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Bamonti PM, Rose GA, Park S, Silberbogen AK, Moye J, Moy ML. Emotional Distress and Physical Activity Engagement in U.S. Veterans With Chronic Obstructive Pulmonary Disease: A Qualitative Study. Ann Behav Med 2024; 58:539-551. [PMID: 38847496 DOI: 10.1093/abm/kaae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Physical activity is recommended as part of guideline-based care for managing chronic obstructive pulmonary disease (COPD) at all stages of the disease. However, physical activity interventions are less effective in individuals with co-occurring emotional distress (i.e., depression and/or anxiety symptoms). Interventions that dually promote improved physical and mental health in COPD are needed. The first step for intervention development is understanding individuals' experience of these factors. PURPOSE To understand the experience of emotional distress in U.S. Veterans diagnosed with COPD and to explore how emotional distress impacts physical activity engagement. METHODS Structured interviews informed by the cognitive and behavioral models of psychopathology were conducted with 29 United States Veterans with COPD (89.66% male, age 67.72 ± 6.55 years, 93.10% White) at the VA Boston Healthcare System. Interviews were audio recorded, transcribed, and underwent thematic analysis. RESULTS Three major themes encapsulating 17 codes emerged through thematic analysis: (i) the experience of emotional distress in Veterans with COPD; (ii) the complex relationship between emotional distress, physical activity engagement, and COPD; (iii) contextual and personal factors. CONCLUSIONS Veterans' interpretation of their COPD symptoms as unpredictable and uncontrollable and COPD-related physical limitations influenced their experience of emotional distress, while the experience of emotional distress both promoted and deterred physical activity engagement. Veterans were motivated to engage in physical activity despite experiencing emotional distress when they faced a responsibility in daily life. They identified motivational strategies and self-regulation techniques to manage emotional distress and to foster physical activity.
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Affiliation(s)
- Patricia M Bamonti
- Research & Development Service, VA Boston Healthcare System, Boston MA, USA
- Department of Psychiatry, Havard Medical School, Boston, MA, USA
| | - Grace A Rose
- Research & Development Service, VA Boston Healthcare System, Boston MA, USA
| | - Stella Park
- New England Geriatric Research Education & Clinical Center, VA Boston Healthcare System, Boston, MA, USA
| | - Amy K Silberbogen
- VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jennifer Moye
- Department of Psychiatry, Havard Medical School, Boston, MA, USA
- New England Geriatric Research Education & Clinical Center, VA Boston Healthcare System, Boston, MA, USA
| | - Marilyn L Moy
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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Warner LM, Jiang D, Yeung DYL, Choi NG, Ho RTH, Kwok JYY, Song Y, Chou KL. Study protocol of the 'HEAL-HOA' dual randomized controlled trial: Testing the effects of volunteering on loneliness, social, and mental health in older adults. Contemp Clin Trials Commun 2024; 38:101275. [PMID: 38435428 PMCID: PMC10904923 DOI: 10.1016/j.conctc.2024.101275] [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: 10/10/2023] [Revised: 01/10/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
Background Interventions to reduce loneliness in older adults usually do not show sustained effects. One potential way to combat loneliness is to offer meaningful social activities. Volunteering has been suggested as one such activity - however, its effects on loneliness remain to be tested in randomized controlled trials (RCT). Methods This planned Dual-RCT aims to recruit older adults experiencing loneliness, with subsequent randomization to either a volunteering condition (6 weeks of training before delivering one of three tele-based loneliness interventions to older intervention recipients twice a week for 6 months) or to an active control condition (psycho-education with social gatherings for six months). Power analyses require the recruitment of N = 256 older adults to detect differences between the volunteering and the active control condition (128 in each) on the primary outcome of loneliness (UCLA Loneliness Scale). Secondary outcomes comprise social network engagement, perceived social support, anxiety and depressive symptoms, self-rated health, cognitive health, perceived stress, sleep quality, and diurnal cortisol (1/3 of the sample). The main analyses will comprise condition (volunteering vs. no-volunteering) × time (baseline, 6-, 12-, 18-, 24-months follow-ups) interactions to test the effects of volunteering on loneliness and secondary outcomes. Effects are expected to be mediated via frequency, time and involvement in volunteering. Discussion If our trial can show that volunteers delivering one of the three telephone-based interventions to lonely intervention recipients benefit from volunteer work themselves, this might encourage more older adults to volunteer, helping to solve some of the societal issues involved with rapid demographic changes.
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Affiliation(s)
- Lisa M. Warner
- Department of Psychology, MSB Medical School Berlin, Rüdesheimer Straße 50, 14197, Berlin, Germany
| | - Da Jiang
- The Education University of Hong Kong, 10 Lo Ping Rd, Tai Po, Hong Kong
| | - Dannii Yuen-lan Yeung
- Department of Social and Behavioural Sciences, City University of Hong Kong, Tat Chee Ave, Kowloon Tong, Hong Kong
| | - Namkee G. Choi
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, USA
| | - Rainbow Tin Hung Ho
- Department of Social Work & Social Administration, Centre on Behavioral Health, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Youqiang Song
- Department of Biochemistry, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kee-Lee Chou
- The Education University of Hong Kong, 10 Lo Ping Rd, Tai Po, Hong Kong
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Jäger M, Zangger G, Bricca A, Dideriksen M, Smith SM, Midtgaard J, Taylor RS, Skou ST. Mapping interventional components and behavior change techniques used to promote self-management in people with multimorbidity: a scoping review. Health Psychol Rev 2024; 18:165-188. [PMID: 36811829 PMCID: PMC7615688 DOI: 10.1080/17437199.2023.2182813] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
Ageing populations and improved survival, have contributed to a rise in the number of people living with multimorbidity, raising issues related to polypharmacy, treatment burden, competing priorities and poor coordination of care. Self-management programs are increasingly included as an essential component of interventions to improve outcomes in this population. However, an overview of how interventions supporting self-management in patients with multimorbidity is missing. This scoping review focused on mapping the literature on patient-centered interventions for people living with multimorbidity. We searched several databases, clinical registries, and grey literature for RCTs published between 1990-2019 describing interventions that supported self-management in people with multimorbidity. We included 72 studies that were found to be very heterogeneous when it comes to the population, delivery modes and modalities, intervention elements and facilitators. The results pointed to an extensive use of cognitive behavioral therapy as a basis for interventions, as well as behavior change theories and disease management frameworks. The most coded behavior change techniques stemmed from the categories Social Support, Feedback and monitoring and Goals and Planning. To allow for implementation of effective interventions in clinical practice, improved reporting of intervention mechanisms in RCTs is warranted.
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Affiliation(s)
- Madalina Jäger
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Danish Centre for Motivation and Behaviour Science, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Graziella Zangger
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Alessio Bricca
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Mette Dideriksen
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Susan M. Smith
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Julie Midtgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, Mental Health Services in the Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark
| | - Rod S. Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, Scotland
| | - Søren T. Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
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Sohanpal R, Pinnock H, Steed L, Heslop-Marshall K, Kelly MJ, Chan C, Wileman V, Barradell A, Dibao-Dina C, Font Gilabert P, Healey A, Hooper R, Mammoliti KM, Priebe S, Roberts M, Rowland V, Waseem S, Singh S, Smuk M, Underwood M, White P, Yaziji N, Taylor SJ. A tailored psychological intervention for anxiety and depression management in people with chronic obstructive pulmonary disease: TANDEM RCT and process evaluation. Health Technol Assess 2024; 28:1-129. [PMID: 38229579 PMCID: PMC11017633 DOI: 10.3310/pawa7221] [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] [Indexed: 01/18/2024] Open
Abstract
Background People with chronic obstructive pulmonary disease have high levels of anxiety and depression, which is associated with increased morbidity and poor uptake of effective treatments, such as pulmonary rehabilitation. Cognitive-behavioural therapy improves mental health of people with long-term conditions and could potentially increase uptake of pulmonary rehabilitation, enabling synergies that could enhance the mental health of people with chronic obstructive pulmonary disease. Aim Our aim was to develop and evaluate the clinical effectiveness and cost effectiveness of a tailored cognitive-behavioural approach intervention, which links into, and optimises the benefits of, routine pulmonary rehabilitation. Design We carried out a pragmatic multicentre randomised controlled trial using a 1.25 : 1 ratio (intervention : control) with a parallel process evaluation, including assessment of fidelity. Setting Twelve NHS trusts and five Clinical Commissioning Groups in England were recruited into the study. The intervention was delivered in participant's own home or at a local NHS facility, and by telephone. Participants Between July 2017 and March 2020 we recruited adults with moderate/very severe chronic obstructive pulmonary disease and mild/moderate anxiety and/or depression, meeting eligibility criteria for assessment for pulmonary rehabilitation. Carers of participants were invited to participate. Intervention The cognitive-behavioural approach intervention (i.e. six to eight 40- to 60-minute sessions plus telephone support throughout pulmonary rehabilitation) was delivered by 31 trained respiratory healthcare professionals to participants prior to commencing pulmonary rehabilitation. Usual care included routine pulmonary rehabilitation referral. Main outcome measures Co-primary outcomes were Hospital Anxiety and Depression Scale - anxiety and Hospital Anxiety and Depression Scale - depression at 6 months post randomisation. Secondary outcomes at 6 and 12 months included health-related quality of life, smoking status, uptake of pulmonary rehabilitation and healthcare use. Results We analysed results from 423 randomised participants (intervention, n = 242; control, n = 181). Forty-three carers participated. Follow-up at 6 and 12 months was 93% and 82%, respectively. Despite good fidelity for intervention delivery, mean between-group differences in Hospital Anxiety and Depression Scale at 6 months ruled out clinically important effects (Hospital Anxiety and Depression Scale - anxiety mean difference -0.60, 95% confidence interval -1.40 to 0.21; Hospital Anxiety and Depression Scale - depression mean difference -0.66, 95% confidence interval -1.39 to 0.07), with similar results at 12 months. There were no between-group differences in any of the secondary outcomes. Sensitivity analyses did not alter these conclusions. More adverse events were reported for intervention participants than for control participants, but none related to the trial. The intervention did not generate quality-of-life improvements to justify the additional cost (adjusted mean difference £770.24, 95% confidence interval -£27.91 to £1568.39) to the NHS. The intervention was well received and many participants described positive affects on their quality of life. Facilitators highlighted the complexity of participants' lives and considered the intervention to be of potential valuable; however, the intervention would be difficult to integrate within routine clinical services. Our well-powered trial delivered a theoretically designed intervention with good fidelity. The respiratory-experienced facilitators were trained to deliver a low-intensity cognitive-behavioural approach intervention, but high-intensity cognitive-behavioural therapy might have been more effective. Our broad inclusion criteria specified objectively assessed anxiety and/or depression, but participants were likely to favour talking therapies. Randomisation was concealed and blinding of outcome assessment was breached in only 15 participants. Conclusions The tailored cognitive-behavioural approach intervention delivered with fidelity by trained respiratory healthcare professionals to people with chronic obstructive pulmonary disease was neither clinically effective nor cost-effective. Alternative approaches that are integrated with routine long-term condition care are needed to address the unmet, complex clinical and psychosocial needs of this group of patients. Trial registration This trial is registered as ISRCTN59537391. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 13/146/02) and is published in full in Health Technology Assessment; Vol. 28, No. 1. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Ratna Sohanpal
