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Watkins ER, Phillips D, Cranston T, Choueiri H, Newton M, Cook H, Taylor G. A randomized controlled trial of a self-guided mobile app targeting repetitive negative thought to prevent depression in university students: study protocol of the Nurture-U Reducing Worry prevention trial. BMC Psychiatry 2024; 24:649. [PMID: 39358704 PMCID: PMC11445847 DOI: 10.1186/s12888-024-06079-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 09/12/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Tackling poor mental health in university students has been identified as a priority in higher education. However, there are few evidence-based prevention initiatives designed for students. Repetitive Negative Thought (RNT, e.g. worry, rumination) is elevated in university students and is a well-established vulnerability factor for anxiety and depression. Furthermore, there are now evidence-based cognitive-behavioural interventions to tackle RNT. A mobile self-help cognitive-behavioural app targeting RNT, adapted for students may therefore be an effective, scalable, and acceptable way to improve prevention in students. METHODS An online single blind, two-arm parallel-group Randomised Controlled Trial (RCT) to examine the incidence of major depression and symptoms of anxiety and depression across 12 months in university students aged over 16 who screen into the study with self-reported high levels of worry and/or rumination and no current diagnosis of major depression. Eligible participants will be randomised to the active intervention arm (usual practice plus using a self-guided mobile app targeting RNT) or to the control arm (usual practice). In total, 648 participants aged over 16, with no current major depression, bipolar disorder or psychosis will be recruited from UK universities. Assessments will take place at baseline (pre-randomisation), 3 months and 12 months post- randomisation. Primary endpoint and outcome is incidence of major depression as determined by self-reported diagnostic criteria at 12-month follow-up. Depressive symptoms, anxiety, well-being, health-related quality of life, functioning and academic outcomes are secondary outcomes. Compliance, adverse events, and potentially mediating variables will be carefully monitored. DISCUSSION The trial aims to provide a better understanding of the causal role of tackling RNT (worry, rumination) using a self-help mobile app with respect to preventing depression in university students. This knowledge will be used to develop and disseminate innovative evidence-based, feasible, and effective mobile-health public health strategies for preventing common mental health problems. TRIAL REGISTRATION https://www.isrctn.com/ISRCTN86795807 Date of registration: 27 October 2022.
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Affiliation(s)
- E R Watkins
- Sir Henry Wellcome Building for Mood Disorders Research, School of Psychology, University of Exeter, Exeter, EX4 4LN, UK.
| | - D Phillips
- Clinical Trials Unit, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - T Cranston
- Clinical Trials Unit, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - H Choueiri
- Sir Henry Wellcome Building for Mood Disorders Research, School of Psychology, University of Exeter, Exeter, EX4 4LN, UK
| | - M Newton
- Sir Henry Wellcome Building for Mood Disorders Research, School of Psychology, University of Exeter, Exeter, EX4 4LN, UK
| | - H Cook
- Clinical Trials Unit, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - G Taylor
- Clinical Trials Unit, University of Exeter Medical School, University of Exeter, Exeter, UK
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Szota K, van der Meer AS, Bourdeau T, Chorpita BF, Chavanon ML, Christiansen H. Pilot study of implementing Managing and Adapting Practice in a German psychotherapy master's program. Sci Rep 2024; 14:16466. [PMID: 39014099 PMCID: PMC11252301 DOI: 10.1038/s41598-024-67407-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 07/10/2024] [Indexed: 07/18/2024] Open
Abstract
Despite a significant accumulation of research, there has been little systemic implementation of evidence-based practices (EBP) in youth mental health care. The fragmentation of the evidence base complicates implementation efforts. In light of this challenge, we sought to pilot a system that consolidates and coordinates the entire evidence base in a single direct service model (i.e., Managing and Adapting Practice; MAP) in the context of a legal reform of psychotherapy training in Germany. This pilot study aimed to evaluate the feasibility of the implementation of MAP into the curriculum of the reformed German master's program. Eligible participants were students in the master's program at Philipps-University Marburg during the winter-term 2022/2023. Students first learned about MAP through introductions and role plays (seminar 1), followed by actively planning and conducting interventions using MAP resources for patients in a case seminar under supervision (seminar 2). A repeated-measures survey was conducted to investigate students' knowledge gains, perception of MAP and changes in their self-rated confidence to use EBP. Results indicated that students perceive MAP to be manageable to learn. Positive progress was achieved with regard to their knowledge and self-reported confidence to use EBP, although interpretation and generalization of the results are limited by small and homogeneous samples, lack of statistical power and missing comparison groups. The feasibility of the implementation and suitability of measures are discussed. Important implications could be drawn with regard to future investigations.
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Affiliation(s)
- Katharina Szota
- Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, 35032, Marburg, Germany.
- Department of Psychology, Goethe-University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt am Main, Germany.
| | - Anna S van der Meer
- Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, 35032, Marburg, Germany
| | - Teri Bourdeau
- PracticeWise, PO Box 372657, Satellite Beach, FL, 32937, USA
| | - Bruce F Chorpita
- UCLA Department of Psychology, 1285 Franz Hall, Los Angeles, CA, 90095, USA
| | - Mira-Lynn Chavanon
- Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, 35032, Marburg, Germany
| | - Hanna Christiansen
- Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, 35032, Marburg, Germany
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Thielecke J, Buntrock C, Titzler I, Braun L, Freund J, Berking M, Baumeister H, Ebert DD. Telephone coaching for the prevention of depression in farmers: Results from a pragmatic randomized controlled trial. J Telemed Telecare 2024; 30:918-930. [PMID: 35695234 DOI: 10.1177/1357633x221106027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Farmers have a high risk for depression (MDD). Preventive measures targeting this often remotely living population might reduce depression burden. The study aimed to evaluate the effectiveness of personalized telephone coaching in reducing depressive symptom severity and preventing MDD in farmers compared to enhanced treatment as usual (TAU + ). METHODS In a two-armed, pragmatic randomized controlled trial (N = 314) with post-treatment at 6 months, farming entrepreneurs, collaborating family members and pensioners with elevated depressive symptoms (PHQ-9 ≥ 5) were randomized to personalized telephone coaching or TAU + . The coaching was provided by psychologists and consists on average of 13 (±7) sessions a 48 min (±15) over 6 months. The primary outcome was depressive symptom severity (QIDS-SR16). RESULTS Coaching participants showed a significantly greater reduction in depressive symptom severity compared to TAU + (d = 0.39). Whereas reliable symptom deterioration was significantly lower in the intervention group compared to TAU + , no significant group differences were found for reliable improvement and in depression onset. Further significant effects in favor of the intervention group were found for stress (d = 0.34), anxiety (d = 0.30), somatic symptoms (d = 0.39), burnout risk (d = 0.24-0.40) and quality of life (d = 0.28). DISCUSSION Limiting, we did not apply an upper cutoff score for depressive symptom severity or controlled for previous MDD episodes, leaving open whether the coaching was recurrence/relapse prevention or early treatment. Nevertheless, personalized telephone coaching can effectively improve mental health in farmers. It could play an important role in intervening at an early stage of mental health problems and reducing disease burden related to MDD. TRIAL REGISTRATION NUMBER AND TRIAL REGISTER German Clinical Trial Registration: DRKS00015655.
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Affiliation(s)
- Janika Thielecke
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Professorship of Psychology and Digital Mental Health Care, Technical University of Munich, Munich, Germany
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ingrid Titzler
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Lina Braun
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Johanna Freund
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Professorship of Psychology and Digital Mental Health Care, Technical University of Munich, Munich, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - David D Ebert
- Professorship of Psychology and Digital Mental Health Care, Technical University of Munich, Munich, Germany
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Sahle BW, Reavley NJ, Morgan AJ, Yap MBH, Reupert A, Jorm AF. How much do adverse childhood experiences contribute to adolescent anxiety and depression symptoms? Evidence from the longitudinal study of Australian children. BMC Psychiatry 2024; 24:289. [PMID: 38632617 PMCID: PMC11022337 DOI: 10.1186/s12888-024-05752-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
This study aims to: (i) examine the association between adverse childhood experiences (ACEs) and elevated anxiety and depressive symptoms in adolescents; and (ii) estimate the burden of anxiety and depressive symptoms attributable to ACEs.Data were analyzed from 3089 children followed between Waves 1 (age 4-5 years) and 7 (16-17 years) of the Longitudinal Study of Australian Children. Logistic regression was used to estimate the associations between ACEs and child-reported elevated anxiety and depressive symptoms at age 16-17. Anxiety and depressive symptoms were measured using the Children's Anxiety Scale and Short Mood and Feelings Questionnaire, respectively. The punaf command available in STATA 14 was used to calculate the population attributable fraction (PAF).Before the age of 18 years, 68.8% of the children had experienced two or more ACEs. In the analysis adjusted for confounding factors, including co-occurring ACEs, both history and current exposure to bullying victimisation and parental psychological distress were associated with a statistically significant increased likelihood of elevated anxiety and depressive symptoms at age 16-17. Overall, 47% of anxiety symptoms (95% CI for PAF: 35-56) and 21% of depressive symptoms (95% CI: 12-29) were attributable to a history of bullying victimisation. Similarly, 17% (95% CI: 11-25%) of anxiety and 15% (95% CI: 4-25%) of depressive symptoms at age 16-17 years were attributable to parental psychological distress experienced between the ages of 4-15 years.The findings demonstrate that intervention to reduce ACEs, especially parental psychological distress and bullying victimisation, may reduce the substantial burden of mental disorders in the population.
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Affiliation(s)
- Berhe W Sahle
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Melbourne, VIC, 3010, Australia.
| | - Nicola J Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Melbourne, VIC, 3010, Australia
| | - Amy J Morgan
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Melbourne, VIC, 3010, Australia
| | - Marie Bee Hui Yap
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Melbourne, VIC, 3010, Australia
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Andrea Reupert
- Faculty of Education, Monash University, Melbourne, VIC, Australia
| | - Anthony F Jorm
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Melbourne, VIC, 3010, Australia
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O'Sullivan S, McEnery C, Cagliarini D, Hinton JDX, Valentine L, Nicholas J, Chen NA, Castagnini E, Lester J, Kanellopoulos E, D'Alfonso S, Gleeson JF, Alvarez-Jimenez M. A Novel Blended Transdiagnostic Intervention (eOrygen) for Youth Psychosis and Borderline Personality Disorder: Uncontrolled Single-Group Pilot Study. JMIR Ment Health 2024; 11:e49217. [PMID: 38557432 PMCID: PMC11019426 DOI: 10.2196/49217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 12/05/2023] [Accepted: 01/12/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Integrating innovative digital mental health interventions within specialist services is a promising strategy to address the shortcomings of both face-to-face and web-based mental health services. However, despite young people's preferences and calls for integration of these services, current mental health services rarely offer blended models of care. OBJECTIVE This pilot study tested an integrated digital and face-to-face transdiagnostic intervention (eOrygen) as a blended model of care for youth psychosis and borderline personality disorder. The primary aim was to evaluate the feasibility, acceptability, and safety of eOrygen. The secondary aim was to assess pre-post changes in key clinical and psychosocial outcomes. An exploratory aim was to explore the barriers and facilitators identified by young people and clinicians in implementing a blended model of care into practice. METHODS A total of 33 young people (aged 15-25 years) and 18 clinicians were recruited over 4 months from two youth mental health services in Melbourne, Victoria, Australia: (1) the Early Psychosis Prevention and Intervention Centre, an early intervention service for first-episode psychosis; and (2) the Helping Young People Early Clinic, an early intervention service for borderline personality disorder. The feasibility, acceptability, and safety of eOrygen were evaluated via an uncontrolled single-group study. Repeated measures 2-tailed t tests assessed changes in clinical and psychosocial outcomes between before and after the intervention (3 months). Eight semistructured qualitative interviews were conducted with the young people, and 3 focus groups, attended by 15 (83%) of the 18 clinicians, were conducted after the intervention. RESULTS eOrygen was found to be feasible, acceptable, and safe. Feasibility was established owing to a low refusal rate of 25% (15/59) and by exceeding our goal of young people recruited to the study per clinician. Acceptability was established because 93% (22/24) of the young people reported that they would recommend eOrygen to others, and safety was established because no adverse events or unlawful entries were recorded and there were no worsening of clinical and social outcome measures. Interviews with the young people identified facilitators to engagement such as peer support and personalized therapy content, as well as barriers such as low motivation, social anxiety, and privacy concerns. The clinician focus groups identified evidence-based content as an implementation facilitator, whereas a lack of familiarity with the platform was identified as a barrier owing to clinicians' competing priorities, such as concerns related to risk and handling acute presentations, as well as the challenge of being understaffed. CONCLUSIONS eOrygen as a blended transdiagnostic intervention has the potential to increase therapeutic continuity, engagement, alliance, and intensity. Future research will need to establish the effectiveness of blended models of care for young people with complex mental health conditions and determine how to optimize the implementation of such models into specialized services.
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Affiliation(s)
- Shaunagh O'Sullivan
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Carla McEnery
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Daniela Cagliarini
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Jordan D X Hinton
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Health Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Lee Valentine
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Jennifer Nicholas
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Nicola A Chen
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Emily Castagnini
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | | | | | - Simon D'Alfonso
- School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - John F Gleeson
- Health Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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Lund C, Jordans MJD, Garman E, Araya R, Avendano M, Bauer A, Bahure V, Dua T, Eleftheriou G, Evans-Lacko S, García Rodríguez JF, Gautam K, Gevonden M, Hessel P, Kohrt BA, Krabbendam L, Luitel NP, Roy S, Seifert Bonifaz M, Singh R, Sinichi M, Sorsdahl K, Thornicroft G, Tol WA, Trujillo D, van der Merwe N, Wahid SS, Yarrow P. Strengthening self-regulation and reducing poverty to prevent adolescent depression and anxiety: Rationale, approach and methods of the ALIVE interdisciplinary research collaboration in Colombia, Nepal and South Africa. Epidemiol Psychiatr Sci 2023; 32:e69. [PMID: 38088153 PMCID: PMC10803189 DOI: 10.1017/s2045796023000811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/20/2023] [Accepted: 10/29/2023] [Indexed: 12/18/2023] Open
Abstract
AIMS Depression and anxiety are the leading contributors to the global burden of disease among young people, accounting for over a third (34.8%) of years lived with disability. Yet there is limited evidence for interventions that prevent adolescent depression and anxiety in low- and middle-income countries (LMICs), where 90% of adolescents live. This article introduces the 'Improving Adolescent mentaL health by reducing the Impact of poVErty (ALIVE)' study, its conceptual framework, objectives, methods and expected outcomes. The aim of the ALIVE study is to develop and pilot-test an intervention that combines poverty reduction with strengthening self-regulation to prevent depression and anxiety among adolescents living in urban poverty in Colombia, Nepal and South Africa. METHODS This aim will be achieved by addressing four objectives: (1) develop a conceptual framework that identifies the causal mechanisms linking poverty, self-regulation and depression and anxiety; (2) develop a multi-component selective prevention intervention targeting self-regulation and poverty among adolescents at high risk of developing depression or anxiety; (3) adapt and validate instruments to measure incidence of depression and anxiety, mediators and implementation parameters of the prevention intervention; and (4) undertake a four-arm pilot cluster randomised controlled trial to assess the feasibility, acceptability and cost of the selective prevention intervention in the three study sites. RESULTS The contributions of this study include the active engagement and participation of adolescents in the research process; a focus on the causal mechanisms of the intervention; building an evidence base for prevention interventions in LMICs; and the use of an interdisciplinary approach. CONCLUSIONS By developing and evaluating an intervention that addresses multidimensional poverty and self-regulation, ALIVE can make contributions to evidence on the integration of mental health into broader development policy and practice.
