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Hollister B, Crabb R, Areán P. Comparative Effectiveness of Clinician- Versus Peer-Supported Problem-Solving Therapy for Rural Older Adults With Depression. Psychiatr Serv 2024; 75:925-928. [PMID: 38650489 PMCID: PMC11366500 DOI: 10.1176/appi.ps.20230027] [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] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Self-guided and peer-supported treatments for depression among rural older adults may address some common barriers to treatment. This pilot study compared the effect on depression of peer-supported, self-guided problem-solving therapy (SG-PST) with case management problem-solving therapy (CM-PST) among older adults in rural California. METHODS Older adults with depression (N=105) received an introductory PST session with a clinician, followed by 11 sessions of CM-PST with a clinician (N=85) or SG-PST with a peer counselor (N=20). RESULTS Both interventions resulted in clinically significant improvement in depression by week 12. Depression scores in the CM-PST group dropped by 4.1 points more than in the SG-PST group between baseline and week 12 (95% CI=0.99-7.22, p<0.001, Hedges's g=1.08). CONCLUSIONS The results suggest that peer-supported SG-PST is a viable, acceptable option for rural older adults with depression as a second-line treatment if access to clinicians is limited.
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Affiliation(s)
- Brooke Hollister
- Institute for Health and Aging, University of California, San Francisco, San Francisco (Hollister, Crabb); Center for Care Research South, Department of Health and Nursing Sciences, University of Agder, Agder, Norway (Hollister); Accelerating the Reach and Impact of Treatments for Youth and Adults With Mental Illness (ALACRITY) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Areán)
| | - Rebecca Crabb
- Institute for Health and Aging, University of California, San Francisco, San Francisco (Hollister, Crabb); Center for Care Research South, Department of Health and Nursing Sciences, University of Agder, Agder, Norway (Hollister); Accelerating the Reach and Impact of Treatments for Youth and Adults With Mental Illness (ALACRITY) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Areán)
| | - Patricia Areán
- Institute for Health and Aging, University of California, San Francisco, San Francisco (Hollister, Crabb); Center for Care Research South, Department of Health and Nursing Sciences, University of Agder, Agder, Norway (Hollister); Accelerating the Reach and Impact of Treatments for Youth and Adults With Mental Illness (ALACRITY) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Areán)
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Lo HKY, Ho FYY, Yeung JWF, Ng STW, Wong EYT, Chung KF. Self-help interventions for the prevention of relapse in mood disorder: a systematic review and meta-analysis. Fam Pract 2024:cmae036. [PMID: 39016242 DOI: 10.1093/fampra/cmae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024] Open
Abstract
INTRODUCTION Self-help interventions may offer a scalable adjunct to traditional care, but their effectiveness in relapse prevention is not well-established. Objectives: This review aimed to assess their effectiveness in preventing relapses among individuals with mood disorders. METHODS We systematically reviewed the pertinent trial literature in Web of Science, EMBASE, PubMed, PsycINFO, and Cochrane databases until May 2024. Randomized controlled trials that examined the self-help interventions among individuals diagnosed with major depressive disorder (MDD) or bipolar disorder (BD) were included. The random-effects model computed the pooled risk ratios of relapse, with subgroup analyses and meta-regression analyses to explore heterogeneity sources. RESULTS Fifteen papers and 16 comparisons of randomized trials involving 2735 patients with mood disorders were eligible for this meta-analysis. Adjunct self-help interventions had a small but significant effect on reducing the relapse rates of major depressive disorder (pooled risk ratio: 0.78, 95% confidence interval (CI): 0.66-0.92, P = 0.0032, NNT = 11), and were marginally better in bipolar disorder (pooled risk ratio: 0.62, 95% CI: 0.40-0.97, P = .0344, NNT = 12), as compared to treatment as usual (TAU). No subgroup difference was found based on intervention components, settings, delivery method, or guidance levels. The average dropout rate for self-help interventions (18.9%) did not significantly differ from TAU dropout rates. The examination of treatment adherence was highly variable, precluding definitive conclusions. CONCLUSIONS Self-help interventions demonstrate a modest preventative effect on relapse in mood disorders, despite low to very low certainty. Future research is essential to identify which elements of self-help interventions are most effective.
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Affiliation(s)
- Heidi Ka-Ying Lo
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Fiona Yan-Yee Ho
- Department of Psychology, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jerry Wing-Fai Yeung
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Stephy Tim-Wai Ng
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Eva Yuen-Ting Wong
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ka-Fai Chung
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
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Tong L, Panagiotopoulou OM, Cuijpers P, Karyotaki E. The effectiveness of self-guided interventions in adults with depressive symptoms: a systematic review and meta-analysis. EBioMedicine 2024; 105:105208. [PMID: 38876043 PMCID: PMC11226978 DOI: 10.1016/j.ebiom.2024.105208] [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: 01/15/2024] [Revised: 06/03/2024] [Accepted: 06/03/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Despite promising scalability and accessibility, evidence on the efficacy of self-guided interventions for adult depression is inconclusive. This study investigated their effectiveness and acceptability, considering diverse delivery formats and support levels. METHODS We systematically searched PubMed, PsycINFO, Embase, and Cochrane Library until 1st January 2024. Included were randomised controlled trials comparing self-guided interventions with a control condition for adult depression. Two independent researchers extracted data. Effect sizes were pooled using random-effects models, with post-intervention depressive severity compared with control conditions as the primary outcome. Study validity was evaluated using Cochrane Risk of Bias 2.0. This study was pre-registered with OSF (https://osf.io/rd43v). FINDINGS We identified 92 studies (111 interventions vs. control comparisons) with 16,706 participants (mean age: 18.78-74.41 years). Compared to controls, self-guided interventions were moderately effective at post-assessment (g = 0.53, 95% CI: 0.45-0.61; I2 = 79.17%) and six to twelve months post-randomisation follow-up (g = 0.32, 95% CI: 0.16-0.48; I2 = 79.19%). Trials with initial human screening (g = 0.59) and interventions delivered in computer programs (g = 1.04) had the significantly largest effect sizes. No differences in treatment effects were observed across support levels, therapy types, commercial availability, or the presence of online discussion forums. Self-guided interventions were less acceptable than control conditions (RR = 0.92, p < 0.001). Most studies showed a moderate to high risk of bias (n = 80). INTERPRETATION Existing trials on self-guided interventions are at high risk of bias, potentially overestimating treatment effects. Despite lower acceptability compared to controls, self-guided interventions are moderately effective in treating adult depression, regardless of support levels and online discussion features. FUNDING None.
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Affiliation(s)
- Lingyao Tong
- Department of Clinical, Neuro & Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Olga-Maria Panagiotopoulou
- Department of Clinical, Neuro & Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro & 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; International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Eirini Karyotaki
- Department of Clinical, Neuro & 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
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Doukani A, Quartagno M, Sera F, Free C, Kakuma R, Riper H, Kleiboer A, Cerga-Pashoja A, van Schaik A, Botella C, Berger T, Chevreul K, Matynia M, Krieger T, Hazo JB, Draisma S, Titzler I, Topooco N, Mathiasen K, Vernmark K, Urech A, Maj A, Andersson G, Berking M, Baños RM, Araya R. Comparison of the Working Alliance in Blended Cognitive Behavioral Therapy and Treatment as Usual for Depression in Europe: Secondary Data Analysis of the E-COMPARED Randomized Controlled Trial. J Med Internet Res 2024; 26:e47515. [PMID: 38819882 PMCID: PMC11179025 DOI: 10.2196/47515] [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: 03/29/2023] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Increasing interest has centered on the psychotherapeutic working alliance as a means of understanding clinical change in digital mental health interventions in recent years. However, little is understood about how and to what extent a digital mental health program can have an impact on the working alliance and clinical outcomes in a blended (therapist plus digital program) cognitive behavioral therapy (bCBT) intervention for depression. OBJECTIVE This study aimed to test the difference in working alliance scores between bCBT and treatment as usual (TAU), examine the association between working alliance and depression severity scores in both arms, and test for an interaction between system usability and working alliance with regard to the association between working alliance and depression scores in bCBT at 3-month assessments. METHODS We conducted a secondary data analysis of the E-COMPARED (European Comparative Effectiveness Research on Blended Depression Treatment versus Treatment-as-usual) trial, which compared bCBT with TAU across 9 European countries. Data were collected in primary care and specialized services between April 2015 and December 2017. Eligible participants aged 18 years or older and diagnosed with major depressive disorder were randomized to either bCBT (n=476) or TAU (n=467). bCBT consisted of 6-20 sessions of bCBT (involving face-to-face sessions with a therapist and an internet-based program). TAU consisted of usual care for depression. The main outcomes were scores of the working alliance (Working Alliance Inventory-Short Revised-Client [WAI-SR-C]) and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]) at 3 months after randomization. Other variables included system usability scores (System Usability Scale-Client [SUS-C]) at 3 months and baseline demographic information. Data from baseline and 3-month assessments were analyzed using linear regression models that adjusted for a set of baseline variables. RESULTS Of the 945 included participants, 644 (68.2%) were female, and the mean age was 38.96 years (IQR 38). bCBT was associated with higher composite WAI-SR-C scores compared to TAU (B=5.67, 95% CI 4.48-6.86). There was an inverse association between WAI-SR-C and PHQ-9 in bCBT (B=-0.12, 95% CI -0.17 to -0.06) and TAU (B=-0.06, 95% CI -0.11 to -0.02), in which as WAI-SR-C scores increased, PHQ-9 scores decreased. Finally, there was a significant interaction between SUS-C and WAI-SR-C with regard to an inverse association between higher WAI-SR-C scores and lower PHQ-9 scores in bCBT (b=-0.030, 95% CI -0.05 to -0.01; P=.005). CONCLUSIONS To our knowledge, this is the first study to show that bCBT may enhance the client working alliance when compared to evidence-based routine care for depression that services reported offering. The working alliance in bCBT was also associated with clinical improvements that appear to be enhanced by good program usability. Our findings add further weight to the view that the addition of internet-delivered CBT to face-to-face CBT may positively augment experiences of the working alliance. TRIAL REGISTRATION ClinicalTrials.gov NCT02542891, https://clinicaltrials.gov/study/NCT02542891; German Clinical Trials Register DRKS00006866, https://drks.de/search/en/trial/DRKS00006866; Netherlands Trials Register NTR4962, https://www.onderzoekmetmensen.nl/en/trial/25452; ClinicalTrials.Gov NCT02389660, https://clinicaltrials.gov/study/NCT02389660; ClinicalTrials.gov NCT02361684, https://clinicaltrials.gov/study/NCT02361684; ClinicalTrials.gov NCT02449447, https://clinicaltrials.gov/study/NCT02449447; ClinicalTrials.gov NCT02410616, https://clinicaltrials.gov/study/NCT02410616; ISRCTN Registry ISRCTN12388725, https://www.isrctn.com/ISRCTN12388725?q=ISRCTN12388725&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10; ClinicalTrials.gov NCT02796573, https://classic.clinicaltrials.gov/ct2/show/NCT02796573. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-016-1511-1.
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Affiliation(s)
- Asmae Doukani
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matteo Quartagno
- Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom
| | - Francesco Sera
- Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Florance, Italy
| | - Caroline Free
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ritsuko Kakuma
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Heleen Riper
- Department of Psychiatry, Amsterdam University Medial Centre, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Annet Kleiboer
- Department Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Institute, Amsterdam, Netherlands
| | - Arlinda Cerga-Pashoja
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anneke van Schaik
- Department of Psychiatry, Amsterdam University Medial Centre, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Academic Department for Depressive Disorders, Dutch Mental Health Care, Amsterdam, Netherlands
| | - Cristina Botella
- Department of Basic Psychology, Clinical and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
- Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Karine Chevreul
- Unité de Recherche Clinique in Health Economics, Assistance Publique-Hôpitaux de Paris, Paris, France
- Health Economics Research Unit, Inserm, University of Paris, Paris, France
| | - Maria Matynia
- Faculty of Psychology, SWPS University, Warsaw, Poland
| | - Tobias Krieger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jean-Baptiste Hazo
- Unité de Recherche Clinique in Health Economics, Assistance Publique-Hôpitaux de Paris, Paris, France
- Health Economics Research Unit, Inserm, University of Paris, Paris, France
| | - Stasja Draisma
- Department on Aging, Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, Netherlands
| | - Ingrid Titzler
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Naira Topooco
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Kim Mathiasen
- Department of Clinical Medicine, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Centre for Digital Psychiatry, Mental Health Services of Southern Denmark, Odense, Denmark
| | - Kristofer Vernmark
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Antoine Urech
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Neurology, Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | - Anna Maj
- Faculty of Psychology, SWPS University, Warsaw, Poland
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Rosa María Baños
- Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Ricardo Araya
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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Pietrabissa G, Semonella M, Marchesi G, Mannarini S, Castelnuovo G, Andersson G, Rossi AA. Validation of the Italian Version of the Web Screening Questionnaire for Common Mental Disorders. J Clin Med 2024; 13:1170. [PMID: 38398481 PMCID: PMC10889998 DOI: 10.3390/jcm13041170] [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: 01/03/2024] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The ever-increasing spread of Internet-based systems for common mental disorders has generated the need for brief online screening methods. This study aims to test the psychometric properties of the Web Screening Questionnaire (WSQ) to examine its suitability for screening for common mental health problems among a community sample of Italian adults. METHODS A total of 1282 subjects (F = 819; mean age = 42.05) answered the WSQ. Its discriminant characteristics were examined with other validated selected scales for measuring mental health widely used in the Italian population using sensitivity, specificity, and area under the curve (AUC), as well as positive (PPV) and negative predictive values (NPV). RESULTS Most of the WSQ subscales exhibited moderate to high specificity values. Specifically, the scales of 'agoraphobia' (0.947; 95%CI [0.934, 0.960]), 'anxiety' (0.959; 95%CI [0.946, 0.970]), and 'panic disorder' (0.973; 95%CI [0.964, 0.981]) showed the highest values whilst the 'obsessive-compulsive' dimension had the lowest value at 0.838, 95%CI [0.815, 0.861]. With exceptions observed for 'depression' (0.716; 95%CI [642, 798]) and 'alcohol abuse' (0.760; 95%CI [560, 920]), instead, the WSQ demonstrated critical sensitivity values (<0.6) in all dimensions. CONCLUSIONS The WSQ was appropriate for discriminating between people with and without a psychiatric condition, as it helps to confirm the absence of disorders. However, further diagnostic procedures are required, in case of a positive WSQ screening result.
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Affiliation(s)
- Giada Pietrabissa
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, 20123 Milano, Italy; (G.M.); (G.C.)
- Clinical Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, 20149 Milano, Italy
| | | | - Gloria Marchesi
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, 20123 Milano, Italy; (G.M.); (G.C.)
| | - Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35131 Padova, Italy; (S.M.); (A.A.R.)
- Center for Intervention and Research Studies on the Family, University of Padova, 35131 Padova, Italy
| | - Gianluca Castelnuovo
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, 20123 Milano, Italy; (G.M.); (G.C.)
- Clinical Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, 20149 Milano, Italy
| | - Gerhard Andersson
- Department of Behavioural Science and Learning, Linköping University, 58183 Linköping, Sweden;
- Department of Clinical Neuroscience, Karolinska Institute, 17177 Solna, Sweden
| | - Alessandro Alberto Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35131 Padova, Italy; (S.M.); (A.A.R.)