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Liz Steed
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Moira J Kelly
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Claire Chan
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Vari Wileman
- School of Mental Health and Psychological Sciences, Institute of Psychiatry, King's College London, London, UK
| | - Amy Barradell
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Paulino Font Gilabert
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Andy Healey
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Richard Hooper
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kristie-Marie Mammoliti
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Stefan Priebe
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mike Roberts
- Safer Care Victoria, Melbourne, Melbourne, VIC, Australia
| | | | | | - Sally Singh
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melanie Smuk
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Patrick White
- Department of Population Health, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Nahel Yaziji
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Stephanie Jc Taylor
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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5
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Altieri M, Sergi MR, Tommasi M, Santangelo G, Saggino A. The efficacy of telephone-delivered cognitive behavioral therapy in people with chronic illnesses and mental diseases: A meta-analysis. J Clin Psychol 2024; 80:223-254. [PMID: 37428900 DOI: 10.1002/jclp.23563] [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: 08/09/2022] [Revised: 03/20/2023] [Accepted: 06/10/2023] [Indexed: 07/12/2023]
Abstract
COVID-19 pandemic led to an increase of remote treatments, such as telephone-delivery cognitive behavioral therapy (T-CBT). To our knowledge, no meta-analyses studied the effect of T-CBT in chronic and/or mental illnesses on multiple psychological outcomes. Therefore, our study aims to evaluating the efficacy of T-CBT compared to other interventions (treatment as usual, TAU, or face-to-face CBT). Each effect size (ES) was calculated in Hedges' g and pooled together to produce a mean ES for each outcome (depression, anxiety, mental and physical QoL, worry, coping, and sleep disturbances). The meta-analysis included 33 studies with a randomized controlled trial design. A large ES was found when comparing the efficacy of T-CBT against TAU on depression (g = 0.84, p < 0.001), whereas a moderate ES was found on anxiety (g = 0.57; p < 0.001), and a small effect on mental quality of life (g = 0.33, p < 0.001), sleep disturbances (g = 0.37, p = 0.042), coping (g = 0.20, p = 0.016) and worry (g = 0.43, p = 0.001). The meta-analysis comparing the efficacy of T-CBT and CBT on depression revealed a not significant pooled ES (g = 0.06, p = 0.466). The results provided evidence that T-CBT could be to be more effective than TAU conditions in multiple psychological outcomes, and as efficient as face-to-face CBT in treating depression.
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Affiliation(s)
- Manuela Altieri
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Maria R Sergi
- Department of Medicine and Aging Sciences, University of Chieti, Chieti, Italy
| | - Marco Tommasi
- Department of Medicine and Aging Sciences, University of Chieti, Chieti, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Aristide Saggino
- Department of Medicine and Aging Sciences, University of Chieti, Chieti, Italy
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Yohannes AM. Anxiety and post-traumatic stress disorders in patients with chronic respiratory diseases. Curr Opin Support Palliat Care 2023; 17:290-295. [PMID: 37877447 DOI: 10.1097/spc.0000000000000670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
PURPOSE OF REVIEW This brief critical review evaluates recent research on the impact of anxiety disorders and post-traumatic stress disorders (PTSD) on patients with chronic obstructive pulmonary disease (COPD) and asthma. In these patients, untreated anxiety and PTSD exacerbate acute symptoms, increase disability and impair quality of life. Therefore, effective interventions are also reviewed. RECENT FINDINGS Anxiety disorders and PTSD are prevalent in COPD and asthma, worsen symptoms in acute exacerbations, and increase morbidity and healthcare utilization. Pulmonary rehabilitation (PR), cognitive behavioural therapy and pharmacological therapy are each effective in COPD patients with anxiety or PTSD. However, very little work examined therapy for combined anxiety and PTSD in patients with either COPD or asthma. SUMMARY Despite the high prevalence of anxiety disorder or PTSD in patients with chronic respiratory diseases, a paucity of literature remains demonstrating the efficacy of pharmacological therapies for these conditions. This review highlights the promising benefits of PR on anxiety, but prospective trials are needed to demonstrate the efficacy of interventions with PTSD alone, or with concomitant anxiety.
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Taylor SJC, Sohanpal R, Steed L, Marshall K, Chan C, Yaziji N, Barradell AC, Font-Gilabert P, Healey A, Hooper R, Kelly MJ, Mammoliti KM, Priebe S, Rajasekaran A, Roberts CM, Rowland V, Singh SJ, Smuk M, Underwood M, Waseem S, White P, Wileman V, Pinnock H. Tailored psychological intervention for anxiety or depression in COPD (TANDEM): a randomised controlled trial. Eur Respir J 2023; 62:2300432. [PMID: 37620042 PMCID: PMC10620475 DOI: 10.1183/13993003.00432-2023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND The TANDEM multicentre, pragmatic, randomised controlled trial evaluated whether a tailored psychological intervention based on a cognitive behavioural approach for people with COPD and symptoms of anxiety and/or depression improved anxiety or depression compared with usual care (control). METHODS People with COPD and moderate to very severe airways obstruction and Hospital Anxiety and Depression Scale subscale scores indicating mild to moderate anxiety (HADS-A) and/or depression (HADS-D) were randomised 1.25:1 (242 intervention and 181 control). Respiratory health professionals delivered the intervention face-to-face over 6-8 weeks. Co-primary outcomes were HADS-A and HADS-D measured 6 months post-randomisation. Secondary outcomes at 6 and 12 months included: HADS-A and HADS-D (12 months), Beck Depression Inventory II, Beck Anxiety Inventory, St George's Respiratory Questionnaire, social engagement, the EuroQol instrument five-level version (EQ-5D-5L), smoking status, completion of pulmonary rehabilitation, and health and social care resource use. RESULTS The intervention did not improve anxiety (HADS-A mean difference -0.60, 95% CI -1.40-0.21) or depression (HADS-D mean difference -0.66, 95% CI -1.39-0.07) at 6 months. The intervention did not improve any secondary outcomes at either time-point, nor did it influence completion of pulmonary rehabilitation or healthcare resource use. Deaths in the intervention arm (13/242; 5%) exceeded those in the control arm (3/181; 2%), but none were associated with the intervention. Health economic analysis found the intervention highly unlikely to be cost-effective. CONCLUSION This trial has shown, beyond reasonable doubt, that this cognitive behavioural intervention delivered by trained and supervised respiratory health professionals does not improve psychological comorbidity in people with advanced COPD and depression or anxiety.
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Affiliation(s)
- Stephanie J C Taylor
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Joint first authors
| | - Ratna Sohanpal
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Joint first authors
| | - Liz Steed
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Karen Marshall
- Chest Clinic, RVI Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Claire Chan
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Nahel Yaziji
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Amy C Barradell
- NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Paulino Font-Gilabert
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Andrew Healey
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Richard Hooper
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Moira J Kelly
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Kristie-Marie Mammoliti
- WHO Collaborating Centre on Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Stefan Priebe
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Arvind Rajasekaran
- Department of Respiratory Medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - C Michael Roberts
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Vickie Rowland
- Department of Population Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Sally J Singh
- Department of Respiratory Sciences, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Melanie Smuk
- Blizard Institute, Queen Mary University of London, London, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
- University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - Sarah Waseem
- Women's Health Division, University College Hospital, London, UK
| | - Patrick White
- Department of Population Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Vari Wileman
- Health Psychology, School of Mental Health and Psychological Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
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Abazari S, Moulaei K, George M. Examining Outcomes and Challenges of Telepsychiatry in Australian Elderly: A Scoping Review. J Aging Res 2023; 2023:8864591. [PMID: 37881169 PMCID: PMC10597727 DOI: 10.1155/2023/8864591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/12/2023] [Accepted: 10/05/2023] [Indexed: 10/27/2023] Open
Abstract
Methods To find relevant articles, we searched PubMed, Scopus, and Web of Science databases. We used a data extraction form to gather information from primary studies. Two researchers followed inclusion and exclusion criteria to select studies and extract data. Disagreements were resolved through discussion with all researchers. Studies needed to be in English, about telepsychiatry for Australian seniors, and use any technology type (synchronous, asynchronous, or both). We excluded nontelepsychiatry articles, books, book chapters, conference abstracts, and editor letters. Results Telepsychiatry was effectively employed to manage depression, anxiety, delirium, and cognitive impairments. Among these four disorders, telepsychiatry was mostly used for depression. Videoconference and telephone were mostly used to provide telepsychiatry services. Most telepsychiatry services for Australian seniors included "patient education on disorder control and management," "creating continuous interaction between the patient and the therapist," and "remote patients' assessment." "Reductions in symptoms of disorders," "improving patients' satisfaction with telepsychiatry," and "cost-effectiveness of telepsychiatry" were the most important positive outcomes of using telepsychiatry. We also identified four challenges in using telepsychiatry for elderly individuals in Australia. Conclusions This study is the first scoping review in Australia and provides valuable insight into telepsychiatry for elderly individuals.
