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Edwards AM, Petitt JC, Sajatovic M, Kumar S, Levin JB. The Efficacy of Telemental Health Interventions for Mood Disorders Pre-COVID-19: A Narrative Review. J Behav Health Serv Res 2024; 51:395-420. [PMID: 38698193 PMCID: PMC11180629 DOI: 10.1007/s11414-024-09884-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 05/05/2024]
Abstract
The onset of the COVID-19 pandemic saw a significant surge in the utilization of telemental health (TMH) services. This narrative review aimed to investigate the efficacy of TMH for serious mood disorders prior to the COVID-19 pandemic. A search across databases was conducted for randomized controlled trials focusing on TMH interventions for mood disorders, encompassing major depressive disorder (MDD) and bipolar disorder (BD). Study and patient characteristics, interventions, and outcomes were extracted. From a pool of 2611 papers initially identified, 17 met the inclusion criteria: 14 focused on MDD, while 4 addressed BD. Among these, 6 papers directly compared TMH interventions to in-person of same treatment, revealing improved access to care and higher rates of appointment follow-up with TMH. Additionally, 6 papers comparing TMH to treatment as usual demonstrated improvements in mood outcomes. Conversely, 3 papers comparing different TMH interventions found no discernible differences in outcomes. Notably, 3 studies evaluated TMH as an adjunct to usual care, all reporting enhancements in depression outcomes. Overall, preliminary evidence suggests that prior to COVID-19, TMH interventions for serious mood disorders facilitated improved access to care and follow-up, with comparable clinical outcomes to traditional in-person interventions. The discussion addresses limitations and provides recommendations for future research in this domain.
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Affiliation(s)
- Alyssa M Edwards
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jordan C Petitt
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
- Department of Psychiatry, University Hospitals Cleveland Medical Center, W.O. Walker Bldg, 7th Floor, 10524 Euclid Ave, Cleveland, OH, 44106, USA.
| | - Sanjana Kumar
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jennifer B Levin
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Psychiatry, University Hospitals Cleveland Medical Center, W.O. Walker Bldg, 7th Floor, 10524 Euclid Ave, Cleveland, OH, 44106, USA
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Warner A, Lobban F, Holland C, Tyler E, Settle G, Rhodes V, Palmier-Claus J. What does it mean to age well with bipolar disorder? A qualitative study using photo elicitation. Psychol Psychother 2024; 97:104-121. [PMID: 37747114 DOI: 10.1111/papt.12501] [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: 03/13/2023] [Revised: 08/24/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES The objective of this study is to explore what ageing well means to older adults with bipolar disorder. METHODS Older adults with bipolar disorder took photographs of aspects of their lives that they felt represented ageing well. They then completed audio-recorded photo elicitation interviews to explore what it meant to age well with bipolar disorder in detail. Data were analysed using reflexive thematic analysis. RESULTS Seventeen participants met the criteria for bipolar disorder I or II. The analysis resulted in four key themes to ageing well with bipolar disorder: (1) Lifelong learning - referring to how participants accumulated a wealth of knowledge about bipolar disorder and used this to maintain stability in later life; (2) Finding where you belong - relating to how participants prioritised finding new communities, utilised family support and refined their support networks over time to age well; (3) Recognising your value and worth - which involved participants using their strengths and experiences to support others; and (4) Continuity of support - older adults with bipolar disorder highlighted the benefits of continuous support that allowed them to be actively involved in their treatment. CONCLUSIONS Participants ageing with bipolar disorder identified unique challenges indicating that services require adaptation to meet their needs and support them to age well. Findings suggested that services should provide continuous care that allows this group to actively engage with their treatment, build upon their strengths, and develop meaningful connections with professionals and peers. This approach may enhance support for older adults with bipolar disorder and reduce the inequalities they experience.
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Affiliation(s)
- Aaron Warner
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
- Division of Health Research, Centre for Ageing Research, Lancaster University, Lancaster, UK
- NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, UK
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
- Lancashire & South Cumbria Care NHS Foundation Trust, Preston, UK
| | - Carol Holland
- Division of Health Research, Centre for Ageing Research, Lancaster University, Lancaster, UK
| | - Elizabeth Tyler
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - Geoff Settle
- NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, UK
| | - Verity Rhodes
- NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, UK
| | - Jasper Palmier-Claus
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
- Lancashire & South Cumbria Care NHS Foundation Trust, Preston, UK
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3
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Kraiss JT, Ten Klooster PM, Chrispijn M, Stevens A, Doornbos B, Kupka RW, Bohlmeijer ET. A multicomponent positive psychology intervention for euthymic patients with bipolar disorder to improve mental well-being and personal recovery: A pragmatic randomized controlled trial. Bipolar Disord 2023; 25:683-695. [PMID: 36856065 DOI: 10.1111/bdi.13313] [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] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Mental well-being and personal recovery are important treatment targets for patients with bipolar disorder (BD). The goal of this study was to evaluate the effectiveness of an 8-week group multicomponent positive psychology intervention (PPI) for euthymic patients with BD as an adjunct to treatment as usual (TAU) compared to TAU alone. METHODS Patients with BD were randomized to receive TAU (n = 43) or the PPI in addition to TAU (n = 54). The primary outcome was well being measured with the Mental Health Continuum-Short Form. Personal recovery was measured with the Questionnaire about the Process of Recovery. Data were collected at baseline, mid-treatment, post-treatment and 6- and 12-month follow-up. Life chart interviews were conducted at 12 months to retrospectively assess recurrence of depression and mania. RESULTS Significant group-by-time interaction effects for well-being and personal recovery were found favouring the PPI. At post-treatment, between-group differences were significant for well-being (d = 0.77) and personal recovery (d = 0.76). Between-group effects for well-being were still significant at 6-month follow-up (d = 0.72). Effects on well-being and personal recovery within the intervention group were sustained until 12-month follow-up. Survival analyses showed no significant differences in time to recurrence. CONCLUSIONS The multicomponent PPI evaluated in this study is effective in improving mental well-being and personal recovery in euthymic patients with BD and would therefore be a valuable addition to the current treatment of euthymic BD patients. The fact that the study was carried out in a pragmatic RCT demonstrates that this intervention can be applied in a real-world clinical setting.
