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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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Kuzminskaite E, Vinkers CH, Smit AC, van Ballegooijen W, Elzinga BM, Riese H, Milaneschi Y, Penninx BWJH. Day-to-day affect fluctuations in adults with childhood trauma history: a two-week ecological momentary assessment study. Psychol Med 2024; 54:1160-1171. [PMID: 37811562 DOI: 10.1017/s0033291723002969] [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] [Indexed: 10/10/2023]
Abstract
BACKGROUND Childhood trauma (CT) may increase vulnerability to psychopathology through affective dysregulation (greater variability, autocorrelation, and instability of emotional symptoms). However, CT associations with dynamic affect fluctuations while considering differences in mean affect levels across CT status have been understudied. METHODS 346 adults (age = 49.25 ± 12.55, 67.0% female) from the Netherlands Study of Depression and Anxiety participated in ecological momentary assessment. Positive and negative affect (PA, NA) were measured five times per day for two weeks by electronic diaries. Retrospectively-reported CT included emotional neglect and emotional/physical/sexual abuse. Linear regressions determined associations between CT and affect fluctuations, controlling for age, sex, education, and mean affect levels. RESULTS Compared to those without CT, individuals with CT reported significantly lower mean PA levels (Cohen's d = -0.620) and higher mean NA levels (d = 0.556) throughout the two weeks. CT was linked to significantly greater PA variability (d = 0.336), NA variability (d = 0.353), and NA autocorrelation (d = 0.308), with strongest effects for individuals reporting higher CT scores. However, these effects were entirely explained by differences in mean affect levels between the CT groups. Findings suggested consistency of results in adults with and without lifetime depressive/anxiety disorders and across CT types, with sexual abuse showing the smallest effects. CONCLUSIONS Individuals with CT show greater affective dysregulation during the two-week monitoring of emotional symptoms, likely due to their consistently lower PA and higher NA levels. It is essential to consider mean affect level when interpreting the impact of CT on affect dynamics.
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Affiliation(s)
- Erika Kuzminskaite
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Stress & Sleep Program, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands
| | - Christiaan H Vinkers
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Stress & Sleep Program, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands
- Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Arnout C Smit
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wouter van Ballegooijen
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bernet M Elzinga
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, The Netherlands
- Institute of Psychology, Clinical Psychology Unit, Leiden University, Leiden, The Netherlands
| | - Harriëtte Riese
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yuri Milaneschi
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Stress & Sleep Program, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Stress & Sleep Program, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands
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Nuij C, van Ballegooijen W, Smit AC, de Beurs D, de Winter RF, O’Connor RC, Kerkhof A, Smit JH, Riper H. A Proof of Concept Study on Individual Trends in Suicidal Ideation: An Ecological Momentary Assessment Study of 5 Patients Over Three Months. J Pers Oriented Res 2023; 9:42-50. [PMID: 37389029 PMCID: PMC10302657 DOI: 10.17505/jpor.2023.25265] [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] [Indexed: 07/01/2023] Open
Abstract
Background Suicidal ideation (SI) is a significant and long-lasting mental health problem, with a third of individuals still experiencing SI after two years. To date, most Ecological Momentary Assessment (EMA) studies of SI have assessed its day-to-day course over one to four consecutive weeks and found no consistent trends in average SI severity over time. Aim The current proof of concept study assessed daily fluctuations of SI over a time span of 3 to 6 months to explore whether individual trends in SI severity could be detected, and if so, if the trajectory of changes were gradual or sudden. The secondary aim was to explore whether changes in SI severity could be detected at an early stage. Method Five adult outpatients with depression and SI used an EMA app on their smartphone in addition to their regular treatment for 3 to 6 months, where SI was assessed 3 times a day. To detect trends in SI for each patient, three models were tested: a null model, a gradual change model and a sudden change model. To detect changes in SI before a new plateau was reached, Early Warning Signals and Exponentially Weighted Moving Average control charts were used. Results In each patient, average SI severity had a unique trajectory of sudden and/or gradual changes. Additionally, in some patients, increases in both sudden and gradual SI could be detected at an early stage. Conclusions The study presents a first indication of unique individual trends in SI severity over a 3 to 6 months period. Though replication in a larger sample is needed to test how well results generalize, a first proof-of-concept is provided that both sudden and gradual changes in SI severity may be detectable at an early stage using the dynamics of time-series data.
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Affiliation(s)
- Chani Nuij
- Section Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Netherlands
| | - Wouter van Ballegooijen
- Section Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC - Location Vrije Universiteit Amsterdam, Netherlands
| | - Arnout C. Smit
- Section Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Netherlands
| | | | - Remco F.P. de Winter
- Section Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Netherlands
- Mental health institution GGZ Rivierduinen, Netherlands
| | - Rory C. O’Connor
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Ad Kerkhof
- Section Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Netherlands
| | - Jan H Smit
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC - Location Vrije Universiteit Amsterdam, Netherlands
| | - Heleen Riper
- Section Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Netherlands
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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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Setkowski K, Palantza C, van Ballegooijen W, Gilissen R, Oud M, Cristea IA, Noma H, Furukawa TA, Arntz A, van Balkom AJLM, Cuijpers P. Which psychotherapy is most effective and acceptable in the treatment of adults with a (sub)clinical borderline personality disorder? A systematic review and network meta-analysis. Psychol Med 2023; 53:3261-3280. [PMID: 37203447 PMCID: PMC10277776 DOI: 10.1017/s0033291723000685] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 05/18/2022] [Revised: 02/11/2023] [Accepted: 02/27/2023] [Indexed: 05/20/2023]
Abstract
A broad range of psychotherapies have been proposed and evaluated in the treatment of borderline personality disorder (BPD), but the question which specific type of psychotherapy is most effective remains unanswered. In this study, two network meta-analyses (NMAs) were conducted investigating the comparative effectiveness of psychotherapies on (1) BPD severity and (2) suicidal behaviour (combined rate). Study drop-out was included as a secondary outcome. Six databases were searched until 21 January 2022, including RCTs on the efficacy of any psychotherapy in adults (⩾18 years) with a diagnosis of (sub)clinical BPD. Data were extracted using a predefined table format. PROSPERO ID:CRD42020175411. In our study, a total of 43 studies (N = 3273) were included. We found significant differences between several active comparisons in the treatment of (sub)clinical BPD, however, these findings were based on very few trials and should therefore be interpreted with caution. Some therapies were more efficacious compared to GT or TAU. Furthermore, some treatments more than halved the risk of attempted suicide and committed suicide (combined rate), reporting RRs around 0.5 or lower, however, these RRs were not statistically significantly better compared to other therapies or to TAU. Study drop-out significantly differed between some treatments. In conclusion, no single treatment seems to be the best choice to treat people with BPD compared to other treatments. Nevertheless, psychotherapies for BPD are perceived as first-line treatments, and should therefore be investigated further on their long-term effectiveness, preferably in head-to-head trials. DBT was the best connected treatment, providing solid evidence of its effectiveness.
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Affiliation(s)
- Kim Setkowski
- Research Department, 113 Suicide Prevention, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC, VU University, Amsterdam Public Health research institute, and GGZinGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Christina Palantza
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Wouter van Ballegooijen
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC, VU University, Amsterdam Public Health research institute, and GGZinGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Renske Gilissen
- Research Department, 113 Suicide Prevention, Amsterdam, the Netherlands
| | - Matthijs Oud
- Department of Treatment, Care and Reintegration, Trimbos Institute, Utrecht, the Netherlands
| | - Ioana A. Cristea
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - Hisashi Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Toshi A. Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Arnoud Arntz
- Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Anton J. L. M. van Balkom
- Department of Psychiatry, Amsterdam UMC, VU University, Amsterdam Public Health research institute, and GGZinGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
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Nuij C, van Ballegooijen W, de Beurs D, de Winter RFP, Gilissen R, O’Connor RC, Smit JH, Kerkhof A, Riper H. The feasibility of using smartphone apps as treatment components for depressed suicidal outpatients. Front Psychiatry 2022; 13:971046. [PMID: 36238944 PMCID: PMC9552877 DOI: 10.3389/fpsyt.2022.971046] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Mental health smartphone apps could increase the safety and self-management of patients at risk of suicide, but it is still unclear whether it is feasible to integrate such apps into routine mental healthcare. This study reports on the feasibility of using a safety planning app (BackUp) and a self-monitoring app (mEMA) as components of the routine treatment of depressed outpatients with suicidal ideation. Clinicians were trained in working with both of the apps, and they invited their eligible patients with suicidal ideation for study participation. Patients used the apps for 3 months and discussed these with their clinician during treatment. Patients completed assessments at baseline (T0), 4 weeks (T1) and post-test (T2, 12 weeks after baseline). Both patients and clinicians also participated in telephone interviews. Feasibility was assessed in terms of usability (score > 70 on System Usability Scale, SUS), acceptability (score > 20 on Client Satisfaction Questionnaire-8, CSQ-8), and uptake (sufficient rates of component completion and app usage in treatment). The sample included 17 adult outpatients (52.9% male, age range 20-50 years) diagnosed with a depressive disorder and suicidal ideation at baseline. BackUp was rated by patients at above the cut-off scores for usability (SUS mean score at T1 75.63 and at T2 77.71) and acceptability (CSQ-8 mean score at T1 23.42 and at T2 23.50). mEMA was similarly rated (SUS mean score at T1 75.83 and at T2 76.25; CSQ-8 mean score at T1 23.92 and at T2 22.75). Telephone interviews with patients and clinicians confirmed the usability and acceptability. The uptake criteria were not met. Our findings suggest that mobile safety planning and mobile self-monitoring can be considered acceptable and usable as treatment components for depressed suicidal outpatients, but the integration of apps into routine treatment needs to be further explored.
