1
|
Farrer LM, Jackson HM, Gulliver A, Calear AL, Leach L, Hasking P, Katruss N, Batterham PJ. A Transdiagnostic Video-Based Internet Intervention (Uni Virtual Clinic-Lite) to Improve the Mental Health of University Students: Randomized Controlled Trial. J Med Internet Res 2024; 26:e53598. [PMID: 39137012 DOI: 10.2196/53598] [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: 10/12/2023] [Revised: 02/27/2024] [Accepted: 05/24/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Numerous studies have demonstrated the effectiveness of digital interventions for improving the mental health of university students. However, low rates of engagement with these interventions are an ongoing challenge and can compromise effectiveness. Brief, transdiagnostic, web-based video interventions are capable of targeting key mental health and related issues affecting university students and may be more engaging and accessible for this population. OBJECTIVE This study used a 2-arm randomized controlled trial to evaluate the effectiveness of Uni Virtual Clinic-Lite (UVC-Lite), a fully automated, transdiagnostic, web-based video intervention, relative to an attention-control condition. The primary outcomes were symptoms of depression and generalized anxiety disorder. The secondary outcomes included psychological distress, social anxiety symptoms, body appreciation, quality of life, well-being, functioning, general self-efficacy, academic self-efficacy, and help seeking. Program use (intervention uptake and engagement) and satisfaction were also assessed. METHODS University students (n=487) with mild to moderate symptoms of distress were recruited from universities across Australia and randomly allocated to receive access to the UVC-Lite intervention or an attention-control condition targeting general health for a period of 6 weeks. UVC-Lite includes 12 modules, each comprising a brief animated video and an accompanying exercise. Of the 12 modules, 7 also included a brief symptom screening quiz. Outcomes were assessed at baseline, postintervention, and 3- and 6-months postintervention. RESULTS The primary and secondary outcomes were analyzed on an intention-to-treat basis using mixed models repeated measures ANOVA. The intervention was not found to be effective relative to the control condition on any of the primary or secondary outcomes. While 67.9% (114/168) of participants accessed at least 1 module of the intervention, module completion was extremely low. Subgroup analyses among those who engaged with the program (completed at least 1 video) and those with higher baseline distress (Distress Questionnaire-5 score ≥15) did not reveal any differences between the conditions over time. However, uptake (accessing at least 1 video) and engagement (completing at least 1 video) were higher among those with higher baseline symptoms. Satisfaction with the intervention was high. CONCLUSIONS The UVC-Lite intervention was not effective relative to a control program, although it was associated with high satisfaction among students and was not associated with symptom deterioration. Given the challenges faced by universities in meeting demand for mental health services, flexible and accessible interventions such as UVC-Lite have the potential to assist students to manage symptoms of mental health problems. However, low uptake and engagement (particularly among students with lower levels of symptomatology) are significant challenges that require further attention. Future studies should examine the effectiveness of the intervention in a more highly symptomatic sample, as well as implementation pathways to optimize effective engagement with the intervention. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12621000375853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380146.
Collapse
Affiliation(s)
- Louise M Farrer
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Hayley M Jackson
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Amelia Gulliver
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Alison L Calear
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Liana Leach
- Department of Health Economics Wellbeing and Society, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Penelope Hasking
- Curtin enAble Institute and School of Population Health, Faculty of Health Sciences, Curtin University, Curtin, Australia
| | - Natasha Katruss
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| |
Collapse
|
2
|
McKay EA, Mattheus D, Fontenot HB. Mental Health Interventions in Middle Schools: A 10-Year Review of Research. J Sch Nurs 2024:10598405241265904. [PMID: 39090789 DOI: 10.1177/10598405241265904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
Schools can play an important role in addressing growing concerns about adolescent mental health. Mental health of high school students has predominantly been the focus in literature with less emphasis on younger adolescents. This review identified articles published in the last decade that described evaluations of middle school-based mental health interventions and randomized participants to an intervention or control condition. Fourteen interventions met the inclusion criteria. About two-thirds of interventions were based on mindfulness or cognitive behavioral therapy. Many trials utilized racially diverse, low-income samples. All interventions were delivered to groups, and three contained a parent component. Five trials increased rigor by using an active control condition. Almost two-thirds of the interventions were effective (p < .10) in reducing at least one depression, anxiety, affect, or internalizing symptom outcome compared to a control group. This article provides information about intervention characteristics, efficacy, theoretical framework, and acceptability/feasibility.
Collapse
Affiliation(s)
- Elizabeth Anne McKay
- University of Massachusetts, Lowell, Solomont School of Nursing, Lowell, MA, USA
| | - Deborah Mattheus
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, School of Nursing, Honolulu, HI, USA
| | - Holly B Fontenot
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, School of Nursing, Honolulu, HI, USA
| |
Collapse
|
3
|
Melnyk BM. The evidence-based COPE program: Reducing the time between diagnosing and treating depression and anxiety in youth. Nurse Pract 2024; 49:40-47. [PMID: 38386473 PMCID: PMC10878455 DOI: 10.1097/01.npr.0000000000000152] [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: 02/24/2024]
Abstract
ABSTRACT The soaring prevalence of depression and anxiety in children, teenagers, and young adults is now a public health epidemic, yet access to timely evidence-based mental health treatment is often lacking due to a severe shortage of mental health providers. This article provides an overview of the current state of depression and anxiety in children and adolescents as well as first-line evidence-based treatment. The Creating Opportunities for Personal Empowerment (COPE) program, a cognitive-behavioral skills-building intervention, is highlighted as an evidence-based intervention for timely treatment that can be delivered by NPs, physicians, and physician associates/assistants in primary care settings, school-based health centers, and chronic care clinics with reimbursement as well as in schools and universities as a preventive mental health intervention.
Collapse
Affiliation(s)
- Bernadette Mazurek Melnyk
- Bernadette Mazurek Melnyk is creator of the COPE program and founder of COPE2Thrive, LLC. She is a globally recognized expert, speaker, author, and researcher in the areas of evidence-based practice, mental health and well-being, and intervention research
| |
Collapse
|
4
|
Bjornstad G, Sonthalia S, Rouse B, Freeman L, Hessami N, Dunne JH, Axford N. A comparison of the effectiveness of cognitive behavioural interventions based on delivery features for elevated symptoms of depression in adolescents: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1376. [PMID: 38188230 PMCID: PMC10771715 DOI: 10.1002/cl2.1376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/03/2023] [Indexed: 01/09/2024]
Abstract
Background Depression is a public health problem and common amongst adolescents. Cognitive behavioural therapy (CBT) is widely used to treat adolescent depression but existing research does not provide clear conclusions regarding the relative effectiveness of different delivery modalities. Objectives The primary aim is to estimate the relative efficacy of different modes of CBT delivery compared with each other and control conditions for reducing depressive symptoms in adolescents. The secondary aim is to compare the different modes of delivery with regard to intervention completion/attrition (a proxy for intervention acceptability). Search Methods The Cochrane Depression, Anxiety and Neurosis Clinical Trials Register was searched in April 2020. MEDLINE, PsycInfo, EMBASE, four other electronic databases, the CENTRAL trial registry, Google Scholar and Google were searched in November 2020, together with reference checking, citation searching and hand-searching of two databases. Selection Criteria Randomised controlled trials (RCTs) of CBT interventions (irrespective of delivery mode) to reduce symptoms of depression in young people aged 10-19 years with clinically relevant symptoms or diagnosis of depression were included. Data Collection and Analysis Screening and data extraction were completed by two authors independently, with discrepancies addressed by a third author. CBT interventions were categorised as follows: group CBT, individual CBT, remote CBT, guided self-help, and unguided self-help. Effect on depressive symptom score was estimated across validated self-report measures using Hedges' g standardised mean difference. Acceptability was estimated based on loss to follow-up as an odds ratio. Treatment rankings were developed using the surface under the cumulative ranking curve (SUCRA). Pairwise meta-analyses were conducted using random effects models where there were two or more head-to-head trials. Network analyses were conducted using random effects models. Main Results Sixty-eight studies were included in the review. The mean age of participants ranged from 10 to 19.5 years, and on average 60% of participants were female. The majority of studies were conducted in schools (28) or universities (6); other settings included primary care, clinical settings and the home. The number of CBT sessions ranged from 1 to 16, the frequency of delivery from once every 2 weeks to twice a week and the duration of each session from 20 min to 2 h. The risk of bias was low across all domains for 23 studies, 24 studies had some concerns and the remaining 21 were assessed to be at high risk of bias. Sixty-two RCTs (representing 6435 participants) were included in the pairwise and network meta-analyses for post-intervention depressive symptom score at post-intervention. All pre-specified treatment and control categories were represented by at least one RCT. Although most CBT approaches, except remote CBT, demonstrated superiority over no intervention, no approaches performed clearly better than or equivalent to another. The highest and lowest ranking interventions were guided self-help (SUCRA 83%) and unguided self-help (SUCRA 51%), respectively (very low certainty in treatment ranking). Nineteen RCTs (3260 participants) were included in the pairwise and network meta-analyses for 6 to 12 month follow-up depressive symptom score. Neither guided self-help nor remote CBT were evaluated in the RCTs for this time point. Effects were generally attenuated for 6- to 12-month outcomes compared to posttest. No interventions demonstrated superiority to no intervention, although unguided self-help and group CBT both demonstrated superiority compared to TAU. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking approaches were unguided self-help and individual CBT, respectively. Sixty-two RCTs (7347 participants) were included in the pairwise and network meta-analyses for intervention acceptability. All pre-specified treatment and control categories were represented by at least one RCT. Although point estimates tended to favour no intervention, no active treatments were clearly inferior. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking active interventions were individual CBT and group CBT respectively. Pairwise meta-analytic findings were similar to those of the network meta-analysis for all analyses. There may be age-based subgroup effects on post-intervention depressive symptoms. Using the no intervention control group as the reference, the magnitudes of effects appear to be larger for the oldest age categories compared to the other subgroups for each given comparison. However, they were generally less precise and formal testing only indicated a significant difference for group CBT. Findings were robust to pre-specified sensitivity analyses separating out the type of placebo and excluding cluster-RCTs, as well as an additional analysis excluding studies where we had imputed standard deviations. Authors' Conclusions At posttreatment, all active treatments (group CBT, individual CBT, guided self-help, and unguided self-help) except for remote CBT were more effective than no treatment. Guided self-help was the most highly ranked intervention but only evaluated in trials with the oldest adolescents (16-19 years). Moreover, the studies of guided self-help vary in the type and amount of therapist support provided and longer-term results are needed to determine whether effects persist. The magnitude of effects was generally attenuated for 6- to 12-month outcomes. Although unguided self-help was the lowest-ranked active intervention at post-intervention, it was the highest ranked at follow-up. This suggests the need for further research into whether interventions with self-directed elements enable young people to maintain effects by continuing or revisiting the intervention independently, and whether therapist support would improve long-term outcomes. There was no clear evidence that any active treatments were more acceptable to participants than any others. The relative effectiveness of intervention delivery modes must be taken into account in the context of the needs and preferences of individual young people, particularly as the differences between effect sizes were relatively small. Further research into the type and amount of therapist support that is most acceptable to young people and most cost-effective would be particularly useful.
