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Biscoe N, Baumann J, Murphy D. Network analysis of comorbid post-traumatic stress disorder and alcohol misuse in treatment-seeking UK Armed Forces veterans. BMJ Mil Health 2024; 170:281-282. [PMID: 36702523 DOI: 10.1136/military-2022-002329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 01/27/2023]
Affiliation(s)
| | - J Baumann
- Research Department, Combat Stress, Leatherhead, UK
| | - D Murphy
- Research Department, Combat Stress, Leatherhead, UK
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De Giorgi R, De Crescenzo F, Ostinelli EG, Cowen PJ, Harmer CJ, Fazel S, Cipriani A. Mortality and adverse events associated with statin use in primary care patients with depression: a real-world, population-based cohort study. BMJ Ment Health 2024; 27:e301035. [PMID: 38772637 DOI: 10.1136/bmjment-2024-301035] [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: 02/20/2024] [Accepted: 04/19/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND New National Institute for Health and Care Excellence (NICE) guidance endorses the prescription of statins in larger population groups for the prevention of cardiovascular and cerebrovascular morbidity and mortality, especially in people with severe mental illness. However, the evidence base for their safety and risk/benefit balance in depression is not established. OBJECTIVES This study aims to assess the real-world mortality and adverse events of statins in depressive disorders. METHODS Population-based, nationwide (England), between-subject, cohort study. We used electronic health records (QResearch database) of people aged 18-100 years with first-episode depression, registered with English primary care practices over January 1998-August 2020 for 12(+) months, divided into statin users versus non-users.Primary safety outcomes included all-cause mortality and any adverse event measured at 2, 6 and 12 months. Multivariable logistic regression was employed to control for several potential confounders and calculate adjusted ORs (aORs) with 99% CIs. FINDINGS From over 1 050 105 patients with depression (42.64% males, mean age 43.23±18.32 years), 21 384 (2.04%) died, while 707 111 (67.34%) experienced at least one adverse event during the 12-month follow-up. Statin use was associated with lower mortality over 12 months (range aOR2-12months 0.66-0.67, range 99% CI 0.60 to 0.73) and with lower adverse events over 6 months (range aOR2-6months 0.90-0.96, range 99% CI 0.91 to 0.99), but not at 1 year (aOR12months 0.99, 99% CI 0.96 to 1.03). No association with any other individual outcome measure (ie, any other neuropsychiatric symptoms) was identified. CONCLUSIONS We found no evidence that statin use among people with depression increases mortality or other adverse events. CLINICAL IMPLICATIONS Our findings support the safety of updated NICE guidelines for prescribing statins in people with depressive disorders.
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Affiliation(s)
- Riccardo De Giorgi
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Franco De Crescenzo
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Edoardo Giuseppe Ostinelli
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
| | - Philip J Cowen
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
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Beaglehole B, Porter R, Douglas K, Lacey CJ, de Bie A, Jordan J, Mentzel C, Thwaites B, Manuel J, Murray G, Frampton C, Glue P. Protocol for a randomised controlled trial of ketamine versus ketamine and behavioural activation therapy for adults with treatment-resistant depression in the community. BMJ Open 2024; 14:e084844. [PMID: 38692731 PMCID: PMC11086269 DOI: 10.1136/bmjopen-2024-084844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/03/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION Although short-term benefits follow parenteral ketamine for treatment-resistant major depressive disorder (TR-MDD), there are challenges that prevent routine use of ketamine by clinicians. These include acute dissociative effects of parenteral ketamine, high relapse rates following ketamine dosing and the uncertain role of psychotherapy. This randomised controlled trial (RCT) seeks to establish the feasibility of evaluating repeated oral doses of ketamine and behavioural activation therapy (BAT), compared with ketamine treatment alone, for TR-MDD. We also aim to compare relapse rates between treatment arms to determine the effect size of adding BAT to oral ketamine. METHODS AND ANALYSIS This is a prospectively registered, two-centre, single-blind RCT. We aim to recruit 60 participants with TR-MDD aged between 18 and 65 years. Participants will be randomised to 8 weeks of oral ketamine and BAT, or 8 weeks of oral ketamine alone. Feasibility will be assessed by tracking attendance for ketamine and BAT, acceptability of treatment measures and retention to the study follow-up protocol. The primary efficacy outcome measure is the Montgomery-Asberg Depression Rating Scale (MADRS) measured weekly during treatment and fortnightly during 12 weeks of follow-up. Other outcome measures will assess the tolerability of ketamine and BAT, cognition and activity (using actigraphy). Participants will be categorised as non-responders, responders, remitters and relapsed during follow-up. MADRS scores will be analysed using a linear mixed model. For a definitive follow-up RCT study to be recommended, the recruitment expectations will be met and efficacy outcomes consistent with a >20% reduction in relapse rates favouring the BAT and ketamine arm will be achieved. ETHICS AND DISSEMINATION Ethics approval was granted by the New Zealand Central Health and Disability Ethics Committee (reference: 2023 FULL18176). Study findings will be reported to participants, stakeholder groups, conferences and peer-reviewed publications. TRIAL REGISTRATION NUMBER UTN: U1111-1294-9310, ACTRN12623000817640p.
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Affiliation(s)
- Ben Beaglehole
- Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Katie Douglas
- Psychological Medicine, University of Otago, Christchurch, New Zealand
| | | | - Aroha de Bie
- Te Whatu Ora-Health New Zealand Waitaha Canterbury, Christchurch, Canterbury, New Zealand
| | - Jennifer Jordan
- Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Charlie Mentzel
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | | | - Jenni Manuel
- Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | | | - Paul Glue
- Psychological Medicine, University of Otago, Dunedin School of Medicine, Dunedin, New Zealand
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Maji S, Mohapatra D, Jena M, Srinivasan A, Maiti R. Repurposing of dextromethorphan as an adjunct therapy in patients with major depressive disorder: a randomised, group sequential adaptive design, controlled clinical trial protocol. BMJ Open 2024; 14:e080500. [PMID: 38688675 PMCID: PMC11086520 DOI: 10.1136/bmjopen-2023-080500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 04/18/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Therapeutic latency, lack of efficacy and adverse drug reactions are the major concerns in current antidepressant therapies. To overcome these treatment hurdles, add-on therapy to conventional antidepressant medications may lead to better therapeutic outcomes. The present randomised controlled trial has been planned to evaluate the efficacy and safety of add-on dextromethorphan to selective serotonin reuptake inhibitors (SSRIs) in major depressive disorder (MDD). METHODS AND ANALYSIS A randomised, double-blind, add-on, placebo-controlled, group sequential design clinical trial will be conducted on patients with MDD who will be randomly assigned to the control and the test group in a 1:1 ratio. Patients in the test group will get dextromethorphan 30 mg once daily, whereas patients in the control group will receive a placebo once daily as an add-on to ongoing SSRI treatment for 8 weeks. All patients will be evaluated for the primary outcome (change in the Montgomery-Åsberg Depression Rating Scale score) and secondary outcomes (treatment response rate, remission rate, Clinical Global Impression, serum brain-derived neurotrophic factor, serum dextromethorphan and treatment-emergent adverse events) over the period of 8 weeks. Intention-to-treat analysis will be done for all parameters using suitable statistical tools. ETHICS AND DISSEMINATION This study was approved by the Institutional Ethics Committee of All India Institute of Medical Sciences, Bhubaneswar, India, and the study conformed to the provisions of the Declaration of Helsinki and ICMR's ethical guidelines for biomedical research on human subjects (2017). Written informed consent will be obtained from the participants before recruitment. The results of this study will be published in peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT05181527.
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Affiliation(s)
- Shampa Maji
- Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Debadatta Mohapatra
- Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Monalisa Jena
- Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Anand Srinivasan
- Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Rituparna Maiti
- Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Awortwe V, Daivadanam M, Adjorlolo S, Olsson EM, Coumoundouros C, Woodford J. Prevalence and social determinants of anxiety and depression among adults in Ghana: a systematic review and meta-analysis protocol. BMJ Open 2024; 14:e081927. [PMID: 38658002 PMCID: PMC11043746 DOI: 10.1136/bmjopen-2023-081927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/11/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Anxiety and depression pose a significant global health challenge, especially affecting adults in low-income and middle-income countries. In many low-income and middle-income countries, including those in sub-Saharan Africa, social determinants such as access to affordable health services, conflict, food insecurity, and poverty may be associated with the prevalence of anxiety and depression, further contributing to health disparities. To mitigate the burden of anxiety and depression in sub-Saharan Africa, it is essential to develop country-level tailored mental health policies and strategies. For example, Ghana is working towards improving mental health via its 12 year Mental Health policy launched in 2021. However, the prevalence of anxiety and depression among adults in Ghana, along with associated social determinants remains largely unknown, posing challenges for mental health planning, resource allocation and developing targeted interventions. This systematic review seeks to (1) examine the prevalence of anxiety and depression among adults in Ghana and (2) explore social determinants potentially associated with anxiety and depression. METHODS AND ANALYSIS Electronic databases (eg, African Index Medicus, CINAHL, EMBASE, MEDLINE, and PsycINFO) will be searched with all screening steps conducted by two independent reviewers. Secondary search strategies, including grey literature searches, will be used. Studies reporting on the prevalence of anxiety, depression and/or a combined symptom measure (ie, psychological distress) among adults in Ghana, using validated instruments will be included. If data allows, random-effects-meta-analyses will be performed to estimate pooled prevalence rates of anxiety and depression. Potential clinical and methodological moderators will be examined using subgroup analyses and meta-regression. A narrative synthesis will explore social determinants potentially associated with anxiety and depression among adults in Ghana. ETHICS AND DISSEMINATION Ethical approval is not required as no primary data will be collected. Results will be disseminated via a peer-reviewed publication and presentations at academic conferences. Plain language summaries will be provided to relevant non-governmental organisations working in Ghana. PROSPERO REGISTRATION NUMBER CRD42023463078.
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Affiliation(s)
- Victoria Awortwe
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Meena Daivadanam
- Global Health and Migration Unit, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Samuel Adjorlolo
- Department of Mental Health, School of Nursing and Midwivery, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Erik Mg Olsson
- Cardiovascular Psychology, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Chelsea Coumoundouros
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Schmidt KL, Kowalski A, Schweda A, Dörrie N, Skoda EM, Bäuerle A, Teufel M. Evaluation of a manualised neurofeedback training in psychosomatic-psychotherapeutic outpatient treatment (Neuro-pp-out): study protocol for a clinical mixed-methods pilot study. BMJ Open 2024; 14:e079098. [PMID: 38631828 PMCID: PMC11029405 DOI: 10.1136/bmjopen-2023-079098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Electroencephalographic neurofeedback (NFB), as a non-invasive form of brainwave training, has been shown to be effective in the treatment of various mental health disorders. However, only few results regarding manualised and standardised NFB trainings exist. This makes comparison as well as replication of studies difficult. Therefore, we developed a standard manual for NFB training in patients with mental health disorders attending a psychosomatic outpatient clinic. The current study aims at investigating the conduction of a standardised manual for NFB training in patients with mental health disorders. If successful, the study provides new opportunities to investigate NFB in a more controlled and comparable manner in clinical practice. METHODS AND ANALYSIS 30 patients diagnosed with a mental health disorder will be included. After the educational interview, patients will undergo baseline diagnostics (T0). The subsequent intervention consists of 10 sessions of NFB training aiming at increasing sensorimotor rhythm and alpha-frequency amplitudes and decreasing theta-frequency and high beta-frequency amplitudes to induce relaxation and decrease subjective stress. All patients will undergo a post-treatment diagnostic assessment (T1) and a follow-up assessment 8 weeks following the closing session (T2). Changes in amplitude bands (primary outcome) will be recorded with electroencephalography during pre-assessments, post-assessments and follow-up assessments and during NFB sessions. Physiological (respiratory rate, blood volume pulse, muscle tension) and psychometric parameters (distress, perceived stress, relaxation ability, depressive and anxiety symptoms, insomnia, self-efficacy and quality of life) will be assessed at T0, T1 and T2. Moreover, satisfaction, acceptance and usability will be assessed at T1 after NFB training. Further, qualitative interviews about the experiences with the intervention will be conducted with NFB practitioners 6 months after the study starts. Quantitative data will be analysed using repeated measures analysis of variance as well as mediation analyses on mixed linear models. Qualitative data will be analysed using Mayring's content analysis. ETHICS AND DISSEMINATION The study was approved by the ethics committee of the Medical Faculty of the University of Duisburg-Essen (23-11140-BO) and patient enrolment began in April 2023. Before participation, written informed consent by each participant will be required. Results will be published in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER Prospectively registered on 28 March 2023 in the German clinical trials register, DRKS00031497.
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Affiliation(s)
- Kira Leandra Schmidt
- Department for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | | | - Adam Schweda
- Department for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Nora Dörrie
- Department for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Eva Maria Skoda
- Department for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Alexander Bäuerle
- Department for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Department for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
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Wienand D, Wijnen LI, Heilig D, Wippel C, Arango C, Knudsen GM, Goodwin GM, Simon J. Comorbid physical health burden of serious mental health disorders in 32 European countries. BMJ Ment Health 2024; 27:e301021. [PMID: 38580438 PMCID: PMC11021748 DOI: 10.1136/bmjment-2024-301021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Mental health disorders (MHDs) are associated with physical health disparities, but underlying excess risk and health burden have not yet been comprehensively assessed. OBJECTIVE To assess the burden of comorbid physical health conditions (PHCs) across serious MHDs in Europe. METHODS We estimated the relative prevalence risk of PHCs associated with alcohol use disorders (AUD), bipolar disorder (BD), depressive disorders (DD) and schizophrenia (SZ) across working-age populations of 32 European countries in 2019 based on a targeted literature review. Excess physical health burden was modelled using population-attributable fractions and country-level prevalence data. FINDINGS We screened 10 960 studies, of which 41 were deemed eligible, with a total sample size of over 18 million persons. Relative prevalence of PHCs was reported in 54%, 20%, 15%, 5% and 7% of studies, respectively, for SZ, DD, BD, AUD or mixed. Significant relative risk estimates ranged from 1.44 to 3.66 for BD, from 1.43 to 2.21 for DD, from 0.81 to 1.97 for SZ and 3.31 for AUD. Excess physical health burden ranged between 27% and 67% of the total, corresponding to 84 million (AUD), 67 million (BD), 66 million (DD) and 5 million (SZ) PHC diagnoses in Europe. A 1% reduction in excess risk assuming causal inference could result in two million fewer PHCs across investigated MHDs. CONCLUSIONS This is the first comprehensive study of the physical health burden of serious MHDs in Europe. The methods allow for updates, refinement and extension to other MHDs or geographical areas. CLINICAL IMPLICATIONS The results indicate potential population health benefits achievable through more integrated mental and physical healthcare and prevention approaches.
