Effectiveness of telemental health during the COVID-19 pandemic: A propensity score noninferiority analysis of outcomes

The COVID-19 pandemic forced governments to implement a range of public health measures that disrupted the personal and professional lives of many, including an abrupt adoption of telemental health services. Using data from a nonprofit counseling practice, we tested whether telemental health services delivered during the pandemic were inferior to face-to-face services delivered prior to the pandemic. We first characterized patients seeking therapy services before and during the pandemic to ascertain whether the demographics and presenting concerns of patients pre- and during COVID-19 differed and found that pandemic patients reported greater anxiety, greater overall distress, were more likely female and not partnered, and earned less than before the pandemic. We used a propensity score matching analysis to account for these differences and investigated whether or not telemental health therapy was inferior to face-to-face therapy. Based on the propensity-matched samples (2,180 patients in each condition), telemental health services were found not to be inferior to in-person services, allaying concerns about the effectiveness of telemental health services delivered during the COVID-19 pandemic. The present study also illustrates the usefulness of propensity matching for examining treatment effects in naturalistic settings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Threat alert: The effect of outliers on the alliance-outcome correlation

Meta-analyses have established the alliance as the most robust predictor of outcome in psychotherapy. A growing number of studies have evaluated potential threats to the conclusion that alliance is a causal factor in psychotherapy. One potential threat that has not been systematically examined is the possibility that the alliance-outcome association is driven by low alliance outliers. We examined the influence of removing low alliance outliers on the alliance-outcome association using data drawn from two large-scale, naturalistic psychotherapy data sets (Ns = 1,052; 11,029). These data sets differed in setting (university counseling center, community mental health center), country (United States and Canada), alliance measure (four-item Working Alliance Inventory Short Form Revised, 10-item Session Rating Scale), and outcome measure (Counseling Center Assessment of Psychological Symptoms-34, Outcome Questionnaire-45). We examined the impact of treating outliers in five different ways: retaining them, removing values three or two standard deviations from the mean, and winsorizing values three or two standard deviations from the mean. We also examined the effect of outliers after disaggregating alliance ratings into within-therapist and between-therapist components. The alliance-outcome correlation and the proportion of variance in posttest outcomes explained by alliance when controlling for pretest outcomes were similar regardless of how low alliance outliers were treated (change in r ≤ .04, change in R² ≤ 1%). Results from the disaggregation were similar. Thus, it appears that the alliance-outcome association is not an artifact of the influence of low alliance outliers. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

761 Associations between Depression and Guidelines Met for Physical Activity and Sufficient Sleep in an International Sample

Introduction

Physical activity (PA) and sleep both influence symptoms of depression. Here we explored relationships between guidelines met for physical activity and sleep and how this related to depression scores.

Methods

N=23,663 respondents (age range 18–98, mean age 40.1y, 51% female) completed the 10-item Harvard Department of Psychiatry National Depression Screening Day Scale (HANDS) online during one week in October from 2018–2020. Higher total scores on the HANDS indicated a higher likelihood of major depressive episode. Additional questions were added to the survey including questions on sleep duration and moderate to strenuous PA. The cut-off guidelines for PA were 150 weekly minutes and 7-9h of sleep per night. We categorized the sample based on those who met PA guidelines or not and whether respondents had short sleep duration (9h), or met the sleep guidelines (7-9h).

Results

One-way ANOVA revealed differences between the groups on HANDS depression score F(5,23657)=262.5, p<0.001. Nearly half of the sample did not meet both PA guidelines or sleep guidelines of 7-9h (N=10,776; 45.5%). The lowest depression scores were associated with those who met both PA and sleep guidelines (8.3 depression score) compared to those with the highest scores who exceeded sleep recommendations (>9h) and did not meet PA guidelines (14.1 depression score). In addition, met sleep guidelines (10.0) appeared to have a bigger influence than met PA guidelines (11.1) in the absence of the other guideline being met on depression score.

