1
|
Terhorst Y, Kaiser T, Brakemeier EL, Moshe I, Philippi P, Cuijpers P, Baumeister H, Sander LB. Heterogeneity of Treatment Effects in Internet- and Mobile-Based Interventions for Depression: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e2423241. [PMID: 39023887 PMCID: PMC11258589 DOI: 10.1001/jamanetworkopen.2024.23241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/21/2024] [Indexed: 07/20/2024] Open
Abstract
Importance While the effects of internet- and mobile-based interventions (IMIs) for depression have been extensively studied, no systematic evidence is available regarding the heterogeneity of treatment effects (HTEs), indicating to what extent patient-by-treatment interactions exist and personalized treatment models might be necessary. Objective To investigate the HTEs in IMIs for depression as well as their efficacy and effectiveness. Data Sources A systematic search in Embase, MEDLINE, Central, and PsycINFO for randomized clinical trials and supplementary reference searches was conducted on October 13, 2019, and updated March 25, 2022. The search string included various terms related to digital psychotherapy, depression, and randomized clinical trials. Study Selection Titles, abstracts, and full texts were reviewed by 2 independent researchers. Studies of all populations with at least 1 intervention group receiving an IMI for depression and at least 1 control group were eligible, if they assessed depression severity as a primary outcome and followed a randomized clinical trial (RCT) design. Data Extraction and Synthesis This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Risk of bias was evaluated using the Cochrane Risk of Bias Tool. HTE was investigated using logarithmic variance ratios (lnVR) and effect sizes using Hedges g. Three-level bayesian meta-regressions were conducted. Main Outcomes and Measures Heterogeneity of treatment effects was the primary outcome of this study; magnitudes of treatment effect sizes were the secondary outcome. Depression severity was measured by different self-report and clinician-rated scales in the included RCTs. Results The systematic review of 102 trials included 19 758 participants (mean [SD] age, 39.9 [10.58] years) with moderate depression severity (mean [SD] in Patient Health Questionnaire-9 score, 12.81 [2.93]). No evidence for HTE in IMIs was found (lnVR = -0.02; 95% credible interval [CrI], -0.07 to 0.03). However, HTE was higher in more severe depression levels (β̂ = 0.04; 95% CrI, 0.01 to 0.07). The effect size of IMI was medium (g = -0.56; 95% CrI, -0.46 to -0.66). An interaction effect between guidance and baseline severity was found (β̂ = -0.24, 95% CrI, -0.03 to -0.46). Conclusions and Relevance In this systematic review and meta-analysis of RCTs, no evidence for increased patient-by-treatment interaction in IMIs among patients with subthreshold to mild depression was found. Guidance did not increase effect sizes in this subgroup. However, the association of baseline severity with HTE and its interaction with guidance indicates a more sensitive, guided, digital precision approach would benefit individuals with more severe symptoms. Future research in this population is needed to explore personalization strategies and fully exploit the potential of IMI.
Collapse
Affiliation(s)
- Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
- Department of Psychology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Tim Kaiser
- Methods and Evaluation/Quality Assurance, Freie Universität Berlin, Berlin, Germany
| | - Eva-Lotta Brakemeier
- Department of Clinical Psychology and Psychotherapy, University Greifswald, Greifswald, Germany
| | - Isaac Moshe
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Paula Philippi
- Department of Clinical Child and Adolescent Psychology and Psychotherapy, Bergische Universität Wuppertal, Wuppertal, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
| | - Lasse Bosse Sander
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| |
Collapse
|
2
|
Diaz-Sanahuja L, Suso-Ribera C, Lucas I, Jiménez-Murcia S, Tur C, Gual-Montolio P, Paredes-Mealla M, García-Palacios A, Bretón-López JM. A Self-Applied Psychological Treatment for Gambling-Related Problems via The Internet: A Pilot, Feasibility Study. J Gambl Stud 2024:10.1007/s10899-024-10318-2. [PMID: 38795233 DOI: 10.1007/s10899-024-10318-2] [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] [Accepted: 05/12/2024] [Indexed: 05/27/2024]
Abstract
The main purpose of this study was to evaluate the feasibility of an online psychological intervention for individuals with gambling-related problems, supported by ecological momentary assessments and interventions (EMAs and EMIs), along with weekly phone-calls, before conducting a randomized controlled trial. Participants were required to complete 3 of the 8 modules of the program based on cognitive-behavioral therapy (CBT) and extensions and innovations of CBT. The study measured the outcomes of feasibility (i.e., reach, appropriateness, technology literacy and technology usability, fidelity, and adherence). In terms of reach, 19.8% (n = 11) of the initial population met the inclusion criteria and completed the three modules (mean age = 41; 90.9% men). The perceived appropriateness and the technology usability after the first use were both excellent, fidelity and adherence to the online treatment (73.3%) were adequate. Adherence to the EMAs and the weekly phone calls were more modest (54.51% and 66.67%, respectively). The results of the present study show that an online treatment for gambling problems enhanced by EMA and EMI might be feasible but challenges were noted in terms of reach and adherence to these assessments and calls. These challenges are important to consider for future trials and the scalability of treatments for individuals with gambling disorders.
Collapse
Affiliation(s)
- Laura Diaz-Sanahuja
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain.
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain
| | - Ignacio Lucas
- CIBER de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Susana Jiménez-Murcia
- CIBER de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Psychology and Psychobiology, Universidad de Barcelona, Barcelona, Spain
| | - Cintia Tur
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain
| | - Patricia Gual-Montolio
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain
| | - Macarena Paredes-Mealla
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain
- CIBER de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Juana María Bretón-López
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain
- CIBER de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
3
|
Bjornstad G, Sonthalia S, Rouse B, Freeman L, Hessami N, Dunne JH, Axford N. A comparison of the effectiveness of cognitive behavioural interventions based on delivery features for elevated symptoms of depression in adolescents: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1376. [PMID: 38188230 PMCID: PMC10771715 DOI: 10.1002/cl2.1376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/03/2023] [Indexed: 01/09/2024]
Abstract
Background Depression is a public health problem and common amongst adolescents. Cognitive behavioural therapy (CBT) is widely used to treat adolescent depression but existing research does not provide clear conclusions regarding the relative effectiveness of different delivery modalities. Objectives The primary aim is to estimate the relative efficacy of different modes of CBT delivery compared with each other and control conditions for reducing depressive symptoms in adolescents. The secondary aim is to compare the different modes of delivery with regard to intervention completion/attrition (a proxy for intervention acceptability). Search Methods The Cochrane Depression, Anxiety and Neurosis Clinical Trials Register was searched in April 2020. MEDLINE, PsycInfo, EMBASE, four other electronic databases, the CENTRAL trial registry, Google Scholar and Google were searched in November 2020, together with reference checking, citation searching and hand-searching of two databases. Selection Criteria Randomised controlled trials (RCTs) of CBT interventions (irrespective of delivery mode) to reduce symptoms of depression in young people aged 10-19 years with clinically relevant symptoms or diagnosis of depression were included. Data Collection and Analysis Screening and data extraction were completed by two authors independently, with discrepancies addressed by a third author. CBT interventions were categorised as follows: group CBT, individual CBT, remote CBT, guided self-help, and unguided self-help. Effect on depressive symptom score was estimated across validated self-report measures using Hedges' g standardised mean difference. Acceptability was estimated based on loss to follow-up as an odds ratio. Treatment rankings were developed using the surface under the cumulative ranking curve (SUCRA). Pairwise meta-analyses were conducted using random effects models where there were two or more head-to-head trials. Network analyses were conducted using random effects models. Main Results Sixty-eight studies were included in the review. The mean age of participants ranged from 10 to 19.5 years, and on average 60% of participants were female. The majority of studies were conducted in schools (28) or universities (6); other settings included primary care, clinical settings and the home. The number of CBT sessions ranged from 1 to 16, the frequency of delivery from once every 2 weeks to twice a week and the duration of each session from 20 min to 2 h. The risk of bias was low across all domains for 23 studies, 24 studies had some concerns and the remaining 21 were assessed to be at high risk of bias. Sixty-two RCTs (representing 6435 participants) were included in the pairwise and network meta-analyses for post-intervention depressive symptom score at post-intervention. All pre-specified treatment and control categories were represented by at least one RCT. Although most CBT approaches, except remote CBT, demonstrated superiority over no intervention, no approaches performed clearly better than or equivalent to another. The highest and lowest ranking interventions were guided self-help (SUCRA 83%) and unguided self-help (SUCRA 51%), respectively (very low certainty in treatment ranking). Nineteen RCTs (3260 participants) were included in the pairwise and network meta-analyses for 6 to 12 month follow-up depressive symptom score. Neither guided self-help nor remote CBT were evaluated in the RCTs for this time point. Effects were generally attenuated for 6- to 12-month outcomes compared to posttest. No interventions demonstrated superiority to no intervention, although unguided self-help and group CBT both demonstrated superiority compared to TAU. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking approaches were unguided self-help and individual CBT, respectively. Sixty-two RCTs (7347 participants) were included in the pairwise and network meta-analyses for intervention acceptability. All pre-specified treatment and control categories were represented by at least one RCT. Although point estimates tended to favour no intervention, no active treatments were clearly inferior. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking active interventions were individual CBT and group CBT respectively. Pairwise meta-analytic findings were similar to those of the network meta-analysis for all analyses. There may be age-based subgroup effects on post-intervention depressive symptoms. Using the no intervention control group as the reference, the magnitudes of effects appear to be larger for the oldest age categories compared to the other subgroups for each given comparison. However, they were generally less precise and formal testing only indicated a significant difference for group CBT. Findings were robust to pre-specified sensitivity analyses separating out the type of placebo and excluding cluster-RCTs, as well as an additional analysis excluding studies where we had imputed standard deviations. Authors' Conclusions At posttreatment, all active treatments (group CBT, individual CBT, guided self-help, and unguided self-help) except for remote CBT were more effective than no treatment. Guided self-help was the most highly ranked intervention but only evaluated in trials with the oldest adolescents (16-19 years). Moreover, the studies of guided self-help vary in the type and amount of therapist support provided and longer-term results are needed to determine whether effects persist. The magnitude of effects was generally attenuated for 6- to 12-month outcomes. Although unguided self-help was the lowest-ranked active intervention at post-intervention, it was the highest ranked at follow-up. This suggests the need for further research into whether interventions with self-directed elements enable young people to maintain effects by continuing or revisiting the intervention independently, and whether therapist support would improve long-term outcomes. There was no clear evidence that any active treatments were more acceptable to participants than any others. The relative effectiveness of intervention delivery modes must be taken into account in the context of the needs and preferences of individual young people, particularly as the differences between effect sizes were relatively small. Further research into the type and amount of therapist support that is most acceptable to young people and most cost-effective would be particularly useful.