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Affiliation(s)
- Chani Nuij
- Section of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Wouter van Ballegooijen
- Section of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (UMC) – Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Derek de Beurs
- Department of Mental Health and Prevention, Trimbos Institute, Utrecht, Netherlands
| | - Remco F. P. de Winter
- Section of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Mental Health Institution, Mental Health Institution (GGZ) Rivierduinen, Leiden, Netherlands
| | - Renske Gilissen
- Department of Research, 113 Suicide Prevention, Amsterdam, Netherlands
| | - Rory C. O’Connor
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Jan H. Smit
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (UMC) – Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ad Kerkhof
- Section of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Heleen Riper
- Section of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (UMC) – Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Juniar D, van Ballegooijen W, Schulte M, van Schaik A, Passchier J, Heber E, Lehr D, Sadarjoen SS, Riper H. A Web-Based Stress Management Intervention for University Students in Indonesia (Rileks): Feasibility Study Using a Pretest-Posttest Design. JMIR Form Res 2022; 6:e37278. [PMID: 35852838 PMCID: PMC9491829 DOI: 10.2196/37278] [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: 02/14/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background University students are susceptible to excessive stress. A web-based stress management intervention holds promise to improve stress but is still at a novel stage in Indonesia. Objective The aim of this paper was to report the feasibility of the intervention we developed—Rileks—among university students in Indonesia in terms of acceptability and usability, and to propose recommendations for future improvements. Methods A single-group pretest and posttest design was used. Participants with scores of 15 or higher on the stress subscale of the 42-item Depression Anxiety Stress Scales were given access to the intervention (N=68). The main outcome measures were the 8-item Client Satisfaction Questionnaire (CSQ-8) score, the System Usability Scale (SUS) score, and intervention uptake. Participants’ experience in each session was evaluated using closed- and open-ended questions for future improvements. Descriptive statistics were used to examine primary outcome and qualitative session evaluations. Participants’ responses to each topic of the open questions were summarized. Results The intervention was evaluated as being satisfactory (CSQ-8 mean score 21.89, SD 8.72; range 8-32). However, the intervention’s usability was still below expectation (SUS mean score 62.8, SD 14.74; range 0-100). The core modules were completed by 10 out of 68 participants (15%), and the study dropout rate was 63% (43/68) at postassessment. In general, the module content was rated positively, with some notes for improvement covering content and technical aspects. Conclusions This study indicates that Rileks is potentially feasible for Indonesian university students. In order to be optimally applied in such a context and before scaling up web-based interventions in Indonesia, in general, further development and refinement are needed. International Registered Report Identifier (IRRID) RR2-10.2196/11493
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Affiliation(s)
- Dilfa Juniar
- Faculty of Psychology, YARSI University, Jakarta, Indonesia
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Wouter van Ballegooijen
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam, Netherlands
- Geestelijke Gezondheids Zorg inGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | - Mieke Schulte
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Anneke van Schaik
- Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam, Netherlands
- Geestelijke Gezondheids Zorg inGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | - Jan Passchier
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Elena Heber
- HelloBetter - GET.ON Institut für Online Gesundheitstrainings GmbH, Hamburg, Germany
| | - Dirk Lehr
- Institute of Psychology, Leuphana University, Lüneburg, Germany
| | | | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
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Janssen W, van Raak J, van der Lucht Y, van Ballegooijen W, Mérelle S. Can Outcomes of a Chat-Based Suicide Prevention Helpline Be Improved by Training Counselors in Motivational Interviewing? A Non-randomized Controlled Trial. Front Digit Health 2022; 4:871841. [PMID: 35801118 PMCID: PMC9253377 DOI: 10.3389/fdgth.2022.871841] [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: 02/08/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To examine whether the outcomes of a chat-based suicide-prevention helpline could be improved by training counselors in motivational interviewing (MI). Methods In a pre- and post-test design, visitors of a chat-based suicide prevention helpline received either the Five-Phase Model (treatment as usual [TAU]) or MI. They completed a pre- and post-chat questionnaire on several suicide-related risk factors. Linear mixed modeling was used to estimate the effect of the condition. Furthermore, the treatment proficiency of newly trained counselors was assessed using MI-Scope. Results A total of 756 visitors and 55 counselors were included in this study. The visitors showed an improvement in suicidal ideation and psychological risk factors after a chat conversation. However, there were no significant differences between the MI and TAU conditions (β = 0.03, 95% CI [−0.23–0.30], p = 0.80). The treatment integrity indices showed that the counselors mostly used MI-consistent techniques but were unable to strategically employ these techniques to evoke enough change talk. Conclusions MI and TAU led to comparable outcomes in a chat-based suicide prevention helpline. The effectiveness of MI might improve by intensifying or improving the training of counselors, keeping the process of engaging more concise or offering visitors multiple sessions of MI.
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Affiliation(s)
- Wilco Janssen
- 113 Suicide Prevention, Amsterdam, Netherlands
- *Correspondence: Wilco Janssen
| | | | | | - Wouter van Ballegooijen
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam UMC, Amsterdam, Netherlands
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van Ballegooijen W, Littlewood DL, Nielsen E, Kapur N, Gooding P. The temporal relationships between defeat, entrapment and suicidal ideation: ecological momentary assessment study. BJPsych Open 2022; 8:e105. [PMID: 35656578 PMCID: PMC9230440 DOI: 10.1192/bjo.2022.68] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Psychological models of suicidal experiences are largely based on cross-sectional or long-term prospective data with follow-up intervals typically greater than 1 year. Recent time-series analyses suggest that these models may not account for fluctuations in suicidal thinking that occur within a period of hours and/or days. AIMS We explored whether previously posited causal relationships between defeat, entrapment and suicidal ideation accounted for temporal associations between these experiences at small time intervals from 3 to 12 h. METHOD Participants (N = 51) completed an ecological momentary assessment (EMA) study, comprising repeated assessments at semi-random time points up to six times per day for 1 week, resulting in 1852 completed questionnaires. Multilevel vector autoregression was used to calculate temporal associations between variables at different time intervals (i.e. 3 to 12 h between measurements). RESULTS The results showed that entrapment severity was temporally associated with current and later suicidal ideation, consistently over these time intervals. Furthermore, entrapment had two-way temporal associations with defeat and suicidal ideation at time intervals of approximately 3 h. The residual and contemporaneous network revealed significant associations between all variables, of which the association between entrapment and defeat was the strongest. CONCLUSIONS Although entrapment is key in the pathways leading to suicidal ideation over time periods of months, our results suggest that entrapment may also account for the emergence of suicidal thoughts across time periods spanning a few hours.
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Affiliation(s)
- Wouter van Ballegooijen
- Department of Psychiatry and Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit; and Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands
| | - Donna L Littlewood
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, and Manchester Academic Health Science Centre, University of Manchester, UK
| | - Emma Nielsen
- Self-Harm Research Group, School of Psychology, University of Nottingham, UK
| | - Nav Kapur
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, and Manchester Academic Health Science Centre, University of Manchester; and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Patricia Gooding
- School of Health Sciences and Manchester Academic Health Science Centre, University of Manchester, UK
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10
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Nuij C, van Ballegooijen W, Derek de B, Juniar D, Erlangsen A, Portzky G, O'Connor RC, Johannes HS, Kerkhof A, Heleen R. Authors' reply. Br J Psychiatry 2022; 220:246. [PMID: 35354506 DOI: 10.1192/bjp.2021.198] [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: 11/23/2022]
Affiliation(s)
- Chani Nuij
- Vrije Universiteit Amsterdam, AmsterdamThe Netherlands.
| | - Wouter van Ballegooijen
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Beurs Derek de
- Vrije Universiteit Amsterdam, The Netherlands and Trimbos-institute, The Netherlands
| | - Dilfa Juniar
- Vrije Universiteit Amsterdam, The Netherlands and Universitas YARSI, Indonesia
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Denmark, Johns Hopkins Bloomberg School of Public Health, USA and Australian National University, Australia
| | | | | | - H Smit Johannes
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands and Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Ad Kerkhof
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Riper Heleen
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands and Amsterdam University Medical Center, Amsterdam, The Netherlands
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11
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Nuij C, van Ballegooijen W, de Beurs D, Juniar D, Erlangsen A, Portzky G, O'Connor RC, Smit JH, Kerkhof A, Riper H. Safety planning-type interventions for suicide prevention: meta-analysis. Br J Psychiatry 2021; 219:419-426. [PMID: 35048835 DOI: 10.1192/bjp.2021.50] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [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: 01/10/2023]
Abstract
BACKGROUND Safety planning-type interventions (SPTIs) for patients at risk of suicide are often used in clinical practice, but it is unclear whether these interventions are effective. AIMS This article reports on a meta-analysis of studies that have evaluated the effectiveness of SPTIs in reducing suicidal behaviour and ideation. METHOD We searched Medline, EMBASE, PsycINFO, Web of Science and Scopus from their inception to 9 December 2019, for studies that compared an SPTI with a control condition and had suicidal behaviour or ideation as outcomes. Two researchers independently extracted the data. To assess suicidal behaviour, we used a random-effects model of relative risk based on a pooled measure of suicidal behaviour. For suicidal ideation, we calculated effect sizes with Hedges' g. The study was registered at PROSPERO (registration number CRD42020129185). RESULTS Of 1816 unique abstracts screened, 6 studies with 3536 participants were eligible for analysis. The relative risk of suicidal behaviour among patients who received an SPTI compared with control was 0.570 (95% CI 0.408-0.795, P = 0.001; number needed to treat, 16). No significant effect was found for suicidal ideation. CONCLUSIONS To our knowledge, this is the first study to report a meta-analysis on SPTIs for suicide prevention. Results support the use of SPTIs to help preventing suicidal behaviour and the inclusion of SPTIs in clinical guidelines for suicide prevention. We found no evidence for an effect of SPTIs on suicidal ideation, and other interventions may be needed for this purpose.
