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Tuijnman A, Kleinjan M, Olthof M, Hoogendoorn E, Granic I, Engels RC. A Game-Based School Program for Mental Health Literacy and Stigma on Depression (Moving Stories): Cluster Randomized Controlled Trial. JMIR Ment Health 2022; 9:e26615. [PMID: 35976200 PMCID: PMC9434393 DOI: 10.2196/26615] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/31/2021] [Accepted: 07/28/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Depressive symptoms are highly prevalent among adolescents in Western countries. However, although treatment for depressive symptoms is available, many adolescents do not seek help when they need it. Important barriers to help-seeking among adolescents include low mental health literacy and high stigma. Therefore, we have developed a game-based school program, Moving Stories, which combines mental health literacy training for depression with contact with someone with lived experience both in the digital and nondigital world. OBJECTIVE The aim of this study is to conduct a first test of the effectiveness of the newly developed game-based program, Moving Stories, using a cluster randomized controlled trial. METHODS A total of 185 adolescents participated, divided over 10 classes from 4 schools. Half of the classes were randomly selected to follow the Moving Stories program, whereas the other half were in the control group, where no intervention was provided. The adolescents filled out digital questionnaires at 4 time points, with questions on mental health literacy, stigma, depressive symptoms, and the program itself (before the program, after the program, 3-month follow-up, and 6-month follow-up). Using R (R Foundation for Statistical Computing), we ran linear mixed-effects models for all continuous outcome variables and generalized linear mixed-effects models for all binary outcome variables. RESULTS Compared with the control group, participants in the Moving Stories group improved after the program in personal stigma (b=-0.53, 95% CI -1.02 to -0.03; t179.16=-2.08; P=.04). Effects on personal stigma lasted over time (3-month follow-up: b=-0.57, 95% CI -1.11 to -0.03; t174.39=-2.07; P=.04). Most adolescents in the Moving Stories group participated in the introduction (97/99, 98%) and contact session (93/99, 94%), played the game for 4 or 5 days (83/99, 83%), and indicated that they would recommend the game to their peers (90/98, 92%). CONCLUSIONS The results of this study show the potential of Moving Stories as a stigma reduction program. With changes in the program to improve its effects on mental health literacy, Moving Stories could be implemented in schools to improve help-seeking in adolescents and reduce the negative consequences and burden of depressive symptoms. TRIAL REGISTRATION Dutch Trial Register NTR7033; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7033. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/11255.
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Affiliation(s)
- Anouk Tuijnman
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands.,Trimbos-institute, Utrecht, Netherlands
| | - Marloes Kleinjan
- Trimbos-institute, Utrecht, Netherlands.,Department of Interdisciplinary Social Sciences, Youth Studies, Utrecht University, Utrecht, Netherlands
| | - Merlijn Olthof
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands
| | | | - Isabela Granic
- Faculty of Social Sciences, McMaster University, Hamilton, ON, Canada
| | - Rutger Cme Engels
- Erasmus School of Social and Behavioural Sciences, Erasmus University, Rotterdam, Netherlands
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Tuijnman A, Kleinjan M, Hoogendoorn E, Granic I, Engels RC. A Game-Based School Program for Mental Health Literacy and Stigma Regarding Depression (Moving Stories): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e11255. [PMID: 30869652 PMCID: PMC6437615 DOI: 10.2196/11255] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/31/2018] [Accepted: 11/10/2018] [Indexed: 12/19/2022] Open
Abstract
