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Hong H, Liu L, Mojtabai R, Stuart EA. Calibrated meta-analysis to estimate the efficacy of mental health treatments in target populations: an application to paliperidone trials for treatment of schizophrenia. BMC Med Res Methodol 2023; 23:150. [PMID: 37365521 DOI: 10.1186/s12874-023-01958-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUNDS Meta-analyses can be a powerful tool but need to calibrate potential unrepresentativeness of the included trials to a target population. Estimating target population average treatment effects (TATE) in meta-analyses is important to understand how treatments perform in well-defined target populations. This study estimated TATE of paliperidone palmitate in patients with schizophrenia using meta-analysis with individual patient trial data and target population data. METHODS We conducted a meta-analysis with data from four randomized clinical trials and target population data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. Efficacy was measured using the Positive and Negative Syndrome Scale (PANSS). Weights to equate the trial participants and target population were calculated by comparing baseline characteristics between the trials and CATIE. A calibrated weighted meta-analysis with random effects was performed to estimate the TATE of paliperidone compared to placebo. RESULTS A total of 1,738 patients were included in the meta-analysis along with 1,458 patients in CATIE. After weighting, the covariate distributions of the trial participants and target population were similar. Compared to placebo, paliperidone palmitate was associated with a significant reduction of the PANSS total score under both unweighted (mean difference 9.07 [4.43, 13.71]) and calibrated weighted (mean difference 6.15 [2.22, 10.08]) meta-analysis. CONCLUSIONS The effect of paliperidone palmitate compared with placebo is slightly smaller in the target population than that estimated directly from the unweighted meta-analysis. Representativeness of samples of trials included in a meta-analysis to a target population should be assessed and incorporated properly to obtain the most reliable evidence of treatment effects in target populations.
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Affiliation(s)
- Hwanhee Hong
- Department of Biostatistics and Bioinformatics, School of Medicine, Duke University, 2424 Erwin Road, Ste 1105, Durham, NC, 27705, USA.
| | - Lu Liu
- Department of Biostatistics and Bioinformatics, School of Medicine, Duke University, 2424 Erwin Road, Ste 1105, Durham, NC, 27705, USA
| | - Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Athreya AP, Vande Voort JL, Shekunov J, Rackley SJ, Leffler JM, McKean AJ, Romanowicz M, Kennard BD, Emslie GJ, Mayes T, Trivedi M, Wang L, Weinshilboum RM, Bobo WV, Croarkin PE. Evidence for machine learning guided early prediction of acute outcomes in the treatment of depressed children and adolescents with antidepressants. J Child Psychol Psychiatry 2022; 63:1347-1358. [PMID: 35288932 PMCID: PMC9475486 DOI: 10.1111/jcpp.13580] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The treatment of depression in children and adolescents is a substantial public health challenge. This study examined artificial intelligence tools for the prediction of early outcomes in depressed children and adolescents treated with fluoxetine, duloxetine, or placebo. METHODS The study samples included training datasets (N = 271) from patients with major depressive disorder (MDD) treated with fluoxetine and testing datasets from patients with MDD treated with duloxetine (N = 255) or placebo (N = 265). Treatment trajectories were generated using probabilistic graphical models (PGMs). Unsupervised machine learning identified specific depressive symptom profiles and related thresholds of improvement during acute treatment. RESULTS Variation in six depressive symptoms (difficulty having fun, social withdrawal, excessive fatigue, irritability, low self-esteem, and depressed feelings) assessed with the Children's Depression Rating Scale-Revised at 4-6 weeks predicted treatment outcomes with fluoxetine at 10-12 weeks with an average accuracy of 73% in the training dataset. The same six symptoms predicted 10-12 week outcomes at 4-6 weeks in (a) duloxetine testing datasets with an average accuracy of 76% and (b) placebo-treated patients with accuracies of 67%. In placebo-treated patients, the accuracies of predicting response and remission were similar to antidepressants. Accuracies for predicting nonresponse to placebo treatment were significantly lower than antidepressants. CONCLUSIONS PGMs provided clinically meaningful predictions in samples of depressed children and adolescents treated with fluoxetine or duloxetine. Future work should augment PGMs with biological data for refined predictions to guide the selection of pharmacological and psychotherapeutic treatment in children and adolescents with depression.