Conclusion

We found those who met both sleep and PA guidelines had the lowest depression scores with those who exceeded the sleep guidelines and did not meet PA recommendations had the highest depression scores. Future research on depression could focus on interventions aimed at improving adherence to both PA and sleep guidelines.

Support (if any):

Benchmarking Community-Based Couple Therapy: Considering Measurement Reactivity

Couple therapy has been shown to be effective in randomized clinical trials; however, results from naturalistic couple therapy have been less consistent. This study utilized a benchmarking approach to compare the effectiveness of couple therapy in a community-based setting with findings from efficacy treatments, such as treatment within randomized clinical trials. The current study is the largest couple therapy sample published to date (N = 3,347 couples). Clients in couple therapy were asked to provide initial and weekly ratings of symptomology on the Outcome Questionnaire (OQ-45.2). We found that treatment effect sizes found at community clinics were smaller than efficacy studies (i.e., the benchmark). However, when taking into account measurement reactivity, the effect sizes were comparable. This is the first benchmarking study for community-based couple therapy, allowing for meaningful comparisons and understanding of outcomes in real-world couple therapy. Implications for the field are offered in terms of evaluating community-based psychotherapy studies with benchmarking for couple therapy. Results of this study provide clinicians and researchers a way to meaningfully compare couple therapy outcomes, accounting for differences in community-based practices and randomized clinical trials. This benchmark also underscores the impact of measurement sensitivity, an issue commonly overlooked in psychotherapy research and practice.

1086 Non-Linear Associations Between Depression and Sleep Duration in an International Sample of 16,997 Respondents

Introduction

Abnormal sleep duration is common in people with depression and can be both a risk-factor and a symptom of depression. Here we determine the prevalence of depression likelihood and assess associations between long and short sleep duration in an international convenience sample.

Methods

N=16,997 respondents (age range: 8-98y, mean age 39.7y ±13.1 SD; 43% female) completed the 10-item Harvard Department of Psychiatry National Depression Screening Day Scale (HANDS) online from October 7 to October 13, 2019. Higher total scores on the HANDS indicate higher likelihood of major depressive episode with scores >8 indicate the presence of a major depressive disorder is likely. Additional questions were added to the survey including the question “During the past two weeks, how many hours of actual sleep did you average at night?” Answer choices ranged from “less than 5 hours” to “more than 10h” in half-hour increments.

Results

Respondents came from 115 different countries with the majority of respondents from Canada (48%) and the United States (38%). Sixty-four percent of the sample were recommended for further evaluation for depression. Of those recommended, 66% reported <7h of sleep per night and 3% reported >9h. Those who reported 7-9h of sleep per night had the lowest depression scores (9.2 points) compared to those who reported <7h (11.8 points) and >9h (13.7 points), F(2,15366)=434.81, p<0.001. The amount of sleep associated with the lowest depression scores was 7.5h (8.6 points) with <5h associated with the highest depression scores (15.5 points).

Conclusion

We found a high prevalence of depression likelihood in 64% of an international convenience sample, with 69% of those not meeting the recommended 7-9h of sleep per night. Both short and long sleep were associated with higher levels of depression with 7.5h of sleep associated with the lowest depression scores. Future research on depression should focus on sleep interventions aimed at improving both short and long sleep duration.

Support

N/A.

Outcomes and Recidivism in Mandated Batterer Intervention Before and After Introducing a Specialized Domestic Violence Court

Both specialized domestic violence (DV) courts and batterer intervention programs were developed to more adequately address intimate partner abuse and recidivism; however, little research has studied them concurrently. The current research examined clinical outcomes and police-reported recidivism in 382 men mandated to attend the Calgary Counselling Centre's Responsible Choices for Men's (RCM) groups between 1998 and 2009, before and after a specialized DV court was established in 2001. The study examines associations between categorical demographic and criminal justice variables, most of which were not correlated with post-group recidivism. Before the specialized court was implemented, 45 RCM members reported significantly more clinical issues at pretest than the 282 RCM members after court implementation (all scores adjusted by social desirability), although the effect sizes were negligible. Regarding group outcomes, depression, anxiety, and self-esteem (adjusted for social desirability) significantly improved on average for all RCM members irrespective of court implementation. Before the specialized DV court was developed, recidivism occurred after RCM program completion for a large proportion of men (41.2%), compared with only 8.2% after court implementation, a significant difference with a moderate effect size. The recidivism results are interpreted in the context of the significant justice and community collaborations entailed in creating the specialized DV court.