Background The prevalence of elevated depressive symptoms among youth in most western societies is high. Yet, most adolescents who are experiencing depressive symptoms do not seek help. Low mental health literacy, high stigma, and low social support have been shown to hinder help-seeking. A small number of interventions has been developed to target mental health literacy and stigma, but few focus on actual help-seeking and first aid behavior. We have developed a game-based school program called Moving Stories that targets mental health literacy, including knowledge and behavior, and stigma among adolescents, in regard to depression specifically. Objective Our aim is to describe the protocol for a study that will test the effectiveness of the program Moving Stories in a Dutch adolescent sample. We hypothesize that adolescents who participate in the program Moving Stories will have better mental health literacy and less stigma regarding depression compared to adolescents in the nonintervention control group at posttest and at 3- and 6-months follow-up. We also expect a positive change in actual help-seeking and first aid behavior at 3- and 6-months follow-up. Methods Moving Stories has been developed by a professional game design company in collaboration with researchers and relevant stakeholders. The effectiveness of Moving Stories will be tested through a randomized controlled trial with two conditions: Moving Stories versus control. Participants will fill in questionnaires at pretest, posttest, and 3- and 6-months follow-up. Our power analysis showed a required sample size of 180 adolescents. Results Four high schools have agreed to participate with a total of 10 classes. A total of 185 adolescents filled in the pretest questionnaire. The last of the follow-up data was collected in December 2018. Conclusions If Moving Stories proves to be effective, it could be implemented as a school-based program to target mental health literacy and stigma regarding depression; this could, in turn, improve early help-seeking in adolescents suffering from depression. Trial Registration Nederlands Trial Register NTR7033; https://www.trialregister.nl/trial/6855 International Registered Report Identifier (IRRID) DERR1-10.2196/11255
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Affiliation(s)
- Anouk Tuijnman
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands.,Trimbos Institute, Utrecht, Netherlands
| | - Marloes Kleinjan
- Trimbos Institute, Utrecht, Netherlands.,Department of Interdisciplinary Social Sciences, Utrecht University, Utrecht, Netherlands
| | | | - Isabela Granic
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Rutger Cme Engels
- Erasmus School of Social and Behavioural Sciences, Erasmus University, Rotterdam, Netherlands
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Buijs-Spanjers KR, Hegge HH, Jansen CJ, Hoogendoorn E, de Rooij SE. A Web-Based Serious Game on Delirium as an Educational Intervention for Medical Students: Randomized Controlled Trial. JMIR Serious Games 2018; 6:e17. [PMID: 30368436 PMCID: PMC6229519 DOI: 10.2196/games.9886] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/23/2018] [Accepted: 06/21/2018] [Indexed: 12/14/2022] Open
Abstract
Background Adequate delirium recognition and management are important to reduce the incidence and severity of delirium. To improve delirium recognition and management, training of medical staff and students is needed. Objective In this study, we aimed to gain insight into whether the serious game, Delirium Experience, is suited as an educational intervention. Methods We conducted a three-arm randomized controlled trial. We enrolled 156 students in the third year of their Bachelor of Medical Sciences degree at the University Medical Centre Groningen. The Game group of this study played Delirium Experience. The Control D group watched a video with explanations on delirium and a patient’s experience of delirious episodes. The Control A group watched a video on healthy aging. To investigate students’ skills, we used a video of a delirious patient for which students had to give care recommendations and complete the Delirium Observations Screening Scale and Delirium Rating Scale R-98. Furthermore, students completed the Delirium Attitude Scale, the Learning Motivation and Engagement Questionnaire, and self-reported knowledge on delirium. Results In total, 156 students participated in this study (Game group, n=51; Control D group, n=51; Control A group, n=55). The Game group scored higher with a median (interquartile range) of 6 (4-8) for given recommendations and learning motivation and engagement compared with the Control D (1, 1-4) and A (0, 0-3) groups (P<.001). Furthermore, the Game group scored higher (7, 6-8) on self-reported knowledge compared with the Control A group (6, 5-6; P<.001). We did not find differences between the groups regarding delirium screening (P=.07) and rating (P=.45) skills or attitude toward delirious patients (P=.55). Conclusions The serious game, Delirium Experience, is suitable as an educational intervention to teach delirium care to medical students and has added value in addition to a lecture.
