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Zhang L, Li Y, Kou W, Xia Y, Yu X, Du X. Reminiscence therapy exhibits alleviation of anxiety and improvement of life quality in postoperative gastric cancer patients: A randomized, controlled study. Medicine (Baltimore) 2021; 100:e26821. [PMID: 34477119 PMCID: PMC8415997 DOI: 10.1097/md.0000000000026821] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/25/2021] [Accepted: 07/16/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Although reminiscence therapy alleviates mental illness and improves quality of life in neurocognitive disorders patients, little study reports its clinical application in cancer patients. Thus, this study aimed to explore the effect of reminiscence therapy on anxiety, depression, quality of life, and survival profile in postoperative gastric cancer patients.One hundred sixty surgical gastric cancer patients were enrolled in this randomized, controlled study, then randomly assigned to Reminiscence therapy group (N = 80) and Control group (N = 80) as 1:1 ratio. The evaluation was carried at baseline (M0), month 3 (M3), month 6 (M6), month 9 (M9), and month 12 (M12) after intervention by Hospital Anxiety and Depression Scale and European Organization for Research and Treatment of Cancer quality of life Questionnaire-Core 30 (QLQ-C30). Furthermore, disease-free survival and overall survival were analyzed using follow-up data.Reminiscence therapy decreased HADS for anxiety score at M6, M9, and M12, decreased anxiety rate at M9 and M12 compared to control care; while it did not affect HADS for depression score or depression rate at any time-point. Also, reminiscence therapy raised QLQ-C30 global health status score at M12, reduced QLQ-C30 symptoms score at M6, while did not affect QLQ-C30 function score at any time-point compared to control care. Reminiscence therapy did not affect disease-free survival and overall survival, either. Further subgroup analyses (divided by age and gender) observed that the effect of reminiscence therapy seemed more obvious in patients with age ≤60 years and male patients.Reminiscence therapy exhibits alleviation of anxiety and improvement of quality of life in postoperative gastric cancer patients.
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Affiliation(s)
- Lisha Zhang
- Department of Gastrointestinal Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, Heilongjiang, China
| | - Yanling Li
- Department of Gastrointestinal Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, Heilongjiang, China
| | - Wenjia Kou
- Department of Gastrointestinal Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, Heilongjiang, China
| | - Yue Xia
- Department of Gastrointestinal Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, Heilongjiang, China
| | - Xiaohui Yu
- Department of Gastrointestinal Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, Heilongjiang, China
| | - Xin Du
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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Han HR, Miller HN, Nkimbeng M, Budhathoki C, Mikhael T, Rivers E, Gray J, Trimble K, Chow S, Wilson P. Trauma informed interventions: A systematic review. PLoS One 2021; 16:e0252747. [PMID: 34157025 PMCID: PMC8219147 DOI: 10.1371/journal.pone.0252747] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 05/23/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Health inequities remain a public health concern. Chronic adversity such as discrimination or racism as trauma may perpetuate health inequities in marginalized populations. There is a growing body of the literature on trauma informed and culturally competent care as essential elements of promoting health equity, yet no prior review has systematically addressed trauma informed interventions. The purpose of this study was to appraise the types, setting, scope, and delivery of trauma informed interventions and associated outcomes. METHODS We performed database searches- PubMed, Embase, CINAHL, SCOPUS and PsycINFO-to identify quantitative studies published in English before June 2019. Thirty-two unique studies with one companion article met the eligibility criteria. RESULTS More than half of the 32 studies were randomized controlled trials (n = 19). Thirteen studies were conducted in the United States. Child abuse, domestic violence, or sexual assault were the most common types of trauma addressed (n = 16). While the interventions were largely focused on reducing symptoms of post-traumatic stress disorder (PTSD) (n = 23), depression (n = 16), or anxiety (n = 10), trauma informed interventions were mostly delivered in an outpatient setting (n = 20) by medical professionals (n = 21). Two most frequently used interventions were eye movement desensitization and reprocessing (n = 6) and cognitive behavioral therapy (n = 5). Intervention fidelity was addressed in 16 studies. Trauma informed interventions significantly reduced PTSD symptoms in 11 of 23 studies. Fifteen studies found improvements in three main psychological outcomes including PTSD symptoms (11 of 23), depression (9 of 16), and anxiety (5 of 10). Cognitive behavioral therapy consistently improved a wide range of outcomes including depression, anxiety, emotional dysregulation, interpersonal problems, and risky behaviors (n = 5). CONCLUSIONS There is inconsistent evidence to support trauma informed interventions as an effective approach for psychological outcomes. Future trauma informed intervention should be expanded in scope to address a wide range of trauma types such as racism and discrimination. Additionally, a wider range of trauma outcomes should be studied.
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Affiliation(s)
- Hae-Ra Han
- School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America
- Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Hailey N. Miller
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Manka Nkimbeng
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Chakra Budhathoki
- School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Tanya Mikhael
- School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Emerald Rivers
- School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ja’Lynn Gray
- School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Kristen Trimble
- School of Nursing, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Sotera Chow
- Medstar Good Samaritan Hospital, Baltimore, Maryland, United States of America
| | - Patty Wilson
- School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America
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Abstract
OBJECTIVE Clinical practice guidelines recommend concurrent treatment of co-occurring depression and substance use disorders; however, the degree to which patients with substance use disorders receive guideline-concordant treatment for depression is unknown. The authors investigated the provision of guideline-concordant depression treatment to patients with and without substance use disorders in a large integrated health care system. METHODS In a retrospective cohort study of 53,034 patients diagnosed with a depressive disorder in fiscal year 2017 in the U.S. Veterans Health Administration, the authors assessed the association of comorbid substance use disorders with guideline-concordant depression treatment, including both medication and psychotherapy, while adjusting for patient demographic and clinical characteristics. RESULTS Guideline-concordant depression treatment was lower across metrics for patients with co-occurring depression and substance use disorders compared to those without substance use disorders. Consistent findings emerged in covariate-adjusted models of antidepressant treatment, such that patients with substance use disorders had 21% lower odds of guideline-concordant acute treatment (adjusted odds ratio=0.79, 95% CI=0.73, 0.84) and 26% lower odds of continuation of treatment (adjusted odds ratio=0.74, 95% CI=0.69, 0.79). With regard to psychotherapy, patients with co-occurring depression and substance use disorders had 13% lower odds (adjusted odds ratio=0.87, 95% CI=0.82, 0.91) of adequate acute-phase treatment and 19% lower odds (adjusted odds ratio=0.81; 95% CI=0.73, 0.89) of psychotherapy continuation. CONCLUSIONS Despite the availability of effective treatments for depression, patients with co-occurring substance use disorders are less likely to receive guideline-concordant depression treatment. Efforts to improve the provision of care to those with co-occurring substance use disorders should focus on clinician-based interventions and use of integrated care models to improve the quality of depression treatment.
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Affiliation(s)
- Lara N Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor (Coughlin, Lin); VA Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor (Pfeiffer, Ganoczy, Lin)
| | - Paul Pfeiffer
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor (Coughlin, Lin); VA Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor (Pfeiffer, Ganoczy, Lin)
| | - Dara Ganoczy
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor (Coughlin, Lin); VA Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor (Pfeiffer, Ganoczy, Lin)
| | - Lewei A Lin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor (Coughlin, Lin); VA Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor (Pfeiffer, Ganoczy, Lin)
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Bauer AM, Jakupcak M, Hawrilenko M, Bechtel J, Arao R, Fortney JC. Outcomes of a health informatics technology-supported behavioral activation training for care managers in a collaborative care program. Fam Syst Health 2021; 39:89-100. [PMID: 32853001 DOI: 10.1037/fsh0000523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Health informatics-supported strategies for training and ongoing support may aid the delivery of evidence-based psychotherapies. The objective of this study was to describe the development, implementation, and practice outcomes of a scalable health informatics-supported training program for behavioral activation for patients who screened positive for posttraumatic stress disorder and/or bipolar disorder. METHOD We trained 34 care managers in 12 rural health centers. They used a registry checklist to document the delivery of 10 behavioral activation skills for 4,632 sessions with 455 patients. Care managers received performance feedback based on registry data. Using encounter-level data reported by care managers, we described the implementation outcomes of patient reach and care manager skill adoption. We used cross-classified multilevel modeling to explore variation in skill delivery accounting for patient characteristics, provider characteristics, and change over time. RESULTS Care managers engaged 88% of patients in behavioral activation and completed a minimum course for 57%. The average patient received 5.9 skills during treatment, with substantial variation driven more by providers (63%) than patients (29%). Care managers significantly increased the range of skills offered to patients over time. DISCUSSION The registry-based checklist was a feasible training and support tool for community-based providers to deliver behavioral activation. Providers received data-driven performance feedback and demonstrated skill improvement over time, promoting sustainment. Future research will examine patient-level outcomes. Results underscore the potential public health impact of a simple registry-based skills checklist coupled with a scalable remote training program for evidence-based psychotherapy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Amy M Bauer
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Matthew Jakupcak
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Matt Hawrilenko
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Jared Bechtel
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Rob Arao
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - John C Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington
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Aafjes-van Doorn K, McCollum J, Silberschatz G, Kealy D, Snyder J. Perceived Adverse Parenting in Childhood and Psychological Distress Among Psychotherapy Patients: The Mediating Role of Pathogenic Beliefs. J Nerv Ment Dis 2021; 209:181-187. [PMID: 33235181 DOI: 10.1097/nmd.0000000000001274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The way people derive inferences from actual adverse experiences plays an important role in the development of psychopathology. This study aims to examine the mediating role of pathogenic beliefs (i.e., emotion-laden, powerful, painful convictions about self and others) on the relation between perceived adverse parenting behaviors in childhood and subsequent adult psychopathology. Participants (mostly Caucasian and heterosexual) were 204 consecutively admitted patients with a range of psychological difficulties, including depression, anxiety, and interpersonal problems, at a low-fee outpatient clinic. Participants completed standard self-report assessments of perceived parental style, depressive and anxiety symptoms, and a clinically derived measure of pathogenic beliefs. We examined the indirect effects of adverse parenting on anxiety and depressive symptom severity through pathogenic beliefs. Pathogenic beliefs reflecting the unreliability of others significantly mediated the relationship between adverse parenting and anxiety symptoms. The other mediation model is consistent with the theory that perceived adverse parenting contributes to the severity of depressive symptoms through beliefs about not being deserving and other people being unreliable. Within the limitations of the cross-sectional, retrospective, and self-report nature of the data, our results seem to suggest that attending to intermediary subjective beliefs might be important in understanding psychopathology development in the context of childhood adversity. Aiming to modify the beliefs in therapy might modify the symptoms. However, this would remain to be demonstrated through formal intervention research.
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Affiliation(s)
| | | | - George Silberschatz
- Department of Psychiatry, University of California, San Francisco, California
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
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Humer E, Stippl P, Pieh C, Pryss R, Probst T. Experiences of Psychotherapists With Remote Psychotherapy During the COVID-19 Pandemic: Cross-sectional Web-Based Survey Study. J Med Internet Res 2020; 22:e20246. [PMID: 33151896 PMCID: PMC7704121 DOI: 10.2196/20246] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/14/2020] [Accepted: 10/02/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The current situation around the COVID-19 pandemic and the measures necessary to fight it are creating challenges for psychotherapists, who usually treat patients face-to-face with personal contact. The pandemic is accelerating the use of remote psychotherapy (ie, psychotherapy provided via telephone or the internet). However, some psychotherapists have expressed reservations regarding remote psychotherapy. As psychotherapists are the individuals who determine the frequency of use of remote psychotherapy, the potential of enabling mental health care during the COVID-19 pandemic in line with the protective measures to fight COVID-19 can be realized only if psychotherapists are willing to use remote psychotherapy. OBJECTIVE This study aimed to investigate the experiences of psychotherapists with remote psychotherapy in the first weeks of the COVID-19 lockdown in Austria (between March 24 and April 1, 2020). METHODS Austrian psychotherapists were invited to take part in a web-based survey. The therapeutic orientations of the psychotherapists (behavioral, humanistic, psychodynamic, or systemic), their rating of the comparability of remote psychotherapy (web- or telephone-based) with face-to-face psychotherapy involving personal contact, and potential discrepancies between their actual experiences and previous expectations with remote psychotherapy were assessed. Data from 1162 psychotherapists practicing before and during the COVID-19 lockdown were analyzed. RESULTS Psychotherapy conducted via telephone or the internet was reported to not be totally comparable to psychotherapy with personal contact (P<.001). Psychodynamic (P=.001) and humanistic (P=.005) therapists reported a higher comparability of telephone-based psychotherapy to in-person psychotherapy than behavioral therapists. Experiences with remote therapy (both web- and telephone-based) were more positive than previously expected (P<.001). Psychodynamic therapists reported more positive experiences with telephone-based psychotherapy than expected compared to behavioral (P=.03) and systemic (P=.002) therapists. In general, web-based psychotherapy was rated more positively (regarding comparability to psychotherapy with personal contact and experiences vs expectations) than telephone-based psychotherapy (P<.001); however, psychodynamic therapists reported their previous expectations to be equal to their actual experiences for both telephone- and web-based psychotherapy. CONCLUSIONS Psychotherapists found their experiences with remote psychotherapy (ie, web- or telephone-based psychotherapy) to be better than expected but found that this mode was not totally comparable to face-to-face psychotherapy with personal contact. Especially, behavioral therapists were found to rate telephone-based psychotherapy less favorably than therapists with other theoretical backgrounds.