- Center for Intervention and Research Studies on the Family, University of Padova, 35131 Padova, Italy
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Claro HG, Menezes PR, Fernandes IF, Seward N, Miranda JJ, Saidel MGB, Baquete AGDL, Daley KL, Aschar S, Cruz DV, Castro HCM, Rocha T, Quayle J, Peters TJ, Araya R. Do baseline participant characteristics impact the effectiveness of a mobile health intervention for depressive symptoms? A post-hoc subgroup analysis of the CONEMO trials. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2024; 46:e20233172. [PMID: 38345934 PMCID: PMC11189110 DOI: 10.47626/1516-4446-2023-3172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 11/23/2023] [Indexed: 06/20/2024]
Abstract
OBJECTIVE To ascertain whether sociodemographic and health-related characteristics known from previous research to have a substantive impact on recovery from depression modified the effect of a digital intervention designed to improve depressive symptoms (CONEMO). METHODS The CONEMO study consisted of two randomized controlled trials, one conducted in Lima, Peru, and one in São Paulo, Brazil. As a secondary trial plan analysis, mixed logistic regression was used to explore interactions between the treatment arm and subgroups of interest defined by characteristics measured before randomization - suicidal ideation, race/color, age, gender, income, type of mobile phone, alcohol misuse, tobacco use, and diabetes/hypertension - in both trials. We estimated interaction effects between the treatment group and these subgroup factors for the secondary outcomes using linear mixed regression models. RESULTS Increased effects of the CONEMO intervention on the primary outcome (reduction of at least 50% in depressive symptom scores at 3-month follow-up) were observed among older and wealthier participants in the Lima trial (p = 0.030 and p = 0.001, respectively). CONCLUSION There was no evidence of such differential effects in São Paulo, and no evidence of impact of any other secondary outcomes in either trial. CLINICAL TRIAL REGISTRATION NCT02846662 (São Paulo, Brazil - SP), NCT03026426 (Lima, Peru - LI).
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Affiliation(s)
- Heloísa Garcia Claro
- Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, SP, Brazil
- Núcleo de Apoio à Pesquisa em Saúde Mental Populacional, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Paulo Rossi Menezes
- Núcleo de Apoio à Pesquisa em Saúde Mental Populacional, Universidade de São Paulo (USP), São Paulo, SP, Brazil
- Departamento de Medicina Preventiva, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Ivan Filipe Fernandes
- Centro de Engenharia, Modelagem e Ciências Sociais Aplicadas, Universidade Federal do ABC, Santo André, SP, Brazil
| | - Nadine Seward
- Centre for Global Mental Health and Primary Care Research, Health Service and Population Research, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
| | - Juan Jaime Miranda
- Centre for Global Mental Health and Primary Care Research, Health Service and Population Research, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
| | | | | | - Kate L. Daley
- Núcleo de Apoio à Pesquisa em Saúde Mental Populacional, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Suzana Aschar
- Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Daniela Vera Cruz
- Núcleo de Apoio à Pesquisa em Saúde Mental Populacional, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | - Thais Rocha
- Departamento de Medicina Preventiva, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Julieta Quayle
- Núcleo de Apoio à Pesquisa em Saúde Mental Populacional, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Tim J. Peters
- Bristol Medical and Dental Schools, University of Bristol, Bristol, UK
| | - Ricardo Araya
- Centre for Global Mental Health and Primary Care Research, Health Service and Population Research, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
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Semonella M, Marchesi G, Castelnuovo G, Andersson G, Pietrabissa G. Internet-delivered emotional self-management program for the general population during the COVID-19 pandemic: Usability testing. Digit Health 2024; 10:20552076241258419. [PMID: 39314812 PMCID: PMC11418310 DOI: 10.1177/20552076241258419] [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: 11/10/2023] [Accepted: 05/14/2024] [Indexed: 09/25/2024] Open
Abstract
Introduction Internet-based self-help interventions have the potential to help people address their emotional needs at relatively low costs. However, if the system does not offer optimal functions, it could reduce end-user adherence and satisfaction with treatment and compromise the effectiveness of the program. This study evaluated the usability of an Internet-based self-help intervention for emotional self-management among the general population of Italy during the COVID-19 pandemic. Methods A balanced sex-age sample of 10 individuals who met the inclusion criteria were consecutively recruited online. The think-aloud testing method, the system usability scale and an ad hoc semi-structured interview were used to determine the overall system usability.Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using thematic analysis. Results The participants were mostly satisfied with the usability of the program. However, older users (<45 years) encountered some problems, which took longer, made more mistakes, and needed more help in performing the tasks than their younger counterparts. The analysis of the interviews revealed three central themes: general thoughts about the platform, weaknesses of the platform and difficulties encountered while navigating and completing tasks, and strengths of the platform. Discussion Based on the results of this study, important improvements will be made before the RinasciMENTE program is tested under real-world conditions. Conducting usability testing is a crucial step at an early stage of the development process of an Internet-based self-help intervention to identify potential usability problems with the system.
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Affiliation(s)
| | - Gloria Marchesi
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of Milan, Milan, Italy
- Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Gerhard Andersson
- Department of Behavioural Science and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of Milan, Milan, Italy
- Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
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McCusker J, Lambert S, Yaffe M, Schwartz H, Haggerty J, Belzile E, Pelland ME, Minotti SC, de Raad M. Adaptation and outcomes of a lay-guided mental health self-care model: Results of six trials. Gen Hosp Psychiatry 2023; 85:63-70. [PMID: 37820547 DOI: 10.1016/j.genhosppsych.2023.09.010] [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: 07/11/2023] [Revised: 09/16/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To synthesize results of six controlled trials of self-care interventions for depression and/or anxiety, focusing on five trials in which lay guidance was compared to self-directed use of the same self-care tools. METHODS The trials were conducted in Canada in different target populations. Self-care tools were adapted to each population. Guidance was provided in 3-15 calls over a period of 6-26 weeks. Depression and/or anxiety were assessed at follow-up (6-26 weeks). Pooled analyses used a meta-analytic approach. Engagement with the self-care tools was compared using the standardized difference or Cohen's d effect size. RESULTS In studies with homogeneous outcomes (three for depression, four for anxiety), the pooled effect sizes of guidance vs. self-directed use of the self-care tools were 0.36 (95% CI 0.10, 0.62, N = 235) for depression and 0.21 (95% CI -0.03, 0.44, N = 285) for anxiety. Guidance consistently led to greater engagement with the tools. CONCLUSIONS The intervention model is a potentially sustainable and accessible alternative to professionally guided self-care for people with mild-moderate depression. Factors which may have limited implementation success include: co-interventions, reduced number of guide calls (3 vs 6 or more), and delivery to dyads (patient-caregiver).
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Affiliation(s)
- Jane McCusker
- Department of Epidemiology and Biostatistics, McGill University, 1020 Pine Ave, Montreal, Quebec H3A 1A2, Canada; St. Mary's Research Centre, 3830 Lacombe Ave, Hayes Pavilion, Suite 4720, Montreal, Quebec H3T 1M5, Canada.
| | - Sylvie Lambert
- St. Mary's Research Centre, 3830 Lacombe Ave, Hayes Pavilion, Suite 4720, Montreal, Quebec H3T 1M5, Canada; Ingram School of Nursing, McGill University, 80 Sherbrooke St W, Suite1800, Montreal, Quebec H3A 2M7, Canada.
| | - Mark Yaffe
- St. Mary's Research Centre, 3830 Lacombe Ave, Hayes Pavilion, Suite 4720, Montreal, Quebec H3T 1M5, Canada; Department of Family Medicine, McGill University, 5858 Chem de la Côte des Neiges, Montreal, Quebec H3S 1Z1, Canada; St. Mary's Hospital Department of Family Medicine, 3777 Jean Brillant St, Montreal, Quebec H3T 1M5, Canada.
| | - Hannah Schwartz
- Department of Psychiatry, McGill University, 1033 Pine Ave W, Montreal, Quebec H3A 1A1, Canada; Department of Psychiatry, St. Mary's Hospital Centre, 3830 Lacombe Ave, Montreal, Quebec H3T 1M5, Canada.
| | - Jeannie Haggerty
- St. Mary's Research Centre, 3830 Lacombe Ave, Hayes Pavilion, Suite 4720, Montreal, Quebec H3T 1M5, Canada; Department of Family Medicine, McGill University, 5858 Chem de la Côte des Neiges, Montreal, Quebec H3S 1Z1, Canada.
| | - Eric Belzile
- St. Mary's Research Centre, 3830 Lacombe Ave, Hayes Pavilion, Suite 4720, Montreal, Quebec H3T 1M5, Canada.
| | - Marie-Eve Pelland
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Pavillon Roger-Gaudry, S-716, 2900, boul Édouard-Montpetit, Montreal, Quebec H3T 1A4, Canada; Radio-oncology Department, Centre hospitalier de l'Université de Montréal, 1000, rue Saint-Denis, Montreal, Quebec H2X 0C1, Canada.
| | - Simona C Minotti
- St. Mary's Research Centre, 3830 Lacombe Ave, Hayes Pavilion, Suite 4720, Montreal, Quebec H3T 1M5, Canada; Institute for Better Health, Trillium Health Partners, 100 Queensway W, Mississauga, Ontario L58 1B8, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario M5T 3M7, Canada.
| | - Manon de Raad
- St. Mary's Research Centre, 3830 Lacombe Ave, Hayes Pavilion, Suite 4720, Montreal, Quebec H3T 1M5, Canada.
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Sampson E. Implementing Digital Cognitive-Behavioral Therapy for Major Depressive Disorder in Routine Psychiatric Appointments: A Pilot Project in a Rural Population. J Psychosoc Nurs Ment Health Serv 2023; 61:44-51. [PMID: 37134285 DOI: 10.3928/02793695-20230424-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Psychotherapy is well-established as an effective treatment for major depressive disorder (MDD). However, many individuals with MDD in rural areas of the United States do not have access to psychotherapy. Self-management (SM) strategies are now the standard of care for chronic medical conditions and may be a viable alternative for individuals without access to psychotherapy. The current article describes the implementation of a 13-week pilot project to integrate digital cognitive-behavioral therapy (dCBT) SM programs into routine psychiatric advanced practice nurse (APN) telehealth appointments in the rural United States. Eight participants completed the project. The project did not meet the benchmark of 20 participants to improve access to treatment; however, one half (n = 4) of participants reported clinically significant improvement in MDD symptoms over 6 weeks. For clients without access to psychotherapy, dCBT SM programs can be effective in improving individual client outcomes when implemented by APNs in routine telehealth appointments. [Journal of Psychosocial Nursing and Mental Health Services, 61(10), 44-51.].
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10
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Hollis C, Hall CL, Khan K, Le Novere M, Marston L, Jones R, Hunter R, Brown BJ, Sanderson C, Andrén P, Bennett SD, Chamberlain LR, Davies EB, Evans A, Kouzoupi N, McKenzie C, Heyman I, Kilgariff J, Glazebrook C, Mataix-Cols D, Serlachius E, Murray E, Murphy T. Online remote behavioural intervention for tics in 9- to 17-year-olds: the ORBIT RCT with embedded process and economic evaluation. Health Technol Assess 2023; 27:1-120. [PMID: 37924247 PMCID: PMC10641713 DOI: 10.3310/cpms3211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023] Open
Abstract
Background Behavioural therapy for tics is difficult to access, and little is known about its effectiveness when delivered online. Objective To investigate the clinical and cost-effectiveness of an online-delivered, therapist- and parent-supported therapy for young people with tic disorders. Design Single-blind, parallel-group, randomised controlled trial, with 3-month (primary end point) and 6-month post-randomisation follow-up. Participants were individually randomised (1 : 1), using on online system, with block randomisations, stratified by site. Naturalistic follow-up was conducted at 12 and 18 months post-randomisation when participants were free to access non-trial interventions. A subset of participants participated in a process evaluation. Setting Two hospitals (London and Nottingham) in England also accepting referrals from patient identification centres and online self-referrals. Participants Children aged 9-17 years (1) with Tourette syndrome or chronic tic disorder, (2) with a Yale Global Tic Severity Scale-total tic severity score of 15 or more (or > 10 with only motor or vocal tics) and (3) having not received behavioural therapy for tics in the past 12 months or started/stopped medication for tics within the past 2 months. Interventions Either 10 weeks of online, remotely delivered, therapist-supported exposure and response prevention therapy (intervention group) or online psychoeducation (control). Outcome Primary outcome: Yale Global Tic Severity Scale-total tic severity score 3 months post-randomisation; analysis done in all randomised patients for whom data were available. Secondary outcomes included low mood, anxiety, treatment satisfaction and health resource use. Quality-adjusted life-years are derived from parent-completed quality-of-life measures. All trial staff, statisticians and the chief investigator were masked to group allocation. Results Two hundred and twenty-four participants were randomised to the intervention (n = 112) or control (n = 112) group. Participants were mostly male (n = 177; 79%), with a mean age of 12 years. At 3 months the estimated mean difference in Yale Global Tic Severity Scale-total tic severity score between the groups adjusted for baseline and site was -2.29 points (95% confidence interval -3.86 to -0.71) in favour of therapy (effect size -0.31, 95% confidence interval -0.52 to -0.10). This effect was sustained throughout to the final follow-up at 18 months (-2.01 points, 95% confidence interval -3.86 to -0.15; effect size -0.27, 95% confidence interval -0.52 to -0.02). At 18 months the mean incremental cost per participant of the intervention compared to the control was £662 (95% confidence interval -£59 to £1384), with a mean incremental quality-adjusted life-year of 0.040 (95% confidence interval -0.004 to 0.083) per participant. The mean incremental cost per quality-adjusted life-year gained was £16,708. The intervention was acceptable and delivered with high fidelity. Parental engagement predicted child engagement and more positive clinical outcomes. Harms Two serious, unrelated adverse events occurred in the control group. Limitations We cannot separate the effects of digital online delivery and the therapy itself. The sample was predominately white and British, limiting generalisability. The design did not compare to face-to-face services. Conclusion Online, therapist-supported behavioural therapy for young people with tic disorders is clinically and cost-effective in reducing tics, with durable benefits extending up to 18 months. Future work Future work should compare online to face-to-face therapy and explore how to embed the intervention in clinical practice. Trial registration This trial is registered as ISRCTN70758207; ClinicalTrials.gov (NCT03483493). The trial is now complete. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Technology Assessment programme (project number 16/19/02) and will be published in full in Health and Technology Assessment; Vol. 27, No. 18. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Chris Hollis
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham, Nottingham, UK
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
- Department of Child and Adolescent Psychiatry, Nottinghamshire Healthcare NHS Foundation Trust, South Block Level E, Queen's Medical Centre, Nottingham, UK
| | - Charlotte L Hall
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham, Nottingham, UK
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Kareem Khan
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Marie Le Novere
- Research Department of Primary Care and Population Health and Priment CTU, University College London, London, UK
| | - Louise Marston
- Research Department of Primary Care and Population Health and Priment CTU, University College London, London, UK
| | - Rebecca Jones
- Division of Psychiatry and Priment CTU, University College London, London, UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health and Priment CTU, University College London, London, UK
| | - Beverley J Brown
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Charlotte Sanderson
- UCL Great Ormond Street Institute of Child Health (ICH), London, UK/Great Ormond Street Hospital for Children NHS Trust, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Per Andrén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sophie D Bennett
- UCL Great Ormond Street Institute of Child Health (ICH), London, UK/Great Ormond Street Hospital for Children NHS Trust, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Liam R Chamberlain
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - E Bethan Davies
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Amber Evans
- UCL Great Ormond Street Institute of Child Health (ICH), London, UK/Great Ormond Street Hospital for Children NHS Trust, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Natalia Kouzoupi
- UCL Great Ormond Street Institute of Child Health (ICH), London, UK/Great Ormond Street Hospital for Children NHS Trust, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Caitlin McKenzie
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health (ICH), London, UK/Great Ormond Street Hospital for Children NHS Trust, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Joseph Kilgariff
- Department of Child and Adolescent Psychiatry, Nottinghamshire Healthcare NHS Foundation Trust, South Block Level E, Queen's Medical Centre, Nottingham, UK
| | - Cristine Glazebrook
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Eva Serlachius
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health and Priment CTU, University College London, London, UK
| | - Tara Murphy
- UCL Great Ormond Street Institute of Child Health (ICH), London, UK/Great Ormond Street Hospital for Children NHS Trust, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Riva G, Di Lernia D, Tuena C, Bernardelli L, Maldonado JG, Ferrer-Garcia M, Porras-Garcia B, Meyer ML, Shiban Y, Castelnuovo G, Pagnini F, Pedroli E, Sforza F, Clementi A, Sansoni M, Wiederhold BK, Serino S. A Self-Help Virtual Therapeutic Experience Intervention for Overcoming Psychological Distress Related to the COVID-19 Pandemic: Results From the European Multicentric COVID Feel Good Trial. Psychosom Med 2023; 85:639-650. [PMID: 37053096 DOI: 10.1097/psy.0000000000001198] [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: 04/14/2023]
Abstract
OBJECTIVE The general objective of the current study was to investigate the efficacy of a novel self-help virtual therapeutic experience (specifically, the COVID Feel Good intervention) in lowering the psychological burden experienced during the COVID-19 lockdowns in four European countries. METHODS We focused on participants recruited from June 2020 to May 2021 in the context of a European multicenter project including four university/academic sites. The total number of participants in the longitudinal studies was 107 (study 1, N = 40; study 2, N = 29; study 3, N = 38). The randomized controlled trial (study 4) included 31 participants in total, 16 in the intervention group and 15 in the control group. Primary outcome measures were depression, anxiety, stress symptoms, perceived stress level, and perceived hopelessness. The secondary outcome was experienced social connectedness. RESULTS Using separate linear mixed-effects models, the most consistent result across countries was a reduction in perceived stress after the participation in the COVID Feel Good intervention. By pooling the results of the models using a random-effects meta-analysis, we found that after the COVID Feel Good intervention, participants reported a decrease in perceived general distress (mean standardized effect size for general distress in the treatment groups compared with the control conditions was -0.52 [ p = .008, 95% confidence interval = -0.89 to -0.14]) and an increase in the perceived social connection (mean standardized effect size for social connection using COVID Feel Good compared with the control conditions was 0.50 [ p ≤ .001, 95% confidence interval = 0.25 to 0.76]). CONCLUSIONS Findings of this study indicate that a virtual self-help intervention is effective in reducing psychological distress. These results contribute to the growing literature supporting the use of digital psychological therapies to relieve psychological distress among the general population during the COVID-19 pandemic.Trial Registration : ISRCTN63887521.
