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Aggestrup AS, Martiny F, Lund Henriksen L, Davidsen AS, Martiny K. Interventions promoting recovery from depression for patients transitioning from outpatient mental health services to primary care: A scoping review. PLoS One 2024; 19:e0302229. [PMID: 38709769 PMCID: PMC11073719 DOI: 10.1371/journal.pone.0302229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/28/2024] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION Major Depressive Disorder (MDD) is one of the most prevalent mental disorders worldwide with significant personal and public health consequences. After an episode of MDD, the likelihood of relapse is high. Therefore, there is a need for interventions that prevent relapse of depression when outpatient mental health care treatment has ended. This scoping review aimed to systematically map the evidence and identify knowledge gaps in interventions that aimed to promote recovery from MDD for patients transitioning from outpatient mental health services to primary care. MATERIALS AND METHODS We followed the guidance by Joanna Briggs Institute in tandem with the PRISMA extension for Scoping Reviews checklist. Four electronic databases were systematically searched using controlled index-or thesaurus terms and free text terms, as well as backward and forward citation tracking of included studies. The search strategy was based on the identification of any type of intervention, whether simple, multicomponent, or complex. Three authors independently screened for eligibility and extracted data. RESULTS 18 studies were included for review. The studies had high heterogeneity in design, methods, sample size, recovery rating scales, and type of interventions. All studies used several elements in their interventions; however, the majority used cognitive behavioural therapy conducted in outpatient mental health services. No studies addressed the transitioning phase from outpatient mental health services to primary care. Most studies included patients during their outpatient mental health care treatment of MDD. CONCLUSIONS We identified several knowledge gaps. Recovery interventions for patients with MDD transitioning from outpatient mental health services to primary care are understudied. No studies addressed interventions in this transitioning phase or the patient's experience of the transitioning process. Research is needed to bridge this gap, both regarding interventions for patients transitioning from secondary to primary care, and patients' and health care professionals' experiences of the interventions and of what promotes recovery. REGISTRATION A protocol was prepared in advance and registered in Open Science Framework (https://osf.io/ah3sv), published in the medRxiv server (https://doi.org/10.1101/2022.10.06.22280499) and in PLOS ONE (https://doi.org/10.1371/journal.pone.0291559).
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Affiliation(s)
- Anne Sofie Aggestrup
- The Research Unit for Mental Health Centre Copenhagen, Copenhagen Affective Disorder Research Centre (CADIC), New Interventions in Depression (NID) Group, Mental Health Services in the Capital Region of Denmark, University of Copenhagen, Frederiksberg Hospital, Frederiksberg, Denmark
| | - Frederik Martiny
- The Research Unit for and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Social Medicine, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Line Lund Henriksen
- The Research Unit for Mental Health Centre Copenhagen, Copenhagen Affective Disorder Research Centre (CADIC), New Interventions in Depression (NID) Group, Mental Health Services in the Capital Region of Denmark, University of Copenhagen, Frederiksberg Hospital, Frederiksberg, Denmark
| | - Annette Sofie Davidsen
- The Research Unit for and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Martiny
- The Research Unit for Mental Health Centre Copenhagen, Copenhagen Affective Disorder Research Centre (CADIC), New Interventions in Depression (NID) Group, Mental Health Services in the Capital Region of Denmark, University of Copenhagen, Frederiksberg Hospital, Frederiksberg, Denmark
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Solis EC, Carlier IVE, Kamminga NGA, Giltay EJ, van Hemert AM. The clinical effectiveness of a self-management intervention for patients with persistent depressive disorder and their partners/caregivers: results from a multicenter, pragmatic randomized controlled trial. Trials 2024; 25:187. [PMID: 38481289 PMCID: PMC10938802 DOI: 10.1186/s13063-024-08033-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 03/04/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Persistent depressive disorder (PDD) is prevalent and debilitating. For patients with PDD, psychiatric rehabilitation using self-management interventions is advised as the next therapeutic step after multiple unsuccessful treatment attempts. The "Patient and Partner Education Program for All Chronic Diseases" (PPEP4All) is a brief, structured self-management program that focuses on functional recovery for patients and their partners/caregivers. In chronic somatic disorder populations, PPEP4All has already been shown to be clinically effective. We examined whether PPEP4All adapted for PDD (PPEP4All-PDD, nine weekly group or individual sessions) is also clinically effective for adults/elderly with PDD and their partners/caregivers compared to care-as-usual (CAU) in specialized mental healthcare. METHODS In this mixed-method multicenter pragmatic randomized controlled trial, 70 patients with PDD and 14 partners/caregivers were allocated to either PPEP4All-PDD (patients, n = 37; partners/caregivers, n = 14) or CAU (patients, n = 33; partners/caregivers, not included) and completed questionnaires at 0, 3, 6, and 12 months regarding depressive symptoms, psychopathology, psychosocial burden, mental resilience, and happiness/well-being. Qualitative data were collected regarding treatment satisfaction. Data were analyzed using mixed model analyses and an intention-to-treat (ITT) approach. RESULTS There was no statistically significant difference in any outcome regarding clinical effectiveness between PPEP4All-PDD and CAU. Subgroup analysis for depressive symptoms did not show any interaction effect for any subgroup. Although 78% of participants recommended PPEP4All-PDD, there was no difference in treatment satisfaction between PPEP4All-PDD (score = 6.6; SD = 1.7) and CAU (score = 7.6; SD = 1.2), p = 0.06. CONCLUSION Although depressive symptoms did not improve relative to CAU, this only confirmed that treatment for patients with treatment-resistant PDD should move from symptom reduction to functional recovery. Also, functional recovery may be reflected in other outcomes than psychosocial burden, such as self-empowerment, in patients with treatment-resistant PDD. Future research on PPEP4All-PDD could focus on a longer-term program and/or online program that may also be offered earlier in the treatment process as an empowerment intervention. TRIAL REGISTRATION: Netherlands Trial Register Identifier NL5818. Registered on 20 July 2016 https://clinicaltrialregister.nl/nl/trial/20302.
