINBOW Randomized Clinical Trial. JAMA 2019; 321:869-879. [PMID: 30835308 PMCID: PMC6439596 DOI: 10.1001/jama.2019.0557] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Coexisting obesity and depression exacerbate morbidity and disability, but effective treatments remain elusive. OBJECTIVE To test the hypothesis that an integrated collaborative care intervention would significantly improve both obesity and depression at 12 months compared with usual care. DESIGN, SETTING, AND PARTICIPANTS The Research Aimed at Improving Both Mood and Weight (RAINBOW) randomized clinical trial enrolled 409 adults with body mass indices (BMIs) of 30 or greater (≥27 for Asian adults) and 9-item Patient Health Questionnaire (PHQ-9) scores of 10 or greater. Primary care patients at a health system in Northern California were recruited from September 30, 2014, to January 12, 2017; the date of final 12-month follow-up was January 17, 2018. INTERVENTIONS All participants randomly assigned to the intervention (n = 204) or the usual care control group (n = 205) received medical care from their personal physicians as usual, received information on routine services for obesity and depression at their clinic, and received wireless physical activity trackers. Intervention participants also received a 12-month intervention that integrated a Diabetes Prevention Program-based behavioral weight loss treatment with problem-solving therapy for depression and, if indicated, antidepressant medications. MAIN OUTCOMES AND MEASURES The co-primary outcome measures were BMI and 20-item Depression Symptom Checklist (SCL-20) scores (range, 0 [best] to 4 [worst]) at 12 months. RESULTS Among 409 participants randomized (mean age of 51.0 years [SD, 12.1 years]; 70% were women; mean BMI of 36.7 [SD, 6.4]; mean PHQ-9 score of 13.8 [SD, 3.1]; and mean SCL-20 score of 1.5 [SD, 0.5]), 344 (84.1%) completed 12-month follow-up. At 12 months, mean BMI declined from 36.7 (SD, 6.9) to 35.9 (SD, 7.1) among intervention participants compared with a change in mean BMI from 36.6 (SD, 5.8) to 36.6 (SD, 6.0) among usual care participants (between-group mean difference, -0.7 [95% CI, -1.1 to -0.2]; P = .01). Mean SCL-20 score declined from 1.5 (SD, 0.5) to 1.1 (SD, 1.0) at 12 months among intervention participants compared with a change in mean SCL-20 score from 1.5 (SD, 0.6) to 1.4 (SD, 1.3) among usual care participants (between-group mean difference, -0.2 [95% CI, -0.4 to 0]; P = .01). There were 47 adverse events or serious adverse events that involved musculoskeletal injuries (27 in the intervention group and 20 in the usual care group). CONCLUSIONS AND RELEVANCE Among adults with obesity and depression, a collaborative care intervention integrating behavioral weight loss treatment, problem-solving therapy, and as-needed antidepressant medications significantly improved weight loss and depressive symptoms at 12 months compared with usual care; however, the effect sizes were modest and of uncertain clinical importance. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02246413.
