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Miguel C, Cecconi J, Harrer M, van Ballegooijen W, Bhattacharya S, Karyotaki E, Cuijpers P, Gentili C, Cristea IA. Assessment of suicidality in trials of psychological interventions for depression: a meta-analysis. Lancet Psychiatry 2024; 11:252-261. [PMID: 38428438 DOI: 10.1016/s2215-0366(24)00027-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Psychological interventions that are efficacious as treatments for depression could indirectly affect suicide-related outcomes. We examined suicidal thoughts and behaviours as eligibility criteria, outcomes, and adverse events across trials of psychotherapy for depression. METHODS We used a publicly available meta-analytic database developed through systematic searches (updated as of May 1, 2023) to identify randomised controlled trials in which a psychological intervention for depression was compared with an inactive or non-specific control condition in adults with depression and in which any suicide-related outcomes were reported. We also identified studies in which suicide risk was an exclusion criterion. We excluded inpatient studies and trials of unguided digital interventions or collaborative care that included a psychological component. Pairs of reviewers worked independently to select studies and extract data. In a random-effects meta-analysis with robust variance estimation, we assessed the effect of the psychological intervention on suicide outcomes in trials in which suicide was explicitly assessed as an outcome with clinical scales with established psychometric properties. Risk of bias was assessed with the Cochrane risk-of-bias tool (version 2). FINDINGS Of the 469 randomised trials we identified in which a psychological intervention was compared with an inactive control in people with depression, 251 excluded people judged at risk of suicide. Any assessment of suicide was included in only 45 trials, 12 of which assessed suicidal ideation or risk as an outcome. These 12 trials included 3930 participants, 2795 (71%) of whom were female and 1135 (29%) of whom were male; data for age and ethnicity were not consistently reported. Psychological interventions for depression were associated with a small reduction in suicidal ideation and risk in 11 trials (one trial reported only follow-up data) after the intervention (standardised mean difference -0·31 [95% CI -0·60 to -0·03]) but not at follow-up (-0·49 [-1·31 to 0·32]). Suicide-related adverse events were reported in 25 trials, and suicide-related serious adverse events (eg, suicide attempts, deaths by suicide) were reported in 13 trials. Heterogeneity was substantial across all analyses, and prediction intervals crossed zero. INTERPRETATION Trials of psychological interventions for depression rarely report assessments of suicide. Psychological interventions might reduce suicidal ideation in patients with depression, but more randomised controlled trials are required to clarify this effect. Monitoring and reporting of suicide-related adverse events should be improved in trials of psychological interventions for depression, and future trials should incorporate outcomes related to suicidal thoughts or behaviours. FUNDING None. TRANSLATION For the Spanish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jessica Cecconi
- Department of General Psychology, University of Padua, Padua, Italy
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Technical University of Munich, Munich, Germany
| | - Wouter van Ballegooijen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Department of Psychiatry, Amsterdam UMC, Amsterdam, Netherlands
| | - Shalini Bhattacharya
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Claudio Gentili
- Department of General Psychology, University of Padua, Padua, Italy
| | - Ioana A Cristea
- Department of General Psychology, University of Padua, Padua, Italy.
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Koumoula A, Marchionatti LE, Karagiorga VE, Schafer JL, Simioni A, Caye A, Serdari A, Kotsis K, Basta M, Athanasopoulou L, Dafoulis V, Tatsiopoulou P, Zilikis N, Vergouli E, Balikou P, Kapsimalli E, Mitropoulou A, Tzotzi A, Klavdianou N, Zeleni D, Mitroulaki S, Botzaki A, Gerostergios G, Samiotakis G, Moschos G, Giannopoulou I, Papanikolaou K, Angeli K, Scarmeas N, Emanuele J, Schuster K, Karyotaki E, Kalikow L, Pronoiti K, Merikangas KR, Szatmari P, Cuijpers P, Georgiades K, Milham MP, Corcoran M, Burke S, Koplewicz H, Salum GA. Understanding priorities and needs for child and adolescent mental health in Greece from multiple informants: an open resource dataset. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02400-2. [PMID: 38558204 DOI: 10.1007/s00787-024-02400-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 02/15/2024] [Indexed: 04/04/2024]
Abstract
The Child and Adolescent Mental Health Initiative (CAMHI) aims to enhance mental health care capacity for children and adolescents across Greece. Considering the need for evidence-based policy, the program developed an open-resource dataset for researching the field within the country. A comprehensive, mixed-method, community-based research was conducted in 2022/2023 assessing the current state, needs, barriers, and opportunities according to multiple viewpoints. We surveyed geographically distributed samples of 1,756 caregivers, 1,201 children/adolescents, 404 schoolteachers, and 475 health professionals using validated instruments to assess mental health symptoms, mental health needs, literacy and stigma, service use and access, professional practices, training background, and training needs and preferences. Fourteen focus groups were conducted with informants from diverse populations (including underrepresented minorities) to reach an in-depth understanding of those topics. A dataset with quantitative and qualitative findings is now available for researchers, policymakers, and society [ https://osf.io/crz6h/ and https://rpubs.com/camhi/sdashboard ]. This resource offers valuable data for assessing the needs and priorities for child and adolescent mental health care in Greece. It is now freely available to consult, and is expected to inform upcoming research and evidence-based professional training. This initiative may inspire similar ones in other countries, informing methodological strategies for researching mental health needs.
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Affiliation(s)
- Anastasia Koumoula
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
| | - Lauro Estivalete Marchionatti
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
- Child Mind Institute, 101 E 56th St, New York, USA
- Department of Psychiatry, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - Vasiliki Eirini Karagiorga
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
- Child Mind Institute, 101 E 56th St, New York, USA
| | - Julia Luiza Schafer
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
- Child Mind Institute, 101 E 56th St, New York, USA
- Department of Psychiatry, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - André Simioni
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
- Child Mind Institute, 101 E 56th St, New York, USA
| | - Arthur Caye
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
- Child Mind Institute, 101 E 56th St, New York, USA
- Department of Psychiatry, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - Aspasia Serdari
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
- Department of Child and Adolescent Psychiatry, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Konstantinos Kotsis
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Maria Basta
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
- Department of Psychiatry, University Hospital of Heraklion, Crete, Greece
- Department of Child and Adolescent Psychiatry, University Hospital of Heraklion, Crete, Greece
| | - Lilian Athanasopoulou
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
| | - Vaios Dafoulis
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
| | - Paraskevi Tatsiopoulou
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
| | - Nikos Zilikis
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
| | - Evangelia Vergouli
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
| | - Panagiota Balikou
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
| | - Efstathia Kapsimalli
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
| | - Andromachi Mitropoulou
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
| | - Alexandra Tzotzi
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
| | - Nikanthi Klavdianou
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
| | - Domna Zeleni
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
| | - Sotiria Mitroulaki
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
| | - Anna Botzaki
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
| | - Giorgos Gerostergios
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
| | - Giorgos Samiotakis
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
| | - Giorgos Moschos
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
| | - Ioanna Giannopoulou
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
- 2nd Department of Psychiatry, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Papanikolaou
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
- Department of Child Psychiatry, Agia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Angeli
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
| | - Nikolaos Scarmeas
- National and Kapodistrian University of Athens (NKUA), Athens, Greece
- Columbia University, New York, NY, USA
| | - Jill Emanuele
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
- Child Mind Institute, 101 E 56th St, New York, USA
| | - Kenneth Schuster
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
- Child Mind Institute, 101 E 56th St, New York, USA
| | - Eirini Karyotaki
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
- Department of Clinical Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lily Kalikow
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
| | - Katerina Pronoiti
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
| | - Kathleen R Merikangas
- Genetic Epidemiology Research Branch, National Institute of Mental Health, Bathesda, USA
| | - Peter Szatmari
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Pim Cuijpers
- Department of Clinical Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Katholiki Georgiades
- Department of Psychiatry and Behavioural Neurosciences & Offord Centre for Child Studies, McMaster University, Hamilton, Canada
| | - Michael P Milham
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
- Child Mind Institute, 101 E 56th St, New York, USA
| | - Mimi Corcoran
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
- Child Mind Institute, 101 E 56th St, New York, USA
| | - Sarah Burke
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
- Child Mind Institute, 101 E 56th St, New York, USA
| | - Harold Koplewicz
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA
- Child Mind Institute, 101 E 56th St, New York, USA
| | - Giovanni Abrahão Salum
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, 101 E 56th St, New York, NY, 10022, USA.
- Child Mind Institute, 101 E 56th St, New York, USA.
- Department of Psychiatry, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil.
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Cuijpers P, Miguel C, Ciharova M, Harrer M, Karyotaki E. Non-directive supportive therapy for depression: A meta-analytic review. J Affect Disord 2024; 349:452-461. [PMID: 38211757 DOI: 10.1016/j.jad.2024.01.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/24/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Non-directive supportive therapy (NDST) is an important treatment of adult depression, but no recent meta-analysis has integrated the randomized trials examining its effects. METHODS We conducted a meta-analysis comparing NDST to control conditions and to other therapies, by using an existing database of randomized trials of psychological treatments of depression in adults. This database was built through searches in PubMed, PsycINFO, Embase and the Cochrane Library. RESULTS 48 randomized controlled trials (5075 participants), with 20 comparisons between NDST and a control group and 49 comparisons between NDST and another psychotherapy were included. Random effects meta-analyses found an effect size of NDST compared with control conditions of g = 0.53 (95 % CI, 0.34; 0.72) with moderate heterogeneity (I2 = 51; 95 % CI: 18; 71; PI = -0.02 to 1.09). NDST was less effective than other therapies (g = -0.21; 95 % CI: -0.31; -0.11). The difference with other therapies was significantly larger in studies in which NDST was used as a control group (p = .003). There was no significant difference between NDST and other therapies in which NDST was not used as a control group (k = 14; g = -0.05; 95 % CI: -0.17; 0.07). CONCLUSIONS NDST probably is an effective treatment of depression. The effects may be somewhat smaller than those of other therapies, but that may also be an artefact, because NDST is often used as a control group and may be designed as an "intent-to-fail" intervention in some studies.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands; Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania.
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Department of Health Sciences, Technical University of Munich, Munich, Germany
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
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Papola D, Miguel C, Mazzaglia M, Franco P, Tedeschi F, Romero SA, Patel AR, Ostuzzi G, Gastaldon C, Karyotaki E, Harrer M, Purgato M, Sijbrandij M, Patel V, Furukawa TA, Cuijpers P, Barbui C. Psychotherapies for Generalized Anxiety Disorder in Adults: A Systematic Review and Network Meta-Analysis of Randomized Clinical Trials. JAMA Psychiatry 2024; 81:250-259. [PMID: 37851421 PMCID: PMC10585589 DOI: 10.1001/jamapsychiatry.2023.3971] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/02/2023] [Indexed: 10/19/2023]
Abstract
Importance Generalized anxiety disorder (GAD) is one of the most common mental disorders in adults. Psychotherapies are among the most recommended treatments for GAD, but which should be considered as first-line treatment needs to be clarified. Objective To use a network meta-analysis to examine the short- and long-term associations of different psychotherapies with outcomes of effectiveness and acceptability in adults with GAD. Data Sources MEDLINE, Embase, PsycINFO, and the Cochrane Register of Controlled Trials were searched from database inception to January 1, 2023, to identify randomized clinical trials (RCTs) of psychotherapies for adults with GAD. Study Selection RCTs comparing any type of psychotherapy against another or with a control condition for the treatment of adults (≥18 years, both sexes) with a primary diagnosis of GAD were eligible for inclusion. Data Extraction and Synthesis This study followed Cochrane standards for extracting data and assessing data quality and used the PRISMA guideline for reporting. Risk of bias of individual studies was assessed using the second version of the Cochrane risk of bias tool, and the Confidence in Network Meta-Analysis was used to rate the certainty of evidence for meta-analytical results. Main Outcomes and Measures Eight psychotherapies were compared against one another and with 2 control conditions. Primary outcomes were severity of GAD symptoms and acceptability of the psychotherapies. Random-effects model pairwise and network meta-analyses were conducted. For effectiveness, standardized mean differences (SMDs) were pooled, and for acceptability, relative risks with 95% CIs were calculated. Results Data from 65 RCTs were included. Effect size estimates on data from 5048 participants (mean [SD], 70.9% [11.9%] women; mean [SD] age, 42.2 [12.5] years) suggested that third-wave cognitive behavior therapies (CBTs) (SMD, -0.76 [95% CI, -1.15 to -0.36]; certainty, moderate), CBT (SMD, -0.74 [95% CI, -1.09 to -0.38]; certainty, moderate), and relaxation therapy (SMD, -0.59 [95% CI, -1.07 to -0.11]; certainty, low) were associated with reduced GAD symptoms vs treatment as usual. Relative risks for all-cause discontinuation (indication of acceptability) signaled no differences compared with treatment as usual for all psychotherapies (eg, relative risk, 1.04 [95% CI, 0.64-1.67] for CBT vs treatment as usual). When excluding studies at high risk of bias, relaxation therapy lost its superiority over treatment as usual (SMD, -0.47; 95% CI, -1.18 to 0.23). When considering anxiety severity at 3 to 12 months after completion of the intervention, only CBT remained significantly associated with greater effectiveness than treatment as usual (SMD, -0.60; 95% CI, -0.99 to -0.21). Conclusions and Relevance Given the evidence in this systematic review and network meta-analysis for its associations with both acute and long-term effectiveness, CBT may represent the first-line therapy of GAD. Third-wave CBTs and relaxation therapy were associated with short-term effectiveness and may also be offered.
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Affiliation(s)
- Davide Papola
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Clara Miguel
- Section of Clinical Psychology, Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Mariacristina Mazzaglia
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Pamela Franco
- Department of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sara A. Romero
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Anushka R. Patel
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Giovanni Ostuzzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Chiara Gastaldon
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Eirini Karyotaki
- Section of Clinical Psychology, Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Department of Health Sciences, Technical University Munich, Munich, Germany
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marit Sijbrandij
- Section of Clinical Psychology, Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Toshi A. Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Pim Cuijpers
- Section of Clinical Psychology, Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Kurath J, Akhtar A, Karyotaki E, Sijbrandij M, Cuijpers P, Bryant R, Morina N. What works for whom and why? Treatment effects and their moderators among forcibly displaced people receiving psychological and psychosocial interventions: study protocol for an individual patient data meta-analysis. BMJ Open 2024; 14:e078473. [PMID: 38309750 PMCID: PMC10840047 DOI: 10.1136/bmjopen-2023-078473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/03/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION Forcibly displaced people (FDP) have a high risk of developing mental disorders such as post-traumatic stress (PTS) disorder. Providing adequate mental healthcare for FDP is crucial but despite overall efficacy of many existing interventions, a large proportion of FDP does not benefit from treatment, highlighting the necessity of further investigating factors contributing to individual differences in treatment outcome. Yet, the few studies that have explored moderators of treatment effects are often insufficiently powered. Therefore, the present Individual Patient Data meta-analysis (IPD-MA) will investigate treatment effects and their moderators-variables related to beneficiaries, providers, intervention and study characteristics in relation to PTS outcomes. METHODS AND ANALYSIS A systematic literature search will be conducted from database inception in the databases PsycINFO, Cochrane, Embase, PTSDpubs and Web of Science. Only studies published in English, German, French, Spanish, Portuguese, and Dutch will be considered. Retrieved records will be screened for eligibility. Randomised controlled trials on adult FDP receiving psychological and psychosocial interventions aimed at alleviating symptoms such as PTS compared with a control condition without intervention will be included in this IPD-MA. Subsequently, authors of eligible studies will be contacted to request individual patient data (IPD). All datasets obtained will be synthesised into one large dataset which will be analysed using a one-stage approach by conducting mixed-effects linear regression models (ie, primary analysis). Additionally, aggregate data meta-analyes will be run using a two-stage approach by conducting multivariate regression models including all IPD (transformed) and available meta-data from study reports (ie, secondary analysis). PTS will serve as primary outcome measure, while mental health outcomes other than PTS, attendance, attrition, treatment non-response and adverse outcomes will be examined as secondary outcomes. ETHICS AND DISSEMINATION This IPD-MA does not require ethical approval. The results will be published in international peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42022299510.
