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Lorente-Català R, Font-Furnieles P, Escriva-Sanchis R, Bertó-García C, Vera-Albero P, García-Palacios A. Telephone support vs. self-guidance in an Internet-based self-administered psychological program for the treatment of depression: Protocol for a hybrid type 1 effectiveness-implementation randomized controlled trial. Internet Interv 2024; 36:100742. [PMID: 38737981 PMCID: PMC11081795 DOI: 10.1016/j.invent.2024.100742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 03/12/2024] [Accepted: 04/17/2024] [Indexed: 05/14/2024] Open
Abstract
Background Depression is already the leading psychological disability around the world, impairing daily life, well-being, and social functioning and leading to personal and social costs. Despite the effectiveness of Evidence-Based Psychological Practices (EBPP), a significant percentage of depressive individuals remain untreated, especially in Primary Care (PC) settings in Spain. There are numerous barriers that limit access to EBPPs, including high costs, professional training, and adherence problems. Information and Communication Technologies (ICTs) offer a cost-effective way to disseminate and scale EBPPs to address these barriers. The iCBT program Smiling is Fun has been demonstrated to be a cost-effective treatment for depression in various Randomized Control Trials. However, adherence and implementation problems in real-world settings need to be addressed. Implementation research can help evaluate these challenges by identifying facilitators and barriers to the implementation process in PC. In this regard, including human support has been pointed out as a possible key factor in addressing the population's mental health needs and promoting treatment adherence. Objective The current study aims to examine the effectiveness, adherence rates, and implementation process of Smiling is Fun to address depression in a PC setting considering the influence of telephone support vs no support. Methods The proposed research is a Hybrid Effectiveness-Implementation Type I study, with a two-armed randomized controlled design, which will test a clinical intervention for major depressive disorder while gathering information on its implementation in a real-world setting. The study will include adult patients with mild to moderate symptoms of depression. Participants will be randomly assigned to one of two groups: self-applied psychotherapy or self-applied psychotherapy with psychotherapeutic telephone support. The trial will recruit 110 patient participants, with a loss-to-follow-up rate of 30 %. Discussion A study protocol for a hybrid effectiveness-implementation study is presented with the aim to assess the implementation of Smiling is Fun for the treatment of depression in PC. The study evaluates the influence of telephone support during a self-administered intervention compared to unguided self-administration. The main goal is to address the barriers and facilitators of the implementation process and to promote treatment adherence. Ultimately, the results of the study could help in the uptake of sustainable resources so that the population could gain better access to psychological interventions in mental health services. Registration ClinicalTrials.gov; NCT06230237.
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Affiliation(s)
- Rosa Lorente-Català
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
| | - Pablo Font-Furnieles
- Foundation for the Promotion of Health and Biomedical Research of the Valencian Community. (FISABIO), Valencia, Spain
| | | | | | | | - Azucena García-Palacios
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
- The Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
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Varela-Moreno E, Anarte-Ortiz MT, Jodar-Sanchez F, Garcia-Palacios A, Monreal-Bartolomé A, Gili M, García-Campayo J, Mayoral-Cleries F. Economic Evaluation of a Web Application Implemented in Primary Care for the Treatment of Depression in Patients With Type 2 Diabetes Mellitus: Multicenter Randomized Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e55483. [PMID: 38754101 PMCID: PMC11140277 DOI: 10.2196/55483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/04/2024] [Accepted: 03/14/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Depressive disorder and type 2 diabetes mellitus (T2DM) are prevalent in primary care (PC). Pharmacological treatment, despite controversy, is commonly chosen due to resource limitations and difficulties in accessing face-to-face interventions. Depression significantly impacts various aspects of a person's life, affecting adherence to medical prescriptions and glycemic control and leading to future complications and increased health care costs. To address these challenges, information and communication technologies (eg, eHealth) have been introduced, showing promise in improving treatment continuity and accessibility. However, while eHealth programs have demonstrated effectiveness in alleviating depressive symptoms, evidence regarding glycemic control remains inconclusive. This randomized controlled trial aimed to test the efficacy of a low-intensity psychological intervention via a web app for mild-moderate depressive symptoms in individuals with T2DM compared with treatment as usual (TAU) in PC. OBJECTIVE This study aimed to analyze the cost-effectiveness and cost-utility of a web-based psychological intervention to treat depressive symptomatology in people with T2DM compared with TAU in a PC setting. METHODS A multicenter randomized controlled trial was conducted with 49 patients with T2DM, depressive symptoms of moderate severity, and glycosylated hemoglobin (HbA1c) of 7.47% in PC settings. Patients were randomized to TAU (n=27) or a web-based psychological treatment group (n=22). This web-based treatment consisted of cognitive behavioral therapy, improvement of diabetes self-care behaviors, and mindfulness. Cost-effectiveness analysis for the improvement of depressive symptomatology was conducted based on reductions in 3, 5, or 50 points on the Patient Health Questionnaire-9 (PHQ-9). The efficacy of diabetes control was estimated based on a 0.5% reduction in HbA1c levels. Follow-up was performed at 3 and 6 months. The cost-utility analysis was performed based on quality-adjusted life years. RESULTS Efficacy analysis showed that the web-based treatment program was more effective in improving depressive symptoms than TAU but showed only a slight improvement in HbA1c. Incremental cost-effectiveness ratios of 186.76 for a 3-point reduction in PHQ-9 and 206.31 for reductions of 5 and 50 percentage points were obtained. In contrast, the incremental cost-effectiveness ratio for improving HbA1c levels amounted to €1510.90 (€1=US $1.18 in 2018) per participant. The incremental cost-utility ratio resulted in €4119.33 per quality-adjusted life year gained. CONCLUSIONS The intervention, using web-based modules incorporating cognitive behavioral therapy tools, diabetes self-care promotion, and mindfulness, effectively reduced depressive symptoms and enhanced glycemic control in patients with T2DM. Notably, it demonstrated clinical efficacy and economic efficiency. This supports the idea that eHealth interventions not only benefit patients clinically but also offer cost-effectiveness for health care systems. The study emphasizes the importance of including specific modules to enhance diabetes self-care behaviors in future web-based psychological interventions, emphasizing personalization and adaptation for this population. TRIAL REGISTRATION ClinicalTrials.gov NCT03426709; https://clinicaltrials.gov/study/NCT03426709. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/S12888-019-2037-3.
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Affiliation(s)
- Esperanza Varela-Moreno
- Research and Innovation Unit, Costa del Sol University Hospital, Marbella, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Málaga, Spain
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Málaga, Málaga, Spain
- Biomedical Research Institute of Malaga, Malaga, Spain
| | - Maria Teresa Anarte-Ortiz
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Málaga, Málaga, Spain
- Biomedical Research Institute of Malaga, Malaga, Spain
| | - Francisco Jodar-Sanchez
- Department of Applied Economics, Faculty of Economics and Business Administration, University of Malaga, Malaga, Spain
- Pharmacoeconomics: Clinical and Economic Evaluation of Medications and Palliative Care, Malaga, Spain
| | - Azucena Garcia-Palacios
- Network Biomedical Research Center. Physiopathology Obesity and Nutrition (CIBERobn), Carlos III Health Institute, Madrid, Spain
- Department of Clinical and Basic Psychology and Biopsychology, Faculty of Health Sciences, University Jaume I, Castellon, Spain
| | - Alicia Monreal-Bartolomé
- Institute of Health Research of Aragon, Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Margalida Gili
- Research Network on Preventive Activities and Health Promotion in Primary Health Care (RedIAPP), Madrid, Spain
- Institut Universitari d'Investigació en Ciències de la Salut, University Institute for Research in Health Sciences (IUNICS)- Palma Health Research Institute (IDISPA), University of the Balearic Islands, Palma, Spain
| | - Javier García-Campayo
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Málaga, Spain
- Institute of Health Research of Aragon, Zaragoza, Spain
| | - Fermin Mayoral-Cleries
- Biomedical Research Institute of Malaga, Malaga, Spain
- Mental Health Clinical Management Unit, University Regional Hospital of Malaga, Malaga, Spain
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Raya-Tena A, Fernández-San-Martín MI, Martín-Royo J, Casajuana-Closas M, Jiménez-Herrera MF. Cost-effectiveness and cost-utility study of a psychoeducational group intervention for people with depression and physical comorbidity in primary care. ENFERMERIA CLINICA (ENGLISH EDITION) 2024; 34:108-119. [PMID: 38508236 DOI: 10.1016/j.enfcle.2024.03.005] [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: 12/15/2022] [Accepted: 12/26/2023] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To evaluate the cost-effectiveness and cost-utility of a psychoeducational group intervention led by primary care (PC) nurses in relation to customary care to prevent the depression and improve quality of life in patients with physical comorbidity. DESIGN Economic evaluation based on data from randomized, multicenter clinical trial with blind response variables and a one-year follow-up, carried in the context of the PSICODEP study. LOCATION 7 PC teams from Catalonia. PARTICIPANTS >50 year-old patients with depression and some physical comorbidity: diabetes mellitus type 2, ischemic heart disease, chronic obstructive pulmonary disease, and/or asthma. INTERVENTION 12 psychoeducational group sessions, 1 per week, led by 2 PC nurses with prior training. MEASUREMENTS Effectiveness: depression-free days (DFD) calculated from the BDI-II and quality-adjusted life years (QALYs) from the Euroqol-5D. Direct costs: PC visits, mental health, emergencies and hospitalizations, drugs. Indirect costs: days of temporary disability (TD). The incremental cost-effectiveness ratios (ICER), cost-effectiveness (ΔCost/ΔDLD) and cost-utility (ΔCost/ΔQALY) were estimated. RESULTS The study includes 380 patients (intervention group [IG] = 204; control group [CG] = 176). 81.6% women; mean age 68.4 (SD = 8.8). The IG had a higher mean cost of visits, less of hospitalizations and less TD than the CG. The difference in costs between the IG and the CG was -357.95€ (95% CI: -2026.96 to 1311.06) at one year of follow-up. There was a mean of 11.95 (95% CI: -15.98 to 39.88) more DFD in the IG than in the CG. QALYs were similar (difference -0.01, 95% CI -0.04 to 0.05). The ICERs were 29.95€/DLD and 35,795€/QALY. CONCLUSIONS Psychoeducational intervention is associated with an improvement in DFD, as well as a reduction in costs at 12 months, although not significantly. QALYs were very similar between groups.
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Affiliation(s)
- Antonia Raya-Tena
- Centre d'Atenció Primària Dr. Lluís Sayé, ABS Raval Nord, Institut Català de la Salut, Barcelona, Spain; Línea d'Investigació en Biomedicina, Epidemiologia i Pràctica Clínica Avançada, Facultat de Infermeria, Universitat Rovira i Virgili, Tarragona, Spain.
| | - María Isabel Fernández-San-Martín
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Unitat Docent Multiprofesional, Gerència Territorial Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Jaume Martín-Royo
- Unitat Bàsica de Prevenció, Gerència Territorial Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Marc Casajuana-Closas
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - María Francisca Jiménez-Herrera
- Línea d'Investigació en Biomedicina, Epidemiologia i Pràctica Clínica Avançada, Facultat de Infermeria, Universitat Rovira i Virgili, Tarragona, Spain
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Ho TQA, Le LKD, Engel L, Le N, Melvin G, Le HND, Mihalopoulos C. Barriers to and facilitators of user engagement with web-based mental health interventions in young people: a systematic review. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02386-x. [PMID: 38356043 DOI: 10.1007/s00787-024-02386-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Abstract
Many young people (YP) are diagnosed with mental illnesses and require support. Web-based mental health interventions (W-MHIs) have been increasingly utilized by YP, healthcare providers, and parents due to reasons including convenience and anonymity. W-MHIs are effective in improving mental health in YP. However, real-world engagement with W-MHIs remains low. Therefore, understanding barriers/facilitators of user engagement with W-MHIs is necessary to promote W-MHIs and help users gain optimal benefits through higher engagement. This review aims to identify barriers/facilitators of user engagement with W-MHIs in YP aged 10-24 years. A systematic search of five databases for English language, peer-reviewed publications was conducted between January 2010 and February 2023. Studies examining factors influencing user engagement with W-MHIs, described as barriers or facilitators, were included. Study quality was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis was performed. Of 4088 articles identified, 69 studies were included. Barriers/facilitators were reported by young people (63 studies), providers (17 studies), and parents/caregivers (8 studies). YP perceived that usefulness and connectedness were the most common facilitators, whereas low-perceived need was the most reported barrier. Both providers and parents reported that perceived usefulness for YP was the most common facilitator, whereas concerns about program effectiveness and privacy were noted as barriers. This review found that program- and individual-related factors were important determinants of engagement with W-MHIs. This review provides guidance on the future design and development of new interventions, narrowing the gap between existing W-MHIs and unmet needs of users.
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Affiliation(s)
- Thi Quynh Anh Ho
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia.
| | - Long Khanh-Dao Le
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lidia Engel
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ngoc Le
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
| | - Glenn Melvin
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Ha N D Le
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Ncheka JM, Menon JA, Davies EB, Paul R, Mwaba SOC, Mudenda J, Wharrad H, Tak H, Glazebrook C. Implementing internet-based cognitive behavioural therapy (moodgym) for African students with symptoms of low mood during the COVID-19 pandemic: a qualitative feasibilty study. BMC Psychiatry 2024; 24:92. [PMID: 38302998 PMCID: PMC10835970 DOI: 10.1186/s12888-024-05542-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/20/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Online therapies have been shown to be effective in improving students' mental health. They are cost-effective and therefore have particular advantages in low-income countries like Zambia where mental health resources are limited. This study aimed to explore the perceived impact of the COVID-19 pandemic and the feasibility of implementing an Internet-Based Cognitive Behavioural Therapy (iCBT) intervention ('moodgym') to improve resilience in vulnerable Zambian students. METHODS The study was a qualitative interview study. Participants identifying as having symptoms of low mood and completing a baseline, online survey (n = 620) had the option to volunteer for a semi-structured interview to explore views about their experience of the pandemic and the acceptability and perceived benefits and limitations of using moodgym. RESULTS A total of 50 students (n = 24 female, n = 26 male) participated in the study. One theme with 4 sub-themes, captured the severe emotional and social impact of the COVID-19 pandemic. A second, very strong theme, with 5 sub-themes, reflected the considerable negative effects of the pandemic on the students' educational experience. This included the challenges of online learning. The third theme, with three subthemes, captured the benefits and acceptability of moodgym, particularly in terms of understanding the relationship between thoughts and feelings and improving academic performance. The fourth theme described the technical difficulties experienced by students in attempting to use moodgym. CONCLUSION COVID-19 caused fear and impacted wellbeing in vulnerable students and severely impaired the quality of students' educational experience. The findings suggest that moodgym might be a valuable support to students in a low-income country.
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Affiliation(s)
- Joyce M Ncheka
- School of Medicine, Department of Psychiatry, University of Zambia, Lusaka, Zambia
| | - J Anitha Menon
- School of Humanities and Social Sciences, Department of Psychology, University of Zambia, Lusaka, Zambia
- School of Liberal Studies, University of Petroleum and Energy Sciences, Dehradun, India
- Rochester Institute of Technology, Liberal Arts Department, Dubai, UAE
| | - E Bethan Davies
- Institute of Mental Health, School of Medicine, NIHR MindTech MedTech Co-operative, The University of Nottingham, Nottingham, UK
- Clinical Neurosciences and Mental Health, School of Medicine, Institute of Mental Health, The University of Nottingham, Nottingham, UK
| | - Ravi Paul
- School of Medicine, Department of Psychiatry, University of Zambia, Lusaka, Zambia
| | - Sidney O C Mwaba
- School of Humanities and Social Sciences, Department of Psychology, University of Zambia, Lusaka, Zambia
| | | | - Heather Wharrad
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Harsa Tak
- Clinical Neurosciences and Mental Health, School of Medicine, Institute of Mental Health, The University of Nottingham, Nottingham, UK
| | - Cris Glazebrook
- Institute of Mental Health, School of Medicine, NIHR MindTech MedTech Co-operative, The University of Nottingham, Nottingham, UK.