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Affiliation(s)
- Jun Ma
- Department of Medicine and Institute of Health Research and Policy, University of Illinois, Chicago
| | - Lisa Goldman Rosas
- Department of Health Research and Policy and Medicine, Stanford University, Palo Alto, California
| | - Nan Lv
- Department of Medicine and Institute of Health Research and Policy, University of Illinois, Chicago
| | - Lan Xiao
- Department of Medicine, Stanford University, Palo Alto, California
| | - Mark B. Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Elizabeth M. Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Megan A. Lewis
- Center for Communications Science, RTI International, Seattle, Washington
| | | | - Philip W. Lavori
- Department of Biomedical Data Science, Stanford University, Stanford, California
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Singh VK, Karmani S, Malo PK, Virupaksha HG, Muralidhar D, Venkatasubramanian G, Muralidharan K. Impact of lifestyle modification on some components of metabolic syndrome in persons with severe mental disorders: A meta-analysis. Schizophr Res 2018; 202:17-25. [PMID: 30539768 DOI: 10.1016/j.schres.2018.06.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/28/2018] [Accepted: 06/30/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Metabolic syndrome (MS) is reportedly associated with high mortality from mostly cardiovascular causes in patients with severe mental disorders (SMD). Lifestyle interventions augment effective management of MS in patients with SMD. The present meta-analysis aims at updating the recent evidence on the effectiveness of lifestyle intervention for MS in patients with SMD. METHOD A literature search for English Language publications of randomized controlled trials (RCTs) from 2001 to 2016 comparing lifestyle modification (LM) with treatment as usual (TAU) in the management of MS were identified. Using PRISMA guidelines, 19 RCTs reporting data on 1688 SMD and MS patients and providing data on change in Body Weight, Body Mass Index (BMI) and waist circumference (WC) were included. Using random effects model, standardized mean difference between LM and TAU for the mean baseline-to-endpoint change in body weight, BMI and WC was calculated with a 95% confidence limit, on RevMan 5.3. The study was registered with PROSPERO (CRD42016046847). RESULTS LM had significantly superior efficacy in the reducing weight (-0.64, 95% CI -0.89, -0.39, Z = 5.03, overall effect p < 0.00001), BMI (-0.68, 95% CI -1.01, -0.35, Z = 4.05, overall effect p < 0.0001), and WC (-0.60, 95% CI -1.17, -0.03, Z = 2.06; overall effect p = 0.04), compared to TAU. LM was significantly more effective than TAU even in short duration (p = 0.0001) and irrespective of the treatment setting. CONCLUSION Interventions targeting LM in persons with SMD and MS are effective in reducing body weight, BMI and WC. It must be routinely recommended to all patients with SMD, ideally during commencement stage of second generation antipsychotic treatment.
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Affiliation(s)
- Vinit Kumar Singh
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences (INI), Bengaluru 560029, Karnataka, India
| | - Sneha Karmani
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bengaluru 560029, Karnataka, India
| | - Palash Kumar Malo
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences (INI), Bengaluru 560029, Karnataka, India
| | - H G Virupaksha
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences (INI), Bengaluru 560029, Karnataka, India
| | - Daliboina Muralidhar
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences (INI), Bengaluru 560029, Karnataka, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bengaluru 560029, Karnataka, India
| | - Kesavan Muralidharan
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bengaluru 560029, Karnataka, India.
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Psychosocial factors associated with treatment outcomes in women with obesity and major depressive disorder who received behavioral activation for depression. J Behav Med 2018; 42:522-533. [PMID: 30467656 PMCID: PMC7286199 DOI: 10.1007/s10865-018-9993-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 11/17/2018] [Indexed: 10/27/2022]
Abstract
Behavioral activation is an empirically supported treatment for depression, but much is unknown about factors associated with treatment response. The present study aimed to determine whether baseline levels and subsequent changes in psychosocial factors were associated with improvement in depression in women with comorbid obesity who received behavioral activation treatment for depression and a lifestyle intervention. Multilevel modeling was used to estimate the associations between psychosocial factors and change in depression scores during the first 10 weeks of treatment and associations between changes in psychosocial factors from baseline to 6-month follow-up and change in depression over the same time period. No baseline psychosocial factors were associated with depression improvement during treatment (p = 0.110-0.613). However, greater improvement in hedonic capacity (p = 0.001), environmental reward (p = 0.004), and social impairment (p = 0.012) were associated with greater reductions in depression over 6 months. Findings highlight the differential relationship specific psychosocial factors have with depression treatment outcomes.
