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Wu Y, De Asis-Cruz J, Limperopoulos C. Brain structural and functional outcomes in the offspring of women experiencing psychological distress during pregnancy. Mol Psychiatry 2024:10.1038/s41380-024-02449-0. [PMID: 38418579 DOI: 10.1038/s41380-024-02449-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 03/01/2024]
Abstract
In-utero exposure to maternal psychological distress is increasingly linked with disrupted fetal and neonatal brain development and long-term neurobehavioral dysfunction in children and adults. Elevated maternal psychological distress is associated with changes in fetal brain structure and function, including reduced hippocampal and cerebellar volumes, increased cerebral cortical gyrification and sulcal depth, decreased brain metabolites (e.g., choline and creatine levels), and disrupted functional connectivity. After birth, reduced cerebral and cerebellar gray matter volumes, increased cerebral cortical gyrification, altered amygdala and hippocampal volumes, and disturbed brain microstructure and functional connectivity have been reported in the offspring months or even years after exposure to maternal distress during pregnancy. Additionally, adverse child neurodevelopment outcomes such as cognitive, language, learning, memory, social-emotional problems, and neuropsychiatric dysfunction are being increasingly reported after prenatal exposure to maternal distress. The mechanisms by which prenatal maternal psychological distress influences early brain development include but are not limited to impaired placental function, disrupted fetal epigenetic regulation, altered microbiome and inflammation, dysregulated hypothalamic pituitary adrenal axis, altered distribution of the fetal cardiac output to the brain, and disrupted maternal sleep and appetite. This review will appraise the available literature on the brain structural and functional outcomes and neurodevelopmental outcomes in the offspring of pregnant women experiencing elevated psychological distress. In addition, it will also provide an overview of the mechanistic underpinnings of brain development changes in stress response and discuss current treatments for elevated maternal psychological distress, including pharmacotherapy (e.g., selective serotonin reuptake inhibitors) and non-pharmacotherapy (e.g., cognitive-behavior therapy). Finally, it will end with a consideration of future directions in the field.
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Affiliation(s)
- Yao Wu
- Developing Brain Institute, Children's National Hospital, Washington, DC, 20010, USA
| | | | - Catherine Limperopoulos
- Developing Brain Institute, Children's National Hospital, Washington, DC, 20010, USA.
- Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, DC, 20010, USA.
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2
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Siriratnam P, Huda S, Butzkueven H, van der Walt A, Jokubaitis V, Monif M. A comprehensive review of the advances in neuromyelitis optica spectrum disorder. Autoimmun Rev 2023; 22:103465. [PMID: 37852514 DOI: 10.1016/j.autrev.2023.103465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/13/2023] [Indexed: 10/20/2023]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare relapsing neuroinflammatory autoimmune astrocytopathy, with a predilection for the optic nerves and spinal cord. Most cases are characterised by aquaporin-4-antibody positivity and have a relapsing disease course, which is associated with accrual of disability. Although the prognosis in NMOSD has improved markedly over the past few years owing to advances in diagnosis and therapeutics, it remains a severe disease. In this article, we review the evolution of our understanding of NMOSD, its pathogenesis, clinical features, disease course, treatment options and associated symptoms. We also address the gaps in knowledge and areas for future research focus.
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Affiliation(s)
- Pakeeran Siriratnam
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Saif Huda
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Vilija Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Mastura Monif
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia.
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3
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Cuijpers P, Miguel C, Harrer M, Plessen CY, Ciharova M, Papola D, Ebert D, Karyotaki E. Psychological treatment of depression: A systematic overview of a 'Meta-Analytic Research Domain'. J Affect Disord 2023; 335:141-151. [PMID: 37178828 DOI: 10.1016/j.jad.2023.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Over the past 16 years, we have developed a 'Meta-analytic Research Domain' (MARD) of all randomized trials of psychological treatments of depression. A MARD is a living systematic review of a research field, that cannot be otherwise covered by one (network) meta-analysis and includes multiple PICOs. In this paper we give an overview of the findings of this MARD. METHODS A narrative review of the results of the 118 meta-analyses on psychotherapies for depression that were published within our MARD. RESULTS Most research has been conducted on cognitive-behavioral therapy (CBT), but several other psychotherapies are also effective, with few differences between therapies. They can be effectively delivered in individual, group, telephone and guided self-help format and are effective in many different target groups and across different age groups, although the effects are significantly smaller in children and adolescents. Psychotherapies have comparable effects as pharmacotherapy at the short term but are probably more effective at the longer term. Combined treatment is more effective than either psychotherapy or pharmacotherapy alone at the short, but also at the longer term. LIMITATIONS We did not summarize all published meta-analyses (protocols, methodological studies) and have not compared our results to those found in other meta-analyses on comparable subjects. CONCLUSION Psychotherapies can contribute considerably to a reduction of the disease burden of depression. MARDs are an important next step in the aggregation of knowledge from randomized controlled trials in psychological treatments of depression as well as in other healthcare sectors.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands; Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania.
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Department of Health Sciences, Technical University Munich, Munich, Germany; Department of Clinical Psychology & Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Constantin Yves Plessen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands; Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Davide Papola
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Italy; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - David Ebert
- Psychology & Digital Mental Health Care, Department of Health Sciences, Technical University Munich, Munich, Germany
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
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Peiper NC, Nelson BW, Aschbacher K, Forman-Hoffman VL. Trajectories of depression symptoms in a therapist-supported digital mental health intervention: a repeated measures latent profile analysis. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1237-1246. [PMID: 36651947 PMCID: PMC9847436 DOI: 10.1007/s00127-022-02402-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 12/12/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE Major depression affects 10% of the US adult population annually, contributing to significant burden and impairment. Research indicates treatment response is a non-linear process characterized by combinations of gradual changes and abrupt shifts in depression symptoms, although less is known about differential trajectories of depression symptoms in therapist-supported digital mental health interventions (DMHI). METHODS Repeated measures latent profile analysis was used to empirically identify differential trajectories based upon biweekly depression scores on the Patient Health Questionnaire-9 (PHQ-9) among patients engaging in a therapist-supported DMHI from January 2020 to July 2021. Multivariate associations between symptom trajectories with sociodemographics and clinical characteristics were examined with multinomial logistic regression. Minimal clinically important differences (MCID) were defined as a five-point change on the PHQ-9 from baseline to week 12. RESULTS The final sample included 2192 patients aged 18 to 82 (mean = 39.1). Four distinct trajectories emerged that differed by symptom severity and trajectory of depression symptoms over 12 weeks. All trajectories demonstrated reductions in symptoms. Despite meeting MCID criteria, evidence of treatment resistance was found among the trajectory with the highest symptom severity. Chronicity of major depressive episodes and lifetime trauma exposures were ubiquitous across the trajectories in a multinomial logistic regression model. CONCLUSIONS These data indicate that changes in depression symptoms during DMHI are heterogenous and non-linear, suggesting a need for precision care strategies to address treatment resistance and increase engagement. Future efforts should examine the effectiveness of trauma-informed treatment modules for DMHIs as well as protocols for continuation treatment and relapse prevention.
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Affiliation(s)
- Nicholas C Peiper
- Meru Health, Inc., 720 South B Street, Second Floor, San Mateo, CA, 94401, USA.
- Department of Epidemiology and Population Health, University of Louisville, Louisville, KY, USA.
| | - Benjamin W Nelson
- Meru Health, Inc., 720 South B Street, Second Floor, San Mateo, CA, 94401, USA
- Department of Psychology and Neuroscience, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Kirstin Aschbacher
- Meru Health, Inc., 720 South B Street, Second Floor, San Mateo, CA, 94401, USA
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Valerie L Forman-Hoffman
- Meru Health, Inc., 720 South B Street, Second Floor, San Mateo, CA, 94401, USA
- Department of Epidemiology, The University of Iowa, Iowa, IA, USA
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Sharpley CF, Bitsika V, Arnold WM, Shadli SM, Jesulola E, Agnew LL. Network analysis of frontal lobe alpha asymmetry confirms the neurophysiological basis of four subtypes of depressive behavior. Front Psychiatry 2023; 14:1194318. [PMID: 37448489 PMCID: PMC10336204 DOI: 10.3389/fpsyt.2023.1194318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Although depression is widespread carries a major disease burden, current treatments remain non-universally effective, arguably due to the heterogeneity of depression, and leading to the consideration of depressive "subtypes" or "depressive behavior subtypes." One such model of depressive behavior (DB) subtypes was investigated for its associations with frontal lobe asymmetry (FLA), using a different data analytic procedure than in previous research in this field. Methods 100 community volunteers (54 males, 46 females) aged between 18 yr. and 75 years (M = 32.53 yr., SD = 14.13 yr) completed the Zung Self-rating Depression Scale (SDS) and underwent 15 min of eyes closed EEG resting data collection across 10 frontal lobe sites. DB subtypes were defined on the basis of previous research using the SDS, and alpha-wave (8-13 Hz) data produced an index of FLA. Data were examined via network analysis. Results Several network analyses were conducted, producing two models of the association between DB subtypes and FLA, confirming unique neurophysiological profiles for each of the four DB subtypes. Discussion As well as providing a firm basis for using these DB subtypes in clinical settings, these findings provide a reasonable explanation for the inconsistency in previous FLA-depression research.
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Affiliation(s)
| | - Vicki Bitsika
- Brain-Behavior Research Group, University of New England, Armidale, NSW, Australia
| | - Wayne M Arnold
- Brain-Behavior Research Group, University of New England, Armidale, NSW, Australia
| | - Shabah M Shadli
- Brain-Behavior Research Group, University of New England, Armidale, NSW, Australia
| | - Emmanuel Jesulola
- Brain-Behavior Research Group, University of New England, Armidale, NSW, Australia
| | - Linda L Agnew
- Brain-Behavior Research Group, University of New England, Armidale, NSW, Australia
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6
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Xiong J, Wen JL, Pei GS, Han X, He DQ. Effectiveness of Internet-based cognitive behavioural therapy for employees with depression: a systematic review and meta-analysis. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2023; 29:268-281. [PMID: 35172706 DOI: 10.1080/10803548.2022.2043647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objectives. The effectiveness of Internet interventions for employees with depressive disorder remains controversial. We summarized all available evidence exploring the role of Internet interventions in reducing employees' depressive symptoms. Methods. This study was a comprehensive systematic review and meta-analysis that included acceptability and preliminary feasibility studies. We excluded programme descriptions, discussion articles and study protocols. We followed the PRISMA guidelines and searched MEDLINE, EMBASE, PsycINFO, the Cochrane Library and Web of Science from database inception to May 2021 for articles published in English. We extracted data concerning demographics, intervention format, including Internet interventions, control group conditions and outcome measures. We used a random-effects model and calculated Hedges' g values for the scores of employees receiving Internet interventions versus control conditions. This systematic review is registered as INPLASY202160082. Results. Data from 19 studies were included. These 19 studies included 5898 participants (2813 participants received Internet interventions, 3085 participants were in control groups). Conclusions. The findings suggest that Internet interventions can be effective in improving depression in employees. However, more randomized controlled trials are needed to provide better evidence regarding Internet interventions for employees with depression, and robust studies are needed to observe the effectiveness of Internet interventions.