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Affiliation(s)
- Jannis T Kraiss
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Peter M Ten Klooster
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | | | - Anja Stevens
- Centre for Bipolar Disorders, Dimence Mental Health, Deventer, The Netherlands
| | - Bennard Doornbos
- Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Outpatient Clinics, Assen, The Netherlands
- Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands
| | - Ralph W Kupka
- VU University Medical Center, Department of Psychiatry, Amsterdam Public Health research center, Amsterdam, The Netherlands
| | - Ernst T Bohlmeijer
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
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Dhaliwal R, Yap S, Talarico F, Al-Shamali H, Mcweeny R, Reeson M, Shalaby R, Chen T, Spronk E, Snodgrass R, Tu E, Erick T, Marshall T, Kennedy M, Greenshaw AJ, Winkler O, Burback L. Synchronous Web-Based Psychotherapy for Mental Disorders From a Health Quality Perspective: Scoping Review. J Med Internet Res 2023; 25:e40710. [PMID: 37921863 PMCID: PMC10656669 DOI: 10.2196/40710] [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: 07/01/2022] [Revised: 09/12/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic necessitated rapid changes to health care delivery, including a shift from in-person to digitally delivered psychotherapy. While these changes helped ensure timely psychotherapy provision, many concerns exist, including clinical, cultural, practical, privacy, and security issues. OBJECTIVE This scoping review systematically mapped existing peer-reviewed research on synchronous, therapist-delivered web-based psychotherapy for individuals with a diagnosed mental illness. Data were analyzed through the lens of the Alberta Quality Matrix for Health (AQMH) to assess to what degree this literature addresses key indicators of health care quality. This analysis aided in the identification and organization of knowledge gaps with regard to web-based psychotherapies, highlighting potential disparities between previously prioritized dimensions of care and those requiring further attention. METHODS This review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We included peer-reviewed primary research studies in the English language investigating synchronous, therapist-delivered remote psychotherapy delivered to adults (aged 18 years and older) with a Diagnostic and Statistical Manual of Mental Disorders or International Statistical Classification of Diseases diagnosed mental illness. All other citations were excluded. Relevant studies were identified through MEDLINE, APA PsycINFO, Embase (OVID), Web of Science: Core Collection (Clarivate), Cochrane Library (Wiley), and Scopus (Elsevier) databases. Databases were searched on March 18, 2021. For every publication that was taken into consideration, the data were charted independently by 2 reviewers, and in the event of a discrepancy, the principal investigator validated the choice of either extractor. Results were thematically described according to the 6 AQMH dimensions: acceptability, accessibility, appropriateness, effectiveness, efficiency, and safety. RESULTS From 13,209 publications, 48 articles were included, largely from North American studies. Most studies measured treatment effectiveness (n=48, 100%) and acceptability (n=29, 60%) health quality dimensions. Over 80% (40/48) of studies investigated either a cognitive or exposure intervention for either posttraumatic stress disorder or a mood or anxiety disorder, generally indicating comparable results to in-person therapy. Safety (n=5, 10%) was measured in fewer studies, while treatment accessibility, appropriateness, and efficiency were not explicitly measured in any study, although these dimensions were mentioned as a future direction, hypothesis, or potential outcome. CONCLUSIONS In relation to web-based therapist-delivered psychotherapies for those with a diagnosed mental illness, important aspects of health care quality (accessibility, appropriateness, efficiency, and safety) have received little scientific examination, underscoring a need to address these gaps. There are also significant issues related to the generalizability of this literature, including the underrepresentation of many geographic regions, cultures, populations, clinical contexts, and psychotherapy modalities. Qualitative research in underrepresented populations and settings may uncover important patient and contextual factors important for the future implementation of quality web-based psychotherapy.
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Affiliation(s)
- Raman Dhaliwal
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sidney Yap
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Fernanda Talarico
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Huda Al-Shamali
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Robert Mcweeny
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Matthew Reeson
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Reham Shalaby
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Teresa Chen
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Elena Spronk
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Rayven Snodgrass
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Eileen Tu
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Taylor Erick
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Tyler Marshall
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Megan Kennedy
- Geoffrey and Robyn Sperber Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Andrew J Greenshaw
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Olga Winkler
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Lisa Burback
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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Su T, Guo X, Liu M, Xiao R, Xiao Z. Better forbearance, lower depression: Evidence based on heart rate variability. Front Psychol 2023; 13:1019402. [PMID: 36704679 PMCID: PMC9872647 DOI: 10.3389/fpsyg.2022.1019402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023] Open
Abstract
Background The relationship between forbearance, a psychological resource, and depression has to date remained inconclusive. The present study investigated heart rate variability (HRV) reactivity to acute stressor tasks in participants with different levels of forbearance to discover how forbearance influences depressive emotions when facing adversity. Method The study examined the relationship between forbearance and depression, comparing HRV reactivity to stressor tasks in participants with different levels of forbearance. The levels of reported forbearance were assessed by the Forbearance Scale (FS). The Patient Health Questionnaire-9 (PHQ-9) was used to assessed depression severity. HRV reactivity was evaluated at five stages: baseline, the active stressor task, the period of recovery after the active stressor task, the passive stressor task, the period of recovery after the passive stressor task. Results FS scores had a significant negative correlation with PHQ-9 and a significant positive correlation with HRV; significant differences existed between the basal HRV in the higher and lower FS groups. In the passive stressor task and the period of recovery after the active stressor task, significantly different HRV responses were identified between the two groups. Discussion Forbearance was correlated with depression and HRV. The present research found differences in HRV among subjects with different levels of forbearance in the baseline as well as stressor and recovery periods, suggesting that self-regulation dysfunction may exist among persons with lower levels of forbearance. Because of the higher levels of forbearance, the negative emotions of individuals caused by adversity are mitigated.
