1
|
Liu W, Wang Q, Zheng D, Mei J, Lu J, Chen G, Wang W, Ding F. The Effects of a Complex Interactive Multimodal Intervention on Personalized Stress Management Among Health Care Workers in China: Nonrandomized Controlled Study. J Med Internet Res 2024; 26:e45422. [PMID: 38996333 DOI: 10.2196/45422] [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: 12/30/2022] [Revised: 04/19/2023] [Accepted: 05/03/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Health care workers (HCWs) frequently face multiple stressors at work, particularly those working night shifts. HCWs who have experienced distress may find it difficult to adopt stress management approaches, even if they are aware of the effects of stress and coping processes. Therefore, an individualized intervention may be required to assist distressed HCWs in bridging the "knowledge-practice" gap in stress management and effectively alleviating stress symptoms. OBJECTIVE The main objective of this research was to compare the effects of a complex interactive multimodal intervention (CIMI) to self-guided stress management interventions on stress symptoms of distressed HCWs, as measured by physiological (heart rate variability), psychological (perceived stress, mental distress, and subjective happiness), and sleep disorder (fatigue and sleepiness) indicators. METHODS We conducted a nonrandomized, controlled study in 2 Chinese general hospitals. The participants in this study were 245 HCWs who fulfilled at least 1 of the 3 dimensions on the Depression, Anxiety, and Stress Scale. All eligible individuals were required to complete a questionnaire and wear a 24-hour Holter device to determine the physiological signs of stress as indexed by heart rate variability at both baseline and after the intervention. The CIMI group received a 12-week online intervention with 4 components-mobile stress management instruction, a web-based WeChat social network, personalized feedback, and a nurse coach, whereas the control group simply received a self-guided intervention. RESULTS After a 12-week intervention, the Perceived Stress Scale (PSS) scores reduced significantly in the CIMI group (mean difference [MD] -5.31, 95% CI -6.26 to -4.37; P<.001) compared to the baseline levels. The changes in PSS scores before and after the intervention exhibited a significant difference between the CIMI and control groups (d=-0.64; MD -4.03, 95% CI -5.91 to -2.14; P<.001), and the effect was medium. In terms of physiological measures, both the control group (MD -9.56, 95% CI -16.9 to -2.2; P=.01) and the CIMI group (MD -8.45, 95% CI -12.68 to -4.22; P<.001) demonstrated a significant decrease in the standard deviation of normal-to-normal intervals (SDNN) within the normal clinical range; however, there were no significant differences between the 2 groups (d=0.03; MD 1.11, 95% CI -7.38 to 9.59; P=.80). CONCLUSIONS The CIMI was an effective intervention for improving sleep disorders, as well as parts of the psychological stress measures in distressed HCWs. The findings provide objective evidence for developing a mobile stress management intervention that is adaptable and accessible to distressed HCWs, but its long-term effects should be investigated in future research. TRIAL REGISTRATION ClinicalTrials.gov NCT05239065; https://clinicaltrials.gov/ct2/show/NCT05239065.
Collapse
Affiliation(s)
- Wenhua Liu
- Department of Pharmacology, School of Basic Medical Science, Shanghai Medical College, Fudan University, Shanghai, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Quan Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Danli Zheng
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junhua Mei
- Department of Neurology, Wuhan No.1 Hospital, Wuhan, China
| | - Jiajia Lu
- Department of Neurology, Wuhan No.1 Hospital, Wuhan, China
| | - Guohua Chen
- Department of Neurology, Wuhan No.1 Hospital, Wuhan, China
| | - Wei Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fengfei Ding
- Department of Pharmacology, School of Basic Medical Science, Shanghai Medical College, Fudan University, Shanghai, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
2
|
Liu X, Zhai M, Li J, Liu D, Yuan L, Wang H, Yu B, Yan H. Longitudinal effects of sexual minority stigma on depressive symptoms among young men who have sex with men: Distinguish between and within person effects. J Adolesc 2024. [PMID: 38769773 DOI: 10.1002/jad.12338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 04/17/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Young men who have sex with men (YMSM) may experience high levels of sexual minority stigma (SMS) and depressive symptoms (DS) over the world and in China. However, there is a lack of studies investigating the longitudinal effects of SMS on DS of YMSM, especially focusing on YMSM and separating the between-person and within-person effects. This study aimed to fill the said gaps. METHODS Study data were derived from a prospective cohort of 349 YMSM from central China (Wuhan, Changsha, Nanchang), the baseline survey was started in 2017 with one follow-up visit every year. SMS and DS were measured three times using valid and reliable instruments. The cross-lagged panel model (CLPM) and the random intercept CLPM (RI-CLPM) were used to examine the between-person and within-person concurrent and lagged effects, respectively. RESULTS Findings of CLPM revealed bidirectional associations between SMS and DS over time. RI-CLPM suggested that at the between-person level, SMS was significantly associated with DS, echoing the results of CLPM. However, this reciprocal relationship has not been found at the within-person level. CONCLUSION The associations between SMS and DS among YMSM at the population level is more significant than that at the individual level. We suggest that interventions should be against the adverse effects of cultural marginalization and systemic change the social concepts to reduce the amount of SMS in society.