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Affiliation(s)
- Crick Lund
- Centre for Global Mental Health, Health Service and Population Research Department, King’s College London, London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Mark J. D. Jordans
- Centre for Global Mental Health, Health Service and Population Research Department, King’s College London, London, UK
- WarChild, Amsterdam, Netherlands
| | - Emily Garman
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Ricardo Araya
- Centre for Global Mental Health and Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
| | - Mauricio Avendano
- Center for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, Lausanne, Switzerland
| | - Annette Bauer
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Vikram Bahure
- Department of International Development, King’s College London, London, UK
| | - Tarun Dua
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Georgia Eleftheriou
- Center for Global Mental Health Equity, Department of Psychiatry, George Washington University, Washington, DC, USA
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | | | - Kamal Gautam
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Baluwatar, Kathmandu, Nepal
| | - Martin Gevonden
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Philipp Hessel
- Alberto Lleras Camargo School of Government, Universidad de los Andes, Bogotá, Colombia
| | - Brandon A. Kohrt
- Center for Global Mental Health Equity, Department of Psychiatry, George Washington University, Washington, DC, USA
| | - Lydia Krabbendam
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Nagendra P. Luitel
- Research Department, Transcultural Psychosocial Organization Nepal (TPO Nepal), Baluwatar, Kathmandu, Nepal
| | - Sanchari Roy
- Department of International Development, King’s College London, London, UK
| | - Manuel Seifert Bonifaz
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Rakesh Singh
- Research Department, Transcultural Psychosocial Organization Nepal (TPO Nepal), Baluwatar, Kathmandu, Nepal
| | - Mohammadamin Sinichi
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Katherine Sorsdahl
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
| | - Wietse A. Tol
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Athena Research Institute, Vrije University Amsterdam, Amsterdam, the Netherlands
| | | | | | - Syed Shabab Wahid
- Department of Global Health, Georgetown University, Washington, DC, USA
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Cuijpers P, Kumar M, Karyotaki E. Climate Change and Mental Health-Time to Act Now. JAMA Psychiatry 2023; 80:1183-1184. [PMID: 37792381 DOI: 10.1001/jamapsychiatry.2023.3413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
This Viewpoint discusses the lack of research on the impact of climate events on mental health, climate change–related inequalities in low- and middle-income countries, and the immediate need to act now.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
- Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
| | - Manasi Kumar
- Department of Psychiatry University of Nairobi, Kenya, East Africa
- Brain and Mind Institute, Aga Khan University, Kenya, East Africa
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
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Arias de la Torre J, Vilagut G, Ronaldson A, Bakolis I, Dregan A, Navarro-Mateu F, Pérez K, Szücs A, Bartoll-Roca X, Molina AJ, Elices M, Pérez-Solá V, Martín V, Serrano-Blanco A, Valderas JM, Alonso J. Reconsidering the Use of Population Health Surveys for Monitoring of Mental Health. JMIR Public Health Surveill 2023; 9:e48138. [PMID: 37995112 PMCID: PMC10704303 DOI: 10.2196/48138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/18/2023] [Accepted: 09/26/2023] [Indexed: 11/24/2023] Open
Abstract
Monitoring of the mental health status of the population and assessment of its determinants are 2 of the most relevant pillars of public mental health, and data from population health surveys could be instrumental to support them. Although these surveys could be an important and suitable resource for these purposes, due to different limitations and challenges, they are often relegated to the background behind other data sources, such as electronic health records. These limitations and challenges include those related to measurement properties and cross-cultural validity of the tools used for the assessment of mental disorders, their degree of representativeness, and possible difficulties in the linkage with other data sources. Successfully addressing these limitations could significantly increase the potential of health surveys in the monitoring of mental disorders and ultimately maximize the impact of the relevant policies to reduce their burden at the population level. The widespread use of data from population health surveys, ideally linked to electronic health records data, would enhance the quality of the information available for research, public mental health decision-making, and ultimately addressing the growing burden of mental disorders.
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Affiliation(s)
- Jorge Arias de la Torre
- Care in Long Term Conditions Research Division, King's College London, London, United Kingdom
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Biomedical Sciences, Universidad de León, León, Spain
| | - Gemma Vilagut
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Amy Ronaldson
- Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Ioannis Bakolis
- Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Alex Dregan
- Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Fernando Navarro-Mateu
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Katherine Pérez
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Anna Szücs
- Department of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Xavier Bartoll-Roca
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Antonio J Molina
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Biomedical Sciences, Universidad de León, León, Spain
| | - Matilde Elices
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Víctor Pérez-Solá
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Vicente Martín
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Biomedical Sciences, Universidad de León, León, Spain
| | - Antoni Serrano-Blanco
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Institut de Recerca Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | | | - Jordi Alonso
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Medical and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
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9
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Toh SHY, Lee SC, Sündermann O. Mobile Behavioral Health Coaching as a Preventive Intervention for Occupational Public Health: Retrospective Longitudinal Study. JMIR Form Res 2023; 7:e45678. [PMID: 37862086 PMCID: PMC10625093 DOI: 10.2196/45678] [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: 01/12/2023] [Revised: 08/17/2023] [Accepted: 08/31/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Researchers have recently proposed that behavioral health coaching (BHC) is effective in promoting proactive care among employees. However, to qualify as a preventive workplace intervention, more research is needed to evaluate whether BHC can further elevate well-being among moderately mentally healthy employees. OBJECTIVE Using real-world data, this study evaluates the preliminary effectiveness of app-based BHC against a nonrandomized control group with open access to self-help tools in improving well-being (ie, mood levels and perceived stress). The study also explores the active ingredients of BHC and dose-response associations between the number of BHC sessions and well-being improvements. METHODS Employees residing across Asia-Pacific countries (N=1025; mean age 30.85, SD 6.97 y) who reported moderately positive mood and medium levels of perceived stress in their first week of using the mental health app Intellect were included in this study. Users who were given access by their organizations to Intellect's BHC services were assigned to the "Coaching" condition (512/1025, 49.95%; mean age 31.09, SD 6.87 y), whereas other employees remained as "Control" participants (513/1025, 50.05%; mean age 30.61, SD 7.06 y). To evaluate effectiveness, monthly scores from the validated mood and stress sliders were aggregated into a composite well-being score and further examined using repeated-measure conditional growth models. Postcoaching items on "Perceived Usefulness of the BHC session" and "Working Alliance with my Coach" were examined as active ingredients of BHC using 1-1-1 multilevel mediation models. Finally, 2-way repeated-measure mixed ANOVA models were conducted to examine dose-response effects on well-being improvements between groups (coaching and control) across time. RESULTS Growth curve analyses revealed significant time by group interaction effects for composite well-being, where "Coaching" users reported significantly greater improvements in well-being than "Control" participants across time (composite well-being: F1,391=6.12; ηp2=0.02; P=.01). Among "Coaching" participants, dependent-sample 2-tailed t tests revealed significant improvements in composite well-being from baseline to 11 months (t512=1.98; Cohen d=0.17; P=.049). Improvements in "Usefulness of the BHC session" (β=.078, 95% Cl .043-.118; P<.001) and "Working Alliance" (β=.070, 95% Cl .037-.107; P<.001) fully mediated within-level well-being enhancements over time. Comparing against baseline or first month scores, significant time by group interactions were observed between the second and sixth months, with the largest effect size observed at the fifth month mark (first month vs fifth month: F1,282=15.0; P<.001; ηp2=0.051). CONCLUSIONS We found preliminary evidence that BHC is an effective preventive workplace intervention. Mobile-based coaching may be a convenient, cost-effective, and scalable means for organizations and governments to boost public mental health.
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Affiliation(s)
| | - Sze Chi Lee
- Intellect Private Limited Company, Singapore, Singapore
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10
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Winter HR, Norton A, Wootton BM. Internet videoconferencing delivered cognitive behavioral therapy for social anxiety disoder: Protocol for a randomized controlled trial. Contemp Clin Trials 2023; 132:107298. [PMID: 37482329 DOI: 10.1016/j.cct.2023.107298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/04/2023] [Accepted: 07/15/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Social anxiety disorder (SAD) is characterized by a fear of scrutiny in social or performance situations. Due to a number of barriers, many individuals do not seek treatment for SAD, resulting in a chronic and debilitating course. Cognitive behaviour therapy (CBT), and more recently Imagery Rescripting (ImR), have been found to be efficacious in the treatment of SAD when delivered face-to-face. However, the efficacy of these treatment approaches when delivered remotely, have not yet been examined in controlled trials. METHODS The authors propose a two-group randomized controlled trial comparing the efficacy of videoconferencing delivered CBT (vCBT) for SAD against a waitlist control group. The study will recruit 78 adults in total with a primary diagnosis of SAD of at least moderate severity. The manualised high-intensity vCBT intervention will be delivered weekly over an 8-week period. After treatment completion, the waitlist participants will receive a high-intensity videoconferencing delivered ImR (vImR) intervention also delivered weekly over an 8-week period. Treatment for both groups will be delivered in real time via an online videoconferencing platform. Outcome measures will be administered at baseline, mid-treatment, post-treatment, and 3-month follow-up. CONCLUSION This trial will report findings on the efficacy of a remote synchronous high-intensity vCBT and vImR intervention for SAD and benchmark the two different treatment methodologies against standard face-to-face CBT. The results have the potential to inform best-practice remote psychological treatment for SAD. TRIAL REGISTRATION The trial was registered on the Australian New Zealand Clinical Trials Registry; ACTRN12623000313639 (5 April 2023).
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Affiliation(s)
- Halaina R Winter
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, NSW, Australia
| | - Alice Norton
- Clinical Psychology Unit, School of Psychology, The University of Sydney, Camperdown, NSW, Australia
| | - Bethany M Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, NSW, Australia..
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11
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Deady M, Collins DAJ, Lavender I, Mackinnon A, Glozier N, Bryant R, Christensen H, Harvey SB. Selective Prevention of Depression in Workers Using a Smartphone App: Randomized Controlled Trial. J Med Internet Res 2023; 25:e45963. [PMID: 37616040 PMCID: PMC10485707 DOI: 10.2196/45963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/27/2023] [Accepted: 07/18/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND There is increasing evidence that depression can be prevented; however, universal approaches have had limited success. Appropriate targeting of interventions to at-risk populations has been shown to have potential, but how to selectively determine at-risk individuals remains unclear. Workplace stress is a risk factor for depression and a target for intervention, but few interventions exist to prevent depression among workers at risk due to heightened stress. OBJECTIVE This trial aimed to evaluate the efficacy of a smartphone-based intervention in reducing the onset of depression and improving related outcomes in workers experiencing at least moderate levels of stress. METHODS A randomized controlled trial was conducted with participants who were currently employed and reported no clinically significant depression and at least moderate stress. The intervention group (n=1053) were assigned Anchored, a 30-day self-directed smartphone app-based cognitive behavioral- and mindfulness-based intervention. The attention-control group (n=1031) were assigned a psychoeducation website. Assessment was performed via web-based self-report questionnaires at baseline and at 1-, 3-, and 6-month postbaseline time points. The primary outcome was new depression caseness aggregated over the follow-up period. The secondary outcomes included depressive and anxiety symptoms, stress, well-being, resilience, work performance, work-related burnout, and quality of life. Analyses were conducted within an intention-to-treat framework using mixed modeling. RESULTS There was no significant between-group difference in new depression caseness (z score=0.69; P=.49); however, those in the Anchored arm had significantly greater depressive symptom reduction at 1 month (Cohen d=0.02; P=.049) and 6 months (Cohen d=0.08; P=.03). Anchored participants also showed significantly greater reduction in anxiety symptoms at 1 month (Cohen d=0.07; P=.04) and increased work performance at 1 month (Cohen d=0.07; P=.008) and 6 months (Cohen d=0.13; P=.01), compared with controls. Notably, for Anchored participants completing at least two-thirds of the intervention, there was a significantly lower rate of depression onset (1.1%, 95% CI 0.0%-3.7%) compared with controls (9.0%, 95% CI 6.8%-12.3%) at 1 month (z score=4.50; P<.001). Significant small to medium effect sizes for most secondary outcomes were seen in the highly engaged Anchored users compared with controls, with effects maintained at the 6-month follow-up for depressive symptoms, well-being, stress, and quality of life. CONCLUSIONS Anchored was associated with a small comparative reduction in depressive symptoms compared with controls, although selective prevention of case-level depression was not observed in the intention-to-treat analysis. When users adequately engaged with the app, significant findings pertaining to depression prevention, overall symptom reduction, and functional improvement were found, compared with controls. There is a need for a greater focus on engagement techniques in future research. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000178943; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378592.
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Affiliation(s)
- Mark Deady
- Black Dog Institute, Faculty of Medicine and Health, University of New South Wales, Randwick, Australia
| | - Daniel A J Collins
- Black Dog Institute, Faculty of Medicine and Health, University of New South Wales, Randwick, Australia
| | - Isobel Lavender
- Black Dog Institute, Faculty of Medicine and Health, University of New South Wales, Randwick, Australia
| | - Andrew Mackinnon
- Black Dog Institute, Faculty of Medicine and Health, University of New South Wales, Randwick, Australia
| | - Nicholas Glozier
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Helen Christensen
- Black Dog Institute, Faculty of Medicine and Health, University of New South Wales, Randwick, Australia
| | - Samuel B Harvey
- Black Dog Institute, Faculty of Medicine and Health, University of New South Wales, Randwick, Australia
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12
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Patel V, Saxena S, Lund C, Kohrt B, Kieling C, Sunkel C, Kola L, Chang O, Charlson F, O'Neill K, Herrman H. Transforming mental health systems globally: principles and policy recommendations. Lancet 2023; 402:656-666. [PMID: 37597892 DOI: 10.1016/s0140-6736(23)00918-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/18/2023] [Accepted: 05/02/2023] [Indexed: 08/21/2023]
Abstract
A burgeoning mental health crisis is emerging globally, regardless of each country's human resources or spending. We argue that effectively responding to this crisis is impeded by the dominant framing of mental ill health through the prism of diagnostic categories, leading to an excessive reliance on interventions that are delivered by specialists; a scarcity of widespread promotive, preventive, and recovery-oriented strategies; and failure to leverage diverse resources within communities. Drawing upon a series of syntheses, we identify five principles to transform current practices; namely, address harmful social environments across the life course, particularly in the early years; ensure that care is not contingent on a categorical diagnosis but aligned with the staging model of mental illness; empower diverse front-line providers to deliver psychosocial interventions; embrace a rights-based approach that seeks to provide alternatives to violence and coercion in care; and centre people with lived experience in all aspects of care. We recommend four policy actions which can transform these principles into reality: a whole of society approach to prevention and care; a redesign of the architecture of care delivery to provide a seamless continuum of care, tailored to the severity of the mental health condition; investing more in what works to enhance the impact and value of the investments; and ensuring accountability through monitoring and acting upon a set of mental health indicators. All these actions are achievable, relying-for the most part-on resources already available to every community and country. What they do require is the acceptance that business as usual will fail and the solutions to transforming mental health-care systems are already present within existing resources.