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Affiliation(s)
- Tiehong Su
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China,Department of Physiology, School of Basic Medical Sciences, Key Laboratory of Psychiatric Disorders of Guangdong Province, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Xinwen Guo
- General Practice Center, The Seventh Affiliated Hospital, Southern Medical University, Foshan, China
| | - Manhua Liu
- General Practice Center, The Seventh Affiliated Hospital, Southern Medical University, Foshan, China
| | - Rong Xiao
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China,Rong Xiao, ✉
| | - Zhongju Xiao
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China,Department of Physiology, School of Basic Medical Sciences, Key Laboratory of Psychiatric Disorders of Guangdong Province, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China,General Practice Center, The Seventh Affiliated Hospital, Southern Medical University, Foshan, China,*Correspondence: Zhongju Xiao, ✉
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6
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Geerling B, Kelders SM, Stevens AWMM, Kupka RW, Bohlmeijer ET. A Web-Based Positive Psychology App for Patients With Bipolar Disorder: Development Study. JMIR Form Res 2022; 6:e39476. [PMID: 35946327 PMCID: PMC9531003 DOI: 10.2196/39476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Patients with bipolar disorder (BD) report lower quality of life and lower levels of well-being than the general population. Despite the growing availability of psychotherapeutic and self-management interventions, important unmet needs remain. These unmet needs are closely linked to positive psychology domains. Although a growing number of studies have evaluated the impact of positive psychology interventions (PPIs) on patients with severe mental illness in general, only few have addressed the application of positive psychology for BD. OBJECTIVE This study aimed to gain insight into the opinions of patients with BD and health care professionals about (web-based) PPIs for BD and to develop and pilot-test an app containing PPIs specifically designed for patients with BD. METHODS The study was conducted in accordance with the Center for eHealth and Disease Management road map principles and incorporated cocreation and designing for implementation. Data were collected using focus group discussions, questionnaires, rapid prototyping, and web-based feedback on a prototype from the participants. In total, 3 focus groups were conducted with 62% (8/13) of patients with BD and 38% (5/13) of professionals. The collected data were used to develop a smartphone app containing short PPIs. The content was based on PPIs for which a solid base of evidence is available. Finally, a pilot test was conducted to test the app. RESULTS Focus groups revealed that PPIs as part of the current BD treatment can potentially meet the following needs: offering hope, increasing self-esteem, expressing feelings, acceptance, and preventing social isolation. Some patients expressed concern that PPIs may provoke a manic or hypomanic episode by increasing positive affect. The pilot of the app showed that the PPIs are moderately to highly valued by the participants. There were no adverse effects such as increase in manic or hypomanic symptoms. CONCLUSIONS With the systematic use of user involvement (patients and professionals) in all steps of the development process, we were able to create an app that can potentially fulfill some of the current unmet needs in the treatment of BD. We reached consensus among consumers and professionals about the potential benefits of PPIs to address the unmet needs of patients with BD. The use of PPI for BD is intriguing and can be usefully explored in further studies. We emphasize that more evaluation studies (quantitative and qualitative) that are focused on the effect of PPIs in the treatment of BD should be conducted. In addition, to establish the working mechanisms in BD, explorative, qualitative, designed studies are required to reveal whether PPIs can address unmet needs in BD.
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Affiliation(s)
- Bart Geerling
- Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research, University of Twente, Enschede, Netherlands
- Centre for Bipolar Disorder, Dimence Mental Health Institute, Deventer, Netherlands
| | - Saskia M Kelders
- Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research, University of Twente, Enschede, Netherlands
- Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
| | - Anja W M M Stevens
- Centre for Bipolar Disorder, Dimence Mental Health Institute, Deventer, Netherlands
| | - Ralph W Kupka
- Department of Psychiatry, Mental Health Program, Amsterdam Public Health, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ernst T Bohlmeijer
- Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research, University of Twente, Enschede, Netherlands
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Anmella G, Faurholt‐Jepsen M, Hidalgo‐Mazzei D, Radua J, Passos IC, Kapczinski F, Minuzzi L, Alda M, Meier S, Hajek T, Ballester P, Birmaher B, Hafeman D, Goldstein T, Brietzke E, Duffy A, Haarman B, López‐Jaramillo C, Yatham LN, Lam RW, Isometsa E, Mansur R, McIntyre RS, Mwangi B, Vieta E, Kessing LV. Smartphone-based interventions in bipolar disorder: Systematic review and meta-analyses of efficacy. A position paper from the International Society for Bipolar Disorders (ISBD) Big Data Task Force. Bipolar Disord 2022; 24:580-614. [PMID: 35839276 PMCID: PMC9804696 DOI: 10.1111/bdi.13243] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The clinical effects of smartphone-based interventions for bipolar disorder (BD) have yet to be established. OBJECTIVES To examine the efficacy of smartphone-based interventions in BD and how the included studies reported user-engagement indicators. METHODS We conducted a systematic search on January 24, 2022, in PubMed, Scopus, Embase, APA PsycINFO, and Web of Science. We used random-effects meta-analysis to calculate the standardized difference (Hedges' g) in pre-post change scores between smartphone intervention and control conditions. The study was pre-registered with PROSPERO (CRD42021226668). RESULTS The literature search identified 6034 studies. Thirteen articles fulfilled the selection criteria. We included seven RCTs and performed meta-analyses comparing the pre-post change in depressive and (hypo)manic symptom severity, functioning, quality of life, and perceived stress between smartphone interventions and control conditions. There was significant heterogeneity among studies and no meta-analysis reached statistical significance. Results were also inconclusive regarding affective relapses and psychiatric readmissions. All studies reported positive user-engagement indicators. CONCLUSION We did not find evidence to support that smartphone interventions may reduce the severity of depressive or manic symptoms in BD. The high heterogeneity of studies supports the need for expert consensus to establish ideally how studies should be designed and the use of more sensitive outcomes, such as affective relapses and psychiatric hospitalizations, as well as the quantification of mood instability. The ISBD Big Data Task Force provides preliminary recommendations to reduce the heterogeneity and achieve more valid evidence in the field.