Collapse
Affiliation(s)
- Xin Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| | - Mengxi Zhai
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| | - Jiayu Li
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| | - Dan Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| | - Liang Yuan
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| | - Huihao Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| | - Bin Yu
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| | - Hong Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| |
Collapse
|
3
|
Wang L, Yuwen W, Hua W, Chen L, Forsythe Cox V, Zheng H, Ning Z, Zhao Z, Liu Z, Jiang Y, Li X, Guo Y, Simoni JM. Enhancing Mental Health and Medication Adherence Among Men Who Have Sex With Men Recently Diagnosed With HIV With a Dialectical Behavior Therapy-Informed Intervention Incorporating mHealth, Online Skills Training, and Phone Coaching: Development Study Using Human-Centered Design Approach. JMIR Form Res 2023; 7:e47903. [PMID: 37831497 PMCID: PMC10611999 DOI: 10.2196/47903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Mental health problems are common among men who have sex with men (MSM) living with HIV and may negatively affect medication adherence. Psychosocial interventions designed to address these urgent needs are scarce in China. Incorporating behavioral health theories into intervention development strengthens the effectiveness of these interventions. The absence of a robust theoretical basis for interventions may also present challenges to identify active intervention ingredients. OBJECTIVE This study aims to systematically describe the development of a mobile health-based intervention for MSM recently diagnosed with HIV in China, including the theoretical basis for the content and the considerations for its technological delivery. METHODS We used intervention mapping (IM) to guide overall intervention development, a behavioral intervention technology model for technological delivery design, and a human-centered design and cultural adaptation model for intervention tailoring throughout all steps of IM. RESULTS The dialectical behavior therapy (DBT)-informed intervention, Turning to Sunshine, comprised 3 components: app-based individual skills learning, group-based skills training, and on-demand phone coaching. The theoretical basis for the intervention content is based on the DBT model of emotions, which fits our conceptualization of the intervention user's mental health needs. The intervention aims to help MSM recently diagnosed with HIV (1) survive moments of high emotional intensity and strong action urges, (2) change emotional expression to regulate emotions, and (3) reduce emotional vulnerability, as well as (4) augment community resources for mental health services. Technological delivery considerations included rationale of the medium, complexity, and esthetics of information delivery; data logs; data visualization; notifications; and passive data collection. CONCLUSIONS This study laid out the steps for the development of a DBT-informed mobile health intervention that integrated app-based individual learning, group-based skills training, and phone coaching. This intervention, Turning to Sunshine, aims to improve mental health outcomes for MSM newly diagnosed with HIV in China. The IM framework informed by human-centered design principles and cultural adaptation considerations offered a systematic approach to develop the current intervention and tailor it to the target intervention users. The behavioral intervention technology model facilitated the translation of behavioral intervention strategies into technological delivery components. The systematic development and reporting of the current intervention can serve as a guide for similar intervention studies. The content of the current intervention could be adapted for a broader population with similar emotional struggles to improve their mental health outcomes.
