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Xu YP, Fu JC, Hong ZL, Zeng DF, Guo CQ, Li P, Wu JX. Psychological stressors involved in the pathogenesis of premature ovarian insufficiency and potential intervention measures. Gynecol Endocrinol 2024; 40:2360085. [PMID: 38813955 DOI: 10.1080/09513590.2024.2360085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/14/2024] [Indexed: 05/31/2024] Open
Abstract
Premature ovarian insufficiency (POI) is a common gynecological endocrine disease, which seriously affects women's physical and mental health and fertility, and its incidence is increasing year by year. With the development of social economy and technology, psychological stressors such as anxiety and depression caused by social, life and environmental factors may be one of the risk factors for POI. We used PubMed to search peer-reviewed original English manuscripts published over the last 10 years to identify established and experimental studies on the relationship between various types of stress and decreased ovarian function. Oxidative stress, follicular atresia, and excessive activation of oocytes, caused by Stress-associated factors may be the main causes of ovarian function damage. This article reviews the relationship between psychological stressors and hypoovarian function and the possible early intervention measures in order to provide new ideas for future clinical treatment and intervention.
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Affiliation(s)
- Ying-Pei Xu
- Department of Reproductive Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian Province, China
- Department of Histology and Embryology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Ji-Chun Fu
- Department of Reproductive Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian Province, China
| | - Zhi-Lin Hong
- Clinical Laboratory Center, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - De-Fei Zeng
- Department of Reproductive Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian Province, China
| | - Chao-Qin Guo
- Department of Reproductive Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian Province, China
| | - Ping Li
- Department of Reproductive Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian Province, China
| | - Jin-Xiang Wu
- Department of Histology and Embryology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
- Department of Reproductive Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
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2
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Rolfzen ML, Nagele P, Conway C, Gibbons R, Bartels K. Management of Depression and Anxiety in Perioperative Medicine. Anesthesiology 2024; 141:765-778. [PMID: 39136627 DOI: 10.1097/aln.0000000000005076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
This Clinical Focus Review summarizes contemporary best practices, recent clinically relevant research, and pertinent unanswered questions related to perioperative screening and treatment of anxiety and depression.
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Affiliation(s)
- Megan L Rolfzen
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Peter Nagele
- Department of Anesthesiology, University of Chicago, Chicago, Illinois
| | - Charles Conway
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Robert Gibbons
- Center for Health Statistics, University of Chicago, Chicago, Illinois
| | - Karsten Bartels
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska
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Bijker L, Scholten-Peeters GGM, Donker MH, Coppieters MW, Cuijpers P, Busink V, Poolman EY, de Wit LM. 'Leaving my comfort zone'. A qualitative study of physiotherapists' experiences blending an eHealth psychosocial intervention with face-to-face physiotherapy. Musculoskelet Sci Pract 2024; 73:103121. [PMID: 38936263 DOI: 10.1016/j.msksp.2024.103121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/21/2024] [Accepted: 06/10/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Many physiotherapists do not feel adequately equipped to address psychosocial risk factors in people with complex pain states. Hence, a biopsychosocial blended intervention (Back2Action) was developed to assist physiotherapists to manage people with persistent spinal pain and coexisting psychosocial risk factors associated with the development or maintenance of persistent pain. OBJECTIVE This study aimed to gain insight into the experiences of physiotherapists with this blended psychosocial intervention. DESIGN and methods: This was an interpretative qualitative study with a reflexive thematic analysis of semi-structured interviews with physiotherapists (N = 15) who delivered Back2Action. The interview started with the grand-tour question: "What was your experience in using Back2Action?" Physiotherapist were encouraged to provide examples, and follow-up questions were posed to ensure a deeper understanding could be reached. RESULTS Four themes were constructed: Physiotherapists became increasingly aware of (1) their own implicit expectations, biases and skills, and underlying treatment paradigms, and (2) the implicit expectations from their patients towards them. This led to (3) creating a deeper and stronger therapeutic alliance with the patient, but also (4) an understanding that implementation of a true biopsychosocial intervention - even if offered in a blended form - requires more practice, confidence and resources. CONCLUSIONS Back2Action is considered a valuable treatment to deliver a biopsychosocial intervention in primary care. Considering the high level of knowledge, skills and competency of the participating physiotherapists, the perceived barriers may be more difficult to overcome for more junior physiotherapists.
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Affiliation(s)
- L Bijker
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences - Program Musculoskeletal Health, the Netherlands; Amsterdam Public Health Research Institute, Department of Clinical Psychology, Vrije Universiteit Amsterdam, the Netherlands.
| | - G G M Scholten-Peeters
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences - Program Musculoskeletal Health, the Netherlands.
| | - M H Donker
- Department of Health Sciences, Vrije Universiteit Amsterdam, the Netherlands.
| | - M W Coppieters
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences - Program Musculoskeletal Health, the Netherlands; School of Health Sciences and Social Work, and Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia.
| | - P Cuijpers
- Amsterdam Public Health Research Institute, Department of Clinical Psychology, Vrije Universiteit Amsterdam, the Netherlands.
| | - V Busink
- Amsterdam Public Health Research Institute, Department of Clinical Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - E Y Poolman
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences - Program Musculoskeletal Health, the Netherlands; Amsterdam Public Health Research Institute, Department of Clinical Psychology, Vrije Universiteit Amsterdam, the Netherlands.
| | - L M de Wit
- Amsterdam Public Health Research Institute, Department of Clinical Psychology, Vrije Universiteit Amsterdam, the Netherlands.
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Varese F, Allsopp K, Carter LA, Shields G, Hind D, Davies L, Barrett A, Bhutani G, McGuirk K, Huntley F, Jordan J, Rowlandson A, Sarsam M, Ten Cate H, Walker H, Watson R, Wilkinson J, Willbourn J, French P. The Resilience Hub approach for addressing mental health of health and social care workers during the COVID-19 pandemic: a mixed-methods evaluation. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-164. [PMID: 39264827 DOI: 10.3310/hgqr5133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/14/2024]
Abstract
Background Resilience Hubs provide mental health screening, facilitation of access and direct provision of psychosocial support for health and social care keyworkers in England affected by the coronavirus disease 2019 pandemic. Aim To explore implementation of the Hubs, including characteristics of staff using the services, support accessed, costing data and a range of stakeholder perspectives on the barriers and enablers to Hub use and implementation of staff well-being support within the context of the pandemic. Design Mixed-methods evaluation. Setting Four Resilience Hubs. Methods Findings were integrated via mixed-method case studies, including: analyses of Hub mental health screening (N = 1973); follow-up questionnaire data (N = 299) on service use and health status of Hub clients; economic information provided by the Hubs; 63 interviews with Hub staff, wider stakeholders, Hub clients and keyworkers who did not use the Hubs. Results Findings were consistent across Hubs and workstreams. Most Hub clients were NHS staff. Under-represented groups included men, keyworkers from minority ethnic communities, care homes and emergency services staff. Clients reported comorbid mental health needs across multiple domains (anxiety; depression; post-traumatic stress; alcohol use; functioning). Their health status was lower than population norms and relevant pre-pandemic data. Several factors predicted higher needs, but having pre-pandemic emotional well-being concerns was one of the most robust predictors of higher need. Sixty per cent of participants who completed follow-up questionnaires reported receiving mental health support since Hub screening, most of which was directly or indirectly due to Hub support. High levels of satisfaction were reported. As in many services, staffing was the central component of Hub cost. Hubs were predominantly staffed by senior clinicians; this staffing model was consistent with the generally severe difficulties experienced by clients and the need for systemic/team-based working. Costs associated with health and social care use for Hub clients were low, which may be due to barriers to accessing support in general. Enablers to accessing Hubs included: a clear understanding of the Hubs, how to self-refer, and managerial support. Barriers included confusion between Hubs and other support; unhelpful beliefs about job roles, unsupportive managers, negative workplace cultures and difficulties caused by systemic issues. Some keyworkers highlighted a perceived need for further diversity and cultural competency training to improve reach to under-represented communities. Other barriers for these groups included prior negative experiences of services, structural inequalities and stigma. Some wider stakeholders had concerns around growing waiting times for Hub-provided therapy, and insufficient data on Hub usage and outcomes. Feedback was otherwise very positive. Limitations Main limitations included lack of comparative and pre-pandemic/baseline data, small numbers from under-represented groups limiting fine-grained analysis, and participant self-selection. Conclusions Findings highlighted the value of the Hub model of outreach, screening, support navigation and provision of direct support during the coronavirus disease 2019 pandemic, and as a potential model to respond to future crises. The research provided recommendations to improve Hub promotion, equality/diversity/inclusion access issues, management of specialist resources and collection of relevant data on Hub outcomes and activities. Broader recommendations for the primary prevention of mental health difficulties across the health and care system are made, as individual support offers should be an adjunct to, not a replacement for, resolutions to systemic challenges. Research recommendations are made to conduct more robust evaluations of the clinical and cost-effectiveness of the Hubs, using larger data sets and comparative data. Study registration This study is registered as researchregistry6303. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132269) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 29. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Filippo Varese
- Faculty of Biology, Medicine and Health, University of Manchester, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Research and Innovation, Manchester, UK
| | - Kate Allsopp
- Faculty of Biology, Medicine and Health, University of Manchester, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Research and Innovation, Manchester, UK
| | - Lesley-Anne Carter
- Faculty of Biology, Medicine and Health, University of Manchester, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
| | - Gemma Shields
- Faculty of Biology, Medicine and Health, University of Manchester, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
| | - Daniel Hind
- University of Sheffield, School of Health and Related Research, Sheffield, UK
| | - Linda Davies
- Faculty of Biology, Medicine and Health, University of Manchester, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
| | - Alan Barrett
- Greater Manchester Resilience Hub, Pennine Care NHS Foundation Trust, Lancashire, UK
- University of Salford, School of Health and Society, Salford, UK
| | - Gita Bhutani
- Faculty of Biology, Medicine and Health, University of Manchester, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
- Lancashire and South Cumbria Resilience Hub, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Katherine McGuirk
- Greater Manchester Health and Social Care Partnership, Manchester, UK
| | - Fay Huntley
- Cheshire and Merseyside Resilience Hub, Mersey Care NHS Foundation Trust, Prescot, UK
| | - Joanne Jordan
- Humber and North Yorkshire Resilience Hub, Tees Esk and Wear Valleys NHS Foundation Trust, West Park Hospital, Darlington, UK
| | - Aleix Rowlandson
- Faculty of Biology, Medicine and Health, University of Manchester, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
| | - May Sarsam
- Cheshire and Merseyside Resilience Hub, Mersey Care NHS Foundation Trust, Prescot, UK
| | - Hein Ten Cate
- Lancashire and South Cumbria Resilience Hub, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Holly Walker
- Humber and North Yorkshire Resilience Hub, Tees Esk and Wear Valleys NHS Foundation Trust, West Park Hospital, Darlington, UK
| | - Ruth Watson
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Research and Innovation, Manchester, UK
| | - Jack Wilkinson
- Faculty of Biology, Medicine and Health, University of Manchester, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
| | - Jenni Willbourn
- Greater Manchester Resilience Hub, Pennine Care NHS Foundation Trust, Lancashire, UK
| | - Paul French
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
- Pennine Care NHS Foundation Trust, Lancashire, UK
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Hinnant L, Rios Villacorta N, Chen E, Bacchus D, Dotson J, Greywoode R, Keefer L, Lupe S, Maggs L, Meek G, Szigethy E, Tomasino K, Ehrlich OG, Ehle S. Consensus Statement on Managing Anxiety and Depression in Individuals with Inflammatory Bowel Disease. Inflamm Bowel Dis 2024:izae151. [PMID: 39173019 DOI: 10.1093/ibd/izae151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Studies have found a higher risk of comorbid anxiety and depression among patients with inflammatory bowel disease (IBD) compared with healthy individuals. If left untreated, comorbid depression and anxiety in patients with IBD can lead to poorer health outcomes and an increased healthcare utilization. The goal of this work was to develop a consensus statement to begin to address patient and provider needs and responsibilities related to screening and treatment of depression and anxiety symptoms among patients with IBD. METHODS A literature scan was conducted to gather evidence-based background information and recommendations on the screening, diagnosis, and treatment of anxiety and depression in patients with IBD. This was followed by the engagement of a panel of IBD and mental health experts and patient advocates using a modified Delphi process to synthesize the literature and distill the information into a core set of statements to support provider actions and care delivery. RESULTS Six statements were distilled from the literature and consensus process that link to the general management, screening, and treatment of anxiety and depression in patients with IBD. CONCLUSIONS Mental healthcare and support for IBD patients is critical; the statements included in this article represent practical considerations for IBD healthcare professionals in addressing key issues on provider awareness, knowledge and behaviors, screening and treatment resources, and patient education.