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Affiliation(s)
- Gerard Anmella
- Digital Innovation Group, Bipolar and Depressive Disorders Unit, Institute of NeuroscienceHospital Clinic, University of Barcelona, IDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Maria Faurholt‐Jepsen
- Copenhagen Affective Disorder research Center (CADIC)Psychiatric Center CopenhagenCopenhagenDenmark
| | - Diego Hidalgo‐Mazzei
- Digital Innovation Group, Bipolar and Depressive Disorders Unit, Institute of NeuroscienceHospital Clinic, University of Barcelona, IDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Joaquim Radua
- Imaging of Mood‐ and Anxiety‐Related Disorders (IMARD) groupIDIBAPS, CIBERSAMBarcelonaSpain,Early Psychosis: Interventions and Clinical‐detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Centre for Psychiatric Research and Education, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Ives C. Passos
- Laboratory of Molecular Psychiatry and Bipolar Disorder Program, Programa de Pós‐Graduação em Psiquiatria e Ciências do Comportamento, Centro de Pesquisa Experimental do Hospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | - Luciano Minuzzi
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | - Martin Alda
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada
| | - Sandra Meier
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada
| | - Tomas Hajek
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada,National Institute of Mental HealthKlecanyCzech Republic
| | - Pedro Ballester
- Neuroscience Graduate ProgramMcMaster UniversityHamiltonCanada
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and ClinicUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Danella Hafeman
- Department of Psychiatry, Western Psychiatric Institute and ClinicUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Tina Goldstein
- Department of Psychiatry, Western Psychiatric Institute and ClinicUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Elisa Brietzke
- Department of PsychiatryQueen's UniversityKingstonONCanada
| | - Anne Duffy
- Department of PsychiatryQueen's UniversityKingstonONCanada
| | - Benno Haarman
- Department of PsychiatryUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Carlos López‐Jaramillo
- Research Group in Psychiatry, Department of Psychiatry, Faculty of MedicineUniversity of AntioquiaMedellínColombia,Mood Disorders ProgramHospital Universitario San Vicente FundaciónMedellínColombia
| | - Lakshmi N. Yatham
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Raymond W. Lam
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Erkki Isometsa
- Department of PsychiatryUniversity of Helsinki and Helsinki University Central HospitalHelsinkiFinland
| | - Rodrigo Mansur
- Mood Disorders Psychopharmacology Unit (MDPU)University Health Network, University of TorontoTorontoONCanada
| | | | - Benson Mwangi
- Department of Psychiatry and Behavioral Sciences, UT Center of Excellence on Mood Disorders, McGovern Medical SchoolThe University of Texas Health Science Center at HoustonHoustonTXUSA
| | - Eduard Vieta
- Digital Innovation Group, Bipolar and Depressive Disorders Unit, Institute of NeuroscienceHospital Clinic, University of Barcelona, IDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder research Center (CADIC)Psychiatric Center CopenhagenCopenhagenDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
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Ho KY, Lam KKW, Bressington DT, Lin J, Mak YW, Wu C, Li WHC. Use of a positive psychology intervention (PPI) to promote the psychological well-being of children living in poverty: study protocol for a feasibility randomised controlled trial. BMJ Open 2022; 12:e055506. [PMID: 35977772 PMCID: PMC9389124 DOI: 10.1136/bmjopen-2021-055506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Poverty has a detrimental influence on psychological well-being of children. Existing evidence shows that positive psychology interventions are possible to mitigate such impact. Despite criticisms that positive psychology resembles a scientific Pollyannaism that promotes overly positivity, positive psychology is not the scientific Pollyannaism that denies the difficulties and emotions that people may experience. Whereas, positive psychology acknowledges the difficulties and emotions, alongside with building up human resilience, strength and growth to face adversity. This study examined the feasibility of implementing a positive psychology intervention among Hong Kong Chinese children living in poverty. METHODS A feasibility randomised controlled trial will be conducted. A convenience sample of 120 children aged 13-17 years will be recruited from a community centre in Kwai Tsing district. Participants who are randomised into the experimental group will join a 1.5-hour workshop covering four positive psychology techniques: (1) gratitude visits/letters, (2) three good things, (3) you at your best and (4) using signature strengths. A booster intervention will be provided at 1 week. Control group participants will not receive any intervention. Assessments will be conducted at baseline and at 1-week, 1-month, 3-month and 6-month follow-ups. ANALYSIS Descriptive statistics will be used to calculate the feasibility measures. Effect sizes on psychological outcomes (ie, self-esteem, depressive symptoms and quality of life) will be estimated by mixed between-within subjects analysis of variance using partial eta squared with poverty (yes, no) entering into the model as a factor. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Hong Kong Polytechnic University Institutional Review Broad. We will obtain parental consent as our subjects are below 18 years old. Findings from this study will be disseminated via international publications and conferences. TRIAL REGISTRATION NUMBER NCT04875507.
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Affiliation(s)
- Ka Yan Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | | | | | - Jessie Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Yim Wah Mak
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Cynthia Wu
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - William H C Li
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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9
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Hancock J, Perich T. Personal recovery in psychological interventions for bipolar disorder: a systematic review. AUSTRALIAN PSYCHOLOGIST 2022. [DOI: 10.1080/00050067.2022.2083484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Jasmine Hancock
- School of Psychology, Western Sydney University, Sydney, Australia
| | - Tania Perich
- School of Psychology, Western Sydney University, Sydney, Australia
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10
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Amonoo HL, El-Jawahri A, Deary EC, Traeger LN, Cutler CS, Antin JA, Huffman JC, Lee SJ. Yin and Yang of Psychological Health in the Cancer Experience: Does Positive Psychology Have a Role? J Clin Oncol 2022; 40:2402-2407. [PMID: 35377731 PMCID: PMC9467675 DOI: 10.1200/jco.21.02507] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Hermioni L Amonoo
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA.,Department of Psychiatry, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Areej El-Jawahri
- Harvard Medical School, Boston, MA.,Mass General Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Emma C Deary
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA
| | - Lara N Traeger
- Harvard Medical School, Boston, MA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Corey S Cutler
- Harvard Medical School, Boston, MA.,Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA
| | - Joseph A Antin
- Harvard Medical School, Boston, MA.,Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA
| | - Jeff C Huffman
- Harvard Medical School, Boston, MA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Stephanie J Lee
- Division of Medical Oncology, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
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11
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Kulbaş E, Özabacı N. The Effects of the Positive Psychology-Based Online Group Counselling Program on Mothers Having Children with Intellectual Disabilities. JOURNAL OF HAPPINESS STUDIES 2021; 23:1817-1845. [PMID: 34785986 PMCID: PMC8586837 DOI: 10.1007/s10902-021-00472-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/31/2021] [Indexed: 06/13/2023]
Abstract
The purpose of the current study is to examine the effects of the Positive Psychology-Based Online Group Counselling Program (PPBOGCP) on the psychological well-being, self-compassion and hope levels of the mothers having children with intellectual disabilities. The current study is a mixed-design research having quantitative and qualitative dimensions. The quantitative dimension of the study was designed in a quasi-experimental design based on the experimental, placebo and control group pre-test, post-test and follow-up test model. The study group is comprised of a total of 35 participants. While in the experimental group, the 10-session PPBOGCP developed by the researcher was implemented, a 10-session group counselling was conducted in the placebo group. No study was conducted with the individuals in the control group. As the data collection tools, the Psychological Well-Being Scale, Self-Compassion Scale and Dispositional Hope Scale were used in the current study. The quantitative analyses were conducted in SPSS 17 program package while the qualitative data were analyzed with the content analysis technique. According to the findings of the current study, the PPBOGCP created significant differences in the psychological well-being, self-compassion and hope levels of the mothers having children with intellectual disabilities according to the intervention time effect (p < 0.05). It was observed that the data obtained in the individual interviews were collected around the categories of "Learning how to cope with, recognizing the sources of support, perceiving positively-acceptance, empathy and development".