Collapse
Affiliation(s)
- Gretchen Bjornstad
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
- Dartington Service Design LabBuckfastleighUK
| | - Shreya Sonthalia
- Dartington Service Design LabBuckfastleighUK
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - Benjamin Rouse
- Center for Clinical Evidence and Guidelines, ECRI InstitutePlymouth MeetingPennsylvaniaUSA
| | | | | | - Jo Hickman Dunne
- The Centre for Youth ImpactLondonUK
- University of ManchesterManchesterUK
| | - Nick Axford
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of PlymouthPlymouthUK
| |
Collapse
|
4
|
De Jesús-Romero R, Holder-Dixon AR, Buss JF, Lorenzo-Luaces L. Race, Ethnicity, and Other Cultural Background Factors in Trials of Internet-Based Cognitive Behavioral Therapy for Depression: Systematic Review. J Med Internet Res 2024; 26:e50780. [PMID: 38300699 PMCID: PMC10870215 DOI: 10.2196/50780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/05/2023] [Accepted: 11/16/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND There is a growing interest in developing scalable interventions, including internet-based cognitive behavioral therapy (iCBT), to meet the increasing demand for mental health services. Given the growth in diversity worldwide, it is essential that the clinical trials of iCBT for depression include diverse samples or, at least, report information on the race, ethnicity, or other background indicators of their samples. Unfortunately, the field lacks data on how well diversity is currently reported and represented in the iCBT literature. OBJECTIVE Thus, the main objective of this systematic review was to examine the overall reporting of racial and ethnic identities in published clinical trials of iCBT for depression. We also aimed to review the representation of specific racial and ethnic minoritized groups and the inclusion of alternative background indicators such as migration status or country of residence. METHODS Studies were included if they were randomized controlled trials in which iCBT was compared to a waiting list, care-as-usual, active control, or another iCBT. The included papers also had to have a focus on acute treatment (eg, 4 weeks to 6 months) of depression, be delivered via the internet on a website or a smartphone app and use guided or unguided self-help. Studies were initially identified from the METAPSY database (n=59) and then extended to include papers up to 2022, with papers retrieved from Embase, PubMed, PsycINFO, and Cochrane (n=3). Risk of bias assessment suggested that reported studies had at least some risk of bias due to use of self-report outcome measures. RESULTS A total of 62 iCBT randomized controlled trials representing 17,210 participants are summarized in this study. Out of those 62 papers, only 17 (27%) of the trials reported race, and only 12 (19%) reported ethnicity. Reporting outside of the United States was very poor, with the United States accounting for 15 (88%) out of 17 of studies that reported race and 9 (75%) out of 12 for ethnicity. Out of 3,623 participants whose race was reported in the systematic review, the racial category reported the most was White (n=2716, 74.9%), followed by Asian (n=209, 5.8%) and Black (n=274, 7.6%). Furthermore, only 25 (54%) out of the 46 papers conducted outside of the United States reported other background demographics. CONCLUSIONS It is important to note that the underreporting observed in this study does not necessarily indicate an underrepresentation in the actual study population. However, these findings highlight the poor reporting of race and ethnicity in iCBT trials for depression found in the literature. This lack of diversity reporting may have significant implications for the scalability of these interventions.
Collapse
Affiliation(s)
- Robinson De Jesús-Romero
- Department of Psychological and Brain Sciences, Indiana University - Bloomington, Bloomington, IN, United States
| | - Amani R Holder-Dixon
- Department of Psychological and Brain Sciences, Indiana University - Bloomington, Bloomington, IN, United States
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - John F Buss
- Department of Psychological and Brain Sciences, Indiana University - Bloomington, Bloomington, IN, United States
| | - Lorenzo Lorenzo-Luaces
- Department of Psychological and Brain Sciences, Indiana University - Bloomington, Bloomington, IN, United States
| |
Collapse
|
5
|
Alarcón Garavito GA, Burgess R, Dedios Sanguinetti MC, Peters LER, Vera San Juan N. Mental health services implementation in Colombia-A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001565. [PMID: 38055705 DOI: 10.1371/journal.pgph.0001565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 10/02/2023] [Indexed: 12/08/2023]
Abstract
Colombia's mental health services have a complex history shaped by 60 years of armed conflict, a predominantly clinical approach to mental health, and social factors such as inequities and stigma. The 1990 Caracas declaration proposed a shift towards decentralised community mental health services and interventions based on the recovery approach and emphasis on social determinants of mental health in the Americas. Colombia has adopted these approaches in its legal and practical framework in recent years, but implementation has been uneven. This systematic review aims to contribute to mental health services understanding in Colombia by examining the barriers and facilitators to the implementation of mental health services in Colombia. A search was conducted to explore available peer-reviewed studies on Colombian mental health services across five databases (Medline, PubMed, Scopus, Scielo and BVS) on quantitative and qualitative research papers published in the last ten years and without language restrictions. The Consolidated Framework for Implementation Research (CFIR) was used to structure the analysis and identify barriers and facilitators during the implementation of mental health services. We adapted the CFIR to attend to gender, race and age informed by the Socio-Political Economy of Global Mental Health framework, given the importance of these factors to the Colombian health landscape. Finally, narrative synthesis was used to summarise the data. 1 530 records were identified, and 12 articles met all inclusion criteria and were included in the analysis. 8 papers described substance use disorders services, 11 involved multidisciplinary healthcare professionals, and 7 were implemented at a local scale. The primary barriers to implementation were the lack of coordination, high workloads, and low funding. Facilitators included the use of protocols, and the involvement of communities, stakeholders, users, and external champions. Findings suggest the continued importance of community and recovery approaches and efforts to improve coordination between multi-sector actors involved in the mental health spaces (e.g., public, and private organisations, users and their families).
Collapse
Affiliation(s)
- Germán Andrés Alarcón Garavito
- Institute for Global Health-University College London, London, United Kingdom
- School of Government-Universidad de los Andes, Bogotá, Colombia
| | - Rochelle Burgess
- Institute for Global Health-University College London, London, United Kingdom
| | | | - Laura E R Peters
- Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
- College of Earth, Ocean, and Atmospheric Sciences, Oregon State University, Corvallis, OR, United States of America
| | - Norha Vera San Juan
- Institute for Global Health-University College London, London, United Kingdom
| |
Collapse
|
6
|
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).
Collapse
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
| |
Collapse
|
7
|
Wang D, Lin B, Xiong F, Deng Y, Zhang L. Effectiveness of Internet-delivered self-help acceptance and commitment therapy (iACT) on nurses' obsessive-compulsive symptoms and sleep quality: A randomized controlled trial with 3-month follow-up. J Affect Disord 2023; 341:319-328. [PMID: 37659615 DOI: 10.1016/j.jad.2023.08.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/14/2023] [Accepted: 08/27/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Frontline nurses suffered unprecedented mental distress during the COVID-19 pandemic. It's essential to explore new and more accessible alternatives to improve the availability of psychological treatments. This study aimed to investigate the influence of online self-help iACT linear intervention and iACT loop intervention on sleep quality (SQ), obsessive-compulsive symptoms (OCS), and psychological flexibility (PF) in nurses. METHODS A randomized controlled trial was conducted at a hospital in China. 602 participants were randomly assigned to the iACT linear intervention, iACT loop intervention, or wait list control group, and required to complete the questionnaires of OCS, PF and SQ. The linear mixed effects analysis (LMM) was used to analyze the impact of the intervention on outcome variables. RESULTS LMM analyses demonstrated that both two intervention had significant improvement on OCS (t = -38.235, p < 0.001), PF (t = 28.156, p < 0.001), as well as SQ (t = -16.336, p < 0.001). There were significant differences between the linear group and loop group on the PF in T2 (t = -8.271, p < 0.001), T3 (t = -8.366, p < 0.001), T4 (t = -8.302, p < 0.001), with the iACT loop model (Cohen's d = 1.652) showing a slight advantage over the iACT linear model (Cohen's d = 1.134). CONCLUSIONS The findings indicate that two interventions positively impact OCS, PF, and SQ. Compared to the iACT linear psychotherapy model, the iACT loop model shows greater effectiveness in enhancing PF, making it helpful to promote significant improvements in psychotherapy planning.
Collapse
Affiliation(s)
- Difan Wang
- School of Psychology, Central China Normal University, China; Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, China; Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan, China; Department of Field Internal Medicine, Psychological Counseling and Service Center, Graduate School of Medical College of Chinese PLA General Hospital, China
| | - Bingyan Lin
- School of Foreign Languages, Harbin University of Science and Technology, China
| | - Fen Xiong
- School of Psychology, Central China Normal University, China; Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, China; Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan, China
| | - Yu Deng
- School of Foreign Languages, Harbin University of Science and Technology, China
| | - Lin Zhang
- School of Psychology, Central China Normal University, China; Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, China; Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan, China.
| |
Collapse
|
8
|
Zimmerman A, García Durán MC, Araya R, Avendano M, Hessel P, Díaz Y, Peña Niño OD, Donetto S, Escobar Lux M, Idrobo F. Piloting a mental health intervention for young adults in poverty enrolled in post-secondary education in post-conflict regions in Colombia: a study protocol. Front Psychiatry 2023; 14:1238725. [PMID: 38034913 PMCID: PMC10686213 DOI: 10.3389/fpsyt.2023.1238725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/23/2023] [Indexed: 12/02/2023] Open
Abstract
Background Colombia has endured more than five decades of internal armed conflict, which led to substantial costs for human capital and mental health. There is currently little evidence about the impact of incorporating a mental health intervention within an existing public cash transfer program to address poverty, and this project aims to develop and pilot a mental health support intervention embedded within the human capital program to achieve better outcomes among beneficiaries, especially those displaced by conflict and the most socioeconomically vulnerable. Methods The study will consist of three phases: semi-structured one-to-one interviews, co-design and adaptations of the proposed intervention with participants and pilot of the digital intervention based on cognitive behavioral therapy and transdiagnostic techniques to determine its feasibility, acceptability, efficacy, and usefulness in 'real settings'. Results will inform if the intervention improves clinical, educational and employment prospects among those who use it. Results Knowledge will be generated on whether the mental health intervention could potentially improve young people's mental health and human capital in conflict-affected areas? We will evaluate of the impact of potential mental health improvements on human capital outcomes, including educational and employment outcomes. Conclusion Findings will help to make conclusions about the feasibility and acceptability of the intervention, and it will assess its effectiveness to improve the mental health and human capital outcomes of beneficiaries. This will enable the identification of strategies to address mental health problems among socioeconomically vulnerable young people that can be adapted to different contexts in in low and middle-income countries.
