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Walters C, Gratzer D, Dang K, Laposa J, Knyahnytska Y, Ortiz A, Gonzalez-Torres C, Moore LP, Chen S, Ma C, Daskalakis Z, Ritvo P. The Use of Text Messaging as an Adjunct to Internet-Based Cognitive Behavioral Therapy for Major Depressive Disorder in Youth: Secondary Analysis. JMIR Form Res 2024; 8:e40275. [PMID: 38820586 PMCID: PMC11179040 DOI: 10.2196/40275] [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: 06/16/2022] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND As an established treatment for major depressive disorder (MDD), cognitive behavioral therapy (CBT) is now implemented and assessed in internet-based formats that, when combined with smartphone apps, enable secure text messaging. As an adjunct to such internet-based CBT (ICBT) approaches, text messaging has been associated with increased adherence and therapeutic alliance. OBJECTIVE This study analyzed data from the intervention arm of a randomized control trial evaluating 24-week ICBT for MDD (intervention arm) against standard-care psychiatry (waitlist control). The aim of this secondary analysis was to assess MDD symptom improvement in relation to the frequency and content of text messages sent by ICBT participants to Navigator-Coaches during randomized control trial participation. Higher text frequency in general and in 3 conceptual categories (appreciating alliance, alliance building disclosures, and agreement confirmation) was hypothesized to predict larger MDD symptom improvement. METHODS Participants were young adults (18-30 years) from the Centre for Addiction and Mental Health. The frequencies of categorized texts from 20 ICBT completers were analyzed with respect to MDD symptom improvement using linear regression models. Texts were coded by 2 independent coders and categorized using content analysis. MDD symptoms were measured using the Beck Depression Inventory-II (BDI-II). RESULTS Participants sent an average of 136 text messages. Analyses indicated that BDI-II improvement was negatively associated with text messaging frequency in general (β=-0.029, 95% CI -0.11 to 0.048) and in each of the 3 categories: appreciating alliance (β=-0.096, 95% CI -0.80 to 0.61), alliance building disclosures (β=-0.098, 95% CI -0.28 to 0.084), and agreement confirmation (β=-0.076, 95% CI -0.40 to 0.25). Altogether, the effect of text messaging on BDI-II improvement was uniformly negative across statistical models. More text messaging appeared associated with less MDD symptom improvement. CONCLUSIONS The hypothesized positive associations between conceptually categorized text messages and MDD symptom improvement were not supported in this study. Instead, more text messaging appeared to indicate less treatment benefit. Future studies with larger samples are needed to discern the optimal use of text messaging in ICBT approaches using adjunctive modes of communication. TRIAL REGISTRATION Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052.
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Affiliation(s)
| | - David Gratzer
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kevin Dang
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada
| | - Judith Laposa
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Abigail Ortiz
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Lindsay P Moore
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada
| | - Sheng Chen
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Clement Ma
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Paul Ritvo
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada
- Department of Psychology, York University, Toronto, ON, Canada
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Bjornstad G, Sonthalia S, Rouse B, Freeman L, Hessami N, Dunne JH, Axford N. A comparison of the effectiveness of cognitive behavioural interventions based on delivery features for elevated symptoms of depression in adolescents: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1376. [PMID: 38188230 PMCID: PMC10771715 DOI: 10.1002/cl2.1376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/03/2023] [Indexed: 01/09/2024]
Abstract
Background Depression is a public health problem and common amongst adolescents. Cognitive behavioural therapy (CBT) is widely used to treat adolescent depression but existing research does not provide clear conclusions regarding the relative effectiveness of different delivery modalities. Objectives The primary aim is to estimate the relative efficacy of different modes of CBT delivery compared with each other and control conditions for reducing depressive symptoms in adolescents. The secondary aim is to compare the different modes of delivery with regard to intervention completion/attrition (a proxy for intervention acceptability). Search Methods The Cochrane Depression, Anxiety and Neurosis Clinical Trials Register was searched in April 2020. MEDLINE, PsycInfo, EMBASE, four other electronic databases, the CENTRAL trial registry, Google Scholar and Google were searched in November 2020, together with reference checking, citation searching and hand-searching of two databases. Selection Criteria Randomised controlled trials (RCTs) of CBT interventions (irrespective of delivery mode) to reduce symptoms of depression in young people aged 10-19 years with clinically relevant symptoms or diagnosis of depression were included. Data Collection and Analysis Screening and data extraction were completed by two authors independently, with discrepancies addressed by a third author. CBT interventions were categorised as follows: group CBT, individual CBT, remote CBT, guided self-help, and unguided self-help. Effect on depressive symptom score was estimated across validated self-report measures using Hedges' g standardised mean difference. Acceptability was estimated based on loss to follow-up as an odds ratio. Treatment rankings were developed using the surface under the cumulative ranking curve (SUCRA). Pairwise meta-analyses were conducted using random effects models where there were two or more head-to-head trials. Network analyses were conducted using random effects models. Main Results Sixty-eight studies were included in the review. The mean age of participants ranged from 10 to 19.5 years, and on average 60% of participants were female. The majority of studies were conducted in schools (28) or universities (6); other settings included primary care, clinical settings and the home. The number of CBT sessions ranged from 1 to 16, the frequency of delivery from once every 2 weeks to twice a week and the duration of each session from 20 min to 2 h. The risk of bias was low across all domains for 23 studies, 24 studies had some concerns and the remaining 21 were assessed to be at high risk of bias. Sixty-two RCTs (representing 6435 participants) were included in the pairwise and network meta-analyses for post-intervention depressive symptom score at post-intervention. All pre-specified treatment and control categories were represented by at least one RCT. Although most CBT approaches, except remote CBT, demonstrated superiority over no intervention, no approaches performed clearly better than or equivalent to another. The highest and lowest ranking interventions were guided self-help (SUCRA 83%) and unguided self-help (SUCRA 51%), respectively (very low certainty in treatment ranking). Nineteen RCTs (3260 participants) were included in the pairwise and network meta-analyses for 6 to 12 month follow-up depressive symptom score. Neither guided self-help nor remote CBT were evaluated in the RCTs for this time point. Effects were generally attenuated for 6- to 12-month outcomes compared to posttest. No interventions demonstrated superiority to no intervention, although unguided self-help and group CBT both demonstrated superiority compared to TAU. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking approaches were unguided self-help and individual CBT, respectively. Sixty-two RCTs (7347 participants) were included in the pairwise and network meta-analyses for intervention acceptability. All pre-specified treatment and control categories were represented by at least one RCT. Although point estimates tended to favour no intervention, no active treatments were clearly inferior. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking active interventions were individual CBT and group CBT respectively. Pairwise meta-analytic findings were similar to those of the network meta-analysis for all analyses. There may be age-based subgroup effects on post-intervention depressive symptoms. Using the no intervention control group as the reference, the magnitudes of effects appear to be larger for the oldest age categories compared to the other subgroups for each given comparison. However, they were generally less precise and formal testing only indicated a significant difference for group CBT. Findings were robust to pre-specified sensitivity analyses separating out the type of placebo and excluding cluster-RCTs, as well as an additional analysis excluding studies where we had imputed standard deviations. Authors' Conclusions At posttreatment, all active treatments (group CBT, individual CBT, guided self-help, and unguided self-help) except for remote CBT were more effective than no treatment. Guided self-help was the most highly ranked intervention but only evaluated in trials with the oldest adolescents (16-19 years). Moreover, the studies of guided self-help vary in the type and amount of therapist support provided and longer-term results are needed to determine whether effects persist. The magnitude of effects was generally attenuated for 6- to 12-month outcomes. Although unguided self-help was the lowest-ranked active intervention at post-intervention, it was the highest ranked at follow-up. This suggests the need for further research into whether interventions with self-directed elements enable young people to maintain effects by continuing or revisiting the intervention independently, and whether therapist support would improve long-term outcomes. There was no clear evidence that any active treatments were more acceptable to participants than any others. The relative effectiveness of intervention delivery modes must be taken into account in the context of the needs and preferences of individual young people, particularly as the differences between effect sizes were relatively small. Further research into the type and amount of therapist support that is most acceptable to young people and most cost-effective would be particularly useful.
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Affiliation(s)
- Gretchen Bjornstad
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
- Dartington Service Design LabBuckfastleighUK
| | - Shreya Sonthalia
- Dartington Service Design LabBuckfastleighUK
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - Benjamin Rouse
- Center for Clinical Evidence and Guidelines, ECRI InstitutePlymouth MeetingPennsylvaniaUSA
| | | | | | - Jo Hickman Dunne
- The Centre for Youth ImpactLondonUK
- University of ManchesterManchesterUK
| | - Nick Axford
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of PlymouthPlymouthUK
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Lodewyk K, Bagnell A, Courtney DB, Newton AS. Review: Adverse event monitoring and reporting in studies of pediatric psychosocial interventions: a systematic review. Child Adolesc Ment Health 2023. [PMID: 37463769 DOI: 10.1111/camh.12661] [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] [Accepted: 05/31/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Adverse event monitoring in studies of psychotherapy is crucial to clinical decision-making, particularly for weighing of benefits and harms of treatment approaches. In this systematic review, we identified how adverse events are defined, measured, and reported in studies of psychosocial interventions for children with mental disorders. METHOD Medline, PsycINFO, Embase, ProQuest Dissertations and Theses Global, and the Cochrane Library were searched from January 2011-January 2023, and Google Scholar from January 2011-February 2023. English language experimental and quasi-experimental studies that evaluated the efficacy or effectiveness of psychosocial interventions for childhood mental disorders were included. Information on the definition, assessment, and report of adverse events was extracted using a checklist based on Good Clinical Practice guidelines. RESULTS In this review, 117 studies were included. Studies most commonly involved treating anxiety disorders or obsessive-compulsive disorder (32/117; 27%); 44% of the experimental interventions tested (52/117) were cognitive behavioral therapies. Adverse events were monitored in 36 studies (36/117; 31%) with a protocol used in 19 of these studies to guide monitoring (19/36; 53%). Twenty-seven different events were monitored across the studies with hospitalization the most frequently monitored (3/36; 8%). Event severity was fully assessed in 6 studies (17%) and partially assessed in 12 studies (33%). Only 4/36 studies (11%) included assessing events for cause. CONCLUSIONS To date, adverse events have been inconsistently defined, measured and reported in psychosocial intervention studies of childhood mental health disorders. Information on adverse events is an essential knowledge component for understanding the potential impacts and risks of therapeutic interventions.