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Affiliation(s)
- Sodabeh Abazari
- Older Persons Mental Health Service, West Moreton Health, Ipswich, Queensland, Australia
| | - Khadijeh Moulaei
- Department of Health Information Technology, Faculty of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Manoj George
- Older Persons Mental Health Service, West Moreton Health, Ipswich, Queensland, Australia
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Volpato E, Farver-Vestergaard I, Brighton LJ, Peters J, Verkleij M, Hutchinson A, Heijmans M, von Leupoldt A. Nonpharmacological management of psychological distress in people with COPD. Eur Respir Rev 2023; 32:32/167/220170. [PMID: 36948501 PMCID: PMC10032611 DOI: 10.1183/16000617.0170-2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/31/2022] [Indexed: 03/24/2023] Open
Abstract
Psychological distress is prevalent in people with COPD and relates to a worse course of disease. It often remains unrecognised and untreated, intensifying the burden on patients, carers and healthcare systems. Nonpharmacological management strategies have been suggested as important elements to manage psychological distress in COPD. Therefore, this review presents instruments for detecting psychological distress in COPD and provides an overview of available nonpharmacological management strategies together with available scientific evidence for their presumed benefits in COPD. Several instruments are available for detecting psychological distress in COPD, including simple questions, questionnaires and clinical diagnostic interviews, but their implementation in clinical practice is limited and heterogeneous. Moreover, various nonpharmacological management options are available for COPD, ranging from specific cognitive behavioural therapy (CBT) to multi-component pulmonary rehabilitation (PR) programmes. These interventions vary substantially in their specific content, intensity and duration across studies. Similarly, available evidence regarding their efficacy varies significantly, with the strongest evidence currently for CBT or PR. Further randomised controlled trials are needed with larger, culturally diverse samples and long-term follow-ups. Moreover, effective nonpharmacological interventions should be implemented more in the clinical routine. Respective barriers for patients, caregivers, clinicians, healthcare systems and research need to be overcome.
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Affiliation(s)
- Eleonora Volpato
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
- Shared first authorship
| | | | - Lisa Jane Brighton
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jeannette Peters
- Department of Pulmonary Diseases, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marieke Verkleij
- Department of Paediatric Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Monique Heijmans
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
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10
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Savira F, Gupta A, Gilbert C, Huggins CE, Browning C, Chapman W, Haines T, Peeters A. Virtual Care Initiatives for Older Adults in Australia: Scoping Review. J Med Internet Res 2023; 25:e38081. [PMID: 36652291 PMCID: PMC9892987 DOI: 10.2196/38081] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/03/2022] [Accepted: 09/26/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There has been a rapid shift toward the adoption of virtual health care services in Australia. It is unknown how widely virtual care has been implemented or evaluated for the care of older adults in Australia. OBJECTIVE We aimed to review the literature evaluating virtual care initiatives for older adults across a wide range of health conditions and modalities and identify key challenges and opportunities for wider adoption at both patient and system levels in Australia. METHODS A scoping review of the literature was conducted. We searched MEDLINE, Embase, PsycINFO, CINAHL, AgeLine, and gray literature (January 1, 2011, to March 8, 2021) to identify virtual care initiatives for older Australians (aged ≥65 years). The results were reported according to the World Health Organization's digital health evaluation framework. RESULTS Among the 6296 documents in the search results, we identified 94 that reported 80 unique virtual care initiatives. Most (69/80, 89%) were at the pilot stage and targeted community-dwelling older adults (64/79, 81%) with chronic diseases (52/80, 65%). The modes of delivery included videoconference, telephone, apps, device or monitoring systems, and web-based technologies. Most initiatives showed either similar or better health and behavioral outcomes compared with in-person care. The key barriers for wider adoption were physical, cognitive, or sensory impairment in older adults and staffing issues, legislative issues, and a lack of motivation among providers. CONCLUSIONS Virtual care is a viable model of care to address a wide range of health conditions among older adults in Australia. More embedded and integrative evaluations are needed to ensure that virtually enabled care can be used more widely by older Australians and health care providers.
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Affiliation(s)
- Feby Savira
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Burwood, Australia
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Adyya Gupta
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Cecily Gilbert
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Catherine E Huggins
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Colette Browning
- Health Innovation and Transformation Centre, Federation University, Ballarat, Australia
- Institute of Health and Wellbeing, Federation University, Ballarat, Australia
| | - Wendy Chapman
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Terry Haines
- National Centre for Healthy Ageing, Monash University, Frankston, Australia
- School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Anna Peeters
- Institute for Health Transformation, Deakin University, Geelong, Australia
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11
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FitzGerald J, Wells YD, Ellis JM. Psychosocial modification of general self-efficacy in older adults: A restricted review. Australas J Ageing 2022; 41:e210-e226. [PMID: 35235249 PMCID: PMC9545063 DOI: 10.1111/ajag.13052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In recent years, the concept of general self-efficacy has increased in popularity. General self-efficacy is positively associated with quality of life and has the potential to act as a psychological buffer against adverse events and circumstances. However, due to the long-term influences that are said to shape general self-efficacy beliefs, they may be resistant to intervention, particularly within the older population. This restricted review aimed to explore whether psychosocial interventions could improve the general self-efficacy of older adults. Aspects of intervention design associated with improvements were also investigated. METHODS A restricted review was undertaken. This included a keyword search of four major health databases (PubMed, CINAHL, PsycINFO and AgeLine). Search terms focused on general self-efficacy and the commonly used measures of this concept and were limited to the older adult population. RESULTS In total, 848 articles were screened, with 20 studies proceeding to data extraction. The modification of general self-efficacy in older adults appears possible, with 7 out of the 20 included studies reporting improvements postintervention. Despite issues relating to the quality of included studies and the generalisability of their results, several aspects of intervention design coincided with intervention success, including intervention duration, and employing sufficiently-qualified staff. CONCLUSIONS Future research must address the generalisability issues identified in this review. Studies comparing the effectiveness of individual- and group-based interventions, the efficacy of remote delivery platforms and the possibility for long-term transfer of any improvements are needed to contribute the high-quality data required for policy and practice decisions in this area.
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Affiliation(s)
- Jarrah FitzGerald
- School of Nursing and MidwiferyLa Trobe UniversityMelbourneVictoriaAustralia
| | - Yvonne D. Wells
- Lincoln Centre for Research on AgeingAustralian Institute for Primary Care & AgeingLa Trobe UniversityMelbourneVictoriaAustralia
| | - Julie M. Ellis
- School of Nursing and MidwiferyLa Trobe UniversityMelbourneVictoriaAustralia
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12
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Maher M, Reilly K, Smith E, Coyne E, Murphy S, Wilson C. Receiving teletherapy in Ireland: The experiences of service users in the public mental health system. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Michael Maher
- School of Psychology, Trinity College Dublin The University of Dublin Dublin 2 Ireland
| | - Katie Reilly
- School of Psychology, Trinity College Dublin The University of Dublin Dublin 2 Ireland
| | - Elaine Smith
- HSE Adult Mental Health Service Dublin South Kildare West Wicklow Community Healthcare Kildare Ireland
| | - Elaine Coyne
- HSE Adult Mental Health Service, Co. Kildare Ireland
| | - Síle Murphy
- HSE Adult Mental Health Service, Co. Kildare Ireland
| | - Charlotte Wilson
- School of Psychology, Trinity College Dublin The University of Dublin Dublin 2 Ireland
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13
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Bolton LE, Seymour J, Gardiner C. Existential suffering in the day to day lives of those living with palliative care needs arising from chronic obstructive pulmonary disease (COPD): A systematic integrative literature review. Palliat Med 2022; 36:567-580. [PMID: 35176924 PMCID: PMC9006392 DOI: 10.1177/02692163221074539] [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: 12/03/2022]
Abstract
BACKGROUND The impact of living with palliative care needs arising from COPD disrupts an individual's existential situation. However, no comprehensive synthesis of existing research has been published to determine the presentation and impact of existential suffering. AIM To provide a synthesis of existing evidence on existential suffering for those living with palliative care needs arising from COPD. DESIGN This is an integrative review paper, undertaken using the methodological approach developed by Soares and reported in accordance with PRISMA guidelines. Data analysis was undertaking using an integrated convergent synthesis approach. DATA SOURCES Nine electronic databases were searched from April 2019 to December 2019. A second search was undertaken in January 2021 to identify recently published papers meeting the inclusion and exclusion criteria. No date restrictions were imposed. Only papers published in the English Language were considered for inclusion. Empirical research papers employing qualitative and/or quantitative methodologies and systematic literature reviews were included. Articles were accepted for inclusion if they discussed any component of existential suffering when living with COPD and palliative care needs. RESULTS Thirty-five papers were included within this review comprising of seven systematic reviews, 10 quantitative studies and 18 qualitative studies. The following themes relating to existential suffering were found: Liminality, Lamented Life, Loss of Personal Liberty, Life meaning and Existential isolation. The absence of life meaning, and purpose was of most importance to participants. CONCLUSIONS This review suggests existential suffering is present and of significant impact within the daily lives of those living with palliative care needs arising from COPD. The absence of life meaning has the most significant impact. Further research is required to understand the essential components of an intervention to address existential suffering for this patient group, to ensure holistic palliative care delivery.
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Affiliation(s)
| | - Jane Seymour
- Division of Nursing & Midwifery, University of Sheffield, Sheffield, UK
| | - Clare Gardiner
- Division of Nursing & Midwifery, University of Sheffield, Sheffield, UK
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14
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Farver-Vestergaard I, Danielsen JTT, Løkke A, Zachariae R. Psychosocial Intervention in Chronic Obstructive Pulmonary Disease: Meta-Analysis of Randomized Controlled Trials. Psychosom Med 2022; 84:347-358. [PMID: 35067652 DOI: 10.1097/psy.0000000000001043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Many patients with chronic obstructive pulmonary disease (COPD) experience persistent interrelated psychological and physical symptoms despite optimal treatment. Several studies of psychosocial intervention in COPD have been published in recent years. The present study aimed to conduct a quantitative summary of the efficacy of such interventions on psychological and physical outcomes. METHODS Two independent raters screened PubMed, PsycINFO, Embase, Web of Science, Cochrane Library, and CINAHL for eligible studies. In all, 35 independent, randomized controlled trials with a total of 3,120 patients with COPD were included, assessed for their methodological quality, and subjected to meta-analytic evaluation. RESULTS Meta-analyses revealed small, statistically significant effects of psychosocial intervention on combined psychological (Hedges's g = 0.28; 95%CI: 0.16-0.41) and physical outcomes (g = 0.21; 95%CI: 0.07-0.35) with no indications of publication bias. Supplementary Bayesian meta-analyses provided strong evidence for a non-zero overall effect on psychological outcomes (Bayes factor (BF) = 305) and moderate support for physical outcomes (BF = 6.1). Exploring sources of heterogeneity with meta-regression indicated that older age of patients and longer duration of interventions were associated with smaller effects on psychological outcomes. CONCLUSIONS The results support psychosocial intervention as an additional, useful tool in multidisciplinary respiratory care with the potential to improve both psychological and physical outcomes. Future studies are recommended to monitor adverse effects, apply blinding of active control conditions, and determine sample sizes with a priori power calculations. REGISTRATION Registered with Prospero (www.crd.york.ac.uk/prospero/) prior to initiation of the literature search (Reg. ID: CRD42020170083).