Collapse
Affiliation(s)
- Gretchen Bjornstad
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
- Dartington Service Design LabBuckfastleighUK
| | - Shreya Sonthalia
- Dartington Service Design LabBuckfastleighUK
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - Benjamin Rouse
- Center for Clinical Evidence and Guidelines, ECRI InstitutePlymouth MeetingPennsylvaniaUSA
| | | | | | - Jo Hickman Dunne
- The Centre for Youth ImpactLondonUK
- University of ManchesterManchesterUK
| | - Nick Axford
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of PlymouthPlymouthUK
| |
Collapse
|
5
|
Padmanabhanunni A, Pretorius TB. Fear of COVID-19 and PTSD: The Protective Function of Problem-Solving Appraisals in Mental Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:220. [PMID: 38397709 PMCID: PMC10888453 DOI: 10.3390/ijerph21020220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/06/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024]
Abstract
The COVID-19 pandemic was experienced by many people as a major traumatic event, and it contributed to high levels of fear, anxiety, and PTSD. Negative cognitive appraisals have been consistently implicated in the onset and maintenance of psychological distress, but there is far less research on the protective role of adaptive appraisals in mental health outcomes. The current study aimed to address this gap by investigating the role of problem-solving appraisals in the relationship between fear of COVID-19 and PTSD. Participants were students (n = 322) who completed the Fear of COVID-19 Scale, the Problem-Solving Inventory, the PTSD Checklist for DSM-5, and the five-item short version of the trait scale of the State-Trait Anxiety Inventory. Participants had a mean age of 26 years (±10.2; range 17-63). The results revealed that problem-solving appraisal mediated the effects of fear of COVID-19 on all the dimensions of PTSD. However, moderated mediation analysis demonstrated that the mediation effect was moderated by anxiety. In this regard, the indirect effects of fear of COVID-19 on PTSD were only significant for respondents with low anxiety levels. Our findings suggest that intervention efforts need to focus on identifying and actively targeting maladaptive appraisals of the problem-solving ability as well as addressing anxiety-related symptoms that may impede coping.
Collapse
Affiliation(s)
- Anita Padmanabhanunni
- Department of Psychology, University of the Western Cape, Western Cape, Cape Town 7530, South Africa;
| | | |
Collapse
|
6
|
Hoying J, Terry A, Kelly S, Melnyk BM. A cognitive-behavioral skills building program improves mental health and enhances healthy lifestyle behaviors in nurses and other hospital employees. Worldviews Evid Based Nurs 2023; 20:542-549. [PMID: 37897217 DOI: 10.1111/wvn.12686] [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: 03/21/2023] [Revised: 09/19/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Mental health outcomes in nurses have historically indicated a greater prevalence of anxiety, depression, and suicide than the general population. It is vital to provide programming for healthcare workers to gain the necessary skills to reduce burnout and improve their mental and physical health. AIMS The aims of this study were to evaluate mental health outcomes and healthy lifestyle beliefs and behaviors among nurses and other hospital employees who completed MINDBODYSTRONG, a cognitive-behavioral skill building program. METHODS A pre-experimental, pre- and poststudy design was used to examine mental health and well-being outcomes among 100 hospital personnel who participated in MINDBODYSTRONG, a program designed to improve coping and resiliency and decrease stress, anxiety, and depressive symptoms. Outcomes measured included healthy lifestyle behaviors, healthy lifestyle beliefs, anxiety, depression, stress, and burnout. RESULTS One hundred hospital personnel, including 93 nurses, completed the pre- and post-survey. Among all participants, post- MINDBODYSTRONG scores for healthy lifestyle beliefs (p = .00; Cohen's d = 0.52) and healthy lifestyle behaviors (p = .00; Cohen's d = -0.74) increased significantly with medium effects, while depression (p = .00; Cohen's d = -0.51), anxiety (p = .00; Cohen's d = -0.54), stress (p = .00; Cohen's d = -0.33), and burnout (p = .00; Cohen's d = -0.37) decreased significantly with small and medium effects. The program produced even stronger positive effects on mental health outcomes for participants who started the study with higher levels of depression and anxiety. LINKING EVIDENCE TO PRACTICE Anxiety, depression, stress, and burnout decreased significantly postintervention. Participants also significantly improved their healthy lifestyle beliefs and behaviors with the MINDBODYSTRONG program. MINDBODYSTRONG is an effective program that reduces anxiety, depression, burnout, and stress and improves healthy lifestyle beliefs and behaviors in hospital-based clinicians. It is of utmost importance to provide evidence-based programs to improve mental resiliency and decrease stress, anxiety, burnout, and depressive symptoms, which will ultimately improve the safety and quality of health care.
Collapse
Affiliation(s)
| | - Ayanna Terry
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Stephanie Kelly
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | | |
Collapse
|
7
|
Halliburton AE, Hill MB, Hightower JM, Harrison TL, LaFever CR. Mental health during COVID-19: College students' need for structure. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-8. [PMID: 37910659 DOI: 10.1080/07448481.2023.2277195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023]
Abstract
Objective: College students made the unprecedented shift to remote learning during the COVID-19 pandemic, potentially contributing to escalating anxiety, depression, and suicide. This loss of structure may be a driving factor in students' distress. We examined the relationship between students' mental health, perceived need for structure, and five stressors related to COVID-19. Participants: Students (N = 1319, 76.3% female, 79.8% White) at a southeastern university responded to a survey in spring 2020. Methods: Participants answered questions about global anxiety and depression, suicide, perceived need for structure, and COVID-19 related stressors. Results: Participants reported increased anxiety and depression and elevated suicidality compared to previous studies of student mental health. Findings indicated that the stressors and lack of structure added unique variance toward predicting anxiety and depression. Conclusions: As COVID-19's consequences persist, counseling centers and other stakeholders are urged to work together in providing support for students' mental wellness and stress management.
Collapse
Affiliation(s)
- Amanda E Halliburton
- Department of Psychological Science, University of North Georgia, Dahlonega, Georgia, USA
| | - Michele B Hill
- Department of Psychological Science, University of North Georgia, Dahlonega, Georgia, USA
| | - Jennifer M Hightower
- Department of Educational and Developmental Science, University of South Carolina, Columbia, South Carolina, USA
| | - Tyler L Harrison
- Department of Psychological Science, University of North Georgia, Dahlonega, Georgia, USA
| | - Christopher R LaFever
- Department of Educational Psychology and Learning Systems, Florida State University, Tallahassee, Florida, USA
| |
Collapse
|
8
|
D’Adamo L, Paraboschi L, Grammer AC, Fennig M, Graham AK, Yaeger LH, Newman MG, Wilfley DE, Taylor CB, Eisenberg D, Fitzsimmons-Craft EE. Reach and uptake of digital mental health interventions based on cognitive-behavioral therapy for college students: A systematic review. JOURNAL OF BEHAVIORAL AND COGNITIVE THERAPY 2023; 33:97-117. [PMID: 37724304 PMCID: PMC10506850 DOI: 10.1016/j.jbct.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Background Mental health problems are increasing in prevalence among college students, yet few students receive treatment due to barriers such as insufficient resources in college counseling centers. Digital mental health interventions (DMHIs) have potential to overcome barriers and offer accessible, evidence-based care to college students. However, to evaluate the true public health impact of evidence-based DMHIs, it is important to assess the reach and uptake rates of DMHIs on college campuses. Objectives We conducted a systematic review to examine the reach (i.e., % of invited students who express interest) and uptake (i.e., % of enrolled participants who initiate an intervention) of DMHIs based on cognitive-behavioral therapy (CBT) for college students. Methods Eight databases were searched. Inclusion criteria included: (1) college population; (2) experimental design; (3) CBT-based intervention; (4) intervention targeting specific mental health conditions; and (5) digital intervention. Reach and uptake rates were calculated from data reported. A systematic narrative review framework was used to synthesize results. Results Of 10,315 articles screened, 90 were included. Seventeen studies (19%) reported sufficient data to calculate reach; 35 studies (39%) reported uptake rates. Of studies that reported reach or uptake, most evaluated unguided (n = 20) or guided (n = 16) self-help programs. Measurement methods varied widely. Overall reach was low, whereas uptake was high among enrolled participants. Discussion Despite evidence that improving reach and uptake can increase the public health impact of DMHIs, most studies did not report on either outcome. Suggested practices to improve these outcomes, and their reporting, are discussed.
Collapse
Affiliation(s)
- Laura D’Adamo
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
- Department of Psychological and Brain Sciences and Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, 3201 Chestnut St. Philadelphia, PA 19104, USA
| | - Layna Paraboschi
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Anne Claire Grammer
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Molly Fennig
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N St Clair St, Chicago, IL 60611, USA
| | - Lauren H. Yaeger
- Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, USA
| | - Michelle G. Newman
- Department of Psychology, The Pennsylvania State University, 371 Moore Building, University Park, PA 16801, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA
- Center for m Health, Palo Alto University, 5150 El Camino Real, Los Altos, CA 94022, USA
| | - Daniel Eisenberg
- Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Ellen E. Fitzsimmons-Craft
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| |
Collapse
|
9
|
Price DM, Figueroa N, Macera-DiClemente L, Wintermeyer-Pingel S, Riley P, Tschannen D. Thinking, Feeling, Behaving: Using the MINDBODYSTRONG ® Intervention to Improve Nurse Well-being Using a Virtual Format. J Nurs Adm 2023; 53:337-343. [PMID: 37184457 DOI: 10.1097/nna.0000000000001293] [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: 05/16/2023]
Abstract
OBJECTIVE This study examined the impact of the MINDBODYSTRONG ® program on mental health and lifestyle behaviors among a sample of staff nurses, clinical nurse leaders, and faculty, when offered after the onset of the COVID-19 pandemic. BACKGROUND Previous studies have demonstrated the MINDBODYSTRONG program decreased anxiety and depressive symptoms, improved job satisfaction, and sustained healthy lifestyle behaviors in newly licensed RNs. This program has not been studied with experienced nurses. In addition, the use of a virtual format is unique. METHODS A pre-post design was used for this pilot study. Subjects were recruited from a large Midwestern medical center and affiliated school of nursing. Registered participants of the MINDBODYSTRONG program attended 7 weekly sessions virtually. RESULTS The MINDBODYSTRONG intervention suggests sustained improvement in perceived stress, anxiety, depression, and use of healthy behaviors. CONCLUSION This pilot study supports that the MINDBODYSTRONG program may be effective in addressing mental health and healthy lifestyle beliefs for staff nurses, clinical nurse leaders, and nursing faculty.