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Affiliation(s)
- Laurie Hinnant
- Health Practice Area, RTI International, Research Triangle Park, NC, USA
| | | | - Eliza Chen
- Health Practice Area, RTI International, Research Triangle Park, NC, USA
| | - Donna Bacchus
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Jennifer Dotson
- Division of Gastroenterology, Hepatology and Nutrition, The Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ruby Greywoode
- Division of Gastroenterology, Montefiore Medical Center, Bronx, NY, USA
| | - Laurie Keefer
- Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Stephen Lupe
- Department of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Eva Szigethy
- Pediatric Psychiatry, Akron Children's Hospital, Akron, OH, USA
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Katheryn Tomasino
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Orna G Ehrlich
- National Headquarters, Crohn's & Colitis Foundation, New York, NY, USA
| | - Sylvia Ehle
- National Headquarters, Crohn's & Colitis Foundation, New York, NY, USA
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Das Chakladar D, Roy PP. Cognitive workload estimation using physiological measures: a review. Cogn Neurodyn 2024; 18:1445-1465. [PMID: 39104683 PMCID: PMC11297869 DOI: 10.1007/s11571-023-10051-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 11/14/2023] [Accepted: 11/28/2023] [Indexed: 08/07/2024] Open
Abstract
Estimating cognitive workload levels is an emerging research topic in the cognitive neuroscience domain, as participants' performance is highly influenced by cognitive overload or underload results. Different physiological measures such as Electroencephalography (EEG), Functional Magnetic Resonance Imaging, Functional near-infrared spectroscopy, respiratory activity, and eye activity are efficiently used to estimate workload levels with the help of machine learning or deep learning techniques. Some reviews focus only on EEG-based workload estimation using machine learning classifiers or multimodal fusion of different physiological measures for workload estimation. However, a detailed analysis of all physiological measures for estimating cognitive workload levels still needs to be discovered. Thus, this survey highlights the in-depth analysis of all the physiological measures for assessing cognitive workload. This survey emphasizes the basics of cognitive workload, open-access datasets, the experimental paradigm of cognitive tasks, and different measures for estimating workload levels. Lastly, we emphasize the significant findings from this review and identify the open challenges. In addition, we also specify future scopes for researchers to overcome those challenges.
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Affiliation(s)
- Debashis Das Chakladar
- Department of Computer Science and Engineering, Indian Institute of Technology Roorkee, Roorkee, Uttarakhand India
| | - Partha Pratim Roy
- Department of Computer Science and Engineering, Indian Institute of Technology Roorkee, Roorkee, Uttarakhand India
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7
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Yi L, Chen J, Li S, Cui W, Li J, Peng L, Peng C. Efficacy and safety of Chinese patent medicines combined with antidepressants for treatment of depression in adults: A multiple-treatment meta-analysis. J Psychiatr Res 2024; 176:205-212. [PMID: 38878648 DOI: 10.1016/j.jpsychires.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 06/03/2024] [Accepted: 06/10/2024] [Indexed: 07/29/2024]
Abstract
BACKGROUND Combinations of Chinese patent medicines (CPM) with antidepressants (including selective serotonin reuptake inhibitors (SSRI), selective serotonin-norepinephrine reuptake inhibitors (SNRI), tricyclic antidepressants (TCA), and noradrenergic and specific serotonergic antidepressants (NaSSA)) are frequently utilized for treating depression in adults. However, the efficacy and safety of these combination treatments remain to be established. METHODS Systematic search was conducted in seven electronic databases, regulatory websites and international registers of trials from 1994 to 2023 that included adult patients with depressive disorders who received CPM combined with antidepressants. The Multiple-Treatment Meta-Analysis (MTMA) was conducted using a random effects model with Stata/MP17 and R4.3.5 software. Primary outcomes were total efficacy rate, Hamilton Depression Scale (HAMD) score, and Treatment Emergency Symptom Scale (TESS) score. Secondary outcomes included brain-derived neurotrophic factor (BDNF) levels. RESULTS A total of 146 randomized controlled trials (13,754 participants: 6929 in intervention and 6825 in control groups) were included. For total effective rate, Multiple-Treatment Meta-Analysis results showed that the overall effect of combined intervention was better compared with antidepressants alone, where Jieyuanshenkeli (JYASKL) presented the optimal option for improving total efficacy (OR = 5.39, 95% CI [2.60, 11.18], SUCRA = 84.50%). In reduding the HAMD, Shuganjieyujiaonang (SGJYJN) was most likely to reduce the HAMD score (SMD = -2.20, 95% CI [-3.06, -1.33], SUCRA = 86.10%), Jieyuanshenkeli (JYASKL),Tianewangbuxindan (TWBXD), Shuyukeli (SYKL), Anshenbuxinwan (ASBXW) combination intervention did not appear to be statistically superior to antidepressants alone. In theTreatment Emergency Symptom Scale (TESS), Wulinjiaonang induced the most significant reduction in TESS score (SMD = -1.98, 95% CI [-3.59, -0.36], SUCRA = 90.40%). Tianmengjiaonang (TMJN) + Antidepressants(AD) (SUCRA = 88.30%) displayed the highest scores in increasing the levels of BDNF, although not statistically significant compared to Antidepressants(AD) alone (SMD = 1.23, 95% CI [0.90, 1.55]). CONCLUSION Combinations of CPM and antidepressants showed superior efficacy over antidepressants alone. The optimal combinations were determined as Shuganjieyu Jiaonang (SGJYJN)/SSRIs and Jieyuanshenkeli (JYASKL)/SSRIs. In terms of safety, results showed that combination therapy did not show better TESS efficacy than antidepressants alone.Although some of the combination interventions were not superior than antidepressants alone in reducing HAMD scores,our findings provide a potentially significant alternative option for clinical complementary therapy. However, these results require further validation through larger sample sizes, multicenter randomized controlled trials, and real-world data.
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Affiliation(s)
- Lidan Yi
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Jing Chen
- Department of Pharmacy, The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, 410011, China
| | - Sini Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Wei Cui
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Jianhe Li
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Liubao Peng
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Ciyan Peng
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, 410011, China.
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Stein MD, Bendiks S, Karzhevsky S, Pierce C, Dunn A, Majeski A, Herman DS, Weisberg RB. Study protocol for the Treating Opioid Patients' Pain and Sadness (TOPPS) study - A randomized control trial to lower depression and chronic pain interference, and increase care retention among persons receiving buprenorphine. Contemp Clin Trials 2024; 143:107608. [PMID: 38878997 DOI: 10.1016/j.cct.2024.107608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/31/2024] [Accepted: 06/12/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Persons receiving prescription buprenorphine for opioid use disorder experience high rates of comorbid conditions such as chronic pain and depression, which present barriers to buprenorphine care retention. This paper describes the protocol of the TOPPS (Treating Opioid Patients' Pain and Sadness) study, which compares a values-based, behavioral activation intervention with a health education contact-control condition, with the aim of decreasing chronic pain and depression, and increasing buprenorphine care retention for persons with opioid use disorder. METHODS This randomized controlled trial (RCT) enrolls and randomizes up to 250 participants currently being treated with buprenorphine to receive three months of either TOPPS, a six-session phone-based behavioral intervention, or a health education (HE) control condition. We compare the TOPPS intervention to HE on the following outcomes: 1) pain interference and pain severity over the 3-month treatment phrase; 2) depressive symptoms over the 3-month treatment phase; and 3) sustained improvements in pain interference, depressive symptoms, and buprenorphine treatment retention over the 12-month study period. We also examine mechanisms by which the intervention may reduce pain interference. DISCUSSION This RCT explores a novel intervention to address chronic pain and depression for individuals receiving buprenorphine in office-based settings. TOPPS may lead to improved pain, depression, and substance use outcomes, and can utilize providers available within buprenorphine programs, broadening the disseminability of this intervention and heightening its public health impact. CLINICAL TRIAL #NCT03698669.
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Affiliation(s)
- Michael D Stein
- Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA.
| | - Sally Bendiks
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA.
| | - Skylar Karzhevsky
- Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA.
| | - Claire Pierce
- Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA.
| | - Ana Dunn
- Department of Behavioral Medicine and Addictions Research, Butler Hospital, 345 Blackstone Blvd, Providence, RI 02906, USA
| | - Adam Majeski
- Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA.
| | - Debra S Herman
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA; Department of Behavioral Medicine and Addictions Research, Butler Hospital, 345 Blackstone Blvd, Providence, RI 02906, USA.
| | - Risa B Weisberg
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, 720 Harrison Avenue, 9(th) Floor, Boston, MA 02118, USA; Department of Family Medicine, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA; RealizedCare, 1690 Ring Road #110, Elizabethtown, KY 42701, USA.
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9
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Yisma E, Walsh S, Hillier S, Gillam M, Gray R, Jones M. Effect of behavioural activation for individuals with post-stroke depression: systematic review and meta-analysis. BJPsych Open 2024; 10:e134. [PMID: 39078076 DOI: 10.1192/bjo.2024.721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Previous research showed that behavioural activation is as effective as cognitive-behavioural therapy for general depression. However, it remains unclear if it leads to greater improvement in depressive symptoms when compared with standard treatment for post-stroke depression. AIMS To compare the effectiveness of behavioural activation against control conditions in reducing depression symptoms in individuals with post-stroke depression. METHOD This review searched five databases from inception until 13 July 2021 (updated 15 September 2023) for randomised controlled trials comparing behavioural activation and any control conditions for post-stroke depression. Risk of bias was assessed with the Cochrane Collaboration's Risk-of-Bias 2 tool. The primary outcome was improvement in depressive symptoms in individuals with post-stroke depression. We calculated a random-effects, inverse variance weighting meta-analysis. RESULTS Of 922 initial studies, five randomised controlled trials with 425 participants met the inclusion criteria. Meta-analysis showed that behavioural activation was associated with reduced depressive symptoms in individuals with post-stroke depression at 6-month follow-up (Hedges' g -0.39; 95% CI -0.64 to -0.14). The risk of bias was low for two (40%) of five trials, and the remaining three (60%) trials were rated as having a high risk of bias. Heterogeneity was low, with no indication of inconsistency. CONCLUSIONS Evidence from this review was too little to confirm the effectiveness of behavioural activation as a useful treatment for post-stroke depression when compared with control conditions. Further high-quality studies are needed to conclusively establish the efficacy of behavioural activation as a treatment option for post-stroke depression.