- Clinical Neurosciences and Mental Health, School of Medicine, Institute of Mental Health, The University of Nottingham, Nottingham, UK.
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Benjet C, Albor Y, Alvis-Barranco L, Contreras-Ibáñez CC, Cuartas G, Cudris-Torres L, González N, Cortés-Morelos J, Gutierrez-Garcia RA, Medina-Mora ME, Patiño P, Vargas-Contreras E, Cuijpers P, Gildea SM, Kazdin AE, Kennedy CJ, Luedtke A, Sampson NA, Petukhova MV, Zainal NH, Kessler RC. Internet-delivered cognitive behavior therapy versus treatment as usual for anxiety and depression among Latin American university students: A randomized clinical trial. J Consult Clin Psychol 2023; 91:694-707. [PMID: 38032621 PMCID: PMC11078571 DOI: 10.1037/ccp0000846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
OBJECTIVE Untreated mental disorders are important among low- and middle-income country (LMIC) university students in Latin America, where barriers to treatment are high. Scalable interventions are needed. This study compared transdiagnostic self-guided and guided internet-delivered cognitive behavioral therapy (i-CBT) with treatment as usual (TAU) for clinically significant anxiety and depression among undergraduates in Colombia and Mexico. METHOD 1,319 anxious, as determined by the Generalized Anxiety Disorder-7 (GAD-7) = 10+ and/or depressed, as determined by the Patient Health Questionnaire-9 (PHQ-9) = 10+, undergraduates (mean [SD] age = 21.4 [3.2]); 78.7% female; 55.9% first-generation university student) from seven universities in Colombia and Mexico were randomized to culturally adapted versions of self-guided i-CBT (n = 439), guided i-CBT (n = 445), or treatment as usual (TAU; n = 435). All randomized participants were reassessed 3 months after randomization. The primary outcome was remission of both anxiety (GAD-7 = 0-4) and depression (PHQ-9 = 0-4). We hypothesized that remission would be higher with guided i-CBT than with the other interventions. RESULTS Intent-to-treat analysis found significantly higher adjusted (for university and loss to follow-up) remission rates (ARD) among participants randomized to guided i-CBT than either self-guided i-CBT (ARD = 13.1%, χ12 = 10.4, p = .001) or TAU (ARD = 11.2%, χ12 = 8.4, p = .004), but no significant difference between self-guided i-CBT and TAU (ARD = -1.9%, χ12 = 0.2, p = .63). Per-protocol sensitivity analyses and analyses of dimensional outcomes yielded similar results. CONCLUSIONS Significant reductions in anxiety and depression among LMIC university students could be achieved with guided i-CBT, although further research is needed to determine which students would most likely benefit from this intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Corina Benjet
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Yesica Albor
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | | | | | - Gina Cuartas
- Facultad de Psicología, Universidad Cooperativa de Colombia, Medellin, Colombia
| | - Lorena Cudris-Torres
- Programa de Psicología, Fundación Universitaria del Area Andina, Valledupar, Colombia
| | - Noé González
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Jacqueline Cortés-Morelos
- Departamento de Psiquiatría y Salud Mental, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Maria Elena Medina-Mora
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Pamela Patiño
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Eunice Vargas-Contreras
- Facultad de Ciencias Administrativas y Sociales, Universidad Autónoma de Baja California, Ensenada, Mexico
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
- Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
| | - Sarah M. Gildea
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Alan E. Kazdin
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Chris J. Kennedy
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Alex Luedtke
- Department of Statistics, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Maria V. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Nur Hani Zainal
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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Bolibar Ribas B, Llobera-Cànaves J, García-Ortiz L, Bellón JÁ, Ramos R, García-Campayo J, Sánchez-Pérez Á, Claveria A, Martínez V, Vicens E, Minué C, Gil-Guillen V, Berenguera A, Moleras-Serra A. [The Research Network on Preventive Activities and Health Promotion (redIAPP): a reference network and promoter of primary care research]. Aten Primaria 2023; 55:102694. [PMID: 37481824 PMCID: PMC10391719 DOI: 10.1016/j.aprim.2023.102694] [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: 04/25/2023] [Revised: 05/14/2023] [Accepted: 05/21/2023] [Indexed: 07/25/2023] Open
Abstract
The Research Network on Preventive Activities and Health Promotion (redIAPP), a reference network and promoter of primary care research was created in 2003 thanks to the program Thematic Networks for Cooperative Research in Health (RETICS) of the Instituto de Salud Carlos III (ISCIII). Its creation has meant a radical change in the situation of research in primary care. Throughout its 19 years (2003-2021), different research groups and autonomous communities have participated, and different lines of research have been developed with numerous projects and publications. Despite the difficulties suffered, it has created a collaborative research experience between different autonomous communities with great vitality and with important results for primary care. The redIAPP, therefore, has been a great reference for research in primary care and for the deepening of its area of knowledge. Several lines of improvement are suggested for the future of primary care research.
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Affiliation(s)
- Bonaventura Bolibar Ribas
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España
| | - Joan Llobera-Cànaves
- Unitat de Recerca en Atenció Primaria de Mallorca, Servei de Salut de les Illes Balears (Ib-Salut), Palma, España; Institut de Investigació Sanitària de les Illes Balears (IdISBa), Hospital Universitari Son Espases, Palma, España
| | - Luis García-Ortiz
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de salud de Castilla y León (SACyL), Salamanca, España; Instituto de investigación Biomédica de Salamanca (IBSAL), Salamanca, España; Departamento de Ciencias Biomédicas y del Diagnóstico, Universidad de Salamanca, Salamanca, España
| | - Juan-Ángel Bellón
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, España; Centro de Salud El Palo, Servicio Andaluz de Salud (SAS), Málaga, España; Departmento de Salud Pública y Psiquiatría, Facultad de Medicina, Universidad de Málaga (UMA), Málaga, España
| | - Rafel Ramos
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Grup de Recerca en Salut Vascular, Institut d'Investigació Biomèdica de Girona (IdibGi), Parc Hospitalari Martí Julià, Girona, España; Department de Ciències Mèdiques, Facultat de Medicina, Campus Salut, Universitat de Girona, Girona, España; Atenció Primària, Institut Català de la Salut, Girona, Catalonia, España
| | - Javier García-Campayo
- Grupo de Aragón en Investigación en Atención Primaria (GAIAP), Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España; Servicio de Psiquiatría, Facultad de Medicina, Universidad de Zaragoza, Zaragoza, España
| | - Álvaro Sánchez-Pérez
- Unidad de Investigación Atención Primaria de Bizkaia, Subdirección para la Coordinación de la Atención Primaria, Dirección General Osakidetza, Bilbao, España; Grupo de Investigación en Ciencias de la Diseminación e Implementación en Servicios Sanitarios, Instituto Investigación Biocruces Bizkaia, Barakaldo, España
| | - Ana Claveria
- Área Sanitaria de Vigo. Servicio Galego de Saúde (SERGAS), Grupo I-Saúde, Instituto de Investigación Sanitaria Galicia Sur, Vigo, Galicia, España
| | - Vicente Martínez
- Centro de Estudios Sociosanitarios, Universidad de Castilla-La Mancha, Cuenca, España; Facultad de Medicina, Universidad Autónoma de Chile, Talca, Chile
| | - Enric Vicens
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, España
| | - César Minué
- Grupo Clínico Asociado Madrid. Servicio Madrileño de Salud. CS Perales del Río, Madrid, España
| | - Vicente Gil-Guillen
- Departamento de Medicina Clínica. Universidad Miguel Hernández, Alicante, España; Unidad de Investigación. Hospital General Universitario de Elda, Alicante, España; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL. Hospital General Universitario de Alicante, Alicante, España
| | - Anna Berenguera
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España
| | - Anna Moleras-Serra
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España.
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8
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Le Goff-Pronost M, Bongiovanni-Delarozière I. Economic evaluation of remote patient monitoring and organizational analysis according to patient involvement: a scoping review. Int J Technol Assess Health Care 2023; 39:e59. [PMID: 37750813 DOI: 10.1017/s0266462323002581] [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: 09/27/2023]
Abstract
BACKGROUND A literature review concerning the economic evaluation of telemonitoring was requested by the authority in charge of health evaluation in France, in a context of deployment of remote patient monitoring and identification of its financing. Due to the heterogeneity of existing telemonitoring solutions, it was necessary to stratify the evaluation according to patient involvement. Three levels of patient involvement are considered: weak (automated monitoring), medium (monitoring supported by a professional), and strong (active remote participation). OBJECTIVES We performed a scoping review to provide a comprehensive overview of different systems of telemonitoring and their reported cost-effectiveness. METHODS Following PRISMA-ScR guidelines, a search was performed in four databases: PubMed, MEDLINE, EMBASE, and Cochrane Library between January 1, 2013 and May 19, 2020. Remote patient monitoring should include the combination of three elements: a connected device, an organizational solution for data analysis and alert management, and a system allowing personalized interactions, and three degrees of involvement. RESULTS We identified 61 eligible studies among the 489 records identified. Heart failure remains the pathology most represented in the studies selected (n = 24). The cost-utility analysis was chosen in a preponderant way (n = 41). Forty-four studies (72 percent) reported that the intervention was expected cost-effective. Heterogeneity has been observed in the remote monitoring solutions but all systems are reported cost-effective. The small number of long-term studies does not allow conclusions to be drawn on the transposability. CONCLUSIONS Remote patient monitoring is reported to be cost-effective whatever the system and patient involvement.
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Udd-granat L, Lahti J, Donnelly M, Treanor C, Pirkola SP, Lallukka T, Kouvonen A. Internet-delivered cognitive behavioral therapy (iCBT) for common mental disorders and subsequent sickness absence: a systematic review and meta-analysis. Scand J Public Health 2023; 51:137-147. [PMID: 35120414 PMCID: PMC9903245 DOI: 10.1177/14034948221075016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM The study aimed to critically review and synthesize the best available evidence about the effectiveness of therapist-guided internet-delivered cognitive behavioral therapy (iCBT) in terms of reducing sickness absence (SA). METHODS We searched Medline (PubMed), Embase, PsycInfo, CINAHL, and Cochrane Central (up to November 2020) for English language peer-reviewed papers that described randomized controlled trials of therapist-guided iCBT compared with usual treatment for SA in adults with common mental disorders. Eligible studies were assessed with the Cochrane Risk of Bias 1 tool, meta-analysis was conducted using a random-effects model, and standardized mean differences (SMD) with 95% confidence intervals (CI) were reported. A subgroup analysis investigated potential moderating variables (diagnosis, SA at baseline, and estimated accuracy of self-report). RESULTS We identified 2788 references, of which 68 remained after the completion of the systematic screening process. A hand search of reference lists yielded no additional studies. The full texts of these 68 studies were appraised critically, and 11 were deemed to be suitable for a meta-analysis. SA was similar for iCBT and usual treatment groups (SMD: 0.02, 95% CI, -0.08 to 0.11), and remained similar even after the removal of two studies in which the recall time was over 3 months (SMD: 0.00, -0.11 to 0.12). Similar SA levels in intervention and control groups at 6-month and 12-month follow-up were observed in studies of participants with depression symptoms. CONCLUSIONS
iCBT did not appear to be effective in terms of reducing (largely self-assessed) SA in adults with common mental disorders. There is a need to improve the method and consistency of assessing SA.
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Affiliation(s)
- Lina Udd-granat
- Department of Public Health, Faculty of Medicine, University of Helsinki, Finland
| | - Jouni Lahti
- Faculty of Social Sciences, University of Helsinki, Finland
| | - Michael Donnelly
- Centre for Public Health, Queen’s University Belfast, Northern Ireland
| | - Charlene Treanor
- Centre for Public Health, Queen’s University Belfast, Northern Ireland
| | - Sami P. Pirkola
- Faculty of Social Sciences, Tampere University, Finland,Department of Psychiatry, Tampere University Central Hospital, Finland
| | - Tea Lallukka
- Department of Public Health, Faculty of Medicine, University of Helsinki, Finland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Finland,Centre for Public Health, Queen’s University Belfast, Northern Ireland,Anne Kouvonen, University of Helsinki, PO Box 54, 00014 Helsinki, Finland. E-mail:
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10
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Rohrbach PJ, Dingemans AE, Evers C, Van Furth EF, Spinhoven P, Aardoom JJ, Lähde I, Clemens FC, Van den Akker-Van Marle ME. Cost-effectiveness of Internet Interventions Compared With Treatment as Usual for People With Mental Disorders: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2023; 25:e38204. [PMID: 36602854 PMCID: PMC9893732 DOI: 10.2196/38204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/27/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The economic costs of mental disorders for society are huge. Internet-based interventions are often coined as cost-effective alternatives to usual care, but the evidence is mixed. OBJECTIVE The aim was to review the literature on the cost-effectiveness of internet interventions for mental disorders compared with usual care and to provide an estimate of the monetary benefits of such interventions compared with usual care. METHODS A systematic review and meta-analysis of randomized controlled trials was conducted, which included participants with symptoms of mental disorders; investigated a telephone- or internet-based intervention; included a control condition in the form of treatment as usual, psychological placebo, waiting list control, or bibliotherapy; reported outcomes on both quality of life and costs; and included articles published in English. Electronic databases such as PubMed (including MEDLINE), Embase, Emcare, PsycINFO, Web of Science, and the Cochrane Library were used. Data on risk of bias, quality of the economic evaluation, quality-adjusted life years, and costs were extracted from the included studies, and the incremental net benefit was calculated and pooled. RESULTS The search yielded 6226 abstracts, and 37 studies with 14,946 participants were included. The quality of economic evaluations of the included studies was rated as moderate, and the risk of bias was high. A random-effects approach was maintained. Analyses suggested internet interventions were slightly more effective than usual care in terms of quality-adjusted life years gain (Hedges g=0.052, 95% CI 0.010-0.094; P=.02) and equally expensive (Hedges g=0.002, 95% CI -0.080 to 0.84; P=.96). The pooled incremental net benefit was US $255 (95% CI US $91 to US $419; P=.002), favoring internet interventions over usual care. The perspective of the economic evaluation and targeted mental disorder moderated the results. CONCLUSIONS The findings indicate that the cost-effectiveness of internet interventions for mental disorders compared with a care-as-usual approach is likely, but generalizability to new studies is poor given the substantial heterogeneity. This is the first study in the field of mental health to pool cost-effectiveness outcomes in an aggregate data meta-analysis. TRIAL REGISTRATION PROSPERO CRD42019141659; https://tinyurl.com/3cu99b34.