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Affiliation(s)
- Ericka C Solis
- Department of Psychiatry, Leiden University Medical Center, P.O. Box 9600, Leiden, 2300, RC, The Netherlands.
| | - Ingrid V E Carlier
- Department of Psychiatry, Leiden University Medical Center, P.O. Box 9600, Leiden, 2300, RC, The Netherlands
| | - Noëlle G A Kamminga
- Department of Psychiatry and Medical Psychology, Maastricht University Medical Center, Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences (MHeNs), Maastricht University, Maastricht, The Netherlands
| | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Center, P.O. Box 9600, Leiden, 2300, RC, The Netherlands
| | - Albert M van Hemert
- Department of Psychiatry, Leiden University Medical Center, P.O. Box 9600, Leiden, 2300, RC, The Netherlands
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Matthews EB, Rahman R, Schiefelbein F, Galis D, Clark C, Patel R. Identifying key roles and responsibilities of peer workers in behavioral health services: A scoping review. PATIENT EDUCATION AND COUNSELING 2023; 114:107858. [PMID: 37348313 DOI: 10.1016/j.pec.2023.107858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/18/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE The roles and responsibilities of peer workers (PWs) are not well articulated. This scoping review aims to systematically identify and describe the roles of PWs in outpatient, community based mental health and substance use services, and compare their roles and responsibilities across these service settings METHODS: The scoping review was a priori developed and implemented according to the Joanna Briggs Institute methodology, which includes stating the review objectives, conducting a three-step search method, and charting the results. RESULTS Forty-four peer reviewed manuscripts were included in the review. PWs were used more often in mental health (n = 27) than substance use (n = 10) programs. Peers adopted a wide range of skills. Across program contexts, peers were frequently used as a source of informal support or mentorship and care coordination. Mental health programs often used peers to deliver manualized interventions, while substance use programs more frequently leveraged PWs to facilitate service linkage and engagement. CONCLUSION Roles of peers differed between substance use and mental health programs, reflecting significant diversity in how peers are being integrated into the behavioral health workforce. PRACTICE IMPLICATIONS Peer certification programs must balance consistency with the wide range of skills required of this workforce.
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Affiliation(s)
- Elizabeth B Matthews
- Fordham University, Graduate School of Social Service, 113W. 60th st., New York, NY 10023, USA.
| | - Rahbel Rahman
- Fordham University, Graduate School of Social Service, 113W. 60th st., New York, NY 10023, USA
| | - Faith Schiefelbein
- Fordham University, Graduate School of Social Service, 113W. 60th st., New York, NY 10023, USA
| | - Danielle Galis
- Fordham University, Graduate School of Social Service, 113W. 60th st., New York, NY 10023, USA
| | - Carson Clark
- Fordham University, Graduate School of Social Service, 113W. 60th st., New York, NY 10023, USA
| | - Rupal Patel
- Fordham University, Graduate School of Social Service, 113W. 60th st., New York, NY 10023, USA
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Høgh Egmose C, Heinsvig Poulsen C, Hjorthøj C, Skriver Mundy S, Hellström L, Nørgaard Nielsen M, Korsbek L, Serup Rasmussen K, Falgaard Eplov L. The Effectiveness of Peer Support in Personal and Clinical Recovery-Systematic Review and Meta-Analysis. Psychiatr Serv 2023:appips202100138. [PMID: 36751908 DOI: 10.1176/appi.ps.202100138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Peer support has been shown to support personal recovery from mental illness. It is unclear whether the effects of peer support across different mental illnesses depend on the organizational setting. The authors reviewed the effectiveness of peer support for both personal recovery and clinical recovery of adults with any mental illness and evaluated the effectiveness of peer support in different settings. METHODS A systematic review of randomized controlled trials (RCTs) was conducted in PubMed, PsycInfo, CINAHL, Cochrane Library, and Web of Science. A meta-analysis of outcomes of personal and clinical recoveries at the end of interventions was conducted. RESULTS In total, 49 RCTs with 12,477 participants with any mental illness were included. Most of the trials had a high risk for bias. Results of the meta-analysis indicated that peer support in general had a small positive effect on personal recovery (standard mean difference [SMD]=0.20; 95% CI=0.11-0.29) and decreased anxiety symptoms (SMD=-0.21; 95% CI=-0.40 to -0.02), with most trials evaluating peers added to mental health-related hospital services. No data for peers in established service roles were available for the meta-analysis. Peer-designed interventions developed to be provided independently of hospital services and delivered in community settings had a modest effect on self-advocacy. A small nonsignificant effect on personal recovery for peer support delivered online was also observed. CONCLUSIONS The effect on personal recovery from mental illness was most evident in peer support added to hospital services. High-quality RCTs with comparable cocreated interventions and clear descriptions of mechanisms of change are needed to further investigate peer support efficacy.
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Affiliation(s)
- Cecilie Høgh Egmose
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| | - Chalotte Heinsvig Poulsen
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| | - Sara Skriver Mundy
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| | - Lone Hellström
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| | - Mette Nørgaard Nielsen
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| | - Lisa Korsbek
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| | - Klavs Serup Rasmussen
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| | - Lene Falgaard Eplov
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
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Tanner A, von Gaudecker J, Buelow JM, Miller WR. Hybrid Concept Analysis of Self-Management Support: School Nurses Supporting Students with Psychogenic Nonepileptic Seizures. J Sch Nurs 2022; 38:428-441. [PMID: 34809511 PMCID: PMC9124726 DOI: 10.1177/10598405211053506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Self-management support has been identified as an effective nursing intervention for improving outcomes for people with chronic conditions, yet this concept lacks a clear definition. Furthermore, the concept has not been used in school nursing literature despite the clear connection between school nursing practice and tenets of self-management support. Additionally, the concept has not been explored in the context of difficult-to-manage mental health concerns, such as psychogenic nonepileptic seizures. A conversion disorder in which seizure events in the absence of abnormal brainwave activity result from stress, psychogenic nonepileptic seizures affect the quality of life and school experience for students experiencing them and could be addressed through self-management support. This hybrid concept analysis included a review of extant literature and semi-structured interviews with school nurses to ascertain a definition of self-management support in the context of school nursing using care of students with psychogenic nonepileptic seizures as an exemplar.
