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Huang S, Wahlquist A, Dahne J. Individual Predictors of Response to A Behavioral Activation-Based Digital Smoking Cessation Intervention: A Machine Learning Approach. Subst Use Misuse 2024:1-9. [PMID: 38898605 DOI: 10.1080/10826084.2024.2369155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Background: Depression is prevalent among individuals who smoke cigarettes and increases risk for relapse. A previous clinical trial suggests that Goal2Quit, a behavioral activation-based smoking cessation mobile app, effectively increases smoking abstinence and reduces depressive symptoms. Objective: Secondary analyses were conducted on these trial data to identify predictors of success in depression-specific digitalized cessation interventions. Methods: Adult who smoked cigarettes (age = 38.4 ± 10.3, 53% women) were randomized to either use Goal2Quit for 12 weeks (N = 103), paired with a 2-week sample of nicotine replacement therapy (patch and lozenge) or to a Treatment-As-Usual (TAU) control (N = 47). The least absolute shrinkage and selection operator was utilized to identify a subset of baseline variables predicting either smoking or depression intervention outcomes. The retained predictors were then fitted via linear regression models to determine relations to each intervention outcome. Results: Relative to TAU, only individuals who spent significant time using Goal2Quit (56 ± 46 min) were more likely to reduce cigarette use by at least 50% after 12 weeks, whereas those who spent minimal time using Goal2Quit (10 ± 2 min) did not exhibit significant changes. An interaction between educational attainment and treatment group revealed that, as compared to TAU, only app users with an educational degree beyond high school exhibited significant reductions in depression. Conclusions: The findings highlight the importance of tailoring depression-specific digital cessation interventions to individuals' unique engagement needs and educational level. This study provides a potential methodological template for future research aimed at personalizing technology-based treatments for cigarette users with depressive symptoms.
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Affiliation(s)
- Siyuan Huang
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, South Carolina, USA
- Hollings Cancer Center, MUSC, Charleston, South Carolina, USA
| | - Amy Wahlquist
- Center for Rural Health Research, East Tennessee State University, Johnson City, Tennessee, USA
| | - Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, South Carolina, USA
- Hollings Cancer Center, MUSC, Charleston, South Carolina, USA
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Nolan RP, Syed F, Stogios N, Maunder R, Sockalingam S, Tai ES, Cobain M, Peiris RG, Huszti E. The evaluation of goal-directed activities to promote well-being and health in heart failure: EUROIA scale. J Patient Rep Outcomes 2024; 8:47. [PMID: 38683439 PMCID: PMC11058156 DOI: 10.1186/s41687-024-00723-x] [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] [Received: 08/29/2023] [Accepted: 04/14/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND The EvalUation of goal-diRected activities to prOmote well-beIng and heAlth (EUROIA) scale is a novel patient-reported measure that was administered to individuals with chronic heart failure (CHF). It assesses goal-directed activities that are self-reported as being personally meaningful and commonly utilized to optimize health-related quality of life (HRQL). Our aim was to evaluate psychometric properties of the EUROIA, and to determine if it accounted for novel variance in its association with clinical outcomes. METHODS This study was a secondary analysis of the CHF-CePPORT trial, which enrolled 231 CHF patients: median age = 59.5 years, 23% women. Baseline assessments included: EUROIA, Kansas City Cardiomyopathy Questionnaire-Overall Summary (KCCQ-OS), Patient Health Questionnaire-9 for depression (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7). 12-month outcomes included health status (composite index of incident hospitalization or emergency department, ED, visit) and mental health (PHQ-9 and GAD-7). RESULTS Exploratory Principal Axis Factoring identified four EUROIA factors with satisfactory internal reliability: i.e., activities promoting eudaimonic well-being (McDondald's ω = 0.79), social affiliation (⍺=0.69), self-affirmation (⍺=0.73), and fulfillment of social roles/responsibilities (Spearman-Brown coefficient = 0.66). Multivariable logistic regression indicated that not only was the EUROIA inversely associated with incidence of 12-month hospitalization/ED visits independent of the KCCQ-OS (Odds Ratio, OR = 0.95, 95% Confidence Interval, CI, 0.91, 0.98), but it was also associated with 12-month PHQ-9 (OR = 0.91, 95% CI, 0.86, 0.97), and GAD-7 (OR = 0.94, 95% CI, 0.90, 0.99) whereas the KCCQ-OS was not. CONCLUSION The EUROIA provides a preliminary taxonomy of goal-directed activities that promote HRQL among CHF patients independently from a current gold standard state-based measure. CLINICAL TRIAL REGISTRATION NCT01864369; https://classic. CLINICALTRIALS gov/ct2/show/NCT01864369 .
