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Akram A, Al‐Sabahy M, Al‐Jedai A, Almudaiheem H, Farghally M, Fallata E, Alibrahim O, Shoukry T, Basu S, Chalouhi D, Elsharkawy A, Mohamed O. The clinical & economic burden of treatment-resistant depression in the Gulf-Cooperation Council: The Kingdom of Saudi Arabia, Kuwait and the United Arab Emirates. Int J Methods Psychiatr Res 2023; 32:e1952. [PMID: 36434774 PMCID: PMC10485320 DOI: 10.1002/mpr.1952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The current analysis assessed the economic and clinical burden of treatment-Resistant Depression (TRD) imposed on the Kingdom of Saudi Arabia (KSA), Kuwait and United Arab Emirates (UAE) from the societal perspective. METHODS A Microsoft Excel® based Markov model was developed to estimate the overall burden of disease imposed by TRD across KSA, Kuwait and UAE. Data for the models' adaptation were retrieved from literature and validated by country-specific key opinion leaders. The cycle length and time horizon used in the model were 4 weeks and 1 year, respectively. RESULTS The study results estimated that at the end of 1-year time horizon, overall burden imposed by TRD was 3994, 982 and 670 million USD in KSA, Kuwait, and UAE, respectively. This can be attributed to the high cost incurred due to non-responsive health state (ranging from 44% to 47%). The productivity loss was either the greatest or second greatest component of TRD's burden in the countries of interest (ranging from 32% to 43%). CONCLUSIONS TRD represents a large clinical and economic burden on both individual patients and society. Hence, noval and innovative treatments are especially required for the management of TRD patients.
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Affiliation(s)
- Aly Akram
- Erfan and Begado General HospitalJeddahSaudi Arabia
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Arabadjian M, Duberstein ZT, Sperber SH, Kaur K, Kalinowski J, Xia Y, Hausvater A, O'Hare O, Smilowitz NR, Dickson VV, Zhong H, Berger JS, Hochman JS, Reynolds HR, Spruill TM. Role of Resilience in the Psychological Recovery of Women With Acute Myocardial Infarction. J Am Heart Assoc 2023; 12:e027092. [PMID: 37026542 PMCID: PMC10227277 DOI: 10.1161/jaha.122.027092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/06/2023] [Indexed: 04/08/2023]
Abstract
Background Psychological well-being is important among individuals with myocardial infarction (MI) given the clear links between stress, depression, and adverse cardiovascular outcomes. Stress and depressive disorders are more prevalent in women than men after MI. Resilience may protect against stress and depressive disorders after a traumatic event. Longitudinal data are lacking in populations post MI. We examined the role of resilience in the psychological recovery of women post MI, over time. Methods and Results We analyzed a sample from a longitudinal observational multicenter study (United States, Canada) of women post MI, between 2016 and 2020. Perceived stress (Perceived Stress Scale-4 [PSS-4]) and depressive symptoms (Patient Health Questionnaire-2 [PHQ-2]) were assessed at baseline (time of MI) and 2 months post MI. Demographics, clinical characteristics, and resilience (Brief Resilience Scale [BRS]) were collected at baseline. Low and normal/high resilience groups were established as per published cutoffs (BRS scores <3 or ≥3). Mixed-effects modeling was used to examine associations between resilience and psychological recovery over 2 months. The sample included 449 women, mean (SD) age, 62.2 (13.2) years, of whom 61.1% identified as non-Hispanic White, 18.5% as non-Hispanic Black, and 15.4% as Hispanic/Latina. Twenty-three percent had low resilience. The low resilience group had significantly higher PSS-4 and PHQ-2 scores than the normal/high resilience group at all time points. In adjusted models, both groups showed a decrease in PSS-4 scores over time. Conclusions In a diverse cohort of women post MI, higher resilience is associated with better psychological recovery over time. Future work should focus on developing strategies to strengthen resilience and improve psychological well-being for women with MI. Registration URL: https://clinicaltrials.gov/ct2/show/NCT02905357; Unique identifier: NCT02905357.
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Affiliation(s)
- Milla Arabadjian
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Center for Population and Health Services ResearchNYU Long Island School of MedicineMineolaNY
- Department of Population HealthNYU Grossman School of MedicineNew YorkNY
| | - Zoe T. Duberstein
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Department of Population HealthNYU Grossman School of MedicineNew YorkNY
| | - Sarah H. Sperber
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Department of Population HealthNYU Grossman School of MedicineNew YorkNY
| | - Kiranjot Kaur
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Department of Population HealthNYU Grossman School of MedicineNew YorkNY
| | - Jolaade Kalinowski
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Department of Human Development and Family SciencesUniversity of ConnecticutStamfordCT
| | - Yuhe Xia
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Department of Population HealthNYU Grossman School of MedicineNew YorkNY
| | - Anaïs Hausvater
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Leon H. Charney Division of Cardiology, Department of MedicineNYU Grossman School of MedicineNew YorkNY
| | - Olivia O'Hare
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- NYU Rory Meyers College of NursingNew YorkNY
| | - Nathaniel R. Smilowitz
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Leon H. Charney Division of Cardiology, Department of MedicineNYU Grossman School of MedicineNew YorkNY
| | - Victoria Vaughan Dickson
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- NYU Rory Meyers College of NursingNew YorkNY
| | - Hua Zhong
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Department of Population HealthNYU Grossman School of MedicineNew YorkNY
| | - Jeffrey S. Berger
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Leon H. Charney Division of Cardiology, Department of MedicineNYU Grossman School of MedicineNew YorkNY
| | - Judith S. Hochman
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Leon H. Charney Division of Cardiology, Department of MedicineNYU Grossman School of MedicineNew YorkNY
| | - Harmony R. Reynolds
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Leon H. Charney Division of Cardiology, Department of MedicineNYU Grossman School of MedicineNew YorkNY
| | - Tanya M. Spruill
- Sarah Ross Soter Center for Women’s Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
- Department of Population HealthNYU Grossman School of MedicineNew YorkNY
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Feusner JD, Farrell NR, Kreyling J, McGrath PB, Rhode A, Faneuff T, Lonsway S, Mohideen R, Jurich JE, Trusky L, Smith SM. Online Video Teletherapy Treatment of Obsessive-Compulsive Disorder Using Exposure and Response Prevention: Clinical Outcomes From a Retrospective Longitudinal Observational Study. J Med Internet Res 2022; 24:e36431. [PMID: 35587365 PMCID: PMC9164091 DOI: 10.2196/36431] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/07/2022] [Accepted: 04/25/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Exposure and response prevention, a type of cognitive-behavioral therapy, is an effective first-line treatment for obsessive-compulsive disorder (OCD). Despite extensive evidence of the efficacy of exposure and response prevention (ERP) from clinical studies and in real-world samples, it is still underused as a treatment. This is likely due to the limits to access to care that include the availability of adequately trained therapists, as well as geographical location, time, and cost barriers. To address these, NOCD created a digital behavioral health treatment for OCD using ERP delivered via video teletherapy and with technology-assisted elements including app-based therapy tools and between-session therapist messaging. OBJECTIVE We examined treatment outcomes in a large naturalistic sample of 3552 adults with a primary OCD diagnosis who received NOCD treatment. METHODS The treatment model consisted of twice-weekly, live, face-to-face video teletherapy ERP for 3 weeks, followed by 6 weeks of once-weekly brief video teletherapy check-ins for 30 minutes. Assessments were conducted at baseline, at midpoint after completion of 3 weeks of twice-weekly sessions, and at the end of 6 weeks of brief check-ins (endpoint). Longitudinal assessments were also obtained at 3, 6, 9, and 12 months after endpoint. RESULTS Treatment resulted in clinically and statistically significant improvements, with a 43.4% mean reduction in obsessive-compulsive symptoms (g=1.0; 95% CI 0.93 to 1.03) and a 62.9% response rate. Treatment also resulted in a 44.2% mean reduction in depression, a 47.8% mean reduction in anxiety, and a 37.3% mean reduction in stress symptoms. Quality of life improved by a mean of 22.7%. Reduction in OCD symptoms and response rates were similar for those with mild, moderate, or severe symptoms. The mean duration of treatment was 11.5 (SD 4.0) weeks, and the mean total therapist time was 10.6 (SD 1.1) hours. Improvements were maintained at 3, 6, 9, and 12 months. CONCLUSIONS In this sample, representing the largest reported treated cohort of patients with OCD to date, video teletherapy treatment demonstrated effectiveness in reducing obsessive-compulsive and comorbid symptoms and improved quality of life. Further, it achieved meaningful results in less than half the total therapist time compared with standard once-weekly outpatient treatment, an efficiency that represents substantial monetary and time savings. The effect size was large and similar to studies of in-person ERP. This technology-assisted remote treatment is readily accessible for patients, offering an advancement in the field in the dissemination of effective evidence-based care for OCD.