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Affiliation(s)
| | | | - Darren B Courtney
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Kobak K, Shear MK, Skritskaya NA, Bloom C, Bottex G. A Web-Based Therapist Training Tutorial on Prolonged Grief Disorder Therapy: Pre-Post Assessment Study. JMIR MEDICAL EDUCATION 2023; 9:e44246. [PMID: 36972105 PMCID: PMC10131787 DOI: 10.2196/44246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Prolonged grief disorder (PGD) is a newly recognized mental disorder characterized by pervasive intense grief that persists longer than cultural or social expectations and interferes with functioning. The COVID-19 epidemic has resulted in increased rates of PGD, and few clinicians feel confident in treating this condition. PGD therapy (PGDT) is a simple, short-term, and evidence-based treatment developed in tandem with the validation of the PGD diagnosis. To facilitate the dissemination of PGDT training, we developed a web-based therapist tutorial that includes didactic training on PGDT concepts and principles as well as web-based multimedia patient scenarios and examples of clinical implementation of PGDT. OBJECTIVE We aimed to evaluate user satisfaction with the tutorial and whether the tutorial increased trainees' knowledge of PGDT principles and procedures. Moreover, we included a small number of pilot questions to evaluate the PGDT-related clinical skills. METHODS This study evaluated tutorial learning using a pre- and poststudy design. Participants were recruited from professional organization mailing lists, announcements to graduates of the Columbia School of Social Work, and through word of mouth. After signing consent, participants completed a brief demographic survey, a 55-item multiple-choice prestudy test on the concepts and principles of PGD and PGDT covered in the tutorial, and a 4-item pilot web-based prestudy test to gauge PGD clinical implementation skills. The link to the course content was then activated, and participants were given 8 weeks to complete the 11-module tutorial containing information, web-based exercises, simulated patient and video examples, and self-tests. RESULTS Overall, 406 clinicians signed consent, and 236 (58.1%) started the tutorial. Of these, 83.1% (196/236) completed all 11 modules. Trainee scores on our PDGT assessment improved substantially from pretraining to the postmodule assessment, with the total number of correct answers increasing from a mean of 29 (SD 5.5; 52.7% correct) to 36.7 (SD 5.2; 66.7% correct; t195=18.93; P<.001). In addition, the trainee's implementation scores on 4 clinical vignettes increased from 2.6 (SD 0.7) correct out of 4 to 3.1 (SD 0.4) out of 4 (t188=7.02; P<.001). Effect sizes (Cohen d) were 1.44 (95% CI 1.23-1.65) for PDGT assessment and 1.06 (95% CI 0.84-1.29) for implementation. Trainees found the tutorial interesting, enjoyable, clearly presented, and useful for professional development. They endorsed a mean score of 3.7 (SD 0.47) on a 1 to 4 scale of agreement with recommending the course to others and feeling satisfied with the tutorial, and a mean of 3.3 (SD 0.57) with feeling able to apply the skills with clients. CONCLUSIONS This pilot study provides support for the usefulness of this web-based training for teaching clinicians how to administer PGDT. The addition of patient scenarios for clinical implementation strategies holds promise for increasing the effectiveness of PGDT training and other evidence-based treatments. TRIAL REGISTRATION ClinicalTrials.gov NCT05121792; https://www.clinicaltrials.gov/ct2/show/NCT05121792.
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Affiliation(s)
- Kenneth Kobak
- Center for Telepsychology, Madison, WI, United States
| | - M Katherine Shear
- Columbia University School of Social Work, New York, NY, United States
| | | | - Colleen Bloom
- Columbia University School of Social Work, New York, NY, United States
| | - Gaelle Bottex
- Columbia University School of Social Work, New York, NY, United States
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Chard I, Van Zalk N, Picinali L. Virtual reality exposure therapy for reducing social anxiety in stuttering: A randomized controlled pilot trial. Front Digit Health 2023; 5:1061323. [PMID: 36845336 PMCID: PMC9947508 DOI: 10.3389/fdgth.2023.1061323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
We report on findings from the first randomized controlled pilot trial of virtual reality exposure therapy (VRET) developed specifically for reducing social anxiety associated with stuttering. People who stutter with heightened social anxiety were recruited from online adverts and randomly allocated to receive VRET (n = 13) or be put on a waitlist (n = 12). Treatment was delivered remotely using a smartphone-based VR headset. It consisted of three weekly sessions, each comprising both performative and interactive exposure exercises, and was guided by a virtual therapist. Multilevel model analyses failed to demonstrate the effectiveness of VRET at reducing social anxiety between pre- and post-treatment. We found similar results for fear of negative evaluation, negative thoughts associated with stuttering, and stuttering characteristics. However, VRET was associated with reduced social anxiety between post-treatment and one-month follow-up. These pilot findings suggest that our current VRET protocol may not be effective at reducing social anxiety amongst people who stutter, though might be capable of supporting longer-term change. Future VRET protocols targeting stuttering-related social anxiety should be explored with larger samples. The results from this pilot trial provide a solid basis for further design improvements and for future research to explore appropriate techniques for widening access to social anxiety treatments in stuttering.
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Affiliation(s)
- Ian Chard
- Design Psychology Lab, Dyson School of Design Engineering, Imperial College London, London, United Kingdom,Correspondence: Ian Chard
| | - Nejra Van Zalk
- Design Psychology Lab, Dyson School of Design Engineering, Imperial College London, London, United Kingdom
| | - Lorenzo Picinali
- Audio Experience Design Group, Dyson School of Design Engineering, Imperial College London, London, United Kingdom
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Ivlev I, Beil TL, Haynes JS, Patnode CD. Rapid Evidence Review of Digital Cognitive-Behavioral Therapy for Adolescents With Depression. J Adolesc Health 2022; 71:14-29. [PMID: 35256238 DOI: 10.1016/j.jadohealth.2022.01.220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/08/2021] [Accepted: 01/15/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE We conducted a rapid evidence review to explore the benefits and harms of digital cognitive-behavioral therapy (dCBT) and the barriers to and facilitators of implementing dCBT for adolescents. METHODS We searched MEDLINE, PsycINFO, CENTRAL through December 6, 2021, for controlled trials conducted in settings highly applicable to the United States. Additionally, we searched relevant systematic reviews for eligible studies. Results were summarized qualitatively. RESULTS We included 12 trials (n = 1,575) that examined the effects of nine dCBT programs. Overall, dCBT was slightly superior to comparators in improving depression symptoms immediately post-intervention, but not at a longer follow-up. The use of dCBT did not appear to result in an increased risk for suicidal attempts or ideation; however, the number of events was very small. Potential barriers to implementing/maintaining dCBT are challenges engaging/retaining patients, developing infrastructure, and training therapists to facilitate dCBT. Data on harms or unintended negative consequences were not reported in the included studies. CONCLUSIONS A limited body of evidence suggests that dCBT programs might outperform control interventions for reducing depressive symptoms immediately post-intervention, but not at a longer follow-up. The safety of dCBT programs for adolescents with depression is understudied.
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Affiliation(s)
- Ilya Ivlev
- Kaiser Permanente, Kaiser Permanente Evidence-based Practice Center, Portland, Oregon.
| | - Tracy L Beil
- Kaiser Permanente, Kaiser Permanente Evidence-based Practice Center, Portland, Oregon
| | - Jill S Haynes
- Kaiser Permanente, Kaiser Permanente Care Management Institute, Oakland, California
| | - Carrie D Patnode
- Kaiser Permanente, Kaiser Permanente Evidence-based Practice Center, Portland, Oregon
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Newton AS, March S, Gehring ND, Rowe AK, Radomski AD. Establishing a Working Definition of User Experience for eHealth Interventions of Self-reported User Experience Measures With eHealth Researchers and Adolescents: Scoping Review. J Med Internet Res 2021; 23:e25012. [PMID: 34860671 PMCID: PMC8686463 DOI: 10.2196/25012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/27/2021] [Accepted: 09/23/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Across eHealth intervention studies involving children, adolescents, and their parents, researchers have measured user experience to assist with intervention development, refinement, and evaluation. To date, no widely accepted definitions or measures of user experience exist to support a standardized approach for evaluation and comparison within or across interventions. OBJECTIVE We conduct a scoping review with subsequent Delphi consultation to identify how user experience is defined and measured in eHealth research studies, characterize the measurement tools used, and establish working definitions for domains of user experience that could be used in future eHealth evaluations. METHODS We systematically searched electronic databases for published and gray literature available from January 1, 2005, to April 11, 2019. We included studies assessing an eHealth intervention that targeted any health condition and was designed for use by children, adolescents, and their parents. eHealth interventions needed to be web-, computer-, or mobile-based, mediated by the internet with some degree of interactivity. We required studies to report the measurement of user experience as first-person experiences, involving cognitive and behavioral factors reported by intervention users. We appraised the quality of user experience measures in included studies using published criteria: well-established, approaching well-established, promising, or not yet established. We conducted a descriptive analysis of how user experience was defined and measured in each study. Review findings subsequently informed the survey questions used in the Delphi consultations with eHealth researchers and adolescent users for how user experience should be defined and measured. RESULTS Of the 8634 articles screened for eligibility, 129 articles and 1 erratum were included in the review. A total of 30 eHealth researchers and 27 adolescents participated in the Delphi consultations. On the basis of the literature and consultations, we proposed working definitions for 6 main user experience domains: acceptability, satisfaction, credibility, usability, user-reported adherence, and perceived impact. Although most studies incorporated a study-specific measure, we identified 10 well-established measures to quantify 5 of the 6 domains of user experience (all except for self-reported adherence). Our adolescent and researcher participants ranked perceived impact as one of the most important domains of user experience and usability as one of the least important domains. Rankings between adolescents and researchers diverged for other domains. CONCLUSIONS Findings highlight the various ways in which user experience has been defined and measured across studies and what aspects are most valued by researchers and adolescent users. We propose incorporating the working definitions and available measures of user experience to support consistent evaluation and reporting of outcomes across studies. Future studies can refine the definitions and measurement of user experience, explore how user experience relates to other eHealth outcomes, and inform the design and use of human-centered eHealth interventions.
