The effects of brief individual cognitive behavioural therapy for depression and homesickness among international students in Malaysia

A comparison of the effectiveness of cognitive behavioural interventions based on delivery features for elevated symptoms of depression in adolescents: A systematic review

Background

Depression is a public health problem and common amongst adolescents. Cognitive behavioural therapy (CBT) is widely used to treat adolescent depression but existing research does not provide clear conclusions regarding the relative effectiveness of different delivery modalities.

Objectives

The primary aim is to estimate the relative efficacy of different modes of CBT delivery compared with each other and control conditions for reducing depressive symptoms in adolescents. The secondary aim is to compare the different modes of delivery with regard to intervention completion/attrition (a proxy for intervention acceptability).

Search Methods

The Cochrane Depression, Anxiety and Neurosis Clinical Trials Register was searched in April 2020. MEDLINE, PsycInfo, EMBASE, four other electronic databases, the CENTRAL trial registry, Google Scholar and Google were searched in November 2020, together with reference checking, citation searching and hand-searching of two databases.

Selection Criteria

Randomised controlled trials (RCTs) of CBT interventions (irrespective of delivery mode) to reduce symptoms of depression in young people aged 10-19 years with clinically relevant symptoms or diagnosis of depression were included.

Data Collection and Analysis

Screening and data extraction were completed by two authors independently, with discrepancies addressed by a third author. CBT interventions were categorised as follows: group CBT, individual CBT, remote CBT, guided self-help, and unguided self-help. Effect on depressive symptom score was estimated across validated self-report measures using Hedges' g standardised mean difference. Acceptability was estimated based on loss to follow-up as an odds ratio. Treatment rankings were developed using the surface under the cumulative ranking curve (SUCRA). Pairwise meta-analyses were conducted using random effects models where there were two or more head-to-head trials. Network analyses were conducted using random effects models.

Main Results

Sixty-eight studies were included in the review. The mean age of participants ranged from 10 to 19.5 years, and on average 60% of participants were female. The majority of studies were conducted in schools (28) or universities (6); other settings included primary care, clinical settings and the home. The number of CBT sessions ranged from 1 to 16, the frequency of delivery from once every 2 weeks to twice a week and the duration of each session from 20 min to 2 h. The risk of bias was low across all domains for 23 studies, 24 studies had some concerns and the remaining 21 were assessed to be at high risk of bias. Sixty-two RCTs (representing 6435 participants) were included in the pairwise and network meta-analyses for post-intervention depressive symptom score at post-intervention. All pre-specified treatment and control categories were represented by at least one RCT. Although most CBT approaches, except remote CBT, demonstrated superiority over no intervention, no approaches performed clearly better than or equivalent to another. The highest and lowest ranking interventions were guided self-help (SUCRA 83%) and unguided self-help (SUCRA 51%), respectively (very low certainty in treatment ranking). Nineteen RCTs (3260 participants) were included in the pairwise and network meta-analyses for 6 to 12 month follow-up depressive symptom score. Neither guided self-help nor remote CBT were evaluated in the RCTs for this time point. Effects were generally attenuated for 6- to 12-month outcomes compared to posttest. No interventions demonstrated superiority to no intervention, although unguided self-help and group CBT both demonstrated superiority compared to TAU. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking approaches were unguided self-help and individual CBT, respectively. Sixty-two RCTs (7347 participants) were included in the pairwise and network meta-analyses for intervention acceptability. All pre-specified treatment and control categories were represented by at least one RCT. Although point estimates tended to favour no intervention, no active treatments were clearly inferior. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking active interventions were individual CBT and group CBT respectively. Pairwise meta-analytic findings were similar to those of the network meta-analysis for all analyses. There may be age-based subgroup effects on post-intervention depressive symptoms. Using the no intervention control group as the reference, the magnitudes of effects appear to be larger for the oldest age categories compared to the other subgroups for each given comparison. However, they were generally less precise and formal testing only indicated a significant difference for group CBT. Findings were robust to pre-specified sensitivity analyses separating out the type of placebo and excluding cluster-RCTs, as well as an additional analysis excluding studies where we had imputed standard deviations.