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Affiliation(s)
- Erdi Kulbaş
- Teacher at the Ministry of National Education, İstanbul, Turkey
| | - Nilüfer Özabacı
- Department of Psychological Counselling and Guidance, Yeditepe University, İstanbul, Turkey
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12
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Shang X, Gu F, Bian Q, Wang M, Lin Z. Effects of a Written Expression-Based Positive Psychological Intervention on the Psychological Status of Patients With Inflammatory Bowel Disease: A Randomized Controlled Trial. Gastroenterol Nurs 2021; 44:437-448. [PMID: 34560705 DOI: 10.1097/sga.0000000000000594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 01/13/2021] [Indexed: 10/20/2022] Open
Abstract
This prospective parallel-group controlled trial explored the effects of a written expression-based positive psychological intervention on the psychological status of patients with inflammatory bowel disease. Primary outcomes were anxiety, depression, hope, optimism, and subjective well-being, assessed at 8 weeks. Secondary outcomes were coping mode, quality of life at 8 weeks, and patient feedback. Sixty-eight volunteer patients meeting inclusion criteria were recruited from a hospital in China and randomized into the intervention group (positive psychological intervention+care as usual = 33) and the control group (care as usual = 35). The intervention group showed significantly greater improvements in anxiety, depression, hope, and quality of life (p > .05). The intervention group scored the feasibility, simplicity, and applicability of the positive psychological intervention themes at more than 6.5 for all measures. The study concludes that written expression-based positive psychological interventions alleviate negative emotions in inflammatory bowel disease patients and enhance their positive psychological characteristics. This approach also promotes a positive coping mode in inflammatory bowel disease patients, and the intervention measures devised are convenient, feasible, and well-accepted by patients.
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Affiliation(s)
- Xingchen Shang
- Xingchen Shang, MSN, is Nursing Faculty, School of Nursing, Yangzhou University, Yangzhou, Jiangsu, China
- Fangchen Gu, BSN, is Under Postgraduate Student, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
- Qiugui Bian, MSN, is Head Nurse, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Meifeng Wang, BSN, is Specialist Nurse, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Zheng Lin, MSN, is Professor and Deputy Director of Nursing Department, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China; the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Fangchen Gu
- Xingchen Shang, MSN, is Nursing Faculty, School of Nursing, Yangzhou University, Yangzhou, Jiangsu, China
- Fangchen Gu, BSN, is Under Postgraduate Student, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
- Qiugui Bian, MSN, is Head Nurse, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Meifeng Wang, BSN, is Specialist Nurse, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Zheng Lin, MSN, is Professor and Deputy Director of Nursing Department, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China; the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qiugui Bian
- Xingchen Shang, MSN, is Nursing Faculty, School of Nursing, Yangzhou University, Yangzhou, Jiangsu, China
- Fangchen Gu, BSN, is Under Postgraduate Student, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
- Qiugui Bian, MSN, is Head Nurse, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Meifeng Wang, BSN, is Specialist Nurse, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Zheng Lin, MSN, is Professor and Deputy Director of Nursing Department, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China; the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Meifeng Wang
- Xingchen Shang, MSN, is Nursing Faculty, School of Nursing, Yangzhou University, Yangzhou, Jiangsu, China
- Fangchen Gu, BSN, is Under Postgraduate Student, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
- Qiugui Bian, MSN, is Head Nurse, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Meifeng Wang, BSN, is Specialist Nurse, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Zheng Lin, MSN, is Professor and Deputy Director of Nursing Department, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China; the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zheng Lin
- Xingchen Shang, MSN, is Nursing Faculty, School of Nursing, Yangzhou University, Yangzhou, Jiangsu, China
- Fangchen Gu, BSN, is Under Postgraduate Student, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
- Qiugui Bian, MSN, is Head Nurse, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Meifeng Wang, BSN, is Specialist Nurse, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Zheng Lin, MSN, is Professor and Deputy Director of Nursing Department, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China; the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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13
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Kraiss JT, ten Klooster PM, Frye E, Kupka RW, Bohlmeijer ET. Exploring factors associated with personal recovery in bipolar disorder. Psychol Psychother 2021; 94:667-685. [PMID: 33742536 PMCID: PMC8451787 DOI: 10.1111/papt.12339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/05/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Personal recovery is increasingly recognized as important outcome for people with bipolar disorder (BD), but research addressing associated factors of personal recovery in this group remains scarce. This study aimed to explore the association of sociodemographic variables, social participation, psychopathology, and positive emotion regulation with personal recovery in BD. METHODS Baseline data from a randomized controlled trial and survey data were combined (N = 209) and split into a training (n = 149) and test sample (n = 60). Block-wise regression analyses and model training were used to determine the most relevant predictors. The final parsimonious model was cross-validated in the test sample. RESULTS In the final parsimonious model, satisfaction with social roles (β = .442, p < .001), anxiety symptoms (β = -.328, p < .001), manic symptoms (β = .276, p < .001), and emotion-focused positive rumination (β = .258, p < .001) were independently associated with personal recovery. The model explained 57.3% variance in personal recovery (adjusted R2 = .561) and performed well in predicting personal recovery in the independent test sample (adjusted R2 = .491). CONCLUSIONS Our findings suggest that especially social participation, anxiety and positive rumination might be relevant treatment targets when aiming to improve personal recovery. PRACTITIONER POINTS Personal recovery is considered an increasingly important outcome for people with chronic mental health conditions, including bipolar disorder. We found that anxiety and manic symptoms as well as positive rumination and social participation were independently associated with personal recovery in bipolar disorder. Therefore, these outcomes might be relevant treatment targets when aiming to improve personal recovery in bipolar disorder. Possible interventions to improve these outcomes are discussed, including supported employment and vocational rehabilitation for social participation and exercising with savoring strategies to increase positive rumination.