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Affiliation(s)
- Amanda S Newton
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Sonja March
- School of Psychology and Counselling, Centre for Health Research, University of Southern Queensland, Springfield Central, Australia
| | - Nicole D Gehring
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Arlen K Rowe
- School of Psychology and Counselling, Centre for Health Research, University of Southern Queensland, Springfield Central, Australia
| | - Ashley D Radomski
- Knowledge Institute for Child and Youth Mental Health and Addictions, Ottawa, ON, Canada.,CHEO (Children's Hospital of Eastern Ontario) Research Institute, Ottawa, ON, Canada
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Malik K, Ibrahim M, Bernstein A, Venkatesh RK, Rai T, Chorpita B, Patel V. Behavioral Activation as an 'active ingredient' of interventions addressing depression and anxiety among young people: a systematic review and evidence synthesis. BMC Psychol 2021; 9:150. [PMID: 34615559 PMCID: PMC8494510 DOI: 10.1186/s40359-021-00655-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 09/13/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Psychological interventions such as behavioral activation (BA) that focus on overt behaviors rather than complex cognitive skills may be developmentally well-suited to address youth mental health problems. The current systematic review synthesized evidence on the characteristics, effectiveness and acceptability of behavioral activation (BA) to examine its role as a potential 'active ingredient' for alleviating depression and anxiety among young people aged 14 to 24 years. METHODS Evidence across the following sources were synthesized: (i) randomized control trials (RCT) evaluating interventions where BA has been used as a standalone intervention or as part of a multicomponent intervention, (ii) qualitative studies examining the acceptability of BA as an intervention or as a coping strategy among young people with lived experiences. Consultations with a youth advisory group (YAG) from India were used to draw inferences from existing evidence and identify future research priorities. RESULTS As part of the review, 23 RCTs were identified; three studies examined BA as a standalone intervention, and the remaining studies examined multicomponent intervention where BA was a constituent element. The intervention protocols varied in composition, with the number of intervention elements ranging between 5 to 18. There was promising but limited evidence in standalone interventions for thse effectiveness of BA for depression. The impact of BA in multicomponent interventions was difficult to evaluate in the absence of focal assessment of activation outcomes. Evidence from 37 additional qualitative studies of youth lived experience literature, corroborated by the YAG inputs, indicated that young people preferred using behavioral strategies similar to BA to cope with depression in their own life. Themes indicated that the activities that are important to an individual and their socio-contextual factors need to be considered in the planning and implementing BA intervention. Evidence for the use of BA in anxiety was limited across data sources. CONCLUSIONS Overall, there was preliminary empirical evidence for the effectiveness and acceptability of BA for youth depression. Further research is needed to examine the components and mechanisms that contribute to its effectiveness as an active intervention ingredient for depression and anxiety.
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Affiliation(s)
- Kanika Malik
- Sangath, New Delhi, India.
- Jindal School of Psychology and Counselling, O.P. Jindal Global University, Sonepat, Haryana, India.
| | - Maliha Ibrahim
- Sangath, New Delhi, India
- Jindal School of Psychology and Counselling, O.P. Jindal Global University, Sonepat, Haryana, India
| | | | | | - Tara Rai
- Department of Psychology, Ashoka University, Sonepat, Haryana, India
| | - Bruce Chorpita
- Department of Psychology, University of California, Los Angeles, USA
| | - Vikram Patel
- Sangath, New Delhi, India
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
- Harvard TH Chan School of Public Health, Boston, USA
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9
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Ranney ML, Pittman SK, Moseley I, Morgan KE, Riese A, Ybarra M, Cunningham R, Rosen R. Cyberbullying Prevention for Adolescents: Iterative Qualitative Methods for Mobile Intervention Design. JMIR Form Res 2021; 5:e25900. [PMID: 34448702 PMCID: PMC8433933 DOI: 10.2196/25900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 06/04/2021] [Accepted: 07/05/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Cybervictimization among adolescents is associated with multiple negative mental health consequences. Although pediatricians often screen for cyberbullying, validated and acceptable programs to reduce the frequency and impact of adolescent cybervictimization are lacking. OBJECTIVE This study uses agile qualitative methods to refine and evaluate the acceptability of a mixed-modality intervention, initiated within the context of usual pediatric care, for adolescents with a history of cyberharassment and cyberbullying victimization. METHODS Three groups of adolescents were successively recruited from an urban primary care clinic to participate in three consecutive iterations (1, 2, and 3) of the program, which consisted of a brief in-clinic intervention followed by 8 weeks of daily, automated SMS text messaging. After 2 weeks of messaging, iteration 1 (I1) participants completed semistructured interviews regarding intervention experiences. Participant feedback was evaluated via framework matrix analysis to guide changes to the program for iteration 2 (I2). Feedback from 2-week interviews of I2 participants was similarly used to improve the program before initiating iteration 3 (I3). Participants in all 3 iterations completed the interviews after completing the program (8 weeks). Daily response rates assessed participant engagement, and satisfaction questionnaires assessed acceptability. RESULTS A total of 19 adolescents (aged 13-17 years) reporting past-year cybervictimization were enrolled: 7 in I1, 4 in I2, and 8 in I3. Demographic variables included the following: a mean age of 15 (SD 1.5) years; 58% (11/19) female, 42% (8/19) male, 63% (12/19) Hispanic, 37% (7/19) non-Hispanic, 79% (15/19) people of color, and 21% (4/19) White. A total of 73% (14/19) self-identified as having a low socioeconomic status, and 37% (7/19) self-identified as lesbian, gay, or bisexual. The average past 12-month cybervictimization score at baseline was 8.2 (SD 6.58; range 2-26). Participant feedback was used to iteratively refine intervention content and design. For example, participants in I1 recommended that the scope of the intervention be expanded to include web-based conflicts and drama, rather than narrowly focusing on cyberbullying prevention. On the basis of this feedback, the I2 content was shifted toward more general de-escalation skills and bystander empowerment. Overall, 88.34% (940/1064) of the daily queries sent to participants across all 3 iterations received a reply. Participant satisfaction improved considerably with each iteration; 0% (0/7) of I1 participants rated the overall quality of Intervention to Prevent Adolescent Cybervictimization with Text message as excellent, compared to 50% (2/4) of I2 participants and 86% (6/7) of I3 participants. Engagement also improved between the first and third iterations, with participants replying to 59.9% (235/392) of messages in I1, compared to 79.9% (358/488) of messages in I3. CONCLUSIONS This study shows the value of structured participant feedback gathered in an agile intervention refinement methodology for the development of a technology-based intervention targeting adolescents.
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Affiliation(s)
- Megan L Ranney
- Center for Digital Health, Brown University, Providence, RI, United States.,Rhode Island Hospital, Providence, RI, United States
| | | | - Isabelle Moseley
- Center for Digital Health, Brown University, Providence, RI, United States
| | | | - Alison Riese
- Center for Digital Health, Brown University, Providence, RI, United States.,Rhode Island Hospital, Providence, RI, United States
| | - Michele Ybarra
- Center for Innovative Public Health Research, San Clemente, CA, United States
| | | | - Rochelle Rosen
- Center for Digital Health, Brown University, Providence, RI, United States.,Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States
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Seshu U, Khan HA, Bhardwaj M, Sangeetha C, Aarthi G, John S, Thara R, Raghavan V. A qualitative study on the use of mobile-based intervention for perinatal depression among perinatal mothers in rural Bihar, India. Int J Soc Psychiatry 2021; 67:467-471. [PMID: 33059490 DOI: 10.1177/0020764020966003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Perinatal depression (PND) is one of the most common psychiatric illnesses in women, with a prevalence around 22% in India. Leveraging mobile-based technologies could help in the prevention and treatment of perinatal depression even in remote places. Understanding the experiences and barriers of using such technology interventions by perinatal mothers could help in the better design and in delivery of these interventions. We aimed to study the experiences of the perinatal women using a mobile phone-based intervention, Interactive Voice Response System (IVRS), for the prevention and management of perinatal depression in a rural district of Bihar, India. MATERIALS AND METHODS A total of 12 in-depth interviews (IDIs) and one focus group discussion (FGD) with eight participants were conducted with perinatal mothers using the mobile-based IVRS to explore the experiences and perspectives of women receiving mobile phone-based interventions for the treatment of PND. Thematic analysis was done to identify major themes. RESULTS Five major themes emerged from the study around accessibility, usability, community participation, cost and preference to either intervention. Women found the mobile-based intervention useful as it made them feel lighter. They considered mental health as a health issue and wanted help to address their problems. They became familiar with terms like anxiety, depression, helplessness and burden and bean using them in their conversations. The patients used therapeutic strategies such as breathing, coping and relaxation. They even agreed to take up sessions for their peer group. CONCLUSION Women in rural Bihar seemed satisfied with the technology-based intervention. It has made mental health issues more visible and acceptable even in the rural hinterlands of Bihar.
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Affiliation(s)
- Uttara Seshu
- Innovators in Health (India) Nagar Panchayat, Dalsinghsarai, Samastipur, Bihar, India
| | - Homam A Khan
- Innovators in Health (India) Nagar Panchayat, Dalsinghsarai, Samastipur, Bihar, India
| | - Manish Bhardwaj
- Innovators in Health (India) Nagar Panchayat, Dalsinghsarai, Samastipur, Bihar, India
| | - C Sangeetha
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
| | - G Aarthi
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
| | - Sujit John
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
| | - R Thara
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
| | - Vijaya Raghavan
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
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Méndez J, Sánchez-Hernández Ó, Garber J, Espada JP, Orgilés M. Psychological Treatments for Depression in Adolescents: More Than Three Decades Later. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094600. [PMID: 33926111 PMCID: PMC8123571 DOI: 10.3390/ijerph18094600] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/24/2021] [Accepted: 04/25/2021] [Indexed: 12/29/2022]
Abstract
Depression is a common and impairing disorder which is a serious public health problem. For some individuals, depression has a chronic course and is recurrent, particularly when its onset is during adolescence. The purpose of the current paper was to review the clinical trials conducted between 1980 and 2020 in adolescents with a primary diagnosis of a depressive disorder, excluding indicated prevention trials for depressive symptomatology. Cognitive behavioral therapy (CBT) is the pre-eminent treatment and is well established from an evidence-based treatment perspective. The body of research on the remaining treatments is smaller and the status of these treatments is varied: interpersonal therapy (IPT) is well established; family therapy (FT) is possibly effective; and short-term psychoanalytic therapy (PT) is experimental treatment. Implementation of the two treatments that work well-CBT and IPT-has more support when provided individually as compared to in groups. Research on depression treatments has been expanding through using transdiagnostic and modular protocols, implementation through information and communication technologies, and indicated prevention programs. Despite significant progress, however, questions remain regarding the rate of non-response to treatment, the fading of specific treatment effects over time, and the contribution of parental involvement in therapy.
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Affiliation(s)
- Javier Méndez
- Department of Personality, Assessment and Psychological Treatment, University of Murcia, 30100 Murcia, Spain
- Correspondence:
| | - Óscar Sánchez-Hernández
- Department of Developmental and Educational Psychology, University of Murcia, 30100 Murcia, Spain;
| | - Judy Garber
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN 37302, USA;
| | - José P. Espada
- Department of Health Psychology, Miguel Hernández University, 03202 Elche, Spain; (J.P.E.); (M.O.)
| | - Mireia Orgilés
- Department of Health Psychology, Miguel Hernández University, 03202 Elche, Spain; (J.P.E.); (M.O.)