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Affiliation(s)
- Elke Humer
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems, Austria
| | - Peter Stippl
- Austrian Federal Association for Psychotherapy, Vienna, Austria
| | - Christoph Pieh
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems, Austria
| | - Rüdiger Pryss
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems, Austria
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Dockweiler C, Kupitz A, Palmdorf S, Hornberg C. [Online therapy for depressive disorders : An acceptance-based analysis from the perspective of therapists]. Nervenarzt 2020; 91:243-251. [PMID: 31165209 DOI: 10.1007/s00115-019-0730-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The supply of online therapy options for mild to moderate depressive disorders has substantially risen both nationally and internationally in the past years. While the efficacy and efficiency of specific online-based therapeutic services were indicated within the framework of scientific evaluations, little is known about the acceptance of these new therapy options. METHODS In a nationwide online survey of online-based therapy options for mild to moderate depressive disorders, the attitude and stance as well as the use intention and the subjectively perceived knowledge of 657 medical practitioners and therapists, active in psychotherapeutic and psychiatric treatment were collated. The impact of the potential predictors on the use intention of online-based therapies, based on the unified theory of acceptance and use of technology, was analyzed by means of a binary logistic regression model. RESULTS Besides the perceived performance and expense expectations, the supportive framework conditions, the influence of the cooperative environment, the individual technical affinity as well as the evaluation of the prospective significance of online-based therapy proved to be significantly influential predictors on the user intention. Special predictability for a positive user intention was shown related to the perceived potential of online therapy. CONCLUSION The results underline the relevance of further evidence-basing of online therapy for mild to moderate depressive disorders. A user-oriented, participatory technology development proves to be just as relevant as a comprehensive sensitization, elucidation and education of potential users for a successful implementation.
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Affiliation(s)
- Christoph Dockweiler
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Universitätsstraße 25, 33501, Bielefeld, Deutschland.
| | - Anna Kupitz
- Deutsches Kinderschmerzzentrum, Universität Witten/Herdecke, Dr.-Friedrich-Steiner Str. 5, 45711, Datteln, Deutschland
| | - Sarah Palmdorf
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Universitätsstraße 25, 33501, Bielefeld, Deutschland
| | - Claudia Hornberg
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Universitätsstraße 25, 33501, Bielefeld, Deutschland
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Humer E, Pieh C, Kuska M, Barke A, Doering BK, Gossmann K, Trnka R, Meier Z, Kascakova N, Tavel P, Probst T. Provision of Psychotherapy during the COVID-19 Pandemic among Czech, German and Slovak Psychotherapists. Int J Environ Res Public Health 2020; 17:E4811. [PMID: 32635422 PMCID: PMC7370023 DOI: 10.3390/ijerph17134811] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/24/2020] [Accepted: 07/01/2020] [Indexed: 01/18/2023]
Abstract
Psychotherapists around the world are facing an unprecedented situation with the outbreak of the novel coronavirus disease (COVID-19). To combat the rapid spread of the virus, direct contact with others has to be avoided when possible. Therefore, remote psychotherapy provides a valuable option to continue mental health care during the COVID-19 pandemic. The present study investigated the fear of psychotherapists to become infected with COVID-19 during psychotherapy in personal contact and assessed how the provision of psychotherapy changed due to the COVID-19 situation and whether there were differences with regard to country and gender. Psychotherapists from three European countries: Czech Republic (CZ, n = 112), Germany (DE, n = 130) and Slovakia (SK, n = 96), with on average 77.8% female participants, completed an online survey. Participants rated the fear of COVID-19 infection during face-to-face psychotherapy and reported the number of patients treated on average per week (in personal contact, via telephone, via internet) during the COVID-19 situation as well as (retrospectively) in the months before. Fear of COVID-19 infection was highest in SK and lowest in DE (p < 0.001) and was higher in female compared to male psychotherapists (p = 0.021). In all countries, the number of patients treated on average per week in personal contact decreased (p < 0.001) and remote psychotherapies increased (p < 0.001), with more patients being treated via internet than via telephone during the COVID-19 situation (p < 0.001). Furthermore, female psychotherapists treated less patients in personal contact (p = 0.036), while they treated more patients via telephone than their male colleagues (p = 0.015). Overall, the total number of patients treated did not differ during COVID-19 from the months before (p = 0.133) and psychotherapy in personal contact remained the most common treatment modality. Results imply that the supply of mental health care could be maintained during COVID-19 and that changes in the provision of psychotherapy vary among countries and gender.
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Affiliation(s)
- Elke Humer
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria; (E.H.); (C.P.); (M.K.)
| | - Christoph Pieh
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria; (E.H.); (C.P.); (M.K.)
| | - Martin Kuska
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria; (E.H.); (C.P.); (M.K.)
| | - Antonia Barke
- Clinical and Biological Psychology, Catholic University of Eichstätt-Ingolstadt, 85072 Eichstätt, Germany; (A.B.); (B.K.D.); (K.G.)
| | - Bettina K. Doering
- Clinical and Biological Psychology, Catholic University of Eichstätt-Ingolstadt, 85072 Eichstätt, Germany; (A.B.); (B.K.D.); (K.G.)
| | - Katharina Gossmann
- Clinical and Biological Psychology, Catholic University of Eichstätt-Ingolstadt, 85072 Eichstätt, Germany; (A.B.); (B.K.D.); (K.G.)
| | - Radek Trnka
- Science and Research Department, Prague College of Psychosocial Studies, 14900 Prague, Czech Republic;
- Olomouc University Social Health Institute (OUSHI), Palacky University Olomouc, 77111 Olomouc, Czech Republic; (Z.M.); (N.K.); (P.T.)
| | - Zdenek Meier
- Olomouc University Social Health Institute (OUSHI), Palacky University Olomouc, 77111 Olomouc, Czech Republic; (Z.M.); (N.K.); (P.T.)
| | - Natalia Kascakova
- Olomouc University Social Health Institute (OUSHI), Palacky University Olomouc, 77111 Olomouc, Czech Republic; (Z.M.); (N.K.); (P.T.)
- Psychiatric-Psychotherapeutic Outpatient Clinic, Pro mente sana, 81108 Bratislava, Slovakia
| | - Peter Tavel
- Olomouc University Social Health Institute (OUSHI), Palacky University Olomouc, 77111 Olomouc, Czech Republic; (Z.M.); (N.K.); (P.T.)
| | - Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria; (E.H.); (C.P.); (M.K.)
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Probst T, Stippl P, Pieh C. Changes in Provision of Psychotherapy in the Early Weeks of the COVID-19 Lockdown in Austria. Int J Environ Res Public Health 2020; 17:E3815. [PMID: 32471295 PMCID: PMC7312759 DOI: 10.3390/ijerph17113815] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/16/2020] [Accepted: 05/26/2020] [Indexed: 12/19/2022]
Abstract
Reducing personal contacts is a central measure against the spreading of the novel coronavirus disease (COVID-19). This troubles mental health, but also mental health care as treatments usually take place in personal contact and switching to remote treatments might be necessary in times of COVID-19. The present study investigated the question how the provision of psychotherapy changed in the early weeks of the COVID-19 lockdown in Austria and whether there were differences between the four therapeutic orientations eligible in Austria (psychodynamic, humanistic, systemic, behavioral). Psychotherapists (N = 1547) completed an online survey. They entered their number of patients treated on average per week (in personal contact, via telephone, via Internet) in the early weeks of the COVID-19 lockdown in Austria as well as (retrospectively) in the months before. The number of patients treated on average per week in personal contact decreased (on average 81%; p < 0.001), whereas the number of patients treated on average per week via telephone and via Internet increased (on average 979% and 1561%; both p < 0.001). Yet, the decrease of psychotherapies through personal contact was not compensated for by increases of remote psychotherapies (p < 0.001). No differences between the four therapeutic orientations emerged. Results imply an undersupply of psychotherapy in the COVID-19 lockdown and that further changes are necessary to cover the increased need for timely psychotherapy in times of COVID-19.
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Affiliation(s)
- Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria;
| | - Peter Stippl
- Austrian Federal Association for Psychotherapy, 1030 Vienna, Austria;
| | - Christoph Pieh
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria;
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Storebø OJ, Stoffers-Winterling JM, Völlm BA, Kongerslev MT, Mattivi JT, Jørgensen MS, Faltinsen E, Todorovac A, Sales CP, Callesen HE, Lieb K, Simonsen E. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev 2020; 5:CD012955. [PMID: 32368793 PMCID: PMC7199382 DOI: 10.1002/14651858.cd012955.pub2] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Over the decades, a variety of psychological interventions for borderline personality disorder (BPD) have been developed. This review updates and replaces an earlier review (Stoffers-Winterling 2012). OBJECTIVES To assess the beneficial and harmful effects of psychological therapies for people with BPD. SEARCH METHODS In March 2019, we searched CENTRAL, MEDLINE, Embase, 14 other databases and four trials registers. We contacted researchers working in the field to ask for additional data from published and unpublished trials, and handsearched relevant journals. We did not restrict the search by year of publication, language or type of publication. SELECTION CRITERIA Randomised controlled trials comparing different psychotherapeutic interventions with treatment-as-usual (TAU; which included various kinds of psychotherapy), waiting list, no treatment or active treatments in samples of all ages, in any setting, with a formal diagnosis of BPD. The primary outcomes were BPD symptom severity, self-harm, suicide-related outcomes, and psychosocial functioning. There were 11 secondary outcomes, including individual BPD symptoms, as well as attrition and adverse effects. DATA COLLECTION AND ANALYSIS At least two review authors independently selected trials, extracted data, assessed risk of bias using Cochrane's 'Risk of bias' tool and assessed the certainty of the evidence using the GRADE approach. We performed data analysis using Review Manager 5 and quantified the statistical reliability of the data using Trial Sequential Analysis. MAIN RESULTS We included 75 randomised controlled trials (4507 participants), predominantly involving females with mean ages ranging from 14.8 to 45.7 years. More than 16 different kinds of psychotherapy were included, mostly dialectical behaviour therapy (DBT) and mentalisation-based treatment (MBT). The comparator interventions included treatment-as-usual (TAU), waiting list, and other active treatments. Treatment duration ranged from one to 36 months. Psychotherapy versus TAU Psychotherapy reduced BPD symptom severity, compared to TAU; standardised mean difference (SMD) -0.52, 95% confidence interval (CI) -0.70 to -0.33; 22 trials, 1244 participants; moderate-quality evidence. This corresponds to a mean difference (MD) of -3.6 (95% CI -4.4 to -2.08) on the Zanarini Rating Scale for BPD (range 0 to 36), a clinically relevant reduction in BPD symptom severity (minimal clinical relevant difference (MIREDIF) on this scale is -3.0 points). Psychotherapy may be more effective at reducing self-harm compared to TAU (SMD -0.32, 95% CI -0.49 to -0.14; 13 trials, 616 participants; low-quality evidence), corresponding to a MD of -0.82 (95% CI -1.25 to 0.35) on the Deliberate Self-Harm Inventory Scale (range 0 to 34). The MIREDIF of -1.25 points was not reached. Suicide-related outcomes improved compared to TAU (SMD -0.34, 95% CI -0.57 to -0.11; 13 trials, 666 participants; low-quality evidence), corresponding to a MD of -0.11 (95% CI -0.19 to -0.034) on the Suicidal Attempt Self Injury Interview. The MIREDIF of -0.17 points was not reached. Compared to TAU, psychotherapy may result in an improvement in psychosocial functioning (SMD -0.45, 95% CI -0.68 to -0.22; 22 trials, 1314 participants; low-quality evidence), corresponding to a MD of -2.8 (95% CI -4.25 to -1.38), on the Global Assessment of Functioning Scale (range 0 to 100). The MIREDIF of -4.0 points was not reached. Our additional Trial Sequential Analysis on all primary outcomes reaching significance found that the required information size was reached in all cases. A subgroup analysis comparing the different types of psychotherapy compared to TAU showed no clear evidence of a difference for BPD severity and psychosocial functioning. Psychotherapy may reduce depressive symptoms compared to TAU but the evidence is very uncertain (SMD -0.39, 95% CI -0.61 to -0.17; 22 trials, 1568 participants; very low-quality evidence), corresponding to a MD of -2.45 points on the Hamilton Depression Scale (range 0 to 50). The MIREDIF of -3.0 points was not reached. BPD-specific psychotherapy did not reduce attrition compared with TAU. Adverse effects were unclear due to too few data. Psychotherapy versus waiting list or no treatment Greater improvements in BPD symptom severity (SMD -0.49, 95% CI -0.93 to -0.05; 3 trials, 161 participants), psychosocial functioning (SMD -0.56, 95% CI -1.01 to -0.11; 5 trials, 219 participants), and depression (SMD -1.28, 95% CI -2.21 to -0.34, 6 trials, 239 participants) were observed in participants receiving psychotherapy versus waiting list or no treatment (all low-quality evidence). No evidence of a difference was found for self-harm and suicide-related outcomes. Individual treatment approaches DBT and MBT have the highest numbers of primary trials, with DBT as subject of one-third of all included trials, followed by MBT with seven RCTs. Compared to TAU, DBT was more effective at reducing BPD severity (SMD -0.60, 95% CI -1.05 to -0.14; 3 trials, 149 participants), self-harm (SMD -0.28, 95% CI -0.48 to -0.07; 7 trials, 376 participants) and improving psychosocial functioning (SMD -0.36, 95% CI -0.69 to -0.03; 6 trials, 225 participants). MBT appears to be more effective than TAU at reducing self-harm (RR 0.62, 95% CI 0.49 to 0.80; 3 trials, 252 participants), suicidality (RR 0.10, 95% CI 0.04, 0.30, 3 trials, 218 participants) and depression (SMD -0.58, 95% CI -1.22 to 0.05, 4 trials, 333 participants). All findings are based on low-quality evidence. For secondary outcomes see review text. AUTHORS' CONCLUSIONS Our assessments showed beneficial effects on all primary outcomes in favour of BPD-tailored psychotherapy compared with TAU. However, only the outcome of BPD severity reached the MIREDIF-defined cut-off for a clinically meaningful improvement. Subgroup analyses found no evidence of a difference in effect estimates between the different types of therapies (compared to TAU) . The pooled analysis of psychotherapy versus waiting list or no treatment found significant improvement on BPD severity, psychosocial functioning and depression at end of treatment, but these findings were based on low-quality evidence, and the true magnitude of these effects is uncertain. No clear evidence of difference was found for self-harm and suicide-related outcomes. However, compared to TAU, we observed effects in favour of DBT for BPD severity, self-harm and psychosocial functioning and, for MBT, on self-harm and suicidality at end of treatment, but these were all based on low-quality evidence. Therefore, we are unsure whether these effects would alter with the addition of more data.