Collapse
Affiliation(s)
- Deborah M Price
- Author Affiliations: Clinical Associate Professor (Dr Price), Clinical Assistant Professor (Dr Macera-DiClemente), Clinical Instructor (Dr Wintermeyer-Pingel), Director of Undergraduate Studies (Dr Riley), and Associate Dean of Undergraduate Studies (Dr Tschannen), University of Michigan School of Nursing; and Nurse Leader for Wellbeing (Figueroa), Office of Workplace Resilience, University of Michigan Health, Ann Arbor
| | | | | | | | | | | |
Collapse
|
10
|
Oliveira C, Pacheco M, Borges J, Meira L, Santos A. Internet-delivered cognitive behavioral therapy for anxiety among university students: A systematic review and meta-analysis. Internet Interv 2023; 31:100609. [PMID: 36873307 PMCID: PMC9982642 DOI: 10.1016/j.invent.2023.100609] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 02/14/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
University years are marked by multiple stressors. Consequently, university students often report anxiety symptoms or disorders, but most remain untreated. Internet-delivered cognitive behavioral therapy (ICBT) has been proposed as an alternative to address known help-seeking barriers, which were aggravated during the COVID-19 pandemic. This meta-analysis aims to evaluate the efficacy of ICBT for university students with anxiety. A systematic search on three databases, EBSCOhost, PubMed, and Web of Science, and a manual search were performed. Fifteen studies were identified, including a total of 1619 participants. Seven studies evaluated ICBT treatment for both anxiety and depression, three for social anxiety, two for generalized anxiety, while the remaining (k = 3) only targeted anxiety, test anxiety, and comorbidity between anxiety and insomnia. Analyses were performed based on a random-effects model using the metafor package in R. The results indicated that ICBT had a significant and positive effect on university students with anxiety compared to controls at post-test (g = -0.48; 95 % CI: -0.63, -0.27; p < .001, I 2 = 67.30 %). Nevertheless, more research is required to determine the intervention components that are more relevant for therapeutic change, how much guidance is required to produce better outcomes, and how patient engagement can be improved.
Collapse
Affiliation(s)
- Cláudia Oliveira
- University of Maia, Av. Carlos Oliveira Campos, 4475-690 Maia, Portugal.,Center for Psychology at University of Porto, 4200-135 Porto, Portugal
| | - Mara Pacheco
- University of Maia, Av. Carlos Oliveira Campos, 4475-690 Maia, Portugal
| | - Janete Borges
- University of Maia, Av. Carlos Oliveira Campos, 4475-690 Maia, Portugal
| | - Liliana Meira
- University of Maia, Av. Carlos Oliveira Campos, 4475-690 Maia, Portugal.,Center for Psychology at University of Porto, 4200-135 Porto, Portugal
| | - Anita Santos
- University of Maia, Av. Carlos Oliveira Campos, 4475-690 Maia, Portugal.,Center for Psychology at University of Porto, 4200-135 Porto, Portugal
| |
Collapse
|
11
|
Toward a Positive Life beyond COVID-19: Problem-Solving Appraisal as a Resistance Resource in the Relationship between Stress and Well-Being in Students. Healthcare (Basel) 2023; 11:healthcare11030350. [PMID: 36766925 PMCID: PMC9914683 DOI: 10.3390/healthcare11030350] [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: 12/29/2022] [Revised: 01/15/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
The COVID-19 pandemic is a major global stressor that has been associated with elevated risk of negative mental health symptoms. As a helping profession, our main task should be identifying factors that may shield individuals from the negative consequences of stress, rather than only focusing on the causes and symptoms of stress. One such factor, identified in the literature, is an individual's perception of their problem-solving skills. In this study we investigate the role of problem-solving appraisal in the association between perceived stress and psychological well-being. Participants were students (n = 322) who completed the Problem Solving Inventory, the Perceived Stress Scale, the short forms of the trait scale of the State-Trait Anxiety Inventory, and the Beck Hopelessness Scale. The results demonstrate the health-sustaining benefits of problem-solving appraisal, as all dimensions of problem-solving appraisal (problem-solving confidence, approach-avoidance style, and problem-solving control) were directly associated with hopelessness and anxiety. The stress-buffering role of problem-solving appraisal with respect to hopelessness was demonstrated through the interaction between perceived stress and problem-solving appraisal. However, problem-solving appraisal did not buffer the effects of stress on anxiety. The findings indicate that problem-solving appraisal may be an important protective resource that could be beneficial for coping with other negative events and experiences beyond COVID-19. The implications of these findings for interventions are discussed.
Collapse
|
12
|
Graves RJ, Harrell M, Barinas JL, Taylor SE, Fruh SM, Williams SG, McDermott R, Hall HR, Hauff C, Sittig S, Campbell M, Hudson G, Bernadette MM. Effects of the Perceived Risk of Contracting COVID-19 on Nursing Students' Well-Being. J Nurs Educ 2022; 61:641-645. [PMID: 36343194 PMCID: PMC9782991 DOI: 10.3928/01484834-20220912-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although mental health symptoms increased during the coronavirus disease 2019 (COVID-19) pandemic, little is known about the associations between nursing students' perceived risk of contracting COVID-19 and their academic and psychological well-being. This study examined associations between perceived COVID-19 risk, likelihood of completing nursing education, and mental health factors of nursing students. METHOD A total of 979 nursing students completed self-report measures of perceived COVID-19 risk, anticipated academic completion, anxiety and depressive symptoms, stress, coping self-efficacy, hope, and social support. RESULTS Students with higher perceived COVID-19 risk reported increased anxiety and depression as well as decreased likelihood of graduating, coping self-efficacy, and levels of social support. CONCLUSION Findings indicate the need for increased mental health support for nursing students for successful completion of their programs. Educators should increase support and proactively strengthen positive psychology factors to mitigate the effects of COVID-19 and other crises on nursing students' well-being. [J Nurs Educ. 2022;61(11):641-645.].
Collapse
|
13
|
Li SH, Achilles MR, Werner-Seidler A, Beames JR, Subotic-Kerry M, O'Dea B. Appropriate Use and Operationalization of Adherence to Digital Cognitive Behavioral Therapy for Depression and Anxiety in Youth: Systematic Review. JMIR Ment Health 2022; 9:e37640. [PMID: 35976180 PMCID: PMC9434387 DOI: 10.2196/37640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/07/2022] [Accepted: 06/16/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Digital, self-guided cognitive behavioral therapy (CBT) interventions circumvent many barriers to in-person therapy for young people (aged 12-24 years), although adherence to these interventions is low. The absence or insufficient disclosure of recommendations or instructions for appropriate use may account for this. As such, many young people may not self-administer these interventions appropriately or receive the optimal degree of treatment. OBJECTIVE This systematic review aims to synthesize the literature on digital CBT for depression and anxiety in young people to describe how appropriate use has been defined and communicated to users as instructions for use, to describe how adherence has been measured, and to determine the associations between adherence and treatment outcomes. METHODS A systematic review was conducted with 2 reviewers (SHL and MRA) extracting data independently. Overall, 4 electronic databases (Embase, MEDLINE, PsycINFO, and Cochrane Library) were searched in April 2021 for studies that met the following inclusion criteria: participants aged between 12 and 24 years, evaluated a digital CBT intervention targeting depression or anxiety, and reported instructions or recommendations for use or measures of adherence. Studies that evaluated non-CBT interventions or cognitive- or behavioral-only interventions were excluded. Methodological quality was assessed using the Cochrane Risk of Bias Tool and the Integrated Quality Criteria for the Review of Multiple Study Designs. RESULTS There were 32 manuscripts that met the inclusion criteria, of which 28 (88%) were unique studies (N=16,578 youths). Definitions of appropriate use varied among the different interventions in terms of intended recipients, duration and frequency of use, and the features used to support engagement and adherence to appropriate use definitions. Reporting of appropriate use definitions in studies was inconsistent, with no study systematically describing components of appropriate use or providing information on how recommendations for use were relayed to users. Most often, definitions of appropriate use were derived from the study protocol and descriptions of intervention features. Adherence was mostly operationalized as the degree of intervention completion; however, reporting of adherence data was heterogeneous. There was little evidence of an association between degree of use and outcomes in the 9 studies that examined this. CONCLUSIONS Definitions of appropriate use are unique to each digital CBT intervention. However, statements of appropriate use are not systematically reported in the literature. Furthermore, the extent to which recommendations for use are communicated to users is not routinely reported. Despite unique definitions of appropriate use, adherence was most often generically operationalized as the degree of intervention completion and was not consistently associated with outcomes. We proposed a framework to promote systematic reporting of definitions of appropriate use for digital interventions to provide guidance to users and to assist the development of appropriate and nuanced measures of adherence. TRIAL REGISTRATION PROSPERO CRD42020208668; https://tinyurl.com/4bu2yram.