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Affiliation(s)
- Arjun P. Athreya
- Department of Molecular Pharmacology and Experimental TherapeuticsMayo ClinicRochesterMNUSA
| | | | - Julia Shekunov
- Department of Psychiatry and PsychologyMayo ClinicRochesterMNUSA
| | | | | | | | | | - Betsy D. Kennard
- Peter O’Donnell Jr. Brain Institute and the Department of PsychiatryUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Graham J. Emslie
- Peter O’Donnell Jr. Brain Institute and the Department of PsychiatryUniversity of Texas Southwestern Medical CenterDallasTXUSA,Children’s HealthChildren’s Medical CenterDallasTXUSA
| | - Taryn Mayes
- Peter O’Donnell Jr. Brain Institute and the Department of PsychiatryUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Madhukar Trivedi
- Peter O’Donnell Jr. Brain Institute and the Department of PsychiatryUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Liewei Wang
- Department of Molecular Pharmacology and Experimental TherapeuticsMayo ClinicRochesterMNUSA
| | | | - William V. Bobo
- Department of Psychiatry and PsychologyMayo ClinicJacksonvilleFLUSA
| | - Paul E. Croarkin
- Department of Psychiatry and PsychologyMayo ClinicRochesterMNUSA
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Towbin KE. Editorial: Not the Same as Adults: Vortioxetine in Adolescents With Major Depression. J Am Acad Child Adolesc Psychiatry 2022; 61:1081-1083. [PMID: 35364250 DOI: 10.1016/j.jaac.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/22/2022] [Indexed: 11/28/2022]
Abstract
In this issue, readers can review a multisite, double-blind, randomized, controlled trial (DBRCT) of vortioxetine for adolescent major depression (AMD) by Findling et al.1 The investigators deserve credit for this industry-sponsored study's several innovations: initial treatment following current guidelines, efforts to reduce placebo response rates (PRRs), and creation of both placebo- and active-control arms. The Journal deserves our respect for its commitment to highlighting these innovations, despite the trial's negative result. It is essential to perform treatment studies in adolescents, and this study underscores the fallacy of presuming that drugs showing efficacy in adults will be as effective in our patients.
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Affiliation(s)
- Kenneth E Towbin
- Emotion and Development Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland.
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Moukaddam N, Sano A, Salas R, Hammal Z, Sabharwal A. Turning data into better mental health: Past, present, and future. Front Digit Health 2022; 4:916810. [PMID: 36060543 PMCID: PMC9428351 DOI: 10.3389/fdgth.2022.916810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
In this mini-review, we discuss the fundamentals of using technology in mental health diagnosis and tracking. We highlight those principles using two clinical concepts: (1) cravings and relapse in the context of addictive disorders and (2) anhedonia in the context of depression. This manuscript is useful for both clinicians wanting to understand the scope of technology use in psychiatry and for computer scientists and engineers wishing to assess psychiatric frameworks useful for diagnosis and treatment. The increase in smartphone ownership and internet connectivity, as well as the accelerated development of wearable devices, have made the observation and analysis of human behavior patterns possible. This has, in turn, paved the way to understand mental health conditions better. These technologies have immense potential in facilitating the diagnosis and tracking of mental health conditions; they also allow the implementation of existing behavioral treatments in new contexts (e.g., remotely, online, and in rural/underserved areas), and the possibility to develop new treatments based on new understanding of behavior patterns. The path to understand how to best use technology in mental health includes the need to match interdisciplinary frameworks from engineering/computer sciences and psychiatry. Thus, we start our review by introducing bio-behavioral sensing, the types of information available, and what behavioral patterns they may reflect and be related to in psychiatric diagnostic frameworks. This information is linked to the use of functional imaging, highlighting how imaging modalities can be considered "ground truth" for mental health/psychiatric dimensions, given the heterogeneity of clinical presentations, and the difficulty of determining what symptom corresponds to what disease. We then discuss how mental health/psychiatric dimensions overlap, yet differ from, psychiatric diagnoses. Using two clinical examples, we highlight the potential agreement areas in assessment/management of anhedonia and cravings. These two dimensions were chosen because of their link to two very prevalent diseases worldwide: depression and addiction. Anhedonia is a core symptom of depression, which is one of the leading causes of disability worldwide. Cravings, the urge to use a substance or perform an action (e.g., shopping, internet), is the leading step before relapse. Lastly, through the manuscript, we discuss potential mental health dimensions.
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Affiliation(s)
- Nidal Moukaddam
- Department of Psychiatry, Baylor College of Medicine, Houston Texas, United States
| | - Akane Sano
- Department of Electrical and Computer Engineering, Rice University, Houston, Texas, United States
| | - Ramiro Salas
- Department of Psychiatry, Baylor College of Medicine, The Menninger Clinic, Michael E DeBakey VA Medical Center, Houston, Texas, United States
| | - Zakia Hammal
- The Robotics Institute Department in the School of Computer Science, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Ashutosh Sabharwal
- Department of Electrical and Computer Engineering, Rice University, Houston, Texas, United States
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Age of onset of social anxiety disorder and psychiatric and mental health outcomes: Results from a nationally representative study. J Affect Disord 2022; 309:252-258. [PMID: 35489557 DOI: 10.1016/j.jad.2022.04.149] [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: 01/16/2021] [Revised: 06/05/2021] [Accepted: 04/25/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Prior studies support that younger age of onset would be associated with poorer psychiatric and mental health outcomes for many psychiatric disorders. However, such relationship has never been examined for social anxiety disorder (SAD) in a nationally representative sample. METHODS Using data from the second Wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we have identified four groups of participants with a lifetime DSM-IV diagnosis of SAD based on the self-reported age of onset (childhood onset (<12 years, N = 658), adolescence onset (12-17 years, N = 663), early-adulthood onset (18-39 years, N = 663), and late-adulthood onset (>39 years, N = 415)), and a control group without a lifetime history of SAD (N = 32,205). We performed multinomial logistic regression models to compare lifetime DSM-IV psychiatric disorders and current mental health-related quality of life (assessed with the mental component summary score (MSC) of the SF-12) across these groups. RESULTS The lifetime prevalence rates of panic disorder, agoraphobia and post-traumatic stress disorder were significantly higher in the adulthood onset groups than in groups with an onset during childhood or adolescence (p < 0.01 for most models). MCS score was significantly higher in the childhood (46.0 (SE = 0.5)) or adolescence (46.5 (SE = 0.5)) onset groups than in the groups with an onset during adulthood (early-adulthood onset: 43.5 (SE = 0.6), and late-adulthood onset: 43.0 (SE = 0.8)). LIMITATIONS Our results relied on retrospective self-reported data. CONCLUSION Among individuals with SAD, a later age of onset was significantly associated with greater lifetime rates of psychiatric disorders and diminished quality of life.