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Affiliation(s)
- Engida Yisma
- Department of Rural Health, University of South Australia, Allied Health & Human Performance, Australia; and IIMPACT in Health, University of South Australia, Australia
| | - Sandra Walsh
- Department of Rural Health, University of South Australia, Allied Health & Human Performance, Australia; and IIMPACT in Health, University of South Australia, Australia
| | - Susan Hillier
- IIMPACT in Health, University of South Australia, Australia
| | - Marianne Gillam
- Department of Rural Health, University of South Australia, Allied Health & Human Performance, Australia; and IIMPACT in Health, University of South Australia, Australia
| | - Richard Gray
- Department of Rural Health, University of South Australia, Allied Health & Human Performance, Australia; and School of Nursing and Midwifery, La Trobe University, Australia
| | - Martin Jones
- Department of Rural Health, University of South Australia, Allied Health & Human Performance, Australia; and IIMPACT in Health, University of South Australia, Australia
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Ferreira RJO, Henriques A, Moe RH, Matos C, Tveter AT, Osteras N, Nogueira P, Costa AS, Haavardsholm EA, Carmona L, Richards D. Presentation of the first international research network to foster high-quality clinical trials testing non-pharmacological interventions (TRACTION network). BMJ Open 2024; 14:e081864. [PMID: 39019643 PMCID: PMC11256069 DOI: 10.1136/bmjopen-2023-081864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 07/03/2024] [Indexed: 07/19/2024] Open
Abstract
Clinical trials are essential for evaluating the efficacy and safety of new treatments and health interventions. However, while pharmacological trials are well-established, non-pharmacological trials face unique challenges related to their complexity and difficulties such as recruitment, retention, intervention standardisation, selection of outcome measures and blinding of clinicians, participants and data collectors. This communication paper describes the objectives, implementation steps and bylaws of the 'Trials foR heAlth Care inTerventIONs' Network (TRACTION), established by an international multiprofessional task force of experts to foster high-quality non-pharmacological research, ultimately improving patient care and healthcare outcomes.The TRACTION research network will provide information and resources through a collaborative hub for researchers, health professionals, patient research partners and stakeholders in diverse biomedical and healthcare areas, connecting people with different levels of expertise but with the same interests (eg, to evaluate the effect of non-pharmacological interventions, recruiting participants). This open network will support researchers in optimising trial design, participant recruitment, data management and analysis, and disseminating and implementing trial results.The network will also facilitate specialisation training and provide educational materials and mentoring.
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Affiliation(s)
- Ricardo J O Ferreira
- Nursing Research Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Lisbon, Portugal
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Rheumatology, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- QLV Research Consulting, Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICiSA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Laboratório Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Adriana Henriques
- Nursing Research Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Lisbon, Portugal
- Laboratório Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Saúde Ambiental (ISAMB), Universidade de Lisboa Faculdade de Medicina, Lisboa, Portugal
| | - Rikke H Moe
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Cristiano Matos
- QLV Research Consulting, Coimbra, Portugal
- Laboratório Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Saúde Ambiental (ISAMB), Universidade de Lisboa Faculdade de Medicina, Lisboa, Portugal
- Department of Pharmacy, Instituto Politécnico de Coimbra Escola Superior de Tecnologia da Saúde de Coimbra, Coimbra, Portugal
| | - Anne-Therese Tveter
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Nina Osteras
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Paulo Nogueira
- Laboratório Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Saúde Ambiental (ISAMB), Universidade de Lisboa Faculdade de Medicina, Lisboa, Portugal
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Área Disciplinar Autónoma de Bioestatística (Laboratório de Biomatemática), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Andreia Silva Costa
- Nursing Research Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Lisbon, Portugal
- Laboratório Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Saúde Ambiental (ISAMB), Universidade de Lisboa Faculdade de Medicina, Lisboa, Portugal
| | - Espen A Haavardsholm
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (INMUSC), Madrid, Madrid, Spain
| | - David Richards
- Western Norway University of Applied Sciences, Bergen, Norway
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Bae JH, Park EH, Lee HK, Yoon KH, Won KC, Kim HM, Kim SG. Enhancing Diabetes Care through a Mobile Application: A Randomized Clinical Trial on Integrating Physical and Mental Health among Disadvantaged Individuals. Diabetes Metab J 2024; 48:790-801. [PMID: 38310877 PMCID: PMC11307109 DOI: 10.4093/dmj.2023.0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/16/2023] [Indexed: 02/06/2024] Open
Abstract
BACKGRUOUND This study examines integrating physical and mental healthcare for disadvantaged persons with type 2 diabetes mellitus and mild-to-moderate depression in the community, using a mobile application within a public-private-academic partnership. METHODS The Korean Diabetes Association has developed a mobile application combining behavioral activation for psychological well-being and diabetes self-management, with conventional medical therapy. Participants were randomly assigned to receive the application with usual care or only usual care. Primary outcomes measured changes in psychological status and diabetes selfmanagement through questionnaires at week 12 from the baseline. Secondary outcomes assessed glycemic and lipid control, with psychological assessments at week 16. RESULTS Thirty-nine of 73 participants completed the study (20 and 19 in the intervention and control groups, respectively) and were included in the analysis. At week 12, the intervention group showed significant reductions in depression severity and perceived stress compared to the control group. Additionally, they reported increased perceived social support and demonstrated improved diabetes self-care behavior. These positive effects persisted through week 16, with the added benefit of reduced anxiety. While fasting glucose levels in the intervention group tended to improve, no other significant differences were observed in laboratory assessments between the groups. CONCLUSION This study provides compelling evidence for the potential efficacy of a mobile application that integrates physical and mental health components to address depressive symptoms and enhance diabetes self-management in disadvantaged individuals with type 2 diabetes mellitus and depression. Further research involving larger and more diverse populations is warranted to validate these findings and solidify their implications.
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Affiliation(s)
- Jae Hyun Bae
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eun Hee Park
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, Korea
| | | | - Kun Ho Yoon
- Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyu Chang Won
- Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | | | - Sin Gon Kim
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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12
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Remmerswaal KC, Batelaan NM, van Oppen P, Scholten WD, van Balkom AJ. Multifaceted, Brief Intensive Home-Based Exposure Treatment in Patients with Obsessive-Compulsive Disorder Who are Nonresponsive to Regular Cognitive Behavior Therapy: An Uncontrolled Pilot Study. J Psychiatr Pract 2024; 30:297-307. [PMID: 39058530 PMCID: PMC11280449 DOI: 10.1097/pra.0000000000000796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
OBJECTIVE To test a multifaceted treatment program for patients with obsessive-compulsive disorder (OCD) who did not respond to regular cognitive behavior therapy (CBT). The treatment addresses several factors that may play a role in maintaining OCD. METHODS We designed a treatment consisting of a 6-day intensive, individual exposure in vivo with response prevention (ERP) format, with 24 therapist-assisted treatment hours at the patient's home and 12 self-controlled ERP hours, including behavioral activation and family interventions. Next, we investigated the effect (obsessive-compulsive symptoms, comorbidity, functioning, quality of life, OCD-related interaction patterns) and feasibility (dropout, treatment satisfaction, and organization) of this program using pre-post-tests, pre-follow-up tests, and qualitative data from patients, family members, and therapists. RESULTS In a sample of 22 participants, obsessive-compulsive symptoms (Y-BOCS pre: 28.7, post: 15.9; Wilcoxon S-R tests P<0.01) improved significantly, as did most other effect measures. Results were largely, but not completely, preserved at 3-month follow-up. There was only 1 dropout. Patients, family members, and therapists were satisfied with the treatment. Implementation of the treatment did not pose difficulties. CONCLUSIONS In nonresponders with OCD, a multifaceted, brief, intensive home-based ERP program targeting factors maintaining OCD is promising and feasible. Extra care is needed to maintain improvement.
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Qin N, Luo Y, Wang S, Li Y, Li J, Luo J, Zhou J, Zhang Q, Xie J, Cheng ASK. Effectiveness of a modified behavioural activation treatment training program for primary medical staff to manage depressive symptoms among rural elderly in Hunan Province, China: study protocol for a cluster randomised controlled trial. BMJ Open 2024; 14:e086489. [PMID: 38925704 PMCID: PMC11202641 DOI: 10.1136/bmjopen-2024-086489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Depression is a major global health problem, with high prevalence rates of depressive symptoms observed among the elderly population in China, particularly exacerbating in rural areas. Due to a lack of professional mental health training and inadequate psychotherapy capacity within primary medical staff, rural elderly individuals grappling with depressive symptoms often encounter challenges in receiving timely diagnosis and treatment. In this landscape, the modified behavioural activation treatment (MBAT) emerges as a promising approach due to its practicality, ease of therapist training and application, patient acceptability, and broad applicability. However, existing evidence for MBAT mainly hails from developed countries, leaving a gap in its adaptation and implementation within rural China. This study aims to develop an MBAT training programme for primary medical staff to manage depressive symptoms among rural elderly and evaluate its effectiveness. METHODS AND ANALYSIS A cluster randomised controlled trial will be conducted in 10 randomly selected township hospitals in Lengshuijiang and Lianyuan, Hunan Province. We aim to recruit 150 participants, with 5 township hospitals selected for each group, each consisting of 15 participants. The intervention group will implement the MBAT training programme, while the control group will receive usual care training programme. Depressive symptoms, psychosocial functioning, quality of life and satisfaction will be measured at baseline, immediately post-intervention, and at 3 and 6 months post-intervention. Effectiveness will be assessed using linear or generalised linear mixed models. ETHICS AND DISSEMINATION This study has obtained approval from the Institutional Review Board of the Third Xiangya Hospital, Centre South University (No.: 2022-S261). Results will be disseminated through publication in international peer-reviewed journals and presentations at national and international conferences. TRIAL REGISTRATION NUMBER ChiCTR2300074544.
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Affiliation(s)
- Ning Qin
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Yating Luo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Sha Wang
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuxuan Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jing Li
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Juan Luo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jian Zhou
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, Hunan, China
| | - Qiuxiang Zhang
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jianfei Xie
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Andy S K Cheng
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
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14
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Huang X, Chen Y, Luo J, Wang D, Yang C, Luo W, Zhou Y. The effect of behavioral activation play therapy in adolescents with depression: A study protocol for a randomized controlled trial. PLoS One 2024; 19:e0304084. [PMID: 38900751 PMCID: PMC11189190 DOI: 10.1371/journal.pone.0304084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/30/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Depression is a common psychological problem in adolescents worldwide. Although the World Health Organization recommends that members of this population engage in physical activity to reduce depressive symptoms, compliance with this recommendation is often low. Furthermore, although behavioral activation (BA) is recommended as a treatment for adolescents with depression, the reported effect size is small. Compared with traditional exercises, gamified physical activity (GPA) can be particularly appealing to adolescents because it is perceived as an enjoyable experience. In this study, we integrated BA and GPA to create behavioral activation play therapy (BAPT). We designed a clinical trial to investigate the feasibility, acceptability, and effectiveness of this treatment in adolescents with depression. METHODS This study is a randomized controlled trial (RCT) with a three-arm, assessor-blinded design, conducted to validate the effectiveness and applicability of BAPT for treating adolescent with depression. We will recruit 258 participants and randomly assign them to a BAPT group, BA group, or GPA group using a ratio of 1:1:1. Based on conventional strategies for treatment and care, the three groups will receive nine BAPT sessions, nine BA sessions, or nine GPA sessions, respectively. We will compare the outcomes of the BAPT with those of the BA and GPA interventions. DISCUSSION This is the first RCT to explore the effectiveness and applicability of BAPT in adolescents with depression. This study will provide evidence that may help to decrease depressive symptoms in adolescents, and will demonstrate the treatment effectiveness in terms of increasing levels of physical activity, reducing the rate of non-suicidal self-injury behaviors, and improving sleep quality. We will also assess the presence of side effects and the treatment adherence of patients receiving BAPT. TRIAL REGISTRATION Trial registration: Chinese Clinical Trial Registry, ChiCTR2300072671. Registered on 20 June 2023.