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Affiliation(s)
- Ole Jakob Storebø
- Child and Adolescent Psychiatric Department, Region Zealand, Roskilde, Denmark
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Psychology, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | | | - Birgit A Völlm
- Department of Forensic Psychiatry, Center for Neurology, University Rostock, Rostock, Germany
| | - Mickey T Kongerslev
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Psychology, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Jessica T Mattivi
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Mie S Jørgensen
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
| | - Erlend Faltinsen
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
| | - Adnan Todorovac
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
| | - Christian P Sales
- Duncan MacMillan House, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
- Institute of Mental Health, Department of Psychiatry & Applied Psychology, Nottingham, UK
| | | | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
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de Maat SM, Dekker J, Schoevers RA, de Jonghe F. Relative efficacy of psychotherapy and combined therapy in the treatment of depression: A meta-analysis. Eur Psychiatry 2020; 22:1-8. [PMID: 17194571 DOI: 10.1016/j.eurpsy.2006.10.008] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [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: 09/05/2006] [Revised: 10/27/2006] [Accepted: 10/29/2006] [Indexed: 12/16/2022] Open
Abstract
AbstractBackgroundReviews of the relative efficacy of psychotherapy and combined therapy (psychotherapy with pharmacotherapy) for depression have yielded contradicting conclusions. This may be explained by the clinical heterogeneity of the studies reviewed.AimsTo conduct a meta-analysis with an acceptable level of homogeneity in order to investigate the relative efficacy of psychotherapy and combined therapy in the acute treatment of depression.MethodA systematic search was performed for RCTs published between 1980 and 2005 comparing psychotherapy and combined therapy in adult psychiatric outpatients with non-psychotic unipolar major depressive disorder. The studies were classified according to the chronicity and severity of the depression. Data were pooled by means of meta-analysis and statistical tests were conducted to measure heterogeneity.ResultsThe meta-analysis included seven studies looking at a total of 903 patients. None of the heterogeneity tests established significance. This indicates a lack of evidence for the heterogeneity of the results. The dropout rates did not differ significantly between the two treatment modalities (25% in combined therapy and 24% in psychotherapy, p = 0.77). At treatment termination, the intention-to-treat remission rate for combined therapy (46%) was better than for psychotherapy (34%) (p = 0.0007); Relative Risk 1.32 (95% CI: 1.12–1.56), Odds Ratio 1.59 (95% CI: 1.22–2.09). In moderate depression, the difference between the remission rate for combined therapy and psychotherapy was statistically significant (47% compared to 34% respectively, p = 0.001). This was not the case in mild major depression (42% compared to 37% respectively, p = 0.29). The difference was also statistically significant in chronic major depression (48% compared to 32%, p < 0.001), but not in non-chronic major depression (43% compared to 37%, p = 0.22). On a more specific level, no differences were found in the remission rates for the treatment modalities in mild or moderate non-chronic depression. Combined therapy led to significantly better results than psychotherapy in moderate chronic depression only (48% compared to 32%, p < 0.001).ConclusionsIn the acute treatment of adult psychiatric outpatients with major depressive disorder, patient compliance with combined therapy matches compliance with psychotherapy alone. Combined therapy is more efficacious than psychotherapy alone. However, these results depend on severity and chronicity. Combined therapy outperformed psychotherapy in moderate chronic depression only. No differences were found in mild and moderate non-chronic depression. No data were found for mild chronic depression and for severe depression.
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Affiliation(s)
- Saskia M de Maat
- Mentrum Mental Health Institute Amsterdam, Klaprozenweg 111, P.O. Box 75848, 1070 AV Amsterdam, The Netherlands
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12
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Cuijpers P, van Straten A, Warmerdam L. Problem solving therapies for depression: A meta-analysis. Eur Psychiatry 2020; 22:9-15. [PMID: 17194572 DOI: 10.1016/j.eurpsy.2006.11.001] [Citation(s) in RCA: 188] [Impact Index Per Article: 47.0] [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: 08/16/2006] [Revised: 11/01/2006] [Accepted: 11/03/2006] [Indexed: 11/15/2022] Open
Abstract
AbstractPurposeIn the past decades, the effects of problem-solving therapy (PST) for depression have been examined in several randomized controlled studies. However, until now no meta-analysis has tried to integrate the results of these studies.MethodsWe conducted a systematic literature search and identified 13 randomized studies examining the effects of PST, with a total of 1133 subjects. The quality of studies varied.ResultsThe mean standardized effect size was 0.34 in the fixed effects model and 0.83 in the random effects model, with very high heterogeneity. Subgroup analyses indicated significantly lower effects for individual interventions in studies with subjects who met criteria for major depression, studies in which intention-to-treat analyses were conducted instead of completers-only analyses, and studies with pill placebo and care-as-usual control groups. Heterogeneity was high, and the subgroup analyses did not result in clear indications of what caused this high heterogeneity. This indicates that PST has varying effects on depression, and that it is not known to date what determines whether PST has larger of smaller effects.ConclusionAlthough there is no doubt that PST can be an effective treatment for depression, more research is needed to ascertain the conditions and subjects in which these positive effects are realized.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
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13
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Löffler-Stastka H, Gelo O, Pleschberger I, Hartmann A, Orlinsky DE, Rønnestad MH, Willutzki U. [Psychotherapy training in Austria: Baseline and socio-demographic background data from a SPRISTAD ( Society of Psychotherapy Research Interest Section on Therapist Training and Development)-Pilotstudy]. Z Psychosom Med Psychother 2019; 65:341-352. [PMID: 31801441 DOI: 10.13109/zptm.2019.65.4.341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objectives: Description of the qualifications of psychotherapy-training candidates in Austria at the beginning of their training. Methods: Psychotherapists in training in Austria were interviewed at the beginning of their training concerning their socio-demographic background and prior education. These background data were collected using the Trainee Background Information Form (TBIF), which was designed by the Society for Psychotherapy Research Interest Section on Therapist Training and Development (SPRISTAD). Results: The group of 197 psychotherapy trainees from Austria consists largely of women, of persons with high school education and with a satisfactory, financially secure life situation. One-third of them show a "second career" pattern, which is in line with the predominantly part-time training programs in Austria. A high percentage of the candidates have previous professional experience in the psychosocial field. Conclusions: As this is a pilot study, results can be seen as a starting point for further research in psychotherapy training and competence development. In discussing the findings, both national conditions and opportunities for future interdisciplinary research are considered.
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Affiliation(s)
- Henriette Löffler-Stastka
- Klinik für Psychoanalyse und Psychotherapie Medizinische Universität Wien Währinger Gürtel 18-20 A-1090 Wien Österreich Medizinische Universität Wien
| | - Omar Gelo
- University of Lecce Italien University of Lecce
| | - Ingrid Pleschberger
- Klinik für Psychoanalyse und Psychotherapie Medizinische Universität Wien Währinger Gürtel 18-20 A-1090 Wien Österreich Medizinische Universität Wien
| | - Armin Hartmann
- Klinik für Psychosomatische Medizin und Psychotherapie Zentrum für Psychische Erkrankungen Universitätsklinikum Freiburg Deutschland Uniklinik Freiburg - Klinik für Psychosomatische Medizin und Psychotherapie
| | | | | | - Ulrike Willutzki
- Universität Witten/Herdecke Deutschland Universität Witten/Herdecke
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Owen J, Drinane JM, Kivlighan M, Miller S, Kopta M, Imel Z. Are high-performing therapists both effective and consistent? A test of therapist expertise. J Consult Clin Psychol 2019; 87:1149-1156. [PMID: 31545628 DOI: 10.1037/ccp0000437] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Therapist effectiveness has primarily been defined as being the aggregate of the client therapy outcomes within a therapist's caseload. It may seem intuitive that the most skilled therapists are both effective (in the way defined above) and consistent in facilitating positive outcomes across their clients; however, this premise has not been fully tested. The present study sought to empirically examine this question in a large, multisite, geographically diverse sample. We first computed a consistency variable and an aggregate outcome variable for each therapist among a subset of each individual therapist's caseload (the first 30 clients per therapist within our data set). We then utilized this consistency score and aggregate outcome score to predict the therapy outcomes of their remaining clients. Clients' pretreatment severity scores were also included as a moderator of the association between therapist consistency, therapist aggregate outcome, and client outcomes. METHOD The sample included 27,778 clients who were treated by 275 therapists. At the start of each session, clients completed the Behavioral Health Measure-20 as a measure of psychological functioning. RESULTS Polynomial regression and response surface analysis indicated a discrepant effect, such that subsequent clients' outcomes were highest when therapists' aggregate outcome with their first 30 clients was high and the consistency in the outcomes of their first 30 clients was also high. This relationship was not moderated by clients' pretreatment severity. CONCLUSION Therapists' expertise consists of both high performance and consistency. Therapists who achieved better outcomes consistently were top performers with their subsequent clients. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | - Zac Imel
- Department of Educational Psychology
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15
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Flujas-Contreras JM, García-Palacios A, Gómez I. Technology-based parenting interventions for children's physical and psychological health: a systematic review and meta-analysis. Psychol Med 2019; 49:1787-1798. [PMID: 30977462 DOI: 10.1017/s0033291719000692] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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] [Indexed: 12/22/2022]
Abstract
BACKGROUND Parenting interventions have important consequences for the wellbeing and emotional competences of parents and their children. Technology provides an opportunity with advantages for psychological intervention. The aim of this systematic review and meta-analysis is to analyze the characteristics and effectiveness of technology-based interventions for parents to promote children's physical health or psychological issues. METHODS We conducted a systematic review and meta-analysis for articles about parenting skills for prevention or treatment of children's physical or psychological concerns using technology. We explore the aim of the intervention with parents, kind of problem with children, intervention model, instruments, methodological quality, and risk of bias. A random-effects meta-analysis was conducted. RESULTS Twenty-four studies were included in the systematic review and a meta-analysis of 22 studies was performed to find out the effects of intervention depending on the kind of problem, intervention model, follow-up, type of intervention, type of control condition, and type of outcome data. Results show the usefulness of technology-based therapy for parenting interventions with moderate effect sizes for intervention groups with statistically significant differences from control groups. CONCLUSIONS Technology-based parenting programs have positive effects on parenting and emotional wellbeing of parents and children. Attendance and participation level in technology-based treatment increase compared with traditional parenting intervention.
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Affiliation(s)
| | - Azucena García-Palacios
- Department of Basic Psychology,Clinical and Psychobiology - Personality, Evaluation and Psychological Treatments,University Jaume I,Castellon,Spain
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16
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Leiderman EA, Cordero X, Djmal V, Gómez D, Grosso Sheridan A, Segura E, Parisi G, Tourn A. [Psychotherapeutic treatment in the city of Buenos Aires. Prevalence and characteristics. comparison with the study of the year 2007]. Vertex 2019; XXX:245-252. [PMID: 32119723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION In the last few years, use of psychotherapy has been studied in both our country and other parts of the world. The aim of our study was to determine the current prevalence of psychotherapy use, its characteristics and to compare it with the study done in 2007. METHOD A survey was conducted among 1348 inhabitants over 18 years of age in the city of Buenos Aires between April and May 2019 and it was compared with the study done in the year 2007. RESULTS During the month prior to the survey, 19.9% of the sample received psychotherapy treatment. Psychotherapy treatment is more prevalent among women, middle-aged people and individuals with a higher educational level. Half of the treatments were psychoanalytic and the majority of them were individual and with a private funding source. Only one out of 5 had signed an informed consent before starting the treatment, and only one in 4 had been informed about other treatment options. In comparison with the previous survey, in which the prevalence of psychotherapeutic treatment in the last month was of 15,6%, in this survey a greater percentage of individuals had psychotherapy, although with a lower frequency and mainly with private funding. CONCLUSIONS The prevalence of psychotherapy in the city of Buenos Aires is high and has increased in the last decade.
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Affiliation(s)
- Eduardo A Leiderman
- Departamento de Neurociencias, Facultad de Humanidades y Ciencias Sociales, Universidad de Palermo.