Collapse
Affiliation(s)
- Annie Zimmerman
- Global Health and Social Medicine, King's College London, London, United Kingdom
| | | | - Ricardo Araya
- Global Health and Social Medicine, King's College London, London, United Kingdom
| | - Mauricio Avendano
- Health Service and Population Research Department, King's College London Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
- Health Policy Unit at the Department of Epidemiology and Health Systems in Unisanté at the University of Lausanne, Lausanne, Switzerland
| | - Philipp Hessel
- Escuela de Gobierno Alberto Lleras Camargo, Universidad de los Andes, Bogotá, Colombia
| | - Yadira Díaz
- Escuela de Gobierno Alberto Lleras Camargo, Universidad de los Andes, Bogotá, Colombia
| | | | - Sara Donetto
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care at King’s College London, London, United Kingdom
| | - Martha Escobar Lux
- Eje de Salud Poblacional, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Departamento de Salud Mental, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Facultad de Medicina, Universidad de Los Andes, Bogotá, Colombia
| | - Fabio Idrobo
- Eje de Salud Poblacional, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Facultad de Medicina, Universidad de Los Andes, Bogotá, Colombia
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, United States
| |
Collapse
|
9
|
Eustis EH, LoPresti J, Aguilera A, Schueller SM. Cultural Responsivity in Technology-Enabled Services: Integrating Culture Into Technology and Service Components. J Med Internet Res 2023; 25:e45409. [PMID: 37788050 PMCID: PMC10582817 DOI: 10.2196/45409] [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: 12/29/2022] [Revised: 07/31/2023] [Accepted: 08/21/2023] [Indexed: 10/04/2023] Open
Abstract
Technology-enabled services (TESs) are clinical interventions that combine technological and human components to provide health services. TESs for mental health are efficacious in the treatment of anxiety and depression and are currently being offered as frontline treatments around the world. It is hoped that these interventions will be able to reach diverse populations across a range of identities and ultimately decrease disparities in mental health treatment. However, this hope is largely unrealized. TESs include both technology and human service components, and we argue that cultural responsivity must be considered in each of these components to help address existing treatment disparities. To date, there is limited guidance on how to consider cultural responsivity within these interventions, including specific targets for the development, tailoring, or design of the technologies and services within TESs. In response, we propose a framework that provides specific recommendations for targets based on existing models, both at the technological component level (informed by the Behavioral Intervention Technology Model) and the human support level (informed by the Efficiency Model of Support). We hope that integrating culturally responsive considerations into these existing models will facilitate increased attention to cultural responsivity within TESs to ensure they are ethical and responsive for everyone.
Collapse
Affiliation(s)
- Elizabeth H Eustis
- Center for Anxiety and Related Disorders, Boston University, Boston, MA, United States
| | - Jessica LoPresti
- Department of Psychology, Suffolk University, Boston, MA, United States
| | - Adrian Aguilera
- School of Social Welfare, University of California Berkeley, Berkeley, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Stephen M Schueller
- Department of Psychological Science, University of California Irvine, Irvine, CA, United States
| |
Collapse
|
10
|
Wang M, Chen H, Yang F, Xu X, Li J. Effects of digital psychotherapy for depression and anxiety: A systematic review and bayesian network meta-analysis. J Affect Disord 2023; 338:569-580. [PMID: 37392941 DOI: 10.1016/j.jad.2023.06.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/18/2023] [Accepted: 06/26/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of digital psychotherapies for depression and anxiety. We conducted a systematic review and network meta-analyses (NMA) to make comparisons of digital psychotherapies. METHODS A bayesian NMA was conducted in this study. The databases including PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials and CINAL were searched for all eligible randomized controlled trials (RCTs) published from Jan 1, 2012 to Oct 1, 2022. We used the Cochrane Collaboration's Risk of bias tool for quality assessment. The primary outcomes were set as a standardized mean difference model in efficacy to describe continuous outcomes. We used STATA and WinBUGS to conduct a bayesian network meta-analysis of all interventions based on a random-effects model. This study was registered with PROSPERO, number CRD42022374558. RESULTS From the retrieved 16,750 publications, we included 72 RCTs (13,096 participants) with the overall medium quality and above. In terms of depression scale, cognitive behavioral therapy (CBT) was more effective than TAU (SMDs 0.53) and NT (SMDs 0.98). In terms of anxiety scale, CBT (SMDs 0.68; SMDs 0.72) and exercise therapy (ERT) (SMDs 1.01; SMDs 1.05) were more effective than TAU and NT. LIMITATIONS Uneven quality of literature, simple network, and subjective judgment. CONCLUSION Based on NMA results, we suggest that CBT, which is the most commonly used digital technology, should be preferred among digital psychotherapy for relieving depression and anxiety symptoms. Digital exercise therapy is an effective strategy to relieve some anxiety problems in the context of COVID-19.
Collapse
Affiliation(s)
- Min Wang
- Institute of Medical Information/Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, China
| | - Haoran Chen
- Institute of Medical Information/Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, China
| | - Fengchun Yang
- Institute of Medical Information/Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, China
| | - Xiaowei Xu
- Institute of Medical Information/Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, China
| | - Jiao Li
- Institute of Medical Information/Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, China.
| |
Collapse
|
11
|
Karyotaki E, Miguel C, Panagiotopoulou OM, Harrer M, Seward N, Sijbrandij M, Araya R, Patel V, Cuijpers P. Digital interventions for common mental disorders in low- and middle-income countries: A systematic review and meta-analysis. Glob Ment Health (Camb) 2023; 10:e68. [PMID: 38024798 PMCID: PMC10643260 DOI: 10.1017/gmh.2023.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/26/2023] [Accepted: 09/02/2023] [Indexed: 12/01/2023] Open
Abstract
Background In low-resource settings, e-mental health may substantially increase access to evidence-based interventions for common mental disorders. We conducted a systematic literature search to identify randomised trials examining the effects of digital interventions with or without therapeutic guidance compared to control conditions in individuals with anxiety and/or depression symptoms in low- and middle-income countries (LMICs). Methods The main outcome was the reduction in symptoms at the post-test. Secondary outcomes included improvements in quality of life and longer-term effects (≥20 weeks post-randomisation). The effect size Hedges' g was calculated using the random effects model. Results A total of 21 studies (23 comparisons) with 5.296 participants were included. Digital interventions were more effective than controls in reducing symptoms of common mental disorders at the post-test (g = -0.89, 95% confidence interval [CI] -1.26 to -0.52, p < 0.001; NNT = 2.91). These significant effects were confirmed when examining depressive (g = -0.77, 95% CI -1.11; -0.44) and anxiety symptoms separately (g = -1.02, 95% CI -1.53 to -0.52) and across all other sensitivity analyses. Digital interventions also resulted in a small but significant effect in improving quality of life (g = 0.32, 95% CI 0.19 to 0.45) at the post-test. Over the longer term, the effects were smaller but remained significant for all examined outcomes. Heterogeneity was moderate to high in all analyses. Subgroup and meta-regression analyses did not result in significant outcomes in any of the examined variables (e.g., guided vs. unguided interventions). Conclusions Digital interventions, with or without guidance, may effectively bridge the gap between treatment supply and demand in LMICs. Nevertheless, more studies are needed to draw firm conclusions regarding the magnitude of the effects of digital interventions.
Collapse
Affiliation(s)
- Eirini Karyotaki
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Clara Miguel
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Olga M. Panagiotopoulou
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Department of Health Sciences, Technical University Munich, Munich, Germany
- Department of Clinical Psychology & Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Nadine Seward
- Center for Global Mental Health and Primary Care Research, Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Marit Sijbrandij
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ricardo Araya
- Center for Global Mental Health and Primary Care Research, Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
12
|
Forbes A, Keleher MR, Venditto M, DiBiasi F. Assessing Patient Adherence to and Engagement With Digital Interventions for Depression in Clinical Trials: Systematic Literature Review. J Med Internet Res 2023; 25:e43727. [PMID: 37566447 PMCID: PMC10457707 DOI: 10.2196/43727] [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: 10/24/2022] [Revised: 04/24/2023] [Accepted: 06/28/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND New approaches to the treatment of depression are necessary for patients who do not respond to current treatments or lack access to them because of barriers such as cost, stigma, and provider shortage. Digital interventions for depression are promising; however, low patient engagement could limit their effectiveness. OBJECTIVE This systematic literature review (SLR) assessed how participant adherence to and engagement with digital interventions for depression have been measured in the published literature, what levels of adherence and engagement have been reported, and whether higher adherence and increased engagement are linked to increased efficacy. METHODS We focused on a participant population of adults (aged ≥18 years) with depression or major depressive disorder as the primary diagnosis and included clinical trials, feasibility studies, and pilot studies of digital interventions for treating depression, such as digital therapeutics. We screened 756 unique records from Ovid MEDLINE, Embase, and Cochrane published between January 1, 2000, and April 15, 2022; extracted data from and appraised the 94 studies meeting the inclusion criteria; and performed a primarily descriptive analysis. Otsuka Pharmaceutical Development & Commercialization, Inc (Princeton, New Jersey, United States) funded this study. RESULTS This SLR encompassed results from 20,111 participants in studies using 47 unique web-based interventions (an additional 10 web-based interventions were not described by name), 15 mobile app interventions, 5 app-based interventions that are also accessible via the web, and 1 CD-ROM. Adherence was most often measured as the percentage of participants who completed all available modules. Less than half (44.2%) of the participants completed all the modules; however, the average dose received was 60.7% of the available modules. Although engagement with digital interventions was measured differently in different studies, it was most commonly measured as the number of modules completed, the mean of which was 6.4 (means ranged from 1.0 to 19.7) modules. The mean amount of time participants engaged with the interventions was 3.9 (means ranged from 0.7 to 8.4) hours. Most studies of web-based (34/45, 76%) and app-based (8/9, 89%) interventions found that the intervention group had substantially greater improvement for at least 1 outcome than the control group (eg, care as usual, waitlist, or active control). Of the 14 studies that investigated the relationship between engagement and efficacy, 9 (64%) found that increased engagement with digital interventions was significantly associated with improved participant outcomes. The limitations of this SLR include publication bias, which may overstate engagement and efficacy, and low participant diversity, which reduces the generalizability. CONCLUSIONS Patient adherence to and engagement with digital interventions for depression have been reported in the literature using various metrics. Arriving at more standardized ways of reporting adherence and engagement would enable more effective comparisons across different digital interventions, studies, and populations.