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Affiliation(s)
- Juan Xiong
- School of Marxism, Chongqing University, People's Republic of China
| | - Jian Lin Wen
- School of Marxism, Chongqing University, People's Republic of China
| | - Guang Shu Pei
- School of Marxism, Chongqing University, People's Republic of China
| | - Xu Han
- School of Marxism, Chongqing University, People's Republic of China
| | - Dan Qing He
- School of Humanities, Mianyang Polytechnic, People's Republic of China
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Morales MF, Girard LC, Raouna A, MacBeth A. The association of different presentations of maternal depression with children's socio-emotional development: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001649. [PMID: 36963088 PMCID: PMC10021281 DOI: 10.1371/journal.pgph.0001649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 02/03/2023] [Indexed: 03/01/2023]
Abstract
Maternal depression from the perinatal period onwards is a global health priority associated with an increased likelihood of suboptimal socio-developmental outcomes in offspring. An important aspect of this association is the extent to which sustained maternal depression impacts on these outcomes. The current review synthesised the evidence on maternal depression from the perinatal period onwards and offspring internalising, externalising, and social competence outcomes. We also identified sources of methodological bias. A systematic review following PRISMA guidelines was conducted. Longitudinal studies targeting biological mothers with depressive symptomology, detailing onset, using repeated validated measures, and assessing children's outcomes between three and 12 years were included. Twenty-four studies met inclusion criteria. Findings supported the validity of different presentations of maternal depression, including consistent identification of a group of chronically depressed mothers across countries. Mothers within this group reported poorer internalising, externalising, and social competence outcomes for their offspring, with the highest levels of child problems associated with greater maternal chronicity and symptom severity. Results differed by measurement type with mothers rating poorer outcomes in comparison to teachers reports. For timing of depression, evidence was inconsistent for independent effects of antenatal or postnatal depression on child outcomes. There was substantial variability in study quality assessment. Assessing different presentations of maternal depression is essential for capturing the longitudinal associations between maternal depression and offspring outcomes to inform targets of early intervention. Chronicity, severity, and concurrent maternal depression have important implications for children's development and should be targeted in future programme planning. Further research in low- and middle-income countries is warranted.
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Affiliation(s)
- María Francisca Morales
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, United Kingdom
| | - Lisa-Christine Girard
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, United Kingdom
| | - Aigli Raouna
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, United Kingdom
| | - Angus MacBeth
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, United Kingdom
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Plessen CY, Karyotaki E, Miguel C, Ciharova M, Cuijpers P. Exploring the efficacy of psychotherapies for depression: a multiverse meta-analysis. BMJ MENTAL HEALTH 2023; 26:e300626. [PMID: 36914209 PMCID: PMC10035781 DOI: 10.1136/bmjment-2022-300626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/20/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Hundreds of randomised controlled trials and dozens of meta-analyses have examined psychotherapies for depression-yet not all points in the same direction. Are these discrepancies a result of specific meta-analytical decisions or do most analytical strategies reaching the same conclusion? OBJECTIVE We aim to solve these discrepancies by conducting a multiverse meta-analysis containing all possible meta-analyses, using all statistical methods. STUDY SELECTION AND ANALYSIS We searched four bibliographical databases (PubMed, EMBASE, PsycINFO and Cochrane Register of Controlled Trials), including studies published until 1 January 2022. We included all randomised controlled trials comparing psychotherapies with control conditions without restricting the type of psychotherapy, target group, intervention format, control condition and diagnosis. We defined all possible meta-analyses emerging from combinations of these inclusion criteria and estimated the resulting pooled effect sizes with fixed-effect, random-effects, 3-level, robust variance estimation, p-uniform and PET-PEESE (precision-effect test and precision-effect estimate with SE) meta-analysis models. This study was preregistered (https://doi.org/10.1136/bmjopen-2021-050197). FINDINGS A total of 21 563 records were screened, and 3584 full texts were retrieved; 415 studies met our inclusion criteria containing 1206 effect sizes and 71 454 participants. Based on all possible combinations between inclusion criteria and meta-analytical methods, we calculated 4281 meta-analyses. The average summary effect size for these meta-analyses was Hedges' g mean=0.56, a medium effect size, and ranged from g=-0.66 to 2.51. In total, 90% of these meta-analyses reached a clinically relevant magnitude. CONCLUSIONS AND CLINICAL IMPLICATIONS The multiverse meta-analysis revealed the overall robustness of the effectiveness of psychotherapies for depression. Notably, meta-analyses that included studies with a high risk of bias, compared the intervention with wait-list control groups, and not correcting for publication bias produced larger effect sizes.
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Affiliation(s)
- Constantin Yves Plessen
- Department of Psychosomatic Medicine, Charite University Hospital Berlin, Berlin, Germany
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam Faculty of Behavioural and Movement Sciences, Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam Faculty of Behavioural and Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Clara Miguel
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam Faculty of Behavioural and Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marketa Ciharova
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam Faculty of Behavioural and Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam Faculty of Behavioural and Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Bisby MA, Karin E, Hathway T, Scott AJ, Heriseanu AI, Dudeney J, Fisher A, Gandy M, Cross S, Staples L, Titov N, Dear BF. A meta-analytic review of randomized clinical trials of online treatments for anxiety: Inclusion/exclusion criteria, uptake, adherence, dropout, and clinical outcomes. J Anxiety Disord 2022; 92:102638. [PMID: 36242790 DOI: 10.1016/j.janxdis.2022.102638] [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] [Received: 02/09/2022] [Revised: 09/25/2022] [Accepted: 10/04/2022] [Indexed: 11/18/2022]
Abstract
Over the last decade there has been rapid growth in the number of clinical trials examining internet-delivered interventions for anxiety. While there have been numerous analyses of treatment efficacy, few studies have examined treatment engagement. The current meta-analysis examined participant eligibility, uptake, adherence, and drop-out in clinical trials of internet-delivered treatments for anxiety. This meta-analysis used random effects models to obtain estimates of participant inclusion, uptake, adherence, drop-out, and within-group treatment effect size. Moderator analyses examined the effects of anxiety disorder type, treatment type, and level of clinician guidance. After screening, 140 trials with 199 treatment arms (N = 11,021) were included. An average of 46% (95% CI 42, 50) of interested people were included in the clinical trials. In the active treatment arms, 98% (95% CI 97, 99) of participants began treatment, 81% (95% CI 78, 85) of the assigned treatments were completed, 21% (95% CI 18, 23) of individuals dropped out at post-treatment based on questionnaire non-completion, and an overall within-group effect size of g = 1.03 (95% CI 0.94, 1.13) was obtained. Several moderators of interest were significant (e.g., clinical guidance, anxiety disorder type), and there was substantial heterogeneity in estimates. In conclusion, a large number of inclusion and exclusion criteria have been used in trials of internet-delivered treatments for anxiety. Once recruited into a trial, however, most people appear to begin, adhere, and complete internet-delivered treatment for anxiety. Further research exploring various eligibility criteria and their impact on engagement and efficacy is warranted.
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Affiliation(s)
- Madelyne A Bisby
- eCentreClinic, School of Psychological Sciences, Macquarie University, Australia.
| | - Eyal Karin
- eCentreClinic, School of Psychological Sciences, Macquarie University, Australia
| | - Taylor Hathway
- eCentreClinic, School of Psychological Sciences, Macquarie University, Australia
| | - Amelia J Scott
- eCentreClinic, School of Psychological Sciences, Macquarie University, Australia
| | - Andreea I Heriseanu
- eCentreClinic, School of Psychological Sciences, Macquarie University, Australia
| | - Joanne Dudeney
- eCentreClinic, School of Psychological Sciences, Macquarie University, Australia
| | - Alana Fisher
- eCentreClinic, School of Psychological Sciences, Macquarie University, Australia
| | - Milena Gandy
- eCentreClinic, School of Psychological Sciences, Macquarie University, Australia
| | - Shane Cross
- MindSpot Clinic, MQ Health, Macquarie University, Australia
| | - Lauren Staples
- MindSpot Clinic, MQ Health, Macquarie University, Australia
| | - Nickolai Titov
- eCentreClinic, School of Psychological Sciences, Macquarie University, Australia; MindSpot Clinic, MQ Health, Macquarie University, Australia
| | - Blake F Dear
- eCentreClinic, School of Psychological Sciences, Macquarie University, Australia; MindSpot Clinic, MQ Health, Macquarie University, Australia
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Plessen CY, Karyotaki E, Cuijpers P. Exploring the efficacy of psychological treatments for depression: a multiverse meta-analysis protocol. BMJ Open 2022; 12:e050197. [PMID: 35078836 PMCID: PMC8796219 DOI: 10.1136/bmjopen-2021-050197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION In the past four decades, over 700 randomised controlled trials (RCTs) and 80 meta-analyses have examined the efficacy of psychological treatments for depression. Overwhelming evidence suggests that all types of psychological treatments are effective. Yet, many aspects are still unexplored. Meta-analysts could perform hundreds of potential meta-analyses with the current literature, and a comprehensive bird's-eye view of all published studies is missing. This protocol outlines how a multiverse meta-analysis can evaluate the entire body of the literature on psychological treatments of depression in a single analysis. Thereby, gaps of evidence and areas of robustness are highlighted. METHODS AND ANALYSIS We will conduct systematic literature searches in bibliographical databases (PubMed, Embase, PsycINFO and Cochrane Register of Controlled Trials) up until 1 January 2021. We will include all RCTs comparing a psychological treatment with a control condition. We will include studies published in English, German, Spanish or Dutch, and exclude trials on maintenance and relapse prevention as well as dissertations. Two independent researchers will check all records. All self-reported and clinician-rated instruments measuring depression are included. We will extract information on recruitment settings, target groups, age groups, comorbidity, intervention formats, psychotherapy types, number of sessions, control conditions and country. Two independent researchers will assess risk of bias using the Cochrane Risk of Bias assessment tool. As part of the multiverse meta-analysis, unweighted, fixed effect and random effects models will be calculated. ETHICS AND DISSEMINATION As we will not collect any primary data, an ethical approval of this protocol is not required. We will publish the results in a peer-review journal and present them at international conferences. We will follow open science practices and provide our code and data.
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Affiliation(s)
- Constantin Yves Plessen
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, Netherlands
- Department of Psychosomatic Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Eirini Karyotaki
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, Netherlands
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Initial Severity and Depressive Relapse in Cognitive Behavioral Therapy and Antidepressant Medications: An Individual Patient Data Meta-analysis. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-021-10281-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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12
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Schneider KE, Dayton L, Wilson D, Nestadt PS, Latkin CA. Distress in the time of COVID-19: Understanding the distinction between COVID-19 specific mental distress and depression among United States adults. J Affect Disord 2021; 294:949-956. [PMID: 34375223 PMCID: PMC8321623 DOI: 10.1016/j.jad.2021.07.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, many Americans have experienced mental distress, which may be partially characterized by a rise in mental illnesses. However, COVID-19 specific psychological distress may also be separate from diagnosable conditions, a distinction that has not been well established in the context of the pandemic. METHODS Data came from an online survey of US adults collected in March 2020. We used factor analysis to assess the relationship between COVID-19 related mental distress and depressive symptoms. Using four questions on psychological distress modified for COVID-19 and eight depressive symptoms, we conducted an exploratory factor analysis (EFA) to identify the factor structure and then estimated a confirmatory factor analysis (CFA). RESULTS The EFA model indicated a two-factor solution, where the COVID-19 distress items loaded onto the first factor and depression items loaded onto the second. Only two items cross-loaded between factors: feeling fearful and being bothered by things that do not usually bother the participant. The CFA indicated that this factor structure fit the data adequately (RMSEA=0.106, SRMR=0.046, CFI=0.915, TLI=0.890). LIMITATIONS It is possible that there are additional important symptoms of COVID-19 distress that were not included. Depression symptoms were measured via the CES-D-10, which while validated is not equivalent to a clinician diagnosis. CONCLUSIONS As COVID-19 related mental distress appears to be distinct from, though related to, depression, public health responses must consider what aspects of depression treatment may apply to this phenomenon. For COVID-related distress, it may be more appropriate to treat symptomatically and with supportive psychotherapy.
