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Ezeonu NA, Hertelendy AJ, Adu MK, Kung JY, Itanyi IU, Dias RDL, Agyapong B, Hertelendy P, Ohanyido F, Agyapong VIO, Eboreime E. Mobile Apps to Support Mental Health Response in Natural Disasters: Scoping Review. J Med Internet Res 2024; 26:e49929. [PMID: 38520699 DOI: 10.2196/49929] [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] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 02/25/2024] [Accepted: 03/23/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Disasters are becoming more frequent due to the impact of extreme weather events attributed to climate change, causing loss of lives, property, and psychological trauma. Mental health response to disasters emphasizes prevention and mitigation, and mobile health (mHealth) apps have been used for mental health promotion and treatment. However, little is known about their use in the mental health components of disaster management. OBJECTIVE This scoping review was conducted to explore the use of mobile phone apps for mental health responses to natural disasters and to identify gaps in the literature. METHODS We identified relevant keywords and subject headings and conducted comprehensive searches in 6 electronic databases. Studies in which participants were exposed to a man-made disaster were included if the sample also included some participants exposed to a natural hazard. Only full-text studies published in English were included. The initial titles and abstracts of the unique papers were screened by 2 independent review authors. Full texts of the selected papers that met the inclusion criteria were reviewed by the 2 independent reviewers. Data were extracted from each selected full-text paper and synthesized using a narrative approach based on the outcome measures, duration, frequency of use of the mobile phone apps, and the outcomes. This scoping review was reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). RESULTS Of the 1398 papers retrieved, 5 were included in this review. A total of 3 studies were conducted on participants exposed to psychological stress following a disaster while 2 were for disaster relief workers. The mobile phone apps for the interventions included Training for Life Skills, Sonoma Rises, Headspace, Psychological First Aid, and Substance Abuse and Mental Health Services Administration (SAMHSA) Behavioural Health Disaster Response Apps. The different studies assessed the effectiveness or efficacy of the mobile app, feasibility, acceptability, and characteristics of app use or predictors of use. Different measures were used to assess the effectiveness of the apps' use as either the primary or secondary outcome. CONCLUSIONS A limited number of studies are exploring the use of mobile phone apps for mental health responses to disasters. The 5 studies included in this review showed promising results. Mobile apps have the potential to provide effective mental health support before, during, and after disasters. However, further research is needed to explore the potential of mobile phone apps in mental health responses to all hazards.
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Affiliation(s)
- Nwamaka Alexandra Ezeonu
- Center for Translation and Implementation Research, College of Medicine, University of Nigeria, Nsukka, Nigeria
| | - Attila J Hertelendy
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, United States
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Medard Kofi Adu
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Janice Y Kung
- Geoffrey and Robyn Sperber Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Ijeoma Uchenna Itanyi
- Center for Translation and Implementation Research, College of Medicine, University of Nigeria, Nsukka, Nigeria
- Department of Community Medicine, University of Nigeria, Enugu, Nigeria
- Department of Public Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Raquel da Luz Dias
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Belinda Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Petra Hertelendy
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | | | | | - Ejemai Eboreime
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
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Adu MK, Shalaby R, Agyapong B, Dias RDL, Agyapong VIO. Exploring the prevalence and predictors of low resilience and likely PTSD in residents of two provinces in Canada during the 2023 wildfires. Front Public Health 2024; 12:1343399. [PMID: 38590805 PMCID: PMC10999595 DOI: 10.3389/fpubh.2024.1343399] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/29/2024] [Indexed: 04/10/2024] Open
Abstract
Background The recent wildfires in Canada serve as a stark example of the substantial and enduring harm they cause to the health of individuals and communities. Assessing the prevalence and correlates of Post-traumatic stress disorder (PTSD) and low resilience is valuable for policymakers in public health. Objectives The study aimed to assess the prevalence and predictors of low resilience and likely PTSD among subscribers of Text4Hope, an e-mental health program that delivered daily supportive messages to residents of Nova Scotia (NS) and Alberta(AB) during the recent wildfires. Method Data collection was through a self-administered online survey completed by residents of the affected regions of NS and AB from May 14 to June 23, 2023. Data were analyzed using Statistical Package for the Social Sciences. Results Out of 298 respondents, the prevalence of low resilience and likely PTSD in our sample were 52.0 and 39.3%, respectively. Unemployed respondents were about 3 times more likely to experience both low resilience and PTSD symptoms compared to those employed. Respondents with a history of mental health diagnosis were about 4 times more likely to experience likely PTSD compared to those with no history of mental health diagnosis. Conclusion This study established that unemployment and a history of mental health diagnosis predicted likely PTSD, while unemployment was associated with low resilience during the wildfire. These findings offer insights for clinical interventions and the creation of psychosocial support programs for vulnerable populations.