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Affiliation(s)
- Chani Nuij
- Section Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Wouter van Ballegooijen
- Section Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands; Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, The Netherlands; Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, The Netherlands
| | - Derek de Beurs
- Section Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands; and Department of epidemiology, Trimbos-institute, The Netherlands
| | - Dilfa Juniar
- Section Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands; and Faculty of Psychology, Universitas YARSI, Indonesia
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Denmark; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA; and Centre for Mental Health Research, Australian National University, Australia
| | - Gwendolyn Portzky
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Faculty of Medicine and Health Science, Ghent University, Belgium
| | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Johannes H Smit
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, The Netherlands; and Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, The Netherlands
| | - Ad Kerkhof
- Section Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Heleen Riper
- Section Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands; Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, The Netherlands; and Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, The Netherlands
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12
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Rahmadiana M, Karyotaki E, Schulte M, Ebert DD, Passchier J, Cuijpers P, Berger T, van Ballegooijen W, Wimbarti S, Riper H. Transdiagnostic Internet Intervention for Indonesian University Students With Depression and Anxiety: Evaluation of Feasibility and Acceptability. JMIR Ment Health 2021; 8:e20036. [PMID: 33666553 PMCID: PMC7980121 DOI: 10.2196/20036] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 05/10/2020] [Revised: 11/12/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND University students with depression and anxiety do not easily receive or seek treatment; therefore, internet-based interventions have been suggested to be a promising way to improve treatment accessibility and availability. However, it has not been examined whether a guided, culturally adapted, transdiagnostic, internet-based intervention is effective for treating symptoms of depression, anxiety, or both among university students in Indonesia. OBJECTIVE This study aims to investigate the feasibility (acceptability and satisfaction, usability, and uptake) of a guided, culturally adapted, transdiagnostic, internet-based intervention among university students with symptoms of depression, anxiety, or both in Indonesia. METHODS Students from Universitas Gadjah Mada, Yogyakarta, Indonesia, were screened for symptoms of depression, anxiety, or both, and filled online informed consent, demographic questionnaires, and a quality of life measure at pretreatment assessment (T0). Subsequently, the participants started the intervention. Seven weeks after T0, the primary outcomes of this feasibility study were analyzed at posttreatment assessment (T1) using the 8-item Client Satisfaction Questionnaire (CSQ-8) and the System Usability Scale (SUS). Mean and SDs for the CSQ-8 and SUS were calculated to examine feasibility. Within-group secondary outcomes (depression, anxiety, and quality of life) were inspected for outliers and normal distribution. Paired-sample t tests were used to investigate differences between time points of secondary outcomes. A mixed-method approach of quantitative and qualitative analyses was adopted. Both the primary and secondary outcomes were additionally explored with an individual semistructured interview and synthesized descriptively. RESULTS A total of 50 participants completed the intervention. We found a moderate to high level of satisfaction and acceptability, a slightly below-average level of desirable usability (≥70), and an adherence rate of 52% which was higher than expected given the novelty of the intervention. Results for the secondary outcomes indicated a decrease in depression and anxiety. For depression, the overall mean difference between the 2 time points for depression was 3.92 (95% CI 2.75-5.1; Hedges g 1.15; P<.001). For anxiety, the overall mean difference between the 2 time points was 3.34 (95% CI 2.06-4.61; Hedges g 1.02; P<.001). Further, a moderate effect in improving quality of life was found (g=0.50). Overall, participants were positive about the online intervention and ECoaches (online guidance), and they found the intervention to be culturally appropriate. CONCLUSIONS A culturally adapted, transdiagnostic, internet-based intervention appears to be acceptable and feasible for reducing symptoms of depression, anxiety, or both, and increasing quality of life in university students in Indonesia. Future studies should include a randomized controlled trial to assess the effectiveness of such interventions as they may supplement existing counseling services in universities, reduce the treatment costs, and maximize treatment accessibility in low-resourced settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1016/j.invent.2018.11.002.
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Affiliation(s)
- Metta Rahmadiana
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Mieke Schulte
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - David Daniel Ebert
- Division of Online Health Training, Innovation Incubator, Leuphana University of Lueneburg, Lueneburg, Germany.,Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Department of Clinical Psychology and EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jan Passchier
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Wouter van Ballegooijen
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Department of Psychiatry, Vrije Universiteit Medical Centre/GGZ inGeest, Amsterdam, Netherlands
| | - Supra Wimbarti
- Faculty of Psychology, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Department of Psychiatry, Vrije Universiteit Medical Centre/GGZ inGeest, Amsterdam, Netherlands
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13
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Hu MX, Palantza C, Setkowski K, Gilissen R, Karyotaki E, Cuijpers P, Riper H, de Beurs D, Nuij C, Christensen H, Calear A, Werner-Seidler A, Hoogendoorn A, van Balkom A, Eikelenboom M, Smit J, van Ballegooijen W. Comprehensive database and individual patient data meta-analysis of randomised controlled trials on psychotherapies reducing suicidal thoughts and behaviour: study protocol. BMJ Open 2020; 10:e037566. [PMID: 33277275 PMCID: PMC7722389 DOI: 10.1136/bmjopen-2020-037566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 10/06/2020] [Accepted: 10/21/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Psychotherapy may reduce suicidal thoughts and behaviour, but its effectiveness is not well examined. Furthermore, conventional meta-analyses are unable to test possible effects of moderators affecting this relationship. This protocol outlines the building of a comprehensive database of the literature in this research field. In addition, we will conduct an individual patient data meta-analysis (IPD-MA) to establish the effectiveness of psychotherapy in reducing suicidality, and to examine which factors moderate the efficacy of these interventions. METHODS AND ANALYSIS To build a comprehensive database, randomised controlled trials examining the effect of any psychotherapy targeting any psychiatric disorder on suicidal thoughts or behaviour will be identified by running a systematic search in PubMed, Embase, PsycINFO, Web of Science, Scopus and The Cochrane Central Register of Controlled Trials from data inception to 12 August 2019. For the IPD-MA, we will focus on adult outpatients with suicidal ideation or behaviour. In addition, as a comparison group we will focus on a control group (waiting-list, care as usual or placebo). A 1-stage IPD-MA will be used to determine the effectiveness of psychotherapy on suicidal ideation, suicide attempts and/or suicide deaths, and to investigate potential patient-related and intervention-related moderators. Subgroup and sensitivity analyses will be conducted to test the robustness of the findings. Additionally, a conventional MA will be conducted to determine the differences between studies that provided IPD and those that did not. IPD-MA may determine the effectiveness of psychotherapy in reducing suicidality and provide insights into the moderating factors influencing the efficacy of psychotherapy. Answering these questions will inform mental healthcare practitioners about optimal treatments for different groups of individuals with suicidal ideation and/or behaviour and consequently help to reduce suicide risk. ETHICS AND DISSEMINATION An ethical approval is not required for this study. The results will be published in a peer-review journal. PROSPERO REGISTRATION NUMBER CRD42020140573.
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Affiliation(s)
- Mandy Xian Hu
- GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- 113 Zelfmoordpreventie, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center and GGZinGeest, Amsterdam, The Netherlands
| | - Christina Palantza
- GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Eirini Karyotaki
- 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
| | - Heleen Riper
- GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Derek de Beurs
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Chani Nuij
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydneyali, New South Wales, Australia
| | - Alison Calear
- Centre for Mental Health Research, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Aliza Werner-Seidler
- Black Dog Institute, University of New South Wales, Sydneyali, New South Wales, Australia
| | | | - Anton van Balkom
- GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center and GGZinGeest, Amsterdam, The Netherlands
| | - Merijn Eikelenboom
- GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center and GGZinGeest, Amsterdam, The Netherlands
| | - Jan Smit
- GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- 113 Zelfmoordpreventie, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center and GGZinGeest, Amsterdam, The Netherlands
| | - Wouter van Ballegooijen
- GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center and GGZinGeest, Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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14
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Orhan M, Korten N, Kupka R, van Oppen P, Stek M, Vieta E, Schouws S, van Ballegooijen W, Dols A. Reliability and validity of the functioning assessment short test for older adults with bipolar disorder (FAST-O). Int J Bipolar Disord 2020; 8:28. [PMID: 33006669 PMCID: PMC7532249 DOI: 10.1186/s40345-020-00193-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/16/2020] [Indexed: 12/04/2022] Open
Abstract
Background Many frequently used instruments fail to assess psychosocial functioning in patients with bipolar disorder. The Functioning Assessment Short Test (FAST) was developed in order to tackle this problem and to assess the main functioning problems experienced by patients with bipolar disorder. However, the original FAST is not fully applicable in older adults due to the domain of occupational functioning. The aim of our study was to validate an adapted version for Older adults (FAST-O) in a group of older adults with bipolar disorder (OABD). Methods 88 patients aged 50 years and over diagnosed with bipolar disorder were included. We adapted the items in the area of “work-related functioning” of the FAST into items assessing “societal functioning”. Several measurements were conducted in order to analyse the psychometric qualities of the FAST-O (confirmatory factor analysis for internal structure, Cronbach’s alpha for internal consistency, Spearman’s rho for concurrent validity, Mann–Whitney U test for discriminant validity). Results Mean age in the study sample was 65.3 (SD = 7.5) and 57.3% was female. The internal structure was most similar to the internal structure of the original FAST. The internal consistency was excellent (Cronbach’s alpha = .93). The concurrent validity when correlated with the Social and Occupational Functioning Assessment Scale was low, but significant. The FAST-O was also able to distinguish between euthymic and symptomatic OABD patients. Conclusions The FAST-O has strong psychometric qualities. Based on our results, we can conclude that the FAST-O is a short, efficient solution in order to replace global rating scales or extensive test batteries in order to assess daily functioning of older psychiatric patients in a valid and reliable manner.
