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Laranjeira C, Querido A, Sousa P, Dixe MA. Assessment and Psychometric Properties of the 21-Item Depression Anxiety Stress Scale (DASS-21) among Portuguese Higher Education Students during the COVID-19 Pandemic. Eur J Investig Health Psychol Educ 2023; 13:2546-2560. [PMID: 37998067 PMCID: PMC10670895 DOI: 10.3390/ejihpe13110177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023] Open
Abstract
The COVID-19 pandemic has caused substantial disruptions in the lives of higher education students, with detrimental repercussions for academic performance and overall mental health. Therefore, we aimed to evaluate the prevalence of depression, anxiety, and stress symptoms among Portuguese higher education students during the first wave of the coronavirus pandemic and investigate DASS-21's psychometric characteristics and whether it functions effectively during a pandemic. A convenience sampling procedure was used to recruit 1522 participants (75.1% women and 79.2% undergraduate students) for this cross-sectional research. Participants completed an e-survey created using DASS-21. The results revealed a considerable prevalence of symptoms of depression [≥10] (N = 434, 28.5%), anxiety [≥7] (N = 551, 36.2%), and stress [≥11] (N = 544, 35.7%). Confirmatory factor analysis (CFA) revealed the scale's three-factor structure, which matched the three DASS-21 subscales. Subsequently, the heterotrait-monotrait (HTMT) correlation ratio evaluated the scale's discriminant validity, which was relatively good. Cronbach's alpha measured the internal consistency of the DASS subscales, which was excellent (Cronbach's α > 0.90). DASS-21 was shown to be a reliable and appropriate measure for assessing students' mental health. Furthermore, DASS-21 is recommended for use by academics and healthcare professionals in measuring students' psychological distress. Further validation studies of this scale are needed with larger and more representative samples.
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Affiliation(s)
- Carlos Laranjeira
- School of Health Sciences, Polytechnic University of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal; (A.Q.); (M.A.D.)
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Polytechnic University of Leiria, 2410-541 Leiria, Portugal;
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-801 Évora, Portugal
| | - Ana Querido
- School of Health Sciences, Polytechnic University of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal; (A.Q.); (M.A.D.)
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Polytechnic University of Leiria, 2410-541 Leiria, Portugal;
- Center for Health Technology and Services Research (CINTESIS), NursID, University of Porto, 4200-450 Porto, Portugal
| | - Pedro Sousa
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Polytechnic University of Leiria, 2410-541 Leiria, Portugal;
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Polo A, Av. Bissaya Barreto, 3004-011 Coimbra, Portugal
| | - Maria Anjos Dixe
- School of Health Sciences, Polytechnic University of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal; (A.Q.); (M.A.D.)
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Polytechnic University of Leiria, 2410-541 Leiria, Portugal;
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Fox AJ, Filmer HL, Dux PE. The influence of self-reported history of mild traumatic brain injury on cognitive performance. Sci Rep 2022; 12:16999. [PMID: 36220885 PMCID: PMC9554181 DOI: 10.1038/s41598-022-21067-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/22/2022] [Indexed: 12/29/2022] Open
Abstract
The long-term cognitive consequences of mild traumatic brain injury (mTBI) are poorly understood. Studies investigating cognitive performance in the chronic stage of injury in both hospital-based and population-based samples have revealed inconsistent findings. Importantly, population-based mTBI samples remain under-studied in the literature. This study investigated cognitive performance among individuals with a history of self-reported mTBI using a battery of cognitively demanding behavioural tasks. Importantly, more than half of the mTBI participants had experienced multiple mild head injuries. Compared to control participants (n = 49), participants with a history of mTBI (n = 30) did not demonstrate deficits in working memory, multitasking ability, cognitive flexibility, visuospatial ability, response inhibition, information processing speed or social cognition. There was moderate evidence that the mTBI group performed better than control participants on the visual working memory measure. Overall, these findings suggest that even multiple instances of mTBI do not necessarily lead to long-term cognitive impairment at the group level. Thus, we provide important evidence of the impact of chronic mTBI across a number of cognitive processes in a population-based sample. Further studies are necessary to determine the impact that individual differences in injury-related variables have on cognitive performance in the chronic stage of injury.