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Affiliation(s)
- Giuseppe Riva
- From the Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano (Riva, Tuena, Pedroli); Humane Technology Lab, Università Cattolica del Sacro Cuore (Riva, Di Lernia, Pedroli); Become-Hub (Bernardelli, Sforza, Pedroli), Milan, Italy; Department of Clinical Psychology and Psychobiology (Gutiérrez Maldonado, Ferrer-Garcia, Porras-Garcia, Pedroli), University of Barcelona, Barcelona, Spain; Department of Psychology (Meyer, Shiban, Pedroli), Private University of Applied Science, Goettingen, Germany; Clinical Psychology Research Laboratory (Castelnuovo, Pedroli), Ospedale San Giuseppe, IRCCS Istituto Auxologico Italiano, Verbania; Department of Psychology (Castelnuovo, Pagnini, Pedroli, Clementi, Sansoni, Serino), Università Cattolica del Sacro Cuore, Milan, Italy; Faculty of Psychology (Pedroli), University of eCampus, Novedrate, Italy; Virtual Reality Medical Center (Wiederhold), La Jolla, California; Virtual Reality Medical Institute (Wiederhold), Brussels, Belgium
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12
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Cuijpers P, Miguel C, Harrer M, Plessen CY, Ciharova M, Papola D, Ebert D, Karyotaki E. Psychological treatment of depression: A systematic overview of a 'Meta-Analytic Research Domain'. J Affect Disord 2023; 335:141-151. [PMID: 37178828 DOI: 10.1016/j.jad.2023.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Over the past 16 years, we have developed a 'Meta-analytic Research Domain' (MARD) of all randomized trials of psychological treatments of depression. A MARD is a living systematic review of a research field, that cannot be otherwise covered by one (network) meta-analysis and includes multiple PICOs. In this paper we give an overview of the findings of this MARD. METHODS A narrative review of the results of the 118 meta-analyses on psychotherapies for depression that were published within our MARD. RESULTS Most research has been conducted on cognitive-behavioral therapy (CBT), but several other psychotherapies are also effective, with few differences between therapies. They can be effectively delivered in individual, group, telephone and guided self-help format and are effective in many different target groups and across different age groups, although the effects are significantly smaller in children and adolescents. Psychotherapies have comparable effects as pharmacotherapy at the short term but are probably more effective at the longer term. Combined treatment is more effective than either psychotherapy or pharmacotherapy alone at the short, but also at the longer term. LIMITATIONS We did not summarize all published meta-analyses (protocols, methodological studies) and have not compared our results to those found in other meta-analyses on comparable subjects. CONCLUSION Psychotherapies can contribute considerably to a reduction of the disease burden of depression. MARDs are an important next step in the aggregation of knowledge from randomized controlled trials in psychological treatments of depression as well as in other healthcare sectors.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands; Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania.
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Department of Health Sciences, Technical University Munich, Munich, Germany; Department of Clinical Psychology & Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Constantin Yves Plessen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands; Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Davide Papola
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Italy; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - David Ebert
- Psychology & Digital Mental Health Care, Department of Health Sciences, Technical University Munich, Munich, Germany
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
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Cheng AL, Leo AJ, Calfee RP, Dy CJ, Armbrecht MA, Abraham J. Multi-stakeholder perspectives regarding preferred modalities for mental health intervention delivered in the orthopedic clinic: a qualitative analysis. BMC Psychiatry 2023; 23:347. [PMID: 37208668 DOI: 10.1186/s12888-023-04868-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/13/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Although depressive and anxious symptoms negatively impact musculoskeletal health and orthopedic outcomes, a gap remains in identifying modalities through which mental health intervention can realistically be delivered during orthopedic care. The purpose of this study was to understand orthopedic stakeholders' perceptions regarding the feasibility, acceptability, and usability of digital, printed, and in-person intervention modalities to address mental health as part of orthopedic care. METHODS This single-center, qualitative study was conducted within a tertiary care orthopedic department. Semi-structured interviews were conducted between January and May 2022. Two stakeholder groups were interviewed using a purposive sampling approach until thematic saturation was reached. The first group included adult orthopedic patients who presented for management of ≥ 3 months of neck or back pain. The second group included early, mid, and late career orthopedic clinicians and support staff members. Stakeholders' interview responses were analyzed using deductive and inductive coding approaches followed by thematic analysis. Patients also performed usability testing of one digital and one printed mental health intervention. RESULTS Patients included 30 adults out of 85 approached (mean (SD) age 59 [14] years, 21 (70%) women, 12 (40%) non-White). Clinical team stakeholders included 22 orthopedic clinicians and support staff members out of 25 approached (11 (50%) women, 6 (27%) non-White). Clinical team members perceived a digital mental health intervention to be feasible and scalable to implement, and many patients appreciated that the digital modality offered privacy, immediate access to resources, and the ability to engage during non-business hours. However, stakeholders also expressed that a printed mental health resource is still necessary to meet the needs of patients who prefer and/or can only engage with tangible, rather than digital, mental health resources. Many clinical team members expressed skepticism regarding the current feasibility of scalably incorporating in-person support from a mental health specialist into orthopedic care. CONCLUSIONS Although digital intervention offers implementation-related advantages over printed and in-person mental health interventions, a subset of often underserved patients will not currently be reached using exclusively digital intervention. Future research should work to identify combinations of effective mental health interventions that provide equitable access for orthopedic patients. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Abby L Cheng
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 South Euclid Avenue, St. Louis, MO, 63110, USA.
| | - Ashwin J Leo
- Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO, 63110, USA
| | - Ryan P Calfee
- Division of Hand and Wrist, Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 South Euclid Avenue, St. Louis, MO, 63110, USA
| | - Christopher J Dy
- Division of Hand and Wrist, Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 South Euclid Avenue, St. Louis, MO, 63110, USA
| | - Melissa A Armbrecht
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 South Euclid Avenue, St. Louis, MO, 63110, USA
| | - Joanna Abraham
- Department of Anesthesiology & Institute for Informatics, Washington University School of Medicine, 4990 Children's Place, St. Louis, MO, 63110, USA
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Farahimanesh S, Serino S, Tuena C, Di Lernia D, Wiederhold BK, Bernardelli L, Riva G, Moradi A. Effectiveness of a Virtual-Reality-Based Self-Help Intervention for Lowering the Psychological Burden during the COVID-19 Pandemic: Results from a Randomized Controlled Trial in Iran. J Clin Med 2023; 12:2006. [PMID: 36902793 PMCID: PMC10004117 DOI: 10.3390/jcm12052006] [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: 02/13/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic. In this framework, digital self-help interventions have the potential to provide flexible and scalable solutions for delivering evidence-based treatments that do not necessitate face-to-face meetings. OBJECTIVE as part of a multicentric project, the purpose of the current randomized controlled trial was to evaluate the efficacy of a Virtual-Reality-based self-help intervention (namely, COVID Feel Good) in lowering the psychological distress experienced during the COVID-19 pandemic in Iran. METHODS 60 participants were randomly assigned to the experimental (COVID Feel Good intervention group) or the control (no-treatment control group) condition. At the beginning of the intervention (Day 0), at the end of the intervention (Day 7), and after a 2-week follow-up (Day 21), measurements of depressive and anxiety levels, general distress, perceived levels of stress, hopelessness (primary outcome measures), perceived interpersonal closeness with the social world, and fear of COVID-19 (secondary outcome measure) were collected. The protocol consists of two integrated parts: the first part includes a relaxing 10-min three-hundred-sixty-degree (360°) video, while the second one includes social tasks with specified objectives. RESULTS In terms of the primary outcomes, participants in the COVID Feel Good intervention group improved in depression, stress, anxiety, and perceived stress but not hopelessness. Secondary outcome results showed an improvement in perceived social connectedness and a substantial decrease in fear of COVID-19. CONCLUSIONS these findings on the efficacy of COVID Feel Good training add to the growing body of evidence demonstrating the feasibility of digital self-help interventions in promoting well-being during this unique period.
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Affiliation(s)
- Sharareh Farahimanesh
- Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran 1983969411, Iran
- Institute for Cognitive Science Studies, Tehran 1658344575, Iran
| | - Silvia Serino
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy
| | - Cosimo Tuena
- Applied Technology for Neuropsychology Lab, IRCCS Istituto Auxologico Italiano, 20145 Milan, Italy
| | - Daniele Di Lernia
- Humane Technology Lab, Università Cattolica del Sacro Cuore, 20123 Milan, Italy
| | - Brenda K. Wiederhold
- Virtual Reality Medical Center, La Jolla, CA 92037, USA
- Virtual Reality Medical Institute, 1200 Brussels, Belgium
| | | | - Giuseppe Riva
- Applied Technology for Neuropsychology Lab, IRCCS Istituto Auxologico Italiano, 20145 Milan, Italy
- Humane Technology Lab, Università Cattolica del Sacro Cuore, 20123 Milan, Italy
| | - Alireza Moradi
- Institute for Cognitive Science Studies, Tehran 1658344575, Iran
- Faculty of Psychology & Education, Department of Psychology, Kharazmi University, Tehran 1571914911, Iran
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Aller TB, Russo RB, Kelley HH, Bates L, Fauth EB. Mental Health Concerns in Individuals With Developmental Disabilities: Improving Mental Health Literacy Trainings for Caregivers. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2023; 61:49-64. [PMID: 36706003 DOI: 10.1352/1934-9556-61.1.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/18/2022] [Indexed: 05/16/2023]
Abstract
Although approximately a third of individuals with intellectual and developmental disabilities (IDD) also experience a mental health concern, caregivers often miss early identification of these issues. In this perspective piece, we present an outline for a mental health literacy program that can enhance existing training approaches for caregivers of individuals with IDD. We describe three processes of the Mental Health Awareness and Advocacy (MHAA) curriculum and detail how it provides a strong preventative model to train caregivers to increase their mental health literacy. In describing these processes, we provide illustrative examples and conclude by providing a brief vignette that highlights how this process could be used by caregivers to help reduce mental health concerns in individuals with IDD.
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Affiliation(s)
- Ty B Aller
- Ty B. Aller, Raechel B. Russo, Heather H. Kelley, Lexi Bates, and Elizabeth B. Fauth, Utah State University
| | - Raechel B Russo
- Ty B. Aller, Raechel B. Russo, Heather H. Kelley, Lexi Bates, and Elizabeth B. Fauth, Utah State University
| | - Heather H Kelley
- Ty B. Aller, Raechel B. Russo, Heather H. Kelley, Lexi Bates, and Elizabeth B. Fauth, Utah State University
| | - Lexi Bates
- Ty B. Aller, Raechel B. Russo, Heather H. Kelley, Lexi Bates, and Elizabeth B. Fauth, Utah State University
| | - Elizabeth B Fauth
- Ty B. Aller, Raechel B. Russo, Heather H. Kelley, Lexi Bates, and Elizabeth B. Fauth, Utah State University
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16
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Cheng AL, Leo AJ, Calfee RP, Dy CJ, Armbrecht MA, Abraham J. Multi-stakeholder perspectives regarding preferred modalities for mental health intervention delivered in the orthopedic clinic: A qualitative analysis. RESEARCH SQUARE 2023:rs.3.rs-2327095. [PMID: 36778298 PMCID: PMC9915768 DOI: 10.21203/rs.3.rs-2327095/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although depressive and anxious symptoms negatively impact musculoskeletal health and orthopedic outcomes, a gap remains in identifying modalities through which mental health intervention can realistically be delivered during orthopedic care. The purpose of this study was to understand orthopedic stakeholders' perspectives regarding the feasibility, acceptability, and usability of digital, printed, and in-person intervention modalities to address mental health as part of orthopedic care. METHODS This single-center, qualitative study was conducted within the orthopedic department of a tertiary care center. Semi-structured interviews were conducted between January and May 2022. Two stakeholder groups were interviewed using a purposive sampling approach until thematic saturation was reached. The first group included adult orthopedic patients who presented for management of ≥ 3 months of neck or back pain. The second group included early, mid, and late career orthopedic clinicians and support staff members. Stakeholders' interview responses were analyzed using deductive and inductive coding approaches followed by thematic analysis. Patients also performed usability testing of one digital and one printed mental health intervention. RESULTS Patients included 30 adults out of 85 approached (mean (SD) age 59 (14) years, 21 (70%) women, 12 (40%) non-White). Clinical team stakeholders included 22 orthopedic clinicians and support staff members out of 25 approached (11 (50%) women, 6 (27%) non-White). Clinical team members perceived a digital mental health intervention to be feasible and scalable to implement, and many patients appreciated that the digital modality offered privacy, immediate access to resources, and the ability to engage during non-business hours. However, stakeholders also expressed that a printed mental health resource is still necessary to meet the needs of patients who prefer and/or can only engage with tangible, rather than digital, mental health resources. Many clinical team members expressed skepticism regarding the current feasibility of scalably incorporating in-person mental health support into orthopedic care. CONCLUSIONS Although digital intervention offers implementation-related advantages over printed and in-person mental health interventions, a subset of often underserved patients will not currently be reached using exclusively digital intervention. Future research should work to identify combinations of effective mental health interventions that provide equitable access for orthopedic patients. TRIAL REGISTRATION Not applicable.