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Godfrey KM, Bullock AJ, Dorflinger LM, Min KM, Ruser CB, Masheb RM. Pain and modifiable risk factors among weight loss seeking Veterans with overweight. Appetite 2018; 128:100-105. [PMID: 29885382 DOI: 10.1016/j.appet.2018.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/10/2018] [Accepted: 06/05/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Overweight/obesity and chronic pain frequently co-occur and demonstrate a bidirectional relationship. Modifiable risk factors, such as eating behaviors and mental health symptoms, may be important to understand this relationship and improve interventions in Veterans. DESIGN Cross-sectional. SETTING Veterans Health Administration Medical Center outpatient clinic. SUBJECTS The sample of Veterans (N = 126) was mostly male (89.7%), White (76%), and non-Hispanic (94%) with average age of 61.9 years (SD = 8.5) and average body mass index (BMI) of 38.5 (SD = 7.5). METHODS Veterans referred for weight loss treatment (MOVE!) at VA Connecticut completed self-report questionnaires, and electronic medical records were reviewed. RESULTS Mean self-reported pain rating was 4.5 out of 10 (SD = 2.3). Moderate to severe pain was endorsed by 60% of the sample. Veterans with higher pain intensity and interference reported higher global eating disorder symptoms, emotional overeating, night eating, insomnia severity, and mental health symptoms (all p's < 0.01). However, pain intensity and interference were not associated with BMI. CONCLUSIONS For Veterans seeking behavioral weight loss treatment, higher pain intensity and interference were associated with more severe eating disorder, sleep, and mental health symptoms. A better description of the clinical characteristics of Veterans with pain who participate in MOVE! highlights their unique needs and may improve treatments to address pain in the context of weight loss treatment.
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Affiliation(s)
- Kathryn M Godfrey
- The Drexel University Center for Weight, Eating and Lifestyle Science, Philadelphia, PA, USA
| | | | | | - Kathryn M Min
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Christopher B Ruser
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale School of Medicine, New Haven, CT, USA
| | - Robin M Masheb
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale School of Medicine, New Haven, CT, USA.
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Brown C, Geiszler LC, Lewis KJ, Arbesman M. Effectiveness of Interventions for Weight Loss for People With Serious Mental Illness: A Systematic Review and Meta-Analysis. Am J Occup Ther 2018; 72:7205190030p1-7205190030p9. [PMID: 30157007 DOI: 10.5014/ajot.2018.033415] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We examined the effectiveness of weight loss interventions in community-based settings for people with serious mental illness (SMI). METHOD Four databases were searched for randomized controlled trials published in 2008 or later that met the criteria for the research question and used weight loss as an outcome measure. Data were extracted, and weight loss was analyzed using a meta-analysis. Similarities and differences in interventions were analyzed qualitatively. RESULTS Seventeen studies and a total of 1,874 participants with various diagnoses of SMI were included in the meta-analysis. The various lifestyle-focused interventions had a significant effect on weight loss with an overall effect size of -0.308 (p < .001). CONCLUSION Community-based interventions for people with SMI are effective for weight loss. Occupational therapists can be involved in the provision of weight loss interventions and in the development and study of intervention components that are most effective.
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Affiliation(s)
- Catana Brown
- Catana Brown, PhD, OTR/L, FAOTA, is Professor, Midwestern University-Glendale, Glendale, AZ;
| | - Lydia C Geiszler
- Lydia C. Geiszler, MOT, OTR/L, is Occupational Therapist, Mayo Clinic Hospital, Saint Mary's Campus, Rochester, MN
| | - Kelsie J Lewis
- Kelsie J. Lewis, MOT, OTR/L, is Occupational Therapist, Carondelet St. Mary's, Tucson, AZ
| | - Marian Arbesman
- Marian Arbesman, PhD, OTR/L, FAOTA, is Adjunct Associate Professor, Department of Clinical Research and Leadership, George Washington University School of Medicine and Health Sciences, Washington, DC, and President, ArbesIdeas, Inc., Williamsville, NY
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Faulconbridge LF, Driscoll CFB, Hopkins CM, Bailer Benforado B, Bishop-Gilyard C, Carvajal R, Berkowitz RI, DeRubeis R, Wadden TA. Combined Treatment for Obesity and Depression: A Pilot Study. Obesity (Silver Spring) 2018; 26:1144-1152. [PMID: 29932516 DOI: 10.1002/oby.22209] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 04/04/2018] [Accepted: 04/05/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Obesity and depression frequently co-occur, and each increases risk for cardiovascular disease (CVD). This study tested whether a combined treatment, targeting obesity and depression simultaneously, would yield greater improvements in weight, mood, and CVD risk factors than treatments that targeted each disease individually. METHODS Seventy-six participants with obesity and major depression were randomly assigned to (1) behavioral weight control (BWC), (2) cognitive behavioral therapy for depression (CBT-D), or (3) BWC combined with CBT-D. Participants were provided 18 group treatment sessions over 20 weeks. Mood, weight, and CVD risk were assessed at baseline and weeks 8 and 20, with a follow-up visit at week 46. RESULTS At week 20, participants in combined treatment lost significantly (P < 0.02) more weight (5.2% ± 1.2%) than those assigned to CBT-D (0.8% ± 1.3%) and comparable amounts as those in BWC (3.5% ± 1.3%). Depression scores decreased significantly from baseline levels in each group, with no significant differences between groups. All three groups showed significant improvements in 10-year CVD risk, with no significant differences between groups. Groups did not differ significantly on any of these measures at week 46. CONCLUSIONS BWC yielded short-term improvements in weight, mood, and CVD risk, comparable to a combined treatment that incorporated CBT-D. Results require replication with a larger sample size.