Authors' Conclusions

At posttreatment, all active treatments (group CBT, individual CBT, guided self-help, and unguided self-help) except for remote CBT were more effective than no treatment. Guided self-help was the most highly ranked intervention but only evaluated in trials with the oldest adolescents (16-19 years). Moreover, the studies of guided self-help vary in the type and amount of therapist support provided and longer-term results are needed to determine whether effects persist. The magnitude of effects was generally attenuated for 6- to 12-month outcomes. Although unguided self-help was the lowest-ranked active intervention at post-intervention, it was the highest ranked at follow-up. This suggests the need for further research into whether interventions with self-directed elements enable young people to maintain effects by continuing or revisiting the intervention independently, and whether therapist support would improve long-term outcomes. There was no clear evidence that any active treatments were more acceptable to participants than any others. The relative effectiveness of intervention delivery modes must be taken into account in the context of the needs and preferences of individual young people, particularly as the differences between effect sizes were relatively small. Further research into the type and amount of therapist support that is most acceptable to young people and most cost-effective would be particularly useful.

Design and effectiveness of an online group logotherapy intervention on the mental health of Iranian international students in European countries during the COVID-19 pandemic

Introduction

The secondary impact of the COVID-19 pandemic, leading to widespread psychological challenges, significantly strained international students' mental health. The present work sought to design and assess the efficacy of an Online Group Logotherapy Protocol, an existential psychology approach developed by Viktor Frankl, to reduce anxiety and depression levels among Iranian international students who were migrants/refugees in different European countries during the pandemic.

Methods

The study recruited 70 students (58 females and 12 males, age range 20-35, 6 EU countries) experiencing moderate levels of anxiety and depression as measured by the Beck Anxiety (BAI) and Depression (BDI) Inventories at pre-test. Half the participants received a short-term closed group intervention comprising 6 online sessions / 90 min of logotherapy. The control group received 6 sessions without specific psychological treatment.

Results

The designed logotherapy sessions consisted of 1. Fundamentals of logotherapy, 2. Existential concerns, 3. Introspection, 4. Self-awareness and growth, 5. Empowering and facing challenges, 6. Meaning of life and conclusions. Five logotherapy techniques were used: Socratic Dialog, Modification of Attitude, Paradoxical Intention, Dereflection, and Logodrama. After the sessions, the post-test MANCOVA analysis showed a more potent effect of logotherapy reducing depression and anxiety than that elicited without intervention. The Eta coefficient suggests that the observed difference explains the effect of logotherapy with a strong power of 89%.

Conclusion

These findings unveil (1) the benefits of online group sessions despite the geographical distance and (2) the relevance of logotherapy effectively reducing depression and anxiety in such complex scenarios where psychological resources and cultural competencies are limited.

Cognitive processes associated with emotional disorders: implications for efficient psychological treatments

BACKGROUND

Emotional disorders (EDs) are the most prevalent worldwide. Despite psychotherapies are their treatment of choice, there are difficulties to apply them properly in mental health services. Since literature shows that cognitive processes are associated with anxiety and depressive symptoms, more information is needed in order to improve psychological treatments.

AIMS

To determine the relation between cognitive factors with specific and non-specific ED symptoms in order to promote the development of accurate psychological treatments.

METHODS

We analyzed the relation between rumination, worry, and metacognition with generalized anxiety, panic, and depression disorder symptoms from a clinical sample of 116 individuals through correlation and linear regression analyses.

RESULTS

Although each specific disorder had a closer link with a particular cognitive process, all general ED symptoms were associated with the three cognitive factors studied.

CONCLUSIONS

For "pure" disorders, targeting a concrete cognitive process might be an optimal therapeutic option. However, due to the high comorbidity among EDs, we support the dissemination of the transdiagnostic treatment approach in which all cognitive factors are taken into account.

Psychological Distress and Homesickness Among Sudanese Migrants in the United Arab Emirates

Migration is a global phenomenon growing in scope, and it can be associated with negative emotions such as sense of impending loss, fear of the unknown, and anxiety about those left at home. The objective of this exploratory study was to examine psychological distress and homesickness among Sudanese migrants in the United Arab Emirates (UAE). Participants were 1444 Sudanese migrants (M_age = 40.20; SD = 10.98). The Second Version of the Dundee Relocation Inventory was used to assess homesickness, and the 28-item General Health Questionnaire was used to measure psychological distress, depressive and anxiety symptoms, somatic symptoms, and social dysfunction. The results showed that older age and longer duration of residence in the UAE were associated with lower levels of homesickness, psychological distress, and depressive and anxiety symptoms. Further, homesickness was associated with higher psychological distress, somatic symptoms, and depressive and anxiety symptoms. Women and unemployed migrants had higher psychological distress, somatic symptoms, and depressive and anxiety symptoms compared with men and those employed, respectively. Being unmarried was associated with higher levels of depressive symptoms and homesickness, while those married or divorced/widowed showed lower levels of depressive symptoms and homesickness. It was concluded that there is a need to tackle unemployment among migrants in the UAE and address family reunion issues.