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Affiliation(s)
- Ingeborg Farver-Vestergaard
- From the Department of Medicine (Farver-Vestergaard, Løkke), Vejle Hospital, Lillebaelt Hospital, Vejle, Denmark; and Unit for Psychooncology and Health Psychology (Tingdal Taube Danielsen, Zachariae), Aarhus University Hospital and Aarhus University, Aarhus, Denmark
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15
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Saunders J, Allen C. Transitioning Transdiagnostic CBT from Face-to-Face to Telephone Delivery During the Coronavirus Pandemic: A Case Study. Clin Case Stud 2021; 20:498-514. [PMID: 38603157 PMCID: PMC8137862 DOI: 10.1177/15346501211018278] [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] [Indexed: 11/17/2022]
Abstract
The coronavirus pandemic led to worldwide disruption in the delivery of face-to-face mental health services. This impact was marked for individuals with long-term health conditions and comorbid depression and anxiety. Many face-to-face mental health services switched to remote delivery or paused therapeutic input entirely, despite the lack of research on the efficacy of switching between modalities mid-therapy or having breaks in therapy. This paper presents the case of a patient with long-term health conditions who experienced both breaks in therapy and a switch in modalities from face-to-face to telephone delivery. The intervention used was based on transdiagnostic cognitive behavioral therapy and self-report measures were completed at the beginning and end of the twelve sessions. Despite the shift in modalities, the patient experienced clinically significant recovery on all measures, indicating the efficacy of therapy was not greatly affected by the shift in modalities. Long breaks in therapy were linked to deterioration in mental health, although this could be due to the deterioration in physical health that necessitated these breaks. This case highlights the benefits and challenges of a shifting modality of therapy during treatment and in response to a pandemic for a shielding population. From the work presented here, it seems beneficial for services to be able to work across multiple modalities to suit the needs of the patients and ensure continuity of treatment. It also indicates that pauses in therapy may risk deterioration. Further work is needed to prevent digital exclusion of patients.
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Affiliation(s)
- Jess Saunders
- Assistant Clinical Psychologist for
Berkshire Healthcare NHS Foundation Trust, Berkshire, UK
| | - Chris Allen
- Consultant Clinical Psychologist for
Berkshire Healthcare NHS Foundation Trust, Berkshire, UK
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16
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Kelly C, Hamer O, Irving GJ, Jones K, Knighting K, Wat D, Spencer S. Cognitive behavioural approaches for managing dyspnoea in people with chronic obstructive pulmonary disease (COPD). Hippokratia 2021. [DOI: 10.1002/14651858.cd014957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Carol Kelly
- Respiratory Research Centre, Faculty of Health, Social Care & Medicine; Edge Hill University; Ormskirk UK
| | - Oliver Hamer
- Respiratory Research Centre, Faculty of Health, Social Care & Medicine; Edge Hill University; Ormskirk UK
| | - Greg J Irving
- Health Research Institute; Faculty of Health, Social Care & Medicine, Edge Hill University; Ormskirk UK
| | - Karl Jones
- Liverpool John Moores University; Liverpool UK
| | - Katherine Knighting
- Health Research Institute; Faculty of Health, Social Care & Medicine, Edge Hill University; Ormskirk UK
| | - Dennis Wat
- Liverpool Heart and Chest Hospital; Liverpool UK
- Faculty of Life Sciences; University of Liverpool; Liverpool UK
| | - Sally Spencer
- Health Research Institute, Faculty of Health, Social Care & Medicine; Edge Hill University; Ormskirk UK
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17
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Fearn M, Harper R, Major G, Bhar S, Bryant C, Dow B, Dunt D, Mnatzaganian G, O'Connor D, Ratcliffe J, Samuel S, Bagnall AM, Doyle C. Befriending Older Adults in Nursing Homes: Volunteer Perceptions of Switching to Remote Befriending in the COVID-19 Era. Clin Gerontol 2021; 44:430-438. [PMID: 33403935 DOI: 10.1080/07317115.2020.1868646] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objectives: Residents in nursing homes are being isolated to prevent exposure to COVID-19. Many are prone to depression, anxiety and loneliness, and extra isolation leaves them vulnerable to compromised mental health. In this study, trained volunteers providing befriending for residents with symptoms of depression, anxiety and loneliness switched to remote befriending during COVID-19. The purpose of this study was to gauge volunteer perceptions of the switch.Methods: A qualitative phenomenological approach was used to understand how switching to remote befriending impacted on volunteers and residents. A convenience sample of 18 participants responded to questions either in individual or group interviews.Results: Volunteers adapted their befriending visits, switching from face to face visits to remote options. The format was decided collaboratively. Hearing impairments hindered phone calls. Residents sometimes felt uncomfortable with digital technology but on the whole, the change to remote "visiting" was accepted.Conclusions: Further research is being conducted to gauge mental health outcomes for residents. Most volunteers and residents accepted the switch to remote befriending as better than no contact.Clinical implications: Volunteers can provide valuable support for residents living with social isolation during COVID-19. The format for social support needs to be decided collaboratively between volunteer and resident.
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Affiliation(s)
- Marcia Fearn
- Aged Care Division, National Ageing Research Institute, Melbourne, Australia
| | - Robin Harper
- Aged Care Division, National Ageing Research Institute, Melbourne, Australia
| | - Georgia Major
- Aged Care Division, National Ageing Research Institute, Melbourne, Australia
| | - Sunil Bhar
- Department of Psychological Sciences, Swinburne University, Melbourne, Australia
| | - Christina Bryant
- School Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Briony Dow
- Aged Care Division, National Ageing Research Institute, Melbourne, Australia.,School Psychological Sciences, The University of Melbourne, Melbourne, Australia.,School Nursing, Deakin University, Melbourne, Australia
| | - David Dunt
- School Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | | | | | - Julie Ratcliffe
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Sarah Samuel
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Anne Marie Bagnall
- School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Colleen Doyle
- Aged Care Division, National Ageing Research Institute, Melbourne, Australia.,Department of Psychological Sciences, Swinburne University, Melbourne, Australia
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18
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Doyle C, Bhar S, Bryant C, Dow B, Dunt D, Mnatzaganian G, O'Connor D, Ratcliffe J, You E, Bagnall AM, Major G, Harper R, Fearn M. BEFRIENding for Depression, Anxiety and Social support in older adults living in Australian residential aged care facilities (BEFRIENDAS): randomised controlled trial protocol. BMC Geriatr 2021; 21:305. [PMID: 33980168 PMCID: PMC8115389 DOI: 10.1186/s12877-021-02233-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This protocol describes an ongoing study of the impact of befriending on depression, anxiety and loneliness in older people living in residential aged care facilities in Australia. While systematic reviews of befriending have indicated positive benefits of befriending for people in a range of ages and settings, there have been no randomised controlled trials (RCTs) of befriending for older people living in residential aged care with depression and no studies of the cost effectiveness of befriending in residential aged care facilities (RACFs) in Australia. METHODS AND ANALYSIS We are conducting a single blind pragmatic RCT comparing two groups of older people living in RACFs, one receiving an intervention consisting of weekly befriending for 4 months from a trained volunteer and the other receiving treatment as usual. Participants undergo eligibility screening for depression (GDS-15 ≥ 4) and cognitive impairment (GPCog ≥ 4) and assessments at three measurement time points: baseline prior to randomisation, 2 months post-baseline and 4 months post-baseline. The primary outcome measure is depression, and secondary outcome measures are anxiety, loneliness, social isolation and quality of life. The economic evaluation will take the form of a cost-utility analysis based on the outcome of quality of life. The primary and secondary outcomes will be analysed using negative binomial and logistic regressions utilizing the Generalised Estimating Equations approach. DISCUSSION To our knowledge, this is the first RCT evaluating the effectiveness of befriending on older people with depression living in residential aged care. It is expected that the befriending intervention will reduce the severity of depression symptoms experienced by older people living in residential aged care. If the intervention proves effective it may be incorporated into volunteer training programs and adopted as a way of supporting older people's mental health. TRIAL REGISTRATION Trial registered with the Australian and New Zealand Clinical Trial Registry (ANZCTR) Number: ACTRN12619000676112 , registered 06/05/2019 - retrospectively registered.
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Affiliation(s)
- Colleen Doyle
- Aged Care Division, National Ageing Research Institute, Poplar Road, Parkville, 3052, Australia. .,Department of Psychological Sciences, Swinburne University, John Street, Hawthorn, 3122, Australia. .,School of Nursing and Midwifery, Deakin University, Burwood Highway, Burwood, 3125, Australia.
| | - Sunil Bhar
- Department of Psychological Sciences, Swinburne University, John Street, Hawthorn, 3122, Australia
| | - Christina Bryant
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Grattan Street, Parkville, 3010, Australia
| | - Briony Dow
- Aged Care Division, National Ageing Research Institute, Poplar Road, Parkville, 3052, Australia.,School of Nursing and Midwifery, Deakin University, Burwood Highway, Burwood, 3125, Australia.,School of Population and Global Health, The University of Melbourne, Grattan Street, Parkville, 3010, Australia
| | - David Dunt
- School of Population and Global Health, The University of Melbourne, Grattan Street, Parkville, 3010, Australia
| | | | - Daniel O'Connor
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, 3800, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, Flinders University, Sturt Road, Bedford Park, 5042, Australia
| | - Emily You
- Academic Unit for Psychiatry of Old Age, The University of Melbourne, Poplar Road, Parkville, 3052, Australia
| | | | - Georgia Major
- Aged Care Division, National Ageing Research Institute, Poplar Road, Parkville, 3052, Australia
| | - Robin Harper
- Aged Care Division, National Ageing Research Institute, Poplar Road, Parkville, 3052, Australia
| | - Marcia Fearn
- Aged Care Division, National Ageing Research Institute, Poplar Road, Parkville, 3052, Australia
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19
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Digital Interventions for Psychological Comorbidities in Chronic Diseases-A Systematic Review. J Pers Med 2021; 11:jpm11010030. [PMID: 33418971 PMCID: PMC7825345 DOI: 10.3390/jpm11010030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 12/13/2022] Open
Abstract
Chronic diseases represent one of the main causes of death worldwide. The integration of digital solutions in clinical interventions is broadly diffused today; however, evidence on their efficacy in addressing psychological comorbidities of chronic diseases is sparse. This systematic review analyzes and synthesizes the evidence about the efficacy of digital interventions on psychological comorbidities outcomes of specific chronic diseases. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search of PubMed, PsycInfo, Scopus and Web of Science databases was conducted. Only Randomized Controlled Trials (RCTs) were considered and either depression or anxiety had to be assessed to match the selection criteria. Of the 7636 identified records, 17 matched the inclusion criteria: 9 digital interventions on diabetes, 4 on cardiovascular diseases, 3 on Chronic Obstructive Pulmonary Disease (COPD) and one on stroke. Of the 17 studies reviewed, 14 found digital interventions to be effective. Quantitative synthesis highlighted a moderate and significant overall effect of interventions on depression, while the effect on anxiety was small and non-significant. Design elements making digital interventions effective for psychological comorbidities of chronic diseases were singled out: (a) implementing a communication loop with patients and (b) providing disease-specific digital contents. This focus on “how” to design technologies can facilitate the translation of evidence into practice.