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Rasing SP, Stikkelbroek YA, den Hollander W, Riper H, Deković M, Nauta MH, Creemers DH, Immink MC, Spuij M, Bodden DH. Pragmatic Quasi-Experimental Controlled Trial Evaluating the Outcomes of Blended CBT Compared to Face-to-Face CBT and Treatment as Usual for Adolescents with Depressive Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063102. [PMID: 33802913 PMCID: PMC8002752 DOI: 10.3390/ijerph18063102] [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] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 12/14/2022]
Abstract
Depression is a major problem in youth mental health. Current treatment is on average effective, but adolescents are hesitant to seek help. Blended treatment could lower the barriers to seeking treatment. Evidence on effectiveness is, however, scarce. The present pragmatic quasi-experimental controlled trial aimed to compare the outcomes of blended cognitive behavioral therapy (CBT) to face-to-face CBT and treatment as usual. A total of 129 adolescents with clinical depression (82.2% female), aged 13–22 (M = 16.60, SD = 2.03) received blended CBT, face-to-face CBT or treatment as usual. Clinical diagnosis, depressive symptoms, and secondary outcomes were assessed at baseline, post-intervention, and six-months follow-up. Participants receiving blended CBT were, compared to participants receiving face-to-face CBT and treatment as usual, evenly likely to be in remission from their depressive disorder at post-intervention and at six-month follow-up. Depressive symptoms decreased significantly over time in all three conditions, and changes were not significantly different between conditions. Other secondary outcomes (suicide risk, internalizing and externalizing symptoms, severity of depression, and global functioning) did not differ between treatment conditions at post-intervention and six-month follow-up. Since there was no evidence for favorable outcomes for face-to-face therapies above blended CBT, blended CBT may also be an effective treatment format in clinical practice.
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Affiliation(s)
- Sanne P.A. Rasing
- Clinical Child and Family Studies, Utrecht University, 3508 TC Utrecht, The Netherlands; (Y.A.J.S.); (M.D.); (M.S.); (D.H.M.B.)
- Child and Adolescent Psychiatry, GGZ Oost Brabant, 5427 EM Boekel, The Netherlands;
- Correspondence: ; Tel.: +31-30-253-4744
| | - Yvonne A.J. Stikkelbroek
- Clinical Child and Family Studies, Utrecht University, 3508 TC Utrecht, The Netherlands; (Y.A.J.S.); (M.D.); (M.S.); (D.H.M.B.)
- Child and Adolescent Psychiatry, GGZ Oost Brabant, 5427 EM Boekel, The Netherlands;
| | | | - Heleen Riper
- Department of Clinical, Neuro- and Developmental Psychology, VU University, 1081 HV Amsterdam, The Netherlands;
- Department of Psychiatry, VU University Medical Centre, 1081 HV Amsterdam, The Netherlands
- APH Institute for Health and Care Research, VU University Medical Centre, 1081 HV Amsterdam, The Netherlands
| | - Maja Deković
- Clinical Child and Family Studies, Utrecht University, 3508 TC Utrecht, The Netherlands; (Y.A.J.S.); (M.D.); (M.S.); (D.H.M.B.)
| | - Maaike H. Nauta
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, 9712 CP Groningen, The Netherlands;
- Accare Child and Adolescent Psychiatry, Groningen University Centre, 9712 CP Groningen, The Netherlands
| | - Daan H.M. Creemers
- Child and Adolescent Psychiatry, GGZ Oost Brabant, 5427 EM Boekel, The Netherlands;
- Behavioural Science Institute, Radboud University, 6525 XZ Nijmegen, The Netherlands
| | | | - Mariken Spuij
- Clinical Child and Family Studies, Utrecht University, 3508 TC Utrecht, The Netherlands; (Y.A.J.S.); (M.D.); (M.S.); (D.H.M.B.)
- TOPP-Zorg, Driebergen-Rijsenburg, 3972 WG Driebergen-Rijsenburg, The Netherlands
| | - Denise H.M. Bodden
- Clinical Child and Family Studies, Utrecht University, 3508 TC Utrecht, The Netherlands; (Y.A.J.S.); (M.D.); (M.S.); (D.H.M.B.)
- Child and Youth Psychiatry, Altrecht, 3524 SH Utrecht, The Netherlands
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13
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MacDougall S, Jerrott S, Clark S, Campbell LA, Murphy A, Wozney L. Text Message Interventions in Adolescent Mental Health and Addiction Services: Scoping Review. JMIR Ment Health 2021; 8:e16508. [PMID: 33416504 PMCID: PMC7822725 DOI: 10.2196/16508] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 09/03/2020] [Accepted: 12/04/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The vast majority of adolescent mental health and substance use disorders go undiagnosed and undertreated. SMS text messaging is increasingly used as a method to deliver adolescent health services that promote psychological well-being and aim to protect adolescents from adverse experiences and risk factors critical for their current and future mental health. To date, there has been no comprehensive synthesis of the existing literature on the extent, range, and implementation contexts of these SMS text message interventions. OBJECTIVE The objective of this scoping review was to map and categorize gaps in the current body of peer-reviewed research around the use of SMS text messaging-based interventions for mental health and addiction services among adolescents. METHODS A scoping review was conducted according to Levac's adaptation of Arksey and O'Malley's methodological framework for scoping reviews in six iterative stages. A search strategy was cocreated and adapted for five unique databases. Studies were screened using Covidence software. The PICO (patient, intervention, comparator, outcome) framework and input from multiple stakeholder groups were used to structure and pilot a data extraction codebook. Data were extracted on study methodology and measures, intervention design, and implementation characteristics, as well as policy, practice, and research implications. RESULTS We screened 1142 abstracts. Of these, 31 articles published between 2013 and 2020 were eligible for inclusion. Intervention engagement was the most common type of outcome measured (18/31), followed by changes in cognitions (16/31; eg, disease knowledge, self-awareness) and acceptability (16/31). Interventions were typically delivered in less than 12 weeks, and adolescents received 1-3 messages per week. Bidirectional messaging was involved in 65% (20/31) of the studies. Limited descriptions of implementation features (eg, cost, policy implications, technology performance) were reported. CONCLUSIONS The use of SMS text messaging interventions is a rapidly expanding area of research. However, lack of large-scale controlled trials and theoretically driven intervention designs limits generalizability. Significant gaps in the literature were observed in relation to implementation considerations, cost, clinical workflow, bidirectionality of texting, and level of personalization and tailoring of the interventions. Given the growth of mobile phone-based interventions for this population, a rigorous program of large-scale, well-designed trials is urgently required.
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Affiliation(s)
| | | | | | - Leslie Anne Campbell
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Andrea Murphy
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada
| | - Lori Wozney
- Mental Health and Addictions, Policy and Planning, Nova Scotia Health, Dartmouth, NS, Canada
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Abstract
AbstractDepressive disorders are the most prevalent mental health disorder in adolescents with detrimental consequences; effective and available treatment is crucial. Face-to-face and computerized treatments both have advantages but also downsides. Merging these two into one so-called blended treatment seems to be an optimal combination of elements. This current review addresses blended treatment for youth depression and aims to summarize existing knowledge on effectiveness as well as patients’ and therapists’ perspectives. Results showed promising significant decreases in symptoms, but no evidence for differences between blended and face-to-face treatment was found. Patients’ perspectives were mixed; they reported strong preferences for face-to-face treatment, but participants actually receiving blended treatment were mainly positive. Therapists’ attitudes were neutral, but they expressed their worries about the unknown risks on adverse events. Future research is needed and should, beside effectiveness and cost-effectiveness, pay close attention to the risks that are mentioned by therapists.
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Bear HA, Edbrooke-Childs J, Norton S, Krause KR, Wolpert M. Systematic Review and Meta-analysis: Outcomes of Routine Specialist Mental Health Care for Young People With Depression and/or Anxiety. J Am Acad Child Adolesc Psychiatry 2020; 59:810-841. [PMID: 31881268 DOI: 10.1016/j.jaac.2019.12.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 11/30/2019] [Accepted: 12/19/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Depression and anxiety are the most prevalent mental health problems in youth, yet almost nothing is known about what outcomes are to be expected at the individual level following routine treatment. This paper sets out to address this gap by undertaking a systematic review of outcomes following treatment as usual (TAU) with a particular focus on individual-level outcomes. METHOD MEDLINE, Embase and PsycInfo were searched for articles published between 1980 and January 2019 that assessed TAU outcomes for youth depression and anxiety accessing specialist mental health care. Meta-analysis considered change at both group-level pre-post effect size (ES) and individual-level recovery, reliable change, and reliable recovery. Temporal analysis considered stability of primary and secondary outcomes over time. Subgroup analysis considered the moderating effect of informant; presenting problem; study design; study year; mean age of youth; use of medication; intervention dosage and type of treatment offered on outcomes. A protocol was preregistered on PROSPERO (CRD42017063914). RESULTS Initial screening of 6,350 publications resulted in 38 that met the inclusion criteria, and that were subsequently included in meta-analyses. This resulted in a final full pooled sample of 11,739 young people (61% of whom were female, mean age 13.8 years). The pre-post ES (Hedges' g) at first/final outcome (13/26 weeks) was -0.74/-0.87. The individual-level change on measures of self-report was 38% reliable improvement, 44% no reliable change, and 6% reliable deterioration. Outcomes varied according to moderators, informant, problem type and dosage. CONCLUSION Poor data quantity and quality are limitations, but this is the first study that indicates likely rates of reliable improvement for those accessing TAU. We propose the need for improved reporting of both individual-level metrics and details of TAU to enable greater understanding of likely current outcomes from routine care for youths with depression and anxiety in order to allow the potential for further improvement of impact.