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Affiliation(s)
- Lucy F Faulconbridge
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Colleen F B Driscoll
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christina M Hopkins
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brooke Bailer Benforado
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Chanelle Bishop-Gilyard
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Raymond Carvajal
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert I Berkowitz
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Psychiatry, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Robert DeRubeis
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas A Wadden
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Vrany EA, Hawkins MAW, Wu W, Stewart JC. Depressive symptoms and weight loss behaviors in U.S. adults. Eat Behav 2018; 29:107-113. [PMID: 29631125 DOI: 10.1016/j.eatbeh.2018.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 02/28/2018] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE We sought to determine whether depressive symptoms are associated with attempting to lose weight and engaging in weight loss behaviors in a large, diverse sample of adults representative of the U.S. METHODS Respondents were 23,106 adults, free of cardiovascular disease and diabetes, who participated in the 2005-2014 years of the National Health and Nutrition Examination Survey (NHANES). Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9), and weight loss variables were obtained from a Weight History Questionnaire. RESULTS PHQ-9 total was not associated with attempting to lose weight in the past year (OR = 1.03, 95%CI = 1.00-1.06, p = 0.074; n = 23,106). Among respondents who attempted to lose weight (n = 9582), PHQ-9 total was associated with a lower odds of exercising (OR = 0.84, 95%CI = 0.79-0.89, p < 0.001) and a greater odds of skipping meals (OR = 1.31, 95%CI = 1.22-1.41, p < 0.001), eating diet foods/products (OR = 1.16, 95%CI = 1.08-1.24, p < 0.001), eating less food (OR = 1.09, 95%CI = 1.04-1.15, p < 0.001), taking non-prescription supplements (OR = 1.31, 95%CI = 1.23-1.41, p < 0.001), taking prescription diet pills (OR = 1.28, 95%CI = 1.10-1.49, p = 0.001), and taking laxatives/vomiting (OR = 1.55, 95%CI = 1.28-1.88, p < 0.001). CONCLUSIONS Although depressive symptoms were not associated with attempting to lose weight in the past year, adults who attempted to lose weight tended to employ potentially ineffective/unhealthy weight loss behaviors and avoid effective behaviors. This pattern of behaviors may be another mechanism that explains the excess risk of obesity in depressed adults and may be a modifiable target for future interventions. Given the cross-sectional nature of this study, reverse causality is a possibility. Future studies should investigate the prospective associations between depressive symptoms and weight loss behaviors.
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Affiliation(s)
- Elizabeth A Vrany
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Misty A W Hawkins
- Department of Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Wei Wu
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States.