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Affiliation(s)
- Pieter J Rohrbach
- GGZ Rivierduinen Eating Disorders Ursula, Leiden, Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
| | | | - Catharine Evers
- Department of Social, Health and Organizational Psychology, Utrecht University, Utrecht, Netherlands
| | - Eric F Van Furth
- GGZ Rivierduinen Eating Disorders Ursula, Leiden, Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
| | - Philip Spinhoven
- Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
- Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Jiska J Aardoom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Irene Lähde
- GGZ Rivierduinen Eating Disorders Ursula, Leiden, Netherlands
| | - Fleur C Clemens
- GGZ Rivierduinen Eating Disorders Ursula, Leiden, Netherlands
| | - M Elske Van den Akker-Van Marle
- Section of Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
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11
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Samper-Pardo M, León-Herrera S, Oliván-Blázquez B, Benedé-Azagra B, Magallón-Botaya R, Gómez-Soria I, Calatayud E, Aguilar-Latorre A, Méndez-López F, Pérez-Palomares S, Cobos-Rincón A, Valero-Errazu D, Sagarra-Romero L, Sánchez-Recio R. Development and Validation of a Mobile Application as an Adjuvant Treatment for People Diagnosed with Long COVID-19: Protocol for a Co-Creation Study of a Health Asset and an Analysis of Its Effectiveness and Cost-Effectiveness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:462. [PMID: 36612782 PMCID: PMC9819090 DOI: 10.3390/ijerph20010462] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To analyse the overall effectiveness and cost-efficiency of a mobile application (APP) as a community health asset (HA) with recommendations and recovery exercises created bearing in mind the main symptoms presented by patients in order to improve their quality of life, as well as other secondary variables, such as the number and severity of ongoing symptoms, physical and cognitive functions, affective state, and sleep quality. METHODS The first step was to design and develop the technologic community resource, the APP, following the steps involved in the process of recommending health assets (RHA). After this, a protocol of a randomised clinical trial for analysing its effectiveness and cost-efficiency as a HA was developed. The participants will be assigned to: (1st) usual treatment by the primary care practitioner (TAU), as a control group; and (2nd) TAU + use of the APP as a HA and adjuvant treatment in their recovery + three motivational interviews (MI), as an interventional group. An evaluation will be carried out at baseline with further assessments three and six months following the end of the intervention. DISCUSSION Although research and care for these patients are still in their initial stages, it is necessary to equip patients and health care practitioners with tools to assist in their recovery. Furthermore, enhanced motivation can be achieved through telerehabilitation (TR).
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Affiliation(s)
| | | | - Bárbara Oliván-Blázquez
- Department of Psychology and Sociology, University of Zaragoza, 50009 Zaragoza, Spain
- Institute for Health Research Aragon (IISAragon), 50009 Zaragoza, Spain
- Department of Physiatry and Nursing, University of Zaragoza, 50009 Zaragoza, Spain
| | - Belén Benedé-Azagra
- Institute for Health Research Aragon (IISAragon), 50009 Zaragoza, Spain
- Aragones Group of Research in Primary Health Care (GAIAP), 50009 Zaragoza, Spain
| | - Rosa Magallón-Botaya
- Department of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
- Institute for Health Research Aragon (IISAragon), 50009 Zaragoza, Spain
- Aragones Group of Research in Primary Health Care (GAIAP), 50009 Zaragoza, Spain
| | - Isabel Gómez-Soria
- Institute for Health Research Aragon (IISAragon), 50009 Zaragoza, Spain
- Department of Physiatry and Nursing, University of Zaragoza, 50009 Zaragoza, Spain
| | - Estela Calatayud
- Institute for Health Research Aragon (IISAragon), 50009 Zaragoza, Spain
- Department of Physiatry and Nursing, University of Zaragoza, 50009 Zaragoza, Spain
| | - Alejandra Aguilar-Latorre
- Institute for Health Research Aragon (IISAragon), 50009 Zaragoza, Spain
- Aragones Group of Research in Primary Health Care (GAIAP), 50009 Zaragoza, Spain
| | - Fátima Méndez-López
- Institute for Health Research Aragon (IISAragon), 50009 Zaragoza, Spain
- Aragones Group of Research in Primary Health Care (GAIAP), 50009 Zaragoza, Spain
| | - Sara Pérez-Palomares
- Institute for Health Research Aragon (IISAragon), 50009 Zaragoza, Spain
- Department of Physiatry and Nursing, University of Zaragoza, 50009 Zaragoza, Spain
- Aragones Group of Research in Primary Health Care (GAIAP), 50009 Zaragoza, Spain
| | - Ana Cobos-Rincón
- Department of Nursing, University of La Rioja, 26004 Logroño, Spain
| | - Diana Valero-Errazu
- Department of Psychology and Sociology, University of Zaragoza, 50009 Zaragoza, Spain
| | - Lucia Sagarra-Romero
- GAIAS Research Group, Faculty of Health Sciences, University San Jorge, 50830 Zaragoza, Spain
| | - Raquel Sánchez-Recio
- Institute for Health Research Aragon (IISAragon), 50009 Zaragoza, Spain
- Department of Preventive Medicine and Public Health, University of Zaragoza, 50009 Zaragoza, Spain
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12
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Kählke F, Buntrock C, Smit F, Ebert DD. Systematic review of economic evaluations for internet- and mobile-based interventions for mental health problems. NPJ Digit Med 2022; 5:175. [PMID: 36424463 PMCID: PMC9686241 DOI: 10.1038/s41746-022-00702-w] [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: 02/21/2022] [Accepted: 10/03/2022] [Indexed: 11/27/2022] Open
Abstract
In view of the staggering disease and economic burden of mental disorders, internet and mobile-based interventions (IMIs) targeting mental disorders have often been touted to be cost-effective; however, available evidence is inconclusive and outdated. This review aimed to provide an overview of the cost-effectiveness of IMIs for mental disorders and symptoms. A systematic search was conducted for trial-based economic evaluations published before 10th May 2021. Electronic databases (including MEDLINE, PsycINFO, CENTRAL, PSYNDEX, and NHS Economic Evaluations Database) were searched for randomized controlled trials examining IMIs targeting mental disorders and symptoms and conducting a full health economic evaluation. Methodological quality and risk of bias were assessed. Cost-effectiveness was assumed at or below £30,000 per quality-adjusted life year gained. Of the 4044 studies, 36 economic evaluations were reviewed. Guided IMIs were likely to be cost-effective in depression and anxiety. The quality of most evaluations was good, albeit with some risks of bias. Heterogeneity across studies was high because of factors such as different costing methods, design, comparison groups, and outcomes used. IMIs for anxiety and depression have potential to be cost-effective. However, more research is needed into unguided (preventive) IMIs with active control conditions (e.g., treatment as usual) and longer time horizon across a wider range of disorders.Trial registration: PROSPERO Registration No. CRD42018093808.
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Affiliation(s)
- Fanny Kählke
- grid.6936.a0000000123222966Department of Sport and Health Sciences, Professorship of Psychology and Digital Mental Health Care, Technische Universität München, Munich, Germany
| | - Claudia Buntrock
- grid.5807.a0000 0001 1018 4307Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke-University, Magdeburg, Germany
| | - Filip Smit
- grid.12380.380000 0004 1754 9227Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands ,grid.416017.50000 0001 0835 8259Centre of Health-Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - David Daniel Ebert
- grid.6936.a0000000123222966Department of Sport and Health Sciences, Professorship of Psychology and Digital Mental Health Care, Technische Universität München, Munich, Germany
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13
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Implementation of a psychological online intervention for low to moderate depression in primary care: study protocol. Internet Interv 2022; 30:100581. [PMID: 36573071 PMCID: PMC9789354 DOI: 10.1016/j.invent.2022.100581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/13/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Depression affects millions of people all over the world and implies a great socioeconomic burden. Despite there are different effective evidence-based interventions for treating depression, only a small proportion of these patients receives an appropriate treatment. In this regard, information and communication technologies (ICTs) can be used with therapeutic aims and this can contribute to make interventions more accessible. One example is "Smiling is fun", an internet-based treatment which has proved to be effective and cost-effective for treating depression in Spanish Primary Care (PC). However, the "know-do gap" between research and clinical settings implies that the actual implementation of such interventions could last up to 20 years. To overcome this obstacle, the implementation research establishes the methodology to implement the advances developed in the laboratories to the health care services maintaining the validity of the intervention and offering specific strategies for the implementation process. OBJECTIVE This is the protocol of an implementation study for the Internet-based program "Smiling is fun", which will be conducted on patients with mild-to-moderate depression of Spanish PC settings. In the implementation study, the feasibility, efficacy, cost-efficacy, acceptability, adoption, appropriateness, fidelity, penetration, normalization, and sustainability will be assessed. METHODS The current investigation is a Hybrid Effectiveness-Implementation Type II design. A Stepped Wedge randomized controlled trial design will be used, with a cohort of 420 adults diagnosed with depression (mild-to-moderate) who will undergo a first control phase (no treatment) followed by the intervention, which will last 16 weeks, and finishing with an optional use of the intervention. All patients will be assessed at baseline, during the treatment, and at post-treatment. The study will be conducted in three Spanish regions: Andalusia, Aragon, and the Balearic Islands. Two primary care centers of each region will participate, one located in the urban setting and the other in the rural setting. The primary outcome will be implementation success of the intervention assessing the reach, clinical effect, acceptability, appropriateness, adoption, feasibility, fidelity, penetration, implementation costs and sustainability services. DISCUSSION "Smiling is Fun", which has already been established as effective and cost-effective, will be adapted according to users' experiences and opinions, and the efficacy and cost-efficacy of the program will again be assessed. The study will point out barriers and facilitators to consider in the implementation process of internet-based psychological interventions in health services. The ultimate goal is to break the research-to-practice split, which would undoubtedly contribute to reduce the high burden of depression in our society. TRIAL REGISTRATION ClinicalTrials.gov, Identifier: NCT05294614.
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14
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Rahmani AM, Lai J, Jafarlou S, Azimi I, Yunusova A, Rivera AP, Labbaf S, Anzanpour A, Dutt N, Jain R, Borelli JL. Personal mental health navigator: Harnessing the power of data, personal models, and health cybernetics to promote psychological well-being. Front Digit Health 2022; 4:933587. [PMID: 36213523 PMCID: PMC9535086 DOI: 10.3389/fdgth.2022.933587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
Current digital mental healthcare solutions conventionally take on a reactive approach, requiring individuals to self-monitor and document existing symptoms. These solutions are unable to provide comprehensive, wrap-around, customized treatments that capture an individual’s holistic mental health model as it unfolds over time. Recognizing that each individual requires personally tailored mental health treatment, we introduce the notion of Personalized Mental Health Navigation (MHN): a cybernetic goal-based system that deploys a continuous loop of monitoring, estimation, and guidance to steer the individual towards mental flourishing. We present the core components of MHN that are premised on the importance of addressing an individual’s personal mental health state. Moreover, we provide an overview of the existing physical health navigation systems and highlight the requirements and challenges of deploying the navigational approach to the mental health domain.
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Affiliation(s)
- Amir M. Rahmani
- Department of Computer Science, University of California, Irvine, CA, USA
- School of Nursing, University of California, Irvine, CA, USA
- Institute for Future Health, University of California, Irvine, CA, USA
- Correspondence: Amir Rahmani
| | - Jocelyn Lai
- Department of Psychological Science, University of California, Irvine, CA, USA
| | - Salar Jafarlou
- Department of Computer Science, University of California, Irvine, CA, USA
| | - Iman Azimi
- Department of Computer Science, University of California, Irvine, CA, USA
- Institute for Future Health, University of California, Irvine, CA, USA
| | - Asal Yunusova
- Department of Psychological Science, University of California, Irvine, CA, USA
| | - Alex. P. Rivera
- Department of Psychological Science, University of California, Irvine, CA, USA
| | - Sina Labbaf
- Department of Computer Science, University of California, Irvine, CA, USA
| | - Arman Anzanpour
- Department of Computing, University of Turku, Turku, Finland
| | - Nikil Dutt
- Department of Computer Science, University of California, Irvine, CA, USA
- Institute for Future Health, University of California, Irvine, CA, USA
| | - Ramesh Jain
- Department of Computer Science, University of California, Irvine, CA, USA
- Institute for Future Health, University of California, Irvine, CA, USA
| | - Jessica L. Borelli
- Department of Psychological Science, University of California, Irvine, CA, USA
- Institute for Future Health, University of California, Irvine, CA, USA
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15
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Gentili A, Failla G, Melnyk A, Puleo V, Tanna GLD, Ricciardi W, Cascini F. The cost-effectiveness of digital health interventions: A systematic review of the literature. Front Public Health 2022; 10:787135. [PMID: 36033812 PMCID: PMC9403754 DOI: 10.3389/fpubh.2022.787135] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 07/21/2022] [Indexed: 01/21/2023] Open
Abstract
Background Digital health interventions have significant potential to improve safety, efficacy, and quality of care, reducing waste in healthcare costs. Despite these premises, the evidence regarding cost and effectiveness of digital tools in health is scarce and limited. Objectives The aim of this systematic review is to summarize the evidence on the cost-effectiveness of digital health interventions and to assess whether the studies meet the established quality criteria. Methods We queried PubMed, Scopus and Web of Science databases for articles in English published from January 1, 2016 to December 31, 2020 that performed economic evaluations of digital health technologies. The methodological rigorousness of studies was assessed with the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2009 checklist. Results Search identified 1,476 results, 552 of which were selected for abstract and 35 were included in this review. The studies were heterogeneous by country (mostly conducted in upper and upper-middle income countries), type of eHealth intervention, method of implementation, and reporting perspectives. The qualitative analysis identified the economic and effectiveness evaluation of six different types of interventions: (1) seventeen studies on new video-monitoring service systems; (2) five studies on text messaging interventions; (3) five studies on web platforms and digital health portals; (4) two studies on telephone support; (5) three studies on new mobile phone-based systems and applications; and (6) three studies on digital technologies and innovations. Conclusion Findings on cost-effectiveness of digital interventions showed a growing body of evidence and suggested a generally favorable effect in terms of costs and health outcomes. However, due to the heterogeneity across study methods, the comparison between interventions still remains difficult. Further research based on a standardized approach is needed in order to methodically analyze incremental cost-effectiveness ratios, costs, and health benefits.
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Affiliation(s)
- Andrea Gentili
- Section of Hygiene and Public Health, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy,*Correspondence: Andrea Gentili
| | - Giovanna Failla
- Department of Public Health, University of Verona, Verona, Italy
| | - Andriy Melnyk
- Section of Hygiene and Public Health, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Valeria Puleo
- Section of Hygiene and Public Health, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Gian Luca Di Tanna
- Statistics Division, The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Walter Ricciardi
- Section of Hygiene and Public Health, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Fidelia Cascini
- Section of Hygiene and Public Health, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
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16
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Li M, Bai F, Yao L, Qin Y, Chen K, Xin T, Ma X, Ma Y, Zhou Y, Dai H, Li R, Li X, Yang K. Economic Evaluation of Cognitive Behavioral Therapy for Depression: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1030-1041. [PMID: 35422392 DOI: 10.1016/j.jval.2021.11.1379] [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: 05/08/2021] [Revised: 11/06/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to conduct a systematic review of cost-utility studies of internet-based and face-to-face cognitive behavioral therapy (CBT) for depression from childhood to adulthood and to examine their reporting and methodological quality. METHODS A structured search for cost-utility studies concerning CBT for depression was performed in 7 comprehensive databases from their inception to July 2020. Two reviewers independently screened the literature, abstracted data, and assessed quality using the Consolidated Health Economic Evaluation Reporting Standards and Quality of Health Economic Studies checklists. The primary outcome was the incremental cost-effectiveness ratio (ICER) across all studies. To make a relevant comparison of the ICERs across the identified studies, cost data were inflated to the year 2020 and converted into US dollars. RESULTS Thirty-eight studies were included in this review, of which 26 studies (68%) were deemed of high methodological quality and 12 studies (32%) of fair quality. Despite differences in study designs and settings, the conclusions of most included studies for adult depression were general agreement; they showed that face-to-face CBT monotherapy or combination therapy compared with antidepressants and usual care for adult depression were cost-effective from the societal, health system, or payer perspective (ICER -$241 212.4/quality-adjusted life-year [QALY] to $33 032.47/QALY, time horizon 12-60 months). Internet-based CBT regardless of guided or unguided also has a significant cost-effectiveness advantage (ICER -$37 717.52/QALY to $73 841.34/QALY, time horizon 3-36 months). In addition, CBT was cost-effective in preventing depression (ICER -$23 932.07/QALY to $26 092.02/QALY, time horizon 9-60 months). Nevertheless, the evidence for the cost-effectiveness of CBT for children and adolescents was still ambiguous. CONCLUSIONS Fair or high-quality evidence showed that CBT monotherapy or combination therapy for adult depression was cost-effective; whether CBT-related therapy was cost-effective for children and adolescents depression remains inconclusive.