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Affiliation(s)
- Holly Alice Bear
- University College London, UK; Anna Freud National Centre for Children and Families; The Kantor Centre of Excellence, London, UK.
| | - Julian Edbrooke-Childs
- University College London, UK; Anna Freud National Centre for Children and Families; The Kantor Centre of Excellence, London, UK; Child Outcomes Research Consortium, Brunswick Place London, UK
| | - Sam Norton
- Health Psychology Section at the Institute of Psychiatry, Psychology & Neuroscience, King's College London, Guy's Hospital Campus, London Bridge, London, UK
| | - Karolin Rose Krause
- University College London, UK; Anna Freud National Centre for Children and Families; The Kantor Centre of Excellence, London, UK
| | - Miranda Wolpert
- University College London, UK; Anna Freud National Centre for Children and Families; The Kantor Centre of Excellence, London, UK; Child Outcomes Research Consortium, Brunswick Place London, UK
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16
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Monsour A, Mew EJ, Patel S, Chee-A-Tow A, Saeed L, Santos L, Courtney DB, Watson PN, Monga S, Szatmari P, Offringa M, Butcher NJ. Primary outcome reporting in adolescent depression clinical trials needs standardization. BMC Med Res Methodol 2020; 20:129. [PMID: 32450810 PMCID: PMC7247139 DOI: 10.1186/s12874-020-01019-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/18/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Evidence-based health care is informed by results of randomized clinical trials (RCTs) and their syntheses in meta-analyses. When the trial outcomes measured are not clearly described in trial publications, knowledge synthesis, translation, and decision-making may be impeded. While heterogeneity in outcomes measured in adolescent major depressive disorder (MDD) RCTs has been described, the comprehensiveness of outcome reporting is unknown. This study aimed to assess the reporting of primary outcomes in RCTs evaluating treatments for adolescent MDD. METHODS RCTs evaluating treatment interventions in adolescents with a diagnosis of MDD published between 2008 and 2017 specifying a single primary outcome were eligible for outcome reporting assessment. Outcome reporting assessment was done independently in duplicate using a comprehensive checklist of 58 reporting items. Primary outcome information provided in each RCT publication was scored as "fully reported", "partially reported", or "not reported" for each checklist item, as applicable. RESULTS Eighteen of 42 identified articles were found to have a discernable single primary outcome and were included for outcome reporting assessment. Most trials (72%) did not fully report on over half of the 58 checklist items. Items describing masking of outcome assessors, timing and frequency of outcome assessment, and outcome analyses were fully reported in over 70% of trials. Items less frequently reported included outcome measurement instrument properties (ranging from 6 to 17%), justification of timing and frequency of outcome assessment (6%), and justification of criteria used for clinically significant differences (17%). The overall comprehensiveness of reporting appeared stable over time. CONCLUSIONS Heterogeneous reporting exists in published adolescent MDD RCTs, with frequent omissions of key details about their primary outcomes. These omissions may impair interpretability, replicability, and synthesis of RCTs that inform clinical guidelines and decision-making in this field. Consensus on the minimal criteria for outcome reporting in adolescent MDD RCTs is needed.
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Affiliation(s)
- Andrea Monsour
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9712, Toronto, Ontario, M5G 0A4, Canada
| | - Emma J Mew
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9712, Toronto, Ontario, M5G 0A4, Canada
| | - Sagar Patel
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9712, Toronto, Ontario, M5G 0A4, Canada
| | - Alyssandra Chee-A-Tow
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9712, Toronto, Ontario, M5G 0A4, Canada
| | - Leena Saeed
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9712, Toronto, Ontario, M5G 0A4, Canada
| | - Lucia Santos
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9712, Toronto, Ontario, M5G 0A4, Canada
| | - Darren B Courtney
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Priya N Watson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Suneeta Monga
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9712, Toronto, Ontario, M5G 0A4, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
- Division of Neonatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Nancy J Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9712, Toronto, Ontario, M5G 0A4, Canada
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Singh T, Reyes-Portillo JA. Using Technology to Train Clinicians in Evidence-Based Treatment: A Systematic Review. Psychiatr Serv 2020; 71:364-377. [PMID: 31960775 DOI: 10.1176/appi.ps.201900186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There is a critical shortage of clinicians trained in evidence-based treatments (EBTs). New technologies, such as Internet-based training, video conferences, and mobile applications, can increase accessibility to specialized training and enhance traditional face-to-face training. A systematic review was conducted to identify and summarize research on the use of technology to train clinicians in EBTs. METHODS An electronic database search of PsycINFO, PubMed, Medline, Web of Science, CINAHL, and the Cochrane Library was conducted in June 2018. Articles were independently coded and assessed for risk of bias by two reviewers using the National Heart, Lung, and Blood Institute's Quality Assessment Tool for Controlled Intervention Studies. RESULTS Of the 7,767 citations initially identified, 24 articles met inclusion criteria. These articles described 21 training programs, including training for anxiety, depression, substance abuse, and eating disorder treatment. Most training programs were Internet based (N=19), and a majority of studies used a randomized controlled design (N=21). Most studies reported significant increases in clinician knowledge or skills, with small to large effect sizes. The methodological quality of studies ranged from good to poor. Many programs were limited by their use of completer analyses (i.e., only those who completed study included in analyses) and self-report measures. CONCLUSIONS Technology has great potential for increasing availability of training opportunities for clinicians and increasing the workforce trained in EBTs. Although technology-assisted training programs are not without limitations, overall they promise a new era of facilitative learning that promotes the adoption of new clinical practices in a dynamic and efficient manner.
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Affiliation(s)
- Tanya Singh
- Department of Psychology, Montclair State University, Montclair, New Jersey
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Inal Y, Wake JD, Guribye F, Nordgreen T. Usability Evaluations of Mobile Mental Health Technologies: Systematic Review. J Med Internet Res 2020; 22:e15337. [PMID: 31904579 PMCID: PMC6971511 DOI: 10.2196/15337] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 12/31/2022] Open
Abstract
Background Many mobile health (mHealth) apps for mental health have been made available in recent years. Although there is reason to be optimistic about their effect on improving health and increasing access to care, there is a call for more knowledge concerning how mHealth apps are used in practice. Objective This study aimed to review the literature on how usability is being addressed and measured in mHealth interventions for mental health problems. Methods We conducted a systematic literature review through a search for peer-reviewed studies published between 2001 and 2018 in the following electronic databases: EMBASE, CINAHL, PsycINFO, PubMed, and Web of Science. Two reviewers independently assessed all abstracts against the inclusion and exclusion criteria, following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Results A total of 299 studies were initially identified based on the inclusion keywords. Following a review of the title, abstract, and full text, 42 studies were found that fulfilled the criteria, most of which evaluated usability with patients (n=29) and health care providers (n=11) as opposed to healthy users (n=8) and were directed at a wide variety of mental health problems (n=24). Half of the studies set out to evaluate usability (n=21), and the remainder focused on feasibility (n=10) or acceptability (n=10). Regarding the maturity of the evaluated systems, most were either prototypes or previously tested versions of the technology, and the studies included few accounts of sketching and participatory design processes. The most common reason referred to for developing mobile mental health apps was the availability of mobile devices to users, their popularity, and how people in general became accustomed to using them for various purposes. Conclusions This study provides a detailed account of how evidence of usability of mHealth apps is gathered in the form of usability evaluations from the perspective of computer science and human-computer interaction, including how users feature in the evaluation, how the study objectives and outcomes are stated, which research methods and techniques are used, and what the notion of mobility features is for mHealth apps. Most studies described their methods as trials, gathered data from a small sample size, and carried out a summative evaluation using a single questionnaire, which indicates that usability evaluation was not the main focus. As many studies described using an adapted version of a standard usability questionnaire, there may be a need for developing a standardized mHealth usability questionnaire.
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Affiliation(s)
- Yavuz Inal
- Department of Information Science and Media Studies, University of Bergen, Bergen, Norway
| | | | - Frode Guribye
- Department of Information Science and Media Studies, University of Bergen, Bergen, Norway
| | - Tine Nordgreen
- Psychiatric Division, Haukeland University Hospital, Bergen, Norway
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Rasing SPA, Stikkelbroek YAJ, Bodden DHM. Is Digital Treatment the Holy Grail? Literature Review on Computerized and Blended Treatment for Depressive Disorders in Youth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:E153. [PMID: 31878249 PMCID: PMC6982181 DOI: 10.3390/ijerph17010153] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 12/11/2022]
Abstract
Computerized and blended treatments seem to be an attractive treatment for adolescents as an alternative to face-to-face treatment, but mental health professionals seem hesitant to use these treatment modalities. This review provides an overview of factors contributing to and withholding from using computerized or blended treatment in routine care. Three databases were searched with terms related to (1) adolescents, (2) depression, (3) computerized or blended, and (4) treatment. Of the 33 articles identified, 10 focused on unguided computerized treatments, six on guided, two on blended, two compared unguided, blended- and face-to-face treatment to no treatment, and eight studies on games. Further, two articles that were focused on an online monitoring tool and three on intervention characteristics or preferred modes of help-seeking. Evidence for effectiveness, adherence, drop-out, and forming therapeutic relations were suspected to be barriers, but are no reason to reject computerized or blended treatment. Improvement in mental health literacy and the possibility to tailor the intervention are facilitators. However, adolescents' intention to seek help, acceptability of computerized treatment, symptom severity, time spent by therapist, and other facilities are identified as barriers and they need to be taken into account when using computerized or blended interventions. Nevertheless, computerized and blended are promising treatments for depressed youth.
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Affiliation(s)
- Sanne P. A. Rasing
- Child and Adolescent Studies, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands; (Y.A.J.S.); (D.H.M.B.)
- Child and Adolescent Psychiatry, GGZ Oost Brabant, P.O. Box 3, 5427 ZG Boekel, The Netherlands
| | - Yvonne A. J. Stikkelbroek
- Child and Adolescent Studies, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands; (Y.A.J.S.); (D.H.M.B.)
- Child and Adolescent Psychiatry, GGZ Oost Brabant, P.O. Box 3, 5427 ZG Boekel, The Netherlands
| | - Denise H. M. Bodden
- Child and Adolescent Studies, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands; (Y.A.J.S.); (D.H.M.B.)
- Developmental Psychopathology, Radboud University, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
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Senanayake B, Wickramasinghe SI, Chatfield MD, Hansen J, Edirippulige S, Smith AC. Effectiveness of text messaging interventions for the management of depression: A systematic review and meta-analysis. J Telemed Telecare 2019; 25:513-523. [DOI: 10.1177/1357633x19875852] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Depression is a leading cause of human disability. Telemedicine-based interventions using text messaging are currently being trialled for the management of community-based clients with clinical depression. However, little is known about the effectiveness of such methods. Methods We searched the databases PubMed, Embase, Informit, Cochrane Central Register of Controlled Trials, PsycINFO and Scopus for randomised controlled trials (RCTs) published between January 2000 and April 2019. Studies comparing text messaging interventions to a comparator group for patients with depression were included in the review. Articles were assessed for quality using the Joanna Briggs Institute critical appraisal checklist for RCTs. Results Nine RCTs (945 patients: 764 adults and 181 adolescents) were included in the systematic review. Five studies used text messaging as the only intervention, whilst the remaining combined text messaging with other treatment modalities such as behavioural activation or cognitive behavioural therapy. A meta-analysis was conducted on seven selected RCTs (845 patients: 664 adults and 181 adolescents). The standardised mean reduction in depression due to text messaging interventions was 0.23 (95% confidence interval: –0.02 to 0.48). There was evidence of heterogeneity in treatment effect between studies. Discussion There is marginal evidence supporting text messaging interventions as an effective treatment modality for people living with clinical depression. However, further research is needed to determine how best to utilise text-message interventions alongside other conventional forms of health services delivery.