Collapse
Affiliation(s)
- Sophie H Li
- Black Dog Institute and School of Psychology, The University of New South Wales, Randwick, Australia
| | - Melinda R Achilles
- Black Dog Institute, The University of New South Wales, Randwick, Australia
| | - Aliza Werner-Seidler
- Black Dog Institute and School of Psychology, The University of New South Wales, Randwick, Australia
| | - Joanne R Beames
- Black Dog Institute, The University of New South Wales, Randwick, Australia
| | | | - Bridianne O'Dea
- Black Dog Institute, The University of New South Wales, Randwick, Australia
| |
Collapse
|
14
|
Mazurek Melnyk B, Hoying J, Tan A. Effects of the MINDSTRONG© CBT-based program on depression, anxiety and healthy lifestyle behaviors in graduate health sciences students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1001-1009. [PMID: 32672515 DOI: 10.1080/07448481.2020.1782922] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/21/2020] [Accepted: 06/07/2020] [Indexed: 06/11/2023]
Abstract
ObjectiveTo evaluate effects of the MINDSTRONG© cognitive-behavioral skills building program versus an attention control program on mental health outcomes and lifestyle behaviors of graduate health professional students. Participants: 201 entering graduate students from seven health sciences colleges at a public land grant University in the U.S. Midwest. Methods: A randomized controlled trial was conducted with three-month follow-up. Valid and reliable instruments measured depression, anxiety, stress, healthy lifestyle beliefs and healthy lifestyle behaviors. Results: Students receiving MINDSTRONG© reported less depression/anxiety and healthier lifestyle behaviors than those receiving the control program. Students with elevated levels of depression/anxiety at baseline demonstrated greater benefits from the program. Conclusions: MINDSTRONG© can be used as a preventive and early intervention for improving mental health outcomes and lifestyle behaviors in graduate students. Because the program can be delivered by trained non-mental health professionals, it has the potential to be widely scaled on campuses throughout the U.S.
Collapse
|
15
|
Moore RM, Buffington BC, Abraham SL, Reid K, Burkhard MJ, El-Khoury C, Fark AM, Gonya J, Hoying J, Jennings RN, Knoblaugh SE, Miller MB, Nielsen J, Read EK, Saia S, Silveus AM, Yardley J, Melnyk BM. BE WELL: Changing the culture of a college of veterinary medicine using a comprehensive and integrated approach to promote health and well-being. J Am Vet Med Assoc 2022; 260:844-852. [PMID: 35201997 DOI: 10.2460/javma.21.07.0344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Rustin M Moore
- College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | - Brenda C Buffington
- Office of the Chief Wellness Officer, The Ohio State University, Columbus, OH
| | | | - Katie Reid
- College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | - Mary Jo Burkhard
- College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | | | - Amanda M Fark
- College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | - Jenn Gonya
- College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | | | - Ryan N Jennings
- College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | - Sue E Knoblaugh
- College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | - Matthew B Miller
- College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | - Joelle Nielsen
- College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | - Emma K Read
- College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | - Sharon Saia
- Employee Assistance Program, The Ohio State University, Columbus, OH
| | - Aaron M Silveus
- College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | - Jonathan Yardley
- College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | | |
Collapse
|
16
|
Determining the Type 2 Diabetes Risks and Healthy Lifestyle Behaviors of First Year University Students. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.939375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
17
|
Amanvermez Y, Zhao R, Cuijpers P, de Wit LM, Ebert DD, Kessler RC, Bruffaerts R, Karyotaki E. Effects of self-guided stress management interventions in college students: A systematic review and meta-analysis. Internet Interv 2022; 28:100503. [PMID: 35242591 PMCID: PMC8861419 DOI: 10.1016/j.invent.2022.100503] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND College students face several sources of stress. Self-guided stress management interventions offer an excellent opportunity for scaling up evidence-based interventions for self-management of these stresses. However, little is known about the overall effects of these interventions. Increasing this understanding is essential because self-guided stress management interventions might be a cost-effective and acceptable way of providing help to this important segment of the population during a critical life course stage. METHODS We carried out a systematic literature search of bibliographical databases (PubMed, PsycINFO, Embase, and Cochrane Library) for randomized controlled trials (RCTs) of self-guided stress management interventions published up through April 2020. We conducted two separate meta-analyses for perceived stress, depression, and anxiety. The first included interventions for general college student samples. The second included studies for students with high levels of perceived stress. RESULTS The first meta-analysis included 26 studies with 29 intervention-control comparisons based on a total of 4468 students. The pooled effect size was small but statistically significant (g = 0.19; 95% CI [0.10, 0.29]; p < 0.001). Results showed moderate heterogeneity across studies [I 2 = 48%; 95% CI (19, 66%)]. The second meta-analysis, included four studies based on a total of 491 students with high levels of stress. The pooled effect size was small but statistically significant (g = 0.34; 95% CI [0.16, 0.52]; p < 0.001). Results showed no heterogeneity across studies (I 2 = 0%; 95% CI [0, 79%]), but risk of bias was substantial. DISCUSSION Our results suggest that self-guided stress management programs may be effective when compared to control conditions, but with small average effects. These programs might be a useful element of a multi-component intervention system. Given the psychological barriers to treatment that exist among many college students, self-help interventions might be a good first step in facilitating subsequent help-seeking among students reluctant to engage in other types of treatment. More studies should be conducted to investigate these interventions, sample specifications, mediating effects, and individual-level heterogeneity of effects.
Collapse
Affiliation(s)
- Yagmur Amanvermez
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands,Corresponding author at: Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7-9, 1081 BT Amsterdam, the Netherlands.
| | - Ruiying Zhao
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Leonore M. de Wit
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - David D. Ebert
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum, Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| |
Collapse
|
18
|
Melnyk BM, Hoying J, Hsieh AP, Buffington B, Terry A, Moore RM. Effects of a cognitive-behavioral skills building program on the mental health outcomes and healthy lifestyle behaviors of veterinary medicine students. J Am Vet Med Assoc 2022; 260:789-795. [PMID: 35113803 DOI: 10.2460/javma.21.03.0142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effects of a cognitive-behavioral skills building program (ie, MINDSTRONG; The Ohio State University) on the mental health outcomes and healthy lifestyle beliefs and behaviors of Doctor of Veterinary Medicine (DVM) students. Sample DVM students (n = 62) before beginning their program at a large public Midwest land-grant university. Procedures All 171 incoming DVM students (class of 2024) were required to take the cognitive-behavioral skills building program (7 weeks in length) before starting their 2020 school year. Students were given the option to consent to the study portion of the program. Consenting participants completed a pre- and postsurvey containing demographic questions and 5 valid and reliable scales, including the Patient Health Questionnaire-9 that assesses depressive symptoms, the Generalized Anxiety Disorder-7 that evaluates anxiety, the Brief Inventory of Perceived Stress that measures stress, and the Healthy Lifestyle Beliefs and Healthy Lifestyle Behaviors scales. Descriptive statistics described sample characteristics, paired t tests assessed changes over time in the outcomes Personal Wellness Assessment, and Cohen's d determined effect sizes. Results 62 DVM students completed both surveys. Postintervention, students had significant improvements in depressive symptoms, anxiety, and healthy lifestyle beliefs and behaviors. Clinical Relevance Although this study used a small convenience sample of DVM students from a single university, a cognitive-behavioral skills building program demonstrated the ability to decrease rates of depression, anxiety, and suicidal ideation and improve healthy lifestyle beliefs and behaviors. Requiring DVM students to participate in such programming could provide benefit during their professional education and throughout their careers.
Collapse
Affiliation(s)
- Bernadette M Melnyk
- The Ohio State University, Columbus, OH.,College of Nursing, The Ohio State University, Columbus, OH
| | | | | | | | - Ayanna Terry
- College of Nursing, The Ohio State University, Columbus, OH
| | - Rustin M Moore
- College of Veterinary Medicine, The Ohio State University, Columbus, OH
| |
Collapse
|
19
|
Zhou X, Edirippulige S, Bai X, Bambling M. Are online mental health interventions for youth effective? A systematic review. J Telemed Telecare 2021; 27:638-666. [PMID: 34726992 DOI: 10.1177/1357633x211047285] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This systematic review aims to examine the effectiveness of online mental health interventions for youth. METHODS We searched seven electronic databases (PubMed, PsycINFO, Medline, Embase, CINAHL, Web of Science and SCOPUS) for the past 10 years to identify randomized controlled trials which have evaluated the use of telehealth interventions for young people with mental health problems. The included studies were assessed for quality and risk of bias. RESULTS Forty-five randomized controlled trials (n = 13,291 participants) were eligible for this review. Most studies (35 trials) evaluated the use of web-based self-help platforms to deliver cognitive behavioural therapy (14 trials), mindfulness (four trials), acceptance commitment therapy (five trials) and positive psychology (two trials). Mobile/computer applications were used to deliver cognitive behavioural therapy (four trials) and coping strategies training (two trials). Web-based synchronous chat (one trial) was used to assist communication between counsellors and participants. Three studies used artificial intelligence-based conversational agents to deliver cognitive behavioural therapy (two trials) and problem-solving-strategy training (one trial). Eighty-two percent (n = 37) identified the participants as student population (i.e. university students, high school students). Sixty-four percent (n = 29) of the telehealth interventions were found to be effective in managing depression, anxiety, stress, insomnia and improving quality of life when compared with control conditions. CONCLUSIONS Online mental health interventions were found to be effective in managing diverse mental health conditions among youth. Online self-help platforms were the most frequently used modality and artificial intelligence-based chatbots are merging as potential solutions. Future research is warranted to investigate the solutions to improve the retention rate and satisfaction of telehealth interventions among this population.
Collapse
Affiliation(s)
- Xiaoyun Zhou
- Centre for Online Health, 1974The University of Queensland, Australia
- Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Sisira Edirippulige
- Centre for Online Health, 1974The University of Queensland, Australia
- Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Xuejun Bai
- Academy of Psychology and Behavior, 205359Tianjin Normal University, China
| | - Matthew Bambling
- Centre for Online Health, 1974The University of Queensland, Australia
- Navitas ACAP School of Psychology, Australia
- School of Psychology, Queensland University of Technology, Australia
- Brisbane Central Medical School, 1974The University of Queensland, Australia
| |
Collapse
|
20
|
Hutson E, Thompson B, Bainbridge E, Melnyk BM, Warren BJ. Cognitive-Behavioral Skills Building to Alleviate the Mental Health Effects of Bullying Victimization in Youth. J Psychosoc Nurs Ment Health Serv 2021; 59:15-20. [PMID: 34039123 DOI: 10.3928/02793695-20210415-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Bullying is a long-standing problem with relatively few intervention options for individual youth who have experienced it and have adverse mental health concerns. Depression, anxiety, and suicidal ideation are major consequences of bullying victimization. Although few evidence-based interventions have been put forth to address bullying victimization at the individual level, cognitive-behavioral therapy (CBT) and cognitive-behavioral skills building (CBSB) have been well researched for mental health concerns in youth. The purpose of the current article is to examine the theoretical framework of cognitive theory for individuals who have experienced bullying. Previous work that has addressed CBT for bullying interventions is described. Specific examples of how CBSB components could be applied to a bullying intervention program for youth are discussed. Ultimately, providing a theoretical framework to address this public health concern sets the stage for future intervention research. [Journal of Psychosocial Nursing and Mental Health Services, 59(5), 15-20.].