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17
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Hastings JF, Snowden LR. Mental health treatment and work among African American and Caribbean Black welfare recipients. Cultur Divers Ethnic Minor Psychol 2019; 25:342-349. [PMID: 30489103 PMCID: PMC6541544 DOI: 10.1037/cdp0000240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Untreated depression among Temporary Assistance for Needy Families (TANF) participants greatly reduces chances of securing and holding gainful employment. METHOD Logistic regression models were estimated on data describing 1,000 African American and Caribbean Black TANF recipients and 2,123 African American and Caribbean Black non-TANF recipients obtained from the National Survey of American Life (NSAL). RESULTS Black TANF participants were more likely than Black non-TANF participants to be depressed and treated. Treatment odds were lower for Caribbean Black than for U.S.-born Black TANF participants. CONCLUSION Results indicated that mental health treatment was likely among Black TANF participants if depression was identified. TANF participants working less than full-time did not receive as much treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Lonnie R. Snowden
- Professor of the Graduate School (), Health Policy and Management Division, School of Public Health, University of California, Berkeley, 235 University Hall, Berkeley, CA 94720-7360
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18
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Husain MI, Strawbridge R, Carter B, Jones BDM, Young A, Carvalho AF. Efficacy and acceptability of adjunctive psychological and pharmacological interventions for treatment-resistant depression: protocol for a systematic review and network meta-analysis. BMJ Open 2019; 9:e028538. [PMID: 31092667 PMCID: PMC6530376 DOI: 10.1136/bmjopen-2018-028538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Major depressive disorder (MDD) is a common debilitating illness worldwide. The vast majority of patients with MDD will not achieve remission with first-line treatment and despite the availability of different treatment modalities, at least one-third of patients experience treatment-resistant depression (TRD). There continues to be a paucity of research focused on treatment options for patients with TRD thus treatment decisions are largely based on patient and clinician preference as opposed to evidence-based practice. Herein we propose a systematic review and network meta-analysis (NMA) of available pharmacological and psychological augmentation treatments for TRD, to inform evidence-based management of TRD. METHODS AND ANALYSIS We plan to conduct a search of electronic databases (MEDLINE and ISIWEB) of all dates from inception for randomised controlled trials of pharmacological and psychological augmentation interventions for adults with TRD. Articles for review will be included based upon consensus from two authors. Pharmaceutical companies will be contacted for access to any unpublished data. An NMA will compare the effectiveness pharmacological adjunctive agents for TRD using preanalysis/postanalysis, assuming consistency and transitivity. ETHICS AND DISSEMINATION This project does not require research ethics board approval. The dissemination plan is to present findings at international scientific meetings and publishing results in a peer-reviewed academic journal. PROSPERO REGISTRATION NUMBER CRD42019132588.
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Affiliation(s)
- Muhammad Ishrat Husain
- General Psychiatry and Health Systems Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Ben Carter
- Biostatistics & Health Informatics, King's College London, London, UK
| | - Brett D M Jones
- General Psychiatry and Health Systems Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Allan Young
- Department of Psychological Medicine, King's College London, London, UK
| | - Andre F Carvalho
- General Psychiatry and Health Systems Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Pikouli Κ, Konstantakopoulos G, Kalampaka Spilioti P, Fytrolaki E, Ploumpidis D, Economou M. [The impact of the recent financial crisis on the users' profile of a community mental health unit]. Psychiatriki 2019; 30:97-107. [PMID: 31425138 DOI: 10.22365/jpsych.2019.302.97] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
During previous financial crises as well as the recent global financial crisis, a strong impact of the crisis on the population mental health in many countries has been observed. Similarly, in Greece, a series of epidemiological studies pointed out the consequences of the economic crisis on the population mental health. However, there is limited data available, both in Greece and worldwide, regarding the impact of the economic crisis from the perspective of mental health services. The goal of the present study was to examine possible changes on the community mental health during the first years of the Greek financial crisis, as they are reflected on the operation of a community mental health unit with a specific catchment area within Athens (Byron and Kessariani). The demographic, social and clinical characteristics of adult users who were admitted for the first time at ByronKessariani Mental Health Community Center during the years 2008-2013 were analysed. The impact of the financial crisis on the workload of the center was also assessed during the same period. The sample of the study consisted of 1865 adult users and the data was collected with the use of an ad hoc structured questionnaire as well as from the users' case files. No significant differentiation on the number of clients admitted to the center per year after the beginning of the financial crisis was found. However, it is possible that an upper limit has been reached on the center's capacity to admit new clients, i.e. a ceiling effect, as it is shown from the increased number of provided sessions per year as well as from the increase in the mean waiting time for the intake of new patients during the same period. A constant increase in the number of women among the new clients of ByronKessariani Mental Health Community Center was found, but no significant differentiations were detected during the study period. Moreover, the study showed an upward trend in aggressive behavior as a reason for admission, a significant and continuous increase in the rate of unemployed individuals among the new clients, as well as a statistically significant increase in the number of referrals for psychotherapy during the study period. There was also an increase in the number of patients who had psychiatric history, even though they were admitted to Byron-Kessariani Mental Health Community Center for the first time. No significant differentiations were found in the remaining users' demographic and clinical characteristics assessed. Our study showed that during the crisis community mental health services are under pressure due to the increased needs of patients, especially the needs for psychotherapeutic intervention and psychological support. The increased unemployment rates affect the influx of new patients as well as the therapeutic management of many users. Reinforcement of the community mental health service network is an important strategy against the consequences of the crisis on the population mental health.
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Affiliation(s)
- Κ Pikouli
- First Department of Psychiatry, Byron-Kessariani Community Mental Health Centre, Athens University Medical School, Eginition Hospital, Athens, Greece
| | - G Konstantakopoulos
- First Department of Psychiatry, Byron-Kessariani Community Mental Health Centre, Athens University Medical School, Eginition Hospital, Athens, Greece
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - P Kalampaka Spilioti
- First Department of Psychiatry, Byron-Kessariani Community Mental Health Centre, Athens University Medical School, Eginition Hospital, Athens, Greece
| | - E Fytrolaki
- First Department of Psychiatry, Byron-Kessariani Community Mental Health Centre, Athens University Medical School, Eginition Hospital, Athens, Greece
| | - D Ploumpidis
- First Department of Psychiatry, Byron-Kessariani Community Mental Health Centre, Athens University Medical School, Eginition Hospital, Athens, Greece
| | - M Economou
- First Department of Psychiatry, Byron-Kessariani Community Mental Health Centre, Athens University Medical School, Eginition Hospital, Athens, Greece
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Abstract
Digital interventions for anxiety disorders have been well-researched over the past two decades. However, reviews to date have focused on internet-based cognitive behavioural therapy (iCBT), whereas other psychological interventions have received less attention. The aim of this review was therefore to evaluate the effectiveness of digitally delivered psychological therapies (CBT, Attention Bias Modification, Exposure Therapy, Applied Relaxation, Bibliotherapy, Psychodynamic Therapy, Mindfulness, Behavioural Stress Management, Counselling) compared with control conditions and/or other psychological interventions for anxiety disorders (Social Anxiety Disorder (SAD), Health Anxiety, Obsessive-Compulsive Disorder (OCD), Post-traumatic Stress Disorder (PTSD), Specific Phobias, Panic Disorder (PD), Generalised Anxiety Disorder (GAD)]. 68 randomised controlled trials (RCTs) were reviewed. SAD was the anxiety disorder for which the most RCTs were conducted. Overall, findings support the effectiveness of iCBT for SAD; for the remaining interventions, although some RCTs indicated significant improvement (within groups) at post-treatment and/or follow up, between group findings were less consistent and overall, methodological differences across trials failed to provide strong supporting evidence. Finally, the level of therapist contact or expertise did not appear to affect much treatment effectiveness. Additional large, methodologically rigorous trials are needed to investigate further whether different digitally delivered psychological interventions are equally effective for anxiety disorders. Moreover, further studies are pertinent in order to examine the maintenance of therapy gains after the end of treatments and understand how these work [(e.g. the influence of therapist factors, user engagement and/or satisfaction, potential access barriers and treatments with diverse population groups (e.g. BME groups)].
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Affiliation(s)
- Evgenia Stefanopoulou
- Turning Point, Registered Charity, Standon House, 21 Mansell Street, London, E1 8AA, UK.
| | - David Lewis
- Turning Point, Registered Charity, Standon House, 21 Mansell Street, London, E1 8AA, UK
| | - Matthew Taylor
- Turning Point, Registered Charity, Standon House, 21 Mansell Street, London, E1 8AA, UK
| | - James Broscombe
- Turning Point, Registered Charity, Standon House, 21 Mansell Street, London, E1 8AA, UK
| | - Jan Larkin
- Turning Point, Registered Charity, Standon House, 21 Mansell Street, London, E1 8AA, UK
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21
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Ternes M, Richer I, Farrell MacDonald S. Distinguishing the features of offenders who do and do not complete substance use treatment in corrections: Extending the reach of psychological services. Psychol Serv 2019; 17:422-432. [PMID: 30730154 DOI: 10.1037/ser0000326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Approximately 80% of offenders serving sentences in Canadian federal institutions present a history of substance use that requires psychological services. Correctional substance use programs (SUPs) have been shown to be effective in reducing reconviction for offenders who complete all sessions. However, a significant proportion of offenders entering an SUP do not complete the program for offender-related reasons such as dropping out or suspension. The purpose of the present study was to examine the prevalence of SUP noncompletion and the extent to which offenders who do not complete because of offender-related reasons differ from completers and those who do not complete for administrative reasons (e.g., transferred, released, program cancelled) on demographics, offense characteristics, substance use severity, SUP exposure, criminogenic needs, risk of recidivism, reintegration potential, and institutional charges. The study considered 4,592 federally sentenced men offenders who were enrolled in an SUP. Results showed that noncompleters for offender reasons were younger, less educated, less motivated for intervention, more likely to have committed a violent crime, more likely to have incurred a serious charge while incarcerated, more likely to have presented severe substance use, and more likely to report an unstable employment history. There were relatively few differences between SUP completers and SUP noncompleters for administrative reasons. The results highlight that noncompleters for offender reasons present individual characteristics that might affect their responsivity to treatment. Identifying offenders presenting this specific profile and tailoring psychological services to facilitate their learning could help reduce program noncompletion and improve rehabilitation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Isabelle Richer
- Addiction Research and Study Program, Faculty of Medicine and Health Sciences, University of Sherbrooke
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22
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Abstract
Despite substantial advances in treatment and management strategies for major depression, less than 50% of patients respond to first-line antidepressant treatment or psychotherapy. Given the growing number of controlled studies of psychotherapy for treatment-resistant depression (TRD) and the preference for psychotherapy of depressed subjects as a treatment option, we conducted a meta-analysis and meta-regression analysis to investigate the effectiveness of psychotherapy for TRD. Seven different psychotherapies were studied in 21 trials that included a total of 25 comparisons. In three comparisons of psychotherapy v. treatment as usual (TAU) we found no evidence to conclude that there is a significant benefit of psychotherapy as compared with TAU. In 22 comparisons of add-on psychotherapy plus TAU v. TAU only, we found a moderate general effect size of 0.42 (95% CI 0.29-0.54) in favor of psychotherapy plus TAU. The meta-regression provided evidence for a positive association between baseline severity as well as group v. individual therapy format with the treatment effect. There was no evidence for publication bias. Most frequent investigated treatments were cognitive behavior therapy, interpersonal psychotherapy, mindfulness-based cognitive therapy, and cognitive behavioral analysis system of psychotherapy. Our meta-analysis provides evidence that, in addition to pharmacological and neurostimulatory treatments, the inclusion of add-on of psychotherapy to TAU in guidelines for the treatment of TRD is justified and will provide better outcomes for this difficult-to-treat population.
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Affiliation(s)
- Suzanne van Bronswijk
- Department of Psychiatry and Psychology,University Hospital Maastricht, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University,P.O. Box 5800, 6202 AZ Maastricht,The Netherlands
| | - Neha Moopen
- School of Social and Behavioral Sciences, Tilburg University,Tilburg,The Netherlands
| | - Lian Beijers
- Department of Psychiatry,University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE),Groningen,The Netherlands
| | - Henricus G Ruhe
- Department of Psychiatry,Warneford Hospital, University of Oxford,Oxford,UK
| | - Frenk Peeters
- Department of Psychiatry and Psychology,University Hospital Maastricht, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University,P.O. Box 5800, 6202 AZ Maastricht,The Netherlands
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Minichino A, Rutigliano G, Merlino S, Davies C, Oliver D, De Micheli A, Patel R, McGuire P, Fusar-Poli P. Unmet needs in patients with brief psychotic disorders: Too ill for clinical high risk services and not ill enough for first episode services. Eur Psychiatry 2019; 57:26-32. [PMID: 30658277 DOI: 10.1016/j.eurpsy.2018.12.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with acute and transient psychotic disorders (ATPDs) are by definition remitting, but have a high risk of developing persistent psychoses, resembling a subgroup of individuals at Clinical High Risk for Psychosis (CHR-P). Their pathways to care, treatment offered and long-term clinical outcomes beyond risk to psychosis are unexplored. We conducted an electronic health record-based retrospective cohort study including patients with ATPDs within the SLaM NHS Trust and followed-up to 8 years. METHODS A total of 2561 ATPDs were included in the study. A minority were detected (8%) and treated (18%) by Early Intervention services (EIS) and none by CHR-P services. Patients were offered a clinical follow-up of 350.40 ± 589.90 days. The cumulative incidence of discharges was 40% at 3 months, 60% at 1 year, 69% at 2 years, 77% at 4 years, and 82% at 8 years. Treatment was heterogeneous: the majority of patients received antipsychotics (up to 52%), only a tiny minority psychotherapy (up to 8%). RESULTS Over follow-up, 32.88% and 28.54% of ATPDS received at least one mental health hospitalization or one compulsory hospital admission under the Mental Health Act, respectively. The mean number of days spent in psychiatric hospital was 66.39 ± 239.44 days. CONCLUSIONS The majority of ATPDs are not detected/treated by EIS or CHR-P services, receive heterogeneous treatments and short-term clinical follow-up. ATPDs have a high risk of developing severe clinical outcomes beyond persistent psychotic disorders and unmet clinical needs that are not targeted by current mental health services.