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Young DKW, Carlbring P, Ng PYN, Chen QRJ. Feasibility of Self-Guided Online Cognitive Behavioral Therapy for University Students During COVID-19. RESEARCH ON SOCIAL WORK PRACTICE 2022; 32:898-911. [PMID: 38603083 PMCID: PMC9096000 DOI: 10.1177/10497315221087904] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Objective: This study aimed to test the feasibility and efficacy of a self-guided online cognitive behaviour therapy (iCBT) for university students in Hong Kong during COVID-19. Method: One group pre-post-test design with convenient sampling was adopted in this study, involving 84 university students who received a newly developed iCBT within an 8 week intervention period. The iCBT offered eight online modules for students to learn the skills of CBT at home through an online platform which was accessible any time anywhere anonymously with technical support only. Standardized assessment tools were used for outcomes assessment at the pre- and post-intervention periods. Results: Three quarters of participants completed all iCBT modules. The results of paired t-tests showed that, after completing the iCBT, participants showed reduction in anxiety, depression, and perceived stress. Conclusion: This study provides preliminary evidences to support the feasibility and efficacy of the self-guided iCBT for university students during COVID-19.
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Affiliation(s)
- Daniel K. W. Young
- Department of Social Work, Hong Kong Baptist
University, Hong Kong, Hong Kong
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Petrus Y. N. Ng
- Department of Social Work, Hong Kong Baptist
University, Hong Kong, Hong Kong
| | - Qi-rong J. Chen
- Department of Social Work, Hong Kong Baptist
University, Hong Kong, Hong Kong
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18
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McCusker J, Lambert SD, Ciampi A, Jones JM, Li M, Yaffe MJ, Pelland ME, Belzile E, de Raad M. Trained lay coaches and self-care cognitive-behavioral tools improve depression outcomes. PATIENT EDUCATION AND COUNSELING 2022; 105:2747-2756. [PMID: 35397942 DOI: 10.1016/j.pec.2022.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Identify the key effective components of a depression self-care intervention. METHODS Secondary analysis of data from 3 studies that demonstrated effectiveness of a similar depression self-care intervention (n = 275): 2 studies among patients with chronic physical conditions and 1 among cancer survivors. The studies used similar tools, and telephone-based lay coaching. Depression remission and reduction at 6 months were assessed with either PHQ-9 (chronic condition cohorts) or CES-D (cancer survivor cohort). Multiple logistic regression was used to analyze data when the interaction p-value with cohort was < 0.10. RESULTS The 3 coached cohorts achieved better depression outcomes than usual care. The combination of coaching and joint use of 2 tools based on cognitive-behavioral therapy (CBT) was associated with depression remission and reduction among chronic condition cohorts but not among cancer survivors. Neither the number nor the length of coach calls were associated with outcomes in pooled data. CONCLUSIONS Trained lay coaching and use of CBT-based self-care tools were associated with improved depression outcomes in patients with chronic conditions but not among cancer survivors. PRACTICE IMPLICATIONS Trained lay coaching and CBT tools are key components of depression self-care interventions. Further research is needed on the effective components in cancer survivors.
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Affiliation(s)
- Jane McCusker
- St. Mary's Research Centre, 3830 Lacombe Ave., Hayes Pavilion, Suite 4720, Montreal H3T 1M5, Quebec, Canada; Montreal West Island Integrated University Health and Social Services Centre, 3830 Lacombe Ave., Montreal H3T 1M5, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave, Montreal, Quebec H3A 1A2, Canada.
| | - Sylvie D Lambert
- St. Mary's Research Centre, 3830 Lacombe Ave., Hayes Pavilion, Suite 4720, Montreal H3T 1M5, Quebec, Canada; Montreal West Island Integrated University Health and Social Services Centre, 3830 Lacombe Ave., Montreal H3T 1M5, Quebec, Canada; Ingram School of Nursing, McGill University, 80 Sherbrooke St W, Suite1800, Montreal, Quebec H3A 2M7, Canada.
| | - Antonio Ciampi
- St. Mary's Research Centre, 3830 Lacombe Ave., Hayes Pavilion, Suite 4720, Montreal H3T 1M5, Quebec, Canada; Montreal West Island Integrated University Health and Social Services Centre, 3830 Lacombe Ave., Montreal H3T 1M5, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave, Montreal, Quebec H3A 1A2, Canada.
| | - Jennifer M Jones
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada; Department of Supportive Care, Princess Margaret Cancer Centre, 610 University Ave, Toronto M5G 2C1, Ontario, Canada.
| | - Madeline Li
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada; Department of Supportive Care, Princess Margaret Cancer Centre, 610 University Ave, Toronto M5G 2C1, Ontario, Canada.
| | - Mark J Yaffe
- St. Mary's Research Centre, 3830 Lacombe Ave., Hayes Pavilion, Suite 4720, Montreal H3T 1M5, Quebec, Canada; Montreal West Island Integrated University Health and Social Services Centre, 3830 Lacombe Ave., Montreal H3T 1M5, Quebec, Canada; Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montréal, Quebec H3S 1Z1, Canada; Department of Family Medicine, St. Mary's Hospital Center, 3830 Lacombe Ave, Hayes Pavilion, Montreal H3T 1M5, Quebec, Canada.
| | - Marie-Eve Pelland
- Département de radio-oncologie, Centre hospitalier de l'Université de Montréal, 1000, rue Saint-Denis, Montréal, Québec H2X 0C1, Canada.
| | - Eric Belzile
- St. Mary's Research Centre, 3830 Lacombe Ave., Hayes Pavilion, Suite 4720, Montreal H3T 1M5, Quebec, Canada; Montreal West Island Integrated University Health and Social Services Centre, 3830 Lacombe Ave., Montreal H3T 1M5, Quebec, Canada.
| | - Manon de Raad
- St. Mary's Research Centre, 3830 Lacombe Ave., Hayes Pavilion, Suite 4720, Montreal H3T 1M5, Quebec, Canada; Montreal West Island Integrated University Health and Social Services Centre, 3830 Lacombe Ave., Montreal H3T 1M5, Quebec, Canada.
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Corpas J, Gilbody S, McMillan D. Cognitive, behavioural or cognitive-behavioural self-help interventions for subclinical depression in older adults: A systematic review and meta-analysis. J Affect Disord 2022; 308:384-390. [PMID: 35460732 DOI: 10.1016/j.jad.2022.04.085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/04/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Subclinical depression is a risk factor for the development of major depression in older adults. We aimed to determine the effectiveness of pure self-help or self-help with minimal support to reduce depressive symptoms and to prevent the onset of major depression in this population. METHODS This was a systematic review and meta-analysis of trials that used self-administrated cognitive, behavioural or cognitive-behavioural interventions for older adults with subclinical depression compared to control groups. Medline, Embase, PsycInfo and Cochrane databases were searched for relevant studies. RESULTS We analysed eight trials involving 1449 participants. A small but significant effect favouring the intervention was found at short-term [d = 0.33; 95% CI (Confidence Interval): 0.20-0.47] and at long-term (d = 0.22; 95% CI: 0.04-0.40) for depressive symptoms. None of the studies looked at the preventive effect of self-help interventions in reducing the probability of a subsequent diagnosis of major depression. LIMITATIONS The low number of studies meant that it was not possible to test for publication bias. The absence of pre-published protocols for many of the studies meant that there is a possibility of selective reporting bias for some of the primary studies. CONCLUSIONS There is some evidence that cognitive-behavioural self-help interventions may reduce depressive symptoms in older adults with subclinical depression. However, no study examined whether the intervention had a preventative effect in reducing the likelihood of a subsequent diagnosis of major depression.
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Affiliation(s)
- Jorge Corpas
- Department of Psychology, University of Cordoba, Spain; Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Spain.
| | - Simon Gilbody
- Hull York Medical School, United Kingdom; Department of Health Sciences, University of York, United Kingdom
| | - Dean McMillan
- Hull York Medical School, United Kingdom; Department of Health Sciences, University of York, United Kingdom
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20
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Garagiola ER, Lam Q, Wachsmuth LS, Tan TY, Ghali S, Asafo S, Swarna M. Adolescent Resilience during the COVID-19 Pandemic: A Review of the Impact of the Pandemic on Developmental Milestones. Behav Sci (Basel) 2022; 12:220. [PMID: 35877290 PMCID: PMC9311591 DOI: 10.3390/bs12070220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023] Open
Abstract
This review explores the literature regarding the ways in which the COVID-19 pandemic has affected the navigation of developmental milestones among adolescents, specifically those in late adolescence, across several domains of their lives. The exploration is contextualized globally, focusing on five key areas: mental health, physical health, education, peer relationships, and family relationships. Implications for practice and interventions are explored in each key area to provide recommendations for those working with adolescents, as well as future research. The changes brought about by the pandemic and the readjustment to what some have referred to as the "new normalcy" will undoubtedly have lasting effects on all areas of life for this cohort of adolescents, who have shown remarkable resilience navigating this new and unfamiliar world. These changes are synthesized, with the aim to highlight differences and similarities of the shared experiences of the pandemic globally. After exploring the current realities, this chapter goes on to outline the ways in which the experience of such a significant developmental period of one's life during the COVID-19 pandemic will have an impact on adolescents for years to come. Although it is still impossible to comprehend the long-term effects, in examining proximal effects, we can postulate distal implications and potential future effects, as well as possible ways to mitigate these implications as we transition back to more of what was experienced pre-pandemic life, from a post-pandemic experience.
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Affiliation(s)
- Erica R. Garagiola
- Department of Psychology, Rutgers University, New Brunswick, NJ 08901, USA; (S.G.); (M.S.)
| | - Queenie Lam
- Department of Psychology, Long Island University Brooklyn, Brooklyn, NY 11201, USA;
| | - Louise S. Wachsmuth
- Counseling and Clinical Psychology, Teacher’s College, Columbia University, New York, NY 10027, USA;
| | - Tse Yen Tan
- Yale Center for Emotional Intelligence, New Haven, CT 06511, USA;
| | - Samara Ghali
- Department of Psychology, Rutgers University, New Brunswick, NJ 08901, USA; (S.G.); (M.S.)
| | - Seth Asafo
- Department of Psychiatry, University of Ghana, Korle Bu, Accra P.O. Box GP 4236, Ghana;
| | - Manjari Swarna
- Department of Psychology, Rutgers University, New Brunswick, NJ 08901, USA; (S.G.); (M.S.)
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21
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Brog NA, Hegy JK, Berger T, Znoj H. Age, Motivation, and Emotion Regulation Skills Predict Treatment Outcome in an Internet-Based Self-Help Intervention for COVID-19 Related Psychological Distress. Front Public Health 2022; 10:835356. [PMID: 35757638 PMCID: PMC9218094 DOI: 10.3389/fpubh.2022.835356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction First evidence suggests that internet-based self-help interventions effectively reduce COVID-19 related psychological distress. However, it is yet unclear which participant characteristics are associated with better treatment outcomes. Therefore, we conducted secondary analyses on data from a randomized controlled trial investigating the efficacy of a 3-week internet-based self-help intervention for COVID-19 related psychological distress. In this exploratory analysis, we examined several predictors ranging from sociodemographic variables to psychological distress, resource-related, and treatment-related variables. This includes, for example, age, motivation, and emotion regulation skills. Treatment outcomes were defined as post-treatment depressive symptoms and post-treatment resilience. Methods In a total of 107 participants with at least mild depressive symptoms, possible predictor variables and treatment outcomes were assessed using self-report measures. For example, emotion regulation skills were assessed by the Self-report measure for the assessment of emotion regulation skills. In a first step, we performed a separate linear regression analysis for each potential predictor. In a second step, predictors meeting a significant threshold of p < 0.05 were entered in linear multiple regression models. Baseline scores of the respective outcome measure were controlled for. Results The mean age of the participants was 40.36 years (SD = 14.59, range = 18–81 years) with the majority being female (n = 87, 81.3%). Younger age predicted lower post-treatment depressive symptoms. Additionally, higher motivation to use the intervention and better pre-treatment emotion regulation skills predicted higher post-treatment resilience. Conclusion The current study provides preliminary evidence regarding the relationship between participant characteristics and treatment outcome in internet-based self-help interventions for COVID-19 related distress. Our results suggest that under the circumstances surrounding COVID-19 such interventions might be particularly beneficial for young adults regarding depressive symptoms. Moreover, focusing on participants' existing strengths might be a promising approach to promote resilience through internet-based self-help interventions. However, since this was an exploratory analysis in an uncontrolled setting, further studies are needed to draw firm conclusions about the relationship of participant characteristics and treatment outcome in internet-based self-help interventions for COVID-19 related psychological distress.
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Affiliation(s)
- Noemi Anja Brog
- Department of Health Psychology and Behavioral Medicine, University of Bern, Bern, Switzerland
| | - Julia Katharina Hegy
- Department of Health Psychology and Behavioral Medicine, University of Bern, Bern, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Hansjörg Znoj
- Department of Health Psychology and Behavioral Medicine, University of Bern, Bern, Switzerland
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22
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Philippe TJ, Sikder N, Jackson A, Koblanski ME, Liow E, Pilarinos A, Vasarhelyi K. Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review. JMIR Ment Health 2022; 9:e35159. [PMID: 35551058 PMCID: PMC9109782 DOI: 10.2196/35159] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has shifted mental health care delivery to digital platforms, videoconferencing, and other mobile communications. However, existing reviews of digital health interventions are narrow in scope and focus on a limited number of mental health conditions. OBJECTIVE To address this gap, we conducted a comprehensive systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions. METHODS We searched MEDLINE for secondary literature published between 2010 and 2021 on the use, efficacy, and appropriateness of digital health interventions for the delivery of mental health care. RESULTS Of the 3022 records identified, 466 proceeded to full-text review and 304 met the criteria for inclusion in this study. A majority (52%) of research involved the treatment of substance use disorders, 29% focused on mood, anxiety, and traumatic stress disorders, and >5% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence. CONCLUSIONS Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions.