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Affiliation(s)
- Melis Orhan
- Department of Old Age Psychiatry, GGZ inGeest, Amstelveenseweg 589, 1081JC, Amsterdam, The Netherlands. .,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
| | - Nicole Korten
- Department of Old Age Psychiatry, GGZ inGeest, Amstelveenseweg 589, 1081JC, Amsterdam, The Netherlands
| | - Ralph Kupka
- Department of Old Age Psychiatry, GGZ inGeest, Amstelveenseweg 589, 1081JC, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Patricia van Oppen
- Department of Old Age Psychiatry, GGZ inGeest, Amstelveenseweg 589, 1081JC, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Max Stek
- Department of Old Age Psychiatry, GGZ inGeest, Amstelveenseweg 589, 1081JC, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Eduard Vieta
- Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Sigfried Schouws
- Department of Old Age Psychiatry, GGZ inGeest, Amstelveenseweg 589, 1081JC, Amsterdam, The Netherlands
| | - Wouter van Ballegooijen
- Department of Old Age Psychiatry, GGZ inGeest, Amstelveenseweg 589, 1081JC, Amsterdam, The Netherlands
| | - Annemiek Dols
- Department of Old Age Psychiatry, GGZ inGeest, Amstelveenseweg 589, 1081JC, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Neuroscience Campus, VUMC, Amsterdam, The Netherlands
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15
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Schouten RW, Nadort E, van Ballegooijen W, Loosman WL, Honig A, Siegert CEH, Meuleman Y, Broekman BFP. General distress and symptoms of anxiety and depression: A factor analysis in two cohorts of dialysis patients. Gen Hosp Psychiatry 2020; 65:91-99. [PMID: 32554264 DOI: 10.1016/j.genhosppsych.2020.04.004] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Depression and anxiety often coexist in patients with end-stage-kidney disease. Recently, studies showed that a composite 'general distress score' which combines depression and anxiety symptoms provides a good fit in dialysis and oncology patients. We aim to investigate if the three most frequently used self-report questionnaires to measure depression and anxiety in dialysis patients are sufficiently unidimensional to warrant the use of such a general distress score in two cohorts of dialysis patients. METHODS This study includes two prospective observational cohorts of dialysis patients (total n = 749) which measured depression and anxiety using Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Hospital Anxiety and Depression Scale (HADS). Confirmatory factor analyses was used to investigate both a strictly unidimensional model and a multidimensional bifactor model that includes a general distress, depression and anxiety factor. The comparative fit index (CFI) and The Root Mean Square Error of Approximation (RMSEA) were used as model fit indices. RESULTS Factor analysis did not show a good fit for a strictly unidimensional general distress factor for both the BDI/BAI and HADS (CFI 0.690 and 0.699, RMSEA 0.079 and 0.125 respectively). The multidimensional model performed better with a moderate fit for the BDI/BAI and HADS (CFI 0.873 and 0.839, RMSEA 0.052 and 0.102). CONCLUSIONS This data shows that the BDI/BAI and HADS are insufficiently unidimensional to warrant the use of a general distress score in dialysis patients without also investigating anxiety and depression separately. Future research is needed whether the use of a general distress score might be beneficial to identify patients in need of additional (psychological) support.
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Affiliation(s)
- Robbert W Schouten
- Department of Nephrology, OLVG Hospital, Amsterdam, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Els Nadort
- Department of Psychiatry, OLVG Hospital, Amsterdam, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Wouter van Ballegooijen
- Department of Clinical Psychology, Amsterdam UMC, VUmc, Amsterdam, the Netherlands; Department of Specialized Mental Health Care, GGZ InGeest, Amsterdam, the Netherlands
| | - Wim L Loosman
- Department of Nephrology, OLVG Hospital, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, VUmc, Amsterdam, the Netherlands
| | - Adriaan Honig
- Department of Psychiatry, OLVG Hospital, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, VUmc, Amsterdam, the Netherlands
| | - Carl E H Siegert
- Department of Nephrology, OLVG Hospital, Amsterdam, the Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Medical Psychology, Leiden University Medical Center, Leiden, the Netherlands
| | - Birit F P Broekman
- Department of Psychiatry, OLVG Hospital, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, VUmc, Amsterdam, the Netherlands
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16
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Schouten RW, Nadort E, Harmse V, Honig A, van Ballegooijen W, Broekman BFP, Siegert CEH. Symptom dimensions of anxiety and their association with mortality, hospitalization and quality of life in dialysis patients. J Psychosom Res 2020; 133:109995. [PMID: 32272296 DOI: 10.1016/j.jpsychores.2020.109995] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/01/2019] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Symptoms of anxiety are highly prevalent in dialysis patients and are associated with adverse clinical outcomes. Identifying symptom dimensions may help to understand the pathophysiology, improve screening and guide treatment. Currently, there are no data on symptom dimensions of anxiety in dialysis patients. This study aimed to identify the best fitting dimensional model for anxiety in dialysis patients and assess the association between symptom dimensions of anxiety and adverse clinical outcomes. METHODS This study is a prospective observational cohort study including patients from 10 urban dialysis centers between 2012 and 2017. Anxiety symptoms were measured using the self-reported questionnaire Beck Anxiety Inventory. Confirmatory factor analysis was used to identify symptom dimensions. The association between dimensions and mortality, hospitalization and quality of life was investigated using stepwise cox, poisson and lineair regression models. Multivariable models included demographic, social, laboratory and clinical variables to adjust for possible confounding. RESULTS In total 687 chronic dialysis patients were included. A Somatic and Subjective anxiety dimension were identified. Only Somatic anxiety symptoms showed an association with increased risk of hospitalization and mortality (Rate Ratio 1.73 (1.45-2.06) p = .007 and Hazard Ratio 1.65 (1.15-2.37) p = .007 respectively). These associations were independent from somatic comorbidity. All symptom dimensions of anxiety showed an association with Quality of Life. CONCLUSION This study shows that anxiety is common in chronic dialysis patients and comprises of a somatic, subjective, and a total score. The discrimination between anxiety dimensions can be useful for clinical practice, as they are related to different clinical outcomes.
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Affiliation(s)
| | - Els Nadort
- Department of Psychiatry, OLVG hospital, Amsterdam, the Netherlands
| | - Victor Harmse
- Department of Psychiatry, OLVG hospital, Amsterdam, the Netherlands
| | - Adriaan Honig
- Department of Psychiatry, OLVG hospital, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, Amsterdam, the Netherlands
| | - Wouter van Ballegooijen
- Department of Clinical Psychology, Amsterdam UMC, VUmc, Amsterdam, the Netherlands; Department of Specialized Mental Health Care, GGZ Ingeest, Amsterdam, the Netherlands
| | - Birit F P Broekman
- Department of Psychiatry, OLVG hospital, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, Amsterdam, the Netherlands
| | - Carl E H Siegert
- Department of Nephrology, OLVG hospital, Amsterdam, the Netherlands
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17
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Struijs SY, Lamers F, Verdam MGE, van Ballegooijen W, Spinhoven P, van der Does W, Penninx BWJH. Temporal stability of symptoms of affective disorders, cognitive vulnerability and personality over time. J Affect Disord 2020; 260:77-83. [PMID: 31493643 DOI: 10.1016/j.jad.2019.08.090] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/22/2019] [Accepted: 08/28/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Signs and symptoms of psychopathology can be chronic but are generally regarded as less stable over time than markers of cognitive vulnerability and personality. Some findings suggest that these differences in temporal stability are modest in size but a rigorous examination across concepts is lacking. The current study investigated the temporal stability of affective symptoms, cognitive vulnerability markers and personality traits at various assessments over nine years. METHODS Participants of the Netherlands Study of Depression and Anxiety were assessed at baseline and reassessed after 2, 4, 6 and 9 years. They were grouped on the basis of waves of depression and anxiety CIDI-diagnoses into stable healthy (n = 768), stable patients (n = 352) and unstable patients (n = 821). We determined temporal stability by calculating intraclass correlation coefficients (ICC) and consistency indices of latent state-trait analyses (LST). RESULTS Temporal stability was moderate to high for symptoms (range ICC's 0.54-0.73; range consistency 0.64-0.74), cognitive vulnerability (range ICC's 0.53-0.76; range consistency 0.60-0.74) and personality (range ICC's 0.57-0.80; range consistency.60 -0.75). Consistency indices for all measures were on average a bit lower in the unstable group (ICC = 0.54) compared to the stable groups (ICC = 0.61). Overall stability was similarly high after 2, 4, 6 and 9 years. CONCLUSION The 9-year stability over time of symptoms of affective disorders and that of indices of cognitive vulnerability and personality are remarkably similar and relatively high.