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Affiliation(s)
- Andrea Tanner
- 15841Indiana University School of Nursing, Indianapolis
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Poulsen CH, Egmose CH, Ebersbach BK, Hjorthøj C, Eplov LF. A community-based peer-support group intervention "Paths to EvERyday life" (PEER) added to service as usual for adults with vulnerability to mental health difficulties - a study protocol for a randomized controlled trial. Trials 2022; 23:727. [PMID: 36056407 PMCID: PMC9437410 DOI: 10.1186/s13063-022-06670-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background The number of people struggling with vulnerability to mental health difficulties is increasing worldwide, and there is a need for new interventions, to prevent more people from developing serious mental illnesses. In recent years, peer support has been suggested as a key element in creating person-centered interventions in mental health services. However, the evidence for peer support is not yet established. We aim to investigate the effect of a 10-week peer-support intervention “Paths to EvERyday life” (PEER) added to service as usual (SAU) versus SAU alone in a Danish municipality setting. Methods A two-armed, investigator-initiated, multi-municipal, parallel-group superiority trial to investigate the effectiveness of the PEER intervention added to SAU compared to SAU alone. A total of 284 participants will be recruited from the municipal social services in the participating municipalities and by self-referrals and randomly assigned to (1) the PEER intervention added to SAU or (2) SAU. The primary outcome is a self-assessed personal recovery (Questionnaire about the process of recovery (QPR-15)) at end of the intervention. The secondary outcomes are self-assessed empowerment (Empowerment Scale Rogers (ESR)), quality of life (The Manchester Short Assessment of Quality of life (MANSA)), and functioning (Work and Social Adjustment Scale (WSAS)). Discussion This trial will test a new community-based peer-support intervention, and if the intervention proves to be effective, the goal is that future integration of this intervention will improve individual recovery and mental health and reduce the societal burden of individuals seeking municipal social support and/or mental health services. Trial registration ClinicalTrials.gov NCT04639167. Registered on Nov. 19, 2020.
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Affiliation(s)
- Chalotte Heinsvig Poulsen
- Copenhagen Research Center for Mental Health (CORE), Mental Health Center Copenhagen, University of Copenhagen, Copenhagen, Denmark.
| | - Cecilie Høgh Egmose
- Copenhagen Research Center for Mental Health (CORE), Mental Health Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Bea Kolbe Ebersbach
- Copenhagen Research Center for Mental Health (CORE), Mental Health Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health (CORE), Mental Health Center Copenhagen, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Lene Falgaard Eplov
- Copenhagen Research Center for Mental Health (CORE), Mental Health Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
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Gaiser MG, Buche JL, Wayment CC, Schoebel V, Smith JE, Chapman SA, Beck AJ. A Systematic Review of the Roles and Contributions of Peer Providers in the Behavioral Health Workforce. Am J Prev Med 2021; 61:e203-e210. [PMID: 34175172 DOI: 10.1016/j.amepre.2021.03.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/10/2021] [Accepted: 03/30/2021] [Indexed: 01/16/2023]
Abstract
CONTEXT Peer providers with lived experiences of mental health and substance use are a growing component of the workforce responsible for the prevention and treatment of behavioral health disorders. This systematic literature review aims to better define the roles of peers and their unique contributions to behavioral health care. EVIDENCE ACQUISITION Researchers searched MEDLINE, CINAHL Complete, PsycINFO, Cochrane Central, and Scopus databases for studies published between January 1, 2013 and April 3, 2020. Studies were included if they (1) were experimental or observational studies, (2) included an adult population of people with a behavioral health disorder, and (3) used paid peer providers in addition to traditional behavioral health services. Researchers extracted sample demographics, intervention characteristics, outcome data, and significant associations from studies that met inclusion criteria and assessed the trends in these data in May 2020. EVIDENCE SYNTHESIS A total of 23 articles assessing peer-provided services were included. Peers were employed most frequently in mental healthcare roles in the Department of Veterans Affairs, hospital, and community health facilities. A total of 14 studies observed significant clinical improvements in participants' social functioning, quality of life, patient activation, and behavioral health. A majority of studies involved the supervision of peers and required peers to have completed training in service delivery. CONCLUSIONS Peers are effective providers of behavioral health treatment and relapse prevention services who encourage recovery through resilience building, empowerment, and self-advocacy. There remains a need for more evidence-based interventions on the efficacy of peers in substance use disorder treatment and the impact of formalized certification and training opportunities.
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Affiliation(s)
- Maria G Gaiser
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Jessica L Buche
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Caitlyn C Wayment
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Victoria Schoebel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Judith E Smith
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan
| | - Susan A Chapman
- Department of Social & Behavioral Sciences, School of Nursing, University of California San Francisco, San Francisco, California
| | - Angela J Beck
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan.
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McBain RK, Collins RL, Wong EC, Breslau J, Cefalu MS, Roth E, Burnam MA. Mental Health Services and Personal Recovery in California: A Population-Based Analysis. Psychiatr Serv 2020; 71:580-587. [PMID: 32114940 PMCID: PMC7265972 DOI: 10.1176/appi.ps.201900204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Personal recovery measures have been examined among treatment-seeking individuals enrolled in high-quality care. The authors examined whether utilization of mental health services as typically delivered is associated with personal recovery among adults with clinically significant psychological distress. METHODS The Kessler Psychological Distress Scale (K-6) measured respondents' (N=1,954) psychological distress level. The authors also assessed five dimensions of personal recovery-hope, life satisfaction, empowerment, connectedness, and internalized stigma. Multivariable linear regression analyses were used to examine relationships between personal recovery and treatment, self-reported treatment completion, provider type, and adequacy of care, adjusting for covariates including K-6 score. RESULTS Participants who received care >12 months prior to the survey reported lower levels of hope (95% confidence interval [CI]=-0.36, -0.06, p<0.01), empowerment (95% CI=-0.26, -0.02, p<0.05), and connectedness (95% CI=-0.37, -0.06, p<0.01) than those who had not received treatment. Those who received care in the past 12 months reported lower levels of hope (95% CI=-0.47, -0.14, p<0.001) and life satisfaction (95% CI=-0.42, -0.05, p<0.01). However, treatment completion was associated with higher levels of empowerment (95% CI=0.02, 0.56, p<0.05) and hope (95% CI=0.04, 0.62, p<0.05) and lower levels of stigma (95% CI=-1.21, -0.21, p<0.01) compared with noncompletion. Differences according to provider type and adequacy of care were nonsignificant. CONCLUSIONS Utilization of mental health services was associated with lower levels of personal recovery, which may indicate that care-as typically utilized and received-does not promote personal recovery. Longitudinal research is needed to determine causal relationships underlying these associations.