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20
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Zhang X, Yin C, Tian W, Lu D, Yang X. Effects of cognitive behavioral therapy on anxiety and depression in patients with chronic obstructive pulmonary disease: A meta-analysis and systematic review. THE CLINICAL RESPIRATORY JOURNAL 2020; 14:891-900. [PMID: 32510764 DOI: 10.1111/crj.13226] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 04/27/2020] [Accepted: 05/22/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Symptoms such as depression and anxiety are common psychiatric symptoms in patients with chronic obstructive pulmonary disease (COPD). Cognitive behavioral therapy (CBT) is still controversial in the treatment of anxiety and depression in patients with COPD. We conducted a meta-analysis and systematic review to evaluate the effect of CBT on anxiety and depression in patients with COPD, with a view to providing some guidance for clinical application. MATERIALS AND METHODS Computer search Web of Science, EMbase, PubMed, Cochrane Library, search time limit from the establishment of the library to August 2019. Collect the randomized controlled trial (RCT) for this topic. Two investigators independently screened the literature according to inclusion and exclusion criteria, extracted the data and assessed the risk of bias in the included studies. Meta-analysis using RevMan5.3 software. RESULTS A total of 10 studies were included in a total of 1278 patients. Meta-analysis shows that CBT can improve depression and anxiety in patients with COPD. Subgroup analysis showed that intervention time ≥8 weeks had significant differences in improving anxiety, while intervention time <8weeks had significant differences in improving depression. CONCLUSIONS Cognitive behavioral therapy may possibly relieve depression in COPD patients in a short period of time, and it takes longer to improve anxiety. Therefore, clinical practice can choose the appropriate intervention time according to the patient's psychological condition.
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Affiliation(s)
- Xuemei Zhang
- School of Nursing, Graduate School of Bengbu Medical College, Bengbu, China
- Department of Respiratory Medicine, Chongqing People's Hospital, Chongqing, China
| | - Changchun Yin
- Department of Respiratory Medicine, Chongqing People's Hospital, Chongqing, China
| | - Wuguo Tian
- Department of Breast and Thyroid Surgery, Land Force Featured Medical Center of the Chinese People's Liberation Army, Chongqing, China
| | - Dongbing Lu
- School of Nursing, Graduate School of Bengbu Medical College, Bengbu, China
| | - Xiumu Yang
- School of Nursing, Graduate School of Bengbu Medical College, Bengbu, China
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21
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XIE L, ZHU X, LIU M, LIU Y. Effectiveness of Cognitive Behavioral Therapy on Health Outcomes in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. JOURNAL OF EVIDENCE-BASED PSYCHOTHERAPIES 2020. [DOI: 10.24193/jebp.2020.2.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
"The incidence of psychological distress (such as anxiety and depression) is high in COPD patients. CBT has been proved to reduce depression and anxiety and enhance quality of life. This meta-analysis evaluated the effectiveness of cognitive behavioral therapy(CBT) on patients with chronic obstructive pulmonary disease(COPD). The following electronic databases were searched from inception to March
2020: PubMed, EMBase, Cochrane Library, Web of Science, Medline, OVID, CINAHL, Chinese Biomedical Literature Database (CBM), China
National Knowledge Infrastructure (CNKI), Wangfang Database (WF), PsycARTICLES, VIP database. The Scopus and Google scholar database that we did not use. Randomized controlled trials (RCTs) that compared CBT with routine methods of care in COPD were retrieved in electronic databases. The Cochrane Risk of Bias Tool and Review Manager version 5.3 were used for risk of bias assessment and meta-analysis, respectively. Both data synthesis and descriptive analysis were used for outcome assessment. A total of 10 RCTs involving 1173 patients were included. Data synthesis showed that CBT was statistically significant in improving short- and medium-term depression and treatment compliance. Mediumterm anxiety and quality of life were improved among COPD patients receiving CBT, although no significant effect was found for short-term quality of life and anxiety. Descriptive analysis showed that CBT could reduce dyspnea. No clear evidence supports the effectiveness on improving self-efficacy in COPD patients with the use of CBT (P > 0.05).
CBT can be a useful strategy to improve the symptoms of depression, dyspnea and treatment compliance in patients with COPD. It can also improve patients’ quality of life and anxiety to some extent, but there is still lack of strong evidence in improving patients’ self-efficacy."
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Affiliation(s)
- Lin XIE
- The Second Hospital of Jingzhou, Hubei, China
| | | | - Miao LIU
- School of Nursing, Yangtze University, Hubei, China
| | - Yang LIU
- "Affiliated Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hubei, China"
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22
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Boström E, Ali L, Fors A, Ekman I, Andersson AE. Registered nurses' experiences of communication with patients when practising person-centred care over the phone: a qualitative interview study. BMC Nurs 2020; 19:54. [PMID: 32577097 PMCID: PMC7304080 DOI: 10.1186/s12912-020-00448-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/12/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND To explore registered nurses' (RNs') experiences of practising person-centred care (PCC) by telephone with people diagnosed with chronic obstructive pulmonary disease and/or chronic heart failure. METHODS Qualitative interview study. Four RNs were individually interviewed before, during, and after participating in an intervention practising PCC by telephone. The interviews were analysed using qualitative content analysis. RESULTS The results reflect three categories of their experience: realize the complexity of practising PCC by distance, gain insight into what PCC communication meant to RNs and their approach, and develop the professional role by practising PCC theory and ethics. CONCLUSIONS PCC over the telephone facilitate healthcare and support patients. Through careful listening, the RNs (1) created space for the individual patients to express their thoughts and feelings and (2) emphasized each patient's capabilities and resources. The RNs also gained an understanding of PCC and what it means to patients and to themselves as practitioners. Potential implications are that it is important for RNs practising PCC by telephone to remould their role, to listen carefully, and to communicate as equals in conversations that respect both parties' knowledge and expertise. Health professionals need supervision and support to fully understand the person-centred approach and provide communications that support it.
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Affiliation(s)
- Eva Boström
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Lilas Ali
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 405 30 Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 405 30 Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Närhälsan Research and Development Primary Health Care, Region Västra, Götaland, Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 405 30 Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Annette Erichsen Andersson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 405 30 Gothenburg, Sweden
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Williams MT, Johnston KN, Paquet C. Cognitive Behavioral Therapy for People with Chronic Obstructive Pulmonary Disease: Rapid Review. Int J Chron Obstruct Pulmon Dis 2020; 15:903-919. [PMID: 32425516 PMCID: PMC7186773 DOI: 10.2147/copd.s178049] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/21/2020] [Indexed: 12/30/2022] Open
Abstract
Cognitive behavioral therapy (CBT) is increasingly recommended in the management of people living with chronic obstructive pulmonary disease (COPD). This rapid review presents the evidence base for CBT for people with COPD and describes 1) the nature of CBT interventions and comparators in controlled trials (high or low resource intensity); and 2) factors influencing intervention effects on health outcomes (anxiety, depression, breathlessness, quality of life and exercise capacity). Primary studies reporting CBT interventions in adults with COPD were identified with data extracted by a single reviewer (20% of studies checked for data accuracy). Studies were synthesized descriptively with meta-analyses (random effects models) of controlled trials undertaken to report mean standardized effect sizes (95% CI) for health outcomes. Random effects meta-regression models explored whether CBT target, intervention dosage, intensity, facilitator profession, delivery mode, clinically significant anxiety/depression, trial design/quality and sample size predicted effect size. The search identified 33 primary studies published between 1996 and 2019 (controlled trials n=24, single group cohort n=6, case exemplars n=2, phenomenological n=1). Controlled trials frequently compared high-intensity CBT interventions against enhanced/usual care (n=12) or high-intensity CBT interventions against high-intensity comparators (n=11). When all controlled studies were included, small, significant improvements favoring CBT were evident across all health outcomes (SMD ranged from -0.27 to 0.35, p<0.05). When intensity dyads were considered, significant improvements were evident only when high-intensity CBT interventions were compared to enhanced usual care/usual care (SMDs ranged from -0.45 to 0.54, p <0.05). No other variable consistently predicted intervention effect sizes across all health outcomes. Overall, the evidence base supports the use of CBT for a range of health outcomes in people with COPD. Consistent benefits were evident when high-resource-intensive CBT interventions were compared to usual care. Low-resource-intensity CBT warrants further investigation in settings where cost of comprehensive care is prohibitive.
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Affiliation(s)
- Marie T Williams
- Innovation, Implementation and Clinical Translation in Health (IIMPACT), School of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Kylie N Johnston
- Innovation, Implementation and Clinical Translation in Health (IIMPACT), School of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Catherine Paquet
- Australian Centre of Precision Health, School of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
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Ma RC, Yin YY, Wang YQ, Liu X, Xie J. Effectiveness of cognitive behavioural therapy for chronic obstructive pulmonary disease patients: A systematic review and meta-analysis. Complement Ther Clin Pract 2019; 38:101071. [PMID: 31743870 DOI: 10.1016/j.ctcp.2019.101071] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 11/11/2019] [Accepted: 11/11/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND and purpose: Cognitive behavioural therapy (CBT) has gained increasing attention for the treatment of psychological disorders. This study aims to establish the effectiveness of CBT on psychological and physical outcomes in patients with chronic obstructive pulmonary disease (COPD). METHODS Two waves of electronic searches of the PubMed, Cochrane library, EMBASE, Web of Science and China National Knowledge Infrastructure databases were conducted. Statistical analyses were performed using Revman Manager 5.3 and Stata 12.0 software. RESULTS Sixteen randomized controlled trials were eligible. There were significant improvements in anxiety (SMD = -0.23; 95% CI: -0.42 to -0.04; P = 0.02), depression (SMD = -0.29, 95% CI: -0.40 to -0.19, P < 0.01), quality of life (MD = -5.21; 95% CI: -10.25 to -0.17; P = 0.04), and mean visits to emergency departments in the CBT groups. No statistically significant differences were observed in fatigue (SMD = 0.88, 95% CI: -0.58 to 2.35, P = 0.24), exercise capacity (MD = 28.75, 95% CI: -28.30 to 85.80, P = 0.32), self-efficacy (SMD = 0.15, 95% CI: -0.05 to 0.34, P = 0.14), or sleep quality (MD = 1.21, 95% CI: -0.65 to 3.06, P = 0.20). CONCLUSION This meta-analysis suggests that CBT can serve as a complementary therapy to improve anxiety, depression, and quality of life in COPD patients and deserves more widespread application in clinical practice.