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Affiliation(s)
- Sascha Y Struijs
- Institute of Psychology, Leiden University, AK Leiden 2333, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health, Amsterdam 1081 HV, the Netherlands.
| | - Femke Lamers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health, Amsterdam 1081 HV, the Netherlands
| | | | - Wouter van Ballegooijen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health, Amsterdam 1081 HV, the Netherlands; Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam 1081 BT, the Netherlands
| | - Philip Spinhoven
- Institute of Psychology, Leiden University, AK Leiden 2333, the Netherlands; Department of Psychiatry, Leiden University Medical Centre, 2333 ZA, the Netherlands
| | - Willem van der Does
- Institute of Psychology, Leiden University, AK Leiden 2333, the Netherlands; Department of Psychiatry, Leiden University Medical Centre, 2333 ZA, the Netherlands
| | - Brenda W J H Penninx
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health, Amsterdam 1081 HV, the Netherlands
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Karyotaki E, van Ballegooijen W. Digital self-help interventions for suicidal ideation and behaviour. Lancet Digit Health 2019; 2:e4-e5. [PMID: 33328038 DOI: 10.1016/s2589-7500(19)30215-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Eirini Karyotaki
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115 USA; Department of Clinical, Neuro- and Development Psychology, Section Clinical Psychology, Vrije Universiteit, Amsterdam, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, Amsterdam, Netherlands.
| | - Wouter van Ballegooijen
- Department of Clinical, Neuro- and Development Psychology, Section Clinical Psychology, Vrije Universiteit, Amsterdam, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, Amsterdam, Netherlands; Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, Amsterdam, Netherlands; GGZ in Geest Specialized Mental Health Care, Amsterdam, Netherlands
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van Ballegooijen W, Eikelenboom M, Fokkema M, Riper H, van Hemert AM, Kerkhof AJFM, Penninx BWJH, Smit JH. Comparing factor structures of depressed patients with and without suicidal ideation, a measurement invariance analysis. J Affect Disord 2019; 245:180-187. [PMID: 30396056 DOI: 10.1016/j.jad.2018.10.108] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 11/18/2017] [Revised: 07/05/2018] [Accepted: 10/16/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Suicidality could be associated with specific combinations of biological, social and psychological factors. Therefore, depressive episodes with suicidal ideation could be different from depressive episodes without suicidal ideation in terms of latent variable structures. METHODS In this study we compared latent variable structures between suicidal and non-suicidal depressed patients using confirmatory factor analysis (CFA), following a measurement invariance test procedure. Patients (N = 919) suffering from major depressive disorder were selected from the Netherlands Study of Depression and Anxiety (NESDA) and split into a group that showed no symptoms of suicidal ideation (non-SI; N = 691) and a suicidal ideation (SI) group that had one or more symptoms of suicidal ideation (N = 228). Depression and anxiety symptoms were measured using the short form of the Mood and Anxiety Symptoms Questionnaire (MASQ-D30). RESULTS CFA implied a difference in latent variable structures between the non-SI sample (CFI 0.957; RMSEA 0.041) and the SI sample (CFI 0.900; RMSEA 0.056). Subsequent multiple-group CFA showed violations of measurement invariance. The General distress and Anhedonic depression subscales were best indicated by hopelessness and lack of optimism in the SI sample and by dissatisfaction and not feeling lively in the non-SI sample. Overall, the SI sample had higher scores and lower inter-item correlations on the Anhedonic depression items. LIMITATIONS We have included very mild cases of suicidal ideation in our SI sample. CONCLUSIONS On a latent variable level, depression with suicidal ideation differs from depression without suicidal ideation. Results encourage further research into the symptom structure of depression among suicidal patients.
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Affiliation(s)
- Wouter van Ballegooijen
- Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam, The Netherlands; GGZ inGeest Specialised Mental Health Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Vrije Universiteit Amsterdam, Section Clinical Psychology, Amsterdam, The Netherlands.
| | - Merijn Eikelenboom
- Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam, The Netherlands; GGZ inGeest Specialised Mental Health Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marjolein Fokkema
- Leiden University, Department of Methods & Statistics, Leiden, Netherlands
| | - Heleen Riper
- Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam, The Netherlands; GGZ inGeest Specialised Mental Health Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Vrije Universiteit Amsterdam, Section Clinical Psychology, Amsterdam, The Netherlands
| | - Albert M van Hemert
- Leiden University Medical Centre, Department of Psychiatry, Leiden, Netherlands
| | - Ad J F M Kerkhof
- Vrije Universiteit Amsterdam, Section Clinical Psychology, Amsterdam, The Netherlands
| | - Brenda W J H Penninx
- Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam, The Netherlands; GGZ inGeest Specialised Mental Health Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jan H Smit
- Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam, The Netherlands; GGZ inGeest Specialised Mental Health Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Juniar D, van Ballegooijen W, Karyotaki E, van Schaik A, Passchier J, Heber E, Lehr D, Sadarjoen SS, Riper H. Web-Based Stress Management Program for University Students in Indonesia: Systematic Cultural Adaptation and Protocol for a Feasibility Study. JMIR Res Protoc 2019; 8:e11493. [PMID: 30681970 PMCID: PMC6367666 DOI: 10.2196/11493] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 07/05/2018] [Revised: 12/23/2018] [Accepted: 12/29/2018] [Indexed: 02/04/2023] Open
Abstract
Background The number of university students experiencing stress is increasing, which often leads to adverse effects such as poor grades, academic probation, and emotional problems. Unfortunately, most of these problems remain untreated because of limited professional resources and fear of stigma. Several Web-based stress management interventions are now available for student populations, but these treatments are not yet available in Indonesia. To make treatment for stress more acceptable in Indonesia, a cultural adaptation process is needed, and part of the process is assessing the feasibility of the adapted intervention. Objective This paper describes the first two stages of a cultural adaptation process and the protocol of a feasibility study that will assess the acceptability of a culturally adapted stress management intervention for university students in Indonesia. Methods Focus group discussions with Indonesian university students were held, and input from Indonesian psychologists was gathered for developing the adapted intervention. A single-group feasibility study with a pre-post design will be conducted. We will recruit at minimum 50 university students who have an elevated level of stress (Depression, Anxiety, and Stress Scales–42 stress subscale score ≥15), identify themselves as being of Indonesian culture (eg, able to speak Bahasa Indonesia fluently), and are studying at a university in Indonesia. The primary endpoints of this study will be rates of participant satisfaction, system usability, dropout rates, and level of adherence. We will also use qualitative data to assess the adapted intervention more thoroughly. Secondary study endpoints will be quality of life, stress, anxiety, and depression levels. Feasibility parameters (eg, participant satisfaction, system usability, and level of adherence) will be summarized with descriptive statistics. Two-tailed paired within-group t tests will be used to analyze stress, anxiety, depression, and quality of life. Results The enrollment of pilot study is currently ongoing. First results are expected to be ready for analysis in the second half of 2019. The project was funded as part of a PhD trajectory in 2015 by the Indonesian Endowment Fund for Education. Conclusions This is one of the first studies to assess the feasibility of a culturally adapted Web-based stress management intervention for university students in Indonesia. Strengths and limitations of the study are discussed. International Registered Report Identifier (IRRID) DERR1-10.2196/11493
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Affiliation(s)
| | | | | | | | | | - Elena Heber
- GET.ON Institute for Online Health Training, Hamburg, Germany
| | - Dirk Lehr
- Leuphana University, Lüneburg, Germany
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Rahmadiana M, Karyotaki E, Passchier J, Cuijpers P, van Ballegooijen W, Wimbarti S, Riper H. Guided internet-based transdiagnostic intervention for Indonesian university students with symptoms of anxiety and depression: A pilot study protocol. Internet Interv 2018; 15:28-34. [PMID: 30568878 PMCID: PMC6290259 DOI: 10.1016/j.invent.2018.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/15/2018] [Accepted: 11/21/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is an increasing prevalence of mental health problems among university student populations. In Indonesia, treatment rates are low among university students because of the high cost of treatment, stigma and the limited availability of mental care services. Internet-based interventions have been found to be effective in treating anxiety and depression in Western countries. However, little is known about the effectiveness of Internet-based interventions in low- and middle-income countries (LMICs) such as Indonesia. In this paper, we describe how we culturally adapted an Internet-based intervention to meet the needs of Indonesian students with depression and anxiety based on the theoretical framework of Barrera et al. (2013). METHOD We culturally adapted a Western Internet-based student intervention for depression and anxiety. This intervention consists of 8 guided online sessions. 50 students from Universitas Gadjah Mada Yogyakarta who have mild to moderate depression or anxiety as assessed with the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), will participate in a feasibility study in which we will test participants' satisfaction, system usability and uptake. Secondary outcomes include assessment of participants' depression, anxiety and quality of life. Outcomes will be measured pre and post intervention. DISCUSSION The present paper presents the protocol of a pilot study aimed at assessing the feasibility and acceptability of a culturally adapted intervention for Indonesian university students with depression and anxiety. The results from the feasibility study will further guide the development of the intervention and may inform the protocol of a future randomized controlled trial (RCT) examining the effectiveness of the Internet-based intervention.
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Affiliation(s)
- Metta Rahmadiana
- Department of Clinical, Neuro and Development Psychology. Section of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands,Corresponding author at: Department of Clinical, Neuro and Development Psychology. Section of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands.