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Affiliation(s)
- Jennifer Kurath
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Aemal Akhtar
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
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6
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Li XM, Huang FF, Cuijpers P, Liu H, Karyotaki E, Li ZJ, Miguel C, Ciharova M, Dobson K. The efficacy of cognitive behavioral therapies for depression in China in comparison with the rest of the world: A systematic review and meta-analysis. J Consult Clin Psychol 2024; 92:105-117. [PMID: 37902688 DOI: 10.1037/ccp0000854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
OBJECTIVE There is consistent evidence that cognitive behavioral therapies (CBTs) are effective interventions for adult depression. While some evidence has compared these effects in different countries, no prior systematic review and meta-analysis has compared the efficacy of CBTs between Chinese and people from the rest of the world. The current meta-analysis addressed this gap by a systematic review of eligible studies from Chinese and worldwide databases. METHOD Hedges' g was calculated using a random-effects model. Subgroup analyses and multilevel meta-analytic models were conducted to examine the relationship among effect sizes and the characteristics in Chinese studies. Metaregression analyses were conducted to explore the difference of the efficacy of CBTs between Chinese studies and non-Chinese studies after controlling for the moderators. RESULTS A total of 34 (n = 3,710) studies in China and 307 (n = 30,333) studies from the rest of the world were included. The effect size of CBTs on depression for Chinese participants was 1.19 (95% CI [0.86, 1.52]), which was higher (Q = 4.63, p = .03) than the effect size of the rest of the world (0.82, 95% CI [0.74, 0.90]). After controlling for moderators, the effect size of Chinese studies was still higher than non-Chinese studies (β = 0.351, p = .011). CONCLUSIONS CBTs are effective interventions for adult depression and deserve more attention in China for depression management. Moderators related to study design, clinical features, and cultural factors need to be considered in the interpretation of the results. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Xiao-Miao Li
- Department of Clinical Psychology, University of Calgary
| | - Fang-Fang Huang
- Department of Clinical Psychology, National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam
| | - Huan Liu
- Department of Clinical Psychology, National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam
| | - Zhan-Jiang Li
- Department of Clinical Psychology, National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam
| | - Keith Dobson
- Department of Clinical Psychology, University of Calgary
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7
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Wright SL, Karyotaki E, Cuijpers P, Bisson J, Papola D, Witteveen A, Suliman S, Spies G, Ahmadi K, Capezzani L, Carletto S, Karatzias T, Kullack C, Laugharne J, Lee CW, Nijdam MJ, Olff M, Ostacoli L, Seedat S, Sijbrandij M. EMDR v. other psychological therapies for PTSD: a systematic review and individual participant data meta-analysis. Psychol Med 2024:1-9. [PMID: 38173121 DOI: 10.1017/s0033291723003446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
BACKGROUND This systematic review and individual participant data meta-analysis (IPDMA) examined the overall effectiveness of eye movement desensitization and reprocessing (EMDR) in reducing posttraumatic stress disorder (PTSD) symptoms, achieving response and remission, and reducing treatment dropout among adults with PTSD compared to other psychological treatments. Additionally, we examined available participant-level moderators of the efficacy of EMDR. METHODS This study included randomized controlled trials. Eligible studies were identified by a systematic search in PubMed, Embase, PsyclNFO, PTSDpubs, and CENTRAL. The target population was adults with above-threshold baseline PTSD symptoms. Trials were eligible if at least 70% of study participants had been diagnosed with PTSD using a structured clinical interview. Primary outcomes included PTSD symptom severity, treatment response, and PTSD remission. Treatment dropout was a secondary outcome. The systematic search retrieved 15 eligible randomized controlled trials (RCTs); 8 of these 15 were able to be included in this IPDMA (346 patients). Comparator treatments included relaxation therapy, emotional freedom technique, trauma-focused cognitive behavioral psychotherapies, and REM-desensitization. RESULTS One-stage IPDMA found no significant difference between EMDR and other psychological treatments in reducing PTSD symptom severity (β = -0.24), achieving response (β = 0.86), attaining remission (β = 1.05), or reducing treatment dropout rates (β = -0.25). Moderator analyses found unemployed participants receiving EMDR had higher PTSD symptom severity at the post-test, and males were more likely to drop out of EMDR treatment than females. CONCLUSION The current study found no significant difference between EMDR and other psychological treatments. We found some indication of the moderating effects of gender and employment status.
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Affiliation(s)
- Simonne Lesley Wright
- South Africa PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jonathan Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Davide Papola
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Anke Witteveen
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sharain Suliman
- South Africa PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Georgina Spies
- South Africa PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Khodabakhsh Ahmadi
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Liuva Capezzani
- The International Institute for Psychoanalytic Research and Training of Health Professionals (IIPRTHP), Rome, Italy
- International School for Psychotherapy (SIPSI), Rome, Italy
| | - Sara Carletto
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, Scotland
| | | | - Jonathan Laugharne
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - Christopher William Lee
- Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Australia
| | - Mirjam J Nijdam
- Department of Psychiatry & Amsterdam Public Health, Amsterdam University Medical Center location University of Amsterdam, Amsterdam, The Netherlands
- ARQ National Psychotrauma Center, Diemen, The Netherlands
| | - Miranda Olff
- Department of Psychiatry & Amsterdam Public Health, Amsterdam University Medical Center location University of Amsterdam, Amsterdam, The Netherlands
- ARQ National Psychotrauma Center, Diemen, The Netherlands
| | - Luca Ostacoli
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Soraya Seedat
- South Africa PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council Unit on the Genomics of Brain Disorders, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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8
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Tröger A, Miguel C, Ciharova M, de Ponti N, Durman G, Cuijpers P, Karyotaki E. Baseline depression severity as moderator on depression outcomes in psychotherapy and pharmacotherapy. J Affect Disord 2024; 344:86-99. [PMID: 37820960 DOI: 10.1016/j.jad.2023.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/02/2023] [Accepted: 10/08/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Evidence-based treatments for adult depression include psychotherapy and pharmacotherapy, yet little is known about how baseline depression severity moderates treatment outcome. OBJECTIVES We aimed to compare the effects of psychotherapy and pharmacotherapy for adult depression and to examine the association between baseline depression severity and treatment outcome, converting multiple baseline depression measures into the scores of the Beck Depression Inventory, second edition (BDI-II). METHODS We conducted systematic searches in bibliographical databases up to September 2022 to identify randomized controlled trials (RCTs) in which psychotherapy was compared with pharmacotherapy in the treatment of adult depression. Various meta-regressions using the baseline depression severity as predictor of the relative effects of psychotherapy and pharmacotherapy were performed. RESULTS We identified 65 RCTs including 7250 participants for the meta-analyses and 56 RCTs including 5548 participants for the meta-regression. We found no significant difference between psychotherapy and pharmacotherapy (g = -0.08, 95 % CI: -0.2 to 0.04, p = 0.193) and baseline depression severity was not significantly associated with the relative effects of psychotherapy and pharmacotherapy (B = 0.0032, SE = 0.0096, p = 0.74). Results were similar in several sensitivity analyses. LIMITATIONS Limitations included the low quality of the included studies, and the omission of long-term effects and within-study variability. CONCLUSIONS We found no indication for a moderation effect of baseline depression severity on the relative effects of psychotherapy and pharmacotherapy. Thus, other factors such as availability and patients' preference must be considered when deciding for treatment options.
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Affiliation(s)
- Anna Tröger
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universitat Dresden, Dresden, Germany.
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Nino de Ponti
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Güldehan Durman
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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9
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Shrivastava R, Singh A, Khan A, Choubey S, Haney JR, Karyotaki E, Tugnawat D, Bhan A, Naslund JA. Stress Alleviation Methods for community-Based Health ActiVists (SAMBHAV): Development of a digital program for stress reduction for community health workers in rural India. SSM Ment Health 2023; 4:100230. [PMID: 38188869 PMCID: PMC10769151 DOI: 10.1016/j.ssmmh.2023.100230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Background Community health workers (CHWs) face high levels of stress (both professional and personal) and risk of burnout, highlighting the need for efforts to promote their mental health and well-being. This study seeks to develop a digital stress reduction program for CHWs in rural India. Methods A stepwise design process was employed to adapt and digitize the evidence-based World Health Organization's Self-Help Plus (SH+) intervention for addressing psychological distress among CHWs in Madhya Pradesh, India. This involved participatory design workshops with CHWs to ensure that the digital stress reduction intervention would be relevant for their needs and the local culture and context. Small groups of CHWs reviewed the adapted program content, allowing the research team to make refinements such as simplifying language, tailoring content to the local setting, and ensuring that program materials are both interesting and relevant. Simultaneously, the research team digitized the content, leveraging a combination of video and graphical content, and uploaded it to the Sangath Learning Management System, a digital platform accessible on a smartphone app. Results In total, 18 CHWs contributed to the adaptation of the SH+ content and digital intervention development. Participants commented on finding some terms difficult to follow and recommended simplifying the language and providing detailed explanations. Participants offered positive feedback on the adapted content, expressing that they found the examples covered in the material both relatable and relevant to their own personal experiences at home and in the workplace. By combining participants' insights and comments with feedback from content experts, it was possible to finalize a digital Hindi version of the SH+ intervention for CHWs in rural India. Conclusions This study is timely given the continued detrimental impacts of the COVID-19 pandemic, and offers a promising and potentially scalable digital program to alleviate psychological distress among frontline health workers.
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Affiliation(s)
| | | | | | | | | | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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10
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Amanvermez Y, Karyotaki E, Cuijpers P, Ciharova M, Bruffaerts R, Kessler RC, Klein AM, Wiers RW, de Wit LM. Sources of stress among domestic and international students: a cross-sectional study of university students in Amsterdam, The Netherlands. Anxiety Stress Coping 2023:1-18. [PMID: 38047318 DOI: 10.1080/10615806.2023.2280701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/02/2023] [Indexed: 12/05/2023]
Abstract
High perceived stress is associated with psychological and academic difficulties among college students. In this study, we aimed to investigate associations of student status (international vs domestic student in the Netherlands) with eight common sources of stress (i.e., financial, health, love life, relationship with family, relationship with people at work/ school, the health of loved ones, other problems of loved ones, and life in general). Participants were 2,196 college students (domestic: n = 1,642, international: n = 554) from two universities in Amsterdam, the Netherlands. Hierarchical linear regression analyses were used to estimate associations of student status with all eight sources of stress. Student status was significantly associated with higher levels of perceived stress in almost all life domains. International student status was significantly associated with higher perceived stress in the domains of financial situation and health of loved ones after adjusting for sociodemographic characteristics, depressive and anxiety symptoms, and other sources of stress. Findings highlight that several differences exist in the magnitude of perceived stress in certain areas between international and domestic students in the Netherlands. Consequently, it is essential to uncover the different needs of college students and develop specific strategies to deliver the most suitable services.
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Affiliation(s)
- Yagmur Amanvermez
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Anke M Klein
- Developmental and Educational Psychology of the Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Reinout W Wiers
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, and Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Leonore M de Wit
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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11
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Cuijpers P, Kumar M, Karyotaki E. Climate Change and Mental Health-Time to Act Now. JAMA Psychiatry 2023; 80:1183-1184. [PMID: 37792381 DOI: 10.1001/jamapsychiatry.2023.3413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
This Viewpoint discusses the lack of research on the impact of climate events on mental health, climate change–related inequalities in low- and middle-income countries, and the immediate need to act now.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
- Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
| | - Manasi Kumar
- Department of Psychiatry University of Nairobi, Kenya, East Africa
- Brain and Mind Institute, Aga Khan University, Kenya, East Africa
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
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12
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Tong L, Miguel C, Panagiotopoulou OM, Karyotaki E, Cuijpers P. Psychotherapy for adult depression in low- and middle-income countries: an updated systematic review and meta-analysis. Psychol Med 2023; 53:7473-7483. [PMID: 37609800 PMCID: PMC10951412 DOI: 10.1017/s0033291723002246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 06/19/2023] [Accepted: 07/17/2023] [Indexed: 08/24/2023]
Abstract
Previous meta-analyses on psychotherapy for adult depression have found a larger treatment effect in non-Western trials compared to Western trials (i.e. North America, Europe, and Australia). However, factors contributing to this difference remain unclear. This study investigated different study characteristics between Western and non-Western trials and examined their association with effect size estimates. We systematically searched PubMed, PsycINFO, Embase, and Cochrane Library (01-09-2022). We included randomized-controlled trials (RCTs) that compared psychotherapy with a control condition. The validity of included RCTs was assessed by the Cochrane risk of bias assessment tool (RoB 1). Effect sizes were pooled using the random-effects model. Subgroup analyses and meta-regressions were also conducted. We identified 405 eligible trials, among which 105 trials (117 comparisons, 16 304 participants) were from non-Western countries. We confirmed that non-Western trials had a larger treatment effect (g = 1.10, 95% CI 0.90-1.31) than Western trials (g = 0.57, 95% CI 0.52-0.62). Trials from non-Western countries also had more usual care controls, higher risk of bias, larger sample sizes, lower mean ages, younger adults, more group-based interventions, and other recruitment methods (e.g. systematic screening; p < 0.05). The larger effect sizes found in non-Western trials were related to the presence of wait-list controls, high risk of bias, cognitive-behavioral therapy, and clinician-diagnosed depression (p < 0.05). The larger treatment effects observed in non-Western trials may result from the high heterogeneous study design and relatively low validity. Further research on long-term effects, adolescent groups, and individual-level data are still needed.