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Affiliation(s)
- Xiaolong Huang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Yuqi Chen
- Southern Medical University, Guangzhou, China
| | | | - Dongdong Wang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Chanjuan Yang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Wei Luo
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Yanling Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
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Walsh SM, Muyambi K, Dennis S, Hutchinson S, Turnbull T, Tan KL, Dettwiller P, Bressington D, Gray R, Howard L, Andrews J, Muthuramalingam S, Versace VL, Jones MF. Behavioural activation for people in custody with depression: A protocol for a feasibility randomised controlled study. PLoS One 2024; 19:e0304767. [PMID: 38870235 PMCID: PMC11175500 DOI: 10.1371/journal.pone.0304767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 05/15/2024] [Indexed: 06/15/2024] Open
Abstract
People in custody are at high risk of developing depression. Accessing psychological treatments in a prison setting is a particular challenge, in part, due to difficulties accessing specialist mental health workers. Behavioural Activation (BA) may be helpful in improving health outcomes for people in custody experiencing depressive symptoms. The aim of this study is to establish the feasibility and acceptability of custodial health nurses delivering BA to improve depressive symptoms of people in custody. We will conduct a pilot randomised controlled trial with process observation examining the feasibility and acceptability of BA in treating people in custody with depressive symptoms. 60 people in custody presenting with depressive symptoms will be randomised to receive BA plus treatment as usual (TAU) or TAU provided by custodial health nurses. Eight custodial health nurses will be recruited, trained, and deliver BA. BA will be delivered twice a week for six weeks, with sessions lasting up to 30 minutes. Changes in depression and quality of life (QoL) will be assessed at baseline, 6 weeks, and 3 months post-intervention. Participants will be interviewed to understand feasibility and acceptability of BA in prison settings. The findings will inform the design of a randomised controlled trial to test the efficacy of BA for people in custody with depression. Findings will help determine whether BA for depression is suited to prison health care system and services. Improving depressive symptoms in people in custody has benefits beyond prison settings. The Central Adelaide Local Health Network Human Research Ethics Committee and University of South Australia Human Research Ethics Committee have approved the study. The trial results will be disseminated through peer-reviewed journals and scientific conferences and reported to local stakeholders and policy makers. If feasibility and acceptability is demonstrated, we will seek to progress to an effectiveness study. A potential strength of the trial model proposed, is in its scalability, with potential to increase the trial sites and locations. This trial has been prospectively registered with the Australian New Zealand Clinical Trials Registry (reference number: ACTRN12623000346673p). Trial registration ACTRN12623000346673p.
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Affiliation(s)
- Sandra M. Walsh
- University of South Australia Department of Rural Health, Whyalla Norrie, South Australia, Australia
- University of South Australia IIMPACT in Health, Adelaide, South Australia, Australia
| | - Kuda Muyambi
- University of South Australia Department of Rural Health, Whyalla Norrie, South Australia, Australia
- University of South Australia IIMPACT in Health, Adelaide, South Australia, Australia
| | - Shaun Dennis
- University of South Australia Department of Rural Health, Whyalla Norrie, South Australia, Australia
- Flinders and Upper North Local Health Network, Whyalla Integrated Mental Health Service, Whyalla, South Australia, Australia
| | - Steven Hutchinson
- South Australia Prison Health Service, Central Adelaide Local Health Network, South Australia, Australia
| | - Tom Turnbull
- South Australia Prison Health Service, Central Adelaide Local Health Network, South Australia, Australia
| | - Kuan Liung Tan
- University of South Australia Department of Rural Health, Whyalla Norrie, South Australia, Australia
- University of South Australia IIMPACT in Health, Adelaide, South Australia, Australia
| | - Pascale Dettwiller
- University of South Australia Department of Rural Health, Whyalla Norrie, South Australia, Australia
| | - Daniel Bressington
- Faculty of Nursing, Charles Darwin University, Casuarina, Northern Territory, Australia
- Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - Richard Gray
- University of South Australia Department of Rural Health, Whyalla Norrie, South Australia, Australia
- La Trobe University, Bundoora, Victoria, Australia
| | - Lucy Howard
- South Australia Prison Health Service, Central Adelaide Local Health Network, South Australia, Australia
| | - Joanne Andrews
- South Australia Prison Health Service, Central Adelaide Local Health Network, South Australia, Australia
| | | | - Vincent L. Versace
- Faculty of Health, Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | - Martin F. Jones
- University of South Australia Department of Rural Health, Whyalla Norrie, South Australia, Australia
- University of South Australia IIMPACT in Health, Adelaide, South Australia, Australia
- La Trobe University, Bundoora, Victoria, Australia
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Kumar D, Corner S, Kim R, Meuret A. A randomized controlled trial of brief behavioral activation plus savoring for positive affect dysregulation in university students. Behav Res Ther 2024; 177:104525. [PMID: 38653177 DOI: 10.1016/j.brat.2024.104525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/25/2024]
Abstract
Rising rates of depression on university campuses accentuate the need for specific intervention. Interventions targeting disturbances in positive affect, in particular, remain sparse, yet such deficits interfere substantially with functioning and further exacerbate or maintain negative symptoms. The current study aimed to evaluate the impact of a virtual, two-session Behavioral Activation augmented with Savoring (BA + S) intervention compared to an Emotional Awareness (EA) control group in increasing positive affect. Sixty university students with low positive affect were randomized to BA + S or EA and completed 21 days of experience-sampling of positive affect. Weekly measures of positive and negative valence symptoms were assessed at baseline, sessions one and two, and at one-week follow-up. Through a prori analyses utilizing multilevel and multivariate multilevel models, our results demonstrate that daily positive affect measured via experience-sampling significantly improved in BA + S, whereas positive affect did not change for those receiving EA, though the interaction of condition and time was not significant. Furthermore, interactions in weekly variables were significant. Increases in positive valence symptoms (affect, anhedonia, etc.) were only reported for students receiving BA + S but not EA. Negative valence symptoms (affect, depression, general distress) improved in both conditions but with superior improvements in BA + S compared to EA. BA + S shows promise for a scalable and accessible intervention to university students with clinical levels of positive and negative affect. ClinicalTrials ID: NCT05234476.
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Affiliation(s)
- Divya Kumar
- Department of Psychology, Southern Methodist University, PO Box 750442, Dallas, TX, USA; McLean Hospital/Harvard Medical School, 115 Mill Street, Belmont, MA, 02478, USA.
| | - Sarah Corner
- Department of Psychology, Southern Methodist University, PO Box 750442, Dallas, TX, USA
| | - Richard Kim
- Department of Psychology, Southern Methodist University, PO Box 750442, Dallas, TX, USA
| | - Alicia Meuret
- Department of Psychology, Southern Methodist University, PO Box 750442, Dallas, TX, USA.
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Muyambi K, Walsh S, Dettwiller P, Tan KL, Dennis S, Bressington D, Gray RJ, McCall A, Jones M. Australian trial of behavioural activation for people with schizophrenia experiencing negative symptoms: a feasibility randomised controlled trial protocol. BMJ Open 2024; 14:e080245. [PMID: 38719282 PMCID: PMC11086511 DOI: 10.1136/bmjopen-2023-080245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/16/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Negative symptoms are frequently experienced by people with schizophrenia. People with negative symptoms often have impaired social functioning and reduced quality of life. There is some evidence that cognitive-behavioural therapy results in a modest reduction in negative symptoms. Behavioural activation may be an effective alternative treatment for negative symptoms.The study aims to examine the feasibility and acceptability of implementing a behavioural activation trial delivered in three community mental health services in South Australia to support adult consumers experiencing negative symptoms of schizophrenia. METHOD AND ANALYSIS This randomised controlled study will recruit a total of 60 consumers aged 18 years or above with mild-moderate negative symptoms of schizophrenia. The consumers will be randomly allocated to receive behavioural activation plus usual mental healthcare or usual mental healthcare alone. The intervention group will receive twelve 30 min sessions of behavioural activation, which will be delivered twice weekly over 6 weeks. In addition, we aim to recruit nine mental health workers from the three rural mental health services who will complete a 10-week online training programme in behavioural activation. Changes in negative symptoms of schizophrenia and depressive symptoms will be assessed at three time points: (a) at baseline, at 6 weeks and 3 month follow-ups. Changes in health-related quality of life (Short Form F36; secondary outcome) will be assessed at two time points: (a) at baseline and (b) immediately at postintervention after 6 weeks. At the end of the trial, interviews will be conducted with purposively selected mental health workers and consumers. Descriptive statistics and thematic analysis will be used to assess feasibility and acceptability. ETHICS AND DISSEMINATION The findings from our feasibility study will inform the design of a fully powered randomised controlled trial to test the effectiveness of behavioural activation as a treatment for negative symptoms in schizophrenia. The study protocol was approved by the Central Adelaide Local Health Network Human Research Ethics Committee. The findings from this study will be disseminated through peer-reviewed scientific journals and conferences. TRIAL REGISTRATION NUMBER ACTRN12623000348651p.
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Affiliation(s)
- Kuda Muyambi
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
| | - Sandra Walsh
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
| | - Pascale Dettwiller
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
| | - Kuan Liung Tan
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Shaun Dennis
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
- Rural and Remote Mental Health Service, Barossa Hills Fleurieu Local Health Network, Whyalla, South Australia, Australia
| | - Daniel Bressington
- Charles Darwin University College of Nursing & Midwifery, Casuarina, Odisha, Australia
| | - Richard John Gray
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
- School of Nursing, La Trobe University, Bundoora, Victoria, Australia
| | - Audrey McCall
- Flinders and Upper North Local Health Network, Whyalla, South Australia, Australia
| | - Martin Jones
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
- School of Nursing, La Trobe University, Bundoora, Victoria, Australia
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Wen H, Wu M, Wang Z, Gao B, Zheng Y. Aberrant effort-based reward dynamics in anhedonia. Cereb Cortex 2024; 34:bhae193. [PMID: 38741268 DOI: 10.1093/cercor/bhae193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 05/16/2024] Open
Abstract
Anhedonia is a transdiagnostic symptom and associated with a spectrum of reward deficits among which the motivational dysfunction is poorly understood. Previous studies have established the abnormal cost-benefit trade-off as a contributor to motivational deficits in anhedonia and its relevant psychiatric diseases. However, it remains elusive how the anhedonic neural dynamics underlying reward processing are modulated by effort expenditure. Using an effort-based monetary incentive delay task, the current event-related potential study examined the neural dynamics underlying the effort-reward interplay in anhedonia using a nonclinical sample who scored high or low on an anhedonia questionnaire. We found that effort prospectively decreased reward effect on the contingent variation negativity and the target-P3 but retrospectively enhanced outcome effect on the feedback-P3 following effort expenditure. Compared to the low-anhedonia group, the high-anhedonia group displayed a diminished effort effect on the target-P3 during effort expenditure and an increased effort-enhancement effect for neutral trials during the feedback-P3 period following effort expenditure. Our findings suggest that anhedonia is associated with an inefficient control and motivation allocation along the efforted-based reward dynamics from effort preparation to effort production.
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Affiliation(s)
- Hailing Wen
- Department of Psychology, Dalian Medical University, 9 West Section, Lvshun South Road, Dalian 116044, China
| | - Menglin Wu
- Department of Psychology, Dalian Medical University, 9 West Section, Lvshun South Road, Dalian 116044, China
| | - Zhao Wang
- Department of Psychology, Dalian Medical University, 9 West Section, Lvshun South Road, Dalian 116044, China
| | - Bo Gao
- Department of Psychology, Dalian Medical University, 9 West Section, Lvshun South Road, Dalian 116044, China
| | - Ya Zheng
- Department of Psychology, Guangzhou University, 230 Wai Huan Xi Road, Guangzhou Higher Education Mega Center, Guangzhou 510006, China
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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] [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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20
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Heathcote C, Walton J, Kellett S, Millings A, Simmonds-Buckley M, Wright A. A feasibility and pilot additive randomised control trial of attachment security priming during behavioural activation. Behav Cogn Psychother 2024; 52:301-316. [PMID: 37933537 DOI: 10.1017/s1352465823000504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
BACKGROUND There is some initial evidence that attachment security priming may be useful for promoting engagement in therapy and improving clinical outcomes. AIMS This study sought to assess whether outcomes for behavioural activation delivered in routine care could be enhanced via the addition of attachment security priming. METHOD This was a pragmatic two-arm feasibility and pilot additive randomised control trial. Participants were recruited with depression deemed suitable for a behavioural activation intervention at Step 2 of a Talking Therapies for Anxiety and Depression service. Ten psychological wellbeing practitioners were trained in implementing attachment security priming. Study participants were randomised to either behavioural activation (BA) or BA plus an attachment prime. The diagrammatic prime was integrated into the depression workbook. Feasibility outcomes were training satisfaction, recruitment, willingness to participate and study attrition rates. Pilot outcomes were comparisons of clinical outcomes, attendance, drop-out and stepping-up rates. RESULTS All practitioners recruited to the study, and training satisfaction was high. Of the 39 patients that were assessed for eligibility, 24 were randomised (61.53%) and there were no study drop-outs. No significant differences were found between the arms with regards to drop-out, attendance, stepping-up or clinical outcomes. CONCLUSIONS Further controlled research regarding the utility of attachment security priming is warranted in larger studies that utilise manipulation checks and monitor intervention adherence.