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Rep C, Peyre H, Sánchez-Rico M, Blanco C, Dosquet M, Schuster JP, Limosin F, Hoertel N. Contributing factors to heterogeneity in the timing of the onset of major depressive episode: Results from a national study. J Affect Disord 2022; 299:585-595. [PMID: 34952114 DOI: 10.1016/j.jad.2021.12.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/26/2021] [Accepted: 12/19/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION It remains unclear whether specific clinical factors contribute to heterogeneity in the timing of the onset of major depression. METHODS Using a nationally representative US adult sample, the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions, we compared the characteristics of 5 different groups of patients defined by their age at onset: (i) before 18 years, (ii) between 18 and 34 years, (iii) between 35 and 44 years, (iv) between 45 and 59 years, and (v) 60 years or older. Specifically, we examined parental history of psychiatric disorders, history of childhood maltreatment experiences, sociodemographic characteristics, lifetime psychiatric disorders, and psychiatric disorders that occurred before the first major depressive episode (MDE). RESULTS Compared with first MDE occurring between 18 and 34 years, first MDE before 18 years was more strongly associated with childhood maltreatment and family history of psychiatric disorders, and less strongly linked to prior lifetime psychiatric disorders, whereas first MDE occurring at 60 years and older was more strongly associated with widowhood and a prior lifetime history of generalized anxiety disorder. LIMITATIONS Associations found cannot be interpzreted as causal relationships due to study design and the risk of recall bias. CONCLUSION Our results suggest substantial age differences in risk factors for first MDE. Improving early detection and treatment of major depression and other psychiatric disorders, and preventing childhood maltreatment may have broad benefits to reduce the burden of MDE at all ages.
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Affiliation(s)
- Cécile Rep
- Centre Ressource Régional de Psychiatrie du Sujet Agé (CRRPSA), Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris.
| | - Hugo Peyre
- Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France; Cognitive Sciences and Psycholinguistic Laboratory, Ecole Normale Supérieure, Paris, France
| | - Marina Sánchez-Rico
- Centre Ressource Régional de Psychiatrie du Sujet Agé (CRRPSA), Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris; Faculté de médecine Paris Descartes, Université de Paris, Paris, France
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Marie Dosquet
- Centre Ressource Régional de Psychiatrie du Sujet Agé (CRRPSA), Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris
| | - Jean-Pierre Schuster
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Frédéric Limosin
- Centre Ressource Régional de Psychiatrie du Sujet Agé (CRRPSA), Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris; Faculté de médecine Paris Descartes, Université de Paris, Paris, France; Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Nicolas Hoertel
- Centre Ressource Régional de Psychiatrie du Sujet Agé (CRRPSA), Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris; Faculté de médecine Paris Descartes, Université de Paris, Paris, France; Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
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Liu M, Huang Y, Li X, Liu Y, Yu R, Long Y, Lv F, Zhou X. Aberrant frontolimbic circuit in female depressed adolescents with and without suicidal attempts: A resting-state functional magnetic resonance imaging study. Front Psychiatry 2022; 13:1007144. [PMID: 36386991 PMCID: PMC9641155 DOI: 10.3389/fpsyt.2022.1007144] [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: 07/30/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The neurobiological basis of suicidal behaviors among female adolescents with major depressive disorder (MDD) remains largely unclear. MATERIALS AND METHODS Fifty-eight drug-naïve, first-episode female adolescent MDD [including 31 patients with suicidal attempt (SA group) and 27 patients without SA (non-SA group)], and 36 matched healthy controls (HCs) participated in the present study. Resting-state functional magnetic resonance imaging (MRI) was performed on each subject. The metrics of the amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), and regional homogeneity (ReHo) were compared among the three groups. Then seed-based functional connectivity (FC) was conducted based on the ALFF/fALFF and ReHo results, which were then correlated to clinical variables. RESULTS Compared with the non-SA group, the SA group exhibited increased fALFF in the bilateral insula and right precentral gyrus, and enhanced ReHo in the left superior temporal gyrus, left middle cingulate cortex, right insula, and right precentral gyrus. Relative to the HCs, the SA group demonstrated additionally reduced fALFF and ReHo in the left middle frontal gyrus. Moreover, the SA group showed increased FC between the right precentral gyrus and the left middle frontal gyrus and left insula, and between the right insula and anterior/middle cingulate cortex compared to the non-SA and HC groups. In addition, the fALFF in the left middle frontal gyrus was positively correlated with the 17-item Hamilton Depression Rating Scale scores, and the values in the fALFF/ReHo in the right insula were positively correlated with the duration of MDD within the patient group. CONCLUSION These findings highlight the multiple abnormalities of the frontolimbic circuit, which may enhance our understanding of the neurobiological basis underlying female MDD with SA during adolescence.