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Affiliation(s)
- Tristan J Philippe
- Department of Cellular & Physiological Sciences, The University of British Columbia, Vancouver, BC, Canada.,Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | | | - Anna Jackson
- School of Social Work, The University of British Columbia, Vancouver, BC, Canada
| | - Maya E Koblanski
- Department of Cellular & Physiological Sciences, The University of British Columbia, Vancouver, BC, Canada.,Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | - Eric Liow
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Andreas Pilarinos
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Krisztina Vasarhelyi
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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23
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Brog NA, Hegy JK, Berger T, Znoj H. Effects of an internet-based self-help intervention for psychological distress due to COVID-19: Results of a randomized controlled trial. Internet Interv 2022; 27:100492. [PMID: 34956841 PMCID: PMC8684052 DOI: 10.1016/j.invent.2021.100492] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/30/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic and its far-reaching impact on physical and mental health generate high demand and, accordingly, a great need for treatment opportunities that promote well-being and manage psychological distress. Internet-based interventions are particularly suitable for this purpose. They are easily scalable, readily accessible, and the online format allows for adherence to social distancing. For this reason, we developed an internet-based self-help intervention called ROCO to address psychological distress due to the COVID-19 pandemic. This randomized controlled trial aimed to examine the efficacy of the ROCO intervention. METHODS A total of 107 German-speaking adults with at least mild depressive symptoms were randomized either to the intervention group with direct access to the three-week ROCO intervention plus care as usual or the waiting control group receiving care as usual. Primary outcome (depressive symptoms) and secondary outcomes (stress, anxiety, resilience, emotion regulation, health-related quality of life, embitterment, loneliness, optimism, and self-efficacy) were assessed pre- and post-treatment and at a 6-week follow-up using self-report questionnaires (e.g. Patient Health Questionnaire-9 for depressive symptoms). RESULTS The average age was 40.36 years (SD = 14.59) and 81.3% of participants were female. The intervention did not significantly reduce primary depressive symptoms (between-group effect size: d = 0.04) and secondary outcomes such as anxiety and stress symptoms (between-group effect size: d = -0.19). However, the intervention led to a significant increase in emotion regulation skills (between-group effect size d = 0.35) and resilience (between-group effect size d = 0.38). CONCLUSIONS The internet-based self-help intervention cannot be recommended for the purpose of reducing depressive symptoms. However, the increase in emotion regulation skills and resilience suggest that the intervention may be suitable for preventive purposes, like improving overall coping with psychological distress or potential stressors. Future research is needed to examine for whom and how the intervention is most effective.
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Affiliation(s)
- Noemi Anja Brog
- Department of Health Psychology and Behavioral Medicine, University of Bern, Switzerland
| | - Julia Katharina Hegy
- Department of Health Psychology and Behavioral Medicine, University of Bern, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Hansjörg Znoj
- Department of Health Psychology and Behavioral Medicine, University of Bern, Switzerland
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Haas M, Jakubovski E, Kunert K, Fremer C, Buddensiek N, Häckl S, Lenz-Ziegenbein M, Musil R, Roessner V, Münchau A, Neuner I, Koch A, Müller-Vahl K. ONLINE-TICS: Internet-Delivered Behavioral Treatment for Patients with Chronic Tic Disorders. J Clin Med 2022; 11:jcm11010250. [PMID: 35011989 PMCID: PMC8745756 DOI: 10.3390/jcm11010250] [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] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 02/04/2023] Open
Abstract
Comprehensive Behavioral Intervention for Tics (CBIT) is considered a first-line therapy for tics. However, availability of CBIT is extremely limited due to a lack of qualified therapists. This study is a multicenter (n = 5), randomized, controlled, observer-blind trial including 161 adult patients with chronic tic disorders (CTD) to provide data on efficacy and safety of an internet-delivered, completely therapist-independent CBIT intervention (iCBIT Minddistrict®) in the treatment of tics compared to placebo and face-to-face (f2f) CBIT. Using a linear mixed model with the change to baseline of Yale Global Tic Severity Scale-Total Tic Score (YGTSS-TTS) as a dependent variable, we found a clear trend towards significance for superiority of iCBIT (n = 67) over placebo (n = 70) (−1.28 (−2.58; 0.01); p = 0.053). In addition, the difference in tic reduction between iCBIT and placebo increased, resulting in a significant difference 3 (−2.25 (−3.75; −0.75), p = 0.003) and 6 months (−2.71 (−4.27; −1.16), p < 0.001) after the end of treatment. Key secondary analysis indicated non-inferiority of iCBIT in comparison to f2f CBIT (n = 24). No safety signals were detected. Although the primary endpoint was narrowly missed, it is strongly suggested that iCBIT is superior compared to placebo. Remarkably, treatment effects of iCBIT even increased over time.
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Affiliation(s)
- Martina Haas
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany; (M.H.); (E.J.); (K.K.); (C.F.); (N.B.); (M.L.-Z.)
| | - Ewgeni Jakubovski
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany; (M.H.); (E.J.); (K.K.); (C.F.); (N.B.); (M.L.-Z.)
| | - Katja Kunert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany; (M.H.); (E.J.); (K.K.); (C.F.); (N.B.); (M.L.-Z.)
| | - Carolin Fremer
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany; (M.H.); (E.J.); (K.K.); (C.F.); (N.B.); (M.L.-Z.)
| | - Nadine Buddensiek
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany; (M.H.); (E.J.); (K.K.); (C.F.); (N.B.); (M.L.-Z.)
| | - Sebastian Häckl
- Institute for Biostatistics, Hannover Medical School Hannover, 30625 Hannover, Germany; (S.H.); (A.K.)
| | - Martina Lenz-Ziegenbein
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany; (M.H.); (E.J.); (K.K.); (C.F.); (N.B.); (M.L.-Z.)
| | - Richard Musil
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, 80539 Munich, Germany;
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Technische Universität Dresden, 01307 Dresden, Germany;
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany;
| | - Irene Neuner
- Department of Psychiatry, Psychotherapy, and Psychosomatics, School of Medicine, RWTH Aachen University, 52074 Aachen, Germany;
- Institute of Neuroscience and Medicine 4 (INM-4), Forschungszentrum Jülich, 52428 Jülich, Germany
- JARA-BRAIN—Translational Medicine, 52056 Aachen, Germany
| | - Armin Koch
- Institute for Biostatistics, Hannover Medical School Hannover, 30625 Hannover, Germany; (S.H.); (A.K.)
| | - Kirsten Müller-Vahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany; (M.H.); (E.J.); (K.K.); (C.F.); (N.B.); (M.L.-Z.)
- Correspondence:
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Saad A, Bruno D, Camara B, D'Agostino J, Bolea-Alamanac B. Self-directed Technology-Based Therapeutic Methods for Adult Patients Receiving Mental Health Services: Systematic Review. JMIR Ment Health 2021; 8:e27404. [PMID: 34842556 PMCID: PMC8665378 DOI: 10.2196/27404] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 07/26/2021] [Accepted: 08/12/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Technological interventions used to treat illnesses and promote health are grouped under the umbrella term of digital therapeutics. The use of digital therapeutics is becoming increasingly common in mental health. Although many technologies are currently being implemented, research supporting their usability, efficacy, and risk requires further examination, especially for those interventions that can be used without support. OBJECTIVE This review aims to identify the evidence-based, self-directed, technology-based methods of care that can be used in adult patients after they are discharged from mental health services. The interventions reviewed are automated with no human input required (either at the patient's or at the technology's end), so the patients can implement them without any support. METHODS A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PROSPERO (International Prospective Register of Systematic Reviews) guidelines in 3 databases: PubMed, Web of Science, and OVID. The inclusion criteria were self-directed, automated, and technology-based interventions related to mental health, primarily for adults, having a solid evaluation process. The interventions had to be self-directed, in that the participants could use the technology without any external guidance. RESULTS We identified 36 papers that met the inclusion criteria: 26 randomized controlled trials, 9 nonrandomized controlled trial quantitative studies, and 1 qualitative study. The technologies used included websites, automated text messaging, phone apps, videos, computer software, and integrated voice response. There were 22 studies focused on internet-based cognitive behavioral therapies as a therapeutic paradigm compared with the waitlist, web-based human-delivered therapy, and other interventions. Among these studies, 14 used paradigms other than the internet-based cognitive behavioral therapy. Of the 8 studies comparing guided and unguided digital care, 3 showed no differences, 3 favored guided interventions, and 2 favored unguided interventions. The research also showed that dropout rates were as high as 80%, citing potential problems with the acceptability of the suggested technologies. CONCLUSIONS There is limited research on the efficacy and suitability of self-directed technology-based care options for mental health. Digital technologies have the potential to bridge the gap between ambulatory care and independent living. However, these interventions may need to be developed collaboratively with the users to encourage their acceptability and to avoid high dropout rates.
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Affiliation(s)
- Anthony Saad
- Department of Psychiatry, Women's College Hospital, Toronto, ON, Canada
| | - Deanna Bruno
- Department of Psychiatry, Women's College Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Bettina Camara
- Department of Immunology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Blanca Bolea-Alamanac
- Department of Psychiatry, Women's College Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Ould Brahim L, Lambert SD, Feeley N, Coumoundouros C, Schaffler J, McCusker J, Moodie EEM, Kayser J, Kolne K, Belzile E, Genest C. The effects of self-management interventions on depressive symptoms in adults with chronic physical disease(s) experiencing depressive symptomatology: a systematic review and meta-analysis. BMC Psychiatry 2021; 21:584. [PMID: 34800995 PMCID: PMC8605588 DOI: 10.1186/s12888-021-03504-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 09/28/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chronic diseases are the leading cause of death worldwide. It is estimated that 20% of adults with chronic physical diseases experience concomitant depression, increasing their risk of morbidity and mortality. Low intensity psychosocial interventions, such as self-management, are part of recommended treatment; however, no systematic review has evaluated the effects of depression self-management interventions for this population. The primary objective was to examine the effect of self-management interventions on reducing depressive symptomatology in adults with chronic disease(s) and co-occurring depressive symptoms. Secondary objectives were to evaluate the effect of these interventions on improving other psychosocial and physiological outcomes (e.g., anxiety, glycemic control) and to assess potential differential effect based on key participant and intervention characteristics (e.g., chronic disease, provider). METHODS Studies comparing depression self-management interventions to a control group were identified through a) systematic searches of databases to June 2018 [MEDLINE (1946 -), EMBASE (1996 -), PsycINFO (1967 -), CINAHL (1984 -)] and b) secondary 'snowball' search strategies. The methodological quality of included studies was critically reviewed. Screening of all titles, abstracts, and full texts for eligibility was assessed independently by two authors. Data were extracted by one author and verified by a second. RESULTS Fifteen studies were retained: 12 for meta-analysis and three for descriptive review. In total, these trials included 2064 participants and most commonly evaluated interventions for people with cancer (n = 7) or diabetes (n = 4). From baseline to < 6-months (T1), the pooled mean effect size was - 0.47 [95% CI -0.73, - 0.21] as compared to control groups for the primary outcome of depression and - 0.53 [95% CI -0.91, - 0.15] at ≥ 6-months (T2). Results were also significant for anxiety (T1) and glycemic control (T2). Self-management skills of decision-making and taking action were significant moderators of depression at T1. CONCLUSION Self-management interventions show promise in improving depression and anxiety in those with concomitant chronic physical disease. The findings may contribute to the development of future Self-management interventions and delivering evidence-based care to this population. Further high-quality RCTs are needed to identify sources of heterogeneity and investigate key intervention components.
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Affiliation(s)
| | - Sylvie D. Lambert
- grid.14709.3b0000 0004 1936 8649Ingram School of Nursing, McGill University, Montreal, Canada ,St. Mary’s Research Centre, Montreal, Canada
| | - Nancy Feeley
- grid.14709.3b0000 0004 1936 8649Ingram School of Nursing, McGill University, Montreal, Canada ,Centre for Nursing Research, Montreal, Canada
| | - Chelsea Coumoundouros
- grid.8993.b0000 0004 1936 9457Healthcare Sciences and e-Health, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | | | - Jane McCusker
- St. Mary’s Research Centre, Montreal, Canada ,grid.14709.3b0000 0004 1936 8649Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Erica E. M. Moodie
- grid.14709.3b0000 0004 1936 8649Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Montreal, Montreal, Canada
| | - John Kayser
- grid.459278.50000 0004 4910 4652CIUSSS du Centre-Sud-de-l’Île-de-Montréa, Montreal, Canada
| | - Kendall Kolne
- Trillium Lakelands District School Board, Lindsay, Canada
| | | | - Christine Genest
- grid.14848.310000 0001 2292 3357Faculty of Nursing Sciences, Université de Montreal, Montreal, Quebec Canada
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Taylor H, Strauss C, Cavanagh K. Can a little bit of mindfulness do you good? A systematic review and meta-analyses of unguided mindfulness-based self-help interventions. Clin Psychol Rev 2021; 89:102078. [PMID: 34537665 DOI: 10.1016/j.cpr.2021.102078] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 06/30/2021] [Accepted: 08/24/2021] [Indexed: 12/18/2022]
Abstract
Over the last decade there has been an explosion of interest in mindfulness-based self-help (MBSH) interventions. While widely available and extensively promoted, there is little consensus on their impact in public health or healthcare contexts. We present a systematic review and meta-analyses of 83 randomized controlled trials, comparing unguided MBSH to control conditions on outcomes of depression, mindfulness, anxiety, stress and/or wellbeing/ quality of life. A random effects model was used to compute post-intervention, between-groups effect sizes for each outcome. MBSH demonstrated small, statistically significant effects at post-interventions for outcomes of depression (g = -0.23), mindfulness (g = 0.37) anxiety (g = -0.25), stress (g = -0.41) and wellbeing/ quality of life (g = 0.34). Significant effects were retained at follow-up for mindfulness, stress and wellbeing/ quality of life but not for depression or anxiety. Planned moderator analyses demonstrated significantly larger effects of MBSH when compared to inactive, versus active-control conditions on all outcomes except wellbeing/ quality of life, and non-digital MBSH interventions demonstrated significantly greater effects on depression, mindfulness and wellbeing/ quality of life outcomes than digitally-delivered MBSH. When studies that utilised samples selected for mental and physical health-related difficulties were respectively compared to studies that utilised unselected samples, no significant moderation effects were observed. In sum, these findings provide evidence for the effectiveness of unguided MBSH in public health settings and the practical, access-related implications of this are discussed.
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Affiliation(s)
- Heather Taylor
- School of Psychology, University of Sussex, Falmer, Brighton BN1 9QJ, UK.
| | - Clara Strauss
- School of Psychology, University of Sussex, Falmer, Brighton BN1 9QJ, UK; R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Hove, BN3 7HZ, UK.
| | - Kate Cavanagh
- School of Psychology, University of Sussex, Falmer, Brighton BN1 9QJ, UK; R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Hove, BN3 7HZ, UK.
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Bourne J, Harrison TL, Wigham S, Morison CJ, Hackett S. A systematic review of community psychosocial group interventions for adults with intellectual disabilities and mental health conditions. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:3-23. [PMID: 34337837 DOI: 10.1111/jar.12919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/07/2021] [Accepted: 06/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND People with intellectual disabilities have a high risk of developing mental ill-health. Treatment is often neglected and diagnosis is misattributed to a person's disability. Standard psychosocial interventions can improve a person's well-being. This review aimed to understand what interventions are being delivered, any benefits, and future recommendations. METHODS Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed, and the review registered with PROSPERO-CRD42020160254. Databases searched included: MEDLINE, Embase, and PsycINFO. A framework synthesis approach was used to present the findings. RESULTS There are limited psychosocial interventions offered for this population. When groups are delivered having a creative element, multiple activities over a short period of time, with breaks and group rules outcomes can be improved. CONCLUSIONS Adaptations and reasonable adjustments should be used specifically to a person's ability. A mixed-method design allows people to share their experiences alongside quantitative data that provides clinical information.