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Affiliation(s)
- Medard K. Adu
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Belinda Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | | | - Vincent I. O. Agyapong
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
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Adu MK, da Luz Dias R, Obuobi-Donkor G, Ezeanozie N, Sridharan S, Morrison J, Simon P, Taylor B, MacKinnon M, Gossen S, Awara M, White M, Shalaby R, Agyapong B, Eboreime E, Wang J, Feng C, Wozney L, Koto P, Warford J, Murphy GT, Agyapong VIO. Reducing wait times and avoiding unnecessary use of high-cost mental health services through a Rapid Access and Stabilization Program: protocol for a program evaluation study. BMC Health Serv Res 2024; 24:247. [PMID: 38413957 PMCID: PMC10898149 DOI: 10.1186/s12913-024-10697-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/08/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Emergency psychiatric care, unplanned hospital admissions, and inpatient health care are the costliest forms of mental health care. According to Statistics Canada (2018), almost 18% (5.3 million) of Canadians reported needing mental health support. However, just above half of this figure (56.2%) have reported their needs were fully met. In light of this evidence there is a pressing need to provide accessible mental health services in flexible yet cost-effective ways. To further expand capacity and access to mental health care in the province, Nova Scotia Health has launched a novel mental health initiative for people in need of mental health care without requiring emergency department visits or hospitalization. This new service is referred to as the Rapid Access and Stabilization Program (RASP). This study evaluates the effectiveness and impact of the RASP on high-cost health services utilization (e.g. ED visits, mobile crisis visits, and inpatient treatments) and related costs. It also assesses healthcare partners' (e.g. healthcare providers, policymakers, community leaders) perceptions and patient experiences and satisfaction with the program and identifies sociodemographic characteristics, psychological conditions, recovery, well-being, and risk measures in the assisted population. METHOD This is a hypothesis-driven program evaluation study that employs a mixed methods approach. A within-subject comparison (pre- and post-evaluation study) will examine health services utilization data from patients attending RASP, one year before and one year after their psychiatry assessment at the program. A controlled between-subject comparison (cohort study) will use historical data from a control population will examine whether possible changes in high-cost health services utilization are associated with the intervention (RASP). The primary analysis involves extracting secondary data from provincial information systems, electronic medical records, and regular self-reported clinical assessments. Additionally, a qualitative sub-study will examine patient experience and satisfaction, and health care partners' impressions. DISCUSSION We expect that RASP evaluation findings will demonstrate a minimum 10% reduction in high-cost health services utilization and corresponding 10% cost savings, and also a reduction in the wait times for patient consultations with psychiatrists to less than 30 calendar days, in both within-subject and between-subject comparisons. In addition, we anticipate that patients, healthcare providers and healthcare partners would express high levels of satisfaction with the new service. CONCLUSION This study will demonstrate the results of the Mental Health and Addictions Program (MHAP) efforts to provide stepped-care, particularly community-based support, to individuals with mental illnesses. Results will provide new insights into a novel community-based approach to mental health service delivery and contribute to knowledge on how to implement mental health programs across varying contexts.
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Affiliation(s)
- Medard K Adu
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Raquel da Luz Dias
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Gloria Obuobi-Donkor
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ngozi Ezeanozie
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS, Canada
| | - Sanjana Sridharan
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS, Canada
| | - Jason Morrison
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS, Canada
| | - Patryk Simon
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS, Canada
| | - Bryanne Taylor
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS, Canada
| | - Monica MacKinnon
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS, Canada
| | - Shiloh Gossen
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS, Canada
| | - Mahmoud Awara
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS, Canada
| | - Mattew White
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS, Canada
| | - Reham Shalaby
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Belinda Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Ejemai Eboreime
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - JianLi Wang
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Cindy Feng
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Lori Wozney
- Mental Health and Addictions Program, IWK Health, Halifax, NS, Canada
| | - Prosper Koto
- Research, Innovation and Discovery, Nova Scotia Health, Halifax, NS, Canada
| | - Jordan Warford
- Research, Innovation and Discovery, Nova Scotia Health, Halifax, NS, Canada
| | | | - Vincent Israel Opoku Agyapong
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS, Canada.
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da Luz Dias R, Hazelton L, Esliger M, Brown PA, Tibbo PG, Sinha N, Njoku A, Satyendra S, Siddhartha S, Rahman F, Maguire H, Gray G, Bosma M, Parker D, Connolly O, Raji A, Manning A, Bagnell A, Shalaby R, Agyapong VIO. Distributed Medical Education (DME) in psychiatry: perspectives on facilitators, obstacles, and factors affecting psychiatrists' willingness to engage in teaching activities. BMC Med Educ 2024; 24:192. [PMID: 38403589 PMCID: PMC10895840 DOI: 10.1186/s12909-024-05178-8] [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: 09/01/2023] [Accepted: 02/14/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Distributed Medical Education (DME), a decentralized model focused on smaller cities and communities, has been implemented worldwide to bridge the gap in psychiatric education. Faculty engagement in teaching activities such as clinical teaching, supervision, and examinations is a crucial aspect of DME sites. Implementing or expanding DME sites requires careful consideration to identify enablers that contribute to success and barriers that need to be addressed. This study aims to examine enablers, barriers, and factors influencing psychiatrists' willingness to start or continue participating in teaching activities within Dalhousie University's Faculty of Medicine DME sites in two provinces in Atlantic Canada. METHODOLOGY This cross-sectional study was conducted as part of an environmental scan of Dalhousie Faculty of Medicine's DME programs in Nova Scotia (NS) and New Brunswick (NB), Canada. In February 2023, psychiatrists from seven administrative health zones in these provinces anonymously participated in an online survey. The survey, created with OPINIO, collected data on sociodemographic factors, practice-related characteristics, medical education, and barriers to teaching activities. Five key outcomes were assessed, which included psychiatrists' willingness to engage in (i) clinical training and supervision, (ii) lectures or skills-based teaching, (iii) skills-based examinations, (iv) training and supervision of Canadian-trained psychiatrists, and (v) training and supervision of internationally trained psychiatrists. The study employed various statistical analyses, including descriptive analysis, chi-square tests, and logistic regression, to identify potential predictors associated with each outcome variable. RESULTS The study involved 60 psychiatrists, primarily male (69%), practicing in NS (53.3%), with international medical education (69%), mainly working in outpatient services (41%). Notably, 60.3% lacked formal medical education training, yet they did not perceive the lack of training as a significant barrier, but lack of protected time as the main one. Despite this, there was a strong willingness to engage in teaching activities, with an average positive response rate of 81.98%. The lack of protected time for teaching/training was a major barrier reported by study participants. Availability to take the Royal College of Physicians and Surgeons of Canada Competency by Design training was the main factor associated with psychiatrists' willingness to participate in the five teaching activities investigated in this study: willingness to participate in clinical training and supervision of psychiatry residents (p = .01); provision of lectures or skills-based teaching for psychiatry residents (p < .01); skills-based examinations of psychiatry residents (p < .001); training/supervision of Canadian-trained psychiatrists (p < .01); and training and supervision of internationally trained psychiatrists (p < .01). CONCLUSION The study reveals a nuanced picture regarding psychiatrists' engagement in teaching activities at DME sites. Despite a significant association between interest in formal medical education training and willingness to participate in teaching activities, clinicians do not consider the lack of formal training as a barrier. Addressing this complexity requires thoughtful strategies, potentially involving resource allocation, policy modifications, and adjustments to incentive structures by relevant institutions.
