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Comparative efficacy and acceptability of non-pharmacological interventions for depression in people living with HIV: A systematic review and network meta-analysis. Int J Nurs Stud 2023; 140:104452. [PMID: 36821952 DOI: 10.1016/j.ijnurstu.2023.104452] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 01/11/2023] [Accepted: 01/26/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Treatment for depression in people living with HIV has increasingly turned to non-pharmacological treatments due to the adverse reactions of pharmacotherapy. However, it remains unclear which non-pharmacological treatment is the most effective and acceptable for depression in people living with HIV. OBJECTIVE To compare and rank the efficacy and acceptability of different non-pharmacological treatments for depression in people living with HIV. DESIGN A systematic review and Bayesian network meta-analysis. METHODS We systematically searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, PsycArticles, CINAHL, ProQuest, OpenGrey, and international trial registers for published and unpublished studies from their inception to September 1, 2022, and searched key conference proceedings from January 1, 2020, to September 25, 2022. We searched for randomized controlled trials of any non-pharmacological treatments for depression in adults living with HIV (≥18 years old). Primary outcomes were efficacy (mean change scores in depression) and acceptability (all-cause discontinuation). We used a random-effects network meta-analysis model to synthesize all available evidence. The methodological quality of the included studies was assessed using the Cochrane Collaboration Risk of Bias Tool. We registered this study in PROSPERO, number CRD42021244230. RESULTS A total of 53 randomized controlled trials were included in this network meta-analysis involving seven non-pharmacological treatments for depression in people living with HIV. For efficacy, mind-body therapy, interpersonal psychotherapy, cognitive-behavioral therapy, supportive therapy, and education were significantly more effective than most control conditions (standardized mean differences ranged from -0.96 to -0.36). Rankings probabilities indicated that mind-body therapy (79%), interpersonal psychotherapy (71%), cognitive-behavioral therapy (62%), supportive therapy (57%), and education (57%) might be the top five most significantly effective treatments for depression in people living with HIV, in that order. For acceptability, only supportive therapy and interpersonal psychotherapy were significantly less acceptable than most control conditions (odds ratios ranged from 1.92 to 3.43). Rankings probabilities indicated that education might be the most acceptable treatment for people living with HIV (66%), while supportive therapy (26%) and interpersonal psychotherapy (10%) might rank the worst. The GRADE assessment results suggested that most results were rated as "moderate" to "very low" for the confidence of evidence. CONCLUSIONS Our study confirmed the efficacy and acceptability of several non-pharmacological treatments for depression in people living with HIV. These results should inform future guidelines and clinical decisions for depression treatment in people living with HIV.
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Nestor MS, Lawson A, Fischer D. Improving the mental health and well-being of healthcare providers using the transcendental meditation technique during the COVID-19 pandemic: A parallel population study. PLoS One 2023; 18:e0265046. [PMID: 36867626 PMCID: PMC9983866 DOI: 10.1371/journal.pone.0265046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/14/2023] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION Frontline Healthcare provider (HCP) burnout has dramatically increased due to the COVID 19 pandemic. Hospitals are supporting wellness programs and techniques to reduce burnout including the Transcendental Meditation (TM) technique. This study evaluated the use of TM on HCP symptoms of stress, burnout and wellness. METHODS A total of 65 HCPs at three South Florida hospitals were recruited and instructed in the TM technique which they practiced at home for 20 minutes twice a day. A parallel lifestyle as usual control group was enrolled. Validated measurement scales (Brief Symptom Inventory 18 (BSI-18), Insomnia Severity Index (ISI), Maslach Burnout Inventory-Human Services Survey [MBI-HSS (MP)] and the Warwick Edinburgh Mental Well Being Scale (WEMWBS) were administered at baseline, 2 weeks, one and three months. RESULTS No significant demographic differences were seen between the 2 groups; however, some baseline scales were higher in the TM group. TM average weekly session completion rate was very high at 83%. After 2-weeks, symptoms of somatization, depression, and anxiety in the TM group had all shown near 45% reductions, while insomnia, emotional exhaustion, and well-being had improved by 33%, 16%, and 11% respectively (P = 0.02 for somatization and < .001 for all others); no significant change was noted in the LAU group. At 3-months, in the TM group, the improvement in symptoms showed a mean reduction of in anxiety, 62%, somatization, 58%, depression, 50%, insomnia, 44%, emotional exhaustion 40%, depersonalization, 42%, and improvement of well-being 18% (for all p<0.004). P-values for between-group differences in change from baseline, based upon repeated measures ANCOVA covarying for baseline measurements, showed significance for all scales at 3-months. CONCLUSION The study confirmed the reported significant and rapid benefits of the practice of TM and demonstrated its positive psychological impact on healthcare workers in a high stress setting.
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Affiliation(s)
- Mark S. Nestor
- Center for Clinical and Cosmetic Research, Aventura, Florida, United States of America
- Department of Dermatology and Cutaneous Surgery, Department of Surgery, Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- * E-mail:
| | - Alec Lawson
- Center for Clinical and Cosmetic Research, Aventura, Florida, United States of America
| | - Daniel Fischer
- Center for Clinical and Cosmetic Research, Aventura, Florida, United States of America
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Chu L, Liu S, Wu Y, Yang J, Qiao S, Zhou Y, Deng H, Li X, Shen Z. Hair levels of steroid, endocannabinoid, and the ratio biomarkers predict viral suppression among people living with HIV/AIDS in China. Clin Chim Acta 2022; 535:143-152. [PMID: 36041548 DOI: 10.1016/j.cca.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Predicting viral suppression early is crucial to improving treatment outcomes among people living with HIV/AIDS (PLWH) in clinics. Viral suppression is affected by stress, making stress indicators a potential predictive factor. Most of previous studies used the self-report questionnaire as stress indicators, but there were great drawbacks due to its subjective. In contrast, end products of neuroendocrine systems such as hypothalamic-pituitaryadrenal (HPA) and hypothalamic-pituitary-gonadal (HPG) axes and endogenous cannabinoid system (ECS) that involved in regulating stress as objective stress indicators are urgently needed to predict viral suppression. Therefore, this study aimed to investigate whether neuroendocrine indictors can strongly predict viral suppression among PLWH in China. METHODS This cross-sectional study recruited 1198 PLWH on antiretroviral therapy (ART) in Guangxi, China. The concentrations of steroids (i.e., cortisol, cortisone, dehydroepiandrosterone, testosterone and progesterone) and endocannabinoids (i.e., N-arachidonoyl-ethanolamine and 1-arachidonyl glycerol) in hair were quantitated using the LC-APCI+-MS/MS method. To screen biomarkers that were used to predict viral suppression, association between hair biomarkers and viral suppression was examined by Mann-Whitney U test and partial correlation analyses. Receiver operating characteristic (ROC) curves and binary logistic regression based on the optimal classification threshold determined with ROC curves were used to estimate the prediction effects of the screened biomarkers on viral suppression (HIV-1 RNA < 200 copies/mL). RESULTS Hair levels of dehydroepiandrosterone (DHEA), and N-arachidonoyl-ethanolamine (AEA), and the cortisol to DHEA ratio exhibited significant intergroup differences (ps < 0.05) and were correlated with HIV viral load (ps < 0.05). Hair DHEA concentrations strongly predicted viral suppression, showing good classification performance (area under the ROC curve = 0.651, p < 0.01) and strong predictive utility (adjusted odd ratio = 2.324, 95 % confidence interval = 1.211-4.899, p < 0.05) with an optimal threshold of 10.5 pg/mg. A hair AEA concentration of 2.4 pg/mg was the optimal threshold for predicting viral suppression based on good classification performance (area under the ROC curve = 0.598, p < 0.05) and predictive power (adjusted odd ratio = 2.124, 95 % confidence interval = 1.045-4.244, p < 0.05). In hair levels of cortisol to DHEA, viral suppression was observed to be highly predictive, with a threshold of 10.5 pg/mg being optimal for classification (area under the ROC curve = 0.624, p < 0.05) and prediction (adjusted odd ratio = 0.421, 95 % confidence interval = 0.201-0.785, p < 0.05). CONCLUSION Hair levels of DHEA, and AEA and the cortisol to DHEA ratio were screened and verified to have significant predictive power with optimal thresholds for predicting viral suppression in a large-scale cohort. The data may provide new insights into predictors of successful virological outcomes and inform public health intervention and clinical practice to assist PLWH in achieving and sustaining viral suppression.