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Affiliation(s)
- Kristin E. Schneider
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, 2nd Floor, 624 N. Broadway, Baltimore, MD 21205, USA,Corresponding author
| | - Lauren Dayton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Deborah Wilson
- School of Nursing, Johns Hopkins University, 525 N Wolfe St, Baltimore, MD 21205, USA
| | - Paul S. Nestadt
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, 2nd Floor, 624 N. Broadway, Baltimore, MD 21205, USA,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA
| | - Carl A. Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
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13
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Schuster R, Kaiser T, Terhorst Y, Messner EM, Strohmeier LM, Laireiter AR. Sample size, sample size planning, and the impact of study context: systematic review and recommendations by the example of psychological depression treatment. Psychol Med 2021; 51:902-908. [PMID: 33879275 PMCID: PMC8161431 DOI: 10.1017/s003329172100129x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 01/27/2021] [Accepted: 03/23/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Sample size planning (SSP) is vital for efficient studies that yield reliable outcomes. Hence, guidelines, emphasize the importance of SSP. The present study investigates the practice of SSP in current trials for depression. METHODS Seventy-eight randomized controlled trials published between 2013 and 2017 were examined. Impact of study design (e.g. number of randomized conditions) and study context (e.g. funding) on sample size was analyzed using multiple regression. RESULTS Overall, sample size during pre-registration, during SSP, and in published articles was highly correlated (r's ≥ 0.887). Simultaneously, only 7-18% of explained variance related to study design (p = 0.055-0.155). This proportion increased to 30-42% by adding study context (p = 0.002-0.005). The median sample size was N = 106, with higher numbers for internet interventions (N = 181; p = 0.021) compared to face-to-face therapy. In total, 59% of studies included SSP, with 28% providing basic determinants and 8-10% providing information for comprehensible SSP. Expected effect sizes exhibited a sharp peak at d = 0.5. Depending on the definition, 10.2-20.4% implemented intense assessment to improve statistical power. CONCLUSIONS Findings suggest that investigators achieve their determined sample size and pre-registration rates are increasing. During study planning, however, study context appears more important than study design. Study context, therefore, needs to be emphasized in the present discussion, as it can help understand the relatively stable trial numbers of the past decades. Acknowledging this situation, indications exist that digital psychiatry (e.g. Internet interventions or intense assessment) can help to mitigate the challenge of underpowered studies. The article includes a short guide for efficient study planning.
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Affiliation(s)
- Raphael Schuster
- Department of Psychology, University of Salzburg, Austria
- Center for Clinical Psychology, Psychotherapy and Health Psychology, University of Salzburg, Austria
| | - Tim Kaiser
- Department of Psychology, University of Greifswald, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, University of Ulm, Germany
- Department of Research Methods, University of Ulm, Germany
| | - Eva Maria Messner
- Department of Clinical Psychology and Psychotherapy, University of Ulm, Germany
| | | | - Anton-Rupert Laireiter
- Department of Psychology, University of Salzburg, Austria
- Center for Clinical Psychology, Psychotherapy and Health Psychology, University of Salzburg, Austria
- Faculty of Psychology, University of Vienna, Austria
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14
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Fortieth anniversary of the International Marcé Society for Perinatal Mental Health: innovations in research, policy, and clinical care. Arch Womens Ment Health 2021; 24:797. [PMID: 34427774 PMCID: PMC8383922 DOI: 10.1007/s00737-021-01168-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Brown M, Hooper N, Eslambolchilar P, John A. Development of a Web-Based Acceptance and Commitment Therapy Intervention to Support Lifestyle Behavior Change and Well-Being in Health Care Staff: Participatory Design Study. JMIR Form Res 2020; 4:e22507. [PMID: 33252350 PMCID: PMC7735901 DOI: 10.2196/22507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/28/2020] [Accepted: 09/09/2020] [Indexed: 02/02/2023] Open
Abstract
Background Positive emotional well-being is associated with healthier lifestyle choices and overall health function, whereas poor mental health is associated with significant economic and psychological costs. Thus, the development of effective interventions that improve emotional well-being is crucial to address the worldwide burden of disease. Objective This study aims to develop a web-based emotional well-being intervention for use by health care staff using participatory design to consider adherence and engagement from a user perspective. Methods A 3-staged iterative participatory design process was followed, including multiple stakeholders: researchers, computer scientists, mental health experts, and health care staff. Stage 1 used document analyses, direct observation, and welcome interviews; stage 2 used focus group discussions, rapid prototyping, and usability tasks; and stage 3 evaluated a high-fidelity prototype. Results Different health care staff (N=38) participated during a sustained period. A structured, sequential, automated, 12-week, web-based emotional well-being intervention based on acceptance and commitment therapy was developed. Freely navigated psychoeducational resources were also included. Conclusions The iterative and collaborative participatory design process successfully met its objectives. It generated an in-depth understanding of well-being within the workplace and identified barriers to access. The 3-staged process ensured that participants had the opportunity to explore and articulate criteria relevant to their roles over time and reflect on decisions made at each stage.
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Affiliation(s)
- Menna Brown
- Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Nic Hooper
- Department of Health and Social Sciences, University of the West of England, Bristol, United Kingdom
| | - Parisa Eslambolchilar
- School of Computer Science and Informatics, Cardiff University, Cardiff, United Kingdom
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, United Kingdom
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16
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Grünzig SD, Teigelkötter W, Bengel J, Krämer LV. [Implementation of a Web-Based Self-Help Intervention for Mood Enhancement during Waiting Times for Outpatient Psychotherapy - A Qualitative Study Exploring Participants' Perspectives]. Psychother Psychosom Med Psychol 2020; 71:116-123. [PMID: 33063305 DOI: 10.1055/a-1228-4612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE In Germany, waiting times for outpatient psychotherapy are on average 5 months long. Guided web-based interventions can be implemented to reduce depressive symptoms during waiting times. The study aims to explore how patients experience the usage of a web-based intervention for mood enhancement. METHODS Patients on the waiting lists of cooperating outpatient clinics were invited to participate in the study and apply a web-based intervention for mood enhancement. Eleven participating patients were interviewed about their experiences with the intervention. The data was analyzed based on the Grounded-Theory methodology. RESULTS Three categories could be derived from the data: prior expectations, experiences with the intervention and factors influencing adherence. The web-based intervention was experienced very differently and was associated with both positive and negative experiences. The participants could be grouped into 3 user types. DISCUSSION Not all patients report positive experiences with the intervention and some fail to adhere. In order to prepare patients adequately, they should be informed about the application and goals of the intervention in advance. Interventions should be implemented in accordance with the individual's need of support in order to enhance adherence and allow positive experiences.
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Affiliation(s)
- Sasha-Denise Grünzig
- Institut für Psychologie, Abt. Rehabilitationspsychologie und Psychotherapie, Albert-Ludwigs-Universität Freiburg im Breisgau
| | - Wiebke Teigelkötter
- Institut für Psychologie, Abt. Rehabilitationspsychologie und Psychotherapie, Albert-Ludwigs-Universität Freiburg im Breisgau
| | - Jürgen Bengel
- Institut für Psychologie, Abt. Rehabilitationspsychologie und Psychotherapie, Albert-Ludwigs-Universität Freiburg im Breisgau
| | - Lena Violetta Krämer
- Institut für Psychologie, Abt. Rehabilitationspsychologie und Psychotherapie, Albert-Ludwigs-Universität Freiburg im Breisgau
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17
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O'Neil ME, Harik JM, McDonagh MS, Cheney TP, Hsu FC, Cameron DC, Carlson KF, Norman SB, Hamblen JL. Development of the PTSD-Repository: A Publicly Available Repository of Randomized Controlled Trials for Posttraumatic Stress Disorder. J Trauma Stress 2020; 33:410-419. [PMID: 32667076 DOI: 10.1002/jts.22520] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/05/2019] [Accepted: 11/20/2019] [Indexed: 11/10/2022]
Abstract
Given the extensive research on posttraumatic stress disorder (PTSD) treatment, a single, updatable repository of data from PTSD treatment studies would be useful for clinical, research, and policy stakeholders. To meet this need, we established a preliminary dataset of abstracted PTSD trial data, which serve as the basis for the PTSD Trials Standardized Data Repository (PTSD-Repository), maintained by the National Center for PTSD (NCPTSD). We followed systematic review methods to identify published randomized controlled trials (RCTs) of PTSD interventions. We consulted with a panel of experts to determine a priori inclusion criteria, ensure that we captured all relevant studies, and identify variables for abstraction. We searched multiple databases for materials published from 1980 to 2018 and reviewed reference lists of relevant systematic reviews and clinical practice guidelines. In total, 318 RCTs of PTSD interventions that enrolled almost 25,000 participants were included. We abstracted 337 variables across all studies, including study, participant, and intervention characteristics as well as results. In the present paper, we describe our methods and define data elements included in the data tables. We explain coding challenges, identify inconsistencies in reporting across study types, and discuss ways stakeholders can use PTSD-Repository data to enhance research, education, and policy. The abstracted data are currently publicly available on the NCPTSD website and can be used for future systematic reviews and identifying research gaps and as an information resource for clinicians, patients, and family members.
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Affiliation(s)
- Maya E O'Neil
- Department of Psychiatry, Oregon Health and Science University, Portland, Oregon, USA.,Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA.,Pacific Northwest Evidence-based Practice Center, Portland, Oregon, USA.,VA Portland Health Care System, Portland, Oregon, USA
| | - Juliette M Harik
- National Center for Posttraumatic Stress Disorder, Department of Veterans Affairs, White River Junction, Vermont, USA.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Marian S McDonagh
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA.,Pacific Northwest Evidence-based Practice Center, Portland, Oregon, USA
| | - Tamara P Cheney
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA.,Pacific Northwest Evidence-based Practice Center, Portland, Oregon, USA
| | - Frances C Hsu
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA.,Pacific Northwest Evidence-based Practice Center, Portland, Oregon, USA
| | | | - Kathleen F Carlson
- VA Portland Health Care System, Portland, Oregon, USA.,OHSU-PSU School of Public Health, Oregon Heath & Science University, Portland, Oregon, USA
| | - Sonya B Norman
- National Center for Posttraumatic Stress Disorder, Department of Veterans Affairs, White River Junction, Vermont, USA.,Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Jessica L Hamblen
- National Center for Posttraumatic Stress Disorder, Department of Veterans Affairs, White River Junction, Vermont, USA.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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Saruhanjan K, Zarski AC, Bauer T, Baumeister H, Cuijpers P, Spiegelhalder K, Auerbach RP, Kessler RC, Bruffaerts R, Karyotaki E, Berking M, Ebert DD. Psychological interventions to improve sleep in college students: A meta-analysis of randomized controlled trials. J Sleep Res 2020; 30:e13097. [PMID: 32672865 DOI: 10.1111/jsr.13097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 05/04/2020] [Accepted: 05/10/2020] [Indexed: 11/30/2022]
Abstract
Sleep disturbances and insomnia are common in college students, and reduce their quality of life and academic performance. The aim of this meta-analysis was to evaluate the efficacy of psychological interventions aimed at improving sleep in college students. A meta-analysis was conducted with 10 randomized controlled trials with passive control conditions (N = 2,408). The overall mean effect size (Hedges' g) of all sleep-related outcomes within each trial was moderate to large (g = 0.61; 95% confidence interval: 0.41-0.81; numbers-needed-to-treat = 3). Effect sizes for global measures of sleep disturbances were g = 0.79; 95% confidence interval: 0.52-1.06; and for sleep-onset latency g = 0.65; 95% confidence interval: 0.36-0.94. The follow-up analyses revealed an effect size of g = 0.56; 95% confidence interval: 0.45-0.66 for the combined sleep-related outcomes based on three studies. No significant covariates were identified. These results should be interpreted cautiously due to an overall substantial risk of bias, and in particular with regard to blinding of participants and personnel. Nevertheless, they provide evidence that psychological interventions for improving sleep are efficacious among college students. Further research should explore long-term effects and potential moderators of treatment efficacy in college students.