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Affiliation(s)
- Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Shekhar Saxena
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Crick Lund
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Brandon Kohrt
- Center for Global Mental Health Equity, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Christian Kieling
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Charlene Sunkel
- Global Mental Health Peer Network, Paarl, Cape Town, South Africa
| | - Lola Kola
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Odille Chang
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Fiona Charlson
- School of Public Health, University of Queensland, Herston, QLD, Australia
| | - Kathryn O'Neill
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Helen Herrman
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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13
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Waechter R, Gallant C, De Wilde K, Arens G, Brady T, Custodio J, Wakita Y, Landon B, Boateng Y, Parthab N, Bhagat A. Prevention of mental illness within public health: An analysis of progress via systematic literature review and a pathway forward. Prev Med Rep 2023; 34:102249. [PMID: 37273525 PMCID: PMC10238837 DOI: 10.1016/j.pmedr.2023.102249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 04/10/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023] Open
Abstract
Primary prevention is the cornerstone of public health. Prevention is especially important for chronic diseases of significant burden such as mental illnesses because many of them have limited treatment options, an onset in childhood or in adolescence, and are linked to adverse childhood experiences requiring a focus on early childhood and maternal-child health (MCH). Despite this need, there appears to be a paucity of research into prevention of mental illnesses within public health. To confirm this, we performed a systematic literature review to quantify the proportion of articles in public health that focus on prevention of mental illness versus intervention for these illnesses after their onset, and the proportion of published articles within MCH that focus on mental health. Between November 2019 and August 2021, we reviewed 211,794 published articles from 147 Scimago-ranked English public health journals with no limit on year of publication. As hypothesized, a very small portion (2.2%) of mental health articles included primary prevention and a small portion of MCH articles (7.8%) included mental health. These results are consistent with the existence of a research gap in mental illness prevention within the public health field. Given the early onset of mental illness, the importance of early childhood experiences in the later development of mental illness, and the importance of the social-emotional connection between mother and child for building resilience, public health professionals must incorporate evidence from the field of MCH to develop and assess more primary prevention programs for mental illness.
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Affiliation(s)
- Randall Waechter
- School of Medicine, St. George’s University, Grenada
- Windward Islands Research and Education Foundation, Grenada
- School of Graduate Studies, St. George’s University, Grenada
| | | | | | | | - Taylor Brady
- School of Medicine, St. George’s University, Grenada
| | | | - Yusuke Wakita
- School of Medicine, St. George’s University, Grenada
| | - Barbara Landon
- Windward Islands Research and Education Foundation, Grenada
- School of Graduate Studies, St. George’s University, Grenada
| | | | | | - Anjali Bhagat
- School of Medicine, St. George’s University, Grenada
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14
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Seely HD, Gaskins J, Pössel P, Hautzinger M. Comprehensive Prevention: An Evaluation of Peripheral Outcomes of a School-based Prevention Program. Res Child Adolesc Psychopathol 2023; 51:921-936. [PMID: 36870013 DOI: 10.1007/s10802-023-01043-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 03/05/2023]
Abstract
By age 18, 22-27% of adolescents have experienced depressive symptoms increasing their risk of peripheral mental health and social issues. Despite the development of effective depression prevention programs, issues related to dissemination persist. This study aims to identify ways of increasing the likelihood of dissemination by a) investigating how prevention effects differ based on the professional background of the prevention program group leader and b) evaluating adolescent depression prevention in terms of comprehensive prevention - prevention with the breadth to reduce peripheral mental health and social issues. This cluster-randomized trial included 646 eighth-grade students recruited from German secondary schools. Adolescents were randomized into three conditions: teacher-led prevention, psychologist-led prevention, or school-as-usual. Results from hierarchical linear models reveal differences in effects based on implementation type and adolescent gender and provide preliminary evidence for a wider reach of depression prevention such that, regardless of implementation type or gender, the tested program was effective in reducing hyperactivity over time. Taken together, our findings warrant further research and suggest that depression prevention programs may have an effect on some peripheral outcomes, but not others, and that these effects may differ based on the profession of the group leader and adolescent gender. With continued empirical research investigating the efficaciousness of comprehensive prevention, this type of prevention has the potential to impact a larger proportion of the population and improve the cost-benefit ratio of prevention, thus increasing the likelihood of dissemination.
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15
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Cuijpers P. Preventing the onset of depressive disorders in low-and middle-income countries: An overview. Glob Ment Health (Camb) 2023; 10:e28. [PMID: 37854437 PMCID: PMC10579668 DOI: 10.1017/gmh.2023.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 10/20/2023] Open
Abstract
Depressive disorders constitute an important and costly public health problem and worldwide most of the disease burden is suffered in low-and middle-income countries (LMICs). Treatments only have limited possibilities to reduce the disease burden of depressive disorders. Prevention may be one of the alternative ways to further reduce the disease burden of depressive disorders. In this paper, the results of a subgroup analysis of a previous meta-analysis on the effect of preventive interventions on the incidence of depressive disorders was undertaken. Only 6% of all trials examining the possibility to prevent the onset of major depression have been conducted in LMICs, and these studies find significantly smaller effects than those in high-income settings. It is too early, therefore, to consider implementing and disseminating preventive interventions in LMICS. However, in optimal conditions and assuming that evidence-based preventive interventions will be developed, investments should be made into treatment, universal, selective and indicated prevention, as well as in social institutions focusing on larger risk factors for mental health problems.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands and International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
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16
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Santomauro DF, Purcell C, Whiteford HA, Ferrari AJ, Vos T. Grading disorder severity and averted burden by access to treatment within the GBD framework: a case study with anxiety disorders. Lancet Psychiatry 2023; 10:272-281. [PMID: 36931778 PMCID: PMC10017349 DOI: 10.1016/s2215-0366(23)00037-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/08/2022] [Accepted: 01/17/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND The Global Burden of Disease Study (GBD) estimates burden by cause with major relevance for resource allocators globally. Non-fatal burden estimates are influenced by disorder severity. However, for many disorders, global severity is sourced from a single high-income country survey. We aimed to estimate severity distributions that vary by Healthcare Access Quality Index (HAQI) using anxiety disorders as a case study and present the usefulness of this method in simulating averted and avoidable burden globally. METHODS In this case study, we estimated treatment use among respondents with anxiety disorder in the 1997 Australian National Survey of Mental Health and Wellbeing (NSMHWB), the source used to estimate severity of anxiety disorders in GBD. Treatment effects were sourced from the Cochrane Database of Systematic Reviews and pooled via network meta-analysis. Severity distribution was established via a meta-regression of their disability weights, derived from 12-item short form survey scores. We simulated the shift in severity across scenarios without access to treatment and with full access to optimal treatment (cognitive behavioural therapy and antidepressants). We interpolated this shift linearly along the HAQI, extrapolated country-specific severity from HAQI scores, and calculated averted and avoidable burden. FINDINGS The database review sourced 56 reviews, of which eight were eligible for inclusion. These eight reviews reported on 156 randomised controlled trials, with 194 treatment effects. Respondents to the 1997 NSMHWB consisted of 5936 women (55·8%) and 4705 (44·2%) men aged 18 years or older (mean age and ethnicity data not available). The survey-weighted treatment effect size was -0·28 (95% uncertainty interval -0·45 to -0·12). The pooled treatment effect for full coverage optimal treatment was -1·07 (-1·47 to -0·64). The sequela-weighted disability weight among people with anxiety disorder in the NSMHWB was 0·141 (0·042 to 0·275). The estimated disability weight was 0·188 (0·070 to 0·341) after removing the benefits of treatment and 0·056 (0·013 to 0·140) after providing all people with anxiety disorder access to optimal treatment. Globally, 12·5% (4·6 to 21·5) of anxiety disorder burden was averted because of available treatment. However, 71·1% (46·2 to 87·6) of global anxiety disorder burden could be averted if all people with anxiety disorders had access to optimal treatment. INTERPRETATION Because it is based on guidance from a single survey done in one high-income country, the burden of anxiety disorders in low-income and middle-income countries is probably underestimated by GBD. Despite the availability of effective treatments, low use of these treatments means that most burden is still avoidable. Most of the burden could be averted if all people with anxiety disorders had access to optimal treatment, highlighting the importance of public promotion and referral pathways of treatment for anxiety disorders. Location-specific severity distributions in GBD would greatly increase precision in burden estimates and highlight avertable burden to clinicians, public health practitioners, and policy makers. FUNDING Queensland Health and Bill & Melinda Gates Foundation.
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Affiliation(s)
- Damian F Santomauro
- School of Public Health, University of Queensland, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
| | - Caroline Purcell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Harvey A Whiteford
- School of Public Health, University of Queensland, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Alize J Ferrari
- School of Public Health, University of Queensland, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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Szota K, Christiansen H, Aarons GA, Ehrhart MG, Fischer A, Rosner R, Steil R, Barke A. Climate for evidence-based mental health care implementation in Germany: psychometric investigation of the Implementation Climate Scale (ICS). Sci Rep 2023; 13:5311. [PMID: 37002318 PMCID: PMC10066389 DOI: 10.1038/s41598-023-32282-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 03/25/2023] [Indexed: 04/03/2023] Open
Abstract
Organizational implementation climate is an important construct in implementation research to describe to what extent implementation is expected, supported, and rewarded. Efforts in bridging the research-practice gap by implementing evidence-based practice (EBP) can benefit from consideration of implementation climate. The Implementation Climate Scale (ICS) is a psychometrically strong measure assessing employees' perceptions of the implementation climate. The present cross-sectional study aimed at providing a German translation and investigating its psychometric properties. The translation followed standard procedures for adapting psychometric instruments. German psychotherapists (N = 425) recruited online completed the ICS, the Evidence Based Practice Attitudes Scale (EBPAS-36D) and the Intention Scale for Providers (ISP). We conducted standard item and reliability analyses. Factorial validity was assessed by comparing an independent cluster model of Confirmatory Factorial Analysis (ICM-CFA), a Bifactor CFA, a Second-order CFA and an (Bifactor) Exploratory Structural Equation Model (ESEM). Measurement invariance was tested using multiple-group CFA and ESEM, convergent validity with correlation analysis between the ICS and the ISP subjective norms subscale (ISP-D-SN). The mean item difficulty was pi = .47, mean inter-item correlation r = .34, and mean item-total correlation ritc = .55. The total scale (ω = 0.91) and the subscales (ω = .79-.92) showed acceptable to high internal consistencies. The model fit indices were comparable and acceptable (Second-order CFA: RMSEA [90% CI] = .077 [.069; .085], SRMR = .078, CFI = .93). Multiple-group CFA and ESEM indicated scalar measurement invariance across gender and presence of a psychotherapy license. Psychotherapists in training reported higher educational support for EBP than licensed psychotherapists (T = 2.09, p = .037, d = 0.25). The expected high correlation between the ICS and the ISP-D-SN was found (r = .59, p < .001). Results for the German ICS confirm good psychometric properties including validity.
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Affiliation(s)
- Katharina Szota
- Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, 35032, Marburg, Germany.
| | - Hanna Christiansen
- Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, 35032, Marburg, Germany
| | - Gregory A Aarons
- Department of Psychiatry, University of California, 9500 Gilman Drive (0812), La Jolla, San Diego, CA, 92093-0812, USA
| | - Mark G Ehrhart
- Department of Psychology, University of Central Florida, P.O. Box 161390, Orlando, FL, 32816-1390, USA
| | - Anne Fischer
- Department of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt am Main, Germany
| | - Rita Rosner
- Department of Clinical and Biological Psychology, Catholic University of Eichstätt-Ingolstadt, Levelingstr. 7, 85049, Ingolstadt, Germany
| | - Regina Steil
- Department of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt am Main, Germany
| | - Antonia Barke
- Division of Clinical Psychology and Psychological Intervention, Institute of Psychology, University of Duisburg-Essen, Universitätsstr. 2, S06 S03 B24, 45141, Essen, Germany
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18
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Irwin MR, Boyle CC, Cho JH, Piber D, Breen EC, Sadeghi N, Castillo D, Smith M, Eisenberger NI, Olmstead R. Sleep and Healthy Aging Research on Depression (SHARE-D) randomized controlled trial: Protocol overview of an experimental model of depression with insomnia, inflammation, and affect mechanisms in older adults. Brain Behav Immun Health 2023; 28:100601. [PMID: 36879913 PMCID: PMC9984307 DOI: 10.1016/j.bbih.2023.100601] [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: 01/12/2023] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023] Open
Abstract
Depression, one of the most common diseases in older adults, carries significant risk for morbidity and mortality. Because of the burgeoning population of older adults, the enormous burden of late-life depression, and the limited efficacy of current antidepressants in older adults, biologically plausible models that translate into selective depression prevention strategies are needed. Insomnia predicts depression recurrence and is a modifiable target to prevent incident and recurrent depression in older adults. Yet, it is not known how insomnia gets converted into biological- and affective risk for depression, which is critical for identification of molecular targets for pharmacologic interventions, and for refinement of insomnia treatments that target affective responding to improve efficacy. Sleep disturbance activates inflammatory signaling and primes immune responses to subsequent inflammatory challenge. In turn, inflammatory challenge induces depressive symptoms, which correlate with activation of brain regions implicated in depression. This study hypothesizes that insomnia serves as a vulnerability factor for inflammation-related depression; older adults with insomnia will show heightened inflammatory- and affective responding to inflammatory challenge as compared to those without insomnia. To test this hypothesis, this protocol paper describes a placebo-controlled, randomized, double-blind study of low dose endotoxin in older adults (n = 160; 60-80 y) with insomnia vs. comparison controls without insomnia. The aims of this study are to examine differences in depressive symptoms, measures of negative affective responding, and measures of positive affective responding as a function of insomnia and inflammatory challenge. If the hypotheses are confirmed, older adults with two "hits", insomnia and inflammatory activation, would represent a high risk group to be prioritized for monitoring and for depression prevention efforts using treatments that target insomnia or inflammation. Moreover, this study will inform the development of mechanism-based treatments that target affect responses in addition to sleep behaviors, and which might also be coupled with efforts to reduce inflammation to optimize efficacy of depression prevention.