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Affiliation(s)
- Jannis T. Kraiss
- Department of Psychology, Health, and TechnologyCenter for eHealth and Well‐being ResearchUniversity of TwenteEnschedeNetherlands
| | - Peter M. ten Klooster
- Department of Psychology, Health, and TechnologyCenter for eHealth and Well‐being ResearchUniversity of TwenteEnschedeNetherlands
| | - Emily Frye
- Department of Psychology, Health, and TechnologyCenter for eHealth and Well‐being ResearchUniversity of TwenteEnschedeNetherlands
| | - Ralph W. Kupka
- PsychiatryAmsterdam Public Health Research InstituteVrije UniversiteitAmsterdam UMCThe Netherlands
| | - Ernst T. Bohlmeijer
- Department of Psychology, Health, and TechnologyCenter for eHealth and Well‐being ResearchUniversity of TwenteEnschedeNetherlands
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14
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Tian X, Lu J, Che Y, Fang D, Ran H, He X, Wang Y, Wang T, Xu X, Yang G, Xiao Y. Childhood maltreatment and self-harm in Chinese adolescents: moderation and mediation via resilience. BMC Public Health 2021; 21:1561. [PMID: 34404376 PMCID: PMC8371889 DOI: 10.1186/s12889-021-11605-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background Published studies examining the association between childhood maltreatment (CM) and self-harm (SH) among adolescents have been accumulated. It is possible that resilience serves as a moderator or mediator in CM-SH association, nevertheless, this topic has never been thoroughly investigated. Methods In this population-based cross-sectional study, we surveyed 3146 students aged 10–17 in southwest China. The Childhood Trauma Questionnaire (CTQ), the Modified version of Adolescents Self-Harm Scale (MASHS), and the Resilience Scale for Chinese Adolescents (RSCA) were used to measure CM, SH, and resilience. Correlational analyses, hierarchical multivariate linear regression, and structural equation modeling (SEM) were performed to test the moderation and mediation of resilience in CM-SH association. Results Findings revealed that, resilience with its five dimensions, CM, and SH were significantly correlated with each other. Resilience partially moderated and mediated the association between CM and SH. Besides, among all dimensions of resilience, emotion regulation, interpersonal assistance, and family support presented the strongest mediation in CM-SH association. Conclusions Our results highlight the importance of resilience in CM related SH among Chinese teenagers. Resilience-oriented intervention could be considered in SH intervention measures for adolescents who had experienced CM.
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Affiliation(s)
- Xin Tian
- Department of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, 650500, Yunnan, China.,The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Jin Lu
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.,NHC Key Laboratory of Drug Addiction Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yusan Che
- Department of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, 650500, Yunnan, China
| | - Die Fang
- Department of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, 650500, Yunnan, China
| | - Hailiang Ran
- Department of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, 650500, Yunnan, China
| | - Xingting He
- Lincang Psychiatry Hospital, Lincang, Yunnan, China
| | - Yanjiao Wang
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Tianlan Wang
- Lincang Psychiatry Hospital, Lincang, Yunnan, China
| | - Xiufeng Xu
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Guangya Yang
- Lincang Psychiatry Hospital, Lincang, Yunnan, China
| | - Yuanyuan Xiao
- Department of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, 650500, Yunnan, China.
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15
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Yu J, Goldstein R, Haynie D, Luk JW, Fairman BJ, Patel R, Vidal-Ribas P, Maultsby K, Gudal M, Gilman SE. Resilience Factors in the Association Between Depressive Symptoms and Suicidality. J Adolesc Health 2021; 69:280-287. [PMID: 33431248 PMCID: PMC8479833 DOI: 10.1016/j.jadohealth.2020.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 11/03/2020] [Accepted: 12/04/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE To investigate whether life satisfaction and optimism might reduce the risk of suicidal thoughts and behaviors among adolescents with depressive symptoms. METHODS Participants were 1,904 youth from the NEXT Generation Health Study, a national sample of U.S. adolescents, followed over 7 years from 2009/2010 to 2015/2016. Longitudinal latent profile analysis and logistic regressions were conducted. RESULTS We identified three subgroups of adolescents with different patterns of depressive symptoms across the first six waves: "Low" (40%), "Mild" (42%), and "Moderate to Severe" (18%). The Moderate to Severe (OR = 14.47, 95% CI [6.61, 31.66]) and Mild (OR = 3.90, 95% CI [2.22, 6.86]) depression profiles had significantly higher odds of developing suicidality than the Low depression profile. Both life satisfaction and optimism moderated the association between depressive symptom profile and suicidality. The difference in suicidality risk between the Mild and Low depression profiles was significantly attenuated at high versus low levels of life satisfaction, with a difference of -.08, 95% CI [-.14, -.03]. In addition, the difference in suicidality risk between the Moderate to Severe and Low depression profiles was attenuated at high versus low levels of optimism, with a difference of -.11, 95% CI [-.21, -.01]. CONCLUSIONS For adolescents transitioning to young adulthood, resilience factors such as life satisfaction and optimism may buffer against suicidality risk in the face of mild or moderate to severe depressive symptoms.
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Affiliation(s)
- Jing Yu
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
| | - Risë Goldstein
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health
| | - Denise Haynie
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health
| | - Jeremy W. Luk
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health
| | - Brian J. Fairman
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health
| | - Reeya Patel
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health
| | - Pablo Vidal-Ribas
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health
| | - Katherine Maultsby
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health
| | - Mahad Gudal
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health
| | - Stephen E. Gilman
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health,Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University
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16
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A systematic review and meta-analysis of psychological interventions to improve mental wellbeing. Nat Hum Behav 2021; 5:631-652. [PMID: 33875837 DOI: 10.1038/s41562-021-01093-w] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/05/2021] [Indexed: 12/20/2022]
Abstract
Our current understanding of the efficacy of psychological interventions in improving mental states of wellbeing is incomplete. This study aimed to overcome limitations of previous reviews by examining the efficacy of distinct types of psychological interventions, irrespective of their theoretical underpinning, and the impact of various moderators, in a unified systematic review and meta-analysis. Four-hundred-and-nineteen randomized controlled trials from clinical and non-clinical populations (n = 53,288) were identified for inclusion. Mindfulness-based and multi-component positive psychological interventions demonstrated the greatest efficacy in both clinical and non-clinical populations. Meta-analyses also found that singular positive psychological interventions, cognitive and behavioural therapy-based, acceptance and commitment therapy-based, and reminiscence interventions were impactful. Effect sizes were moderate at best, but differed according to target population and moderator, most notably intervention intensity. The evidence quality was generally low to moderate. While the evidence requires further advancement, the review provides insight into how psychological interventions can be designed to improve mental wellbeing.
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17
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Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, Hopwood M, Lyndon B, Mulder R, Porter R, Singh AB, Murray G. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2021; 55:7-117. [PMID: 33353391 DOI: 10.1177/0004867420979353] [Citation(s) in RCA: 240] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. METHODS Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. CONCLUSION The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.