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Affiliation(s)
- Jamie D Feusner
- NOCD Inc, Chicago, IL, United States
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- General Adult Psychiatry & Health Systems Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Efstathiou V, Stefanou MI, Demetriou M, Siafakas N, Makris M, Tsivgoulis G, Zoumpourlis V, Kympouropoulos S, Tsoporis J, Spandidos D, Smyrnis N, Rizos E. Long COVID and neuropsychiatric manifestations (Review). Exp Ther Med 2022; 23:363. [PMID: 35493431 PMCID: PMC9019760 DOI: 10.3892/etm.2022.11290] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/24/2022] [Indexed: 12/02/2022] Open
Abstract
There is accumulating evidence in the literature indicating that a number of patients with coronavirus disease 2019 (COVID-19) may experience a range of neuropsychiatric symptoms, persisting or even presenting following the resolution of acute COVID-19. Among the neuropsychiatric manifestations more frequently associated with ‘long COVID’ are depression, anxiety, post-traumatic stress disorder, sleep disturbances, fatigue and cognitive deficits, that can potentially be debilitating and negatively affect patients' wellbeing, albeit in the majority of cases symptoms tend to improve over time. Despite variations in results obtained from studies using different methodological approaches to define ‘long COVID’ syndrome, the most widely accepted factors associated with a higher risk of developing neuropsychiatric manifestations include the severity of foregoing COVID-19, the female sex, the presence of comorbidities, a history of mental health disease and an elevation in the levels of inflammatory markers, albeit further research is required to establish causal associations. To date, the pathophysiological mechanisms implicated in neuropsychiatric manifestations of ‘long COVID’ remain only partially elucidated, while the role of the indirect effects of the COVID-19 pandemic, such as social isolation and uncertainty concerning social, financial and health recovery post-COVID, have also been highlighted. Given the alarming effects of ‘long-COVID’, interdisciplinary cooperation for the early identification of patients who are at a high risk of persistent neuropsychiatric presentations, beyond COVID-19 recovery, is crucial to ensure that appropriate integrated physical and mental health support is provided, with the aim of mitigating the risks of long-term disability at a societal and individual level.
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Affiliation(s)
- Vasiliki Efstathiou
- Second Department of Psychiatry, National and Kapodistrian University of Athens, ‘Attikon’ University General Hospital, Athens 12462, Greece
| | - Maria-Ioanna Stefanou
- Second Department of Neurology, National and Kapodistrian University of Athens, ‘Attikon’ University General Hospital, Athens 12462, Greece
| | - Marina Demetriou
- Second Department of Psychiatry, National and Kapodistrian University of Athens, ‘Attikon’ University General Hospital, Athens 12462, Greece
| | - Nikolaos Siafakas
- Clinical Microbiology Laboratory, National and Kapodistrian University of Athens, ‘Attikon’ University General Hospital, Athens 12462, Greece
| | - Michael Makris
- Allergy Unit, Second Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, ‘Attikon’ University General Hospital, Athens 12462, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, ‘Attikon’ University General Hospital, Athens 12462, Greece
| | - Vassilios Zoumpourlis
- Biomedical Applications Unit, Institute of Chemical Biology, National Hellenic Research Foundation (NHRF), Athens 11635, Greece
| | - Stylianos Kympouropoulos
- Second Department of Psychiatry, National and Kapodistrian University of Athens, ‘Attikon’ University General Hospital, Athens 12462, Greece
| | - James Tsoporis
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
| | - Demetrios Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, Heraklion 71003, Greece
| | - Nikolaos Smyrnis
- Second Department of Psychiatry, National and Kapodistrian University of Athens, ‘Attikon’ University General Hospital, Athens 12462, Greece
| | - Emmanouil Rizos
- Second Department of Psychiatry, National and Kapodistrian University of Athens, ‘Attikon’ University General Hospital, Athens 12462, Greece
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Armoon B, Grenier G, Cao Z, Huỳnh C, Fleury MJ. Frequencies of emergency department use and hospitalization comparing patients with different types of substance or polysubstance-related disorders. Subst Abuse Treat Prev Policy 2021; 16:89. [PMID: 34922562 PMCID: PMC8684146 DOI: 10.1186/s13011-021-00421-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 01/20/2023] Open
Abstract
Background This study measured emergency department (ED) use and hospitalization for medical reasons among patients with substance-related disorders (SRD), comparing four subgroups: cannabis-related disorders, drug-related disorders other than cannabis, alcohol-related disorders and polysubstance-related disorders, controlling for various clinical, sociodemographic and service use variables. Methods Clinical administrative data for a cohort of 22,484 patients registered in Quebec (Canada) addiction treatment centers in 2012-13 were extracted for the years 2009-10 to 2015-16. Using negative binomial models, risks of frequent ED use and hospitalization were calculated for a 12-month period (2015-16). Results Patients with polysubstance-related disorders used ED more frequently than other groups with SRD. They were hospitalized more frequently than patients with cannabis or other drug-related disorders, but less frequently than those with alcohol-related disorders. Patients with alcohol-related disorders used ED more frequently than those with cannabis-related disorders and underwent more hospitalizations than both patients with cannabis-related and other drug-related disorders. Co-occurring SRD-mental disorders or SRD-chronic physical illnesses, more years with SRD, being women, living in rural territories, more frequent consultations with usual general practitioner or outpatient psychiatrist, and receiving more interventions in community healthcare centers increased frequency of ED use and hospitalization, whereas both adverse outcomes decreased with high continuity of physician care. Behavioral addiction, age less than 45 years, living in more materially deprived areas, and receiving 1-3 interventions in addiction treatment centers increased risk of frequent ED use, whereas living in semi-urban areas decreased ED use. Patients 25-44 years old receiving 4+ interventions in addiction treatment centers experienced less frequent hospitalization. Conclusion Findings showed higher risk of ED use among patients with polysubstance-related disorders, and higher hospitalization risk among patients with alcohol-related disorders, compared with patients affected by cannabis and other drug-related disorders. However, other variables contributed substantially more to the frequency of ED use and hospitalization, particularly clinical variables regarding complexity and severity of health conditions, followed by service use variables. Another important finding was that high continuity of physician care helped decrease the use of acute care services. Strategies like integrated care and outreach interventions may enhance SRD services. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-021-00421-7.