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Affiliation(s)
- Rui-Chen Ma
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China
| | - Ying-Ying Yin
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China
| | - Ya-Qing Wang
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China
| | - Xin Liu
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China
| | - Jiao Xie
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China.
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Zareifopoulos N, Bellou A, Spiropoulou A, Spiropoulos K. Prevalence, Contribution to Disease Burden and Management of Comorbid Depression and Anxiety in Chronic Obstructive Pulmonary Disease: A Narrative Review. COPD 2019; 16:406-417. [DOI: 10.1080/15412555.2019.1679102] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Nicholas Zareifopoulos
- Department of Pulmonology, University of Patras School of Health Science, Patras, Achaea, Greece
| | - Aggeliki Bellou
- Department of Pulmonology, University of Patras School of Health Science, Patras, Achaea, Greece
| | - Agathi Spiropoulou
- Department of Pulmonology, University of Patras School of Health Science, Patras, Achaea, Greece
| | - Kostas Spiropoulos
- Department of Pulmonology, University of Patras School of Health Science, Patras, Achaea, Greece
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Pumar MI, Roll M, Fung P, Rolls TA, Walsh JR, Bowman RV, Fong KM, Yang IA. Cognitive behavioural therapy (CBT) for patients with chronic lung disease and psychological comorbidities undergoing pulmonary rehabilitation. J Thorac Dis 2019; 11:S2238-S2253. [PMID: 31737351 DOI: 10.21037/jtd.2019.10.23] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background The study aimed to determine the effects of adding cognitive behavioural therapy (CBT) to pulmonary rehabilitation to treat patients with chronic lung disease and comorbid anxiety and/or depression symptoms. Methods An open, parallel group, randomised controlled trial (RCT) was conducted, with longitudinal follow-up of 12 months. CBT was delivered in 2 face-to-face sessions and 4 phone sessions to patients with depression or anxiety undergoing pulmonary rehabilitation. The main outcome measures were change in Geriatric Depression Scale (GDS) and Geriatric Anxiety Inventory (GAI); secondary outcomes were St. Georges Respiratory Questionnaire (SGRQ), 6-minute walk test (6MWT) and pulmonary rehabilitation attendance. Results A total of 65 patients were randomized to Intervention (n=24) and Control (n=41) groups. Of the 24 patients in the Intervention group, 6 patients (25%) withdrew and 4 patients (12.5%) failed to attend more than 2 CBT sessions, which was significantly more than the Control group. The majority of patients (75.4%) had chronic obstructive pulmonary disease. Fourteen (21.5%) had symptoms of depression only, 12 (18.4%) had symptoms of anxiety only, and 39 (60.0%) had symptoms of both anxiety and depression. In the Intervention group, GDS significantly improved at the end of pulmonary rehabilitation (mean difference -3.1, 95% CI: -4.39 to -1.70; P=0.0001), 3 months follow-up (mean difference -1.5, 95% CI: -4.17 to -0.75; P=0.008), and at 12 months follow-up (mean difference -1.6, 95% CI: -3.29 to -0.03, P=0.04), compared to baseline. The Control group demonstrated improvement in GDS by the end of pulmonary rehabilitation (mean difference -1.3, 95% CI: -2.4 to -0.27; P=0.01) which was not maintained at 3 months (P=0.14) and 12 months (P=0.25). GAI significantly improved by the end of rehabilitation in both the Intervention (mean difference -2.6, 95% -4.69 to -0.57; P=0.01) and Control groups (mean difference -2.6, 95% -4.16 to -1.14; P=0.001) and there was no significant improvement at 3 and 12 months. No statistically significant differences in changes in GDS or GAI were observed between the Intervention and Control groups at any time point. There was no significant improvement in SGRQ or 6MWT. There was a significant increase in attended pulmonary rehabilitation sessions in the Intervention group, compared to the Control group (mean difference 1.59; 95% CI: 0.11 to 3.07; P=0.03). Conclusions In this RCT of patients with chronic lung diseases attending pulmonary rehabilitation, there was no evidence found for improved symptoms of anxiety or depression or health-related quality of life with the addition of CBT given in a mixed face-to-face and telephone format, compared to usual care. Slower than anticipated recruitment, leading to a smaller than planned sample size, and a high dropout rate in the group allocated to CBT may have limited the effectiveness of the behavioural intervention approach in this study.
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Affiliation(s)
- Marsus I Pumar
- Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Immunology and Allergy, Royal Melbourne Hospital, Victoria, Australia
| | - Mark Roll
- Physiotherapy Department, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Pamela Fung
- Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Tricia A Rolls
- Psychology Department, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - James R Walsh
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Physiotherapy Department, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Rayleen V Bowman
- Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Kwun M Fong
- Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Ian A Yang
- Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Pollok J, van Agteren JEM, Esterman AJ, Carson‐Chahhoud KV. Psychological therapies for the treatment of depression in chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2019; 3:CD012347. [PMID: 30838649 PMCID: PMC6400788 DOI: 10.1002/14651858.cd012347.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) has been recognised as a global health concern, and one of the leading causes of morbidity and mortality worldwide. Projections of the World Health Organization (WHO) indicate that prevalence rates of COPD continue to increase, and by 2030, it will become the world's third leading cause of death. Depression is a major comorbidity amongst patients with COPD, with an estimate prevalence of up to 80% in severe stages of COPD. Prevalence studies show that patients who have COPD are four times as likely to develop depression compared to those without COPD. Regrettably, they rarely receive appropriate treatment for COPD-related depression. Available findings from trials indicate that untreated depression is associated with worse compliance with medical treatment, poor quality of life, increased mortality rates, increased hospital admissions and readmissions, prolonged length of hospital stay, and subsequently, increased costs to the healthcare system. Given the burden and high prevalence of untreated depression, it is important to evaluate and update existing experimental evidence using rigorous methodology, and to identify effective psychological therapies for patients with COPD-related depression. OBJECTIVES To assess the effectiveness of psychological therapies for the treatment of depression in patients with chronic obstructive pulmonary disease. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2018, Issue 11), and Ovid MEDLINE, Embase and PsycINFO from June 2016 to 26 November 2018. Previously these databases were searched via the Cochrane Airways and Common Mental Disorders Groups' Specialised Trials Registers (all years to June 2016). We searched ClinicalTrials.gov, the ISRCTN registry, and the World Health Organization International Clinical Trials Registry Platform (ICTRP) to 26 November 2018 to identify unpublished or ongoing trials. Additionally, the grey literature databases and the reference lists of studies initially identified for full-text screening were also searched. SELECTION CRITERIA Eligible for inclusion were randomised controlled trials that compared the use of psychological therapies with either no intervention, education, or combined with a co-intervention and compared with the same co-intervention in a population of patients with COPD whose depressive symptoms were measured before or at baseline assessment. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the titles and abstracts identified by the search to determine which studies satisfied the inclusion criteria. We assessed two primary outcomes: depressive symptoms and adverse events; and the following secondary outcomes: quality of life, dyspnoea, forced expiratory volume in one second (FEV1), exercise tolerance, hospital length of stay or readmission rate, and cost-effectiveness. Potentially eligible full-text articles were also independently assessed by two review authors. A PRISMA flow diagram was prepared to demonstrate the decision process in detail. We used the Cochrane 'Risk of bias' evaluation tool to examine the risk of bias, and assessed the quality of evidence using the GRADE framework. All outcomes were continuous, therefore, we calculated the pooled standardised mean difference (SMD) or mean difference (MD) with a corresponding 95% confidence interval (CI). We used a random-effects model to calculate treatment effects. MAIN RESULTS The findings are based on 13 randomised controlled trials (RCTs), with a total of 1500 participants. In some of the included studies, the investigators did not recruit participants with clinically confirmed depression but applied screening criteria after randomisation. Hence, across the studies, baseline scores for depressive symptoms varied from no symptoms to severe depression. The severity of COPD across the studies was moderate to severe.Primary outcomesThere was a small effect showing the effectiveness of psychological therapies in improving depressive symptoms when compared to no intervention (SMD 0.19, 95% CI 0.05 to 0.33; P = 0.009; 6 studies, 764 participants), or to education (SMD 0.23, 95% CI 0.06 to 0.41; P = 0.010; 3 studies, 507 participants).Two studies compared psychological therapies plus a co-intervention versus the co-intervention alone (i.e. pulmonary rehabilitation (PR)). The results suggest that a psychological therapy combined with a PR programme can reduce depressive symptoms more than a PR programme alone (SMD 0.37, 95% CI -0.00 to 0.74; P = 0.05; 2 studies, 112 participants).We rated the quality of evidence as very low. Owing to the nature of psychological therapies, blinding of participants, personnel, and outcome assessment was a concern.None of the included studies measured adverse events.Secondary outcomesQuality of life was measured in four studies in the comparison with no intervention, and in three studies in the comparison with education. We found inconclusive results for improving quality of life. However, when we pooled data from two studies using the same measure, the result suggested that psychological therapy improved quality of life better than no intervention. One study measured hospital admission rates and cost-effectiveness and showed significant reductions in the intervention group compared to the education group. We rated the quality of evidence as very low for the secondary outcomes. AUTHORS' CONCLUSIONS The findings from this review indicate that psychological therapies (using a CBT-based approach) may be effective for treating COPD-related depression, but the evidence is limited. Depressive symptoms improved more in the intervention groups compared to: 1) no intervention (attention placebo or standard care), 2) educational interventions, and 3) a co-intervention (pulmonary rehabilitation). However, the effect sizes were small and quality of the evidence very low due to clinical heterogeneity and risk of bias. This means that more experimental studies with larger numbers of participants are needed, to confirm the potential beneficial effects of therapies with a CBT approach for COPD-related depression.New trials should also address the gap in knowledge related to limited data on adverse effects, and the secondary outcomes of quality of life, dyspnoea, forced expiratory volume in one second (FEV1), exercise tolerance, hospital length of stay and frequency of readmissions, and cost-effectiveness. Also, new research studies need to adhere to robust methodology to produce higher quality evidence.