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Affiliation(s)
- Michael R. Irwin
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Chloe C. Boyle
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Joshua H. Cho
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Dominique Piber
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
- Department of Psychiatry, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Elizabeth C. Breen
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Nina Sadeghi
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Daisy Castillo
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Michael Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Naomi I. Eisenberger
- Department of Psychology, College of Arts and Sciences, UCLA, Los Angeles, CA, USA
| | - Richard Olmstead
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
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19
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Abstract
The World Health Organization's World Mental Health Report is a call for action and reminds all of the huge personal and societal impact of mental illnesses. Significant effort is required to engage, inform and motivate policymakers to act. We must develop more effective, context-sensitive and structurally competent care models.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; and International Institute for Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Afzal Javed
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK; and World Psychiatric Association, Geneva, Switzerland
| | - Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, Oxford, UK; World Psychiatric Association Collaborating Centre, Oxford, UK
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20
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Freund J, Ebert DD, Thielecke J, Braun L, Baumeister H, Berking M, Titzler I. Using the Consolidated Framework for Implementation Research to evaluate a nationwide depression prevention project (ImplementIT) from the perspective of health care workers and implementers: Results on the implementation of digital interventions for farmers. Front Digit Health 2023; 4:1083143. [PMID: 36761450 PMCID: PMC9907445 DOI: 10.3389/fdgth.2022.1083143] [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: 10/28/2022] [Accepted: 12/28/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Depression has a significant impact on individuals and society, which is why preventive measures are important. Farmers represent an occupational group exposed to many risk factors for depression. The potential of guided, tailored internet-based interventions and a personalized telephone coaching is evaluated in a German project of the Social Insurance for Agriculture, Forestry and Horticulture (SVLFG). While user outcomes are promising, not much is known about actual routine care use and implementation of the two digital health interventions. This study evaluates the implementation from the perspective of social insurance employees to understand determinants influencing the uptake and implementation of digital interventions to prevent depression in farmers. Methods The data collection and analysis are based on the Consolidated Framework for Implementation Research (CFIR). Health care workers (n = 86) and implementers (n = 7) completed online surveys and/or participated in focus groups. The surveys consisted of validated questionnaires used in implementation research, adapted items from the CFIR guide or from other CFIR studies. In addition, we used reporting data to map implementation based on selected CFIR constructs. Results Within the five CFIR dimensions, many facilitating factors emerged in relation to intervention characteristics (e.g., relative advantage compared to existing services, evidence and quality) and the inner setting of the SVLFG (e.g., tension for change, compatibility with values and existing working processes). In addition, barriers to implementation were identified in relation to the outer setting (patient needs and resources), inner setting (e.g., available resources, access to knowledge and information) and characteristics of individuals (e.g., self-efficacy). With regard to the implementation process, facilitating factors (formal implementation leaders) as well as hindering factors (reflecting and evaluating) were identified. Discussion The findings shed light on the implementation of two digital prevention services in an agricultural setting. While both offerings seem to be widely accepted by health care workers, the results also point to revealed barriers and contribute to recommendations for further service implementation. For instance, special attention should be given to "patient needs and resources" by raising awareness of mental health issues among the target population as well as barriers regarding the inner setting. Clinical Trial Registration German Clinical Trial Registration: [DRKS00017078]. Registered on 18.04.2019.
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Affiliation(s)
- Johanna Freund
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- TUM Department of Sport and Health Sciences, TU Munich, Munich, Germany
| | | | - Janika Thielecke
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- TUM Department of Sport and Health Sciences, TU Munich, Munich, Germany
| | - Lina Braun
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ingrid Titzler
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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21
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A Preliminary Examination of Treatment Barriers, Preferences, and Histories of Women with Symptoms of Social Anxiety Disorder. BEHAVIOUR CHANGE 2023. [DOI: 10.1017/bec.2022.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Abstract
Social anxiety disorder (SAD) is a common mental health condition that is characterised by a persistent fear of social or performance situations. Despite effective treatments being available, many individuals with SAD do not seek treatment or delay treatment seeking for many years. The aim of the present study was to examine treatment barriers, treatment histories, and cognitive behavioural therapy (CBT) delivery preferences in a sample of women with clinically relevant SAD symptoms. Ninety-nine women (Mage = 34.90, SD = 11.28) completed the online questionnaires and were included in the study. Participants were recruited from advertisements on community noticeboards and posts on social media. The results demonstrated that less than 5% of those who received psychological treatment in the past were likely to have received best-practice CBT. The most commonly cited barriers to accessing treatment for women with SAD related to direct costs (63%) and indirect costs (e.g., transport/childcare) (28%). The most preferred treatment delivery method overall was individual face-to-face treatment (70%). The study demonstrates a need to provide a variety of treatment options in order to enhance access to empirically supported treatment for women with SAD.
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22
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Mishra N, Singh P. Community-Based Intervention Targeting Depressive Symptomatology in Indian Women: An Exploration of Its Efficacy in a Non-Specialized Healthcare Setting. Community Ment Health J 2023; 59:999-1012. [PMID: 36587370 DOI: 10.1007/s10597-022-01083-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/21/2022] [Indexed: 01/02/2023]
Abstract
Depressive symptomatology casts a more adverse impact on the well-being of women in countries with unfavourable societal norms. The prevalence of depressive symptomatology in Indian women and the treatment gap in case of mental health issues are alarming and thus may require interventions at a community level. The present study tested the efficacy of a psychosocial community-based intervention in managing depressive symptomatology and associated factors like rumination, reappraisal, psychological resilience, and self-efficacy using a pre-test post-test control group design. A total of 114 (Mage=23.03, SD = 5.29) and 37 (Mage=24.89, SD = 6.44) adult females were there in the experimental and the control group, respectively. A series of ANOVAs showed that participants' scores on depressive symptomatology and associated vulnerabilities and defences improved as compared to the baseline and the control group. The findings support the use of psychosocial community-based intervention in a non-specialized healthcare setting to manage depressive symptomatology, associated vulnerability and defences.
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Affiliation(s)
- Navneet Mishra
- Department of Humanities and Social Science, Indian Institute of Technology Ropar, Ropar, Punjab, 140001, India.
| | - Parwinder Singh
- Department of Humanities and Social Science, Indian Institute of Technology Ropar, Ropar, Punjab, 140001, India
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23
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Schulte MH, Boumparis N, Kleiboer A, Wind TR, Olff M, Huizink AC, Riper H. The effectiveness of a mobile intervention to reduce young adults' alcohol consumption to not exceed low-risk drinking guidelines. Front Digit Health 2022; 4:1016714. [PMID: 36561923 PMCID: PMC9763894 DOI: 10.3389/fdgth.2022.1016714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022] Open
Abstract
Background Young adults' drinking habits often exceed low-risk drinking guidelines. As young adults show increased access, use, and interest in personalized content related to physical and mental well-being, mobile applications might be a suitable tool to reach this target group. This study investigates the effectiveness of "Boozebuster", a self-guided mobile application incorporating various therapeutic principles to reduce young adults' alcohol consumption to not exceeding low-risk drinking guideline levels, compared to an educational website condition. Method Young adults aged 18-30 wanting to reduce their alcohol consumption entered a two-arm, parallel-group RCT. There were no minimum drinking severity inclusion criteria. Primary outcomes included alcohol consumption quantity and frequency. Secondary outcomes included binge drinking frequency and alcohol-related problem severity. Baseline, 6-week postbaseline, and 3-month post-baseline assessments were analyzed using linear mixed model analyses. Sex, treatment adherence, experienced engagement and motivation to change alcohol use behavior were investigated as moderators. Sub-group analyses contained problem drinkers and binge drinkers. Results 503 participants were randomized to the intervention or control condition. Results showed no intervention effects on primary or secondary outcomes compared to the control group. Both groups showed within-group reductions on all outcomes. Sub-group analyses in problem drinkers or binge drinkers showed similar results. Motivation to change drinking behavior and experienced engagement with the application significantly moderated the intervention effect regarding the quantity or frequency of alcohol consumption, respectively. Exploratory analyses showed that participants who indicated they wanted to change their drinking patterns during the initial PNF/MI module showed a significantly greater reduction in drinking quantity compared to those who indicated not wanting to change their drinking patterns. Conclusion The intervention group did not show a greater reduction in alcohol-related outcomes compared to the control group, but both groups showed a similar decrease. Potential explanations include similar effectiveness of both condition due to using a minimal active control in participants predominantly in the action stage of motivation to change. Future research should further explore the effectiveness of using mobile application to reduce young adults' drinking behavior to not exceed low-risk drinking guideline levels and identify factors that motivate participants to engage with such an intervention.
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Affiliation(s)
- Mieke H.J. Schulte
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Nikolaos Boumparis
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Annet Kleiboer
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Tim R. Wind
- Foundation Centrum ‘45, partner in Arq Psychotrauma Expert Group, Diemen, Netherlands
- Arq Psychotrauma Expert Group, Diemen, Netherlands
| | - Miranda Olff
- Arq Psychotrauma Expert Group, Diemen, Netherlands
- Department of Psychiatry, Amsterdam University Medical Centers Location AMC, Amsterdam Public Health, Amsterdam, Netherlands
| | - Anja C. Huizink
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam UMC-VUmc, Vrije Universiteit, Amsterdam, Netherlands
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24
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Stein DJ, Shoptaw SJ, Vigo DV, Lund C, Cuijpers P, Bantjes J, Sartorius N, Maj M. Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration. World Psychiatry 2022; 21:393-414. [PMID: 36073709 PMCID: PMC9453916 DOI: 10.1002/wps.20998] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Psychiatry has always been characterized by a range of different models of and approaches to mental disorder, which have sometimes brought progress in clinical practice, but have often also been accompanied by critique from within and without the field. Psychiatric nosology has been a particular focus of debate in recent decades; successive editions of the DSM and ICD have strongly influenced both psychiatric practice and research, but have also led to assertions that psychiatry is in crisis, and to advocacy for entirely new paradigms for diagnosis and assessment. When thinking about etiology, many researchers currently refer to a biopsychosocial model, but this approach has received significant critique, being considered by some observers overly eclectic and vague. Despite the development of a range of evidence-based pharmacotherapies and psychotherapies, current evidence points to both a treatment gap and a research-practice gap in mental health. In this paper, after considering current clinical practice, we discuss some proposed novel perspectives that have recently achieved particular prominence and may significantly impact psychiatric practice and research in the future: clinical neuroscience and personalized pharmacotherapy; novel statistical approaches to psychiatric nosology, assessment and research; deinstitutionalization and community mental health care; the scale-up of evidence-based psychotherapy; digital phenotyping and digital therapies; and global mental health and task-sharing approaches. We consider the extent to which proposed transitions from current practices to novel approaches reflect hype or hope. Our review indicates that each of the novel perspectives contributes important insights that allow hope for the future, but also that each provides only a partial view, and that any promise of a paradigm shift for the field is not well grounded. We conclude that there have been crucial advances in psychiatric diagnosis and treatment in recent decades; that, despite this important progress, there is considerable need for further improvements in assessment and intervention; and that such improvements will likely not be achieved by any specific paradigm shifts in psychiatric practice and research, but rather by incremental progress and iterative integration.
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Affiliation(s)
- Dan J. Stein
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape TownCape TownSouth Africa
| | - Steven J. Shoptaw
- Division of Family MedicineDavid Geffen School of Medicine, University of California Los AngelesLos AngelesCAUSA
| | - Daniel V. Vigo
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Crick Lund
- Centre for Global Mental Health, Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental PsychologyAmsterdam Public Health Research Institute, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Jason Bantjes
- Alcohol, Tobacco and Other Drug Research UnitSouth African Medical Research CouncilCape TownSouth Africa
| | - Norman Sartorius
- Association for the Improvement of Mental Health ProgrammesGenevaSwitzerland
| | - Mario Maj
- Department of PsychiatryUniversity of Campania “L. Vanvitelli”NaplesItaly
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25
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Freund J, Buntrock C, Braun L, Thielecke J, Baumeister H, Berking M, Ebert DD, Titzler I. Digital prevention of depression for farmers? A qualitative study on participants' experiences regarding determinants of acceptance and satisfaction with a tailored guided internet intervention program. Internet Interv 2022; 29:100566. [PMID: 36039069 PMCID: PMC9418375 DOI: 10.1016/j.invent.2022.100566] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 07/23/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Farmers, forest workers and gardeners have a higher risk of developing depression compared to other occupational populations. As part of the German pilot project "With us in balance", the potential of six guided internet- and mobile-based interventions (IMIs) to prevent depression among their insurants is examined. The IMI program is tailored to various risk factors of depression, individual symptoms, and needs. Although IMIs have been shown to be effective in reducing depressive symptoms, there is little qualitative research about the acceptance of digital preventive IMIs. The aim of this qualitative study is to gain insights into participants' experiences with the guided IMIs by focusing on determinants for acceptance and satisfaction. Methods Semi-structured interviews were conducted with 22/171 (13 %) intervention group (IG) participants of a randomized controlled trial. The interview guide was developed based on theoretical models of user acceptance (Unified Theory of Acceptance and Use of Technology) and patient satisfaction (evaluation model, discrepancy theory). The interviews were evaluated independently by two coders performing a deductive-inductive content analysis and attaining a substantial level of agreement (K = 0.73). Results The qualitative analysis revealed 71 determinants for acceptance and satisfaction across ten dimensions: performance expectancy, organisation, e-coach, usability, training content and structure, training usage, training outcome, financing, social influence, and behavioural intention. The most frequently identified drivers for the IMI use include "location independence", "positive relationship to the e-coach" (each n = 19, 86 %), "personal e-coach guidance", "expertise of the e-coach", "target group specific adaptation" (each n = 18, 82 %), "flexibility", "high willingness for renewed participation" (each n = 17, 77 %), "fast and easy availability", "training of health enhancing attitudes and behaviours" and "content with figurative expressions" (each n = 16, 73 %). Discussion The qualitative findings predominantly suggest the acceptance of and satisfaction with the IMI program for the prevention of depression in famers and related lines of work. Many identified positive drivers are related to the e-coach guidance, which emphasizes its importance in the preventive setting from the perspective of the participants. Nevertheless, some negative aspects have been identified which help to understand potential weaknesses of the IMI program. Participants indicated different needs in terms of IMI content and usage, which points towards the potential benefit of individualisation. The possibility of being able to use IMIs anonymously, flexibly and independently of location might be highly relevant for this specific target group.
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Affiliation(s)
- Johanna Freund
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
- Faculty TUM Department of Sport and Health Sciences, TU Munich, Munich, Germany
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Lina Braun
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Janika Thielecke
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
- Faculty TUM Department of Sport and Health Sciences, TU Munich, Munich, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
- Faculty TUM Department of Sport and Health Sciences, TU Munich, Munich, Germany
| | - Ingrid Titzler
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
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26
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Connor C, Yap MBH, Warwick J, Birchwood M, De Valliere N, Madan J, Melvin GA, Padfield E, Patterson P, Petrou S, Raynes K, Stewart-Brown S, Thompson A. An online parenting intervention to prevent affective disorders in high-risk adolescents: the PIPA trial protocol. Trials 2022; 23:655. [PMID: 35971178 PMCID: PMC9376903 DOI: 10.1186/s13063-022-06563-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescent depression can place a young person at high risk of recurrence and a range of psychosocial and vocational impairments in adult life, highlighting the importance of early recognition and prevention. Parents/carers are well placed to notice changes in their child's emotional wellbeing which may indicate risk, and there is increasing evidence that modifiable factors exist within the family system that may help reduce the risk of depression and anxiety in an adolescent. A randomised controlled trial (RCT) of the online personalised 'Partners in Parenting' programme developed in Australia, focused on improving parenting skills, knowledge and awareness, showed that it helped reduce depressive symptoms in adolescents who had elevated symptom levels at baseline. We have adapted this programme and will conduct an RCT in a UK setting. METHODS In total, 433 family dyads (parents/carers and children aged 11-15) will be recruited through schools, social media and parenting/family groups in the UK. Following completion of screening measures of their adolescent's depressive symptoms, parents/carers of those with elevated scores will be randomised to receive either the online personalised parenting programme or a series of online factsheets about adolescent development and wellbeing. The primary objective will be to test whether the personalised parenting intervention reduces depressive symptoms in adolescents deemed at high risk, using the parent-reported Short Mood & Feelings Questionnaire. Follow-up assessments will be undertaken at 6 and 15 months and a process evaluation will examine context, implementation and impact of the intervention. An economic evaluation will also be incorporated with cost-effectiveness of the parenting intervention expressed in terms of incremental cost per quality-adjusted life year gained. DISCUSSION Half of mental health problems emerge before mid-adolescence and approximately three-quarters by mid-20s, highlighting the need for effective preventative strategies. However, few early interventions are family focused and delivered online. We aim to conduct a National Institute for Health and Care Research (NIHR) funded RCT of the online personalised 'Partners in Parenting' programme, proven effective in Australia, targeting adolescents at risk of depression to evaluate its effectiveness, cost-effectiveness and usability in a UK setting. TRIAL REGISTRATION {2A}: ISRCTN63358736 . Registered 18 September 2019.