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Affiliation(s)
- Robert P Nolan
- Behavioral Cardiology Research Unit, Peter Munk Cardiac Centre and Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto Faculty of Medicine, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| | - Fatima Syed
- Behavioral Cardiology Research Unit, Peter Munk Cardiac Centre and Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Nicolette Stogios
- Behavioral Cardiology Research Unit, Peter Munk Cardiac Centre and Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Robert Maunder
- Institute of Medical Science, University of Toronto Faculty of Medicine, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Sinai Health System, Toronto, ON, Canada
| | - Sanjeev Sockalingam
- Institute of Medical Science, University of Toronto Faculty of Medicine, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - E Shyong Tai
- Division of Endocrinology, National University Hospital, Singapore, Singapore
| | | | - Rachel G Peiris
- Behavioral Cardiology Research Unit, Peter Munk Cardiac Centre and Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Ella Huszti
- Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
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Clark SM, Reeb RN, Born CC, Hurley KE. Benefits of a health advocacy intervention intended to improve self-efficacy for self-care in residents of a homeless shelter. J Prev Interv Community 2024; 52:198-217. [PMID: 38178550 DOI: 10.1080/10852352.2023.2299895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Despite a great need for healthcare, unhoused individuals encounter significant barriers to utilizing public healthcare systems. Given the inequities in access to healthcare, accompanied by disabilities and health risks associated with homelessness, self-efficacy for self-care is particularly critical. As a primary purpose of this article, we describe a self-care intervention (Health Advocacy Behavioral Activation), which was implemented within a long-standing participatory community action research project for homeless shelters, and report evidence of the intervention's effectiveness in enhancing self-efficacy for self-care. Participants included 62 residents of the St. Vincent de Paul Gateway Shelter for Men (Dayton, Ohio). Shelter residents with disabilities and those without disability benefited approximately equally from the intervention and both showed statistically significant pre- to post-intervention improvements in self-efficacy for self-care. Recommendations for future research examining the effectiveness of the intervention are provided. As a secondary (supplementary) purpose, we report preliminary evidence of psychometric validation for a new instrument (Scale of Self-Efficacy for Self-Care), which was developed in service of our primary purpose (i.e., to examine the effects of intervention on self-efficacy for self-care) because a literature search did not identify an appropriate measure. Because this new instrument fills a void in the literature, we anticipate that it will be useful in practice and research, and so we delineate research recommendations for additional psychometric validation of this measure. Because of the barriers that unhoused people encounter with regard to access to healthcare in the community, self-care interventions provided (and evaluated) on-site (e.g., in homeless shelters) are necessary.