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Affiliation(s)
- Lingyao Tong
- Department of Clinical, Neuro & Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Clara Miguel
- Department of Clinical, Neuro & Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Olga-Maria Panagiotopoulou
- Department of Clinical, Neuro & Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro & Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro & Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
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13
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Ciharova M, Cuijpers P, Amanvermez Y, Riper H, Klein AM, Bolinski F, de Wit LM, van der Heijde CM, Bruffaerts R, Struijs S, Wiers RW, Karyotaki E. Use of tailoring features and reasons for dropout in a guided internet-based transdiagnostic individually-tailored cognitive behavioral therapy for symptoms of depression and/or anxiety in college students. Internet Interv 2023; 34:100646. [PMID: 38099094 PMCID: PMC10719529 DOI: 10.1016/j.invent.2023.100646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/01/2023] [Accepted: 07/07/2023] [Indexed: 12/17/2023] Open
Abstract
Transdiagnostic individually-tailored digital interventions reduce symptoms of depression and anxiety in adults with moderate effects. However, research into these approaches for college students is scarce and contradicting. In addition, the exact reasons for intervention dropout in this target group are not well known, and the use of individually-tailored intervention features, such as optional modules, has not yet been explored. The current study aimed to (1) investigate reasons for dropout from a guided internet-based transdiagnostic individually-tailored intervention for college students assessed in a randomized controlled trial (RCT) and (2) evaluate whether participants used tailoring features intended for their baseline symptoms. A sample of college students with mild to moderate depression and/or anxiety symptoms (n = 48) in the Netherlands (partially) followed a guided internet-based transdiagnostic individually-tailored intervention. We contacted those who did not complete the entire intervention (n = 29) by phone to report the reasons for intervention dropout. Further, we descriptively explored the use of tailoring features (i.e., depression versus anxiety trajectory) and optional modules of the intervention in the whole sample. We identified a range of person- and intervention-related reasons for intervention dropout, most commonly busy schedules, needs for different kinds of help, or absence of personal contact. Furthermore, only less than half of the participants used the individually-tailoring features to address the symptoms they reported as predominant. In conclusion, digital interventions clear about the content and targeted symptoms, tested in user research could prevent dropout and create reasonable expectations of the intervention. Participants would benefit from additional guidance when using tailoring features of digital interventions, as they often do not choose the tailoring features targeting their baseline symptoms.
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Affiliation(s)
- Marketa Ciharova
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- Faculty of Medicine, Dept. of Psychiatry, University of Turku, FI-20014 Turun yliopisto, Finland
- Babeș-Bolyai University, International Institute for Psychotherapy, No.37, Republicii Street 400015, Cluj-Napoca, Romania
| | - Yagmur Amanvermez
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- Faculty of Medicine, Dept. of Psychiatry, University of Turku, FI-20014 Turun yliopisto, Finland
- Research Unit for Telepsychiatry and e-Mental Health, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, 5000 Odense, Denmark
- Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands
| | - Anke M. Klein
- Developmental and Educational Psychology of the Institute of Psychology, Leiden University, Rapenburg 70, 2311 EZ Leiden, the Netherlands
- Addiction, Development, and Psychopathology Lab, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129, 1001NK Amsterdam, the Netherlands
| | - Felix Bolinski
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- Department of Mental Health and Prevention, Trimbos Institute, Da Costakade 45, 3521 VS Utrecht, the Netherlands
| | - Leonore M. de Wit
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
| | - Claudia M. van der Heijde
- Department of Research, Development and Prevention, Student Health Service, University of Amsterdam, Oude Turfmarkt 151, 1012 GC Amsterdam, the Netherlands
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum, Centre for Public Health Psychiatry, Katholieke Universiteit Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Sascha Struijs
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
| | - Reinout W. Wiers
- Addiction, Development, and Psychopathology Lab, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129, 1001NK Amsterdam, the Netherlands
- Center for Urban Mental Health, Oude Turfmarkt 145-147, 1012 GC Amsterdam, the Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
- WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, the Netherlands
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14
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Cuijpers P, Harrer M, Miguel C, Ciharova M, Karyotaki E. Five decades of research on psychological treatments of depression: A historical and meta-analytic overview. Am Psychol 2023:2024-26478-001. [PMID: 37971844 DOI: 10.1037/amp0001250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Since the 1970s, hundreds of randomized trials have examined the effects of psychotherapies for depression, and this number is increasing every year. In this study, we report outcomes from a living systematic review of these studies. We use Poisson regression analyses to examine if the proportions of studies have changed over time across the characteristics of the participants, therapies, and studies. We also present a meta-analysis of the effects across the major types, formats, targets, and age groups. We included 562 randomized controlled trials (669 comparisons; 66,361 patients). Most trials are conducted in adults and the relative proportion of trials in children and adolescents, as well as in older patients is significantly decreasing. The effects in children and adolescents are also significantly smaller than in adults (p = .007). Cognitive behavior therapy (CBT) is by far the best examined type of therapy (52%), but not necessarily more effective than other therapies. Over time, the proportion of studies examining several other types of therapy is significantly decreased compared to CBT. The quality of trials has increased over time, but still, a majority do not meet basic quality criteria, not even in recent years. The effects found in studies with low risk of bias are significantly smaller than in other studies (b = -0.21; SE = 0.05; p < .001). Most trials are conducted in the United States, but the proportion of studies in other parts of the world is rapidly increasing. The evidence that psychotherapies are effective is strong and growing every year. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam
| | - Mathias Harrer
- Department of Psychology and Digital Mental Health Care, Technical University of Munich
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam
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15
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Amanvermez Y, Karyotaki E, Cuijpers P, Ciharova M, Donker M, Hurks P, Salemink E, Spinhoven P, Struijs S, de Wit LM. A Guided, Internet-Based Stress Management Intervention for University Students With High Levels of Stress: Feasibility and Acceptability Study. JMIR Form Res 2023; 7:e45725. [PMID: 37948106 PMCID: PMC10674149 DOI: 10.2196/45725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 06/26/2023] [Accepted: 08/31/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Transitioning to adulthood and challenges in university life can result in increased stress levels among university students. Chronic and severe stress is associated with deleterious psychological and physiological effects. Digital interventions could succeed in approaching and helping university students who might be at risk; however, the experiences of students with internet-based stress management interventions are insufficiently understood. OBJECTIVE This study aims to explore the feasibility; acceptability; and changes in perceived stress, depressive symptoms, and quality of life from baseline to posttest assessment of a 5-session, internet-based stress management intervention guided by an e-coach, developed for university students experiencing high levels of stress. METHODS A single-arm study was conducted. Students were recruited from different channels, mainly from a web survey. Students were eligible if they (1) scored ≥20 on the Perceived Stress Scale-10, (2) were aged ≥18 years, and (3) were studying at one of the participating universities. Feasibility and acceptability of the intervention were investigated using several indications, including satisfaction (Client Satisfaction Questionnaire-8) and usability (System Usability Scale-10). We also investigated the indicators of intervention adherence using use metrics (eg, the number of completed sessions). Our secondary goal was to explore the changes in perceived stress (Perceived Stress Scale-10), depressive symptoms (Patient Health Questionnaire-9), and quality of life (EQ-5D-5L scale) from baseline to posttest assessment. In addition, we conducted semistructured interviews with intervention completers and noncompleters to understand user experiences in depth. For all primary outcomes, descriptive statistics were calculated. Changes from baseline to posttest assessment were examined using 2-tailed paired sample t tests or the Wilcoxon signed rank test. Qualitative data were analyzed using thematic analysis. RESULTS Of 436 eligible students, 307 (70.4%) students started using the intervention. Overall, 25.7% (79/307) completed the core sessions (ie, sessions 1-3) and posttest assessment. A substantial proportion of the students (228/307, 74.3%) did not complete the core sessions or the posttest assessment. Students who completed the core sessions reported high satisfaction (mean 25.78, SD 3.30) and high usability of the intervention (mean 86.01, SD 10.25). Moreover, this group showed large reductions in perceived stress (Cohen d=0.80) and moderate improvements in depression score (Cohen d=0.47) and quality of life (Cohen d=-0.35) from baseline to posttest assessment. Qualitative findings highlight that several personal and intervention-related factors play a role in user experience. CONCLUSIONS The internet-based stress management intervention seems to be feasible, acceptable, and possibly effective for some university students with elevated stress levels. However, given the high dropout rate and qualitative findings, several adjustments in the content and features of the intervention are needed to maximize the user experience and the impact of the intervention. TRIAL REGISTRATION Netherlands Trial Register 8686; https://onderzoekmetmensen.nl/nl/trial/20889. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1016/j.invent.2021.100369.
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Affiliation(s)
- Yagmur Amanvermez
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Marianne Donker
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Petra Hurks
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Elske Salemink
- Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
| | | | - Sascha Struijs
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Leonore M de Wit
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
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Papola D, Karyotaki E, Purgato M, Sijbrandij M, Tedeschi F, Cuijpers P, Orestis E, Furukawa TA, Patel V, Barbui C. Dismantling and personalising task-sharing psychosocial interventions for common mental disorders: a study protocol for an individual participant data component network meta-analysis. BMJ Open 2023; 13:e077037. [PMID: 37918937 PMCID: PMC10626809 DOI: 10.1136/bmjopen-2023-077037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/10/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Common mental disorders, including depression, anxiety and related somatic health symptoms, are leading causes of disability worldwide. Especially in low-resource settings, psychosocial interventions delivered by non-specialist providers through task-sharing modalities proved to be valid options to expand access to mental healthcare. However, such interventions are usually eclectic multicomponent interventions consisting of different combinations of evidence-based therapeutic strategies. Which of these various components (or combinations thereof) are more efficacious (and for whom) to reduce common mental disorder symptomatology is yet to be substantiated by evidence. METHODS AND ANALYSIS Comprehensive search was performed in electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Register of Controlled Trials-CENTRAL from database inception to 15 March 2023 to systematically identify all randomised controlled trials that compared any single component or multicomponent psychosocial intervention delivered through the task-sharing modality against any active or inactive control condition in the treatment of adults suffering from common mental disorders. From these trials, individual participant data (IPD) of all measured outcomes and covariates will be collected. We will dismantle psychosocial interventions creating a taxonomy of components and then apply the IPD component network meta-analysis (IPD-cNMA) methodology to assess the efficacy of individual components (or combinations thereof) according to participant-level prognostic factors and effect modifiers. ETHICS AND DISSEMINATION Ethics approval is not applicable for this study since no original data will be collected. Results from this study will be published in peer-reviewed journals and presented at relevant conferences.
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Affiliation(s)
- Davide Papola
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Efthimiou Orestis
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
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Cuijpers P, Miguel C, Ciharova M, Harrer M, Moir F, Roskvist R, van Straten A, Karyotaki E, Arroll B. Psychological treatment of adult depression in primary care compared with outpatient mental health care: A meta-analysis. J Affect Disord 2023; 339:660-675. [PMID: 37467801 DOI: 10.1016/j.jad.2023.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/05/2023] [Accepted: 07/08/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND It is not yet known whether psychological treatments of depression in primary care have comparable effects to treatments in specialized mental health care. We conducted a meta-analysis comparing randomized controlled trials in primary and specialized care. METHODS We selected studies from an existing database of randomized trials of psychological treatments of depression in adults, which was built through searches in PubMed, PsychINFO, Embase and the Cochrane Library. Random effects meta-analyses were conducted to examine the effects of therapies and mixed effects subgroup analyses were used to compare the effects in primary and specialized care. RESULTS We included 52 trials (7984 patients) in primary care and compared them with 50 trials (3685 patients) in specialized care. The main effect of therapies in primary care was g = 0.43 (95 % CI: 0.32; 0.53; PI: -0.18; 1.03). The overall effects were significantly smaller than those in specialized care (p = 0.006), but this was no longer significant after adjustment for differences between the two settings. The proportion of patients responding to treatment was comparable in primary (0.38; 95 % CI: 0.33; 0.43) and specialized care (0.34; 95 % CI: 0.28; 0.41; p = 0.41), but higher in control conditions in primary care (0.25; 95 % CI: 0.22; 0.28) compared to specialized care (0.16; 95 % CI: 0.12; 0.20; p < 0.001). DISCUSSION Psychological treatments are effective in primary care, but somewhat less than in specialized care. Response rates in control conditions in primary care are higher than in specialized care, which may point at a transient nature of depression in primary care.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands; Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania.
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Technische Universität München, Germany; Clinical Psychology & Psychotherapy, Universität Erlangen-, Nürnberg, Germany
| | - Fiona Moir
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Rachel Roskvist
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Bruce Arroll
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Augustinavicius J, Purgato M, Tedeschi F, Musci R, Leku MR, Carswell K, Lakin D, van Ommeren M, Cuijpers P, Sijbrandij M, Karyotaki E, Tol WA, Barbui C. Prevention and promotion effects of Self Help Plus: secondary analysis of cluster randomised controlled trial data among South Sudanese refugee women in Uganda. BMJ Open 2023; 13:e048043. [PMID: 37699637 PMCID: PMC10503328 DOI: 10.1136/bmjopen-2020-048043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 10/26/2022] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION Evidence-based and scalable prevention and promotion focused mental health and psychosocial support interventions are needed for conflict-affected populations in humanitarian settings. This study retrospectively assessed whether participation in Self Help Plus (SH+) versus enhanced usual care (EUC) resulted in reduced incidence of probable mental disorder and increased positive mental health and well-being post-intervention among South Sudanese refugee women in Uganda. METHODS This study used secondary data from treatment-oriented pilot (n=50) and fully-powered cluster randomised controlled trials (cRCT)s (n=694) of SH+ versus EUC. Data from baseline and post-intervention assessments were combined. A composite latent indicator for mental health problems was generated using mental health and well-being measures included in both cRCTs. In order to assess incidence, a binary variable approximating probable mental disorder was created to exclude those with probable mental disorder from the analysis sample and as the primary prevention outcome. The promotive effects of SH+ relative to EUC were examined in the same sample by assessing subjective well-being and psychological flexibility scale scores. RESULTS A single factor for mental health problems was identified with all factor loadings >0.30 and acceptable internal consistency (α=0.70). We excluded 161 women who met criteria for probable mental disorder at baseline. Among those with at least moderate psychological distress but without probable mental disorder at baseline and with follow-up data (n=538), the incidence of probable mental disorder at post-intervention was lower among those who participated in SH+ relative to EUC (Risk ratio =0.16, 95% CI: 0.05 to 0.53). Participation in SH+ versus EUC was also associated with increased subjective well-being (β=2.62, 95% CI: 1.63 to 3.60) and psychological flexibility (β=4.55, 95% CI: 2.92 to 6.18) at post-intervention assessment. CONCLUSIONS These results support the use and further testing of SH+ as a selective and indicated prevention and promotion focused psychosocial intervention in humanitarian settings. TRIAL REGISTRATION NUMBER ISRCTN50148022.