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Affiliation(s)
- Amedeo Minichino
- Early Psychosis: Interventions & Clinical-detection (EPIC) lab, Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Grazia Rutigliano
- Early Psychosis: Interventions & Clinical-detection (EPIC) lab, Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
| | - Sergio Merlino
- Early Psychosis: Interventions & Clinical-detection (EPIC) lab, Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
| | - Cathy Davies
- Early Psychosis: Interventions & Clinical-detection (EPIC) lab, Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
| | - Dominic Oliver
- Early Psychosis: Interventions & Clinical-detection (EPIC) lab, Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
| | - Andrea De Micheli
- Early Psychosis: Interventions & Clinical-detection (EPIC) lab, Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
| | - Rashmi Patel
- Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
| | - Philip McGuire
- Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions & Clinical-detection (EPIC) lab, Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; OASIS Service, South London and the Maudsley NHS Foundation Trust, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
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Cummings JR, Ji X, Lally C, Druss BG. Racial and Ethnic Differences in Minimally Adequate Depression Care Among Medicaid-Enrolled Youth. J Am Acad Child Adolesc Psychiatry 2019; 58:128-138. [PMID: 30577928 PMCID: PMC8051617 DOI: 10.1016/j.jaac.2018.04.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 04/04/2018] [Accepted: 06/20/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine racial and ethnic disparities in the receipt of minimally adequate depression treatment in Medicaid-enrolled youth. METHOD Medicaid claims data of 2008 through 2011 were used to derive a cohort of youth (5-17 years old) who were diagnosed with a new episode of major depression (N = 45,816) across 9 states. Dichotomous outcomes measured the receipt of minimally adequate psychotherapy (≥4 psychotherapy visits within 12 weeks of initiation); minimally adequate medication (filled antidepressants for 84 of 144 days); any minimally adequate treatment (psychotherapy or medication); and no psychotherapy or medication. Racial/ethnic disparities in the outcome measures were estimated using logistic regression models that controlled for predisposing, enabling, and need-related factors. RESULTS Less than four-tenths (38.3%) of the cohort received minimally adequate psychotherapy, 19.2% received minimally adequate pharmacotherapy, and 49.9% received any minimally adequate treatment; conversely, 16.4% received no treatment. Adjusted percentages of black (42.3%; p < .001) and Hispanic (48.2%; p < .001) youth who received minimally adequate treatment were significantly smaller than for non-Hispanic whites (54.7%) because of lower likelihoods of receiving minimally adequate psychotherapy and/or minimally adequate pharmacotherapy. In addition, adjusted percentages of black (20.2%; p < .001) and Hispanic (15.0%; p < .01) youth who received no treatment were significantly larger than for non-Hispanic white youth (12.9%). CONCLUSION The percentage of Medicaid-enrolled youth who receive minimally adequate treatment for depression is small overall and even smaller for racial/ethnic minorities than for whites. Future research is needed to identify strategies that improve the overall quality of depression treatment in Medicaid-enrolled youth and decrease disparities in care.
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Affiliation(s)
| | - Xu Ji
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Cathy Lally
- Rollins School of Public Health, Emory University, Atlanta, GA
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25
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Abstract
OBJECTIVE The aim of present study is to quantitatively evaluate the association between different interventions and abstinence rates based on network meta-analysis. METHOD Following PRISMA guidelines, randomized clinical trials that compared different alcoholic interventions for alcohol use disorders associated with abstinence rates in treatment sessions or/and follow-up sessions were recruited. Main data synthesis was performed by Bayesian random-effects network meta-analyses, and the relative ranking of interventions was estimated by cumulative probability P values (SUCRA). Funnel plot symmetry was used to detect publication bias. Moreover, pair-wised comparison was also conducted to determine the statistical difference and forest plots were generated to calculate the differences between the groups. The Grades of Recommendations Assessment, Development and Evaluation (GRADE) criteria were utilized for the recommendations of evidence from pairwise direct comparisons. RESULTS A total of 137 RCTs containing 27,282 participants and 8 variations of psychotherapy, pharmacotherapy, contingency management, and brief intervention used as treatment interventions were included. In summary, contingency management plus psychotherapy was demonstrated to be effective and possessed the best rank of achieving the highest abstinence rate in treatment sessions (SUCRA, 0.61). Pharmacotherapy plus psychotherapy also revealed its efficacy and was associated with the highest abstinence rate in follow-up sessions (SUCRA, 0.40). More importantly, psychotherapy alone was demonstrated not to be associated with higher abstinence rates in both treatment (OR, 1.052; 95% CI, 0.907-1.220) and follow-up sessions (OR, 0.967; 95% CI, 0.552-1.693), yet pharmacotherapy seemed to be the only intervention associated with higher abstinence rates compared to controls in both sessions (treatment session: OR, 1.074; 95% CI, 1.002-1.152) (follow-up session: OR, 1.442; 95% CI, 1.094-1.900). CONCLUSIONS Contingency management plus psychotherapy and pharmacotherapy plus psychotherapy were demonstrated to be associated with the highest abstinence rates in treatment sessions and follow-up sessions, respectively. However, contingency management and pharmacotherapy seemed to be the substantial crucial factors allowing for the maintenance of the highest abstinence rates in respective sessions, although we need more evidence for further validation.
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Affiliation(s)
- Jiamin Gao
- Department of Emergency, Huashan Hospital, Fudan University, Shanghai
| | - Jun Cao
- Department of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan
| | - Tao Guo
- Department of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan
| | - Yunyue Xiao
- Department of Clinical Psychology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Mercer L, Evans LJ, Turton R, Beck A. Psychological Therapy in Secondary Mental Health Care: Access and Outcomes by Ethnic Group. J Racial Ethn Health Disparities 2018; 6:419-426. [PMID: 30430460 DOI: 10.1007/s40615-018-00539-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/05/2018] [Accepted: 10/29/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To explore the differences in access to, and outcomes of, psychological therapy for different ethnic groups across a South London Mental Health Trust. METHOD This study used Trust data to explore the proportions of ethnic groups accessing psychological therapy as a proportion of all patients supported by the Trust, as well as their outcomes within broad diagnostic clusters. RESULTS Compared to proportions in the local population, there were significantly more White/White British patients and significantly fewer patients from 'other ethnic groups' in the Trust (p < .05). There was also significantly greater proportion of Black/Black British patients with schizophrenia diagnoses compared to the proportion of Black/Black British people in the local population (p < .001). Of those accessing psychological therapy, there were significantly more White/White British and 'other ethnic group' patients and significantly fewer Black/Black British patients (p < .05). For schizophrenia diagnoses, significantly fewer Black/Black British and 'other ethnic group' patients were accessing psychological therapy (p < .05); however for behavioural and emotional disorders, there were significantly higher proportions of 'other ethnic group' and White/White British patients. Outcomes varied by diagnosis; Black/Black British patients experienced significantly higher distress scores at the beginning of therapy for depression and neurotic diagnoses (p < .05), with the latter persisting at the end of treatment. CONCLUSIONS Across the Trust, there were significant differences in the proportion of ethnic groups in accessing psychological therapy, as well as in outcomes. More research is needed to understand the factors that may underlie these disparities.
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Affiliation(s)
- Louise Mercer
- South London and Maudsley NHS Foundation Trust, London, England, UK
- Department of Psychology and Psychotherapy, Maudsley Hospital, Denmark Hill, London, UK
| | - Lauren Jayne Evans
- South London and Maudsley NHS Foundation Trust, London, England, UK
- Department of Psychology and Psychotherapy, Maudsley Hospital, Denmark Hill, London, UK
| | - Robert Turton
- South London and Maudsley NHS Foundation Trust, London, England, UK.
- Department of Psychology and Psychotherapy, Maudsley Hospital, Denmark Hill, London, UK.
| | - Alison Beck
- South London and Maudsley NHS Foundation Trust, London, England, UK
- Department of Psychology and Psychotherapy, Maudsley Hospital, Denmark Hill, London, UK
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Shimoyama M, Iwasa K, Sonoyama S. The prevalence of mental health problems in adults with intellectual disabilities in Japan, associated factors and mental health service use. J Intellect Disabil Res 2018; 62:931-940. [PMID: 29968366 DOI: 10.1111/jir.12515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/15/2018] [Accepted: 06/10/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND People with intellectual disabilities are more likely than people in the general population to experience life events associated with an increased risk of mental health problems. However, there has been little research in Japan on the prevalence of mental health problems in adults with intellectual disability (ID) or on associated factors and access to relevant services. METHODS Informants completed the Japanese version of the Psychiatric Assessment Schedule for Adults with Developmental Disabilities Checklist, and questions on the use of mental health services, for 126 adults with ID living in Tokyo. RESULTS A total of 23.8% of adults with ID had scores above the Psychiatric Assessment Schedule for Adults with Developmental Disabilities Checklist threshold score. Mental health problems were associated with age, gender and life events and not associated with the level of ID or living environment. Approximately 60% of participants with mental health problems were treated by psychiatrists and 6% of them received psychotherapy. CONCLUSION In the present study, mental health problems occurred in adults with ID at similar frequencies as in previous studies. Adults with ID who experienced mental health problems tended to receive less psychological therapy than the general Japanese population experiencing such problems. This result may indicate poor provision of psychological services for people with intellectual disabilities in Japan.
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Affiliation(s)
- M Shimoyama
- Faculty of Education, Shinshu University, Nagano, Japan
| | - K Iwasa
- Department of Educational Psychology, Shujitsu University, Okayama, Japan
| | - S Sonoyama
- Faculty of Human Sciences, University of Tsukuba, Ibaraki, Japan
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28
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Abstract
BACKGROUND More than half of patients who present with depressive disorders also have elevated comorbid anxiety symptoms. Given the high comorbidity between these disorders, it is important to understand the extent that psychotherapies for depression additionally ameliorate symptoms of anxiety. METHODS Systematic searches were conducted in PubMed, PSYCinfo, EMBASE, and the Cochrane Registry of Controlled Trials. Included studies were randomized controlled trials that compared psychotherapy compared with a control condition for the treatment of adults with a primary diagnosis or elevated symptoms of depression and that examined the effects of treatment on anxiety outcomes. Acute phase depression and anxiety (continuous measure) outcomes were extracted. Effect sizes were calculated by subtracting the average post-treatment scores of the psychotherapy group from the average post-treatment scores of the comparison group divided by the pooled standard deviation. RESULTS Fifty-two studies of varying quality met the inclusion criteria. Pooled effect sizes showed that anxiety outcomes were significantly lower in the psychotherapy conditions than in control conditions at post-treatment [g = 0.52; 95% confidence interval (CI) 0.44-0.60; NNT (numbers-needed-to-treat) = 3.50]. Moderate heterogeneity was observed (I2 = 55%, 95% CI 40-66). Bivariate metaregression analysis revealed a significant association between depression and anxiety effect sizes at post-treatment Longer-term follow-ups of up to 14 months post-baseline showed indications for a small lasting effect of psychotherapy on anxiety outcomes (g = 0.27). CONCLUSIONS This meta-analysis provides evidence that psychotherapy aimed at depression can also reduce anxiety symptoms in relation to control conditions.
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Affiliation(s)
- Erica Weitz
- Department of Clinical, Neuro and Developmental Psychology,EMGO Institute for Health and Care Research,Vrije Universiteit Amsterdam,Van der Boechorststraat 1, 1081 BT Amsterdam,The Netherlands
| | - Annet Kleiboer
- Department of Clinical, Neuro and Developmental Psychology,EMGO Institute for Health and Care Research,Vrije Universiteit Amsterdam,Van der Boechorststraat 1, 1081 BT Amsterdam,The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology,EMGO Institute for Health and Care Research,Vrije Universiteit Amsterdam,Van der Boechorststraat 1, 1081 BT Amsterdam,The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology,EMGO Institute for Health and Care Research,Vrije Universiteit Amsterdam,Van der Boechorststraat 1, 1081 BT Amsterdam,The Netherlands
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Salomonsson S, Hedman-Lagerlöf E, Öst LG. Sickness absence: a systematic review and meta-analysis of psychological treatments for individuals on sick leave due to common mental disorders. Psychol Med 2018; 48:1954-1965. [PMID: 29380722 DOI: 10.1017/s0033291718000065] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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] [Indexed: 02/06/2023]
Abstract
Sick leave due to common mental disorders (CMDs) increase rapidly and present a major societal challenge. The overall effect of psychological interventions to reduce sick leave and symptoms has not been sufficiently investigated and there is a need for a systematic review and meta-analysis of the field. The aim of the present meta-analysis was to calculate the effect size of psychological interventions for CMDs on sick leave and psychiatric symptoms based on all published randomized controlled trials. Methodological quality, the risk of bias and publication bias were also assessed. The literature searches gave 2240 hits and 45 studies were included. The psychological interventions were more effective than care as usual on both reduced sick leave (g = 0.15) and symptoms (g = 0.21). There was no significant difference in effect between work focused interventions, problem-solving therapy, cognitive behavioural therapy or collaborative care. We conclude that psychological interventions are more effective than care as usual to reduce sick leave and symptoms but the effect sizes are small. More research is needed on psychological interventions that evaluate effects on sick leave. Consensual measures of sick leave should be established and quality of psychotherapy for patients on sick leave should be improved.