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Affiliation(s)
- Raquel da Luz Dias
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Lara Hazelton
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Mandy Esliger
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Peggy Alexiadis Brown
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Saint John, NB, Canada
| | - Philip G Tibbo
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Nachiketa Sinha
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Saint John, NB, Canada
| | - Anthony Njoku
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Saint John, NB, Canada
| | | | - Sanjay Siddhartha
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Saint John, NB, Canada
| | - Faisal Rahman
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Hugh Maguire
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Gerald Gray
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Mark Bosma
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Deborah Parker
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Owen Connolly
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Adewale Raji
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Alexandra Manning
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Alexa Bagnell
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Reham Shalaby
- Department of Psychiatry, Faculty of Dentistry and Medicine, University of Alberta, Edmonton, AB, Canada
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Obuobi-Donkor G, Shalaby R, Agyapong B, Dias RDL, Agyapong VIO. Mitigating Psychological Problems Associated with the 2023 Wildfires in Alberta and Nova Scotia: Six-Week Outcomes from the Text4Hope Program. J Clin Med 2024; 13:865. [PMID: 38337558 PMCID: PMC10856019 DOI: 10.3390/jcm13030865] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/21/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Background: In 2023, wildfires led to widespread destruction of property and displacement of residents in Alberta and Nova Scotia, Canada. Previous research suggests that wildfires increase the psychological burden of impacted communities, necessitating population-level interventions. Cognitive Behavioural Therapy (CBT)-based text message interventions, Text4HopeAB and Text4HopeNS, were launched in Alberta and Nova Scotia, respectively, during the 2023 wildfire season to support the mental health of impacted individuals. Objectives: The study examines the effectiveness of Text4HopeNS and Text4HopeAB in alleviating psychological symptoms and improving wellbeing among subscribers. Methods: The study involved longitudinal and naturalistic controlled trial designs. The longitudinal study comprised subscribers who completed program surveys at baseline and six weeks post-enrolment, while the naturalistic controlled study compared psychological symptoms in subscribers who had received daily supportive text messages for six weeks (intervention group) and new subscribers who had enrolled in the program during the same period but had not yet received any text messages (control group). The severity of low resilience, poor mental wellbeing, likely Major Depressive Disorder (MDD), likely Generalized Anxiety Disorder (GAD), likely Post-Traumatic Stress Disorder (PTSD), and suicidal ideation were measured on the Brief Resilience Scale (BRS), the World Health Organization-5 Wellbeing Index (WHO-5), Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7) scale, PTSD Checklist-Civilian Version (PCL-C), and the ninth question on the PHQ-9, respectively. The paired and independent sample t-tests were employed in data analysis. Results: The results from the longitudinal study indicated a significant reduction in the mean scores on the PHQ-9 (-12.3%), GAD-7 (-14.8%), and the PCL-C (-5.8%), and an increase in the mean score on the WHO-5, but not on the BRS, from baseline to six weeks. In the naturalistic controlled study, the intervention group had a significantly lower mean score on the PHQ-9 (-30.1%), GAD-7 (-29.4%), PCL-C (-17.5%), and the ninth question on the PHQ-9 (-60.0%) which measures the intensity of suicidal ideation, and an increase in the mean score on the WHO-5 (+24.7%), but not on the BRS, from baseline to six weeks compared to the control group. Conclusions: The results of this study suggests that the Text4Hope program is an effective intervention for mitigating psychological symptoms in subscribers during wildfires. This CBT-based text messaging program can be adapted to provide effective support for individuals' mental health, especially in the context of traumatic events and adverse experiences such as those induced by climate change. Policymakers and mental health professionals should consider these findings when shaping strategies for future disaster response efforts, emphasizing the value of scalable and culturally sensitive mental health interventions.
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Affiliation(s)
- Gloria Obuobi-Donkor
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (G.O.-D.); (R.d.L.D.)
| | - Reham Shalaby
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (R.S.); (B.A.)
| | - Belinda Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (R.S.); (B.A.)
| | - Raquel da Luz Dias
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (G.O.-D.); (R.d.L.D.)
| | - Vincent Israel Opoku Agyapong
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (G.O.-D.); (R.d.L.D.)
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (R.S.); (B.A.)
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Adu MK, Dias RDL, Agyapong B, Eboreime E, Sapara AO, Lawal MA, Chew C, Diamond Frost K, Li D, Flynn M, Hassan S, Saleh A, Sridharan S, White M, Agyapong VI. Repetitive Transcranial Magnetic Stimulation With and Without Text4Support for the Treatment of Resistant Depression: Protocol for a Patient-Centered Multicenter Randomized Controlled Pilot Trial. JMIR Res Protoc 2023; 12:e46830. [PMID: 38060308 PMCID: PMC10739251 DOI: 10.2196/46830] [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: 02/27/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Treatment-resistant depression (TRD) is the inability of a patient with major depressive disorder (MDD) to accomplish or achieve remission after an adequate trial of antidepressant treatments. Several combinations and augmentation treatment strategies for TRD exist, including the use of repetitive transcranial magnetic stimulation (rTMS), and new therapeutic options are being introduced. Text4Support, a text message-based form of cognitive behavioral therapy that allows patients with MDD to receive daily supportive text messages for correcting or altering negative thought patterns through positive reinforcement, may be a useful augmentation treatment strategy for patients with TRD. It is however currently unknown if adding the Text4Support intervention will enhance the response of patients with TRD to rTMS treatment. OBJECTIVE This study aims to assess the initial comparative clinical effectiveness of rTMS with and without the Text4Support program as an innovative patient-centered intervention for the management of patients diagnosed with TRD. METHODS This study is a multicenter, prospective, parallel-design, 2-arm, rater-blinded randomized controlled pilot trial. The recruitment process is scheduled to last 12 months. It will involve active treatment for 6 weeks, observation, and a follow-up period of 6 months for participants in the study arms. In total, 200 participants diagnosed with TRD at rTMS care clinics in Edmonton, Alberta, and rTMS clinics in Halifax, Nova Scotia will be randomized to 1 of 2 treatment arms (rTMS sessions alone or rTMS sessions plus Text4Support intervention). Participants in each group will be made to complete evaluation measures at baseline, and 1, 3, and 6 months. The primary outcome measure will be the mean change in the scores of the Patient Health Questionnaire-9 (PHQ-9). The secondary outcome measures will involve the scores of the 7-item Generalized Anxiety Disorders Scale (GAD-7), Columbia-Suicide Severity Rating Scale (CSSRS), and World Health Organization-Five Well-Being Index (WHO-5). Patient data will be analyzed with descriptive statistics, repeated measures, and correlational analyses. Qualitative data will be analyzed using the thematic analysis framework. RESULTS The results of the study are expected to be available 18 months from the start of recruitment. We hypothesize that participants enrolled in the rTMS plus Text4Support intervention treatment arm of the study will achieve superior outcomes compared with the outcomes of participants enrolled in the rTMS alone arm. CONCLUSIONS The application of the combination of rTMS and Text4Support has not been investigated previously. Therefore, we hope that this study will provide a concrete base of data to evaluate the practical application and efficacy of using the novel combination of these 2 treatment modalities. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/46830.