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Affiliation(s)
- Karina Saruhanjan
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Anna-Carlotta Zarski
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Tobias Bauer
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Harald Baumeister
- Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Randy P Auerbach
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ronny Bruffaerts
- Center for Public Health Psychiatry, Universitair Psychiatrisch Centrum, KU Leuven, Leuven, Belgium
| | - Eirini Karyotaki
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Matthias Berking
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - David Daniel Ebert
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Blanchet V, Provencher MD. Évaluation des effets de l’activation comportementale de groupe pour le traitement de la dépression sévère en milieu clinique. SANTE MENTALE AU QUEBEC 2020. [DOI: 10.7202/1070239ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bien que l’efficacité de la thérapie d’activation comportementale (AC) pour le traitement de la dépression ait été établie à travers de nombreux essais aléatoires et contrôlés, les études ayant évalué l’efficacité de l’AC, lorsqu’implantée dans les établissements du réseau de la santé, sont rares et les données la supportant sont insuffisantes. Cette étude s’intéresse à l’AC appliquée de manière à tenir compte de la réalité clinique des milieux et des patients. Elle évalue les effets de l’AC de groupe pour le traitement de la dépression sévère en milieu clinique auprès d’une population hétérogène en termes de diagnostic (dépression unipolaire et bipolaire) et de comorbidité (Axes I et II). Les 45 participants souffrant de dépression sévère ont été recrutés en milieu hospitalier et ont reçu une intervention de groupe d’AC de 10 séances. Des questionnaires ont été administrés afin d’obtenir des données prétraitement, posttraitement et 4 semaines suivant la fin du traitement. Les résultats soutiennent les effets de l’AC de groupe pour le traitement de la dépression sévère en milieu clinique auprès d’une population hétérogène, de même que pour le maintien des acquis à court terme. Les effets de l’AC ont également été observés sur l’ensemble des mesures d’activation comportementale, de renforcement, d’anxiété, d’adaptation sociale et de qualité de vie ainsi que sur les symptômes de dépression bipolaire.
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Affiliation(s)
| | - Martin D. Provencher
- Ph. D., Professeur titulaire, École de psychologie, Université Laval ; Chercheur régulier, Centre de recherche sur les soins et les services de première ligne de l’Université Laval et Centre de recherche CERVO
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20
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Driessen E, Dekker JJM, Peen J, Van HL, Maina G, Rosso G, Rigardetto S, Cuniberti F, Vitriol VG, Florenzano RU, Andreoli A, Burnand Y, López-Rodríguez J, Villamil-Salcedo V, Twisk JWR, Cuijpers P. The efficacy of adding short-term psychodynamic psychotherapy to antidepressants in the treatment of depression: A systematic review and meta-analysis of individual participant data. Clin Psychol Rev 2020; 80:101886. [PMID: 32650213 DOI: 10.1016/j.cpr.2020.101886] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/03/2020] [Accepted: 06/17/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE We examined the efficacy of adding short-term psychodynamic psychotherapy (STPP) to antidepressants in the treatment of depression by means of a systematic review and meta-analysis of individual participant data, which is currently considered the most reliable method for evidence synthesis. RESULTS A thorough systematic literature search resulted in 7 studies comparing combined treatment of antidepressants and STPP versus antidepressant mono-therapy (n = 3) or versus antidepressants and brief supportive psychotherapy (n = 4). Individual participant data were obtained for all these studies and totaled 482 participants. Across the total sample of studies, combined treatment of antidepressants and STPP was found significantly more efficacious in terms of depressive symptom levels at both post-treatment (Cohen's d = 0.26, SE = 0.10, p = .01) and follow-up (d = 0.50, SE = 0.10, p < .001). This effect was most apparent at follow-up and in studies examining STPP's specific treatment efficacy. Effects were still apparent in analyses that controlled for risk of bias and STPP quality in the primary studies. CONCLUSIONS These findings support the evidence-base of adding STPP to antidepressants in the treatment of depression. However, further studies are needed, particularly assessing outcome measures other than depression and cost-effectiveness, as well as examining the relative merits of STPP versus other psychotherapies as added to antidepressants.
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Affiliation(s)
- Ellen Driessen
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, Netherlands; Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - Jack J M Dekker
- Department of Research, Arkin Mental Health Care, Amsterdam, Netherlands
| | - Jaap Peen
- Department of Research, Arkin Mental Health Care, Amsterdam, Netherlands
| | | | - Giuseppe Maina
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, Turin, Italy; Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Gianluca Rosso
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, Turin, Italy; Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Sylvia Rigardetto
- Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Francesco Cuniberti
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, Turin, Italy; Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | | | - Ramon U Florenzano
- Department of Psychiatry and Mental Health, School of Medicine, Universidad de Los Andes, Santiago de Chile, Chile
| | - Antonio Andreoli
- Psychiatric Services, Geneva University Hospital, Geneva, Switzerland
| | - Yvonne Burnand
- Psychiatric Services, Geneva University Hospital, Geneva, Switzerland
| | | | | | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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21
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Kappelmann N, Rein M, Fietz J, Mayberg HS, Craighead WE, Dunlop BW, Nemeroff CB, Keller M, Klein DN, Arnow BA, Husain N, Jarrett RB, Vittengl JR, Menchetti M, Parker G, Barber JP, Bastos AG, Dekker J, Peen J, Keck ME, Kopf-Beck J. Psychotherapy or medication for depression? Using individual symptom meta-analyses to derive a Symptom-Oriented Therapy (SOrT) metric for a personalised psychiatry. BMC Med 2020; 18:170. [PMID: 32498707 PMCID: PMC7273646 DOI: 10.1186/s12916-020-01623-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/07/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Antidepressant medication (ADM) and psychotherapy are effective treatments for major depressive disorder (MDD). It is unclear, however, if treatments differ in their effectiveness at the symptom level and whether symptom information can be utilised to inform treatment allocation. The present study synthesises comparative effectiveness information from randomised controlled trials (RCTs) of ADM versus psychotherapy for MDD at the symptom level and develops and tests the Symptom-Oriented Therapy (SOrT) metric for precision treatment allocation. METHODS First, we conducted systematic review and meta-analyses of RCTs comparing ADM and psychotherapy at the individual symptom level. We searched PubMed Medline, PsycINFO, and the Cochrane Central Register of Controlled Trials databases, a database specific for psychotherapy RCTs, and looked for unpublished RCTs. Random-effects meta-analyses were applied on sum-scores and for individual symptoms for the Hamilton Rating Scale for Depression (HAM-D) and Beck Depression Inventory (BDI) measures. Second, we computed the SOrT metric, which combines meta-analytic effect sizes with patients' symptom profiles. The SOrT metric was evaluated using data from the Munich Antidepressant Response Signature (MARS) study (n = 407) and the Emory Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) study (n = 234). RESULTS The systematic review identified 38 RCTs for qualitative inclusion, 27 and 19 for quantitative inclusion at the sum-score level, and 9 and 4 for quantitative inclusion on individual symptom level for the HAM-D and BDI, respectively. Neither meta-analytic strategy revealed significant differences in the effectiveness of ADM and psychotherapy across the two depression measures. The SOrT metric did not show meaningful associations with other clinical variables in the MARS sample, and there was no indication of utility of the metric for better treatment allocation from PReDICT data. CONCLUSIONS This registered report showed no differences of ADM and psychotherapy for the treatment of MDD at sum-score and symptom levels. Symptom-based metrics such as the proposed SOrT metric do not inform allocation to these treatments, but predictive value of symptom information requires further testing for other treatment comparisons.
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Affiliation(s)
- Nils Kappelmann
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany.
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany.
| | - Martin Rein
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Julia Fietz
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Helen S Mayberg
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - W Edward Craighead
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Charles B Nemeroff
- Institute for Early Life Adversity Research, University of Texas Dell Medical School in Austin, Austin, TX, USA
| | - Martin Keller
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, RI, USA
| | - Daniel N Klein
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Bruce A Arnow
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94304, USA
| | - Nusrat Husain
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - Robin B Jarrett
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Gordon Parker
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Jacques P Barber
- Gordon F. Derner School of Psychology, Adelphi University, Garden City, New York, USA
| | - Andre G Bastos
- Contemporary Institute of Psychoanalysis and Transdisciplinarity of Porto Alegre, Porto Alegre, Brazil
| | - Jack Dekker
- Department of Research, Arkin Mental Health Care, Amsterdam, Netherlands
| | - Jaap Peen
- Department of Research, Arkin Mental Health Care, Amsterdam, Netherlands
| | - Martin E Keck
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Johannes Kopf-Beck
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
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Monteregge S, Tsagkalidou A, Cuijpers P, Spinhoven P. The effects of different types of treatment for anxiety on repetitive negative thinking: A meta‐analysis. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2020. [DOI: 10.1111/cpsp.12316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | | | - Pim Cuijpers
- Department of Clinical Psychology VU University Amsterdam Amsterdam The Netherlands
| | - Philip Spinhoven
- Institute of Psychology Leiden University Leiden The Netherlands
- Department of Psychiatry Leiden University Medical Center Leiden The Netherlands
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Lepping P, Whittington R, Sambhi R, Lane S, Poole R, Leucht S, Cuijpers P, McCabe R, Waheed W. Clinical relevance of findings in trials of CBT for depression. Eur Psychiatry 2020; 45:207-211. [DOI: 10.1016/j.eurpsy.2017.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/08/2017] [Indexed: 12/15/2022] Open
Abstract
AbstractCognitive behavioural therapy (CBT) is beneficial in depression. Symptom scores can be translated into Clinical Global Impression (CGI) scale scores to indicate clinical relevance. We aimed to assess the clinical relevance of findings of randomised controlled trials (RCTs) of CBT in depression. We identified RCTs of CBT that used the Hamilton Rating Scale for Depression (HAMD). HAMD scores were translated into Clinical Global Impression – Change scale (CGI-I) scores to measure clinical relevance. One hundred and seventy datasets from 82 studies were included. The mean percentage HAMD change for treatment arms was 53.66%, and 29.81% for control arms, a statistically significant difference. Combined active therapies showed the biggest improvement on CGI-I score, followed by CBT alone. All active treatments had better than expected HAMD percentage reduction and CGI-I scores. CBT has a clinically relevant effect in depression, with a notional CGI-I score of 2.2, indicating a significant clinical response. The non-specific or placebo effect of being in a psychotherapy trial was a 29% reduction of HAMD.
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Psychological Treatment for Depressive Disorder. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1180:233-265. [PMID: 31784967 DOI: 10.1007/978-981-32-9271-0_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Depression is highly prevalent and causes unnecessary human suffering and economic loss. Therefore, its treatment and prevention are of utmost importance. There are several advantages of using psychotherapy either by itself or combined with pharmacological treatment methods in the treatment of depression. First, it is well known that combining biological treatment with psychosocial methods increases the chances of recovery. Second, in some individuals, psychotherapy continues to be the only solution. Third, the use of antidepressants contains some safety risks and side effects, but psychotherapy does not. Fourth, clinically, depressive patients prefer psychotherapy to drug therapy. Use of a depression-focused psychotherapy alone is recommended as an initial treatment choice for patients with mild to moderate depression, with clinical evidence supporting the use of cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), psychodynamic psychotherapy (PDP), and problem-solving therapy (PST) in individual and group formats. Important developments took place within the past 20 years in the psychotherapy of depression. In the present chapter, we introduced several key issues, such as, Are all psychotherapies equally effective? Who benefits from psychotherapies? Is telepsychotherapy effective? Finally, we introduce the psychotherapy for special populations.
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Increase value and reduce waste in research on psychological therapies. Behav Res Ther 2019; 123:103479. [PMID: 31639527 DOI: 10.1016/j.brat.2019.103479] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 07/25/2019] [Accepted: 09/09/2019] [Indexed: 12/27/2022]
Abstract
A seminal Lancet series focused on increasing value and reducing waste in biomedical research, providing a transferrable template to diagnose problems in research. Our goal was to document how some of these sources of waste apply to mental health and particularly psychological treatments research. We synthesize and critically evaluate empirical findings in relation to four major sources: i) defining research priorities; ii) research design, methods and analysis; iii) accessibility of research information; iv) accuracy and usability of research reports. We demonstrate that each source of waste considered is well-represented and amply documented within this field. We describe hype and insufficient consideration of what is known in defining research priorities, persistent risk of bias, particularly due to selective outcome reporting, for psychotherapy trials across mental disorders, intellectual and financial biases, direct and indirect evidence of publication bias, largely inexistent adoption of data sharing, issues of multiplicity and fragmentation of data and findings, and insufficient adoption of reporting guidelines. We expand on a few general solutions, including supporting meta-research, properly testing interventions to increase research quality, placing open science at the center of psychological treatment research and remaining vigilant particularly regarding the strains of research currently prioritized, such as experimental psychopathology.