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Affiliation(s)
- Mengqi Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Huang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuemei Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Renqiang Yu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yicheng Long
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyu Zhou
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Kittelson AJ, Loyd BJ, Graber J, Himawan MA, Waugh D, Davenport J, Hoogeboom TJ, Stevens-Lapsley J. Examination of exclusion criteria in total knee arthroplasty rehabilitation trials: influence on the application of evidence in day-to-day practice. J Eval Clin Pract 2021; 27:1335-1342. [PMID: 33763961 PMCID: PMC8627122 DOI: 10.1111/jep.13564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/03/2021] [Accepted: 03/08/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Total knee arthroplasty (TKA) rehabilitation trials use exclusion criteria, which may limit their generalizability in practice. We investigated whether patients seen in routine practice who meet common exclusion criteria recover differently from TKA compared to research-eligible patients. We hypothesized that research-ineligible patients would demonstrate poorer average postoperative function and slower rate of functional recovery compared to research-eligible patients. METHODS Patient characteristics and exclusion criteria were extracted and summarized from trials included in the three most recent systematic reviews of TKA rehabilitation. Trial participant characteristics were compared to a clinical dataset of patient outcomes collected in routine TKA rehabilitation. Where possible, individual exclusion criterion from the trials were applied to the clinical dataset to determine "eligible" and "ineligible" groups for research participation. Postoperative functional outcomes including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Timed Up and Go (TUG) were compared between "eligible" and "ineligible" groups using mixed effects models. RESULTS 2,528 participants from 27 trials were compared to 474 patients from the clinical dataset. Research participants were older, with lower Body Mass Index than patients in the clinical dataset. Many patients in the clinical dataset would be "ineligible" for research participation based upon common exclusion criteria from the trials. Differences were observed in average postoperative functioning between some "eligible" and "ineligible" groups in the clinical dataset. However, no differences were observed in functional recovery rate between groups, except for patients with diabetes whose TUG recovered more slowly than their "eligible" counterparts. CONCLUSIONS Many patients in the clinical dataset were "ineligible" for research participation based upon common TKA rehabilitation trial exclusion criteria. However, the postoperative recovery rate did not differ between "eligible" and "ineligible" groups based on individual exclusion criterion-except for individuals with diabetes. This suggests that both clinical and research populations may recover similarly from TKA.
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Affiliation(s)
- Andrew J Kittelson
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA
| | - Brian J Loyd
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA.,Department of Physical Therapy and Athletic Training, College of Health, University of Utah, Salt Lake City, Utah, USA
| | - Jeremy Graber
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Michael A Himawan
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Dawn Waugh
- ATI Physical Therapy, Greenville, South Carolina, USA
| | | | - Thomas J Hoogeboom
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Jennifer Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA.,Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, Colorado, USA
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Morgan AJ, Ross AM, Yap MBH, Reavley NJ, Parker A, Simmons MB, Scanlan F, Jorm AF. What works for mental health problems in youth? Survey of real-world experiences of treatments and side effects. Early Interv Psychiatry 2021; 15:1502-1512. [PMID: 33260268 DOI: 10.1111/eip.13087] [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: 06/15/2020] [Revised: 09/28/2020] [Accepted: 11/14/2020] [Indexed: 11/26/2022]
Abstract
AIM Despite youth being the most common age group for onset of mental disorders, there is less knowledge on the benefits and harms of treatments in young people. In addition, efficacy data from randomized controlled trials may not generalize to how treatment works outside of research settings. This study aimed to investigate young people's perceived effectiveness of different treatments for mental health problems, the professionals who delivered these, and the experience of negative effects. METHODS We developed a consumer report website where young people who were ever diagnosed with a mental disorder provided ratings on the helpfulness or harmfulness of different types of professionals, mental health treatments (medical, psychological complementary/alternative) and self-help strategies, and whether they had experienced particular negative effects. RESULTS Here, 557 young people aged 12-25 years, who were recruited from English-speaking, high-income countries, provided 1258 ratings of treatments. All treatments showed varied perceptions of effectiveness. Medical and psychological treatments were rated moderately helpful on average with low rates of harmfulness. Self-help strategies were rated as being as helpful as professional treatments. Side effects related to the head or mind (e.g., concentration difficulties, inability to feel emotions, depression and irritability) were the most common across all types of medicines. For psychological treatments, treatment being too expensive and feeling worse at the end of a session were the most commonly reported negative effects. CONCLUSIONS Study findings may be a useful guide to clinicians, researchers, young people and their families about what is likely to work in real-world settings.