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Affiliation(s)
- Amaya J. Fox
- grid.1003.20000 0000 9320 7537School of Psychology, The University of Queensland, McElwain Building, Campbell Road, St Lucia, QLD 4072 Australia
| | - Hannah L. Filmer
- grid.1003.20000 0000 9320 7537School of Psychology, The University of Queensland, McElwain Building, Campbell Road, St Lucia, QLD 4072 Australia
| | - Paul E. Dux
- grid.1003.20000 0000 9320 7537School of Psychology, The University of Queensland, McElwain Building, Campbell Road, St Lucia, QLD 4072 Australia
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3
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Wearne TA, Logan JA, Trimmer EM, Wilson E, Filipcikova M, Kornfeld E, Rushby JA, McDonald S. Regulating emotion following severe traumatic brain injury: a randomized controlled trial of heart-rate variability biofeedback training. Brain Inj 2021; 35:1390-1401. [PMID: 34487459 DOI: 10.1080/02699052.2021.1972337] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND While difficulties regulating emotions are almost ubiquitous after traumatic brain injury (TBI), remediation techniques are limited. Heart-rate variability (HRV) is a physiological measure of emotion regulation and can be modified using biofeedback training. The aim of the current study was to evaluate the efficacy of repeated biofeedback training for improving emotion regulation difficulties following TBI. DESIGN Fifty adults with severe TBI were allocated to either biofeedback or waitlist conditions. Treatment consisted of six biofeedback sessions whereby participants were taught to breathe at their resonant frequency. Outcomes included changes in physiological and subjective reactivity to anger-induction, emotional well-being, and physiology at rest, together with symptoms of psychological distress and sleep disturbances (ACTRN12618002031246). RESULTS While biofeedback led to reduced skin conductance, it did not affect any other objective or subjective response to the mood induction procedure. Biofeedback led to fewer sleep disturbances, and reduced negative mood valence and depression during follow-up. CONCLUSIONS HRV biofeedback training is a feasible technique following TBI that transfers to improved symptoms of general emotional well-being, psychological distress, and sleep. Biofeedback does not transfer to a laboratory-based emotional provocation task. HRV biofeedback training may represent a novel adjunct for generalized emotional difficulties following injury.
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Affiliation(s)
- T A Wearne
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - J A Logan
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - E M Trimmer
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - E Wilson
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - M Filipcikova
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - E Kornfeld
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - J A Rushby
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - S McDonald
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
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4
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Shahid F, Beshai S, Del Rosario N. Fatalism and Depressive Symptoms: Active and Passive Forms of Fatalism Differentially Predict Depression. JOURNAL OF RELIGION AND HEALTH 2020; 59:3211-3226. [PMID: 32441015 DOI: 10.1007/s10943-020-01024-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Classic fatalism is the belief that regardless of actions, events are predestined to occur (Straughan and Seow 1998). Researchers have found that fatalism is positively correlated with depression symptoms and higher endorsement of an external locus of control. Although fatalism is thought to be a unitary construct, based on the current literature, we hypothesized fatalism may take on other forms. We defined active fatalism as the belief in a predestined personal and global future, combined with the belief that one must do their part to bring this predestined future into fruition. Therefore, we predicted that active fatalism will be negatively correlated with depression symptoms, external locus of control, and negative coping skills. We recruited a sample of religious participants online (n = 282; 49.3% female) who completed self-report scales measuring depression symptoms, classic fatalism, active fatalism, coping skills, and locus of control. We found that while classic fatalism was significantly and positively associated with depression and negative coping, active fatalism was positively correlated with positive coping skills, and negatively correlated with depression and external locus of control. Finally, the present study found that active fatalism explained variance in both depression and anxiety symptoms above and beyond the classic form of fatalism. This confirmed our hypotheses and suggested that there may be several forms of fatalism, each differentially predicting mental health processes and outcomes. The significant positive correlation of positive coping and negative correlations of depression and external locus of control with active fatalism offer evidence in support of the notion that this form of fatalism may in fact be associated with protective mechanisms against depression. Differential assessment of these varying concepts may be appropriate for assessment and psychotherapy.