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Affiliation(s)
- Dennis Wienand
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Lena I Wijnen
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Daniel Heilig
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Christoph Wippel
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Gitte M Knudsen
- Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Department of Psychiatry, University of Oxford, Oxford, UK
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Vainre M, Dalgleish T, Watson P, Haag C, Dercon Q, Galante J, Hitchcock C. Work Engagement and Well-being Study (SWELL): a randomised controlled feasibility trial evaluating the effects of mindfulness versus light physical exercise at work. BMJ Ment Health 2024; 27:e300885. [PMID: 38423582 PMCID: PMC10910646 DOI: 10.1136/bmjment-2023-300885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Mindfulness-based programmes (MBPs) are increasingly offered at work, often in online self-guided format. However, the evidence on MBPs' effect on work performance (WP) is inconsistent. OBJECTIVE This pragmatic randomised controlled feasibility trial assessed procedural uncertainties, intervention acceptability and preliminary effect sizes of an MBP on WP, relative to an alternative intervention. METHODS 241 employees from eight employers were randomised (1:1) to complete a 4-week, self-guided, online MBP or a light physical exercise programme (LE)(active control). Feasibility and acceptability measures were of primary interest. WP at postintervention (PostInt) was the primary outcome for preliminary assessment of effect sizes. Secondary outcomes assessed mental health (MH) and cognitive processes hypothesised to be targeted by the MBP. Outcomes were collected at baseline, PostInt and 12-week follow-up (12wFUP). Prospective trial protocol: NCT04631302. FINDINGS 87% of randomised participants started the course. Courses had high acceptability. Retention rates were typical for online trials (64% PostInt; 30% 12wFUP). MBP, compared with the LE control, offered negligible benefits for WP (PostInt (d=0.06, 95% CI -0.19 to 0.32); 12wFUP (d=0.02, 95% CI -0.30 to 0.26)). Both interventions improved MH outcomes (ds=-0.40 to 0.58, 95% CI -0.32 to 0.18); between-group differences were small (ds=-0.09 to 0.04, 95% CI -0.15 to 0.17). CONCLUSION The trial is feasible; interventions are acceptable. Results provide little support for a later phase trial comparing an MBP to a light exercise control. To inform future trials, we summarise procedural challenges. CLINICAL IMPLICATIONS Results suggest MBPs are unlikely to improve WP relative to light physical exercise. Although the MBP improved MH, other active interventions may be just as efficacious. TRIAL REGISTRATION NUMBER NCT04631302.
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Affiliation(s)
- Maris Vainre
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge University, Cambridge, UK
- Institute of Psychology, University of Tartu, Tartu, Estonia
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge University, Cambridge, UK
| | - Peter Watson
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge University, Cambridge, UK
| | - Christina Haag
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Quentin Dercon
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge University, Cambridge, UK
- Institute of Mental Health, University College London, London, UK
| | - Julieta Galante
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Contemplative Studies Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Caitlin Hitchcock
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge University, Cambridge, UK
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
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Holland TJ, Smith M, King K. The Defence General Practitioner: an Updated Definition and Model. BMJ Mil Health 2024:e002635. [PMID: 38413165 DOI: 10.1136/military-2023-002635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/09/2024] [Indexed: 02/29/2024]
Abstract
The geopolitical setting has changed significantly since the definition of UK Armed Forces General Practice was published in 2012. New operating models require medical services to provide smaller teams operating at greater reach from secondary care and logistical support. The Defence Medical Services have reorganised to meet these changing needs. Defence general practices (DGPs) are key enablers of the Defence strategic effort, both integral to deployed units, in preparing forces for deployment and managing their rehabilitation back to fitness. A formal role performance statement (RPS) has been created to guide the training and development of DGPs to meet these changing requirements. The RPS details the additional scope of practice, beyond the national GP licensing standard, in which DGPs work. In this article, we compare and contrast the RPS with the previous definition of a DGP. The resultant updated model recharacterises the extended roles into five themes of DGP built on the foundation of the Royal College of General Practitioners curriculum. This new model provides the platform on which to develop the clinical specialty over the next decade and highlights avenues for educational interventions to develop future generations of DGPs.
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Affiliation(s)
- Toby James Holland
- Academic Department of Militay General Practice, Research and Clinical Innovation, Defence Medical Directorate, HQ Surgeon General, Birmingham, West Midlands, UK
| | - M Smith
- Academic Department of Militay General Practice, Research and Clinical Innovation, Defence Medical Directorate, HQ Surgeon General, Birmingham, West Midlands, UK
| | - K King
- Academic Department of Militay General Practice, Research and Clinical Innovation, Defence Medical Directorate, HQ Surgeon General, Birmingham, West Midlands, UK
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Harrer M, Nixon P, Sprenger AA, Heber E, Boß L, Heckendorf H, Buntrock C, Ebert DD, Lehr D. Are web-based stress management interventions effective as an indirect treatment for depression? An individual participant data meta-analysis of six randomised trials. BMJ Ment Health 2024; 27:e300846. [PMID: 38351099 PMCID: PMC10897957 DOI: 10.1136/bmjment-2023-300846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/15/2023] [Indexed: 02/16/2024]
Abstract
QUESTION Depression is highly prevalent and associated with numerous adverse consequences for both individuals and society. Due to low uptake of direct treatment, interventions that target related, but less stigmatising problems, such as perceived stress, have emerged as a new research paradigm.This individual participant data (IPD) meta-analysis examines if a web-based stress management intervention can be used as an 'indirect' treatment of depression. STUDY SELECTION AND ANALYSIS Bayesian one-stage models were used to estimate pooled effects on depressive symptom severity, minimally important improvement and reliable deterioration. The dose-response relationship was examined using multilevel additive models, and IPD network meta-analysis was employed to estimate the effect of guidance. FINDINGS In total, N=1235 patients suffering from clinical-level depression from K=6 randomised trials were included. Moderate-to-large effects were found on depressive symptom severity at 7 weeks post-intervention (d=-0.65; 95% credibility interval (CrI): -0.84 to -0.48) as measured with the Center for Epidemiological Studies' Depression Scale. Effects were sustained at 3-month follow-up (d=-0.74; 95% CrI: -1.01 to -0.48). Post-intervention symptom severity was linearly related to the number of completed sessions. The incremental impact of guidance was estimated at d=-0.25 (95% CrI: -1.30 to 0.82), with a 35% posterior probability that guided and unguided formats produce equivalent effects. CONCLUSIONS Our results indicate that web-based stress management can serve as an indirect treatment, yielding effects comparable with direct interventions for depression. Further research is needed to determine if such formats can indeed increase the utilisation of evidence-based treatment, and to corroborate the favourable effects for human guidance. STUDY REGISTRATION Open material repository: osf.io/dbjc8, osf.io/3qtbe. TRIAL REGISTRATION NUMBER German Clinical Trial Registration (DRKS): DRKS00004749, DRKS00005112, DRKS00005384, DRKS00005687, DRKS00005699, DRKS00005990.
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Affiliation(s)
- Mathias Harrer
- Technical University of Munich, Munich, Germany
- Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | - Patricia Nixon
- Health Psychology and Applied Biological Psychology, Leuphana Universitat Luneburg, Luneburg, Germany
| | | | - Elena Heber
- GetOn Institut für Gesundheitstrainings GmbH/HelloBetter, Hamburg, Germany
| | - Leif Boß
- Health Psychology and Applied Biological Psychology, Leuphana Universitat Luneburg, Luneburg, Germany
| | - Hanna Heckendorf
- Health Psychology and Applied Biological Psychology, Leuphana Universitat Luneburg, Luneburg, Germany
| | | | | | - Dirk Lehr
- Health Psychology and Applied Biological Psychology, Leuphana Universitat Luneburg, Luneburg, Germany
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11
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Cohen SE, Zantvoord JB, Storosum BWC, Mattila TK, Daams J, Wezenberg B, de Boer A, Denys DAJP. Influence of study characteristics, methodological rigour and publication bias on efficacy of pharmacotherapy in obsessive-compulsive disorder: a systematic review and meta-analysis of randomised, placebo-controlled trials. BMJ Ment Health 2024; 27:e300951. [PMID: 38350669 PMCID: PMC10862307 DOI: 10.1136/bmjment-2023-300951] [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: 11/25/2023] [Accepted: 01/26/2024] [Indexed: 02/15/2024]
Abstract
QUESTION We examined the effect of study characteristics, risk of bias and publication bias on the efficacy of pharmacotherapy in randomised controlled trials (RCTs) for obsessive-compulsive disorder (OCD). STUDY SELECTION AND ANALYSIS We conducted a systematic search of double-blinded, placebo-controlled, short-term RCTs with selective serotonergic reuptake inhibitors (SSRIs) or clomipramine. We performed a random-effect meta-analysis using change in the Yale-Brown Obsessive-Compulsive Scale (YBOCS) as the primary outcome. We performed meta-regression for risk of bias, intervention, sponsor status, number of trial arms, use of placebo run-in, dosing, publication year, age, severity, illness duration and gender distribution. Furthermore, we analysed publication bias using a Bayesian selection model. FINDINGS We screened 3729 articles and included 21 studies, with 4102 participants. Meta-analysis showed an effect size of -0.59 (Hedges' G, 95% CI -0.73 to -0.46), equalling a 4.2-point reduction in the YBOCS compared with placebo. The most recent trial was performed in 2007 and most trials were at risk of bias. We found an indication for publication bias, and subsequent correction for this bias resulted in a depleted effect size. In our meta-regression, we found that high risk of bias was associated with a larger effect size. Clomipramine was more effective than SSRIs, even after correcting for risk of bias. After correction for multiple testing, other selected predictors were non-significant. CONCLUSIONS Our findings reveal superiority of clomipramine over SSRIs, even after adjusting for risk of bias. Effect sizes may be attenuated when considering publication bias and methodological rigour, emphasising the importance of robust studies to guide clinical utility of OCD pharmacotherapy. PROSPERO REGISTRATION NUMBER CRD42023394924.
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Affiliation(s)
- Sem E Cohen
- Psychiatry, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Jasper Brian Zantvoord
- Psychiatry, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Bram W C Storosum
- Psychiatry, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | | | - Joost Daams
- Medical Library, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Babet Wezenberg
- Psychiatry, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Anthonius de Boer
- Medicines Evaluation Board, Utrecht, The Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Damiaan A J P Denys
- Psychiatry, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
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12
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Diamond R, Waite F, Boylan AM, Hicks A, Kabir T, Freeman D. Framework for understanding movement and physical activity in patients diagnosed with psychosis. BMJ Ment Health 2024; 27:e300878. [PMID: 38302410 PMCID: PMC10836347 DOI: 10.1136/bmjment-2023-300878] [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] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/30/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Patients diagnosed with psychosis often spend less time than others engaged in exercise and more time sitting down, which likely contributes to poorer physical and mental health. OBJECTIVE The aim of this study was to develop a comprehensive framework from the perspective of patients, carers, and staff for understanding what promotes movement and physical activity. METHODS A critical realist approach was taken to design the study. Interviews (n=23) and focus groups (n=12) were conducted with (1) outpatients aged 16 years or older diagnosed with psychosis, and under the care of a mental health team, (2) carers and (3) mental health staff working in the community. Purposive sampling was used to maximise variation in participant characteristics. Data were analysed using reflexive thematic analysis. FINDINGS 19 patients (9 women and 10 men, mean age=45·0 (SD=12·2) years, 15 White British, 2 Black African, 1 Pakistani and 1 other ethnic group), 14 carers (11 women and 3 men, mean age=59·9 (SD=12·7) years, 13 White British and 1 Asian) and 18 staff (14 women and 4 men, mean age=38·7 (SD=12·3) years, 15 White British, 1 White other, 1 Asian Bangladeshi and 1 other Asian) participated in the study. Five factors were found to promote movement and physical activity. Patients must be able to find a purpose to moving which is meaningful to them (Factor 1: Purpose). Patients need to have an expectation of the positive consequences of movement and physical activity, which can be influenced by others' expectations (Factor 2: Predictions). A patient's current physical (eg, pain) and emotional state (eg, distress about voices) needs to be addressed to allow movement and physical activity (Factor 3: Present state). Movement and physical activity can also be encouraged by the availability of effective and tailored support, provided by engaged and supported people (Factor 4: Provision). Finally, through the identification and interruption of vicious cycles (eg, between inactivity and mood states) more positive cycles can be put in place (Factor 5: Process). CONCLUSIONS AND CLINICAL IMPLICATIONS The 5 P (Purpose, Predictions, Present state, Provision and Process Physical Activity Framework) for understanding movement and physical activity for people diagnosed with psychosis has the potential to inform future research and guide interventions. A checklist is provided for clinicians to help foster change in activity levels.
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Affiliation(s)
- Rowan Diamond
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Felicity Waite
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Anne-Marie Boylan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Thomas Kabir
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Daniel Freeman
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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Porter A, Franklin M, De Vocht F, d'Apice K, Curtin E, Albers P, Kidger J. Estimating the effectiveness of an enhanced 'Improving Access to Psychological Therapies' (IAPT) service addressing the wider determinants of mental health: a real-world evaluation. BMJ Open 2024; 14:e077220. [PMID: 38296286 PMCID: PMC10828880 DOI: 10.1136/bmjopen-2023-077220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/22/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Addressing the wider determinants of mental health alongside psychological therapy could improve mental health service outcomes and population mental health. OBJECTIVES To estimate the effectiveness of an enhanced 'Improving Access to Psychological Therapies' (IAPT) mental health service compared with traditional IAPT in England. Alongside traditional therapy treatment, the enhanced service included well-being support and community service links. DESIGN A real-world evaluation using IAPT's electronic health records. SETTING Three National Health Service IAPT services in England. PARTICIPANTS Data from 17 642 service users classified as having a case of depression and/or anxiety at baseline. INTERVENTION We compared the enhanced IAPT service (intervention) to an IAPT service in a different region providing traditional treatment only (geographical control), and the IAPT service with traditional treatment before additional support was introduced (historical control). PRIMARY OUTCOME MEASURES Patient Health Questionnaire-9 (PHQ-9) Depression Scale (score range: 0-27) and Generalised Anxiety Disorder-7 (GAD-7) Anxiety Scale (score range: 0-21); for both, lower scores indicate better mental health. Propensity scores were used to estimate inverse probability of treatment weights, subsequently used in mixed effects regression models. RESULTS Small improvements (mean, 95% CI) were observed for PHQ-9 (depression) (-0.21 to -0.32 to -0.09) and GAD-7 (anxiety) (-0.23 to -0.34 to -0.13) scores in the intervention group compared with the historical control. There was little evidence of statistically significant differences between intervention control and geographical control. CONCLUSIONS Embedding additional health and well-being (H&W) support into standard IAPT services may lead to improved mental health outcomes. However, the lack of improved outcomes compared with the geographical control may instead reflect a more general improvement to the intervention IAPT service. It is not clear from our findings whether an IAPT service with additional H&W support is clinically superior to traditional IAPT models.