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Affiliation(s)
- Liuxi Chu
- Department of Brain and Learning Science, School of Biological Science & Medical Engineering, Southeast University, Nanjing 210096, China; Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing 210096, China; Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing 210096, China
| | - Shuaifeng Liu
- Guangxi Center for Disease Control and Prevention, Nanning 530028, China
| | - Yan Wu
- Department of Brain and Learning Science, School of Biological Science & Medical Engineering, Southeast University, Nanjing 210096, China; Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing 210096, China; Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing 210096, China
| | - Jin Yang
- Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing 210096, China; School of Public Health, Southeast University, Nanjing 210009, China
| | - Shan Qiao
- Department of Health Promotion, Education and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Yuejiao Zhou
- Guangxi Center for Disease Control and Prevention, Nanning 530028, China
| | - Huihua Deng
- Department of Brain and Learning Science, School of Biological Science & Medical Engineering, Southeast University, Nanjing 210096, China; Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing 210096, China; Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing 210096, China.
| | - Xiaoming Li
- Department of Health Promotion, Education and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | - Zhiyong Shen
- Guangxi Center for Disease Control and Prevention, Nanning 530028, China.
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Álvarez-Pérez Y, Rivero-Santana A, Perestelo-Pérez L, Duarte-Díaz A, Ramos-García V, Toledo-Chávarri A, Torres-Castaño A, León-Salas B, Infante-Ventura D, González-Hernández N, Rodríguez-Rodríguez L, Serrano-Aguilar P. Effectiveness of Mantra-Based Meditation on Mental Health: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063380. [PMID: 35329068 PMCID: PMC8949812 DOI: 10.3390/ijerph19063380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/24/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022]
Abstract
Background: Meditation is defined as a form of cognitive training that aims to improve attentional and emotional self-regulation. This systematic review aims to evaluate the available scientific evidence on the effectiveness and safety of mantra-based meditation techniques (MBM), in comparison to passive or active controls, or other active treatment, for the management of mental health symptoms. Methods: MEDLINE, EMBASE, Cochrane Library, and PsycINFO databases were consulted up to April 2021. Randomised controlled trials regarding meditation techniques mainly based on the repetition of mantras, such as transcendental meditation or others, were included. Results: MBM, compared to control conditions, was found to produce significant small-to-moderate effect sizes in the reduction of anxiety (g = −0.46, IC95%: −0.60, −0.32; I2 = 33%), depression (g = −0.33, 95% CI: −0.48, −0.19; I2 = 12%), stress (g = −0.45, 95% CI: −0.65, −0.24; I2 = 46%), post-traumatic stress (g = −0.59, 95% CI: −0.79, −0.38; I2 = 0%), and mental health-related quality of life (g = 0.32, 95% CI: 0.15, 0.49; I2 = 0%). Conclusions: MBM appears to produce small-to-moderate significant reductions in mental health; however, this evidence is weakened by the risk of study bias and the paucity of studies with psychiatric samples and long-term follow-up.
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Affiliation(s)
- Yolanda Álvarez-Pérez
- Canary Islands Health Research Institute Foundation (FIISC), 38109 Tenerife, Spain; (A.R.-S.); (A.D.-D.); (V.R.-G.); (A.T.-C.); (A.T.-C.); (B.L.-S.); (D.I.-V.); (L.R.-R.)
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Tenerife, Spain; (L.P.-P.); (P.S.-A.)
- Spanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), 28071 Madrid, Spain
- Correspondence:
| | - Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation (FIISC), 38109 Tenerife, Spain; (A.R.-S.); (A.D.-D.); (V.R.-G.); (A.T.-C.); (A.T.-C.); (B.L.-S.); (D.I.-V.); (L.R.-R.)
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Tenerife, Spain; (L.P.-P.); (P.S.-A.)
- Spanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), 28071 Madrid, Spain
| | - Lilisbeth Perestelo-Pérez
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Tenerife, Spain; (L.P.-P.); (P.S.-A.)
- Spanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), 28071 Madrid, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), 38109 Tenerife, Spain;
| | - Andrea Duarte-Díaz
- Canary Islands Health Research Institute Foundation (FIISC), 38109 Tenerife, Spain; (A.R.-S.); (A.D.-D.); (V.R.-G.); (A.T.-C.); (A.T.-C.); (B.L.-S.); (D.I.-V.); (L.R.-R.)
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Tenerife, Spain; (L.P.-P.); (P.S.-A.)
- Spanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), 28071 Madrid, Spain
| | - Vanesa Ramos-García
- Canary Islands Health Research Institute Foundation (FIISC), 38109 Tenerife, Spain; (A.R.-S.); (A.D.-D.); (V.R.-G.); (A.T.-C.); (A.T.-C.); (B.L.-S.); (D.I.-V.); (L.R.-R.)
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Tenerife, Spain; (L.P.-P.); (P.S.-A.)
- Spanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), 28071 Madrid, Spain
| | - Ana Toledo-Chávarri
- Canary Islands Health Research Institute Foundation (FIISC), 38109 Tenerife, Spain; (A.R.-S.); (A.D.-D.); (V.R.-G.); (A.T.-C.); (A.T.-C.); (B.L.-S.); (D.I.-V.); (L.R.-R.)
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Tenerife, Spain; (L.P.-P.); (P.S.-A.)
- Spanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), 28071 Madrid, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), 38109 Tenerife, Spain;
| | - Alezandra Torres-Castaño
- Canary Islands Health Research Institute Foundation (FIISC), 38109 Tenerife, Spain; (A.R.-S.); (A.D.-D.); (V.R.-G.); (A.T.-C.); (A.T.-C.); (B.L.-S.); (D.I.-V.); (L.R.-R.)
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Tenerife, Spain; (L.P.-P.); (P.S.-A.)
- Spanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), 28071 Madrid, Spain
| | - Beatriz León-Salas
- Canary Islands Health Research Institute Foundation (FIISC), 38109 Tenerife, Spain; (A.R.-S.); (A.D.-D.); (V.R.-G.); (A.T.-C.); (A.T.-C.); (B.L.-S.); (D.I.-V.); (L.R.-R.)
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Tenerife, Spain; (L.P.-P.); (P.S.-A.)
- Spanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), 28071 Madrid, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), 38109 Tenerife, Spain;
| | - Diego Infante-Ventura
- Canary Islands Health Research Institute Foundation (FIISC), 38109 Tenerife, Spain; (A.R.-S.); (A.D.-D.); (V.R.-G.); (A.T.-C.); (A.T.-C.); (B.L.-S.); (D.I.-V.); (L.R.-R.)
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Tenerife, Spain; (L.P.-P.); (P.S.-A.)
- Spanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), 28071 Madrid, Spain
| | - Nerea González-Hernández
- Research Network on Health Services in Chronic Diseases (REDISSEC), 38109 Tenerife, Spain;
- Osakidetza Basque Health Service, Barrualde-Galdakao Integrated Health Organisation, 48960 Galdakao, Spain
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1 torre del Bilbao Exhibition Centre, 48902 Barakaldo, Spain
| | - Leticia Rodríguez-Rodríguez
- Canary Islands Health Research Institute Foundation (FIISC), 38109 Tenerife, Spain; (A.R.-S.); (A.D.-D.); (V.R.-G.); (A.T.-C.); (A.T.-C.); (B.L.-S.); (D.I.-V.); (L.R.-R.)