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Affiliation(s)
| | - James Walton
- Tees, Esk and Wear Valleys NHS Foundation Trust, UK
| | - Stephen Kellett
- Rotherham, Doncaster and South Humber NHS Foundation Trust and University of Sheffield, UK
| | | | | | - Andy Wright
- Tees, Esk and Wear Valleys NHS Foundation Trust, UK
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21
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Haakana R, Rosenström T, Parkkinen L, Tuomisto MT, Isometsä E. Effectiveness of an add-on brief group behavioral activation treatment for depression in psychiatric care: a randomized clinical trial. Front Psychiatry 2024; 15:1284363. [PMID: 38745781 PMCID: PMC11091724 DOI: 10.3389/fpsyt.2024.1284363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 04/09/2024] [Indexed: 05/16/2024] Open
Abstract
Objective Behavioral activation (BA) is an effective treatment for depression. We investigated the effectiveness of add-on group-format BA and peer support (PS) with treatment as usual (TAU) in a registered randomized clinical trial in psychiatric outpatient settings (ISRCTN10647845). Methods Adult outpatients (N = 140) with major depressive disorder (MDD) and Patient Health Questionnaire (PHQ-9) score ≥10 were randomized into a) group BA, consisting of eight 90-minute weekly group sessions plus TAU; b) group PS, including eight 90-minute weekly group sessions plus TAU; or c) TAU alone. The primary outcome was a within-individual change in PHQ-9 score between baseline and 8 weeks. Secondary outcomes were 1) response, 2) remission, and 3) functional impairment at 8 weeks, plus 4) change in PHQ-9 at 6 months. Results Of the randomized patients, 100 (71.4%) completed treatments, including 29/45 (64.4%) patients in the BA group, 39/49 (79.6%) in the PS group, and 32/46 (69.6%) in the TAU group. By 8 weeks, PHQ-9 scores declined most in the TAU group [BA -0.28 (95% CI -2.48, 1.92), PS -0.58 (-2.09, 0.94) vs. TAU -3.32 (-5.21, -1.44); group-difference test, p = 0.034]. The secondary outcomes in the BA or PS arms did not significantly differ from those in TAU. Videotaped sessions revealed marked variation in briefly trained therapists' adherence to the treatment manual. Conclusions In this randomized trial, the effectiveness of treatments with the added BA and PS groups did not exceed that of TAU alone. The preconditions in which brief BA or PS group interventions benefit outpatients with depression in psychiatric settings warrant critical investigation.
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Affiliation(s)
- Riikka Haakana
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tom Rosenström
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Lauri Parkkinen
- Faculty of Social Sciences (Psychology), Tampere University, Tampere, Finland
| | - Martti T. Tuomisto
- Faculty of Social Sciences (Psychology), Tampere University, Tampere, Finland
| | - Erkki Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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22
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Melicherova U, Schott T, Köllner V, Hoyer J. Behavioral activation for depression in groups embedded in psychosomatic rehabilitation inpatient treatment: a quasi-randomized controlled study. Front Psychiatry 2024; 15:1229380. [PMID: 38726384 PMCID: PMC11079813 DOI: 10.3389/fpsyt.2024.1229380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
Background Behavioral activation (BA) and cognitive-behavioral therapy (CBT) have shown to be efficacious treatment methods for depression. Previous studies focused mostly on the outpatient treatment either in group or individual setting. The present study aimed at comparing the efficacy of group treatment BA vs. CBT, when embedded in inpatient psychosomatic rehabilitation treatment. Methods 375 inpatients were randomly assigned to either BA (N = 174) or CBT (N = 201). We used established scales for depression such as the Beck Depression Inventory II (BDI-II, self-rating), the Quick Inventory of Depressive Symptomatology (QIDS; expert rating) and the Behavioral Activation for Depression Scale (BADS) to assess changes over the course of the treatment and at follow-up (4 to 6 months). In addition, we measured disability-related functioning with the Mini-ICF-APP, a rating scale built in reference to the International Classification of Functioning, Disability and Health (ICF). Multilevel models with repeated measures were conducted to examine the differences between groups in relation to change over time with patients' random effects. Results Both group formats showed substantial reduction in depressive symptoms at the end of treatment (d= 0.83 BA vs. d= 1.08 CBT; BDI-II) and at follow-up after 4 to 6 months (d = 0.97 BA vs. d = 1.33 CBT, BDI-II; and d = 1.17 BA vs. d = 1.09 CBT, QIDS). There were no significant differences between treatment approaches. At least 50% symptom reduction was achieved by 53.7% and 54.2% in BA vs. CBT respectively. Reported activation levels increased from pre- to posttreatment (d = 0.76 BA vs. d = 0.70CBT), while showing loss of increment between the end of the treatment until follow up in both formats (d = 0.28 BA vs. d = 0.29 CBT). Discussion Both modalities led to significant improvement of symptomatology and functioning at the end of the treatment and at follow-up, thus for the first time demonstrating the practicability of BA in rehabilitation clinics. Considering its lower requirements regarding cognitive abilities and its easier implementation, BA proved to be a good alternative to other psychotherapeutic treatments.
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Affiliation(s)
- Ursula Melicherova
- Psychosomatic Rehabilitation Research Group, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Schott
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Volker Köllner
- Psychosomatic Rehabilitation Research Group, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychosomatic Medicine, Rehabilitation Center Seehof, Federal German Pension Agency Teltow, Teltow, Germany
| | - Jürgen Hoyer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
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23
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Tindall L, Kerrigan P, Li J, Hayward E, Gega L. Is behavioural activation an effective treatment for depression in children and adolescents? An updated systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02429-3. [PMID: 38615316 DOI: 10.1007/s00787-024-02429-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/25/2024] [Indexed: 04/15/2024]
Abstract
Behavioural Activation (BA)-a brief therapy based on the scheduling of enjoyable, purposeful and rewarding activities-is an effective and cost-effective treatment for depression in adults that shows promise for children and adolescents. We provide an update on a previous systematic review of evidence on BA-delivered in-person, telephone, or online-for depression and comorbid anxiety in children and adolescents. We conducted systematic literature searches in 6 databases up to February 2024. We included all study designs evaluating BA with participants up to 18 years old with diagnosable depression, as established by a validated screening tool or diagnostic manual. We used the Moncrieff Scale and the Cochrane Risk of Bias tool to assess study quality. We summarised the findings of all study types with a narrative synthesis and of randomised controlled trials (RCTs) with a meta-analysis. Overall, 24 studies (6 RCTs, 18 pre-post evaluations, n = 2,758) met our inclusion criteria. A meta-analysis of 4 RCTs (n = 156) showed that BA has a small effect of 0.24 (Hedge's adjusted g) in reducing depression symptoms compared to a waiting-list control, usual care and other therapies. Online and telephone-facilitated BA was shown to be feasible in 3 studies and effective in 1. Outcomes on comorbid anxiety were mixed. No economic evaluations met our inclusion criteria. BA shows sufficient promise as an intervention for reducing depression symptoms in children and adolescents to justify the need for further RCTs, providing that five conditions are met: studies are powered to detect a minimal clinically important difference; BA materials are fit-for-purpose to produce clinically meaningful change; follow-ups are longer than 6 months; primary outcomes are child-reported; and intervention costs, resource use and adverse events are reported.
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Affiliation(s)
- Lucy Tindall
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
| | - Philip Kerrigan
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Jinshuo Li
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Emily Hayward
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Lina Gega
- Hull York Medical School, University of York, Heslington, UK
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24
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Borrelli B, Bartlett YK, Fulford D, Frasco G, Armitage CJ, Wearden A. Behavioral Activation Mobile App to Motivate Smokers to Quit: Feasibility and Pilot Randomized Controlled Trial. JMIR Form Res 2024; 8:e54912. [PMID: 38573739 PMCID: PMC11027050 DOI: 10.2196/54912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/25/2024] [Accepted: 02/21/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Behavioral activation (BA) is an evidence-based treatment for depression that fosters engagement in values-based activities to increase access to positive reinforcement. Depressed mood has been shown to hinder smoking cessation. OBJECTIVE This study determined the feasibility and preliminary efficacy of a mobile app to motivate smokers to quit by using BA and integrating motivational messages to quit smoking. METHODS Adult smokers (N=56; mean age 34.5, SD 9.52 years) who were not ready to quit smoking within 30 days were recruited from advertisements and randomized to either 8 weeks of the BA app (set 2 values-based activities per week+motivational messages+feedback on changes in smoking, mood, and values-based activities) or the control group (no app; received resources for quitting smoking). All participants completed the baseline and end-of-treatment web-based questionnaires. Controls also completed weekly web-based assessments, and BA app participants completed assessments through the app. RESULTS There were no dropouts and only 2 participants in each condition did not complete the end-of-treatment questionnaire. The results demonstrated that it is feasible to recruit smokers who are unmotivated to quit into a smoking cessation induction trial: 86% (57/66) of eligible participants were randomized (BA app: n=27; control: n=29). Participants reported high levels of satisfaction: 80% (20/25) of participants said they would recommend the BA app, there were moderate-to-high scores on the Mobile App Rating Scale, and 88% (22/25) of participants rated the app 3 stars or higher (out of 5). There were high levels of BA app engagement: 96% (26/27) of participants planned activities, and 67% (18/27) of participants planned 7 or more activities. High engagement was found even among those who were at the highest risk for continued smoking (low motivation to quit, low confidence to quit, and high negative affect). The results provided support for the hypothesized relationships between BA constructs: greater pleasant activity completion was associated with greater positive affect (b=0.37, SE 0.21; 95% CI -0.05 to 0.79; P=.08), and greater positive affect tended to predict fewer cigarettes smoked the next day (b=-0.19, SE 0.10; 95% CI -0.39 to 0.01; P=.06). Additionally, a greater number of activities planned was associated with lower negative affect (b=-0.26, SE 0.15; 95% CI -0.55 to 0.04; P=.09). Overall, 16% (4/25) of BA app participants set a quit date versus 4% (1/27) among controls, and there were promising (but not significant) trends for motivation and confidence to quit. CONCLUSIONS The findings suggest that a mobile app intervention can be made appealing to smokers who are unmotivated to quit by focusing on aspects most important to them, such as mood management. This theory-based intervention has shown some initial support for the underlying theoretical constructs, and further efficacy testing is warranted in a fully powered trial.