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Affiliation(s)
- Gin S Malhi
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | | | - Philip Boyce
- Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.,Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Bill Lyndon
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
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18
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Liu JY, Xu KK, Zhu GL, Zhang QQ, Li XM. Effects of smartphone-based interventions and monitoring on bipolar disorder: A systematic review and meta-analysis. World J Psychiatry 2020; 10:272-285. [PMID: 33269223 PMCID: PMC7672788 DOI: 10.5498/wjp.v10.i11.272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Recently, there has been a range of studies about smartphone-based interventions and monitoring for reducing symptoms of bipolar disorder (BD). However, their efficacy for BD remains unclear.
AIM To compare the effect of smartphone-based interventions and monitoring with control methods in treating patients with BD.
METHODS A systematic literature search was performed on PubMed, Embase, Clinical trials, psycINFO, Web of Science, and Cochrane Library. Randomized clinical trials (RCTs) or single-group trials in which smartphone-based interventions and monitoring were compared with control methods or baseline in patients with symptoms of BD were included. Data were synthesized using a random-effects or a fixed-effects model to analyze the effects of psychological interventions and monitoring delivered via smartphone on psychiatric symptoms in patients with BD. The primary outcome measures were set for mania and depression symptoms. Subgroups were created to explore which aspects of smartphone interventions are relevant to the greater or lesser efficacy of treating symptoms.
RESULTS We identified ten articles, including seven RCTs (985 participants) and three single-group trials (169 participants). Analysis of the between-group study showed that smartphone-based interventions were effective in reducing manic [g = -0.19, 95% confidence interval (CI): -0.33 to -0.04, P = 0.01] and depressive (g = -0.28, 95%CI: -0.55 to -0.01, P < 0.05) symptoms. In within-group analysis, smartphone-based interventions significantly reduced manic (g = 0.17, 95%CI: 0.04 to 0.30, P < 0.01) and depressive (g = 0.48, 95%CI: 0.18 to 0.78) symptoms compared to the baseline. Nevertheless, smartphone-based monitoring systems significantly reduced manic (g = 0.27, 95%CI: 0.02 to 0.51, P < 0.05) but not depressive symptoms. Subgroup analysis indicated that the interventions with psychoeducation had positive effects on depressive (g = -0.62, 95%CI: -0.81 to -0.43, P < 0.01) and manic (g = -0.24, 95%CI: -0.43 to -0.06, P = 0.01) symptoms compared to the controlled conditions, while the interventions without psychoeducation did not (P > 0.05). The contacts between therapists and patients that contributed to the implementation of psychological therapy reduced depression symptoms (g = -0.47, 95%CI: -0.75 to -0.18, P = 0.01).
CONCLUSION Smartphone-based interventions and monitoring have a significant positive impact on depressive and manic symptoms of BD patients in between-group and within-group analysis.
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Affiliation(s)
- Jia-Yuan Liu
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei 230032, Anhui Province, China
- Department of Anesthesia, First Clinical Medical College, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Kang-Kang Xu
- Department of Clinical Medicine, Second Clinical Medical College, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Guang-Lin Zhu
- Department of Clinical Medicine, Second Clinical Medical College, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Qi-Qi Zhang
- Department of Clinical Medicine, First Clinical Medical College, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Xiao-Ming Li
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei 230032, Anhui Province, China
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19
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Wang H, Du C, Liu H, Zhang S, Wu S, Fu Y, Zhao J. Exploration of symptom experience in kidney transplant recipients based on symptoms experience model. Qual Life Res 2020; 29:1281-1290. [PMID: 31898113 DOI: 10.1007/s11136-019-02404-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Kidney transplant recipients suffer from a variety of symptoms, and symptom management is crucial in improving their quality of life (QOL). Accordingly, this study aims to identify the symptoms experienced by kidney transplant recipients and examine the relationship amongst antecedents, symptom experience and QOL of recipients in China. METHODS A total of 300 kidney transplant recipients were investigated in one of the most first-rate hospitals in China by asking them to fill out a self-designed general questionnaire, the Symptom Experience Scale, the Sense of Coherence Scale (Chinese version), the Revised Life Orientation Test (Chinese version) and the 36-item Short Form Health Survey (Chinese version). RESULTS Kidney transplant recipients experienced multiple symptoms that were frequent, severe and bothersome. The final model showed significant consistency with the data. In the QOL model, post-transplant time, complications, immunosuppressive agents and sense of coherence explained 30.7% of the variance of symptom experience. Moreover, habitual residence, economic burden, post-transplant time, kidney function, optimism and symptom experience accounted for 70.6% of the variance on QOL. CONCLUSIONS We can explain the relationship between antecedents, symptom experience and QOL amongst Chinese kidney transplant recipients by using Symptoms Experience Model. Clinicians and caregivers can manage the recipient's symptoms during follow-up from psychological, physical and medication management perspectives. Improving sense of coherence, maintaining optimism and managing symptoms are essential for enhancing QOL.
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Affiliation(s)
- Han Wang
- School of Nursing, Beijing University of Chinese Medicine, Intersection of Yangguang South Street and Baiyang East Road, Fang Shan District, Beijing, 102488, China
| | - Chunyan Du
- School of Nursing, Beijing University of Chinese Medicine, Intersection of Yangguang South Street and Baiyang East Road, Fang Shan District, Beijing, 102488, China
| | - Hongxia Liu
- School of Nursing, Beijing University of Chinese Medicine, Intersection of Yangguang South Street and Baiyang East Road, Fang Shan District, Beijing, 102488, China.