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Affiliation(s)
- Fakhra Shahid
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S0A2, Canada.
| | - Shadi Beshai
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S0A2, Canada
| | - Nicole Del Rosario
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S0A2, Canada
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Doroszkiewicz C, Gold D, Green R, Tartaglia MC, Ma J, Tator CH. Anxiety, Depression, and Quality of Life: A Long-Term Follow-Up Study of Patients with Persisting Concussion Symptoms. J Neurotrauma 2020; 38:493-505. [PMID: 32962513 DOI: 10.1089/neu.2020.7313] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Persisting concussion symptoms (PCS) can last for months, years, or indefinitely and affect a considerable number of concussion patients. The objectives of this study were to evaluate the prevalence of clinical symptoms of anxiety and depression and the relationship between PCS and quality of life in patients examined at the Canadian Concussion Centre. The Depression and Anxiety Stress Scale-42 (DASS-42) and the World Health Organization Quality of Life Assessment-BREF (WHOQOL-BREF) were sent to 526 adult patients diagnosed with PCS. Median with interquartile range follow-up time was 5 (4-7) years. Of the 105 respondents, 35.2% displayed mild or greater symptoms of anxiety, depression, or both. Importantly, the number of previous concussions was correlated with elevations on the DASS-42 Anxiety (p = 0.030) and Depression (p = 0.018) subscale scores, suggesting an acquired cause of symptoms. Patients with clinical elevations of depression, anxiety, or both exhibited poorer mean WHOQOL-BREF scores in each domain (p < 0.001) compared to those who scored in the normal range on the DASS-42. These findings indicate that depression and anxiety in PCS can endure for years and are associated with diminished quality of life. Consequently, depression and anxiety should be identified and treated early in PCS populations in order to optimize recovery. Although the underlying etiology of depression and anxiety cannot be ascertained with certainty in the present study, the association between depression and anxiety and the number of concussions may indicate an organic explanation. In the future, quality-of-life measures should be incorporated into treatment and research in PCS to improve intervention strategies and enhance understanding of the trajectory of recovery in this population.
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Affiliation(s)
| | - David Gold
- Neuropsychology Clinic, Krembil Neuroscience Network, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Robin Green
- Canadian Concussion Center, Toronto, Ontario, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Maria Carmela Tartaglia
- Canadian Concussion Center, Toronto, Ontario, Canada.,Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jin Ma
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Charles H Tator
- Canadian Concussion Center, Toronto, Ontario, Canada.,Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Vasterling JJ, Aslan M, Proctor SP, Ko J, Leviyah X, Concato J. Long-term negative emotional outcomes of warzone TBI. Clin Neuropsychol 2020; 34:1088-1104. [PMID: 32301397 DOI: 10.1080/13854046.2020.1749935] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Many veterans of the Iraq and Afghanistan Wars have experienced traumatic brain injury (TBI). Although prior work has examined associations between TBI and development of psychiatric syndromes, less is known about associations between TBI and component emotions constituting these syndromes, especially in the long term. The purpose of this study was to examine the long-term emotional consequences of deployment-related TBI. METHODS As part of VA Cooperative Studies Program #566, we assessed a sample of n = 456 US Army soldiers prior to an index deployment to Iraq, and again an average of 8.3 years (SD = 2.4 years) after their deployment for a long-term follow-up assessment. In this report, we used adjusted regression analyses to examine the relationship of deployment TBI to depression, anxiety, and stress symptom severity measured at the long-term follow-up assessment. A structured interview was used to determine TBI history; the Depression, Anxiety, and Stress Scale, 21-item version (DASS-21) was used to determine emotional status at the follow-up evaluation. RESULTS Warzone TBI events, particularly when greater than mild in severity, were independently associated with depression, anxiety, and stress severity at long-term follow-up, even after taking into account variance attributable to pre-deployment emotional distress and war-zone stress. Post-hoc analyses did not detect independent associations of either number of events or injury mechanism with outcomes. CONCLUSIONS These findings highlight the potentially enduring and multi-faceted emotional effects of deployment TBI, underscoring the need for early assessment of negative affectivity in warzone veterans reporting TBI.