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Affiliation(s)
- Ryan K McBain
- RAND Health Care, RAND Corporation, Boston (McBain); Santa Monica, California (Collins, Wong, Cefalu, Roth, Burnam); and Pittsburgh (Breslau)
| | - Rebecca L Collins
- RAND Health Care, RAND Corporation, Boston (McBain); Santa Monica, California (Collins, Wong, Cefalu, Roth, Burnam); and Pittsburgh (Breslau)
| | - Eunice C Wong
- RAND Health Care, RAND Corporation, Boston (McBain); Santa Monica, California (Collins, Wong, Cefalu, Roth, Burnam); and Pittsburgh (Breslau)
| | - Joshua Breslau
- RAND Health Care, RAND Corporation, Boston (McBain); Santa Monica, California (Collins, Wong, Cefalu, Roth, Burnam); and Pittsburgh (Breslau)
| | - Mathew S Cefalu
- RAND Health Care, RAND Corporation, Boston (McBain); Santa Monica, California (Collins, Wong, Cefalu, Roth, Burnam); and Pittsburgh (Breslau)
| | - Elizabeth Roth
- RAND Health Care, RAND Corporation, Boston (McBain); Santa Monica, California (Collins, Wong, Cefalu, Roth, Burnam); and Pittsburgh (Breslau)
| | - M Audrey Burnam
- RAND Health Care, RAND Corporation, Boston (McBain); Santa Monica, California (Collins, Wong, Cefalu, Roth, Burnam); and Pittsburgh (Breslau)
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Smit D, Peelen J, Vrijsen JN, Spijker J. An exploration of the conditions for deploying self-management strategies: a qualitative study of experiential knowledge in depression. BMC Psychiatry 2020; 20:210. [PMID: 32393226 PMCID: PMC7212680 DOI: 10.1186/s12888-020-02559-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 03/23/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Living with recurrent, and/or chronic depression requires long-term management in addition to active coping on a day-to-day basis. Previous research on long-term management, and coping with depression mainly focused on identifying self-management strategies. However, research on the conditions for deploying self-management strategies in depression is lacking. By means of exploring the development of experiential knowledge in depression, and its relation with coping with depression, this study aims to gain insight into the conditions for deploying self-management strategies. METHODS In the current qualitative study, individual pathways to recovery, living with depression, and recurrence risk were assessed, including but not limited to long-term management. 'Experiential knowledge', which can be defined as patients' unique knowledge and own lived experiences in facilitating and debilitating factors in the recovery process and coping with the disorder, was used as a sensitizing concept. Thirteen semi-structured interviews were conducted with individuals who experienced at least two depressive episodes and were currently in (partial) remission, plus two deviant cases were interviewed to check for saturation. Until saturation was achieved, participants were purposively selected to include diverse perspectives on coping with depression. Data were analysed using a narrative research method. RESULTS The results show that deploying self-management strategies are an integral part of 'experiential knowledge'. The evolvement of experiential knowledge can be seen as a cyclical process of the main themes that were identified as relevant when coping with depression: introspection, empowerment, self-management strategies, and external moderators of the environment. The identification of supporting and impeding factors in coping with depression from a patient perspective might increase a sustainable use of self-management strategies. CONCLUSION These results highlight the need for an individualised holistic model of coping with depression, both in research, and in practice. By means of integrating experiential knowledge in this holistic approach, the conditions for deployment of self-management strategies in depressive patients can be specified.
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Affiliation(s)
- Dorien Smit
- Behavioural Science Institute, Radboud University Nijmegen, PO Box 9101, Nijmegen, 6500 HB, The Netherlands. .,Pro Persona Mental Health Care, Depression Expertise Center, PO Box 7049, Nijmegen, 6503 GM, The Netherlands.
| | - Janneke Peelen
- grid.450078.e0000 0000 8809 2093HAN University of Applied Sciences, Research Group for Key Factors in Youth Care, PO Box 6960, Nijmegen, 6503 GL The Netherlands
| | - Janna N. Vrijsen
- grid.5590.90000000122931605Behavioural Science Institute, Radboud University Nijmegen, PO Box 9101, Nijmegen, 6500 HB The Netherlands ,grid.491369.00000 0004 0466 1666Pro Persona Mental Health Care, Depression Expertise Center, PO Box 7049, Nijmegen, 6503 GM The Netherlands ,grid.10417.330000 0004 0444 9382Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9010, Nijmegen, 6500 GL The Netherlands
| | - Jan Spijker
- grid.5590.90000000122931605Behavioural Science Institute, Radboud University Nijmegen, PO Box 9101, Nijmegen, 6500 HB The Netherlands ,grid.491369.00000 0004 0466 1666Pro Persona Mental Health Care, Depression Expertise Center, PO Box 7049, Nijmegen, 6503 GM The Netherlands
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Jones SM, Shulman LJ, Richards JE, Ludman EJ. Mechanisms for the testing effect on patient-reported outcomes. Contemp Clin Trials Commun 2020; 18:100554. [PMID: 32215338 PMCID: PMC7090376 DOI: 10.1016/j.conctc.2020.100554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/02/2020] [Accepted: 03/14/2020] [Indexed: 11/19/2022] Open
Abstract
The testing effect is when patient-reported outcomes (PRO) improve with repeated administration without intervention. The testing effect can confound interpretation of clinical trials using PROs as endpoints. This study investigated potential mechanisms. The parent study (n = 302) investigated a self-management intervention for depression. We qualitatively analyzed exit interview feedback from the 89 control group participants completing the last assessment. Participants reported several perceived benefits from control group participation including novel mechanisms (study participation was meaningful, emotional support, appreciating outreach), a possible negative testing effect and mechanisms previously identified (behavioral change).