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Affiliation(s)
- Jura Augustinavicius
- School of Population and Global Health, McGill University, Montreal, Québec, Canada
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Veneto, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Veneto, Italy
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Veneto, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Veneto, Italy
| | - Rashelle Musci
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Kenneth Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneve, Switzerland
| | - Daniel Lakin
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneve, Switzerland
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Section of Clinical Psychology, Vrije Univ Amsterdam, Amsterdam, Netherlands
- WHO Collaborating Center for Research and Dissemination of Psychological Interventions and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Section of Clinical Psychology, Vrije Univ Amsterdam, Amsterdam, Netherlands
- WHO Collaborating Center for Research and Dissemination of Psychological Interventions and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, Section of Clinical Psychology, Vrije Univ Amsterdam, Amsterdam, Netherlands
- WHO Collaborating Center for Research and Dissemination of Psychological Interventions and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Wietse A Tol
- Global Health Section, University of Copenhagen, Kobenhavn, Denmark
- Athena Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- HealthRight International, New York city, New York, USA
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Veneto, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Veneto, Italy
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20
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Cuijpers P, Miguel C, Harrer M, Plessen CY, Ciharova M, Papola D, Ebert D, Karyotaki E. Psychological treatment of depression: A systematic overview of a 'Meta-Analytic Research Domain'. J Affect Disord 2023; 335:141-151. [PMID: 37178828 DOI: 10.1016/j.jad.2023.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Over the past 16 years, we have developed a 'Meta-analytic Research Domain' (MARD) of all randomized trials of psychological treatments of depression. A MARD is a living systematic review of a research field, that cannot be otherwise covered by one (network) meta-analysis and includes multiple PICOs. In this paper we give an overview of the findings of this MARD. METHODS A narrative review of the results of the 118 meta-analyses on psychotherapies for depression that were published within our MARD. RESULTS Most research has been conducted on cognitive-behavioral therapy (CBT), but several other psychotherapies are also effective, with few differences between therapies. They can be effectively delivered in individual, group, telephone and guided self-help format and are effective in many different target groups and across different age groups, although the effects are significantly smaller in children and adolescents. Psychotherapies have comparable effects as pharmacotherapy at the short term but are probably more effective at the longer term. Combined treatment is more effective than either psychotherapy or pharmacotherapy alone at the short, but also at the longer term. LIMITATIONS We did not summarize all published meta-analyses (protocols, methodological studies) and have not compared our results to those found in other meta-analyses on comparable subjects. CONCLUSION Psychotherapies can contribute considerably to a reduction of the disease burden of depression. MARDs are an important next step in the aggregation of knowledge from randomized controlled trials in psychological treatments of depression as well as in other healthcare sectors.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands; Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania.
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Department of Health Sciences, Technical University Munich, Munich, Germany; Department of Clinical Psychology & Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Constantin Yves Plessen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands; Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Davide Papola
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Italy; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - David Ebert
- Psychology & Digital Mental Health Care, Department of Health Sciences, Technical University Munich, Munich, Germany
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
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Cuijpers P, Miguel C, Harrer M, Ciharova M, Karyotaki E. Does the use of pharmacotherapy interact with the effects of psychotherapy? A meta-analytic review. Eur Psychiatry 2023; 66:e63. [PMID: 37534407 PMCID: PMC10594340 DOI: 10.1192/j.eurpsy.2023.2437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND It is not clear if there is an interaction between psychotherapy and pharmacotherapy. First, there may be no interaction at all, meaning that the effects of both are independent of each other. Second, antidepressants may reduce the effects of psychotherapy, and third, antidepressants may increase the effects of psychotherapy. We examined which of the three is correct. METHODS We conducted random effects meta-analyses of randomized trials comparing psychotherapies for adult depression with control conditions. The proportion of users of antidepressants was used as a predictor of the effect size in a series of meta-regression analyses, while adjusting for relevant moderators, such as type of control group and baseline severity. RESULTS We included 300 randomized controlled trials (353 comparisons between treatment and control; 32,852 participants). The main effect size of psychotherapy was g = 0.71 (95% CI: 0.64; 0.79) with high heterogeneity (I2 = 82; 95% CI: 80; 84). We found no significant association between the proportion of antidepressants users and effect size (p = .07). We did find a significant association with some other predictors, including the type of control group and risk of bias. The use of antidepressants was associated with higher response rates within the control conditions, but not with the relative effects of the treatments compared to the control groups. DISCUSSION We found support for the independent effects of psychotherapy and pharmacotherapy, which is good news from a clinical perspective. Apparently, patients can start with psychotherapy and do not have to be afraid that this will reduce the effects of the therapy.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, 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
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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22
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Karyotaki E, Sijbrandij M, Purgato M, Acarturk C, Lakin D, Bailey D, Peckham E, Uygun E, Tedeschi F, Wancata J, Augustinavicius J, Carswell K, Välimäki M, van Ommeren M, Koesters M, Popa M, Leku MR, Anttila M, Churchill R, White RG, Al-Hashimi S, Lantta T, Au T, Klein T, Tol WA, Cuijpers P, Barbui C. Self-Help Plus for refugees and asylum seekers: an individual participant data meta-analysis. BMJ Ment Health 2023; 26:e300672. [PMID: 37524517 PMCID: PMC10391800 DOI: 10.1136/bmjment-2023-300672] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/31/2023] [Indexed: 08/02/2023]
Abstract
QUESTION Refugees and asylum seekers are at high risk of mental disorders due to various stressors before, during and after forceful displacement. The WHO Self-Help Plus (SH+) intervention was developed to manage psychological distress and a broad range of mental health symptoms in vulnerable populations. This study aimed to examine the effects and moderators of SH+ compared with Enhanced Care as Usual (ECAU) in reducing depressive symptoms among refugees and asylum seekers. STUDY SELECTION AND ANALYSIS Three randomised trials were identified with 1795 individual participant data (IPD). We performed an IPD meta-analysis to estimate the effects of SH+, primarily on depressive symptoms and second on post-traumatic stress, well-being, self-identified problems and functioning. Effects were also estimated at 5-6 months postrandomisation (midterm). FINDINGS There was no evidence of a difference between SH+ and ECAU+ in reducing depressive symptoms at postintervention. However, SH+ had significantly larger effects among participants who were not employed (β=1.60, 95% CI 0.20 to 3.00) and had lower mental well-being levels (β=0.02, 95% CI 0.001 to 0.05). At midterm, SH+ was significantly more effective than ECAU in improving depressive symptoms (β=-1.13, 95% CI -1.99 to -0.26), self-identified problems (β=-1.56, 95% CI -2.54 to -0.59) and well-being (β=6.22, 95% CI 1.60 to 10.90). CONCLUSIONS Although SH+ did not differ significantly from ECAU in reducing symptoms of depression at postintervention, it did present benefits for particularly vulnerable participants (ie, unemployed and with lower mental well-being levels), and benefits were also evident at midterm follow-up. These results are promising for the use of SH+ in the management of depressive symptoms and improvement of well-being and self-identified problems among refugees and asylum seekers.
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Affiliation(s)
- Eirini Karyotaki
- Department of Clinical, Neuro-, and Developmental Psychology and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro-, and Developmental Psychology and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Ceren Acarturk
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Daniel Lakin
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Della Bailey
- Department of Health Sciences, University of York, York, UK
| | - Emily Peckham
- Department of Health Sciences, University of York, York, UK
| | - Ersin Uygun
- Department of Trauma and Disasters, Bilge University, Ankara, Turkey
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Johannes Wancata
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Jura Augustinavicius
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kenneth Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland
- Xiangya School of Nursing, The Xiangya Evidence-Based Practice and Healthcare Innovation, Central South University, Chang, People's Republic of China
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Mariana Popa
- School of Psychology, Queen's University Belfast, Belfast, UK
| | | | - Minna Anttila
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Ross G White
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - Sarah Al-Hashimi
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Teresa Au
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Thomas Klein
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Wietse A Tol
- Xiangya School of Nursing, The Xiangya Evidence-Based Practice and Healthcare Innovation, Central South University, Chang, People's Republic of China
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
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23
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Sander LB, Beisemann M, Karyotaki E, van Ballegooijen W, Cuijpers P, Teismann T, Doebler P, Domhardt M, Baumeister H, Büscher R. Effects of digital cognitive behavioral therapy for depression on suicidal thoughts and behavior: Protocol for a systematic review and meta-analysis of individual participant data. PLoS One 2023; 18:e0285622. [PMID: 37289758 PMCID: PMC10249902 DOI: 10.1371/journal.pone.0285622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/22/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION Digital cognitive behavioral therapy (i-CBT) interventions for the treatment of depression have been extensively studied and shown to be effective in the reduction of depressive symptoms. However, little is known about their effects on suicidal thoughts and behaviors (STB). Information on the impact of digital interventions on STB are essential for patients' safety because most digital interventions are self-help interventions without direct support options in case of a suicidal crisis. Therefore, we aim to conduct a meta-analysis of individual participant data (IPDMA) to investigate the effects of i-CBT interventions for depression on STB and to explore potential effect moderators. METHODS Data will be retrieved from an established and annually updated IPD database of randomized controlled trials investigating the effectiveness of i-CBT interventions for depression in adults and adolescents. We will conduct a one-stage and a two-stage IPDMA on the effects of these interventions on STB. All types of control conditions are eligible. STB can be measured using specific scales (e.g., Beck scale suicide, BSS) or single items from depression scales (e.g., item 9 of the PHQ-9) or standardized clinical interviews. Multilevel linear regression will be used for specific scales, and multilevel logistic regression will be used for treatment response or deterioration, operationalized as a change in score by at least one quartile from baseline. Exploratory moderator analyses will be conducted at participant, study, and intervention level. Two independent reviewers will assess the risk of bias using the Cochrane Risk of Bias Tool 2. CONCLUSION This IPDMA will harness the available data to assess the effects (response and deterioration) of i-CBT interventions for depression interventions on STB. Information about changes in STB is essential to estimate patients' safety when engaging in digital treatment formats. TRIAL REGISTRATION We will pre-register this study with the open science framework after article acceptance to ensure consistency between online registration and the published trial protocol.
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Affiliation(s)
- Lasse Bosse Sander
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Marie Beisemann
- Department of Statistics, TU Dortmund University, Dortmund, Germany
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wouter van Ballegooijen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Philipp Doebler
- Department of Statistics, TU Dortmund University, Dortmund, Germany
| | - Matthias Domhardt
- Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Harald Baumeister
- Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Rebekka Büscher
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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24
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Scholten W, Seldenrijk A, Hoogendoorn A, Bosman R, Muntingh A, Karyotaki E, Andersson G, Berger T, Carlbring P, Furmark T, Bouchard S, Goldin P, Kampmann I, Morina N, Kocovski N, Leibing E, Leichsenring F, Stolz T, van Balkom A, Batelaan N. Baseline Severity as a Moderator of the Waiting List-Controlled Association of Cognitive Behavioral Therapy With Symptom Change in Social Anxiety Disorder: A Systematic Review and Individual Patient Data Meta-analysis. JAMA Psychiatry 2023:2805367. [PMID: 37256597 PMCID: PMC10233456 DOI: 10.1001/jamapsychiatry.2023.1291] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Importance Social anxiety disorder (SAD) can be adequately treated with cognitive behavioral therapy (CBT). However, there is a large gap in knowledge on factors associated with prognosis, and it is unclear whether symptom severity predicts response to CBT for SAD. Objective To examine baseline SAD symptom severity as a moderator of the association between CBT and symptom change in patients with SAD. Data Sources For this systematic review and individual patient data meta-analysis (IPDMA), PubMed, PsycInfo, Embase, and the Cochrane Library were searched from January 1, 1990, to January 13, 2023. Primary search topics were social anxiety disorder, cognitive behavior therapy, and randomized controlled trial. Study Selection Inclusion criteria were randomized clinical trials comparing CBT with being on a waiting list and using the Liebowitz Social Anxiety Scale (LSAS) in adults with a primary clinical diagnosis of SAD. Data Extraction and Synthesis Authors of included studies were approached to provide individual-level data. Data were extracted by pairs of authors following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline, and risk of bias was assessed using the Cochrane tool. An IPDMA was conducted using a 2-stage approach for the association of CBT with change in LSAS scores from baseline to posttreatment and for the interaction effect of baseline LSAS score by condition using random-effects models. Main Outcomes and Measures The main outcome was the baseline to posttreatment change in symptom severity measured by the LSAS. Results A total of 12 studies including 1246 patients with SAD (mean [SD] age, 35.3 [10.9] years; 738 [59.2%] female) were included in the meta-analysis. A waiting list-controlled association between CBT and pretreatment to posttreatment LSAS change was found (b = -20.3; 95% CI, -24.9 to -15.6; P < .001; Cohen d = -0.95; 95% CI, -1.16 to -0.73). Baseline LSAS scores moderated the differences between CBT and waiting list with respect to pretreatment to posttreatment symptom reductions (b = -0.22; 95% CI, -0.39 to -0.06; P = .009), indicating that individuals with severe symptoms had larger waiting list-controlled symptom reductions after CBT (Cohen d = -1.13 [95% CI, -1.39 to -0.88] for patients with very severe SAD; Cohen d = -0.54 [95% CI, -0.80 to -0.29] for patients with mild SAD). Conclusions and Relevance In this systematic review and IPDMA, higher baseline SAD symptom severity was associated with greater (absolute but not relative) symptom reductions after CBT in patients with SAD. The findings contribute to personalized care by suggesting that clinicians can confidently offer CBT to individuals with severe SAD symptoms.
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Affiliation(s)
- Willemijn Scholten
- GGZ inGeest, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Adrie Seldenrijk
- GGZ inGeest, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Adriaan Hoogendoorn
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Renske Bosman
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Anna Muntingh
- GGZ inGeest, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Eirini Karyotaki
- Faculty of Behavioural and Movement Sciences, Department of Clinical, Neuro- and Developmental Psychology, VU Amsterdam, Amsterdam, the Netherlands
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Tomas Furmark
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Stéphane Bouchard
- Departement de Psychoéducation et Psychologie, Université du Québec en Outaouais, Gatineau, Quebec, Canada
- Centre de Recherche, Centre Intégré de Santé et des Services Sociaux de l'Outaouais, Gatineau, Quebec, Canada
| | - Philippe Goldin
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento
| | - Isabel Kampmann
- Institute of Psychology, University of Münster, Münster, Germany
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
| | - Nancy Kocovski
- Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Eric Leibing
- Clinic of Psychosomatic Medicine and Psychotherapy, University Medicine Goettingen, Georg-August-Universität Goettingen, Goettingen, Germany
| | - Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
| | - Timo Stolz
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Anton van Balkom
- GGZ inGeest, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Neeltje Batelaan
- GGZ inGeest, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
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25
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Koumoula A, Marchionatti LE, Caye A, Karagiorga VE, Balikou P, Lontou K, Arkoulaki V, Simioni A, Serdari A, Kotsis K, Basta M, Kapsimali E, Mitropoulou A, Klavdianou N, Zeleni D, Mitroulaki S, Botzaki A, Gerostergios G, Samiotakis G, Moschos G, Giannopoulou I, Papanikolaou K, Aggeli K, Scarmeas N, Koulouvaris P, Emanuele J, Schuster K, Karyotaki E, Kalikow L, Pronoiti K, Gosmann NP, Schafer JL, Merikangas KR, Szatmari P, Cuijpers P, Georgiades K, Milham MP, Corcoran M, Burke S, Koplewicz H, Salum GA. The science of child and adolescent mental health in Greece: a nationwide systematic review. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02213-9. [PMID: 37179505 DOI: 10.1007/s00787-023-02213-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/11/2023] [Indexed: 05/15/2023]
Abstract
Evidence-based information is essential for effective mental health care, yet the extent and accessibility of the scientific literature are critical barriers for professionals and policymakers. To map the necessities and make validated resources accessible, we undertook a systematic review of scientific evidence on child and adolescent mental health in Greece encompassing three research topics: prevalence estimates, assessment instruments, and interventions. We searched Pubmed, Web of Science, PsycINFO, Google Scholar, and IATPOTEK from inception to December 16th, 2021. We included studies assessing the prevalence of conditions, reporting data on assessment tools, and experimental interventions. For each area, manuals informed data extraction and the methodological quality were ascertained using validated tools. This review was registered in protocols.io [68583]. We included 104 studies reporting 533 prevalence estimates, 223 studies informing data on 261 assessment instruments, and 34 intervention studies. We report the prevalence of conditions according to regions within the country. A repository of locally validated instruments and their psychometrics was compiled. An overview of interventions provided data on their effectiveness. The outcomes are made available in an interactive resource online [ https://rpubs.com/camhi/sysrev_table ]. Scientific evidence on child and adolescent mental health in Greece has now been cataloged and appraised. This timely and accessible compendium of up-to-date evidence offers valuable resources for clinical practice and policymaking in Greece and may encourage similar assessments in other countries.