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Development Psychology. Section of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Jan Passchier
- Department of Clinical, Neuro and Development Psychology. Section of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Development Psychology. Section of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Wouter van Ballegooijen
- Department of Clinical, Neuro and Development Psychology. Section of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands,Department of Psychiatry, Vrije University Medical Centre/GGZ inGeest, Amsterdam, the Netherlands
| | - Supra Wimbarti
- Faculty of Psychology, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Heleen Riper
- Department of Clinical, Neuro and Development Psychology. Section of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands,Department of Psychiatry, Vrije University Medical Centre/GGZ inGeest, Amsterdam, the Netherlands
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22
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Nuij C, van Ballegooijen W, Ruwaard J, de Beurs D, Mokkenstorm J, van Duijn E, de Winter RF, O'Connor RC, Smit JH, Riper H, Kerkhof A. Smartphone-based safety planning and self-monitoring for suicidal patients: Rationale and study protocol of the CASPAR (Continuous Assessment for Suicide Prevention And Research) study. Internet Interv 2018; 13:16-23. [PMID: 30206514 PMCID: PMC6112103 DOI: 10.1016/j.invent.2018.04.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 04/25/2018] [Accepted: 04/30/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND It remains difficult to predict and prevent suicidal behaviour, despite growing understanding of the aetiology of suicidality. Clinical guidelines recommend that health care professionals develop a safety plan in collaboration with their high-risk patients, to lower the imminent risk of suicidal behaviour. Mobile health applications provide new opportunities for safety planning, and enable daily self-monitoring of suicide-related symptoms that may enhance safety planning. This paper presents the rationale and protocol of the Continuous Assessment for Suicide Prevention And Research (CASPAR) study. The aim of the study is two-fold: to evaluate the feasibility of mobile safety planning and daily mobile self-monitoring in routine care treatment for suicidal patients, and to conduct fundamental research on suicidal processes. METHODS The study is an adaptive single cohort design among 80 adult outpatients or day-care patients, with the main diagnosis of major depressive disorder or dysthymia, who have an increased risk for suicidal behaviours. There are three measurement points, at baseline, at 1 and 3 months after baseline. Patients are instructed to use their mobile safety plan when necessary and monitor their suicidal symptoms daily. Both these apps will be used in treatment with their clinician. CONCLUSION The results from this study will provide insight into the feasibility of mobile safety planning and self-monitoring in treatment of suicidal patients. Furthermore, knowledge of the suicidal process will be enhanced, especially regarding the transition from suicidal ideation to behaviour.The study protocol is currently under revision for medical ethics approval by the medical ethics board of the Vrije Universiteit Medical centre Amsterdam (METc number 2017.512/NL62795.029.17).
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Affiliation(s)
- Chani Nuij
- Department of Clinical Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Wouter van Ballegooijen
- Department of Clinical Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Public Health research institute, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ Ingeest, Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Jeroen Ruwaard
- Department of Psychiatry, Amsterdam Public Health research institute, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ Ingeest, Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Derek de Beurs
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Jan Mokkenstorm
- Department of Psychiatry, Amsterdam Public Health research institute, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ Ingeest, Specialized Mental Health Care, Amsterdam, The Netherlands
- 113 Suicide Prevention, Amsterdam, The Netherlands
| | | | - Remco F.P. de Winter
- Department of Clinical Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands
- Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Rory C. O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jan H. Smit
- Department of Psychiatry, Amsterdam Public Health research institute, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ Ingeest, Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Clinical Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Public Health research institute, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ Ingeest, Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Ad Kerkhof
- Department of Clinical Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands
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Kramer J, Boon B, Schotanus-Dijkstra M, van Ballegooijen W, Kerkhof A, van der Poel A. The mental health of visitors of web-based support forums for bereaved by suicide. Crisis 2016; 36:38-45. [PMID: 25410257 DOI: 10.1027/0227-5910/a000281] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Persons bereaved by suicide are reluctant to ask for social support when they experience feelings of guilt and blame. A web-based peer forum may provide a safe and anonymous place for mutual support. AIMS This study examined the mental health changes of visitors of two online support forums for persons bereaved by suicide and their experiences with the forum over 1 year. METHOD Visitors of two forums completed self-report measures at baseline and at 6 and 12 months' follow-up. Repeated measures analyses were used to study changes in well-being, depressive symptoms, and complicated grief. Additionally, participants were interviewed about their experiences with the forum. RESULTS The 270 participants were mostly female, low in well-being, with high levels of depressive symptoms and complicated grief. Suicidal risk was high for 5.9%. At 12 months, there were small to medium-sized significant improvements in well-being and depressive symptoms (p < .001) and nearly as much for grief (p = .08). About two thirds reported benefit from visiting the forum. Because of the pre-post design we cannot determine whether a causal relationship exists between the form and changes in mental health. CONCLUSION After 1 year some positive changes but a large group was still struggling with their mental health. Interviews indicate that the forum was valued for finding recognition.
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Affiliation(s)
- Jeannet Kramer
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - Brigitte Boon
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | | | - Wouter van Ballegooijen
- Department of Clinical Psychology, VU University Amsterdam, and the EMGO Institute for Health and Care Research, Amsterdam, The Netherlands Department of Psychiatry, VU University Medical Centre/GGZ inGeest, Amsterdam, The Netherlands
| | - Ad Kerkhof
- Department of Clinical Psychology and EMGO+ Research Institute Faculty of Psychology and Education, VU University Amsterdam, The Netherlands
| | - Agnes van der Poel
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
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Schuurmans J, van der Linden JL, van Ballegooijen W, Ruwaard J, Stek ML, Smit JH, Riper H. Tablet-based support for older adults with severe mood disorders treated in an ambulatory geriatric psychiatry setting: Protocol of a feasibility study of the eCare@Home platform. Internet Interv 2016; 6:22-28. [PMID: 30135811 PMCID: PMC6096249 DOI: 10.1016/j.invent.2016.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 09/01/2016] [Accepted: 09/01/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Although older adults are just as likely to benefit from e-mental health as their younger counterparts, there are virtually no applications specifically designed to accommodate the needs of older adults with recurrent depression or bipolar disorder. Recurrent mood disorders constitute a large and rising proportion of the global disease in older populations, indicating a need for more e-mental health applications targeting this group. This paper describes the theoretical background and methodology of a study examining the feasibility of a tablet-based self-management platform for older adults with recurrent mood disorders. The eCare@Home platform was designed to 1) improve patients' awareness and knowledge of recurrent mood disorders and their treatment, 2) promote self-management through the use of a simple daily monitoring tool, and 3) facilitate online contact with their clinician through videoconferencing. METHODS The design involves a single-group four-month pilot study, with measurements at baseline (T0), and at weeks 8 and 16 (T1 and T2). The target group consists of older outpatients (aged 60 or above) who are undergoing treatment for recurrent depressive or bipolar disorder (N = 50), and their clinicians (N = 10). Primary feasibility endpoints will be system acceptability, system usability, and client satisfaction with the platform. In addition, qualitative data from semi-structured interviews in N = 10 patients and N = 5 clinicians will be gathered to provide more insight into user experiences and evaluations of the platform's added value. DISCUSSION To the best of our knowledge, this is the first study to evaluate the feasibility and acceptability of a tablet-based e-mental health platform for older adults with severe mood disorders. If tablet-based support for this group is shown to be feasible, the intention is to proceed with the design of a large-scale process and outcome evaluation. The strengths and limitations of the methodology used are addressed in this article.Trial Registration: registration is pending.
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Affiliation(s)
- Josien Schuurmans
- Department of Research & Innovation, GGZ inGeest, Amsterdam, P.O. Box 7057, Amsterdam MB 1007, The Netherlands
| | - Juliette L. van der Linden
- Department of Research & Innovation, GGZ inGeest, Amsterdam, P.O. Box 7057, Amsterdam MB 1007, The Netherlands
- Department of Psychiatry and EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, The Netherlands
| | - Wouter van Ballegooijen
- Department of Research & Innovation, GGZ inGeest, Amsterdam, P.O. Box 7057, Amsterdam MB 1007, The Netherlands
- Department of Psychiatry and EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, The Netherlands
- Faculty of Behavioural and Movement Sciences/Department of Clinical, Neuro- and Developmental Psychology, Clinical Psychology section, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Jeroen Ruwaard
- Faculty of Behavioural and Movement Sciences/Department of Clinical, Neuro- and Developmental Psychology, Clinical Psychology section, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Max L. Stek
- Department of Research & Innovation, GGZ inGeest, Amsterdam, P.O. Box 7057, Amsterdam MB 1007, The Netherlands
- Department of Psychiatry and EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, The Netherlands
| | - Jan H. Smit
- Department of Research & Innovation, GGZ inGeest, Amsterdam, P.O. Box 7057, Amsterdam MB 1007, The Netherlands
- Department of Psychiatry and EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Research & Innovation, GGZ inGeest, Amsterdam, P.O. Box 7057, Amsterdam MB 1007, The Netherlands
- Department of Psychiatry and EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, The Netherlands
- Faculty of Behavioural and Movement Sciences/Department of Clinical, Neuro- and Developmental Psychology, Clinical Psychology section, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
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van Ballegooijen W, Ruwaard J, Karyotaki E, Ebert DD, Smit JH, Riper H. Reactivity to smartphone-based ecological momentary assessment of depressive symptoms (MoodMonitor): protocol of a randomised controlled trial. BMC Psychiatry 2016; 16:359. [PMID: 27769201 PMCID: PMC5075187 DOI: 10.1186/s12888-016-1065-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 10/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ecological momentary assessment (EMA) of mental health symptoms may influence the symptoms that it measures, i.e. assessment reactivity. In the field of depression, EMA reactivity has received little attention. We aim to investigate whether EMA of depressive symptoms induces assessment reactivity. Reactivity will be operationalised as an effect of EMA on depressive symptoms measured by a retrospective questionnaire, and, secondly, as a change in response rate and variance of the EMA ratings. METHODS This study is a 12-week randomised controlled trial comprising three groups: group 1 carries out EMA of mood and completes a retrospective questionnaire, group 2 carries out EMA of how energetic they feel and completes a retrospective questionnaire, group 3 is the control group, which completes only the retrospective questionnaire. The retrospective questionnaire (Centre for Epidemiologic Studies Depression scale; CES-D) assesses depressive symptoms and is administered at baseline, 6 weeks after baseline and 12 weeks after baseline. We aim to recruit 160 participants who experience mild to moderate depressive symptoms, defined as a Patient Health Questionnaire (PHQ-9) score of 5 to 15. This study is powered to detect a small between-groups effect, where no clinically relevant effect is defined as the effect size margin -0.25< d <0.25. DISCUSSION To our knowledge, this is the first study to investigate whether self-rated EMA of depressive symptoms could induce assessment reactivity among mildly depressed individuals. TRIAL REGISTRATION Netherlands Trial Register NTR5803. Registered 12 April 2016. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5803 .