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Affiliation(s)
- Sigrid Salomonsson
- Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden
| | - Erik Hedman-Lagerlöf
- Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden
| | - Lars-Göran Öst
- Department of Psychology,Stockholm University,Stockholm,Sweden
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30
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Burkey MD, Hosein M, Morton I, Purgato M, Adi A, Kurzrok M, Kohrt BA, Tol WA. Psychosocial interventions for disruptive behaviour problems in children in low- and middle-income countries: a systematic review and meta-analysis. J Child Psychol Psychiatry 2018; 59:982-993. [PMID: 29633271 DOI: 10.1111/jcpp.12894] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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] [Accepted: 02/12/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Most of the evidence for psychosocial interventions for disruptive behaviour problems comes from Western, high-income countries. The transferability of this evidence to culturally diverse, low-resource settings with few mental health specialists is unknown. METHODS We conducted a systematic review with random-effects meta-analysis of randomized controlled trials examining the effects of psychosocial interventions on reducing behaviour problems among children (under 18) living in low- and middle-income countries (LMIC). RESULTS Twenty-six randomized controlled trials (representing 28 psychosocial interventions), evaluating 4,441 subjects, met selection criteria. Fifteen (54%) prevention interventions targeted general or at-risk populations, whereas 13 (46%) treatment interventions targeted children selected for elevated behaviour problems. Most interventions were delivered in group settings (96%) and half (50%) were administered by non-specialist providers. The overall effect (standardized mean difference, SMD) of prevention studies was -0.25 (95% confidence interval (CI): -0.41 to -0.09; I2 : 78%) and of treatment studies was -0.56 (95% CI: -0.51 to -0.24; I2 : 74%). Subgroup analyses demonstrated effectiveness for child-focused (SMD: -0.35; 95% CI: -0.57 to -0.14) and behavioural parenting interventions (SMD: -0.43; 95% CI: -0.66 to -0.20), and that interventions were effective across age ranges. CONCLUSIONS Our meta-analysis supports the use of psychosocial interventions as a feasible and effective way to reduce disruptive behaviour problems among children in LMIC. Our study provides strong evidence for child-focused and behavioural parenting interventions, interventions across age ranges and interventions delivered in groups. Additional research is needed on training and supervision of non-specialists and on implementation of effective interventions in LMIC settings.
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Affiliation(s)
- Matthew D Burkey
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- University of British Columbia, Vancouver, BC, Canada
| | | | - Isabella Morton
- University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Marianna Purgato
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- University of Verona, Verona, Italy
| | - Ahmad Adi
- Duke University School of Medicine, Durham, NC, USA
| | - Mark Kurzrok
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Wietse A Tol
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Rodenburg-Vandenbussche S, Carlier IVE, van Vliet IM, van Hemert AM, Stiggelbout AM, Zitman FG. Clinical and sociodemographic associations with treatment selection in major depression. Gen Hosp Psychiatry 2018; 54:18-24. [PMID: 30048764 DOI: 10.1016/j.genhosppsych.2018.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/19/2018] [Accepted: 06/22/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate treatment selection in a naturalistic sample of MDD outpatients and the factors influencing treatment selection in specialized psychiatric care. METHOD Multinomial Logistic Regression analysis investigated associations between treatment selection and patients' sociodemographic and clinical characteristics, using retrospective chart review data and Routine Outcome Monitoring (ROM) data of MDD outpatients. RESULTS Of the patients included for analyses (N = 263), 34% received psychotherapy, 32% received an antidepressant (AD) and 35% received a combination. Men were more likely than women to receive AD with reference to psychotherapy (ORAD = 5.57, 95% CI 2.38-13.00). Patients with severe depression and patients with AD use upon referral, prescribed by their general practitioner, were more likely to receive AD (ORsevere depression = 5.34, 95% CI 1.70-16.78/ORAD GP = 9.26, 95% CI 2.53-33.90) or combined treatment (ORsevere depression = 6.32, 95% CI 1.86-21.49/ORAD GP = 22.36, 95% CI 5.89-83.59) with respect to psychotherapy. More severe patients with AD upon referral received combined treatment less often compared to psychotherapy (OR = 0.14, 95% CI 0.03-0.68). CONCLUSION AD prescriptions in primary care, severity and gender influenced treatment selection for depressive disorders in secondary psychiatric care. Other factors such as the accessibility of treatment and patient preferences may have played a role in treatment selection in this setting and need further investigation.
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Affiliation(s)
| | - I V E Carlier
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
| | - I M van Vliet
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
| | - A M van Hemert
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
| | - A M Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - F G Zitman
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
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Nassri L, Schneider I, Gaum PM, Lang J. A call for Applied Knowledge and Lived Interdisciplinarity in the medical care of depressed employees: a cross-sectional survey with German occupational physicians and psychotherapists. BMJ Open 2018; 8:e021786. [PMID: 30104315 PMCID: PMC6091909 DOI: 10.1136/bmjopen-2018-021786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To identify approaches for an effective patient-centred care of depressed employees, we investigated occupational physicians' (OPs) and psychotherapists' (PTs) knowledge about job stressors on the development of depression, application of this knowledge, interdisciplinary cooperation and perceived barriers. STUDY DESIGN A cross-sectional online survey. PARTICIPANTS OPs (163; 48.5% male) and PTs (69; 43.5% male) providing complete data on the survey out of 257 OPs and 112 PTs who started the survey. There have been 458 (OPs) and 821 (PTs) initial clicks. METHODS Main outcome measures were the importance ratings of specific job stressors, the frequency of asking patients about those stressors, the need for interdisciplinary cooperation, as well as perceived barriers for cooperation. We performed multivariate analysis of variance, intraclass correlation coefficients (ICCs) and Spearman's rank-order correlations. RESULTS The achieved response rate for OPs was 56.1% and for PTs 13.6%. Both disciplines agreed on the importance of job stressors regarding depression (ICC=0.90; 95% CI: 0.54 to 0.98), but both ranked these factors differently from the current state of research. As to knowledge application, OPs showed positive associations between the importance of job stressors and the frequency of asking employees about them (eg, job insecurity (rs=0.20, p=0.005)) and PTs for social stressors (eg, interpersonal conflicts (rs=0.38, p=0.001)). OPs (mean=3.41) reported a higher necessity of interdisciplinary cooperation than PTs (mean=3.17; F(1,230)=7.02, p=0.009). Furthermore, cooperation was reported as difficult to implement. PTs perceived barriers (eg, time restriction) as more hindering (mean=3.2) than OPs (mean=2.8; F(1,171)=8.16, p=0.005). CONCLUSIONS Both disciplines are aware of the relevance of job stressors as risk factors for depression, but should be encouraged to ask employees more frequently about them. The need for interdisciplinary cooperation and possible barriers are discussed. It is crucial to emphasise the meaning of sufficient cooperation, since closing this gap for improving patient-centred care especially for employees suffering from depression is necessary.
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Affiliation(s)
- Lina Nassri
- Institute for Occupational, Social and Environmental Medicine, RWTH Aachen University, Aachen, Germany
| | - Isabell Schneider
- Institute for Occupational, Social and Environmental Medicine, RWTH Aachen University, Aachen, Germany
| | - Petra Maria Gaum
- Institute for Occupational, Social and Environmental Medicine, RWTH Aachen University, Aachen, Germany
| | - Jessica Lang
- Institute for Occupational, Social and Environmental Medicine, RWTH Aachen University, Aachen, Germany
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Abstract
Objective Youth at clinical high risk (CHR) for psychosis often demonstrate significant negative symptoms, which have been reported to be predictive of conversion to psychosis and a reduced quality of life but treatment options for negative symptoms remain inadequate. Therefore, we conducted a systematic review and network meta-analysis of all intervention studies examining negative symptom outcomes in youth at CHR for psychosis. Method The authors searched PsycINFO, Medline, Embase, CINAHL, and EBM from inception to December 2016. Studies were selected if they included any intervention that reported follow-up negative symptoms in youth at CHR for psychosis. Treatment comparisons were evaluated using both pairwise and network meta-analyses. Due to the differences in negative symptom scales the effect sizes were reported as the standardized mean difference (SMD). Results Of 3027 citations, 32 studies met our inclusion criteria, including a total of 2463 CHR participants. The null hypothesis was not rejected for any of the 11 treatments. N-methyl-D-aspartate-receptor (NMDAR) modulators trended toward a significant reduction in negative symptoms compared to placebo (SMD = -0.54; 95% CI = -1.09 to 0.02; I2 = 0%, P = .06). In respective order of descending effectiveness as per the treatment hierarchy, NMDAR modulators were more effective than family therapy, need-based interventions, risperidone, amisulpride, cognitive behavioral therapy, omega-3, olanzapine, supportive therapy, and integrated psychological interventions. Conclusions Efficacy and effectiveness were not confirmed for any negative symptom treatment. Many studies had small samples and the majority were not designed to target negative symptoms.
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Affiliation(s)
- Daniel J Devoe
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada
| | - Aaron Peterson
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada
| | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada
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Abstract
There is a lack of knowledge about specific components that make interventions effective in preventing or reducing child maltreatment. The aim of the present meta-analysis was to increase this knowledge by summarizing findings on effects of interventions for child maltreatment and by examining potential moderators of this effect, such as intervention components and study characteristics. Identifying effective components is essential for developing or improving child maltreatment interventions. A literature search yielded 121 independent studies (N = 39,044) examining the effects of interventions for preventing or reducing child maltreatment. From these studies, 352 effect sizes were extracted. The overall effect size was significant and small in magnitude for both preventive interventions (d = 0.26, p < .001) and curative interventions (d = 0.36, p < .001). Cognitive behavioral therapy, home visitation, parent training, family-based/multisystemic, substance abuse, and combined interventions were effective in preventing and/or reducing child maltreatment. For preventive interventions, larger effect sizes were found for short-term interventions (0-6 months), interventions focusing on increasing self-confidence of parents, and interventions delivered by professionals only. Further, effect sizes of preventive interventions increased as follow-up duration increased, which may indicate a sleeper effect of preventive interventions. For curative interventions, larger effect sizes were found for interventions focusing on improving parenting skills and interventions providing social and/or emotional support. Interventions can be effective in preventing or reducing child maltreatment. Theoretical and practical implications are discussed.
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Affiliation(s)
- Claudia E van der Put
- Research Institute of Child Development and Education, University of Amsterdam, P.O. Box 15780, 1001 NG, Amsterdam, The Netherlands.
| | - Mark Assink
- Research Institute of Child Development and Education, University of Amsterdam, P.O. Box 15780, 1001 NG, Amsterdam, The Netherlands
| | - Jeanne Gubbels
- Research Institute of Child Development and Education, University of Amsterdam, P.O. Box 15780, 1001 NG, Amsterdam, The Netherlands
| | - Noëlle F Boekhout van Solinge
- Research Institute of Child Development and Education, University of Amsterdam, P.O. Box 15780, 1001 NG, Amsterdam, The Netherlands
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Degnan A, Baker S, Edge D, Nottidge W, Noke M, Press CJ, Husain N, Rathod S, Drake RJ. The nature and efficacy of culturally-adapted psychosocial interventions for schizophrenia: a systematic review and meta-analysis. Psychol Med 2018; 48:714-727. [PMID: 28830574 DOI: 10.1017/s0033291717002264] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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: 01/13/2023]
Abstract
BACKGROUND Evidence-based psychosocial treatments for schizophrenia founded on Western belief systems and values may not be efficacious in different cultures without adaptation. This systematic review analyses the nature and outcomes of culturally-adapted psychosocial interventions in schizophrenia, examining how interventions have been adapted, their efficacy and what features drive heterogeneity in outcome. METHOD Articles identified by searching electronic databases from inception to 3 March 2016, reference lists and previous reviews were independently screened by two authors for eligible controlled trials. Data on the nature of adaptations was analysed inductively using thematic analyses. Meta-analyses were conducted using random effects models to calculate effect sizes (Hedges' g) for symptoms. RESULTS Forty-six studies with 7828 participants were included, seven adapted for minority populations. Cultural adaptations were grouped into nine themes: language, concepts and illness models, family, communication, content, cultural norms and practices, context and delivery, therapeutic alliance, and treatment goals. Meta-analyses showed significant post-treatment effects in favour of adapted interventions for total symptom severity (n = 2345, g: -0.23, 95% confidence interval (CI) -0.36 to -0.09), positive (n = 1152, g: -0.56, 95% CI -0.86 to -0.26), negative (n = 855, g: -0.39, 95% CI -0.63 to -0.15), and general (n = 525, g: -0.75, CI -1.21 to -0.29) symptoms. CONCLUSIONS The adaptation process can be described within a framework that serves as a benchmark for development or assessment of future adaptations. Culturally adapted interventions were more efficacious than usual treatment in proportion to the degree of adaptation. There is insufficient evidence to show that adapted interventions are better than non-adapted interventions. Features of context, intervention and design influenced efficacy. Investigating whether adaptation improves efficacy, most importantly amongst ethnic minorities, requires better designed trials with comparisons against unadapted interventions.