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Affiliation(s)
- C Connor
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK.
| | - M B H Yap
- Monash University, Melbourne, Australia
| | - J Warwick
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - M Birchwood
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - N De Valliere
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - J Madan
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | | | - E Padfield
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - P Patterson
- Birmingham Women's & Children's NHS Foundation Trust, Birmingham, UK
| | - S Petrou
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - K Raynes
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - S Stewart-Brown
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - A Thompson
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
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27
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Chen P. Inner child of the past: long-term protective role of childhood relationships with mothers and fathers and maternal support for mental health in middle and late adulthood. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1399-1416. [PMID: 34842965 DOI: 10.1007/s00127-021-02200-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE National longitudinal studies that investigate the long-term association between early family life and mental health in middle and older adulthood are limited. This study aims to fill the gap by examining the protective effect of positive childhood relationships with mothers and fathers and parental support against depression among women and men in middle and late adulthood. METHODS The sample of 12,606 adults (7319 females; 5287 males) from the US Health and Retirement Study was nationally representative with the inclusion of 7 depression measures from 2008 to 2018. Two depression measures, CESD-8 scale and binary indicators of severe depressive symptoms, were used. Generalized estimation equations (GEE)-negative binomial models were estimated for CESD-8 and GEE-logit models were estimated for the binary indicator of severe depression. This study aimed to assess how positive parent-child relationships and maternal support protect the mental health of women and men in adulthood. Other risk and psychosocial factors, such as childhood depression, traumatic life events, stressful life events, marital status, and social support in adulthood were adjusted for. RESULTS Positive childhood relationships with mothers, fathers, or both parents and increased maternal support were associated with a lower risk of depression among both females and males from middle to old age, even if they experienced trauma, stressful life events, divorce, singlehood, widowhood, or little social support. Females benefited more psychologically than males from positive mother-daughter relationships and high-quality relationships with both parents. However, compared to mother-child relationships, positive father-child relationships protected men better psychosocially than females. CONCLUSION Findings underscore the importance of fathers' roles in promoting their children's, especially sons', emotional well-being. Interventions in early mother-child and father-child relationships and parental support are crucial for healthy aging in mental development.
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Affiliation(s)
- Ping Chen
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Campus Box #8180, Chapel Hill, NC, 27599-8180, USA.
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Campion J, Javed A, Saxena S, Sharan P. Public mental health: An opportunity to address implementation failure. Indian J Psychiatry 2022; 64:113-116. [PMID: 35494336 PMCID: PMC9045347 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_87_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/12/2022] [Accepted: 02/12/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jonathan Campion
- South London and Maudsley NHS Foundation Trust, London.,Public Mental Health Implementation Centre, Royal College of Psychiatrists, London.,Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Afzal Javed
- Department of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, UK
| | - Shekhar Saxena
- Department of Global Health and Population, The Harvard T.H. Chan School of Public Health, Harvard University, UK
| | - Pratap Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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Effectiveness of Physical Activity in Primary Prevention of Anxiety: Systematic Review and Meta-Analysis of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031813. [PMID: 35162835 PMCID: PMC8835486 DOI: 10.3390/ijerph19031813] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 01/27/2023]
Abstract
The aim of this study was to evaluate the effectiveness of physical activity in the primary prevention of anxiety. A systematic review of randomized controlled trials (RCTs) was performed. RCTs were searched in seven electronic databases. We included RCTs that assessed either the incidence of anxiety or the reduction of anxiety symptoms which excluded participants with baseline anxiety. Measurements were required to have been made using validated instruments. Objective or subjective (with validated questionnaires) verification of the performance of physical activity was required. Three reviewers carried out the search, selection, data extraction, and risk assessment of Cochrane Collaboration’s tool simultaneously and independently, reaching an agreement in their discrepancies by consensus. In addition, a meta-analysis of fixed-effects model was carried out. Three RCTs met inclusion criteria, comprising 350 patients from 3 different countries. A meta-analysis was performed using five comparisons extracted from the selected studies, and the pooled standardized mean difference (SMD) was −0.18 (95% CI: −0.44; 0.07), p = 0.158. The heterogeneity was irrelevant, I2 = 17.7% (p = 0.30). There is no evidence that anxiety can be prevented through physical activity, although the quality of evidence was very low.
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30
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Pössel P, Gaskins J, Gu T, Hautzinger M. Migration Background, Gender, and the Prevention of Depressive Symptoms: A Secondary Analysis. COUNSELING PSYCHOLOGIST 2022. [DOI: 10.1177/00110000211052640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adolescent girls, independent of their migration background, and adolescent boys, specifically with a migration background, experience more depressive symptoms than boys without a migration background. Adolescent girls also benefit more from depression prevention programs than boys. However, no studies have examined the role of migration background on depression prevention. This cluster-randomized trial included 439 eighth-grade students (43.5% girls, 42.4% with a migration background) in Germany. Adolescents were randomized into either a 10-week universal prevention program or school-as-usual. Following our secondary analyses and as predicted, depressive symptoms decreased in girls in the prevention but not in the control group. Consistent with our hypotheses, boys did not benefit from the prevention program, nor was there a significant interaction between gender and migration background. Independent of condition, depressive symptoms increased in adolescents with a migration background. More research is needed to improve depression prevention for adolescent boys and in adolescents with a migration background.
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Affiliation(s)
- Patrick Pössel
- Department of Counseling and Human Development, University of Louisville, Louisville, KY, USA
| | - Jeremy Gaskins
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, USA
| | - Tao Gu
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, USA
| | - Martin Hautzinger
- Department of Clinical and Developmental Psychology, University of Tuebingen, Tübingen, Germany
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Vigo D, Jones W, Dove N, Maidana DE, Tallon C, Small W, Samji H. Estimating the Prevalence of Mental and Substance Use Disorders: A Systematic Approach to Triangulating Available Data to Inform Health Systems Planning. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:107-116. [PMID: 33827278 PMCID: PMC8978221 DOI: 10.1177/07067437211006872] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To estimate the prevalence of specific mental and substance use disorders (MSUDs), by age and sex, as a first step toward informing needs-based health systems planning by decision-makers. METHODS We developed a conceptual framework and a systematic methodology for combining available data sources to yield prevalence estimates for specific MSUDs. Data sources used included published, peer-reviewed literature from Canada and comparable countries, Canadian population survey data, and health administrative data from British Columbia. Several well-established methodologies including systematic review and meta-analyses of published prevalence estimates, modelling of age- and sex-specific distributions, and the Global Burden of Disease severity distribution model were incorporated in a novel mode of triangulation. RESULTS Using this novel approach, we obtained prevalence estimates for 10 MSUDs for British Columbia, Canada, as well as prevalence distributions across age groups, by sex. CONCLUSION Obtaining reliable assessments of disorder prevalence and severity is a useful first step toward rationally estimating service need and plan health services. We propose a methodology to leverage existing information to obtain robust estimates in a timely manner and with sufficient granularity to, after adjusting for comorbidity and matching with severity-specific service bundles, inform need-based planning efforts for adult (15 years and older) mental health and substance use services.
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Affiliation(s)
- Daniel Vigo
- Department of Psychiatry, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Wayne Jones
- Centre for Applied Research in Mental Health and Addictions, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Naomi Dove
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Daniel E Maidana
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, The University of Illinois at Chicago, IL, USA
| | - Corinne Tallon
- Foundry, Providence Health Care, Vancouver, British Columbia, Canada
| | - Will Small
- Centre for Applied Research in Mental Health and Addictions, Simon Fraser University, Vancouver, British Columbia, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.,British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Hasina Samji
- Centre for Applied Research in Mental Health and Addictions, Simon Fraser University, Vancouver, British Columbia, Canada.,British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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Deady M, Glozier N, Calvo R, Johnston D, Mackinnon A, Milne D, Choi I, Gayed A, Peters D, Bryant R, Christensen H, Harvey SB. Preventing depression using a smartphone app: a randomized controlled trial. Psychol Med 2022; 52:457-466. [PMID: 32624013 DOI: 10.1017/s0033291720002081] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is evidence that depression can be prevented; however, traditional approaches face significant scalability issues. Digital technologies provide a potential solution, although this has not been adequately tested. The aim of this study was to evaluate the effectiveness of a new smartphone app designed to reduce depression symptoms and subsequent incident depression amongst a large group of Australian workers. METHODS A randomized controlled trial was conducted with follow-up assessments at 5 weeks and 3 and 12 months post-baseline. Participants were employed Australians reporting no clinically significant depression. The intervention group (N = 1128) was allocated to use HeadGear, a smartphone app which included a 30-day behavioural activation and mindfulness intervention. The attention-control group (N = 1143) used an app which included a 30-day mood monitoring component. The primary outcome was the level of depressive symptomatology (PHQ-9) at 3-month follow-up. Analyses were conducted within an intention-to-treat framework using mixed modelling. RESULTS Those assigned to the HeadGear arm had fewer depressive symptoms over the course of the trial compared to those assigned to the control (F3,734.7 = 2.98, p = 0.031). Prevalence of depression over the 12-month period was 8.0% and 3.5% for controls and HeadGear recipients, respectively, with odds of depression caseness amongst the intervention group of 0.43 (p = 0.001, 95% CI 0.26-0.70). CONCLUSIONS This trial demonstrates that a smartphone app can reduce depression symptoms and potentially prevent incident depression caseness and such interventions may have a role in improving working population mental health. Some caution in interpretation is needed regarding the clinical significance due to small effect size and trial attrition.Trial Registration Australian and New Zealand Clinical Trials Registry (www.anzctr.org.au/) ACTRN12617000548336.
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Affiliation(s)
- Mark Deady
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Nicholas Glozier
- Central Clinical School, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Rafael Calvo
- School of Electrical and Information Engineering, University of Sydney, Sydney, NSW, Australia
- Dyson School of Design Engineering, Imperial College London, London, UK
| | - David Johnston
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Andrew Mackinnon
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - David Milne
- School of Systems Management and Leadership, Faculty of Engineering and IT, University of Technology Sydney, Sydney, NSW, Australia
| | - Isabella Choi
- Central Clinical School, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Aimee Gayed
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Dorian Peters
- School of Electrical and Information Engineering, University of Sydney, Sydney, NSW, Australia
- Leverhulme Centre for the Future of Intelligence, University of Cambridge, Cambridge, UK
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Helen Christensen
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Samuel B Harvey
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Campion J, Javed A, Lund C, Sartorius N, Saxena S, Marmot M, Allan J, Udomratn P. Public mental health: required actions to address implementation failure in the context of COVID-19. Lancet Psychiatry 2022; 9:169-182. [PMID: 35065723 PMCID: PMC8776278 DOI: 10.1016/s2215-0366(21)00199-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/19/2021] [Accepted: 05/14/2021] [Indexed: 12/13/2022]
Abstract
Mental disorders account for at least 18% of global disease burden, and the associated annual global costs are projected to be US$6 trillion by 2030. Evidence-based, cost-effective public mental health (PMH) interventions exist to prevent mental disorders from arising, prevent associated impacts of mental disorders (including through treatment), and promote mental wellbeing and resilience. However, only a small proportion of people with mental disorders receive minimally adequate treatment. Compared with treatment, there is even less coverage of interventions to prevent the associated impacts of mental disorders, prevent mental disorders from arising, or promote mental wellbeing and resilience. This implementation failure breaches the right to health, has increased during the COVID-19 pandemic, and results in preventable suffering, broad impacts, and associated economic costs. In this Health Policy paper, we outline specific actions to improve the coverage of PMH interventions, including PMH needs assessments, collaborative advocacy and leadership, PMH practice to inform policy and implementation, training and improvement of population literacy, settings-based and integrated approaches, use of digital technology, maximising existing resources, focus on high-return interventions, human rights approaches, legislation, and implementation research. Increased interest in PMH in populations and governments since the onset of the COVID-19 pandemic supports these actions. Improved implementation of PMH interventions can result in broad health, social, and economic impacts, even in the short-term, which support the achievement of a range of policy objectives, sustainable economic development, and recovery.
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Affiliation(s)
- Jonathan Campion
- South London and Maudsley NHS Foundation Trust, London, UK; Public Mental Health Implementation Centre, Royal College of Psychiatrists, London, UK.
| | - Afzal Javed
- Department of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Crick Lund
- King's Global Health Institute, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | - Shekhar Saxena
- Department of Global Health and Population at the Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Michael Marmot
- Institute of Health Equity, Department of Epidemiology and Public Health, UCL, London, UK
| | - John Allan
- Office of the President, Royal Australian and New Zealand College of Psychiatrists, Melbourne, VIC, Australia; Mental Health, Alcohol and Other Drugs Branch, Clinical Excellence Queensland, Queensland Health, Brisbane, QLD, Australia; Mayne Academy of Psychiatry, University of Queensland Medical School, University of Queensland, Brisbane, QLD, Australia
| | - Pichet Udomratn
- Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Irwin MR, Carrillo C, Sadeghi N, Bjurstrom MF, Breen EC, Olmstead R. Prevention of Incident and Recurrent Major Depression in Older Adults With Insomnia: A Randomized Clinical Trial. JAMA Psychiatry 2022; 79:33-41. [PMID: 34817561 PMCID: PMC8733847 DOI: 10.1001/jamapsychiatry.2021.3422] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
IMPORTANCE Older adults with insomnia have a high risk of incident and recurrent depression. Depression prevention is urgently needed, and such efforts have been neglected for older adults. OBJECTIVE To examine whether treatment of insomnia disorder with cognitive behavioral therapy for insomnia (CBT-I) compared with an active comparator condition, sleep education therapy (SET), prevents major depressive disorder in older adults. DESIGN, SETTING, AND PARTICIPANTS This assessor-blinded, parallel-group, single-site randomized clinical trial assessed a community-based sample of 431 people and enrolled 291 adults 60 years or older with insomnia disorder who had no major depression or major health events in past year. Study recruitment was performed from July 1, 2012, to April 30, 2015. The trial protocol was modified to extend follow-up from 24 to 36 months, with follow-up completion in July 2018. Data analysis was performed from March 1, 2019, to March 30, 2020. INTERVENTIONS Participants were randomized to 2 months of CBT-I (n = 156) or SET (n = 135). MAIN OUTCOMES AND MEASURES The primary outcome was time to incident major depressive disorder as diagnosed by interview and Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria. Secondary outcome was sustained remission of insomnia disorder before depression event or duration of follow-up. RESULTS Among 291 randomized participants (mean [SD] age, 70.1 [6.7] years; 168 [57.7%] female; 7 [2.4%] Asian, 32 [11.0%] Black, 3 [1.0%] Pacific Islander, 241 [82.8%] White, 6 [2.1%] multiracial, and 2 [0.7%] unknown), 156 were randomized to CBT-I and 135 to SET. A total of 140 participants (89.7%) completed CBT-I and 130 (96.3%) participants completed SET (χ2 = 4.9, P = .03), with 114 (73.1%) completing 24 months of follow-up in the CBT-I group and 117 (86.7%) in the SET group (χ2 = 8.4, P = .004). After protocol modification, 92 (59.0%) of the CBT-I participants and 86 (63.7%) of the SET participants agreed to extended follow-up (χ2 = 0.7, P = .41), with 81 (51.9%) of the CBT-I participants and 77 (57.0%) of the SET group completing 36 months of follow-up (χ2 = 0.8; P = .39). Incident or recurrent major depression occurred in 19 participants (12.2%) in the CBT-I group and in 35 participants (25.9%) in the SET group, with an overall benefit (hazard ratio, 0.51; 95%, CI 0.29-0.88; P = .02) consistent across subgroups. Remission of insomnia disorder continuously sustained before depression event or during follow-up was more likely in CBT-I participants (41 [26.3%]) compared with the SET participants (26 [19.3%], P = .03). Those in the CBT-I group with sustained remission of insomnia disorder had an 82.6% decreased likelihood of depression (hazard ratio, 0.17; 95%, CI 0.04-0.73; P = .02) compared with those in the SET group without sustained remission of insomnia disorder. CONCLUSIONS AND RELEVANCE The findings of this randomized clinical trial indicate that treatment of insomnia with CBT-I has an overall benefit in the prevention of incident and recurrent major depression in older adults with insomnia disorder. Community-level screening for insomnia concerns in older adults and wide delivery of CBT-I-based treatment for insomnia could substantially advance public health efforts to treat insomnia and prevent depression in this vulnerable older adult population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01641263.