Collapse
Affiliation(s)
- Ainslie Forbes
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, United States
| | | | | | - Faith DiBiasi
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, United States
| |
Collapse
|
13
|
Cohen ZD, Schueller SM. Expanding, improving, and understanding behaviour research and therapy through digital mental health. Behav Res Ther 2023; 167:104358. [PMID: 37418857 DOI: 10.1016/j.brat.2023.104358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Affiliation(s)
- Zachary D Cohen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA.
| | - Stephen M Schueller
- Department of Psychological Science, University of California, Irvine, USA; Department of Informatics, University of California, Irvine, USA
| |
Collapse
|
14
|
D’Adamo L, Paraboschi L, Grammer AC, Fennig M, Graham AK, Yaeger LH, Newman MG, Wilfley DE, Taylor CB, Eisenberg D, Fitzsimmons-Craft EE. Reach and uptake of digital mental health interventions based on cognitive-behavioral therapy for college students: A systematic review. JOURNAL OF BEHAVIORAL AND COGNITIVE THERAPY 2023; 33:97-117. [PMID: 37724304 PMCID: PMC10506850 DOI: 10.1016/j.jbct.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Background Mental health problems are increasing in prevalence among college students, yet few students receive treatment due to barriers such as insufficient resources in college counseling centers. Digital mental health interventions (DMHIs) have potential to overcome barriers and offer accessible, evidence-based care to college students. However, to evaluate the true public health impact of evidence-based DMHIs, it is important to assess the reach and uptake rates of DMHIs on college campuses. Objectives We conducted a systematic review to examine the reach (i.e., % of invited students who express interest) and uptake (i.e., % of enrolled participants who initiate an intervention) of DMHIs based on cognitive-behavioral therapy (CBT) for college students. Methods Eight databases were searched. Inclusion criteria included: (1) college population; (2) experimental design; (3) CBT-based intervention; (4) intervention targeting specific mental health conditions; and (5) digital intervention. Reach and uptake rates were calculated from data reported. A systematic narrative review framework was used to synthesize results. Results Of 10,315 articles screened, 90 were included. Seventeen studies (19%) reported sufficient data to calculate reach; 35 studies (39%) reported uptake rates. Of studies that reported reach or uptake, most evaluated unguided (n = 20) or guided (n = 16) self-help programs. Measurement methods varied widely. Overall reach was low, whereas uptake was high among enrolled participants. Discussion Despite evidence that improving reach and uptake can increase the public health impact of DMHIs, most studies did not report on either outcome. Suggested practices to improve these outcomes, and their reporting, are discussed.
Collapse
Affiliation(s)
- Laura D’Adamo
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
- Department of Psychological and Brain Sciences and Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, 3201 Chestnut St. Philadelphia, PA 19104, USA
| | - Layna Paraboschi
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Anne Claire Grammer
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Molly Fennig
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N St Clair St, Chicago, IL 60611, USA
| | - Lauren H. Yaeger
- Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, USA
| | - Michelle G. Newman
- Department of Psychology, The Pennsylvania State University, 371 Moore Building, University Park, PA 16801, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA
- Center for m Health, Palo Alto University, 5150 El Camino Real, Los Altos, CA 94022, USA
| | - Daniel Eisenberg
- Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Ellen E. Fitzsimmons-Craft
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| |
Collapse
|
15
|
Hornstein S, Zantvoort K, Lueken U, Funk B, Hilbert K. Personalization strategies in digital mental health interventions: a systematic review and conceptual framework for depressive symptoms. Front Digit Health 2023; 5:1170002. [PMID: 37283721 PMCID: PMC10239832 DOI: 10.3389/fdgth.2023.1170002] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction Personalization is a much-discussed approach to improve adherence and outcomes for Digital Mental Health interventions (DMHIs). Yet, major questions remain open, such as (1) what personalization is, (2) how prevalent it is in practice, and (3) what benefits it truly has. Methods We address this gap by performing a systematic literature review identifying all empirical studies on DMHIs targeting depressive symptoms in adults from 2015 to September 2022. The search in Pubmed, SCOPUS and Psycinfo led to the inclusion of 138 articles, describing 94 distinct DMHIs provided to an overall sample of approximately 24,300 individuals. Results Our investigation results in the conceptualization of personalization as purposefully designed variation between individuals in an intervention's therapeutic elements or its structure. We propose to further differentiate personalization by what is personalized (i.e., intervention content, content order, level of guidance or communication) and the underlying mechanism [i.e., user choice, provider choice, decision rules, and machine-learning (ML) based approaches]. Applying this concept, we identified personalization in 66% of the interventions for depressive symptoms, with personalized intervention content (32% of interventions) and communication with the user (30%) being particularly popular. Personalization via decision rules (48%) and user choice (36%) were the most used mechanisms, while the utilization of ML was rare (3%). Two-thirds of personalized interventions only tailored one dimension of the intervention. Discussion We conclude that future interventions could provide even more personalized experiences and especially benefit from using ML models. Finally, empirical evidence for personalization was scarce and inconclusive, making further evidence for the benefits of personalization highly needed. Systematic Review Registration Identifier: CRD42022357408.
Collapse
Affiliation(s)
- Silvan Hornstein
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kirsten Zantvoort
- Institute of Information Systems, Leuphana University, Lueneburg, Germany
| | - Ulrike Lueken
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Burkhardt Funk
- Institute of Information Systems, Leuphana University, Lueneburg, Germany
| | - Kevin Hilbert
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
16
|
Yoshinaga N, Thew GR, Hayashi Y, Matsuoka J, Tanoue H, Takanashi R, Araki M, Kanai Y, Smith A, Grant SHL, Clark DM. Preliminary Evaluation of Translated and Culturally Adapted Internet-Delivered Cognitive Therapy for Social Anxiety Disorder: Multicenter, Single-Arm Trial in Japan. JMIR Form Res 2023; 7:e45136. [PMID: 37145850 DOI: 10.2196/45136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/15/2023] [Accepted: 03/31/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Internet-delivered cognitive therapy for social anxiety disorder (iCT-SAD), which is a therapist-guided modular web-based treatment, has shown strong efficacy and acceptability in English-language randomized controlled trials in the United Kingdom and Hong Kong. However, it is not yet known whether iCT-SAD can retain its efficacy following linguistic translation and cultural adaptation of treatment contents and implementation in other countries such as Japan. OBJECTIVE This study aimed to examine the preliminary efficacy and acceptability of the translated and culturally adapted iCT-SAD in Japanese clinical settings. METHODS This multicenter, single-arm trial recruited 15 participants with social anxiety disorder. At the time of recruitment, participants were receiving usual psychiatric care but had not shown improvement in their social anxiety and required additional treatment. iCT-SAD was provided in combination with usual psychiatric care for 14 weeks (treatment phase) and for a subsequent 3-month follow-up phase that included up to 3 booster sessions. The primary outcome measure was the self-report version of the Liebowitz Social Anxiety Scale. The secondary outcome measures examined social anxiety-related psychological processes, taijin kyofusho (the fear of offending others), depression, generalized anxiety, and general functioning. The assessment points for the outcome measures were baseline (week 0), midtreatment (week 8), posttreatment (week 15; primary assessment point), and follow-up (week 26). Acceptability was measured using the dropout rate from the treatment, the level of engagement with the program (the rate of module completion), and participants' feedback about their experience with the iCT-SAD. RESULTS Evaluation of the outcome measures data showed that iCT-SAD led to significant improvements in social anxiety symptoms during the treatment phase (P<.001; Cohen d=3.66), and these improvements were maintained during the follow-up phase. Similar results were observed for the secondary outcome measures. At the end of the treatment phase, 80% (12/15) of participants demonstrated reliable improvement, and 60% (9/15) of participants demonstrated remission from social anxiety. Moreover, 7% (1/15) of participants dropped out during treatment, and 7% (1/15) of participants declined to undergo the follow-up phase after completing the treatment. No serious adverse events occurred. On average, participants completed 94% of the modules released to them. Participant feedback was positive and highlighted areas of strength in treatment, and it included further suggestions to improve suitability for Japanese settings. CONCLUSIONS Translated and culturally adapted iCT-SAD demonstrated promising initial efficacy and acceptability for Japanese clients with social anxiety disorder. A randomized controlled trial is required to examine this more robustly.