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Alhalel N, Schueller SM, O'Brien MJ. Association of changes in mental health with weight loss during intensive lifestyle intervention: does the timing matter? Obes Sci Pract 2018; 4:153-158. [PMID: 29670753 PMCID: PMC5893461 DOI: 10.1002/osp4.157] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/08/2018] [Accepted: 01/17/2018] [Indexed: 12/31/2022] Open
Abstract
Objective This study examined changes in mental health symptoms and weight during weight loss treatment. It was hypothesized that worsening mental health would negatively impact weight loss. Methods Data were analyzed from a trial of 92 Hispanic women with overweight/obesity and prediabetes, who were randomized to receive intensive lifestyle intervention (ILI), metformin 1,700 mg daily, or standard care. Depression, anxiety and perceived stress were assessed at 0, 6 and 12 months. Six‐ and 12‐month weight change was compared among participants whose symptom scores worsened on any mental health measure (W) vs. improved or remained stable on all three (I/S). Results Among ILI participants, the 12‐month difference in weight loss between I/S and W groups was statistically significant: −5.1 kg (P = 0.001). From baseline to 6 months, ILI participants in I/S and W groups experienced comparable weight loss. However, from 6 to 12 months, W participants regained weight, whereas I/S participants experienced continued weight loss. In the metformin and standard care arms, there was no weight difference between I/S and W groups. Conclusions In ILI, 12‐month improvement or stability in mental health was significantly associated with weight loss. Weight trajectories between I/S and W groups diverged at 6 months.
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Affiliation(s)
- N Alhalel
- Northwestern University Feinberg School of Medicine Chicago IL USA
| | - S M Schueller
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL USA.,Center for Behavioral Intervention Technologies Northwestern University Feinberg School of Medicine Chicago IL USA
| | - M J O'Brien
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL USA.,Division of General Internal Medicine and Geriatrics Northwestern University Feinberg School of Medicine Chicago IL USA.,Center for Community Health, Institute for Public Health and Medicine Northwestern University Feinberg School of Medicine Chicago IL USA
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Payne ME, Porter Starr KN, Orenduff M, Mulder HS, McDonald SR, Spira AP, Pieper CF, Bales CW. Quality of Life and Mental Health in Older Adults with Obesity and Frailty: Associations with a Weight Loss Intervention. J Nutr Health Aging 2018; 22:1259-1265. [PMID: 30498835 PMCID: PMC6444357 DOI: 10.1007/s12603-018-1127-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To examine the bi-directional associations of a weight loss intervention with quality of life and mental health in obese older adults with functional limitations. DESIGN Combined-group analyses of secondary variables from the MEASUR-UP randomized controlled trial. SETTING Academic medical center. PARTICIPANTS Obese community-dwelling men and women (N = 67; age ≥60; BMI ≥30) with functional limitations (Short Physical Performance Battery [SPPB] score of 4-10 out of 12). INTERVENTION Six-month reduced calorie diet at two protein levels. MEASUREMENTS Weight, height, body composition, physical function, medical history, and mental health and quality of life assessments (Center for Epidemiologic Studies Depression Scale [CES-D]; Profile of Mood States [POMS], Pittsburgh Sleep Quality Index [PSQI]; Perceived Stress Scale [PSS]; Satisfaction with Life Scale [SWLS]; and Short Form Health Survey [SF-36]) were acquired at 0, 3 and 6 months. RESULTS Physical composite quality of life (SF-36) improved significantly at 3 months (β = 6.29, t2,48 = 2.60, p = 0.012) and 6 months (β = 10.03, t2,48 = 4.83, p < 0.001), as did several domains of physical quality of life. Baseline depression symptoms (CES-D and POMS) were found to predict lower amounts of weight loss; higher baseline sleep latency (PSQI) and anger (POMS) predicted less improvement in physical function (SPPB). CONCLUSION The significant bi-directional associations found between a weight loss intervention and mental health/quality of life, including substantial improvements in physical quality of life with obesity treatment, indicate the importance of considering mental health and quality of life as part of any weight loss intervention for older adults.