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Affiliation(s)
- Meixuan Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Fei Bai
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; National Center for Medical Service Administration, Beijing, China
| | - Liang Yao
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Yu Qin
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Kaiyue Chen
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Tianjiao Xin
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Xiaoya Ma
- The Second School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - YinXia Ma
- The Second School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Yinjuan Zhou
- The Second School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Hui Dai
- The First School of Clinical Medicine Lanzhou University, Lanzhou, China
| | - Rui Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Xiuxia Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
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17
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Batterham PJ, Gulliver A, Kurz E, Farrer LM, Vis C, Schuurmans J, Calear AL. The Effect of Dissemination Pathways on Uptake and Relative Costs for a Transdiagnostic, Self-guided Internet Intervention for Reducing Depression, Anxiety, and Suicidal Ideation: Comparative Implementation Study. J Med Internet Res 2022; 24:e34769. [PMID: 35522458 PMCID: PMC9123540 DOI: 10.2196/34769] [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: 11/08/2021] [Revised: 01/27/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Self-guided web-based programs are effective; however, inadequate implementation of these programs limits their potential to provide effective and low-cost treatment for common mental health problems at scale. There is a lack of research examining optimal methods for the dissemination of web-based programs in the community. Objective This study aimed to compare the uptake, reach, relative costs, and adherence associated with 3 community-based pathways for delivering a low-intensity web-based transdiagnostic mental health program. The 3 dissemination pathways were social media advertising, advertising in general practice, and advertising in pharmacies. Methods Participants were recruited on the web, from general practices, or from community pharmacies; completed a screener for psychological distress; and were offered the 4-week FitMindKit program—a 12-module psychotherapeutic intervention. Uptake was defined as the number of participants who enrolled in the web-based program; reach was defined as the rate of uptake per exposure; and costs were calculated based on staff time, equipment, and advertising. Adherence was assessed as the number of modules of FitMindKit completed by the participants. Results Uptake comprised 1014 participants who were recruited through the 3 dissemination pathways: on the web (991/1014, 97.73%), in general practice (16/1014, 1.58%), and in pharmacy (7/1014, 0.69%). Reach was highest for social media: 1 in every 50 people exposed to web-based advertising took up the intervention compared with 1 in every 441 in general practitioner clinics and 1 in every 1708 in pharmacies. The dissemination cost was US $4.87 per user on social media, US $557 per user for general practitioner clinics, and US $1272 per user for pharmacy dissemination. No significant differences in adherence were observed between the conditions, whereas all pathways showed an underrepresentation of men and linguistic diversity. Conclusions The web-based dissemination pathway was the most efficient and cost-effective for delivering a self-guided internet-based mental health program to people in the community. More research is needed to identify how best to engage men and those with culturally diverse backgrounds in web-based interventions. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12618001688279; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376113
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Affiliation(s)
- Philip J Batterham
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Amelia Gulliver
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Ella Kurz
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Louise M Farrer
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Christiaan Vis
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Alison L Calear
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
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18
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Gega L, Jankovic D, Saramago P, Marshall D, Dawson S, Brabyn S, Nikolaidis GF, Melton H, Churchill R, Bojke L. Digital interventions in mental health: evidence syntheses and economic modelling. Health Technol Assess 2022; 26:1-182. [PMID: 35048909 PMCID: PMC8958412 DOI: 10.3310/rcti6942] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Economic evaluations provide evidence on whether or not digital interventions offer value for money, based on their costs and outcomes relative to the costs and outcomes of alternatives. OBJECTIVES (1) Evaluate and summarise published economic studies about digital interventions across different technologies, therapies, comparators and mental health conditions; (2) synthesise clinical evidence about digital interventions for an exemplar mental health condition; (3) construct an economic model for the same exemplar mental health condition using the previously synthesised clinical evidence; and (4) consult with stakeholders about how they understand and assess the value of digital interventions. METHODS We completed four work packages: (1) a systematic review and quality assessment of economic studies about digital interventions; (2) a systematic review and network meta-analysis of randomised controlled trials on digital interventions for generalised anxiety disorder; (3) an economic model and value-of-information analysis on digital interventions for generalised anxiety disorder; and (4) a series of knowledge exchange face-to-face and digital seminars with stakeholders. RESULTS In work package 1, we reviewed 76 economic evaluations: 11 economic models and 65 within-trial analyses. Although the results of the studies are not directly comparable because they used different methods, the overall picture suggests that digital interventions are likely to be cost-effective, compared with no intervention and non-therapeutic controls, whereas the value of digital interventions compared with face-to-face therapy or printed manuals is unclear. In work package 2, we carried out two network meta-analyses of 20 randomised controlled trials of digital interventions for generalised anxiety disorder with a total of 2350 participants. The results were used to inform our economic model, but when considered on their own they were inconclusive because of the very wide confidence intervals. In work package 3, our decision-analytic model found that digital interventions for generalised anxiety disorder were associated with lower net monetary benefit than medication and face-to-face therapy, but greater net monetary benefit than non-therapeutic controls and no intervention. Value for money was driven by clinical outcomes rather than by intervention costs, and a value-of-information analysis suggested that uncertainty in the treatment effect had the greatest value (£12.9B). In work package 4, stakeholders identified several areas of benefits and costs of digital interventions that are important to them, including safety, sustainability and reducing waiting times. Four factors may influence their decisions to use digital interventions, other than costs and outcomes: increasing patient choice, reaching underserved populations, enabling continuous care and accepting the 'inevitability of going digital'. LIMITATIONS There was substantial uncertainty around effect estimates of digital interventions compared with alternatives. This uncertainty was driven by the small number of studies informing most comparisons, the small samples in some of these studies and the studies' high risk of bias. CONCLUSIONS Digital interventions may offer good value for money as an alternative to 'doing nothing' or 'doing something non-therapeutic' (e.g. monitoring or having a general discussion), but their added value compared with medication, face-to-face therapy and printed manuals is uncertain. Clinical outcomes rather than intervention costs drive 'value for money'. FUTURE WORK There is a need to develop digital interventions that are more effective, rather than just cheaper, than their alternatives. STUDY REGISTRATION This study is registered as PROSPERO CRD42018105837. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Lina Gega
- Department of Health and Social Care Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
- Tees, Esk and Wear Valleys NHS Foundation Trust, Middlesbrough, UK
| | - Dina Jankovic
- Centre for Health Economics, University of York, York, UK
| | - Pedro Saramago
- Centre for Health Economics, University of York, York, UK
| | - David Marshall
- Centre for Reviews & Dissemination, University of York, York, UK
| | - Sarah Dawson
- Common Mental Disorders Group, Cochrane Collaboration, University of York, York, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Sally Brabyn
- Department of Health and Social Care Sciences, University of York, York, UK
| | | | - Hollie Melton
- Centre for Reviews & Dissemination, University of York, York, UK
| | - Rachel Churchill
- Centre for Reviews & Dissemination, University of York, York, UK
- Common Mental Disorders Group, Cochrane Collaboration, University of York, York, UK
| | - Laura Bojke
- Centre for Health Economics, University of York, York, UK
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19
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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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20
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Taguchi K, Numata N, Takanashi R, Takemura R, Yoshida T, Kutsuzawa K, Yoshimura K, Nozaki-Taguchi N, Ohtori S, Shimizu E. Clinical Effectiveness and Cost-effectiveness of Videoconference-Based Integrated Cognitive Behavioral Therapy for Chronic Pain: Randomized Controlled Trial. J Med Internet Res 2021; 23:e30690. [PMID: 34813489 PMCID: PMC8663446 DOI: 10.2196/30690] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/01/2021] [Accepted: 10/05/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cognitive behavioral therapy is known to improve the management of chronic pain. However, the components of this therapy are still being investigated and debated. OBJECTIVE This study aimed to examine the effectiveness of an integrated cognitive behavioral therapy program with new components (attention-shift, memory work, video feedback, and image training) delivered via videoconferencing. METHODS This study was unblinded and participants were recruited and assessed face-to-face in the outpatient department. We conducted a randomized controlled trial for chronic pain to compare 16 weekly videoconference-based cognitive behavioral therapy (vCBT) sessions provided by a therapist with treatment as usual (TAU). Thirty patients (age range, 22-75 years) with chronic pain were randomly assigned to either vCBT (n=15) or TAU (n=15). Patients were evaluated at week 1 (baseline), week 8 (midintervention), and week 16 (postintervention). The primary outcome was the change in pain intensity, which was recorded using the numerical rating scale at 16 weeks from the baseline. Secondary outcomes were pain severity and pain interference, which were assessed using the Brief Pain Inventory. Additionally, we evaluated disability, pain catastrophizing cognition, depression, anxiety, quality of life, and cost utility. RESULTS In the eligibility assessment, 30 patients were eventually randomized and enrolled; finally, 15 patients in the vCBT and 14 patients in the TAU group were analyzed. Although no significant difference was found between the 2 groups in terms of changes in pain intensity by the numerical rating scale scores at week 16 from baseline (P=.36), there was a significant improvement in the comprehensive evaluation of pain by total score of Brief Pain Inventory (-1.43, 95% CI -2.49 to -0.37, df=24; P=.01). Further, significant improvement was seen in pain interference by using the Brief Pain Inventory (-9.42, 95% CI -14.47 to -4.36, df=25; P=.001) and in disability by using the Pain Disability Assessment Scale (-1.95, 95% CI -3.33 to -0.56, df=24; P=.008) compared with TAU. As for the Medical Economic Evaluation, the incremental cost-effectiveness ratio for 1 year was estimated at 2.9 million yen (about US $25,000) per quality-adjusted life year gained. CONCLUSIONS The findings of our study suggest that integrated cognitive behavioral therapy delivered by videoconferencing in regular medical care may reduce pain interference but not pain intensity. Further, this treatment method may be cost-effective, although this needs to be further verified using a larger sample size. TRIAL REGISTRATION University Hospital Medical Information Network UMIN000031124; https://tinyurl.com/2pr3xszb.
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Affiliation(s)
- Kayoko Taguchi
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Noriko Numata
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Rieko Takanashi
- Department of Psychology, Teikyo University, Hachioji, Japan
| | | | - Tokiko Yoshida
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Kana Kutsuzawa
- Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | | | | | - Eiji Shimizu
- Graduate School of Medicine, Chiba University, Chiba, Japan
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21
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Miki A, Lau MA, Moradian H. An Open Trial of the Effectiveness, Program Usage, and User Experience of Internet-based Cognitive Behavioural Therapy for Mixed Anxiety and Depression for Healthcare Workers on Disability Leave. J Occup Environ Med 2021; 63:865-874. [PMID: 34597283 PMCID: PMC8478326 DOI: 10.1097/jom.0000000000002248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE An open trial of an internet-based Cognitive Behavioural Therapy (iCBT) program for healthcare workers was conducted. METHODS Healthcare workers on disability leave who used the iCBT program were assessed on: self-reported depression and anxiety symptoms using the Depression Anxiety Stress Scales-21; and, program usage. Healthcare workers' experience of using iCBT was evaluated in a separate survey. RESULTS Of the 497 healthcare workers referred to the iCBT program, 51% logged in, 25% logged in more than once, and 12% logged in more than once and completed at least two assessments. For the latter group, self-reported depression and anxiety symptoms significantly decreased from the first assessment. CONCLUSIONS This iCBT program was perceived to be of benefit to healthcare workers, with program usage and effectiveness that was similar to what has been previously reported for unguided iCBT.
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Affiliation(s)
- Andrew Miki
- Starling Minds (Dr Miki, Dr Lau, Dr Moradian); and Department of Psychiatry, Faculty of Medicine, University of British Columbia (Dr Lau), Vancouver, BC, Canada
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22
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Mitchell LM, Joshi U, Patel V, Lu C, Naslund JA. Economic Evaluations of Internet-Based Psychological Interventions for Anxiety Disorders and Depression: A Systematic Review. J Affect Disord 2021; 284:157-182. [PMID: 33601245 PMCID: PMC8008508 DOI: 10.1016/j.jad.2021.01.092] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 01/12/2021] [Accepted: 01/31/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Internet-based interventions show clinical effectiveness for treating anxiety disorders and depression and could make mental healthcare more affordable. METHODS We searched databases including PubMed; EMBASE; Cochrane Central; PsychINFO; CINAHL; EconLit; and Web of Science from January 1, 2000 to August 21, 2020. Inclusion criteria were: 1) pertained to the treatment or prevention of anxiety disorders or depression; 2) evaluated the use of an internet-delivered psychological intervention; 3) recruited participants; and 4) reported costs or cost-effectiveness. RESULTS Of the 6,069 articles identified, 33 targeted anxiety (N=13) and depression (n=20) and met final inclusion criteria. All studies were from high-income countries. The control conditions and cost components included were heterogeneous. Only eight studies reported costs of developing the intervention. Of 27 studies that made a conclusion about cost-effectiveness, 81% of interventions were cost-effective. The quality of studies included was high based on a quality assessment checklist of economic evaluations, although many studies did not include definitions of cost components or differentiate between patient-side and system-level costs. LIMITATIONS Studies varied in methodology, making conclusions about cost-effectiveness difficult. The generalizability of these results is unclear as studies were clustered in a small number of high-income countries and costs vary over time and between regions. CONCLUSIONS Internet-delivered interventions appeared to be cost-effective although control conditions and cost component reporting were variable. We propose a checklist of cost components for future cost analyses to better compare intervention costs. More research is needed to describe development costs, cost-effectiveness in low-resource settings, and cost-effectiveness of newer technologies.
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Affiliation(s)
- Lauren M Mitchell
- Department of Internal Medicine, New York Presbyterian Hospital - Weill Cornell, New York, NY, USA.
| | | | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA,Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Chunling Lu
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA,Division of Global Health Equity, Brigham & Women’s Hospital, Boston, MA, USA
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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23
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Ritvo P, Knyahnytska Y, Pirbaglou M, Wang W, Tomlinson G, Zhao H, Linklater R, Bai S, Kirk M, Katz J, Harber L, Daskalakis Z. Online Mindfulness-Based Cognitive Behavioral Therapy Intervention for Youth With Major Depressive Disorders: Randomized Controlled Trial. J Med Internet Res 2021; 23:e24380. [PMID: 33688840 PMCID: PMC7991990 DOI: 10.2196/24380] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/30/2020] [Accepted: 01/10/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Approximately 70% of mental health disorders appear prior to 25 years of age and can become chronic when ineffectively treated. Individuals between 18 and 25 years old are significantly more likely to experience mental health disorders, substance dependencies, and suicidality. Treatment progress, capitalizing on the tendencies of youth to communicate online, can strategically address depressive disorders. OBJECTIVE We performed a randomized controlled trial (RCT) that compared online mindfulness-based cognitive behavioral therapy (CBT-M) combined with standard psychiatric care to standard psychiatric care alone in youth (18-30 years old) diagnosed with major depressive disorder. METHODS Forty-five participants were randomly assigned to CBT-M and standard care (n=22) or to standard psychiatric care alone (n=23). All participants were provided standard psychiatric care (ie, 1 session per month), while participants in the experimental group received an additional intervention consisting of the CBT-M online software program. Interaction with online workbooks was combined with navigation coaching delivered by phone and secure text messaging. RESULTS In a two-level linear mixed-effects model intention-to-treat analysis, significant between-group differences were found for the Beck Depression Inventory-II score (difference -8.54, P=.01), Quick Inventory of Depressive Symptoms score (difference -4.94, P=.001), Beck Anxiety Inventory score (difference -11.29, P<.001), and Brief Pain Inventory score (difference -1.99, P=.03), while marginal differences were found for the Five Facet Mindfulness Questionnaire-Nonjudging subscale (difference -2.68, P=.05). CONCLUSIONS These results confirm that youth depression can be effectively treated with online CBT-M that can be delivered with less geographic restriction. TRIAL REGISTRATION Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052.