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Affiliation(s)
- Medard Kofi Adu
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | | | - Belinda Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Ejemai Eboreime
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | | | - Mobolaji A Lawal
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Corina Chew
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB, Canada
| | | | - Daniel Li
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB, Canada
| | - Michael Flynn
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - Sameh Hassan
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - Ahmed Saleh
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - Sanjana Sridharan
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - Matt White
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - Vincent Io Agyapong
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
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Hazelton L, da Luz Dias R, Esliger M, Tibbo P, Sinha N, Njoku A, Satyanarayana S, Siddhartha S, Alexiadis-Brown P, Rahman F, Maguire H, Gray G, Bosma M, Parker D, Connolly O, Raji A, Manning A, Bagnell A, Israel Opoku Agyapong V. Exploring Current Practices, Needs, and Barriers for Expanding Distributed Medical Education and Scholarship in Psychiatry: Protocol for an Environmental Scan Using a Formal Information Search Approach and Explanatory Design. JMIR Res Protoc 2023; 12:e46835. [PMID: 38010790 DOI: 10.2196/46835] [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: 02/27/2023] [Revised: 08/25/2023] [Accepted: 09/23/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Distributed medical education (DME) offers manifold benefits, such as increased training capacity, enhanced clinical learning, and enhanced rural physician recruitment. Engaged faculty are pivotal to DME's success, necessitating efforts from the academic department to promote integration into scholarly and research activities. Environmental scanning has been used to gather, analyze, and apply information for strategic planning purposes. It helps organizations identify current practices, assess needs and barriers, and respond to emerging risks and opportunities. There are process models and conceptual frameworks developed for environmental scanning in the business and educational sectors. However, the literature lacks methodological direction on how to go about designing and implementing this strategy to guide research and practice in DME, especially in the psychiatry field. OBJECTIVE This paper presents a protocol for an environmental scanning that aims to understand current practices and identify needs and barriers that must be addressed to facilitate the integration of psychiatrists from the Dalhousie University Faculty of Medicine's distributed education sites in Nova Scotia and New Brunswick into the Department of Psychiatry, contributing for the expansion of DME in both provinces and informing strategic planning and decision-making within the organization. METHODS This protocol adopts an innovative approach combining a formal information search and an explanatory design that includes quantitative and qualitative data. About 120 psychiatrists from 8 administrative health zones of both provinces will be invited to complete an anonymous web-based survey with questions about demographics, participants' experience and interest in undergraduate, postgraduate, and continuing medical education, research and scholarly activities, quality improvement, and knowledge translation. Focus group sessions will be conducted with a purposive sample of psychiatrists to collect qualitative data on their perspectives on the expansion of DME. RESULTS Results are expected within 6 months of data collection and will inform policy options for expanding Dalhousie University's psychiatry residency and fellowship programs using the infrastructure and human resources at distributed learning sites, leveraging opportunities regionally, especially in rural areas. CONCLUSIONS This paper proposes a comprehensive environmental scan procedure adapted from existing approaches. It does this by collecting important characteristics that affect psychiatrists' desire to be involved with research and scholarly activities, which is crucial for the DME expansion. Furthermore, its concordance with the literature facilitates interpretation and comparison. The protocol's new method also fills DME information gaps, allowing one to identify insights and patterns that may shape psychiatric education. This environmental scan's results will answer essential questions about how training programs could involve therapists outside the academic core and make the most of training experiences in semiurban and rural areas. This could help other psychiatry and medical units outside tertiary care establish residency and fellowship programs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46835.