Collapse
Affiliation(s)
- Naoki Yoshinaga
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Graham R Thew
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Yuta Hayashi
- Department of Nursing, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Jun Matsuoka
- Higashi-Omiya Mental Health Clinic, Saitama, Japan
- Ogu Mental Health Clinic, Tokyo, Japan
| | - Hiroki Tanoue
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Rieko Takanashi
- Department of Psychology, Teikyo University, Tokyo, Japan
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | | | - Yoshihiro Kanai
- Department of Psychology and Behavioral Sciences, Faculty of Human Sciences, Tohoku Gakuin University, Sendai, Japan
| | - Alisha Smith
- School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Sophie H L Grant
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - David M Clark
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
17
|
Kim J, Aryee LMD, Bang H, Prajogo S, Choi YK, Hoch JS, Prado EL. Effectiveness of Digital Mental Health Tools to Reduce Depressive and Anxiety Symptoms in Low- and Middle-Income Countries: Systematic Review and Meta-analysis. JMIR Ment Health 2023; 10:e43066. [PMID: 36939820 PMCID: PMC10131603 DOI: 10.2196/43066] [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: 09/29/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Depression and anxiety contribute to an estimated 74.6 million years of life with disability, and 80% of this burden occurs in low- and middle-income countries (LMICs), where there is a large gap in care. OBJECTIVE We aimed to systematically synthesize available evidence and quantify the effectiveness of digital mental health interventions in reducing depression and anxiety in LMICs. METHODS In this systematic review and meta-analysis, we searched PubMed, Embase, and Cochrane databases from the inception date to February 2022. We included randomized controlled trials conducted in LMICs that compared groups that received digital health interventions with controls (active control, treatment as usual, or no intervention) on depression or anxiety symptoms. Two reviewers independently extracted summary data reported in the papers and performed study quality assessments. The outcomes were postintervention measures of depression or anxiety symptoms (Hedges g). We calculated the pooled effect size weighted by inverse variance. RESULTS Among 11,196 retrieved records, we included 80 studies in the meta-analysis (12,070 participants n=6052, 50.14% in the intervention group and n=6018, 49.85% in the control group) and 96 studies in the systematic review. The pooled effect sizes were -0.61 (95% CI -0.78 to -0.44; n=67 comparisons) for depression and -0.73 (95% CI -0.93 to -0.53; n=65 comparisons) for anxiety, indicating that digital health intervention groups had lower postintervention depression and anxiety symptoms compared with controls. Although heterogeneity was considerable (I2=0.94 for depression and 0.95 for anxiety), we found notable sources of variability between the studies, including intervention content, depression or anxiety symptom severity, control type, and age. Grading of Recommendations, Assessments, Development, and Evaluation showed that the evidence quality was overall high. CONCLUSIONS Digital mental health tools are moderately to highly effective in reducing depression and anxiety symptoms in LMICs. Thus, they could be effective options to close the gap in depression and anxiety care in LMICs, where the usual mental health care is minimal. TRIAL REGISTRATION PROSPERO CRD42021289709; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=289709.
Collapse
Affiliation(s)
- Jiyeong Kim
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Lois M D Aryee
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Steffi Prajogo
- Johns Hopkins Bayview Medical Center, Baltimore, MD, United States
| | - Yong K Choi
- Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Elizabeth L Prado
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, Davis, CA, United States
| |
Collapse
|
18
|
Silveus SA, Schmit MK, Oliveira JT, Hughes LE. Meta‐analysis of culturally adapted cognitive behavioral therapy for anxiety and depression. JOURNAL OF COUNSELING AND DEVELOPMENT 2023. [DOI: 10.1002/jcad.12463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- Sarah A. Silveus
- Hazelden Betty Ford Graduate School of Addiction Studies Center City Minnesota USA
| | - Michael K. Schmit
- Hazelden Betty Ford Graduate School of Addiction Studies Center City Minnesota USA
| | - Joy Teles Oliveira
- Department of Counseling & Human Services University of North Texas‐Dallas Dallas Texas USA
| | | |
Collapse
|
19
|
Alavi N, Moghimi E, Stephenson C, Gutierrez G, Jagayat J, Kumar A, Shao Y, Miller S, Yee CS, Stefatos A, Gholamzadehmir M, Abbaspour Z, Shirazi A, Gizzarelli T, Khan F, Patel C, Patel A, Yang M, Omrani M. Comparison of online and in-person cognitive behavioral therapy in individuals diagnosed with major depressive disorder: a non-randomized controlled trial. Front Psychiatry 2023; 14:1113956. [PMID: 37187863 PMCID: PMC10175610 DOI: 10.3389/fpsyt.2023.1113956] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
Objective The increased prevalence of major depressive disorder (MDD) amid the COVID-19 pandemic has resulted in substantial growth in online mental health care delivery. Compared to its in-person counterpart, online cognitive behavioral therapy (e-CBT) is a time-flexible and cost-effective method of improving MDD symptoms. However, how its efficacy compares to in-person CBT is yet to be explored. Therefore, the current study compared the efficacy of a therapist-supported, electronically delivered e-CBT program to in-person therapy in individuals diagnosed with MDD. Methods Participants (n = 108) diagnosed with MDD selected either a 12 week in-person CBT or an asynchronous therapist-supported e-CBT program. E-CBT participants (n = 55) completed weekly interactive online modules delivered through a secure cloud-based online platform (Online Psychotherapy Tool; OPTT). These modules were followed by homework in which participants received personalized feedback from a trained therapist. Participants in the in-person CBT group (n = 53) discussed sessions and homework with their therapists during one-hour weekly meetings. Program efficacy was evaluated using clinically validated symptomatology and quality of life questionnaires. Results Both treatments yielded significant improvements in depressive symptoms and quality of life from baseline to post-treatment. Participants who opted for in-person therapy presented significantly higher baseline symptomatology scores than the e-CBT group. However, both treatments demonstrated comparable significant improvements in depressive symptoms and quality of life from baseline to post-treatment. e-CBT seems to afford higher participant compliance as dropouts in the e-CBT group completed more sessions on average than those in the in-person CBT group. Conclusion The findings support e-CBT with therapist guidance as a suitable option to treat MDD. Future studies should investigate how treatment accessibility is related to program completion rates in the e-CBT vs. in-person group. Clinical Trial Registration ClinicalTrials.Gov Protocol Registration and Results System (NCT04478058); clinicaltrials.gov/ct2/show/NCT04478058.
Collapse
Affiliation(s)
- Nazanin Alavi
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
- OPTT Inc., Toronto, ON, Canada
- *Correspondence: Nazanin Alavi,
| | - Elnaz Moghimi
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
| | | | - Gilmar Gutierrez
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
| | - Jasleen Jagayat
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
| | - Anchan Kumar
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
| | - Yijia Shao
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Shadé Miller
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
| | - Caitlin S. Yee
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
| | - Anthi Stefatos
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
| | | | - Zara Abbaspour
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
| | | | - Tessa Gizzarelli
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
| | - Ferwa Khan
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
| | - Charmy Patel
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
| | - Archana Patel
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
| | - Megan Yang
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
| | - Mohsen Omrani
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
- OPTT Inc., Toronto, ON, Canada
| |
Collapse
|
20
|
Børtveit L, Dechsling A, Sütterlin S, Nordgreen T, Nordahl-Hansen A. Guided Internet-Delivered Treatment for Depression: Scoping Review. JMIR Ment Health 2022; 9:e37342. [PMID: 36194467 PMCID: PMC9579933 DOI: 10.2196/37342] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/01/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies on guided internet-delivered treatment have demonstrated promising results for patients with depressive disorder. OBJECTIVE The aim of this study was to provide an overview of this research area and identify potential gaps in the research. METHODS In this scoping review, web-based databases were used to identify research papers published between 2010 and 2022 where guided internet-delivered treatment was administered to participants with depressive disorders, a standardized rating scale of depressive symptoms was used as the primary outcome measure, and the treatment was compared with a control condition. RESULTS A total of 111 studies were included, and an overview of the studies was provided. Several gaps in the research were identified regarding the design of the studies, treatments delivered, participant representation, and treatment completion. CONCLUSIONS This review provides a comprehensive overview of the research area, and several research gaps were identified. The use of other designs and active control conditions is recommended. Future studies should provide access to treatment manuals, and more replications should be conducted. Researchers should aim to include underrepresented populations and provide reports of comorbidities. Definitions of adequate dosage, reports of completion rates, and reasons for treatment dropout are recommended for future studies.
Collapse
Affiliation(s)
- Line Børtveit
- Faculty of Health, Welfare and Organisation, Østfold University College, Halden, Norway.,Faculty of Health Sciences, Department of Behavioral Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Anders Dechsling
- Department of Education, ICT, and Learning, Østfold University College, Halden, Norway
| | - Stefan Sütterlin
- Faculty of Health, Welfare and Organisation, Østfold University College, Halden, Norway.,Faculty of Computer Science, Albstadt-Sigmaringen University, Sigmaringen, Germany
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Departement of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Anders Nordahl-Hansen
- Department of Education, ICT, and Learning, Østfold University College, Halden, Norway
| |
Collapse
|
21
|
Benjet C, Kessler RC, Kazdin AE, Cuijpers P, Albor Y, Carrasco Tapias N, Contreras-Ibáñez CC, Durán González MS, Gildea SM, González N, Guerrero López JB, Luedtke A, Medina-Mora ME, Palacios J, Richards D, Salamanca-Sanabria A, Sampson NA. Study protocol for pragmatic trials of Internet-delivered guided and unguided cognitive behavior therapy for treating depression and anxiety in university students of two Latin American countries: the Yo Puedo Sentirme Bien study. Trials 2022; 23:450. [PMID: 35658942 PMCID: PMC9164185 DOI: 10.1186/s13063-022-06255-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 03/29/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are highly prevalent among university students and predict impaired college performance and later life role functioning. Yet most students do not receive treatment, especially in low-middle-income countries (LMICs). We aim to evaluate the effects of expanding treatment using scalable and inexpensive Internet-delivered transdiagnostic cognitive behavioral therapy (iCBT) among college students with symptoms of MDD and/or GAD in two LMICs in Latin America (Colombia and Mexico) and to investigate the feasibility of creating a precision treatment rule (PTR) to predict for whom iCBT is most effective. METHODS We will first carry out a multi-site randomized pragmatic clinical trial (N = 1500) of students seeking treatment at student mental health clinics in participating universities or responding to an email offering services. Students on wait lists for clinic services will be randomized to unguided iCBT (33%), guided iCBT (33%), and treatment as usual (TAU) (33%). iCBT will be provided immediately whereas TAU will be whenever a clinic appointment is available. Short-term aggregate effects will be assessed at 90 days and longer-term effects 12 months after randomization. We will use ensemble machine learning to predict heterogeneity of treatment effects of unguided versus guided iCBT versus TAU and develop a precision treatment rule (PTR) to optimize individual student outcome. We will then conduct a second and third trial with separate samples (n = 500 per arm), but with unequal allocation across two arms: 25% will be assigned to the treatment determined to yield optimal outcomes based on the PTR developed in the first trial (PTR for optimal short-term outcomes for Trial 2 and 12-month outcomes for Trial 3), whereas the remaining 75% will be assigned with equal allocation across all three treatment arms. DISCUSSION By collecting comprehensive baseline characteristics to evaluate heterogeneity of treatment effects, we will provide valuable and innovative information to optimize treatment effects and guide university mental health treatment planning. Such an effort could have enormous public-health implications for the region by increasing the reach of treatment, decreasing unmet need and clinic wait times, and serving as a model of evidence-based intervention planning and implementation. TRIAL STATUS IRB Approval of Protocol Version 1.0; June 3, 2020. Recruitment began on March 1, 2021. Recruitment is tentatively scheduled to be completed on May 30, 2024. TRIAL REGISTRATION ClinicalTrials.gov NCT04780542 . First submission date: February 28, 2021.