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Affiliation(s)
- M E Payne
- M. E. Payne, Duke University School of Medicine, Davison Building, Suite 410, Durham, North Carolina, 27710 USA, Tel +1 919 681-1611, email
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Wang ML, Waring ME, Jake-Schoffman DE, Oleski JL, Michaels Z, Goetz JM, Lemon SC, Ma Y, Pagoto SL. Clinic Versus Online Social Network-Delivered Lifestyle Interventions: Protocol for the Get Social Noninferiority Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e243. [PMID: 29229591 PMCID: PMC5742659 DOI: 10.2196/resprot.8068] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/22/2017] [Accepted: 09/23/2017] [Indexed: 11/25/2022] Open
Abstract
Background Online social networks may be a promising modality to deliver lifestyle interventions by reducing cost and burden. Although online social networks have been integrated as one component of multimodality lifestyle interventions, no randomized trials to date have compared a lifestyle intervention delivered entirely via online social network with a traditional clinic-delivered intervention. Objective This paper describes the design and methods of a noninferiority randomized controlled trial, testing (1) whether a lifestyle intervention delivered entirely through an online social network would produce weight loss that would not be appreciably worse than that induced by a traditional clinic-based lifestyle intervention among overweight and obese adults and (2) whether the former would do so at a lower cost. Methods Adults with body mass index (BMI) between 27 and 45 kg/m2 (N=328) will be recruited from the communities in central Massachusetts. These overweight or obese adults will be randomized to two conditions: a lifestyle intervention delivered entirely via the online social network Twitter (Get Social condition) and an in-person group-based lifestyle intervention (Traditional condition) among overweight and obese adults. Measures will be obtained at baseline, 6 months, and 12 months after randomization. The primary noninferiority outcome is percentage weight loss at 12 months. Secondary noninferiority outcomes include dietary intake and moderate intensity physical activity at 12 months. Our secondary aim is to compare the conditions on cost. Exploratory outcomes include treatment retention, acceptability, and burden. Finally, we will explore predictors of weight loss in the online social network condition. Results The final wave of data collection is expected to conclude in June 2019. Data analysis will take place in the months following and is expected to be complete in September 2019. Conclusions Findings will extend the literature by revealing whether delivering a lifestyle intervention via an online social network is an effective alternative to the traditional modality of clinic visits, given the former might be more scalable and feasible to implement in settings that cannot support clinic-based models. Trial Registration ClinicalTrials.gov NCT02646618; https://clinicaltrials.gov/ct2/show/NCT02646618 (Archived by WebCite at http://www.webcitation.org/6v20waTFW)
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Affiliation(s)
- Monica L Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Molly E Waring
- Department of Allied Health Sciences, College of Agriculture, Health, and Natural Resources, University of Connecticut, Storrs, CT, United States
| | - Danielle E Jake-Schoffman
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Jessica L Oleski
- Department of Allied Health Sciences, College of Agriculture, Health, and Natural Resources, University of Connecticut, Storrs, CT, United States
| | - Zachary Michaels
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Jared M Goetz
- Department of Allied Health Sciences, College of Agriculture, Health, and Natural Resources, University of Connecticut, Storrs, CT, United States
| | - Stephenie C Lemon
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Yunsheng Ma
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Sherry L Pagoto
- Department of Allied Health Sciences, College of Agriculture, Health, and Natural Resources, University of Connecticut, Storrs, CT, United States
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Ma J, Xiao L, Lv N, Rosas LG, Lewis MA, Goldhaber-Fiebert JD, Venditti EM, Snowden MB, Lesser L, Ward E. Profiles of sociodemographic, behavioral, clinical and psychosocial characteristics among primary care patients with comorbid obesity and depression. Prev Med Rep 2017; 8:42-50. [PMID: 28840096 PMCID: PMC5560114 DOI: 10.1016/j.pmedr.2017.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 07/31/2017] [Indexed: 11/20/2022] Open
Abstract
The objective of this study is to characterize profiles of obese depressed participants using baseline data collected from October 2014 through December 2016 for an ongoing randomized controlled trial (n = 409) in Bay Area, California, USA. Four comorbidity severity categories were defined by interaction of the binary levels of body mass index (BMI) and depression Symptom Checklist 20 (SCL20) scores. Sociodemographic, behavioral, clinical and psychosocial characteristics were measured. Mean (SD) age was 51 (12.1) years, BMI 36.7 (6.4) kg/m2, and SCL20 1.5 (0.5). Participants in the 4 comorbidity severity categories had similar sociodemographic characteristics, but differed significantly in the other characteristics. Two statistically significant canonical dimensions were identified. Participants with BMI ≥ 35 and SCL20 ≥ 1.5 differed significantly from those with BMI < 35 and SCL20 < 1.5 on dimension 1, which primarily featured high physical health (e.g., central obesity, high blood pressure and impaired sleep) and mental health comorbidities (e.g., post-traumatic stress and anxiety), poor health-related quality of life (in general and problems specifically with obesity, anxiety, depression, and usual daily activities), and an avoidance problem-solving style. Participants with BMI < 35 and SCL20 ≥ 1.5 differed significantly from those with BMI ≥ 35 and SCL20 < 1.5 on dimension 2, which primarily included fewer Hispanics, less central obesity, and more leisure-time physical activity, but greater anxiety and post-traumatic stress and poorer obesity- or mental health-related quality of life. In conclusion, patients with comorbid obesity and depression of varying severity have different profiles of behavioral, clinical and psychosocial characteristics. This insight may inform analysis of treatment heterogeneity and development of targeted intervention strategies. Trial registration:ClinicalTrials.gov #NCT02246413.