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Cuijpers P, Karyotaki E, de Wit L, Ebert DD. The effects of fifteen evidence-supported therapies for adult depression: A meta-analytic review. Psychother Res 2019; 30:279-293. [DOI: 10.1080/10503307.2019.1649732] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Leonore de Wit
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - David D. Ebert
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Clinical Psychology and Psychotherapy, Institute for Psychology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Song R, Sun N, Song X. The Efficacy of Psychological Capital Intervention (PCI) for Depression From the Perspective of Positive Psychology: A Pilot Study. Front Psychol 2019; 10:1816. [PMID: 31447745 PMCID: PMC6692487 DOI: 10.3389/fpsyg.2019.01816] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 07/22/2019] [Indexed: 12/14/2022] Open
Abstract
Extensive psychological interventions primarily target the negative symptoms of depression and the deficits in positive resources have been systematically neglected. So far, little attention has been devoted to psychological capital (PsyCap) intervention from the perspective of developing positive resources. The aim of the present pilot study was to evaluate the efficacy of psychological capital intervention (PCI) for depression in a randomized controlled trial. A total of 56 patients were randomized to either care as usual (CAU) for normal medication or psychological capital intervention (PCI) group, where the normal medication was supplemented with the PCI. Participants were assessed at pre- and post-treatment, as well as 6-month follow-up, on measures of depressive symptoms and PsyCap. The PCI group displayed significantly larger improvements in PsyCap and larger reductions in depression symptoms from pre- to post treatment compared to control group. Improvements were sustained over the 6-month follow-up period. Targeting the positive resources intervention in the PCI may be effective against the treatment of depression.
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Affiliation(s)
- Ruijun Song
- School of Politics and Law, Shaoyang University, Shaoyang, China
- School of Psychology, Shandong Normal University, Jinan, China
| | - Nana Sun
- Department of Education, Luliang University, Luliang, China
| | - Xuhong Song
- Department of Medical Psychology, Shanxi Medical University, Taiyuan, China
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Karyotaki E, Furukawa TA, Efthimiou O, Riper H, Cuijpers P. Guided or self-guided internet-based cognitive-behavioural therapy (iCBT) for depression? Study protocol of an individual participant data network meta-analysis. BMJ Open 2019; 9:e026820. [PMID: 31171550 PMCID: PMC6561406 DOI: 10.1136/bmjopen-2018-026820] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Although guided forms of internet-based cognitive-behavioural therapy (iCBT) result in a substantial reduction in depression, it seems that the most scalable way to deliver iCBT is without guidance. However, direct evidence on the comparison between guided and self-guided iCBT is scarce. Moreover, it is unclear which types of patients may benefit more from each of these two forms of iCBT. Network meta-analysis (NMA) using individual participant data (IPD) offers a way to assess the relative efficacy of multiple (>2) interventions. Moreover, it maximises our power to detect patient-level characteristics (covariates) that have an important effect on the efficacy of interventions. This protocol describes the procedures of an IPD-NMA, which aims at examining the relative efficacy of guided compared with self-guided iCBT and at identifying predictors and moderators of treatment outcome. METHODS AND ANALYSIS We will use an existing database on psychotherapies for adult depression to identify eligible studies. This database has been updated up to 1 January 2018, through literature searches in PubMed, Embase, PsycINFO and Cochrane Library. The outcome of this IPD-NMA is reduction in depressive symptoms severity. We will fit the model in a Bayesian setting. After fitting the model, we will report the relative treatment effects for different types of patients, and we will discuss the clinical implications of our findings. Based on the results from the IPD-NMA model, we will develop and validate a personalised prediction model, aiming to provide patient-level predictions about the effects of the interventions. ETHICS AND DISSEMINATION An ethical approval is not required for this study. The results will be published in a peer-review journal. These results will guide clinical decisions about the most efficient way to allocate iCBT resources, thereby increasing the scalability of this innovative therapeutic approach.
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Affiliation(s)
- Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, VU Amsterdam, Amsterdam, The Netherlands
| | - Toshi A Furukawa
- Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
| | - Orestis Efthimiou
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Heleen Riper
- Department of Clinical, Neuro- and Developmental Psychology, VU Amsterdam, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, VU Amsterdam, Amsterdam, The Netherlands
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Abstract
AIMS The Hamilton Depression Rating Scale (HAMD) and the Beck Depression Inventory (BDI) are the most frequently used observer-rated and self-report scales of depression, respectively. It is important to know what a given total score or a change score from baseline on one scale means in relation to the other scale. METHODS We obtained individual participant data from the randomised controlled trials of psychological and pharmacological treatments for major depressive disorders. We then identified corresponding scores of the HAMD and the BDI (369 patients from seven trials) or the BDI-II (683 patients from another seven trials) using the equipercentile linking method. RESULTS The HAMD total scores of 10, 20 and 30 corresponded approximately with the BDI scores of 10, 27 and 42 or with the BDI-II scores of 13, 32 and 50. The HAMD change scores of -20 and -10 with the BDI of -29 and -15 and with the BDI-II of -35 and -16. CONCLUSIONS The results can help clinicians interpret the HAMD or BDI scores of their patients in a more versatile manner and also help clinicians and researchers evaluate such scores reported in the literature or the database, when scores on only one of these scales are provided. We present a conversion table for future research.
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Furukawa TA, Karyotaki E, Suganuma A, Pompoli A, Ostinelli EG, Cipriani A, Cuijpers P, Efthimiou O. Dismantling, personalising and optimising internet cognitive-behavioural therapy for depression: a study protocol for individual participant data component network meta-analysis. BMJ Open 2019; 8:e026137. [PMID: 30798295 PMCID: PMC6278798 DOI: 10.1136/bmjopen-2018-026137] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Psychotherapy is a complex intervention, consisting of various components and being implemented flexibly in consideration of individual patient's characteristics. It is then of utmost importance to know which of the various components or combinations thereof are more efficacious, what their specific effect sizes are and which types of patients may benefit more from different components or their combinations. METHODS AND ANALYSIS Internet-delivered cognitive-behavioural therapy (iCBT) offers a unique opportunity to systematically review and quantitatively disentangle the efficacy of various components because, unlike face-to-face cognitive-behavioural therapy, it allows identification of constituent components that are actually delivered to patients. We will systematically identify all randomised controlled trials that compared any form of iCBT against another form or a control intervention in the acute phase treatment of adult depression. We will apply component network meta-analysis (cNMA) to dismantle efficacy of individual components. We will use individual participant data in the cNMA to identify participant-level prognostic factors and effect modifiers for different components. ETHICS AND DISSEMINATION The investigators of the primary trials will have obtained ethical approval for the data used in the present study and for sharing the data, if this was necessary, according to local requirements and was not covered from the initial ethic assessment. Results from this study will be published in peer-reviewed journals and presented at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42018104683.
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Affiliation(s)
- Toshi A Furukawa
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/ School of Public Health, Kyoto, Japan
| | - Eirini Karyotaki
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Aya Suganuma
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/ School of Public Health, Kyoto, Japan
- Amsterdam Public Health research institute, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | | | | | - Andrea Cipriani
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Yoder WR, Karyotaki E, Cristea IA, van Duin D, Cuijpers P. Researcher allegiance in research on psychosocial interventions: meta-research study protocol and pilot study. BMJ Open 2019; 9:e024622. [PMID: 30782912 PMCID: PMC6377509 DOI: 10.1136/bmjopen-2018-024622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION One potential source of bias in randomised clinical trials of psychological interventions is researcher allegiance (RA). The operationalisation of RA differs strongly across studies, and there is not a generally accepted method of operationalising or measuring it. Furthermore, it remains unclear as to how RA affects the outcomes of trials and if it results in better outcomes for a preferred intervention. The aim of this project is to develop and validate a scale that accurately identifies RA, contribute to the understanding of the impact that RA has in a research setting and to make recommendations for addressing RA in practice. METHODS AND ANALYSIS A scale will first be developed and validated to measure RA in psychotherapy trials. The scale will be validated by surveying authors of psychotherapy trials to assess their opinions, beliefs and preferences of psychotherapy interventions. Furthermore, the scale will be validated for use outside the field of psychotherapy. The validated checklist will then be used to examine two potential mechanisms of how RA may affect outcomes of interventions: publication bias (by assessing grants) and risk of bias (RoB). Finally, recommendations will be developed, and a feasibility study will be conducted at a national mental health agency in The Netherlands. Main analyses comprise inter-rater reliability of checklist items, correlations to examine the relationship between checklist items and author survey (convergent validity) as well as checklist items and trial outcomes and multivariate meta-regression techniques to assess potential mechanisms of how allegiance affects trial outcomes (publication bias and RoB). ETHICS AND DISSEMINATION This study has been reviewed and approved by the Scientific and Ethical Review Board (VCWE) at the Vrije Universiteit Amsterdam. Study result and advancements will also be published on the Open Science Framework. Furthermore, main findings will be disseminated through articles in international peer-reviewed open access journals. Results and recommendations will be communicated to the Cochrane Collaboration, the Campbell Collaboration and other funding agencies.
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Affiliation(s)
- Whitney Rose Yoder
- Department of Clinical, Neuro and Developmental Psychology Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ioana-Alina Cristea
- Department of Clinical, Neuro and Developmental Psychology Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania
| | | | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Polo AJ, Makol BA, Castro AS, Colón-Quintana N, Wagstaff AE, Guo S. Diversity in randomized clinical trials of depression: A 36-year review. Clin Psychol Rev 2019; 67:22-35. [DOI: 10.1016/j.cpr.2018.09.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/18/2018] [Accepted: 09/21/2018] [Indexed: 10/28/2022]
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Abstract
AIMS In the 1950s, Eysenck suggested that psychotherapies may not be effective at all. Twenty-five years later, the first meta-analysis of randomised controlled trials showed that the effects of psychotherapies were considerable and that Eysenck was wrong. However, since that time methods have become available to assess biases in meta-analyses. METHODS We examined the influence of these biases on the effects of psychotherapies for adult depression, including risk of bias, publication bias and the exclusion of waiting list control groups. RESULTS The unadjusted effect size of psychotherapies compared with control groups was g = 0.70 (limited to Western countries: g = 0.63), which corresponds to a number-needed-to-treat of 4.18. Only 23% of the studies could be considered as a low risk of bias. When adjusting for several sources of bias, the effect size across all types of therapies dropped to g = 0.31. CONCLUSIONS These results suggest that the effects of psychotherapy for depression are small, above the threshold that has been suggested as the minimal important difference in the treatment of depression, and Eysenck was probably wrong. However, this is still not certain because we could not adjust for all types of bias. Unadjusted meta-analyses of psychotherapies overestimate the effects considerably, and for several types of psychotherapy for adult depression, insufficient evidence is available that they are effective because too few low-risk studies were available, including problem-solving therapy, interpersonal psychotherapy and behavioural activation.
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Milling LS, Valentine KE, McCarley HS, LoStimolo LM. A Meta-Analysis of Hypnotic Interventions for Depression Symptoms: High Hopes for Hypnosis? AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2019; 61:227-243. [PMID: 34874235 DOI: 10.1080/00029157.2018.1489777] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This meta-analysis quantifies the effectiveness of hypnosis for treating the symptoms of depression. To be included in the meta-analysis, studies were required to use a between-subjects or mixed-model design in which a hypnotic intervention for depression was compared with a control condition in reducing depression symptoms. Of 197 records screened, 10 studies incorporating 13 trials of hypnosis met the inclusion criteria. The mean weighted effect size for 13 trials of hypnosis at the end of active treatment was 0.71 (p ≤ .001), indicating the average participant receiving hypnosis showed more improvement than about 76% of control participants. The mean weighted effect size for four trials of hypnosis at the longest follow-up was 0.52 (p ≤ .01), indicating the average participant treated with hypnosis showed more improvement than about 51% of control participants. These effect sizes are comparable to those associated with well-known psychological interventions for depression (e.g., Beck's cognitive therapy, interpersonal therapy) and suggest hypnosis is a very effective way of alleviating the symptoms of depression. Clinicians may wish to give serious consideration to hypnosis as a treatment option when working with clients and patients who are depressed.