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Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Zhirong Cao
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Christophe Huỳnh
- Institut universitaire sur les dépendances du Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 Louvain Est, Montréal, Québec, H2M 2E8, Canada
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada. .,Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
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Shepardson RL, Buckheit KA, Funderburk JS. Anxiety treatment preferences among veteran primary care patients: Demographic, mental health, and treatment-related correlates. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2021; 39:563-575. [PMID: 34472956 PMCID: PMC9358443 DOI: 10.1037/fsh0000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Anxiety symptoms are common, yet undertreated, among primary care patients. Accommodating patient treatment preferences improves engagement and retention. In contrast to depression, little is known about primary care patients' preferences for anxiety treatment. METHOD Participants were 144 veterans experiencing anxiety symptoms but not receiving psychotherapy who were recruited from primary care. Preferences for 11 anxiety treatment attributes (method; location; type; format; provider; frequency, length, and number of appointments; psychotherapy orientation; symptom focus; and topic/skill) and demographic, mental health (e.g., anxiety symptom severity), and treatment-related (e.g., psychotherapy history) variables were assessed via mailed survey. We used chi-square goodness of fit tests to identify patient preferences for each attribute and multivariate multinomial logistic regression models to explore demographic, mental health, and treatment-related correlates of treatment preferences. RESULTS Patient preferences were largely consistent with integrated primary care models, particularly Primary Care Behavioral Health, with a few exceptions. Patients preferred longer appointments (e.g., 45-60 minutes) and a longer duration of treatment (e.g., ≥13 appointments) than is typically offered in primary care. Several variables, particularly education level, perceived need for help, anxiety symptom severity, and attitudes toward psychotherapy, were repeatedly associated with preferences for various anxiety treatment attributes. DISCUSSION Results from this study suggest that patients tend to have distinct preferences for anxiety treatment in primary care that are largely consistent with common integrated primary care models. Results also identify several variables that may be associated with specific preferences, which may help match patients to their preferred type of care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Balaskas A, Schueller SM, Cox AL, Doherty G. The Functionality of Mobile Apps for Anxiety: Systematic Search and Analysis of Engagement and Tailoring Features. JMIR Mhealth Uhealth 2021; 9:e26712. [PMID: 34612833 PMCID: PMC8529472 DOI: 10.2196/26712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/02/2021] [Accepted: 07/15/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND A range of mobile apps for anxiety have been developed in response to the high prevalence of anxiety disorders. Although the number of publicly available apps for anxiety is increasing, attrition rates among mobile apps are high. These apps must be engaging and relevant to end users to be effective; thus, engagement features and the ability to tailor delivery to the needs of individual users are key. However, our understanding of the functionality of these apps concerning engagement and tailoring features is limited. OBJECTIVE The aim of this study is to review how cognitive behavioral elements are delivered by anxiety apps and their functionalities to support user engagement and tailoring based on user needs. METHODS A systematic search for anxiety apps described as being based on cognitive behavioral therapy (CBT) was conducted on Android and iPhone marketplaces. Apps were included if they mentioned the use of CBT for anxiety-related disorders. We identified 597 apps, of which 36 met the inclusion criteria and were reviewed through direct use. RESULTS Cognitive behavioral apps for anxiety incorporate a variety of functionalities, offer several engagement features, and integrate low-intensity CBT exercises. However, the provision of features to support engagement is highly uneven, and support is provided only for low-intensity CBT treatment. Cognitive behavioral elements combine various modalities to deliver intervention content and support the interactive delivery of these elements. Options for personalization are limited and restricted to goal selection upon beginning use or based on self-monitoring entries. Apps do not appear to provide individualized content to users based on their input. CONCLUSIONS Engagement and tailoring features can be significantly expanded in existing apps, which make limited use of social features and clinical support and do not use sophisticated features such as personalization based on sensor data. To guide the evolution of these interventions, further research is needed to explore the effectiveness of different types of engagement features and approaches to tailoring therapeutic content.
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Affiliation(s)
- Andreas Balaskas
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Stephen M Schueller
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States.,Department of Informatics, University of California, Irvine, Irvine, CA, United States
| | - Anna L Cox
- UCL Interaction Centre, University College London, London, United Kingdom
| | - Gavin Doherty
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
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Yadav S, Lokala U, Daniulaityte R, Thirunarayan K, Lamy F, Sheth A. "When they say weed causes depression, but it's your fav antidepressant": Knowledge-aware attention framework for relationship extraction. PLoS One 2021; 16:e0248299. [PMID: 33764983 PMCID: PMC7993863 DOI: 10.1371/journal.pone.0248299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/23/2021] [Indexed: 11/19/2022] Open
Abstract
With the increasing legalization of medical and recreational use of cannabis, more research is needed to understand the association between depression and consumer behavior related to cannabis consumption. Big social media data has potential to provide deeper insights about these associations to public health analysts. In this interdisciplinary study, we demonstrate the value of incorporating domain-specific knowledge in the learning process to identify the relationships between cannabis use and depression. We develop an end-to-end knowledge infused deep learning framework (Gated-K-BERT) that leverages the pre-trained BERT language representation model and domain-specific declarative knowledge source (Drug Abuse Ontology) to jointly extract entities and their relationship using gated fusion sharing mechanism. Our model is further tailored to provide more focus to the entities mention in the sentence through entity-position aware attention layer, where ontology is used to locate the target entities position. Experimental results show that inclusion of the knowledge-aware attentive representation in association with BERT can extract the cannabis-depression relationship with better coverage in comparison to the state-of-the-art relation extractor.
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Affiliation(s)
- Shweta Yadav
- Wright State University, Dayton, Ohio, United States of America
- * E-mail:
| | - Usha Lokala
- University of South Carolina, Columbia, South Carolina, United States of America
| | | | | | | | - Amit Sheth
- University of South Carolina, Columbia, South Carolina, United States of America
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Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury. J Spinal Cord Med 2021; 44:102-162. [PMID: 33630722 PMCID: PMC7993020 DOI: 10.1080/10790268.2021.1863738] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Bombardier CH, Azuero CB, Fann JR, Kautz DD, Richards JS, Sabharwal S. Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers. Top Spinal Cord Inj Rehabil 2021; 27:152-224. [PMID: 34108836 PMCID: PMC8152173 DOI: 10.46292/sci2702-152] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Casey B. Azuero
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jesse R. Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Donald D. Kautz
- School of Nursing, University of North Carolina Greensboro, Greensboro, NC, USA
| | - J. Scott Richards
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sunil Sabharwal
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
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Abstract
OBJECTIVE To describe the prevalence, use of antidepressants, and predictors of major and minor depression among nonpregnant women of childbearing age. METHODS Using data from the National Health and Nutrition Examination Surveys 2007-2014, we performed a cross-sectional study of 3,705 nonpregnant women of childbearing age. The primary outcome is the prevalence of major depression, and secondary outcomes are the prevalence of minor depression, rates of antidepressant use, and predictors of major and minor depression. Major and minor depression were classified using the Patient Health Questionnaire 9. Univariate and multivariate associations between major depression and minor depression with potential predictors were estimated using multinomial logistic regression. RESULTS The overall prevalences of major and minor depression were 4.8% (95% CI 4.0-5.7%) and 4.3% (95% CI 3.5-5.2%), respectively. The prevalences of antidepressant use among women with major depression and minor depression were 32.4% (95% CI 25.3-40.4%) and 20.0% (95% CI 12.9-29.7%), respectively. Factors most strongly associated with major depression were government insurance (adjusted relative risk [RR] ratio 2.49, 95% CI 1.56-3.96) and hypertension (adjusted RR 2.09, 95% CI 1.25-3.50); for minor depression, these were education less than high school (adjusted RR 4.34, 95% CI 2.09-9.01) or high school education (adjusted RR 2.92, 95% CI 1.35-6.31). CONCLUSION Our analysis indicates that 1 in 20 nonpregnant women of childbearing age experience major depression. Antidepressants are used by one third of those with major depression and one fifth of those with minor depression.