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Key Words
- Behavior
- Clinical characteristics
- Depression
- EHR, Electronic health record
- EQ-5D-5 L, European Quality of Life-5 Dimension-5 Levels
- GAD7, Generalized Anxiety Disorder Scale
- MET, Metabolic equivalent of task
- MINI, Mini-International Neuropsychiatric Interview
- Obesity
- PCPs, Primary care providers
- PHQ, Patient Health Questionnaire
- PTSD, Posttraumatic stress disorder
- Psychosocial characteristics
- SCL20, Depression Symptom Checklist 20
- SF-8, Short Form-8 Health Survey
- SPSI-R:S, Social Problem-Solving Inventory—Revised: Short Form
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Affiliation(s)
- Jun Ma
- Institute for Health Research and Policy and Department of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
| | - Lan Xiao
- Palo Alto Medical Foundation Research Institute, Sutter Health, Palo Alto, CA, United States
| | - Nan Lv
- Palo Alto Medical Foundation Research Institute, Sutter Health, Palo Alto, CA, United States
| | - Lisa G. Rosas
- Palo Alto Medical Foundation Research Institute, Sutter Health, Palo Alto, CA, United States
- Department of Medicine, School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Megan A. Lewis
- Center for Communications Science, RTI International, Seattle, WA, United States
| | | | - Elizabeth M. Venditti
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Mark B. Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | | | - Elizabeth Ward
- Pacific Coast Psychiatric Associates, San Francisco, CA, United States
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Alvarez-Galvez J, Gomez-Baya D. Socioeconomic Context as a Moderator in the Relationship between Body Mass Index and Depression in Europe. Appl Psychol Health Well Being 2017; 9:410-428. [PMID: 29171197 DOI: 10.1111/aphw.12104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Obesity and depression are two major health issues in contemporary societies. This study aims to address two fundamental questions: (1) what is the impact of macro-level adverse socioeconomic circumstances on depression? and (2) how do macro-level variations in the socioeconomic context affect the relationship between body mass index (BMI) and depression? METHODS Data from the 7th round of the European Social Survey were used, collected from a sample size of 37,623 participants and aggregated around a total of 20 countries. A random intercept multilevel model was constructed to study the variations in the relationship between depression and BMI. The contextual effect of risk of poverty, unemployment rate, and gross domestic product per capita were studied at the country level. RESULTS First, both unemployment and poverty risk were found to be positively associated with depressive disorders. Second, the results show that a higher risk of poverty at the macro level may increase the effect of BMI on depression in European countries. CONCLUSION The present study provides new evidence suggesting that the obesity-depression relationship will be, on average, stronger in countries with poor socioeconomic conditions. Therefore, adverse socioeconomic contextual conditions may increase depression associated with obesity.