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Affiliation(s)
- Lara Hazelton
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Raquel da Luz Dias
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Mandy Esliger
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Philip Tibbo
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Nachiketa Sinha
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Saint John, NB, Canada
| | - Anthony Njoku
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Saint John, NB, Canada
| | | | - Sanjay Siddhartha
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Saint John, NB, Canada
| | - Peggy Alexiadis-Brown
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Saint John, NB, Canada
| | - Faisal Rahman
- Mental Health and Addictions Program, Nova Scotia Health, Antigonish, NS, Canada
| | - Hugh Maguire
- Mental Health and Addictions Program, Nova Scotia Health, Truro, NS, Canada
| | - Gerald Gray
- Mental Health and Addictions Program, Nova Scotia Health, Kentville, NS, Canada
| | - Mark Bosma
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Deborah Parker
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Owen Connolly
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Adewale Raji
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Alexandra Manning
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Child and Adolescent Psychiatry, IWK Health, Halifax, NS, Canada
| | - Alexa Bagnell
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Child and Adolescent Psychiatry, IWK Health, Halifax, NS, Canada
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Dias RDL, Shalaby R, Agyapong B, Vuong W, Gusnowski A, Surood S, Greenshaw AJ, Agyapong VIO. The effectiveness of CBT-based daily supportive text messages in improving female mental health during COVID-19 pandemic: results from the Text4Hope program. Front Glob Womens Health 2023; 4:1182267. [PMID: 38025982 PMCID: PMC10667914 DOI: 10.3389/fgwh.2023.1182267] [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] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The COVID-19 pandemic has significantly exacerbated gender disparities in mental health, particularly impacting women. To address this, Alberta, Canada, launched Text4Hope, a Cognitive Behaviour Therapy-based text messaging intervention, to provide support and resources for psychological challenges during the pandemic. This study aimed to assess the effectiveness of Text4Hope in reducing stress, anxiety, depression, sleeping disturbances, and suicidal ideation among female subscribers during the COVID-19 pandemic. Methods The study employed both an uncontrolled longitudinal design and a controlled cohort design. The uncontrolled longitudinal study analyzed a one-year dataset (n = 9,545) of clinical outcomes, comparing mean differences in mental health symptoms from baseline to 6 weeks after subscription. The controlled cohort design compared two groups, with (n = 1,763) and without (n = 567) intervention exposure during the same period. Data were collected through self-administered online surveys completed at baseline and six weeks after subscription. Sociodemographic information and validated scales (e.g., 10-item Perceived Stress Scale (PSS-10), Generalized Anxiety Disorder (GAD-7), and Patient Health Questionnaire (PHQ-9)) were used to assess mental health outcomes. Results The results from the longitudinal study indicated a significant reduction in anxiety prevalence and anxiety symptoms, with a 19.63% decrease in GAD-7 mean score and a 32.02% decrease in likely anxiety from baseline to six weeks. Depressive symptoms and perceived stress also showed a significant reduction (p < 0.001), albeit to a lesser extent. In the controlled cohort study, the intervention group had significantly (p < 0.001) lower PHQ-9 [19.5 (SD 7.05)], GAD-7 [7.5 (SD 5.27)], and CMH [35.53 (SD 18.45)] scores. Additionally, the study found substantial differences (p < 0.001) in suicidal ideation (26.1 vs. 15.7) between groups but no significant differences in sleep disruption. Discussion These findings suggest that Text4Hope could be an effective intervention for reducing stress, depression, suicidal ideation, and particularly anxiety symptoms among women during public emergencies. The study provides valuable insights into the potential benefits of text messaging interventions in supporting mental health during crisis situations.
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Affiliation(s)
- Raquel da Luz Dias
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Reham Shalaby
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Belinda Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Wesley Vuong
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - April Gusnowski
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Shireen Surood
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Andrew James Greenshaw
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Vincent I. O. Agyapong
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry, Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Obuobi-Donkor G, Eboreime E, Shalaby R, Agyapong B, Phung N, Eyben S, Wells K, Dias RDL, Hilario C, Jones C, Brémault-Phillips S, Zhang Y, Greenshaw AJ, Agyapong VIO. User Satisfaction With a Daily Supportive Text Message Program (Text4PTSI) for Public Safety Personnel: Longitudinal Cross-Sectional Study. JMIR Form Res 2023; 7:e46431. [PMID: 37351940 DOI: 10.2196/46431] [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] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/30/2023] [Accepted: 04/17/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Public safety personnel (PSP) are exposed to traumatic events due to their work environments, which increases the risk of mental health challenges. Providing effective and evidence-based interventions, such as SMS text messaging programs, can improve PSP's overall mental well-being with high user satisfaction rates. OBJECTIVE This study aims to evaluate users' satisfaction, receptiveness, and perceptions of a cognitive behavioral therapy (CBT)-based supportive SMS text messaging intervention (Text4PTSI). METHODS Participants self-subscribed to Text4PTSI and received unidirectional cognitive behavioral-based supportive text messages for 6 months. Participants completed a web-based survey delivered via SMS text message at enrollment, and 6 weeks, 3 months, and 6 months post enrollment. Respondents' perception and receptivity of the program were assessed using a questionnaire measured on a 5-point Likert scale. Data were collected as categorical variables, and overall satisfaction with the Text4PTSI program was measured on a scale from 0 to 100. RESULTS There were 131 subscribers to the Text4PTSI program; however, only 81 subscribers responded to the survey, producing 100 survey responses across the 3 follow-up time points. The overall mean score of satisfaction was 85.12 (SD 13.35). More than half of the survey responses agreed or strongly agreed that Text4PTSI helped participants cope with anxiety (79/100 responses, 79%), depressive symptoms (72/100 responses, 72%), and loneliness (54/100 responses, 54%). Similarly, most of the survey responses agreed or strongly agreed that the Text4PTSI program made respondents feel connected to a support system, improved their overall mental well-being (84/100 responses, 84%), felt more hopeful about managing concerns about their mental health or substance use (82 out of responses, 82%), and helped enhance their overall quality of life (77/100 responses, 77%). The available survey responses suggest that the majority always read the supportive text messages (84/100 responses, 84%), took time to reflect on each message (75/100 responses, 75%), and returned to read the text messages more than once (76/100 responses, 76%). CONCLUSIONS PSP who responded to the follow-up surveys reported high user satisfaction and appreciation for receiving the Text4PTSI intervention during the 6-month program. The reported satisfaction with the service provided could pave the way to ensuring a better uptake of the service with potential effectiveness to end users.