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Affiliation(s)
- Paul Ritvo
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada.,Department of Psychology, York University, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yuliya Knyahnytska
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Meysam Pirbaglou
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - George Tomlinson
- THETA Collaborative, University Health Network, University of Toronto, Toronto, ON, Canada.,Biostatistics Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Haoyu Zhao
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Renee Linklater
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Aboriginal Engagement and Outreach, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Shari Bai
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Megan Kirk
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada
| | - Joel Katz
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Lillian Harber
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Zafiris Daskalakis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Mood and Anxiety Ambulatory Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
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24
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Quiñonez-Freire C, Vara MD, Herrero R, Mira A, García-Palacios A, Botella C, Baños RM. Cultural adaptation of the Smiling is Fun program for the treatment of depression in the Ecuadorian public health care system: A study protocol for a randomized controlled trial. Internet Interv 2021; 23:100352. [PMID: 33335847 PMCID: PMC7733006 DOI: 10.1016/j.invent.2020.100352] [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: 07/29/2020] [Revised: 10/13/2020] [Accepted: 10/28/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Depression is one of the world's major health problems. Due to its high prevalence, it constitutes the first cause of disability among the Americas, where only a very low percentage of the population receives the adequate evidence-based psychological treatment. Internet-Based Interventions (IBIs) are a great alternative to reduce the treatment gap for mental disorders. Although there are several studies in low-and middle-income countries proving IBIs' feasibility and acceptability, there is still little evidence of the effectiveness in diverse social and cultural contexts such as Latin America. METHODS Two studies will be described: Study 1 is focused on the cultural adaptation of a cognitive-behavioral IBI Smiling is Fun (Botella et al. 2012, 2015) for Ecuadorian population with depression based on the procedure by Salamanca-Sanabria et al. (2018). Study 2 describes the design of a randomized controlled trial to test the preliminary efficacy of the culturally adapted intervention in a Public Health Care setting. A total of 153 patients with mild to moderate degree of depression as assessed with the Mini-International Neuropsychiatric Interview (M.I.N.I.) and the Patient Health Questionnaire-9 (PHQ-9) will be randomly assigned to either an IBI group using only automated support by the system; an IBI group including also minimal human support; or a waiting list group. The primary outcome (depression) and secondary outcomes (e.g., anxiety, affect, quality of life) will be collected at baseline, 3, 6 and 12 months. Mixed-model analyses with no ad hoc imputations will be conducted. DISCUSSION This paper is pioneering in exploring the role of an Internet-based culturally adapted intervention for depression in a public care context in Ecuador. Results obtained will offer new insights into the viability and effectiveness of digital technologies for the psychological treatment of mental illnesses in developing countries.
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Key Words
- APOI, Attitudes Towards Psychological Online Interventions
- AQoL-6D, Assessment of Quality of Life 6 Dimensions
- BDI-II, Beck Depression Inventory-II
- CEQ, Credibility and Expectancy Questionnaire
- CONSORT, Consolidated Standards of Reporting Trials
- CRQ, Cultural Relevance Questionnaire
- CSQ, Client Satisfaction Questionnaire
- Cultural adaptation
- Depression
- E-SF, Ecuadorian Cultural Version of Smiling is Fun
- EBPTs, Evidence-Based Psychological Treatments
- GAD-7, Generalized Anxiety Disorder-7
- IBIs, Internet-Based Interventions
- ICD-10, International Classification of Diseases-10
- ICERs, Incremental Cost-Effectiveness Ratios
- Internet-based intervention
- Latin America
- M.I.N.I. 5.0, MINI International Neuropsychiatric Interview 5.0
- MCAR, Missing Completely at Random
- OASIS, Overall Anxiety Severity and Impairment Scale
- ODSIS, Overall Depression Severity and Impairment Scale
- PANAS, Positive and Negative Affect Schedule
- PC, Primary Care
- PHC, Public Health Care
- PHQ-9, Patient Health Questionnaire-9
- Public Health Care
- QALYs, Quality-Adjusted Life-Years
- RCI, Reliable Change Index
- RCT, Randomized Control Trial
- Randomized Controlled Trial
- SPIRIT, Recommendations for Interventional Trials
- SUS, System Usability Scale
- TiC-P, Trimbos/iMTA Questionnaire on Costs on Psychiatric Illnesses
- WAI-TECH-SF, Working Alliance Inventory for Online Intervention-Short Form
- WL, Waiting List
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Affiliation(s)
- Carlos Quiñonez-Freire
- Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
- Mental Health Unit, Hospital Dr, Gustavo Dominguez Z, Santo Domingo, Ecuador
| | - M. Dolores Vara
- Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - Rocío Herrero
- Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - Adriana Mira
- Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Azucena García-Palacios
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
- Department of Basic Psychology, Clinical and Psychobiology, Jaume I University, Castellón, Spain
| | - Cristina Botella
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
- Department of Basic Psychology, Clinical and Psychobiology, Jaume I University, Castellón, Spain
| | - Rosa M. Baños
- Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
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25
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Aguilar-Latorre A, Navarro C, Oliván-Blázquez B, Gervilla E, Magallón Botaya R, Calafat-Villalonga C, García-Toro M, Boira S, Serrano-Ripoll MJ. Effectiveness and cost-effectiveness of a lifestyle modification programme in the prevention and treatment of subclinical, mild and moderate depression in primary care: a randomised clinical trial protocol. BMJ Open 2020; 10:e038457. [PMID: 33372070 PMCID: PMC7772323 DOI: 10.1136/bmjopen-2020-038457] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 10/19/2020] [Accepted: 11/19/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Major depression is a highly prevalent pathology that is currently the second most common cause of disease-induced disability in our society. The onset and continuation of depression may be related to a wide variety of biological and psychosocial factors, many of which are linked to different lifestyle aspects. Therefore, health systems must design and implement health promotion and lifestyle modification programmes (LMPs), taking into account personal factors and facilitators. The main objective of this protocol is to analyse the clinical effectiveness, cost-effectiveness and cost utility of an LMP and an LMP with information and communication technologies (ICTs) as adjunctive treatment for depression in primary care patients. The secondary objectives are to analyse the clinical effectiveness in the subgroup that presents comorbidity and to analyse the correlation between personal factors on health behaviour and lifestyle patterns. METHODS AND ANALYSIS A randomised, multicenter pragmatic clinical trial with three parallel groups consisting of primary healthcare patients suffering from subclinical, mild or moderate depression. The following interventions will be used: (1) Usual antidepressant treatment with psychological advice and/or psychotropic drugs prescribed by the general practitioner (treatment as usual (TAU)). (2) TAU+LMP. A programme to be imparted in six weekly 90-minute group sessions, intended to improve the following aspects: behavioural activation+daily physical activity+adherence to the Mediterranean diet pattern+sleep hygiene+careful exposure to sunlight. (3) TAU+LMP+ICTs: healthy lifestyle recommendations (TAU+LMP)+monitoring using ICTs (a wearable smartwatch). The primary outcome will be the depressive symptomatology and the secondary outcomes will be the quality of life, the use of health and social resources, personal factors on health behaviour, social support, lifestyle patterns and chronic comorbid pathology. Data will be collected before and after the intervention, with 6-month and 12-month follow-ups. ETHICS AND DISSEMINATION This study has been approved by the Clinical Research Ethics Committee of Aragón (approval number: C.P.-C.I. PI18/286) and the Research Ethics Committee of the Balearic Islands (IB3950/19 PI). Data distribution will be anonymous. Results will be disseminated via conferences and papers published in peer-reviewed, open-access journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03951350).
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Affiliation(s)
- Alejandra Aguilar-Latorre
- Primary Health Care Research Group of Aragón (GAIAP), Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
| | - Capilla Navarro
- Department of Psychology, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Bárbara Oliván-Blázquez
- Primary Health Care Research Group of Aragón (GAIAP), Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Elena Gervilla
- Department of Psychology, University of the Balearic Islands, Palma de Mallorca, Spain
- Statistic and psychometric procedures implemented in Health Sciences Research Group, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
| | - Rosa Magallón Botaya
- Primary Health Care Research Group of Aragón (GAIAP), Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
| | | | - Mauro García-Toro
- Mental disorders of high prevalence Research Group (TRAMAP), Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
- Department of Medicine, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Santiago Boira
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - María Jesús Serrano-Ripoll
- Department of Psychology, University of the Balearic Islands, Palma de Mallorca, Spain
- Research in Preventive Activities and Promotion and in Cancer Illes Balears (GRAPP-CAIB), Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
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26
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Duevel JA, Hasemann L, Peña-Longobardo LM, Rodríguez-Sánchez B, Aranda-Reneo I, Oliva-Moreno J, López-Bastida J, Greiner W. Considering the societal perspective in economic evaluations: a systematic review in the case of depression. HEALTH ECONOMICS REVIEW 2020; 10:32. [PMID: 32964372 PMCID: PMC7510122 DOI: 10.1186/s13561-020-00288-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/07/2020] [Indexed: 05/27/2023]
Abstract
BACKGROUND Depressive disorders are associated with a high burden of disease. However, due to the burden posed by the disease on not only the sufferers, but also on their relatives, there is an ongoing debate about which costs to include and, hence, which perspective should be applied. Therefore, the aim of this paper was to examine whether the change between healthcare payer and societal perspective leads to different conclusions of cost-utility analyses in the case of depression. METHODS A systematic literature search was conducted to identify economic evaluations of interventions in depression, launched on Medline and the Cost-Effectiveness Registry of the Tufts University using a ten-year time horizon (2008-2018). In a two-stepped screening process, cost-utility studies were selected by means of specified inclusion and exclusion criteria. Subsequently, relevant findings was extracted and, if not fully stated, calculated by the authors of this work. RESULTS Overall, 53 articles with 92 complete economic evaluations, reporting costs from healthcare payer/provider and societal perspective, were identified. More precisely, 22 estimations (24%) changed their results regarding the cost-effectiveness quadrant when the societal perspective was included. Furthermore, 5% of the ICURs resulted in cost-effectiveness regarding the chosen threshold (2% of them became dominant) when societal costs were included. However, another four estimations (4%) showed the opposite result: these interventions were no longer cost-effective after the inclusion of societal costs. CONCLUSIONS Summarising the disparities in results and applied methods, the results show that societal costs might alter the conclusions in cost-utility analyses. Hence, the relevance of the perspectives chosen should be taken into account when carrying out an economic evaluation. This systematic review demonstrates that the results of economic evaluations can be affected by different methods available for estimating non-healthcare costs.
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Affiliation(s)
- Juliane Andrea Duevel
- AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Universitaetsstrasse 25, 33615, Bielefeld, Germany.
| | - Lena Hasemann
- AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Universitaetsstrasse 25, 33615, Bielefeld, Germany
| | - Luz María Peña-Longobardo
- Faculty of Law and Social Sciences, Economic Analysis Department, Research Group in Economics and Health, University of Castilla-La Mancha, Cobertizo San Pedro Mártir, S/N, 45002, Toledo, Spain
| | - Beatriz Rodríguez-Sánchez
- Faculty of Law and Social Sciences, Economic Analysis Department, Research Group in Economics and Health, University of Castilla-La Mancha, Cobertizo San Pedro Mártir, S/N, 45002, Toledo, Spain
- Faculty of Technology and Science, University Camilo José Cela, Urb. Villafranca del Castillo, Calle Castillo de Alarcón, 49, 28692 Villanueva de la Cañada, Madrid, Spain
| | - Isaac Aranda-Reneo
- Faculty of Social Science, Economic Analysis and Finance Department, Research Group in Economics and Health, University of Castilla-La Mancha, Avda. Real Fábrica s/n, Talavera de la Reina, 45600, Toledo, Spain
| | - Juan Oliva-Moreno
- Faculty of Law and Social Sciences, Economic Analysis Department, Research Group in Economics and Health, University of Castilla-La Mancha, Cobertizo San Pedro Mártir, S/N, 45002, Toledo, Spain
| | - Julio López-Bastida
- Faculty of Health Science, Research Group in Economics and Health, University of Castilla-La Mancha, Av. Real Fábrica de Sedas, s/n, Talavera de la Reina, 45600, Toledo, Spain
| | - Wolfgang Greiner
- AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Universitaetsstrasse 25, 33615, Bielefeld, Germany
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27
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González-Robles A, Díaz-García A, García-Palacios A, Roca P, Ramos-Quiroga JA, Botella C. Effectiveness of a Transdiagnostic Guided Internet-Delivered Protocol for Emotional Disorders Versus Treatment as Usual in Specialized Care: Randomized Controlled Trial. J Med Internet Res 2020; 22:e18220. [PMID: 32673226 PMCID: PMC7381075 DOI: 10.2196/18220] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 12/20/2022] Open
Abstract
Background Anxiety disorders and depression (emotional disorders) are highly prevalent mental disorders. Extensive empirical evidence supports the efficacy of cognitive behavioral therapy (CBT) for the treatment of these disorders. However, there are still some barriers related to their dissemination and implementation, which make it difficult for patients to receive these treatments, especially in public health care settings where resources are limited. Recent advances in improving CBT dissemination encompass different perspectives. One is the transdiagnostic approach, which offers treatment protocols that can be used for a range of emotional disorders. Another approach is the use of the internet to reach a larger number of people who could benefit from CBT. Objective This study aimed to analyze the effectiveness and acceptability of a transdiagnostic internet-delivered protocol (EmotionRegulation) with human and automated guidance in patients from public specialized mental health care settings. Methods A 2-armed randomized controlled trial (RCT) was conducted to compare the effectiveness of EmotionRegulation with treatment as usual (TAU) in specialized mental health care. In all, 214 participants were randomly assigned to receive either EmotionRegulation (n=106) or TAU (n=108). Measurement assessments were conducted at pre- and postintervention and at a 3-month follow-up. Results The results revealed the superiority of EmotionRegulation over TAU on measures of depression (d=0.41), anxiety (d=0.35), and health-related quality of life (d=−0.45) at posttreatment, and these gains were maintained at the 3-month follow-up. Furthermore, the results for expectations and opinions showed that EmotionRegulation was well accepted by participants. Conclusions EmotionRegulation was more effective than TAU for the treatment of emotional disorders in the Spanish public mental health system. The implications of this RCT, limitations, and suggestions for future research are discussed. Trial Registration ClinicalTrials.gov NCT02345668; https://clinicaltrials.gov/ct2/show/NCT02345668
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Affiliation(s)
- Alberto González-Robles
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Amanda Díaz-García
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Carlos III, Madrid, Spain
| | - Pablo Roca
- Department of Personality, Assessment, and Clinical Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Botella
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Carlos III, Madrid, Spain
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Yates BT. Research on Improving Outcomes and Reducing Costs of Psychological Interventions: Toward Delivering the Best to the Most for the Least. Annu Rev Clin Psychol 2020; 16:125-150. [PMID: 32040339 DOI: 10.1146/annurev-clinpsy-071519-110415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Treatment and prevention efforts guided by psychological theory, research, and practice can have outcomes of greater value than the resources consumed by those efforts-and outcomes superior to those attainable by other means, often at lower costs. How can we make this hope true more often, for more of the clients who need our services, despite severe resource constraints? Routinely reporting the costs, effectiveness, and benefits of psychological interventions from client, practitioner, and societal perspectives is only a beginning. We also need to use descriptive and inferential statistics to measure, report, and analyze the cost-effectiveness and cost-benefit of our interventions to discover the strongest determinants of intervention costs and outcomes. The emerging literature on cost-inclusive research in psychology suggests that delivery systems are one primary determinant of costs and outcomes of most interventions, as are the psychological techniques applied.