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Affiliation(s)
- A Degnan
- Division of Psychology & Mental Health, Faculty of Biology,Medicine & Health, The University of Manchester,Manchester,UK
| | - S Baker
- Division of Psychology & Mental Health, Faculty of Biology,Medicine & Health, The University of Manchester,Manchester,UK
| | - D Edge
- Division of Psychology & Mental Health, Faculty of Biology,Medicine & Health, The University of Manchester,Manchester,UK
| | - W Nottidge
- Division of Psychology & Mental Health, Faculty of Biology,Medicine & Health, The University of Manchester,Manchester,UK
| | - M Noke
- Division of Psychology & Mental Health, Faculty of Biology,Medicine & Health, The University of Manchester,Manchester,UK
| | - C J Press
- Division of Psychology & Mental Health, Faculty of Biology,Medicine & Health, The University of Manchester,Manchester,UK
| | - N Husain
- Division of Psychology & Mental Health, Faculty of Biology,Medicine & Health, The University of Manchester,Manchester,UK
| | - S Rathod
- Southern Health NHS Foundation Trust, Clinical Trials Facility, Tom Rudd Unit, Moorgreen Hospital,West End, Southampton,UK
| | - R J Drake
- Division of Psychology & Mental Health, Faculty of Biology,Medicine & Health, The University of Manchester,Manchester,UK
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Degnan A, Berry K, Sweet D, Abel K, Crossley N, Edge D. Social networks and symptomatic and functional outcomes in schizophrenia: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2018; 53:873-888. [PMID: 29951929 PMCID: PMC6133157 DOI: 10.1007/s00127-018-1552-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 06/14/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To conduct a systematic review and meta-analysis to examine the strength of associations between social network size and clinical and functional outcomes in schizophrenia. METHOD Studies were identified from a systematic search of electronic databases (EMBASE, Medline, PsycINFO, and Web of Science) from January 1970 to June 2016. Eligible studies included peer-reviewed English language articles that examined associations between a quantitative measure of network size and symptomatic and/or functional outcome in schizophrenia-spectrum diagnoses. RESULTS Our search yielded 16 studies with 1,929 participants. Meta-analyses using random effects models to calculate pooled effect sizes (Hedge's g) found that smaller social network size was moderately associated with more severe overall psychiatric symptoms (N = 5, n = 467, g = - 0.53, 95% confidence interval (CI) = - 0.875, - 0.184, p = 0.003) and negative symptoms (N = 8, n = 577, g = - 0.75, 95% CI = - 0.997, - 0.512, p = 0.000). Statistical heterogeneity was observed I2 = 63.04%; I2 = 35.75%,) which could not be explained by low-quality network measures or sample heterogeneity in sensitivity analyses. There was no effect for positive symptoms (N = 7, n = 405, g = - 0.19, 95% CI = 0.494, 0.110, p = 0.213) or social functioning (N = 3, n = 209, g = 0.36, 95% CI = - 0.078, 0.801, p = 0.107). Narrative synthesis suggested that larger network size was associated with improved global functioning, but findings for affective symptoms and quality of life were mixed. CONCLUSION Psychosocial interventions which support individuals to build and maintain social networks may improve outcomes in schizophrenia. The review findings are cross-sectional and thus causal direction cannot be inferred. Further research is required to examine temporal associations between network characteristics and outcomes in schizophrenia and to test theoretical models relating to explanatory or mediating mechanisms.
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Affiliation(s)
- Amy Degnan
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Zochonis Building; Oxford Road, Manchester, M13 9PL, UK.
| | - Katherine Berry
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - Daryl Sweet
- School of Social Sciences, Education and Social Work, Queen's University, Belfast, UK
| | - Kathryn Abel
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - Nick Crossley
- School of Social Sciences, The University of Manchester, Manchester, UK
| | - Dawn Edge
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
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Clough BA, Nazareth SM, Casey LM. The Therapy Attitudes and Process Questionnaire: A Brief Measure of Factors Related to Psychotherapy Appointment Attendance. Patient 2017; 10:237-250. [PMID: 27718132 DOI: 10.1007/s40271-016-0199-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient non-attendance and dropout remains problematic in mental health settings. The theory of planned behavior (TPB) has proven useful in understanding such challenges in a variety of healthcare settings, but the absence of an adequate measure in mental health has hampered research in this area. OBJECTIVE The aim of the current study was to develop and conduct an initial psychometric investigation of a brief measure, the Therapy Attitudes and Process Questionnaire (TAP), utilizing the TPB to understand factors associated with attendance in mental health settings. METHODS We used a quantitative survey-based design and administered the TAP to 178 adult participants who were engaged in individual or group psychotherapy. A subsample also provided data to assess validity and reliability. RESULTS A four-factor solution was revealed through exploratory factor analysis and accounted for approximately 75 % of the variance in scores. Factors corresponded to those predicted by the TPB. Analyses supported the reliability, validity, and internal consistency of the measure. CONCLUSIONS Results suggest that the TAP may be a useful tool for examining patients' attitudes and beliefs about attending psychotherapy appointments. The TAP can be used to better understand patients' intentions, attitudes, perceptions of behavioral control, and subjective norms relating to psychotherapy attendance. This understanding may facilitate improved outcomes for patients and clinicians.
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Affiliation(s)
- Bonnie A Clough
- School of Psychology and Counselling, Institute for Resilient Regions, University of Southern Queensland, 37 Sinnathamby Boulevard, Springfield Central, QLD, 4300, Australia.
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Mt Gravatt, QLD, Australia.
| | - Sonia M Nazareth
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Mt Gravatt, QLD, Australia
| | - Leanne M Casey
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Mt Gravatt, QLD, Australia
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Eisele M, Boczor S, Rakebrandt A, Blozik E, Träder JM, Störk S, Herrmann-Lingen C, Scherer M. General practitioners' awareness of depressive symptomatology is not associated with quality of life in heart failure patients - cross-sectional results of the observational RECODE-HF Study. BMC Fam Pract 2017; 18:100. [PMID: 29221442 PMCID: PMC5723041 DOI: 10.1186/s12875-017-0670-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 11/22/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Depression is a common comorbidity in patients with chronic heart failure (HF) and linked to a wider range of symptoms which, in turn, are linked to a decreased health-related quality of life (HRQOL). Treatment of depression might improve HRQOL but detecting depression is difficult due to the symptom overlap between HF and depression. Therefore, clinical guidelines recommend to routinely screen for depression in HF patients. No studies have so far investigated the treatment after getting aware of a depressive symptomatology and its correlation with HRQOL in primary care HF patients. Therefore, we examined the factors linked to depression treatment and those linked to HRQOL in HF patients. We hypothesized that GPs' awareness of depressive symptomatology was associated with depression treatment and HRQOL in HF patients. METHODS For this observational study, HF patients were recruited in primary care practices and filled out a questionnaire including PHQ-9 and HADS. A total of 574 patients screened positive for depressive symptomatology. Their GPs were interviewed by phone regarding the patients' comorbidities and potential depression treatment. Descriptive and regression analysis were performed. RESULTS GPs reported various types of depression treatments (including dialogue/counselling by the GP him/herself in 31.8% of the patients). The reported rates differed considerably between GP-reported initiated treatment and patient-reported utilised treatment regarding psychotherapy (16.4% vs. 9.5%) and pharmacotherapy (61.2% vs. 30.3%). The GPs' awareness of depressive symptomatology was significantly associated with the likelihood of receiving pharmacotherapy (OR 2.8; p < 0.001) but not psychotherapy. The patient's HRQOL was not significantly associated with the GPs' awareness of depression. CONCLUSION GPs should be aware of the gap between GP-initiated and patient-utilised depression treatments in patients with chronic HF, which might lead to an undersupply of depression treatment. It remains to be investigated why GPs' awareness of depressive symptomatology is not linked to patients' HRQOL. We hypothesize that GPs are aware of cases with reduced HRQOL (which improves under depression treatment) and unaware of cases whose depression do not significantly impair HRQOL, resulting in comparable levels of HRQOL in both groups. This hypothesis needs to be further investigated.
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Affiliation(s)
- Marion Eisele
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Sigrid Boczor
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Anja Rakebrandt
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Eva Blozik
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Jens-Martin Träder
- Department of Primary Medical Care, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Straubmühlweg 2a, 97078 Würzburg, Germany
| | - Christoph Herrmann-Lingen
- University of Göttingen Medical Center, and German Center for Cardiovascular Research, partner site Göttingen, von-Siebold-Str. 5, D-37099 Göttingen, Germany
| | - Martin Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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Nouwens PJG, Smulders NBM, Embregts PJCM, van Nieuwenhuizen C. Meeting the support needs of persons with mild intellectual disability or borderline intellectual functioning: still a long way to go. J Intellect Disabil Res 2017; 61:1104-1116. [PMID: 29047184 DOI: 10.1111/jir.12427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 07/22/2017] [Accepted: 09/14/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Among persons with a mild intellectual disability or borderline intellectual functioning, differences in their characteristics imply that a differentiated approach is required to meet their needs. This retrospective study examined whether the history of support/treatment programs and the type of healthcare providers involved matched the specific support needs of persons with a mild intellectual disability or borderline intellectual functioning. METHOD Five (previously identified) profiles of persons with a mild intellectual disability or borderline intellectual functioning were used to investigate to what extent the support needs of this group had been met. For the 250 persons with mild intellectual disability or borderline intellectual functioning who matched these five profiles, data were collected retrospectively from their case files. RESULTS Persons with mild intellectual disability or borderline intellectual functioning received a very similar amount and type of support/treatment programs. Differences between the profiles were found for non-verbal therapy, residential treatment and contacts with social work. Regarding the type of healthcare providers involved, differences between the profiles emerged for specialised intellectual disability services, youth services and specialised addiction services. CONCLUSIONS The support programs for a heterogeneous population of persons with mild intellectual disability or borderline intellectual functioning seem to be suboptimal, indicating that more differentiation is required in the services offered to these individuals.
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Affiliation(s)
- P J G Nouwens
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Netherlands
| | - N B M Smulders
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Netherlands
- Prisma, Waalwijk, Netherlands
| | - P J C M Embregts
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Netherlands
- Dichterbij Innovation and Science, Gennep, Netherlands
| | - C van Nieuwenhuizen
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Netherlands
- GGzE, Institute for Forensic Mental Health Care, Centre for Child & Adolescent Psychiatry, Eindhoven, Netherlands
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Hom MA, Stanley IH, Rogers ML, Sheffler JL, Nelson KR, Joiner TE, Schramm E. Examining the characteristics and clinical features of in- and between-session suicide risk assessments among psychiatric outpatients. J Clin Psychol 2017; 74:806-818. [PMID: 29131333 DOI: 10.1002/jclp.22555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 05/18/2017] [Accepted: 09/04/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the characteristics of suicide risk assessments completed using the Decision Tree framework both in and between psychotherapy sessions, clinical features of patients for whom between-session assessments are indicated, and data collected across assessments. METHOD Data were collected from 1,358 suicide risk assessments conducted with psychiatric outpatients (N = 41) at elevated suicide risk engaged in care at a psychology training clinic. RESULTS Participants completed an average of 4.75 (standard deviation = 4.95) suicide risk assessments (2.81 ± 4.43 between-session assessments) per each month in treatment. Assessment frequency and patient ratings of suicidal desire and intent were each significantly associated with therapist risk level categorizations. CONCLUSION The Decision Tree framework's in- and between-session assessments have the potential to be implemented in a routinized format among psychiatric outpatients at elevated suicide risk. Additional research is needed to establish the feasibility and clinical utility of this framework across samples and providers.
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Liu F, Zhou N, Cao H, Fang X, Deng L, Chen W, Lin X, Liu L, Zhao H. Chinese college freshmen's mental health problems and their subsequent help-seeking behaviors: A cohort design (2005-2011). PLoS One 2017; 12:e0185531. [PMID: 29040266 PMCID: PMC5644985 DOI: 10.1371/journal.pone.0185531] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [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: 02/18/2016] [Accepted: 09/14/2017] [Indexed: 12/04/2022] Open
Abstract
Based on cohort data obtained from 13,085 college freshmen’s (2005 to 2011) SCL-90 (the Symptom Check-List-90) reports and their subsequent 4-year psychological counseling help-seeking records, this study examined the association between college students’ mental health problems and help-seeking behaviors across four college years. Female students’ mental health problems and help-seeking behaviors increased from the 2005 to the 2011 cohorts and no changes emerged for male students across cohorts. Overall, male students reported higher levels of mental health problems than did female students in the first college year, whereas female students reported more help-seeking behaviors than did male students in the following four college years. College students’ mental health problems was associated positively with help-seeking behaviors. College students were more likely to seek help from the college psychological counselling center when they experienced relatively few or quite a lot of mental health issues (i.e., an inversed U shape). Implications for future studies and practices are discussed.
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Affiliation(s)
- Fenge Liu
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China
- Counseling Center, Central University of Finance and Economics, Beijing, China
| | - Nan Zhou
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China
- * E-mail: (NZ); (XYF)
| | - Hongjian Cao
- School of Education, Guangzhou University, Guangzhou, China
- Psychological and Behavioral Research Center of Cantonese, Guangzhou University, Guangzhou, China
| | - Xiaoyi Fang
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China
- * E-mail: (NZ); (XYF)
| | - Linyuan Deng
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China
| | - Wenrui Chen
- New York University, New York, New York, United States of America
| | - Xiuyun Lin
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China
| | - Lu Liu
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China
| | - Huichun Zhao
- Counseling Center, Central University of Finance and Economics, Beijing, China
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Simon VA, Barnett D, Smith E, Mucka L, Willis D. Caregivers' abuse stigmatization and their views of mental health treatment following child sexual abuse. Child Abuse Negl 2017; 70:331-341. [PMID: 28683373 PMCID: PMC5600842 DOI: 10.1016/j.chiabu.2017.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/20/2017] [Accepted: 06/24/2017] [Indexed: 06/07/2023]
Abstract
Many families do not utilize mental health services after the discovery of child sexual abuse (CSA), even when trauma-focused treatments are offered at low or no cost. Non-offending caregivers frequently serve as gatekeepers to youths' treatment, and their reactions to CSA may figure into decisions about treatment engagement. The current study examined caregivers' abuse stigmatization (i.e., self-blame and shame about their children's CSA) and associations with two factors predictive of treatment engagement (motivation, obstacles). Participants were recruited from a Child Advocacy Center where they received forensic interviews and were offered services following CSA discovery. Participating caregiver-child dyads included 52 non-offending caregivers (83% biological parents) and their children (69% girls; Mage=10.94, SDage=2.62). Caregiver abuse stigmatization was associated with higher motivation for treatment but also more obstacles to treatment. Further, abuse stigmatization moderated associations between children's PTSD symptoms and perceived obstacles to treatment with medium effect sizes (M f2=0.287). Among caregivers experiencing high abuse stigmatization, greater child PTSD symptoms were associated with more obstacles to treatment. Among caregivers experiencing low stigmatization, child PTSD was either associated with fewer treatment obstacles or was unrelated to treatment obstacles. Results highlight the potential significance of reducing parents' abuse stigmatization for increasing mental health service utilization following CSA discovery, especially for more symptomatic youth.