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Affiliation(s)
| | | | - Mark D Chatfield
- Centre for Online Health, The University of Queensland, Brisbane, Australia
| | - Julie Hansen
- Herston Health Sciences Library, The University of Queensland, Brisbane, Australia
| | | | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- The University of Southern Denmark, Odense, Denmark
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21
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Martínez V, Rojas G, Martínez P, Gaete J, Zitko P, Vöhringer PA, Araya R. Computer-Assisted Cognitive-Behavioral Therapy to Treat Adolescents With Depression in Primary Health Care Centers in Santiago, Chile: A Randomized Controlled Trial. Front Psychiatry 2019; 10:552. [PMID: 31417440 PMCID: PMC6682617 DOI: 10.3389/fpsyt.2019.00552] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 07/15/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction: Evidence from developed countries shows the efficacy of computer-assisted cognitive-behavioral therapy (cCBT) in addressing adolescent depression in home and/or school settings. This paper presents the results of a randomized controlled trial (RCT) of a brief therapist-guided cCBT intervention for adolescent depression in resource-constrained primary health care (PHC) settings. Material and methods: A multicenter, two-arm parallel-group, individually RCT with a 1:1 allocation ratio assigned 216 depressed adolescents (aged 15-19) attending four PHC centers in a low-income municipality of Santiago, Chile, to receive eight weekly face-to-face therapist-guided cCBT sessions by study therapists (N = 108), or to receive an enhanced usual care (EUC) intervention by trained PHC psychologists, encouraged to adhere to the national clinical guidelines for the management of depression (N = 108). Both groups received pharmacotherapy concordant with these guidelines. The primary outcome was the Beck Depression Inventory (BDI) at 4 months post-randomization, to assess depressive symptoms. BDI at 6 months post-randomization was a secondary outcome. Additional measures included patients' compliance, and satisfaction with different treatment components, at 6 months post-randomization. Main Results: The adjusted difference in mean BDI score between groups was -3.75 (95% CI -6.23 to -1.28; p = 0.003) at 4 months post-randomization. At 6 months post-randomization, the adjusted difference in mean BDI score between groups was -2.31 (95% CI -4.89 to 0.27; p = 0.078). The effect size was small-to-medium at 4 months post-randomization, d = 0.39 (0.12 to 0.67), and small and non-significant at 6 months post-randomization d = 0.29 (-0.00 to 0.59). Adolescents in the experimental treatment group were significantly more satisfied with treatment, with the PHC centers' facilities, with the psychological care received, and with non-professional staff than those in the comparator treatment group. Discussion: A brief therapist-guided cCBT eight-session intervention improves the response of depressed adolescents attending PHC centers at 4 months post-randomization. At 6 months post-randomization, the differences of between groups were not significant. Future research may focus on exploring strategies to sustain and increase response. Clinical trial registration: www.ClinicalTrials.gov, identifier NCT01862913 and URL: https://clinicaltrials.gov/ct2/show/NCT01862913.
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Affiliation(s)
- Vania Martínez
- Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente (CEMERA), Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
| | - Graciela Rojas
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
- Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago, Chile
| | - Pablo Martínez
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
- Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago, Chile
- School of Psychology, Faculty of Humanities, Universidad de Santiago de Chile, Santiago, Chile
| | - Jorge Gaete
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile
- Department of Public Health and Epidemiology, Faculty of Medicine, Universidad de Los Andes, Santiago, Chile
| | - Pedro Zitko
- Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Unit of Healthcare Studies, Complejo Asistencial Barros Luco, Santiago, Chile
| | - Paul A. Vöhringer
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
- Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago, Chile
- Mood Disorders Program, Tufts Medical Center, Tufts University, Boston, MA, United States
| | - Ricardo Araya
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile
- Unit of Healthcare Studies, Complejo Asistencial Barros Luco, Santiago, Chile
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22
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Ranney ML, Patena JV, Dunsiger S, Spirito A, Cunningham RM, Boyer E, Nugent NR. A technology-augmented intervention to prevent peer violence and depressive symptoms among at-risk emergency department adolescents: Protocol for a randomized control trial. Contemp Clin Trials 2019; 82:106-114. [PMID: 31129373 DOI: 10.1016/j.cct.2019.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/10/2019] [Accepted: 05/22/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Peer violence and depressive symptoms are increasingly prevalent among adolescents, and for many, use the emergency department (ED) as their primary source of healthcare. Brief in-person interventions and longitudinal text-message-based interventions are feasible, acceptable, and may be effective in reducing peer violence and depressive symptoms when delivered in the ED setting. This paper presents the study design and protocol for an in-ED brief intervention (BI) and text messaging program (Text). METHODS This study will be conducted in a pediatric ED which serves over 50,000 pediatric patients per year. Recruitment of study participants began in August 2018 and anticipated to continue until October 2021. The study will enroll 800 adolescents (ages13-17) presenting to the ED for any reason who self-report past-year physical peer violence and past-two week mild-to-moderate depressive symptoms. The study will use a factorial randomized trial to test both overall intervention efficacy and determine the optimal combination of intervention components. A full 2 × 2 factorial design randomizes patients at baseline to 1) BI or no BI; and 2) Text or no Text. Peer violence and depressive symptoms improvements will be measured at 2, 4, and 8 months through self-report and medical record review. DISCUSSION This study has important implications for the progress of the greater field of mobile health interventions, as well as for adolescent violence and depression prevention in general. This proposal has high clinical and public health significance with high potential scalability, acceptability, and impact.
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Affiliation(s)
- Megan L Ranney
- Department of Emergency Medicine, Alpert Medical School of Brown University, 55 Claverick Street 2nd Floor, Providence, RI 02903, United States; Rhode Island Hospital, Department of Emergency Medicine, 593 Eddy Street, Providence, RI 02903, United States.
| | - John V Patena
- Rhode Island Hospital, Department of Emergency Medicine, 593 Eddy Street, Providence, RI 02903, United States.
| | - Shira Dunsiger
- Department of Behavioral and Social Sciences, Brown University, Box G-5121-4, Providence, RI 02912, United States.
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Brown University, 700 Butler Drive, Providence, RI 02906, United States.
| | - Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States; University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States.
| | - Edward Boyer
- Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States.
| | - Nicole R Nugent
- Department of Psychiatry and Human Behavior, Brown University, 700 Butler Drive, Providence, RI 02906, United States.
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23
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Ralston AL, Andrews AR, Hope DA. Fulfilling the promise of mental health technology to reduce public health disparities: Review and research agenda. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/cpsp.12277] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Søgaard Neilsen A, Wilson RL. Combining e-mental health intervention development with human computer interaction (HCI) design to enhance technology-facilitated recovery for people with depression and/or anxiety conditions: An integrative literature review. Int J Ment Health Nurs 2019; 28:22-39. [PMID: 30133096 DOI: 10.1111/inm.12527] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2018] [Indexed: 01/20/2023]
Abstract
Computer scientists contend that understanding human computer interaction (HCI) is an important factor in developing successful computer user experiences. Mental health professionals across a range of disciplines are increasingly developing and implementing Internet-based treatments for people with a variety of mental health conditions. Many therapeutic and economic benefits are associated with technology-enabled treatments for a range of mental health disorders. Despite this, the role of HCI and associated design elements remains poorly understood in regard to the impact on patient safety, effectiveness, and to adherence of treatment for computer users who engage with e-mental health interventions. An integrative literature review was conducted to investigate how adequately HCI and user-centred design is incorporated in the development of e-mental health interventions for depression and anxiety, and subsequently reported in literature to inform evidence-based practice. The PRISMA model was used to locate, select, and include 30 relevant articles. The main finding of this review is that Internet-based e-mental health interventions are routinely implemented without sufficiently describing the relevant HCI design features applied. This is a limitation that in turn jeopardizes the assessment validity of e-mental interventions generally, leaving those who administer the interventions with incomplete evidence to support the safe, reliable, dependable, credible, and trustworthy implementation of the interventions. The recommendation arising from this review is that human computer interaction should be carefully considered when mental health nurses and other practitioners adopt e-mental health interventions for therapeutic purposes to assure the quality and safety of e-mental health interventions on offer to patients.
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Affiliation(s)
| | - Rhonda L Wilson
- E Mental Health, Clinical Institute of Research, University of Southern Denmark, Odense, Denmark
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25
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Wozney L, McGrath PJ, Gehring ND, Bennett K, Huguet A, Hartling L, Dyson MP, Soleimani A, Newton AS. eMental Healthcare Technologies for Anxiety and Depression in Childhood and Adolescence: Systematic Review of Studies Reporting Implementation Outcomes. JMIR Ment Health 2018; 5:e48. [PMID: 29945858 PMCID: PMC6039769 DOI: 10.2196/mental.9655] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 04/15/2018] [Accepted: 05/19/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anxiety disorders and depression are frequent conditions in childhood and adolescence. eMental healthcare technologies may improve access to services, but their uptake within health systems is limited. OBJECTIVE The objective of this review was to examine and describe how the implementation of eMental healthcare technologies for anxiety disorders and depression in children and adolescents has been studied. METHODS We conducted a search of 5 electronic databases and gray literature. Eligible studies were those that assessed an eMental healthcare technology for treating or preventing anxiety or depression, included children or adolescents (<18 years), or their parents or healthcare providers and reported findings on technology implementation. The methodological quality of studies was evaluated using the Mixed Methods Appraisal Tool. Outcomes of interest were based on 8 implementation outcomes: acceptability (satisfaction with a technology), adoption (technology uptake and utilization), appropriateness ("fitness for purpose"), cost (financial impact of technology implementation), feasibility (extent to which a technology was successfully used), fidelity (implementation as intended), penetration ("spread" or "reach" of the technology), and sustainability (maintenance or integration of a technology within a healthcare service). For extracted implementation outcome data, we coded favorable ratings on measurement scales as "positive results" and unfavorable ratings on measurement scales as "negative results." Those studies that reported both positive and negative findings were coded as having "mixed results." RESULTS A total of 46 studies met the inclusion criteria, the majority of which were rated as very good to excellent in methodological quality. These studies investigated eMental healthcare technologies for anxiety (n=23), depression (n=18), or both anxiety and depression (n=5). Studies of technologies for anxiety evaluated the following: (1) acceptability (78%) reported high levels of satisfaction, (2) adoption (43%) commonly reported positive results, and (3) feasibility (43%) reported mixed results. Studies of technologies for depression evaluated the following: (1) appropriateness (56%) reported moderate helpfulness and (2) acceptability (50%) described a mix of both positive and negative findings. Studies of technologies designed to aid anxiety and depression commonly reported mixed experiences with acceptability and adoption and positive findings for appropriateness of the technologies for treatment. Across all studies, cost, fidelity, and penetration and sustainability were the least measured implementation outcomes. CONCLUSIONS Acceptability of eMental healthcare technology is high among users and is the most commonly investigated implementation outcome. Perceptions of the appropriateness and adoption of eMental healthcare technology were varied. Implementation research that identifies, evaluates, and reports on costs, sustainability, and fidelity to clinical guidelines is crucial for making high-quality eMental healthcare available to children and adolescents.