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Karyotaki E, Kemmeren L, Riper H, Twisk J, Hoogendoorn A, Kleiboer A, Mira A, Mackinnon A, Meyer B, Botella C, Littlewood E, Andersson G, Christensen H, Klein JP, Schröder J, Bretón-López J, Scheider J, Griffiths K, Farrer L, Huibers MJH, Phillips R, Gilbody S, Moritz S, Berger T, Pop V, Spek V, Cuijpers P. Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis. Psychol Med 2018; 48:2456-2466. [PMID: 29540243 PMCID: PMC6190066 DOI: 10.1017/s0033291718000648] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/02/2018] [Accepted: 02/16/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Little is known about potential harmful effects as a consequence of self-guided internet-based cognitive behaviour therapy (iCBT), such as symptom deterioration rates. Thus, safety concerns remain and hamper the implementation of self-guided iCBT into clinical practice. We aimed to conduct an individual participant data (IPD) meta-analysis to determine the prevalence of clinically significant deterioration (symptom worsening) in adults with depressive symptoms who received self-guided iCBT compared with control conditions. Several socio-demographic, clinical and study-level variables were tested as potential moderators of deterioration. METHODS Randomised controlled trials that reported results of self-guided iCBT compared with control conditions in adults with symptoms of depression were selected. Mixed effects models with participants nested within studies were used to examine possible clinically significant deterioration rates. RESULTS Thirteen out of 16 eligible trials were included in the present IPD meta-analysis. Of the 3805 participants analysed, 7.2% showed clinically significant deterioration (5.8% and 9.1% of participants in the intervention and control groups, respectively). Participants in self-guided iCBT were less likely to deteriorate (OR 0.62, p < 0.001) compared with control conditions. None of the examined participant- and study-level moderators were significantly associated with deterioration rates. CONCLUSIONS Self-guided iCBT has a lower rate of negative outcomes on symptoms than control conditions and could be a first step treatment approach for adult depression as well as an alternative to watchful waiting in general practice.
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Affiliation(s)
- Eirini Karyotaki
- Department of Clinical Psychology, VU Amsterdam and Institute for Public Health Research, Amsterdam, the Netherlands
| | - Lise Kemmeren
- Department of Psychiatry, GGZ inGeest and VU University Medical Centre, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Heleen Riper
- Department of Clinical Psychology, VU Amsterdam and Institute for Public Health Research, Amsterdam, the Netherlands
| | - Jos Twisk
- Department of Epidemiology and Biostatistics and Amsterdam Institute for Public Health Research, VU University Amsterdam, Amsterdam, the Netherlands
| | - Adriaan Hoogendoorn
- Department of Psychiatry, GGZ inGeest and VU University Medical Centre, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Annet Kleiboer
- Department of Clinical Psychology, VU Amsterdam and Institute for Public Health Research, Amsterdam, the Netherlands
| | - Adriana Mira
- Department of Psychology and Technology, Jaume University, Castellon, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Spain
| | - Andrew Mackinnon
- Black Dog Institute and University of New South Wales, Prince of Wales Hospital, Sydney, Australia
- Center for Mental Health, University of Melbourne, Melbourne, Australia
| | - Björn Meyer
- Research Department, Germany and Department of Psychology, City University, Gaia AG, Hamburg, London, UK
| | - Cristina Botella
- Department of Psychology and Technology, Jaume University, Castellon, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Spain
| | | | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Sweden Institute for Disability Research, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institute for Disability Research, Stockholm, Sweden
| | - Helen Christensen
- Black Dog Institute and University of New South Wales, Prince of Wales Hospital, Sydney, Australia
| | - Jan P. Klein
- Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany
| | - Johanna Schröder
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Juana Bretón-López
- Department of Psychology and Technology, Jaume University, Castellon, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Spain
| | - Justine Scheider
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Kathy Griffiths
- Research School of Psychology, College of Biology, Medicine & Environment, Australian National University, Canberra, Australia
| | - Louise Farrer
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Marcus J. H. Huibers
- Department of Clinical Psychology, VU Amsterdam and Institute for Public Health Research, Amsterdam, the Netherlands
| | - Rachel Phillips
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Victor Pop
- CoRPS – Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, the Netherlands
| | - Viola Spek
- CoRPS – Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, the Netherlands
| | - Pim Cuijpers
- Department of Clinical Psychology, VU Amsterdam and Institute for Public Health Research, Amsterdam, the Netherlands
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Cuijpers P, Reijnders M, Karyotaki E, de Wit L, Ebert DD. Negative effects of psychotherapies for adult depression: A meta-analysis of deterioration rates. J Affect Disord 2018; 239:138-145. [PMID: 30005327 DOI: 10.1016/j.jad.2018.05.050] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 04/10/2018] [Accepted: 05/28/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND The risk for deterioration in patients receiving psychotherapy for adult depression has not been examined extensively and it is not clear whether psychotherapy reduces this risk or may even increase it in some patients. We conducted a meta-analysis of trials comparing these psychotherapies with control conditions that report deterioration rates. METHODS We used an existing database of randomized trials on psychotherapies for adult depression which was updated up to 1/1/2017, through systematic searches in bibliographic databases. We included trials that reported clinically significant deterioration rates. RESULTS We included 18 studies with 23 comparisons between therapy and control groups. The pooled risk ratio of deterioration was 0.39 (95% CI: 0.27∼0.57), indicating that patients in the psychotherapy groups have a 61% lower chance to deteriorate than patients in the control groups. We found that 20 patients need to be treated with psychotherapy in order to avoid one case of deterioration, compared to the control conditions. The median deterioration rate in the therapy groups was 4%, and in some studies more than 10%, indicating that clinicians should always be aware of the risk of deterioration. LIMITATIONS The results should be considered with caution because most studies had at least some risk of bias. Only 6% of all trials comparing psychotherapy with a control condition reported deterioration rates, using different ways to define deterioration which made pooling the prevalence rates across treatments and control groups impossible. CONCLUSIONS Psychological treatments of adult depression may reduce the risk for deterioration, compared to control groups, but this should be considered with caution because of the small proportion of studies reporting deterioration rates.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands.
| | - Mirjam Reijnders
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Leonore de Wit
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands
| | - David D Ebert
- Clinical Psychology and Psychotherapy, Institute for Psychology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Weitz E, Kleiboer A, van Straten A, Cuijpers P. The effects of psychotherapy for depression on anxiety symptoms: a meta-analysis. Psychol Med 2018; 48:2140-2152. [PMID: 29361995 DOI: 10.1017/s0033291717003622] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND More than half of patients who present with depressive disorders also have elevated comorbid anxiety symptoms. Given the high comorbidity between these disorders, it is important to understand the extent that psychotherapies for depression additionally ameliorate symptoms of anxiety. METHODS Systematic searches were conducted in PubMed, PSYCinfo, EMBASE, and the Cochrane Registry of Controlled Trials. Included studies were randomized controlled trials that compared psychotherapy compared with a control condition for the treatment of adults with a primary diagnosis or elevated symptoms of depression and that examined the effects of treatment on anxiety outcomes. Acute phase depression and anxiety (continuous measure) outcomes were extracted. Effect sizes were calculated by subtracting the average post-treatment scores of the psychotherapy group from the average post-treatment scores of the comparison group divided by the pooled standard deviation. RESULTS Fifty-two studies of varying quality met the inclusion criteria. Pooled effect sizes showed that anxiety outcomes were significantly lower in the psychotherapy conditions than in control conditions at post-treatment [g = 0.52; 95% confidence interval (CI) 0.44-0.60; NNT (numbers-needed-to-treat) = 3.50]. Moderate heterogeneity was observed (I2 = 55%, 95% CI 40-66). Bivariate metaregression analysis revealed a significant association between depression and anxiety effect sizes at post-treatment Longer-term follow-ups of up to 14 months post-baseline showed indications for a small lasting effect of psychotherapy on anxiety outcomes (g = 0.27). CONCLUSIONS This meta-analysis provides evidence that psychotherapy aimed at depression can also reduce anxiety symptoms in relation to control conditions.
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Affiliation(s)
- Erica Weitz
- Department of Clinical, Neuro and Developmental Psychology,EMGO Institute for Health and Care Research,Vrije Universiteit Amsterdam,Van der Boechorststraat 1, 1081 BT Amsterdam,The Netherlands
| | - Annet Kleiboer
- Department of Clinical, Neuro and Developmental Psychology,EMGO Institute for Health and Care Research,Vrije Universiteit Amsterdam,Van der Boechorststraat 1, 1081 BT Amsterdam,The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology,EMGO Institute for Health and Care Research,Vrije Universiteit Amsterdam,Van der Boechorststraat 1, 1081 BT Amsterdam,The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology,EMGO Institute for Health and Care Research,Vrije Universiteit Amsterdam,Van der Boechorststraat 1, 1081 BT Amsterdam,The Netherlands
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Lorenzo-Luaces L, Zimmerman M, Cuijpers P. Are studies of psychotherapies for depression more or less generalizable than studies of antidepressants? J Affect Disord 2018. [PMID: 29522947 DOI: 10.1016/j.jad.2018.02.066] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The generalizability of findings from studies exploring the efficacy of psychotherapy and antidepressants has been called into question in part because studies exclude many patients. Despite this, the frequency with which psychotherapy and antidepressant studies use specific inclusion and exclusion criteria has never been compared. We explored the exclusion criteria used in psychotherapy and pharmacotherapy studies from 1995 to 2014. METHOD Systematic literature searches were conducted in PubMed, Medline, PsycINFO, and Embase of published randomized controlled trials (RCTs) of the treatment of major depressive disorder (MDD) in adults with either antidepressants (vs. placebos) or psychotherapy (vs. placebos, treatments as usual, or other controls). RESULTS Most psychotherapy (81%) and antidepressant (100%) trials excluded patients with milder symptoms as well as patients with elevated suicidal risk (56-75%), psychotic symptoms (84-88%), or substance misuse (75-81%). Psychotherapy studies were less likely to exclude patients on the basis of brief episode duration (0% vs. 48%) and co-morbid Axis I disorders (6% vs. 27%). However, psychotherapy studies excluded patients with more severe symptoms more frequently (38%) than antidepressant studies (8%). CONCLUSIONS Overall, psychotherapy studies appear somewhat more inclusive than antidepressant studies. On average, antidepressant studies appear to target patients with more chronic and severe, as well as more purely depressive presentations.