Collapse
Affiliation(s)
- Corina Benjet
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico.
| | - Ronald C Kessler
- Department of Health care Policy, Harvard Medical School, Boston, MA, USA
| | | | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Yesica Albor
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | | | | | | | - Sarah M Gildea
- Department of Health care Policy, Harvard Medical School, Boston, MA, USA
| | - Noé González
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz and School of Psychology, UNAM, Mexico City, Mexico
| | | | - Alex Luedtke
- Department of Statistics, University of Washington, Seattle, WA, USA
| | - Maria Elena Medina-Mora
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz and School of Psychology, UNAM, Mexico City, Mexico
| | - Jorge Palacios
- SilverCloud Health, Dublin, Ireland
- E-mental Health Group, School of Psychology, University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - Derek Richards
- SilverCloud Health, Dublin, Ireland
- E-mental Health Group, School of Psychology, University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - Alicia Salamanca-Sanabria
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore
| | - Nancy A Sampson
- Department of Health care Policy, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
22
|
Lara MA, Patiño P, Tiburcio M, Navarrete L. Satisfaction and Acceptability Ratings of a Web-Based Self-help Intervention for Depression: Retrospective Cross-sectional Study From a Resource-Limited Country. JMIR Form Res 2022; 6:e29566. [PMID: 35377324 PMCID: PMC9016498 DOI: 10.2196/29566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 10/25/2021] [Accepted: 12/03/2021] [Indexed: 01/27/2023] Open
Abstract
Background Web-based interventions are at an early stage in non–English-speaking low- and middle-income countries, where they remain scarce. Help for Depression (HDep) is one of the few unguided web-based interventions available in Latin America. The results of a use/usability analysis of the original version served as the basis for generating a more user-friendly second version. Objective The aim of this study is to explore participants’ satisfaction and acceptability for the second version of HDep. Methods A retrospective cross-sectional design was used. An email invitation to complete a web-based survey was sent to all people who accessed HDep in 2018. The questionnaire included satisfaction and acceptability scales and open-ended questions. Complete questionnaires were retrieved from 191 participants: 35.1% (67/191) from those who visited only the home page (home page users [HPUs]) and 6.47% (124/1916) from those who registered to use the program (program users [PUs]). Results In all groups, users experienced high levels of depressive symptoms (189/191, 98.9%; Center for Epidemiological Studies Scale-Depression >16). Moderate levels of satisfaction (HPUs: mean 21.9, SD 6.7; PUs: mean 21.1, SD 5.8; range: 8-32) and acceptability (HPUs: mean 13.8, SD 3.9; PUs: mean 13.9, SD 3.2; range: 5-20) were found in both groups. Logistic regression analyses showed that among HPUs, women were more satisfied with HDep (odds ratio [OR] 3.4, 95% CI 1.1-10.0), whereas among PUs, older respondents (OR 1.04, 95% CI 1.01-1.08), those with paid work (OR 3.1, 95% CI 2.4-7.6), those who had not been in therapy (OR 2.42, 95% CI 1.09-5.98), and those who had not attempted suicide (OR 3.4, 95% CI 1.1-11.1) showed higher satisfaction. None of the sociodemographic/mental health variables distinguished the acceptability ratings among HPUs. Among PUs, those with paid work (OR 2.5, 95% CI 1.1-5.5), those who had not been in therapy (OR 3.1, 95% CI 1.3-7.3), those without disability (OR 2.9, 95% CI 1.3-6.6), and those who had not attempted suicide (OR 2.6, 95% CI 1.0-6.6) showed higher acceptability. Conclusions HDep has good levels of satisfaction and acceptability for approximately half of its users, and the information provided by respondents suggested feasible ways to remedy some of the deficiencies. This qualitative–quantitative study from a low- to middle-income, non–English-speaking country adds to existing knowledge regarding acceptance and satisfaction with web-based interventions for depression in resource-limited countries. This information is important for the creation and adaptation of web-based interventions in low- and middle-income countries, where access to treatment is a major concern, and web-based prevention and treatment programs can help deliver evidence-based alternatives. It is necessary to document the pitfalls, strengths, and challenges of such interventions in this context. Understanding how users perceive an intervention might suggest modifications to increase adherence.
Collapse
Affiliation(s)
- Ma Asunción Lara
- Department of Psychosocial Studies in Specific Population, Division of Epidemiological and Psychosocial Research, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Pamela Patiño
- Division of Epidemiological and Psychosocial Research, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Marcela Tiburcio
- Department of Social Sciences in Health, Division of Epidemiological and Psychosocial Research, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Laura Navarrete
- Department of Psychosocial Studies in Specific Population, Division of Epidemiological and Psychosocial Research, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| |
Collapse
|
23
|
Mekonen T, Ford S, Chan GCK, Hides L, Connor JP, Leung J. What is the short-term remission rate for people with untreated depression? A systematic review and meta-analysis. J Affect Disord 2022; 296:17-25. [PMID: 34583099 DOI: 10.1016/j.jad.2021.09.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Depression is one of the prevalent mental illnesses and leading cause of global disease burden. However, most people with depression do not access treatment. Remission without treatment may occur in some cases of depression. This study aimed to estimate the short-term remission (natural recovery) from untreated depression. METHODS A systematic review and meta-analysis was registered on PROSPERO and conducted following PRISMA guidelines. EMBASE, PsycINFO, and PubMed were searched, supplemented with an additional hand search to identify studies reporting natural recovery from untreated depression. Study selection and screening were carried out by three independent reviewers. Methodological quality assessment of the included studies was conducted. Remission was defined as no longer meeting the diagnostic criteria or scoring below the cut off points of the validated tools as reported by the included studies. The data were synthesized using narrative summary and random-effects meta-analysis. RESULTS Sixteen waitlist-controlled trial studies were included in the systematic review and meta-analysis. The duration of follow-up ranged from 4 to 12 weeks with a median duration of 8 weeks. The overall pooled remission from untreated depression was 12.5%, 95% confidence interval (7.8, 18.0%). Due to lack of published data, we were unable to determine if the severity of depression symptoms was associated with remission rates. CONCLUSIONS Short-term remission from depression without treatment is uncommon. Across studies, 8 - 18% of people remitted without treatment within 12 weeks. Waitlist control groups may not represent all persons with depression.
Collapse
Affiliation(s)
- Tesfa Mekonen
- School of Psychology, The University of Queensland, Australia; Psychiatry Department, Bahir Dar University, Ethiopia; National Centre for Youth Substance Use Research, The University of Queensland, Australia.
| | - Sarah Ford
- School of Psychology, The University of Queensland, Australia
| | - Gary C K Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Australia
| | - Leanne Hides
- School of Psychology, The University of Queensland, Australia; National Centre for Youth Substance Use Research, The University of Queensland, Australia
| | - Jason P Connor
- National Centre for Youth Substance Use Research, The University of Queensland, Australia; Discipline of Psychiatry, The University of Queensland, Australia
| | - Janni Leung
- School of Psychology, The University of Queensland, Australia; National Centre for Youth Substance Use Research, The University of Queensland, Australia
| |
Collapse
|
24
|
Preliminary evaluation of a culturally adapted CBT-based online programme for depression and anxiety from a lower middle-income country. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x21000313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Abstract
Online cognitive behaviour therapy (CBT), self-help and guided self-help (GSH) interventions have been found to be efficacious and cost-effective for treatment of anxiety and depression, but there are limited data from low- and middle-income countries on culturally adapted digital interventions for these common mental disorders. The aim of this study was to investigate the feasibility and acceptability of an online culturally adapted CBT-based guided self-help (CaCBT-GSH) for patients with anxiety and depression in Pakistan. This randomized controlled trial recruited 39 participants from primary care in Karachi, Pakistan and randomized them to two groups. The intervention group received seven modules of CaCBT-GSH plus treatment as usual (TAU) over 12 weeks. The control group was a waitlist control plus TAU. The primary outcomes were feasibility and acceptability. Clinical outcomes included results from the Hospital Anxiety and Depression Scale (HADS) and the WHO Disability Assessment Schedule 2 (WHODAS 2). Assessments were carried out at baseline and at 12 weeks. All 39 individuals who met eligibility criteria for the study agreed to participate. Adherence to the intervention was excellent, with 85% (17/20) completing more than five modules. Statistically significant improvements were found in all clinical outcomes in the intervention group. This was the first trial of an online CaCBT-GSH intervention, which was found to be feasible and acceptable to Pakistani patients with anxiety and depression. CaCBT-GSH may help improve symptoms, depression, anxiety and overall functioning in this population. The results provide rationale for a larger, confirmatory randomized controlled trial of digital CaCBT-GSH.
Key learning aims
(1)
Leveraging digital and virtual platforms to deliver psychosocial interventions may contribute to addressing the significant treatment gap in low-resource settings.
(2)
CBT-informed guided self-help is feasible and acceptable in the treatment of common mental disorders in Pakistan.
(3)
The results of this study merit a larger, appropriately powered confirmatory randomized controlled trial to determine clinical and cost effectiveness.