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Cox G, Hetrick S. Psychosocial interventions for self-harm, suicidal ideation and suicide attempt in children and young people: What? How? Who? and Where? Evid Based Ment Health 2017; 20:35-40. [PMID: 28373210 PMCID: PMC10688523 DOI: 10.1136/eb-2017-102667] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 03/13/2017] [Indexed: 12/26/2022]
Abstract
We reviewed the evidence for the effectiveness of indicated individual psychosocial interventions for the treatment of self-harm, suicidal ideation and suicide attempts in children and young people, with a particular emphasis on the emerging use of electronic methods to deliver psychological interventions. In total, 16 randomised controlled trials (RCTs) were identified, none of which included children under the age of 12 years. Cognitive-behavioural therapy is the most commonly implemented approach in RCTs until now, although problem-solving therapy, interpersonal psychotherapy, social support and distal support methods by provision of a green card and regular receipt of postcards have also been investigated. Young people have been recruited into RCTs within schools, outpatient clinics, emergency departments and inpatient facilities. Face-to-face delivery of therapy has dominated the intervention trials thus far; however, the use of the internet, social media and mobile devices to deliver interventions to young people and other family members allows for a more novel approach to suicide prevention in youth going forward.
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Affiliation(s)
- Georgina Cox
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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Block C, Santos OA, Flores-Medina Y, Rivera Camacho DF, Arango-Lasprilla JC. Neuropsychology and Rehabilitation Services in the United States: Brief Report from a Survey of Clinical Neuropsychologists. Arch Clin Neuropsychol 2017; 32:369-374. [PMID: 28431032 DOI: 10.1093/arclin/acx002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 01/09/2017] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVE To provide a brief presentation of preliminary data on rehabilitation services provided by clinical neuropsychologists within the United States. METHOD This survey utilized data extracted from a larger international research study conducted in 39 countries including N = 173 professionals who reported to engage in neuropsychological rehabilitative services within the past year (63.6% female, 44.36 ± 11.83 years of age) took part in the study. RESULTS Neuropsychologists providing rehabilitation services in the United States in the past year were more likely to provide individual versus group therapy, likely to employ technology (e.g., personal computers, mobile phones/smartphones) as part of treatment services, see a range of diagnostic groups most prominently traumatic brain injury and stroke/vascular conditions, and work to address a range of both cognitive (e.g., memory, attention/concentration, and executive functioning) and psychological (e.g., emotional/behavioral adjustment and well-being, awareness of disability/disease) issues. CONCLUSIONS Prior published surveys suggest that clinical neuropsychologists have a growing involvement in rehabilitation services within the United States but with little clarity as to the actual characteristics of actual professional activities and practices. The present study aimed to provide such information and hopefully will be helpful in promoting additional systematic studies in this area.
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Affiliation(s)
- Cady Block
- Department of Psychiatry and Behavioral Health, Section of Neurobehavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Octavio A Santos
- Department of Psychology, University of Wisconsin at Milwaukee, Milwaukee, WI 53211, USA
| | - Yvonne Flores-Medina
- Department of Psychology, National Institute of Psychiatry Ramón de la Fuente Muñiz, Distrito Federal, Mexico City, Mexico
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Kamenov K, Twomey C, Cabello M, Prina AM, Ayuso-Mateos JL. The efficacy of psychotherapy, pharmacotherapy and their combination on functioning and quality of life in depression: a meta-analysis. Psychol Med 2017; 47:414-425. [PMID: 27780478 PMCID: PMC5244449 DOI: 10.1017/s0033291716002774] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 09/30/2016] [Accepted: 10/04/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is growing recognition of the importance of both functioning and quality of life (QoL) outcomes in the treatment of depressive disorders, but the meta-analytic evidence is scarce. The objective of this meta-analysis of randomized controlled trials (RCTs) was to determine the absolute and relative effects of psychotherapy, pharmacotherapy and their combination on functioning and QoL in patients with depression. METHOD One hundred and fifty-three outcome trials involving 29 879 participants with depressive disorders were identified through database searches in Pubmed, PsycINFO and the Cochrane Central Register of Controlled Trials. RESULTS Compared to control conditions, psychotherapy and pharmacotherapy yielded small to moderate effect sizes for functioning and QoL, ranging from g = 0.31 to g = 0.43. When compared directly, initial analysis yielded no evidence that one of them was superior. After adjusting for publication bias, psychotherapy was more efficacious than pharmacotherapy (g = 0.21) for QoL. The combination of psychotherapy and medication performed significantly better for both outcomes compared to each treatment alone yielding small effect sizes (g = 0.32 to g = 0.39). Both interventions improved depression symptom severity more than functioning and QoL. CONCLUSION Despite the small number of comparative trials for some of the analyses, this study reveals that combined treatment is superior, but psychotherapy and pharmacotherapy alone are also efficacious for improving functioning and QoL. The overall relatively modest effects suggest that future tailoring of therapies could be warranted to better meet the needs of individuals with functioning and QoL problems.
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Affiliation(s)
- K. Kamenov
- Instituto de Salud Carlos III, Centro de
Investigación Biomédica en Red, CIBERSAM, Madrid,
Spain
- Department of Psychiatry,
UniversityAutónoma de Madrid, Madrid,
Spain
| | - C. Twomey
- Faculty of Social and Human Sciences,
University of Southampton, Southampton,
UK
| | - M. Cabello
- Instituto de Salud Carlos III, Centro de
Investigación Biomédica en Red, CIBERSAM, Madrid,
Spain
- Department of Psychiatry,
UniversityAutónoma de Madrid, Madrid,
Spain
| | - A. M. Prina
- Health Service and Population Research
Department, Centre for Global Mental Health, Institute of
Psychiatry, Psychology and Neuroscience, King's College London,
London, UK
| | - J. L. Ayuso-Mateos
- Instituto de Salud Carlos III, Centro de
Investigación Biomédica en Red, CIBERSAM, Madrid,
Spain
- Department of Psychiatry,
UniversityAutónoma de Madrid, Madrid,
Spain
- Instituto de investigación de la Princesa,
(IIS-IP), Hospital Universitario de la Princesa,
Madrid, Spain
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Abstract
OBJECTIVE To document the range of web and smartphone apps used and recommended for stress, anxiety or depression by the National Health Service (NHS) in England. DESIGN The study was conducted using Freedom of Information (FOI) requests and systematic website searches. DATA SOURCES Data were collected via FOI requests to NHS services between 13 February 2015 and 31 March 2015, and searches conducted on NHS apps library websites between 26 March 2015 and 2 November 2015. DATA COLLECTION/EXTRACTION METHODS Data were compiled from responses to: (1) FOI requests sent to all Improving Access to Psychological Therapies (IAPT) services and NHS Mental Health Trusts in England and (2) NHS apps library search results. RESULTS A total of 61 (54.95%) out of the then 111 IAPT service providers responded, accounting for 191 IAPT services, and all 51 of the then NHS Mental Health Trusts responded. The results were that 13 different web apps and 35 different smartphone apps for depression, anxiety or stress were available through either referral services or the online NHS Apps Libraries. The apps used and recommended vary by area and by point of access (online library/IAPT/trust). CONCLUSIONS Future research is required to establish the evidence base for the apps that are being used in the NHS in England. There is a need for service provision to be based on evidence and established guidelines.
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Affiliation(s)
- M R Bennion
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - G Hardy
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - R K Moore
- Department of Computer Science, University of Sheffield, Sheffield, UK
| | - A Millings
- Department of Psychology, University of Sheffield, Sheffield, UK
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Evans J, Dummer V, Kinzl J. [Psychiatric and psychosomatic day hospitals in Austria]. Neuropsychiatr 2016; 30:216-222. [PMID: 27854010 DOI: 10.1007/s40211-016-0207-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/24/2016] [Indexed: 06/06/2023]
Abstract
This paper on psychiatric and psychosomatic day hospitals in Austria first looks at the overall situation of Austrian day clinics then, in a second step, compares psychiatric and psychosomatic day hospitals. For this purpose, a questionnaire was developed and sent to all psychiatric and psychosomatic day hospitals in Austria. The first part consisted of closed questions and was used to gather and evaluate the categories: general conditions for treatment in day hospitals, tasks of day hospitals, therapeutic paradigms, indication and contraindication, diagnostics, day hospital organisation, interdisciplinary cooperation and the offering in day hospitals. The second section consisted of open questions which were used to gather and evaluate active factors, difficulties, specifics and requests for future treatment in day hospitals. The results show that there is a trend towards more day hospitals. Psychosomatic day hospitals are a rather new phenomenon. Furthermore, the distinction between psychiatric and psychosomatic day hospitals is important in order to offer patients distinguishable treatment options in future. The results show that psychiatric and psychosomatic day hospitals both have a strong focus on psychotherapy and both fulfill the active factors for psychotherapy by Grawe.
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Affiliation(s)
- Janet Evans
- Leopold-Franzens Universität Innsbruck, Innsbruck, Österreich.
| | - Verena Dummer
- Universitätsklinik für Psychiatrie II, Department für Psychiatrie, Psychotherapie und Psychosomatik, Innsbruck, Österreich
| | - Johann Kinzl
- Universitätsklinik für Psychiatrie II, Department für Psychiatrie, Psychotherapie und Psychosomatik, Innsbruck, Österreich
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Abstract
IMPORTANCE Individuals released from prison have high rates of violent reoffending, and there is uncertainty about whether pharmacological treatments reduce reoffending risk. OBJECTIVE To investigate the associations between major classes of psychotropic medications and violent reoffending. DESIGN, SETTING, AND PARTICIPANTS This cohort study included all released prisoners in Sweden from July 1, 2005, to December 31, 2010, through linkage of population-based registers. Rates of violent reoffending during medicated periods were compared with rates during nonmedicated periods using within-individual analyses. Follow-up ended December 31, 2013. EXPOSURES Periods with or without dispensed prescription of psychotropic medications (antipsychotics, antidepressants, psychostimulants, drugs used in addictive disorders, and antiepileptic drugs) after prison release. Prison-based psychological treatments were investigated as a secondary exposure. MAIN OUTCOMES AND MEASURES Violent crime after release from prison. RESULTS The cohort included 22 275 released prisoners (mean [SD] age, 38 [13] years; 91.9% male). During follow-up (median, 4.6 years; interquartile range, 3.0-6.4 years), 4031 individuals (18.1%) had 5653 violent reoffenses. The within-individual hazard ratio (HR) associated with dispensed antipsychotics was 0.58 (95% CI, 0.39-0.88), based on 100 events in 1596 person-years during medicated periods and 1044 events in 11 026 person-years during nonmedicated periods, equating to a risk difference of 39.7 (95% CI, 11.3-57.7) fewer violent reoffenses per 1000 person-years. The within-individual HR associated with dispensed psychostimulants was 0.62 (95% CI, 0.40-0.98), based on 94 events in 1648 person-years during medicated periods and 513 events in 4553 person-years during nonmedicated periods, equating to a risk difference of 42.8 (95% CI, 2.2-67.6) fewer violent reoffenses per 1000 person-years. The within-individual HR associated with dispensed drugs for addictive disorders was 0.48 (95% CI, 0.23-0.97), based on 46 events in 1168 person-years during medicated periods and 1103 events in 15 725 person-years during nonmedicated periods, equating to a risk difference of 36.4 (95% CI, 2.1-54.0) fewer violent reoffenses per 1000 person-years. In contrast, antidepressants and antiepileptics were not significantly associated with violent reoffending rates (HR = 1.09 [95% CI, 0.83-1.43] and 1.14 [95% CI, 0.79-1.65], respectively). The most common prison-based program was psychological treatments for substance abuse, associated with an HR of 0.75 (95% CI, 0.63-0.89), which equated to a risk difference of 23.2 (95% CI, 10.3-34.1) fewer violent reoffenses per 1000 person-years. CONCLUSIONS AND RELEVANCE Among released prisoners in Sweden, rates of violent reoffending were lower during periods when individiduals were dispensed antipsychotics, psychostimulants, and drugs for addictive disorders, compared with periods in which they were not dispensed these medications. Further research is needed to understand the causal nature of this association.
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Affiliation(s)
- Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden2Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, England
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Långström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden3Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden4School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Seena Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, England
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Brown GSJ, Simon A, Cameron J, Minami T. A collaborative outcome resource network (ACORN): Tools for increasing the value of psychotherapy. ACTA ACUST UNITED AC 2016; 52:412-21. [PMID: 26641371 DOI: 10.1037/pst0000033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors describe a collaborative outcomes resource network (ACORN) and the suite of measurement and decision support tools (ACORN Toolkit) that have emerged from this collaboration for the purpose of providing clinical feedback to therapists. The ACORN Toolkit is most accurately described as a comprehensive clinical information system designed to increase the value of mental health services across large systems of care. It was built to integrate large datasets from multiple sources including outcome data, client demographics and diagnostic data, therapist credentialing information, pharmacy data, and service claims data. For the limited purposes of this article, the authors focus on the ACORN Toolkit for measuring and how it has contributed to improving outcomes in psychotherapy. Implications to current practice and future training are provided.
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Abstract
The Treatment Outcome Package (TOP; D. R. Kraus, Seligman, & Jordan, 2005) is a multidimensional routine progress and outcome measure developed for use in diverse naturalistic practice settings. In this article, we (a) provide a brief review and summary of the extant psychometric and research support for the TOP, (b) provide examples of the TOP's use in clinical training and practice, and (c) discuss the implications of the TOP for future psychotherapy training, research, and practice. In particular, we focus on the implications of risk-adjusted progress monitoring for systems of care and mental health care decision making.
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Affiliation(s)
- James F Boswell
- Department of Psychology, University at Albany, State University of New York (SUNY)
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