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Affiliation(s)
- Justyna Pollok
- The University of AdelaideFaculty of Health and Medical SciencesNorth TerraceAdelaideSouth AustraliaAustralia5005
- The University of AdelaideAdelaideAustralia
| | - Joep EM van Agteren
- Flinders UniversityCollege of Medicine and Public HealthAdelaideAustralia
- South Australian Health and Medical Research InstituteWellbeing and Resilience CentreAdelaideAustralia
| | - Adrian J Esterman
- University of South AustraliaDivision of Health SciencesAdelaideAustralia
- James Cook UniversityAustralian Institute of Tropical Health and MedicineCairnsAustralia
| | - Kristin V Carson‐Chahhoud
- University of South AustraliaSchool of Health SciencesCity East Campus, Frome RoadAdelaideAustralia5001
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28
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Moayeri F, Dunt D, Hsueh YSA, Doyle C. Cost-utility analysis of telephone-based cognitive behavior therapy in chronic obstructive pulmonary disease (COPD) patients with anxiety and depression comorbidities: an application for willingness to accept concept. Expert Rev Pharmacoecon Outcomes Res 2018; 19:331-340. [PMID: 30324818 DOI: 10.1080/14737167.2019.1536550] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND This study evaluated the cost-utility of telephone-based cognitive behavioral therapy (TB-CBT) (experimental arm) in comparison with a placebo-befriending (control arm) program in COPD participants with mild to severe depression and/or anxiety. METHODS The decision rule was based on willingness-to-pay if there is an increased unit of effectiveness (a quality-adjusted life year [QALY] gain) and an increase in cost, and willingness-to-accept (WTA) if there is a reduced unit of effectiveness (a QALY loss) and decrease in cost (a cost-saving). RESULTS TB-CBT group was associated with a reduction in the incremental cost of AUS-$407.3 (p < 0.001, SE:34.1) plus a negative, nonsignificant incremental QALY gain of -0.008 (SE:0.011) per patient compared to control group. The point estimate of the mean incremental cost-utility ratio was AUS$50,284.0 cost saving per QALY sacrificed (the high value associated with small QALY value in the denominator). Ninety-five percent CI was AUS$13,426 cost sacrificed to AUS$32,018 cost gain (lower values associated with larger QALY values in the denominator). If the societal's minimum (flooring threshold) WTA is AUS$64,000 per QALY forgone, the probability of TB-CBT being cost-effective was 42% Conclusions: This study showed that TB-CBT can be recommended as a cost-saving and preventive approach over usual care plus befriending program.
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Affiliation(s)
- Foruhar Moayeri
- a Centre for Health Policy, Melbourne School of Population and Global Health , The University of Melbourne , Carlton Victoria , Australia
| | - David Dunt
- a Centre for Health Policy, Melbourne School of Population and Global Health , The University of Melbourne , Carlton Victoria , Australia
| | - Ya-Seng Arthur Hsueh
- a Centre for Health Policy, Melbourne School of Population and Global Health , The University of Melbourne , Carlton Victoria , Australia
| | - Colleen Doyle
- b Australian Catholic University, Faculty of Health Sciences , School of Behavioural and Health Sciences (VIC), Villa Maria Catholic Homes , Kew Victoria , Australia
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29
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Pelgrim CE, Peterson JD, Gosker HR, Schols AMWJ, van Helvoort A, Garssen J, Folkerts G, Kraneveld AD. Psychological co-morbidities in COPD: Targeting systemic inflammation, a benefit for both? Eur J Pharmacol 2018; 842:99-110. [PMID: 30336140 DOI: 10.1016/j.ejphar.2018.10.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/24/2018] [Accepted: 10/08/2018] [Indexed: 12/15/2022]
Abstract
COPD is a chronic lung disease characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities. Furthermore, COPD is often characterized by extrapulmonary manifestations and comorbidities worsening COPD progression and quality of life. A neglected comorbidity in COPD management is mental health impairment defined by anxiety, depression and cognitive problems. This paper summarizes the evidence for impaired mental health in COPD and focuses on current pharmacological intervention strategies. In addition, possible mechanisms in impaired mental health in COPD are discussed with a central role for inflammation. Many comorbidities are associated with multi-organ-associated systemic inflammation in COPD. Considering the accumulative evidence for a major role of systemic inflammation in the development of neurological disorders, it can be hypothesized that COPD-associated systemic inflammation also affects the function of the brain and is an interesting therapeutic target for nutra- and pharmaceuticals.
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Affiliation(s)
- Charlotte E Pelgrim
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Julia D Peterson
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Harry R Gosker
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Respiratory Medicine, Maastricht, the Netherlands
| | - Annemie M W J Schols
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Respiratory Medicine, Maastricht, the Netherlands
| | - Ardy van Helvoort
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Respiratory Medicine, Maastricht, the Netherlands; Nutrition, Metabolism and Muscle Sciences, Nutricia Research, Utrecht, the Netherlands
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands; Platform Immunology, Nutricia Research, Utrecht, the Netherlands
| | - Gert Folkerts
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Aletta D Kraneveld
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands; Veterinary Pharmacology & Therapeutics, Institute of Risk Assessment Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands.
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30
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Kastner M, Cardoso R, Lai Y, Treister V, Hamid JS, Hayden L, Wong G, Ivers NM, Liu B, Marr S, Holroyd-Leduc J, Straus SE. Effectiveness of interventions for managing multiple high-burden chronic diseases in older adults: a systematic review and meta-analysis. CMAJ 2018; 190:E1004-E1012. [PMID: 30150242 PMCID: PMC6110649 DOI: 10.1503/cmaj.171391] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION More than half of older adults (age ≥ 65 yr) have 2 or more high-burden multimorbidity conditions (i.e., highly prevalent chronic diseases, which are associated with increased health care utilization; these include diabetes [DM], dementia, depression, chronic obstructive pulmonary disease [COPD], cardiovascular disease [CVD], arthritis, and heart failure [HF]), yet most existing interventions for managing chronic disease focus on a single disease or do not respond to the specialized needs of older adults. We conducted a systematic review and meta-analysis to identify effective multimorbidity interventions compared with a control or usual care strategy for older adults. METHODS We searched bibliometric databases for randomized controlled trials (RCTs) evaluating interventions for managing multiple chronic diseases in any language from 1990 to December 2017. The primary outcome was any outcome specific to managing multiple chronic diseases as reported by studies. Reviewer pairs independently screened citations and full-text articles, extracted data and assessed risk of bias. We assessed statistical and methodological heterogeneity and performed a meta-analysis of RCTs with similar interventions and components. RESULTS We included 25 studies (including 15 RCTs and 6 cluster RCTs) (12 579 older adults; mean age 67.3 yr). In patients with [depression + COPD] or [CVD + DM], care-coordination strategies significantly improved depressive symptoms (standardized mean difference -0.41; 95% confidence interval [CI] -0.59 to -0.22; I2 = 0%) and reduced glycosylated hemoglobin (HbA1c) levels (mean difference -0.51; 95% CI -0.90 to -0.11; I2 = 0%), but not mortality (relative risk [RR] 0.79; 95% CI 0.53 to 1.17; I2 = 0%). Among secondary outcomes, care-coordination strategies reduced functional impairment in patients with [arthritis + depression] (between-group difference -0.82; 95% CI -1.17 to -0.47) or [DM + depression] (between-group difference 3.21; 95% CI 1.78 to 4.63); improved cognitive functioning in patients with [DM + depression] (between-group difference 2.44; 95% CI 0.79 to 4.09) or [HF + COPD] (p = 0.006); and increased use of mental health services in those with [DM + (CVD or depression)] (RR 2.57; 95% CI 1.90 to 3.49; I2 = 0%). INTERPRETATION Subgroup analyses showed that older adults with diabetes and either depression or cardiovascular disease, or with coexistence of chronic obstructive pulmonary disease and heart failure, can benefit from care-coordination strategies with or without education to lower HbA1c, reduce depressive symptoms, improve health-related functional status, and increase the use of mental health services. PROTOCOL REGISTRATION PROSPERO-CRD42014014489.
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Affiliation(s)
- Monika Kastner
- Knowledge Translation and Implementation unit (Kastner, Hayden), North York General Hospital, Li Ka Shing Knowledge Institute of St. Michael's Hospital (Kastner, Cardoso, Lai, Treister, Hamid, Straus); Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Clinical Epidemiology and Biostatistics (Hamid), McMaster University, Hamilton, Ont.; Nuffield Department of Primary Care Health Sciences (Wong), University of Oxford, Oxford, UK; Family Practice Health Centre (Ivers), Women's College Research Institute, and Institute for Health System Solutions and Virtual Care, Women's College Hospital; Department of Family and Community Medicine and Institute of Health Policy (Ivers), Management and Evaluation, University of Toronto, Toronto; Regional Geriatric Program of Toronto (Liu), Sunnybrook Health Sciences, Geriatric Medicine, Toronto, Ont.; St. Peter's Hospital, Hamilton Health Sciences (Marr), Division of Geriatric Medicine (Marr), McMaster University, Hamilton, Ont.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Foothills Hospital, Calgary, Alta.; Department of Medicine (Straus), University of Toronto, Toronto, Ont.