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Affiliation(s)
- Anastasia Koumoula
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
| | - Lauro Estivalete Marchionatti
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
- Child Mind Institute, 101 E 56Th St, New York, NY, 10022, USA
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Arthur Caye
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
- Child Mind Institute, 101 E 56Th St, New York, NY, 10022, USA
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Vasiliki Eirini Karagiorga
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
- Child Mind Institute, 101 E 56Th St, New York, NY, 10022, USA
| | - Panagiota Balikou
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
| | - Katerina Lontou
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
| | - Vicky Arkoulaki
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
| | - André Simioni
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
- Child Mind Institute, 101 E 56Th St, New York, NY, 10022, USA
| | - Aspasia Serdari
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
- Department of Child and Adolescent Psychiatry, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Konstantinos Kotsis
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Maria Basta
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
- Department of Psychiatry, University Hospital of Heraklion, Crete, Greece
- Department of Child and Adolescent Psychiatry, University Hospital of Heraklion, Crete, Greece
| | - Efi Kapsimali
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
| | - Andromachi Mitropoulou
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
| | - Nikanthi Klavdianou
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
| | - Domna Zeleni
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
| | - Sotiria Mitroulaki
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
| | - Anna Botzaki
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
| | - Giorgos Gerostergios
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
| | - Giorgos Samiotakis
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
| | - Giorgos Moschos
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
| | - Ioanna Giannopoulou
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
- 2nd Department of Psychiatry, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Papanikolaou
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
- Department of Child Psychiatry, Agia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Aggeli
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
| | - Nikolaos Scarmeas
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
- Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
- Department of Neurology, Columbia University, New York, USA
| | - Panagiotis Koulouvaris
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
| | - Jill Emanuele
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
- Child Mind Institute, 101 E 56Th St, New York, NY, 10022, USA
| | - Kenneth Schuster
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
- Child Mind Institute, 101 E 56Th St, New York, NY, 10022, USA
| | - Eirini Karyotaki
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
- Department of Clinical Neuro and Developmental Psychology, Vrije University Amsterdam, Amsterdam, The Netherlands
| | - Lily Kalikow
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
| | - Katerina Pronoiti
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
| | - Natan Pereira Gosmann
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
- Child Mind Institute, 101 E 56Th St, New York, NY, 10022, USA
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Julia Luiza Schafer
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
- Child Mind Institute, 101 E 56Th St, New York, NY, 10022, USA
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Kathleen R Merikangas
- Genetic Epidemiology Research Branch, National Institute of Mental Health, Bethesda, USA
| | - Peter Szatmari
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Pim Cuijpers
- Department of Clinical Neuro and Developmental Psychology, Vrije University Amsterdam, Amsterdam, The Netherlands
| | - Katholiki Georgiades
- Department of Psychiatry and Behavioural Neurosciences & Offord Centre for Child Studies, McMaster University, Hamilton, Canada
| | - Michael P Milham
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
- Child Mind Institute, 101 E 56Th St, New York, NY, 10022, USA
| | - Mimi Corcoran
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
- Child Mind Institute, 101 E 56Th St, New York, NY, 10022, USA
| | - Sarah Burke
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
- Child Mind Institute, 101 E 56Th St, New York, NY, 10022, USA
| | - Harold Koplewicz
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA
- Child Mind Institute, 101 E 56Th St, New York, NY, 10022, USA
| | - Giovanni Abrahão Salum
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, New York, USA.
- Child Mind Institute, 101 E 56Th St, New York, NY, 10022, USA.
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
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Sadeh Y, Denejkina A, Karyotaki E, Lenferink LIM, Kassam-Adams N. Erratum: Opportunities for improving data sharing and FAIR data practices to advance global mental health-Corrigendum. Glob Ment Health (Camb) 2023; 10:e20. [PMID: 37854415 PMCID: PMC10579671 DOI: 10.1017/gmh.2023.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
[This corrects the article DOI: 10.1017/gmh.2023.7.].
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Abstract
OBJECTIVE Behavioral activation (BA) is an extensively examined treatment for depression which is relatively simple to apply in comparison to other psychotherapies. BA aims to increase positive interactions between a person and the environment. All previous meta-analyses focused on BA in groups and guided self-help, but none focused on BA in individual psychotherapy. The goal of the current meta-analysis is to examine the pooled effects of trials comparing individual BA to control conditions. METHODS We conducted systematic searches and conducted random effects meta-analyses to examine the effects of BA. RESULTS We included 22 randomized controlled trials (with 819 patients) comparing individual behavioral activation with waitlist, usual care, or other control conditions on distal treatment outcomes. Nine studies were rated as low risk of bias. We found a large effect (Hedges' g = 0.85; 95% CI: 0.57; 1.1) with high heterogeneity (75%; 95% CI: 62; 83). When only studies with low risk of bias were considered, the effect size was still significant (g = 0.56; 95% CI: 0.09; 1.03), with high heterogeneity (I2 = 80%; 95% CI: 66; 89; prediction interval: -0.85; 1.98). CONCLUSION BA is an effective, relatively simple type of therapy that can be applied broadly in differing populations/.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Mathias Harrer
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Yvonne Stikkelbroek
- Depression Expertise Centre-Youth, GGZ Oost Brabant, Boekel, Netherlands
- Department of Clinical Child and Family Studies, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, Netherlands
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Miguel C, Karyotaki E, Ciharova M, Cristea IA, Penninx BW, Cuijpers P. Psychotherapy for comorbid depression and somatic disorders: a systematic review and meta-analysis. Psychol Med 2023; 53:2503-2513. [PMID: 34792017 PMCID: PMC10123840 DOI: 10.1017/s0033291721004414] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 09/01/2021] [Accepted: 10/11/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The treatment of depression in patients with somatic disorders is crucial, given its negative impact on quality of life (QoL), functioning, and even on the somatic disease prognosis. We aimed to examine the most updated evidence on the effects of psychotherapy in patients with depression and somatic disorders, including HIV, oncological, cardiometabolic, and neurological disorders. METHODS We conducted a meta-analysis of 75 randomized trials (8209 participants) of psychotherapy for adults with somatic disorders and a diagnosis or elevated symptoms of depression. Outcomes included depression, QoL, somatic health-related outcomes, and mortality. RESULTS Psychotherapy significantly reduced the severity of depression at post-treatment across all categories of somatic disorders (Hedges'g = 0.65; 95% CI 0.52-0.79), with sustained effects at 6-11 months (g = 0.38; 95% CI 0.22-0.53) and at 12 months follow-up or longer (g = 0.13; 95% CI 0.04-0.21). Psychotherapy also showed significant effects on QoL (g = 0.26; 95% CI 0.17-0.35), maintained up to 11 months follow-up (g = 0.25; 95% CI 0.16-0.34). No significant effects were observed on the most frequently reported somatic health-related outcomes (glycemic control, pain), and neither on mortality. Heterogeneity in most analyses was very high, and only 29 (38%) trials were rated at low risk of bias (RoB). CONCLUSIONS Psychotherapy may be an effective treatment option for patients with depression and somatic disorders, with long-term effects on depression severity and QoL. However, these results should be interpreted with caution due to heterogeneity and RoB.
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Affiliation(s)
- Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, The Netherlands
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Ioana A. Cristea
- Department of Brain and Behavioral Sciences, University of Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - Brenda W.J.H. Penninx
- Department of Psychiatry, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, The Netherlands
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Miguel C, Amarnath A, Akhtar A, Malik A, Baranyi G, Barbui C, Karyotaki E, Cuijpers P. Universal, selective and indicated interventions for supporting mental health at the workplace: an umbrella review of meta-analyses. Occup Environ Med 2023; 80:225-236. [PMID: 36828633 PMCID: PMC10086469 DOI: 10.1136/oemed-2022-108698] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/19/2023] [Indexed: 02/26/2023]
Abstract
The current umbrella review aimed to assess and summarise evidence on universal, selective and indicated interventions for mental health at the workplace. This umbrella review forms one of the evidence reviews which were commissioned by the WHO to develop global guidelines on mental health at work. We conducted systematic searches in five bibliographic databases (PubMed, Embase, PsycINFO, Cochrane and Global Medicus Index) and included meta-analyses of randomised trials examining psychosocial, physical activity and lifestyle interventions delivered to all general workers (universal interventions), at-risk workers (selective interventions) and workers already experiencing symptoms of mental disorders (indicated interventions). We included outcomes from seven domains: symptoms of mental health conditions, positive mental health, quality of life, work-related outcomes, substance use, suicide-related outcomes and potential adverse effects. We identified 16 meta-analyses producing 66 pooled effect sizes of the examined interventions, mostly on symptoms of mental health conditions (n=43 pooled effect sizes) (eg, burnout, insomnia, stress) and positive mental health (n=15) (eg, well-being). Most of the evidence on universal, selective and indicated interventions was focused on psychosocial interventions, showing small to moderate effects across the various outcomes. Certainty levels according to GRADE (Grading of Recommendations Assessment, Development and Evaluation) were low to very low in almost all of the examined outcomes. The results of existing meta-analyses are promising for the use of preventative and early treatment interventions in the workplace. However, the quality and certainty of the evidence were very modest, and further research on the effectiveness of these interventions is warranted.
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Affiliation(s)
- Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Arpana Amarnath
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia.,Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Aiysha Malik
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Gergő Baranyi
- Society and Health, The University of Edinburgh, Edinburgh, UK
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - 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
| | - 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
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30
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Cuijpers P, Franco P, Ciharova M, Miguel C, Segre L, Quero S, Karyotaki E. Psychological treatment of perinatal depression: a meta-analysis. Psychol Med 2023; 53:2596-2608. [PMID: 37310303 PMCID: PMC10123831 DOI: 10.1017/s0033291721004529] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 06/08/2021] [Accepted: 10/18/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Depression during pregnancy and after the birth of a child is highly prevalent and an important public health problem. Psychological interventions are the first-line treatment and, although a considerable number of randomized trials have been conducted, no recent comprehensive meta-analysis has evaluated treatment effects. METHODS We used an existing database of randomized controlled trials of psychotherapies for adult depression and included studies aimed at perinatal depression. Random effects models were used in all analyses. We examined the effects of the interventions in the short and long term, and also examined secondary outcomes. RESULTS Forty-three studies with 49 comparisons and 6270 participants between an intervention and control group were included. The overall effect size was g = 0.67 [95% confidence interval (CI) 0.45~0.89; numbers needed-to-be-treated = 4.39] with high heterogeneity (I2 = 80%; 95% CI 75~85). This effect size remained largely unchanged and significant in a series of sensitivity analyses, although some publication bias was found. The effects remained significant at 6-12 months follow-up. Significant effects were also found for social support, anxiety, functional limitations, parental stress and marital stress, although the number of studies for each outcome was low. All results should be considered with caution because of the high levels of heterogeneity in most analyses. CONCLUSIONS Psychological interventions are probably effective in the treatment of perinatal depression, with effects that last at least up to 6-12 months and probably also have effects on social support, anxiety, functional impairment, parental stress, and marital stress.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pamela Franco
- Department of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lisa Segre
- College of Nursing, University of Iowa, Iowa City, USA
| | - Soledad Quero
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
- CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Sadeh Y, Denejkina A, Karyotaki E, Lenferink LIM, Kassam-Adams N. Opportunities for improving data sharing and FAIR data practices to advance global mental health. Glob Ment Health (Camb) 2023; 10:e14. [PMID: 37860102 PMCID: PMC10581864 DOI: 10.1017/gmh.2023.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/24/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023] Open
Abstract
It is crucial to optimize global mental health research to address the high burden of mental health challenges and mental illness for individuals and societies. Data sharing and reuse have demonstrated value for advancing science and accelerating knowledge development. The FAIR (Findable, Accessible, Interoperable, and Reusable) Guiding Principles for scientific data provide a framework to improve the transparency, efficiency, and impact of research. In this review, we describe ethical and equity considerations in data sharing and reuse, delineate the FAIR principles as they apply to mental health research, and consider the current state of FAIR data practices in global mental health research, identifying challenges and opportunities. We describe noteworthy examples of collaborative efforts, often across disciplinary and national boundaries, to improve Findability and Accessibility of global mental health data, as well as efforts to create integrated data resources and tools that improve Interoperability and Reusability. Based on this review, we suggest a vision for the future of FAIR global mental health research and suggest practical steps for researchers with regard to study planning, data preservation and indexing, machine-actionable metadata, data reuse to advance science and improve equity, metrics and recognition.