Collapse
|
25
|
Spanhel K, Burdach D, Pfeiffer T, Lehr D, Spiegelhalder K, Ebert DD, Baumeister H, Bengel J, Sander LB. Effectiveness of an internet-based intervention to improve sleep difficulties in a culturally diverse sample of international students: A randomised controlled pilot study. J Sleep Res 2021; 31:e13493. [PMID: 34549852 DOI: 10.1111/jsr.13493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
Abstract
Sleep difficulties are widespread among international students. Internet-based interventions are suggested as a low-threshold treatment option but may require cultural adaptation among culturally diverse populations. The present pilot study investigated the effectiveness and acceptance of an internet-based intervention to improve sleep difficulties in international students. A total of 81 international students of 36 nationalities were randomly assigned to the intervention (n = 41) or waitlist control group (n = 40). The intervention group received immediate access to a culturally non-adapted unguided internet-based sleep intervention consisting of three modules based on sleep hygiene and cognitive techniques to reduce rumination. At baseline, 4 and 12 weeks after randomisation, insomnia severity, measured by the Insomnia Severity Index, and secondary outcomes (sleep quality, depression, anxiety, perceived stress, well-being, presenteeism, mental health literacy) were assessed. Data were analysed using linear multi-level analyses. Additionally, satisfaction and perceived cultural appropriateness of the intervention were evaluated by international students after 4 weeks, and compared with ratings of German students, who represent the original target group. Insomnia severity improved over time in the intervention group compared to the control group, revealing a significant estimated mean difference of -5.60 (Hedges' g = 0.84, p < 0.001) after 12 weeks. Satisfaction and perceived cultural appropriateness was high and comparable to that of German students. The present study shows that a culturally non-adapted internet-based sleep intervention can be a low-threshold treatment option to help meet the high demand for mental healthcare among international students. It thus indicates that cultural adaptation might not represent a precondition for providing effective internet-based sleep interventions to this target group.
Collapse
Affiliation(s)
- Kerstin Spanhel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Daniela Burdach
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Teresa Pfeiffer
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Dirk Lehr
- Department of Health Psychology, Institute of Psychology, Leuphana University Lueneburg, Lueneburg, Germany
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David D Ebert
- Psychology und Digital Mental Health Care, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Juergen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Lasse B Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| |
Collapse
|
26
|
Ma L, Huang C, Tao R, Cui Z, Schluter P. Meta-analytic review of online guided self-help interventions for depressive symptoms among college students. Internet Interv 2021; 25:100427. [PMID: 34401386 PMCID: PMC8350612 DOI: 10.1016/j.invent.2021.100427] [Citation(s) in RCA: 3] [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] [Received: 06/02/2020] [Revised: 05/18/2021] [Accepted: 07/05/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE This meta-analysis examines the effect of online guided self-help interventions for depressive symptoms among college students. METHODS We searched studies through PubMed, Embase, Web of Science, PsycINFO, and Cochrane Central. Effect estimates were reported as standardized mean differences (SMD) and data were pooled using random-effects models. Subgroup analyses were conducted to investigate the differential effects of these interventions by sample type, level of contact, use of incentive, length of intervention, and program content. RESULTS 24 comparisons (n = 3074) deriving from 19 trials were included in the meta-analysis. Intervention participants (n = 1620) indicated significant reductions in depressive symptoms at post-intervention compared to non-active control conditions (n = 1454). The weighted effect size was 0.46 (95% CI: 0.28-0.64), which dropped to 0.36 (95% CI: 0.26-0.45) after an outlier was removed. Subgroup analyses showed that the effects were significant among interventions using both selective and universal samples; among interventions of shorter (≤4 weeks), moderate (4-8 weeks), and greater length (≥8 weeks); among interventions with high, moderate, and low levels of contact; among interventions with and without incentive; and among interventions employing cognitive-behavioral therapy (CBT) and third-wave CBT. CONCLUSION This meta-analysis reinforces evidence to support the effectiveness of online guided self-help interventions in reducing depressive symptoms among college students. However, because of the generally variable and limited quality of current evidence, further research applying rigorous methods is needed to confirm and extend the findings of this meta-analysis.
Collapse
Affiliation(s)
- Liang Ma
- The First Hospital of China Medical University, Shenyang, China
| | - Cong Huang
- Department of Sports and Exercise Science, Zhejiang University, Hangzhou, China
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Rimeng Tao
- The First Hospital of China Medical University, Shenyang, China
| | - Zeshi Cui
- School of Pharmacy, China Medical University, Shenyang, China
| | - Philip Schluter
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| |
Collapse
|
27
|
Spanhel K, Balci S, Feldhahn F, Bengel J, Baumeister H, Sander LB. Cultural adaptation of internet- and mobile-based interventions for mental disorders: a systematic review. NPJ Digit Med 2021; 4:128. [PMID: 34433875 PMCID: PMC8387403 DOI: 10.1038/s41746-021-00498-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 08/03/2021] [Indexed: 02/07/2023] Open
Abstract
Providing accessible and effective healthcare solutions for people living in low- and middle-income countries, migrants, and indigenous people is central to reduce the global mental health treatment gap. Internet- and mobile-based interventions (IMI) are considered scalable psychological interventions to reduce the burden of mental disorders and are culturally adapted for implementation in these target groups. In October 2020, the databases PsycInfo, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were systematically searched for studies that culturally adapted IMI for mental disorders. Among 9438 screened records, we identified 55 eligible articles. We extracted 17 content, methodological, and procedural components of culturally adapting IMI, aiming to consider specific situations and perspectives of the target populations. Adherence and effectiveness of the adapted IMI seemed similar to the original IMI; yet, no included study conducted a direct comparison. The presented taxonomy of cultural adaptation of IMI for mental disorders provides a basis for future studies investigating the relevance and necessity of their cultural adaptation.PROSPERO registration number: CRD42019142320.
Collapse
Affiliation(s)
- Kerstin Spanhel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany.
| | - Sumeyye Balci
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Felicitas Feldhahn
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Juergen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Lasse B Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| |
Collapse
|
28
|
Alavi N, Stephenson C, Yang M, Kumar A, Shao Y, Miller S, Yee CS, Stefatos A, Gholamzadehmir M, Abbaspour Z, Jagayat J, Shirazi A, Omrani M, Patel A, Patel C, Groll D. Feasibility and Efficacy of Delivering Cognitive Behavioral Therapy Through an Online Psychotherapy Tool for Depression: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e27489. [PMID: 33990076 PMCID: PMC8277395 DOI: 10.2196/27489] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/16/2021] [Accepted: 05/12/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a prevalent and debilitating mental health disorder. Among different therapeutic approaches (eg, medication and psychotherapy), psychotherapy in the form of cognitive behavioral therapy (CBT) is considered the gold standard treatment for MDD. However, although efficacious, CBT is not readily accessible to many patients in need because of hurdles such as stigma, long wait times, high cost, the large time commitment for health care providers, and cultural or geographic barriers. Electronically delivered cognitive behavioral therapy (e-CBT) can effectively address many of these accessibility barriers. OBJECTIVE This study aims to investigate the efficacy and feasibility of implementing an e-CBT program compared with in-person treatment for MDD. It is hypothesized that the e-CBT program will offer results comparable with those of the in-person treatment program, regarding symptom reduction and quality of life improvement. METHODS This nonrandomized controlled trial intervention will provide e-CBT for MDD through the Online Psychotherapy Tool, a secure, cloud-based, digital mental health platform. Participants (aged 18-65 years) will be offered 12 weekly sessions of an e-CBT program tailored to MDD to address their depressive symptoms. Participants (n=55) will complete predesigned modules and homework assignments while receiving personalized feedback and interacting with a therapist through the platform. Using clinically validated symptomology questionnaires, the efficacy of the e-CBT program will be compared with that of a group (n=55) receiving in-person CBT. Questionnaires will be completed at baseline, at week 6 and week 12, and at a 6-month follow-up. Focus groups will be conducted to investigate personal, cultural, and social factors impacting the accessibility and feasibility of implementing a web-based psychotherapy tool from a patient and care provider perspective. Inclusion criteria include diagnosis of MDD, competence to consent to participate, ability to speak and read English, and consistent and reliable access to the internet. Exclusion criteria include active psychosis, acute mania, severe alcohol or substance use disorder, and active suicidal or homicidal ideation. RESULTS Ethics approval was obtained in January 2019, and recruitment of participants began in June 2019. Recruitment has been conducted via social media, web-based communities, and physician referrals. To date, 52 participants have been recruited to the e-CBT group, and 48 patients have been recruited to the in-person CBT group. Data collection is expected to be completed by March 2021, and analyses are expected to be completed by June 2021, as linear regression (for continuous outcomes) and binomial regression analysis (for categorical outcomes) are still being conducted. CONCLUSIONS The results of this study can provide valuable information for the development of more accessible and scalable mental health interventions with increased care capacity for MDD, without sacrificing the quality of care. TRIAL REGISTRATION ClinicalTrials.gov NCT04478058; http://clinicaltrials.gov/ct2/show/NCT04478058. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/27489.
Collapse
Affiliation(s)
- Nazanin Alavi
- Department of Psychiatry, Queen's University, Kingston, ON, Canada.,Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Callum Stephenson
- Department of Psychiatry, Queen's University, Kingston, ON, Canada.,Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Megan Yang
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Anchan Kumar
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Yijia Shao
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Shadé Miller
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Caitlin S Yee
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Anthi Stefatos
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Maedeh Gholamzadehmir
- Department of Psychiatry, Queen's University, Kingston, ON, Canada.,Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,OPTT Inc, Digital Media Zone, Ryerson University, Toronto, ON, Canada
| | - Zara Abbaspour
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Jasleen Jagayat
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Amirhossein Shirazi
- Department of Psychiatry, Queen's University, Kingston, ON, Canada.,Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,OPTT Inc, Digital Media Zone, Ryerson University, Toronto, ON, Canada
| | - Mohsen Omrani
- OPTT Inc, Digital Media Zone, Ryerson University, Toronto, ON, Canada
| | - Archana Patel
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Charmy Patel
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Dianne Groll
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| |
Collapse
|
29
|
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.