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Affiliation(s)
- Kiki R Buijs-Spanjers
- Department of Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Harianne Hm Hegge
- Department of Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Carolien J Jansen
- Department of Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Sophia E de Rooij
- Department of Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Asselbergs J, Sijbrandij M, Hoogendoorn E, Cuijpers P, Olie L, Oved K, Merkies J, Plooijer T, Eltink S, Riper H. Development and testing of TraumaGameplay: an iterative experimental approach using the trauma film paradigm. Eur J Psychotraumatol 2018; 9:1424447. [PMID: 29441151 PMCID: PMC5804785 DOI: 10.1080/20008198.2018.1424447] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 12/21/2017] [Indexed: 11/29/2022] Open
Abstract
Background: Vivid trauma-related intrusions are a hallmark symptom of posttraumatic stress disorder (PTSD), and may be involved in its onset. Effective interventions to reduce intrusions and to potentially prevent the onset of subsequent PTSD are scarce. Studies suggest that playing the videogame Tetris, shortly after watching aversive film clips, reduces subsequent intrusions. Other studies have shown that taxing working memory (WM) while retrieving an emotional memory reduces the memory's vividness and emotionality. Objective: We developed TraumaGameplay (TGP), a gaming app designed to reduce intrusions. This paper describes two successive experiments to determine whether playing TGP without memory retrieval (regular TGP) or TGP with memory retrieval (dual-task TGP) reduces intrusion frequency at one week compared to a no-game control. Method: For both experiments, healthy university students were recruited. Experiment 1: 92 participants were exposed to a trauma film and randomized to (1) regular TGP1 (n = 31), (2) dual-task TGP1 (n = 31) or (3) control (n = 30). In experiment 2, 120 healthy students were exposed to a trauma film and randomized to (1) regular TGP2 (n = 30), (2) dual-task TGP2 (n = 29), (3) recall only (n = 31) or (4) control (n = 30). Results: We found no significant difference between conditions on the number of intrusions for either playing regular TGP or dual-task TGP in both experiment 1 and experiment 2. Conclusion: Our results could not replicate earlier promising findings from preceding experimental research. Several reasons may underpin this difference ranging from the visuospatial videogame used in our experiments to the method of the experiment to the difficulties of replicability in general.
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Affiliation(s)
- Joost Asselbergs
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,The Netherlands and EMGO Institute for Health Care and Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,The Netherlands and EMGO Institute for Health Care and Research, VU University Medical Centre, Amsterdam, The Netherlands
| | | | - Pim Cuijpers
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lara Olie
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kfir Oved
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Job Merkies
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tessa Plooijer
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Simone Eltink
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Heleen Riper
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,The Netherlands and EMGO Institute for Health Care and Research, VU University Medical Centre, Amsterdam, The Netherlands.,GGZ inGeest, Amsterdam, The Netherlands.,Health and Life Sciences Faculty, Telepsychiatry Unit, Southern Denmark University, Odense, Denmark
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Helderman-van den Enden AT, Maaswinkel-Mooij PD, Hoogendoorn E, Willemsen R, Maat-Kievit JA, Losekoot M, Oostra BA. Monozygotic twin brothers with the fragile X syndrome: different CGG repeats and different mental capacities. J Med Genet 1999; 36:253-7. [PMID: 10204857 PMCID: PMC1734321] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Little is known about the mechanism of CGG instability and the time frame of instability early in embryonic development in the fragile X syndrome. Discordant monozygotic twin brothers with the fragile X syndrome could give us insight into the time frame of the instability. We describe monochorionic diamniotic twin brothers with the fragile X syndrome who had different CGG repeats and different mental capacities, whereas the normal mother had a premutation. The more retarded brother had a full mutation in all his cells and no FMR-1 protein expression in lymphocytes, whereas the less retarded brother had 50%/50% mosaicism for a premutation and full mutation and FMR-1 protein expression in 26% of his lymphocytes. The differences in repeat size could have arisen either before or after the time of splitting. The time of splitting in this type of twin is around day 6-7. Given the high percentage of mosaicism, we hypothesise that the instability started before the time of splitting at day 6-7.
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Losekoot M, Hoogendoorn E, Olmer R, Jansen CC, Oosterwijk JC, van den Ouweland AM, Halley DJ, Warren ST, Willemsen R, Oostra BA, Bakker E. Prenatal diagnosis of the fragile X syndrome: loss of mutation owing to a double recombinant or gene conversion event at the FMR1 locus. J Med Genet 1997; 34:924-6. [PMID: 9391887 PMCID: PMC1051121 DOI: 10.1136/jmg.34.11.924] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [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: 02/05/2023]
Abstract
The fragile X syndrome, an X linked mental retardation syndrome, is caused by an expanded CGG repeat in the first exon of the FMR1 gene. In patients with an expanded repeat the FMR1 promoter is methylated and, consequently, the gene is silenced and no FMR1 protein (FMRP) is produced, thus leading to the clinical phenotype. Here we describe a prenatal diagnosis performed in a female from a fragile X family carrying a large premutation. In chorionic villus DNA of the male fetus the normal maternal CGG allele and a normal pattern on Southern blot analysis were found in combination with the FRAXAC2 and DXS297 allele of the maternal at risk haplotype. A second chorionic villus sampling was performed giving identical results on DNA analysis and, in addition, expression of FMRP was shown by immunohistochemistry. We concluded that the male fetus was not affected with the fragile X syndrome. Subsequent detailed haplotype analysis showed a complex recombination pattern resembling either gene conversion or a double crossover within a 20 kb genomic region.