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Affiliation(s)
- Lori Wozney
- Izaak Walton Killam Centre, Centre for Research in Family Health, Halifax, NS, Canada
| | | | - Nicole D Gehring
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kathryn Bennett
- Offord Centre for Child Studies, Department of Health Research Methods, Evidence and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University, Hamilton, ON, Canada
| | - Anna Huguet
- Izaak Walton Killam Centre, Centre for Research in Family Health, Halifax, NS, Canada.,Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Lisa Hartling
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Michele P Dyson
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Amir Soleimani
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Amanda S Newton
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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26
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Hill C, Creswell C, Vigerland S, Nauta MH, March S, Donovan C, Wolters L, Spence SH, Martin JL, Wozney L, McLellan L, Kreuze L, Gould K, Jolstedt M, Nord M, Hudson JL, Utens E, Ruwaard J, Albers C, Khanna M, Albano AM, Serlachius E, Hrastinski S, Kendall PC. Navigating the development and dissemination of internet cognitive behavioral therapy (iCBT) for anxiety disorders in children and young people: A consensus statement with recommendations from the #iCBTLorentz Workshop Group. Internet Interv 2018; 12:1-10. [PMID: 30135763 PMCID: PMC6096322 DOI: 10.1016/j.invent.2018.02.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 12/21/2022] Open
Abstract
Initial internet-based cognitive behavioral therapy (iCBT) programs for anxiety disorders in children and young people (CYP) have been developed and evaluated, however these have not yet been widely adopted in routine practice. The lack of guidance and formalized approaches to the development and dissemination of iCBT has arguably contributed to the difficulty in developing iCBT that is scalable and sustainable beyond academic evaluation and that can ultimately be adopted by healthcare providers. This paper presents a consensus statement and recommendations from a workshop of international experts in CYP anxiety and iCBT (#iCBTLorentz Workshop Group) on the development, evaluation, engagement and dissemination of iCBT for anxiety in CYP.
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Affiliation(s)
- Claire Hill
- School of Psychology & Clinical Language Sciences, University of Reading, UK
| | - Cathy Creswell
- School of Psychology & Clinical Language Sciences, University of Reading, UK
| | - Sarah Vigerland
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
- Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Maaike H. Nauta
- Clinical Psychology and Experimental Psychopathology, University of Groningen, The Netherlands
| | - Sonja March
- School of Psychology and Counselling & Institute for Resilient Regions, University of Southern Queensland, Australia
| | | | - Lidewij Wolters
- Norwegian University of Science and Technology (NTNU), Faculty of Medicine, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Trondheim, Norway
- Academic Center for Child and Adolescent Psychiatry, de Bascule, Amsterdam, The Netherlands
| | - Susan H. Spence
- Australian Institute of Suicide Research and Prevention and School of Applied Psychology, Griffith University, Australia
| | - Jennifer L. Martin
- NIHR MindTech Cooperative, Faculty of Medicine & Health Sciences, University of Nottingham, UK
| | - Lori Wozney
- Centre for Research in Family Health, IWK Health Centre, Halifax, Canada
| | - Lauren McLellan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Australia
| | - Leonie Kreuze
- Clinical Psychology and Experimental Psychopathology, University of Groningen, The Netherlands
| | - Karen Gould
- Centre for Emotional Health, Department of Psychology, Macquarie University, Australia
| | - Maral Jolstedt
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
- Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Martina Nord
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
- Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Jennifer L. Hudson
- Centre for Emotional Health, Department of Psychology, Macquarie University, Australia
| | - Elisabeth Utens
- Academic Center for Child and Adolescent Psychiatry, de Bascule, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, The Netherlands
| | - Jeroen Ruwaard
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Casper Albers
- Department of Psychometrics & Statistics, University of Groningen, The Netherlands
| | - Muniya Khanna
- OCD & Anxiety Institute, Plymouth Meeting, PA, USA
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Eva Serlachius
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
- Stockholm Health Care Services, Stockholm County Council, Sweden
| | | | - Philip C. Kendall
- Child & Adolescent Anxiety Disorders Clinic, Temple University, Philadelphia, PA, USA
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27
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Wozney L, Huguet A, Bennett K, Radomski AD, Hartling L, Dyson M, McGrath PJ, Newton AS. How do eHealth Programs for Adolescents With Depression Work? A Realist Review of Persuasive System Design Components in Internet-Based Psychological Therapies. J Med Internet Res 2017; 19:e266. [PMID: 28793983 PMCID: PMC5569246 DOI: 10.2196/jmir.7573] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/05/2017] [Accepted: 06/30/2017] [Indexed: 11/21/2022] Open
Abstract
Background Major depressive disorders are common among adolescents and can impact all aspects of their daily life. Traditional therapies, cognitive behavioral therapy (CBT), and interpersonal psychotherapy (IPT) have been delivered face-to-face. However, Internet-based (online) delivery of these therapies is emerging as an option for adolescents. Internet-based CBT and IPT involve therapeutic content, interaction between the user and the system, and different technological features embedded into the online program (eg, multimedia). Studies of Internet-based CBT and IPT for adolescent depression differ on all three aspects, and variable, positive therapy effects have been reported. A better understanding of the treatment conditions that influence therapy outcomes is important to designing and evaluating these novel therapies. Objective Our aim was to examine the technological and program delivery features of Internet-based CBT and IPT for adolescent depression and to document their potential relation to treatment outcomes and program use. Methods We performed a realist synthesis. We started with an extensive search of published and gray literature. We included intervention studies that evaluated Internet-based CBT or IPT for adolescent depression. We included mixed-methods and qualitative studies, theoretical papers, and policy/implementation documents if they included a focus on how Internet-based psychological therapy is proposed to work for adolescents with depression/depressive symptoms. We used the Mixed-Methods Appraisal Tool to assess the methodological quality of studies. We used the Persuasive System Design (PSD) model as a framework for data extraction and analysis to examine how Internet-based CBT and IPT, as technology-based systems, influence the attitudes and behaviors of system users. PSD components described for the therapies were linked to reported outcomes using a cross-case comparison method and thematic synthesis. Results We identified 19 Internet-based CBT programs in 59 documents. Of those, 71% (42/59) were of moderate to high quality. The PSD features surface credibility (competent “look and feel”), dialogue support (online program + in-person support), liking and similarity (esthetics and content appeal to adolescent users), the reduction and tunneling of therapeutic content (reducing online content into simple tasks, guiding users), and use of self-monitoring were present in therapies that resulted in improved therapy engagement, satisfaction, and adherence, as well as symptom and functional impairments. Conclusions When incorporated into Internet-based CBT for adolescent depression, PSD features may improve adolescent adherence, satisfaction, and depression-related outcomes. Testing of these features using hypothesis-driven dismantling approaches is recommended to advance our understanding of how these features contribute to therapy effectiveness.
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Affiliation(s)
- Lori Wozney
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada
| | - Anna Huguet
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada
| | - Kathryn Bennett
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Ashley D Radomski
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Lisa Hartling
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Michele Dyson
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Patrick J McGrath
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada
| | - Amanda S Newton
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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28
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Agyapong VIO, Juhás M, Ohinmaa A, Omeje J, Mrklas K, Suen VYM, Dursun SM, Greenshaw AJ. Randomized controlled pilot trial of supportive text messages for patients with depression. BMC Psychiatry 2017; 17:286. [PMID: 28768493 PMCID: PMC5541655 DOI: 10.1186/s12888-017-1448-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 07/28/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Depression is projected to be the primary cause of disability worldwide by 2030. In a recent survey, the most commonly cited unmet need among 42.4% of depressed Albertans was the lack of sufficient, accessible, and affordable counselling. Our aim was to test the efficacy of a supportive text messaging mobile health intervention in improving treatment outcomes in depressed patients. METHODS We performed a single-rater-blinded randomized trial involving 73 patients with Major Depressive Disorder. Patients in the intervention group (n = 35) received twice-daily supportive text messages for 3 months while those in the control group (n = 38) received a single text message every fortnight thanking them for participating in the study. The primary outcome of this study was: "Mean changes in the BDI scores from baseline". RESULTS After adjusting for baseline BDI scores, a significant difference remained in the 3 month mean BDI scores between the intervention and control groups: (20.8 (SD = 11.7) vs. 24.9 (SD = 11.5), F (1, 60) = 4.83, p = 0.03, ηp2 = 0.07). The mean difference in the BDI scores change was significant with an effect size (Cohen's d) of 0.67. Furthermore, after adjusting for baseline scores, a significant difference remained in the 3 month mean self-rated VAS scores (EQ-5D-5 L scale) between the intervention and control groups, 65.7 (SD = 15.3) vs. 57.4 (SD = 22.9), F (1, 60) =4.16, p = 0.05, ηp2 = 0.065. The mean difference in change mean self-rated VAS scores was also statistically significant with an effect size (Cohen's d) of 0.51. CONCLUSIONS Our findings suggest that supportive text messages are a potentially useful psychological intervention for depression, especially in underserved populations. Further studies are needed to explore the implications of our findings in larger clinical samples. TRIAL REGISTRATION ClinicalTrials.gov NCT02327858 . Registered 24 December 2014.