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Affiliation(s)
- Belinda Borrelli
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, United States
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Y Kiera Bartlett
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Daniel Fulford
- Department of Psychological & Brain Sciences, Boston University, Boston, MA, United States
- Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, MA, United States
| | - Greg Frasco
- Rafik B. Hariri Institute for Computing and Computational Science & Engineering, Boston University, Boston, MA, United States
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Greater Manchester Patient Safety Research Collaboration, National Institute for Health and Care Research, Manchester, United Kingdom
| | - Alison Wearden
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
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25
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Kennedy MA, Stevens CJ, Pepin R, Lyons KD. Behavioral Activation: Values-Aligned Activity Engagement as a Transdiagnostic Intervention for Common Geriatric Conditions. THE GERONTOLOGIST 2024; 64:gnad046. [PMID: 37068017 PMCID: PMC10943502 DOI: 10.1093/geront/gnad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Indexed: 04/18/2023] Open
Abstract
Scalable, transdiagnostic interventions are needed to meet the needs of a growing population of older adults experiencing multimorbidity and functional decline. Behavioral activation (BA) is a pragmatic, empirically supported treatment for depression that focuses on increasing engagement in values-aligned activities. We propose BA is an ideal transdiagnostic intervention approach for older adults because it (a) specifically targets activity restriction, a shared characteristic of common conditions of aging; and (b) has strong potential for scalability through delivery by a broad range of clinician and nonclinician interventionists and via telehealth. We describe the history of BA and review recent literature demonstrating impacts beyond depression including on cognition, social isolation, and disability. We also describe the feasibility of delivering BA across interventionists, settings, and modalities. Our approach advances scholarship by proposing BA as a scalable, transdiagnostic behavioral intervention to address functional decline in older adults with common geriatric conditions.
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Affiliation(s)
- Meaghan A Kennedy
- New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Courtney J Stevens
- Department of Psychiatry, Dartmouth-Hitchcock Medicine Center, Lebanon, New Hampshire, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Renée Pepin
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Kathleen D Lyons
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, Massachusetts, USA
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26
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Mohamed Z, Russell A, Palmer M, Simonoff E, Hollocks MJ. Co-designing behavioural activation for depression for autistic adolescents: A case series. Clin Child Psychol Psychiatry 2024; 29:608-623. [PMID: 38286623 PMCID: PMC10945993 DOI: 10.1177/13591045241229583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Autistic youth are at high risk of depression, but there are few psychological interventions that have been specifically designed for use with this population. Behavioural activation (BA) is a particularly promising approach for autistic adolescents, having an established evidence-base for the treatment of depression in non-autistic people, and with a strong focus on behavioural, rather than cognitive change, which is a challenge for some autistic people. In this study, we worked with autistic adolescents and clinicians to co-design a BA-informed intervention to be delivered in an online format. We then conducted a pilot case-series with seven autistic adolescents with depression. Our focus was on establishing the acceptability and feasibility of the intervention but clinical outcomes on both self- and parent-reported symptoms of depression and anxiety are also presented. Our results indicate the intervention to be acceptable and feasible for autistic adolescents, with six out of seven participants being retained to the end of the intervention. Qualitative feedback indicated that all participants found the intervention a positive experience and would recommend it to others. Similarly, all participants found the online format acceptable, with 64% preferring this format to face-to-face therapy. Qualitative feedback and suggestions for refinement will also be discussed.
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Affiliation(s)
- Zameer Mohamed
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ailsa Russell
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, UK
| | - Melanie Palmer
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Emily Simonoff
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Matthew J Hollocks
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Trust, London, UK
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27
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Wang J, Carru C, Sedda S, Fiori PL, Li Z, Chen Z. Comparative impact of exercise-based interventions for postpartum depression: A Bayesian network meta-analysis. Int J Gynaecol Obstet 2024; 165:67-75. [PMID: 37688384 DOI: 10.1002/ijgo.15091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/02/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE The current study aimed to address and rank which exercise-based interventions are preferable to standard care/no therapy or another exercise intervention for postpartum depression (PPD) management and provide estimates for future definitive evidence. METHODS The authors systematically searched PubMed, Embase, the Web of Science, PsycInfo, and ClinicalTrails.gov for randomized controlled trials (RCTs) on exercise-based interventions for PPD from their inception to May 9, 2023. Included were RCTs of exercise-based interventions for PPD with at least 4 weeks' duration. The pooled effects of intervention comparisons were generated by the Bayesian random-effects model, and the quality of evidence was evaluated by the Grading of Recommendations, Assessment, Development, and Evaluations framework. RESULTS Twelve RCTs (1260 women; mean age, 20-35 years) comparing exercise-based interventions with usual care/no therapy were included. Exercise effectively treats depressive symptoms (standard mean difference [SMD], -0.81 [95% confidence interval (CI), -1.20 to -0.42], P < 0.001). Pram walking was significantly associated with a reduction of depressive symptoms during the postpartum period (SMD, -1.00 [95% CI, -2.60 to -0.10], P = 0.020), as well as yoga (SMD, -0.73 [95% CI, -1.84 to -0.43], P < 0.001) and supervised mixed exercise (SMD, -0.77 [95% CI, -1.67 to -0.01], P = 0.041) compared with usual care/no therapy. In indirect comparisons, pram walking (surface under the cumulative ranking curve, 58.9%) was better than yoga (SMD, -0.28 [95% CI, -1.86 to 1.22], P = 0.322) and supervised mixed exercise (SMD, -0.23 [95% CI, -1.59 to 1.12], P = 0.358). However, the difference was not statistically significant. The confidence in evidence was very low to moderate. CONCLUSION In women with PPD, all commonly prescribed physical exercises were effective alternative or complementary treatments. However, pram walking may perform better in improving the symptoms of PPD.
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Affiliation(s)
- Jing Wang
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Stefania Sedda
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Pier Luigi Fiori
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Zhi Li
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zhichao Chen
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
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28
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Pohl JS, Fleury J. Behavioral activation for family caregiver connectedness: Adaptation of an evidenced based intervention. Geriatr Nurs 2024; 56:285-290. [PMID: 38412635 DOI: 10.1016/j.gerinurse.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/29/2024]
Abstract
Informal caregivers of older adults with chronic illness have unique barriers to social connection. As the older adult population increases, individualized interventions are urgently needed to address the social disconnection experienced across generations of informal caregivers. Adapting an evidenced-based intervention to target social connectedness and leverage technology-mediated communication may be a promising approach. This article describes the adaptation of the Brief Behavioral Activation Treatment for Depression-Revised intervention using elements of the Framework for Reporting Adaptations and Modifications-Enhanced. Facilitating the comprehensive documentation of modifications made, we discuss the (a) rationale for modifications, (b) timing and approach to modifications, (c) nature of context and content modifications, and (d) fidelity in modifications. The Behavioral Activation for Family Caregiver Connectedness intervention addresses unique barriers to caregiver social connection with individualized value-based plans. Modifications to content and delivery reflect the goal of improving intervention fit in the context of social connectedness experienced by informal caregivers.
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Affiliation(s)
- Janet S Pohl
- Arizona State University, Edson College of Nursing and Health Innovation, 500 N 3rd Street, Phoenix, AZ 85004, United States.
| | - Julie Fleury
- Arizona State University, Edson College of Nursing and Health Innovation, 500 N 3rd Street, Phoenix, AZ 85004, United States
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29
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Soini E, Rosenström T, Määttänen I, Jokela M. Physical activity and specific symptoms of depression: A pooled analysis of six cohort studies. J Affect Disord 2024; 348:44-53. [PMID: 38128736 DOI: 10.1016/j.jad.2023.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The association between physical activity (PA) and depression is well-established, but the details that explain this association remain elusive. We examined whether PA is differentially associated with specific symptoms of depression (e.g., cognitive vs somatic symptoms), and whether these associations follow a dose-response pattern with respect to intensity or frequency of PA. METHODS Cross-sectional analyses were based on 6 samples of the continuous U.S. National Health and Nutrition Examination Surveys (NHANES) carried out between 2007 and 2018 (n = 28,520). Depressive symptoms were assessed with Patient Health Questionnaire 9 (PHQ-9). Information about PA (vigorous, moderate, and daily commuting by foot or bike) and covariates was self-reported. RESULTS After adjusting for education, health behaviors, body-mass index, physical functioning, and all the other depressive symptoms, lower PA was specifically associated with four depressive symptoms: loss of interest/pleasure, feeling down/hopeless, fatigue, and changes in appetite (odds ratios from 0.94 to 0.59). A monotonic dose-response pattern on PA amount was observed only for interest/pleasure and fatigue, and these associations were independent of PA intensity. LIMITATIONS Cross-sectional data did not allow us to assess temporal ordering. Both depressive symptoms and PA were self-reported, which may induce bias. CONCLUSION Low PA may be linked to depressive symptoms particularly through the symptoms of anhedonia and fatigue. Given that their association with PA amount follows a dose-response pattern and is independent of PA intensity, we hypothesize that behavioral activation and exposure to rewarding experiences might help to explain why PA alleviates depression.
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Affiliation(s)
- Eetu Soini
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Tom Rosenström
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Psychiatry, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Ilmari Määttänen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Markus Jokela
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Lin J, Zhao R, Li H, Lei Y, Cuijpers P. Looking back on life: An updated meta-analysis of the effect of life review therapy and reminiscence on late-life depression. J Affect Disord 2024; 347:163-174. [PMID: 37995927 DOI: 10.1016/j.jad.2023.11.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/07/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Twenty years ago, we confirmed the effectiveness of life review therapy and reminiscence (LRT-REM) to treat late-life depression in a meta-analysis. In the current study, we aimed to examine the most updated evidence on the effects of LRT-REM in older adults with depression. METHODS We systematically searched records in English and Chinese databases up to December 2022 and included randomized controlled studies comparing LRT-REM with control conditions in older adults with depression. Outcomes included depression, anxiety, quality of life, and life satisfaction. Effect sizes (Hedges' g) at post-treatment were pooled with random effects meta-analyses. RESULTS 42 studies with 3361 depressed older adults (≥60 years) met the selection criteria. We found a significant and large effect of LRT-REM (g = 1.41, p < 0.001) on late-life depression, corresponding to a number-needed-to-treat (NNT) of 1.98. Heterogeneity shrunk from high (I2 = 86.78) to moderate (I2 = 46.87) after excluding eight detected outliers. There were no significant differences between the examined subgroups except for the type of control condition. The effects of LRT-REM were not statistically significant at follow-up when corrected for publication bias. The quality of many included studies was not optimal. LIMITATIONS The quality of many included studies was not optimal, with a high risk of bias. CONCLUSIONS LRT-REM may be effective for treating late-life depression, but long-term effects are unclear. More research is needed on the effects of LRT-REM, especially when guided by (para)professional or lay therapists in low- and middle-income countries.
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Affiliation(s)
- Jingyuan Lin
- The Institute of Brain and Psychological Science, Sichuan Normal University, China
| | - Ruiying Zhao
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Hong Li
- The Institute of Brain and Psychological Science, Sichuan Normal University, China; School of Psychology, South China Normal University, China
| | - Yi Lei
- The Institute of Brain and Psychological Science, Sichuan Normal University, China.
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands.
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Jennings HM, Anas A, Asmat S, Naz A, Afaq S, Ahmed N, Aslam F, Gomez GZ, Siddiqi N, Ekers D. Living with depression and diabetes: A qualitative study in Bangladesh and Pakistan. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002846. [PMID: 38271347 PMCID: PMC10810509 DOI: 10.1371/journal.pgph.0002846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/29/2023] [Indexed: 01/27/2024]
Abstract
Diabetes and depression are both serious health conditions. While their relationship is bidirectional and each condition adversely affects outcomes for the other, they are treated separately. In low and middle income countries, such as Bangladesh and Pakistan, health systems are already stretched and the integration of diabetes and depression care is rarely a priority. Within this context through interviews with patients, healthcare workers and policy makers the study explored: lived experiences of people living with depression and diabetes, current practice in mental health and diabetes care and barriers and perspectives on integrating a brief psychological therapy into diabetes care. The findings of the study included: differing patient and practitioner understandings of distress/depression, high levels of stigma for mental health and a lack of awareness and training on treating depression. While it was apparent there is a need for more holistic care and the concept of a brief psychological intervention appeared acceptable to participants, many logistical barriers to integrating a mental health intervention into diabetes care were identified. The study highlights the importance of context and of recognising drivers and understandings of distress when planning for more integrated mental and physical health services, and specifically when adapting and implementing a new intervention into existing services.