Collapse
Affiliation(s)
- Liying Wang
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Weichao Yuwen
- School of Nursing & Healthcare Leadership, University of Washington, Tacoma, Tacoma, WA, United States
| | - Wenzhe Hua
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Lingxiao Chen
- Department of Human and Organizational Development, Vanderbilt University, Nashville, TN, United States
| | - Vibh Forsythe Cox
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Huang Zheng
- Shanghai China Sex Worker & Men who have Sex with Men Center, Shanghai, China
| | - Zhen Ning
- Department of HIV/STD Control and Prevention, Shanghai Municipal Centers for Disease Control and Prevention, Shanghai, China
| | - Zhuojun Zhao
- Department of Human-Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Zhaoyu Liu
- Department of Human-Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Yunzhang Jiang
- Courant Institute of Mathematical Sciences, New York University, New York, NY, United States
| | - Xinran Li
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Yawen Guo
- Information School, University of Washington, Seattle, WA, United States
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, WA, United States
| |
Collapse
|
4
|
Comparative efficacy and acceptability of non-pharmacological interventions for depression in people living with HIV: A systematic review and network meta-analysis. Int J Nurs Stud 2023; 140:104452. [PMID: 36821952 DOI: 10.1016/j.ijnurstu.2023.104452] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 01/11/2023] [Accepted: 01/26/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Treatment for depression in people living with HIV has increasingly turned to non-pharmacological treatments due to the adverse reactions of pharmacotherapy. However, it remains unclear which non-pharmacological treatment is the most effective and acceptable for depression in people living with HIV. OBJECTIVE To compare and rank the efficacy and acceptability of different non-pharmacological treatments for depression in people living with HIV. DESIGN A systematic review and Bayesian network meta-analysis. METHODS We systematically searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, PsycArticles, CINAHL, ProQuest, OpenGrey, and international trial registers for published and unpublished studies from their inception to September 1, 2022, and searched key conference proceedings from January 1, 2020, to September 25, 2022. We searched for randomized controlled trials of any non-pharmacological treatments for depression in adults living with HIV (≥18 years old). Primary outcomes were efficacy (mean change scores in depression) and acceptability (all-cause discontinuation). We used a random-effects network meta-analysis model to synthesize all available evidence. The methodological quality of the included studies was assessed using the Cochrane Collaboration Risk of Bias Tool. We registered this study in PROSPERO, number CRD42021244230. RESULTS A total of 53 randomized controlled trials were included in this network meta-analysis involving seven non-pharmacological treatments for depression in people living with HIV. For efficacy, mind-body therapy, interpersonal psychotherapy, cognitive-behavioral therapy, supportive therapy, and education were significantly more effective than most control conditions (standardized mean differences ranged from -0.96 to -0.36). Rankings probabilities indicated that mind-body therapy (79%), interpersonal psychotherapy (71%), cognitive-behavioral therapy (62%), supportive therapy (57%), and education (57%) might be the top five most significantly effective treatments for depression in people living with HIV, in that order. For acceptability, only supportive therapy and interpersonal psychotherapy were significantly less acceptable than most control conditions (odds ratios ranged from 1.92 to 3.43). Rankings probabilities indicated that education might be the most acceptable treatment for people living with HIV (66%), while supportive therapy (26%) and interpersonal psychotherapy (10%) might rank the worst. The GRADE assessment results suggested that most results were rated as "moderate" to "very low" for the confidence of evidence. CONCLUSIONS Our study confirmed the efficacy and acceptability of several non-pharmacological treatments for depression in people living with HIV. These results should inform future guidelines and clinical decisions for depression treatment in people living with HIV.
Collapse
|
5
|
Han S, Zhang Y, Yang X, Li K, Zhang L, Shao Y, Ma J, Hu Y, Zhu Z, Zhang Y, Wang Z. Exploring core mental health symptoms among persons living with HIV: A network analysis. Front Psychiatry 2023; 14:1081867. [PMID: 36741117 PMCID: PMC9895861 DOI: 10.3389/fpsyt.2023.1081867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/04/2023] [Indexed: 01/21/2023] Open
Abstract
CONTEXT Persons living with HIV (PLWH) commonly experience mental health symptoms. However, little is known about the core mental health symptoms and their relationships. OBJECTIVE This study aimed to evaluate the prevalence of various mental health symptoms and to explore their relationships in symptom networks among PLWH. METHODS From April to July 2022, we recruited 518 participants through convenience sampling in Beijing, China, for this cross-sectional study. Forty mental health symptoms, including six dimensions (somatization symptoms, negative affect, cognitive function, interpersonal communication, cognitive processes, and social adaptation), were assessed through paper-based or online questionnaires. Network analysis was performed in Python 3.6.0 to explore the core mental health symptoms and describe the relationships among symptoms and clusters. RESULTS Of the 40 mental health symptoms, the most common symptoms were fatigue (71.2%), trouble remembering things (65.6%), and uncertainty about the future (64.0%). In the single symptom network, sadness was the most central symptom across the three centrality indices (rS = 0.59, rC = 0.61, rB = 0.06), followed by feeling discouraged about the future (rS = 0.51, rC = 0.57, rB = 0.04) and feelings of worthlessness (rS = 0.54, rC = 0.53, rB = 0.05). In the symptom cluster network, negative affect was the most central symptom cluster across the three centrality indices (rS = 1, rC = 1, rB = 0.43). CONCLUSION Our study provides a new perspective on the role of each mental health symptom among PLWH. To alleviate the mental health symptoms of PLWH to the greatest extent possible and comprehensively improve their mental health, we suggest that psychological professionals pay more attention to pessimistic mood and cognitive processes in PLWH. Interventions that apply positive psychology skills and cognitive behavioral therapy may be necessary components for the mental health care of PLWH.