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Affiliation(s)
- Gloria Obuobi-Donkor
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ejemai Eboreime
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Reham Shalaby
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Belinda Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Natalie Phung
- Operational Stress Injury Clinic, Alberta Health Services, Edmonton, AB, Canada
| | - Scarlett Eyben
- Operational Stress Injury Clinic, Alberta Health Services, Edmonton, AB, Canada
| | - Kristopher Wells
- Department of Child and Youth Care, Faculty of Health and Community Studies, MacEwan University, Edmonton, AB, Canada
| | - Raquel da Luz Dias
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Carla Hilario
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Chelsea Jones
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Operational Stress Injury Clinic, Alberta Health Services, Edmonton, AB, Canada
| | - Suzette Brémault-Phillips
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Yanbo Zhang
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Andrew J Greenshaw
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Vincent Israel Opoku Agyapong
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Agyapong B, Chishimba C, Wei Y, da Luz Dias R, Eboreime E, Msidi E, Abidi SSR, Mutaka-Loongo M, Mwansa J, Orji R, Zulu JM, Agyapong VIO. Improving Mental Health Literacy and Reducing Psychological Problems Among Teachers in Zambia: Protocol for Implementation and Evaluation of a Wellness4Teachers Email Messaging Program. JMIR Res Protoc 2023; 12:e44370. [PMID: 36877571 PMCID: PMC10028515 DOI: 10.2196/44370] [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: 11/17/2022] [Revised: 01/02/2023] [Accepted: 01/17/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Primary, basic, secondary, and high school teachers are constantly faced with increased work stressors that can result in psychological health challenges such as burnout, anxiety, and depression, and in some cases, physical health problems. It is presently unknown what the mental health literacy levels are or the prevalence and correlates of psychological issues among teachers in Zambia. It is also unknown if an email mental messaging program (Wellness4Teachers) would effectively reduce burnout and associated psychological problems and improve mental health literacy among teachers. OBJECTIVE The primary objectives of this study are to determine if daily supportive email messages plus weekly mental health literacy information delivered via email can help improve mental health literacy and reduce the prevalence of moderate to high stress symptoms, burnout, moderate to high anxiety symptoms, moderate to high depression symptoms, and low resilience among school teachers in Zambia. The secondary objectives of this study are to evaluate the baseline prevalence and correlates of moderate to high stress, burnout, moderate to high anxiety, moderate to high depression, and low resilience among school teachers in Zambia. METHODS This is a quantitative longitudinal and cross-sessional study. Data will be collected at the baseline (the onset of the program), 6 weeks, 3 months, 6 months (the program midpoint), and 12 months (the end point) using web-based surveys. Individual teachers will subscribe by accepting an invitation to do so from the Lusaka Apex Medical University organizational account on the ResilienceNHope web-based application. Data will be analyzed using SPSS version 25 with descriptive and inferential statistics. Outcome measures will be evaluated using standardized rating scales. RESULTS The Wellness4Teachers email program is expected to improve the participating teachers' mental health literacy and well-being. It is anticipated that the prevalence of stress, burnout, anxiety, depression, and low resilience among teachers in Zambia will be similar to those reported in other jurisdictions. In addition, it is expected that demographic, socioeconomic, and organizational factors, class size, and grade teaching will be associated with burnout and other psychological disorders among teachers, as indicated in the literature. Results are expected 2 years after the program's launch. CONCLUSIONS The Wellness4Teachers email program will provide essential insight into the prevalence and correlates of psychological problems among teachers in Zambia and the program's impact on subscribers' mental health literacy and well-being. The outcome of this study will help inform policy and decision-making regarding psychological interventions for teachers in Zambia. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/44370.
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Affiliation(s)
- Belinda Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | | | - Yifeng Wei
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Raquel da Luz Dias
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ejemai Eboreime
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | | | | | | | | | - Rita Orji
- Faculty of Computer Sciences, Dalhousie University, Halifax, NS, Canada
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11
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Obuobi-Donkor G, Shalaby R, Eboreime E, Agyapong B, Phung N, Eyben S, Wells K, Hilario C, Dias RDL, Jones C, Brémault-Phillips S, Zhang Y, Greenshaw AJ, Agyapong VIO. Text4PTSI: A Promising Supportive Text Messaging Program to Mitigate Psychological Symptoms in Public Safety Personnel. Int J Environ Res Public Health 2023; 20:4215. [PMID: 36901235 PMCID: PMC10001524 DOI: 10.3390/ijerph20054215] [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] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Public safety personnel experience various mental health conditions due to their work's complex and demanding nature. There are barriers to seeking support and treatment; hence, providing innovative and cost-effective interventions can help improve mental health symptoms in public safety personnel. OBJECTIVE The study aimed to evaluate the impact of Text4PTSI on depression, anxiety, trauma, and stress-related symptoms, and the resilience of public safety personnel after six months of providing supportive text message intervention. METHODS Public safety personnel subscribed to Text4PTSI and received daily supportive and psychoeducational SMS text messages for six months. Participants were invited to complete standardized self-rated web-based questionnaires to assess depression, anxiety, posttraumatic stress disorder (PTSD), and resilience symptoms measured on the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 scale (GAD-7), Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C), and the Brief Resilience Scale (BRS), respectively. The assessment of mental health conditions was conducted at baseline (enrolment) and six weeks, three months, and six months after enrollment. RESULTS One hundred and thirty-one subscribers participated in the Text4PTSI program, and eighteen completed both the baseline and any follow-up survey. A total of 31 participants completed the baseline survey and 107 total surveys were recorded at all follow-up time points. The baseline prevalence of psychological problems among public safety personnel were as follows: likely major depressive disorder (MDD) was 47.1%, likely generalized anxiety disorder (GAD) was 37.5%, low resilience was 22.2%, and likely PTSD was 13.3%. At six months post-intervention, the prevalence of likely MDD, likely GAD, and likely PTSD among respondents reduced; however, a statistically significant reduction was reported only for likely MDD (-35.3%, X2 (1) = 2.55, p = 0.03). There was no significant change in the prevalence of low resilience between baseline and post-intervention. There was a decrease in the mean scores on the PHQ-9, GAD-7, PCL-C, and the BRS from baseline to post-intervention by 25.8%, 24.7%, 9.5%, and 0.3%, respectively. However, the decrease was only statistically significant for the mean change in GAD-7 scores with a low effect size (t (15) = 2.73, p = 0.02). CONCLUSIONS The results of this study suggest a significant reduction in the prevalence of likely MDD as well as the severity of anxiety symptoms from baseline to post-intervention for subscribers of the Text4PTSI program. Text4PTSI is a cost-effective, convenient, and easily scalable program that can augment other services for managing the mental health burdens of public safety personnel.