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Affiliation(s)
- Amy J Morgan
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Anna M Ross
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Marie B H Yap
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | - Nicola J Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Alexandra Parker
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Magenta B Simmons
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Faye Scanlan
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,headspace, The National Youth Mental Health Foundation, Melbourne, Australia
| | - Anthony F Jorm
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
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10
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Hoertel N, Rotenberg L, Schuster JP, Blanco C, Lavaud P, Hanon C, Hozer F, Teruel E, Manetti A, Costemale-Lacoste JF, Seigneurie AS, Limosin F. Generalizability of pharmacologic and psychotherapy trial results for late-life unipolar depression. Aging Ment Health 2021; 25:367-377. [PMID: 31726850 DOI: 10.1080/13607863.2019.1691146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Despite evidence of low representativeness of clinical trial results for depression in adults, the generalizability of clinical trial results for late-life depression is unknown. This study sought to quantify the representativeness of pharmacologic and psychotherapy clinical trial results for late-life unipolar depression. METHOD Data were derived from the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of 34,653 adults from the United States population. To assess the generalizability of clinical trial results for late-life depression, we applied a standard set of eligibility criteria representative of pharmacologic and psychotherapy clinical trials to all individuals aged 65 years and older in NESARC with a DSM-IV diagnosis of MDE and no lifetime history of mania/hypomania (n = 273) and in a subsample of individuals seeking help for depression (n = 78). RESULTS More than four of ten respondents and about two of ten respondents would have been excluded by at least one exclusion criterion in a typical pharmacologic and psychotherapy efficacy trial, respectively. Similar results (i.e.41.1% and 25.9%, respectively) were found in the subsample of individuals seeking help for depression. Excess percentage of exclusion in typical pharmacologic studies was accounted for by the criterion "significant medical condition". We also found that populations typically included in pharmacologic and psychotherapy clinical trials for late-life unipolar depression may substantially differ. CONCLUSION Psychotherapy trial results may be representative of most patients with late-life unipolar depression in routine clinical practice. By contrast, pharmacologic clinical trials may not be readily generalizable to community samples.
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Affiliation(s)
- Nicolas Hoertel
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France.,Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.,Centre Psychiatrie et Neurosciences, Inserm Umr 894, Paris, France.,Université de Paris, Université Paris Descartes, Paris, France
| | - Léa Rotenberg
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Jean-Pierre Schuster
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Pierre Lavaud
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Cécile Hanon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Franz Hozer
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Elisabeth Teruel
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Aude Manetti
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | | | - Anne-Sophie Seigneurie
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Frédéric Limosin
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France.,Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.,Centre Psychiatrie et Neurosciences, Inserm Umr 894, Paris, France.,Université de Paris, Université Paris Descartes, Paris, France
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11
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Venegas A, Meredith LR, Cooper ZD, Towns B, Ray LA. Inclusion of Cannabis Users in Alcohol Research Samples: Screening In, Screening Out, and Implications. Alcohol Alcohol 2020; 55:416-423. [PMID: 32328657 PMCID: PMC7307319 DOI: 10.1093/alcalc/agaa023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 03/10/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Alcohol and cannabis are frequently co-used, as 20-50% of those who drink alcohol report co-using cannabis. This study is based on the argument that alcohol researchers should enroll cannabis users in human laboratory studies of alcohol use disorder (AUD) to strengthen generalizability. This study examines how heavy drinking cannabis users differ from non-cannabis using heavy drinkers. METHODS In a community sample of non-treatment-seeking heavy drinkers (n = 551, 35% female), cannabis users were identified through: (a) self-reported cannabis use in the past 6 months and (b) positive urine toxicology test for tetrahydrocannabinol (THC). Cannabis users, identified as described previously, were compared with non-cannabis users on demographic and clinical characteristics. RESULTS Those who endorsed cannabis use in the past 6 months reported more binge drinking days. Participants who tested positive for THC had higher Alcohol Use Disorder Identification Test scores and more binge drinking days. Younger age and being a tobacco smoker were associated with an increased likelihood of cannabis use in the past 6 months, whereas male gender and being a tobacco use were associated with a greater likelihood of testing positive for THC. Individuals with cannabis use disorder (CUD) endorsed more depression and anxiety and had higher AUD symptom counts than cannabis users without CUD. CONCLUSIONS The inclusion of cannabis users in AUD samples allows for increased clinical severity. Excluding cannabis users from AUD studies may limit representativeness and expend unnecessary study resources. Lastly, tobacco use may explain a large portion of the effects of cannabis use on sample characteristics. SHORT SUMMARY Alcohol and cannabis are frequently co-used substances. In a sample of non-treatment-seeking heavy drinkers (n = 551, 35% female), cannabis users reported higher alcohol use and higher likelihood of tobacco use than non-cannabis users. Including cannabis users in alcohol research studies will improve representativeness and likely increase clinical severity.