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Affiliation(s)
- Brian T Yates
- Department of Psychology, American University, Washington, DC 20016-8062, USA;
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29
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Matsumoto K, Hamatani S, Nagai K, Sutoh C, Nakagawa A, Shimizu E. Long-Term Effectiveness and Cost-Effectiveness of Videoconference-Delivered Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder, Panic Disorder, and Social Anxiety Disorder in Japan: One-Year Follow-Up of a Single-Arm Trial. JMIR Ment Health 2020; 7:e17157. [PMID: 32324150 PMCID: PMC7206520 DOI: 10.2196/17157] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/10/2020] [Accepted: 03/25/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Face-to-face individual cognitive behavioral therapy (CBT) and internet-based CBT (ICBT) without videoconferencing are known to have long-term effectiveness for obsessive-compulsive disorder (OCD), panic disorder (PD), and social anxiety disorder (SAD). However, videoconference-delivered CBT (VCBT) has not been investigated regarding its long-term effectiveness and cost-effectiveness. OBJECTIVE The purpose of this study was to investigate the long-term effectiveness and cost-effectiveness of VCBT for patients with OCD, PD, or SAD in Japan via a 1-year follow-up to our previous 16-week single-arm study. METHODS Written informed consent was obtained from 25 of 29 eligible patients with OCD, PD, and SAD who had completed VCBT in our clinical trial. Participants were assessed at baseline, end of treatment, and at the follow-up end points of 3, 6, and 12 months. Outcomes were the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Panic Disorder Severity Scale (PDSS), Liebowitz Social Anxiety Scale (LSAS), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), and EuroQol-5D-5L (EQ-5D-5L). To analyze long-term effectiveness, we used mixed-model analysis of variance. To analyze cost-effectiveness, we employed relevant public data and derived data on VCBT implementation costs from Japanese national health insurance data. RESULTS Four males and 21 females with an average age of 35.1 (SD 8.6) years participated in the 1-year follow-up study. Principal diagnoses were OCD (n=10), PD (n=7), and SAD (n=8). The change at 12 months on the Y-BOCS was -4.1 (F1=4.45, P=.04), the change in PDSS was -4.4 (F1=6.83, P=.001), and the change in LSAS was -30.9 (F1=6.73, P=.01). The change in the PHQ-9 at 12 months was -2.7 (F1=7.72, P=.007), and the change in the GAD-7 was -3.0 (F1=7.09, P=.009). QALY at 12 months was 0.7469 (SE 0.0353, 95% Cl 0.6728-0.821), and the change was a significant increase of 0.0379 (P=.01). Total costs to provide the VCBT were ¥60,800 to ¥81,960 per patient. The set threshold was ¥189,500 ($1723, €1579, and £1354) calculated based on willingness to pay in Japan. CONCLUSIONS VCBT was a cost-effective way to effectively treat Japanese patients with OCD, PD, or SAD. TRIAL REGISTRATION University Hospital Medical Information Network Clinical Trials Registry UMIN000026609; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000030495.
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Affiliation(s)
- Kazuki Matsumoto
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Sayo Hamatani
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Kazue Nagai
- Research and Education Center of Health Sciences, Graduate School of Health Sciences, Gunma University, Gunma, Japan
| | - Chihiro Sutoh
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chia, Japan
| | - Akiko Nakagawa
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chia, Japan
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30
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Díaz-García A, González-Robles A, Mor S, Mira A, Quero S, García-Palacios A, Baños RM, Botella C. Positive and Negative Affect Schedule (PANAS): psychometric properties of the online Spanish version in a clinical sample with emotional disorders. BMC Psychiatry 2020; 20:56. [PMID: 32039720 PMCID: PMC7008531 DOI: 10.1186/s12888-020-2472-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 01/30/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The Positive and Negative Affect Schedule (PANAS) is the most widely and frequently used scale to assess positive and negative affect. The PANAS has been validated in several languages, and it has shown excellent psychometric properties in the general population and some clinical samples, such as forensic samples, substance users, and adult women with fibromyalgia. Nevertheless, the psychometric properties of the scale have not yet been examined in clinical samples with anxiety, depressive, and adjustment disorders. In addition, the proliferation of Internet-based treatments has led to the development of a wide range of assessments conducted online with digital versions of pen and paper self-report questionnaires. However, no validations have been carried out to analyze the psychometric properties of the online version of the PANAS. The present study investigates the psychometric properties of the online Spanish version of the PANAS in a clinical sample of individuals with emotional disorders. METHODS The sample was composed of 595 Spanish adult volunteers with a diagnosis of depressive disorder (n = 237), anxiety disorder (n = 284), or adjustment disorder (n = 74). Factor structure, construct validity, internal consistency, and sensitivity to change were analyzed. RESULTS Confirmatory factor analysis yielded a latent structure of two independent factors, consistent with previous validations of the instrument. The analyses showed adequate convergent and discriminant validity, good internal consistency as well as sensitivity to change. CONCLUSIONS Overall, the results obtained in this study show that the online version of the PANAS has adequate psychometric properties for the assessment of positive and negative affect in a Spanish clinical population.
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Affiliation(s)
- Amanda Díaz-García
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Alberto González-Robles
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Sonia Mor
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Adriana Mira
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Soledad Quero
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Carlos III, Madrid, Spain
| | - Rosa María Baños
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Carlos III, Madrid, Spain
| | - Cristina Botella
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Carlos III, Madrid, Spain
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31
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Romero-Sanchiz P, Nogueira-Arjona R, Araos P, Serrano A, Barrios V, Argente J, Garcia-Marchena N, Lopez-Tellez A, Rodriguez-Moreno S, Mayoral F, Pavón FJ, Fonseca FRD. Variation in chemokines plasma concentrations in primary care depressed patients associated with Internet-based cognitive-behavioral therapy. Sci Rep 2020; 10:1078. [PMID: 31974503 PMCID: PMC6978323 DOI: 10.1038/s41598-020-57967-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 12/31/2019] [Indexed: 11/08/2022] Open
Abstract
How the presence of inflammation has repercussions for brain function is a topic of active research into depression. Signals released from immune system-related cells, including chemokines, might be indicative of active depression and can, hypothetically, serve as biomarkers of response to interventions, both pharmacological and psychological. The objective of this study is to analyze the peripheral plasma concentrations of CXCL12, CCL11, CX3CL1 and CCL2 in a cohort of depressed primary-care patients, as well as their evolution after an internet-based cognitive-behavioral intervention. The concentrations of those chemokines were measured in 66 primary-care patients with mild and moderate depression, before and after the intervention, as well as 60 controls, using multiplex immunoassays. Concentrations of CXCL12 and CCL2 were significantly higher in the clinical sample in comparison with controls. A stable multivariate discriminative model between both groups was found. Concentrations of all chemokines decreased after the internet-based psychological intervention. These findings support the implication of chemokines in depression, even in a sample of patients with mild and moderate severity. Furthermore, they demonstrate the need for further multidisciplinary research that confirms how biomarkers such as plasma chemokines can serve as a marker for depression and are sensitive to non-pharmacological interventions.
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Affiliation(s)
- Pablo Romero-Sanchiz
- Unidad de Gestión Clínica de Salud Mental. Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga/Universidad de Málaga, Málaga, 29010, Spain.
- Department of Personality, Assessment, and Psychological Treatment, School of Psychology, University of Malaga, Blv. Louis Pasteur s/n, Malaga, CP, 29010, Spain.
- Department of Psychology and Neuroscience, Dalhousie University, Life Sciences Centre, 1355 Oxford Street, PO BOX 15000, Halifax, Nova Scotia, B3H 4R2, Canada.
| | - Raquel Nogueira-Arjona
- Unidad de Gestión Clínica de Salud Mental. Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga/Universidad de Málaga, Málaga, 29010, Spain
- Department of Psychology and Neuroscience, Dalhousie University, Life Sciences Centre, 1355 Oxford Street, PO BOX 15000, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Pedro Araos
- Unidad de Gestión Clínica de Salud Mental. Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga/Universidad de Málaga, Málaga, 29010, Spain
- Departamento de Psicobiología y Metodología de las Ciencias del Comportamiento,Facultad de Psicología, Universidad de Málaga (UMA), Málaga, Spain
| | - Antonia Serrano
- Unidad de Gestión Clínica de Salud Mental. Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga/Universidad de Málaga, Málaga, 29010, Spain
| | - Vicente Barrios
- Department of Endocrinology, Research Institute "La Princesa", Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús Argente
- Department of Endocrinology, Research Institute "La Princesa", Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Department of Pediatrics, Universidad Autónoma de Madrid, Madrid, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- CEI UAM + CSIC, IMDEA Food Institute, Madrid, Spain
| | - Nuria Garcia-Marchena
- Unidad de Gestión Clínica de Salud Mental. Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga/Universidad de Málaga, Málaga, 29010, Spain
- Institut Germans Trias i Pujol -IGTP-Campus Can Ruti, Carretera de Canyet s/n, Badalona, 08916, Spain
| | - Antonio Lopez-Tellez
- Unidad de Gestión Clínica Puerta Blanca, Av. Gregorio de Diego, 46, Málaga, CP, 29004, Spain
| | - Silvia Rodriguez-Moreno
- Unidad de Gestión Clínica Teatinos/Colonia Santa Inés, Calle Andrés Bernáldez, 12, Málaga, CP, 29010, Spain
| | - Fermin Mayoral
- Unidad de Gestión Clínica de Salud Mental. Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga/Universidad de Málaga, Málaga, 29010, Spain
| | - Francisco J Pavón
- Unidad de Gestión Clínica de Salud Mental. Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga/Universidad de Málaga, Málaga, 29010, Spain
| | - Fernando Rodríguez de Fonseca
- Unidad de Gestión Clínica de Salud Mental. Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga/Universidad de Málaga, Málaga, 29010, Spain.
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Renfrew ME, Morton DP, Morton JK, Hinze JS, Beamish PJ, Przybylko G, Craig BA. A Web- and Mobile App-Based Mental Health Promotion Intervention Comparing Email, Short Message Service, and Videoconferencing Support for a Healthy Cohort: Randomized Comparative Study. J Med Internet Res 2020; 22:e15592. [PMID: 31904578 PMCID: PMC6971514 DOI: 10.2196/15592] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/14/2019] [Accepted: 10/20/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The rapid increase in mental health disorders has prompted a call for greater focus on mental health promotion and primary prevention. Web- and mobile app-based interventions present a scalable opportunity. Little is known about the influence of human support on the outcomes of these interventions. OBJECTIVE This study aimed to compare the influence of 3 modes of human support on the outcomes (ie, mental health, vitality, depression, anxiety, stress, life satisfaction, and flourishing) of a 10-week, Web- and mobile app-based, lifestyle-focused mental health promotion intervention among a healthy adult cohort. METHODS Participants were recruited voluntarily using a combination of online and offline advertising. They were randomized, unblinded into 3 groups differentiated by human support mode: Group 1 (n=201): standard-fully automated emails (S); Group 2 (n=202): standard plus personalized SMS (S+pSMS); and Group 3 (n=202): standard plus weekly videoconferencing support (S+VCS), hosted by 1 trained facilitator. Participants accessed the intervention, including the questionnaire, on a Web-based learning management system or through a mobile app. The questionnaire, administered at pre- and postintervention, contained self-reported measures of mental well-being, including the "mental health" and "vitality" subscales from the Short Form Health Survey-36, Depression Anxiety and Stress Scale-21, Diener Satisfaction With Life Scale (SWLS), and Diener Flourishing Scale. RESULTS Of 605 potential participants, 458 (S: n=157, S+pSMS: n=163, and S+VCS: n=138) entered the study by completing registration and the preintervention questionnaire. At post intervention, 320 out of 458 participants (69.9%; S: n=103, S+pSMS: n=114, and S+VCS: n=103) completed the questionnaire. Significant within-group improvements were recorded from pre- to postintervention in all groups and in every outcome measure (P≤.001). No significant between-group differences were observed for outcomes in any measure: mental health (P=.77), vitality (P=.65), depression (P=.93), anxiety (P=.25), stress (P.57), SWLS (P=.65), and Flourishing Scale (P=.99). Adherence was not significantly different between groups for mean videos watched (P=.42) and practical activity engagement (P=.71). Participation in videoconference support sessions (VCSSs) was low; 37 out of 103 (35.9%) participants did not attend any VCSSs, and only 19 out of 103 (18.4%) attended 7 or more out of 10 sessions. Stratification within the S+VCS group revealed that those who attended 7 or more VCSSs experienced significantly greater improvements in the domains of mental health (P=.006; d=0.71), vitality (P=.005; d=0.73), depression (P=.04; d=0.54), and life satisfaction (P=.046; d=0.50) compared with participants who attended less than 7. CONCLUSIONS A Web- and mobile app-based mental health promotion intervention enhanced domains of mental well-being among a healthy cohort, irrespective of human support. Low attendance at VCSSs hindered the ability to make meaningful between-group comparisons. Supplementing the intervention with VCSSs might improve outcomes when attendance is optimized. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR): 12619001009101; http://www.anzctr.org.au/ACTRN12619001009101.aspx.
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Affiliation(s)
- Melanie Elise Renfrew
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, New South Wales, Australia
| | - Darren Peter Morton
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, New South Wales, Australia
| | - Jason Kyle Morton
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, New South Wales, Australia
| | - Jason Scott Hinze
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, New South Wales, Australia
| | - Peter James Beamish
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, New South Wales, Australia
| | - Geraldine Przybylko
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, New South Wales, Australia
| | - Bevan Adrian Craig
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, New South Wales, Australia
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Ospina-Pinillos L, Davenport T, Mendoza Diaz A, Navarro-Mancilla A, Scott EM, Hickie IB. Using Participatory Design Methodologies to Co-Design and Culturally Adapt the Spanish Version of the Mental Health eClinic: Qualitative Study. J Med Internet Res 2019; 21:e14127. [PMID: 31376271 PMCID: PMC6696860 DOI: 10.2196/14127] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 12/11/2022] Open
Abstract
Background The Mental Health eClinic (MHeC) aims to deliver best-practice clinical services to young people experiencing mental health problems by making clinical care accessible, affordable, and available to young people whenever and wherever they need it most. The original MHeC consists of home page with a visible triage system for those requiring urgent help; a online physical and mental health self-report assessment; a results dashboard; a booking and videoconferencing system; and the generation of a personalized well-being plan. Populations who do not speak English and reside in English-speaking countries are less likely to receive mental health care. In Australia, international students have been identified as disadvantaged compared with their peers; have weaker social support networks; and have higher rates of psychological distress. This scenario is acquiring significant relevance as Spanish-speaking migration is rapidly growing in Australia, and the mental health services for culturally and linguistically diverse populations are limited. Having a Spanish version (MHeC-S) of the Mental Health eClinic would greatly benefit these students. Objective We used participatory design methodologies with users (young people aged 16-30 years, supportive others, and health professionals) to (1) conduct workshops with users to co-design and culturally adapt the MHeC; (2) inform the development of the MHeC-S alpha prototype; (3) test the usability of the MHeC-S alpha prototype; (4) translate, culturally adapt, and face-validate the MHeC-S self-report assessment; and (5) collect information to inform its beta prototype. Methods A research and development cycle included several participatory design phases: co-design workshops; knowledge translation; language translation and cultural adaptation; and rapid prototyping and user testing of the MHeC-S alpha prototype. Results We held 2 co-design workshops with 17 users (10 young people, 7 health professionals). A total of 15 participated in the one-on-one user testing sessions (7 young people, 5 health professionals, 3 supportive others). We collected 225 source documents, and thematic analysis resulted in 5 main themes (help-seeking barriers, technology platform, functionality, content, and user interface). A random sample of 106 source documents analyzed by 2 independent raters revealed almost perfect agreement for functionality (kappa=.86; P<.001) and content (kappa=.92; P<.001) and substantial agreement for the user interface (kappa=.785; P<.001). In this random sample, no annotations were coded for help-seeking barriers or the technology platform. Language was identified as the main barrier to getting medical or psychological services, and smartphones were the most-used device to access the internet. Acceptability was adequate for the prototype’s 5 main elements: home page and triage system, self-report assessment, dashboard of results, booking and video visit system, and personalized well-being plan. The data also revealed gaps in the alpha prototype, such as the need for tailored assessment tools and a greater integration with Spanish-speaking services and communities. Spanish-language apps and e-tools, as well as online mental health information, were lacking. Conclusions Through a research and development process, we co-designed and culturally adapted, developed and user tested, and evaluated the MHeC-S. By translating and culturally adapting the MHeC to Spanish, we aimed to increase accessibility and availability of e-mental health care in the developing world, and assist vulnerable populations that have migrated to English-speaking countries.