Collapse
Affiliation(s)
- Shuyu Han
- School of Nursing, Peking University, Beijing, China
| | - Yizhu Zhang
- School of Nursing, Peking University, Beijing, China
| | - Xianxia Yang
- School of Public Health, Wuhan University, Wuhan, Hubei, China
| | - Ke Li
- Department of Emergency, Peking University First Hospital, Beijing, China
| | - Lili Zhang
- Department of Nursing, Beijing Youan Hospital Affiliated with Capital Medical University, Beijing, China
| | - Ying Shao
- Department of Infection, Beijing Youan Hospital Affiliated With Capital Medical University, Beijing, China
| | - Jianhong Ma
- Department of Infection, Beijing Youan Hospital Affiliated With Capital Medical University, Beijing, China
| | - Yan Hu
- School of Nursing, Fudan University, Shanghai, China
| | - Zheng Zhu
- School of Nursing, Fudan University, Shanghai, China
| | - Yukun Zhang
- School of Nursing, Fudan University, Shanghai, China
| | - Zhiwen Wang
- School of Nursing, Peking University, Beijing, China
| |
Collapse
|
6
|
Qin K, Zeng J, Liu L, Cai Y. Effects of cognitive behavioral therapy on improving depressive symptoms and increasing adherence to antiretroviral medication in people with HIV. Front Psychiatry 2022; 13:990994. [PMID: 36440403 PMCID: PMC9682157 DOI: 10.3389/fpsyt.2022.990994] [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: 07/11/2022] [Accepted: 10/28/2022] [Indexed: 11/11/2022] Open
Abstract
The incidence of depression is higher in PLWH (people living with HIV) than in the general population. It is of clinical significance to explore effective measures to improve depression in patients. But the available evidence is still quite limited. CBT (cognitive behavioral therapy) is considered to be one of the effective methods to improve depression, medication adherence and quality of life in PLWH. Therefore, this study aimed to systematically evaluate the effect of cognitive behavioral therapy on improving depressive symptoms and increasing adherence to antiretroviral therapy (ART) in people living with HIV (Human Immunodeficiency Virus). The Cochrane Library, Embase, PubMed, and Web of Science databases were searched by computer to collect randomized controlled trials on the effects of cognitive behavioral therapy on improving depression and increasing ART medication adherence in PLWH, and the retrieval time was from the inception of each database to January 10, 2022. Meta-analysis was performed by two researchers using Stata 15.0 software after screening the literature, extracting data and evaluating quality according to inclusion and exclusion criteria. A total of 16 studies with 1,998 patients were included. Meta-analysis results showed that CBT improved depressive symptoms in PLWH (SMD = -0.09, 95% CI [-0.13 to -0.04], P < 0.001) with better long-term (<6 months) depression improvement (SMD = -0.09, 95% CI [-0.15 to -0.02], P = 0.006) than short-term (0-6 months); the difference in improved ART medication adherence in the CBT group compared to the control group was not statistically significant (SMD = 0.04, 95% CI [-0.06 to 0.13], P = 0.490). There may be publication bias due to incomplete inclusion of literature as only published literature was searched. Cognitive behavioral therapy is effective in improving depressive symptoms in people living with HIV, with better long-term (>6 months) results than short-term (0-6 months).
Collapse
Affiliation(s)
- Keke Qin
- School of Politics and Public Administration, Guangxi Normal University, Guilin, China
| | - Jiale Zeng
- School of Management, Jinan University, Guangzhou, China
| | - Li Liu
- School of Social and Public Administration, East China University of Science and Technology, Shanghai, China
| | - Yumei Cai
- Population Research Institute, Peking University, Beijing, China
| |
Collapse
|