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Affiliation(s)
- Salene M.W. Jones
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
- Corresponding author.
| | - Lisa J. Shulman
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
| | - Julie E. Richards
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
- University of Washington Health Services Department, Seattle, WA, USA
| | - Evette J. Ludman
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
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11
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Moriarty AS, Coventry PA, Hudson JL, Cook N, Fenton OJ, Bower P, Lovell K, Archer J, Clarke R, Richards DA, Dickens C, Gask L, Waheed W, Huijbregts KM, van der Feltz-Cornelis C, Ali S, Gilbody S, McMillan D. The role of relapse prevention for depression in collaborative care: A systematic review. J Affect Disord 2020; 265:618-644. [PMID: 31791677 DOI: 10.1016/j.jad.2019.11.105] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 10/01/2019] [Accepted: 11/21/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Relapse (the re-emergence of depression symptoms before full recovery) is common in depression and relapse prevention strategies are not well researched in primary care settings. Collaborative care is effective for treating acute phase depression but little is known about the use of relapse prevention strategies in collaborative care. We undertook a systematic review to identify and characterise relapse prevention strategies in the context of collaborative care. METHODS We searched for Randomised Controlled Trials (RCTs) of collaborative care for depression. In addition to published material, we obtained provider and patient manuals from authors to provide more detail on intervention content. We reported the extent to which collaborative care interventions addressed four relapse prevention components. RESULTS 93 RCTs were identified. 31 included a formal relapse prevention plan; 42 had proactive monitoring and follow-up after the acute phase; 39 reported strategies for optimising sustained medication adherence; and 20 of the trials reported psychological or psycho-educational treatments persisting beyond the acute phase or focussing on long-term health/relapse prevention. 30 (32.3%) did not report relapse prevention approaches. LIMITATIONS We did not receive trial materials for approximately half of the trials, which limited our ability to identify relevant features of intervention content. CONCLUSION Relapse is a significant risk amongst people treated for depression and interventions are needed that specifically address and minimise this risk. Given the advantages of collaborative care as a delivery system for depression care, there is scope for more consistency and increased effort to implement and evaluate relapse prevention strategies.
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Affiliation(s)
- Andrew S Moriarty
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Peter A Coventry
- Department of Health Sciences and Centre for Reviews and Dissemination, University of York, Heslington, York, YO10 5DD, UK.
| | - Joanna L Hudson
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Natalie Cook
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Oliver J Fenton
- Tees, Esk and Wear Valleys NHS Foundation Trust, South and West Community Mental Health Team, Acomb Garth, 2 Oak Rise, York, YO24 4LJ, UK.
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Janine Archer
- School of Health and Society, University of Salford, Mary Seacole Building, Broad St, Frederick Road Campus, Salford, M6 6PU, UK.
| | - Rose Clarke
- Sheffield IAPT, St George's Community Health Centre, Winter Street, Sheffield, South Yorkshire, S3 7ND, UK.
| | - David A Richards
- Institute of Health Research, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Chris Dickens
- Institute of Health Research, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Linda Gask
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Waquas Waheed
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Klaas M Huijbregts
- GGNet, Mental Health, RGC SKB Winterswijk, Beatrixpark 1, 7101 BN Winterswijk, The Netherlands.
| | | | - Shehzad Ali
- Epidemiology and Biostatistics Department, Schulich School of Medicine & Dentistry, Western University, Kresge Building, Room K201, London, Ontario, N6A 5C1, Canada; Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
| | - Simon Gilbody
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Dean McMillan
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
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12
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Menear M, Dugas M, Careau E, Chouinard MC, Dogba MJ, Gagnon MP, Gervais M, Gilbert M, Houle J, Kates N, Knowles S, Martin N, Nease DE, Zomahoun HTV, Légaré F. Strategies for engaging patients and families in collaborative care programs for depression and anxiety disorders: A systematic review. J Affect Disord 2020; 263:528-539. [PMID: 31744737 DOI: 10.1016/j.jad.2019.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/23/2019] [Accepted: 11/02/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patients and families are often referred to as important partners in collaborative mental health care (CMHC). However, how to meaningfully engage them as partners remains unclear. We aimed to identify strategies for engaging patients and families in CMHC programs for depression and anxiety disorders. METHODS We updated a Cochrane review of CMHC programs for depression and anxiety disorders. Searches were conducted in Cochrane CCDAN and CINAHL, complemented by additional database searches, trial registry searches, and cluster searches for 'sibling' articles. Coding and data extraction of engagement strategies was an iterative process guided by a conceptual framework. We used narrative synthesis and descriptive statistics to report on findings. FINDINGS We found 148 unique CMCH programs, described in 578 articles. Most programs (96%) featured at least one strategy for engaging patients or families. Programs adopted 15 different strategies overall, with a median of two strategies per program (range 0-9 strategies). The most common strategies were patient education (87% of programs) and self-management supports (47% of programs). Personalized care planning, shared decision making, and family or peer supports were identified in fewer than one third of programs. LIMITATIONS Our search strategy was designed to capture programs evaluated in clinical trials and so other innovative programs not studied in trials were likely missed. CONCLUSION Most CMHC programs for depression and anxiety disorders adopted a limited number of strategies to engage patients and families in their care. However, this review identifies numerous strategies that can be used to strengthen the patient- and family-centeredness of collaborative care.
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Affiliation(s)
- Matthew Menear
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada; Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada.
| | - Michèle Dugas
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada
| | - Emmanuelle Careau
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada; Department of Rehabilitation, Laval University, Quebec, Canada
| | | | - Maman Joyce Dogba
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada; Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada
| | | | - Michel Gervais
- Centre intégré universitaire en santé et en services sociaux de la Capitale-Nationale, Quebec, Canada
| | - Michel Gilbert
- National Centre for Excellence in Mental Health, Quebec, Canada
| | - Janie Houle
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Nick Kates
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Sarah Knowles
- NIHR Collaboration for Leadership in Applied Health Research an Care (CLAHRC) Greater Manchester, University of Manchester, Manchester, UK
| | | | - Donald E Nease
- Department of Family Medicine, University of Colorado Denver, Denver, US
| | | | - France Légaré
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada; Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada
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Abstract
Self-management is increasingly becoming the standard of care among people with chronic medical conditions. Its application to depression is mostly extrapolated from the paradigms used for nonpsychiatric medical illnesses. Such an approach falls short in addressing strength-based interventions that foster recovery in individuals with depression. This article describes a new paradigm of self-management, which is in line with the recovery model, is patient-centered, and goes beyond amelioration of clinical symptoms.