| | - Shuping Zhang
- School of Nursing, Beijing University of Chinese Medicine, Intersection of Yangguang South Street and Baiyang East Road, Fang Shan District, Beijing, 102488, China
| | - Sisi Wu
- School of Nursing, Beijing University of Chinese Medicine, Intersection of Yangguang South Street and Baiyang East Road, Fang Shan District, Beijing, 102488, China
| | - Yingxin Fu
- Organ Transplant Centre, Tianjin First Central Hospital, Tianjin, China
| | - Jie Zhao
- Organ Transplant Centre, Tianjin First Central Hospital, Tianjin, China
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20
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Painter JM, Mote J, Peckham AD, Lee EH, Campellone TR, Pearlstein JG, Morgan S, Kring AM, Johnson SL, Moskowitz JT. A positive emotion regulation intervention for bipolar I disorder: Treatment development and initial outcomes. Gen Hosp Psychiatry 2019; 61:96-103. [PMID: 31439286 PMCID: PMC6861691 DOI: 10.1016/j.genhosppsych.2019.07.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Dysfunction in positive affect is a defining symptom of bipolar I disorder (BD), both during and between mood episodes. We hypothesize that helping people with BD learn skills to create balance in their affective experiences by engaging in strategies that increase low activation positive emotion (LAP; e.g., relaxation) could help to improve well-being during periods of symptom remission. We discuss the development and preliminary outcomes of a positive emotion regulation (PER) group treatment for people with BD, designed as a supplement to pharmacological treatment. METHOD The Learning Affective Understanding for a Rich Emotional Life (LAUREL) intervention is a group-based intervention covering 10 empirically supported skills designed to increase LAP. Sixteen people with BD enrolled in the LAUREL intervention and twelve completed baseline and post-intervention assessments. RESULTS Participants who completed the study (n = 12) attended the majority of groups (87.96%) and reported practicing skills, on average, 16 times a week. We were unable to detect significant differences in mania symptoms following engagement in this PER intervention. Finally, participants reported increases in several areas associated with well-being post-intervention, including mindfulness, reappraisal, and self-compassion. CONCLUSION This study provides a theoretical framework and preliminary support for a PER intervention for BD.
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Affiliation(s)
- Janelle M Painter
- University of California, Berkeley, Department of Psychology, United States of America.
| | - Jasmine Mote
- University of California, Berkeley, Department of Psychology, United States of America.
| | - Andrew D Peckham
- University of California, Berkeley, Department of Psychology, United States of America.
| | - Erica H Lee
- University of California, Berkeley, Department of Psychology, United States of America.
| | - Timothy R Campellone
- University of California, Berkeley, Department of Psychology, United States of America.
| | - Jennifer G Pearlstein
- University of California, Berkeley, Department of Psychology, United States of America.
| | - Stefana Morgan
- University of California, San Francisco, Department of Psychiatry, United States of America.
| | - Ann M Kring
- University of California, Berkeley, Department of Psychology, United States of America.
| | - Sheri L Johnson
- University of California, Berkeley, Department of Psychology, United States of America.
| | - Judith T Moskowitz
- University of California, San Francisco, Department of Psychiatry, United States of America.
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21
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Celano CM, Gianangelo T, Millstein RA, Chung WJ, Wexler DJ, Park ER, Huffman JC. A positive psychology-motivational interviewing intervention for patients with type 2 diabetes: Proof-of-concept trial. Int J Psychiatry Med 2019; 54:97-114. [PMID: 30114958 PMCID: PMC6370502 DOI: 10.1177/0091217418791448] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Eighteen million Americans with type 2 diabetes (T2D) do not follow recommended guidelines for physical activity. Motivational interviewing (MI) has had modest effects on activity and related behaviors in T2D. Positive psychological attributes (e.g., optimism) are associated with superior medical outcomes in T2D, and positive psychology (PP) interventions promote such attributes. There had been no study in T2D of a combined PP-MI intervention to promote well-being and health behavior adherence. We developed a novel, telephone-delivered, 16-week PP-MI intervention and explored its feasibility and impact in T2D patients in a single-arm, proof-of-concept trial. METHOD Participants completed PP-based exercises and MI-based physical activity goal-setting activities and reviewed these activities weekly with a study trainer for 16 weeks. Feasibility and acceptability were assessed via exercise completion rates and post-exercise ratings of ease/utility (0-10 scales). Impact was explored by examining changes in physical activity (via accelerometers and self-report), other health behaviors, psychological measures, and medical outcomes (e.g., hemoglobin A1c (A1C)) from baseline to 16 weeks, using paired t tests. RESULTS Twelve participants enrolled, and 10 provided follow-up data. Seventy-eight percent of PP-MI activities were completed, and participants rated the PP-MI content and sessions as easy (mean = 8.2/10, standard deviation (SD) = 1.9) and useful (mean = 9.1/10, SD = 1.5). PP-MI was associated with improved adherence to health behaviors and overall self-care, variable effects on accelerometer-measured activity and psychological outcomes, and modest beneficial effects on body mass index and A1C. CONCLUSION Further testing of this intervention is warranted in a larger, controlled trial to assess its effects on important health outcomes.
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Affiliation(s)
- Christopher M. Celano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Taylor Gianangelo
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Rachel A. Millstein
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Wei-Jean Chung
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Deborah J. Wexler
- Harvard Medical School, Boston, MA,MGH Diabetes Center, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Elyse R. Park
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Jeff C. Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
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22
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Campbell KA, Healy BC, Celano CM, Albanese A, Millstein RA, Huffman JC. Predictors of completion of a psychological-behavioral intervention in acute coronary syndrome patients. J Psychosom Res 2018; 112:9-12. [PMID: 30097141 PMCID: PMC6090553 DOI: 10.1016/j.jpsychores.2018.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/06/2018] [Accepted: 06/11/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Dropout from health behavior interventions in patients with heart disease is a major clinical issue that can impact recovery and prognosis. Positive psychology (PP)-based treatments have the potential to promote health behaviors, but predictors of PP intervention completion have not been examined in persons with heart disease. METHODS Among 128 patients receiving a phone-based PP intervention to promote physical activity among acute coronary syndrome (ACS) patients, numerous baseline sociodemographic, medical, and psychological variables, along with self-reported pre/post improvements in happiness and optimism (on 0-10 Likert scales) associated with an initial PP exercise, were examined as potential predictors of intervention completion. Logistic and linear regression analyses were used to assess relationships between these predictors and (a) intervention completion (at least 4 of 8 sessions completed) and (b) number of total sessions completed. RESULTS No patient characteristic was associated with greater likelihood of completing the PP intervention. However, immediate pre-post change in optimism following the initial exercise was associated with intervention completion (odds ratio = 1.98; 95% confidence interval: 1.28-3.05; p = .002; mean post-exercise increase in optimism 0.79 [SD 1.52] in completers vs. mean optimism decrease of 0.59 [SD 1.42] in non-completers). CONCLUSIONS Pre-post change in optimism with a single PP activity predicted completion of an 8-week PP-based health behavior intervention in post-ACS patients. This information could be used clinically by having potential enrollees complete a single PP activity to assess intervention fit.
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Affiliation(s)
- Kirsti A Campbell
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Brian C Healy
- Harvard Medical School, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher M Celano
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Ariana Albanese
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Rachel A Millstein
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jeff C Huffman
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
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