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Tenerife, Spain; (L.P.-P.); (P.S.-A.)
- Spanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), 28071 Madrid, Spain
| | - Pedro Serrano-Aguilar
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Tenerife, Spain; (L.P.-P.); (P.S.-A.)
- Spanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), 28071 Madrid, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), 38109 Tenerife, Spain;
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Mantra meditation as adjunctive therapy in major depression: A randomized controlled trial. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Movahed AH, Sabouhi F, Mohammadpourhodki R, Mahdavi S, Goudarzian S, Amerian M, Mohtashami M, Kheiri M, Imeni M. Investigating the effect of transcendental meditation on spiritual wellbeing of Type-2 diabetic amputees: A clinical trial study. Heliyon 2020; 6:e05567. [PMID: 33305031 PMCID: PMC7710631 DOI: 10.1016/j.heliyon.2020.e05567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/13/2020] [Accepted: 11/17/2020] [Indexed: 12/31/2022] Open
Abstract
Objectives Diabetes is a chronic, progressive and life-threatening metabolic syndrome that causes physical complications such as amputation, psychological complications and crisis in one's life, which leads to increased expression of spirituality and increased use of spiritual support as a coping mechanism. The aim of the present study was to investigate the effect of spiritual care on the spiritual wellbeing of type-2 diabetic amputees. Materials and methods In the present clinical trial study, 54 type-2 diabetic amputees were randomly divided into two groups; namely, experimental and control in 2014 and underwent meditation in three sessions. The 20-item spiritual well-being scale (SWBS) (Paloutzian and Ellision), which measures the spiritual well-being dimensions, was completed by patients before and after the intervention. Data analysis was performed using descriptive and inferential methods (paired T-test, independent t-test, Fisher's exact test, mann-whitney test, and chi-square) in SPSS ver. 16. Results The results showed no statistically significant difference between the experimental and control groups in terms of mean spiritual wellbeing before the intervention, but, the post-intervention mean spiritual wellbeing score in the control and experimental groups was 97.82 ± 9.25 and 88.40 ± 9.47, respectively. (α = 0.05) (P = 0.001). Conclusion According to the results of the present study, it seems that spiritual care is able to improve the spiritual wellbeing status of individuals.
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Affiliation(s)
- Ali Heydari Movahed
- Student Research Committee, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Fakhri Sabouhi
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Mohammadpourhodki
- Kashmar Center of Higher Health Education, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sepideh Mahdavi
- Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | | | - Malihe Amerian
- Department of Midwifery, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mona Mohtashami
- Department of Anesthesiology, School of Allied Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mansoure Kheiri
- Department of Nursing, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Malihe Imeni
- Department of Nursing, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
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Koncz A, Demetrovics Z, Takacs ZK. Meditation interventions efficiently reduce cortisol levels of at-risk samples: a meta-analysis. Health Psychol Rev 2020; 15:56-84. [PMID: 32635830 DOI: 10.1080/17437199.2020.1760727] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Previous meta-analytic results showed beneficial effects of meditation interventions for cortisol levels. In the present meta-analysis we tested whether effects are larger for those who might be in need of such stress reduction programs due to a risk for elevated cortisol levels as compared to no-risk samples. We included RCTs that measured change in cortisol levels. Based on 10 studies using blood samples meditation interventions had a significant, medium effect from pre-to post-test compared to the control group. Upon closer inspection, this effect was only present for at-risk samples, that is, patients with a somatic illness. In the 21 studies using saliva samples the effect was small and not significant, but there was a marginally significant effect for groups living in stressful life situations. This pattern may suggest that that meditation interventions are most beneficial for at-risk populations. These interventions might provide people with strategies of stress management that can contribute to well-being. Preliminary results suggest that benefits of meditation interventions might not fade with time.
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Affiliation(s)
- Adam Koncz
- Doctoral School of Psychology, ELTE Eötvös Loránd University, MTA-ELTE Lendület Adaptation Research Group, Budapest, Hungary
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Zsofia K Takacs
- Institute of Education, ELTE Eötvös Loránd University; MTA-ELTE Lendület Adaptation Research Group, Budapest, Hungary
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8
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Avvenuti G, Leo A, Cecchetti L, Franco MF, Travis F, Caramella D, Bernardi G, Ricciardi E, Pietrini P. Reductions in perceived stress following Transcendental Meditation practice are associated with increased brain regional connectivity at rest. Brain Cogn 2020; 139:105517. [PMID: 31945602 DOI: 10.1016/j.bandc.2020.105517] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/17/2019] [Accepted: 01/06/2020] [Indexed: 01/08/2023]
Abstract
Transcendental Meditation (TM) is defined as a mental process of transcending using a silent mantra. Previous work showed that relatively brief period of TM practice leads to decreases in stress and anxiety. However, whether these changes are subserved by specific morpho-functional brain modifications (as observed in other meditation techniques) is still unclear. Using a longitudinal design, we combined psychometric questionnaires, structural and resting-state functional magnetic resonance imaging (RS-fMRI) to investigate the potential brain modifications underlying the psychological effects of TM. The final sample included 19 naïve subjects instructed to complete two daily 20-min TM sessions, and 15 volunteers in the control group. Both groups were evaluated at recruitment (T0) and after 3 months (T1). At T1, only meditators showed a decrease in perceived anxiety and stress (t(18) = 2.53, p = 0.02), which correlated negatively with T1-T0 changes in functional connectivity among posterior cingulate cortex (PCC), precuneus and left superior parietal lobule. Additionally, TM practice was associated with increased connectivity between PCC and right insula, likely reflecting changes in interoceptive awareness. No structural changes were observed in meditators or control subjects. These preliminary findings indicate that beneficial effects of TM may be mediated by functional brain changes that take place after a short practice period of 3 months.
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Affiliation(s)
- Giulia Avvenuti
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Andrea Leo
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Luca Cecchetti
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Lucca, Italy
| | | | | | - Davide Caramella
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giulio Bernardi
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Emiliano Ricciardi
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Pietro Pietrini
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Lucca, Italy.
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Quigley A, Brouillette MJ, Gahagan J, O’Brien KK, MacKay-Lyons M. Feasibility and Impact of a Yoga Intervention on Cognition, Physical Function, Physical Activity, and Affective Outcomes among People Living with HIV: A Randomized Controlled Pilot Trial. J Int Assoc Provid AIDS Care 2020; 19:2325958220935698. [PMID: 32583707 PMCID: PMC7318828 DOI: 10.1177/2325958220935698] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 04/07/2020] [Accepted: 05/26/2020] [Indexed: 12/30/2022] Open
Abstract
The purpose of this pilot randomized controlled trial is to assess the feasibility and impact of a triweekly 12-week yoga intervention among people living with HIV (PLWH). Additional objectives included evaluating cognition, physical function, medication adherence, health-related quality of life (HRQoL), and mental health among yoga participants versus controls using blinded assessors. We recruited 22 medically stable PLWH aged ≥35 years. A priori feasibility criteria were ≥70% yoga session attendance and ≥70% of participants satisfied with the intervention using a postparticipation questionnaire. Two participants withdrew from the yoga group. Mean yoga class attendance was 82%, with 100% satisfaction. Intention-to-treat analyses (yoga n = 11, control n = 11) showed no within- or between-group differences in cognitive and physical function. The yoga group improved over time in HRQoL cognition (P = .047) with trends toward improvements in HRQoL health transition (P =.063) and depression (P = .055). This pilot study provides preliminary evidence of feasibility and benefits of yoga for PLWH.