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Affiliation(s)
- Jane Bourne
- Arts Therapies Department, Cumbria Northumberland Tyne & Wear NHS Foundation Trust, Northgate Hospital, Morpeth, UK
| | - Toni Leigh Harrison
- Arts Therapies Department, Cumbria Northumberland Tyne & Wear NHS Foundation Trust, Northgate Hospital, Morpeth, UK
| | - Sarah Wigham
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Cindy-Jo Morison
- Arts Therapies Department, Cumbria Northumberland Tyne & Wear NHS Foundation Trust, Northgate Hospital, Morpeth, UK
| | - Simon Hackett
- Arts Therapies Department, Cumbria Northumberland Tyne & Wear NHS Foundation Trust, Northgate Hospital, Morpeth, UK
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Hoppen LM, Kuck N, Bürkner PC, Karin E, Wootton BM, Buhlmann U. Low intensity technology-delivered cognitive behavioral therapy for obsessive-compulsive disorder: a meta-analysis. BMC Psychiatry 2021; 21:322. [PMID: 34193113 PMCID: PMC8243493 DOI: 10.1186/s12888-021-03272-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 05/10/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) is a well-established treatment for people suffering from obsessive-compulsive disorder (OCD) and technology-based CBT applications are an emerging treatment option for people with OCD. These applications involve treatment protocols with automated content delivery and relatively low clinical contact. Whilst such CBT applications are promising, however, further investigation is needed to establish the efficacy of this treatment approach for individuals with OCD. The aim of the present study was to review the efficacy of technology-delivered CBT with minimal clinician support for OCD using a meta-analytic approach. METHODS Randomized controlled trials (RCT) were identified through PsycINFO, Medline and Scopus resulting in 18 eligible studies (n = 1707). Control conditions comprised both passive (namely no treatment, other treatments and waitlist controls) and active. Measurement of OCD symptoms improvement was the outcome in each study. RESULTS Participants in the technology-delivered CBT group scored lower on Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) (g = - 0.59, 95% CI = [- 0.99, - 0.18], p = 0.01), Y-BOCS and Dimensional Obsessive-Compulsive Scale (DOCS) combined (g = - 0.55, 95% CI = [- 0.87, - 0.24], p = 0.003) and Obsessive-Compulsive-Inventory-Revised (OCI-R) (g = - 0.36, 95% CI = [- 0.62, - 0.09], p = 0.02) at post-treatment than passive control groups. There were no significant findings when compared to controls with other treatments. CONCLUSIONS This meta-analysis suggests that technology-delivered CBT with low personal contact intensity, relative to passive control groups, is an efficacious and promising treatment option for individuals with OCD. Further research is needed to allow for a comparison with control groups with other treatments.
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Affiliation(s)
| | - Nora Kuck
- University of Münster, Fliednerstr. 21, 48149, Münster, Germany
| | | | | | - Bethany M Wootton
- Macquarie University, Sydney, Australia
- University of Technology Sydney, Sydney, Australia
| | - Ulrike Buhlmann
- University of Münster, Fliednerstr. 21, 48149, Münster, Germany.
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Kay-Lambkin F, Searl A, Johnson MP, Baker A. Working with people experiencing psychotic disorders and co-occurring nicotine dependence: Attitudes and reflections from psychologists on the Healthy Lifestyles research trial. Bull Menninger Clin 2021; 85:204-230. [PMID: 34032459 DOI: 10.1521/bumc.2021.85.2.204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The combination of psychotic and substance use disorders compounds the well-documented challenges of treatment engagement, retention, and outcome for these single conditions. This study focuses on the formation of alliance among this important clinical group. Psychologists working on a research trial participated in qualitative interviews focused on their impression of delivering treatment to people with psychotic disorders and concurrent nicotine dependence. Utilizing Interpretive Phenomenological Analysis, the authors highlighted the complex and unusual experience of working with people with psychotic disorders and concurrent nicotine dependence, the importance of considering each client as an individual, and the many layers of interaction between therapist and client. The authors found that meaningful therapeutic relationships over the longer term are possible, even when active symptoms are present. There is also potential for telephone-based treatments to work well. Clinical supervision and support, tailored to the unique experience of therapists working with psychotic populations, is pivotal.
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Affiliation(s)
- Frances Kay-Lambkin
- Professor/Senior Research Fellow in the School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Amanda Searl
- Clinical Psychologist in the School of Psychology, University of Newcastle, Callaghan, NSW, Australia
| | - Martin P Johnson
- Senior Lecturer in the School of Psychology, University of Newcastle, Callaghan, NSW, Australia
| | - Amanda Baker
- Professor/Senior Clinical Psychologist in the School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
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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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Young CL, Mohebbi M, Staudacher H, Berk M, Jacka FN, O'Neil A. Assessing the feasibility of an m-Health intervention for changing diet quality and mood in individuals with depression: the My Food & Mood program. Int Rev Psychiatry 2021; 33:266-279. [PMID: 34039236 DOI: 10.1080/09540261.2020.1854193] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Recent randomized controlled trials have shown that improving diet quality reduces symptoms in those with depression. The provision of digital health interventions that can support dietary change in those with depression has important benefits with respect to reach, accessibility convenience and cost. The My Food & Mood study used single arm cohort design to test the feasibility of such an intervention. Participants with current depressive symptoms were recruited and enrolled online to use the My Food & Mood m-Health (smartphone delivered) program for 8 weeks. Participants completed depression (PHQ-8) and dietary questionnaires (MEDAS) at baseline, week 4 and week 8. Metrics of use and intensity of use engagement measures were calculated from system logs and data entries. There was a significant change in both MEDAS score (t = 8.147, df = 44, p < 0.001) and PHQ-8 score (t = -7.199, df = 44, p < 0.001) throughout the study. There was a moderate positive association between change in MEDAS score and activities completed, goals and weeks engaged, and a strong inverse association between change in MEDAS score and change in PHQ-8 score. An m-Health program targeting dietary intervention in those with depression was feasible. Dietary change was associated with higher engagement and reduced depressive symptoms.
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Affiliation(s)
- Claire L Young
- Food & Mood Centre, IIMPACT (the Institute for Mental and Physical Health and Clinical Translation), School of Medicine, Deakin University, Barwon Health, Geelong, VIC, Australia
| | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Heidi Staudacher
- Food & Mood Centre, IIMPACT (the Institute for Mental and Physical Health and Clinical Translation), School of Medicine, Deakin University, Barwon Health, Geelong, VIC, Australia
| | - Michael Berk
- IMPACT (the Institute for Mental and Physical Health and Clinical Translation), School of Medicine, Deakin University, Barwon Health, Geelong, VIC, Australia
| | - Felice N Jacka
- Food & Mood Centre, IIMPACT (the Institute for Mental and Physical Health and Clinical Translation), School of Medicine, Deakin University, Barwon Health, Geelong, VIC, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Black Dog Institute, Randwick, NSW, Australia.,James Cook University, Townsville, QLD, Australia
| | - Adrienne O'Neil
- Food & Mood Centre, IIMPACT (the Institute for Mental and Physical Health and Clinical Translation), School of Medicine, Deakin University, Barwon Health, Geelong, VIC, Australia
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Krämer R, Köhler S. Evaluation of the online-based self-help programme "Selfapy" in patients with unipolar depression: study protocol for a randomized, blinded parallel group dismantling study. Trials 2021; 22:264. [PMID: 33836810 PMCID: PMC8034195 DOI: 10.1186/s13063-021-05218-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 03/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background Patients with mild to moderate depressive symptoms can have limited access to regular treatment; to ensure appropriate care, low-threshold treatment is needed. Effective online interventions could increase the supply of low-threshold treatment. Further research is needed to evaluate the effectiveness of online interventions. This study aims to evaluate the online-based self-help programme “Selfapy” on a sample of depressive subjects and compares the impact of the programme’s unaccompanied version with its therapeutic accompanied version. Methods A sample of 400 subjects that have a mild to severe depressive episode (Becks Depression Inventory - II and Hamilton Depression Scale) will be used. Subjects are randomly assigned to immediate access to an unaccompanied course (no support from psychologist via weekly phone calls), immediate access to an accompanied course (support from a psychologist via weekly phone calls) or a waiting list control group (access to the intervention after 24 weeks). The intervention will last for a period of 12 weeks. Depressive symptoms as a primary parameter, as well as various secondary parameters, such as life satisfaction, therapeutic relationships, social activation, self-esteem, attitudes towards Internet interventions and drop-out rates, are recorded at four different points in time: at baseline (T1), 6 weeks after the start of the intervention (T2), 12 weeks after the start of the intervention (T3) and 3 months after completion of the treatment follow-up (T4). Conclusion This randomized and controlled, blinded study will make use of a “dismantled” approach to adequately compare the accompanied and unaccompanied versions of the intervention. Positive and meaningful results are expected that could influence the acceptance and implementation of online interventions. Trial registration German Clinical Trials Register DRKS00017191. Registered on 14 June 2019
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Affiliation(s)
- Rico Krämer
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany.
| | - Stephan Köhler
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
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Young CL, Mohebbi M, Staudacher HM, Kay-Lambkin F, Berk M, Jacka FN, O'Neil A. Optimizing Engagement in an Online Dietary Intervention for Depression (My Food & Mood Version 3.0): Cohort Study. JMIR Ment Health 2021; 8:e24871. [PMID: 33787501 PMCID: PMC8047812 DOI: 10.2196/24871] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/28/2020] [Accepted: 01/16/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Online interventions can be a cost-effective and efficient way to deliver programs to large numbers of people regardless of geographic location. However, attrition in web-based interventions is often an issue. Developing ways to keep participants engaged is important for ensuring validity and limiting potential biases. We developed a web-based dietary intervention as part of The My Food & Mood study which aimed to optimize ways to engage participants with low mood or depressive symptoms to promote dietary behavior change. Different versions of the My Food & Mood program were tested during optimization. Iterations were developed based on user feedback and usage analysis. OBJECTIVE The purpose of this study was to compare engagement and nonusage attrition across 4 program iterations-which differed by platform format, delivery mode, and activity type-to create an optimized version. METHODS Each program version contained modular videos with key activities with respect to implementing behavior change techniques of equivalent levels of required participation and length: version 1.0, desktop program and smartphone app; version 2.1, desktop or smartphone program; version 2.2, desktop program; and version 3.0, smartphone app. Adults with PHQ-8 scores of 5 or greater were recruited online and assigned to 1 of the 4 versions. Participants were asked to use the program for 8 weeks and complete measures at weeks 4 and 8. Engagement data were collected from the web-based platform system logs and customized reports. Cox regression survival analysis examined nonusage attrition and Kruskal-Wallis tests compared engagement across each cohort. RESULTS A total of 614 adults participated. Kruskal-Wallis tests showed significant differences across the 4 cohorts in all engagement measures. The smartphone app (version 3.0) had the greatest engagement as measured by weeks engaged, total usage time, total time key activities, number of active sessions, percentage of activities completed against protocol, goals completed, and percentage of videos watched. Cox regression multivariate survival analysis showed referral from a health practitioner (hazard ratio [HR] 0.344, P=.001) and greater proficiency with computers (HR 0.796, P=.049) reduced the risk of nonusage attrition. Computer confidence was associated with an increased risk of nonusage attrition. CONCLUSIONS My Food & Mood version 3.0, a dietary intervention delivered via smartphone app with self-monitoring tools for diet quality and mood monitoring, was the version with greatest engagement in a population with low mood or depression. The iterative design techniques employed and analysis of feedback from participants resulted in a program that achieved lower rates of nonusage attrition and higher rates of intensity of use.
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Affiliation(s)
- Claire Louise Young
- Food & Mood Centre, Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia
| | | | - Heidi M Staudacher
- Food & Mood Centre, Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia
| | - Frances Kay-Lambkin
- Priority Research Centre for Brain and Mental Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia
| | - Felice Nellie Jacka
- Food & Mood Centre, Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Black Dog Institute, Syndey, New South Wales, Australia
- James Cook University, Queensland, Australia
| | - Adrienne O'Neil
- Food & Mood Centre, Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia
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Brog NA, Hegy JK, Berger T, Znoj H. An internet-based self-help intervention for people with psychological distress due to COVID-19: study protocol for a randomized controlled trial. Trials 2021; 22:171. [PMID: 33648555 PMCID: PMC7917378 DOI: 10.1186/s13063-021-05089-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The coronavirus-19 (COVID-19) has reached pandemic status and is affecting countries all over the world. The COVID-19 pandemic is accompanied by various stressors that require adjustment in everyday life and possibly changes in personal future prospects. While some individuals cope well with these challenges, some develop psychological distress including depressive symptoms, anxiety, or stress. Internet-based self-help interventions have proven to be effective in the treatment of various mental disorders such as depression and anxiety. Based on that, we developed an internet-based self-help program for individuals with psychological distress due to the situation surrounding the COVID-19 pandemic. The 3-week self-help program consists of 6 modules comprising texts, videos, figures, and exercises. Participants can request guidance within the self-help program (guidance on demand). The primary aim of this study is to evaluate the efficacy and feasibility of the self-help program compared to a waiting control condition. METHODS The design is a parallel group randomized controlled trial. Participants are allocated to a 3-week self-help intervention plus care as usual or a 3-week waiting period with only care as usual. There are follow-ups after 6 weeks and 18 weeks. At least 80 participants with COVID-19 pandemic related psychological distress will be recruited. Primary outcome are depressive symptoms. Secondary outcomes include anxiety and chronic stress, suicidal experiences and behavior, health-related quality of life, generalized optimism and pessimism, embitterment, optimistic self-beliefs, emotion regulation skills, loneliness, resilience, and the satisfaction with and usability of the self-help program. DISCUSSION To the best of our knowledge, this is one of the first studies investigating the efficacy of an internet-based self-help program for psychological distress due to the situation surrounding the COVID-19 pandemic. Thus, the results of this study may give further insight into the use of internet-based self-help programs in pandemic-related psychological distress. TRIAL REGISTRATION ClinicalTrials.gov NCT04380909 . Retrospectively registered on 8 May 2020.
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Affiliation(s)
- Noemi Anja Brog
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Julia Katharina Hegy
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Thomas Berger
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Hansjörg Znoj
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
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Lutz-Kopp C, Luka-Krausgrill U, Honsbrok B, Meinhardt-Injac B, Gropalis M. Development, Implementation and First Evaluation of an Online Portal to Promote the Mental Health of University Students (me@JGU). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1179. [PMID: 33525749 PMCID: PMC7908504 DOI: 10.3390/ijerph18031179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND University students encounter various stressors such as exam preparation, workload and economic concerns. Having to deal with a multitude of stressors can lead to mental health problems and have a negative impact on academic outcomes in students attending university. This paper describes the development and usability evaluation of an open and easily accessible online portal (me@JGU) designed to help students build skills they need to cope with common stressors and manage their own mental health. METHODS We developed a website that addresses the most common stressors among university students and offers strategies for dealing with difficult situations. Initial evaluation results were collected using website statistics and a short anonymous survey regarding the attractiveness and usability of the website. RESULTS Over an eight-month period, there were 5739 visitors, a total of 16,495 page views and 3748 downloads. The survey results indicate that me@JGU covers relevant topics and that the students like the layout. CONCLUSIONS Online interventions promoting mental health of university populations are easily accessible and cost effective for large populations. They may prevent study difficulties, inform students about mental health and offer possible solutions. In addition, at-risk students can receive information about other relevant resources, and feel encouraged to access support and treatment.