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Affiliation(s)
- Michael R. Irwin
- Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA (University of California, Los Angeles),Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA
| | - Carmen Carrillo
- Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA (University of California, Los Angeles)
| | - Nina Sadeghi
- Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA (University of California, Los Angeles)
| | - Martin F. Bjurstrom
- Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA (University of California, Los Angeles)
| | - Elizabeth C. Breen
- Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA (University of California, Los Angeles),Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA
| | - Richard Olmstead
- Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA (University of California, Los Angeles),Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Jonkers R, Wijnen BF, van Dijk MK, Oosterbaan DB, Verbraak MJ, van Balkom AJ, Lokkerbol J. The cost-effectiveness of the Dutch clinical practice guidelines for anxiety disorders. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Huang L, Huang G, Ding Q, Liang P, Hu C, Zhang H, Zhan L, Wang Q, Cao Y, Zhang J, Shen W, Jia X, Xing W. Amplitude of low-frequency fluctuation (ALFF) alterations in adults with subthreshold depression after physical exercise: A resting-state fMRI study. J Affect Disord 2021; 295:1057-1065. [PMID: 34706414 DOI: 10.1016/j.jad.2021.08.094] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/04/2021] [Accepted: 08/28/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Physical exercise has been proved to reduce the risk of major depression in Subthreshold depression (StD) individuals effectively, yet little is known about the spontaneous brain activity changes associated with physical exercise. METHODS A total of 70 adult subjects, including 38 StD and 32 healthy control (HC) subjects, underwent a resting-state functional magnetic resonance imaging (rs-fMRI) before and after eight-week aerobic exercise respectively. Then, the amplitude of low-frequency fluctuation (ALFF) alterations between the two groups were quantitatively analyzed. RESULTS Before exercise intervention, the rs-fMRI data showed increased ALFF of the right putamen in the StD group compared with HC group. After exercise intervention, there was no significant ALFF change observed between the StD and HC groups. The longitudinal ALFF differences from pre- to post- exercise intervention showed significantly decreased ALFF in the right middle and inferior occipital gyrus, right middle and inferior temporal gyrus, right fusiform gyrus (FG), while increased ALFF in the right middle cingulate, right superior parietal louble, right inferior parietal lobule (IPL) (inferior parietal gyrus and supramarginal gyrus), and bilateral precuneus in the StD group. As for HC group, the results showed that decreased ALFF in the right FG and right parahippocampus, while increased ALFF in the right precuneus, right middle cingulate, right supplementary motor area, right superior parietal lobule and right paracentral lobule in the HC group. No significant correlation between changes of ALFF and clinical scale scores in the StD group. LIMITATIONS The definitions of StD are varied in terms of different studies, the final sample size was relatively small, and the age range of the subjects in this study was narrow. Meanwhile, the exercise intervention trial was short-term. CONCLUSIONS These results further support the standpoint that physical exercise has the potential to reshape the abnormal patterns of spontaneous brain activity in adults with StD.
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Affiliation(s)
- Lina Huang
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China; Department of Radiology, Changshu Hospital Affiliated to Xuzhou Medical University, Jiangsu, China
| | - Guofeng Huang
- School of Information and Electronics Technology, Jiamusi University, Jiamusi, Heilongjian, China
| | - Qingguo Ding
- Department of Radiology, Changshu Hospital Affiliated to Xuzhou Medical University, Jiangsu, China
| | - Pei Liang
- Department of Radiology, Changshu Hospital Affiliated to Xuzhou Medical University, Jiangsu, China; Department of Psychology, Faculty of Education, Hubei University, Wuhan, Hubei, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Soochow, Jiangsu, Chna
| | - Hongqiang Zhang
- Department of Radiology, Changshu Hospital Affiliated to Xuzhou Medical University, Jiangsu, China
| | - Linlin Zhan
- School of Western Language, Heilongjiang University, Heilongjiang, China
| | - Qianqian Wang
- School of Teacher Education, Zhejiang Normal University, Jinhua, Zhejiang, China
| | - Yikang Cao
- School of Computer Science and Technology, Jiamusi University, Jiamusi, Heilongjiang, China
| | - Jun Zhang
- Department of Psychiatry, Changshu Third People's Hospital, Changshu, Jiangsu, China
| | - Wenbin Shen
- Department of Radiology, Changshu Hospital Affiliated to Xuzhou Medical University, Jiangsu, China
| | - Xize Jia
- Center for Cognition and Brain Disorders, Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Wei Xing
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
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School-based depression and anxiety prevention programs: An updated systematic review and meta-analysis. Clin Psychol Rev 2021; 89:102079. [PMID: 34571372 DOI: 10.1016/j.cpr.2021.102079] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 07/27/2021] [Accepted: 08/24/2021] [Indexed: 11/22/2022]
Abstract
Depression and anxiety are often first experienced during childhood and adolescence, and interest in the prevention of these disorders is growing. The focus of this review was to assess the effectiveness of psychological prevention programs delivered in schools, and to provide an update to our previous review from five years ago (Werner-Seidler, Perry, Calear, Newby, & Christensen, 2017). Three electronic databases were systematically searched for published articles of randomised controlled trials (RCTs) evaluating the efficacy of school-based prevention programs until October 2020. There were 130 articles that met inclusion criteria, representing 118 unique trials and 45,924 participants. Small between-group effect sizes for depression (g = 0.21) and anxiety (g = 0.18) were detected immediately post-intervention. Subgroup analyses suggested that targeted prevention programs (for young people with risk factors or symptoms) were associated with significantly greater effect sizes relative to universal programs for depression, which was confirmed by meta-regression. There was also some evidence that external providers conferred some benefit over school-staff delivered programs. Overall, study quality was moderate and no association between risk of bias and effect size was detected. School-delivered psychological prevention programs have small effects in reducing symptoms of depression and anxiety. Refinement of these programs, and knowledge about how they can be sustainably delivered in schools beyond the trial period is now needed for population-level preventive effects. Systematic Review Registration Number: PROPSERO - CRD42020188323.
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Setkowski K, Boogert K, Hoogendoorn AW, Gilissen R, van Balkom AJLM. Guidelines improve patient outcomes in specialised mental health care: A systematic review and meta-analysis. Acta Psychiatr Scand 2021; 144:246-258. [PMID: 34033121 PMCID: PMC8456921 DOI: 10.1111/acps.13332] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/20/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The uptake of evidence-based guideline recommendations appears to be challenging. In the midst of the discussion on how to overcome these barriers, the question of whether the use of guidelines leads to improved patient outcomes threatens to be overlooked. This study examined the effectiveness of evidence-based guidelines for all psychiatric disorders on patient health outcomes in specialist mental health care. All types of evidence-based guidelines, such as psychological and medication-focused guidelines, were eligible for inclusion. Provider performance was measured as a secondary outcome. Time to remission when treated with the guidelines was also examined. METHOD Six databases were searched until 10 August 2020. Studies were selected, and data were extracted independently according to the PRISMA guidelines. Random effects meta-analyses were used to pool estimates across studies. Risk of bias was assessed according to the Cochrane Effective Practice and Organization of Care Review Group criteria. PROSPERO CRD42020171311. RESULTS The meta-analysis included 18 studies (N = 5380). Guidelines showed a positive significant effect size on the severity of psychopathological symptoms at the patient level when compared to treatment-as-usual (TAU) (d = 0.29, 95%-CI = (0.19, 0.40), p < 0.001). Removal of a potential outlier gave globally the same results with Cohen's d = 0.26. Time to remission was shorter in the guideline treatment compared with TAU (HR = 1.54, 95%-CI = (1.29, 1.84), p = 0.001, n = 3). CONCLUSIONS Patients cared for with guideline-adherent treatments improve to a greater degree and more quickly than patients treated with TAU. Knowledge on the mechanisms of change during guideline-adherent treatment needs to be developed further such that we can provide the best possible treatment to patients in routine care.
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Affiliation(s)
- Kim Setkowski
- Department of PsychiatryAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Public Health Research Institute and GGZ inGeest Specialised Mental Health CareAmsterdamThe Netherlands,113 Suicide PreventionAmsterdamThe Netherlands
| | | | - Adriaan W. Hoogendoorn
- Department of PsychiatryAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Public Health Research Institute and GGZ inGeest Specialised Mental Health CareAmsterdamThe Netherlands
| | | | - Anton J. L. M. van Balkom
- Department of PsychiatryAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Public Health Research Institute and GGZ inGeest Specialised Mental Health CareAmsterdamThe Netherlands
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van Dijk SEM, Pols AD, Adriaanse MC, van Marwijk HWJ, van Tulder MW, Bosmans JE. Cost-effectiveness of a stepped care program to prevent depression among primary care patients with diabetes mellitus type 2 and/or coronary heart disease and subthreshold depression in comparison with usual care. BMC Psychiatry 2021; 21:402. [PMID: 34389017 PMCID: PMC8361858 DOI: 10.1186/s12888-021-03367-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patients with diabetes mellitus type 2 (DM2) and/or coronary heart disease (CHD) are at high risk to develop major depression. Preventing incident major depression may be an important tool in reducing the personal and societal burden of depression. The aim of the current study was to assess the cost-effectiveness of a stepped care program to prevent major depression (Step-Dep) in diabetes mellitus type 2 and/or coronary heart disease patients with subthreshold depression in comparison with usual care. METHODS An economic evaluation with 12 months follow-up was conducted alongside a pragmatic cluster-randomized controlled trial from a societal perspective. Participants received care as usual (n = 140) or Step-Dep (n = 96) which consisted of four sequential treatment steps: watchful waiting, guided self-help, problem solving treatment and referral to a general practitioner. Primary outcomes were quality-adjusted life years (QALYs) and cumulative incidence of major depression. Costs were measured every 3 months. Missing data was imputed using multiple imputation. Uncertainty around cost-effectiveness outcomes was estimated using bootstrapping and presented in cost-effectiveness planes and acceptability curves. RESULTS There were no significant differences in QALYs or depression incidence between treatment groups. Secondary care costs (mean difference €1644, 95% CI €344; €3370) and informal care costs (mean difference €1930, 95% CI €528; €4089) were significantly higher in the Step-Dep group than in the usual care group. The difference in total societal costs (€1001, 95% CI €-3975; €6409) was not statistically significant. The probability of the Step-Dep intervention being cost-effective was low, with a maximum of 0.41 at a ceiling ratio of €30,000 per QALY gained and 0.32 at a ceiling ratio of €0 per prevented case of major depression. CONCLUSIONS The Step-Dep intervention is not cost-effective compared to usual care in a population of patients with DM2/CHD and subthreshold depression. Therefore, widespread implementation cannot be recommended. TRIAL REGISTRATION The trial was registered in the Netherlands Trial Register ( NTR3715 ).
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Affiliation(s)
- S. E. M. van Dijk
- grid.16872.3a0000 0004 0435 165XDepartment of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands
| | - A. D. Pols
- grid.16872.3a0000 0004 0435 165XDepartment of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands ,grid.16872.3a0000 0004 0435 165XDepartment of General Practice and Elderly Medicine and the Amsterdam Public Health research institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - M. C. Adriaanse
- grid.16872.3a0000 0004 0435 165XDepartment of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands
| | - H. W. J. van Marwijk
- grid.16872.3a0000 0004 0435 165XDepartment of General Practice and Elderly Medicine and the Amsterdam Public Health research institute, VU University Medical Centre, Amsterdam, The Netherlands ,Department of Primary Care and Public Health Medicine, Brighton, UK ,Sussex Medical School, Brighton, UK
| | - M. W. van Tulder
- grid.16872.3a0000 0004 0435 165XDepartment of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands
| | - J. E. Bosmans
- grid.16872.3a0000 0004 0435 165XDepartment of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands
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Wang X, Xie H, Chen T, Cotton AS, Salminen LE, Logue MW, Clarke-Rubright EK, Wall J, Dennis EL, O'Leary BM, Abdallah CG, Andrew E, Baugh LA, Bomyea J, Bruce SE, Bryant R, Choi K, Daniels JK, Davenport ND, Davidson RJ, DeBellis M, deRoon-Cassini T, Disner SG, Fani N, Fercho KA, Fitzgerald J, Forster GL, Frijling JL, Geuze E, Gomaa H, Gordon EM, Grupe D, Harpaz-Rotem I, Haswell CC, Herzog JI, Hofmann D, Hollifield M, Hosseini B, Hudson AR, Ipser J, Jahanshad N, Jovanovic T, Kaufman ML, King AP, Koch SBJ, Koerte IK, Korgaonkar MS, Krystal JH, Larson C, Lebois LAM, Levy I, Li G, Magnotta VA, Manthey A, May G, McLaughlin KA, Mueller SC, Nawijn L, Nelson SM, Neria Y, Nitschke JB, Olff M, Olson EA, Peverill M, Phan KL, Rashid FM, Ressler K, Rosso IM, Sambrook K, Schmahl C, Shenton ME, Sierk A, Simons JS, Simons RM, Sponheim SR, Stein MB, Stein DJ, Stevens JS, Straube T, Suarez-Jimenez B, Tamburrino M, Thomopoulos SI, van der Wee NJA, van der Werff SJA, van Erp TGM, van Rooij SJH, van Zuiden M, Varkevisser T, Veltman DJ, Vermeiren RRJM, Walter H, Wang L, Zhu Y, Zhu X, Thompson PM, Morey RA, Liberzon I. Cortical volume abnormalities in posttraumatic stress disorder: an ENIGMA-psychiatric genomics consortium PTSD workgroup mega-analysis. Mol Psychiatry 2021; 26:4331-4343. [PMID: 33288872 PMCID: PMC8180531 DOI: 10.1038/s41380-020-00967-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 10/29/2020] [Accepted: 11/18/2020] [Indexed: 01/31/2023]
Abstract
Studies of posttraumatic stress disorder (PTSD) report volume abnormalities in multiple regions of the cerebral cortex. However, findings for many regions, particularly regions outside commonly studied emotion-related prefrontal, insular, and limbic regions, are inconsistent and tentative. Also, few studies address the possibility that PTSD abnormalities may be confounded by comorbid depression. A mega-analysis investigating all cortical regions in a large sample of PTSD and control subjects can potentially provide new insight into these issues. Given this perspective, our group aggregated regional volumes data of 68 cortical regions across both hemispheres from 1379 PTSD patients to 2192 controls without PTSD after data were processed by 32 international laboratories using ENIGMA standardized procedures. We examined whether regional cortical volumes were different in PTSD vs. controls, were associated with posttraumatic stress symptom (PTSS) severity, or were affected by comorbid depression. Volumes of left and right lateral orbitofrontal gyri (LOFG), left superior temporal gyrus, and right insular, lingual and superior parietal gyri were significantly smaller, on average, in PTSD patients than controls (standardized coefficients = -0.111 to -0.068, FDR corrected P values < 0.039) and were significantly negatively correlated with PTSS severity. After adjusting for depression symptoms, the PTSD findings in left and right LOFG remained significant. These findings indicate that cortical volumes in PTSD patients are smaller in prefrontal regulatory regions, as well as in broader emotion and sensory processing cortical regions.