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Roberge P, Provencher MD, Gosselin P, Vasiliadis HM, Gaboury I, Benoit A, Antony MM, Chaillet N, Houle J, Hudon C, Norton PJ. A pragmatic randomized controlled trial of group transdiagnostic cognitive-behaviour therapy for anxiety disorders in primary care: study protocol. BMC Psychiatry 2018; 18:320. [PMID: 30285672 PMCID: PMC6169021 DOI: 10.1186/s12888-018-1898-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/18/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Anxiety disorders are the most common mental disorders in community settings, and they are associated with significant psychological distress, functional and social impairment. While cognitive behaviour therapy (CBT) is the most consistently efficacious psychological treatment for anxiety disorders, barriers preclude widespread implementation of CBT in primary care. Transdiagnostic group CBT (tCBT) focuses on cognitive and behavioural processes and intervention strategies common to different anxiety disorders, and could be a promising alternative to conventional CBT. This study aims to examine the effectiveness of a transdiagnostic group CBT for anxiety disorders program as a complement to treatment-as-usual (TAU) in primary mental health care. METHODS/DESIGN The trial is a multicentre pragmatic randomized controlled trial with a pre-treatment, post-treatment, and follow-up at 4, 8 and 12-months design. Treatment and control groups. a) tCBT (12 weekly 2-h group sessions following a manualized treatment protocol); b) TAU for anxiety disorders. Inclusion criteria comprise meeting DSM-5 criteria for primary Panic Disorder, Agoraphobia, Social Anxiety Disorder and/or Generalized Anxiety Disorder. Patients are recruited in three regions in the province of Quebec, Canada. The primary outcome measures are the self-reported Beck Anxiety Inventory and the clinician-administered Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5); secondary outcome measures include treatment responder status based on the ADIS-5, and self-reported instruments for specific anxiety and depression symptoms, quality of life, functioning, and service utilisation. STATISTICAL ANALYSIS Intention-to-treat analysis. A mixed effects regression model will be used to account for between- and within-subject variations in the analysis of the longitudinal effects of the intervention. DISCUSSION This rigorous evaluation of tCBT in the real world will provide invaluable information to decision makers, health care managers, clinicians and patients regarding the effectiveness of the intervention. Widespread implementation of tCBT protocols in primary care could lead to better effectiveness, efficiency, access and equity for the large number of patients suffering from anxiety disorders that are currently not obtaining evidence-based psychotherapy. TRIAL REGISTRATION ClinicalTrials.gov: NCT02811458 .
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Affiliation(s)
- Pasquale Roberge
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4 Canada
| | - Martin D Provencher
- École de psychologie, Pavillon Félix-Antoine-Savard, 2325, rue des Bibliothèques, Université Laval, Québec, QC G1V 0A6 Canada
| | - Patrick Gosselin
- Institut universitaire de première ligne en santé et services sociaux (CIUSSS de l’Estrie- CHUS), Department of Psychology, Université de Sherbrooke, 2500, boulevard de l’Université, Sherbrooke, QC J1K 2R1 Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Sciences, Université de Sherbrooke, Centre de recherche Hôpital Charles LeMoyne, 3120, boul. Taschereau, Greenfield Park, QC J4V 2H1 Canada
| | - Isabelle Gaboury
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4 Canada
| | - Annie Benoit
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4 Canada
| | - Martin M Antony
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3 Canada
| | - Nils Chaillet
- Department of Obstetrics, Gynecology, and Reproduction, Université Laval, 2705, boulevard Laurier, Québec, QC G1V 4G2 Canada
| | - Janie Houle
- Department of Psychology, Université du Québec à Montréal, C.P. 8888, succ. Centre-ville, Montréal, QC H3C 3P8 Canada
| | - Catherine Hudon
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4 Canada
| | - Peter J Norton
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Clayton, VIC 3800 Australia
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Mays VM, Jones AL, Cochran SD, Taylor RJ, Rafferty J, Jackson JS. Chronicity and Mental Health Service Utilization for Anxiety, Mood, and Substance Use Disorders among Black Men in the United States; Ethnicity and Nativity Differences. Healthcare (Basel) 2018; 6:E53. [PMID: 29882853 PMCID: PMC6023328 DOI: 10.3390/healthcare6020053] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/14/2018] [Accepted: 05/14/2018] [Indexed: 11/16/2022] Open
Abstract
This study investigated ethnic and nativity differences in the chronicity and treatment of psychiatric disorders of African American and Caribbean Black men in the U.S. Data were analyzed from the National Survey of American Life, a population-based study which included 1859 self-identified Black men (1222 African American, 176 Caribbean Black men born within the U.S., and 461 Caribbean Black men born outside the U.S.). Lifetime and twelve-month prevalence of DSM-IV mood, anxiety, and substance use disorders (including Bipolar I and Dysthmia), disorder chronicity, and rate of mental health services use among those meeting criteria for a lifetime psychiatric disorder were examined. Logistic regression models were employed to determine ethnic differences in chronicity, and treatment utilization for disorders. While rates of DSM-IV disorders were generally low in this community sample of Black men, their disorders were chronic and remained untreated. Caribbean Black men born in the U.S. had higher prevalence of Post-Traumatic Stress Disorder, Major Depressive Disorder, and Alcohol Abuse Disorder compared with African American men. Foreign born Caribbean Black men experienced greater chronicity in Social Phobia and Generalized Anxiety Disorder compared to other Black Men. Utilization of mental health service was low for all groups of Black Men, but lowest for the foreign born Caribbean Black men. Results underscore the large unmet needs of both African American and Caribbean Black men in the United States. Results also highlight the role of ethnicity and nativity in mental disorder chronicity and mental health service utilization patterns of Black men.
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Affiliation(s)
- Vickie M Mays
- Departments of Psychology and Health Policy and Management, University of California, Los Angeles Fielding School of Public Health, Los Angeles, CA 90095, USA.
- UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions, Los Angeles, CA 90095, USA.
| | - Audrey L Jones
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), Veteran Affairs Salt Lake City Health Care System, Salt Lake City, UT 84148, USA.
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
| | - Susan D Cochran
- UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions, Los Angeles, CA 90095, USA.
- Departments of Epidemiology and Statistics, University of California, Los Angele Fielding School of Public Health, Los Angeles, CA 90095, USA.
| | - Robert Joseph Taylor
- School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA.
- Program for Research on Black Americans, Institute of Social Research, Ann Arbor, MI 48106, USA.
| | - Jane Rafferty
- Program for Research on Black Americans, Institute of Social Research, Ann Arbor, MI 48106, USA.
| | - James S Jackson
- Program for Research on Black Americans, Institute of Social Research, Ann Arbor, MI 48106, USA.
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA.
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Examining the short-term anxiolytic and antidepressant effect of Floatation-REST. PLoS One 2018; 13:e0190292. [PMID: 29394251 PMCID: PMC5796691 DOI: 10.1371/journal.pone.0190292] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/04/2017] [Indexed: 11/19/2022] Open
Abstract
Floatation-REST (Reduced Environmental Stimulation Therapy) reduces sensory input to the nervous system through the act of floating supine in a pool of water saturated with Epsom salt. The float experience is calibrated so that sensory signals from visual, auditory, olfactory, gustatory, thermal, tactile, vestibular, gravitational and proprioceptive channels are minimized, as is most movement and speech. This open-label study aimed to examine whether Floatation-REST would attenuate symptoms of anxiety, stress, and depression in a clinical sample. Fifty participants were recruited across a spectrum of anxiety and stress-related disorders (posttraumatic stress, generalized anxiety, panic, agoraphobia, and social anxiety), most (n = 46) with comorbid unipolar depression. Measures of self-reported affect were collected immediately before and after a 1-hour float session, with the primary outcome measure being the pre- to post-float change score on the Spielberger State Anxiety Inventory. Irrespective of diagnosis, Floatation-REST substantially reduced state anxiety (estimated Cohen’s d > 2). Moreover, participants reported significant reductions in stress, muscle tension, pain, depression and negative affect, accompanied by a significant improvement in mood characterized by increases in serenity, relaxation, happiness and overall well-being (p < .0001 for all variables). In reference to a group of 30 non-anxious participants, the effects were found to be more robust in the anxious sample and approaching non-anxious levels during the post-float period. Further analysis revealed that the most severely anxious participants reported the largest effects. Overall, the procedure was well-tolerated, with no major safety concerns stemming from this single session. The findings from this initial study need to be replicated in larger controlled trials, but suggest that Floatation-REST may be a promising technique for transiently reducing the suffering in those with anxiety and depression. Trial registration: ClinicalTrials.gov NCT03051074
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Jorm AF, Patten SB, Brugha TS, Mojtabai R. Has increased provision of treatment reduced the prevalence of common mental disorders? Review of the evidence from four countries. World Psychiatry 2017; 16:90-99. [PMID: 28127925 PMCID: PMC5269479 DOI: 10.1002/wps.20388] [Citation(s) in RCA: 301] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Many people identified as having common mental disorders in community surveys do not receive treatment. Modelling has suggested that closing this "treatment gap" should reduce the population prevalence of those disorders. To evaluate the effects of reducing the treatment gap in industrialized countries, data from 1990 to 2015 were reviewed from four English-speaking countries: Australia, Canada, England and the US. These data show that the prevalence of mood and anxiety disorders and symptoms has not decreased, despite substantial increases in the provision of treatment, particularly antidepressants. Several hypotheses for this lack of improvement were considered. There was no support for the hypothesis that reductions in prevalence due to treatment have been masked by increases in risk factors. However, there was little evidence relevant to the hypothesis that improvements have been masked by increased reporting of symptoms because of greater public awareness of common mental disorders or willingness to disclose. A more strongly supported hypothesis for the lack of improvement is that much of the treatment provided does not meet the minimal standards of clinical practice guidelines and is not targeted optimally to those in greatest need. Lack of attention to prevention of common mental disorders may also be a factor. Reducing the prevalence of common mental disorders remains an unsolved challenge for health systems globally, which may require greater attention to the "quality gap" and "prevention gap". There is also a need for nations to monitor outcomes by using standardized measures of service provision and mental disorders over time.