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Affiliation(s)
- Adria Quigley
- Department of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Jacqueline Gahagan
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kelly Kathleen O’Brien
- Department of Physiotherapy, University of Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Marilyn MacKay-Lyons
- Department of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Canada
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10
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Klimes-Dougan B, Chong LS, Samikoglu A, Thai M, Amatya P, Cullen KR, Lim KO. Transcendental meditation and hypothalamic-pituitary-adrenal axis functioning: a pilot, randomized controlled trial with young adults. Stress 2020; 23:105-115. [PMID: 31418329 DOI: 10.1080/10253890.2019.1656714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Transcendental meditation (TM) is effective in alleviating stress and anxiety and promoting well-being. While the underlying biological mechanisms of TM are not yet fully explored, the hypothalamic-pituitary-adrenal (HPA) axis represents an index providing important clues embodying the stress system cascade. In this pilot study, young adults were randomly assigned to TM training followed by 8 weeks of meditation practice or a wait-list control condition. TM was conducted over 8 weeks. Thirty-four young adult participants were randomized; 27 participants completed the HPA outcome assessments (41% male). To assess HPA axis functioning, salivary samples to assess cortisol awakening response (CAR) that were collected in the morning, both at baseline and at week-4. Salivary cortisol in the context of a social stressor using the Trier Social Stress Test (TSST) was collected at week-8. The results indicate that participants who were randomly assigned to TM had lower awakening salivary cortisol levels and a greater drop in CAR from baseline to week-4 than the control group. There were no significant differences in HPA axis functioning in the context of the TSST. Primary limitations of this randomized controlled trial were the small sample size, the use of a wait-list as opposed to an active control, and the limited scope of HPA axis assessments. The results of this pilot study provide tentative evidence that TM may impact biological stress system functioning and suggests that this may be a worthwhile avenue to continue to examine. It will also be useful to extend these findings to a broader array of meditative and mindful practices, particularly for those who are experiencing more distress.
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Affiliation(s)
| | - Li Shen Chong
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Ali Samikoglu
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Michelle Thai
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Palistha Amatya
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Kathryn R Cullen
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Kelvin O Lim
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
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11
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Gathright EC, Salmoirago-Blotcher E, DeCosta J, Balletto BL, Donahue ML, Feulner MM, Cruess DG, Wing RR, Carey MP, Scott-Sheldon LAJ. The impact of transcendental meditation on depressive symptoms and blood pressure in adults with cardiovascular disease: A systematic review and meta-analysis. Complement Ther Med 2019; 46:172-179. [PMID: 31519275 PMCID: PMC7046170 DOI: 10.1016/j.ctim.2019.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Transcendental Meditation (TM) as a stress management technique may offer an adjunctive strategy to improve health and well-being in adults with cardiovascular disease (CVD). OBJECTIVES To examine the efficacy of TM to improve aspects of cardiovascular health and psychological functioning in adults with CVD. METHOD Studies (a) evaluating TM in adults with hypertension or CVD and (b) assessing a physiological or psychological outcome were retrieved and meta-analyzed. Weighted mean effect sizes were computed to assess between- and within-group changes. RESULTS Nine studies met inclusion criteria (N = 851; mean age = 60 ± 8 years; 47% women). Between-group analyses revealed no differences between TM and control groups. However, within-group (i.e., pre- to post-intervention) analyses revealed reductions in systolic (d+ = 0.31) and diastolic (d+ = 0.53) blood pressure (BP) for the TM group. There were no changes in depressive symptoms for TM or control participants. CONCLUSIONS TM was associated with within-group (but not between-groups) improvements in BP. Continued research using randomized controlled trials with larger samples, and measuring psychophysiological outcomes at longer follow-up intervals is recommended.
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Affiliation(s)
- Emily C Gathright
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.
| | - Elena Salmoirago-Blotcher
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Julie DeCosta
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Brittany L Balletto
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Marissa L Donahue
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Melissa M Feulner
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Dean G Cruess
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA; Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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12
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Post-traumatic Stress Disorder: A Review of Therapeutic Role of Meditation Interventions. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1113:53-59. [PMID: 29502192 DOI: 10.1007/5584_2018_167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
Abstract
This review is an attempt to provide a comprehensive view of post-traumatic-stress disorder (PTSD) and its therapy, focusing on the use of meditation interventions. PTSD is a multimodal psycho-physiological-behavioral disorder, which calls for the potential usefulness of spiritual therapy. Recent times witness a substantial scientific interest in an alternative mind-to-body psychobehavioral therapy; the exemplary of which is meditation. Meditation is a form of mental exercise that has an extensive, albeit still mostly empiric, therapeutic value. Meditation steadily gains an increasing popularity as a psychobehavioral adjunct to therapy in many areas of medicine and psychology. While the review does not provide a final or conclusive answer on the use of meditation in PTSD treatment we believe the available empirical evidence demonstrates that meditation is associated with overall reduction in PTSD symptoms, and it improves mental and somatic quality of life of PTSD patients. Therefore, studies give a clear cue for a trial of meditation-associated techniques as an adjunct to pharmacotherapy or standalone treatment in otherwise resistant cases of the disease.
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13
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Bruce D, Bouris AM, Bowers S, Blocker O, Lee SY, Glidden MF, Schneider JA, Reirden DH. Medical, therapeutic, and recreational use of cannabis among young men who have sex with men living with HIV. ADDICTION RESEARCH & THEORY 2019; 28:250-259. [PMID: 32952491 PMCID: PMC7500448 DOI: 10.1080/16066359.2019.1629427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 06/11/2023]
Abstract
Cannabis plays a role in symptoms management in HIV, especially the alleviation of pain and nausea and stimulation of appetite, and prevalence of cannabis use in HIV-positive populations exceeds that of the general U.S. population. Previous research has described an "overlap" between medical and recreational cannabis use among persons living with HIV. To understand better the motives associated cannabis use among young men who have sex with men living with HIV (HIV+ YMSM), we conducted semi-structured interviews with 30 HIV+YMSM in Denver and Chicago. Interviews were audio-recorded, transcribed, and coded by a diverse team of analysts. In addition to findings that mapped onto previously identified medical motives and recreational motives, we identified several themes that straddled medical and recreational use in a domain we describe as therapeutic. Themes identified in this therapeutic domain of cannabis use include (a) enhanced introspection among individuals that promotes psychological adjustment to an HIV diagnosis, improved medical management, and future orientation; (b) reflection processes that mitigate interpersonal conflict and improve interpersonal communication; and (c) a social-therapeutic phenomena of cannabis use among young persons with living HIV that is characterized by both enhanced introspection and improved interpersonal communication. Our findings suggest a spectrum of cannabis use among HIV+ YMSM that may be characterized not only by an overlap between medical and recreational use, but also by a distinct therapeutic domain that incorporates stress alleviation and cognitive expansion processes to improve focus on HIV management and self-care.