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Affiliation(s)
- Caroline Lutz-Kopp
- Mental Health Services for Students, Johannes Gutenberg University, 55122 Mainz, Germany; (U.L.-K.); (B.H.); (M.G.)
| | - Ursula Luka-Krausgrill
- Mental Health Services for Students, Johannes Gutenberg University, 55122 Mainz, Germany; (U.L.-K.); (B.H.); (M.G.)
| | - Bettina Honsbrok
- Mental Health Services for Students, Johannes Gutenberg University, 55122 Mainz, Germany; (U.L.-K.); (B.H.); (M.G.)
| | - Bozana Meinhardt-Injac
- Department of Psychology, Catholic University of Applied Sciences Berlin, 10318 Berlin, Germany;
| | - Maria Gropalis
- Mental Health Services for Students, Johannes Gutenberg University, 55122 Mainz, Germany; (U.L.-K.); (B.H.); (M.G.)
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Aubry C, Rider A, Russell S, Moyer S, Kinser PA. "I'm Not the Only One With Depression": Women's Perceptions of In-Person Group Formats of Depressive Symptom Interventions. J Perinat Neonatal Nurs 2021; 35:37-45. [PMID: 33528186 PMCID: PMC7863574 DOI: 10.1097/jpn.0000000000000530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A standard format for depression management has long been the in-person group-based intervention, yet recent calls for scalable interventions have increased interest in individual online formats. However, the perspectives and preferences of women are largely missing in the literature. This secondary qualitative data analysis using a phenomenological method of inquiry explored the lived experiences of pregnant and nonpregnant women with depressive symptoms (N = 44) who participated in 2 studies involving group-based face-to-face mindful physical activity interventions for depressive symptom self-management. Four main themes emerged regarding the group format: shared experiences enhanced the feeling of safety and impact of the group interventions; group instructors played a key role in fostering a safe environment; participants wished for more group interactions; and participants preferred a synchronous group-based intervention over a technology-based or asynchronous alternative for depressive symptom management. The findings from this study suggest that women with depression enjoy synchronous group-based interventions and find them to be beneficial for the shared experiences with other women and the safe environment created by group instructors. Future research should include study designs that consider these factors in the context of hybrid or fully online intervention formats for depression management.
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Affiliation(s)
- Christine Aubry
- Virginia Commonwealth University School of Nursing Richmond, VA
| | - Amy Rider
- Virginia Commonwealth University School of Nursing Richmond, VA
| | - Sasha Russell
- Virginia Commonwealth University School of Nursing Richmond, VA
| | - Sara Moyer
- Virginia Commonwealth University School of Nursing Richmond, VA
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Hegy JK, Brog NA, Berger T, Znoj H. Web-based Self-help Program for Adjustment Problems After an Accident (SelFIT): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e21200. [PMID: 33331830 PMCID: PMC7775196 DOI: 10.2196/21200] [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: 06/08/2020] [Revised: 08/12/2020] [Accepted: 11/10/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Accidents and the resulting injuries are among the world's biggest health care issues, often causing long-term effects on psychological and physical health. With regard to psychological consequences, accidents can cause a wide range of burdens including adjustment problems. Although adjustment problems are among the most frequent mental health problems, there are few specific interventions available. The newly developed program SelFIT (German acronym: Selber wieder fit nach einem Unfall; "fit again after an accident") aims to remedy this situation by offering a low-threshold, web-based self-help intervention for psychological distress after an accident. OBJECTIVE The overall aim is to evaluate the efficacy and cost-effectiveness of the SelFIT program plus care as usual (CAU) compared to only CAU. Furthermore, the program's user-friendliness, acceptance, and adherence are assessed. We expect that the use of SelFIT will be associated with a greater reduction in psychological distress, greater improvement in mental and physical well-being, and greater cost-effectiveness compared to CAU. METHODS Adults (n=240) experiencing adjustment problems due to an accident they had between 2 weeks and 2 years before entering the study will be randomized into either the intervention or control group. Participants in the intervention group receive direct access to SelFIT. The control group receives access to the program after 12 weeks. There are 6 measurement points for both groups (baseline as well as after 4, 8, 12, 24, and 36 weeks). The main outcome is a reduction in anxiety, depression, and stress symptoms that indicate adjustment problems. Secondary outcomes include well-being, optimism, embitterment, self-esteem, self-efficacy, emotion regulation, pain, costs of health care consumption, and productivity loss, as well as the program's adherence, acceptance, and user-friendliness. RESULTS Recruitment began in December 2019 and will continue at least until January 2021, with the option to extend this for another 6 months until July 2021. As of July 2020, 324 people have shown interest in participating, and 48 people have given their informed consent. CONCLUSIONS To the best of our knowledge, this is the first study examining a web-based self-help program designed to treat adjustment problems resulting from an accident. If effective, the program could complement the still limited offerings for secondary and tertiary prevention of psychological distress after an accident. TRIAL REGISTRATION ClinicalTrials.gov NCT03785912; https://clinicaltrials.gov/ct2/show/NCT03785912. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21200.
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Affiliation(s)
- Julia Katharina Hegy
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Noemi Anja Brog
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Hansjoerg Znoj
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Bern, Switzerland
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Lussier-Valade M, Ngô TL, Leblanc J. www.psychopap.com : améliorer l’accès à la psychothérapie par le transfert des connaissances aux patients et aux futurs thérapeutes. SANTE MENTALE AU QUEBEC 2020. [DOI: 10.7202/1073525ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
La psychothérapie est un traitement efficace pour plusieurs troubles mentaux. Elle est, toutefois, peu accessible pour différentes raisons, dont son coût, la façon de l’offrir et la disponibilité locale des thérapeutes. Par ailleurs, l’accès à la formation en psychothérapie pour les futurs thérapeutes peut être compliqué par différents facteurs incluant le manque de ressources adaptées à différents contextes de pratique et la difficulté à obtenir une supervision. Dans ce contexte, un site web offrant des documents d’autothérapie aux patients, des miniguides de formation dans différents types de psychothérapies basées sur des données probantes, des suggestions d’articles et livres phares, des capsules vidéo expliquant les principes sous-tendant différents modèles théoriques et démontrant des techniques de psychothérapie, pourrait bénéficier autant aux patients qu’aux psychothérapeutes débutants.
L’Hôpital en santé mentale Albert-Prévost (HSMAP), impliqué dès ses origines dans la formation et la pratique de la psychothérapie, conçoit un tel outil pour célébrer son centenaire, le site www.psychopap.com. Le présent article propose de décrire la genèse et le déploiement de ce projet de transmission de connaissances en psychothérapie en décrivant d’abord le contexte et l’implication des membres de l’HSMAP dans l’enseignement de la psychothérapie puis une brève recension des écrits concernant l’autothérapie pour les troubles mentaux, l’utilisation des ordinateurs/Internet pour l’enseignement de la psychothérapie et comment ces données ont été appliquées dans la création de www.psychopap.com.
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Affiliation(s)
| | - Thanh-Lan Ngô
- M.D., M. Sc. FRCPC, psychiatre, CIUSSS du Nord-de-l’Île-de-Montréal - Professeur agrégé de clinique, Département de psychiatrie et d’addictologie, Université de Montréal
| | - Jean Leblanc
- M.D., FRCPC, psychiatre, HSMAP - Professeur agrégé de clinique, Département de psychiatrie et d’addictologie, Université de Montréal
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Fischer R, Bortolini T, Karl JA, Zilberberg M, Robinson K, Rabelo A, Gemal L, Wegerhoff D, Nguyễn TBT, Irving B, Chrystal M, Mattos P. Rapid Review and Meta-Meta-Analysis of Self-Guided Interventions to Address Anxiety, Depression, and Stress During COVID-19 Social Distancing. Front Psychol 2020; 11:563876. [PMID: 33192837 PMCID: PMC7655981 DOI: 10.3389/fpsyg.2020.563876] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/24/2020] [Indexed: 12/21/2022] Open
Abstract
We conducted a rapid review and quantitative summary of meta-analyses that have examined interventions which can be used by individuals during quarantine and social distancing to manage anxiety, depression, stress, and subjective well-being. A literature search yielded 34 meta-analyses (total number of studies k = 1,390, n = 145,744) that were summarized. Overall, self-guided interventions showed small to medium effects in comparison to control groups. In particular, self-guided therapeutic approaches (including cognitive-behavioral, mindfulness, and acceptance-based interventions), selected positive psychology interventions, and multi-component and activity-based interventions (music, physical exercise) showed promising evidence for effectiveness. Overall, self-guided interventions on average did not show the same degree of effectiveness as traditional guided individual or group therapies. There was no consistent evidence of dose effects, baseline differences, and differential effectiveness of eHealth interventions. More research on the effectiveness of interventions in diverse cultural settings is needed.
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Affiliation(s)
- Ronald Fischer
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand.,Instituto D'Or de Pesquisa & Ensino, Rio de Janeiro, Brazil
| | | | - Johannes Alfons Karl
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | | | - Kealagh Robinson
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | | | - Lucas Gemal
- Instituto D'Or de Pesquisa & Ensino, Rio de Janeiro, Brazil
| | - Daniel Wegerhoff
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - Thị Bảo Trâm Nguyễn
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - Briar Irving
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - Megan Chrystal
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - Paulo Mattos
- Instituto D'Or de Pesquisa & Ensino, Rio de Janeiro, Brazil.,Medical School, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Examining the effectiveness of an online program to cultivate mindfulness and self-compassion skills (Mind-OP): Randomized controlled trial on Amazon's Mechanical Turk. Behav Res Ther 2020; 134:103724. [PMID: 32942203 DOI: 10.1016/j.brat.2020.103724] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/19/2020] [Accepted: 09/02/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The demand for effective psychological treatments for depression, anxiety, and heightened stress is far outstripping their supply. Accordingly, internet delivered, self-help interventions offer hope to many people, as they can be easily accessed and at a fraction of the price of face-to-face options. Mindfulness and self-compassion are particularly exciting approaches, as evidence suggests interventions that cultivate these skills are effective in reducing depression, anxiety, and heightened stress. We examined the effectiveness of a newly developed program that combines mindfulness, self-compassion, and goal-setting exercises into a brief self-guided intervention (Mind-OP). The secondary aim of this study was to investigate the feasibility of conducting a randomized-controlled trial entirely on a popular crowdsourcing platform, Amazon's Mechanical Turk (MTurk). METHODS We randomized 456 participants reporting heightened depression, anxiety, or stress to one of two conditions: the 4-week Mind-OP intervention (n = 227) or to an active control condition (n = 229) where participants watched nature videos superimposed onto relaxing meditation music for four consecutive weeks. We administered measures of anxiety, depression, perceived stress, dispositional and state mindfulness, self-compassion, and nonattachment. RESULTS Intent-to-treat and per-protocol analyses revealed that, compared to participants in the control condition, participants in the Mind-OP intervention condition reported significantly less anxiety and stress at the end of the trial, as well as significantly greater mindfulness, self-compassion, and nonattachment. CONCLUSIONS Mind-OP appears effective in reducing anxiety symptoms and perceived stress among MTurk participants. We highlight issues (e.g., attrition) related to feasibility of conducting randomized trials on crowdsourcing platforms such as MTurk.
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Rogala A, Szczepaniak M, Michalak N, Andersson G. Internet-based self-help intervention aimed at increasing social self-efficacy among internal migrants in Poland: Study protocol for a randomized controlled trial. Internet Interv 2020; 21:100322. [PMID: 32328440 PMCID: PMC7176581 DOI: 10.1016/j.invent.2020.100322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Migration is a challenging life transition that may be a source of various problems related to well-being and mental health. However, the psychological adaptation of migrants may be potentially facilitated by social self-efficacy-the beliefs in one's ability to initiate and maintain interpersonal relationships. Previous research suggests that social self-efficacy is positively related to adjustment and negatively related to loneliness, depression, and psychological distress. Research also confirms that self-efficacy beliefs can be effectively enhanced using Internet-based interventions. These results served as a background for creating the New in Town, a self-help Internet-based intervention for internal migrants in Poland that aims at increasing social self-efficacy. Exercises in the intervention are based on the principles of Cognitive Behavioral Therapy and relate to sources of self-efficacy beliefs: mastery experiences, vicarious experiences, verbal persuasions, and emotional and physiological states. Users complete increasingly challenging tasks that encourage them to interact with their environment. The aim of this trial was to investigate the efficacy of the New in Town intervention. METHODS The efficacy of the New in Town intervention will be tested in a two-arm randomized controlled trial with a waitlist control group. Social self-efficacy will be the primary outcome. Secondary outcomes will include loneliness, perceived social support, and satisfaction with life. Additionally, we will measure user experience among participants allocated to the experimental group. We aim to recruit a total of N = 280 participants aged at least 18 years who have changed their place of residence in the last 6 months and have an Internet connection. Participants will be assessed at baseline, 3-week post-test, and 8-week follow-up. DISCUSSION The trial will provide insights into the efficacy of Internet-based self-help interventions in increasing social self-efficacy. Given that the intervention works, New in Town could provide an easily accessible support option for internal migrants in Poland. TRIAL REGISTRATION The trial was registered with ClinicalTrials.gov (identifier: NCT04088487) on 11th September 2019.
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Affiliation(s)
- Anna Rogala
- Department of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Maria Szczepaniak
- Department of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Natalia Michalak
- Department of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Baumel A, Edan S, Kane JM. Is there a trial bias impacting user engagement with unguided e-mental health interventions? A systematic comparison of published reports and real-world usage of the same programs. Transl Behav Med 2020; 9:1020-1033. [PMID: 31689344 DOI: 10.1093/tbm/ibz147] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Trial settings that include proactive recruitment, human contact, and assessment procedures may substantially impact the way users engage with unguided e-mental health programs and the generalizability of reported findings. This study examined the impact of trial setting on user behavior by directly comparing reported user engagement in trial-based research and objective measures of real-world usage of the same unguided mental health programs. The authors conducted a systematic search for papers reporting user engagement with off-the-shelf unguided e-mental health programs. Real-world usage was obtained from a panel that presents aggregated nonpersonal information on user engagement with digital programs across the world. A total of 13 papers yielding 14 comparable usage metrics met all inclusion criteria. In three papers reporting the use of programs by lay users without any proactive trial procedures, the ratios calculated by dividing the usage reported in the paper by the usage documented within the objective dataset were 0.84, 1.05, and 1.27-suggesting a sufficient criterion validity for our examination. In studies that proactively recruited users and included pre- to post-assessment procedures (11 comparisons), the median program usage rate reported was 4.06 times higher (IQR = 4.49) than the real-world usage of the same program. Severity of clinical symptoms, in-person versus remote assessment procedures, study design, and program cost had no impact on these differences. The results suggest that trial settings have a large impact on user engagement with unguided interventions and, therefore, on the generalizability of the findings to the real world.