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Affiliation(s)
- Xin Wang
- Department of Psychiatry, University of Toledo, Toledo, OH, USA.
| | - Hong Xie
- Department of Neurosciences, University of Toledo, Toledo, OH, USA
| | - Tian Chen
- Department of Mathematics and Statistics, University of Toledo, Toledo, OH, USA
| | - Andrew S Cotton
- Department of Psychiatry, University of Toledo, Toledo, OH, USA
| | - Lauren E Salminen
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of the University of Southern California, Marina del Rey, CA, USA
| | - Mark W Logue
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Emily K Clarke-Rubright
- Brain Imaging and Analysis Center, Duke University, Durham, NC, USA
- VISN 6 MIRECC, Durham VA Health Care System, Durham, NC, USA
| | - John Wall
- Department of Neurosciences, University of Toledo, Toledo, OH, USA
| | - Emily L Dennis
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of the University of Southern California, Marina del Rey, CA, USA
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Brian M O'Leary
- Department of Psychiatry, University of Toledo, Toledo, OH, USA
| | - Chadi G Abdallah
- Clinical Neuroscience Division, National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | | | - Lee A Baugh
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD, USA
- Center for Brain and Behavior Research, University of South Dakota, Vermillion, SD, USA
- Sioux Falls VA Health Care System, Sioux Falls, SD, USA
| | - Jessica Bomyea
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Steven E Bruce
- Center for Trauma Recovery, Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Kyle Choi
- Health Services Research Center, University of California, San Diego, La Jolla, CA, USA
| | - Judith K Daniels
- Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands
| | - Nicholas D Davenport
- Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Richard J Davidson
- Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI, USA
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, USA
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael DeBellis
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Terri deRoon-Cassini
- Department of Surgery, Division of Trauma & Acute Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Seth G Disner
- Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Kelene A Fercho
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD, USA
- Center for Brain and Behavior Research, University of South Dakota, Vermillion, SD, USA
- Sioux Falls VA Health Care System, Sioux Falls, SD, USA
- Civil Aerospace Medical Institute, US Federal Aviation Administration, Oklahoma City, OK, USA
| | | | - Gina L Forster
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD, USA
- Brain Health Research Centre, Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Jessie L Frijling
- Department of Psychiatry, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Elbert Geuze
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
- Brain Research and Innovation Centre, Ministry of Defence, Utrecht, The Netherlands
| | - Hassaan Gomaa
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA
| | - Evan M Gordon
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Dan Grupe
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, USA
| | - Ilan Harpaz-Rotem
- Clinical Neuroscience Division, National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Courtney C Haswell
- Brain Imaging and Analysis Center, Duke University, Durham, NC, USA
- VISN 6 MIRECC, Durham VA Health Care System, Durham, NC, USA
| | - Julia I Herzog
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - David Hofmann
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Münster, Germany
| | - Michael Hollifield
- Program for Traumatic Stress, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Bobak Hosseini
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Anna R Hudson
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Jonathan Ipser
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of the University of Southern California, Marina del Rey, CA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Milissa L Kaufman
- Division of Women's Mental Health, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Anthony P King
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Saskia B J Koch
- Department of Psychiatry, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Mayuresh S Korgaonkar
- Brain Dynamics Centre, Westmead Institute of Medical Research, University of Sydney, Westmead, NSW, Australia
| | - John H Krystal
- Clinical Neuroscience Division, National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Christine Larson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Lauren A M Lebois
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Ifat Levy
- Clinical Neuroscience Division, National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Comparative Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Gen Li
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Vincent A Magnotta
- Departments of Radiology, Psychiatry, and Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Antje Manthey
- Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Geoffrey May
- VISN 17 Center of Excellence for Research on Returning War Veterans, Doris Miller VA Medical Center, Waco, TX, USA
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
- Department of Psychiatry and Behavioral Science, Texas A&M University College of Medicine, College Station, TX, USA
| | | | - Sven C Mueller
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
- Department of Personality, Psychological Assessment and Treatment, University of Deusto, Bilbao, Spain
| | - Laura Nawijn
- Department of Psychiatry, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Centers, Location VU University Medical Center, VU University, Amsterdam, The Netherlands
| | - Steven M Nelson
- VISN 17 Center of Excellence for Research on Returning War Veterans, Doris Miller VA Medical Center, Waco, TX, USA
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Yuval Neria
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Jack B Nitschke
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
| | - Miranda Olff
- Department of Psychiatry, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
- ARQ National Psychotrauma Centrum, Diemen, The Netherlands
| | - Elizabeth A Olson
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, USA
| | - Matthew Peverill
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - K Luan Phan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Faisal M Rashid
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of the University of Southern California, Marina del Rey, CA, USA
| | - Kerry Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Isabelle M Rosso
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, USA
| | - Kelly Sambrook
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- Department of Psychiatry, University of Western Ontario, London, ON, Canada
| | - Martha E Shenton
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
- Department of Psychiatry, VA Boston Healthcare System, Brockton, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Anika Sierk
- Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - Jeffrey S Simons
- Sioux Falls VA Health Care System, Sioux Falls, SD, USA
- Department of Psychology, University of South Dakota, Vermillion, SD, USA
| | - Raluca M Simons
- Center for Brain and Behavior Research, University of South Dakota, Vermillion, SD, USA
- Department of Psychology, University of South Dakota, Vermillion, SD, USA
| | - Scott R Sponheim
- Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Murray B Stein
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Dan J Stein
- SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Münster, Germany
| | - Benjamin Suarez-Jimenez
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | | | - Sophia I Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of the University of Southern California, Marina del Rey, CA, USA
| | - Nic J A van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Steven J A van der Werff
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Theo G M van Erp
- Clinical Translational Neuroscience Laboratory, Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA, USA
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, Irvine, CA, USA
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Mirjam van Zuiden
- Department of Psychiatry, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Tim Varkevisser
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
- Brain Research and Innovation Centre, Ministry of Defence, Utrecht, The Netherlands
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam University Medical Centers, Location VU University Medical Center, VU University, Amsterdam, The Netherlands
| | - Robert R J M Vermeiren
- Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Youz-Parnassia Group, Leiden, The Netherlands
| | - Henrik Walter
- Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Li Wang
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Ye Zhu
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xi Zhu
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of the University of Southern California, Marina del Rey, CA, USA
| | - Rajendra A Morey
- Brain Imaging and Analysis Center, Duke University, Durham, NC, USA
- VISN 6 MIRECC, Durham VA Health Care System, Durham, NC, USA
| | - Israel Liberzon
- Department of Psychiatry and Behavioral Science, Texas A&M University College of Medicine, College Station, TX, USA
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Health-economic evaluation of psychological interventions for depression prevention: Systematic review. Clin Psychol Rev 2021; 88:102064. [PMID: 34304111 DOI: 10.1016/j.cpr.2021.102064] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 06/24/2021] [Accepted: 06/30/2021] [Indexed: 01/03/2023]
Abstract
Psychological interventions have been proven to be effective to prevent depression, however, little is known on the cost-effectiveness of psychological interventions for the prevention of depression in various populations. A systematic review was conducted using PubMed, PsycINFO, Web of Science, Embase, Cochrane Central Register of Controlled Trials, Econlit, NHS Economic Evaluations Database, NHS Health Technology Assessment and OpenGrey up to January 2021. Only health-economic evaluations based on randomized controlled trials of psychological interventions to prevent depression were included. Independent evaluators selected studies, extracted data and assessed the quality using the Consensus on Health Economic Criteria and the Cochrane Risk of Bias Tool. Twelve trial-based economic evaluations including 5929 participants from six different countries met the inclusion criteria. Overall, the quality of most economic evaluations was considered good, but some studies have some risk of bias. Setting the willingness-to-pay upper limit to US$40,000 (2018 prices) for gaining one quality adjusted life year (QALY), eight psychological preventive interventions were likely to be cost-effective compared to care as usual. The likelihood of preventive psychological interventions being more cost-effective than care as usual looks promising, but more economic evaluations are needed to bridge the many gaps that remain in the evidence-base. ETHICS: As this systematic review is based on published data, approval from the local ethics committee was not required.
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Caldwell DM, Davies SR, Thorn JC, Palmer JC, Caro P, Hetrick SE, Gunnell D, Anwer S, López-López JA, French C, Kidger J, Dawson S, Churchill R, Thomas J, Campbell R, Welton NJ. School-based interventions to prevent anxiety, depression and conduct disorder in children and young people: a systematic review and network meta-analysis. PUBLIC HEALTH RESEARCH 2021. [DOI: 10.3310/phr09080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background
Schools in the UK increasingly have to respond to anxiety, depression and conduct disorder as key causes of morbidity in children and young people.
Objective
The objective was to assess the comparative effectiveness of educational setting-based interventions for the prevention of anxiety, depression and conduct disorder in children and young people.
Design
This study comprised a systematic review, a network meta-analysis and an economic evaluation.
Data sources
The databases MEDLINE, EMBASE™ (Elsevier, Amsterdam, the Netherlands), PsycInfo® (American Psychological Association, Washington, DC, USA) and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to 4 April 2018, and the NHS Economic Evaluation Database (NHS EED) was searched on 22 May 2019 for economic evaluations. No language or date filters were applied.
Main outcomes
The main outcomes were post-intervention self-reported anxiety, depression or conduct disorder symptoms.
Review methods
Randomised/quasi-randomised trials of universal or targeted interventions for the prevention of anxiety, depression or conduct disorder in children and young people aged 4–18 years were included. Screening was conducted independently by two reviewers. Data extraction was conducted by one reviewer and checked by a second. Intervention- and component-level network meta-analyses were conducted in OpenBUGS. A review of the economic literature and a cost–consequence analysis were conducted.
Results
A total of 142 studies were included in the review, and 109 contributed to the network meta-analysis. Of the 109 studies, 57 were rated as having an unclear risk of bias for random sequence generation and allocation concealment. Heterogeneity was moderate. In universal secondary school settings, mindfulness/relaxation interventions [standardised mean difference (SMD) –0.65, 95% credible interval (CrI) –1.14 to –0.19] and cognitive–behavioural interventions (SMD –0.15, 95% CrI –0.34 to 0.04) may be effective for anxiety. Cognitive–behavioural interventions incorporating a psychoeducation component may be effective (SMD –0.30, 95% CrI –0.59 to –0.01) at preventing anxiety immediately post intervention. There was evidence that exercise was effective in preventing anxiety in targeted secondary school settings (SMD –0.47, 95% CrI –0.86 to –0.09). There was weak evidence that cognitive–behavioural interventions may prevent anxiety in universal (SMD –0.07, 95% CrI –0.23 to 0.05) and targeted (SMD –0.38, 95% CrI –0.84 to 0.07) primary school settings. There was weak evidence that cognitive–behavioural (SMD –0.04, 95% CrI –0.16 to 0.07) and cognitive–behavioural + interpersonal therapy (SMD –0.18, 95% CrI –0.46 to 0.08) may be effective in preventing depression in universal secondary school settings. Third-wave (SMD –0.35, 95% CrI –0.70 to 0.00) and cognitive–behavioural interventions (SMD –0.11, 95% CrI –0.28 to 0.05) incorporating a psychoeducation component may be effective at preventing depression immediately post intervention. There was no evidence of intervention effectiveness in targeted secondary, targeted primary or universal primary school settings post intervention. The results for university settings were unreliable because of inconsistency in the network meta-analysis. A narrative summary was reported for five conduct disorder prevention studies, all in primary school settings. None reported the primary outcome at the primary post-intervention time point. The economic evidence review reported heterogeneous findings from six studies. Taking the perspective of a single school budget and based on cognitive–behavioural therapy intervention costs in universal secondary school settings, the cost–consequence analysis estimated an intervention cost of £43 per student.
Limitations
The emphasis on disorder-specific prevention excluded broader mental health interventions and restricted the number of eligible conduct disorder prevention studies. Restricting the study to interventions delivered in the educational setting may have limited the number of eligible university-level interventions.
Conclusions
There was weak evidence of the effectiveness of school-based, disorder-specific prevention interventions, although effects were modest and the evidence not robust. Cognitive–behavioural therapy-based interventions may be more effective if they include a psychoeducation component.
Future work
Future trials for prevention of anxiety and depression should evaluate cognitive–behavioural interventions with and without a psychoeducation component, and include mindfulness/relaxation or exercise comparators, with sufficient follow-up. Cost implications must be adequately measured.
Study registration
This study is registered as PROSPERO CRD42016048184.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah R Davies
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Joanna C Thorn
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jennifer C Palmer
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paola Caro
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Sarah E Hetrick
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol, UK
| | - Sumayya Anwer
- Centre for Reviews and Dissemination, University of York, York, UK
| | - José A López-López
- Department of Basic Psychology and Methodology, Faculty of Psychology, University of Murcia, Murcia, Spain
| | - Clare French
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - James Thomas
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), University College London, London, UK
| | - Rona Campbell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol, UK
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Abstract
Bipolar disorder (BD) is a highly disabling mental illness that affects approximately 1% of the global population. Cognitive capacity is a strong predictor of "everyday" functional outcome in BD and should thus be considered a key treatment target. Interventions to improve cognition have been largely unsuccessful, likely due to the substantial heterogeneity inherent to the illness. It is known that 40%-60% of people with BD have cognitive impairment, yet impairment is not "one size fits all"; in fact, the literature supports discrete cognitive subtypes in BD (e.g., intact, globally impaired, and selectively impaired). Gaining a better understanding of these cognitive subtypes, their longitudinal trajectories, and their biological underpinnings will be essential for improving patient outcomes. The prevailing hypothesis for the development of cognitive impairment in BD postulates a stepwise cumulative effect of repeated mood episodes causing wear-and-tear on the brain. However, a paucity of data supports this idea at the group level. We propose that studying heterogeneity longitudinally will allow for clearer delineation of the natural history of cognitive trajectories in BD. In sum, parsing heterogeneity in BD will allow us to identify causal mechanisms and optimize treatment at the level of the individual.