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Affiliation(s)
- Alice Porter
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Matthew Franklin
- Health Economic and Decision Science, The University of Sheffield, Sheffield, UK
| | - Frank De Vocht
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (NIHR ARC West), Bristol, UK
| | - Katrina d'Apice
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Esther Curtin
- Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Patricia Albers
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Judi Kidger
- Population Health Sciences, University of Bristol, Bristol, UK
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14
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Phelps AJ, Adler AB, Belanger SAH, Bennett C, Cramm H, Dell L, Fikretoglu D, Forbes D, Heber A, Hosseiny F, Morganstein JC, Murphy D, Nazarov A, Pedlar D, Richardson JD, Sadler N, Williamson V, Greenberg N, Jetly R. Addressing moral injury in the military. BMJ Mil Health 2024; 170:51-55. [PMID: 35705259 DOI: 10.1136/bmjmilitary-2022-002128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/04/2022] [Indexed: 11/03/2022]
Abstract
Moral injury is a relatively new, but increasingly studied, construct in the field of mental health, particularly in relation to current and ex-serving military personnel. Moral injury refers to the enduring psychosocial, spiritual or ethical harms that can result from exposure to high-stakes events that strongly clash with one's moral beliefs. There is a pressing need for further research to advance understanding of the nature of moral injury; its relationship to mental disorders such as posttraumatic stress disorder and depression; triggering events and underpinning mechanisms; and prevalence, prevention and treatment. In the meantime, military leaders have an immediate need for guidance on how moral injury should be addressed and, where possible, prevented. Such guidance should be theoretically sound, evidence-informed and ethically responsible. Further, the implementation of any practice change based on the guidance should contribute to the advancement of science through robust evaluation. This paper draws together current research on moral injury, best-practice approaches in the adjacent field of psychological resilience, and principles of effective implementation and evaluation. This research is combined with the military and veteran mental health expertise of the authors to provide guidance on the design, implementation and evaluation of moral injury interventions in the military. The paper discusses relevant training in military ethical practice, as well as the key roles leaders have in creating cohesive teams and having frank discussions about the moral and ethical challenges that military personnel face.
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Affiliation(s)
- Andrea J Phelps
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Victoria, Australia
| | - A B Adler
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - S A H Belanger
- Royal Military College of Canada, Kingston, Ontario, Canada
- Canadian Institute for Military and Veteran Health Research, Kingston, Ontario, Canada
| | - C Bennett
- New Zealand Defence Force, Wellington, New Zealand
| | - H Cramm
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - L Dell
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Victoria, Australia
| | - D Fikretoglu
- Defence Research and Development Canada, Toronto Research Centre, Toronto, Ontario, Canada
| | - D Forbes
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Victoria, Australia
| | - A Heber
- Veterans Affairs Canada, Charottetown, Prince Edward Island, Canada
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - F Hosseiny
- Canadian Centre of Excellence on PTSD and Related Mental Health Conditions, Ottawa, Ontario, Canada
| | - J C Morganstein
- Center for the Study of Traumatic Stress, Department of Psychiatry, School of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - D Murphy
- Combat Stress, Leatherhead, UK
- King's Centre for Military Health Research, King's College London, London, UK
| | - A Nazarov
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
- MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - D Pedlar
- Canadian Institute for Military and Veteran Health Research, Kingston, Ontario, Canada
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - J D Richardson
- MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - N Sadler
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Victoria, Australia
| | - V Williamson
- Institute of Psychiatry Psychology, and Neuroscience, King's College London, London, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - N Greenberg
- King's Centre for Military Health Research, King's College London, London, UK
| | - R Jetly
- Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
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15
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Yesuf W, Hiko D, Alemayehu E, Kusheta S, Shita A, Beyene M. Health-related quality of life in epilepsy and its associated factors among adult patients with epilepsy attending Mizan Tepi University Teaching Hospital, Southwest Ethiopia: a cross-sectional study. BMJ Open 2024; 14:e079165. [PMID: 38262645 PMCID: PMC10806578 DOI: 10.1136/bmjopen-2023-079165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE To determine the mean score of health-related quality of life in epilepsy and its associated factors among adult patients with epilepsy. DESIGN Institution-based cross-sectional study based on random case selection was conducted. SETTING The study was carried out at Mizan-Tepi University Teaching Hospital located in Southwest Ethiopia. PARTICIPANTS A total of 346 patients with epilepsy who visited the psychiatric clinic for follow-up for at least 3 months and who were 18 years or older were included in the study. MAIN OUTCOME MEASURE Health-related quality of life in epilepsy measured using quality-of-life in epilepsy (QOLIE)-31 health survey evaluated as a dependent variable with simple and multivariable linear regressions. RESULTS The overall weighted mean score of health-related quality of life was 55.6 (SD=20.9). Only 50.3% of patients scored above a total score of 50. Age (β=-0.35, 95% CI-0.46 to -0.23), anxiety (β=-6.79, 95% CI -9.26 to -4.32), depression (β=-7.36, 95% CI -10.16 to -4.55), low self-esteem (β=-5.29, 95% CI -8.07 to -2.51), perceived stigma (β=-3.62, 95% CI -6.30 to -0.94), taking medication two times or more times per day (β=-2.4, 95% CI -4.58 to -0.27), being illiterate (β=-4.1, 95% CI -6.87 to -1.31) and having more than two seizures for a year (β=-4.18, 95% CI -6.97 to -1.39) were negatively affecting health-related quality of life while income of >1000 birr per month (β=4.5, 95% CI 2.00 to 6.99), social support (β=0.34, 95% CI 0.27 to 0.40) and being free of seizure for a year (β=6.5, 95% CI 3.66 to 9.33) were positively affecting health-related quality of life. CONCLUSIONS Only half of the patients with epilepsy in the study area are leading a better quality of life and the overall mean health-related quality of life score is lower than the global mean score. Health-related quality of life was inversely associated with age, anxiety, depression, low self-esteem, perceived stigma, taking medication two times a day or more, being illiterate and experiencing more than two seizures in a year. Besides controlling seizures, public educational campaigns should be conducted to raise public awareness regarding the need for social support.
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Affiliation(s)
- Wudu Yesuf
- Department of Public Health, Mizan-Aman College of Health Sciences, Aman, Ethiopia
| | - Desta Hiko
- Department of Epidemiology, Jimma University College of Public Health and Medical Sciences, Jimma, Ethiopia
| | - Eshetu Alemayehu
- Department of Epidemiology, Jimma University College of Public Health and Medical Sciences, Jimma, Ethiopia
| | - Samuel Kusheta
- Department of Public Health, Hosanna College of Health Sciences, Hosanna, Ethiopia
| | - Abel Shita
- Department of Public Health, Mizan-Aman College of Health Sciences, Aman, Ethiopia
| | - Melkamu Beyene
- Department of Epidemiology, Mizan-Tepi University, Mizzan, Ethiopia
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16
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Minshall D. Suicide in the UK Armed Forces: prediction is difficult, prevention is complex, a strategy and plan now bring critical coherence. BMJ Mil Health 2024:e002617. [PMID: 38177072 DOI: 10.1136/military-2023-002617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Darren Minshall
- DCMH Plymouth, HMS DRAKE, HMNB Devonport, Plymouth, PL2 2BG, UK
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17
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Ramfjord LS, Kahn N, Langsrud K, Halvorsen JØØ, Morken G, Saksvik S, Engvik LSS, Lydersen S, Kallestad H. Chronotherapy for patients with a depressive episode treated in a public outpatient mental healthcare clinic in Norway: protocol for a randomised controlled trial. BMJ Open 2024; 14:e076039. [PMID: 38171633 PMCID: PMC10773329 DOI: 10.1136/bmjopen-2023-076039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Depression is highly prevalent in outpatients receiving treatment for mental disorders. Treatment as usual (TAU) usually consists of either psychotherapy and/or antidepressant medication and often takes several weeks before clinical effect. Chronotherapy, consisting of sleep deprivation, sleep-wake phase advancement and stabilisation, and light therapy, is a possible addition to TAU that may decrease the time to treatment response. This randomised controlled trial will examine the benefits of adding chronotherapy to TAU compared with TAU alone. METHODS AND ANALYSIS The trial will include 76 participants with a depressive episode who initiate outpatient treatment at a secondary mental healthcare outpatient clinic at St. Olavs University Hospital. Participants will be randomly allocated 1:1 to either chronotherapy in addition to TAU or TAU alone. Assessments will be performed at baseline, day 3, day 4, day 7, day 14 and weeks 4, 8, 24 and 52, in addition to longer-term follow ups. The main outcome is difference in levels of depressive symptoms after week 1 using the Inventory of Depressive Symptomatology Self-Report. Secondary outcomes include levels of depressive symptoms at other time points, as well as anxiety, health-related quality of life and sleep assessed through subjective and objective measures. ETHICS AND DISSEMINATION The study protocol has been approved by the Regional Committee for Medical Research Ethics Central Norway (ref: 480812) and preregistered at ClinicalTrials.gov (ref: NCT05691647). Results will be published via peer-reviewed publications, presentations at research conferences and presentations for clinicians and other relevant groups. The main outcomes will be provided separately from exploratory analysis. TRIAL REGISTRATION NUMBER NCT05691647.
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Affiliation(s)
- Lina Stålesen Ramfjord
- Department of Mental Health Care, St Olavs Hospital Trondheim University Hospital, Trondheim, Trøndelag, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Trøndelag, Norway
| | - Nikolaj Kahn
- Department of Mental Health Care, St Olavs Hospital Trondheim University Hospital, Trondheim, Trøndelag, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Trøndelag, Norway
| | - Knut Langsrud
- Department of Mental Health Care, St Olavs Hospital Trondheim University Hospital, Trondheim, Trøndelag, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Trøndelag, Norway
| | - Joar Øveraas Øveraas Halvorsen
- Department of Mental Health Care, St Olavs Hospital Trondheim University Hospital, Trondheim, Trøndelag, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Trøndelag, Norway
| | - Gunnar Morken
- Department of Mental Health Care, St Olavs Hospital Trondheim University Hospital, Trondheim, Trøndelag, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Trøndelag, Norway
| | - Simen Saksvik
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Trøndelag, Norway
| | - Liv Sigrun Sættem Engvik
- Department of Mental Health Care, St Olavs Hospital Trondheim University Hospital, Trondheim, Trøndelag, Norway
| | - Stian Lydersen
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Trøndelag, Norway
| | - Håvard Kallestad
- Department of Mental Health Care, St Olavs Hospital Trondheim University Hospital, Trondheim, Trøndelag, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Trøndelag, Norway
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18
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Hansen CØ, Thorup AAE, Nordentoft M, Hjorthøj C. Predictors of transfer and prognosis after transfer from child and adolescent mental health services to adult mental health services-a Danish nationwide prospective register-based cohort study. Eur Child Adolesc Psychiatry 2024; 33:79-87. [PMID: 36598584 DOI: 10.1007/s00787-022-02136-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/23/2022] [Indexed: 01/05/2023]
Abstract
Onset of mental health disorder peaks during adolescence making continuity of care during this period of life crucial both to ensure a smooth treatment course and high quality of mental health services for adolescents. We aimed to examine which clinical and sociodemographic features predict transfer from child and adolescent mental health services to adult mental health services and if transfer is associated with prognosis. A Danish register study including all 16-17-year-olds with an outpatient contact in child and adolescent mental health services, who were discharged in the period of 1/1/06-10/05/15. Out of 27,170 Danish adolescents, 16% transferred to adult mental health services. Transfer was predicted by schizophrenia (OR 6.16; 95% CI 5.51-6.90) and personality disorders (OR 2.08; 95% CI 1.84-2.34), while hyperkinetic (OR 0.54; 95% CI 0.49-0.59) and pervasive developmental disorders (OR 0.42; 95% CI 0.31-0.58) decreased likelihood of transfer. Transfer was also substantially predicted by inpatient admission (OR 3.37; 95% CI 3.14-3.61) and psychiatric medication (OR 2.07; 95% CI 1.92-2.23). Transfer was associated with higher rates of inpatient admission to adult mental health services (IRR 5.83; 95% CI 4.37-7.77), more psychiatric emergency contacts (IRR 12.0; 95% CI 10.7-13.4), more convictions (IRR 1.40; 95% CI 1.23-1.59) and suicide attempts (IRR 5.70; 95% CI 4.72-6.90). Policy-makers and clinicians should push for improvements and open a discussion of how to ensure continuity of care for adolescents with psychiatric disorders.
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Affiliation(s)
- Christina Østergaard Hansen
- Copenhagen Research Center for Mental Health-CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Mental Health Services Capital Region, Gentofte Hospitalsvej 15 4th Floor, 2900, Hellerup, Denmark.
| | - Anne Amalie Elgaard Thorup
- Child and Adolescent Mental Health Centre, Mental Health Services Capital Region, Research Unit, Copenhagen University Hospital, Hellerup, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health-CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Mental Health Services Capital Region, Gentofte Hospitalsvej 15 4th Floor, 2900, Hellerup, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health-CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Mental Health Services Capital Region, Gentofte Hospitalsvej 15 4th Floor, 2900, Hellerup, Denmark
- Department of Public Health, University of Copenhagen, Section of Epidemiology, Copenhagen, Denmark
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Rashtbari A, Rahnejat AM, Taghva A, Jamil L, Sheykholeslami A. Psychometric properties, predictive utility and diagnostic capacity of the Persian version of the Scale of Resilience to Suicide Attempts in army conscripts. BMJ Mil Health 2023:e002602. [PMID: 38154824 DOI: 10.1136/military-2023-002602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/11/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION Suicide among army conscripts represents a poorly understood and complex public health issue that has escalated in recent decades. The early identification of individuals at risk holds the potential to significantly contribute to the effective prevention of suicide attempts. To address this, the Scale of Resilience to Suicide Attempts-18 (SRSA-18) has been developed to assess protective factors related to suicide attempts. The present study aimed to develop a Persian version of SRSA-18 (P-SRSA) and examine its psychometric properties and predictive utility within a sample of the Iranian Army. METHODS The initial study sample consisted of 400 male conscripts from the Iranian Army grand forces (M=19.86, SD=1.40). Subsequently, for the follow-up stage, 296 participants (M=19.83, SD=1.39) were recruited. The participants were assessed using various measures of resilience, social support, suicide and hopelessness at baseline and a 6-month follow-up. RESULTS In contrast to the original version, both exploratory and confirmatory factor analyses supported an 18-item two-factor model of the P-SRSA (root mean square error of approximation=0.076; 95% CI (0.069 to 0.086), comparative fit index=0.943, Tucker-Lewis index=0.936). P-SRSA strongly correlated with convergent/divergent measures and demonstrated satisfactory internal consistency (α=0.82). Furthermore, regression analysis revealed that the P-SRSA significantly predicted suicide reattempts at baseline and during a 6-month follow-up period. CONCLUSION The study confirms that the P-SRSA, comprising a two-factor, 18-item solution, is a reliable measure of resilience, displaying robust discriminant and predictive validity. These findings provide substantial support for implementing P-SRSA in samples from the Iranian Army, highlighting its potential to identify suicidal conscripts effectively.