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Affiliation(s)
- Hannah Maria Jennings
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, Heslington, United Kingdom
| | - Ashraful Anas
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Sara Asmat
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Anum Naz
- Institute of Psychiatry (IoP), Benazir Bhutto Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Saima Afaq
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Faiza Aslam
- Institute of Psychiatry (IoP), Benazir Bhutto Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan
| | | | - Najma Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, Heslington, United Kingdom
| | - David Ekers
- Department of Health Sciences, University of York, York, United Kingdom
- Tees Esk and Wear Valleys NHS FT, Darlington, United Kingdom
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Yisma E, Walsh S, Steen M, Gray R, Dennis S, Gillam M, Parange N, Jones M. Effect of Behavioral Activation for Women with Postnatal Depression: A Systematic Review and Meta-Analysis. NURSING REPORTS 2024; 14:78-88. [PMID: 38251185 PMCID: PMC10801525 DOI: 10.3390/nursrep14010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/20/2023] [Accepted: 12/24/2023] [Indexed: 01/23/2024] Open
Abstract
Evidence shows that behavioral activation (BA), a simple form of psychological therapy, is as effective as the more complex psychological therapy-cognitive behavioral therapy (CBT)-in treating general depression. However, it remains unclear whether BA when compared with treatment-as-usual (TAU) has greater contributions in reducing postnatal depression. This systematic review compared the effect of BA versus TAU in reducing depression symptoms among postnatal women. Five databases (MEDLINE, Embase, Emcare, Cochrane Library, and PsycINFO) were searched. Risk of bias was assessed using the Cochrane Collaboration's 'risk-of-bias 2 tool'. A random-effects meta-analysis was conducted to examine the effect of BA on postnatal depression. Of 2844 initial studies, only two randomized control trials (RCTs) met the inclusion criteria. The overall quality of evidence of these two RCTs was low. When compared to TAU, meta-analysis showed that BA was associated with reduced depression symptoms in postnatal women (standard mean difference -0.56; 95% confidence interval -0.76 to -0.37). This review suggests that BA might be more effective than TAU for alleviating postnatal depression. However, due to concerns about evidence quality, these findings should be interpreted cautiously.
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Affiliation(s)
- Engida Yisma
- Department of Rural Health, Allied Health & Human Performance, University of South Australia, Adelaide, SA 5000, Australia; (S.W.); (M.S.); (R.G.); (S.D.); (M.G.); (M.J.)
- IIMPACT in Health, University of South Australia, Adelaide, SA 5000, Australia;
| | - Sandra Walsh
- Department of Rural Health, Allied Health & Human Performance, University of South Australia, Adelaide, SA 5000, Australia; (S.W.); (M.S.); (R.G.); (S.D.); (M.G.); (M.J.)
- IIMPACT in Health, University of South Australia, Adelaide, SA 5000, Australia;
| | - Mary Steen
- Department of Rural Health, Allied Health & Human Performance, University of South Australia, Adelaide, SA 5000, Australia; (S.W.); (M.S.); (R.G.); (S.D.); (M.G.); (M.J.)
- Department Nursing, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
| | - Richard Gray
- Department of Rural Health, Allied Health & Human Performance, University of South Australia, Adelaide, SA 5000, Australia; (S.W.); (M.S.); (R.G.); (S.D.); (M.G.); (M.J.)
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
| | - Shaun Dennis
- Department of Rural Health, Allied Health & Human Performance, University of South Australia, Adelaide, SA 5000, Australia; (S.W.); (M.S.); (R.G.); (S.D.); (M.G.); (M.J.)
- Flinders and Upper North Local Health Network, Whyalla, SA 5600, Australia
| | - Marianne Gillam
- Department of Rural Health, Allied Health & Human Performance, University of South Australia, Adelaide, SA 5000, Australia; (S.W.); (M.S.); (R.G.); (S.D.); (M.G.); (M.J.)
- IIMPACT in Health, University of South Australia, Adelaide, SA 5000, Australia;
| | - Nayana Parange
- IIMPACT in Health, University of South Australia, Adelaide, SA 5000, Australia;
- Allied Health & Human Performance, University of South Australia, Adelaide, SA 5000, Australia
| | - Martin Jones
- Department of Rural Health, Allied Health & Human Performance, University of South Australia, Adelaide, SA 5000, Australia; (S.W.); (M.S.); (R.G.); (S.D.); (M.G.); (M.J.)
- IIMPACT in Health, University of South Australia, Adelaide, SA 5000, Australia;
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IsHak WW, Hamilton MA, Korouri S, Diniz MA, Mirocha J, Hedrick R, Chernoff R, Black JT, Aronow H, Vanle B, Dang J, Edwards G, Darwish T, Messineo G, Collier S, Pasini M, Tessema KK, Harold JG, Ong MK, Spiegel B, Wells K, Danovitch I. Comparative Effectiveness of Psychotherapy vs Antidepressants for Depression in Heart Failure: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2352094. [PMID: 38231511 PMCID: PMC10794938 DOI: 10.1001/jamanetworkopen.2023.52094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/28/2023] [Indexed: 01/18/2024] Open
Abstract
Importance Heart failure (HF) affects more than 6 million adults in the US and more than 64 million adults worldwide, with 50% prevalence of depression. Patients and clinicians lack information on which interventions are more effective for depression in HF. Objective To compare the effectiveness of behavioral activation psychotherapy (BA) vs antidepressant medication management (MEDS) on patient-centered outcomes inpatients with HF and depression. Design, Setting, and Participants This pragmatic randomized comparative effectiveness trial was conducted from 2018 to 2022, including 1-year follow-up, at a not-for-profit academic health system serving more than 2 million people from diverse demographic, socioeconomic, cultural, and geographic backgrounds. Participant included inpatients and outpatients diagnosed with HF and depression, and data were analyzed as intention-to-treat. Data were analyzed from 2022 to 2023. Interventions BA is an evidence-based manualized treatment for depression, promoting engagement in personalized pleasurable activities selected by patients. MEDS involves the use of an evidence-based collaborative care model with care managers providing coordination with patients, psychiatrists, and primary care physicians to only administer medications. Main Outcomes and Measures The primary outcome was depressive symptom severity at 6 months, measured using the Patient Health Questionnaire 9-Item (PHQ-9). Secondary outcomes included physical and mental health-related quality of life (HRQOL), measured using the Short-Form 12-Item version 2 (SF-12); heart failure-specific HRQOL, measured using the Kansas City Cardiomyopathy Questionnaire; caregiver burden, measured with the Caregiver Burden Questionnaire for Heart Failure; emergency department visits; readmissions; days hospitalized; and mortality at 3, 6, and 12 months. Results A total of 416 patients (mean [SD] age, 60.71 [15.61] years; 243 [58.41%] male) were enrolled, with 208 patients randomized to BA and 208 patients randomized to MEDS. At baseline, mean (SD) PHQ-9 scores were 14.54 (3.45) in the BA group and 14.31 (3.60) in the MEDS group; both BA and MEDS recipients experienced nearly 50% reduction in depressive symptoms at 3, 6, and 12 months (eg, mean [SD] score at 12 months: BA, 7.62 (5.73); P < .001; MEDS, 7.98 (6.06); P < .001; between-group P = .55). There was no statistically significant difference between BA and MEDS in the primary outcome of PHQ-9 at 6 months (mean [SD] score, 7.53 [5.74] vs 8.09 [6.06]; P = .88). BA recipients, compared with MEDS recipients, experienced small improvement in physical HRQOL at 6 months (mean [SD] SF-12 physical score: 38.82 [11.09] vs 37.12 [10.99]; P = .04), had fewer ED visits (3 months: 38% [95% CI, 14%-55%] reduction; P = .005; 6 months: 30% [95% CI, 14%-40%] reduction; P = .008; 12 months: 27% [95% CI, 15%-38%] reduction; P = .001), and spent fewer days hospitalized (3 months: 17% [95% CI, 8%-25%] reduction; P = .002; 6 months: 19% [95% CI, 13%-25%] reduction; P = .005; 12 months: 36% [95% CI, 32%-40%] reduction; P = .001). Conclusions and Relevance In this comparative effectiveness trial of BA and MEDS in patients with HF experiencing depression, both treatments significantly reduced depressive symptoms by nearly 50% with no statistically significant differences between treatments. BA recipients experienced better physical HRQOL, fewer ED visits, and fewer days hospitalized. The study findings suggested that patients with HF could be given the choice between BA or MEDS to ameliorate depression. Trial Registration ClinicalTrials.gov Identifier: NCT03688100.
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Affiliation(s)
- Waguih William IsHak
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Michele A. Hamilton
- Smidt Heart Institute, Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Samuel Korouri
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Marcio A. Diniz
- Biostatistics Research Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - James Mirocha
- Biostatistics Research Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Rebecca Hedrick
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Robert Chernoff
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Harriet Aronow
- Department of Nursing Research, Cedars-Sinai Medical Center, Los Angeles, California
| | - Brigitte Vanle
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jonathan Dang
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Gabriel Edwards
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Tarneem Darwish
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Gabrielle Messineo
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Stacy Collier
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mia Pasini
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - John G. Harold
- Smidt Heart Institute, Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Michael K. Ong
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Brennan Spiegel
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Health System, Los Angeles, California
| | - Kenneth Wells
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Itai Danovitch
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
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Suen YN, Leung CM, Wan YS, Chan KT, Wong MTH, Hui CLM, Chan KWS, Lee EHM, Chen EYH. Evaluation of a Low-Intensity Online Intervention (LiON) for Reducing Distress and Mental Health Symptoms in Young People. J Adolesc Health 2024; 74:89-97. [PMID: 37815770 DOI: 10.1016/j.jadohealth.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 07/12/2023] [Accepted: 08/14/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE Enhancing young people's mental health is crucial given that most adult mental disorders develop before age 24 years. However, it is unclear whether low-intensity interventions delivered online can be effective. This study aimed to provide preliminary evidence on whether a low-intensity online intervention (LiON) can effectively lower young people's distress levels and mental health symptoms. METHODS We compared the preintervention and postintervention changes in distress level and severity of depression and anxiety symptoms in 137 young people aged 15-24 years who used the LiON service with the three-month changes in a 1:1 propensity score-matched control group of community young people who did not use the service. They participated in one of the following modules for the first time: (1) sleep and relaxation, (2) stress-coping, and (3) problem-solving. RESULTS Participants who received LiON intervention (mean age 22.88 [standard deviation 3.67] years, 65.7% female) showed significantly greater reductions in distress level (Cohen's f2: 0.079), as well as the severity of depressive symptoms (Cohen's f2: 0.056) and anxiety symptoms (Cohen's f2: 0.044) compared to the control group. DISCUSSION The findings suggest that the LiON intervention has the potential to effectively reduce distress and mental health symptoms in young people. Future research should aim to confirm these findings through randomized controlled trials and explore the cost-effectiveness of the intervention.
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Affiliation(s)
- Yi Nam Suen
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China.
| | - Chung Ming Leung
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | - Yau Sum Wan
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | - Kai Tai Chan
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | | | | | - Kit Wa Sherry Chan
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China
| | - Edwin Ho Ming Lee
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | - Eric Yu Hai Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China.