| | - Roberta Cardoso
- Knowledge Translation and Implementation unit (Kastner, Hayden), North York General Hospital, Li Ka Shing Knowledge Institute of St. Michael's Hospital (Kastner, Cardoso, Lai, Treister, Hamid, Straus); Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Clinical Epidemiology and Biostatistics (Hamid), McMaster University, Hamilton, Ont.; Nuffield Department of Primary Care Health Sciences (Wong), University of Oxford, Oxford, UK; Family Practice Health Centre (Ivers), Women's College Research Institute, and Institute for Health System Solutions and Virtual Care, Women's College Hospital; Department of Family and Community Medicine and Institute of Health Policy (Ivers), Management and Evaluation, University of Toronto, Toronto; Regional Geriatric Program of Toronto (Liu), Sunnybrook Health Sciences, Geriatric Medicine, Toronto, Ont.; St. Peter's Hospital, Hamilton Health Sciences (Marr), Division of Geriatric Medicine (Marr), McMaster University, Hamilton, Ont.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Foothills Hospital, Calgary, Alta.; Department of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Yonda Lai
- Knowledge Translation and Implementation unit (Kastner, Hayden), North York General Hospital, Li Ka Shing Knowledge Institute of St. Michael's Hospital (Kastner, Cardoso, Lai, Treister, Hamid, Straus); Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Clinical Epidemiology and Biostatistics (Hamid), McMaster University, Hamilton, Ont.; Nuffield Department of Primary Care Health Sciences (Wong), University of Oxford, Oxford, UK; Family Practice Health Centre (Ivers), Women's College Research Institute, and Institute for Health System Solutions and Virtual Care, Women's College Hospital; Department of Family and Community Medicine and Institute of Health Policy (Ivers), Management and Evaluation, University of Toronto, Toronto; Regional Geriatric Program of Toronto (Liu), Sunnybrook Health Sciences, Geriatric Medicine, Toronto, Ont.; St. Peter's Hospital, Hamilton Health Sciences (Marr), Division of Geriatric Medicine (Marr), McMaster University, Hamilton, Ont.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Foothills Hospital, Calgary, Alta.; Department of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Victoria Treister
- Knowledge Translation and Implementation unit (Kastner, Hayden), North York General Hospital, Li Ka Shing Knowledge Institute of St. Michael's Hospital (Kastner, Cardoso, Lai, Treister, Hamid, Straus); Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Clinical Epidemiology and Biostatistics (Hamid), McMaster University, Hamilton, Ont.; Nuffield Department of Primary Care Health Sciences (Wong), University of Oxford, Oxford, UK; Family Practice Health Centre (Ivers), Women's College Research Institute, and Institute for Health System Solutions and Virtual Care, Women's College Hospital; Department of Family and Community Medicine and Institute of Health Policy (Ivers), Management and Evaluation, University of Toronto, Toronto; Regional Geriatric Program of Toronto (Liu), Sunnybrook Health Sciences, Geriatric Medicine, Toronto, Ont.; St. Peter's Hospital, Hamilton Health Sciences (Marr), Division of Geriatric Medicine (Marr), McMaster University, Hamilton, Ont.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Foothills Hospital, Calgary, Alta.; Department of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Jemila S Hamid
- Knowledge Translation and Implementation unit (Kastner, Hayden), North York General Hospital, Li Ka Shing Knowledge Institute of St. Michael's Hospital (Kastner, Cardoso, Lai, Treister, Hamid, Straus); Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Clinical Epidemiology and Biostatistics (Hamid), McMaster University, Hamilton, Ont.; Nuffield Department of Primary Care Health Sciences (Wong), University of Oxford, Oxford, UK; Family Practice Health Centre (Ivers), Women's College Research Institute, and Institute for Health System Solutions and Virtual Care, Women's College Hospital; Department of Family and Community Medicine and Institute of Health Policy (Ivers), Management and Evaluation, University of Toronto, Toronto; Regional Geriatric Program of Toronto (Liu), Sunnybrook Health Sciences, Geriatric Medicine, Toronto, Ont.; St. Peter's Hospital, Hamilton Health Sciences (Marr), Division of Geriatric Medicine (Marr), McMaster University, Hamilton, Ont.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Foothills Hospital, Calgary, Alta.; Department of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Leigh Hayden
- Knowledge Translation and Implementation unit (Kastner, Hayden), North York General Hospital, Li Ka Shing Knowledge Institute of St. Michael's Hospital (Kastner, Cardoso, Lai, Treister, Hamid, Straus); Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Clinical Epidemiology and Biostatistics (Hamid), McMaster University, Hamilton, Ont.; Nuffield Department of Primary Care Health Sciences (Wong), University of Oxford, Oxford, UK; Family Practice Health Centre (Ivers), Women's College Research Institute, and Institute for Health System Solutions and Virtual Care, Women's College Hospital; Department of Family and Community Medicine and Institute of Health Policy (Ivers), Management and Evaluation, University of Toronto, Toronto; Regional Geriatric Program of Toronto (Liu), Sunnybrook Health Sciences, Geriatric Medicine, Toronto, Ont.; St. Peter's Hospital, Hamilton Health Sciences (Marr), Division of Geriatric Medicine (Marr), McMaster University, Hamilton, Ont.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Foothills Hospital, Calgary, Alta.; Department of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Geoff Wong
- Knowledge Translation and Implementation unit (Kastner, Hayden), North York General Hospital, Li Ka Shing Knowledge Institute of St. Michael's Hospital (Kastner, Cardoso, Lai, Treister, Hamid, Straus); Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Clinical Epidemiology and Biostatistics (Hamid), McMaster University, Hamilton, Ont.; Nuffield Department of Primary Care Health Sciences (Wong), University of Oxford, Oxford, UK; Family Practice Health Centre (Ivers), Women's College Research Institute, and Institute for Health System Solutions and Virtual Care, Women's College Hospital; Department of Family and Community Medicine and Institute of Health Policy (Ivers), Management and Evaluation, University of Toronto, Toronto; Regional Geriatric Program of Toronto (Liu), Sunnybrook Health Sciences, Geriatric Medicine, Toronto, Ont.; St. Peter's Hospital, Hamilton Health Sciences (Marr), Division of Geriatric Medicine (Marr), McMaster University, Hamilton, Ont.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Foothills Hospital, Calgary, Alta.; Department of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Noah M Ivers
- Knowledge Translation and Implementation unit (Kastner, Hayden), North York General Hospital, Li Ka Shing Knowledge Institute of St. Michael's Hospital (Kastner, Cardoso, Lai, Treister, Hamid, Straus); Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Clinical Epidemiology and Biostatistics (Hamid), McMaster University, Hamilton, Ont.; Nuffield Department of Primary Care Health Sciences (Wong), University of Oxford, Oxford, UK; Family Practice Health Centre (Ivers), Women's College Research Institute, and Institute for Health System Solutions and Virtual Care, Women's College Hospital; Department of Family and Community Medicine and Institute of Health Policy (Ivers), Management and Evaluation, University of Toronto, Toronto; Regional Geriatric Program of Toronto (Liu), Sunnybrook Health Sciences, Geriatric Medicine, Toronto, Ont.; St. Peter's Hospital, Hamilton Health Sciences (Marr), Division of Geriatric Medicine (Marr), McMaster University, Hamilton, Ont.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Foothills Hospital, Calgary, Alta.; Department of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Barbara Liu
- Knowledge Translation and Implementation unit (Kastner, Hayden), North York General Hospital, Li Ka Shing Knowledge Institute of St. Michael's Hospital (Kastner, Cardoso, Lai, Treister, Hamid, Straus); Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Clinical Epidemiology and Biostatistics (Hamid), McMaster University, Hamilton, Ont.; Nuffield Department of Primary Care Health Sciences (Wong), University of Oxford, Oxford, UK; Family Practice Health Centre (Ivers), Women's College Research Institute, and Institute for Health System Solutions and Virtual Care, Women's College Hospital; Department of Family and Community Medicine and Institute of Health Policy (Ivers), Management and Evaluation, University of Toronto, Toronto; Regional Geriatric Program of Toronto (Liu), Sunnybrook Health Sciences, Geriatric Medicine, Toronto, Ont.; St. Peter's Hospital, Hamilton Health Sciences (Marr), Division of Geriatric Medicine (Marr), McMaster University, Hamilton, Ont.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Foothills Hospital, Calgary, Alta.; Department of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Sharon Marr
- Knowledge Translation and Implementation unit (Kastner, Hayden), North York General Hospital, Li Ka Shing Knowledge Institute of St. Michael's Hospital (Kastner, Cardoso, Lai, Treister, Hamid, Straus); Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Clinical Epidemiology and Biostatistics (Hamid), McMaster University, Hamilton, Ont.; Nuffield Department of Primary Care Health Sciences (Wong), University of Oxford, Oxford, UK; Family Practice Health Centre (Ivers), Women's College Research Institute, and Institute for Health System Solutions and Virtual Care, Women's College Hospital; Department of Family and Community Medicine and Institute of Health Policy (Ivers), Management and Evaluation, University of Toronto, Toronto; Regional Geriatric Program of Toronto (Liu), Sunnybrook Health Sciences, Geriatric Medicine, Toronto, Ont.; St. Peter's Hospital, Hamilton Health Sciences (Marr), Division of Geriatric Medicine (Marr), McMaster University, Hamilton, Ont.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Foothills Hospital, Calgary, Alta.; Department of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Jayna Holroyd-Leduc
- Knowledge Translation and Implementation unit (Kastner, Hayden), North York General Hospital, Li Ka Shing Knowledge Institute of St. Michael's Hospital (Kastner, Cardoso, Lai, Treister, Hamid, Straus); Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Clinical Epidemiology and Biostatistics (Hamid), McMaster University, Hamilton, Ont.; Nuffield Department of Primary Care Health Sciences (Wong), University of Oxford, Oxford, UK; Family Practice Health Centre (Ivers), Women's College Research Institute, and Institute for Health System Solutions and Virtual Care, Women's College Hospital; Department of Family and Community Medicine and Institute of Health Policy (Ivers), Management and Evaluation, University of Toronto, Toronto; Regional Geriatric Program of Toronto (Liu), Sunnybrook Health Sciences, Geriatric Medicine, Toronto, Ont.; St. Peter's Hospital, Hamilton Health Sciences (Marr), Division of Geriatric Medicine (Marr), McMaster University, Hamilton, Ont.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Foothills Hospital, Calgary, Alta.; Department of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Sharon E Straus
- Knowledge Translation and Implementation unit (Kastner, Hayden), North York General Hospital, Li Ka Shing Knowledge Institute of St. Michael's Hospital (Kastner, Cardoso, Lai, Treister, Hamid, Straus); Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Clinical Epidemiology and Biostatistics (Hamid), McMaster University, Hamilton, Ont.; Nuffield Department of Primary Care Health Sciences (Wong), University of Oxford, Oxford, UK; Family Practice Health Centre (Ivers), Women's College Research Institute, and Institute for Health System Solutions and Virtual Care, Women's College Hospital; Department of Family and Community Medicine and Institute of Health Policy (Ivers), Management and Evaluation, University of Toronto, Toronto; Regional Geriatric Program of Toronto (Liu), Sunnybrook Health Sciences, Geriatric Medicine, Toronto, Ont.; St. Peter's Hospital, Hamilton Health Sciences (Marr), Division of Geriatric Medicine (Marr), McMaster University, Hamilton, Ont.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Foothills Hospital, Calgary, Alta.; Department of Medicine (Straus), University of Toronto, Toronto, Ont
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