Collapse
|
21
|
Universal and Selective Interventions to Prevent Poor Mental Health Outcomes in Young People: Systematic Review and Meta-analysis. Harv Rev Psychiatry 2021; 29:196-215. [PMID: 33979106 DOI: 10.1097/hrp.0000000000000294] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Much is not known about the efficacy of interventions to prevent poor mental health outcomes in young people by targeting either the general population (universal prevention) or asymptomatic individuals with high risk of developing a mental disorder (selective prevention). METHODS We conducted a PRISMA/MOOSE-compliant systematic review and meta-analysis of Web of Science to identify studies comparing post-test efficacy (effect size [ES]; Hedges' g) of universal or selective interventions for poor mental health outcomes versus control groups, in samples with mean age <35 years (PROSPERO: CRD42018102143). Measurements included random-effects models, I2 statistics, publication bias, meta-regression, sensitivity analyses, quality assessments, number needed to treat, and population impact number. RESULTS 295 articles (447,206 individuals; mean age = 15.4) appraising 17 poor mental health outcomes were included. Compared to control conditions, universal and selective interventions improved (in descending magnitude order) interpersonal violence, general psychological distress, alcohol use, anxiety features, affective symptoms, other emotional and behavioral problems, consequences of alcohol use, posttraumatic stress disorder features, conduct problems, tobacco use, externalizing behaviors, attention-deficit/hyperactivity disorder features, and cannabis use, but not eating-related problems, impaired functioning, internalizing behavior, or sleep-related problems. Psychoeducation had the highest effect size for ADHD features, affective symptoms, and interpersonal violence. Psychotherapy had the highest effect size for anxiety features. CONCLUSION Universal and selective preventive interventions for young individuals are feasible and can improve poor mental health outcomes.
Collapse
|
22
|
Craig SL, Leung VWY, Pascoe R, Pang N, Iacono G, Austin A, Dillon F. AFFIRM Online: Utilising an Affirmative Cognitive-Behavioural Digital Intervention to Improve Mental Health, Access, and Engagement among LGBTQA+ Youth and Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1541. [PMID: 33562876 PMCID: PMC7915123 DOI: 10.3390/ijerph18041541] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 02/06/2023]
Abstract
Digital mental health interventions may enable access to care for LGBTQA+ youth and young adults that face significant threats to their wellbeing. This study describes the preliminary efficacy of AFFIRM Online, an eight-session manualised affirmative cognitive behavioural group intervention delivered synchronously. Participants (Mage = 21.17; SD = 4.52) had a range of sexual (e.g., queer, lesbian, pansexual) and gender (e.g., non-binary, transgender, cisgender woman) identities. Compared to a waitlist control (n = 50), AFFIRM Online participants (n = 46) experienced significantly reduced depression (b = -5.30, p = 0.005, d = 0.60) and improved appraisal of stress as a challenge (b = 0.51, p = 0.005, d = 0.60) and having the resources to meet those challenges (b = 0.27, p = 0.059, d = 0.39) as well active coping (b = 0.36, p = 0.012, d = 0.54), emotional support (b = 0.38, p = 0.017, d = 0.51), instrumental support (b = 0.58, p < 0.001, d = 0.77), positive framing (b = 0.34, p = 0.046, d = 0.42), and planning (b = 0.41, p = 0.024, d = 0.49). Participants reported high acceptability. This study highlights the potential of digital interventions to impact LGBTQA+ youth mental health and explores the feasibility of digital mental health to support access and engagement of youth with a range of identities and needs (e.g., pandemic, lack of transportation, rural locations). Findings have implications for the design and delivery of digital interventions for marginalised youth and young adults.
Collapse
Affiliation(s)
- Shelley L. Craig
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada; (V.W.Y.L.); (R.P.); (N.P.)
| | - Vivian W. Y. Leung
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada; (V.W.Y.L.); (R.P.); (N.P.)
| | - Rachael Pascoe
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada; (V.W.Y.L.); (R.P.); (N.P.)
| | - Nelson Pang
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada; (V.W.Y.L.); (R.P.); (N.P.)
| | - Gio Iacono
- School of Social Work, University of Connecticut, Storrs, CT 06269, USA;
| | - Ashley Austin
- Ellen Whiteside-McDonnell School of Social Work, Barry University, Tallahassee, FL 32304, USA;
| | - Frank Dillon
- College of Integrative Sciences and Arts, Arizona State University, Tempe, AZ 85281, USA;
| |
Collapse
|
23
|
Antunes‐Alves S, Langmuir T. Evaluating a combined intervention targeting at‐risk post‐secondary students: When it comes to graduating, mental health matters. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
24
|
Hadler NL, Bu P, Winkler A, Alexander AW. College Student Perspectives of Telemental Health: a Review of the Recent Literature. Curr Psychiatry Rep 2021; 23:6. [PMID: 33404975 PMCID: PMC7785477 DOI: 10.1007/s11920-020-01215-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW We review the recent literature regarding college student experiences with and attitudes toward telemental health (TMH). We examine their perspectives of the advantages and drawbacks to this form of mental healthcare and their willingness to engage in TMH. RECENT FINDINGS College students view TMH as convenient, accessible, easy to use, and helpful. TMH helps to overcome the barrier of stigma associated with seeking mental health treatment. Despite positive reviews, many students find a lack of customization or connection to the provider to be drawbacks to some forms of TMH. Willingness to engage in TMH varies based on prior experience with mental health treatment, ethnicity, and severity of symptoms. The recent literature highlights the potential for TMH to play a key role in mental health services for college students. It also highlights some of its shortcomings, which are indicative of the continued need for in-person services. Future studies should continue to track college student perspectives toward and utilization of TMH.
Collapse
Affiliation(s)
- Nicole L Hadler
- University of Michigan Medical School, 1301 Catherine Street, Ann Arbor, MI, 48109, USA.
| | - Paula Bu
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aaron Winkler
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Amy W Alexander
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
25
|
Payne L, Flannery H, Kambakara Gedara C, Daniilidi X, Hitchcock M, Lambert D, Taylor C, Christie D. Business as usual? Psychological support at a distance. Clin Child Psychol Psychiatry 2020; 25:672-686. [PMID: 32594756 PMCID: PMC7370649 DOI: 10.1177/1359104520937378] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The impact of COVID-19 has challenged the long accepted 'norm' in delivery of psychological therapy. Public policies designed to reduce transmission have made it extremely difficult to meet with service-users safely in the traditional face-to-face context. E-therapies have existed in theory and practice since technological progress has made them possible. They can offer a host of advantages over face-to-face equivalents, including improved access, greater flexibility for service-users and professionals, and cost savings. However, despite the emerging evidence and anticipated positive value, implementation has been slower than anticipated. Concerns have been raised by service-users, clinicians, and public health organisations, identifying significant barriers to the wide spread use of e-therapies. In the current climate, many clinicians are offering e-therapies for the first time, without prior arrangement or training, as the only viable option to continue to support their clients. This paper offers a clinically relevant review of the e-therapies literature, including effectiveness and acceptability dilemmas and challenges that need to be addressed to support the safe use and growth of e-therapies in psychology services. Further research is needed to better understand what might be lost and what gained in comparison to face-to-face therapy, and for which client groups and settings it might be most effective.
Collapse
Affiliation(s)
- Lara Payne
- Child and Adolescent Psychology Service, University College London Hospital, London, UK
| | - Halina Flannery
- Child and Adolescent Psychology Service, University College London Hospital, London, UK
| | | | - Xeni Daniilidi
- Child and Adolescent Psychology Service, University College London Hospital, London, UK
| | - Megan Hitchcock
- Child and Adolescent Psychology Service, University College London Hospital, London, UK
| | - Danielle Lambert
- Child and Adolescent Psychology Service, University College London Hospital, London, UK
| | - Charlotte Taylor
- Child and Adolescent Psychology Service, University College London Hospital, London, UK
| | - Deborah Christie
- Child and Adolescent Psychology Service, University College London Hospital, London, UK
| |
Collapse
|
26
|
Bolinski F, Boumparis N, Kleiboer A, Cuijpers P, Ebert D, Riper H. The effect of e-mental health interventions on academic performance in university and college students: A meta-analysis of randomized controlled trials. Internet Interv 2020; 20:100321. [PMID: 32382515 PMCID: PMC7201188 DOI: 10.1016/j.invent.2020.100321] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Mental health symptoms are common among college and university students and these can affect their academic performance. E-mental health interventions have proven effective in addressing mental health complaints but their effect on academic performance has not been synthesized yet. OBJECTIVES To synthesize the evidence from randomized controlled trials for the effectiveness of e-mental health interventions on academic performance in college and university students compared to inactive controls. DATA SOURCES AND ELIGIBILITY CRITERIA We searched six databases (PubMed, Cochrane library, CINAHL, ERIC, PsycINFO, Web of Science) during the period January 2000 until September 2019 for randomized controlled trials that reported on e-mental health interventions (guided or unguided) for college and university students and measured academic performance (e.g. grade point average). STUDY APPRAISAL AND SYNTHESIS METHODS Study and participant characteristics and the academic performance measures at post-intervention were extracted. The latter were pooled and Hedges' g was calculated as the effect size. Heterogeneity and publication bias were investigated. RESULTS Six studies containing 2428 participants were included in the meta-analysis. These focussed on either mood and anxiety or alcohol and tobacco use. The pooling of data resulted in a small but non-significant effect of g = 0.26 (95% CI, -0.00, 0.52; p = .05) on academic performance, favouring e-mental health interventions over inactive controls. Interventions had positive effects on depression (g = -0.24) and anxiety (g = -0.2). Heterogeneity was high. DISCUSSION Despite the small and non-significant effect, our meta-analysis points to a promising direction for the effectiveness of e-mental health interventions on academic performance. Yet, these results must be interpreted with caution, as heterogeneity was high and few studies on the effectiveness of e-mental health interventions for students reported academic performance measures.