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Affiliation(s)
- Douglas Bruce
- Department of Health Sciences, DePaul University, Chicago, IL
| | - Alida M. Bouris
- School of Social Service Administration, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL
| | - Shannon Bowers
- Department of Health Sciences, DePaul University, Chicago, IL
| | - Olivia Blocker
- School of Social Service Administration, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL
| | - Soo Young Lee
- School of Social Service Administration, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL
| | - Mary F. Glidden
- Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - John A. Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL
- Department of Medicine, University of Chicago, Chicago, IL
- Department of Public Health Sciences, University of Chicago, Chicago, IL
| | - Daniel H. Reirden
- Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
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14
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Ramirez-Garcia MP, Gagnon MP, Colson S, Côté J, Flores-Aranda J, Dupont M. Mind-body practices for people living with HIV: a systematic scoping review. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 19:125. [PMID: 31185970 PMCID: PMC6560810 DOI: 10.1186/s12906-019-2502-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/15/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Mind-body practices are frequently used by people living with HIV to reduce symptoms and improve wellbeing. These include Tai Chi, Qigong, yoga, meditation, and all types of relaxation. Although there is substantial research on the efficacy of mind-body practices in people living with HIV, there is no summary of the available evidence on these practices. The aim of this scoping review is to map available evidence of mind-body practices in people living with HIV. METHODS The Arksey and O'Malley (Int J Soc Res Methodol 8:19-32, 2005) methodological framework was used. A search of 16 peer-review and grey literature databases, websites, and relevant journals (1983-2015) was conducted. To identify relevant studies, two reviewers independently applied the inclusion criteria to all abstracts or full articles. Inclusion criteria were: participants were people living with HIV; the intervention was any mind-body practice; and the study design was any research study evaluating one or several of these practices. Data extraction and risk of bias assessment were performed by one reviewer and checked by a second, as needed, using the criteria that Cochrane Collaboration recommends for systematic reviews of interventions (Higgins and Green, Cochrane handbook for systematic reviews of intervention. 2011). A tabular and narrative synthesis was carried out for each mind-body practice. RESULTS One hundred thirty-six documents drawing on 84 studies met the inclusion criteria. The most widely studied mind-body practice was a combination of least three relaxation techniques (n = 20), followed in declining order by meditation (n = 17), progressive muscle relaxation (n = 10), yoga (n = 9) and hypnosis (n = 8). Slightly over half (47/84) of studies used a RCT design. The interventions were mainly (46/84) conducted in groups and most (51/84) included daily individual home practice. All but two studies were unblinded to participants. CONCLUSION The amount of available research on mind-body practices varies by practice. Almost half of the studies in this review were at high risk of bias. However, mindfulness, a combination of least three relaxation techniques and cognitive behavioral strategies, and yoga show encouraging results in decreasing physical and psychological symptoms and improving quality of life and health in people living with HIV. More rigorous studies are necessary to confirm the results of Tai Chi, Qigong, and some relaxation techniques.
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Affiliation(s)
- Maria Pilar Ramirez-Garcia
- Faculty of Nursing, Université de Montréal, Montréal, Canada
- Research Center of the Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - Marie-Pier Gagnon
- Faculty of Nursing, Université Laval, Québec, Canada
- Research Center of the Centre Hospitalier Universitaire, Québec, Canada
| | - Sébastien Colson
- Faculty of Medicine, Aix Marseille Université, Marseille, France
| | - José Côté
- Faculty of Nursing, Université de Montréal, Montréal, Canada
- Research Center of the Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - Jorge Flores-Aranda
- University Institute on Addiction, Montreal-Island-South-Center Integrated University Health and Social Services Centre, Montréal, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Canada
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15
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Rubtsova AA, Marquine MJ, Depp C, Holstad M, Ellis RJ, Letendre S, Jeste DV, Moore DJ. Psychosocial Correlates of Frailty Among HIV-Infected and HIV-Uninfected Adults. Behav Med 2019; 45:210-220. [PMID: 30431403 PMCID: PMC6612538 DOI: 10.1080/08964289.2018.1509053] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Frailty is a geriatric condition characterized by increased vulnerability to physical impairments and limitations that may lead to disabilities and mortality. Although studies in the general population suggest that psychosocial factors affect frailty, less is known about whether similar associations exist among people living with HIV (PLWH). The purpose of this study was to examine psychosocial correlates of frailty among PLWH and HIV-uninfected adults. Our sample included 127 adults (51% PLWH) participating in the Multi-Dimensional Successful Aging among HIV-Infected Adults study at the University of California San Diego (average age 51 years, 80% male, 53% White). Frailty was assessed via the Fried Frailty Index. Psychosocial variables significant in bivariate models were included in principal component analysis to generate factor variables summarizing psychosocial correlates. Multivariate logistic regression models were fit to examine the independent effects of factor variables and their interaction terms with HIV status. In bivariate models, frailty was associated with multiple psychosocial variables, for example, grit, optimism, personal mastery, social support, emotional support. Factor analysis revealed that psychosocial variables loaded on two factors-Positive Resources/Outlook and Support by Others. The multivariate model showed significant main effects of Support by Others and HIV status, and interactive effects HIV X Positive Resources/Outlook, such that Positive Resources/Outlook was negatively associated with frailty for PLWH but not for HIV-uninfected individuals. These analyses indicate that psychosocial factors may be associated with frailty among PLWH. Positive resources and outlook may play a role in frailty prevention. Future longitudinal studies are needed to establish causal links.
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Affiliation(s)
- Anna A. Rubtsova
- Department of Behavioral Sciences and Health Education,
Emory University Rollins School of Public Health, Atlanta, GA
| | - María J. Marquine
- Department of Psychiatry, University of California, San
Diego, CA,Sam and Rose Stein Institute for Research on Aging,
University of California, San Diego, CA,HIV Neurobehavioral Research Program, University of
California, San Diego
| | - Colin Depp
- Department of Psychiatry, University of California, San
Diego, CA,Sam and Rose Stein Institute for Research on Aging,
University of California, San Diego, CA
| | - Marcia Holstad
- Emory University Nell Hodgson Woodruff School of Nursing,
Atlanta, GA
| | - Ronald J. Ellis
- Department of Neuroscience, University of California, San
Diego, CA,HIV Neurobehavioral Research Program, University of
California, San Diego
| | - Scott Letendre
- Department of Medicine, University of California, San
Diego, CA,HIV Neurobehavioral Research Program, University of
California, San Diego
| | - Dilip V. Jeste
- Department of Psychiatry, University of California, San
Diego, CA,Department of Neuroscience, University of California, San
Diego, CA,Sam and Rose Stein Institute for Research on Aging,
University of California, San Diego, CA
| | - David J. Moore
- Department of Psychiatry, University of California, San
Diego, CA,HIV Neurobehavioral Research Program, University of
California, San Diego
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16
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Mindfulness-based intervention among People living with HIV/AIDS: A Systematic Review. Complement Ther Clin Pract 2018; 33:12-19. [PMID: 30396609 DOI: 10.1016/j.ctcp.2018.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/10/2018] [Indexed: 12/11/2022]
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17
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van Luenen S, Garnefski N, Spinhoven P, Spaan P, Dusseldorp E, Kraaij V. The Benefits of Psychosocial Interventions for Mental Health in People Living with HIV: A Systematic Review and Meta-analysis. AIDS Behav 2018; 22:9-42. [PMID: 28361453 PMCID: PMC5758656 DOI: 10.1007/s10461-017-1757-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In this systematic review and meta-analysis we investigated the effectiveness of different psychosocial treatments for people living with HIV (PLWH) and mental health problems. Additionally, characteristics that may influence the effectiveness of a treatment (e.g., treatment duration) were studied. PubMed, PsycINFO and Embase were searched for randomized controlled trials on psychosocial interventions for PLWH. Depression, anxiety, quality of life, and psychological well-being were investigated as treatment outcome measures. Sixty-two studies were included in the meta-analysis. It was found that psychosocial interventions for PLWH had a small positive effect on mental health (ĝ = 0.19, 95% CI [0.13, 0.25]). Furthermore, there was evidence for publication bias. Six characteristics influenced the effectiveness of a treatment for depression. For example, larger effects were found for studies with psychologists as treatment providers. To conclude, this systematic review and meta-analysis suggests that psychosocial interventions have a beneficial effect for PLWH with mental health problems.