Collapse
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
Collapse
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
| |
Collapse
|
30
|
Dwyer A, de Almeida Neto A, Estival D, Li W, Lam-Cassettari C, Antoniou M. Suitability of Text-Based Communications for the Delivery of Psychological Therapeutic Services to Rural and Remote Communities: Scoping Review. JMIR Ment Health 2021; 8:e19478. [PMID: 33625373 PMCID: PMC7946577 DOI: 10.2196/19478] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/18/2020] [Accepted: 01/15/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND People living in rural and remote areas have poorer access to mental health services than those living in cities. They are also less likely to seek help because of self-stigma and entrenched stoic beliefs about help seeking as a sign of weakness. E-mental health services can span great distances to reach those in need and offer a degree of privacy and anonymity exceeding that of traditional face-to-face counseling and open up possibilities for identifying at-risk individuals for targeted intervention. OBJECTIVE This scoping review maps the research that has explored text-based e-mental health counseling services and studies that have used language use patterns to predict mental health status. In doing so, one of the aims was to determine whether text-based counseling services have the potential to circumvent the barriers faced by clients in rural and remote communities using technology and whether text-based communications, in particular, can be used to identify individuals at risk of psychological distress or self-harm. METHODS We conducted a comprehensive electronic literature search of PsycINFO, PubMed, ERIC, and Web of Science databases for articles published in English through November 2020. RESULTS Of the 9134 articles screened, 70 met the eligibility criteria and were included in the review. There is preliminary evidence to suggest that text-based, real-time communication with a qualified therapist is an effective form of e-mental health service delivery, particularly for individuals concerned with stigma and confidentiality. There is also converging evidence that text-based communications that have been analyzed using computational linguistic techniques can be used to accurately predict progress during treatment and identify individuals at risk of serious mental health conditions and suicide. CONCLUSIONS This review reveals a clear need for intensified research into the extent to which text-based counseling (and predictive models using modern computational linguistics tools) may help deliver mental health treatments to underserved groups such as regional communities, identify at-risk individuals for targeted intervention, and predict progress during treatment. Such approaches have implications for policy development to improve intervention accessibility in at-risk and underserved populations.
Collapse
Affiliation(s)
- Anne Dwyer
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Penrith, Australia
| | | | - Dominique Estival
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Penrith, Australia
| | - Weicong Li
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Penrith, Australia
| | - Christa Lam-Cassettari
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Penrith, Australia
| | - Mark Antoniou
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Penrith, Australia
| |
Collapse
|
31
|
Fu Z, Burger H, Arjadi R, Bockting CLH. Effectiveness of digital psychological interventions for mental health problems in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Psychiatry 2020; 7:851-864. [PMID: 32866459 PMCID: PMC7455253 DOI: 10.1016/s2215-0366(20)30256-x] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND The effectiveness of digital psychological interventions in low-income and middle-income countries (LMICs) remains unclear. We aimed to systematically investigate the available evidence for digital psychological interventions in reducing mental health problems in LMICs. METHODS In this systematic review and meta-analysis, we searched PubMed, PsycINFO, Embase, and Cochrane databases for articles published in English from database inception to March 9, 2020. We included randomised controlled trials investigating digital psychological interventions in individuals with mental health problems in LMICs. We extracted data on demographics, inclusion and exclusion criteria, details of the intervention, including the setting, digital delivery method, control group conditions, number of sessions, therapeutic orientation (eg, cognitive therapy or behaviour therapy), presence or absence of guidance, and length of follow-up, and statistical information to calculate effect sizes. If a study reported insufficient data to calculate effect sizes, the corresponding authors were contacted to provide data that could be aggregated. We did random-effects meta-analyses, and calculated the standardised mean difference in scores of digital psychological interventions versus control conditions (Hedges'g). Quality of evidence was assessed by use of the Grading of Recommendations Assessment, Development, and Evaluation approach. The primary outcome was post-intervention mental health problems, as measured by self-reporting instruments or clinical interviews. This study is registered with PROSPERO, CRD42019137755. FINDINGS We identified 22 eligible studies that were included in the meta-analysis. The included studies involved a total of 4104 participants (2351 who received a digital psychological intervention and 1753 who were in the control group), and mainly focused on young adults (mean age of the study population was 20-35 years) with depression or substance misuse. The results showed that digital psychological interventions are moderately effective when compared with control interventions (Hedges'g 0·60 [95% CI 0·45-0·75]; Hedges'g with treatment as usual subgroup for comparison 0·54 [0·35-0·73]). Heterogeneity between studies was substantial (I2=74% [95% CI 60-83]). There was no evidence of publication bias, and the quality of evidence according to the GRADE criteria was generally high. INTERPRETATION Digital psychological interventions, which have been mostly studied in individuals with depression and substance misuse, are superior to control conditions, including usual care, and are moderately effective in LMICs. However, the considerable heterogeneity observed in our analysis highlights the need for more studies to be done, with standardised implementation of digital psychological intervention programmes to improve their reproducibility and efficiency. Digital psychological interventions should be considered for regions where usual care for mental health problems is minimal or absent. FUNDING None. TRANSLATIONS For the Persian, Chinese, Hindi, Portuguese, Bahasa, Turkish, Romanian, Spanish and Thai translations of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- Zhongfang Fu
- Faculty of Psychology, Beijing Normal University, Beijing, China; Department of Psychiatry, Amsterdam University Medical Center, Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Huibert Burger
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Retha Arjadi
- Faculty of Psychology, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Claudi L H Bockting
- Department of Psychiatry, Amsterdam University Medical Center, Location AMC, University of Amsterdam, Amsterdam, Netherlands; Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands.
| |
Collapse
|
32
|
Shala M, Morina N, Burchert S, Cerga-Pashoja A, Knaevelsrud C, Maercker A, Heim E. Cultural adaptation of Hap-pas-Hapi, an internet and mobile-based intervention for the treatment of psychological distress among Albanian migrants in Switzerland and Germany. Internet Interv 2020; 21:100339. [PMID: 32983906 PMCID: PMC7495109 DOI: 10.1016/j.invent.2020.100339] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/24/2020] [Accepted: 07/31/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Internet- and mobile-based mental health interventions have the potential to narrow the treatment gap in ethnic groups. Little evidence exists on the cultural adaptation of such interventions. Cultural adaptation of evidence-based interventions distinguishes between surface and deep structure adaptation. Surface refers to matching materials (e.g., illustrations, language) or methods of treatment delivery to the target population, whereas deep structure adaptation considers cultural concepts of distress (CCD). So far, CCD have only been considered to a limited extent in cultural adaptation of psychological interventions, and there is a lack of well documented adaptation procedures. AIMS With a cross-disciplinary and mixed-method approach, following a new conceptual framework for cultural adaptation of scalable psychological interventions, this study aimed to develop both surface and deep structure adaptations of an internet- and mobile-based intervention called Hap-pas-Hapi for the treatment of psychological distress among Albanian migrants in Switzerland and Germany. METHODS A qualitative ethnopsychological study was conducted to examine the target group's CCD. Focus group discussions, an online survey, and individual key informant interviews were utilised to evaluate the original intervention, adaptation drafts and the final adapted intervention. A reporting system was developed to support the decision-making process and to report all adaptations in a transparent and replicable way. RESULTS The ongoing involvement of target population key informants provided valuable feedback for the development of a more person-centred intervention, which might enhance treatment acceptance, motivation and adherence. DISCUSSION This study provides empirical and theory-based considerations and suggestions for future implementation that may foster acceptability and effectiveness of culturally adapted evidence-based interventions.
Collapse
Affiliation(s)
- Mirëlinda Shala
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Switzerland
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital of Zurich, University of Zurich, Switzerland
| | - Sebastian Burchert
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Arlinda Cerga-Pashoja
- Faculty of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Central and North West London NHS Foundation Trust, London, United Kingdom
| | - Christine Knaevelsrud
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Andreas Maercker
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Switzerland
| | - Eva Heim
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Switzerland
| |
Collapse
|
33
|
Sit HF, Ling R, Lam AIF, Chen W, Latkin CA, Hall BJ. The Cultural Adaptation of Step-by-Step: An Intervention to Address Depression Among Chinese Young Adults. Front Psychiatry 2020; 11:650. [PMID: 32733296 PMCID: PMC7359726 DOI: 10.3389/fpsyt.2020.00650] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/23/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Digital mental health interventions leverage digital communication technology to address the mental health needs of populations. Culturally adapting interventions can lead to a successful, scalable mental health intervention implementation, and cultural adaptation of digital mental health interventions is a critical component to implementing interventions at scale within contexts where mental health services are not well supported. OBJECTIVE The study aims to describe the cultural adaptation of a digital mental health intervention Step-by-Step in order to address depression among Chinese young adults. METHODS Cultural adaptation was carried out in four phases following Ecological Validity Model: (1) stage setting and expert consultation; (2) preliminary content adaptation; (3) iterative content adaptation with community members; (4) finalized adaptation with community feedback meetings. Cognitive interviewing was applied to probe for relevance, acceptability, comprehensibility, and completeness of illustrations and text. Six mental health experts and 34 Chinese young adults were recruited for key informant interviews and focus group discussions. RESULTS We adapted the text and illustrations to fit the culture among Chinese young adults. Eight elements of the intervention were chosen as the targets of cultural adaptation (e.g., language, metaphors, content). Samples of major adaptations included: adding scenarios related to university life (relevance), changing leading characters from a physician to a peer and a cartoon (acceptability), incorporating two language versions (traditional Chinese and simplified Chinese) in the intervention (comprehensibility), and maintaining fundamental therapeutic components (completeness). CONCLUSION This study showed the utility of using Ecological Validity Model and a four-point procedure framework for cultural adaptation and achieved a culturally appropriate version of the Step-by-Step program for Chinese young adults.
Collapse
Affiliation(s)
- Hao Fong Sit
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macau, China
| | - Rui Ling
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macau, China
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Agnes Iok Fong Lam
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macau, China
- Department of Communication, Faculty of Social Science, University of Macau, Macau, China
- Centre for Macau Studies, University of Macau, Macau, China
| | - Wen Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Carl A. Latkin
- Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Brian J. Hall
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macau, China
- Centre for Macau Studies, University of Macau, Macau, China
- Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| |
Collapse
|