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Affiliation(s)
- Anthony F Jorm
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Scott B Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Traolach S Brugha
- Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Blom K, Jernelöv S, Lindefors N, Kaldo V. Facilitating and hindering factors in Internet-delivered treatment for insomnia and depression. Internet Interv 2016; 4:51-60. [PMID: 30135790 PMCID: PMC6096295 DOI: 10.1016/j.invent.2016.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 03/29/2016] [Accepted: 03/29/2016] [Indexed: 11/18/2022] Open
Abstract
Insomnia and depression is a common and debilitating comorbidity, and treatment is usually given mainly for depression. Guided Internet-based cognitive behavioral therapy for insomnia (ICBT-i) was, in a recent study on which this report is based, found superior to a treatment for depression (ICBT-d) for this patient group, but many patients did not reach remission. AIMS To identify facilitating and hindering factors for patients in ICBT-i and ICBT-d and formulate hypotheses for future research. METHOD Qualitative telephone interviews at the time of the 6-month follow-up. Thirty-five interviews were done and analyzed with a grounded theory approach. Based on the qualitative results, an iterative method-triangulation including quantitative and semi-qualitative was performed. RESULTS The interviews were coded into 738 sentences, condensed into 47 categories and finally 11 themes. Four areas were investigated further with method triangulation: Opinions about treatment, adherence, hindering symptoms and acceptance. Patients in ICBT-i were more positive regarding the treatment than patients in ICBT-d. Using treatment components was positively associated with outcome in both groups. Symptoms of insomnia, depression and other comorbidities were perceived as more hindering for ICBT-d than for ICBT-i. Acceptance of diagnose-related problems as well as negative emotions and cognitions was positively associated with outcome for ICBT-i. PROPOSED FUTURE RESEARCH HYPOTHESES 1) A combination of CBT for insomnia and CBT for depression is more effective than only one of the treatments. 2) Additional therapist support increases outcomes for patients with more comorbidities. 3) Acceptance is a mechanism of change in CBT-i.
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Affiliation(s)
- Kerstin Blom
- Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatry Research, Stockholm, Sweden
| | - Susanna Jernelöv
- Karolinska Institutet, Department of Clinical Neuroscience, Section of Psychology, Stockholm, Sweden
| | - Nils Lindefors
- Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatry Research, Stockholm, Sweden
| | - Viktor Kaldo
- Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatry Research, Stockholm, Sweden
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Andrea SB, Siegel SAR, Teo AR. Social Support and Health Service Use in Depressed Adults: Findings From the National Health and Nutrition Examination Survey. Gen Hosp Psychiatry 2016; 39:73-9. [PMID: 26795687 PMCID: PMC5560028 DOI: 10.1016/j.genhosppsych.2015.11.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/21/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We investigated the relationship between social support and health service use among men and women with depression. METHODS Participants were 1379 adults with symptoms of depression (Patient Health Questionnaire-9 score ≥ 5) in the National Health and Nutrition Examination Survey. Using the framework of the Andersen Behavioral Model of Health Services Use, multivariable regression models used social support, stratified by depression severity, to estimate association with utilization of mental health and nonmental health services. Partial F-tests examined a priori interactions between social support and gender. RESULTS Among those with adequate social support, odds of seeing a nonmental health provider were much higher when depression was moderate [Odds Ratio (OR): 2.6 (1.3-5.3)] or severe [OR: 3.2 (1.2-8.7)], compared to those lacking social support. Conversely, odds of mental health service use were 60% lower among those with moderate depression [OR: 0.4 (0.2-1.0)] when social support was adequate as opposed to inadequate. Social support was unrelated to service use when depression was mild. Gender moderated the relationship between social support and health service use among individuals with severe depression. CONCLUSIONS Social support has opposite associations with mental and nonmental health service use among adults with clinically significant depression. This association is largely attributable to the effect of male gender on the relationship between social support and health service use.
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Affiliation(s)
- Sarah B Andrea
- VA Portland Health Care System and HSR&D Center to Improve Veteran Involvement in Care, Portland, OR, USA; OHSU-PSU School of Public Health, Portland, OR, USA
| | | | - Alan R Teo
- VA Portland Health Care System and HSR&D Center to Improve Veteran Involvement in Care, Portland, OR, USA; OHSU-PSU School of Public Health, Portland, OR, USA.
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18
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Rate and Predictors of Persistent Major Depressive Disorder in a Nationally Representative Sample. Community Ment Health J 2015; 51:701-7. [PMID: 25527224 PMCID: PMC4475503 DOI: 10.1007/s10597-014-9793-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 12/06/2014] [Indexed: 10/24/2022]
Abstract
This study examined predictors of persistent major depressive disorder over 10 years, focusing on the effects of clinical variables, physical health, and social support. Data from the National Survey of Midlife Development in the United States in 1995-1996 and 2004-2006 were analyzed. Logistic regression was used to predict non-recovery from major depression among individuals who met clinical-based criteria for major depressive disorder at baseline. Fifteen percent of the total sample was classified as having major depression in 1995-1996; of these individuals, 37 % had major depression in 2004-2006. Baseline variables that were significantly associated with persistent major depression at follow-up were being female, having never married, having two or more chronic medical conditions, experiencing activity limitation, and less contact with family. Therefore, treatment strategies focused on physical health, social support, and mental health needs are necessary to comprehensively address the factors that contribute to persistent major depressive disorder.
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Mackenzie CS, El-Gabalawy R, Chou KL, Sareen J. Prevalence and predictors of persistent versus remitting mood, anxiety, and substance disorders in a national sample of older adults. Am J Geriatr Psychiatry 2014; 22:854-65. [PMID: 23800537 PMCID: PMC4284958 DOI: 10.1016/j.jagp.2013.02.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 01/30/2013] [Accepted: 02/04/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Relatively little is known about whether mental disorders other than depression remit versus persist in later life, especially within nationally representative samples. Our objectives were to examine the prevalence of persistent mood, anxiety, and substance disorders in older adults and to explore a range of physical and mental health predictors of disorder chronicity. METHODS This study involved a 3-year follow-up design using Wave 1 (2001-2002) and Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Participants included 1,994 adults aged 55 years and older who had a past-year mental disorder at Wave 1 and who completed Wave 2. The primary outcome was the prevalence of persistent mood, anxiety, and substance disorders at Wave 2. Potential predictors of persistence included sociodemographic variables, physical health (chronic health conditions and physical health-related quality of life), and mental health (childhood adversity, suicide attempts, mental health-related quality of life, comorbid mental disorders, personality disorders, and lifetime treatment-seeking). RESULTS With the exception of nicotine dependence, the prevalence of persistent mood, anxiety, and substance disorders ranged from 13% to 33%. Only younger age predicted substance disorder chronicity. Significant predictors of persistent mood and anxiety disorders included physical and mental health comorbidity, physical health- and mental health-related quality of life, suicide attempts, comorbid personality disorders, and treatment-seeking. CONCLUSIONS At least two-thirds of mental disorders in these older adults were not persistent. Sociodemographic variables had little influence on chronicity, whereas a number of markers of mental disorder severity and complexity predicted persistent mood and anxiety disorders. The findings have important treatment and prevention implications.