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Affiliation(s)
- Sarah M Clark
- Department of Psychology, University of Dayton, Dayton, Ohio, USA
| | - Roger N Reeb
- Department of Psychology, University of Dayton, Dayton, Ohio, USA
| | - Caroline C Born
- Department of Psychology, University of Dayton, Dayton, Ohio, USA
| | - Kathryn E Hurley
- Department of Psychology, University of Dayton, Dayton, Ohio, USA
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Harrison F, Mortby ME, Mather KA, Sachdev PS, Brodaty H. Apathy as a determinant of health behaviors in older adults: Implications for dementia risk reduction. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12505. [PMID: 38026759 PMCID: PMC10668002 DOI: 10.1002/dad2.12505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 08/04/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Long-term improvements in physical inactivity and other behavioral risk factors are integral to dementia risk reduction; however, sustained behavior change is challenging. Apathy, depression, and fatigue may impact engagement in health behaviors, but their presentation overlaps. This study investigates whether these symptoms are differentially associated with multiple health behaviors. METHODS In 1037 community-dwelling older adults without dementia (aged 70-90, 55% women), regression analyses examined apathy, depression, and fatigue as predictors of health behaviors (physical activity, diet, alcohol, smoking) and a behavioral risk index. RESULTS Apathy was associated with reduced physical activity and alcohol use, and one or multiple behavioral risk factors. No or inconsistent relations were found between depression or fatigue and health behaviors. DISCUSSION Apathy is relevant to multiple health behaviors and should be considered when designing health promotion for older adults, including interventions for dementia risk reduction. Findings highlight the importance of distinguishing apathy from comorbid symptoms. Highlights Novel theory-based perspective on behavioural risk factors for dementia.Higher apathy predicted less physical activity and alcohol use, and increased odds of lifestyle risk factors.Depressive symptoms were not associated with any health behavior.Apathy may be a determinant of multiple health behaviors in older adults, distinct from depression and fatigue.Considering apathy in precision prevention of dementia appears warranted.
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Affiliation(s)
- Fleur Harrison
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry & Mental HealthFaculty of Medicine & Health, UNSW SydneySydneyNew South WalesAustralia
| | - Moyra E. Mortby
- School of Psychology, UNSW SydneySydneyNew South WalesAustralia
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- UNSW Ageing Futures Institute, UNSW SydneySydneyNew South WalesAustralia
| | - Karen A. Mather
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry & Mental HealthFaculty of Medicine & Health, UNSW SydneySydneyNew South WalesAustralia
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry & Mental HealthFaculty of Medicine & Health, UNSW SydneySydneyNew South WalesAustralia
- NeuroPsychiatric InstitutePrince of Wales HospitalRandwickNew South WalesAustralia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry & Mental HealthFaculty of Medicine & Health, UNSW SydneySydneyNew South WalesAustralia
- Older People's Mental Health ServicePrince of Wales HospitalRandwickNew South WalesAustralia
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KOŞAN Y, SEÇER İ. Adaptation of Adolescent Behavioral Activation Program and Investigation of Its Effectiveness by Mixed Method. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2022. [DOI: 10.18863/pgy.1188941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In this study, the Adolescent Behavioral Activation Program (A-BAP) based on behavioral activation (BA) therapy to reduce depressive symptoms in adolescents was adapted to Turkish culture, and its effectiveness was tested with intervention design, one of the mixed method designs. In this direction, experimental and control groups were formed with 20 students studying in three different high schools in Turkey and with highly elevated depressive symptoms. The study group was determined by nested sampling from mixed-method sampling strategies. The starting point of this study is the absence of any BA-based practice to reduce adolescent depression in Turkey. In this direction, experimental and control groups were formed with 20 students studying in three different high schools in Turkey and with highly elevated depressive symptoms. The adapted A-BAP was applied individually to the students in the experimental group for 12 weeks. Three sessions were also held with the parents of the students in the experimental group. In the quantitative phase of the study, pre-test and post-test control groups paired patterns from semi-experimental designs, and a case study was used in the qualitative stage. The qualitative data of the study were collected from adolescents and their parents through semi-structured interviews and session evaluation forms. It was determined that the adapted BA-based A-BAP was an effective intervention in reducing depressive symptoms in the Turkish adolescent sample and provided a significant decrease in the depression scores of the participants in the experimental group . The qualitative findings show that adolescents perceive the A-BAP process as a factor contributing to making them feel better. Adolescents have reported that A-BAP is effective in reducing avoidance behavior, achieving anger control, and increasing self-esteem and social interaction. Parents consider A-BAP as a developer, educator, and practice that reduces depressive symptoms in their children. In addition, it was determined that the qualitative findings obtained supported the quantitative results. Since the study is the first application of BA therapy in Turkey, it is thought that it will contribute to new studies in Turkey and intercultural studies at the international level.
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Affiliation(s)
| | - İsmail SEÇER
- ATATÜRK ÜNİVERSİTESİ, KAZIM KARABEKİR EĞİTİM FAKÜLTESİ
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