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Affiliation(s)
| | - Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Ejemai Eboreime
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Belinda Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Natalie Phung
- Operational Stress Injury Clinic, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Scarlett Eyben
- Operational Stress Injury Clinic, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Kristopher Wells
- Department of Child and Youth Care, Faculty of Health and Community Studies, MacEwan University, Edmonton, AB T5J 4S2, Canada
| | - Carla Hilario
- School of Nursing, Faculty of Health and Social Development, The University of British Columbia, Kelowna, BC V1V 1V7, Canada
| | - Raquel da Luz Dias
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Chelsea Jones
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Suzette Brémault-Phillips
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Yanbo Zhang
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Andrew J. Greenshaw
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Vincent Israel Opoku Agyapong
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
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12
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Dias RDL, Shalaby R, Agyapong B, Obuobi-Donkor G, Adu MK, Eboreime E, Obeng Nkrumah S, Sridharan S, Simon P, Taylor B, Henderson N, White MD, Maguire H, Gray G, Rahman F, Fair J, Wadden N, Sulyman M, Williams O, Akinkunmi O, Edem D, Arenella P, Morrison J, Awara M, Natarajan A, Nunes A, Hajek T, O’Donavan C, Uher R, Wang J, Rusak B, Wozney L, Sampalli T, Grant D, Tomblin Murphy G, Warford J, Hodder S, Boe R, Agyapong VIO. Augmenting Mental Health Support for Patients Accessing Different Degrees of Formal Psychiatric Care through a Supportive Text Messaging Program: Protocol for a Randomized Controlled Trial. Methods Protoc 2023; 6:mps6010019. [PMID: 36827506 PMCID: PMC9959317 DOI: 10.3390/mps6010019] [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] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/23/2022] [Accepted: 01/23/2023] [Indexed: 02/16/2023] Open
Abstract
Patients feel more vulnerable when accessing community mental health programs for the first time or after being discharged from psychiatric inpatient units. Long wait times for follow-up appointments, shortage of mental health professionals, lack of service integration, and scarcity of tailored support can weaken their connection to the health care system. As a result, patients can present low adherence, dissatisfaction with treatment, and recurrent hospitalizations. Finding solutions to avoid unnecessary high-cost services and providing tailored and cost-effective mental health interventions may reduce the health system burden and augment patient support. We propose implementing an add-on, supportive text messaging service (Text4Support), developed using cognitive-behavioural therapy (CBT) principles to augment mental health support for patients attending to or being discharged from psychiatric care in Nova Scotia, Canada. This randomized controlled trial aims to investigate the effectiveness of Text4Support in improving mental health outcomes and overall mental well-being compared with usual care. We also will examine the intervention's impact on health services utilization and patient satisfaction. The results from this study will provide evidence on stepped and technology-based mental health care, which will contribute to generating new knowledge about mental health innovations in various clinical contexts, which is not only helpful for the local context but to other jurisdictions in Canada and abroad that are seeking to improve their health care.
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Affiliation(s)
- Raquel da Luz Dias
- Department of Psychiatry, Nova Scotia Health, Halifax, NS B3H 2E2, Canada
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
| | - Reham Shalaby
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Belinda Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Gloria Obuobi-Donkor
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
| | - Medard K. Adu
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
| | - Ejemai Eboreime
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | | | - Sanjana Sridharan
- Department of Psychiatry, Nova Scotia Health, Halifax, NS B3H 2E2, Canada
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
| | - Patryk Simon
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Bryanne Taylor
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Neal Henderson
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Mathew D. White
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Hugh Maguire
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Gerald Gray
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Faisal Rahman
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Janah Fair
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Nadine Wadden
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Mutiat Sulyman
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Olugbenga Williams
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Oluseye Akinkunmi
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Dorothy Edem
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Pamela Arenella
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Jason Morrison
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Mahmoud Awara
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Anand Natarajan
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Abraham Nunes
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Tomas Hajek
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Claire O’Donavan
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Rudolf Uher
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - JianLi Wang
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Nova Scotia Health Innovation Hub, Halifax, NS B3S 0H6, Canada
| | - Benjamin Rusak
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
| | - Lori Wozney
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
- Mental Health and Addictions Program, IWK Health, Halifax, NS B3K 6R8, Canada
| | - Tara Sampalli
- Nova Scotia Health Innovation Hub, Halifax, NS B3S 0H6, Canada
| | - Doris Grant
- Nova Scotia Health Innovation Hub, Halifax, NS B3S 0H6, Canada
| | | | - Jordan Warford
- Nova Scotia Health Innovation Hub, Halifax, NS B3S 0H6, Canada
| | - Samantha Hodder
- School of Nursing, Cape Breton University, Cape Breton, NS B1M 1A2, Canada
| | - Rachel Boe
- Addictions and Mental Health, Horizon Health Network, Fredericton, NB E3B 4R3, Canada
| | - Vincent Israel Opoku Agyapong
- Department of Psychiatry, Nova Scotia Health, Halifax, NS B3H 2E2, Canada
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
- Correspondence: or
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Agyapong B, Wei Y, da Luz Dias R, Agyapong VIO. Burnout and Associated Psychological Problems among Teachers in Alberta and Nova Scotia, and the impact of a Supportive Text Messaging Program (Wellness4Teachers)- Protocol for a Cross-Sectional and Program Evaluation Study (Preprint). JMIR Res Protoc 2022; 11:e37934. [PMID: 35834305 PMCID: PMC9335169 DOI: 10.2196/37934] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/25/2022] [Accepted: 06/13/2022] [Indexed: 01/30/2023] Open
Abstract
Background Stress, burnout, anxiety, and depression continue to be a problem among teachers worldwide. It is not presently known what the prevalence and correlates for these psychological problems are among teachers in Alberta and Nova Scotia. It is also not known if a supportive text message program (Wellness4Teachers) would be effective in reducing stress, burnout, anxiety, or depression symptoms among teachers. Objective The goal of this study is to evaluate the prevalence and correlates of stress, burnout, symptoms of anxiety, depression, and low resilience among elementary and high school teachers in Alberta and Nova Scotia, Canada. It also aims to determine if daily supportive text messages can help reduce the prevalence of these psychological problems in teachers. Methods This is a cross-sessional mixed methods study with data to be collected from subscribers of Wellness4Teachers using a web-based survey at baseline (onset of text messaging), 6 weeks, the program’s midpoint (3 months), and end point (6 months). Teachers can subscribe to the Wellness4Teachers program by texting the keyword “TeachWell” to the program phone number. Outcome measures will be assessed using standardized rating scales and key informant interviews. Data will be analyzed with descriptive and inferential statistics using SPSS and thematic analysis using NVivo. Results The results of this study are expected 24 months after program launch. It is expected that the prevalence of stress, burnout, anxiety, depression, and low resilience among teachers in Alberta and Nova Scotia would be comparable to those reported in other jurisdictions. It is also expected that factors such as gender, number of years teaching, grade of teaching, and school type (elementary vs high school) will have an association with burnout and other psychological disorders among teachers. Furthermore, it is expected that Wellness4Teachers will reduce the prevalence and severity of psychological problems in teachers, and subscriber satisfaction will be high. Conclusions The Wellness4Teachers project will provide key information regarding prevalence and correlates of common mental health conditions in teachers in Alberta and Nova Scotia, as well as the impact of daily supportive text messages on these mental health parameters. Information from this study will be useful for informing policy and decision-making concerning psychological interventions for schoolteachers.