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Affiliation(s)
| | | | - Kee-Lee Chou
- Department of Social Work and Social Administration, University of Hong Kong
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Layer P, Stanghellini V. Review article: Linaclotide for the management of irritable bowel syndrome with constipation. Aliment Pharmacol Ther 2014; 39:371-84. [PMID: 24433216 PMCID: PMC4305214 DOI: 10.1111/apt.12604] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 07/27/2013] [Accepted: 12/11/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Irritable bowel syndrome with constipation (IBS-C) represents a significant burden to patients and healthcare systems due to its prevalence and lack of successful symptomatic resolution with established treatment options. Linaclotide 290 μg has recently been approved by the European Medicines Agency (EMA) for moderate-to-severe IBS-C and by the US Food and Drug Administration for IBS-C (290 μg dose) and for chronic constipation (145 μg dose). AIM To summarise data leading to the approval of linaclotide for IBS-C, with focus on EMA-pre-specified outcome measures. METHODS Literature search of a peer-review database (PubMed) and review of congress abstracts on linaclotide preclinical and clinical trial data in IBS-C. RESULTS Preclinical studies suggest that the guanylate cyclase C agonist (GCCA) linaclotide acts through elevation of cyclic guanosine monophosphate (cGMP) levels, leading to accelerated gastrointestinal (GI) transit through increased fluid secretion and reduced visceral hypersensitivity. Clinical trial data demonstrate that linaclotide improves abdominal symptoms (pain, bloating) and bowel symptoms (constipation) compared with placebo in patients with IBS-C. The most frequent side effect, diarrhoea, results from the therapeutic action of linaclotide. Linaclotide acts locally in the GI tract with minimal systemic exposure, resulting in low oral bioavailability and thus a low risk of relevant systemic adverse effects. CONCLUSION Linaclotide, a first-in-class GCCA, is a promising new drug with a novel, dual mechanism of action that, unlike more well-established agents, can relieve the abdominal pain, bloating and constipation associated with IBS-C and has a low propensity for systemic side effects.
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Affiliation(s)
- P Layer
- Medizinische Klinik, Israelitisches KrankenhausHamburg, Germany
- Correspondence to:, Dr P. Layer, Israelitisches Krankenhaus in Hamburg, Orchideenstieg 14, 22297 Hamburg, Germany., E-mail:
| | - V Stanghellini
- Department of Digestive Diseases & Internal Medicine, University of BolognaBologna, Italy
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Bousman CA, Potiriadis M, Everall IP, Gunn JM. Methylenetetrahydrofolate reductase (MTHFR) genetic variation and major depressive disorder prognosis: A five-year prospective cohort study of primary care attendees. Am J Med Genet B Neuropsychiatr Genet 2014; 165B:68-76. [PMID: 24123968 DOI: 10.1002/ajmg.b.32209] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 09/12/2013] [Indexed: 11/10/2022]
Abstract
Methylenetetrahydrofolate reductase (MTHFR) genetic variation has been associated with the diagnosis of major depressive disorder (MDD) but no study to date has examined the effect MTHFR variation has on MDD prognosis. We sought to examine the prospective effects of two common MTHFR variants (C677T and A1298C) as well as seven haplotype-tagging single nucleotide polymorphisms (htSNPs) on MDD prognosis over a 5-year (60-month) period. Participants were 147 depressed primary care attendees enrolled in the Diagnosis, Management and Outcomes of Depression in Primary Care (diamond) prospective cohort study. Prognosis of MDD was measured using three methods: (1) DSM-IV criteria, (2) Primary Care Evaluation of Mental Disorders Patient Health Questionnaire-9 (PHQ-9), and (3) Center for Epidemiologic Studies Depression Scale (CESD). DSM-IV criteria for MDD was assessed using the Composite International Diagnostic Interview at baseline and 24, 36, 48, and 60 months post-baseline; whereas, PHQ-9 and CESD measures were employed at baseline and 12, 24, 36, 48, and 60 months post-baseline. Repeated measures analysis of variance showed that PHQ-9 symptom severity trajectories differed by C677T genotype (F = 3.34, df = 2,144, P = 0.038), with 677CC genotype showing the most severe symptom severity course over the 60 months of observation. Neither the A1298C polymorphism nor any of the htSNPs were associated with MDD prognosis regardless of measure used. Our results suggest that the MTHFR C677T polymorphism may serve as a marker for MDD prognosis pending independent replication.
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Affiliation(s)
- Chad A Bousman
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia; Department of General Practice, The University of Melbourne, Parkville, VIC, Australia; Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorne, VIC, Australia; Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
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Assessing therapist reservations about exposure therapy for anxiety disorders: the Therapist Beliefs about Exposure Scale. J Anxiety Disord 2013; 27:772-80. [PMID: 23816349 DOI: 10.1016/j.janxdis.2013.04.006] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 04/21/2013] [Indexed: 01/08/2023]
Abstract
Exposure therapy is underutilized in the treatment of pathological anxiety and is often delivered in a suboptimal manner. Negative beliefs about exposure appear common among therapists and may pose a barrier to its dissemination. To permit reliable and valid assessment of such beliefs, we constructed the 21-item Therapist Beliefs about Exposure Scale (TBES) and examined its reliability and validity in three samples of practicing clinicians. The TBES demonstrated a clear single-factor structure, excellent internal consistency (αs=.90-.96), and exceptionally high six-month test-retest reliability (r=.89). Negative beliefs about exposure therapy were associated with therapist demographic characteristics, negative reactions to a series of exposure therapy case vignettes, and the cautious delivery of exposure therapy in the treatment of a hypothetical client with obsessive-compulsive disorder. Lastly, TBES scores decreased markedly following a didactic workshop on exposure therapy. The present findings support the reliability and validity of the TBES.
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Bhattacharjee S, Bhattacharya R, Kelley GA, Sambamoorthi U. Antidepressant use and new-onset diabetes: a systematic review and meta-analysis. Diabetes Metab Res Rev 2013; 29:273-84. [PMID: 23390036 PMCID: PMC4888867 DOI: 10.1002/dmrr.2393] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 12/16/2012] [Accepted: 01/11/2013] [Indexed: 11/06/2022]
Abstract
Antidepressant use has been linked to new-onset diabetes. However, the existing literature on this relationship has yielded inconsistent findings. The primary objective of this study was to systematically synthesize the literature on the relationship between antidepressant use and new-onset diabetes using meta-analysis. A systematic literature search was conducted to identify relevant studies in seven electronic databases. Two independent reviewers identified the final list of studies to be included in the meta-analysis using a priori selection criteria. Results for the primary outcome of interest, that is, odds and hazards of developing new-onset diabetes, were pooled using a random-effects model. Egger's regression test and the Trim and Fill method were utilized to detect the presence of any potential publication bias. Sensitivity analysis was conducted using the leave-one-out method as well as individual categories of antidepressant drugs. Eight studies met the inclusion criteria. Random effects models revealed that adults with any use of antidepressants were more likely to develop new-onset diabetes compared with those without any use of antidepressants [odd ratios = 1.50, 95% confidence interval (CI), 1.08-2.10; hazards ratio = 1.19, 95% CI, 1.08-1.32]. Sensitivity analyses revealed fair robustness; selective serotonin reuptake inhibitors and tricyclic antidepressants were more likely to be associated with the development of new-onset diabetes. Results from the Egger's regression test and Trim and Fill method revealed no evidence of publication bias. Among adults, antidepressant use was associated with higher chances of new-onset diabetes. However, because a cause-and-effect relationship cannot be established by observational studies, future randomized controlled studies are needed to confirm this association.