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Affiliation(s)
- Wouter van Ballegooijen
- Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, Netherlands. .,Department of Psychiatry, VU Medical Centre/GGZ inGeest, Amsterdam, Netherlands.
| | - Jeroen Ruwaard
- Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, Netherlands
| | - Eirini Karyotaki
- Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, Netherlands
| | - David D. Ebert
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Johannes H. Smit
- Department of Psychiatry, VU Medical Centre/GGZ inGeest, Amsterdam, Netherlands
| | - Heleen Riper
- Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, Netherlands
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van Ballegooijen W, Riper H, Cuijpers P, van Oppen P, Smit JH. Validation of online psychometric instruments for common mental health disorders: a systematic review. BMC Psychiatry 2016; 16:45. [PMID: 26915661 PMCID: PMC4766750 DOI: 10.1186/s12888-016-0735-7] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 02/04/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Online questionnaires for measuring common mental health disorders such as depression and anxiety disorders are increasingly used. The psychometrics of several pen-and-paper questionnaires have been re-examined for online use and new online instruments have been developed and tested for validity as well. This study aims to review and synthesise the literature on this subject and provide a framework for future research. METHODS We searched Medline and PsycINFO for psychometric studies on online instruments for common mental health disorders and extracted the psychometric data. Studies were coded and assessed for quality by independent raters. RESULTS We included 56 studies on 62 online instruments. For common instruments such as the CES-D, MADRS-S and HADS there is mounting evidence for adequate psychometric properties. Further results are scattered over different instruments and different psychometric characteristics. Few studies included patient populations. CONCLUSIONS We found at least one online measure for each of the included mental health disorders and symptoms. A small number of online questionnaires have been studied thoroughly. This study provides an overview of online instruments to refer to when choosing an instrument for assessing common mental health disorders online, and can structure future psychometric research.
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Affiliation(s)
- Wouter van Ballegooijen
- Department of Psychiatry, VU Medical Centre / GGZ inGeest, Amsterdam, Netherlands. .,Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands. .,EMGO Institute for Health and Care Research, VU Medical Centre, Amsterdam, Netherlands.
| | - Heleen Riper
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands. .,EMGO Institute for Health and Care Research, VU Medical Centre, Amsterdam, Netherlands.
| | - Pim Cuijpers
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands. .,EMGO Institute for Health and Care Research, VU Medical Centre, Amsterdam, Netherlands.
| | - Patricia van Oppen
- Department of Psychiatry, VU Medical Centre / GGZ inGeest, Amsterdam, Netherlands. .,EMGO Institute for Health and Care Research, VU Medical Centre, Amsterdam, Netherlands.
| | - Johannes H. Smit
- Department of Psychiatry, VU Medical Centre / GGZ inGeest, Amsterdam, Netherlands ,EMGO Institute for Health and Care Research, VU Medical Centre, Amsterdam, Netherlands
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Ebenfeld L, Kleine Stegemann S, Lehr D, Ebert DD, Jazaieri H, van Ballegooijen W, Funk B, Riper H, Berking M. Efficacy of a hybrid online training for panic symptoms and agoraphobia: study protocol for a randomized controlled trial. Trials 2014; 15:427. [PMID: 25370504 PMCID: PMC4233107 DOI: 10.1186/1745-6215-15-427] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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: 08/06/2014] [Accepted: 10/14/2014] [Indexed: 11/10/2022] Open
Abstract
Background Recently, internet-based interventions have been proposed as effective treatments for people with panic disorder (PD). However, little is known about the clinical effects of integrating mobile technology into these interventions. Because users carry their smartphones with them throughout the day, we hypothesize that this technology can be used to significantly support individuals with monitoring and overcoming their PD symptoms. The aim of the present study is to evaluate the efficacy and cost-effectiveness of a newly developed hybrid intervention that combines internet/PC with smartphone delivery to treat the symptoms of PD. The intervention is based on cognitive behavioral therapy and consists of six modules over a total of six weeks. Methods/Design A two-arm randomized controlled trial (RCT) will be conducted to evaluate the effects of a hybrid online training module for PD. Based on a power calculation (d =0.60; 1-β of 80%; α =0.05), 90 participants with mild to moderate panic symptoms with or without agoraphobia (as assessed by the Panic and Agoraphobia Scale) will be recruited from the general population and randomly assigned to either the intervention group or a six-month waitlist control group. The primary outcome measure will be the severity of panic symptoms. Secondary outcomes will include depression, quality of life, and an observer-based rating of panic severity. Furthermore, data regarding acceptance and the usability of the smartphone app will be assessed. Assessments will take place at baseline as well as eight weeks, three months, and six months after randomization. Moreover, a cost-effectiveness analysis will be performed from a societal perspective. Data will be analyzed on an intention-to-treat basis and per protocol. Discussion To our knowledge, this RCT is one of the first to examine the efficacy of a hybrid online training for adult PD. This study seeks to contribute to the emerging field of hybrid online training. If the intervention is efficacious, then research on this hybrid online training should be extended. The cost-effectiveness analysis will also indicate whether online training is an economical tool for treating PD among adults. Trial registration German Clinical Trial Register:
DRKS00005223 (registered on 15 August 2013).
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Affiliation(s)
- Lara Ebenfeld
- Division of Health Training Online, Leuphana University Lueneburg, Innovation Incubator, Rotenbleicher Weg 67, 21335 Lueneburg, Germany.
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van Ballegooijen W, Cuijpers P, van Straten A, Karyotaki E, Andersson G, Smit JH, Riper H. Adherence to Internet-based and face-to-face cognitive behavioural therapy for depression: a meta-analysis. PLoS One 2014; 9:e100674. [PMID: 25029507 PMCID: PMC4100736 DOI: 10.1371/journal.pone.0100674] [Citation(s) in RCA: 242] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 05/30/2014] [Indexed: 11/19/2022] Open
Abstract
Background Internet-based cognitive behavioural therapy (iCBT) is an effective and acceptable treatment for depression, especially when it includes guidance, but its treatment adherence has not yet been systematically studied. We conducted a meta-analysis, comparing the adherence to guided iCBT with the adherence to individual face-to-face CBT. Methods Studies were selected from a database of trials that investigate treatment for adult depression (see www.evidencebasedpsychotherapies.org), updated to January 2013. We identified 24 studies describing 26 treatment conditions (14 face-to-face CBT, 12 guided iCBT), by means of these inclusion criteria: targeting depressed adults, no comorbid somatic disorder or substance abuse, community recruitment, published in the year 2000 or later. The main outcome measure was the percentage of completed sessions. We also coded the percentage of treatment completers (separately coding for 100% or at least 80% of treatment completed). Results We did not find studies that compared guided iCBT and face-to-face CBT in a single trial that met our inclusion criteria. Face-to-face CBT treatments ranged from 12 to 28 sessions, guided iCBT interventions consisted of 5 to 9 sessions. Participants in face-to-face CBT completed on average 83.9% of their treatment, which did not differ significantly from participants in guided iCBT (80.8%, P = .59). The percentage of completers (total intervention) was significantly higher in face-to-face CBT (84.7%) than in guided iCBT (65.1%, P < .001), as was the percentage of completers of 80% or more of the intervention (face-to-face CBT: 85.2%, guided iCBT: 67.5%, P = .003). Non-completers of face-to-face CBT completed on average 24.5% of their treatment, while non-completers of guided iCBT completed on average 42.1% of their treatment. Conclusion We did not find studies that compared guided iCBT and face-to-face CBT in a single trial. Adherence to guided iCBT appears to be adequate and could be equal to adherence to face-to-face CBT.
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Affiliation(s)
- Wouter van Ballegooijen
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Centre/GGZ inGeest, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Annemieke van Straten
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jan H Smit
- Department of Psychiatry, VU University Medical Centre/GGZ inGeest, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Centre/GGZ inGeest, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands; Leuphana University, Lüneburg, Germany
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Schotanus-Dijkstra M, Havinga P, van Ballegooijen W, Delfosse L, Mokkenstorm J, Boon B. What Do the Bereaved by Suicide Communicate in Online Support Groups? Crisis 2014; 35:27-35. [DOI: 10.1027/0227-5910/a000225] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Every year, more than six million people lose a loved one through suicide. These bereaved by suicide are at relatively high risk for mental illnesses including suicide. The social stigma attached to suicide often makes it difficult to talk about grief. Participating in online forums may be beneficial for the bereaved by suicide, but it is unknown what they communicate in these forums. Aims: What do the bereaved by suicide communicate in online forums? We examined which self-help mechanisms, grief reactions, and experiences with health-care services they shared online. Method: We conducted a content analysis of 1,250 messages from 165 members of two Dutch language forums for the bereaved by suicide. Results: We found that sharing personal experiences featured most prominently in the messages, often with emotional expressions of grief. Other frequently used self-help mechanisms were expressions of support or empathy, providing advice, and universality (recognition), while experiences with health-care services featured only occasionally. Compared with previous studies about online forums for somatic illnesses, the bereaved by suicide communicated more personal experiences and engaged much less in chitchat. Conclusion: Online forums appear to have relevant additional value as a platform for talking about grief and finding support.