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Affiliation(s)
- Alexandra Venegas
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Lindsay R Meredith
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Ziva D Cooper
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA,University of California, Los Angeles, Cannabis Research Initiative, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Brandon Towns
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Lara A Ray
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, USA,University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA,Corresponding author: Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, USA. Tel.: +1 (310) 794-5383; Fax: +1 (310) 206-5985; E-mail:
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12
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Using filled prescription sequences to rank antidepressants according to their acceptability in the general population: The Constances cohort. J Psychiatr Res 2020; 123:72-80. [PMID: 32036076 DOI: 10.1016/j.jpsychires.2020.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/23/2019] [Accepted: 01/27/2020] [Indexed: 12/13/2022]
Abstract
Ranking antidepressants according to their acceptability (i.e. a combination of both efficacy and tolerability) in the general population may help choosing the best first-line medication. This study aimed to rank antidepressants according to the proportion of filled prescription sequences consistent with a continuation of the first treatment versus those consistent with a change. A first step was validating this measure as a proxy of acceptability by examining the association of these two kinds of sequences with levels of depressive symptoms. Among 64,467 individuals included in the French population-based Constances cohort, reimbursements of antidepressants from January 2009 to December 2015 were extracted from the French national health insurance system claims database. Depressive symptoms were measured at inclusion with the Center for Epidemiologic Studies-Depression scale (CES-D). Between January 2010 and December 2015, 6675 participants newly initiated an antidepressant (34.5% men, mean (SD) age: 48.3 (12.1) years). Among the subsample of participants included during the six-month period following treatment initiation, individuals with continuation sequences had lower levels of depressive symptoms than those with change sequences (mean (SE) CES-D score: 18.9 (0.8) versus 26.5 (2.1), p < 0.001). According to the continuation/change ratio observed over this six-month period in all participants, escitalopram ranked first, followed by sertraline, venlafaxine, citalopram, fluoxetine and paroxetine. In an independent replication sample representative of the French national population, the same six medications ranked first, with escitalopram remaining in first place. The proportion of filled prescription sequences consistent with a continuation versus a change of the first prescribed treatment may provide a widely available measure of antidepressant acceptability in community practice.
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13
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Cao J, Truong AL, Banu S, Shah AA, Sabharwal A, Moukaddam N. Tracking and Predicting Depressive Symptoms of Adolescents Using Smartphone-Based Self-Reports, Parental Evaluations, and Passive Phone Sensor Data: Development and Usability Study. JMIR Ment Health 2020; 7:e14045. [PMID: 32012072 PMCID: PMC7007590 DOI: 10.2196/14045] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/19/2019] [Accepted: 09/24/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Depression carries significant financial, medical, and emotional burden on modern society. Various proof-of-concept studies have highlighted how apps can link dynamic mental health status changes to fluctuations in smartphone usage in adult patients with major depressive disorder (MDD). However, the use of such apps to monitor adolescents remains a challenge. OBJECTIVE This study aimed to investigate whether smartphone apps are useful in evaluating and monitoring depression symptoms in a clinically depressed adolescent population compared with the following gold-standard clinical psychometric instruments: Patient Health Questionnaire (PHQ-9), Hamilton Rating Scale for Depression (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A). METHODS We recruited 13 families with adolescent patients diagnosed with MDD with or without comorbid anxiety disorder. Over an 8-week period, daily self-reported moods and smartphone sensor data were collected by using the Smartphone- and OnLine usage-based eValuation for Depression (SOLVD) app. The evaluations from teens' parents were also collected. Baseline depression and anxiety symptoms were measured biweekly using PHQ-9, HAM-D, and HAM-A. RESULTS We observed a significant correlation between the self-evaluated mood averaged over a 2-week period and the biweekly psychometric scores from PHQ-9, HAM-D, and HAM-A (0.45≤|r|≤0.63; P=.009, P=.01, and P=.003, respectively). The daily steps taken, SMS frequency, and average call duration were also highly correlated with clinical scores (0.44≤|r|≤0.72; all P<.05). By combining self-evaluations and smartphone sensor data of the teens, we could predict the PHQ-9 score with an accuracy of 88% (23.77/27). When adding the evaluations from the teens' parents, the prediction accuracy was further increased to 90% (24.35/27). CONCLUSIONS Smartphone apps such as SOLVD represent a useful way to monitor depressive symptoms in clinically depressed adolescents, and these apps correlate well with current gold-standard psychometric instruments. This is a first study of its kind that was conducted on the adolescent population, and it included inputs from both teens and their parents as observers. The results are preliminary because of the small sample size, and we plan to expand the study to a larger population.