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Affiliation(s)
- Yaara Sadeh
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Trauma Data Institute, Lovingston, VA, USA
| | - Anna Denejkina
- Graduate Research School, Western Sydney University, Penrith, NSW, Australia
- Translational Health Research Institute, Sydney, Australia
- Young and Resilient Research Centre, Sydney, Australia
| | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Institute, Amsterdam, Netherlands
| | - Lonneke I. M. Lenferink
- Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Nancy Kassam-Adams
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Trauma Data Institute, Lovingston, VA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Seo M, Furukawa TA, Karyotaki E, Efthimiou O. Developing prediction models when there are systematically missing predictors in individual patient data meta-analysis. Res Synth Methods 2023; 14:455-467. [PMID: 36755407 DOI: 10.1002/jrsm.1625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
Clinical prediction models are widely used in modern clinical practice. Such models are often developed using individual patient data (IPD) from a single study, but often there are IPD available from multiple studies. This allows using meta-analytical methods for developing prediction models, increasing power and precision. Different studies, however, often measure different sets of predictors, which may result to systematically missing predictors, that is, when not all studies collect all predictors of interest. This situation poses challenges in model development. We hereby describe various approaches that can be used to develop prediction models for continuous outcomes in such situations. We compare four approaches: a "restrict predictors" approach, where the model is developed using only predictors measured in all studies; a multiple imputation approach that ignores study-level clustering; a multiple imputation approach that accounts for study-level clustering; and a new approach that develops a prediction model in each study separately using all predictors reported, and then synthesizes all predictions in a multi-study ensemble. We explore in simulations the performance of all approaches under various scenarios. We find that imputation methods and our new method outperform the restrict predictors approach. In several scenarios, our method outperformed imputation methods, especially for few studies, when predictor effects were small, and in case of large heterogeneity. We use a real dataset of 12 trials in psychotherapies for depression to illustrate all methods in practice, and we provide code in R.
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Affiliation(s)
- Michael Seo
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Toshi A Furukawa
- Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Eirini Karyotaki
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.,Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Psychiatry, University of Oxford, Oxford, UK
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Cuijpers P, Miguel C, Ciharova M, Kumar M, Brander L, Kumar P, Karyotaki E. Impact of climate events, pollution, and green spaces on mental health: an umbrella review of meta-analyses. Psychol Med 2023; 53:638-653. [PMID: 36606450 PMCID: PMC9975983 DOI: 10.1017/s0033291722003890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 11/25/2022] [Accepted: 12/09/2022] [Indexed: 01/07/2023]
Abstract
Climate change may affect mental health. We conducted an umbrella review of meta-analyses examining the association between mental health and climate events related to climate change, pollution and green spaces. We searched major bibliographic databases and included meta-analyses with at least five primary studies. Results were summarized narratively. We included 24 meta-analyses on mental health and climate events (n = 13), pollution (n = 11), and green spaces (n = 2) (two meta-analyses provided data on two categories). The quality was suboptimal. According to AMSTAR-2, the overall confidence in the results was high for none of the studies, for three it was moderate, and for the other studies the confidence was low to critically low. The meta-analyses on climate events suggested an increased prevalence of symptoms of post-traumatic stress, depression, and anxiety associated with the exposure to various types of climate events, although the effect sizes differed considerably across study and not all were significant. The meta-analyses on pollution suggested that there may be a small but significant association between PM2.5, PM10, NO2, SO2, CO and mental health, especially depression and suicide, as well as autism spectrum disorders after exposure during pregnancy, but the resulting effect sizes varied considerably. Serious methodological flaws make it difficult to draw credible conclusions. We found reasonable evidence for an association between climate events and mental health and some evidence for an association between pollution and mental disorders. More high-quality research is needed to verify these associations.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Manasi Kumar
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Luke Brander
- Institute for Environmental Studies, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pushpam Kumar
- United Nations Environment Programme, Washington, DC, USA
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Plessen CY, Karyotaki E, Miguel C, Ciharova M, Cuijpers P. Exploring the efficacy of psychotherapies for depression: a multiverse meta-analysis. BMJ Ment Health 2023; 26:e300626. [PMID: 36914209 PMCID: PMC10035781 DOI: 10.1136/bmjment-2022-300626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/20/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Hundreds of randomised controlled trials and dozens of meta-analyses have examined psychotherapies for depression-yet not all points in the same direction. Are these discrepancies a result of specific meta-analytical decisions or do most analytical strategies reaching the same conclusion? OBJECTIVE We aim to solve these discrepancies by conducting a multiverse meta-analysis containing all possible meta-analyses, using all statistical methods. STUDY SELECTION AND ANALYSIS We searched four bibliographical databases (PubMed, EMBASE, PsycINFO and Cochrane Register of Controlled Trials), including studies published until 1 January 2022. We included all randomised controlled trials comparing psychotherapies with control conditions without restricting the type of psychotherapy, target group, intervention format, control condition and diagnosis. We defined all possible meta-analyses emerging from combinations of these inclusion criteria and estimated the resulting pooled effect sizes with fixed-effect, random-effects, 3-level, robust variance estimation, p-uniform and PET-PEESE (precision-effect test and precision-effect estimate with SE) meta-analysis models. This study was preregistered (https://doi.org/10.1136/bmjopen-2021-050197). FINDINGS A total of 21 563 records were screened, and 3584 full texts were retrieved; 415 studies met our inclusion criteria containing 1206 effect sizes and 71 454 participants. Based on all possible combinations between inclusion criteria and meta-analytical methods, we calculated 4281 meta-analyses. The average summary effect size for these meta-analyses was Hedges' g mean=0.56, a medium effect size, and ranged from g=-0.66 to 2.51. In total, 90% of these meta-analyses reached a clinically relevant magnitude. CONCLUSIONS AND CLINICAL IMPLICATIONS The multiverse meta-analysis revealed the overall robustness of the effectiveness of psychotherapies for depression. Notably, meta-analyses that included studies with a high risk of bias, compared the intervention with wait-list control groups, and not correcting for publication bias produced larger effect sizes.
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Affiliation(s)
- Constantin Yves Plessen
- Department of Psychosomatic Medicine, Charite University Hospital Berlin, Berlin, Germany
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam Faculty of Behavioural and Movement Sciences, Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam Faculty of Behavioural and Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Clara Miguel
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam Faculty of Behavioural and Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marketa Ciharova
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam Faculty of Behavioural and Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam Faculty of Behavioural and Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Cuijpers P, Miguel C, Harrer M, Plessen CY, Ciharova M, Ebert D, Karyotaki E. Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: a comprehensive meta-analysis including 409 trials with 52,702 patients. World Psychiatry 2023; 22:105-115. [PMID: 36640411 PMCID: PMC9840507 DOI: 10.1002/wps.21069] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 01/15/2023] Open
Abstract
Cognitive behavior therapy (CBT) is by far the most examined type of psychological treatment for depression and is recommended in most treatment guide-lines. However, no recent meta-analysis has integrated the results of randomized trials examining its effects, and its efficacy in comparison with other psychotherapies, pharmacotherapies and combined treatment for depression remains uncertain. We searched PubMed, PsycINFO, Embase and the Cochrane Library to identify studies on CBT, and separated included trials into several subsets to conduct random-effects meta-analyses. We included 409 trials (518 comparisons) with 52,702 patients, thus conducting the largest meta-analysis ever of a specific type of psychotherapy for a mental disorder. The quality of the trials was found to have increased significantly over time (with increasing numbers of trials with low risk of bias, less waitlist control groups, and larger sample sizes). CBT had moderate to large effects compared to control conditions such as care as usual and waitlist (g=0.79; 95% CI: 0.70-0.89), which remained similar in sensitivity analyses and were still significant at 6-12 month follow-up. There was no reduction of the effect size of CBT according to the publication year (<2001 vs. 2001-2010 vs. >2011). CBT was significantly more effective than other psychotherapies, but the difference was small (g=0.06; 95% CI: 0-0.12) and became non-significant in most sensitivity analyses. The effects of CBT did not differ significantly from those of pharmacotherapies at the short term, but were significantly larger at 6-12 month follow-up (g=0.34; 95% CI: 0.09-0.58), although the number of trials was small, and the difference was not significant in all sensitivity analyses. Combined treatment was more effective than pharmacotherapies alone at the short (g=0.51; 95% CI: 0.19-0.84) and long term (g=0.32; 95% CI: 0.09-0.55), but it was not more effective than CBT alone at either time point. CBT was also effective as unguided self-help intervention (g=0.45; 95% CI: 0.31-0.60), in institutional settings (g=0.65; 95% CI: 0.21-1.08), and in children and adolescents (g=0.41; 95% CI: 0.25-0.57). We can conclude that the efficacy of CBT in depression is documented across different formats, ages, target groups, and settings. However, the superiority of CBT over other psychotherapies for depression does not emerge clearly from this meta-analysis. CBT appears to be as effective as pharmacotherapies at the short term, but more effective at the longer term.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands,Babes,‐Bolyai University, International Institute for PsychotherapyCluj‐NapocaRomania,WHO Collaborating Centre for Research and Dissemination of Psychological InterventionsVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Department of Health SciencesTechnical University MunichMunichGermany,Department of Clinical Psychology & PsychotherapyFriedrich‐Alexander‐University Erlangen‐NurembergErlangenGermany
| | - Constantin Yves Plessen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands,Department of Psychosomatic MedicineCharité Universitätsmedizin BerlinBerlinGermany
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - David Ebert
- Psychology & Digital Mental Health Care, Department of Health SciencesTechnical University MunichMunichGermany
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
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36
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Papola D, Ostuzzi G, Tedeschi F, Gastaldon C, Purgato M, Del Giovane C, Pompoli A, Pauley D, Karyotaki E, Sijbrandij M, Furukawa TA, Cuijpers P, Barbui C. CBT treatment delivery formats for panic disorder: a systematic review and network meta-analysis of randomised controlled trials. Psychol Med 2023; 53:614-624. [PMID: 37132646 PMCID: PMC9975966 DOI: 10.1017/s0033291722003683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 11/03/2022] [Accepted: 11/10/2022] [Indexed: 12/13/2022]
Abstract
Several in-person and remote delivery formats of cognitive-behavioural therapy (CBT) for panic disorder are available, but up-to-date and comprehensive evidence on their comparative efficacy and acceptability is lacking. Our aim was to evaluate the comparative efficacy and acceptability of all CBT delivery formats to treat panic disorder. To answer our question we performed a systematic review and network meta-analysis of randomised controlled trials. We searched MEDLINE, Embase, PsycINFO, and CENTRAL, from inception to 1st January 2022. Pairwise and network meta-analyses were conducted using a random-effects model. Confidence in the evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). The protocol was published in a peer-reviewed journal and in PROSPERO. We found a total of 74 trials with 6699 participants. Evidence suggests that face-to-face group [standardised mean differences (s.m.d.) -0.47, 95% confidence interval (CI) -0.87 to -0.07; CINeMA = moderate], face-to-face individual (s.m.d. -0.43, 95% CI -0.70 to -0.15; CINeMA = Moderate), and guided self-help (SMD -0.42, 95% CI -0.77 to -0.07; CINeMA = low), are superior to treatment as usual in terms of efficacy, whilst unguided self-help is not (SMD -0.21, 95% CI -0.58 to -0.16; CINeMA = low). In terms of acceptability (i.e. all-cause discontinuation from the trial) CBT delivery formats did not differ significantly from each other. Our findings are clear in that there are no efficacy differences between CBT delivered as guided self-help, or in the face-to-face individual or group format in the treatment of panic disorder. No CBT delivery format provided high confidence in the evidence at the CINeMA evaluation.
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Affiliation(s)
- Davide Papola
- Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Giovanni Ostuzzi
- Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Federico Tedeschi
- Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Chiara Gastaldon
- Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Marianna Purgato
- Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | - Darin Pauley
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Toshi A. Furukawa
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
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37
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Cuijpers P, Miguel C, Ciharova M, Quero S, Plessen CY, Ebert D, Harrer M, van Straten A, Karyotaki E. Psychological treatment of depression with other comorbid mental disorders: systematic review and meta-analysis. Cogn Behav Ther 2023; 52:246-268. [PMID: 36718645 DOI: 10.1080/16506073.2023.2166578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Most people with a mental disorder meet criteria for multiple disorders. We conducted a systematic review and meta-analysis of randomized trials comparing psychotherapies for people with depression and comorbid other mental disorders with non-active control conditions. We identified studies through an existing database of randomized trials on psychotherapies for depression. Thirty-five trials (3,157 patients) met inclusion criteria. Twenty-seven of the 41 interventions in the 35 trials (66%) were based on CBT. The overall effect on depression was large (g = 0.65; 95% CI: 0.40 ~ 0.90), with high heterogeneity (I2 = 78%; 95% CI: 70 ~ 83). The ten studies in comorbid anxiety showed large effects on depression (g = 0.90; 95% CI: 0.30 ~ 1.51) and anxiety (g = 1.01; 95% CI: 0.28 ~ 1.74). For comorbid insomnia (11 comparisons) a large and significant effect on depression (g = 0.99; 95% CI: 0.16 ~ 1.82) and insomnia (g = 1.38; 95% CI: 0.38 ~ 2.38) were found. For comorbid substance use problems (12 comparisons) effects on depression (g = 0.25; 95% CI: 0.06 ~ 0.43) and on substance use problems (g = 0.25; 95% CI: 0.01 ~ 0.50) were significant. Most effects were no longer significant after adjustment for publication bias and when limited to studies with low risk of bias. Therapies are probably effective in the treatment of depression with comorbid anxiety, insomnia, and substance use problems.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands.,WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands
| | - Soledad Quero
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Avda. Vicente Sos Baynat s/n, Castellón de la Plana 12071, Spain.,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, C/Monforte de Lemos 3, Pb 11, Madrid 28029, Spain
| | - Constantin Yves Plessen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands
| | - David Ebert
- Psychology & Digital Mental Health Care, Technische Universität München, Connollystraße 32, Munich 80809, Germany
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Technische Universität München, Connollystraße 32, Munich 80809, Germany.,Clinical Psychology & Psychotherapy, Universität Erlangen-Nürnberg, Nägelsbachstr. 25a, Erlangen 91052, Germany
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands.,WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands
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38
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Cuijpers P, Miguel C, Ciharova M, Ebert D, Harrer M, Karyotaki E. Transdiagnostic treatment of depression and anxiety: a meta-analysis. Psychol Med 2023; 53:1-12. [PMID: 36606456 PMCID: PMC10600931 DOI: 10.1017/s0033291722003841] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/26/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND In the past 10 years an increasing number of randomised trials have examined the effects of transdiagnostic treatments of patients with depression or anxiety. We conducted the first comprehensive meta-analysis of the outcomes of this emerging field. METHODS We used the searches in PubMed, PsychINFO, Embase and the Cochrane library of an existing database of randomised trials of psychological interventions for depression to identify studies comparing a transdiagnostic treatment of patients with depression or anxiety with a control group (deadline 1 January 2022). We conducted random-effects meta-analyses and examined the effects on depression and anxiety at the short and longer term. RESULTS We included 45 randomised controlled trials with 51 comparisons between a psychotherapy and a control group and 5530 participants. Thirty-five (78%) studies were conducted in the last 10 years. The overall effect size was g = 0.54 (95% CI 0.40-0.69; NNT = 5.87), with high heterogeneity (I2 = 78; 95% CI 71-83), and a broad PI (-0.31-1.39). The effects remained significant in a series of sensitivity analyses, including exclusion of outliers, adjustment for publication bias, for studies with low risk of bias, and in multilevel analyses. The results were comparable for depression and anxiety separately. At 6 months after randomisation the main effects were still significant, but not at 12 months, although the number of studies was small. CONCLUSIONS Transdiagnostic treatments of patients with depression or anxiety are increasingly examined and are probably effective at the short term.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - David Ebert
- Psychology & Digital Mental Health Care, Technical University Munich, Munich, Germany
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Technical University Munich, Munich, Germany
- Clinical Psychology & Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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39
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Cuijpers P, Karyotaki E, Ciharova M, Miguel C, Noma H, Stikkelbroek Y, Weisz JR, Furukawa TA. The effects of psychological treatments of depression in children and adolescents on response, reliable change, and deterioration: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2023; 32:177-192. [PMID: 34611729 PMCID: PMC9908674 DOI: 10.1007/s00787-021-01884-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/23/2021] [Indexed: 11/30/2022]
Abstract
Meta-analyses show that psychotherapies are effective in the treatment of depression in children and adolescents. However, these effects are usually reported in terms of effect sizes. For patients and clinicians, it is important to know whether patients achieve a clinically significant improvement or deterioration. We conducted such a meta-analysis to examine response, clinically significant change, clinically significant deterioration and recovery as outcomes. We searched four bibliographic databases and included 40 randomised trials comparing psychotherapy for youth depression against control conditions. We used a validated method to estimate outcome rates, based on means, standard deviation and N at baseline and post-test. We also calculated numbers-need-to- treat (NNT). The overall response rate in psychotherapies at 2 (±1) months after baseline was 39% (95% CI: 34-45) and 24% (95% CI: 0.19-28) in control conditions (NNT: 6.2). The difference between therapy and control was still significant at 6-12 months after baseline (NNT=7.8). Clinically significant improvement was found in 54% of youth in therapy, compared with 32% in control groups (NNT=5.3); clinically significant deterioration was 6% in therapy, 13% in controls (NNT=5.1); recovery was 58% in therapy, 36% in controls (NNT=3.3). Smaller effects were found in studies with low risk of bias. Psychotherapies for depression in youth are effective compared to control conditions, but more than 60% of youth receiving therapy do not respond. More effective treatments and treatment strategies are clearly needed. Trial registration https://osf.io/84xka.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit, Van der Boechorststraat 7-9, 1081 BT, Amsterdam, The Netherlands. .,WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam,, The Netherlands.