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Affiliation(s)
- Sandipan Bhattacharjee
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA.
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Kanner AM. The treatment of depressive disorders in epilepsy: what all neurologists should know. Epilepsia 2013; 54 Suppl 1:3-12. [PMID: 23458461 DOI: 10.1111/epi.12100] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
One of every three patients with epilepsy (PWE) will experience a depressive disorder in the course of their life, often associated with anxiety symptoms or a full blown anxiety disorder. Clearly, the high prevalence of these psychiatric comorbidities calls for their early identification and management. This article provides practical strategies in the management of depressive episodes in PWE. Contrary to long-held beliefs, the use of antidepressant drugs are safe in PWE when used at therapeutic doses. Antidepressant drugs of the selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) families are the first line of therapy in depressive disorders, and failure to achieve complete symptom remission after a trial of an SSRI or SNRI at optimal doses should be followed by a second trial with a drug from the other antidepressant family. In developing countries, antidepressant drugs of these two antidepressant families are not always available, and tricyclic antidepressants (TCAs) are the drugs of choice. Although there are no differences in efficacy among the three families of antidepressants, TCAs have a lower tolerability and higher toxicity, with greater mortality risk associated with cardiotoxic effects in overdoses. Cognitive behavior therapy is another treatment modality that has been shown to be effective in the treatment of depressive disorders in patients with and without epilepsy. Its use should be considered together with pharmacotherapy or by itself.
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Affiliation(s)
- Andres M Kanner
- Comprehensive Epilepsy Program and Department of Neurology, University of Miami, Miller School of Medicine, Miami, Florida 33136, USA.
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Burnett-Zeigler I, Zivin K, Islam K, Ilgen MA. Longitudinal predictors of first time depression treatment utilization among adults with depressive disorders. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1617-25. [PMID: 22218726 DOI: 10.1007/s00127-011-0465-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 12/14/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE Depressive disorders are a growing public health concern, however, a substantial number of depressed individuals do not receive treatment. This study examined the longitudinal predictors of receiving depression treatment among adults with persistent depressive disorders and no lifetime history of treatment. METHODS The sample included respondents to the National Epidemiologic Survey on Alcohol Related Conditions (NESARC), a large population-based survey, who met criteria for a 12-month major depressive disorder (MDD) or dysthymia (DYS) and had no prior depression treatment. Bivariate and multivariate analyses were conducted examining which socio-demographic and clinical predictors among individuals with depressive disorders and no prior treatment at Wave 1 were associated with receiving depression treatment at Wave 2 (N = 337). RESULTS Only 47.2% of those with MDD or DYS and no prior treatment at Wave 1 had received depression treatment at Wave 2. Females were more likely to have received treatment at Wave 2: those of Hispanic ethnicity, other race, unmarried, 12 years of education, self-rated health of good/very good/excellent and anxiety disorders were less likely to have received treatment at Wave 2. Those with substance use disorders were more likely to have received treatment at Wave 2. CONCLUSIONS This study highlights individuals who would likely benefit from increased efforts to enhance depression treatment utilization.
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Affiliation(s)
- Inger Burnett-Zeigler
- VA Ann Arbor Healthcare System, VA Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), 2215 Fuller Road (11H), Ann Arbor, MI 48105, USA.
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Murphy JA, Byrne GJ. Prevalence and correlates of the proposed DSM-5 diagnosis of Chronic Depressive Disorder. J Affect Disord 2012; 139:172-80. [PMID: 22381955 DOI: 10.1016/j.jad.2012.01.033] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 01/30/2012] [Accepted: 01/30/2012] [Indexed: 10/28/2022]
Abstract
CONTEXT The draft proposal to add Chronic Depressive Disorder to DSM-5 will combine DSM-IV Dysthymic Disorder and Major Depressive Disorder, with chronic specifier, into a single diagnosis. OBJECTIVE The objective of this study is to estimate the prevalence and correlates of the proposed DSM-5 diagnosis of Chronic Depressive Disorder using unit record data from the 2007 Australian National Survey of Mental Health and Wellbeing. DESIGN Secondary analysis of a nationally representative household survey. SETTING Urban and rural census tracts. PARTICIPANTS One individual between the ages of 16 and 85 years from 8841 households was interviewed for the survey. MAIN OUTCOME MEASURE Lifetime prevalence estimates for chronic and non-chronic depression were determined using data from the World Health Organization's Composite International Diagnostic Interview, version 3.0 (WMH-CIDI 3.0). RESULTS Chronic depression of at least two years' duration had a lifetime prevalence of 4.6% (95% CI: 3.9-5.3%) and was found in 29.4% (95% CI: 25.6-33.3%) of individuals with a lifetime depressive disorder. Higher rates of psychiatric co-morbidity (OR=1.42; 95% CI=1.26-1.61), older age (OR=1.04; 95% CI=1.02-1.05), a younger age of onset (OR=0.97; 95% CI=0.95-0.98) and more frequent episodes of depression (OR=1.75; 95% CI=1.07-2.86) were found to be significant correlates of chronic depression. The first episode of depression for individuals with chronic depression often developed after the death of someone close (OR=2.38; 95% CI 1.16-5.79). CONCLUSIONS Chronic depression is highly prevalent among community-residing persons and has a set of correlates that discriminate it from non-chronic depression. The distinction between chronic and non-chronic depression proposed for DSM-5, in the form of Chronic Depressive Disorder, seems to be warranted.
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Affiliation(s)
- Jenifer A Murphy
- The University of Queensland, School of Medicine, Academic Discipline of Psychiatry, K Floor, Mental Health Centre, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia.
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Reid WD, Yamabayashi C, Goodridge D, Chung F, Hunt MA, Marciniuk DD, Brooks D, Chen YW, Hoens AM, Camp PG. Exercise prescription for hospitalized people with chronic obstructive pulmonary disease and comorbidities: a synthesis of systematic reviews. Int J Chron Obstruct Pulmon Dis 2012; 7:297-320. [PMID: 22665994 PMCID: PMC3363140 DOI: 10.2147/copd.s29750] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The prescription of physical activity for hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) can be complicated by the presence of comorbidities. The current research aimed to synthesize the relevant literature on the benefits of exercise for people with multimorbidities who experience an AECOPD, and ask: What are the parameters and outcomes of exercise in AECOPD and in conditions that are common comorbidities as reported by systematic reviews (SRs)? METHODS An SR was performed using the Cochrane Collaboration protocol. Nine electronic databases were searched up to July 2011. Articles were included if they (1) described participants with AECOPD, chronic obstructive pulmonary disease (COPD), or one of eleven common comorbidities, (2) were an SR, (3) examined aerobic training (AT), resistance training (RT), balance training (BT), or a combination thereof, (4) included at least one outcome of fitness, and (5) compared exercise training versus control/sham. RESULTS This synthesis examined 58 SRs of exercise training in people with AECOPD, COPD, or eleven chronic conditions commonly associated with COPD. Meta-analyses of endurance (aerobic or exercise capacity, 6-minute walk distance--6MWD) were shown to significantly improve in most conditions (except osteoarthritis, osteoporosis, and depression), whereas strength was shown to improve in five of the 13 conditions searched: COPD, older adults, heart failure, ischemic heart disease, and diabetes. Several studies of different conditions also reported improvements in quality of life, function, and control or prevention outcomes. Meta-analyses also demonstrate that exercise training decreases the risk of mortality in older adults, and those with COPD or ischemic heart disease. The most common types of training were AT and RT. BT and functional training were commonly applied in older adults. The quality of the SRs for most conditions was moderate to excellent (>65%) as evaluated by AMSTAR scores. CONCLUSION In summary, this synthesis showed evidence of significant benefits from exercise training in AECOPD, COPD, and conditions that are common comorbidities. A broader approach to exercise and activity prescription in pulmonary rehabilitation may induce therapeutic benefits to ameliorate clinical sequelae associated with AECOPD and comorbidities such as the inclusion of BT and functional training.