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Affiliation(s)
- Laura Ospina-Pinillos
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.,Department of Psychiatry and Mental Health, Pontifical Javeriana University, Bogota, Colombia
| | - Tracey Davenport
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Antonio Mendoza Diaz
- School of Psychiatry, Department of Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Elizabeth M Scott
- School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
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Sebastianski M, Gates M, Gates A, Nuspl M, Bialy LM, Featherstone RM, Breault L, Mason-Lai P, Hartling L. Evidence available for patient-identified priorities in depression research: results of 11 rapid responses. BMJ Open 2019; 9:e026847. [PMID: 31256024 PMCID: PMC6609077 DOI: 10.1136/bmjopen-2018-026847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/07/2019] [Accepted: 06/11/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES Patient priority setting projects (PPSPs) can reduce research agenda bias. A key element of PPSPs is a review of available literature to determine if the proposed research priorities have been addressed, identify research gaps, recognise opportunities for knowledge translation (KT) and avoid duplication of research efforts. We conducted rapid responses for 11 patient-identified priorities in depression to provide a map of the existing evidence. DESIGN Eleven rapid responses. DATA SOURCES Single electronic database (PubMed). ELIGIBILITY CRITERIA Each rapid response had unique eligibility criteria. For study designs, we used a stepwise inclusion process that started with systematic reviews (SRs) if available, then randomised controlled trials and observational studies as necessary. RESULTS For all but one of the rapid responses we identified existing SRs (median 7 SRs per rapid response, range 0-179). There were questions where extensive evidence exists (ie, hundreds of primary studies), yet uncertainties remain. For example, there is evidence supporting the effectiveness of many non-pharmacological interventions (including psychological interventions and exercise) to reduce depressive symptoms. However, targeted research is needed that addresses comparative effectiveness of promising interventions, specific populations of interest (eg, children, minority groups) and adverse effects. CONCLUSIONS We identified an extensive body of evidence addressing patient priorities in depression and mapped the results and limitations of existing evidence, areas of uncertainty and general directions for future research. This work can serve as a solid foundation to guide future research in depression and KT activities. Integrated knowledge syntheses bring value to the PPSP process; however, the role of knowledge synthesis in PPSPs and methodological approaches are not well defined at present.
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Affiliation(s)
- Meghan Sebastianski
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Gates
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Allison Gates
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Megan Nuspl
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Liza M Bialy
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Robin M Featherstone
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Lorraine Breault
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Ping Mason-Lai
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Patient Engagement Platform, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Hartling
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Mira A, Soler C, Alda M, Baños R, Castilla D, Castro A, García-Campayo J, García-Palacios A, Gili M, Hurtado M, Mayoral F, Montero-Marín J, Botella C. Exploring the Relationship Between the Acceptability of an Internet-Based Intervention for Depression in Primary Care and Clinical Outcomes: Secondary Analysis of a Randomized Controlled Trial. Front Psychiatry 2019; 10:325. [PMID: 31133899 PMCID: PMC6523778 DOI: 10.3389/fpsyt.2019.00325] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/26/2019] [Indexed: 12/03/2022] Open
Abstract
Background: Depression is one of the most prevalent psychological disorders worldwide. Although psychotherapy for depression is effective, there are barriers to its implementation in primary care in Spain. The use of the Internet has been shown to be a feasible solution. However, the acceptability of Internet-based interventions has not been studied sufficiently. Objective: To assess the acceptability of an Internet-based intervention (IBI) for depression in primary care, and explore the relationship between expectations and satisfaction and the improvement in the clinical variables in primary care patients receiving this intervention. Furthermore, it offers data about the effects of some sociodemographic characteristics on these acceptability variables and analyzes whether the expectations are related to finalizing the intervention. Methods: Data were based on depressive patients who were participants in a randomized controlled trial. In the present study, we present the data from all the participants in the Internet intervention groups (N = 198). All the participants filled out the expectation and satisfaction scales (six-item scales regarding treatment logic, satisfaction, recommending, usefulness for other disorders, usefulness for the patient, and unpleasantness), the Beck Depression Inventory-II, and the secondary outcome measures: depression and anxiety impairment, and positive and negative affect. Results: Results showed that participants' expectations and satisfaction with the program were both high and differences in expectations and satisfaction depended on some sociodemographic variables (age: older people have higher expectations; sex: women have greater satisfaction). A positive relationship between these variables and intervention efficacy was found: expectations related to "usefulness for the patient" were a statistically related predictor to the results on the BDI-II (Beta = 0.364), and the perception of how logical the treatment is (Beta = 0.528) was associated with change in the clinical variable. Furthermore, the higher the expectations, the higher the improvements exhibited by the patients in all measures evaluated during the ten intervention modules. High expectations were also directly related to finalizing the intervention. Conclusions: This is the first study in Spain to address this issue in the field of IBIs for depression in primary care. The IBI showed high acceptance related to the intervention's efficacy and completion. Research on IBI acceptability could help to implement the treatment offered. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT01611818.
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Affiliation(s)
- Adriana Mira
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón, Spain
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
| | - Carla Soler
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Marta Alda
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain
- University Hospital Miguel Servet, Zaragoza, Spain
| | - Rosa Baños
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatment, Universitat de València, Valencia, Spain
| | - Diana Castilla
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón, Spain
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Adoración Castro
- Department of Psychology, Universitat de les Illes Balears, Palma de Mallorca, Spain
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, ISCIII, Madrid, Spain
| | - Javier García-Campayo
- Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain
- University Hospital Miguel Servet, Zaragoza, Spain
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, ISCIII, Madrid, Spain
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Margalida Gili
- Department of Psychology, Universitat de les Illes Balears, Palma de Mallorca, Spain
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, ISCIII, Madrid, Spain
| | - Mariena Hurtado
- Mental Health Clinical Management Unit, Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital Carlos Haya, University of Malaga, Málaga, Spain
| | - Fermín Mayoral
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, ISCIII, Madrid, Spain
- Mental Health Clinical Management Unit, Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital Carlos Haya, University of Malaga, Málaga, Spain
| | - Jesús Montero-Marín
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, ISCIII, Madrid, Spain
| | - Crisitina Botella
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
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Oehler C, Görges F, Böttger D, Hug J, Koburger N, Kohls E, Rummel-Kluge C. Efficacy of an internet-based self-management intervention for depression or dysthymia - a study protocol of an RCT using an active control condition. BMC Psychiatry 2019; 19:90. [PMID: 30871544 PMCID: PMC6419490 DOI: 10.1186/s12888-019-2063-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 02/20/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The treatment of major depressive disorder, a highly prevalent disorder associated with pronounced burden, is a large challenge to healthcare systems worldwide. Internet based self-management interventions seem to be a cost effective way to complement the treatment of depressed patients, but the accumulating evidence is mainly based on the comparison to waitlist controls and treatment as usual, which might lead to an overestimation of effects. Furthermore, studies assessing long-term effects and possible negative outcomes are still rare. METHODS/DESIGN The proposed study evaluates the efficacy of the German version of the iFightDepression® tool in comparison to an active control condition. A total of 360 patients with mild to moderate depressive symptoms are included into a two-armed randomized controlled trial. They receive one of two six week interventions; either the iFightDepression® tool or progressive muscle relaxation serving as the control condition. Both intervention groups receive information material, weekly tasks via the internet and regular phone calls as part of the intervention. The primary outcome is change in depressive symptoms after the intervention period, as measured with the Inventory of Depressive Symptomatology. Satisfaction with the program, usability, changes in perceived quality of life, and possible negative effects are assessed as secondary outcomes. DISCUSSION This study represents the first randomized controlled trial on the iFightDepression® self-management tool in its German version, aiming at efficacy, but also at providing new insights into so far understudied aspects of E-mental health programs, namely the specificity of the treatment effect compared to an active control condition, it's continuity over a time course of 12 months, and possible negative effects of these internet based interventions. TRIAL REGISTRATION International trial-registration took place through the "international clinical trials registry platform" (WHO) with the secondary ID 080-15-09032015. German Clinical Trial Registration: DRKS00009323 (DRKS.de, registered on 25 February 2016).
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Affiliation(s)
- Caroline Oehler
- German Depression Foundation, Semmelweisstr. 10, 04103 Leipzig, Germany
| | - Frauke Görges
- German Depression Foundation, Semmelweisstr. 10, 04103 Leipzig, Germany
| | - Daniel Böttger
- German Depression Foundation, Semmelweisstr. 10, 04103 Leipzig, Germany
| | - Juliane Hug
- grid.493241.9European Alliance Against Depression, Semmelweisstr. 10, 04103 Leipzig, Germany
| | - Nicole Koburger
- Research Academy Leipzig, Wächterstraße 30, 04107 Leipzig, Germany
| | - Elisabeth Kohls
- 0000 0001 2230 9752grid.9647.cDepartment of Psychiatry and Psychotherapy, Medical Faculty, University Leipzig, Semmelweisstr. 10, 04103 Leipzig, Germany
| | - Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Leipzig, Semmelweisstr. 10, 04103, Leipzig, Germany.
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Internet-Delivered Cognitive Behavioural Therapy for Major Depression and Anxiety Disorders: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2019; 19:1-199. [PMID: 30873251 PMCID: PMC6394534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Major depression is defined as a period of depression lasting at least 2 weeks characterized by depressed mood, most of the day, nearly every day, and/or markedly diminished interest or pleasure in all, or almost all, activities. Anxiety disorders encompass a broad range of disorders in which people experience feelings of fear and excessive worry that interfere with normal day-to-day functioning.Cognitive behavioural therapy (CBT) is a form of evidence-based psychotherapy used to treat major depression and anxiety disorders. Internet-delivered CBT (iCBT) is structured, goal-oriented CBT delivered via the internet. It may be guided, in which the patient communicates with a regulated health care professional, or unguided, in which the patient is not supported by a regulated health care professional. METHODS We conducted a health technology assessment, which included an evaluation of clinical benefit, value for money, and patient preferences and values related to the use of iCBT for the treatment of mild to moderate major depression or anxiety disorders. We performed a systematic review of the clinical and economic literature and conducted a grey literature search. We reported Grading of Recommendations Assessment, Development, and Evaluation (GRADE) ratings if sufficient information was provided. When other quality assessment tools were used by the systematic review authors in the included studies, these were reported. We assessed the risk of bias within the included reviews. We also developed decision-analytic models to compare the costs and benefits of unguided iCBT, guided iCBT, face-to-face CBT, and usual care over 1 year using a sequential approach. We further explored the lifetime and short-term cost-effectiveness of stepped-care models, including iCBT, compared with usual care. We calculated incremental cost-effectiveness ratios (ICERs) from the perspective of the Ontario Ministry of Health and Long-Term Care and estimated the 5-year budget impact of publicly funding iCBT for mild to moderate major depression or anxiety disorders in Ontario. To contextualize the potential value of iCBT as a treatment option for major depression or anxiety disorders, we spoke with people with these conditions. RESULTS People who had undergone guided iCBT for mild to moderate major depression (standardized mean difference [SMD] = 0.83, 95% CI 0.59-1.07, GRADE moderate), generalized anxiety disorder (SMD = 0.84, 95% CI 0.45-1.23, GRADE low), panic disorder (small to very large effects, GRADE low), and social phobia (SMD = 0.85, 95% CI 0.66-1.05, GRADE moderate) showed a statistically significant improvement in symptoms compared with people on a waiting list. People who had undergone iCBT for panic disorder (SMD= 1.15, 95% CI: 0.94 to 1.37) and iCBT for social anxiety disorder (SMD=0.91, 95% CI: 0.74-1.07) showed a statistically significant improvement in symptoms compared with people on a waiting list. There was a statistically significant improvement in quality of life for people with generalized anxiety disorder who had undergone iCBT (SMD = 0.38, 95% CI 0.08-0.67) compared with people on a waiting list. The mean differences between people who had undergone iCBT compared with usual care at 3, 5, and 8 months were -4.3, -3.9, and -5.9, respectively. The negative mean difference at each follow-up showed an improvement in symptoms of depression for participants randomized to the iCBT group compared with usual care. People who had undergone guided iCBT showed no statistically significant improvement in symptoms of panic disorder compared with individual or group face-to-face CBT (d = 0.00, 95% CI -0.41 to 0.41, GRADE very low). Similarly, there was no statistically significant difference in symptoms of specific phobia in people who had undergone guided iCBT compared with brief therapist-led exposure (GRADE very low). There was a small statistically significant improvement in symptoms in favour of guided iCBT compared with group face-to-face CBT (d= 0.41, 95% CI 0.03-0.78, GRADE low) for social phobia. There was no statistically significant improvement in quality of life reported for people with panic disorder who had undergone iCBT compared with face-to-face CBT (SMD = -0.07, 95% CI -0.34 to 0.21).Guided iCBT was the optimal strategy in the reference case cost-utility analyses. For adults with mild to moderate major depression, guided iCBT was associated with increases in both quality-adjusted survival (0.04 quality-adjusted life-years [QALYs]) and cost ($1,257), yielding an ICER of $31,575 per QALY gained when compared with usual care. In adults with anxiety disorders, guided iCBT was also associated with increases in both quality-adjusted survival (0.03 QALYs) and cost ($1,395), yielding an ICER of $43,214 per QALY gained when compared with unguided iCBT. In this population, guided iCBT was associated with an ICER of $26,719 per QALY gained when compared with usual care. The probability of cost-effectiveness of guided iCBT for major depression and anxiety disorders, respectively, was 67% and 70% at willingness-to-pay of $100,000 per QALY gained. Guided iCBT delivered within stepped-care models appears to represent good value for money for the treatment of mild to moderate major depression and anxiety disorders.Assuming a 3% increase in access per year (from about 8,000 people in year 1 to about 32,000 people in year 5), the net budget impact of publicly funding guided iCBT for the treatment of mild to moderate major depression would range from about $10 million in year 1 to about $40 million in year 5. The corresponding net budget impact for the treatment of anxiety disorders would range from about $16 million in year 1 (about 13,000 people) to about $65 million in year 5 (about 52,000 people).People with depression or an anxiety disorder with whom we spoke reported that iCBT improves access for those who face challenges with face-to-face therapy because of costs, time, or the severity of their condition. They reported that iCBT provides better control over the pace, time, and location of therapy, as well as greater access to educational material. Some reported barriers to iCBT include the cost of therapy; the need for a computer and internet access, computer literacy, and the ability to understand complex written information. Language and disability barriers also exist. Reported limitations to iCBT include the ridigity of the program, the lack of face-to-face interactions with a therapist, technological difficulties, and the inability of an internet protocol to treat severe depression and some types of anxiety disorder. CONCLUSIONS Compared with waiting list, guided iCBT is effective and likely results in symptom improvement in mild to moderate major depression and social phobia. Guided iCBT may improve the symptoms of generalized anxiety disorder and panic disorder compared with waiting list. However, we are uncertain about the effectiveness of iCBT compared with individual or group face-to-face CBT. Guided iCBT represents good value for money and could be offered for the short-term treatment of adults with mild to moderate major depression or anxiety disorders. Most people with mild to moderate depression or anxiety disorders with whom we spoke felt that, despite some perceived limitations, iCBT provides greater control over the time, pace, and location of therapy. It also improves access for people who could not otherwise access therapy because of cost, time, or the nature of their health condition.