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Affiliation(s)
- Jian Cao
- Electrical and Computer Engineering Department, Rice University, Houston, TX, United States
| | - Anh Lan Truong
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States
| | - Sophia Banu
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States
| | - Asim A Shah
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States
| | - Ashutosh Sabharwal
- Electrical and Computer Engineering Department, Rice University, Houston, TX, United States
| | - Nidal Moukaddam
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States
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14
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Lorenzo-Luaces L, Johns E, Keefe JR. The Generalizability of Randomized Controlled Trials of Self-Guided Internet-Based Cognitive Behavioral Therapy for Depressive Symptoms: Systematic Review and Meta-Regression Analysis. J Med Internet Res 2018; 20:e10113. [PMID: 30413400 PMCID: PMC6251981 DOI: 10.2196/10113] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 07/11/2018] [Accepted: 07/19/2018] [Indexed: 01/23/2023] Open
Abstract
Background Self-guided internet-based cognitive behavioral therapies (iCBTs) for depressive symptoms may substantially increase accessibility to mental health treatment. Despite this, questions remain as to the generalizability of the research on self-guided iCBT. Objective We sought to describe the clinical entry criteria used in studies of self-guided iCBT, explore the criteria’s effects on study outcomes, and compare the frequency of use of these criteria with their use in studies of face-to-face psychotherapy and antidepressant medications. We hypothesized that self-guided iCBT studies would use more stringent criteria that would bias the sample toward those with a less complex clinical profile, thus inflating treatment outcomes. Methods We updated a recently published meta-analysis by conducting a systematic literature search in PubMed, MEDLINE, PsycINFO, and EMBASE. We conducted a meta-regression analysis to test the effect of the different commonly used psychiatric entry criteria on the treatment-control differences. We also compared the frequency with which exclusion criteria were used in the self-guided iCBT studies versus studies of face-to-face psychotherapy and antidepressants from a recently published review. Results Our search yielded 5 additional studies, which we added to the 16 studies identified by Karyotaki and colleagues in 2017. Few self-guided iCBT studies excluded patients with severe depressive symptoms (6/21, 29%), but self-guided iCBT studies were more likely than antidepressant (14/170, 8.2%) studies to use this criterion. However, self-guided iCBT studies did not use this criterion more frequently than face-to-face psychotherapy studies (6/16, 38%). Beyond this, we found no evidence that self-guided iCBTs used more stringent entry criteria. Strong evidence suggested that they were actually less likely to use most entry criteria, especially exclusions on the basis of substance use or personality pathology. None of the entry criteria used had an effect on outcomes. Conclusions A conservative interpretation of our findings is that the patient population sampled in the literature on self-guided iCBT is relatively comparable with that of studies of antidepressants or face-to-face psychotherapy. Alternatively, studies of unguided cognitive behavioral therapy may sample from a more heterogeneous and representative patient population. Until evidence emerges to suggest otherwise, the patient population sampled in self-guided iCBT studies cannot be considered as less complex than the patient population from face-to-face psychotherapy or antidepressant studies.
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Affiliation(s)
- Lorenzo Lorenzo-Luaces
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, United States
| | - Emily Johns
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, United States
| | - John R Keefe
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
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15
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Lorenzo-Luaces L, Zimmerman M, Cuijpers P. Are studies of psychotherapies for depression more or less generalizable than studies of antidepressants? J Affect Disord 2018. [PMID: 29522947 DOI: 10.1016/j.jad.2018.02.066] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The generalizability of findings from studies exploring the efficacy of psychotherapy and antidepressants has been called into question in part because studies exclude many patients. Despite this, the frequency with which psychotherapy and antidepressant studies use specific inclusion and exclusion criteria has never been compared. We explored the exclusion criteria used in psychotherapy and pharmacotherapy studies from 1995 to 2014. METHOD Systematic literature searches were conducted in PubMed, Medline, PsycINFO, and Embase of published randomized controlled trials (RCTs) of the treatment of major depressive disorder (MDD) in adults with either antidepressants (vs. placebos) or psychotherapy (vs. placebos, treatments as usual, or other controls). RESULTS Most psychotherapy (81%) and antidepressant (100%) trials excluded patients with milder symptoms as well as patients with elevated suicidal risk (56-75%), psychotic symptoms (84-88%), or substance misuse (75-81%). Psychotherapy studies were less likely to exclude patients on the basis of brief episode duration (0% vs. 48%) and co-morbid Axis I disorders (6% vs. 27%). However, psychotherapy studies excluded patients with more severe symptoms more frequently (38%) than antidepressant studies (8%). CONCLUSIONS Overall, psychotherapy studies appear somewhat more inclusive than antidepressant studies. On average, antidepressant studies appear to target patients with more chronic and severe, as well as more purely depressive presentations.