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Tucker JM, Cadieux A, Culver K, Smith L, Stratbucker W. Psychiatric diagnoses and medication treatment among patients presenting for paediatric weight management: associations with adiposity, aerobic fitness and cardiometabolic health. Clin Obes 2017; 7:145-150. [PMID: 28320057 DOI: 10.1111/cob.12185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/19/2017] [Accepted: 02/08/2017] [Indexed: 01/31/2023]
Abstract
We compared anthropometry, cardiometabolic risk and aerobic fitness among obese youth in weight management who were diagnosed with one or more psychiatric disorders (PD), with (PD+M) or without (PD-M) a prescribed psychotropic medication with those with no PD (NPD). Physical measures were evaluated at baseline, and psychiatric diagnoses and related medications were identified from medical records. Of 99 patients 64 (65%) had a diagnosed PD, and of those, 23 (36%) had a related medication (PD+M). Compared to NPD, PD-M had a higher body mass index (BMI) (P = 0.003), BMI z-score (P = 0.015), percent body fat (P = 0.005) and waist circumference (P < 0.001), after adjusting for age, but PD+M did not. Cardiometabolic risk did not differ between groups, but aerobic fitness was lower among PD-M (P = 0.001) and PD+M (P = 0.008) compared to NPD. Obese youth in weight management exhibit high rates of psychiatric diagnoses that are associated with lower fitness and higher adiposity and may impact treatment efficacy.
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Affiliation(s)
- J M Tucker
- Healthy Weight Center, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - A Cadieux
- Healthy Weight Center, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - K Culver
- Healthy Weight Center, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - L Smith
- Healthy Weight Center, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - W Stratbucker
- Healthy Weight Center, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
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Naparstek J, Wing RR, Xu X, Leahey TM. Internet-delivered obesity treatment improves symptoms of and risk for depression. Obesity (Silver Spring) 2017; 25:671-675. [PMID: 28224713 PMCID: PMC5373949 DOI: 10.1002/oby.21773] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 12/14/2016] [Accepted: 12/19/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In-person lifestyle interventions for obesity treatment yield significant improvements in depression. These improvements may be attributed to the excellent weight losses produced by in-person interventions. In contrast, Internet programs yield more modest weight losses, and their effect on depression is unknown. This study is the first to examine whether Internet-delivered obesity treatment impacts depressive symptoms. METHODS Participants (N = 136) were randomized to either a community campaign plus Internet behavioral weight loss (IBWL) or community campaign alone (Control). IBWL did not include online social support components. A measure of depressive symptoms was administered, and weight was objectively assessed. RESULTS Of the total sample, 24% met the clinical cutoff for elevated depression risk at baseline. IBWL participants lost more weight during treatment (P = 0.005) and experienced significantly greater improvements in depressive symptoms (P = 0.02). Among participants who met the clinical cutoff for elevated risk for depression at baseline, those assigned to IBWL had greater improvements in depressive symptoms during treatment compared to Control (P = 0.033). Consequently, at post-treatment, a smaller percentage of IBWL participants were at elevated risk for depression. CONCLUSIONS This study is the first to show that Internet-delivered obesity treatment improves depression risk and depressive symptoms in individuals with overweight or obesity.
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Affiliation(s)
- Jacob Naparstek
- University of Connecticut, Allied Health Sciences; Storrs CT, United States
| | - Rena R. Wing
- Warren Alpert Medical School of Brown University, Psychiatry and Human Behavior; Providence RI, United States
| | - Xiaomeng Xu
- Idaho State University, Psychology; Pocatello ID, United States
| | - Tricia M. Leahey
- University of Connecticut, Allied Health Sciences; Storrs CT, United States
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Adherence as a predictor of weight loss in a commonly used smartphone application. Obes Res Clin Pract 2017; 11:206-214. [DOI: 10.1016/j.orcp.2016.05.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 04/14/2016] [Accepted: 05/04/2016] [Indexed: 11/20/2022]
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50
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Peterhänsel C, Nagl M, Wagner B, Dietrich A, Kersting A. Predictors of Changes in Health-Related Quality of Life 6 and 12 months After a Bariatric Procedure. Obes Surg 2017; 27:2120-2128. [DOI: 10.1007/s11695-017-2617-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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