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Fuller SM, Koester KA, Erguera XA, Wilde Botta E, von Beetzen F, Steward WT, Avery A. The collaborative care model for HIV and depression: Patient perspectives and experiences from a safety-net clinic in the United States. SAGE Open Med 2019; 7:2050312119842249. [PMID: 31044076 PMCID: PMC6446432 DOI: 10.1177/2050312119842249] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 03/14/2019] [Indexed: 12/22/2022] Open
Abstract
Objectives: Collaborative care models may improve outcomes for both HIV and depression. The model includes routine screening and re-assessment of depressive symptoms as well as care coordination services delivered by an ancillary provider focused on mental health. We sought to explore patient experiences and attitudes about the services received through the collaborative care model, including measurement-based care using the Patient Health Questionnaire-9. Methods: We conducted 17 qualitative interviews with patients in a collaborative care model implemented at an HIV primary care clinic in a safety-net hospital in the United States. Interviews were analyzed using Framework Analysis. Results: Our findings illustrate the ways in which the collaborative care model for depression may be meaningful to patients in HIV care settings. Participants appreciated the support offered through the collaborative care model. Most participants perceived measurement-based care as useful to their providers, and an additional subset used the Patient Health Questionnaire-9 for their own self-management and awareness of depression. Over time, the collaborative care model appeared to motivate some patients to address depressive symptoms. Conclusion: The collaborative care model may be particularly helpful to patients in the way that it reinforces how depressive symptoms can be measured and managed. Furthermore, routine screening and re-measurement for depressive symptoms using the Patient Health Questionnaire-9 hold promise as an additional self-management tool to complement other clinical and supportive services.
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Affiliation(s)
- Shannon M Fuller
- Division of Prevention Sciences, Center for AIDS Prevention Studies, The University of California, San Francisco, San Francisco, CA, USA
| | - Kimberly A Koester
- Division of Prevention Sciences, Center for AIDS Prevention Studies, The University of California, San Francisco, San Francisco, CA, USA
| | - Xavier A Erguera
- Division of Prevention Sciences, Center for AIDS Prevention Studies, The University of California, San Francisco, San Francisco, CA, USA
| | - Emma Wilde Botta
- Division of Prevention Sciences, Center for AIDS Prevention Studies, The University of California, San Francisco, San Francisco, CA, USA
| | - Fredrik von Beetzen
- Division of Prevention Sciences, Center for AIDS Prevention Studies, The University of California, San Francisco, San Francisco, CA, USA
| | - Wayne T Steward
- Division of Prevention Sciences, Center for AIDS Prevention Studies, The University of California, San Francisco, San Francisco, CA, USA
| | - Ann Avery
- MetroHealth Medical Center, Cleveland, OH, USA.,Case Western Reserve University, School of Medicine, Cleveland, OH, USA
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15
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Zoun MHH, Koekkoek B, Sinnema H, van der Feltz-Cornelis CM, van Balkom AJLM, Schene AH, Smit F, Spijker J. Effectiveness of a self-management training for patients with chronic and treatment resistant anxiety or depressive disorders on quality of life, symptoms, and empowerment: results of a randomized controlled trial. BMC Psychiatry 2019; 19:46. [PMID: 30691421 PMCID: PMC6348638 DOI: 10.1186/s12888-019-2013-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 01/04/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Anxiety and depressive disorders are common mental disorders. A substantial part of patients does not achieve symptomatic remission after treatment in specialized services. Current care as usual (CAU) for these patients consists of long-term supportive contacts. Termination of CAU is often not considered to be an option due to persistent symptoms, a low level of functioning, and the absence of further treatment options. A new intervention, ZemCAD, offers a program focused on rehabilitation and self-management, followed by referral back to primary care. METHODS This multicenter randomized controlled trial was carried out in twelve specialized outpatient mental health care services in the Netherlands. Consenting and eligible patients were invited for the MINI interview and the baseline questionnaire. Assessments were done at 6 (T1), 12 (T2) and 18 (T3) months post baseline. We used linear mixed model analysis (LMM) to ascertain the effectiveness of the ZemCAD group relative to the CAU group on quality of life, symptom severity and empowerment. RESULTS In total 141 patients were included. The results at 18-month follow-up regarding to quality of life and symptom severity, showed no significant differences between the ZemCAD group and the CAU group, except on the 'social relationships'-domain (d = 0.37). With regard to empowerment a significant difference between both groups was observed in the total empowerment score and one empowerment dimension (d = 0.45 and d = 0.39, respectively). After the ZemCAD intervention, more patients went from specialized outpatient mental health services back to a less specialized health care setting with less intensive treatment, such as primary care. CONCLUSION The findings in this study suggest that patients with chronic and treatment-resistant anxiety and depression using the ZemCAD intervention improve on empowerment but not on symptom severity or quality of life. Since little is known about the effects of rehabilitation and self-management in patients with chronic and treatment resistant anxiety and depressive disorders, this is a first attempt to provide a proof-of-concept study in this under-researched but important field. TRIAL REGISTRATION Netherlands Trial Register: NTR3335 , registered 7 March 2012.