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Affiliation(s)
- Amit Baumel
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Stav Edan
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - John M Kane
- Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
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Ayorinde AA, Williams I, Mannion R, Song F, Skrybant M, Lilford RJ, Chen YF. Publication and related bias in quantitative health services and delivery research: a multimethod study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Bias in the publication and reporting of research findings (referred to as publication and related bias here) poses a major threat in evidence synthesis and evidence-based decision-making. Although this bias has been well documented in clinical research, little is known about its occurrence and magnitude in health services and delivery research.
Objectives
To obtain empirical evidence on publication and related bias in quantitative health services and delivery research; to examine current practice in detecting/mitigating this bias in health services and delivery research systematic reviews; and to explore stakeholders’ perception and experiences concerning such bias.
Methods
The project included five distinct but interrelated work packages. Work package 1 was a systematic review of empirical and methodological studies. Work package 2 involved a survey (meta-epidemiological study) of randomly selected systematic reviews of health services and delivery research topics (n = 200) to evaluate current practice in the assessment of publication and outcome reporting bias during evidence synthesis. Work package 3 included four case studies to explore the applicability of statistical methods for detecting such bias in health services and delivery research. In work package 4 we followed up four cohorts of health services and delivery research studies (total n = 300) to ascertain their publication status, and examined whether publication status was associated with statistical significance or perceived ‘positivity’ of study findings. Work package 5 involved key informant interviews with diverse health services and delivery research stakeholders (n = 24), and a focus group discussion with patient and service user representatives (n = 8).
Results
We identified only four studies that set out to investigate publication and related bias in health services and delivery research in work package 1. Three of these studies focused on health informatics research and one concerned health economics. All four studies reported evidence of the existence of this bias, but had methodological weaknesses. We also identified three health services and delivery research systematic reviews in which findings were compared between published and grey/unpublished literature. These reviews found that the quality and volume of evidence and effect estimates sometimes differed significantly between published and unpublished literature. Work package 2 showed low prevalence of considering/assessing publication (43%) and outcome reporting (17%) bias in health services and delivery research systematic reviews. The prevalence was lower among reviews of associations than among reviews of interventions. The case studies in work package 3 highlighted limitations in current methods for detecting these biases due to heterogeneity and potential confounders. Follow-up of health services and delivery research cohorts in work package 4 showed positive association between publication status and having statistically significant or positive findings. Diverse views concerning publication and related bias and insights into how features of health services and delivery research might influence its occurrence were uncovered through the interviews with health services and delivery research stakeholders and focus group discussion conducted in work package 5.
Conclusions
This study provided prima facie evidence on publication and related bias in quantitative health services and delivery research. This bias does appear to exist, but its prevalence and impact may vary depending on study characteristics, such as study design, and motivation for conducting the evaluation. Emphasis on methodological novelty and focus beyond summative assessments may mitigate/lessen the risk of such bias in health services and delivery research. Methodological and epistemological diversity in health services and delivery research and changing landscape in research publication need to be considered when interpreting the evidence. Collection of further empirical evidence and exploration of optimal health services and delivery research practice are required.
Study registration
This study is registered as PROSPERO CRD42016052333 and CRD42016052366.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 33. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Abimbola A Ayorinde
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Iestyn Williams
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Russell Mannion
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Fujian Song
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Magdalena Skrybant
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Richard J Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Yen-Fu Chen
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Gräfe V, Moritz S, Greiner W. Health economic evaluation of an internet intervention for depression (deprexis), a randomized controlled trial. HEALTH ECONOMICS REVIEW 2020; 10:19. [PMID: 32548724 PMCID: PMC7298860 DOI: 10.1186/s13561-020-00273-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/13/2020] [Indexed: 05/17/2023]
Abstract
BACKGROUND Depressive disorders often remain undiagnosed or are treated inadequately. Online-based programs may reduce the present treatment gap for depressive disorders and reduce disease-related costs. This study aimed to examine the potential of the internet intervention "deprexis" to reduce the total costs of statutory health insurance. Changes in depression severity, health-related quality of life and impairment in functioning were also examined. METHOD A total of 3805 participants with, at minimum, mild depressive symptoms were randomized to either a 12-week online intervention (deprexis) or a control condition. The primary outcome measure was statutory health insurance costs, estimated using health insurers' administrative data. Secondary outcomes were: depression severity, health-related quality of life, and impairment in functioning; assessed on patient's self-report at baseline, post-treatment, and three-months' and nine-months' follow-up. RESULTS In both groups, total costs of statutory health insurance decreased during the study period, but changes from baseline differed significantly. In the intervention group total costs decreased by 32% from 3139€ per year at baseline to 2119€ in the study year (vs. a mean reduction in total costs of 13% in the control group). In comparison to the control group, the intervention group also showed a significantly greater reduction in depression severity, and impairment in functioning and a significantly greater increase in health-related quality of life. CONCLUSION The study underlines the potential of innovative internet intervention programs in treating depressive disorders. The results suggest that the use of deprexis over a period of 12 weeks leads to a significant improvement in symptoms with a simultaneous reduction in the costs of statutory health insurance.
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Affiliation(s)
- Viola Gräfe
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615 Bielefeld, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615 Bielefeld, Germany
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Dirkse D, Hadjistavropoulos HD, Alberts NA, Karin E, Schneider LH, Titov N, Dear BF. Making Internet-delivered cognitive behaviour therapy scalable for cancer survivors: a randomized non-inferiority trial of self-guided and technician-guided therapy. J Cancer Surviv 2020; 14:211-225. [PMID: 31853727 DOI: 10.1007/s11764-019-00810-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare the effectiveness and acceptability of two low-intensity methods of offering a transdiagnostic Internet-delivered cognitive behaviour therapy (ICBT) intervention for treating symptoms of anxiety and depression among cancer survivors. METHODS Cancer survivors with symptoms of anxiety or depression (n = 86) were randomly assigned to receive a transdiagnostic ICBT programme (Wellbeing After Cancer) that was either guided by a technician (n = 42) or self-guided (n = 44). Measures of anxiety, depression, fear of cancer recurrence, and quality of life were completed at pre-treatment, post-treatment, and 4 weeks following treatment completion. RESULTS Large within-group effect sizes were observed on measures of depression, anxiety, and mental health-related quality of life (d range, 0.98-1.86) at post-treatment. Medium effects were found for reductions in fear of cancer recurrence (d range, 0.65-0.78). Non-inferiority was established for the primary outcome measures of anxiety and depression. All participants reported high satisfaction ratings of the programme; however, technician-guided participants were slightly more satisfied with their level of support (d = 0.57, p = .014). CONCLUSIONS The Wellbeing After Cancer Course was associated with improved levels of anxiety, depression, fear of cancer recurrence, and quality of life, regardless of how ICBT was offered. IMPLICATIONS FOR CANCER SURVIVORS ICBT is emerging as an accessible and effective treatment for depression, anxiety, and fear of cancer recurrence in cancer survivors. The success of non-therapist-guided options increases the potential scalability of ICBT, which is particularly valuable for cancer survivors from rural areas who have less access to mental health services.
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Affiliation(s)
- D Dirkse
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, PZ 350 - 771 Bannatyne Avenue, Winnipeg, MB, R3E 3N4, Canada.
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada.
| | - H D Hadjistavropoulos
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - N A Alberts
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| | - E Karin
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - L H Schneider
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - N Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - B F Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
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Moshe I, Terhorst Y, Cuijpers P, Cristea I, Pulkki-Råback L, Sander L. Three Decades of Internet- and Computer-Based Interventions for the Treatment of Depression: Protocol for a Systematic Review and Meta-Analysis. JMIR Res Protoc 2020; 9:e14860. [PMID: 32207695 PMCID: PMC7139420 DOI: 10.2196/14860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Depression is one of the leading causes of disability worldwide. Internet- and computer-based interventions (IBIs) have been shown to provide effective, scalable forms of treatment. More than 100 controlled trials and a growing number of meta-analyses published over the past 30 years have demonstrated the efficacy of IBIs in reducing symptoms in the short and long term. Despite the large body of research, no comprehensive review or meta-analysis has been conducted to date that evaluates how the effectiveness of IBIs has evolved over time. OBJECTIVE This systematic review and meta-analysis aims to evaluate whether there has been a change in the effectiveness of IBIs on the treatment of depression over the past 30 years and to identify potential variables moderating the effect size. METHODS A sensitive search strategy will be executed across the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PsycINFO. Data extraction and evaluation will be conducted by two independent researchers. Risk of bias will be assessed. A multilevel meta-regression model will be used to analyze the data and estimate effect size. RESULTS The search was completed in mid-2019. We expect the results to be submitted for publication in early 2020. CONCLUSIONS The year 2020 will mark 30 years since the first paper was published on the use of IBIs for the treatment of depression. Despite the large and rapidly growing body of research in the field, evaluations of effectiveness to date are missing the temporal dimension. This review will address that gap and provide valuable analysis of how the effectiveness of interventions has evolved over the past three decades; which participant-, intervention-, and study-related variables moderate changes in effectiveness; and where research in the field may benefit from increased focus. TRIAL REGISTRATION PROSPERO CRD42019136554; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=136554. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/14860.
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Affiliation(s)
- Isaac Moshe
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Yannik Terhorst
- Department of Research Methods, University of Ulm, Ulm, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ioana Cristea
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Laura Pulkki-Råback
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Lasse Sander
- Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
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Kerst A, Zielasek J, Gaebel W. Smartphone applications for depression: a systematic literature review and a survey of health care professionals' attitudes towards their use in clinical practice. Eur Arch Psychiatry Clin Neurosci 2020; 270:139-152. [PMID: 30607530 DOI: 10.1007/s00406-018-0974-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 12/19/2018] [Indexed: 12/30/2022]
Abstract
Smartphone applications ("apps") may contribute to closing the treatment gap for depression by reaching large populations at relatively low costs. The general public seems open towards the use of apps for mental disorders but less is known about the attitudes of health care professionals. Therefore, the aim of this study was to examine the available evidence on the effectiveness of apps for depression and to explore the attitudes of health care professionals towards their use in practice. A systematic literature search was performed aimed at studies utilizing smartphone applications for depression. In addition, a survey was conducted to explore health care professionals' attitudes towards using these treatment apps in clinical practice. Twelve articles were identified in the systematic literature review. All included trials reported a decline in depressive symptoms after the intervention periods. In the survey, 72 health care professionals participated. Significant differences were found between the level of technology experience and how much the health care professional would consider the use of mobile applications in clinical practice. Survey participants reported openness towards therapeutic app use but very little knowledge and experience in the field. Apps appear to be a promising self-management tool for reducing depressive symptoms. Despite some concerns, health care professionals' attitudes towards the use of smartphone applications in clinical practice are quite positive. The provision of information on the potential benefits of e-health interventions as well as the training of professionals in the application of new technologies may increase health care professionals' awareness and knowledge about mobile apps for the treatment of mental disorders.
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Affiliation(s)
- Ariane Kerst
- Department of Psychiatry, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.
- WHO Collaborating Center for Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany.
| | | | - Wolfgang Gaebel
- Department of Psychiatry, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- WHO Collaborating Center for Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
- LVR-Institute for Healthcare Research, Cologne, Germany
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49
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Cerga-Pashoja A, Doukani A, Gega L, Walke J, Araya R. Added value or added burden? A qualitative investigation of blending internet self-help with face-to-face cognitive behaviour therapy for depression. Psychother Res 2020; 30:998-1010. [PMID: 32024447 DOI: 10.1080/10503307.2020.1720932] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objectives: Numerous studies and reviews have explored the value of adding therapist support to internet self-help for improving client adherence and outcomes. This study is different as it explores the value of adding internet self-help to face-to-face therapy, from the perspective of practitioners who used both. This study explores practitioners' experiences of whether-and how-internet self-help blended with face-to-face therapy may confer an added value or become an added burden to their routine practice. Methods: Using a structured topic guide, we collected narrative data via 3 focus groups and 1 telephone interview from 11 practitioners across two sites in England. We carried out a thematic analysis within two domains, "value vs. burden". Results: Practitioners reported that internet self-help can confer added value to face-to-face therapy by: fostering client engagement with face-to-face sessions; making therapy ubiquitous beyond sessions; and preventing therapeutic drift between sessions. Conversely, internet self-help can add burden to face-to-face therapy when it is experienced as disruptive, overwhelming and time-consuming. Conclusions: Recognizing and mitigating factors that can turn internet self-help from an added value to an added burden will help practitioners adopt and make the most out of blended therapy.
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Affiliation(s)
- Arlinda Cerga-Pashoja
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Asmae Doukani
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lina Gega
- Department of Health Sciences & Hull York Medical School, University of York, York, UK
| | - Jennifer Walke
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ricardo Araya
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Kooistra L, Ruwaard J, Wiersma J, van Oppen P, Riper H. Working Alliance in Blended Versus Face-to-Face Cognitive Behavioral Treatment for Patients with Depression in Specialized Mental Health Care. J Clin Med 2020; 9:jcm9020347. [PMID: 32012722 PMCID: PMC7073833 DOI: 10.3390/jcm9020347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 01/14/2020] [Accepted: 01/18/2020] [Indexed: 12/24/2022] Open
Abstract
This study investigates working alliance in blended cognitive behavioral therapy (bCBT) for depressed adults in specialized mental health care. Patients were randomly allocated to bCBT (n = 47) or face-to-face CBT (n = 45). After 10 weeks of treatment, both patients and therapists in the two groups rated the therapeutic alliance on the Working Alliance Inventory Short-Form Revised (WAI-SR; Task, Bond, Goal, and composite scores). No between-group differences were found in relation to either patient or therapist alliance ratings, which were high in both groups. In the full sample, a moderate positive association was found between patient and therapist ratings on Task (ρ = 0.41, 95% CI 0.20; 0.59), but no significant associations emerged on other components or composite scores. At 30 weeks, within-and between-group associations between alliance and changes in depression severity (QIDS, Quick Inventory of Depressive Symptomatology) were analyzed with linear mixed models. The analyses revealed an association between depression over time, patient-rated alliance, and group (p < 0.001). In face-to-face CBT, but not in bCBT, lower depression scores were associated with higher alliance ratings. The online component in bCBT may have led patients to evaluate the working alliance differently from patients receiving face-to-face CBT only.
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Affiliation(s)
- Lisa Kooistra
- Department of Clinical, Neuro-and Developmental Psychology and the Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands; (J.W.); (P.v.O.)
- Correspondence:
| | - Jeroen Ruwaard
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands; (J.W.); (P.v.O.)
- Department of Psychiatry and the Amsterdam Public Health Research Institute, GGZ inGeest/Amsterdam UMC, Vrije Universiteit, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Jenneke Wiersma
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands; (J.W.); (P.v.O.)
| | - Patricia van Oppen
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands; (J.W.); (P.v.O.)
- Department of Psychiatry and the Amsterdam Public Health Research Institute, GGZ inGeest/Amsterdam UMC, Vrije Universiteit, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro-and Developmental Psychology and the Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands; (J.W.); (P.v.O.)
- Department of Psychiatry and the Amsterdam Public Health Research Institute, GGZ inGeest/Amsterdam UMC, Vrije Universiteit, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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