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Affiliation(s)
- Alireza Rashtbari
- Aja University of Medical Sciences, Tehran, The Islamic Republic of Iran
| | - A M Rahnejat
- Aja University of Medical Sciences, Tehran, The Islamic Republic of Iran
| | - A Taghva
- Aja University of Medical Sciences, Tehran, The Islamic Republic of Iran
| | - L Jamil
- Aja University of Medical Sciences, Tehran, The Islamic Republic of Iran
| | - A Sheykholeslami
- Aja University of Medical Sciences, Tehran, The Islamic Republic of Iran
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20
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Andreu-Bernabeu Á, González-Peñas J, Arango C, Díaz-Caneja CM. Socioeconomic status and severe mental disorders: a bidirectional multivariable Mendelian randomisation study. BMJ Ment Health 2023; 26:e300821. [PMID: 38007229 PMCID: PMC10680010 DOI: 10.1136/bmjment-2023-300821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/18/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Despite the evidence supporting the relationship between socioeconomic status (SES) and severe mental disorders (SMD), the directionality of the associations between income or education and mental disorders is still poorly understood. OBJECTIVE To investigate the potential bidirectional causal relationships between genetic liability to the two main components of SES (income and educational attainment (EA)) on three SMD: schizophrenia, bipolar disorder (BD) and depression. METHODS We performed a bidirectional, two-sample univariable Mendelian randomisation (UVMR) and multivariable Mendelian randomisation (MVMR) study using SES phenotypes (income, n=397 751 and EA, n=766 345) and SMD (schizophrenia, n=127 906; BD, n=51 710 and depression, n=500 119) genome-wide association studies summary-statistics to dissect the potential direct associations of income and EA with SMD. FINDINGS UVMR showed that genetic liability to higher income was associated with decreased risk of schizophrenia and depression, with a smaller reverse effect of schizophrenia and depression on income. Effects were comparable after adjusting for EA in the MVMR. UMVR showed bidirectional negative associations between genetic liability to EA and depression and positive associations between genetic liability to EA and BD, with no significant effects on schizophrenia. After accounting for income, MVMR showed a bidirectional positive direction between genetic liability to EA and BD and schizophrenia but not with depression. CONCLUSIONS Our results suggest a heterogeneous link pattern between SES and SMD. We found a negative bidirectional association between genetic liability to income and the risk of schizophrenia and depression. On the contrary, we found a positive bidirectional relationship of genetic liability to EA with schizophrenia and BD, which only becomes apparent after adjusting for income in the case of schizophrenia. CLINICAL IMPLICATIONS These findings shed light on the directional mechanisms between social determinants and mental disorders and suggest that income and EA should be studied separately in relation to mental illness.
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Affiliation(s)
- Álvaro Andreu-Bernabeu
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier González-Peñas
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
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21
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von Below A, Hällström T, Sundh V, Björkelund C, Hange D. Association between anxiety and depression and all-cause mortality: a 50-year follow-up of the Population Study of Women in Gothenburg, Sweden. BMJ Open 2023; 13:e075471. [PMID: 37989363 PMCID: PMC10668159 DOI: 10.1136/bmjopen-2023-075471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVES This study aimed to examine the association between anxiety disorders and/or major depression disorder (ADs/MDD) and all-cause mortality in a 50-year perspective and to examine specific risk and health factors that may influence such an association. DESIGN Observational population study, 1968-2019. SETTING The Population Study of Women in Gothenburg, Sweden (PSWG). PARTICIPANTS In 1968-1969, 899 (out of 1462) women from PSWG were selected according to date of birth for a psychiatric investigation, including diagnostic evaluation. Eight hundred (89%) were accepted. Twenty-two women were excluded. Of the 778 included, 135 participants (17.4 %) had solely ADs, 32 (4.1%) had solely MDD and 25 (3.2%) had comorbid AD/MDD. PRIMARY AND SECONDARY OUTCOME MEASURES Associations between ADs, MDD, comorbid AD/MDD and all-cause mortality with adjustments for potential confounding factors. Differences between the groups concerning health and risk factors and their association with mortality. RESULTS In a fully adjusted model, ADs were non-significantly associated with all-cause mortality (HR 1.17, 95% CI 0.98 to 1.41). When examining age during risk time as separate intervals, a significant association between mortality and AD was seen in the group of participants who died at the age of 65-80 years (HR 1.70, 95% CI 1.26 to 2.29). In the younger or older age interval, the association did not reach significance at the 95% level of confidence. Among confounding factors, smoking and physical activity were the strongest contributors. The association between smoking and mortality tended to be further increased in the group with ADs versus the group without such disorders (HR 2.10, 95% CI 1.60 to 2.75 and HR 1.82, 95% CI 1.56 to 2.12, respectively). CONCLUSIONS This study suggests potential links between ADs, age and mortality among women with 50 years of follow-up, but does not provide definitive conclusions due to the borderline significance of the results.
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Affiliation(s)
- Amanda von Below
- Primary Health Care/School of Public Health and Community Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Tore Hällström
- Department of Psychiatry and Neurochemistry, Gothenburg University, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Valter Sundh
- Primary Health Care/School of Public Health and Community Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Cecilia Björkelund
- Primary Health Care/School of Public Health and Community Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Dominique Hange
- Primary Health Care/School of Public Health and Community Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
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22
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Abstract
Against the global need for increased access to mental services, health organisations are looking to technological advances to improve the delivery of care and lower costs. Since November 2022, with the public launch of OpenAI's ChatGPT, the field of generative artificial intelligence (AI) has received expanding attention. Although generative AI itself is not new, technical advances and the increased accessibility of large language models (LLMs) (eg, OpenAI's GPT-4 and Google's Bard) suggest use of these tools could be clinically significant. LLMs are an application of generative AI technology that can summarise and generate content based on training on vast data sets. Unlike search engines, which provide internet links in response to typed entries, chatbots that rely on generative language models can simulate dialogue that resembles human conversations. We examine the potential promise and the risks of using LLMs in mental healthcare today, focusing on their scope to impact mental healthcare, including global equity in the delivery of care. Although we caution that LLMs should not be used to disintermediate mental health clinicians, we signal how-if carefully implemented-in the long term these tools could reap benefits for patients and health professionals.
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Affiliation(s)
- Charlotte Blease
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
- Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - John Torous
- Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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23
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Zhang L, Yin J, Sun H, Yang J, Liu Y. Association between atherogenic coefficient and depression in US adults: a cross-sectional study with data from National Health and Nutrition Examination Survey 2005-2018. BMJ Open 2023; 13:e074001. [PMID: 37899167 PMCID: PMC10619029 DOI: 10.1136/bmjopen-2023-074001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/11/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE The pathogenesis of depression is related to immune inflammatory response. Atherogenic coefficient (AC) is an important indicator of lipid abnormalities, which can lead to immune inflammatory responses. However, no study has investigated the relationship between AC and depression in adult Americans. Therefore, we investigated this relationship. DESIGN This study used a cross-sectional design. SETTING The National Health and Nutrition Examination Survey (2005-2018) data were used for this study. PARTICIPANTS A total of 32 502 participants aged 20 years or older who had complete information for AC and depression were included in this study. PRIMARY AND SECONDARY OUTCOME MEASURES Depressive symptoms were assessed using the nine-item version of the Patient Health Questionnaire (PHQ-9), with a cut-off point of 9/10 indicating likely depression cases. Weighted logistic regression analyses and the smooth curve fittings were performed to explore the association between AC and depression. RESULTS After adjusting for potential confounders, a single unit increase in AC was associated with a 3% increase in the prevalence of depression (HR=1.03, 95% CI=1.00 to 1.06, p=0.039). The relationship between AC and depression was more obvious in females. CONCLUSIONS The AC is positively associated with depression.
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Affiliation(s)
- Lu Zhang
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jiahui Yin
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Haiyang Sun
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jiguo Yang
- College of Acupuncture and Massage, Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Yuanxiang Liu
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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24
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Kroener J, Mahler J, Sosic-Vasic Z. Addressing self-criticism in depression using CBT-based emotion-focused chairwork: study protocol of a randomised controlled trial. BMJ Open 2023; 13:e073128. [PMID: 37899154 PMCID: PMC10619115 DOI: 10.1136/bmjopen-2023-073128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 10/05/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION Self-criticism is a key feature in people diagnosed with depression, resulting in significant psychological distress. Despite the fact that cognitive-behavioural treatments are readily available, a significant number of patients report experiencing cognitive, but not emotional, change following therapy, resulting in the maintenance of psychological symptoms. Additionally, interventions targeting emotional experiencing, such as chairwork, are generally implemented within large-scale therapeutic treatments. Therefore, within the present study, we aim to evaluate the efficacy and safety of a short intervention using emotion-focused chairwork to target self-criticism in patients diagnosed with depression. METHODS AND ANALYSIS The study is designed as a randomised controlled trial with two parallel arms. 62 patients diagnosed with depression will be randomised to the intervention group or the waiting-list control group receiving treatment as usual. The intervention comprises of three treatment sessions using the chairwork technique over the course of 3 weeks. Outcome assessments will take place 1 week before the first treatment session, as well as 1 week and 3 months after the last treatment session. The primary outcomes are self-criticism and self-compassion. Secondary outcomes assess depressive symptoms, emotion regulation and overall self-esteem. Statistical analysis will be performed using intention-to-treat analysis, as well as per-protocol analysis implementing linear-mixed models. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee of the State Chamber of Physicians in Baden-Wuerttemberg, Germany (approval number: F-2023-12). Scientific findings shall be published in peer-reviewed journals to inform prospective clinical studies focusing on the implementation of chairwork within clinical practice. TRIAL REGISTRATION NUMBER German Clinical Trials Register (DRKS00031307; https://drks.de/search/de/trial/DRKS00031307).
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Affiliation(s)
- Julia Kroener
- Department of Applied Psychotherapy and Psychiatry, Christophsbad GmbH & Co Fachkrankenhaus, Goppingen, Germany
- Medical Department, University of Ulm, Ulm, Germany
| | - Jacqueline Mahler
- Department of Applied Psychotherapy and Psychiatry, Christophsbad GmbH & Co Fachkrankenhaus, Goppingen, Germany
- Medical Department, University of Ulm, Ulm, Germany
| | - Zrinka Sosic-Vasic
- Department of Applied Psychotherapy and Psychiatry, Christophsbad GmbH & Co Fachkrankenhaus, Goppingen, Germany
- Medical Department, University of Ulm, Ulm, Germany
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25
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Goff Z, Palmer C, Jadhakhan F, Barber A. Are diabetes self-management interventions delivered in the psychiatric inpatient setting effective? A protocol for a systematic review. BMJ Open 2023; 13:e069603. [PMID: 37798028 PMCID: PMC10565205 DOI: 10.1136/bmjopen-2022-069603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 08/24/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Diabetes is a major risk factor for cardiovascular disease, which is the most significant contributor to increased mortality due to natural causes in those with severe mental illness (SMI). Self-management interventions for diabetes have been shown to be effective in the general population, however, effects of these interventions in those with SMI is still unclear. Psychiatric admission could be used opportunistically to deliver interventions of this kind and help improve diabetes self-management. This review aims to assess whether interventions of this kind improve diabetes outcomes and have an effect on reducing cardiovascular risk. METHODS AND ANALYSIS This review will include studies assessing diabetes self-management interventions designed to be delivered to those aged 18 and over with comorbid type 2 diabetes and SMI during admission to psychiatric inpatient settings. Databases including the Cochrane Library, Medline, Psychinfo, CINAHL, Embase, WHO's International Clinical Trials Registry Platform, International Health Technology Assessment Database, UK Clinical Research Network and ClinicalTrials.gov will be searched from inception to September 2022. Where possible, meta-analysis of included studies will be conducted. If heterogeneity is high and meta-analysis is not possible, we will use other means of data synthesis and will include a narrative description of included studies. ETHICS AND DISSEMINATION Ethical approval is not required as the systematic review will only include data from existing studies. The results will be disseminated via peer-reviewed publication and presentation at relevant national and international conferences. PROSPERO REGISTRATION NUMBER CRD42022357672.
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Affiliation(s)
- Zoe Goff
- Leeds Institute of Health Science, University of Leeds, Leeds, UK
- Higher Trainee in Old Age Psychiatry, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Charlotte Palmer
- Leeds Institute of Health Science, University of Leeds, Leeds, UK
| | - Ferozkhan Jadhakhan
- Institute of Mental Health, School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
- Research and Innovation, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Alice Barber
- Leeds Institute of Health Science, University of Leeds, Leeds, UK
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26
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Higson L, O'Brien TJ, Rayner G, Alpitsis R, Winton-Brown T. Content or context? A study protocol for a three-arm parallel randomised controlled trial of R e-PROGRAM, a brief internet-based intervention for patients with functional seizures. BMJ Open 2023; 13:e072835. [PMID: 37793938 PMCID: PMC10551981 DOI: 10.1136/bmjopen-2023-072835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/29/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Functional seizures (FS) mimic epilepsy but are not caused by epileptic electrical activity in the brain and are believed to have a psychological origin. There is a well-documented gap between the needs of patients with FS and available therapeutic resources. While there is potential for reducing seizure burden in patients via psychosocial intervention, there is no evidence-based care pathway or consistent availability of treatment and no effective pharmacological treatment. The objective of this study is to investigate the clinical efficacy and tolerability of a novel internet-based intervention in reducing seizure frequency. METHODS AND ANALYSIS A 3-arm parallel randomised controlled trial will compare the efficacy of brief guided internet-based therapy to unguided internet-based therapy and to standard care. Approximately 100 participants with FS will be recruited, with diagnostic criteria based on gold standard video-electroencephalogram (v-EEG) monitoring; patients will be randomly assigned to one of the three study arms. The primary study outcome will be FS frequency at 6 weeks and at follow-up (6 and 12 months) compared with baseline. Seizure frequency will be modelled using Poisson regression. Secondary outcomes include psychosocial functioning, healthcare resource usage, anxiety, depression, somatisation and life impact. Between-group differences will be evaluated using analysis of variance. Analysis of covariance will estimate within-group changes on secondary outcomes. Cognitive and psychological factors will be used as predictors of seizure reduction in exploratory analyses. A qualitative survey using a semi-structured interview will use thematic analyses to explore participants' treatment experiences, their impressions of FS management and perceived mechanisms for change. ETHICS AND DISSEMINATION The study was approved by the Human Research and Ethics Committee of the Alfred Hospital Human Research Ethics Committee as part of the Australian Multisite Ethics approval system. Results of the study will be presented at national and international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12622000262707.