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Affiliation(s)
- W Darlene Reid
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
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Primary Care Medical Provider Attitudes Regarding Mental Health and Behavioral Medicine in Integrated and Non-integrated Primary Care Practice Settings. J Clin Psychol Med Settings 2012; 19:364-75. [DOI: 10.1007/s10880-011-9283-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Serotonin transporter gene moderates childhood maltreatment's effects on persistent but not single-episode depression: replications and implications for resolving inconsistent results. J Affect Disord 2011; 135:56-65. [PMID: 21439648 PMCID: PMC3752793 DOI: 10.1016/j.jad.2011.03.010] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 03/01/2011] [Accepted: 03/02/2011] [Indexed: 01/10/2023]
Abstract
BACKGROUND Genetic and environmental factors shape life-long vulnerability to depression, but most gene-environment interaction (G×E) research has focused on cross-sectional assessments rather than life-course phenotypes. This study tests the hypothesis that the G×E involving the length polymorphism in the serotonin-transporter-gene-linked-promoter-region (5-HTTLPR) and childhood maltreatment is specific to depression that runs a persistent course in adulthood. METHODS The hypothesis is tested in two cohorts. Men and women in the Dunedin Study (N=847), New Zealand, followed to age 32 years with 96% retention and women in the E-Risk Study (N=930), England, followed to age 40 years with 96% retention. Diagnoses of past-year major depressive episode were established at four separate assessments. Depression diagnosed on two or more occasions was considered persistent. RESULTS In both cohorts, statistical tests of gene-environment interactions showed positive results for persistent depression but not single-episode depression. Individuals with two short 5-HTTLPR alleles and childhood maltreatment had elevated risk of persistent but not single-episode depression. LIMITATIONS Some cases of recurrent depression may have been misclassified as single-episode due to non-contiguous assessment windows, but this would have a conservative effect on the findings. Chronic and recurrent depression could not be reliably distinguished due to non-contiguous periods of assessment. Therefore, the term persistent depression is used to describe either chronic or recurrent course. CONCLUSIONS The specific effect on persistent depression increases the significance of this G×E for public health. Research that does not distinguish persistent course may underestimate G×E effects and account for some replication failures in G×E research.
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O'Loughlin RE, Duberstein PR, Veazie PJ, Bell RA, Rochlen AB, Fernandez y Garcia E, Kravitz RL. Role of the gender-linked norm of toughness in the decision to engage in treatment for depression. PSYCHIATRIC SERVICES (WASHINGTON, D.C.) 2011. [PMID: 21724786 DOI: 10.1176/appi.ps.62.7.740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Given their prevalence and persuasive power in our culture, gender norms--commonly described as socially reinforced, learned expectations of what it means to be a man or a woman--likely contribute to sex differences in service utilization for depression. This study investigated whether sex differences in toughness, a gender-linked norm characterized by a desire to hide pain and maintain independence, were associated with a preference to wait for depression to resolve on its own without active professional treatment ("wait-and-see" approach). METHODS Participants (N=1,051) in the California Behavioral Risk Factor Surveillance System (BRFSS) survey were contacted in a follow-on survey to assess toughness, the kind of treatment they would prefer were they to receive a diagnosis of depression, and current symptoms of depression. Participants who reported ever having been diagnosed as having a depressive disorder on the BRFSS were oversampled threefold. Analyses were conducted using linear and logistic regressions. RESULTS Men and women who scored higher on toughness had a greater preference for the wait-and-see approach (OR=1.14, p<.01). Women were less likely to prefer the wait-and-see approach (OR=.58, p<.04) and scored lower on toughness (B=-.70, p<.01). Men's greater levels of toughness partially mediated the sex difference in treatment preferences (OR=.91, p<.03). CONCLUSIONS Men's greater adherence to the toughness norm explained part of the sex difference observed in treatment-seeking preferences, but toughness undermined women's treatment seeking as well. Findings could be used to inform novel public health communications intended to attract both men and women to psychiatric services.
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Affiliation(s)
- Ryan E O'Loughlin
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA.
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O'Loughlin RE, Duberstein PR, Veazie PJ, Bell RA, Rochlen AB, Fernandez y Garcia E, Kravitz RL. Role of the gender-linked norm of toughness in the decision to engage in treatment for depression. Psychiatr Serv 2011; 62:740-6. [PMID: 21724786 PMCID: PMC3129782 DOI: 10.1176/ps.62.7.pss6207_0740] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Given their prevalence and persuasive power in our culture, gender norms--commonly described as socially reinforced, learned expectations of what it means to be a man or a woman--likely contribute to sex differences in service utilization for depression. This study investigated whether sex differences in toughness, a gender-linked norm characterized by a desire to hide pain and maintain independence, were associated with a preference to wait for depression to resolve on its own without active professional treatment ("wait-and-see" approach). METHODS Participants (N=1,051) in the California Behavioral Risk Factor Surveillance System (BRFSS) survey were contacted in a follow-on survey to assess toughness, the kind of treatment they would prefer were they to receive a diagnosis of depression, and current symptoms of depression. Participants who reported ever having been diagnosed as having a depressive disorder on the BRFSS were oversampled threefold. Analyses were conducted using linear and logistic regressions. RESULTS Men and women who scored higher on toughness had a greater preference for the wait-and-see approach (OR=1.14, p<.01). Women were less likely to prefer the wait-and-see approach (OR=.58, p<.04) and scored lower on toughness (B=-.70, p<.01). Men's greater levels of toughness partially mediated the sex difference in treatment preferences (OR=.91, p<.03). CONCLUSIONS Men's greater adherence to the toughness norm explained part of the sex difference observed in treatment-seeking preferences, but toughness undermined women's treatment seeking as well. Findings could be used to inform novel public health communications intended to attract both men and women to psychiatric services.
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Affiliation(s)
- Ryan E O'Loughlin
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA.
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Embry DD. Behavioral vaccines and evidence-based kernels: nonpharmaceutical approaches for the prevention of mental, emotional, and behavioral disorders. Psychiatr Clin North Am 2011; 34:1-34. [PMID: 21333837 PMCID: PMC3064963 DOI: 10.1016/j.psc.2010.11.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In the United States the rates for some mental, emotional, and behavioral problems (MEBs) have objectively increased over the past 20 to 50 years. The attributes of a public health approach to the treatment of MEBs are defined in this article. Multiple examples of how public health approaches might reduce or prevent MEBs using low-cost evidence-based kernels, which are fundamental units of behavior, are discussed. Such kernels can be used repeatedly, which then act as "behavioral vaccines" to reduce morbidity or mortality and/or improve human wellbeing. The author calls for 6 key policy actions to improve MEBs in young people.
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Chung B, Jones L, Dixon EL, Miranda J, Wells K. Using a community partnered participatory research approach to implement a randomized controlled trial: planning community partners in care. J Health Care Poor Underserved 2010; 21:780-95. [PMID: 20693725 DOI: 10.1353/hpu.0.0345] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
SUMMARY Quality improvement (QI) for depression in primary care can reduce disparities in outcomes. We describe how community-partnered participatory research was used to design Community Partners in Care, a randomized trial of community engagement to activate a multiple-agency network versus support for individual agencies to implement depression QI in underserved communities.
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Affiliation(s)
- Bowen Chung
- RAND Corporation, Santa Monica, CA 90509, USA.
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