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Affiliation(s)
- Jennifer J Vasterling
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.,National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - Mihaela Aslan
- Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, CT, USA.,Department of Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Susan P Proctor
- U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA.,Research Service, VA Boston Healthcare System, Boston, MA, USA
| | - John Ko
- Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, CT, USA
| | - Xenia Leviyah
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - John Concato
- Department of Medicine, School of Medicine, Yale University, New Haven, CT, USA.,Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
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7
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Factors Associated With Response to Adapted Cognitive Behavioral Therapy for Anxiety and Depression Following Traumatic Brain Injury. J Head Trauma Rehabil 2020; 35:117-126. [DOI: 10.1097/htr.0000000000000510] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Predictors of Anxiety and Depression Symptom Improvement in CBT Adapted for Traumatic Brain Injury: Pre/Post-Injury and Therapy Process Factors. J Int Neuropsychol Soc 2020; 26:97-107. [PMID: 31983372 DOI: 10.1017/s1355617719000791] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The current study examined the association of demographic/preinjury, injury-related, and cognitive behavior therapy (CBT) process variables, with anxiety and depression symptom change in traumatic brain injury (TBI)-adapted CBT (CBT-ABI). METHODS The audio recordings of 177 CBT-ABI sessions representing 31 therapist-client dyads were assessed from the independent observer perspective on measures of working alliance, homework engagement, and therapist competency in using homework. RESULTS Linear regressions showed that older client age, longer post-TBI recovery period, better executive functioning, higher levels of client homework engagement, as well as higher levels of therapist competence in reviewing homework were associated with greater improvement in anxiety and/or depression symptoms. CONCLUSIONS CBT-ABI is a promising treatment for post-TBI depression and anxiety. The current study highlights how therapists can enhance CBT-ABI effectiveness, specifically: comprehensive facilitation of client homework engagement with emphasis on homework review, and accommodation of executive deficits. The current study also suggests that the role of client age and the length of post-TBI recovery period require further investigation.
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9
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Yasuhara T, Kawauchi S, Kin K, Morimoto J, Kameda M, Sasaki T, Bonsack B, Kingsbury C, Tajiri N, Borlongan CV, Date I. Cell therapy for central nervous system disorders: Current obstacles to progress. CNS Neurosci Ther 2019; 26:595-602. [PMID: 31622035 PMCID: PMC7248543 DOI: 10.1111/cns.13247] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/24/2019] [Accepted: 09/29/2019] [Indexed: 12/13/2022] Open
Abstract
Cell therapy for disorders of the central nervous system has progressed to a new level of clinical application. Various clinical studies are underway for Parkinson's disease, stroke, traumatic brain injury, and various other neurological diseases. Recent biotechnological developments in cell therapy have taken advantage of the technology of induced pluripotent stem (iPS) cells. The advent of iPS cells has provided a robust stem cell donor source for neurorestoration via transplantation. Additionally, iPS cells have served as a platform for the discovery of therapeutics drugs, allowing breakthroughs in our understanding of the pathology and treatment of neurological diseases. Despite these recent advances in iPS, adult tissue‐derived mesenchymal stem cells remain the widely used donor for cell transplantation. Mesenchymal stem cells are easily isolated and amplified toward the cells' unique trophic factor‐secretion property. In this review article, the milestone achievements of cell therapy for central nervous system disorders, with equal consideration on the present translational obstacles for clinic application, are described.