People with lived experience (PWLE) of depression: describing and reflecting on an explicit patient engagement process within depression research priority setting in Alberta, Canada

PLAIN ENGLISH SUMMARY

The Alberta Depression Research Priority Setting Project aimed to meaningfully involve patients, families and clinicians in determining a research agenda aligned to the needs of Albertans who have experienced depression. The project was modeled after a process developed in the UK by the James Lind Alliance and adapted to fit the Alberta, Canada context. This study describes the processes used to ensure the voices of people with lived experience of depression were integrated throughout the project stages. The year long project culminated with a facilitated session to identify the top essential areas of depression research focus. People with lived experience were engaged as part of the project's Steering Committee, as survey participants and as workshop participants. It is hoped this process will guide future priority setting opportunities and advance depression research in Alberta.

ABSTRACT

Background The Depression Research Priority Setting (DRPS) project has the clear aim of describing the patient engagement process used to identify depression research priorities and to reflect on the successes of this engagement approach, positive impacts and opportunities for improvement. To help support patient-oriented depression research priority setting in Alberta, the Patient Engagement (PE) Platform of the Alberta Strategy for Patient Oriented Research Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit designed, along with the support of their partners in addictions and mental health, an explit process to engage patients in the design and execution of the DRPS. Methods The UK's James Lind Alliance (JLA) Priority Setting Partnership (PSP) method was adapted into a six step process to ensure voices of "people with lived experience" (PWLE) with depression were included throughout the project stages. This study uses an explicit and parallel patient engagement process throughout each estage of the PSP designed by the PE Platform. Patient engagement was divided into a five step process: i) Awareness and relationship building; ii) Co-designing and co-developing a shared decision making process; iii) Collaborative communication; iv) Collective sensemaking; and v) Acknowledgement, celebration and recognition. A formative evaluation of the six PE processes was undertaken to explore the success of the parallel patient engagement process. Results This project was successful in engaging people with lived depression experience as partners in research priority setting, incorporating their voices into the discussions and decisions that led to the top 25 depression research questions. Conclusions The DRPS project has positively contributed to depression research in Canada by identifying the priorities of Albertans who have experienced depression for depression research. Dissemination activities to promote further knowledge exchange of prioritized research questions, with emphasis on the importance of process in engaging the voices of PWLE of depression are planned.

The top research questions asked by people with lived depression experience in Alberta: a survey

BACKGROUND

To support patient-oriented setting of priorities for depression research in Alberta, the Patient Engagement Platform of the Alberta Strategy for Patient Oriented Research's Support for People and Patient-Oriented Research and Trials Unit and Alberta Health Services' Addiction and Mental Health Strategic Clinical Network, along with partners in addictions and mental health, designed the Alberta Depression Research Priority Setting Project. The aim of the project was to survey patients, caregivers and clinicians/researchers in Alberta about what they considered to be the most important unanswered questions about depression.

METHODS

The project adapted the James Lind Alliance Priority Setting Partnership method into a 6-step process to gather and prioritize questions about depression posed by people with lived depression experience, which included patients, caregivers, clinicians and health care practitioners.

RESULTS

Implementation of the project, from initial data collection to final priority setting, took 10 months (August 2016 to June 2017). A total of 445 Albertans with lived experience of depression participated, ultimately identifying 11 priority depression research questions spanning the health continuum, life stages, and treatment and prevention opportunities.