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Affiliation(s)
- Vincent I. O. Agyapong
- grid.17089.37Faculty of Health Sciences, Department of Psychiatry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, Edmonton, AB T6G 2B7 Canada
| | - Michal Juhás
- grid.17089.37Faculty of Health Sciences, Department of Psychiatry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, Edmonton, AB T6G 2B7 Canada
| | - Arto Ohinmaa
- grid.17089.37Institute of Health Economics and School of Public Health, University of Alberta, Edmonton, AB Canada
| | - Joy Omeje
- 0000 0001 0693 8815grid.413574.0Department of Public Health, Alberta Health Services, Fort Mc Murray, AB Canada
| | - Kelly Mrklas
- 0000 0001 0693 8815grid.413574.0Research Priorities and Implementation, Research Innovation and Analytics, Alberta Health Services, Calgary, AB Canada
| | - Victoria Y. M. Suen
- 0000 0001 0693 8815grid.413574.0Addiction and Mental Health Strategic Clinical Network, Alberta Health Services, Edmonton, AB Canada
| | - Serdar M. Dursun
- grid.17089.37Faculty of Health Sciences, Department of Psychiatry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, Edmonton, AB T6G 2B7 Canada
| | - Andrew J. Greenshaw
- grid.17089.37Faculty of Health Sciences, Department of Psychiatry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, Edmonton, AB T6G 2B7 Canada
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29
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Kobak KA, Lipsitz JD, Markowitz JC, Bleiberg KL. Web-Based Therapist Training in Interpersonal Psychotherapy for Depression: Pilot Study. J Med Internet Res 2017; 19:e257. [PMID: 28716769 PMCID: PMC5537562 DOI: 10.2196/jmir.7966] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/04/2017] [Accepted: 06/05/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Training mental health professionals to deliver evidence-based therapy (EBT) is now required by most academic accreditation bodies, and evaluating the effectiveness of such training is imperative. However, shortages of time, money, and trained EBT clinician teachers make these challenges daunting. New technologies may help. The authors have developed the first empirically evaluated comprehensive Internet therapist training program for interpersonal psychotherapy (IPT). OBJECTIVE The aim of this study was to examine whether (1) the training protocol would increase clinicians' knowledge of IPT concepts and skills and (2) clinicians would deem the training feasible as measured by satisfaction and utility ratings. METHODS A total of 26 clinicians enrolled in the training, consisting of (1) a Web-based tutorial on IPT concepts and techniques; (2) live remote training via videoconference, with trainees practicing IPT techniques in a role-play using a case vignette; and (3) a Web-based portal for therapists posttraining use to help facilitate implementation of IPT and maintain adherence over time. RESULTS Trainees' knowledge of IPT concepts and skills improved significantly (P<.001). The standardized effect size for the change was large: d=2.53, 95% CI 2.23-2.92. Users found the technical features easy to use, the content useful for helping them treat depressed clients, and felt the applied training component enhanced their professional expertise. Mean rating of applied learning was 3.9 (scale range from 1=very little to 5=a great deal). Overall satisfaction rating was 3.5 (range from 1=very dissatisfied to 4=very satisfied). CONCLUSIONS Results support the efficacy and feasibility of this technology in training clinicians in EBTs and warrant further empirical evaluation.
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Affiliation(s)
| | - Joshua D Lipsitz
- Department of Psychology, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - John C Markowitz
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University College of Physicians & Surgeons, New York, NY, United States
| | - Kathryn L Bleiberg
- Weill Cornell Medicine, Department of Psychiatry, New York, NY, United States
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Rith-Najarian LR, Park AL, Wang T, Etchison AI, Chavira DA, Chorpita BF. Applying new evidence standards to youth cognitive behavioral therapies - A review. Behav Res Ther 2017; 90:147-158. [PMID: 28061375 DOI: 10.1016/j.brat.2016.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 11/11/2016] [Accepted: 12/16/2016] [Indexed: 12/19/2022]
Abstract
This review included 136 published randomized controlled trials (RCTs) of youth cognitive behavioral therapy (CBT) treatments. We aimed to test the premise that evidence-based youth treatments can be better differentiated from each other by applying more nuanced standards of evidence. Accordingly, we applied three standards to this article sample to determine how many treatments produced significant results: (a) on multiple target symptom measures, (b) at follow-up, and/or (c) against an active comparison group. We identified how many trials met standards individually and in combination. Although 87 of the 136 articles produced at least one significant treatment result at post-assessment, the subsets of "passing" articles were smaller and varied for any one of our three standards, with only 11 articles (8%) meeting all three standards simultaneously. Implications are discussed regarding the definition of "evidence-based," the need for multi-parameter filtering in treatment selection and clinical decision making, and future directions for research. We ultimately argue the value in assessing youth treatments for different types of evidence, which is better achieved through dynamic sets of standards, rather than a single approach to assessing general strength of evidence.
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Affiliation(s)
- Leslie R Rith-Najarian
- Department of Psychology, University of California, Los Angeles 1285 Franz Hall, Los Angeles, CA, 90095, USA.
| | - Alayna L Park
- Department of Psychology, University of California, Los Angeles 1285 Franz Hall, Los Angeles, CA, 90095, USA
| | - Tina Wang
- Department of Psychology, University of California, Los Angeles 1285 Franz Hall, Los Angeles, CA, 90095, USA
| | - Ana I Etchison
- Department of Psychology, University of California, Los Angeles 1285 Franz Hall, Los Angeles, CA, 90095, USA
| | - Denise A Chavira
- Department of Psychology, University of California, Los Angeles 1285 Franz Hall, Los Angeles, CA, 90095, USA
| | - Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles 1285 Franz Hall, Los Angeles, CA, 90095, USA
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Archangeli C, Marti FA, Wobga-Pasiah EA, Zima B. Mobile Health Interventions for Psychiatric Conditions in Children: A Scoping Review. Child Adolesc Psychiatr Clin N Am 2017; 26:13-31. [PMID: 27837939 DOI: 10.1016/j.chc.2016.07.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A scoping review was performed to determine what evidence exists to support the clinical use of mobile health (mHealth) interventions to address child psychiatric disorders. The review focused on children less than 18 years old who were diagnosed with a mental disorder, used an mHealth intervention, and included novel outcome data. Each study assessed feasibility of the intervention and concluded that the interventions were accepted and/or liked by patients. Of the 2 studies that examined effectiveness using a randomized controlled trial design, there were no statistically significant differences in clinical outcomes, but results were limited by small sample size.
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Affiliation(s)
- Christopher Archangeli
- Department of Psychiatry, University of Vermont, 1 South Prospect Street, Burlington, VT 05401, USA.
| | - F Alethea Marti
- UCLA Center for Health Services and Society, 10920 Wilshire Boulevard, Suite 300, Los Angeles, CA 90024, USA
| | - Emilia Antonievna Wobga-Pasiah
- University of Arkansas for Medical Sciences, Northwest Family Medicine Residency, 1125 North College Avenue, Fayetteville, AR 72701, USA
| | - Bonnie Zima
- Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine, UCLA Center for Health Services and Society, 10920 Wilshire Boulevard, Suite 300, Los Angeles, CA 90024, USA
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Ranney ML, Freeman JR, Connell G, Spirito A, Boyer E, Walton M, Guthrie K, Cunningham RM. A Depression Prevention Intervention for Adolescents in the Emergency Department. J Adolesc Health 2016; 59:401-10. [PMID: 27267141 PMCID: PMC5035565 DOI: 10.1016/j.jadohealth.2016.04.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/06/2016] [Accepted: 04/06/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate acceptability and feasibility of a theoretically based two-part (brief in-person + 8-week automated text message) depression prevention program, "intervention for DepressiOn and Violence prevention in the Emergency department" (iDOVE), for high-risk adolescents. METHODS English-speaking emergency department (ED) patients (age 13-17, any chief complaint) were sequentially approached for consent on a convenience sample of shifts and screened for inclusion based on current depressive symptoms and past-year violence. After consent, baseline assessments were obtained; all participants were enrolled in the two-part intervention (brief in-ED + 8-week two-way text messaging). At 8 weeks, quantitative and qualitative follow-up assessments were obtained. Measures included feasibility, acceptability, and preliminary data on efficacy. Qualitative data were transcribed verbatim, double coded, and interpreted using thematic analysis. Quantitative results were analyzed descriptively and with paired t tests. RESULTS As planned, 16 participants (eight each gender) were recruited (75% of those who were eligible; 66% nonwhite, 63% low income, mean age 15.4). The intervention had high feasibility and acceptability: 93.8% completed 8-week follow-up; 80% of daily text messages received responses; 31% of participants requested ≥1 "on-demand" text message. In-person and text message portions were rated as good/excellent by 87%. Qualitatively, participants articulated: (1) iDOVE was welcome and helpful, if unexpected in the ED; (2) the daily text message mood assessment was "most important"; (3) content was "uplifting"; and (4) balancing intervention "relatability" and automation was challenging. Participants' mean ΔBDI-2 (Beck Depression Inventory) from baseline to 8-week follow-up was -4.9, (p = .02). CONCLUSIONS This automated preventive text message intervention is acceptable and feasible. Qualitative data emphasize the importance of creating positive, relevant, and interactive digital health tools for adolescents.
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Affiliation(s)
- Megan L. Ranney
- Emergency Digital Health Innovation program, Department of Emergency Medicine, Alpert Medical School, Brown University; 593 Eddy St, Claverick 2, Providence, RI 02903, USA.
| | - Joshua R. Freeman
- Emergency Digital Health Innovation program, Department of Emergency Medicine, Alpert Medical School, Brown University; 593 Eddy St, Claverick 2, Providence, RI 02903, USA.
| | - Gerianne Connell
- Emergency Digital Health Innovation program, Department of Emergency Medicine, Alpert Medical School, Brown University; 593 Eddy St, Claverick 2, Providence, RI 02903, USA.
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA. ;
| | - Edward Boyer
- Department of Emergency Medicine, University of Massachusetts Worcester, 55 Lake Avenue, North Worcester, MA 01655, USA.
| | - Maureen Walton
- Injury Control Research Center, Department of Emergency Medicine, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI 48109-2800, USA. ; ;
| | - Kate Guthrie
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA. ;
| | - Rebecca M. Cunningham
- Injury Control Research Center, Department of Emergency Medicine, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI 48109-2800, USA. ; ;
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Kobak KA, Mundt JC, Kennard B. Erratum to: Integrating technology into cognitive behavior therapy for adolescent depression: a pilot study. Ann Gen Psychiatry 2016; 15:2. [PMID: 26779277 PMCID: PMC4714435 DOI: 10.1186/s12991-015-0089-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 12/11/2015] [Indexed: 12/19/2022] Open
Abstract
[This corrects the article DOI: 10.1186/s12991-015-0077-8.].
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Affiliation(s)
- Kenneth A Kobak
- Center for Telepsychology, 22 North Harwood, Madison, WI 53717 USA
| | - James C Mundt
- Center for Telepsychology, 22 North Harwood, Madison, WI 53717 USA
| | - Betsy Kennard
- UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390 USA
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