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit, Van der Boechorststraat 7-9, 1081 BT Amsterdam, The Netherlands ,WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam,, The Netherlands
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit, Van der Boechorststraat 7-9, 1081 BT Amsterdam, The Netherlands
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit, Van der Boechorststraat 7-9, 1081 BT Amsterdam, The Netherlands
| | - Hisashi Noma
- Department of Data Science, Institute of Statistical Mathematics, Tokyo, Japan
| | - Yvonne Stikkelbroek
- Department of Clinical Child and Family Studies, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands ,GGZ Oost Brabant, P.O. Box 3, 5427 ZG Boekel, The Netherlands
| | | | - Toshi A. Furukawa
- Department of Clinical Child and Family Studies, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands ,Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
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40
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Zhao R, Amarnath A, Karyotaki E, Struijs SY, Cuijpers P. Effects of psychological treatment for depression among people not actively seeking help: a meta-analysis. Psychol Med 2023; 53:320-331. [PMID: 36404636 PMCID: PMC9899569 DOI: 10.1017/s0033291722003518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 09/22/2022] [Accepted: 10/20/2022] [Indexed: 11/22/2022]
Abstract
Although psychological treatments have been found to be effective for depression in adults, many individuals with depression do not actively seek help. It is currently unclear whether psychological treatments are effective among those not actively seeking help. Besides, little is known about the proportion of patients who completed a screening questionnaire who end up in a clinical trial. Therefore, we conducted a meta-analysis of 52 randomized trials comparing psychotherapies for adults with a diagnosis or elevated symptoms of depression against control conditions (care-as-usual, waiting list, and other inactive treatment). Only studies recruiting participants who do not actively seek help (participants who have been recruited through screening instead of advertisements and clinical referrals) were included. To obtain an overall effect estimate of psychotherapy, we pooled all post-test differences with a random-effects model. We found that psychological treatments had a moderate to high effect on reducing depressive symptoms compared to control groups [g = 0.55; 95% confidence interval (CI) 0.41-0.69]. Heterogeneity was high (I2 = 75%; 95% CI 68-80). At 12 months' follow-up, the effects were small but significant (6-8 months: g = 0.33; 95% CI 0.14-0.52; 9-12 months: g = 0.24; 95% CI 0.11-0.37). As a secondary outcome, we found that 13% of patients who completed a screening questionnaire met the inclusion criteria for depression and agreed to be randomized in the trial. Based on the current evidence, psychological treatments for depression might be effective for depressed patients who are not actively seeking help.
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Affiliation(s)
- Ruiying Zhao
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Arpana Amarnath
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sascha Y. Struijs
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Institute of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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41
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Pauley D, Cuijpers P, Papola D, Miguel C, Karyotaki E. Two decades of digital interventions for anxiety disorders: a systematic review and meta-analysis of treatment effectiveness. Psychol Med 2023; 53:567-579. [PMID: 34047264 PMCID: PMC9899576 DOI: 10.1017/s0033291721001999] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/24/2021] [Accepted: 04/28/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Digital interventions for anxiety disorders are a promising solution to address barriers to evidence-based treatment access. Precise and powerful estimates of digital intervention effectiveness for anxiety disorders are necessary for further adoption in practice. The present systematic review and meta-analysis examined the effectiveness of digital interventions across all anxiety disorders and specific to each disorder v. wait-list and care-as-usual controls. METHODS A systematic search of bibliographic databases identified 15 030 abstracts from inception to 1 January 2020. Forty-seven randomized controlled trials (53 comparisons; 4958 participants) contributed to the meta-analysis. Subgroup analyses were conducted by an anxiety disorder, risk of bias, treatment support, recruitment, location and treatment adherence. RESULTS A large, pooled effect size of g = 0.80 [95% Confidence Interval: 0.68-0.93] was found in favor of digital interventions. Moderate to large pooled effect sizes favoring digital interventions were found for generalized anxiety disorder (g = 0.62), mixed anxiety samples (g = 0.68), panic disorder with or without agoraphobia (g = 1.08) and social anxiety disorder (g = 0.76) subgroups. No subgroups were significantly different or related to the pooled effect size. Notably, the effects of guided interventions (g = 0.84) and unguided interventions (g = 0.64) were not significantly different. Supplemental analysis comparing digital and face-to-face interventions (9 comparisons; 683 participants) found no significant difference in effect [g = 0.14 favoring digital interventions; Confidence Interval: -0.01 to 0.30]. CONCLUSION The precise and powerful estimates found further justify the application of digital interventions for anxiety disorders in place of wait-list or usual care.
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Affiliation(s)
- Darin Pauley
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam, The Netherlands
| | - Davide Papola
- Department of Neuroscience, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam, The Netherlands
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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42
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Mavragani A, Kleiboer A, Neijenhuijs K, Karyotaki E, Wiers R, de Koning L, Jacobi C, Zarski AC, Weisel KK, Cuijpers P, Riper H. Challenges in Recruiting University Students for Web-Based Indicated Prevention of Depression and Anxiety: Results From a Randomized Controlled Trial (ICare Prevent). J Med Internet Res 2022; 24:e40892. [PMID: 36515986 PMCID: PMC9798269 DOI: 10.2196/40892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/02/2022] [Accepted: 09/13/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Depression and anxiety are common mental health conditions in college and university student populations. Offering transdiagnostic, web-based prevention programs such as ICare Prevent to those with subclinical complaints has the potential to reduce some barriers to receiving help (eg, availability of services, privacy considerations, and students' desire for autonomy). However, uptake of these interventions is often low, and accounts of recruitment challenges are needed to complement available effectiveness research in student populations. OBJECTIVE The aims of this study were to describe recruitment challenges together with effective recruitment strategies for ICare Prevent and provide basic information on the intervention's effectiveness. METHODS A 3-arm randomized controlled trial was conducted in a student sample with subclinical symptoms of depression and anxiety on the effectiveness of an individually guided (human support and feedback on exercises provided after each session, tailored to each participant) and automatically guided (computer-generated messages provided after each session, geared toward motivation) version of ICare Prevent, a web-based intervention with transdiagnostic components for the indicated prevention of depression and anxiety. The intervention was compared with care as usual. Descriptive statistics were used to outline recruitment challenges and effective web-based and offline strategies as well as students' use of the intervention. A basic analysis of intervention effects was conducted using a Bayesian linear mixed model, with Bayes factors reported as the effect size. RESULTS Direct recruitment through students' email addresses via the central student administration was the most effective strategy. Data from 35 participants were analyzed (individually guided: n=14, 40%; automatically guided: n=8, 23%; care as usual: n=13, 37%). Use of the intervention was low, with an average of 3 out of 7 sessions (SD 2.9) completed. The analyses did not suggest any intervention effects other than anecdotal evidence (all Bayes factors10≤2.7). CONCLUSIONS This report adds to the existing literature on recruitment challenges specific to the student population. Testing the feasibility of recruitment measures and the greater involvement of the target population in their design, as well as shifting from direct to indirect prevention, can potentially help future studies in the field. In addition, this report demonstrates an alternative basic analytical strategy for underpowered randomized controlled trials. TRIAL REGISTRATION International Clinical Trials Registry Platform NTR6562; https://tinyurl.com/4rbexzrk. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-018-2477-y.
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Affiliation(s)
| | - Annet Kleiboer
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Koen Neijenhuijs
- Department of Research and Business Development, HumanTotalCare, Utrecht, Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Reinout Wiers
- Department of Psychology and Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
| | - Lisa de Koning
- Department of Psychology and Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
| | - Corinna Jacobi
- Department of Clinical Psychology and Psychotherapy, Technical University Dresden, Dresden, Germany
| | - Anna-Carlotta Zarski
- Department of Sport and Health Science, Technical University Munich, Munich, Germany
| | - Kiona K Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich Alexander University, Erlangen-Nuremberg, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Heleen Riper
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam UMC, location VUmc, Amsterdam, Netherlands
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43
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Karyotaki E. Coding Error for the Sex Variable in a Meta-analysis. JAMA Psychiatry 2022; 79:1241. [PMID: 36197690 DOI: 10.1001/jamapsychiatry.2022.3138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Eirini Karyotaki
- Department of Clinical Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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44
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Barbui C, Tedeschi F, Acarturk C, Anttila M, Au T, Baumgartner J, Carswell K, Churchill R, Cuijpers P, Karyotaki E, Klein T, Koesters M, Lantta T, Nosè M, Ostuzzi G, Pasquini M, Prina E, Sijbrandij M, Tarsitani L, Turrini G, Uygun E, Välimäki M, Walker L, Wancata J, White RG, Purgato M. Risk factors for mental disorder development in asylum seekers and refugees resettled in Western Europe and Turkey: Participant-level analysis of two large prevention studies. Int J Soc Psychiatry 2022; 69:664-674. [PMID: 36326024 DOI: 10.1177/00207640221132430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In asylum seekers and refugees, the frequency of mental disorders, such as depression, anxiety and post-traumatic stress disorder, is higher than the general population, but there is a lack of data on risk factors for the development of mental disorders in this population. AIM This study investigated the risk factors for mental disorder development in a large group of asylum seekers and refugees resettled in high- and middle-income settings. METHODS Participant-level data from two randomized prevention studies involving asylum seekers and refugees resettled in Western European countries and in Turkey were pooled. The two studies randomized participants with psychological distress, but without a diagnosis of mental disorder, to the Self-Help Plus psychological intervention or enhanced care as usual. At baseline, exposure to potentially traumatic events was measured using the Harvard Trauma Questionnaire-part I, while psychological distress and depressive symptoms were assessed with the General Health Questionnaire and the Patient Health Questionnaire. After 3 and 6 months of follow-up, the proportion of participants who developed a mental disorder was calculated using the Mini International Neuropsychiatric Interview. RESULTS A total of 1,101 participants were included in the analysis. At 3- and 6-month follow-up the observed frequency of mental disorders was 13.51% (115/851) and 24.30% (207/852), respectively, while the frequency estimates after missing data imputation were 13.95% and 23.78%, respectively. After controlling for confounders, logistic regression analysis showed that participants with a lower education level (p = .034), a shorter duration of journey (p = .057) and arriving from countries with war-related contexts (p = .017), were more at risk of developing mental disorders. Psychological distress (p = .004), depression (p = .001) and exposure to potentially traumatic events (p = .020) were predictors of mental disorder development. CONCLUSIONS This study identified several risk factors for the development of mental disorders in asylum seekers and refugees, some of which may be the target of risk reduction policies. The identification of asylum seekers and refugees at increased risk of mental disorders should guide the implementation of focused preventative psychological interventions.
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Affiliation(s)
- Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Ceren Acarturk
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Minna Anttila
- University of Turku, Department of Nursing Science, University of Turku, Finland
| | - Teresa Au
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Josef Baumgartner
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Ken Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands.,WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, The Netherlands.,Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands.,WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, The Netherlands
| | - Thomas Klein
- Department of Psychiatry II, Ulm University, Germany
| | | | - Tella Lantta
- University of Turku, Department of Nursing Science, University of Turku, Finland
| | - Michela Nosè
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Giovanni Ostuzzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Eleonora Prina
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands.,WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, The Netherlands
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Giulia Turrini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Ersin Uygun
- Trauma and Disaster Mental Health, Istanbul Bilgi University, Turkey
| | - Maritta Välimäki
- University of Turku, Department of Nursing Science, University of Turku, Finland.,Xiangya Nursing School, Central South University, Xiangya Center for Evidence-Based Practice and Healthcare Innovation, Changsha, China
| | - Lauren Walker
- Department of Health Sciences, University of York, UK
| | - Johannes Wancata
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Ross G White
- School of Psychology, Queen's University Belfast, UK
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
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Papola D, Ostuzzi G, Tedeschi F, Gastaldon C, Purgato M, Del Giovane C, Pompoli A, Pauley D, Karyotaki E, Sijbrandij M, Furukawa TA, Cuijpers P, Barbui C. Comparative efficacy and acceptability of psychotherapies for panic disorder with or without agoraphobia: systematic review and network meta-analysis of randomised controlled trials. Br J Psychiatry 2022; 221:507-519. [PMID: 35049483 DOI: 10.1192/bjp.2021.148] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Psychotherapies are the treatment of choice for panic disorder, but which should be considered as first-line treatment is yet to be substantiated by evidence. AIMS To examine the most effective and accepted psychotherapy for the acute phase of panic disorder with or without agoraphobia via a network meta-analysis. METHOD We conducted a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the most effective and accepted psychotherapy for the acute phase of panic disorder. We searched MEDLINE, Embase, PsycInfo and CENTRAL, from inception to 1 Jan 2021 for RCTs. Cochrane and PRISMA guidelines were used. Pairwise and network meta-analyses were conducted using a random-effects model. Confidence in the evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). The protocol was published in a peer-reviewed journal and in PROSPERO (CRD42020206258). RESULTS We included 136 RCTs in the systematic review. Taking into consideration efficacy (7352 participants), acceptability (6862 participants) and the CINeMA confidence in evidence appraisal, the best interventions in comparison with treatment as usual (TAU) were cognitive-behavioural therapy (CBT) (for efficacy: standardised mean differences s.m.d. = -0.67, 95% CI -0.95 to -0.39; CINeMA: moderate; for acceptability: relative risk RR = 1.21, 95% CI -0.94 to 1.56; CINeMA: moderate) and short-term psychodynamic therapy (for efficacy: s.m.d. = -0.61, 95% CI -1.15 to -0.07; CINeMA: low; for acceptability: RR = 0.92, 95% CI 0.54-1.54; CINeMA: moderate). After removing RCTs at high risk of bias only CBT remained more efficacious than TAU. CONCLUSIONS CBT and short-term psychodynamic therapy are reasonable first-line choices. Studies with high risk of bias tend to inflate the overall efficacy of treatments. Results from this systematic review and network meta-analysis should inform clinicians and guidelines.