An evaluation of homesickness in children: A systematic review and meta-analysis

OBJECTIVE

To provide a systematic review and meta-analysis of the quantitative literature on homesickness in children, including how it is assessed and relationship to other negative states.

STUDY SELECTION AND SYNTHESIS

A literature search was conducted using Medline, PsychINFO and Scopus databases. Studies were included if they assessed homesickness in children under eighteen years of age and were published in peer reviewed journals in the English language between 1990 and December 2020. A total of 176 studies were screened for relevance and 17 met the inclusion criteria for the systematic review with five studies included in the meta-analysis.

MAIN OUTCOMES AND MEASURES

The primary outcome measure was homesickness severity, and it was examined in relation to measures of depression and anxiety. The literature in relation to known risk and protective factors was also reviewed.

RESULTS

Homesickness was reported in the majority of children who were separated from their home. It was associated with negative emotional states. A total of seventeen studies were included in the quantitative review. The meta-analysis showed a significant relationship between homesickness and depression r=0.431 (95% CI 0.344-0.510; p<0.001) and homesickness and anxiety r=0.426 (95% CI 0.369-0.479; p<0.001). Age was not a significant moderator of homesickness severity. Consideration of effective interventions to address homesickness was limited.

CONCLUSIONS AND RELEVANCE

Homesickness significantly impacts children's well-being regardless of age and is associated with overall distress, depression and anxiety. Future studies are required to examine homesickness interventions and supports to improve well-being in children.

Efficacy of Interventional Programs in Reducing Acculturative Stress and Enhancing Adjustment of International Students to the New Host Educational Environment: A Systematic Review and Meta-Analysis

This review aimed to systematically outline and meta-analyze the efficacy of psychoeducational, cultural orientation, socio-cultural, and peer-pairing programs in reducing acculturative stress and enhancing adjustment among international students worldwide. The consulted databases were PubMed, Scopus, Web of Science, ScienceDirect, EBSCO, and ProQuest. Eligibility criteria allowed the inclusion of randomized controlled trials (RCTs) and quasi-experimental trials without applying language, country, publication type or time restrictions. The quality of the eligible studies was appraised by the RoB2 tool of Cochrane for RCTs and JBI critical appraisal tools for quasi-experimental trials. Data items were collected based on PICO acronym by two investigators and reviewed for accuracy by a third one. The evidence was narratively synthesized and validated by proceeding with a random model meta-analysis using Cochrane RevMan software(Version 5.4). The quality of the pooled evidence from meta-analysis was assessed using the tool of GRADE. Out of 29,975 retrieved records, 14 studies (six RCTs and eight quasi-experimental trials) were included. The psychoeducational program significantly reduced acculturative stress and enhanced adjustment. In contrast, cultural orientation and peer-pairing programs significantly enhanced adjustment, but could not reduce acculturative stress. In meta-analysis, acculturative stress was significantly reduced in the psychoeducational intervention versus controls [overall pooled size effect = -3.89 (95% CI: -5.42, -2.53) at p < 0.001]. Similarly, adjustment was significantly enhanced in the psychoeducation and socio-cultural interventions versus control [overall pooled size effect = 3.10 (95% CI: 2.35, 3.85) at p < 0.001]. In conclusion, the psychoeducational program demonstrated superior efficacy in reducing acculturative stress and enhancing adjustment compared to the other interventional programs. However, socio-cultural programs have still been effective in enhancing adjustment. This systematic review is registered in PROSPERO (CRD42018104211).

The efficacy of psychological interventions for the prevention and treatment of mental health disorders in university students: A systematic review and meta-analysis

BACKGROUND

Mental health problems are becoming increasingly prevalent among students and adequate support should be provided to prevent and treat mental health disorders in those at risk.