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Affiliation(s)
- Maringa H. H. Zoun
- 0000 0004 0444 9382grid.10417.33Behavioural Science Institute, Radboud University Medical Center, PO Box 9104, 6500 HE Nijmegen, The Netherlands ,0000 0004 0466 1666grid.491369.0Pro Persona Mental Health Care, Wolfheze 2, 6874 BE, Wolfheze, The Netherlands ,0000 0004 0466 1666grid.491369.0Pro Persona Mental Health Care, Wagnerlaan 2, 6815, AG Arnhem, The Netherlands
| | - Bauke Koekkoek
- 0000 0004 0466 1666grid.491369.0Pro Persona Mental Health Care, Wolfheze 2, 6874 BE, Wolfheze, The Netherlands ,0000 0000 8809 2093grid.450078.eResearch Group for Social Psychiatry and Mental Health Nursing, HAN University of Applied Science, PO Box 6960, 6503 GL Nijmegen, The Netherlands
| | - Henny Sinnema
- Institute for Nursing Studies, HU University of Applied Sciences, Heidelberglaan 7, 3584 CS Utrecht, The Netherlands
| | - Christina M. van der Feltz-Cornelis
- 0000 0004 0418 4513grid.491213.cTop Clinical Centre for Body, Mind and Health, GGZ Breburg, Lage Witsiebaan 4, 5042 DA Tilburg, The Netherlands ,0000 0004 1936 9668grid.5685.eDepartment of Health Sciences, HYMS, York Biomedical Research Institute, University of York, Room ARRC/204, Area 4, ARRC Building, YO10 5DD Yorkshire Heslington, UK
| | - Anton J. L. M. van Balkom
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Psychiatry and Amsterdam Public Health Research Institute, VU University Medical Centre and GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
| | - Aart H. Schene
- 0000 0004 0444 9382grid.10417.33Department of Psychiatry, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands ,0000000122931605grid.5590.9Donders Institute for Brain, Cognition and Behavior, Radboud University, Montessorilaan 3, 6525 HR, Nijmegen, The Netherlands
| | - Filip Smit
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Clinical, Neuro and Developmental Psychology, VU University Medical Centre, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands ,0000 0004 0435 165Xgrid.16872.3aDepartment of Epidemiology and Biostatistics, VU University Medical Centre, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands ,0000 0001 0835 8259grid.416017.5Trimbos Institute (Netherlands Institute of Mental Health and Addiction), PO Box 725, 3500 AS Utrecht, The Netherlands
| | - Jan Spijker
- 0000 0004 0444 9382grid.10417.33Behavioural Science Institute, Radboud University Medical Center, PO Box 9104, 6500 HE Nijmegen, The Netherlands ,0000 0004 0466 1666grid.491369.0Pro Persona Mental Health Care, Wolfheze 2, 6874 BE, Wolfheze, The Netherlands
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Bay E, Chan RR. Mindfulness-Based Versus Health Promotion Group Therapy After Traumatic Brain Injury. J Psychosoc Nurs Ment Health Serv 2018; 57:26-33. [PMID: 30272810 DOI: 10.3928/02793695-20180924-03] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 06/08/2018] [Indexed: 01/15/2023]
Abstract
The current pre- and posttest intervention study is designed for individuals with chronic symptoms and stress associated with mild-to-moderate traumatic brain injury (TBI). The researchers' intent was to evaluate whether an 8-week mindfulness-based group therapy compared to health promotion active control group therapy reduces chronic stress, TBI symptoms, and depressive symptoms. Significant mean reductions in chronic stress and TBI depressive and general symptoms for individuals in the mindfulness group compared to the active control group were present, according to paired t test analyses. Further, while controlling for baseline scores, the mindfulness-based intervention group change score was greater compared to the control group using regression analyses. Results suggest that mindfulness-based group intervention for individuals with chronic difficulties after TBI is feasible and effective. Further study of this cost-effective and self-management approach to stress and symptom management is warranted and has the potential to be a broad-based intervention for early therapy after injury. [Journal of Psychosocial Nursing and Mental Health Services, 57(1), 26-33.].
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Ijaz S, Davies P, Williams CJ, Kessler D, Lewis G, Wiles N. Psychological therapies for treatment-resistant depression in adults. Cochrane Database Syst Rev 2018; 5:CD010558. [PMID: 29761488 PMCID: PMC6494651 DOI: 10.1002/14651858.cd010558.pub2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Antidepressants are a first-line treatment for adults with moderate to severe major depression. However, many people prescribed antidepressants for depression don't respond fully to such medication, and little evidence is available to inform the most appropriate 'next step' treatment for such patients, who may be referred to as having treatment-resistant depression (TRD). National Institute for Health and Care Excellence (NICE) guidance suggests that the 'next step' for those who do not respond to antidepressants may include a change in the dose or type of antidepressant medication, the addition of another medication, or the start of psychotherapy. Different types of psychotherapies may be used for TRD; evidence on these treatments is available but has not been collated to date.Along with the sister review of pharmacological therapies for TRD, this review summarises available evidence for the effectiveness of psychotherapies for adults (18 to 74 years) with TRD with the goal of establishing the best 'next step' for this group. OBJECTIVES To assess the effectiveness of psychotherapies for adults with TRD. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register (until May 2016), along with CENTRAL, MEDLINE, Embase, and PsycINFO via OVID (until 16 May 2017). We also searched the World Health Organization (WHO) trials portal (ICTRP) and ClinicalTrials.gov to identify unpublished and ongoing studies. There were no date or language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) with participants aged 18 to 74 years diagnosed with unipolar depression that had not responded to minimum four weeks of antidepressant treatment at a recommended dose. We excluded studies of drug intolerance. Acceptable diagnoses of unipolar depression were based onthe Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) or earlier versions, International Classification of Diseases (ICD)-10, Feighner criteria, or Research Diagnostic Criteria. We included the following comparisons.1. Any psychological therapy versus antidepressant treatment alone, or another psychological therapy.2. Any psychological therapy given in addition to antidepressant medication versus antidepressant treatment alone, or a psychological therapy alone.Primary outcomes required were change in depressive symptoms and number of dropouts from study or treatment (as a measure of acceptability). DATA COLLECTION AND ANALYSIS We extracted data, assessed risk of bias in duplicate, and resolved disagreements through discussion or consultation with a third person. We conducted random-effects meta-analyses when appropriate. We summarised continuous outcomes using mean differences (MDs) or standardised mean differences (SMDs), and dichotomous outcomes