Collapse
Affiliation(s)
- F. Bolinski
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - N. Boumparis
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - A. Kleiboer
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - P. Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - D.D. Ebert
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Germany
| | - H. Riper
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| |
Collapse
|
27
|
Reducing Healthcare Costs for Mental Health Hospitalizations With the Evidence-based COPE Program for Child and Adolescent Depression and Anxiety: A Cost Analysis. J Pediatr Health Care 2020; 34:117-121. [PMID: 31615687 DOI: 10.1016/j.pedhc.2019.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/29/2019] [Accepted: 08/28/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Although depression and anxiety affect approximately 20% of children and adolescents, many of those affected do not receive treatment because, in large part to the shortage of mental health providers across the United States. As an alternative to traditional mental health counseling, the Creating Opportunities for Personal Empowerment (COPE) program is an evidence-based manualized 7-session cognitive behavioral therapy-based program that is being effectively delivered to children and teens with depression and anxiety by pediatric and family healthcare providers in primary care practices with reimbursement from insurers. METHODS The purpose of this study was to perform a cost analysis of delivering COPE and compare it to the cost of hospitalization for primary mental health diagnosis. RESULTS Findings indicated a cost savings of $14,262 for every hospitalization that is prevented. DISCUSSION Implementation of COPE can improve outcomes for children and teens with depression and anxiety, and could potentially result in millions of dollars of cost savings for the U.S. healthcare system.
Collapse
|
28
|
Hoying J, Melnyk BM, Hutson E, Tan A. Prevalence and Correlates of Depression, Anxiety, Stress, Healthy Beliefs, and Lifestyle Behaviors in First-Year Graduate Health Sciences Students. Worldviews Evid Based Nurs 2020; 17:49-59. [PMID: 31912989 DOI: 10.1111/wvn.12415] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Graduate and professional students are reported to have higher than average rates of depression compared to age- and gender-matched populations. Further, more than half of student health visits are due to anxiety, yet little is known about the relationships among depression, anxiety, and healthy lifestyle behaviors in this population as well as what factors predict depression and anxiety. AIMS The purposes of this study were as follows: (a) to examine the prevalence of depression, anxiety, stress, physical health, healthy beliefs, and lifestyle behaviors in incoming first-year health sciences professional students; (b) to describe the relationships among these variables; and (c) to determine predictors of depression and anxiety. METHODS A descriptive correlational study design was used with baseline data collected from first-year graduate health sciences students from seven health professions colleges who were participating in a wellness onboarding intervention program, including Dentistry, Medicine, Nursing, Optometry, Pharmacy, Social Work, and Veterinary Medicine. RESULTS Seventeen percent of incoming students reported moderate-to-severe depressive symptoms with 6% reporting suicidal ideation. In addition, 14% of the participating students reported moderate-to-severe anxiety. Factors that predicted depression and anxiety included having less than 7 hr of sleep per night, worse general health, lower healthy lifestyle beliefs, lower healthy lifestyle behaviors, higher stress, and a perceived lack of control. LINKING EVIDENCE TO ACTION These findings highlight the need to routinely screen incoming health sciences students for depression and anxiety upon entrance into their academic programs so that evidence-based interventions can be delivered and students who report severe depression or suicidal ideation can be immediately triaged for further evaluation and treatment. Providing cultures of well-being and emphasizing self-care throughout academic programs also are essential for students to engage in healthy lifestyles.
Collapse
Affiliation(s)
- Jacqueline Hoying
- MINDSTRONG, Columbus, OH, USA.,The Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare, Columbus, OH, USA.,The Ohio State University College of Nursing, Columbus, OH, USA
| | - Bernadette Mazurek Melnyk
- The Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare, Columbus, OH, USA.,College of Nursing, Columbus, OH, USA.,College of Medicine, Columbus, OH, USA.,The Ohio State University, Columbus, OH, USA
| | | | - Alai Tan
- The Ohio State University, Columbus, OH, USA
| |
Collapse
|
29
|
Santilhano M. Online intervention to reduce pediatric anxiety: An evidence-based review. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2019; 32:197-209. [PMID: 31682052 DOI: 10.1111/jcap.12256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/07/2019] [Accepted: 10/02/2019] [Indexed: 12/25/2022]
Abstract
TOPIC Online intervention for school-age youth suffering from symptoms of generalized anxiety disorder. PURPOSE A review of the evidence was conducted to examine the effects of nonpharmacological interventions available online for a reduction of symptoms of generalized anxiety disorder in school-age youth. SOURCES USED The search strategy included the databases of Pubmed, PsychINFO, CINAHL, Cochrane Systematic Reviews, and Cochrane Clinical Trials, and Evidence-Based Reviews. A combination of search terms was used to identify studies with database-specific truncations: "Child* and youth* anxiety screen and intervention" AND "meta-analysis", "child anxiety" AND "systematic review", "child anxiety and personal empowerment and SR", "SCARED*", "COPE", and "SCARED* and SR". Studies published between 2007 and 2017 were included for this review. Twenty studies met criteria and represented level one or two using Melnyk and Fineout-Overholt, Level of Evidence Rating System for intervention inquiries. CONCLUSION Positive outcomes of improved physiological, social, and cognitive development are supported in the studies using cognitive behavior therapy such as the Creating Opportunities for Personal Empowerment (COPE) program. The COPE-online program is a cost-effective strategy to complements models used for early screening and timely interventions for school-age youth who struggle with symptoms of generalized anxiety disorder.
Collapse
|
30
|
Morrison-Beedy D, Mazurek Melnyk B. Making a Case for Integrating Evidence-Based Sexual Risk Reduction and Mental Health Interventions for Adolescent Girls. Issues Ment Health Nurs 2019; 40:932-941. [PMID: 31403363 PMCID: PMC7080305 DOI: 10.1080/01612840.2019.1639087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Recently identified as the top concern of teens, mental health issues now compete with sexual health risks as major threats to the well-being of adolescent females. Depression and anxiety can lead to or compound the negative repercussions of sexual behavior choices that result in disproportionately high rates of sexually-transmitted infections (STIs), hetero-sexually acquired HIV, and unplanned pregnancy rates in girls ages 15-19. There are a limited number of CDC- and DHHS-recognized HIV/STI and teen pregnancy evidence-based interventions (EBIs) targeted to adolescent girls of diverse races/ethnicities and none that simultaneously address common mental health disorders. The Health Improvement Project for Teens (HIPTeens), a manualized gender-specific sexual risk reduction intervention, and the Creating Opportunities for Personal Empowerment (COPE) Program, a manualized cognitive-behavioral skills intervention that reduces depression and anxiety, are recognized by national agencies as strong EBIs that have successfully improved their targeted outcomes. Baseline data from the HIPTeens clinical trial revealed that a substantial portion of the more than 700 girls enrolled had moderate to high levels of depressive symptoms as well as other mental health challenges (e.g., binge drinking and eating, cannabis use). Thus, there is an urgent need to combine EBIs, such as HIPTeens and COPE, to curtail these leading public health problems confronting today's adolescents.
Collapse
Affiliation(s)
| | - Bernadette Mazurek Melnyk
- Department of Pediatrics & Psychiatry, College of Nursing and College of Medicine, The Helene Fuld Health Trust National Institute for EBP, The Ohio State University , Columbus , OH , USA
| |
Collapse
|
31
|
Spratling R, Spezia Faulkner M, Feinberg I, Hayat MJ. Creating opportunities for personal empowerment: Symptom and technology management resources (COPE-STAR) for caregivers of children who require medical technology. J Adv Nurs 2019; 76:347-355. [PMID: 31612518 DOI: 10.1111/jan.14235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/27/2019] [Accepted: 10/02/2019] [Indexed: 12/25/2022]
Abstract
AIM This research protocol addresses the development of web-based modules for the 'creating opportunities for personal empowerment: symptom and technology management resources' intervention with caregivers of children who require medical technology. The commonly experienced symptoms of fever and increased respiratory symptoms (coughing, wheezing, increased secretions), and the care of technologies (tracheostomy tubes, respiratory equipment and feeding tubes) are addressed in this nurse-led and nurse-developed intervention. DESIGN The purpose of this study was to develop web-based intervention modules and obtain review by expert and caregiver reviewers using a systematic, structured process and form. METHODS The intervention includes evidenced-based, theory-based, modules that address the child's most common emotions and behavioural responses with the management of their symptoms and technologies using a web-based format. To establish fidelity of the intervention, expert and caregiver reviewers (e.g. caregivers of children with multiple complex chronic illnesses and technologies) will review the modules that will then be refined prior to feasibility testing. Funding for the study began in July 2018. DISCUSSION The intervention development led by nurses entails an evidence-based literature review; development of scripts with appropriate health literacy level; and content by experts, photography, and videography; production of video modules and creation of a website for modules. IMPACT This nursing intervention addresses the educational needs and skills considered essential and most applicable to caregivers of children who require medical technology to improve self-management of their child's symptoms and technology in the home setting. The information obtained from this study will be valuable to nursing, other healthcare providers and healthcare systems in planning and implementing programs and services for these children and for nurse researchers designing intervention studies for children with multiple complex chronic illnesses. TRIAL REGISTRATION This study is not designated as a clinical trial per NIH/NINR study and grant proposal guidelines.
Collapse
Affiliation(s)
- Regena Spratling
- School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| | - Melissa Spezia Faulkner
- School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| | - Iris Feinberg
- Adult Literacy Research Center, College of Education and Human Development, Georgia State University, Atlanta, GA, USA
| | - Matthew J Hayat
- Biostatistics, Department of Population Health Sciences, School of Public Health, Byrdine F. Lewis College of Nursing & Health Professions (Joint), Georgia State University, Atlanta, GA, USA
| |
Collapse
|
32
|
Morrison-Beedy D, Melnyk BM. Making a Case for Integrating Evidence-Based Sexual Risk Reduction and Mental Health Interventions for Adolescent Girls. Issues Ment Health Nurs 2019:1-9. [PMID: 31599658 DOI: 10.1080/01612840.2019.1640322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
|
33
|
Intervention Effects of the MINDBODYSTRONG Cognitive Behavioral Skills Building Program on Newly Licensed Registered Nurses' Mental Health, Healthy Lifestyle Behaviors, and Job Satisfaction. J Nurs Adm 2019; 49:487-495. [PMID: 31517756 DOI: 10.1097/nna.0000000000000792] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effects of the MINDBODYSTRONG for Healthcare Professionals Program on stress, anxiety, depressive symptoms, healthy lifestyle behaviors, and job satisfaction on newly licensed RNs (NLRNs) participating in a nurse residency program. BACKGROUND The constellation of burnout, depression, and suicide in clinicians is a public health epidemic that affects the quality and safety of healthcare. The National Academy of Medicine's Action Collaborative on Clinician Well-being and Resilience has called for an increase in evidence-based interventions to combat this alarming problem. The MINDBODYSTRONG Program is a novel adaptation of an evidence-based cognitive behavioral skills-building intervention that provides a theory-based approach to improve the mental health, healthy lifestyle beliefs and behaviors, and job satisfaction of NLRNs. METHODS A 2-group, cluster randomized controlled trial was used with 89 new nurses participating in a new-graduate nurse residency program. The experimental intervention, MINDBODYSTRONG, consisted of 8 manualized weekly 45-minute sessions. Data were collected at baseline, immediately following, and 3 months after intervention that measured stress, depressive symptoms, anxiety, healthy lifestyle beliefs and behaviors, and job satisfaction. Repeated-measures analysis of variance was used for data analysis. RESULTS The intervention group scored significantly better with moderate to large positive effects on the mental health variables as well as healthy lifestyle beliefs and healthy lifestyle behaviors at both follow-up time points compared with the attention control group. Moderate to large positive effects also were found for job satisfaction. CONCLUSIONS The MINDBODYSTRONG Program has excellent potential as an evidence-based intervention for improving the mental health, healthy lifestyle beliefs and behaviors, and job satisfaction, in NLRNs.