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Affiliation(s)
- Lorenzo Lorenzo-Luaces
- Indiana University, Department of Psychological and Brain Sciences, 1101 E 10th St, Bloomington, IN 47405, United States.
| | - Mark Zimmerman
- Brown University School of Medicine, Department of Psychiatry and Human Behavior, United States
| | - Pim Cuijpers
- VU University Amsterdam, Department of Clinical, Neuro, and Developmental Psychology, The Netherlands
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Spinhoven P, Klein N, Kennis M, Cramer AO, Siegle G, Cuijpers P, Ormel J, Hollon SD, Bockting CL. The effects of cognitive-behavior therapy for depression on repetitive negative thinking: A meta-analysis. Behav Res Ther 2018; 106:71-85. [DOI: 10.1016/j.brat.2018.04.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 04/02/2018] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
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Karyotaki E, Ebert DD, Donkin L, Riper H, Twisk J, Burger S, Rozental A, Lange A, Williams AD, Zarski AC, Geraedts A, van Straten A, Kleiboer A, Meyer B, Ünlü Ince BB, Buntrock C, Lehr D, Snoek FJ, Andrews G, Andersson G, Choi I, Ruwaard J, Klein JP, Newby JM, Schröder J, Laferton JAC, Van Bastelaar K, Imamura K, Vernmark K, Boß L, Sheeber LB, Kivi M, Berking M, Titov N, Carlbring P, Johansson R, Kenter R, Perini S, Moritz S, Nobis S, Berger T, Kaldo V, Forsell Y, Lindefors N, Kraepelien M, Björkelund C, Kawakami N, Cuijpers P. Do guided internet-based interventions result in clinically relevant changes for patients with depression? An individual participant data meta-analysis. Clin Psychol Rev 2018; 63:80-92. [PMID: 29940401 DOI: 10.1016/j.cpr.2018.06.007] [Citation(s) in RCA: 187] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 06/06/2018] [Accepted: 06/14/2018] [Indexed: 12/22/2022]
Abstract
Little is known about clinically relevant changes in guided Internet-based interventions for depression. Moreover, methodological and power limitations preclude the identification of patients' groups that may benefit more from these interventions. This study aimed to investigate response rates, remission rates, and their moderators in randomized controlled trials (RCTs) comparing the effect of guided Internet-based interventions for adult depression to control groups using an individual patient data meta-analysis approach. Literature searches in PubMed, Embase, PsycINFO and Cochrane Library resulted in 13,384 abstracts from database inception to January 1, 2016. Twenty-four RCTs (4889 participants) comparing a guided Internet-based intervention with a control group contributed data to the analysis. Missing data were multiply imputed. To examine treatment outcome on response and remission, mixed-effects models with participants nested within studies were used. Response and remission rates were calculated using the Reliable Change Index. The intervention group obtained significantly higher response rates (OR = 2.49, 95% CI 2.17-2.85) and remission rates compared to controls (OR = 2.41, 95% CI 2.07-2.79). The moderator analysis indicated that older participants (OR = 1.01) and native-born participants (1.66) were more likely to respond to treatment compared to younger participants and ethnic minorities respectively. Age (OR = 1.01) and ethnicity (1.73) also moderated the effects of treatment on remission.Moreover, adults with more severe depressive symptoms at baseline were more likely to remit after receiving internet-based treatment (OR = 1.19). Guided Internet-based interventions lead to substantial positive treatment effects on treatment response and remission at post-treatment. Thus, such interventions may complement existing services for depression and potentially reduce the gap between the need and provision of evidence-based treatments.
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Affiliation(s)
- Eirini Karyotaki
- Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands.
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Liesje Donkin
- The Brain and Mind Research Institute, University of Sydney, NSW 2050, Australia
| | - Heleen Riper
- Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands
| | - Jos Twisk
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
| | - Simone Burger
- Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands
| | - Alexander Rozental
- Institute of Child Health, University College London, United Kingdom; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Alfred Lange
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Alishia D Williams
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Anna Carlotta Zarski
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Annemieke van Straten
- Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands
| | - Annet Kleiboer
- Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands
| | - Björn Meyer
- Research Department, Gaia AG, Hamburg, Germany; Department of Psychology, City, University of London, London, United Kingdom
| | | | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Dirk Lehr
- Institute of Psychology, Leuphana University Lüneburg, Germany
| | - Frank J Snoek
- Department of Medical Psychology, VU Medical Center, Academic Medical Center, Public Health Research institute, Amsterdam, the Netherlands
| | - Gavin Andrews
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, Linköping University, Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institute for Disability Research, Stockholm, Sweden
| | - Isabella Choi
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Jeroen Ruwaard
- Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, Luebeck University, Luebeck, Germany
| | - Jill M Newby
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia; The MRC Cognition and Brain Sciences Unit, Cambridge, United Kingdom; School of Psychology, the University of New South Wales, Sydney, Australia
| | - Johanna Schröder
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute for Sex Research and Forensic Psychiatry, Hamburg, Germany
| | - Johannes A C Laferton
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Kim Van Bastelaar
- Department of Medical Psychology, VU Medical Center, Amsterdam, the Netherlands
| | - Kotaro Imamura
- Department of Mental Health, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyō-ku, Tokyo, Japan
| | - Kristofer Vernmark
- Department of Behavioural Sciences and Learning, Linkoping University, Linkoping, Sweden
| | - Leif Boß
- Institute of Psychology, Leuphana University Lüneburg, Germany
| | | | - Marie Kivi
- Department of Psychology, University of Gothenburg, Göteborg, Sweden
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Nickolai Titov
- MindSpot Clinic and eCentreClinic, Department of Psychology, Macquarie University, Australia
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden; Department of Psychology, University of Southern Denmark, Denmark
| | - Robert Johansson
- Department of Behavioral Sciences and Learning, Linköping University, and Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Robin Kenter
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Sarah Perini
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Steffen Moritz
- Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands
| | - Stephanie Nobis
- Division of Online Health Training, Innovation Incubator, Leuphana University Lüneburg, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Viktor Kaldo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Yvonne Forsell
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Nils Lindefors
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Martin Kraepelien
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Cecilia Björkelund
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Norito Kawakami
- Department of Mental Health, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyō-ku, Tokyo, Japan
| | - Pim Cuijpers
- Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands
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De Silva S, Bailey AP, Parker AG, Montague AE, Hetrick SE. Open-access evidence database of controlled trials and systematic reviews in youth mental health. Early Interv Psychiatry 2018; 12:474-477. [PMID: 28488387 DOI: 10.1111/eip.12423] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/31/2016] [Accepted: 11/13/2016] [Indexed: 12/19/2022]
Abstract
AIM To present an update to an evidence-mapping project that consolidates the evidence base of interventions in youth mental health. To promote dissemination of this resource, the evidence map has been translated into a free online database (https://orygen.org.au/Campus/Expert-Network/Evidence-Finder or https://headspace.org.au/research-database/). Included studies are extensively indexed to facilitate searching. METHODS A systematic search for prevention and treatment studies in young people (mean age 6-25 years) is conducted annually using Embase, MEDLINE, PsycINFO and the Cochrane Library. Included studies are restricted to controlled trials and systematic reviews published since 1980. RESULTS To date, 221 866 publications have been screened, of which 2680 have been included in the database. Updates are conducted annually. CONCLUSIONS This shared resource can be utilized to substantially reduce the amount of time involved with conducting literature searches. It is designed to promote the uptake of evidence-based practice and facilitate research to address gaps in youth mental health.
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Affiliation(s)
- Stefanie De Silva
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia.,headspace National Youth Mental Health Foundation Ltd, Melbourne, Victoria, Australia
| | - Alan P Bailey
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia.,headspace National Youth Mental Health Foundation Ltd, Melbourne, Victoria, Australia
| | - Alexandra G Parker
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia.,headspace National Youth Mental Health Foundation Ltd, Melbourne, Victoria, Australia
| | - Alice E Montague
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia.,headspace National Youth Mental Health Foundation Ltd, Melbourne, Victoria, Australia
| | - Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
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Zhang Y, Zhou X, Pu J, Zhang H, Yang L, Liu L, Zhou C, Yuan S, Jiang X, Xie P. Antidepressants for depressive disorder in children and adolescents: a database of randomised controlled trials. BMC Psychiatry 2018; 18:162. [PMID: 29855280 PMCID: PMC5984320 DOI: 10.1186/s12888-018-1749-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 05/15/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In recent years, whether, when and how to use antidepressants to treat depressive disorder in children and adolescents has been hotly debated. Relevant evidence on this topic has increased rapidly. In this paper, we present the construction and content of a database of randomised controlled trials of antidepressants to treat depressive disorder in children and adolescents. This database can be freely accessed via our website and will be regularly updated. DESCRIPTION Major bibliographic databases (PubMed, the Cochrane Library, Web of Science, Embase, CINAHL, PsycINFO and LiLACS), international trial registers and regulatory agencies' websites were systematically searched for published and unpublished studies up to April 30, 2017. We included randomised controlled trials in which the efficacy or tolerability of any oral antidepressant was compared with that of a control group or any other treatment. In total, 7377 citations from bibliographical databases and 3289 from international trial registers and regulatory agencies' websites were identified. Of these, 53 trials were eligible for inclusion in the final database. Selected data were extracted from each study, including characteristics of the participants (the study population, setting, diagnostic criteria, type of depression, age, sex, and comorbidity), characteristics of the treatment conditions (the treatment conditions, general information, and detail of pharmacotherapy and psychotherapy) and study characteristics (the sponsor, country, number of sites, blinding method, sample size, treatment duration, depression scales, other scales, and primary outcome measure used, and side-effect monitoring method). Moreover, the risk of bias for each trial were assessed. CONCLUSION This database provides information on nearly all randomised controlled trials of antidepressants in children and adolescents. By using this database, researchers can improve research efficiency, avoid inadvertent errors and easily focus on the targeted subgroups in which they are interested. For authors of subsequent reviews, they could only use this database to insure that they have completed a comprehensive review, rather than relied solely on the data from this database. We expect this database could help to promote research on evidence-based practice in the treatment of depressive disorder in children and adolescents. The database could be freely accessed in our website: http://xiepengteam.cn/research/evidence-based-medicine .
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Affiliation(s)
- Yuqing Zhang
- 0000 0000 8653 0555grid.203458.8Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China ,0000 0000 8653 0555grid.203458.8Chongqing Key Laboratory for Cerebrovascular Disease Research, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyu Zhou
- grid.452206.7Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Juncai Pu
- grid.452206.7Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016 China
| | - Hanping Zhang
- grid.452206.7Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016 China
| | - Lining Yang
- grid.452206.7Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016 China
| | - Lanxiang Liu
- grid.452206.7Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016 China
| | - Chanjuan Zhou
- 0000 0000 8653 0555grid.203458.8Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China ,0000 0000 8653 0555grid.203458.8Chongqing Key Laboratory for Cerebrovascular Disease Research, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Shuai Yuan
- grid.452206.7Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016 China
| | - Xiaofeng Jiang
- grid.452206.7Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016 China
| | - Peng Xie
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China. .,Chongqing Key Laboratory for Cerebrovascular Disease Research, Yongchuan Hospital of Chongqing Medical University, Chongqing, China. .,Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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Ebert DD, Buntrock C, Reins JA, Zimmermann J, Cuijpers P. Efficacy and moderators of psychological interventions in treating subclinical symptoms of depression and preventing major depressive disorder onsets: protocol for an individual patient data meta-analysis of randomised controlled trials. BMJ Open 2018; 8:e018582. [PMID: 29549201 PMCID: PMC5857689 DOI: 10.1136/bmjopen-2017-018582] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The long-term effectiveness of psychological interventions for the treatment of subthreshold depression and the prevention of depression is unclear and effects vary among subgroups of patients, indicating that not all patients profit from such interventions. Randomised clinical trials are mostly underpowered to examine adequately subgroups and moderator effects. The aim of the present study is, therefore, to examine the short-term and long-term as well as moderator effects of psychological interventions compared with control groups in adults with subthreshold depression on depressive symptom severity, treatment response, remission, symptom deterioration, quality of life, anxiety and the prevention of major depressive disorder (MDD) onsets on individual patient level and study level using an individual patient data meta-analysis approach. METHODS AND ANALYSIS Systematic searches in PubMed, PsycINFO, Embase and the Cochrane Central Register of Controlled Trials were conducted. We will use the following types of outcome criteria: (A) onset of major depression; (B) time to major depression onset; (C) observer-reported and self-reported depressive symptom severity; (D) response; (E) remission; (F) symptom deterioration; (G) quality of life, (H) anxiety; and (I) suicidal thoughts and behaviours. Multilevel models with participants nested within studies will be used. Missing data will be handled using a joint modelling approach to multiple imputation. A number of sensitivity analyses will be conducted in order test the robustness of our findings. ETHICS AND DISSEMINATION The investigators of the primary trials have obtained ethical approval for the data used in the present study and for sharing the data, if this was necessary, according to local requirements and was not covered from the initial ethic assessment.This study will summarise the available evidence on the short-term and long-term effectiveness of preventive psychological interventions for the treatment of subthreshold depression and prevention of MDD onset. Identification of subgroups of patients in which those interventions are most effective will guide the development of evidence-based personalised interventions for patients with subthreshold depression. PROSPERO REGISTRATION NUMBER CRD42017058585.