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Affiliation(s)
- M Losekoot
- MGC-Department of Human Genetics, Leiden University, The Netherlands
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De Waard-Siebinga I, Blom DJ, Griffioen M, Schrier PI, Hoogendoorn E, Beverstock G, Danen EH, Jager MJ. Establishment and characterization of an uveal-melanoma cell line. Int J Cancer 1995; 62:155-61. [PMID: 7622289 DOI: 10.1002/ijc.2910620208] [Citation(s) in RCA: 130] [Impact Index Per Article: 4.5] [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: 01/26/2023]
Abstract
A human uveal melanoma cell line (92-1) was established from a primary uveal melanoma, and has now been maintained in culture for over 2 1/2 years. Light microscopy of the cultured cells demonstrated extremely pleiomorphic cells with large prominent nucleoli. Cell proliferation was determined with a non-radioactive propidium-iodide assay and indicated an in vitro doubling time of approximately 58 hr. Furthermore, the cell line was characterized by cytogenetic analysis, electron microscopy, immunocytochemistry and Northern blotting for HLA and c-myc-mRNA analysis. Cytogenetic analysis revealed numerical abnormalities of chromosome 8 and structural abnormalities of chromosome 6. By electron microscopy, different stages of melanosome development were observed. Immunocytochemical analysis demonstrated expression of the melanoma-associated antigen gp 100. Expression analysis of HLA antigens revealed a very low level of, in particular, the HLA-B locus products, which could be induced by interferon-alpha or -gamma treatment. Likewise, Northern-blot experiments revealed decreased levels of HLA-B mRNA as compared with HLA-A. In addition, high levels of c-myc expression were observed. The phenotypic characteristics of the cultured cells indicate that we have established an uveal melanoma cell line. This now well-characterized uveal melanoma cell line can be used in future studies.
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Kluin-Nelemans HC, Beverstock GC, Mollevanger P, Wessels HW, Hoogendoorn E, Willemze R, Falkenburg JH. Proliferation and cytogenetic analysis of hairy cell leukemia upon stimulation via the CD40 antigen. Blood 1994; 84:3134-41. [PMID: 7524766] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Using the CD40 system, in vitro proliferation of hairy cell leukemia (HCL) was examined in 43 patients. In this culture system, cells were stimulated by interleukin-4 (IL-4) and anti-CD40 monoclonal antibodies (MoAbs) that were added in soluble form or were cross-linked via their Fc part using Fc gamma RII-transfected mouse fibroblast cells. Proliferation was induced and confirmed by 3H-thymidine incorporation in 14 cases and by the presence of metaphases in 42 cases. 3H-thymidine incorporation showed a heterogeneous pattern: cross-linking of anti-CD40 gave the highest proliferation in 8 cases; in 11 cases, stimulation with anti-CD40 MoAbs alone, without cross-linking also resulted in proliferation; the addition of IL-4 further enhanced 3H-thymidine incorporation in 5 cases, but suppressed this phenomenon in 5 other cases. The CD40 system proved to be very effective in obtaining cytogenetic data. With a success rate of 42 of 43 patients tested, we found clonal abnormalities in 8 cases (19%) and nonclonal abnormalities with involvement of one or two abnormal metaphases in another 7 cases. The chromosomes most frequently involved in the abnormal karyotypes, both structurally and numerically, were chromosomes 5, 7, and 14. By fluorescence-activated cell-sorting analysis of the cultured cells, and by immunophenotypic analysis of metaphase spreads, T-cell growth could be excluded and the HCL-lineage confirmed. Stimulation via the CD40 antigen is an excellent tool for growing hairy cell leukemia cells.
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Affiliation(s)
- H C Kluin-Nelemans
- Department of Hematology, University Medical Center, Leiden, The Netherlands
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