Collapse
|
34
|
Lattie EG, Adkins EC, Winquist N, Stiles-Shields C, Wafford QE, Graham AK. Digital Mental Health Interventions for Depression, Anxiety, and Enhancement of Psychological Well-Being Among College Students: Systematic Review. J Med Internet Res 2019; 21:e12869. [PMID: 31333198 PMCID: PMC6681642 DOI: 10.2196/12869] [Citation(s) in RCA: 270] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 05/29/2019] [Accepted: 06/14/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND College students are increasingly reporting common mental health problems, such as depression and anxiety, and they frequently encounter barriers to seeking traditional mental health treatments. Digital mental health interventions, such as those delivered via the Web and apps, offer the potential to improve access to mental health treatment. OBJECTIVE This study aimed to review the literature on digital mental health interventions focused on depression, anxiety, and enhancement of psychological well-being among samples of college students to identify the effectiveness, usability, acceptability, uptake, and adoption of such programs. METHODS We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number CRD42018092800), and the search strategy was conducted by a medical research librarian in the following databases: MEDLINE (Ovid), EMBASE (Elsevier), PsycINFO (EbscoHost), the Cochrane Library (Wiley), and Web of Science (Thomson Reuters) from the date of inception to April 2019. Data were synthesized using a systematic narrative synthesis framework, and formal quality assessments were conducted to address the risk of bias. RESULTS A total of 89 studies met the inclusion criteria. The majority of interventions (71/89, 80%) were delivered via a website, and the most common intervention was internet-based cognitive behavioral therapy (28, 31%). Many programs (33, 37%) featured human support in the form of coaching. The majority of programs were either effective (42, 47%) or partially effective (30, 34%) in producing beneficial changes in the main psychological outcome variables. Approximately half of the studies (45, 51%) did not present any usability or acceptability outcomes, and few studies (4, 4%) examined a broad implementation of digital mental health interventions on college campuses. Quality assessments revealed a moderate-to-severe risk of bias in many of the studies. CONCLUSIONS Results suggest that digital mental health interventions can be effective for improving depression, anxiety, and psychological well-being among college students, but more rigorous studies are needed to ascertain the effective elements of these interventions. Continued research on improving the user experience of, and thus user engagement with, these programs appears vital for the sustainable implementation of digital mental health interventions on college campuses.
Collapse
Affiliation(s)
- Emily G Lattie
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, United States
| | - Elizabeth C Adkins
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, United States
| | - Nathan Winquist
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, United States
| | - Colleen Stiles-Shields
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Q Eileen Wafford
- Galter Health Sciences Library and Learning Center, Northwestern University, Chicago, IL, United States
| | - Andrea K Graham
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, United States
| |
Collapse
|
35
|
Recent Developments in Digital Mental Health Interventions for College and University Students. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s40501-019-00178-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
36
|
Garrido S, Millington C, Cheers D, Boydell K, Schubert E, Meade T, Nguyen QV. What Works and What Doesn't Work? A Systematic Review of Digital Mental Health Interventions for Depression and Anxiety in Young People. Front Psychiatry 2019; 10:759. [PMID: 31798468 PMCID: PMC6865844 DOI: 10.3389/fpsyt.2019.00759] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 09/20/2019] [Indexed: 12/21/2022] Open
Abstract
Background: A major challenge in providing mental health interventions for young people is making such interventions accessible and appealing to those most in need. Online and app-based forms of therapy for mental health are burgeoning. It is therefore crucial to identify features that are most effective and engaging for young users. Objectives: This study reports a systematic review and meta-analysis of digital mental health interventions and their effectiveness in addressing anxiety and depression in young people to determine factors that relate to outcomes, adherence, and engagement with such interventions. Methods: A mixed methods approach was taken, including a meta-analysis of 9 randomized controlled trials that compared use of a digital intervention for depression in young people to a no-intervention control group, and 6 comparing the intervention to an active control condition. A thematic analysis and narrative synthesis of 41 studies was also performed. Results: The pooled effect size of digital mental health interventions on depression in comparison to a no-intervention control was small (Cohen's d = 0.33, 95% CI 0.11 to 0.55), while the pooled effect size of studies comparing an intervention group to an active control showed no significant differences (Cohen's d = 0.14, 95% CI -.04 to 0.31). Pooled effect sizes were higher when supervision was involved (studies with no-intervention controls: Cohen's d = 0.52, 95% CI 0.23 to 0.80; studies with active control: Cohen's d = 0.49, 95% CI -0.11, 1.01). Engagement and adherence rates were low. Qualitative analysis revealed that users liked interventions with a game-like feel and relatable, interactive content. Educational materials were perceived as boring, and users were put off by non-appealing interfaces and technical glitches. Conclusions: Digital interventions work better than no intervention to improve depression in young people when results of different studies are pooled together. However, these interventions may only be of clinical significance when use is highly supervised. Digital interventions do not work better than active alternatives regardless of the level of support. Future interventions need to move beyond the use of digital educational materials, considering other ways to attract and engage young people and to ensure relevance and appeal.
Collapse
Affiliation(s)
- Sandra Garrido
- MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Milperra, NSW, Australia.,Translational Health Institute, Western Sydney University, Campbelltown, NSW, Australia.,School of Social Sciences & Psychology, Western Sydney University, Milperra, NSW, Australia
| | - Chris Millington
- MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Milperra, NSW, Australia
| | - Daniel Cheers
- MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Milperra, NSW, Australia.,NSW Health, Sydney, NSW, Australia
| | | | - Emery Schubert
- School of Arts & Humanities, University of New South Wales, Kensington, NSW, Australia
| | - Tanya Meade
- School of Social Sciences & Psychology, Western Sydney University, Milperra, NSW, Australia
| | - Quang Vinh Nguyen
- School of Computing & Engineering, Western Sydney University, Parramatta, NSW, Australia
| |
Collapse
|
37
|
Hart Abney BG, Lusk P, Hovermale R, Melnyk BM. Decreasing Depression and Anxiety in College Youth Using the Creating Opportunities for Personal Empowerment Program (COPE). J Am Psychiatr Nurses Assoc 2019; 25:89-98. [PMID: 29865903 DOI: 10.1177/1078390318779205] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND College is a time of major transition in the lives of many young adults. Roughly 30% of college students have reported that anxiety and depressive symptoms negatively affect their lives and academic functioning. Currently, anxiety has surpassed depression as the reason college students seek help at counseling centers. Unfortunately, only one third of students receive treatment for anxiety and only 25% of students receive treatment for their depression. OBJECTIVES The objectives of this pilot project were to (a) assess levels of depression and anxiety in identified "at risk" college students who present to the college Student Health Services (Primary Care), (b) implement a new cognitive behavioral therapy-based intervention titled "Creating Opportunities for Personal Empowerment" (COPE), and (c) evaluate the effectiveness of the intervention on students' levels of depression and anxiety as well as satisfaction with the intervention. DESIGN A one group pre- and post-test design was used. RESULTS Students who received COPE demonstrated clinically meaningful improvement in depressive and anxiety symptoms as measured by the Beck Depression Inventory-II and the State-Trait Anxiety Inventory. CONCLUSION COPE is an effective brief program for reducing depression and anxiety in college-age youth. Implementation of evidenced-based programs into the college experience could lead to less severe depression and anxiety and better academic performance, ultimately increasing the likelihood of students successfully completing their academic programs.
Collapse
Affiliation(s)
- Beverly G Hart Abney
- 1 Beverly G. Hart Abney, PhD, APRN-BC, Eastern Kentucky University, Richmond, KY, USA
| | - Pamela Lusk
- 2 Pamela Lusk, DNP, PMHNP-BC, FAANP, The Ohio State University, Columbus, OH, USA
| | - Rachael Hovermale
- 3 Rachael Hovermale, DNP, APRN-BC, Eastern Kentucky University, Richmond, KY, USA
| | - Bernadette Mazurek Melnyk
- 4 Bernadette Mazurek Melnyk, PhD, RN, CPNP/PMHNP, FAANP, FNAP, FAAN, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
38
|
Musiat P, Potterton R, Gordon G, Spencer L, Zeiler M, Waldherr K, Kuso S, Nitsch M, Adamcik T, Wagner G, Karwautz A, Ebert DD, Dodd A, Dooley B, Harrison A, Whitt E, Haselgrove M, Sharpe H, Smith J, Tressler R, Troop N, Vinyard C, Görlich D, Beecham J, Bonin E, Jacobi C, Schmidt U. Web-based indicated prevention of common mental disorders in university students in four European countries - Study protocol for a randomised controlled trial. Internet Interv 2018; 16:35-42. [PMID: 30775263 PMCID: PMC6364328 DOI: 10.1016/j.invent.2018.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/17/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Mental disorders and their symptoms are highly prevalent in the university student population, and the transition from secondary to tertiary education is associated with a rise in mental health problems. Existing web-based interventions for the prevention of common mental disorders in student populations often focus on just one disorder and have not been designed specifically for students. There is thus a need for transdiagnostic, student-specific preventative interventions that can be widely disseminated. This two-arm, parallel group randomised controlled trial aims to evaluate the effectiveness and cost-effectiveness of a web-based transdiagnostic mental health problem prevention programme (PLUS) across several universities in four countries. METHOD Students (N = 5550) will be recruited through a variety of channels and asked to complete a personality assessment to determine whether they are at high risk for developing common mental disorders. Students at high risk will be randomly allocated to either PLUS or a control intervention, which provides practical support around issues commonly experienced at university. Students at low risk will be allocated to the control intervention. Both intervention groups will be assessed at baseline, 4 weeks, 3 months, 6 months and 12 months after randomisation. Depression and generalised anxiety, assessed using the Patient Health Questionnaire and the Generalised Anxiety Disorder scales, will form the primary outcomes in this study. Secondary outcome measures include alcohol and drug use, eating behaviour, self-esteem, and quality of life. The cost-effectiveness of the intervention will also be evaluated. CONCLUSIONS This study will contribute to understanding the role of transdiagnostic indicated web-based interventions for the prevention of common mental disorders in university students. It will also be one of the first studies to investigate the cost-effectiveness of such interventions. TRIAL REGISTRATION This trial was registered in the ISRCTN register (ISRCTN15570935) on 12th February 2016.