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Affiliation(s)
- Lana Higson
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Genevieve Rayner
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Rubina Alpitsis
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Toby Winton-Brown
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Alfred Hospital, Melbourne, Victoria, Australia
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Nordby ES, Guribye F, Nordgreen T, Lundervold AJ. Silver linings of ADHD: a thematic analysis of adults' positive experiences with living with ADHD. BMJ Open 2023; 13:e072052. [PMID: 37788928 PMCID: PMC10551976 DOI: 10.1136/bmjopen-2023-072052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 09/13/2023] [Indexed: 10/05/2023] Open
Abstract
OBJECTIVES To identify and explore positive aspects of attention deficit hyperactivity disorder (ADHD) as reported by adults with the diagnosis. DESIGN The current study used a qualitative survey design including the written responses to an open-ended question on positive aspects of ADHD. The participants' responses were analysed using thematic analysis. SETTING The participants took part in trial of a self-guided internet-delivered intervention in Norway. As part of the intervention, the participants were asked to describe positive aspects of having ADHD. PARTICIPANTS The study included 50 help-seeking adults with an ADHD diagnosis. RESULTS The participants described a variety of positive aspects related to having ADHD. The participants' experiences were conceptualised and thematically organised into four main themes: (1) the dual impact of ADHD characteristics; (2) the unconventional mind; (3) the pursuit of new experiences and (4) resilience and growth. CONCLUSIONS Having ADHD was experienced as both challenging and beneficial, depending on the context and one's sociocultural environment. The findings provide arguments for putting a stronger emphasis on positive aspects of ADHD, alongside the challenges, in treatment settings. TRIAL REGISTRATION NUMBER NCT04511169.
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Affiliation(s)
- Emilie S Nordby
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Frode Guribye
- Department of Information Science and Media Studies, University of Bergen, Bergen, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Astri J Lundervold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
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28
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Pizzol D, Trott M, Butler L, Barnett Y, Ford T, Neufeld SA, Ragnhildstveit A, Parris CN, Underwood BR, López Sánchez GF, Fossey M, Brayne C, Fernandez-Egea E, Fond G, Boyer L, Shin JI, Pardhan S, Smith L. Relationship between severe mental illness and physical multimorbidity: a meta-analysis and call for action. BMJ Ment Health 2023; 26:e300870. [PMID: 37907331 PMCID: PMC10619039 DOI: 10.1136/bmjment-2023-300870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND People with severe mental illness (SMI) have a higher prevalence of several chronic physical health conditions, and the prevalence of physical multimorbidity is expected to rise. The aim of this study was to assess the strength of the association between SMI and physical multimorbidity. STUDY SELECTION AND ANALYSIS We systematically searched PubMed/Medline, Scopus, Embase, Web of Science, PsycINFO and the behavioural sciences collection databases, from inception to 31 January 2023, for studies that investigated the association between SMI and physical multimorbidity. Humans of any age either clinically diagnosed and/or currently receiving treatment for SMI, specified as schizophrenia (and related psychotic disorders), bipolar disorder and psychotic depression, were eligible. Data from studies selected for inclusion were converted into ORs, with a subsequent meta-analysis conducted. FINDINGS We included 19 studies with a total of 194 123 patients with SMI with different diagnoses and drawn from the general population. The pooled OR for physical multimorbidity in people with versus without SMI was 1.84 (95% CI 1.33 to 2.54), with the analysis indicating a high level of heterogeneity (98.38%). The other 15 studies included in the systematic review for which it was not possible to conduct a meta-analysis showed strong associations between SMI and physical multimorbidity. CONCLUSIONS The current evidence highlights the link between SMI and physical multimorbidity. A multidisciplinary approach is now urgent to develop the best models of services tailored to patients with SMI with physical multimorbidities to improve physical, mental and social outcomes. PROSPERO registration number CRD42023395165.
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Affiliation(s)
| | - Mike Trott
- Queensland Centre for Mental Health Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Laurie Butler
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Yvonne Barnett
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation trust, Cambridge, UK
| | | | | | - Christopher N Parris
- School of Life Sciences, Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, UK
| | - Benjamin R Underwood
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation trust, Cambridge, UK
| | | | - Matt Fossey
- Veterans and Families Institute for Military Social Research, Anglia Ruskin University, Cambridge, UK
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Emilio Fernandez-Egea
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation trust, Cambridge, UK
| | - Guillaume Fond
- CEReSS-Health Services Research and Quality of Life Center, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Laurent Boyer
- CEReSS-Health Services Research and Quality of Life Center, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Shahina Pardhan
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK
- Centre for Inclusive Community Eye Health, Anglia Ruskin University, Caambridge, UK
| | - Lee Smith
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
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29
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Hua P, Shakoor S, Fenton SJ, Freestone M, Weich S, Bhui K. Racialised staff-patient relationships in inpatient mental health wards: a realist secondary qualitative analysis of patient experience data. BMJ Ment Health 2023; 26:e300661. [PMID: 37852630 PMCID: PMC10583032 DOI: 10.1136/bmjment-2023-300661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/24/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND The current study is a secondary analysis of qualitative data collected as part of EURIPIDES, a study which assessed how patient experience data were used to improve the quality of care in National Health Service (NHS) mental health services. OBJECTIVE We undertook a detailed realist secondary qualitative analysis of 10 interviews in which expressions of racialisation were unexpectedly reported. This theme and these data did not form part of the primary realist evaluation. METHODS Interviews were originally conducted with the patients (18-65 years: 40% female, 60% male) from four different geographically located NHS England mental health trusts between July and October 2017. Secondary qualitative data analysis was conducted in two phases: (1) reflexive thematic analysis and retroduction; (2) refinement of context-mechanism-outcome configurations to explore the generative mechanisms underpinning processes of racialisation and revision of the initial programme theory. FINDINGS There were two main themes: (1) absence of safe spaces to discuss racialisation which silenced and isolated patients; (2) strained communication and power imbalances shaped a process of mutual racialisation by patients and staff. Non-reporting of racialisation and discrimination elicited emotions such as feeling othered, misunderstood, disempowered and fearful. CONCLUSIONS The culture of silence, non-reporting and power imbalances in inpatient wards perpetuated relational racialisation and prevented authentic feedback and staff-patient rapport. CLINICAL IMPLICATIONS Racialisation in mental health trusts reflects lack of psychological safety which weakens staff-patient rapport and has implications for authentic patient engagement in feedback and quality improvement processes. Larger-scale studies are needed to investigate racialisation in the staff-patient relationships.
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Affiliation(s)
- Phuong Hua
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Sania Shakoor
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Sarah-Jane Fenton
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Mark Freestone
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | - Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, Oxford, UK
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Hinze V, Henshall C, Smith T, Littlejohns J, Collett Z, Jones H, Maughan D, Ede R, Moll D, Marlowe K, Broughton N, Geddes J, Cipriani A. Count Me In: an inclusive approach towards patient recruitment for clinical research studies in the NHS. BMJ Ment Health 2023; 26:e300774. [PMID: 37879674 PMCID: PMC10603415 DOI: 10.1136/bmjment-2023-300774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Participation in clinical research is associated with better patient outcomes and higher staff retention and satisfaction rates. Nevertheless, patient recruitment to mental health studies is challenging due to a reliance on clinician or patient referrals (standard approach). To empower patients and make healthcare research more equitable, we explored a novel researcher-led approach, called 'Count Me In' (CMI). OBJECTIVE To evaluate a 12-month implementation of CMI in a routine clinical setting. METHODS CMI was launched in August 2021 in a mental health National Health Service (NHS) Trust in England. Patients (aged 18+) learnt about CMI at their initial clinical appointment. Unless they opted out, they became contactable for research (via research informatics searches). FINDINGS After 12 months, 368 patients opted out and 22 741 became contactable through CMI, including 2716 through the standard approach and 20 025 through electronic searches (637% increase). Of those identified via electronic searches, 738 were contacted about specific studies and 270 consented to participate. Five themes were identified based on patient and staff experiences of CMI: 'level of awareness and accessibility of CMI', 'perceptions of research and perceived engagement with CMI', 'inclusive research practice', 'engagement and incentives for research participation', and 'relationships between clinical and research settings'. CONCLUSIONS CMI (vs standard) led to a larger and diverse patient cohort and was favoured by patients and staff. Yet a shift in the NHS research culture is needed to ensure that this diversity translates to actual research participation. CLINICAL IMPLICATIONS Through collaboration with other NHS Trusts and services, key funders (National Institute for Health and Care Research) and new national initiatives (Office for Life Sciences Mental Health Mission), CMI has the potential to address recruitment challenges through rapid patient recruitment into time-sensitive country-wide studies.
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Affiliation(s)
- Verena Hinze
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Catherine Henshall
- Oxford Precision Psychiatry Lab, NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
- Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR), Oxford Brookes University Faculty of Health and Life Sciences, Oxford, UK
| | - Tanya Smith
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | | | - Zoe Collett
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Helen Jones
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Daniel Maughan
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Roger Ede
- Oxford Precision Psychiatry Lab, NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Deborah Moll
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Karl Marlowe
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Nick Broughton
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - John Geddes
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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Clemmensen L, Jørgensen G, Gundersen KB, Smith LC, Midtgaard J, Bouchard S, Thomsen CP, Turgut L, Glenthoj LB. Study protocol for virtual leisure investigating the effect of virtual reality-delivered stress reduction, entertainment and distraction on the use of coercion and need-based medication and patient satisfaction at a closed psychiatric intensive care unit - a mixed-methods pilot clinical trial. BMJ Open 2023; 13:e070566. [PMID: 37739476 PMCID: PMC10533807 DOI: 10.1136/bmjopen-2022-070566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 08/25/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION The environment at a psychiatric inpatient ward can lead to emotional distress and behavioural deviations in vulnerable individuals potentially resulting in conflicts, increased use of need-based medication and coercive actions, along with low satisfaction with treatment. To accommodate these challenges, recreational and entertaining interventions are recommended. The tested interventions have, however, shown varying effects and demand a high degree of planning and staff involvement while being difficult to adapt to individual needs. Virtual reality (VR) may help overcome these challenges. METHODS AND ANALYSIS The study is a mixed-methods clinical trial with a target sample of 124 patients hospitalised at a closed psychiatric ward in the capital region of Denmark. Outcomes (eg, coercion, need-based medication and perceived stress) for a 12-month period where all patients are offered VR-based recreational experiences during their hospitalisation will be compared with outcomes for a 12-month period where VR is not offered. Feasibility and acceptability will be explored with qualitative interviews supplemented with non-participant observations and focus groups. The study began on 1 January 2023, and we expect to complete data collection by 31 December 2024. ETHICS AND DISSEMINATION The study is registered at Danish Data Protection Agency (j.no P-2022-466) and is approved by the Committee on Health Research Ethics of the capital region of Denmark (j.no 22013313). All patients will be required to provide informed consent. Results from this study will be disseminated via peer-reviewed journals and congress/consortium presentations. TRIAL REGISTRATION NUMBER NCT05654740.
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Affiliation(s)
- Lars Clemmensen
- VIRTU Research Group, Copenhagen Research Centre of Mental Health (CORE), Psychiatric Centre Copenhagen, Hellerup, Denmark
| | - Gry Jørgensen
- VIRTU Research Group, Copenhagen Research Centre of Mental Health (CORE), Psychiatric Centre Copenhagen, Hellerup, Denmark
| | - Kristina Ballestad Gundersen
- VIRTU Research Group, Copenhagen Research Centre of Mental Health (CORE), Psychiatric Centre Copenhagen, Hellerup, Denmark
| | - Lisa Charlotte Smith
- VIRTU Research Group, Copenhagen Research Centre of Mental Health (CORE), Psychiatric Centre Copenhagen, Hellerup, Denmark
| | - Julie Midtgaard
- Centre for applied research in mental health care (CARMEN), Psychiatric Center Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | | | | | | | - Louise Birkedal Glenthoj
- VIRTU Research Group, Copenhagen Research Centre of Mental Health (CORE), Psychiatric Centre Copenhagen, Hellerup, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Mackay CE. Trichotillomania: a perspective synthesised from neuroscience and lived experience. BMJ Ment Health 2023; 26:e300795. [PMID: 37734751 DOI: 10.1136/bmjment-2023-300795] [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: 06/09/2023] [Accepted: 08/25/2023] [Indexed: 09/23/2023]
Abstract
Trichotillomania, or hair-pulling disorder, is one of a family of disorders called body-focused repetitive behaviours (BFRBs), which also include disordered skin-picking (dermotillomania) and nail-biting (onychophagia). The disorders affect 1%-2% of the population, cause high levels of distress and have high levels of comorbidity with other psychiatric diagnoses. The key facts and figures are briefly reviewed and some important points are further explored: (1) BFRBs are associated with psychological distress, but are distinct from other diagnoses, (2) The pathological behaviours mirror excessive self-grooming behaviours in other species, and may relate to immune-system mediated feedback loops, and (3) The resulting behaviours are stigmatised and cause intense shame and isolation for those who suffer, which might in itself maintain the feedback loop. These observations lead to the hypothesis that the core disorder is one of pathological grooming, which may have a basis in an immune response, with shame being both a consequence and a maintainer of the disorder. The major barrier to testing the hypotheses and potential interventions remains the stigma that keeps these disorders, and those who suffer from them, in the shadows.
