Self-help CBT for depression: opportunities for primary care mental health nurses?

Self-help interventions for the prevention of relapse in mood disorder: a systematic review and meta-analysis

INTRODUCTION

Self-help interventions may offer a scalable adjunct to traditional care, but their effectiveness in relapse prevention is not well-established. Objectives: This review aimed to assess their effectiveness in preventing relapses among individuals with mood disorders.

METHODS

We systematically reviewed the pertinent trial literature in Web of Science, EMBASE, PubMed, PsycINFO, and Cochrane databases until May 2024. Randomized controlled trials that examined the self-help interventions among individuals diagnosed with major depressive disorder (MDD) or bipolar disorder (BD) were included. The random-effects model computed the pooled risk ratios of relapse, with subgroup analyses and meta-regression analyses to explore heterogeneity sources.

RESULTS

Fifteen papers and 16 comparisons of randomized trials involving 2735 patients with mood disorders were eligible for this meta-analysis. Adjunct self-help interventions had a small but significant effect on reducing the relapse rates of major depressive disorder (pooled risk ratio: 0.78, 95% confidence interval (CI): 0.66-0.92, P = 0.0032, NNT = 11), and were marginally better in bipolar disorder (pooled risk ratio: 0.62, 95% CI: 0.40-0.97, P = .0344, NNT = 12), as compared to treatment as usual (TAU). No subgroup difference was found based on intervention components, settings, delivery method, or guidance levels. The average dropout rate for self-help interventions (18.9%) did not significantly differ from TAU dropout rates. The examination of treatment adherence was highly variable, precluding definitive conclusions.

CONCLUSIONS

Self-help interventions demonstrate a modest preventative effect on relapse in mood disorders, despite low to very low certainty. Future research is essential to identify which elements of self-help interventions are most effective.

Better care through an optimized mental health services continuum (Eastern Townships, Québec, Canada): A systematic and multisource literature review

INTRODUCTION

In 2014, the health authorities of the Eastern Townships (Québec, Canada) commissioned an evaluation of the mental health admission system for adults (GASMA) to identify the best GASMA organizational or structural elements and optimize the mental health services continuum.

METHODS

To develop better services, seven indicators (ie, accessibility to services, integration of levels of services, user satisfaction, guidance and management time, evaluation tools, professional composition, and interprofessional collaboration) were examined through four evaluation questions. A three-step systematic and multisource evaluation was realized. A systematic review of the scientific and gray literature was performed. This evaluation also included key informant opinions to contextualize results from this review.

RESULTS

Results from 91 scientific articles, 40 gray literature documents, and 10 interviews highlighted determinants and barriers associated with the examined indicators. From these results, 24 preliminary recommendations were formulated and discussed in a steering committee. These recommendations were then weighted and validated. This served to formulate three final recommendations.

CONCLUSION

To optimize the regional mental health services continuum, stakeholders should (1) implement a single-window access for adults with mental health needs, (2) develop alternative services based on users' needs, and (3) test the effectiveness of new methods, initiatives, and tools.

A preliminary assessment of a combination of rhodiola and saffron in the management of mild-moderate depression

OBJECTIVE

The medicinal plants Rhodiola rosea L. (rhodiola, golden root) and Crocus sativus L. (saffron) have been shown separately to induce significant effects in depression. The objective of this study was to assess a fixed combination of rhodiola and saffron in mild-moderate depression.

METHODS

In this observational study conducted with general practitioners (GPs), 45 adults (aged 18-85 years) suffering from mild or moderate depression (International Statistical Classification of Diseases and Related Health Problems 10th Revision definition) and reaching a score on the Hamilton Rating Scale for Depression of 8-18 were supplemented with a combination of rhodiola and saffron extracts (one tablet, 154 mg of rhodiola and 15 mg of saffron; recommended dose two tablets per day for 6 weeks).

RESULTS

After 6 weeks (D42) of supplementation, Hamilton Rating Scale for Depression scores (primary outcome) decreased significantly by 58%±28.5% (from 13.6±2.3 at D0 to 5.6±3.8 at D42, P<0.0001; n=41). Score improvement was reported in 85.4% of patients. A significant drop in both Hospital Anxiety and Depression Scale anxiety and depression scores was also observed at D42, the decrease being significant from 2 weeks of supplementation. At the end of the study, both GPs and patients deemed there was a significant improvement in depression (Clinical Global Impression - improvement and Patient Global Impression of Change). Safety was excellent, and no serious adverse effects were recorded.

CONCLUSION

Results of this observational study performed in primary care suggest that the combination of rhodiola and saffron tested could be useful for the management of mild-moderate depression and improve depressive and anxiety symptoms. A double-blind placebo-controlled study is needed to confirm these results.

Working in the real world: a review of sociological concepts of health and well-being and their relation to modern mental health nursing

Since 2008, the world has witnessed several socio-economic upheavals that have fundamentally changed the global economy. Within the UK, these upheavals have coincided with a change in political administration and thus a new approach to managing the volatility of economy. This change has resulted in root and branch reform of service provision that is based around a model that incorporates a shrinking public sector coupled with an increase in civic participation (i.e. 'The Big Society' espoused by the UK-governing coalition). It is also unlikely that healthcare provision on a global level will remain unchanged in such turbulent times. It would therefore seem a useful time to review how socio-economic forces are believed to affect the health and well-being of an individual. These forces include social inequality, the mechanisms of social inclusion and exclusion, social role and the erosion of resilience. This paper will then conclude by offering some potential avenues that nurses can explore to make these forces less damaging for their clients. These avenues include developing a clinical focus based around positive psychology, well-being and some novel ways that nurses can help overcome the maintenance cycles that perpetuate inequality and exclusion.

Effectiveness of guided self-help for depression and anxiety disorders in primary care: a pragmatic randomized controlled trial

The objective of this study is to evaluate the effectiveness of (guided) self-help in primary care for patients diagnosed with a minor or major mood and/or anxiety disorder. The study population consists of 120 (screened) primary care patients aged 18-65 years with at least one mood and/or anxiety disorder. The primary focus is the reduction of depressive and anxiety symptoms. The self-help courses (Problem Solving Treatment and exposure) took 6 weeks to complete. The self-help group reported slightly better outcomes than the care-as-usual group but these results were not significant: d=-0.18 (95% CI=-2.29 to 7.31) for symptoms of depression and d=-0.20 (95% CI=-0.74 to 2.29) for symptoms of anxiety. For patients with an anxiety disorder only, the anxiety symptoms decreased significantly compared to the care-as-usual group (d=-0.68; 95% CI=0.25 to 4.77). Self-help seems only slightly superior to care-as-usual and therefore might not be an effective tool in general practice. But the lack of results could also be due to our selection of patients or to our selection of GPs (with interest in psychiatric disorders). Nonetheless the promising signals with respect to anxiety disorders warrant further research.