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Affiliation(s)
- Belinda Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Yifeng Wei
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Raquel da Luz Dias
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
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da Luz Dias R, de Oliveira Lima M, Alves JGB, Van Woensel W, Naqvi A, Take Z, Abidi SSR. A Digital Health Platform to Deliver Tailored Early Stimulation Programs for Children with Developmental Delays. Stud Health Technol Inform 2019; 264:571-575. [PMID: 31437988 DOI: 10.3233/shti190287] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Developmental delay is a deviation from the regular development of normative milestones during childhood. Early stimulation is a standardized and straightforward technique to support children with developmental delays (aged 0-3 years) in reaching basic motor skills, which are essential for the execution of everyday activities, such as playing, feeding and locomotion. In doing so, early stimulation reduces the chances of permanent motor impairment, thus allowing the child to live a more functional life. However, outcomes of this treatment depend heavily on the involvement of the family, who are required to continue the early stimulation activities at home on a daily basis. To empower and educate families to administer standardized early stimulation programs at home, we developed an electronic early stimulation program, which provides personalized guidance to parents to administer early stimulation; together with evidence-based clinical decision support to therapists in tailoring ESP to observed needs.
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Affiliation(s)
- Raquel da Luz Dias
- Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marcela de Oliveira Lima
- Rehabilitation Centre Prof. Fernando Figueira Integral Medicine Institute, Recife, Pernambuco, Brazil
| | | | - William Van Woensel
- Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Asil Naqvi
- Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Zahra Take
- Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada
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Dias RDL, Silva KCCG, Lima MRDO, Alves JGB, Abidi SSR. A Mobile Early Stimulation Program to Support Children with Developmental Delays in Brazil. Stud Health Technol Inform 2018; 247:785-789. [PMID: 29678068] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Developmental delay is a deviation development from the normative milestones during the childhood and it may be caused by neurological disorders. Early stimulation is a standardized and simple technique to treat developmental delays in children (aged 0-3 years), allowing them to reach the best development possible and to mitigate neuropsychomotor sequelae. However, the outcomes of the treatment depending on the involvement of the family, to continue the activities at home on a daily basis. To empower and educate parents of children with neurodevelopmental delays to administer standardized early stimulation programs at home, we developed a mobile early stimulation program that provides timely and evidence-based clinical decision support to health professionals and a personalized guidance to parents about how to administer early stimulation to their child at home.
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Dias RDL, Moraes MC, Leite LL. Video Production and Video Tutorials in Professional Health Education. International Journal of Healthcare Information Systems and Informatics 2014. [DOI: 10.4018/ijhisi.2014070105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Motivated by the significant increase in the presence of mobile devices in the classroom and the opportunity to use these resources to improve and streamline the process of teaching and learning, this paper proposes a pedagogical use of mobile technologies, specifically, tablets in the class. The proposal was developed under LabsMóveis, a subproject of the LabTEAR Project, and applied in an undergraduate program of the Health area. The use of tablets in the University classroom contributed to the expansion of general and specific cognitive abilities, stimulating creativity and leadership for the learners, while enhancing their initiatives to solve problems.
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Affiliation(s)
- Raquel da Luz Dias
- Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Márcia Cristina Moraes
- School of Computer Science, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Leticia Lopes Leite
- School of Education, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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Fagherazzi S, Dias RDL, Bortolon F. Impacto do exercício físico isolado e combinado com dieta sobre os níveis séricos de HDL, LDL, colesterol total e triglicerídeos. REV BRAS MED ESPORTE 2008. [DOI: 10.1590/s1517-86922008000400012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Adequados hábitos alimentares e a prática de exercícios físicos exercem efeito benéfico sobre as dislipidemias. Se associados, podem ainda otimizar as mudanças do perfil lipoprotéico plasmático, sendo, além disso, intervenções de custo moderado quando comparados com tratamentos medicamentosos e dependentes de alta tecnologia. Este estudo tem por objetivo avaliar o impacto do exercício físico isolado e combinado com dieta sobre o perfil lipídico em indivíduos com sobrepeso/obesos. O presente trabalho é do tipo retrospectivo analítico observacional. Nele foi analisada a evolução do perfil lipídico e do peso, por período entre três e seis meses, de 30 indivíduos, divididos em dois grupos: grupo exercício (prática de exercício físico) e grupo dieta (prática de exercício físico associada à intervenção nutricional). Foram encontradas reduções estatisticamente significativas no CT (-14,4mg/dl; P = 0,022) e no LDL-c (-20,9mg/dl; P = 0,013) para os componentes do grupo exercício. Tal redução também ocorreu em relação à razão CT/HDL-c (-0,9; P = 0,005) para os componentes do grupo dieta. Foi observada elevação dos níveis de HDL-c, apenas no grupo dieta (+4,2 mg/dl). Nesse mesmo grupo verificou-se diminuição no CT (-8mg/dl) e no LDL-c (-9,8mg/dl), bem como redução de peso (-2,6kg), no entanto, tais resultados não foram estatisticamente significativos. Quanto aos níveis de TG, não foi verificada evolução positiva em ambos os grupos. Concluiu-se que o efeito isolado do exercício físico foi mais evidente em relação às variáveis CT e LDL-c. Os TG não sofreram modificações positivas com a prática exclusiva de exercícios físicos ou com sua associação à dieta. Para as variáveis HDL-c e peso, a combinação da dieta com o exercício físico apresentou maiores benefícios.
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