METHODS

This systematic review and meta-analysis examined the efficacy of psychological interventions for students, with consideration of how adaptions to intervention content and delivery could improve outcomes. We searched for randomised controlled trials (RCTs) of interventions in students with or at risk of mental health problems and extracted data for study characteristics, symptom severity, wellbeing, educational outcomes, and attrition. Eighty-four studies were included.

RESULTS

Promising effects were found for indicated and selective interventions to treat anxiety disorders, depression and eating disorders. PTSD and self-harm data was limited, and did not demonstrate significant effects. Relatively few trials adapted intervention delivery to student-specific concerns, and overall adapted interventions showed no benefit over non-adapted interventions. There was some suggestion that adaptions based on empirical evidence and provision of additional sessions, and transdiagnostic models may yield some benefits.

LIMITATIONS

The review is limited by the often poor quality of the literature and exclusion of non-published data.

CONCLUSIONS

Interventions for students show benefit though uncertainty remains around how best to optimise treatment delivery and content for students. Additional research into content targeting specific underlying mechanisms of problems and transdiagnostic approaches to provision could be promising avenues for further research.

Brief psychological treatments for emotional disorders in Primary and Specialized Care: A randomized controlled trial

Background/Objective Brief transdiagnostic psychotherapies are a possible treatment for emotional disorders. We aimed to determine their efficacy on mild/moderate emotional disorders compared with treatment as usual (TAU) based on pharmacological interventions. Method: This study was a single-blinded randomized controlled trial with parallel design of three groups. Patients (N = 102) were assigned to brief individual psychotherapy (n = 34), brief group psychotherapy (n = 34) or TAU (n = 34). Participants were assessed before and after the interventions with the following measures: PHQ-15, PHQ-9, PHQ-PD, GAD-7, STAI, BDI-II, BSI-18, and SCID. We conducted per protocol and intention-to-treat analyses. Results: Brief psychotherapies were more effective than TAU for the reduction of emotional disorders symptoms and diagnoses with moderate/high effect sizes. TAU was only effective in reducing depressive symptoms. Conclusions: Brief transdiagnostic psychotherapies might be the treatment of choice for mild/moderate emotional disorders and they seem suitable to be implemented within health care systems.

[Homesickness - A Systematic Review of the Incidence and Consequences of a Phenomenon of Topical Relevance]

INTRODUCTION

Homesickness is a phenomenon of many cultures. International research deals with this topic, not so in Germany. The aim of this work is to bring the phenomenon of homesickness closer to the reader from a scientific and psychiatric point of view, to provide evidence and to create an awareness of its actuality.

METHODOLOGY

Systematic literature research in the databases "Psyndex", "Pubmed" and "google scholar".

RESULTS

Data on the incidence in different populations vary from 20 to 90 %, which is mainly due to inconsistent definitions of homesickness and the different measuring instruments. The clinical consequences range from sleep disorders to depression and social anomalies.

CONCLUSION

Migration movements, increasing prevalence of mental illness and impairments resulting from homesickness make clear how important a modern understanding of homesickness is.

Evidence-Based Brief Psychological Treatment for Emotional Disorders in Primary and Specialized Care: Study Protocol of a Randomized Controlled Trial

Emotional Disorders (EDs) are very prevalent in Primary Care (PC). However, general practitioners (GPs) have difficulties to make the diagnosis and the treatment of this disorders that are usually treated with drugs. Brief psychological therapies may be a new option to treat EDs in a PC context. This article aims to present a study protocol to evaluate the effectiveness and the efficiency of an adaptation to brief format of the "Unified Protocol (UP) for the transdiagnostic treatment of EDs." This is a single-blinded RCT among 165 patients with EDs. Patients will be randomly assigned to receive brief psychological treatment based on UP, conventional psychological treatment, conventional psychological treatment plus pharmacological treatment, minimum intervention based on basic psychoeducational information, or pharmacological treatment only. Outcome measure will be the following: GAD-7, STAI, PHQ-9, BDI-II, PHQ-15, PHQ-PD, and BSI-18. Assessments will be carried out by blinded raters at baseline, after the treatment and 6-month follow-up. The findings of this RCT may encourage the implementation of brief therapies in the PC context, what would lead to the decongestion of the public health system, the treatment of a greater number of people with EDs in a shorter time, the reduction of the side effects of pharmacological treatment and a possible economic savings for public purse. Clinical Trial Registration: ClinicalTrial.gov, identifier NCT03286881. Registered September 19, 2017.