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Zeka F, Clemmensen L, Arnfred BT, Nordentoft M, Glenthøj LB. Examination of gaze behaviour in social anxiety disorder using a virtual reality eye-tracking paradigm: protocol for a case -control study. BMJ Open 2023; 13:e071927. [PMID: 37620268 PMCID: PMC10450086 DOI: 10.1136/bmjopen-2023-071927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Social anxiety disorder (SAD) has an early onset, a high lifetime prevalence, and may be a risk factor for developing other mental disorders. Gaze behaviour is considered an aberrant feature of SAD. Eye-tracking, a novel technology device, enables recording eye movements in real time, making it a direct and objective measure of gaze behaviour. Virtual reality (VR) is a promising tool for assessment and diagnostic purposes. Developing an objective screening tool based on examination of gaze behaviour in SAD may potentially aid early detection. The objective of this current study is, therefore to examine gaze behaviour in SAD utilising VR. METHODS AND ANALYSIS A case-control study design is employed in which a clinical sample of 29 individuals with SAD will be compared with a matched healthy control group of 29 individuals. In the VR-based eye-tracking paradigm, participants will be presented to stimuli consisting of high-res 360° 3D stereoscopic videos of three social-evaluative tasks designed to elicit social anxiety. The study will investigate between-group gaze behaviour differences during stimuli presentation. ETHICS AND DISSEMINATION The study has been approved by the National Committee on Health Research Ethics for the Capital Region of Denmark (H-22041443). The study has been preregistered on OSF registries: https://doi.org/10.17605/OSF.IO/XCTAKAll participants will be provided with written and oral information. Informed consent is required for all the participants. Participation is voluntarily, and the participants can at any time terminate their participation without any consequences. Study results; positive, negative or inconclusive will be published in relevant scientific journals.
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Affiliation(s)
- Fatime Zeka
- VIRTU Research Group, Copenhagen Research Centre on Mental Health (CORE), Hellerup, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Lars Clemmensen
- VIRTU Research Group, Copenhagen Research Centre on Mental Health (CORE), Hellerup, Denmark
| | | | - Merete Nordentoft
- Copenhagen Research Centre on Mental Health (CORE), Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Louise Birkedal Glenthøj
- VIRTU Research Group, Copenhagen Research Centre on Mental Health (CORE), Hellerup, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Namaky N, Swearingen HR, Winter J, Bozzay M, Primack JM, Philip NS, Barredo J. Suicidal thoughts and behaviours among military veterans: protocol for a prospective, observational, neuroimaging study. BMJ Open 2023; 13:e070654. [PMID: 37586858 PMCID: PMC10432662 DOI: 10.1136/bmjopen-2022-070654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION This study's overarching goal is to examine the relationship between brain circuits and suicidal thoughts and behaviours (STBs) in a transdiagnostic sample of US military veterans. Because STBs have been linked with maladaptive decision-making and disorders linked to impulsivity, this investigation focuses on valence and inhibitory control circuits. METHODS AND ANALYSIS In this prospective, observational study, we will collect functional MRI (fMRI), cognitive and clinical data from 136 veterans (target sample size) recruited from the Providence VA Health System (PVAHS): 68 with STBs and 68 matched controls. Behavioural data will be collected using standardised measures of STBs, psychiatric symptoms, cognition, functioning and medical history. Neuroimaging data will include structural, task and resting fMRI. We will conduct follow-up interviews and assessments at 6, 12 and 24 months post-enrolment. Primary analyses will compare data from veterans with and without STBs and will also evaluate whether activation and connectivity within circuits of valence and inhibition covary with historical and prospective patterns of suicidal ideation and behaviour. ETHICS AND DISSEMINATION The PVAHS Institutional Review Board approved this study (2018-051). Written informed consent will be obtained from all participants. Findings from this study will be published in peer-reviewed journals and presented at local, regional, national and international conferences.Nauder Namaky, Ph.D.* nauder_namaky@brown.edu.
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Affiliation(s)
- Nauder Namaky
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence, Rhode Island, USA
| | - Hannah R Swearingen
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence, Rhode Island, USA
| | - Jake Winter
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence, Rhode Island, USA
| | - Melanie Bozzay
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jennifer M Primack
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- VA Long Term Services and Support Center of Innovation, Providence, Rhode Island, USA
| | - Noah S Philip
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence, Rhode Island, USA
| | - Jennifer Barredo
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence, Rhode Island, USA
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Shields M, Tonmyr L, Gonzalez A, Atkinson L, Blair DL, Hovdestad W, MacMillan H. Depression, parenting and the COVID-19 pandemic in Canada: results from three nationally representative cross-sectional surveys. BMJ Open 2023; 13:e063991. [PMID: 37580094 PMCID: PMC10432656 DOI: 10.1136/bmjopen-2022-063991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/03/2023] [Indexed: 08/16/2023] Open
Abstract
OBJECTIVES Depression is associated with problems in functioning in many aspects of life, including parenting. COVID-19 has increased risk factors for depression. We investigated the prevalence of depression among parents during the pandemic and the association with dysfunctional parenting. DESIGN Canadian nationwide cross-sectional study. SETTING AND PARTICIPANTS The 2020 and 2021 Surveys on COVID-19 and Mental Health (SCMH) and the Canadian Community Health Survey (CCHS) (2015‒2019). Responding sample sizes for parents were 3121 for the 2020-SCMH; 1574 for the 2021-SCMH and 6076 for the CCHS. PRIMARY OUTCOME MEASURES All three surveys collected information on symptoms of major depressive disorder (MDD). The SCMH measured harsh parenting. RESULTS Based on data from the 2021-SCMH collected during wave 3 of COVID-19, 14.4% of fathers and 21.2% of mothers screened positive for MDD. These prevalence estimates were similar to those from the 2020-SCMH during wave 2, but at least two times higher than pre-COVID-19 estimates from the CCHS. Multivariate analyses revealed a linear association between MDD and harsh parenting. COVID-19-related stressors were associated with harsh parenting. Among mothers, feeling lonely or isolated because of COVID-19 was a risk factor for harsh parenting; among fathers, being a front-line worker was a risk factor. Meditation was a protective factor for mothers. CONCLUSIONS After years of stability, the prevalence of MDD increased substantially among Canadian parents during the pandemic. Ongoing monitoring is vital to determine if elevated levels of depression persist because chronic depression increases the likelihood of negative child outcomes. Programmes aimed at addressing depression and bolstering parenting skills are needed as families continue to face stressors associated with COVID-19.
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Affiliation(s)
| | - Lil Tonmyr
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Andrea Gonzalez
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Leslie Atkinson
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Dawn-Li Blair
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | | | - Harriet MacMillan
- Departments of Psychiatry & Behavioural Neurosciences, and of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Khoury JE, Atkinson L, Jack S, Bennett T, Raha S, Duku E, Gonzalez A. Protocol for the COVID-19 Wellbeing and Stress Study: a longitudinal study of parent distress, biological stress and child biopsychosocial development during the pandemic and beyond. BMJ Open 2023; 13:e071926. [PMID: 37580092 PMCID: PMC10432660 DOI: 10.1136/bmjopen-2023-071926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/22/2023] [Indexed: 08/16/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has had a unique impact on the mental health and well-being of pregnant individuals and parents of young children. However, the impact of COVID-19-related stress during pregnancy on early child biopsychosocial development, remains unclear. The COVID-19 Wellbeing and Stress Study will: (1) investigate the impact of different forms of prenatal stress experienced during the pandemic (including objective hardship, perceived psychological distress and biological stress) on child stress biology, (2) examine the association between child stress biology and child developmental outcomes, (3) determine whether child stress biology acts as a mechanism linking prenatal stress to adverse child developmental outcomes and (4) assess whether gestational age at the onset of the COVID-19 pandemic or child sex, moderate these associations. METHODS AND ANALYSES The COVID-19 Wellbeing and Stress Study is a prospective longitudinal study, consisting of six time points, spanning from pregnancy to 3 years postpartum. The study began in June 2020, consisting of 304 pregnant people from Ontario, Canada. This multimethod study is composed of questionnaires, biological samples, behavioural observations and developmental assessments ETHICS AND DISSEMINATION: This study was approved by the Hamilton Integrated Research Ethics Board (#11034) and the Mount Saint Vincent University Research Ethics Board (#2020-187, #2021-075, #2022-008). Findings will be disseminated through peer-reviewed presentations and publications, community presentations, and electronic forums (social media, newsletters and website postings).
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Affiliation(s)
- Jennifer E Khoury
- Department of Psychology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Leslie Atkinson
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Susan Jack
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Teresa Bennett
- Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Sandeep Raha
- Department of Biochemistry & Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Eric Duku
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Gonzalez
- Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
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Sheriff R, Hong JSW, Henshall C, D'Agostino A, Tomassi S, Stein HC, Cerveri G, Cibra C, Bonora S, Giordano B, Smith T, Phiri P, Asher C, Elliot K, Zangani C, Ede R, Saad F, Smith KA, Cipriani A. Evaluation of telepsychiatry during the COVID-19 pandemic across service users, carers and clinicians: an international mixed-methods study. BMJ Ment Health 2023; 26:e300646. [PMID: 37567731 PMCID: PMC10577786 DOI: 10.1136/bmjment-2022-300646] [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: 12/14/2022] [Accepted: 06/14/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Worldwide uptake of telepsychiatry accelerated during the COVID-19 pandemic. OBJECTIVE To conduct an evaluation of the opinions, preferences and attitudes to telepsychiatry from service users, carers and clinicians in order to understand how telepsychiatry can be best used in the peri/post-COVID-19 era. METHODS This mixed-methods, multicentre, international study of telepsychiatry was set in two sites in England and two in Italy. Survey questionnaires and focus group topic guides were co-produced for each participant group (service users, carers and clinicians). FINDINGS In the UK, 906 service users, 117 carers and 483 clinicians, and in Italy, 164 service users, 56 carers and 72 clinicians completed the surveys. In all, 17 service users/carers and 14 clinicians participated in focus groups. Overall, telepsychiatry was seen as convenient in follow-ups with a specific purpose such as medication reviews; however, it was perceived as less effective for establishing a therapeutic relationship or for assessing acutely disturbed mental states. In contrast to clinicians, most service users and carers indicated that telepsychiatry had not improved during the COVID-19 pandemic. Most service users and carers reported that the choice of appointment modality was most often determined by the service or clinician. CONCLUSION AND RELEVANCE There were circumstances in which telepsychiatry was seen as more suitable than others and clear differences in clinician, carer and service user perspectives on telepsychiatry. CLINICAL IMPLICATIONS All stakeholders should be actively engaged in determining a hybrid model of care according to clinical features and service user and carer preferences. Clinicians should be engaged in training programmes on telepsychiatry.
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Affiliation(s)
- Rebecca Sheriff
- Department of Psychiatry, Oxford University, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - James S W Hong
- Oxford Health NHS Foundation Trust, Oxford, UK
- Oxford Precision Psychiatry Lab, Oxford Health Biomedical Research Centre, Oxford, UK
| | - Catherine Henshall
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
- Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Armando D'Agostino
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Simona Tomassi
- Psychiatric Unit 1, Azienda ULSS 9 Scaligera, Verona, Italy
| | | | | | - Chiara Cibra
- Department of Psychiatry and Addiction, ASST Lodi, Lodi, Italy
| | - Stefano Bonora
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Barbara Giordano
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Tanya Smith
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Peter Phiri
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, UK
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Carolyn Asher
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, UK
| | - Kathryn Elliot
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, UK
| | - Caroline Zangani
- Department of Psychiatry, Oxford University, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
- Oxford Precision Psychiatry Lab, Oxford Health Biomedical Research Centre, Oxford, UK
| | - Roger Ede
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Fathi Saad
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Katharine Alison Smith
- Department of Psychiatry, Oxford University, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
- Oxford Precision Psychiatry Lab, Oxford Health Biomedical Research Centre, Oxford, UK
| | - Andrea Cipriani
- Department of Psychiatry, Oxford University, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
- Oxford Precision Psychiatry Lab, Oxford Health Biomedical Research Centre, Oxford, UK
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Williams R, Morris A, Gupta V, Penington E, Cullen AE, Quirk A, French P, Lennox B, Bottle A, Crawford MJ. Predictors of positive patient-reported outcomes from 'Early Intervention in Psychosis': a national cross-sectional study. BMJ Ment Health 2023; 26:e300716. [PMID: 37541700 PMCID: PMC10577709 DOI: 10.1136/bmjment-2023-300716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/05/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND The components of care delivered by Early Intervention in Psychosis (EIP) services vary, but the impact on patient experience is unknown. OBJECTIVE To investigate associations between components of care provided by EIP services in England and patient-reported outcomes. METHODS 2374 patients from EIP services in England were surveyed during the National Clinical Audit of Psychosis. Participants were asked about the care they received, and completed the 'Patient Global Impressions' Scale (rating whether their mental health had improved), and 'Friends and Family Test' (rating whether they would recommend their service). Information about service structure was obtained from service providers. We analysed associations between outcomes and components of care using multilevel regression. FINDINGS The majority of participants were likely to recommend the treatment they had received (89.8%), and felt that their mental health had improved (89.0%). Participants from services where care coordinators had larger case loads were less likely to recommend their care. Participants were more likely to recommend their care if they had been offered cognitive behavioural therapy for psychosis, family therapy or targeted interventions for carers. Participants were more likely to report that their mental health had improved if they had been offered cognitive behavioural therapy for psychosis or targeted interventions for carers. CONCLUSIONS Specific components of EIP care were associated with improved patient reported outcomes. Psychosocial interventions and carer support may be particularly important in optimising outcomes for patients. CLINICAL IMPLICATIONS These findings emphasise the need for small case load sizes and comprehensive packages of treatment in EIP services.
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Affiliation(s)
- Ryan Williams
- Department of Brain Sciences, Imperial College London, London, UK
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Aimee Morris
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Veenu Gupta
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Ed Penington
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Alexis E Cullen
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Psychosis Studies, King's College London, London, UK
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Alan Quirk
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Paul French
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Belinda Lennox
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Alex Bottle
- School of Public Health, Imperial College London, London, UK
| | - Mike J Crawford
- Department of Brain Sciences, Imperial College London, London, UK
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Pozuelo JR, Bradenbrink R, Stierna MF, Sterck O. Depression, violence and socioeconomic outcomes among refugees in East Africa: evidence from a multicountry representative survey. BMJ Ment Health 2023; 26:e300773. [PMID: 37597876 PMCID: PMC10577724 DOI: 10.1136/bmjment-2023-300773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/28/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Existing research on refugee mental health is heavily skewed towards refugees in high-income countries, even though most refugees (83%) are hosted in low-income and middle-income countries. This problem is further compounded by the unrepresentativeness of samples, small sample sizes and low response rates. OBJECTIVE To present representative findings on the prevalence and correlates of depression among different refugee subgroups in East Africa. METHODS We conducted a multicountry representative survey of refugee and host populations in urban and camp contexts in Kenya, Uganda and Ethiopia (n=15 915). We compared the prevalence of depression between refugee and host populations and relied on regression analysis to explore the association between violence, depression and socioeconomic outcomes. FINDINGS We found a high prevalence of elevated depressive symptoms (31%, 95% CI 28% to 35%) and functional impairment (62%, 95% CI 58% to 66%) among the refugee population, which was significantly higher than that found in the host population (10% for depressive symptoms, 95% CI 8% to 13% and 25% for functional impairment, 95% CI 22% to 28%) (p<0·001). Further, we observed a dose-response relationship between exposure to violence and mental illness. Lastly, high depressive symptoms and functional impairment were associated with worse socioeconomic outcomes. CONCLUSION Our results highlight that refugees in East-Africa-particularly those exposed to violence and extended exile periods-are disproportionately affected by depression, which may also hinder their socioeconomic integration. CLINICAL IMPLICATIONS Given the high prevalence of depression among refugees in East Africa, our results underline the need for scalable interventions that can promote refugees' well-being.