INTERPRETATION

This project is a fundamental step that has the potential to positively influence depression research. Including the voices of Albertans with lived experience will create advantages for depression research for Albertans, researchers and research funders, and for patient engagement in the research enterprise overall.

Creating a climate for therapist improvement: A case study of an agency focused on outcomes and deliberate practice

Recent evidence suggests that psychotherapists may not increase in effectiveness over accrued experience in naturalistic settings, even settings that provide access to patients' outcomes. The current study examined changes in psychotherapists' effectiveness within an agency making a concerted effort to improve outcomes through the use of routine outcome monitoring coupled with ongoing consultation and the planful application of feedback including the use of deliberate practice. Data were available for 7 years of implementation from 5,128 patients seen by 153 psychotherapists. Results indicate that outcomes indeed improved across time within the agency, with increases of d = 0.035 (p = .003) per year. In contrast with previous reports, psychotherapists in the current sample showed improvements within their own caseloads across time (d = 0.034, p = .042). It did not appear that the observed agency-level improvement was due to the agency simply hiring higher-performing psychotherapists or losing lower-performing psychotherapists. Implications of these findings are discussed in relation to routine outcome monitoring, expertise in psychotherapy, and quality improvement within mental health care. (PsycINFO Database Record

The association of readiness to change and motivational interviewing with treatment outcomes in males involved in domestic violence group therapy

The present study investigated the impact of motivational interviewing (MI) and stage of change on a self-report measure of global functioning (Outcome Questionnaire [OQ 45.2]). Participants were men mandated to attend the Responsible Choices for Men (RCM) group therapy program following an incident of domestic violence. The study design utilized a quasi-experimental between-groups comparison utilizing data collected at three time points (pregroup, first group session, and final group session). One group of mandated program attendees received two sessions of MI (n = 106), whereas the comparison group did not (n = 106). Stage of change was assessed using the URICA-G and the URICA-DV (University of Rhode Island Change Assessment--Domestic Violence). Multilevel growth modeling indicated that stage of change has a significant relationship to global functioning. Discussion focuses on the potential benefits of MI as a pregroup treatment and the importance of accounting for individual readiness to change.

Managing victim status in group therapy for men: a discourse analysis

In contrast to the abundance of research on women victims, this article sheds light on the discourse of men who are self-identified as victims of their female partners' abuse. The purpose of this study was to investigate the most salient identity constructions and abuse conceptualizations among participants of group psychotherapy for men who have been abused in intimate, heterosexual partner relationships (i.e., Calgary Counselling Centre's 14-week group program titled "A Turn for the Better"). The men's identity work was examined using the methods and theoretical perspective of discourse analysis. Analysis of the talk demonstrated that the group agenda was to work through the ambiguity of abuse in the service of having the men identify themselves as victims. Thus, both the men and the group facilitators actively constructed "true victim" subject positions through their resistance to commonsense orientations of (a) "men as perpetrators" and (b) whether abuse consisted of more than physical violence. The therapeutic language of resistance was a common strategy used to manage victim status but also required further negotiation as it entailed a component of abuse (i.e., risked positioning the men as abusers rather than victims). The discussion focuses on how these findings may differ from the identity work present in women victim therapeutic groups. In addition, we note that it is difficult to uphold the victim-versus-perpetrator dichotomy in therapeutic discourse.

The long-term impacts of group treatment for partner abuse

This paper evaluates Responsible Choices for Men, a 14-week therapy group for abusive men based on feminist perspectives using narrative methods. Pre-test and post-test information was available for 76 program completers measuring physical and non-physical abuse, self-esteem, perceived stress, family relations, depression, assertiveness, and sex-role beliefs. The men significantly improved on all variables. A further focus was following up with 22 group members, contacted 5 to 28 months post treatment and asked to complete the same measures. The results indicated not only maintenance of the post-group changes, but continued improvement. Clinical implications and recommendations for group programming with abusive men are presented.