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Affiliation(s)
- Takao Yasuhara
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Satoshi Kawauchi
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Kyohei Kin
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Jun Morimoto
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Masahiro Kameda
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Tatsuya Sasaki
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Brooke Bonsack
- Department of Neurosurgery and Brain Repair, Center of Excellence for Aging and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Chase Kingsbury
- Department of Neurosurgery and Brain Repair, Center of Excellence for Aging and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Naoki Tajiri
- Department of Neurophysiology and Brain Science, Nagoya City University Graduate School of Medical Sciences and Medical School, Aichi, Japan
| | - Cesario V Borlongan
- Department of Neurosurgery and Brain Repair, Center of Excellence for Aging and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
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10
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Predictors of Homework Engagement in CBT Adapted for Traumatic Brain Injury: Pre/post-Injury and Therapy Process Factors. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10036-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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11
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Zelencich L, Kazantzis N, Wong D, McKenzie D, Downing M, Ponsford J. Predictors of working alliance in cognitive behaviour therapy adapted for traumatic brain injury. Neuropsychol Rehabil 2019; 30:1682-1700. [PMID: 30990370 DOI: 10.1080/09602011.2019.1600554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cognitive Behaviour Therapy (CBT) has the strongest preliminary support for treatment of depression and anxiety following traumatic brain injury (TBI). TBI associated cognitive impairments may pose an obstacle to development of a strong working alliance, on which therapeutic gains depend. The current study examined the association of demographic (i.e., gender, age at study entry, years of education and premorbid IQ) and injury-related (i.e., years since injury, post-trauma amnesia duration, memory and executive functioning test performance) variables with alliance in CBT adapted for TBI (CBT-ABI). The audio-recordings of 177 CBT-ABI sessions from 31 participants were assessed with an observer version of the Working Alliance Inventory at nine time-points. Multi-level mixed model regressions showed that participants and therapists maintained a relatively strong alliance across all sessions. Pre-intervention symptom severity was considered as a confounder variable and was found to have no statistically significant influence on the models. None of the demographic variables were significantly associated with alliance scores. More years since injury was associated with a stronger alliance. These findings demonstrate that TBI associated cognitive impairments do not necessarily pose an obstacle to development and maintenance of a strong working alliance, which is more likely to develop with more time post-brain injury.
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Affiliation(s)
- Leah Zelencich
- School of Psychological Sciences, Cognitive Behaviour Therapy Research Unit, Monash University, Clayton, Australia
| | - Nikolaos Kazantzis
- School of Psychological Sciences, Cognitive Behaviour Therapy Research Unit, Monash University, Clayton, Australia
| | - Dana Wong
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Dean McKenzie
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia
| | - Marina Downing
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
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12
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Lee J, Lee EH, Moon SH. Systematic review of the measurement properties of the Depression Anxiety Stress Scales-21 by applying updated COSMIN methodology. Qual Life Res 2019; 28:2325-2339. [PMID: 30937732 DOI: 10.1007/s11136-019-02177-x] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE The Depression Anxiety Stress Scales (DASS)-21 measures emotional symptoms of depression, anxiety, and stress, is relatively short, and is freely available in the public domain, which has resulted in it being applied to various clinical and non-clinical populations in many countries. The aim of this study was to systematically review the measurement properties of the DASS-21. METHODS The MEDLINE, Embase, and CINAHL databases were searched. The methodological quality of each identified study was assessed using the updated COSMIN Risk of Bias checklist. The quality of the measurement properties of the studies was rated using the updated criteria for good measurement properties. The quality of evidence was rated using a modified version of the GRADE approach. RESULTS This study included 48 studies in its review. The content validity of the DASS-21 demonstrated sufficient moderate-quality evidence. The instrument exhibited sufficient high-quality evidence for bifactor structural validity and internal consistency. The instrument also showed sufficient high-quality evidence for hypothesis testing of construct validity. Regarding criterion validity, only the DASS-21 Depression subscale demonstrated sufficient high-quality evidence. The measurement invariance across gender demonstrated inconsistent moderate-quality evidence. There was insufficient low-quality evidence for the reliability of each subscale. For responsiveness there was sufficient low-quality evidence for depression and stress subscales, and insufficient very-low-quality evidence for anxiety subscale. CONCLUSIONS The DASS-21 demonstrated sufficient high-quality evidence for bifactor structural validity, internal consistency (bifactor), criterion validity (Depression subscale), and hypothesis testing for construct validity. Further studies are required to assess the other measurement properties of the DASS-21.
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Affiliation(s)
- Jiyeon Lee
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Eun-Hyun Lee
- Graduate School of Public Health, Ajou University, 164 World cup-ro, Yeongtong-Gu, Suwon, 16499, Republic of Korea.