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Affiliation(s)
- Sanne van Luenen
- Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, P.O. Box 9555, 2300 RB, Leiden, The Netherlands.
| | - Nadia Garnefski
- Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, P.O. Box 9555, 2300 RB, Leiden, The Netherlands
| | - Philip Spinhoven
- Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, P.O. Box 9555, 2300 RB, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Pascalle Spaan
- Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, P.O. Box 9555, 2300 RB, Leiden, The Netherlands
| | - Elise Dusseldorp
- Section of Methodology and Statistics, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Vivian Kraaij
- Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, P.O. Box 9555, 2300 RB, Leiden, The Netherlands
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18
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Pascoe MC, Thompson DR, Jenkins ZM, Ski CF. Mindfulness mediates the physiological markers of stress: Systematic review and meta-analysis. J Psychiatr Res 2017; 95:156-178. [PMID: 28863392 DOI: 10.1016/j.jpsychires.2017.08.004] [Citation(s) in RCA: 197] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 08/07/2017] [Accepted: 08/07/2017] [Indexed: 02/08/2023]
Abstract
Meditation is a popular form of stress management, argued to mediate stress reactivity. However, many studies in this field commonly fail to include an active control group. Given the frequency with which people are selecting meditation as a form of self-management, it is important to validate if the practice is effective in mediating stress-reactivity using well-controlled studies. Thus, we aimed to conduct a meta-analysis investigating the neurobiological effects of meditation, including focused attention, open monitoring and automatic self-transcending subtypes, compared to an active control, on markers of stress. In the current meta-analysis and systematic review, we included randomised controlled trials comparing meditation interventions compared to an active control on physiological markers of stress. Studied outcomes include cortisol, blood pressure, heart-rate, lipids and peripheral cytokine expression. Forty-five studies were included. All meditation subtypes reduced systolic blood pressure. Focused attention meditations also reduced cortisol and open monitoring meditations also reduced heart rate. When all meditation forms were analysed together, meditation reduced cortisol, C - reactive protein, blood pressure, heart rate, triglycerides and tumour necrosis factor-alpha. Overall, meditation practice leads to decreased physiological markers of stress in a range of populations.
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Affiliation(s)
- Michaela C Pascoe
- Department of Cancer Experiences, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia.
| | - David R Thompson
- Department of Psychiatry, University of Melbourne, Melbourne, VIC 3010, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3000, Australia.
| | - Zoe M Jenkins
- Mental Health Service, St. Vincent's Hospital, Melbourne, VIC 3065, Australia.
| | - Chantal F Ski
- Mental Health Service, St. Vincent's Hospital, Melbourne, VIC 3065, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC 3010, Australia.
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19
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Chong LS, Thai M, Cullen KR, Lim KO, Klimes-Dougan B. Cortisol Awakening Response, Internalizing Symptoms, and Life Satisfaction in Emerging Adults. Int J Mol Sci 2017; 18:E2501. [PMID: 29186884 PMCID: PMC5751104 DOI: 10.3390/ijms18122501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/16/2017] [Accepted: 11/17/2017] [Indexed: 12/31/2022] Open
Abstract
The cortisol awakening response (CAR) has been associated with depression and a broader range of internalizing problems. Emerging adulthood is characterized by numerous stressful transitional life events. Furthermore, the functioning of the neurobiological stress system changes across development. These considerations underscore the importance of evaluating the physiological stress system in emerging adults in identifying the extent to which cortisol levels vary with risk and protective factors for mental health. The present study evaluated the association between internalizing symptoms and perceived life satisfaction with CAR in 32 young adults. Three saliva samples were collected to measure cortisol levels upon awakening and participants completed the Depression Anxiety Stress Scale (DASS) and Satisfaction with Life Scale (SWLS). Results show a significant positive correlation between area under the curve for CAR with internalizing symptoms (DASS total) and the DASS-depression subscale, but not with life satisfaction. Study limitations, implications, and future directions for these finding were discussed.
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Affiliation(s)
- Li Shen Chong
- Department of Psychology, College of Liberal Arts, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Michelle Thai
- Department of Psychology, College of Liberal Arts, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Kathryn R Cullen
- Department of Psychiatry, School of Medicine, University of Minnesota, Minneapolis, MN 55454, USA.
| | - Kelvin O Lim
- Department of Psychiatry, School of Medicine, University of Minnesota, Minneapolis, MN 55454, USA.
| | - Bonnie Klimes-Dougan
- Department of Psychology, College of Liberal Arts, University of Minnesota, Minneapolis, MN 55455, USA.
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20
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Liu Z, Chen QL, Sun YY. Mindfulness training for psychological stress in family caregivers of persons with dementia: a systematic review and meta-analysis of randomized controlled trials. Clin Interv Aging 2017; 12:1521-1529. [PMID: 29026290 PMCID: PMC5626236 DOI: 10.2147/cia.s146213] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Caring for a relative with dementia is extremely challenging; conventional interventions may not be highly effective or easily available on some occasions. This study aimed to explore the efficacy of mindfulness training in improving stress-related outcomes in family caregivers of people with dementia using a meta-analytic review. We searched randomized controlled trials (RCT) through April 2017 from five electronic databases, and assessed the risk of bias using the Cochrane Collaboration tool. Seven RCTs were included in our review. Mindfulness interventions showed significant effects of improvement in depression (standardized mean difference: -0.58, [95% CI: -0.79 to -0.37]), perceived stress (-0.33, [-0.57 to -0.10]), and mental health-related quality of life (0.38 [0.14 to 0.63]) at 8 weeks post-treatment. Pooled evidence did not show a significant advantage of mindfulness training compared with control conditions in the alleviation of caregiver burden or anxiety. Future large-scale and rigorously designed trials are needed to confirm our findings. Clinicians may consider the mindfulness program as a promising alternative to conventional interventions.
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Affiliation(s)
- Zheng Liu
- Department of Psychiatry, The Chinese University of Hong Kong, Tai Po Hospital, Hong Kong SAR, China
| | - Qian-lin Chen
- Department of Psychiatry, The Chinese University of Hong Kong, Tai Po Hospital, Hong Kong SAR, China
| | - Yu-ying Sun
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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21
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Bhatta DN, Liabsuetrakul T, McNeil EB. Social and behavioral interventions for improving quality of life of HIV infected people receiving antiretroviral therapy: a systematic review and meta-analysis. Health Qual Life Outcomes 2017; 15:80. [PMID: 28438211 PMCID: PMC5404320 DOI: 10.1186/s12955-017-0662-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 04/21/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Improvement in quality of life is crucial for HIV infected people. Social and behavioral interventions have been implemented in different contexts to improve the quality of life among HIV infected people. This review appraises the evidence for available interventions that focused on quality of life of HIV infected people receiving antiretroviral therapy (ART). METHODS We searched electronic databases for randomized controlled trials of interventions to improve the quality of life of HIV infected people receiving ART. We searched PUBMED and the Cochrane Centre Register of Controlled Trials (CENTRAL) with the terms "social", "behavioral", "educational", "quality of life", "HIV", and "RCT". Searches were conducted for articles published from 1980 to December 16, 2015. Standardized data abstraction methods and searching steps were applied. RESULTS Twenty-eight studies reported the impact of social or behavioral interventions in quality of life among HIV infected people, of which 15 were conducted in United States of America. A total of 4136 participants were enrolled. Of the 28 studies, four studies included females, two studies included males and remaining studies excluded both males and females. The overall reported methodological quality of the studies was subject to a high risk of bias and the study criteria were unclear in most studies. Twenty-one studies reported a significant intervention effect on at least one quality of life domain. Meta-analyses showed significant improvement in general health, mental health, physical function and environment domains of quality of life among intervention groups. However, the expected impact of the intervention was low to moderate because the rigorousness of the studies was low, information was limited, the sample sizes were small and other the quality of the study designs were poor. CONCLUSIONS Although the available evidence suggests that existing social and behavioral interventions can improve some quality of life domains, the quality of evidence was insufficient to support the notion that these interventions can improve the overall quality of life of HIV infected people receiving ART. Well-designed and rigorous randomized controlled trials with high methodological quality are required.