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Doyle CM, Lasch C, Vollman EP, Desjardins CD, Helwig NE, Jacob S, Wolff JJ, Elison JT. Phenoscreening: a developmental approach to research domain criteria-motivated sampling. J Child Psychol Psychiatry 2021; 62:884-894. [PMID: 33137226 PMCID: PMC11221542 DOI: 10.1111/jcpp.13341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND To advance early identification efforts, we must detect and characterize neurodevelopmental sequelae of risk among population-based samples early in development. However, variability across the typical-to-atypical continuum and heterogeneity within and across early emerging psychiatric/neurodevelopmental disorders represent fundamental challenges to overcome. Identifying multidimensionally determined profiles of risk, agnostic to DSM categories, via data-driven computational approaches represents an avenue to improve early identification of risk. METHODS Factor mixture modeling (FMM) was used to identify subgroups and characterize phenotypic risk profiles, derived from multiple parent-report measures of typical and atypical behaviors common to autism spectrum disorder, in a community-based sample of 17- to 25-month-old toddlers (n = 1,570). To examine the utility of risk profile classification, a subsample of toddlers (n = 107) was assessed on a distal, independent outcome examining internalizing, externalizing, and dysregulation at approximately 30 months. RESULTS FMM results identified five asymmetrically sized subgroups. The putative high- and moderate-risk groups comprised 6% of the sample. Follow-up analyses corroborated the utility of the risk profile classification; the high-, moderate-, and low-risk groups were differentially stratified (i.e., HR > moderate-risk > LR) on outcome measures and comparison of high- and low-risk groups revealed large effect sizes for internalizing (d = 0.83), externalizing (d = 1.39), and dysregulation (d = 1.19). CONCLUSIONS This data-driven approach yielded five subgroups of toddlers, the utility of which was corroborated by later outcomes. Data-driven approaches, leveraging multiple developmentally appropriate dimensional RDoC constructs, hold promise for future efforts aimed toward early identification of at-risk-phenotypes for a variety of early emerging neurodevelopmental disorders.
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Affiliation(s)
- Colleen M. Doyle
- Institute of Child Development, University of Minnesota, Minneapolis, MN,USA
| | - Carolyn Lasch
- Institute of Child Development, University of Minnesota, Minneapolis, MN,USA
| | - Elayne P. Vollman
- Department of Comparative Human Development, University of Chicago, Chicago, IL, USA
| | | | - Nathaniel E. Helwig
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
- Department of Statistics, University of Minnesota, Minneapolis, MN, USA
| | - Suma Jacob
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Jason J. Wolff
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Jed T. Elison
- Institute of Child Development, University of Minnesota, Minneapolis, MN,USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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46
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Szota K, Thielemann JFB, Christiansen H, Rye M, Aarons GA, Barke A. Cross-cultural adaption and psychometric investigation of the German version of the Evidence Based Practice Attitude Scale (EBPAS-36D). Health Res Policy Syst 2021; 19:90. [PMID: 34078387 PMCID: PMC8173815 DOI: 10.1186/s12961-021-00736-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 05/12/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The implementation of evidence-based practice (EBP) in mental health care confers many benefits to patients, and research into factors facilitating the implementation of EBP is needed. As an important factor affecting the implementation of EBP, service providers' attitudes toward EBP emerged. The Evidence-Based Practice Attitude Scale (EBPAS-36) is an instrument with good psychometric characteristics that measures positive and ambivalent attitudes toward EBP. However, a German version is missing. The present study therefore aims to provide a validated German translation of the EBPAS-36. METHODS The scale was translated and back-translated as recommended by standard procedures. German psychotherapists were recruited to participate in an online survey. They provided demographic and professional information, completed the EBPAS-36, the Implementation Climate Scale (ICS) and the Intention Scale for Providers (ISP). Standard item and reliability analyses were conducted. Construct validity was evaluated with exploratory (EFA) and confirmatory factor analyses (CFA) in two subsamples (random split). Convergent validity was tested by predicting a high positive correlation of the EBPAS-36D with two scores of attitudes of the ISP and an interest in EBP score. It was tested whether the EBPAS-36D predicts the intention to use EBP. RESULTS N = 599 psychotherapists participated in the study. The item analyses showed a mean item difficulty of pi = 0.64, a mean inter-item correlation of r = 0.18, and a mean item-total correlation of ritc = 0.40. The internal consistency was very good for the total scale (α = 0.89) and ranged from adequate to very good for the subscales (0.65-0.89), indicating high reliability. The original factor structure showed an acceptable model fit (RMSEA = 0.064 (90% CI = 0.059-0.068); SRMR = 0.0922; AIC = 1400.77), confirming the 12-factor structure of the EBPAS-36. However, a second-order factor structure derived by the EFA had an even better model fit (RMSEA = 0.057 (90% CI = 0.052-0.062); SRMR = 0.0822; AIC = 1274.56). When the EBPAS-36D was entered in a hierarchical regression model with the criterion Intention to use EBP, the EBPAS-36D contributed significantly to the prediction (Change in R2 = 0.28, p < 0.001) over and above gender, age and participants' report of ever having worked in a university context. CONCLUSIONS The present study confirms good psychometric properties and validity of a German version of the EBPAS-36 in a sample of psychotherapists.
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Affiliation(s)
- Katharina Szota
- Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, 35032, Marburg, Germany.
| | - Jonathan F B Thielemann
- Department of Clinical and Biological Psychology, Catholic University of Eichstätt-Ingolstadt, Levelingstr. 7, 85049, Ingolstadt, Germany
| | - Hanna Christiansen
- Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, 35032, Marburg, Germany
| | - Marte Rye
- Faculty of Health Sciences, UiT The Arctic University of Norway, Regional Centre for Child and Youth Mental Health and Child Welfare, 9037, Tromsø, Norway
| | - Gregory A Aarons
- Department of Psychiatry, University of California, 9500 Gilman Drive (0812), La Jolla, San Diego, CA, 92093-0812, USA
| | - Antonia Barke
- Department of Clinical and Biological Psychology, Catholic University of Eichstätt-Ingolstadt, Levelingstr. 7, 85049, Ingolstadt, Germany
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47
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Mental health during the COVID-19 pandemic and beyond: The importance of the vagus nerve for biopsychosocial resilience. Neurosci Biobehav Rev 2021; 125:1-10. [PMID: 33582230 PMCID: PMC8106638 DOI: 10.1016/j.neubiorev.2021.02.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/27/2021] [Accepted: 02/04/2021] [Indexed: 12/22/2022]
Abstract
The COVID-19 pandemic has led to widespread increases in mental health problems, including anxiety and depression. The development of these and other psychiatric disorders may be related to changes in immune, endocrine, autonomic, cognitive, and affective processes induced by a SARS-CoV-2 infection. Interestingly, many of these same changes can be triggered by psychosocial stressors such as social isolation and rejection, which have become increasingly common due to public policies aimed at reducing the spread of SARS-CoV-2. The present review aims to shed light on these issues by describing how viral infections and stress affect mental health. First, we describe the multi-level mechanisms linking viral infection and life stress exposure with risk for psychopathology. Then, we summarize how resilience can be enhanced by targeting vagus nerve function by, for example, applying transcutaneous vagus nerve stimulation and targeting lifestyle factors, such as exercise. With these biopsychosocial insights in mind, researchers and healthcare professionals will be better equipped to reduce risk for psychopathology and increase resilience during this challenging pandemic period and beyond.
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48
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Detweiler Guarino I, Cowan DR, Fellows AM, Buckey JC. Use of a Self-guided Computerized Cognitive Behavioral Tool During COVID-19: Evaluation Study. JMIR Form Res 2021; 5:e26989. [PMID: 33973856 PMCID: PMC8168639 DOI: 10.2196/26989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/08/2021] [Accepted: 05/07/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Internet-based programs can help provide accessible and inexpensive behavioral health care to those in need; however, the evaluation of these interventions has been mostly limited to controlled trials. Data regarding patterns of use and effectiveness of self-referred, open-access online interventions are lacking. We evaluated an online-based treatment designed to address stress, depression, and conflict management, the Dartmouth PATH Program, in a freely available and self-guided format during the COVID-19 pandemic. OBJECTIVE The primary aim is to determine users' levels of stress and depression, and the nature of problems and triggers they reported during the COVID-19 pandemic. A secondary objective is to assess the acceptability and usability of the PATH content and determine whether such a program would be useful as a stand-alone open-access resource. The final objective is understanding the high dropout rates associated with online behavioral programs by contrasting the use pattern and program efficacy of individuals who completed session one and did not return to the program with those who came back to complete more sessions. METHODS Cumulative anonymous data from 562 individuals were analyzed. Stress triggers, stress responses, and reported problems were analyzed using qualitative analysis techniques. Scores on usability and acceptability questionnaires were evaluated using the sign test and Wilcoxon signed rank test. Mixed-effects linear modeling was used to evaluate changes in stress and depression over time. RESULTS A total of 2484 users registered from April through October 2020, most of whom created an account without initiating a module. A total of 562 individuals started the program and were considered in the data analysis. The most common stress triggers individuals reported involved either conflicts with family or spouses and work or workload. The most common problems addressed in the mood module were worry, anxiousness, or stress and difficulty concentrating or procrastination. The attrition rate was high with 13% (21/156) completing the conflict module, 17% (50/289) completing session one of the mood module, and 14% (16/117) completing session one of the stress module. Usability and acceptability scores for the mood and stress modules were significantly better than average. In those who returned to complete sessions, symptoms of stress showed a significant improvement over time (P=.03), and there was a significant decrease in depressive symptoms over all time points (P=.01). Depression severity decreased on average by 20% (SD 35.2%; P=.60) between sessions one and two. CONCLUSIONS Conflicts with others, worry, and difficulty concentrating were some of the most common problems people used the programs to address. Individuals who completed the modules indicated improvements in self-reported stress and depression symptoms. Users also found the modules to be effective and rated the program highly for usability and acceptability. Nevertheless, the attrition rate was very high, as has been found with other freely available online-based interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT02726061; https://clinicaltrials.gov/ct2/show/NCT02726061.
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Affiliation(s)
- Isadora Detweiler Guarino
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Devin R Cowan
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Abigail M Fellows
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Jay C Buckey
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
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Gu R, Ao X, Mo L, Zhang D. Neural correlates of negative expectancy and impaired social feedback processing in social anxiety. Soc Cogn Affect Neurosci 2021; 15:285-291. [PMID: 32232371 PMCID: PMC7236026 DOI: 10.1093/scan/nsaa038] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 02/29/2020] [Accepted: 03/23/2020] [Indexed: 02/07/2023] Open
Abstract
Social anxiety has been associated with abnormalities in cognitive processing in the literature, manifesting as various cognitive biases. To what extent these biases interrupt social interactions remains largely unclear. This study used the Social Judgment Paradigm that could separate the expectation and experience stages of social feedback processing. Event-related potentials (ERPs) in these two stages were recorded to detect the effect of social anxiety that might not be reflected by behavioral data. Participants were divided into two groups according to their social anxiety level. Participants in the high social anxiety (HSA) group were more likely to predict that they would be socially rejected by peers than did their low social anxiety (LSA) counterparts (i.e. the control group). Compared to the ERP data of the LSA group, the HSA group showed: (a) a larger P1 component to social cues (peer faces) prior to social feedback presentation, possibly indicating an attention bias; (b) a difference in feedback-related negativity amplitude between unexpected social acceptance and unexpected social rejection, possibly indicating an expectancy bias; and (c) a diminished sensitivity of the P3 amplitude to social feedback valence (be accepted/be rejected), possibly indicating an experience bias. These results could help understand the cognitive mechanisms that comprise and maintain social anxiety.
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Affiliation(s)
- Ruolei Gu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing 100101, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Xiang Ao
- School of Psychology, Shenzhen University, Shenzhen 518060, China
| | - Licheng Mo
- School of Psychology, Shenzhen University, Shenzhen 518060, China
| | - Dandan Zhang
- School of Psychology, Shenzhen University, Shenzhen 518060, China.,Shenzhen Institute of Neuroscience, Shenzhen 518060, China
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50
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Unursaikhan B, Tanaka N, Sun G, Watanabe S, Yoshii M, Funahashi K, Sekimoto F, Hayashibara F, Yoshizawa Y, Choimaa L, Matsui T. Development of a Novel Web Camera-Based Contact-Free Major Depressive Disorder Screening System Using Autonomic Nervous Responses Induced by a Mental Task and Its Clinical Application. Front Physiol 2021; 12:642986. [PMID: 34054567 PMCID: PMC8160373 DOI: 10.3389/fphys.2021.642986] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/23/2021] [Indexed: 12/28/2022] Open
Abstract
Background To increase the consultation rate of potential major depressive disorder (MDD) patients, we developed a contact-type fingertip photoplethysmography-based MDD screening system. With the outbreak of SARS-CoV-2, we developed an alternative to contact-type fingertip photoplethysmography: a novel web camera-based contact-free MDD screening system (WCF-MSS) for non-contact measurement of autonomic transient responses induced by a mental task. Methods The WCF-MSS measures time-series interbeat intervals (IBI) by monitoring color tone changes in the facial region of interest induced by arterial pulsation using a web camera (1920 × 1080 pixels, 30 frames/s). Artifacts caused by body movements and head shakes are reduced. The WCF-MSS evaluates autonomic nervous activation from time-series IBI by calculating LF (0.04-0.15 Hz) components of heart rate variability (HRV) corresponding to sympathetic and parasympathetic nervous activity and HF (0.15-0.4 Hz) components equivalent to parasympathetic activities. The clinical test procedure comprises a pre-rest period (Pre-R; 140 s), mental task period (MT; 100 s), and post-rest period (Post-R; 120 s). The WCF-MSS uses logistic regression analysis to discriminate MDD patients from healthy volunteers via an optimal combination of four explanatory variables determined by a minimum redundancy maximum relevance algorithm: HF during MT (HF MT ), the percentage change of LF from pre-rest to MT (%ΔLF(Pre-R⇒MT) ), the percentage change of HF from pre-rest to MT (%ΔHF(Pre-R⇒MT) ), and the percentage change of HF from MT to post-rest (%ΔHF(MT⇒Post-R) ). To clinically test the WCF-MSS, 26 MDD patients (16 males and 10 females, 20-58 years) were recruited from BESLI Clinic in Tokyo, and 27 healthy volunteers (15 males and 12 females, 18-60 years) were recruited from Tokyo Metropolitan University and RICOH Company, Ltd. Electrocardiography was used to calculate HRV variables as references. Result The WCF-MSS achieved 73% sensitivity and 85% specificity on 5-fold cross-validation. IBI correlated significantly with IBI from reference electrocardiography (r = 0.97, p < 0.0001). Logit scores and subjective self-rating depression scale scores correlated significantly (r = 0.43, p < 0.05). Conclusion The WCF-MSS seems a promising contact-free MDD screening apparatus. This method enables web camera built-in smartphones to be used as MDD screening systems.
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Affiliation(s)
- Batbayar Unursaikhan
- Graduate School of System Design, Tokyo Metropolitan University, Tokyo, Japan.,Machine Intelligence Laboratory, School of Engineering and Applied Sciences, National University of Mongolia, Ulaanbaatar, Mongolia
| | | | - Guanghao Sun
- Graduate School of Informatics and Engineering, The University of Electro-Communications, Tokyo, Japan
| | | | | | | | - Fumihiro Sekimoto
- Graduate School of Informatics and Engineering, The University of Electro-Communications, Tokyo, Japan
| | - Fumiaki Hayashibara
- Graduate School of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Yutaka Yoshizawa
- Graduate School of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Lodoiravsal Choimaa
- Machine Intelligence Laboratory, School of Engineering and Applied Sciences, National University of Mongolia, Ulaanbaatar, Mongolia
| | - Takemi Matsui
- Graduate School of System Design, Tokyo Metropolitan University, Tokyo, Japan
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