| | - Seung Hei Moon
- Department of Nursing, Graduate School, Inha University, Incheon, Republic of Korea
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13
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Liska MG, Dela Peña I. Granulocyte-colony stimulating factor and umbilical cord blood cell transplantation: Synergistic therapies for the treatment of traumatic brain injury. Brain Circ 2017; 3:143-151. [PMID: 30276316 PMCID: PMC6057694 DOI: 10.4103/bc.bc_19_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 08/31/2017] [Accepted: 09/05/2017] [Indexed: 02/06/2023] Open
Abstract
Traumatic brain injury (TBI) is now characterized as a progressive, degenerative disease and continues to stand as a prevalent cause of death and disability. The pathophysiology of TBI is complex, with a variety of secondary cell death pathways occurring which may persist chronically following the initial cerebral insult. Current therapeutic options for TBI are minimal, with surgical intervention or rehabilitation therapy existing as the only viable treatments. Considering the success of stem-cell therapies in various other neurological diseases, their use has been proposed as a potential potent therapy for patients suffering TBI. Moreover, stem cells are highly amenable to adjunctive use with other therapies, providing an opportunity to overcome the inherent limitations of using a single therapeutic agent. Our research has verified this additive potential by demonstrating the efficacy of co-delivering human umbilical cord blood (hUCB) cells with granulocyte-colony stimulating factor (G-CSF) in a murine model of TBI, providing encouraging results which support the potential of this approach to treat patients suffering from TBI. These findings justify ongoing research toward uncovering the mechanisms which underlie the functional improvements exhibited by hUCB + G-CSF combination therapy, thereby facilitating its safe and effect transition into the clinic. This paper is a review article. Referred literature in this paper has been listed in the reference section. The datasets supporting the conclusions of this article are available online by searching various databases, including PubMed. Some original points in this article come from the laboratory practice in our research center and the authors’ experiences.
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Affiliation(s)
- Michael G Liska
- Center of Excellence for Aging and Brain Repair, Tampa, FL 33612, USA
| | - Ike Dela Peña
- Department of Pharmaceutical and Administrative Sciences, School of Pharmacy, College of Pharmacy, Loma Linda University, Loma Linda, CA, USA
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Abstract
Management of cognitive difficulties is a significant unmet need for individuals with stroke. Incorporating multiple functions, including memory aids and communication tools, smartphones have potential to improve everyday cognitive function and independence in daily activities post-stroke. We aimed to investigate patterns of smartphone use, facilitators and barriers to use, and relationships between smartphone use and daily functioning. Twenty-nine participants with stroke and 29 comparison participants with no history of neurological conditions completed measures of smartphone use, objective and subjective cognitive function, mood and community integration. The majority of participants used smartphones, though the proportion of users was lower in the stroke group (62%) than the comparison group (86%). Older participants were less likely to use smartphones. Using apps that support memory was a main benefit of smartphone use post-stroke. In the stroke group, frequent users of memory apps had significantly fewer motor symptoms (d = 1.20), and higher productivity (d = 0.84). Stroke survivors identified difficulty learning how to use smartphones, but only one participant had assistance with this from a clinician. These results suggest that smartphones have potential as assistive technology post-stroke, however, support in using them is essential, particularly for older individuals with motor dysfunction.
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Depression Anxiety Stress Scales (DASS-21): Factor Structure in Traumatic Brain Injury Rehabilitation. J Head Trauma Rehabil 2017; 32:134-144. [DOI: 10.1097/htr.0000000000000250] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wong D, Sinclair K, Seabrook E, McKay A, Ponsford J. Smartphones as assistive technology following traumatic brain injury: a preliminary study of what helps and what hinders. Disabil Rehabil 2016; 39:2387-2394. [DOI: 10.1080/09638288.2016.1226434] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Dana Wong
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Center, Melbourne, Australia
| | - Kelly Sinclair
- Monash-Epworth Rehabilitation Research Center, Melbourne, Australia
| | - Elizabeth Seabrook
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia
| | - Adam McKay
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Center, Melbourne, Australia
- Epworth Hospital, Melbourne, Australia
| | - Jennie Ponsford
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Center, Melbourne, Australia