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Affiliation(s)
- David D Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen Nuremberg, Erlangen, Germany
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen Nuremberg, Erlangen, Germany
| | - Jo Annika Reins
- Institute of Psychology, Leuphana University of Luneburg, Luneburg, Germany
| | - Johannes Zimmermann
- Chair for Psychological Methods and Diagnostics, Psychologische Hochschule Berlin, Berlin, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, EMGO+ Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
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Keough MT, Penniston TL, Vilhena-Churchill N, Michael Bagby R, Quilty LC. Depression symptoms and reasons for gambling sequentially mediate the associations between insecure attachment styles and problem gambling. Addict Behav 2018; 78:166-172. [PMID: 29175293 DOI: 10.1016/j.addbeh.2017.11.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/09/2017] [Accepted: 11/09/2017] [Indexed: 11/28/2022]
Abstract
One of the central pathways to problem gambling (PG) is gambling to cope with negative moods, which is a cardinal feature of depression. Insecure attachment styles are also etiologically related to depression; and, therefore, by extension, those who are insecurely attached may engage in excessive gambling behaviors to cope with depression. In this study, we aimed to evaluate this and to this end predicted that depression severity and coping motives for gambling would conjointly mediate the relations between insecure attachment styles and PG. Data came from a larger investigation of PG within mood disorders. Participants exhibited a lifetime depressive or bipolar disorder and endorsed a mood episode within the past ten years. Participants (N=275) completed self-report measures during a two-day assessment. Path analysis supported two main indirect effects. First, anxious attachment predicted elevated depression, which in turn predicted increased coping motives for gambling, which subsequently predicted greater PG severity. Second, this double mediational pathway was also observed for avoidant attachment. Results suggest that insecure attachment relates to PG via depressive symptoms and coping-related gambling motives. Mood symptoms and associated gambling motives are malleable and are promising targets of gambling interventions for insecurely attached individuals.
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Affiliation(s)
- Matthew T Keough
- University of Manitoba, Department of Psychology, 190 Dysart Road, P314 Duff Roblin Building, Winnipeg, MB R3T 2N2, Canada.
| | - Trinda L Penniston
- University of Manitoba, Department of Psychology, 190 Dysart Road, P314 Duff Roblin Building, Winnipeg, MB R3T 2N2, Canada
| | - Natalie Vilhena-Churchill
- Altum Health, University Health Network, Krembil Discovery Tower, 399, Bathurst St., Toronto, Ontario M5T 2S8, Canada
| | - R Michael Bagby
- University of Toronto, Departments of Psychology and Psychiatry, 1265 Military Trail, Toronto, Ontario M1C 1A4, Canada
| | - Lena C Quilty
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, 100 Stokes Street, Bell Gateway Building, Toronto, Ontario M6J 1H4, Canada; University of Toronto, Department of Psychiatry, 250 College St., Toronto, Ontario M5T 1R8, Canada
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Driessen E, Abbass AA, Barber JP, Connolly Gibbons MB, Dekker JJM, Fokkema M, Fonagy P, Hollon SD, Jansma EP, de Maat SCM, Town JM, Twisk JWR, Van HL, Weitz E, Cuijpers P. Which patients benefit specifically from short-term psychodynamic psychotherapy (STPP) for depression? Study protocol of a systematic review and meta-analysis of individual participant data. BMJ Open 2018; 8:e018900. [PMID: 29463590 PMCID: PMC5855455 DOI: 10.1136/bmjopen-2017-018900] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Short-term psychodynamic psychotherapy (STPP) is an empirically supported treatment that is often used to treat depression. However, it is largely unclear if certain subgroups of depressed patients can benefit specifically from this treatment method. We describe the protocol for a systematic review and meta-analysis of individual participant data (IPD) aimed at identifying predictors and moderators of STPP for depression efficacy. METHOD AND ANALYSIS We will conduct a systematic literature search in multiple bibliographic databases (PubMed, PsycINFO, Embase.com, Web of Science and Cochrane's Central Register of Controlled Trials), 'grey literature' databases (GLIN and UMI ProQuest) and a prospective trial register (http://www.controlled-trials.com). We will include studies reporting (a) outcomes on standardised measures of (b) depressed (c) adult patients (d) receiving STPP. We will next invite the authors of these studies to share the participant-level data of their trials and combine these data to conduct IPD meta-analyses. The primary outcome for this study is post-treatment efficacy as assessed by a continuous depression measure. Potential predictors and moderators include all sociodemographic variables, clinical variables and psychological patient characteristics that are measured before the start of treatment and are assessed consistently across studies. One-stage IPD meta-analyses will be conducted using mixed-effects models. ETHICS AND DISSEMINATION Institutional review board approval is not required for this study. We intend to submit reports of the outcomes of this study for publication to international peer-reviewed journals in the fields of psychiatry or clinical psychology. We also intend to present the outcomes at international scientific conferences aimed at psychotherapy researchers and clinicians. The findings of this study can have important clinical implications, as they can inform expectations of STPP efficacy for individual patients, and help to make an informed choice concerning the best treatment option for a given patient. PROSPERO REGISTRATION NUMBER CRD42017056029.
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Affiliation(s)
- Ellen Driessen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Allan A Abbass
- Centre for Emotions & Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jacques P Barber
- Gordon F. Derner School of Psychology, Adelphi University, Garden City, New York, USA
| | | | - Jack J M Dekker
- Department of Research, Arkin Mental Health Care, Amsterdam, Netherlands
| | - Marjolein Fokkema
- Department of Methodology and Statistics, Leiden University, Leiden, Netherlands
| | - Peter Fonagy
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Steven D Hollon
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Elise P Jansma
- University Library, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Saskia C M de Maat
- Dutch Psychoanalytic Institute, Arkin Mental Health Care, Amsterdam, Netherlands
| | - Joel M Town
- Centre for Emotions & Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jos W R Twisk
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Amsterdam, Netherlands
| | - Henricus L Van
- Dutch Psychoanalytic Institute, Arkin Mental Health Care, Amsterdam, Netherlands
| | - Erica Weitz
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Kennedy JC, Dunlop BW, Craighead LW, Nemeroff CB, Mayberg HS, Craighead WE. Follow-up of monotherapy remitters in the PReDICT study: Maintenance treatment outcomes and clinical predictors of recurrence. J Consult Clin Psychol 2018; 86:189-199. [PMID: 29369664 PMCID: PMC6892631 DOI: 10.1037/ccp0000279] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This study followed remitted patients from a randomized controlled trial of adults with major depressive disorder (MDD). The aims were to describe rates of recurrence and to evaluate 3 clinical predictor domains. METHOD Ninety-four treatment-naïve patients (50% female; Mage = 38.1 years; 48.9% White; 30.9% Hispanic) with MDD who had remitted to 12-week monotherapy (escitalopram, duloxetine, or cognitive behavior therapy [CBT]) participated in a 21-month maintenance phase (i.e., continued medication or 3 possible CBT booster sessions per year). Recurrence was assessed quarterly, and the clinical predictors were the following: 2 measures of residual depressive symptoms, 1 measure of lifetime depressive episodes, and 2 measures of baseline anxiety. Survival analysis models evaluated recurrence rates, and regression models evaluated the predictors. RESULTS Among all patients, 15.5% experienced a recurrence, and the survival distributions did not statistically differ among treatments. Residual depressive symptoms on the Hamilton Depression Rating Scale at the end of monotherapy were associated with increased risk for recurrence (hazard ratio = 1.31, 95% confidence interval [CI: 1.02, 1.67], Wald χ2 = 4.41, p = .036), and not having a comorbid anxiety disorder diagnosis at study baseline reduced the risk of recurrence (hazard ratio = .31, 95% CI [.10, .94], Wald χ2 = 4.28, p = .039). CONCLUSIONS The study supported the benefits of maintenance treatment for treatment-naïve patients who remitted to initial monotherapy; nevertheless, remitted patients with a comorbid anxiety disorder diagnosis at the beginning of treatment or residual depressive symptoms after initial treatment were at risk for poorer long-term outcomes. (PsycINFO Database Record
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Affiliation(s)
| | - Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University
| | | | | | - Helen S Mayberg
- Department of Psychiatry and Behavioral Sciences, Emory University
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Dondé C, Moirand R, Carre A. L’activation comportementale : un outil simple et efficace dans le traitement de la dépression. Encephale 2018; 44:59-66. [DOI: 10.1016/j.encep.2017.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/07/2017] [Accepted: 02/09/2017] [Indexed: 01/09/2023]
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Cuijpers P, Karyotaki E, Reijnders M, Huibers MJH. Who benefits from psychotherapies for adult depression? A meta-analytic update of the evidence. Cogn Behav Ther 2018; 47:91-106. [DOI: 10.1080/16506073.2017.1420098] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Pim Cuijpers
- Department of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam 1081 BT, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam 1081 BT, The Netherlands
| | - Mirjam Reijnders
- Department of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam 1081 BT, The Netherlands
| | - Marcus J. H. Huibers
- Department of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam 1081 BT, The Netherlands
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, 19104-6241, USA
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Cuijpers P, de Wit L, Kleiboer A, Karyotaki E, Ebert DD. Problem-solving therapy for adult depression: An updated meta-analysis. Eur Psychiatry 2018; 48:27-37. [PMID: 29331596 DOI: 10.1016/j.eurpsy.2017.11.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Problem-solving therapy (PST) is one of the best examined types of psychotherapy for adult depression. No recent meta-analysis has examined the effects of PST compared to control groups or to other treatments. We wanted to verify whether PST is effective, whether effects are comparable to those of other treatments, and whether we could identify the possible sources of high heterogeneity that was found in earlier meta-analyses. METHODS We conducted systematic searches in bibliographical databases, including PubMed, PsycInfo, Embase and the Cochrane database of randomized trials. RESULTS We included 30 randomized controlled trials on PST (with 3530 patients), in which PST was compared to control conditions, with other therapies, and with pharmacotherapy. We could compare these 30 trials on PST also with 259 trials on other psychotherapies for adult depression. The effect size of PST versus control groups was g=0.79 (0.57-1.01) with very high heterogeneity (I2=84; 95% CI: 77-88). The effect size from the 9 studies with low risk of bias was g=0.34 (95% CI: 0.22-0.46) with low heterogeneity (I2=32; 95% CI: 0-68), which is comparable to the effects of other psychotherapies. PST was a little more effective than other therapies in direct comparisons, but that may be explained by the considerable number of studies with researcher allegiance towards PST. In meta-regression analyses of all controlled studies, no significant difference between PST and other therapies was found. CONCLUSION PST is probably an effective treatment for depression, with effect sizes that are small, but comparable to those found for other psychological treatments of depression.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands.
| | - Leonore de Wit
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Annet Kleiboer
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - David D Ebert
- Clinical Psychology and Psychotherapy, Institute for Psychology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Abstract
Some of the most important decisions that a researcher will make when conducting a meta-analysis are decisions about the search strategies and inclusion/exclusion criteria. Decisions regarding inclusion/exclusion criteria serve to define the scope of a meta-analysis and search strategy decisions can have a large impact on how well the results of a meta-analysis actually represent the existing body of literature. In this article, we provide descriptions and recommendations for performing searches and making inclusion/exclusion decisions. We also provide a review of 65 meta-analyses of psychotherapy versus pharmacotherapy in order to offer frequency data on the use of various search strategies and inclusion/exclusion decisions in the field.
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Affiliation(s)
- Joshua K Swift
- a Department of Psychology , Idaho State University , Pocatello , ID , USA
| | - Bruce E Wampold
- b Modum Bad Psychiatric Center and Department of Counseling Psychology , University of Wisconsin-Madison , Madison , WI , USA
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