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Affiliation(s)
- Dharma Nand Bhatta
- Department of Community Medicine and Public Health, Tribhuvan University, Peoples’ Dental College, Kathmandu, Nepal
- Faculty of Medicine, Epidemiology Unit, Prince of Songkla University, Hat Yai, Thailand
- Department of Public Health, Pokhara University, Nobel College, Kathmandu, Nepal
| | | | - Edward B. McNeil
- Faculty of Medicine, Epidemiology Unit, Prince of Songkla University, Hat Yai, Thailand
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22
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van der Heijden I, Abrahams N, Sinclair D. Psychosocial group interventions to improve psychological well-being in adults living with HIV. Cochrane Database Syst Rev 2017; 3:CD010806. [PMID: 28291302 PMCID: PMC5461871 DOI: 10.1002/14651858.cd010806.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Being diagnosed with human immunodeficiency virus (HIV), and labelled with a chronic, life-threatening, and often stigmatizing disease, can impact on a person's well-being. Psychosocial group interventions aim to improve life-functioning and coping as individuals adjust to the diagnosis. OBJECTIVES To examine the effectiveness of psychosocial group interventions for improving the psychological well-being of adults living with HIV/AIDS. SEARCH METHODS We searched the following electronic databases up to 14 March 2016: the Cochrane Central Register of Controlled Trials (CENTRAL) published in the Cochrane Library (Issue 2, 2016), PubMed (MEDLINE) (1996 to 14 March 2016), Embase (1996 to 14 March 2016), and Clinical Trials.gov. SELECTION CRITERIA Randomized controlled trials (RCTs) or quasi-RCTs that compared psychosocial group interventions with versus control (standard care or brief educational interventions), with at least three months follow-up post-intervention. We included trials that reported measures of depression, anxiety, stress, or coping using standardized scales. DATA COLLECTION AND ANALYSIS Two review authors independently screened abstracts, applied the inclusion criteria, and extracted data. We compared continuous outcomes using mean differences (MD) with 95% confidence intervals (95% CIs), and pooled data using a random-effects model. When the included trials used different measurement scales, we pooled data using standardized mean difference (SMD) values. We reported trials that we could not include in the meta analysis narratively in the text. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 16 trials (19 articles) that enrolled 2520 adults living with HIV. All the interventions were multifaceted and included a mix of psychotherapy, relaxation, group support, and education. The included trials were conducted in the USA (12 trials), Canada (one trial), Switzerland (one trial), Uganda (one trial), and South Africa (one trial), and published between 1996 and 2016. Ten trials recruited men and women, four trials recruited homosexual men, and two trials recruited women only. Interventions were conducted with groups of four to 15 people, for 90 to 135 minutes, every week for up to 12 weeks. All interventions were conducted face-to-face except two, which were delivered by telephone. All were delivered by graduate or postgraduate trained health, psychology, or social care professionals except one that used a lay community health worker and two that used trained mindfulness practitioners.Group-based psychosocial interventions based on cognitive behavioural therapy (CBT) may have a small effect on measures of depression, and this effect may last for up to 15 months after participation in the group sessions (SMD -0.26, 95% CI -0.42 to -0.10; 1139 participants, 10 trials, low certainty evidence). Most trials used the Beck Depression Inventory (BDI), which has a maximum score of 63, and the mean score in the intervention groups was around 1.4 points lower at the end of follow-up. This small benefit was consistent across five trials where participants had a mean depression score in the normal range at baseline, but trials where the mean score was in the depression range at baseline effects were less consistent. Fewer trials reported measures of anxiety, where there may be little or no effect (four trials, 471 participants, low certainty evidence), stress, where there may be little or no effect (five trials, 507 participants, low certainty evidence), and coping (five trials, 697 participants, low certainty evidence).Group-based interventions based on mindfulness have not demonstrated effects on measures of depression (SMD -0.23, 95% CI -0.49 to 0.03; 233 participants, 2 trials, very low certainty evidence), anxiety (SMD -0.16, 95% CI -0.47 to 0.15; 62 participants, 2 trials, very low certainty evidence), or stress (MD -2.02, 95% CI -4.23 to 0.19; 137 participants, 2 trials, very low certainty evidence). No mindfulness based interventions included in the studies had any valid measurements of coping. AUTHORS' CONCLUSIONS Group-based psychosocial interventions may have a small effect on measures of depression, but the clinical importance of this is unclear. More high quality evidence is needed to assess whether group psychosocial intervention improve psychological well-being in HIV positive adults.
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Affiliation(s)
- Ingrid van der Heijden
- Medical Research CouncilGender and Health UnitFrancie van Zijl DriveTygerbergWestern CapeSouth Africa7505
| | - Naeemah Abrahams
- Medical Research CouncilGender and Health UnitFrancie van Zijl DriveTygerbergWestern CapeSouth Africa7505
| | - David Sinclair
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolUKL3 5QA
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23
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Liu S, Qiu G, Louie W. Use of Mindfulness Sitting Meditation in Chinese American Women in Treatment of Cancer. Integr Cancer Ther 2016; 16:110-117. [PMID: 27252075 PMCID: PMC5736067 DOI: 10.1177/1534735416649661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background. Very few studies have been conducted to examine the prevalence, frequency, perceived effectiveness, and possible influencing factors of use of meditation in patients with cancer. Objectives. To examine use of mindfulness sitting medication (MSM) in Chinese American women in treatment of cancer, its relationship to specific symptom distress, and possible influencing factors of MSM. Methods. Volunteer participants were recruited through the American Cancer Society support groups. The participants completed a demographic data form, a researcher-developed criteria and checklist for MSM, and the Memorial Symptom Assessment Scale–Short Form. Results. Eighty-nine Chinese American women with a mean age of 58 years completed the questionnaires. Twenty-one patients (24%) reported the use of MSM during active treatment of cancer. Patients who had higher education, better income, better English proficiency, and health insurance were more likely to use MSM. Patients who had more symptom distress also reported to use more MSM. Most patients (20/21) who used meditation considered it effective. After controlling other variables, better English proficiency, breast cancer, and higher symptom distress predicted the use of MSM in Chinese American women in treatment of cancer. Conclusions. About 24% of Chinese American women used MSM in the treatment of cancer and most of them considered it effective. Symptom distress and English proficiency levels predicted the use of MSM. Implications for Practice. Given the effectiveness of MSM, oncology nurses could recommend using MSM in Chinese American women in treatment of cancer, especially for patients who had higher symptom distress.
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Affiliation(s)
- Shan Liu
- 1 Adelphi University College of Nursing and Public Health, Garden City, NY, USA
| | - Guang Qiu
- 2 The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Wendy Louie
- 3 New York Presbyterian Queen Hospital, Flushing, NY, USA
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24
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Walter KN, Petry NM. Lifetime suicide attempt history, quality of life, and objective functioning among HIV/AIDS patients with alcohol and illicit substance use disorders. Int J STD AIDS 2016; 27:476-85. [PMID: 25953963 PMCID: PMC5023430 DOI: 10.1177/0956462415585668] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 04/10/2015] [Indexed: 12/13/2022]
Abstract
This cross-sectional study evaluated lifetime prevalence of suicide attempts in 170 HIV/AIDS patients with substance use disorders and the impact of suicide attempt history on subjective indices of quality of life and objective indices of cognitive and physical functioning. All patients met the diagnostic criteria for past-year cocaine or opioid use disorders and 27% of patients also had co-occurring alcohol use disorders. Compared to their counterparts without a history of a suicide attempt, patients with a history of a suicide attempt (n = 60, 35.3%) had significantly poorer emotional and cognitive quality of life scores (ps < .05), but not physical, social, or functional/global quality-of-life scores. Lifetime suicide attempt status was unrelated to objective indices of cognitive functioning, but there was a non-significant trend (p = .07) toward lower viral loads in those with a lifetime suicide attempt relative to those without. The findings indicate that suicide attempt histories are prevalent among HIV/AIDS patients with substance use disorders and relate to poorer perceived emotional and cognitive quality of life, but not objective functioning. HIV/AIDS patients with substance use disorders should be screened for lifetime histories of suicide attempts and offered assistance to improve perceived emotional and cognitive functioning.