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Ponsford J, Lee NK, Wong D, McKay A, Haines K, Alway Y, Downing M, Furtado C, O'Donnell ML. Efficacy of motivational interviewing and cognitive behavioral therapy for anxiety and depression symptoms following traumatic brain injury. Psychol Med 2016; 46:1079-1090. [PMID: 26708017 DOI: 10.1017/s0033291715002640] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Anxiety and depression are common following traumatic brain injury (TBI), often co-occurring. This study evaluated the efficacy of a 9-week cognitive behavioral therapy (CBT) program in reducing anxiety and depression and whether a three-session motivational interviewing (MI) preparatory intervention increased treatment response. METHOD A randomized parallel three-group design was employed. Following diagnosis of anxiety and/or depression using the Structured Clinical Interview for DSM-IV, 75 participants with mild-severe TBI (mean age 42.2 years, mean post-traumatic amnesia 22 days) were randomly assigned to an Adapted CBT group: (1) MI + CBT (n = 26), or (2) non-directive counseling (NDC) + CBT (n = 26); or a (3) waitlist control (WC, n = 23) group. Groups did not differ in baseline demographics, injury severity, anxiety or depression. MI and CBT interventions were guided by manuals adapted for individuals with TBI. Three CBT booster sessions were provided at week 21 to intervention groups. RESULTS Using intention-to-treat analyses, random-effects regressions controlling for baseline scores revealed that Adapted CBT groups (MI + CBT and NDC + CBT) showed significantly greater reduction in anxiety on the Hospital Anxiety and Depression Scale [95% confidence interval (CI) -2.07 to -0.06] and depression on the Depression Anxiety and Stress Scale (95% CI -5.61 to -0.12) (primary outcomes), and greater gains in psychosocial functioning on Sydney Psychosocial Reintegration Scale (95% CI 0.04-3.69) (secondary outcome) over 30 weeks post-baseline relative to WC. The group receiving MI + CBT did not show greater gains than the group receiving NDC + CBT. CONCLUSIONS Findings suggest that modified CBT with booster sessions over extended periods may alleviate anxiety and depression following TBI.
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Affiliation(s)
- J Ponsford
- Monash-Epworth Rehabilitation Research Centre,School of Psychological Sciences, Monash University,Clayton,Victoria,Australia
| | - N K Lee
- National Centre for Education and Training on Addiction,Flinders University,SA,Australia
| | - D Wong
- Monash-Epworth Rehabilitation Research Centre,School of Psychological Sciences, Monash University,Clayton,Victoria,Australia
| | - A McKay
- Monash-Epworth Rehabilitation Research Centre,School of Psychological Sciences, Monash University,Clayton,Victoria,Australia
| | - K Haines
- Monash-Epworth Rehabilitation Research Centre,School of Psychological Sciences, Monash University,Clayton,Victoria,Australia
| | - Y Alway
- Monash-Epworth Rehabilitation Research Centre,School of Psychological Sciences, Monash University,Clayton,Victoria,Australia
| | - M Downing
- Monash-Epworth Rehabilitation Research Centre,School of Psychological Sciences, Monash University,Clayton,Victoria,Australia
| | - C Furtado
- Monash-Epworth Rehabilitation Research Centre,School of Psychological Sciences, Monash University,Clayton,Victoria,Australia
| | - M L O'Donnell
- Phoenix Australia,University of Melbourne,Victoria,Australia
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de la Peña I, Sanberg PR, Acosta S, Lin SZ, Borlongan CV. Umbilical cord blood cell and granulocyte-colony stimulating factor: combination therapy for traumatic brain injury. Regen Med 2015; 9:409-12. [PMID: 25159056 DOI: 10.2217/rme.14.32] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Ike de la Peña
- Department of Neurosurgery & Brain Repair, Center of Excellence for Aging & Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA
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De La Peña I, Sanberg PR, Acosta S, Lin SZ, Borlongan CV. G-CSF as an adjunctive therapy with umbilical cord blood cell transplantation for traumatic brain injury. Cell Transplant 2015; 24:447-57. [PMID: 25646620 DOI: 10.3727/096368915x686913] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Traumatic brain injury (TBI), a major contributor to deaths and permanent disability worldwide, has been recently described as a progressive cell death process rather than an acute event. TBI pathophysiology is complicated and can be distinguished by the initial primary injury and the subsequent secondary injury that ensues days after the trauma. Therapeutic opportunities for TBI remain very limited with patients subjected to surgery or rehabilitation therapy. The efficacy of stem cell-based interventions, as well as neuroprotective agents in other neurological disorders of which pathologies overlap with TBI, indicates their potential as alternative TBI treatments. Furthermore, their therapeutic limitations may be augmented when combination therapy is pursued instead of using a single agent. Indeed, we demonstrated remarkable combined efficacy of human umbilical cord blood (hUCB) cell therapy and granulocyte-colony-stimulating factor (G-CSF) treatment in TBI models, providing essential evidence for the translation of this approach to treat TBI. Further studies are warranted to determine the mechanisms underlying therapeutic benefits exerted by hUCB + G-CSF in order to enhance its safety and efficacy in the clinic.