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Affiliation(s)
- Julia R Pozuelo
- Department of Global Health and Social Medicine, Harvard University, Cambridge, Massachusetts, USA
- Department of Psychiatry, University of Oxford, Oxford, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Maria Flinder Stierna
- Department of International Development, University of Oxford, Oxford, UK
- ODI (Overseas Development Institute), London, UK
| | - Olivier Sterck
- Department of International Development, University of Oxford, Oxford, UK
- Institute of Development Policy, University of Antwerp, Antwerpen, Belgium
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Ahlberg R, Garcia-Argibay M, Taylor M, Lichtenstein P, D'Onofrio BM, Butwicka A, Hill C, Cortese S, Larsson H, Du Rietz E. Prevalence of sleep disorder diagnoses and sleep medication prescriptions in individuals with ADHD across the lifespan: a Swedish nationwide register-based study. BMJ Ment Health 2023; 26:e300809. [PMID: 37657817 PMCID: PMC10577710 DOI: 10.1136/bmjment-2023-300809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/09/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Consistent evidence suggests a strong association between attention-deficit/hyperactivity disorder (ADHD) and subjectively reported sleep problems. However, the prevalence of clinically ascertained sleep disorder diagnoses and sleep medication prescriptions in individuals with ADHD remains unclear. OBJECTIVE To determine the rates of sleep disorder diagnoses and sleep medication prescriptions in children, adolescents and adults with ADHD. METHODS We linked Swedish national registers to create a cohort of individuals born 1945-2008. We estimated the absolute and relative risks (using logistic regression models) of different sleep disorder diagnoses and medication prescriptions in individuals with and without ADHD. The analyses were performed across five different age groups: children (5-11 years), adolescents (12-17 years), young adults (18-30 years), middle-aged adults (31-45 years) and older adults (46-60 years). FINDINGS Among individuals with ADHD (N=145 490, 2.25% of the cohort), 7.5% had a sleep disorder diagnosis and 47.5% had been prescribed sleep medication. Individuals with ADHD, across all age groups, had a statistically significantly increased risk of having any sleep disorder diagnosis (ORrange=6.4-16.1) and any sleep medication prescription (ORrange=12.0-129.4) compared with individuals without ADHD. While rates of sleep disorders were highest in older adults, the relative risks were highest in youth. CONCLUSIONS Individuals with ADHD have a substantially increased risk of sleep disorder diagnoses and sleep medication prescriptions, from childhood into older adulthood. CLINICAL IMPLICATIONS More clinical efforts are needed to tackle impairing sleep problems in individuals with ADHD via systematic sleep assessment, appropriate diagnosis, and pharmacological and non-pharmacological interventions. Sleep medication use should be informed by sleep disorder diagnosis.
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Affiliation(s)
- Rickard Ahlberg
- School of Medical Sciences, Örebro University, Orebro, Sweden
| | - Miguel Garcia-Argibay
- School of Medical Sciences, Örebro University, Orebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Marc Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Agniezska Butwicka
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Catherine Hill
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Sleep Medicine, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK, Southampton, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton Faculty of Environmental and Life Sciences, Southampton, UK
- Solent NHS Trust; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Henrik Larsson
- School of Medical Sciences, Örebro University, Orebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ebba Du Rietz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Ara T, Ferdous Z, Mahi M, Amin E, Chowdhury SB, Shafiur Rahman M, Rahman L, Rahman MM. Assessment of COVID-19 management and its consequences on healthcare professionals: a cross-sectional study from Bangladesh. BMJ Open 2023; 13:e068633. [PMID: 37524557 PMCID: PMC10391835 DOI: 10.1136/bmjopen-2022-068633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE This explorative study aims to identify the gaps in COVID-19 management and their consequences on physicians in terms of contracting infection and psychological well-being during the early phase of the pandemic. DESIGN, SETTINGS AND PARTICIPANTS We conducted a nationwide cross-sectional online study to collect information from 420 intern doctors who were at their internship in government medical colleges from February to August 2020. METHODS We performed univariate and bivariate analyses to assess COVID-19 management. We investigated the consequences of COVID-19 management on infection risk, experiencing stress, developing anxiety, depression and sleep disturbance using five sets of multivariable logistic regression analyses. RESULTS Findings indicate a delay in first-case detection and identify people's tendency to hide COVID-19 symptoms as one of the possible causes of that delay. About 56% of the intern doctors experienced that patients were trying to hide COVID-19 symptoms in the earlier phase of the pandemic. More than half of the respondents did not get any training on COVID-19 from their working institutions. About 30% and 20% of the respondents did not use personal protective equipment (PPE) and masks while treating patients. Respondents who treated patients without PPE, masks, face shields and gloves were almost two times as likely to be infected by COVID-19. The odds of experiencing COVID-19-related stress was almost twofold among respondents who treated patients without wearing PPE and masks. Experiencing COVID-19-related stress was further associated with an increased risk of developing anxiety and depression that led to sleep disturbance. CONCLUSION Ensuring the maximum utilization of limited resources during any public health crisis such as COVID-19 needs developing coping mechanisms by projecting future demand. Ensuring proper training and safety measures can reduce physical and psychological hazards among physicians.
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Affiliation(s)
- Tasnim Ara
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Zannatul Ferdous
- Institute of Health Economics, University of Dhaka, Dhaka, Bangladesh
| | - Mahfuza Mahi
- Mathematics and Natural Sciences, BRAC University, Dhaka, Bangladesh
| | - Emama Amin
- Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh
| | | | - Md Shafiur Rahman
- National Institute of Preventive and Social Medicine, Dhaka, Bangladesh
| | - Lutfor Rahman
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Md Mahabubur Rahman
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
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Pigott HE, Kim T, Xu C, Kirsch I, Amsterdam J. What are the treatment remission, response and extent of improvement rates after up to four trials of antidepressant therapies in real-world depressed patients? A reanalysis of the STAR*D study's patient-level data with fidelity to the original research protocol. BMJ Open 2023; 13:e063095. [PMID: 37491091 PMCID: PMC10373710 DOI: 10.1136/bmjopen-2022-063095] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE Reanalyse the patient-level data set of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study with fidelity to the original research protocol and related publications. DESIGN The study was open label and semirandomised examining the effectiveness of up to four optimised and increasingly aggressive, antidepressant therapies in depressed adults. Patients who failed to gain adequate relief from their level 1 trial on the SSRI citalopram could receive up to three additional treatment trials in levels 2-4. SETTING 41 North American psychiatry and primary care treatment centres. PARTICIPANTS 4041 adults screened positive for major depressive disorder. In contrast to most clinical trials, STAR*D enrolled patients seeking care (vs recruited) and included patients with a wide range of common comorbid medical and psychiatric conditions to enhance the generalisability of findings to real-world clinical practice. INTERVENTIONS STAR*D evaluated the relative effectiveness of 13 antidepressants therapies in treatment levels 2-4 for depressed patients who failed to gain adequate benefit from their level 1 medication trial. MAIN OUTCOME MEASURES According to the STAR*D protocol, the primary outcome was remission, defined as a score <8 on the blinded Hamilton Rating Scale for Depression (HRSD). Response was a secondary outcome defined as ≥50% reduction in HRSD scores. STAR*D's protocol specifically excluded all non-blinded clinic-administered assessments from use as research outcome measures. RESULTS STAR*D investigators did not use the protocol-stipulated HRSD to report cumulative remission and response rates in their summary article and instead used a non-blinded clinic-administered assessment. This inflated their report of outcomes, as did their inclusion of 99 patients who scored as remitted on the HRSD at study outset as well as 125 who scored as remitted when initiating their next-level treatment. These patients should have been excluded from data analysis. In contrast to the STAR*D-reported 67% cumulative remission rate after up to four antidepressant treatment trials, the rate was 35.0% when using the protocol-stipulated HRSD and inclusion in data analysis criteria. CONCLUSION STAR*D's cumulative remission rate was approximately half of that reported.
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Affiliation(s)
| | - Thomas Kim
- Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Colin Xu
- Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Irving Kirsch
- Harvard Medical School, Arlington, Massachusetts, USA
| | - Jay Amsterdam
- Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Krakau L, Leuzinger-Bohleber M, Brähler E, Schmidt P, Rost F, Huber D, Klug G, Löffler-Stastka H, Rössler-Schülein H, Leichsenring F, Salzer S, Brockmann J, Jakobsen T, Ernst M, Beutel ME. Efficacy of high-intensity versus low-intensity psychoanalytically oriented long-term treatments and determinants of outcome: individual participant data Meta-analysis of Long-term Analytic treatment Studies (MeLAS). BMJ Open 2023; 13:e069332. [PMID: 37474167 PMCID: PMC10357799 DOI: 10.1136/bmjopen-2022-069332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION Long-term psychodynamic/psychoanalytic psychotherapy (LTPP) is a prevalent treatment option for complex mental disorders. Yet, little is known about the role of treatment intensity in LTPP. We present a study protocol for a systematic review and individual participant data (IPD) meta-analysis aggregating and analysing individual data from randomised and quasi-experimental trials by meta-analysis. The purpose is to (1) determine the treatment effectiveness of LTPP with low versus high intensity (up to 2 weekly sessions vs three or more), (2) compare their joint effectiveness to shorter therapies and treatments as usual, (3) identify predictors and moderators of treatment outcomes and (4) determine reciprocal relationships between different outcome domains (symptomatic and structural/personality change) over the courses of LTPP. METHODS AND ANALYSIS We include studies from (randomised controlled trial, RCT) and quasi-experimental trials, where at least one condition was LTPP of high or low frequency. Long-term treatment is defined as ≥1 year or ≥50 sessions. To be eligible studies must include a standardised outcome measure of symptoms (global or disorder specific) with at least one proof of reliability. The primary outcome is symptom reduction (global or specific), secondary outcome criteria are reliable change, remission, functional capacities, personality, personality functioning and interpersonal pathology. Relevant studies will mainly be identified by searching relevant databases: PubMed, PsycINFO (via EBSCO), Web of Science (via Elsevier), Chochrane's Central Register of Controlled Trials (via Wiley). Risk of bias will be evaluated in line with the Cochrane assessments tools for quasi-experimental trials and RCTs, respectively. ETHICS AND DISSEMINATION Aggregation of data from primary trials collected based on ethics votes. Dissemination into clinical practice via open access publications of findings. PROSPERO REGISTRATION NUMBER CRD42022304982; Pre-results.
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Affiliation(s)
- Lina Krakau
- Psychosomatic Medicine and Psychotherapy, University Medical Center of The Johannes Gutenberg University, Mainz, Germany
| | - Marianne Leuzinger-Bohleber
- Psychosomatic Medicine and Psychotherapy, University Medical Center of The Johannes Gutenberg University, Mainz, Germany
| | - Elmar Brähler
- Psychosomatic Medicine and Psychotherapy, University Medical Center of The Johannes Gutenberg University, Mainz, Germany
- Department of Psychiatry and Psychotherapy Leipzig, Leipzig University Medical Center, Leipzig, Germany
| | - Peter Schmidt
- Psychosomatic Medicine and Psychotherapy, University Medical Center of The Johannes Gutenberg University, Mainz, Germany
| | - Felicitas Rost
- Tavistock and Portman NHS Foundation Trust, London, UK
- School of Psychology and Psychotherapy, Faculty of Arts and Social Sciences, The Open University, Milton Keynes, UK
| | - Dorothea Huber
- Department of Clinical Psychology and Psychosomatics, International Psychoanalytic University, Berlin, Germany
| | | | | | | | - Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
| | - Simone Salzer
- Clinical Psychology and Psychoanalysis, International Psychoanalytic University, Berlin, Germany
| | | | | | - Mareike Ernst
- Department of Clinical Psychology, University of Klagenfurt, Klagenfurt am Wörthersee, Austria
| | - Manfred E Beutel
- Psychosomatic Medicine and Psychotherapy, University Medical Center of The Johannes Gutenberg University, Mainz, Germany
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Tan L, Strudwick J, Deady M, Bryant R, Harvey SB. Mind-body exercise interventions for prevention of post-traumatic stress disorder in trauma-exposed populations: a systematic review and meta-analysis. BMJ Open 2023; 13:e064758. [PMID: 37438059 PMCID: PMC10347470 DOI: 10.1136/bmjopen-2022-064758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVE Mind-body exercise (MBE) interventions, such as yoga, are increasingly recognised as an adjunct treatment for trauma-related mental disorders but less is known about their efficacy as a preventative intervention. We aimed to systematically review if, and what type of, MBE interventions are effective at preventing the development of post-traumatic stress disorder (PTSD) or acute stress disorder (ASD) in trauma-exposed populations. DESIGN Systematic review and meta-analysis. METHODS A systematic search of MEDLINE, PsycINFO, EMBASE and CENTRAL databases was conducted to identify controlled trials of MBE interventions aimed at preventing the development of PTSD or ASD in high-risk populations. Risk of bias was assessed using the revised Cochrane risk-of-bias and ROBINS-I tools. Pooled effect sizes using Hedges' g and 95% CIs were calculated using random effects modelling for the main meta-analysis and planned subgroup and sensitivity analyses. RESULTS Six studies (N analysed=399) were included in the final meta-analysis. Overall, there was a small effect for MBE interventions in preventing the development of PTSD (g=-0.25, 95% CI -0.56 to 0.06) among those with previous or ongoing exposure to trauma. Although a prespecified subgroup analyses comparing the different types of MBE intervention were conducted, meaningful conclusions could not be drawn due to the small number of studies. None of the included studies assessed ASD symptoms. CONCLUSION Limited evidence was found for MBE interventions in reducing PTSD symptomology in the short term. Findings must be interpreted with caution due to the small number of studies and possible publication bias. PROSPERO REGISTRATION NUMBER CRD42020180375.