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Monreal-Bartolomé A, Barceló-Soler A, Castro A, Pérez-Ara MÁ, Gili M, Mayoral F, Hurtado MM, Moreno EV, Botella C, García-Palacios A, Baños RM, López-Del-Hoyo Y, García-Campayo J. Efficacy of a blended low-intensity internet-delivered psychological programme in patients with multimorbidity in primary care: study protocol for a randomized controlled trial. BMC Psychiatry 2019; 19:66. [PMID: 30744610 PMCID: PMC6371446 DOI: 10.1186/s12888-019-2037-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/25/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) has included comorbidity between depression and a chronic disease among the 10 leading global health priorities. Although there is a high prevalence of multimorbidity, health care systems are mainly designed for the management of individual diseases. Given the difficulty in delivering face-to-face psychological treatments, alternative models of treatment delivery have been proposed, emphasizing the role of technologies such as the Internet. The aim of this study is to assess the efficacy in Primary Care (PC) of a blended low-intensity psychological intervention applied using information and communication technologies (ICTs) for the treatment of multimorbidity in PC (depression and type 2 diabetes/low back pain) by means of a randomized controlled trial (RCT). Our main hypothesis is that improved usual care combined with psychological therapy applied using ICTs will be more efficacious for improvement in the symptomatology of multimorbidity, compared to a group with only improved treatment as usual six months after the end of treatment. METHODS A protocol has been designed combining a face-to-face intervention with a supporting online programme that will be tested by an RCT conducted in three different regions (Andalusia, Aragon and the Balearic Islands). The RCT will evaluate three hundred participants diagnosed with depression and type 2 diabetes/low back pain. Four highly experienced research groups specializing in clinical psychology are involved in this trial, and there will be ample possibilities for translation and transfer to usual clinical practice. DISCUSSION This clinical trial will lead to improvement in financial sustainability, maximizing the use of resources and responding to principles of efficiency and effectiveness. Furthermore, based on the evaluation of the feasibility of implementing this intervention in primary care facilities, we expect to be able to suggest the intervention for incorporation into public policy. In conclusion, positive results of this study could have a significant impact on one of the most important health-related problems, multimorbidity. TRIAL REGISTRATION ClinicalTrials.gov, NCT03426709 . Registered retrospectively on 08 February 2018.
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Affiliation(s)
- Alicia Monreal-Bartolomé
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, Carlos III Health Institute, Madrid, Spain
- Aragon Institute for Health Research, IIS Aragon, Zaragoza, Spain
| | - Alberto Barceló-Soler
- Aragon Institute for Health Research, IIS Aragon, Zaragoza, Spain
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain
| | - Adoración Castro
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain
- Institut Universitari d’Investigació en Ciències de la Salut, IUNICS-IDISPA, University of the Balearic Islands, Palma, Spain
| | - Mª. Ángeles Pérez-Ara
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain
- Institut Universitari d’Investigació en Ciències de la Salut, IUNICS-IDISPA, University of the Balearic Islands, Palma, Spain
| | - Margalida Gili
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain
- Institut Universitari d’Investigació en Ciències de la Salut, IUNICS-IDISPA, University of the Balearic Islands, Palma, Spain
| | - Fermín Mayoral
- Mental Health Department, Institute of Biomedicine of Malaga, University Regional Hospital of Malaga, Malaga, Spain
| | - Maria Magdalena Hurtado
- Mental Health Department, Institute of Biomedicine of Malaga, University Regional Hospital of Malaga, Malaga, Spain
| | - Esperanza Varela Moreno
- Mental Health Department, Institute of Biomedicine of Malaga, University Regional Hospital of Malaga, Malaga, Spain
| | - Cristina Botella
- Jaume I University, Castellon de la Plana, Spain
- CIBER Physiopathology Obesity and Nutrition (CIBERobn) Carlos III Health Institute, Madrid, Spain
| | - Azucena García-Palacios
- CIBER Physiopathology Obesity and Nutrition (CIBERobn) Carlos III Health Institute, Madrid, Spain
- Department of Clinical and Basic Psychology and Biopsychology, Faculty of Health Sciences, University Jaume I, Castellon, Spain
| | - Rosa M. Baños
- CIBER Physiopathology Obesity and Nutrition (CIBERobn) Carlos III Health Institute, Madrid, Spain
- Department of Psychological, Personality, Evaluation and Treatment, University of Valencia, Valencia, Spain
| | - Yolanda López-Del-Hoyo
- Aragon Institute for Health Research, IIS Aragon, Zaragoza, Spain
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Javier García-Campayo
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Goldin PR, Lindholm R, Ranta K, Hilgert O, Helteenvuori T, Raevuori A. Feasibility of a Therapist-Supported, Mobile Phone-Delivered Online Intervention for Depression: Longitudinal Observational Study. JMIR Form Res 2019; 3:e11509. [PMID: 30682726 PMCID: PMC6362390 DOI: 10.2196/11509] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/12/2018] [Accepted: 12/10/2018] [Indexed: 01/01/2023] Open
Abstract
Background Depression is a very common condition that impairs functioning and is often untreated. More than 60% of the treatments for depressive disorder are administered in primary care settings by care providers who lack the time and expertise to treat depression. To address this issue, we developed Ascend, a therapist-supported, mobile phone–delivered 8-week intervention administered at the Meru Health Online Clinic in Finland. Objective We conducted two pilot studies to examine the feasibility of the Ascend intervention, specifically, dropout rates, daily practice, weekly group chat use, and changes in depression symptoms. We also explored whether daily practice and weekly group chat use were associated with changes in depression symptoms. Methods A total of 117 Finnish adults with elevated depressive symptoms enrolled in Ascend, a program that included daily cognitive behavioral and mindfulness meditation exercises delivered through a mobile phone app, anonymous group chat with other users, and chat/phone access to a licensed therapist. Eight weekly themes were delivered in a fixed, sequential format. Depression symptoms were measured at baseline, every second week during the intervention, immediately after the intervention, and 4 weeks after completion of the intervention. Data were analyzed using intent-to-treat repeated-measures analysis of variance and linear regression models. Results For studies 1 and 2, we observed dropout rates of 27% and 15%, respectively, decreasing daily practice and group chat use, and decreased depression symptoms from baseline to immediately and 4 weeks after the intervention (P<.001). We found that both more daily practice and chat group use predicted the occurrence of fewer depressive symptoms at 4 weeks postintervention (Study 1: ∆R2=.38, P=.004 and ∆R2=.38, P=.002, respectively; Study 2: ∆R2=.16, P<.001 and ∆R2=.08, P=.002, respectively). Conclusions This therapist-supported, mobile phone–delivered treatment for depression is feasible and associated with reduced depression symptoms. Design features that enhance daily practice and group chat use are areas of future investigation. Validation of these results using a controlled study design is needed to establish the evidence base for the Ascend intervention.
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Affiliation(s)
- Philippe R Goldin
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA, United States
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Fortune K, Becerra-Posada F, Buss P, Galvão LAC, Contreras A, Murphy M, Rogger C, Keahon GE, de Francisco A. Health promotion and the agenda for sustainable development, WHO Region of the Americas. Bull World Health Organ 2018; 96:621-626. [PMID: 30262943 PMCID: PMC6154061 DOI: 10.2471/blt.17.204404] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/16/2018] [Accepted: 04/16/2018] [Indexed: 11/27/2022] Open
Abstract
The approaches and tools of health promotion can be useful for civil society groups, local and national governments and multilateral organizations that are working to operationalize the 2030 agenda for sustainable development. Health promotion and sustainable development share several core priorities, such as equity, intersectoral approaches and sustainability, that help maximize their impact across traditional sectoral boundaries. In the Region of the Americas, each of these priorities has strong resonance because of prominent and long-standing health inequities that are proving resistant to interventions driven solely by the health sector. We describe several cases from the World Health Organization's (WHO) Region of the Americas in which the approaches and tools of health promotion, with a focus on cities, healthy settings and multisectoral collaboration, have been used to put the agenda into practice. We highlight areas where such approaches and tools can be applied effectively and provide evidence of the transformative potential of health promotion in efforts to achieve the sustainable development goals.
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Affiliation(s)
- Kira Fortune
- Family, Health Promotion, and Life Course, Pan American Health Organization, 525 23rd Street, Washington, DC 20037, United States of America (USA)
| | | | - Paulo Buss
- Centre for International Relations in Health, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Luiz Augusto C Galvão
- Centre for International Relations in Health, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Matthew Murphy
- Department of Internal Medicine, Brown University, Rhode Island, USA
| | - Caitlin Rogger
- Family, Health Promotion, and Life Course, Pan American Health Organization, 525 23rd Street, Washington, DC 20037, United States of America (USA)
| | - Gabriela E Keahon
- Family, Health Promotion, and Life Course, Pan American Health Organization, 525 23rd Street, Washington, DC 20037, United States of America (USA)
| | - Andres de Francisco
- Family, Health Promotion, and Life Course, Pan American Health Organization, 525 23rd Street, Washington, DC 20037, United States of America (USA)
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Kraepelien M, Mattsson S, Hedman-Lagerlöf E, Petersson IF, Forsell Y, Lindefors N, Kaldo V. Cost-effectiveness of internet-based cognitive-behavioural therapy and physical exercise for depression. BJPsych Open 2018; 4:265-273. [PMID: 30057780 PMCID: PMC6060490 DOI: 10.1192/bjo.2018.38] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 05/21/2018] [Accepted: 06/06/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Both internet-based cognitive-behavioural therapy (ICBT) and physical exercise are alternatives to treatment as usual (TAU) in managing mild to moderate depression in primary care. AIMS To determine the cost-effectiveness of ICBT and physical exercise compared with TAU in primary care. METHOD Economic evaluation of a randomised controlled trial (N = 945) in Sweden. Costs were estimated by a service use questionnaire and used together with the effects on quality-adjusted life-years (QALYs). The primary 3-month healthcare provider perspective in primary care was complemented by a 1-year societal perspective. RESULTS The primary analysis showed that incremental cost per QALY gain was €8817 for ICBT and €14 571 for physical exercise compared with TAU. At the established willingness-to-pay threshold of €21 536 (£20 000) per QALY, the probability of ICBT being cost-effective is 90%, and for physical exercise is 76%, compared with TAU. CONCLUSIONS From a primary care perspective, both ICBT and physical exercise for depression are likely to be cost-effective compared with TAU. DECLARATION OF INTEREST None.
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Affiliation(s)
- Martin Kraepelien
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Sweden
| | - Simon Mattsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Sweden
| | - Erik Hedman-Lagerlöf
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Sweden; Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Sweden
| | - Ingemar F Petersson
- Department of Clinical Sciences, Department of Orthopaedics, Lund University, Sweden
| | - Yvonne Forsell
- Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research, Karolinska Institutet, Sweden
| | - Nils Lindefors
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Sweden
| | - Viktor Kaldo
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Sweden; Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Sweden
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Ahern E, Kinsella S, Semkovska M. Clinical efficacy and economic evaluation of online cognitive behavioral therapy for major depressive disorder: a systematic review and meta-analysis. Expert Rev Pharmacoecon Outcomes Res 2018; 18:25-41. [PMID: 29145746 DOI: 10.1080/14737167.2018.1407245] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Leading cause of disability worldwide, depression is the most prevalent mental disorder with growing societal costs. As mental health services demand often outweighs provision, accessible treatment options are needed. Our systematic review and meta-analysis evaluated the clinical efficacy and economic evidence for the use of online cognitive behavioral therapy (oCBT) as an accessible treatment solution for depression. AREAS COVERED Electronic databases were searched for controlled trials published between 2006 and 2016. Of the reviewed 3,324 studies, 29 met the criteria for inclusion in the efficacy meta-analysis. The systematic review identified five oCBT economic evaluations. Therapist-supported oCBT was equivalent to face-to-face CBT at improving depressive symptoms and superior to treatment-as-usual, waitlist control, and attention control. Depression severity, number of sessions, or support did not affect efficacy. From a healthcare provider perspective, oCBT tended to show greater costs with greater benefits in the short term, relative to comparator treatments. EXPERT COMMENTARY Although efficacious, further economic evidence is required to support the provision of oCBT as a cost-effective treatment for depression. Economic evaluations that incorporate a societal perspective will better account for direct and indirect treatment costs. Nevertheless, oCBT shows promise of effectively improving depressive symptoms, considering limited mental healthcare resources.
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Affiliation(s)
- Elayne Ahern
- a Department of Psychology , University of Limerick , Limerick , Ireland
- b Department of Economics , Kemmy Business School, University of Limerick , Limerick , Ireland
| | - Stephen Kinsella
- b Department of Economics , Kemmy Business School, University of Limerick , Limerick , Ireland
| | - Maria Semkovska
- a Department of Psychology , University of Limerick , Limerick , Ireland
- c Health Research Institute , University of Limerick , Limerick , Ireland
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Williams A. True technology-enabled mental health care: when will we trust the computers and robots? Mhealth 2018; 4:10. [PMID: 29782568 PMCID: PMC5945702 DOI: 10.21037/mhealth.2018.04.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 03/27/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Alishia Williams
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
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Kumar V, Sattar Y, Bseiso A, Khan S, Rutkofsky IH. The Effectiveness of Internet-Based Cognitive Behavioral Therapy in Treatment of Psychiatric Disorders. Cureus 2017; 9:e1626. [PMID: 29098136 PMCID: PMC5659300 DOI: 10.7759/cureus.1626] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
This review article is an overview of the effectiveness of internet-based cognitive behavioral therapy (ICBT) in the treatment of psychiatric disorders. ICBT’s effectiveness has been investigated in treating and managing conditions like depression, generalized anxiety disorder (GAD), panic disorder, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), adjustment disorder, bipolar disorder, chronic pain, and phobias. ICBT’s role in the treatment of medical conditions such as diabetes mellitus with comorbid psychiatric illnesses was also explored. Furthermore, this study elaborates on its cost-effectiveness and its impact in rural areas. We conducted a thorough literature search using PubMed and Google Scholar with no restrictions on the date. ICBT's role in treating and controlling psychiatric illnesses has been established in the literature. From the data compiled, we conclude that ICBT is useful in treating mental health and medical illnesses with psychiatric comorbidities. It has also been found to be cost-effective for patients and society. ICBT is a potential tool emerging with modern day technological advancements and is useful in rural and urban settings, across various languages and cultures, and on a global scale. Larger randomized control trials on its use in clinical practice and in reaching rural populations are bound to shed more light on the effectiveness of this tool along with spreading awareness among physician and patient communities.
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Affiliation(s)
- Vikram Kumar
- California Institute of Behavioral Neurosciences and Psychology, Sri ramachandra University
| | - Yasar Sattar
- Research Assistant Psychiatry, SUNY Downstate University
| | | | - Sara Khan
- California Institute of Behavioral Neurosciences and Psychology, Dow Medical College, Pakistan
| | - Ian H Rutkofsky
- Research, California Institute of Behavioral Neurosciences & Psychology
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