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Affiliation(s)
- Ike De La Peña
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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Acosta SA, Tajiri N, Shinozuka K, Ishikawa H, Sanberg PR, Sanchez-Ramos J, Song S, Kaneko Y, Borlongan CV. Combination therapy of human umbilical cord blood cells and granulocyte colony stimulating factor reduces histopathological and motor impairments in an experimental model of chronic traumatic brain injury. PLoS One 2014; 9:e90953. [PMID: 24621603 PMCID: PMC3951247 DOI: 10.1371/journal.pone.0090953] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 02/06/2014] [Indexed: 01/09/2023] Open
Abstract
Traumatic brain injury (TBI) is associated with neuro-inflammation, debilitating sensory-motor deficits, and learning and memory impairments. Cell-based therapies are currently being investigated in treating neurotrauma due to their ability to secrete neurotrophic factors and anti-inflammatory cytokines that can regulate the hostile milieu associated with chronic neuroinflammation found in TBI. In tandem, the stimulation and mobilization of endogenous stem/progenitor cells from the bone marrow through granulocyte colony stimulating factor (G-CSF) poses as an attractive therapeutic intervention for chronic TBI. Here, we tested the potential of a combined therapy of human umbilical cord blood cells (hUCB) and G-CSF at the acute stage of TBI to counteract the progressive secondary effects of chronic TBI using the controlled cortical impact model. Four different groups of adult Sprague Dawley rats were treated with saline alone, G-CSF+saline, hUCB+saline or hUCB+G-CSF, 7-days post CCI moderate TBI. Eight weeks after TBI, brains were harvested to analyze hippocampal cell loss, neuroinflammatory response, and neurogenesis by using immunohistochemical techniques. Results revealed that the rats exposed to TBI treated with saline exhibited widespread neuroinflammation, impaired endogenous neurogenesis in DG and SVZ, and severe hippocampal cell loss. hUCB monotherapy suppressed neuroinflammation, nearly normalized the neurogenesis, and reduced hippocampal cell loss compared to saline alone. G-CSF monotherapy produced partial and short-lived benefits characterized by low levels of neuroinflammation in striatum, DG, SVZ, and corpus callosum and fornix, a modest neurogenesis, and a moderate reduction of hippocampal cells loss. On the other hand, combined therapy of hUCB+G-CSF displayed synergistic effects that robustly dampened neuroinflammation, while enhancing endogenous neurogenesis and reducing hippocampal cell loss. Vigorous and long-lasting recovery of motor function accompanied the combined therapy, which was either moderately or short-lived in the monotherapy conditions. These results suggest that combined treatment rather than monotherapy appears optimal for abrogating histophalogical and motor impairments in chronic TBI.
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Affiliation(s)
- Sandra A. Acosta
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, University of South Florida College of Medicine, Tampa, Florida, United States of America
| | - Naoki Tajiri
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, University of South Florida College of Medicine, Tampa, Florida, United States of America
| | - Kazutaka Shinozuka
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, University of South Florida College of Medicine, Tampa, Florida, United States of America
| | - Hiroto Ishikawa
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, University of South Florida College of Medicine, Tampa, Florida, United States of America
| | - Paul R. Sanberg
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, University of South Florida College of Medicine, Tampa, Florida, United States of America
- Office of Research and Innovation, University of South Florida, Tampa, Florida, United States of America
| | - Juan Sanchez-Ramos
- James Haley Veterans Affairs Medical Center, Tampa, Florida, United States of America
- Department of Neurology, University of South Florida, Tampa, Florida, United States of America
- Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, Florida, United States of America
| | - Shijie Song
- James Haley Veterans Affairs Medical Center, Tampa, Florida, United States of America
- Department of Neurology, University of South Florida, Tampa, Florida, United States of America
- Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, Florida, United States of America
| | - Yuji Kaneko
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, University of South Florida College of Medicine, Tampa, Florida, United States of America
| | - Cesar V. Borlongan
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, University of South Florida College of Medicine, Tampa, Florida, United States of America
- * E-mail:
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