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Affiliation(s)
- Davide Papola
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Italy
| | - Giovanni Ostuzzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Italy
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Italy
| | - Chiara Gastaldon
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Italy
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Italy
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | | | - Darin Pauley
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Toshi A Furukawa
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Italy
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46
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Mortier P, Alonso J, Auerbach RP, Bantjes J, Benjet C, Bruffaerts R, Cuijpers P, Ebert DD, Green JG, Hasking P, Karyotaki E, Kiekens G, Mak A, Nock MK, O'Neill S, Pinder-Amaker S, Sampson NA, Stein DJ, Vilagut G, Wilks C, Zaslavsky AM, Mair P, Kessler RC. Childhood adversities and suicidal thoughts and behaviors among first-year college students: results from the WMH-ICS initiative. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1591-1601. [PMID: 34424350 PMCID: PMC8878415 DOI: 10.1007/s00127-021-02151-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 07/30/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the associations of childhood adversities (CAs) with lifetime onset and transitions across suicidal thoughts and behaviors (STB) among incoming college students. METHODS Web-based self-report surveys administered to 20,842 incoming college students from nine countries (response rate 45.6%) assessed lifetime suicidal ideation, plans and attempts along with seven CAs: parental psychopathology, three types of abuse (emotional, physical, sexual), neglect, bully victimization, and dating violence. Logistic regression estimated individual- and population-level associations using CA operationalizations for type, number, severity, and frequency. RESULTS Associations of CAs with lifetime ideation and the transition from ideation to plan were best explained by the exact number of CA types (OR range 1.32-52.30 for exactly two to seven CAs). Associations of CAs with a transition to attempts were best explained by the frequency of specific CA types (scaled 0-4). Attempts among ideators with a plan were significantly associated with all seven CAs (OR range 1.16-1.59) and associations remained significant in adjusted analyses with the frequency of sexual abuse (OR = 1.42), dating violence (OR = 1.29), physical abuse (OR = 1.17) and bully victimization (OR = 1.17). Attempts among ideators without plan were significantly associated with frequency of emotional abuse (OR = 1.29) and bully victimization (OR = 1.36), in both unadjusted and adjusted analyses. Population attributable risk simulations found 63% of ideation and 30-47% of STB transitions associated with CAs. CONCLUSION Early-life adversities represent a potentially important driver in explaining lifetime STB among incoming college students. Comprehensive intervention strategies that prevent or reduce the negative effects of CAs may reduce subsequent onset of STB.
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Affiliation(s)
- Philippe Mortier
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Dr. Aiguader, 88, 08003, Barcelona, Spain.
- CIBER en Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain.
- Department of Neurosciences, Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium.
| | - Jordi Alonso
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Dr. Aiguader, 88, 08003, Barcelona, Spain
- CIBER en Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
- Pompeu Fabra University (UPF), Barcelona, Spain
| | | | - Jason Bantjes
- Department of Global Health, Faculty of Medicine and Health Sciences, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de La Fuente Muñiz, Mexico City, Mexico
| | - Ronny Bruffaerts
- Department of Neurosciences, Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium
- Institute for Social Research, Population Studies Center, University of Michigan, Ann Arbor, MI, USA
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - David D Ebert
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jennifer Greif Green
- Wheelock College of Education and Human Development, Boston University, Boston, USA
| | - Penelope Hasking
- School of Population Health, Curtin University, Perth, Australia
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Glenn Kiekens
- Department of Neurosciences, Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium
- Faculty of Psychology and Educational Sciences, Clinical Psychology, KU Leuven, Leuven, Belgium
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Arthur Mak
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, People's Republic of China
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Siobhan O'Neill
- School of Psychology, Ulster University, Derry-Londonderry, Northern Ireland
| | - Stephanie Pinder-Amaker
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Dan J Stein
- Department of Psychiatry and Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town and Groote Schuur Hospital, Cape Town, Republic of South Africa
| | - Gemma Vilagut
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Dr. Aiguader, 88, 08003, Barcelona, Spain
- CIBER en Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - Chelsey Wilks
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Patrick Mair
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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47
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Cuijpers P, Miguel C, Papola D, Harrer M, Karyotaki E. From living systematic reviews to meta-analytical research domains. Evid Based Ment Health 2022; 25:ebmental-2022-300509. [PMID: 35853730 PMCID: PMC9685685 DOI: 10.1136/ebmental-2022-300509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/29/2022] [Indexed: 11/04/2022]
Abstract
Because of the rapidly increasing number of randomised controlled trials (RCTs) and meta-analyses in many fields, there is an urgent need to step up from meta-analyses to higher levels of aggregation of outcomes of RCTs. Network meta-analyses and umbrella reviews allow higher levels of aggregation of RCT outcomes, but cannot adequately cover the evidence for a whole field. The 'Meta-Analytic Research Domain' (MARD) may be a new methodology to aggregate RCT data of a whole field. A MARD is a living systematic review of a research domain that cannot be covered by one PICO. For example, a MARD of psychotherapy for depression covers all RCTs comparing the effects of all types of psychotherapy to control conditions, to each other, to pharmacotherapy and combined treatment. It also covers all RCTs comparing treatment formats, the effects in different target groups, subtypes of depression and secondary outcomes. Although the time and resources needed to build a MARD are considerable, they offer many advantages, including a comprehensive and consistent overview of a research field and important meta-analytic studies that cannot be conducted with conventional methods. MARDs are a promising method to step up the aggregation of RCTs to a next level and it is highly relevant to work out the methods of this approach in a more detailed way.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit, Amsterdam, The Netherlands
- Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Davide Papola
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mathias Harrer
- Department of Clinical Psychology & Psychotherapy, Friedrich-Alexander-University Erlangen, Nuremberg, Germany
- Psychology & Digital Mental Health Care, Department of Health Sciences, Technical University Munich, Munich, Germany
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit, Amsterdam, The Netherlands
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48
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Waqas A, Sikander S, Malik A, Atif N, Karyotaki E, Rahman A. Predicting Remission among Perinatal Women with Depression in Rural Pakistan: A Prognostic Model for Task-Shared Interventions in Primary Care Settings. J Pers Med 2022; 12:jpm12071046. [PMID: 35887543 PMCID: PMC9320748 DOI: 10.3390/jpm12071046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 12/03/2022] Open
Abstract
Perinatal depression is highly prevalent in low- and middle-income countries (LMICs) and is associated with adverse maternal and child health consequences. Task-shared psychological and psychosocial interventions for perinatal depression have demonstrated clinical and cost-effectiveness when delivered on a large scale. However, task-sharing approaches, especially in LMICs, require an effective mechanism, whereby clients who are not likely to benefit from such interventions are identified from the outset so that they can benefit from higher intensity treatments. Such a stratified approach can ensure that limited resources are utilized appropriately and effectively. The use of standardized and easy-to-implement algorithmic devices (e.g., nomograms) could help with such targeted dissemination of interventions. The present investigation posits a prognostic model and a nomogram to predict the prognosis of perinatal depression among women in rural Pakistan. The nomogram was developed to deliver stratified model of care in primary care settings by identifying those women who respond well to a non-specialist delivered intervention and those requiring specialist care. This secondary analysis utilized data from 903 pregnant women with depression who participated in a cluster randomized, controlled trial that tested the effectiveness of the Thinking Healthy Program in rural Rawalpindi, Pakistan. The participants were recruited from 40 union councils in two sub-districts of Rawalpindi and randomly assigned to intervention and enhanced usual care. Sixteen sessions of the THP intervention were delivered by trained community health workers to women with depression over pregnancy and the postnatal period. A trained assessment team used the Structured Clinical Interview for DSM-IV current major depressive episode module to diagnose major depressive disorder at baseline and post-intervention. The intervention received by the participants emerged as the most significant predictor in the prognostic model. Among clinical factors, baseline severity of core-emotional symptoms emerged as an essential predictor, followed by atypical symptoms and insomnia. Higher severity of these symptoms was associated with a poorer prognosis. Other important predictors of a favorable prognosis included support from one’s mother or mother-in-law, financial empowerment, higher socioeconomic class, and living in a joint family system. This prognostic model yielded acceptable discrimination (c-statistic = 0.75) and calibration to aid in personalized delivery of the intervention.
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Affiliation(s)
- Ahmed Waqas
- Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, Liverpool L69 7ZA, UK; (S.S.); (A.R.)
- Correspondence: ; Tel.: +44-794-767-3943
| | - Siham Sikander
- Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, Liverpool L69 7ZA, UK; (S.S.); (A.R.)
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Rawalpindi 46000, Pakistan
| | - Abid Malik
- Department of Public Mental Health, Health Services Academy, Chak Shahzad, Islamabad 44000, Pakistan;
- Rawalpindi Medical University, Rawalpindi 46000, Pakistan
| | - Najia Atif
- Human Development Research Foundation, Islamabad, Pakistan;
| | - Eirini Karyotaki
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
| | - Atif Rahman
- Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, Liverpool L69 7ZA, UK; (S.S.); (A.R.)
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49
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Karyotaki E, Cuijpers P. [Personalised internet-based interventions for depression: with or without personal support?]. Ned Tijdschr Geneeskd 2022; 166:D5963. [PMID: 35736386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Psychological treatment of depression can be made more accessible with internet-based interventions. A large number of trials has shown that on average these interventions are more effective when some kind of personal support by a clinician is given compared to unguided interventions. In order to examine whether there are subgroups of patients for whom unguided interventions are as effective as guided interventions, we conducted an 'individual patient data' network meta-analysis in which the primary data of 36 randomised trials with 8107 patients were integrated into one dataset. We found that several patient characteristics predict the outcome. Unguided interventions were as effective as guided interventions in mild depression. These data also make it possible to predict which patient with which characteristics benefits from guided and unguided interventions. We consider this as an important step towards personalised treatment of depression.
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Affiliation(s)
- Eirini Karyotaki
- Vrije Universiteit, Faculteuit Gedrags- en Bewegingswetenschappen, afd. Klinische, Neuro- en Ontwikkelingspsychologie, Amsterdam
| | - Pim Cuijpers
- Vrije Universiteit, Faculteuit Gedrags- en Bewegingswetenschappen, afd. Klinische, Neuro- en Ontwikkelingspsychologie, Amsterdam
- Contact: Pim Cuijpers
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50
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Karyotaki E, Araya R, Kessler RC, Waqas A, Bhana A, Rahman A, Matsuzaka CT, Miguel C, Lund C, Garman EC, Nakimuli-Mpungu E, Petersen I, Naslund JA, Schneider M, Sikander S, Jordans MJD, Abas M, Slade P, Walters S, Brugha TS, Furukawa TA, Amanvermez Y, Mello MF, Wainberg ML, Cuijpers P, Patel V. Association of Task-Shared Psychological Interventions With Depression Outcomes in Low- and Middle-Income Countries: A Systematic Review and Individual Patient Data Meta-analysis. JAMA Psychiatry 2022; 79:430-443. [PMID: 35319740 PMCID: PMC8943620 DOI: 10.1001/jamapsychiatry.2022.0301] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/02/2022] [Indexed: 01/14/2023]
Abstract
Importance Task sharing, the training of nonspecialist workers with no formal experience in counseling, is a promising strategy for addressing the large gap in treatment for depression in low- and middle-income countries (LMICs). Objective To examine the outcomes and moderators of task-shared psychological interventions associated with depression severity, response, and remission. Data Sources Systematic literature searches in PubMed, Embase, PsycINFO, and Cochrane Library up to January 1, 2021. Study Selection Randomized clinical trials (RCTs) of task-shared psychological interventions compared with control conditions for adults with depressive symptoms in LMICs were included. Data Extraction and Synthesis Two researchers independently reviewed the titles, abstracts, and full text of articles from an existing generic meta-analytic database that includes all RCTs on psychotherapy for depression. A systematic review and individual patient data (IPD) meta-analysis was used to estimate the outcomes of task-shared psychological interventions across patient characteristics using mixed-effects models. Procedures for abstracting data and assessing data quality and validity followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Main Outcomes and Measures Primary outcome was reduction in depression symptom severity measured by the 9-item Patient Health Questionnaire (PHQ-9). Response and remission rates were also estimated. Results Of 13 eligible trials, 11 (4145 participants) contributed IPD. Task-shared psychological interventions were associated with a greater decrease in depressive symptom severity than control conditions (Hedges g, 0.32; 95% CI, -0.26 to -0.38). Participants in the intervention groups had a higher chance of responding (odds ratio, 2.11; 95% CI, 1.60 to 2.80) and remitting (odds ratio, 1.87; 95% CI, 1.20 to 1.99). The presence of psychomotor symptoms was significantly associated with the outcomes of task-shared psychological interventions (β [SE], -1.21 [0.39]; P = .002). No other significant associations were identified. Heterogeneity among the trials with IPD was 74% (95% CI, 53%-86%). Conclusions and Relevance In this meta-analysis of IPD, task-shared psychological interventions were associated with a larger reduction in depressive symptom severity and a greater chance of response and remission than control conditions. These findings show potential for the use of task-sharing of psychological interventions across different groups of patients with depression. Further research would help identify which people are most likely to benefit and strengthen larger-scale implementation of this strategy to address the burden of depression in LMICs.
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Affiliation(s)
- Eirini Karyotaki
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit 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, United Kingdom
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Ahmed Waqas
- Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Arvin Bhana
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Atif Rahman
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Camila T. Matsuzaka
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Clara Miguel
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Crick Lund
- 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, United Kingdom
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Emily C. Garman
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Marguerite Schneider
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Siham Sikander
- Human Development Research Foundation, Islamabad, Pakistan
- Health Services Academy, Islamabad, Pakistan
| | - Mark J. D. Jordans
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Melanie Abas
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Pauline Slade
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Stephen Walters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Traolach S. Brugha
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Toshi A. Furukawa
- Departments of Health Promotion and Human Behaviour and of Clinical Epidemiology, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Yagmur Amanvermez
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Marcelo F. Mello
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
- Albert Einstein Israelite Hospital, Medicine School, São Paulo, Brazil
| | - Milton L. Wainberg
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York
| | - Pim Cuijpers
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
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