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Affiliation(s)
- Lorenzo Lorenzo-Luaces
- Indiana University, Department of Psychological and Brain Sciences, 1101 E 10th St, Bloomington, IN 47405, United States.
| | - Mark Zimmerman
- Brown University School of Medicine, Department of Psychiatry and Human Behavior, United States
| | - Pim Cuijpers
- VU University Amsterdam, Department of Clinical, Neuro, and Developmental Psychology, The Netherlands
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16
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Nelson KE, Feinstein JA, Gerhardt CA, Rosenberg AR, Widger K, Faerber JA, Feudtner C. Emerging Methodologies in Pediatric Palliative Care Research: Six Case Studies. CHILDREN-BASEL 2018; 5:children5030032. [PMID: 29495384 PMCID: PMC5867491 DOI: 10.3390/children5030032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/13/2018] [Accepted: 02/16/2018] [Indexed: 12/17/2022]
Abstract
Given the broad focus of pediatric palliative care (PPC) on the physical, emotional, and spiritual needs of children with potentially life-limiting illnesses and their families, PPC research requires creative methodological approaches. This manuscript, written by experienced PPC researchers, describes issues encountered in our own areas of research and the novel methods we have identified to target them. Specifically, we discuss potential approaches to: assessing symptoms among nonverbal children, evaluating medical interventions, identifying and treating problems related to polypharmacy, addressing missing data in longitudinal studies, evaluating longer-term efficacy of PPC interventions, and monitoring for inequities in PPC service delivery.
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Affiliation(s)
- Katherine E Nelson
- Pediatric Advanced Care Team, Department of Paediatrics, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada.
| | - James A Feinstein
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, Children's Hospital Colorado, Aurora, CO 80045, USA.
- Division of General Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.
- Departments of Pediatrics and Psychology, The Ohio State University, Columbus, OH 43210, USA.
| | - Abby R Rosenberg
- Department of Pediatrics, University of Washington School of Medicine; Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA 98105, USA.
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA 98101, USA.
| | - Kimberley Widger
- Pediatric Advanced Care Team, Department of Paediatrics, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada.
| | - Jennifer A Faerber
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| | - Chris Feudtner
- Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
- Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
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17
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Wei S, Chang M, Zhang R, Jiang X, Wang F, Tang Y. Amygdala functional connectivity in female patients with major depressive disorder with and without suicidal ideation. Ann Gen Psychiatry 2018; 17:37. [PMID: 30214465 PMCID: PMC6134510 DOI: 10.1186/s12991-018-0208-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 09/03/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a known major risk factor for suicide and is one of the most common mental disorders. Meanwhile, gender differences in suicidal behavior have long been recognized including the finding that women have higher rates of suicidal ideation and/or suicidal behavior than men. The mechanism underlying suicide ideation in female patients with MDD remains poorly understood. The aim of the present study was to examine possible suicidal behavior-related neural circuitry in female MDD. METHODS In this study, 15 female participants with the first-episode MDD with suicidal ideation and 24 participants with the first-episode MDD without suicidal ideation as well as 39 female participants in a healthy control (HC) group, ranging in age from 18 to 50 years, underwent resting-state functional magnetic resonance imaging. The whole-brain amygdala resting-state functional connectivity (rsFC) was compared among these three groups. RESULTS Compared with female participants with the first-episode MDD without suicidal ideation and those in the HC group, female participants with the first-episode MDD with suicidal ideation showed a significant difference in rsFC between the amygdala and precuneus/cuneus (p < 0.05, corrected). No significant difference in amygdala-precuneus/cuneus rsFC was observed between female patients with the first-episode MDD without suicidal ideation and the HC group (p < 0.05, corrected). CONCLUSIONS Our findings suggest that suicidal ideation in female patients with the first-episode MDD may be related to an abnormality in amygdala neural circuitry. The abnormality in amygdala-precuneus/cuneus functional connectivity might present the trait feature for suicide in women with the first-episode MDD. The precuneus/cuneus may be an important region related to suicide and require future study.
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Affiliation(s)
- Shengnan Wei
- 1Brain Function Research Section, First Affiliated Hospital, China Medical University, Shenyang, Liaoning People's Republic of China.,2Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning People's Republic of China
| | - Miao Chang
- 2Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning People's Republic of China
| | - Ran Zhang
- 3Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, 110001 Liaoning People's Republic of China
| | - Xiaowei Jiang
- 1Brain Function Research Section, First Affiliated Hospital, China Medical University, Shenyang, Liaoning People's Republic of China.,2Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning People's Republic of China
| | - Fei Wang
- 1Brain Function Research Section, First Affiliated Hospital, China Medical University, Shenyang, Liaoning People's Republic of China.,2Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning People's Republic of China.,3Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, 110001 Liaoning People's Republic of China
| | - Yanqing Tang
- 1Brain Function Research Section, First Affiliated Hospital, China Medical University, Shenyang, Liaoning People's Republic of China.,3Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, 110001 Liaoning People's Republic of China.,4Department of Geriatric Medicine, First Affiliated Hospital, China Medical University, Shenyang, Liaoning People's Republic of China
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18
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Mistry KB, Forrest CB. Applying Evidence From Clinical Trials: Need for Pediatric Learning Health System Research. Pediatrics 2017; 140:peds.2017-3098. [PMID: 29097613 DOI: 10.1542/peds.2017-3098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kamila B Mistry
- Agency for Healthcare Research and Quality, Rockville, Maryland; and
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