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Affiliation(s)
- Leona Tan
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Black Dog Institute, Randwick, New South Wales, Australia
| | | | - Mark Deady
- Black Dog Institute, Randwick, New South Wales, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
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Anatürk M, Patel R, Ebmeier KP, Georgiopoulos G, Newby D, Topiwala A, de Lange AMG, Cole JH, Jansen MG, Singh-Manoux A, Kivimäki M, Suri S. Development and validation of a dementia risk score in the UK Biobank and Whitehall II cohorts. BMJ Ment Health 2023; 26:e300719. [PMID: 37603383 PMCID: PMC10577770 DOI: 10.1136/bmjment-2023-300719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/31/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Current dementia risk scores have had limited success in consistently identifying at-risk individuals across different ages and geographical locations. OBJECTIVE We aimed to develop and validate a novel dementia risk score for a midlife UK population, using two cohorts: the UK Biobank, and UK Whitehall II study. METHODS We divided the UK Biobank cohort into a training (n=176 611, 80%) and test sample (n=44 151, 20%) and used the Whitehall II cohort (n=2934) for external validation. We used the Cox LASSO regression to select the strongest predictors of incident dementia from 28 candidate predictors and then developed the risk score using competing risk regression. FINDINGS Our risk score, termed the UK Biobank Dementia Risk Score (UKBDRS), consisted of age, education, parental history of dementia, material deprivation, a history of diabetes, stroke, depression, hypertension, high cholesterol, household occupancy, and sex. The score had a strong discrimination accuracy in the UK Biobank test sample (area under the curve (AUC) 0.8, 95% CI 0.78 to 0.82) and in the Whitehall cohort (AUC 0.77, 95% CI 0.72 to 0.81). The UKBDRS also significantly outperformed three other widely used dementia risk scores originally developed in cohorts in Australia (the Australian National University Alzheimer's Disease Risk Index), Finland (the Cardiovascular Risk Factors, Ageing, and Dementia score), and the UK (Dementia Risk Score). CLINICAL IMPLICATIONS Our risk score represents an easy-to-use tool to identify individuals at risk for dementia in the UK. Further research is required to determine the validity of this score in other populations.
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Affiliation(s)
- Melis Anatürk
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Raihaan Patel
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | | | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Danielle Newby
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Anya Topiwala
- Department of Psychiatry, University of Oxford, Oxford, UK
- Big Data Institute, University of Oxford, Oxford, UK
| | - Ann-Marie G de Lange
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Clinical Neurosciences, University of Lausanne, Lausanne, Switzerland
- Department of Psychology, University of Oslo, Oslo, Norway
| | - James H Cole
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Michelle G Jansen
- Donders Centre for Cognition, Donders Institute for Brain, Cognition and Behaviour, Radboud Universiteit, Nijmegen, The Netherlands
| | - Archana Singh-Manoux
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université Paris Cité, Paris, France
- Faculty of Brain Sciences, University College London, London, UK
| | - Mika Kivimäki
- Faculty of Brain Sciences, University College London, London, UK
| | - Sana Suri
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
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Karyotaki E, Sijbrandij M, Purgato M, Acarturk C, Lakin D, Bailey D, Peckham E, Uygun E, Tedeschi F, Wancata J, Augustinavicius J, Carswell K, Välimäki M, van Ommeren M, Koesters M, Popa M, Leku MR, Anttila M, Churchill R, White RG, Al-Hashimi S, Lantta T, Au T, Klein T, Tol WA, Cuijpers P, Barbui C. Self-Help Plus for refugees and asylum seekers: an individual participant data meta-analysis. BMJ Ment Health 2023; 26:e300672. [PMID: 37524517 PMCID: PMC10391800 DOI: 10.1136/bmjment-2023-300672] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/15/2023] [Accepted: 05/31/2023] [Indexed: 08/02/2023]
Abstract
QUESTION Refugees and asylum seekers are at high risk of mental disorders due to various stressors before, during and after forceful displacement. The WHO Self-Help Plus (SH+) intervention was developed to manage psychological distress and a broad range of mental health symptoms in vulnerable populations. This study aimed to examine the effects and moderators of SH+ compared with Enhanced Care as Usual (ECAU) in reducing depressive symptoms among refugees and asylum seekers. STUDY SELECTION AND ANALYSIS Three randomised trials were identified with 1795 individual participant data (IPD). We performed an IPD meta-analysis to estimate the effects of SH+, primarily on depressive symptoms and second on post-traumatic stress, well-being, self-identified problems and functioning. Effects were also estimated at 5-6 months postrandomisation (midterm). FINDINGS There was no evidence of a difference between SH+ and ECAU+ in reducing depressive symptoms at postintervention. However, SH+ had significantly larger effects among participants who were not employed (β=1.60, 95% CI 0.20 to 3.00) and had lower mental well-being levels (β=0.02, 95% CI 0.001 to 0.05). At midterm, SH+ was significantly more effective than ECAU in improving depressive symptoms (β=-1.13, 95% CI -1.99 to -0.26), self-identified problems (β=-1.56, 95% CI -2.54 to -0.59) and well-being (β=6.22, 95% CI 1.60 to 10.90). CONCLUSIONS Although SH+ did not differ significantly from ECAU in reducing symptoms of depression at postintervention, it did present benefits for particularly vulnerable participants (ie, unemployed and with lower mental well-being levels), and benefits were also evident at midterm follow-up. These results are promising for the use of SH+ in the management of depressive symptoms and improvement of well-being and self-identified problems among refugees and asylum seekers.
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Affiliation(s)
- Eirini Karyotaki
- Department of Clinical, Neuro-, and Developmental Psychology and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro-, and Developmental Psychology and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Ceren Acarturk
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Daniel Lakin
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Della Bailey
- Department of Health Sciences, University of York, York, UK
| | - Emily Peckham
- Department of Health Sciences, University of York, York, UK
| | - Ersin Uygun
- Department of Trauma and Disasters, Bilge University, Ankara, Turkey
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Johannes Wancata
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Jura Augustinavicius
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kenneth Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland
- Xiangya School of Nursing, The Xiangya Evidence-Based Practice and Healthcare Innovation, Central South University, Chang, People's Republic of China
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Mariana Popa
- School of Psychology, Queen's University Belfast, Belfast, UK
| | | | - Minna Anttila
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Ross G White
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - Sarah Al-Hashimi
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Teresa Au
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Thomas Klein
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Wietse A Tol
- Xiangya School of Nursing, The Xiangya Evidence-Based Practice and Healthcare Innovation, Central South University, Chang, People's Republic of China
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
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Ronaldson A, Stewart R, Mueller C, Das-Munshi J, Newbury JB, Mudway IS, Broadbent M, Fisher HL, Beevers S, Dajnak D, Hotopf M, Hatch SL, Bakolis I. Associations between air pollution and mental health service use in dementia: a retrospective cohort study. BMJ Ment Health 2023; 26:e300762. [PMID: 37550086 PMCID: PMC10577765 DOI: 10.1136/bmjment-2023-300762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/11/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Little is known about the role of air pollution in how people with dementia use mental health services. OBJECTIVE We examined longitudinal associations between air pollution exposure and mental health service use in people with dementia. METHODS In 5024 people aged 65 years or older with dementia in South London, high resolution estimates of nitrogen dioxide (NO2) and particulate matter (PM2.5 and PM10) levels in ambient air were linked to residential addresses. Associations between air pollution and Community Mental Health Team (CMHT) events (recorded over 9 years) were examined using negative binomial regression models. Cognitive function was measured using the Mini Mental State Examination (MMSE) and health and social functioning was measured using the Health of the Nation Outcomes Scale (HoNOS65+). Associations between air pollution and both MMSE and HoNOS65+ scores were assessed using linear regression models. FINDINGS In the first year of follow-up, increased exposure to all air pollutants was associated with an increase in the use of CMHTs in a dose-response manner. These associations were strongest when we compared the highest air pollution quartile (quartile 4: Q4) with the lowest quartile (Q1) (eg, NO2: adjusted incidence rate ratio (aIRR) 1.27, 95% CI 1.11 to 1.45, p<0.001). Dose-response patterns between PM2.5 and CMHT events remained at 5 and 9 years. Associations were strongest for patients with vascular dementia. NO2 levels were linked with poor functional status, but not cognitive function. CONCLUSIONS Residential air pollution exposure is associated with increased CMHT usage among people with dementia. CLINICAL IMPLICATIONS Efforts to reduce pollutant exposures in urban settings might reduce the use of mental health services in people with dementia, freeing up resources in already considerably stretched psychiatric services.
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Affiliation(s)
- Amy Ronaldson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Christoph Mueller
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Joanne B Newbury
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Social, Genetic & Developmental Psychiatry Centre, IoPPN, King's College London, London, UK
| | - Ian S Mudway
- MRC Centre for Environment and Health, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, UK
| | - Matthew Broadbent
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Helen L Fisher
- ESRC Centre for Society and Mental Health, King's College London, London, UK
- Social, Genetic & Developmental Psychiatry Centre, IoPPN, King's College London, London, UK
| | - Sean Beevers
- MRC Centre for Environment and Health, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, UK
| | - David Dajnak
- MRC Centre for Environment and Health, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Ioannis Bakolis
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
- Department of Biostatistics and Health Informatics, IoPPN, King's College London, London, UK
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Abstract
OBJECTIVE To examine current knowledge about suicide bereavement and postvention interventions for university staff and students. DESIGN Scoping review. DATA SOURCES AND ELIGIBILITY We conducted systematic searches in 12 electronic databases (PubMed, PsycINFO, MEDLINE, CINAHL, Africa-Wide Information, PsycARTICLES, Health Source: Nursing/Academic Edition, Academic Search Premier, SocINDEX through the EBSCOHOST platform; Cochrane Library, Web of Science, SCOPUS), hand searched lists of references of included articles and consulted with library experts during September 2021 and June 2022. Eligible studies were screened against the inclusion criteria independently by two reviewers. Only studies published in English were included. DATA EXTRACTION AND SYNTHESIS Screening was conducted by two independent reviewers following a three-step article screening process. Biographical data and study characteristics were extracted using a data extraction form and synthesised. RESULTS Our search strategy identified 7691 records from which 3170 abstracts were screened. We assessed 29 full texts and included 17 articles for the scoping review. All studies were from high-income countries (USA, Canada, UK). The review identified no postvention intervention studies on university campuses. Study designs were mostly descriptive quantitative or mixed methods. Data collection and sampling were heterogeneous. CONCLUSION Staff and students require support measures due to the impact of suicide bereavement and the unique nature of the university context. There is a need for further research to move from descriptive studies to focus on intervention studies, particularly at universities in low-income and middle-income countries.
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Affiliation(s)
| | - Jason Bantjes
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit (MASTRU), South African Medical Research Council, Tygerberg, Western Cape, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Karl Andriessen
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Corbaz F, Boussac E, Lepigeon K, Gomes Dias D, Marcadent S, Desseauve D, Horsch A. 'connEcted caesarean section': creating a virtual link between MOthers and their infanTs to ImprOve maternal childbirth experieNce - study protocol for a PILOT trial (e-motion-pilot). BMJ Open 2023; 13:e065830. [PMID: 37286319 DOI: 10.1136/bmjopen-2022-065830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION One-third of mothers rate their childbirth as traumatic. The prevalence of childbirth-related post-traumatic stress disorder (CB-PTSD) is 4.7%. Skin-to-skin contact is a protective factor against CB-PTSD. However, during a caesarean section (CS), skin-to-skin contact is not always feasible and mothers and infants are often separated. In those cases, there is no validated and available solution to substitute this unique protective factor. Based on the results of studies using virtual reality and head-mounted displays (HMDs) and studies on childbirth experience, we hypothesise that enabling the mother to have a visual and auditory contact with her baby could improve her childbirth experience while she and her baby are separated. To facilitate this connection, we will use a two-dimensional 360° camera filming the baby linked securely to an HMD that the mother can wear during the end of the surgery. METHODS AND ANALYSIS This study protocol describes a monocentric open-label controlled pilot trial with minimal risk testing the effects of a visual and auditory contact via an HMD worn by the mother airing a live video of her newborn compared with treatment-as-usual in 70 women after CS. The first 35 consecutive participants will be the control group and will receive the standard care. The next 35 consecutive participants will have the intervention. The primary outcome will be differences in maternal childbirth experience (Childbirth Experience Questionnaire 2) at 1-week postpartum between the intervention and control groups. Secondary outcomes will be CB-PTSD symptoms, birth satisfaction, mother-infant bonding, perceived pain and stress during childbirth, maternal anxiety and depression symptoms, anaesthesiological data and acceptability of the procedure. ETHICS AND DISSEMINATION Ethics approval was granted by the Human Research Ethics Committee of the Canton de Vaud (study number 2022-00215). Dissemination of results will occur via national and international conferences, peer-reviewed journals, public conferences and social media. TRIAL REGISTRATION NUMBER NCT05319665.
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Affiliation(s)
- Fiona Corbaz
- Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Emilie Boussac
- Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Karine Lepigeon
- Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Diana Gomes Dias
- Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | | | - David Desseauve
- Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Antje Horsch
- Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
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McFarlane A. Staging model of PTSD: a strategy for the implementation of precision medicine in military settings. BMJ Mil Health 2023:military-2023-002352. [PMID: 37280012 DOI: 10.1136/military-2023-002352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/15/2023] [Indexed: 06/08/2023]
Abstract
Biomarkers have been of considerable interest in military medicine as a strategy to identify objective measures of resilience in the context of the cumulative trauma exposure of combat as well defining the emerging neurobiological dysregulation associated with post-traumatic stress disorder (PTSD). This body of work has been driven by the imperative of developing strategies to optimally manage the long-term health outcomes of personnel and finding novel treatment approaches. However, the challenge of defining the relevant phenotypes of PTSD and in the context of the multiplicity of biological systems of interest has hampered the identification of biomarkers that have clinical utility. One key strategy to improve the utility of precision medicine in military settings is to use a staging approach to define the relevant phenotypes. A staging model of PTSD captures the progression of the disorder and the transitions from being at risk to subsyndromal disorder and the path to chronic disorder.A staging approach addresses the longitudinal course of PTSD and the fluidity of the disorder across time. Staging describes how symptoms evolve into more stable diagnostic syndromes and the stepwise changes in clinical status which is key to the identification of phenotypes that can be tied to relevant biomarkers. When a population is exposed to a trauma, the individuals will be at different stages in the emergence of risk and the development of PTSD. The staging approach provides a method of capturing the matrix of phenotypes that need to be demarcated to study the role of multiple biomarkers. This paper forms part of the Special issue of BMJ Military Health dedicated to personalised digital technology for mental health in the armed forces.
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