Collapse
Affiliation(s)
- Peter Musiat
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO59, 16 De Crespigny Park, London SE5 8AF, United Kingdom,Corresponding author.
| | - Rachel Potterton
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO59, 16 De Crespigny Park, London SE5 8AF, United Kingdom
| | - Gemma Gordon
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO59, 16 De Crespigny Park, London SE5 8AF, United Kingdom
| | - Lucy Spencer
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO59, 16 De Crespigny Park, London SE5 8AF, United Kingdom
| | - Michael Zeiler
- Medical University of Vienna, Department for Child and Adolescent Psychiatry, Eating Disorders Unit, Spitalgasse 23, 1090 Vienna, Austria
| | - Karin Waldherr
- Ferdinand-Porsche Distance Learning University for Applied Sciences, Wr. Neustadt, Austria
| | - Stefanie Kuso
- Medical University of Vienna, Department for Child and Adolescent Psychiatry, Eating Disorders Unit, Spitalgasse 23, 1090 Vienna, Austria,Ferdinand-Porsche Distance Learning University for Applied Sciences, Wr. Neustadt, Austria
| | - Martina Nitsch
- Ferdinand-Porsche Distance Learning University for Applied Sciences, Wr. Neustadt, Austria
| | - Tanja Adamcik
- Ferdinand-Porsche Distance Learning University for Applied Sciences, Wr. Neustadt, Austria
| | - Gudrun Wagner
- Medical University of Vienna, Department for Child and Adolescent Psychiatry, Eating Disorders Unit, Spitalgasse 23, 1090 Vienna, Austria
| | - Andreas Karwautz
- Medical University of Vienna, Department for Child and Adolescent Psychiatry, Eating Disorders Unit, Spitalgasse 23, 1090 Vienna, Austria
| | - David Daniel Ebert
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Lehrstuhl für Klinische Psychologie und Psychotherapie, Nägelsbachstr, 25a, 91052 Erlangen, Germany
| | - Alyson Dodd
- Northumbria University, Department of Psychology, Northumberland Building, Newcastle upon Tyne NE1 8ST, United Kingdom
| | - Barbara Dooley
- University College Dublin, School of Psychology, Belfield Dublin 4, United Kingdom
| | - Amy Harrison
- University College London, Institute of Education, 20 Bedford Way, London WC1H 0AL, United Kingdom
| | - Emma Whitt
- University of Nottingham, School of Psychology, University Park Campus, Nottingham NG7 2RD, United Kingdom
| | - Mark Haselgrove
- University of Nottingham, School of Psychology, University Park Campus, Nottingham NG7 2RD, United Kingdom
| | - Helen Sharpe
- University of Edinburgh, School of Health in Social Science, Teviot Place, Edinburgh EH8 9AG, United Kingdom
| | - Jo Smith
- University of Worcester, Institute of Health and Society, St. John's, Worcester WR2 6AJ, United Kingdom
| | - Rosie Tressler
- Student Minds, 16-17 Turl Street, Oxford OX1 3DH, United Kingdom
| | - Nicholas Troop
- University of Hertfordshire, Department of Psychology, College Lane, Hatfield AL10 9AB, United Kingdom
| | - Chantal Vinyard
- University of Worcester, Institute of Health and Society, St. John's, Worcester WR2 6AJ, United Kingdom
| | - Dennis Görlich
- Westfälische Wilhelms-Universität Münster, Institute of Biostatistics and Clinical Research, Schmedingtraße 56, Münster, Germany
| | - Jenny Beecham
- London School of Economics and Political Science, Personal Social Services Research Unit, Houghton Street, London WC2A 2AE, UK
| | - Eva Bonin
- London School of Economics and Political Science, Personal Social Services Research Unit, Houghton Street, London WC2A 2AE, UK
| | - Corinna Jacobi
- Technische Universität Dresden, Institute für Klinische Psychologies und Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Ulrike Schmidt
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO59, 16 De Crespigny Park, London SE5 8AF, United Kingdom
| |
Collapse
|
39
|
A National Study Links Nurses’ Physical and Mental Health to Medical Errors and Perceived Worksite Wellness. J Occup Environ Med 2018; 60:126-131. [DOI: 10.1097/jom.0000000000001198] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
40
|
Wozney L, Huguet A, Bennett K, Radomski AD, Hartling L, Dyson M, McGrath PJ, Newton AS. How do eHealth Programs for Adolescents With Depression Work? A Realist Review of Persuasive System Design Components in Internet-Based Psychological Therapies. J Med Internet Res 2017; 19:e266. [PMID: 28793983 PMCID: PMC5569246 DOI: 10.2196/jmir.7573] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/05/2017] [Accepted: 06/30/2017] [Indexed: 11/21/2022] Open
Abstract
Background Major depressive disorders are common among adolescents and can impact all aspects of their daily life. Traditional therapies, cognitive behavioral therapy (CBT), and interpersonal psychotherapy (IPT) have been delivered face-to-face. However, Internet-based (online) delivery of these therapies is emerging as an option for adolescents. Internet-based CBT and IPT involve therapeutic content, interaction between the user and the system, and different technological features embedded into the online program (eg, multimedia). Studies of Internet-based CBT and IPT for adolescent depression differ on all three aspects, and variable, positive therapy effects have been reported. A better understanding of the treatment conditions that influence therapy outcomes is important to designing and evaluating these novel therapies. Objective Our aim was to examine the technological and program delivery features of Internet-based CBT and IPT for adolescent depression and to document their potential relation to treatment outcomes and program use. Methods We performed a realist synthesis. We started with an extensive search of published and gray literature. We included intervention studies that evaluated Internet-based CBT or IPT for adolescent depression. We included mixed-methods and qualitative studies, theoretical papers, and policy/implementation documents if they included a focus on how Internet-based psychological therapy is proposed to work for adolescents with depression/depressive symptoms. We used the Mixed-Methods Appraisal Tool to assess the methodological quality of studies. We used the Persuasive System Design (PSD) model as a framework for data extraction and analysis to examine how Internet-based CBT and IPT, as technology-based systems, influence the attitudes and behaviors of system users. PSD components described for the therapies were linked to reported outcomes using a cross-case comparison method and thematic synthesis. Results We identified 19 Internet-based CBT programs in 59 documents. Of those, 71% (42/59) were of moderate to high quality. The PSD features surface credibility (competent “look and feel”), dialogue support (online program + in-person support), liking and similarity (esthetics and content appeal to adolescent users), the reduction and tunneling of therapeutic content (reducing online content into simple tasks, guiding users), and use of self-monitoring were present in therapies that resulted in improved therapy engagement, satisfaction, and adherence, as well as symptom and functional impairments. Conclusions When incorporated into Internet-based CBT for adolescent depression, PSD features may improve adolescent adherence, satisfaction, and depression-related outcomes. Testing of these features using hypothesis-driven dismantling approaches is recommended to advance our understanding of how these features contribute to therapy effectiveness.
Collapse
Affiliation(s)
- Lori Wozney
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada
| | - Anna Huguet
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada
| | - Kathryn Bennett
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Ashley D Radomski
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Lisa Hartling
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Michele Dyson
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Patrick J McGrath
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada
| | - Amanda S Newton
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
41
|
Hollis C, Falconer CJ, Martin JL, Whittington C, Stockton S, Glazebrook C, Davies EB. Annual Research Review: Digital health interventions for children and young people with mental health problems - a systematic and meta-review. J Child Psychol Psychiatry 2017; 58:474-503. [PMID: 27943285 DOI: 10.1111/jcpp.12663] [Citation(s) in RCA: 387] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Digital health interventions (DHIs), including computer-assisted therapy, smartphone apps and wearable technologies, are heralded as having enormous potential to improve uptake and accessibility, efficiency, clinical effectiveness and personalisation of mental health interventions. It is generally assumed that DHIs will be preferred by children and young people (CYP) given their ubiquitous digital activity. However, it remains uncertain whether: DHIs for CYP are clinically and cost-effective, CYP prefer DHIs to traditional services, DHIs widen access and how they should be evaluated and adopted by mental health services. This review evaluates the evidence-base for DHIs and considers the key research questions and approaches to evaluation and implementation. METHODS We conducted a meta-review of scoping, narrative, systematic or meta-analytical reviews investigating the effectiveness of DHIs for mental health problems in CYP. We also updated a systematic review of randomised controlled trials (RCTs) of DHIs for CYP published in the last 3 years. RESULTS Twenty-one reviews were included in the meta-review. The findings provide some support for the clinical benefit of DHIs, particularly computerised cognitive behavioural therapy (cCBT), for depression and anxiety in adolescents and young adults. The systematic review identified 30 new RCTs evaluating DHIs for attention deficit/hyperactivity disorder (ADHD), autism, anxiety, depression, psychosis, eating disorders and PTSD. The benefits of DHIs in managing ADHD, autism, psychosis and eating disorders are uncertain, and evidence is lacking regarding the cost-effectiveness of DHIs. CONCLUSIONS Key methodological limitations make it difficult to draw definitive conclusions from existing clinical trials of DHIs. Issues include variable uptake and engagement with DHIs, lack of an agreed typology/taxonomy for DHIs, small sample sizes, lack of blinded outcome assessment, combining different comparators, short-term follow-up and poor specification of the level of human support. Research and practice recommendations are presented that address the key research questions and methodological issues for the evaluation and clinical implementation of DHIs for CYP.
Collapse
Affiliation(s)
- Chris Hollis
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR MindTech Healthcare Technology Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Caroline J Falconer
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR MindTech Healthcare Technology Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Jennifer L Martin
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR MindTech Healthcare Technology Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | | | - Sarah Stockton
- Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Cris Glazebrook
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR MindTech Healthcare Technology Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - E Bethan Davies
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR MindTech Healthcare Technology Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| |
Collapse
|