using risk ratios (RRs). MAIN RESULTS We included six trials (n = 698; most participants were women approximately 40 years of age). All studies evaluated psychotherapy plus usual care (with antidepressants) versus usual care (with antidepressants). Three studies addressed the addition of cognitive-behavioural therapy (CBT) to usual care (n = 522), and one each evaluated intensive short-term dynamic psychotherapy (ISTDP) (n = 60), interpersonal therapy (IPT) (n = 34), or group dialectical behavioural therapy (DBT) (n = 19) as the intervention. Most studies were small (except one trial of CBT was large), and all studies were at high risk of detection bias for the main outcome of self-reported depressive symptoms.A random-effects meta-analysis of five trials (n = 575) showed that psychotherapy given in addition to usual care (vs usual care alone) produced improvement in self-reported depressive symptoms (MD -4.07 points, 95% confidence interval (CI) -7.07 to -1.07 on the Beck Depression Inventory (BDI) scale) over the short term (up to six months). Effects were similar when data from all six studies were combined for self-reported depressive symptoms (SMD -0.40, 95% CI -0.65 to -0.14; n = 635). The quality of this evidence was moderate. Similar moderate-quality evidence of benefit was seen on the Patient Health Questionnaire-9 Scale (PHQ-9) from two studies (MD -4.66, 95% CI 8.72 to -0.59; n = 482) and on the Hamilton Depression Rating Scale (HAMD) from four studies (MD -3.28, 95% CI -5.71 to -0.85; n = 193).High-quality evidence shows no differential dropout (a measure of acceptability) between intervention and comparator groups over the short term (RR 0.85, 95% CI 0.58 to 1.24; six studies; n = 698).Moderate-quality evidence for remission from six studies (RR 1.92, 95% CI 1.46 to 2.52; n = 635) and low-quality evidence for response from four studies (RR 1.80, 95% CI 1.2 to 2.7; n = 556) indicate that psychotherapy was beneficial as an adjunct to usual care over the short term.With the addition of CBT, low-quality evidence suggests lower depression scores on the BDI scale over the medium term (12 months) (RR -3.40, 95% CI -7.21 to 0.40; two studies; n = 475) and over the long term (46 months) (RR -1.90, 95% CI -3.22 to -0.58; one study; n = 248). Moderate-quality evidence for adjunctive CBT suggests no difference in acceptability (dropout) over the medium term (RR 0.98, 95% CI 0.66 to 1.47; two studies; n = 549) and lower dropout over long term (RR 0.80, 95% CI 0.66 to 0.97; one study; n = 248).Two studies reported serious adverse events (one suicide, two hospitalisations, and two exacerbations of depression) in 4.2% of the total sample, which occurred only in the usual care group (no events in the intervention group).An economic analysis (conducted as part of an included study) from the UK healthcare perspective (National Health Service (NHS)) revealed that adjunctive CBT was cost-effective over nearly four years. AUTHORS' CONCLUSIONS Moderate-quality evidence shows that psychotherapy added to usual care (with antidepressants) is beneficial for depressive symptoms and for response and remission rates over the short term for patients with TRD. Medium- and long-term effects seem similarly beneficial, although most evidence was derived from a single large trial. Psychotherapy added to usual care seems as acceptable as usual care alone.Further evidence is needed on the effectiveness of different types of psychotherapies for patients with TRD. No evidence currently shows whether switching to a psychotherapy is more beneficial for this patient group than continuing an antidepressant medication regimen. Addressing this evidence gap is an important goal for researchers.
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Affiliation(s)
- Sharea Ijaz
- Population Health Sciences, Bristol Medical School, University of BristolNIHR CLAHRC West at University Hospitals Bristol NHS Foundation TrustLewins Mead, Whitefriars BuildingBristolUKBS1 2NT
| | - Philippa Davies
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge HallBristolUKBS8 2PS
| | - Catherine J Williams
- University of BristolSchool of Social and Community Medicine39 Whatley RoadBristolUKBS8 2PS
| | - David Kessler
- University of BristolSchool of Social and Community Medicine39 Whatley RoadBristolUKBS8 2PS
| | - Glyn Lewis
- UCLUCL Division of Psychiatry67‐73 Riding House StLondonUKW1W 7EJ
| | - Nicola Wiles
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge HallBristolUKBS8 2PS
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Hagerty BM, Bathish MA, Kuchman E. Development and testing of a self-regulation model for recurrent depression. J Health Psychol 2018; 25:1732-1742. [PMID: 29722280 DOI: 10.1177/1359105318772083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Self-regulation is a strategy for self-management of depression. Study aims were to (1) describe development of an intervention based on metacognition and self-regulation, (2) test intervention feasibility and utility, and (3) determine its effectiveness in reducing depressive symptoms. The Self-Regulated Illness Management of Depression intervention was developed and taught to 22 participants with recurrent depression. There was no attrition 6 months post intervention. At 6 months, there was a significant decrease in depressive symptoms (M = 10.21, standard deviation = 8.0), t(18) = 5.60, p < .001, and 73 percent of participants used Self-Regulated Illness Management of Depression frequently. Results indicated that Self-Regulated Illness Management of Depression was feasible and useful.
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Jones SMW, Ludman EJ. Factor Structure and Sensitivity to Change of the Recovery Assessment Scale. J Behav Health Serv Res 2017; 45:690-699. [PMID: 28726086 DOI: 10.1007/s11414-017-9563-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The focus on recovery, not just symptom reduction, in mental health care brings a need for psychometrically sound measures of recovery. This study examined the factor structure and sensitivity to change of a common measure of mental health recovery, the Recovery Assessment Scale (RAS). We conducted a secondary data analysis from a randomized clinical trial of self-management for depression (n = 302). We tested both bifactor and the previously found five-factor model. Sensitivity to change was examined three ways: (1) between the intervention and control group; (2) across time in the intervention group; and (3) in those whose depression remitted. The previous five-factor model was supported. One subscale, no domination by symptoms, was particularly sensitive to change and showed sensitivity to change whereas the subscale reliance on others did not show change in any of the comparisons. Results suggest that the subscales of the RAS should be examined separately in future studies of recovery.
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Affiliation(s)
- Salene M W Jones
- Group Health Research Institute, 1730 Minor Ave, #1600, Seattle, WA, 98101, USA.
| | - Evette J Ludman
- Group Health Research Institute, 1730 Minor Ave, #1600, Seattle, WA, 98101, USA
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