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Affiliation(s)
| | - Nancy M Petry
- University of Connecticut School of Medicine, Farmington, CT, USA
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25
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26
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Lifestyle Medicine and HIV-Infected Patients. LIFESTYLE MEDICINE 2016. [DOI: 10.1007/978-3-319-24687-1_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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27
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Leach MJ, Francis A, Ziaian T. Transcendental Meditation for the improvement of health and wellbeing in community-dwelling dementia caregivers [TRANSCENDENT]: a randomised wait-list controlled trial. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 15:145. [PMID: 25952550 PMCID: PMC4429365 DOI: 10.1186/s12906-015-0666-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 04/30/2015] [Indexed: 11/26/2022]
Abstract
Background Dementia is a prevalent neurodegenerative disorder affecting an estimated 24.3 million people across the globe. The burden on those caring for people with dementia is substantial, with widespread implications for the caregiver, the care recipient and the community. Relaxation techniques, such as Transcendental Meditation® (TM), have been shown to reduce stress and anxiety in healthy workers; similar benefits are anticipated in dementia caregivers. The objective of this study was to ascertain whether TM can improve psychological stress, quality of life, affect and cognitive performance in dementia caregivers. Methods The study was conducted as a pilot prospective, multi-centre, community-based, randomised wait-list controlled trial. Community-dwelling caregivers of persons with diagnosed dementia were randomly assigned to a 12-week (14-hour) TM training program or wait-list control. Participants were assessed for quality of life, stress, affect, cognitive performance and adverse effects. The feasibility of the study was also evaluated. Results Seventeen caregivers were recruited and randomised. Improvements in WebNeuro response speed scores over time were significantly (p = 0.03) greater in the TM group relative to control. Changes between groups over time in all other primary and secondary outcome measures did not reach statistical significance. However, there was a trend toward greater improvement in WebNeuro stress, depression and negativity bias scores in the TM group. Adverse events were reported amongst 63 % of TM-treated subjects; however, events were generally transient, of mild-moderate intensity and only ‘possibly’ related to TM. Conclusions Dementia caregivers exposed to TM demonstrated varying degrees of improvement in several measures of cognitive function, mood, quality of life and stress following exposure to TM. However, as the pilot study was underpowered, no firm conclusions can be made about the effectiveness of TM in this caregiver population. Findings from full-scale trials are now warranted. Trial registration Australian New Zealand Clinical Trial Registry ACTRN12613000184774 (Registered 15th February 2013).
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28
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Abstract
The rapidly growing body of research regarding the use of meditation interventions in chronic disease presents an opportunity to compare outcomes based on intervention content. For this review, meditation interventions were described as those interventions delivered to persons with chronic disease where sitting meditation was the main or only content of the intervention with or without the addition of mindful movement. This systematic review identified 45 individual research studies that examined meditations effect on levels of anxiety, depression, and chronic disease symptoms in persons with chronic disease. Individual studies were assessed based on interventional content, the consistency with which interventions were applied, and the research quality. This study identified seven categories of meditation interventions based on the meditation skills and mindful movement practices that were included in the intervention. Overall, half of the interventions had clearly defined and specific meditation interventions (25/45) and half of the studies were conducted using randomized control trials (24/45).
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29
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Agarwal RP, Kumar A, Lewis JE. A pilot feasibility and acceptability study of yoga/meditation on the quality of life and markers of stress in persons living with HIV who also use crack cocaine. J Altern Complement Med 2015; 21:152-8. [PMID: 25695849 DOI: 10.1089/acm.2014.0112] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Persons living with HIV (PLWH) who also use crack cocaine may have stressful, chaotic lives and typically do not engage in standard medical care that addresses a multitude of extenuating life circumstances. Yoga/meditation (YM) improves quality of life (QOL) and biomarkers of stress, but the effect of this intervention is almost unknown in PLWH, particularly those who use crack cocaine. OBJECTIVES This pilot study sought to compare the feasibility and acceptability of 60-minute, twice-per-week sessions of YM for 2 months with those of no-contact control and to evaluate the effects of the intervention on QOL (according to the Short Form-36, Perceived Stress Scale [PSS], and Impact of Events Scale [IES]) and salivary cortisol and dehydroepiandrosterone sulfate (DHEA-S) among PLWH who use crack cocaine. DESIGN Participants were randomly assigned to YM or no-contact control and were assessed at baseline, 2 months after the intervention, and 4 months' follow-up. RESULTS The YM program was acceptable and feasible, with high overall attendance (89%) and individual participation in yoga sessions (83%). YM participants showed modest improvements on QOL. The PSS total score and the IES intrusion score improved significantly 2 months after the intervention, but cortisol and DHEA-S did not change. CONCLUSIONS This pilot study showed a high level of feasibility and acceptability and modest effects on measures of QOL among PLWH who use crack cocaine. The results suggest utility of YM as a simple, safe, and inexpensive format to improve QOL in a population that has many medical difficulties and extenuating stressors.
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Affiliation(s)
- Ram P Agarwal
- 1 Department of Medicine, University of Miami Miller School of Medicine , Miami, FL
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30
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Goyal M, Singh S, Sibinga EMS, Gould NF, Rowland-Seymour A, Sharma R, Berger Z, Sleicher D, Maron DD, Shihab HM, Ranasinghe PD, Linn S, Saha S, Bass EB, Haythornthwaite JA. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med 2014; 174:357-68. [PMID: 24395196 PMCID: PMC4142584 DOI: 10.1001/jamainternmed.2013.13018] [Citation(s) in RCA: 1042] [Impact Index Per Article: 104.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Many people meditate to reduce psychological stress and stress-related health problems. To counsel people appropriately, clinicians need to know what the evidence says about the health benefits of meditation. OBJECTIVE To determine the efficacy of meditation programs in improving stress-related outcomes (anxiety, depression, stress/distress, positive mood, mental health-related quality of life, attention, substance use, eating habits, sleep, pain, and weight) in diverse adult clinical populations. EVIDENCE REVIEW We identified randomized clinical trials with active controls for placebo effects through November 2012 from MEDLINE, PsycINFO, EMBASE, PsycArticles, Scopus, CINAHL, AMED, the Cochrane Library, and hand searches. Two independent reviewers screened citations and extracted data. We graded the strength of evidence using 4 domains (risk of bias, precision, directness, and consistency) and determined the magnitude and direction of effect by calculating the relative difference between groups in change from baseline. When possible, we conducted meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals. FINDINGS After reviewing 18 753 citations, we included 47 trials with 3515 participants. Mindfulness meditation programs had moderate evidence of improved anxiety (effect size, 0.38 [95% CI, 0.12-0.64] at 8 weeks and 0.22 [0.02-0.43] at 3-6 months), depression (0.30 [0.00-0.59] at 8 weeks and 0.23 [0.05-0.42] at 3-6 months), and pain (0.33 [0.03- 0.62]) and low evidence of improved stress/distress and mental health-related quality of life. We found low evidence of no effect or insufficient evidence of any effect of meditation programs on positive mood, attention, substance use, eating habits, sleep, and weight. We found no evidence that meditation programs were better than any active treatment (ie, drugs, exercise, and other behavioral therapies). CONCLUSIONS AND RELEVANCE Clinicians should be aware that meditation programs can result in small to moderate reductions of multiple negative dimensions of psychological stress. Thus, clinicians should be prepared to talk with their patients about the role that a meditation program could have in addressing psychological stress. Stronger study designs are needed to determine the effects of meditation programs in improving the positive dimensions of mental health and stress-related behavior.
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Affiliation(s)
- Madhav Goyal
- Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Sonal Singh
- Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Erica M S Sibinga
- Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - Neda F Gould
- Department of Psychiatry and Behavioral Services, The Johns Hopkins University, Baltimore, Maryland
| | | | - Ritu Sharma
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Zackary Berger
- Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Dana Sleicher
- Department of Psychiatry and Behavioral Services, The Johns Hopkins University, Baltimore, Maryland
| | - David D Maron
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Hasan M Shihab
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
| | | | - Shauna Linn
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Shonali Saha
- Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - Eric B Bass
- Department of Medicine, The Johns Hopkins University, Baltimore, Maryland4Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
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