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Affiliation(s)
| | - Petra Havinga
- Trimbos Institute, Department of Public Mental Health, Utrecht, the Netherlands
| | - Wouter van Ballegooijen
- Department of Clinical Psychology, VU University Amsterdam, and the EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | | | | | - Brigitte Boon
- Trimbos Institute, Department of Public Mental Health, Utrecht, the Netherlands
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Ünlü Ince B, Cuijpers P, van 't Hof E, van Ballegooijen W, Christensen H, Riper H. Internet-based, culturally sensitive, problem-solving therapy for Turkish migrants with depression: randomized controlled trial. J Med Internet Res 2013; 15:e227. [PMID: 24121307 PMCID: PMC3849840 DOI: 10.2196/jmir.2853] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 08/30/2013] [Accepted: 09/09/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Turkish migrants living in the Netherlands have a high prevalence of depressive disorders, but experience considerable obstacles to accessing professional help. Providing easily accessible Internet treatments may help to overcome these barriers. OBJECTIVE The aim of this study was to evaluate the effectiveness of a culturally sensitive, guided, self-help, problem-solving intervention through the Internet for reducing depressive symptoms in Turkish migrants. METHODS A two-armed randomized controlled trial was conducted. The primary outcome measure was the severity of depressive symptoms; secondary outcome measures were somatic symptoms, anxiety, quality of life, and satisfaction with the treatment. Participants were assessed online at baseline, posttest (6 weeks after baseline), and 4 months after baseline. Posttest results were analyzed on the intention-to-treat sample. Missing values were estimated by means of multiple imputation. Differences in clinical outcome between groups were analyzed with a t test. Cohen's d was used to determine the between-groups effect size at posttreatment and follow-up. RESULTS Turkish adults (N=96) with depressive symptoms were randomized to the experimental group (n=49) or to a waitlist control group (n=47). High attrition rates were found among the 96 participants of which 42% (40/96) did not complete the posttest (6 weeks) and 62% (59/96) participants did not complete the follow-up assessment at 4 months. No significant difference between the experimental group and the control group was found for depression at posttest. Recovery occurred significantly more often in the experimental group (33%, 16/49) than in the control group (9%, 4/47) at posttest (P=.02). Because of the high attrition rate, a completers-only analysis was conducted at follow-up. The experimental group showed significant improvement in depression compared to the control group both at posttest (P=.01) and follow-up (P=.01). CONCLUSIONS The results of this study did not show a significant effect on the reduction of depressive symptoms. However, the effect size at posttest was high, which might be an indicator of the possible effectiveness of the intervention when assessed in a larger sample and robust trial. Future research should replicate our study with adequately powered samples. TRIAL REGISTRATION Dutch Trial Register: NTR2303. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2303 (Archived by WebCite at http://www.webcitation.org/6IOxNgoDu).
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Affiliation(s)
- Burçin Ünlü Ince
- Department of Clinical Psychology, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, Netherlands.
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van Ballegooijen W, Riper H, Klein B, Ebert DD, Kramer J, Meulenbeek P, Cuijpers P. An Internet-based guided self-help intervention for panic symptoms: randomized controlled trial. J Med Internet Res 2013; 15:e154. [PMID: 23896222 PMCID: PMC3742403 DOI: 10.2196/jmir.2362] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [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: 10/24/2012] [Revised: 01/26/2013] [Accepted: 05/11/2013] [Indexed: 12/01/2022] Open
Abstract
Background Internet-based guided self-help is efficacious for panic disorder, but it is not known whether such treatment is effective for milder panic symptoms as well. Objective To evaluate the effectiveness of Don’t Panic Online, an Internet-based self-help course for mild panic symptoms, which is based on cognitive behavioral principles and includes guidance by email. Methods A pragmatic randomized controlled trial was conducted. Participants (N=126) were recruited from the general population and randomized to either the intervention group or to a waiting-list control group. Inclusion criteria were a Panic Disorder Severity Scale-Self Report (PDSS-SR) score between 5-15 and no suicide risk. Panic symptom severity was the primary outcome measure; secondary outcome measures were anxiety and depressive symptom severity. Measurements were conducted online and took place at baseline and 12 weeks after baseline (T1). At baseline, diagnoses were obtained by telephone interviews. Results Analyses of covariance (intention-to-treat) showed no significant differences in panic symptom reduction between groups. Completers-only analyses revealed a moderate effect size in favor of the intervention group (Cohen’s d=0.73, P=.01). Only 27% of the intervention group finished lesson 4 or more (out of 6). Nonresponse at T1 was high for the total sample (42.1%). Diagnostic interviews showed that many participants suffered from comorbid depression and anxiety disorders. Conclusions The Internet-based guided self-help course appears to be ineffective for individuals with panic symptoms. However, intervention completers did derive clinical benefits from the intervention. Trial Registration Nederlands Trial Register: NTR1639; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1639 (Archived by WebCite at http://www.webcitation.org/6ITZPozs9).
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Affiliation(s)
- Wouter van Ballegooijen
- Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University Amsterdam, Van der Boechorststraat 1,Amsterdam, Netherlands.
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Hemelrijk E, van Ballegooijen W, Donker T, van Straten A, Kerkhof A. Internet-based screening for suicidal ideation in common mental disorders. Crisis 2012; 33:215-21. [PMID: 22713975 DOI: 10.1027/0227-5910/a000142] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Common mental disorders have been found to be related to suicidal ideation and behavior. Research in the field of web-based interventions for common mental disorders, however, usually excludes participants with a suicidal risk, although a large proportion of participants might suffer from suicidal ideation. AIMS To investigate the prevalence of suicidal ideation in common mental disorders in an online sample. METHOD In total, 502 participants completed nine web-based questionnaires on common mental disorders, of which 120 were also interviewed by telephone to obtain a diagnosis. Logistic regression analyses were applied to investigate associations between disorders and suicidal ideation. RESULTS Based on web-based self-report, 53% of participants had some form of suicidal ideation. Fewer participants reported suicidal ideation during the interview by telephone. Depression (multivariate odds ratio 7.1), generalized anxiety disorder (2.1), social phobia (2.1), and posttraumatic stress disorder (1.7) were significantly associated with suicidal ideation, while a higher number of comorbid common mental disorders increased the risk. CONCLUSION Researchers and clinicians should be aware that one out of every two helpseekers on the internet with common mental disorders may have suicidal ideation. Comorbidity of two or more disorders greatly increase the risk of suicidal ideation.
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van Ballegooijen W, Riper H, Donker T, Martin Abello K, Marks I, Cuijpers P. Single-item screening for agoraphobic symptoms: validation of a web-based audiovisual screening instrument. PLoS One 2012; 7:e38480. [PMID: 22844391 PMCID: PMC3402507 DOI: 10.1371/journal.pone.0038480] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 05/06/2012] [Indexed: 11/26/2022] Open
Abstract
The advent of web-based treatments for anxiety disorders creates a need for quick and valid online screening instruments, suitable for a range of social groups. This study validates a single-item multimedia screening instrument for agoraphobia, part of the Visual Screener for Common Mental Disorders (VS-CMD), and compares it with the text-based agoraphobia items of the PDSS-SR. The study concerned 85 subjects in an RCT of the effects of web-based therapy for panic symptoms. The VS-CMD item and items 4 and 5 of the PDSS-SR were validated by comparing scores to the outcomes of the CIDI diagnostic interview. Screening for agoraphobia was found moderately valid for both the multimedia item (sensitivity.81, specificity.66, AUC.734) and the text-based items (AUC.607–.697). Single-item multimedia screening for anxiety disorders should be further developed and tested in the general population and in patient, illiterate and immigrant samples.
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Affiliation(s)
- Wouter van Ballegooijen
- Department of Clinical Psychology and EMGO Institute, VU University, Amsterdam, The Netherlands.
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van Ballegooijen W, Riper H, van Straten A, Kramer J, Conijn B, Cuijpers P. The effects of an Internet based self-help course for reducing panic symptoms--Don't Panic Online: study protocol for a randomised controlled trial. Trials 2011; 12:75. [PMID: 21396089 PMCID: PMC3062612 DOI: 10.1186/1745-6215-12-75] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 03/11/2011] [Indexed: 11/22/2022] Open
Abstract
Background Internet based self-help for panic disorder (PD) has proven to be effective. However, studies so far have focussed on treating a full-blown disorder. Panic symptoms that do not meet DSM-IV criteria are more prevalent than the full-blown disorder and patients with sub-clinical panic symptoms are at risk of developing PD. This study is a randomised controlled trial aimed to evaluate an Internet based self-help intervention for sub-clinical and mild PD compared to a waiting list control group. Methods Participants with mild or sub-clinical PD (N = 128) will be recruited in the general population. Severity of panic and anxiety symptoms are the primary outcome measures. Secondary outcomes include depressive symptoms, quality of life, loss of production and health care consumption. Assessments will take place on the Internet at baseline and three months after baseline. Discussion Results will indicate the effectiveness of Internet based self-help for sub-clinical and mild PD. Strengths of this design are the external validity and the fact that it is almost completely conducted online. Trial registration Netherlands Trial Register (NTR): NTR1639 The Netherlands Trial Register is part of the Dutch Cochrane Centre.
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Affiliation(s)
- Wouter van Ballegooijen
- Department of clinical psychology and EMGO Institute, VU-University, Amsterdam, The Netherlands.
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