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Kumar D, Hameed W, Avan BI. Comparing the effectiveness of mother-focused interventions to that of mother-child focused interventions in improving maternal postpartum depression outcomes: A systematic review. PLoS One 2023; 18:e0295955. [PMID: 38117801 PMCID: PMC10732407 DOI: 10.1371/journal.pone.0295955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/28/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Most empirically researched interventions for postpartum depression (PPD) tend to target mothers' depression alone. Harmful effects of PPD on physical and mental health of both mother and child has led researchers to investigate the impact of interventions on PPD and child outcomes together. So far, the evidence is limited regarding how these interventions compare with those focusing only on mothers' depression. This review compares the effectiveness of PPD-improving interventions focusing only on mothers with those focusing on mother and child together. METHODS Nine electronic databases were searched. Thirty-seven studies evaluating mother-focused (n = 30) and mother-child focused interventions (n = 7) were included. Under each category, three theoretical approaches-psychological, psychosocial and mixed-were compared using standardized qualitative procedures. The review's primary outcome was maternal PPD. RESULTS A higher proportion of mother-focussed interventions [20/30 (66.7%)] brought significant reduction in PPD outcomes as compared to a lower proportion of mother-child focused interventions [4/7 (57.14%)]. Mother-focused mixed approaches [3/3 (100%)] performed better in improving PPD than psychological [16/24 (67%)] or psychosocial approaches [1/3 (33.3%)] alone. Amongst mother-child focused interventions, psychosocial approaches performed well with two-thirds demonstrating positive effects on PPD. CONCLUSION The evidence strongly favors mother-focused interventions for improving PPD with mixed interventions being more effective. Psychosocial approaches performed better with PPD once child-related elements were added, and also seemed best for child outcomes. Psychological approaches were most practiced and effective for PPD, irrespective of the intervention's focus. Further trials are needed to unpack intervention components that improve PPD and increase uptake, especially in lower-and middle-income countries.
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Affiliation(s)
- Divya Kumar
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Waqas Hameed
- Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Bilal Iqbal Avan
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
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Du Y, Gao F, Sun H, Wu C, Zhu G, Zhu M. Novel substituted 4-(Arylethynyl)-Pyrrolo[2,3-d]pyrimidines negative allosteric modulators (NAMs) of the metabotropic glutamate receptor subtype 5 (mGlu5) Treat depressive disorder in mice. Eur J Med Chem 2023; 261:115855. [PMID: 37847955 DOI: 10.1016/j.ejmech.2023.115855] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/13/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023]
Abstract
In view of the fact that the G-protein-coupled receptors (GPCRs) sit at the top of the signaling pathways triggering a diverse range of signaling cascades towards a cellular event, GPCRs are regarded as central drug targets. mGlu5, a type of classical GPCRs, is highly expressed in the central nervous system (CNS) and responds to the neurotransmitter glutamate. Researches show that mGlu5 is a potential drug target for the treatment of depression. Up to now, multiple mGlu5 negative allosteric modulators (NAMs) have entered clinical trials, but no small molecule mGlu5 NAM has yet to reach market. Herein, we report the structural optimization and structure-activity relationship studies of a series of novel mGlu5 NAMs. Among them, the novel compound 10b is a high-affinity mGluR5 antagonist, with an IC50 value of 11.5 nM. Besides, we evaluated the anti-depressant effect of compound 10b using the chronic unpredictable mild stress (CUMS)-induced depression model. The data showed that the mice in CUMS group were featured by decreased level of serum 5-HT and increased level of serum CORT, and the expression of synaptic proteins were reduced, including GluA1, GluA2, p-PKA, BDNF and TrkB. However, those factors for identifying sensitivity to depression-like behaviors could be improved by compound 10b treatment. The preliminary toxicology evaluations indicated that compound 10b had a good safety profile in vivo. Collectively, the compound 10b represents a promising lead compound for the treatment of depressive disorder.
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Affiliation(s)
- Yonglei Du
- Department of Chemistry and Centre for Atomic Engineering of Advanced Materials, Key Laboratory of Structure and Functional Regulation of Hybrid Materials of Ministry of Education, Institutes of Physical Science and Information Technology and Anhui Province Key Laboratory of Chemistry for Inorganic/Organic Hybrid Functionalized Materials, Anhui University, Hefei, Anhui, 230601, China
| | - Feng Gao
- Key Laboratory of Xin'an Medicine, the Ministry of Education and Key Laboratory of Molecular Biology (Brain diseases), Anhui University of Chinese Medicine, Hefei, 230012, China
| | - Hongwei Sun
- Department of Chemistry and Centre for Atomic Engineering of Advanced Materials, Key Laboratory of Structure and Functional Regulation of Hybrid Materials of Ministry of Education, Institutes of Physical Science and Information Technology and Anhui Province Key Laboratory of Chemistry for Inorganic/Organic Hybrid Functionalized Materials, Anhui University, Hefei, Anhui, 230601, China
| | - Chenglin Wu
- School of Pharmacy, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China.
| | - Guoqi Zhu
- Key Laboratory of Xin'an Medicine, the Ministry of Education and Key Laboratory of Molecular Biology (Brain diseases), Anhui University of Chinese Medicine, Hefei, 230012, China.
| | - Manzhou Zhu
- Department of Chemistry and Centre for Atomic Engineering of Advanced Materials, Key Laboratory of Structure and Functional Regulation of Hybrid Materials of Ministry of Education, Institutes of Physical Science and Information Technology and Anhui Province Key Laboratory of Chemistry for Inorganic/Organic Hybrid Functionalized Materials, Anhui University, Hefei, Anhui, 230601, China.
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Hawighorst A, Knight MJ, Fourrier C, Sampson E, Hori H, Cearns M, Jörgens S, Baune BT. Cognitive improvement in patients with major depressive disorder after personalised multi domain training in the CERT-D study. Psychiatry Res 2023; 330:115590. [PMID: 37984280 DOI: 10.1016/j.psychres.2023.115590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/03/2023] [Accepted: 11/04/2023] [Indexed: 11/22/2023]
Abstract
The CERT-D program offers a new treatment approach addressing disturbed cognitive and psychosocial functioning in major depressive disorder (MDD). The current analysis of a randomised controlled trial (RCT) comprises two objectives: Firstly, evaluating the program's efficacy of a personalised versus standard treatment and secondly, assessing the treatment's persistence longitudinally. Participants (N = 112) were randomised into a personalised or standard treatment group. Both groups received 8 weeks of cognitive training, followed by a three-month follow-up without additional training. The type of personalised training was determined by pre-treatment impairments in the domains of cognition, emotion-processing and social-cognition. Standard training addressed all three domains equivalent. Performance in these domains was assessed repeatedly during RCT and follow-up. Treatment comparisons during the RCT-period showed benefits of personalised versus standard treatment in certain aspects of social-cognition. Conversely, no benefits in the remaining domains were found, contradicting a general advantage of personalisation. Exploratory follow-up analysis on persistence of the program's effects indicated sustained intervention outcomes across the entire sample. A subsequent comparison of clinical outcomes between personalised versus standard treatment over a three-month follow-up period showed similar results. First evidence suggests that existing therapies for MDD could benefit from an adjunct administration of the CERT-D program.
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Affiliation(s)
- Arne Hawighorst
- Department of Psychiatry and Psychotherapy, University Hospital Münster, University of Münster, Münster, Germany
| | - Matthew J Knight
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Célia Fourrier
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Emma Sampson
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Hikaru Hori
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Micah Cearns
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Silke Jörgens
- Department of Psychiatry and Psychotherapy, University Hospital Münster, University of Münster, Münster, Germany; Department Hamm 2, Hamm-Lippstadt University of Applied Sciences, Hamm, Germany
| | - Bernhard T Baune
- Department of Psychiatry and Psychotherapy, University Hospital Münster, University of Münster, Münster, Germany; Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, Australia; The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia.
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Pozuelo JR, Moffett BD, Davis M, Stein A, Cohen H, Craske MG, Maritze M, Makhubela P, Nabulumba C, Sikoti D, Kahn K, Sodi T, van Heerden A, O'Mahen HA. User-Centered Design of a Gamified Mental Health App for Adolescents in Sub-Saharan Africa: Multicycle Usability Testing Study. JMIR Form Res 2023; 7:e51423. [PMID: 38032691 PMCID: PMC10722378 DOI: 10.2196/51423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND There is an urgent need for scalable psychological treatments to address adolescent depression in low-resource settings. Digital mental health interventions have many potential advantages, but few have been specifically designed for or rigorously evaluated with adolescents in sub-Saharan Africa. OBJECTIVE This study had 2 main objectives. The first was to describe the user-centered development of a smartphone app that delivers behavioral activation (BA) to treat depression among adolescents in rural South Africa and Uganda. The second was to summarize the findings from multicycle usability testing. METHODS An iterative user-centered agile design approach was used to co-design the app to ensure that it was engaging, culturally relevant, and usable for the target populations. An array of qualitative methods, including focus group discussions, in-depth individual interviews, participatory workshops, usability testing, and extensive expert consultation, was used to iteratively refine the app throughout each phase of development. RESULTS A total of 160 adolescents from rural South Africa and Uganda were involved in the development process. The app was built to be consistent with the principles of BA and supported by brief weekly phone calls from peer mentors who would help users overcome barriers to engagement. Drawing on the findings of the formative work, we applied a narrative game format to develop the Kuamsha app. This approach taught the principles of BA using storytelling techniques and game design elements. The stories were developed collaboratively with adolescents from the study sites and included decision points that allowed users to shape the narrative, character personalization, in-app points, and notifications. Each story consists of 6 modules ("episodes") played in sequential order, and each covers different BA skills. Between modules, users were encouraged to work on weekly activities and report on their progress and mood as they completed these activities. The results of the multicycle usability testing showed that the Kuamsha app was acceptable in terms of usability and engagement. CONCLUSIONS The Kuamsha app uniquely delivered BA for adolescent depression via an interactive narrative game format tailored to the South African and Ugandan contexts. Further studies are currently underway to examine the intervention's feasibility, acceptability, and efficacy in reducing depressive symptoms.
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Affiliation(s)
- Julia R Pozuelo
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, United States
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- 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
| | - Bianca D Moffett
- 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
| | | | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- 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
- Africa Health Research Institute, KwaZulu Natal, South Africa
| | - Halley Cohen
- Lincoln College, University of Oxford, Oxford, United Kingdom
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Meriam Maritze
- 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
| | - Princess Makhubela
- 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
| | | | | | - Kathleen Kahn
- 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
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Tholene Sodi
- SAMRC-DSI/NRF-UL SARChI Research Chair in Mental Health and Society, University of Limpopo, Limpopo, South Africa
| | - Alastair van Heerden
- Center for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Heather A O'Mahen
- Mood Disorders Centre, Department of Psychology, University of Exeter, Exeter, United Kingdom
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Papola D, Karyotaki E, Purgato M, Sijbrandij M, Tedeschi F, Cuijpers P, Orestis E, Furukawa TA, Patel V, Barbui C. Dismantling and personalising task-sharing psychosocial interventions for common mental disorders: a study protocol for an individual participant data component network meta-analysis. BMJ Open 2023; 13:e077037. [PMID: 37918937 PMCID: PMC10626809 DOI: 10.1136/bmjopen-2023-077037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/10/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Common mental disorders, including depression, anxiety and related somatic health symptoms, are leading causes of disability worldwide. Especially in low-resource settings, psychosocial interventions delivered by non-specialist providers through task-sharing modalities proved to be valid options to expand access to mental healthcare. However, such interventions are usually eclectic multicomponent interventions consisting of different combinations of evidence-based therapeutic strategies. Which of these various components (or combinations thereof) are more efficacious (and for whom) to reduce common mental disorder symptomatology is yet to be substantiated by evidence. METHODS AND ANALYSIS Comprehensive search was performed in electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Register of Controlled Trials-CENTRAL from database inception to 15 March 2023 to systematically identify all randomised controlled trials that compared any single component or multicomponent psychosocial intervention delivered through the task-sharing modality against any active or inactive control condition in the treatment of adults suffering from common mental disorders. From these trials, individual participant data (IPD) of all measured outcomes and covariates will be collected. We will dismantle psychosocial interventions creating a taxonomy of components and then apply the IPD component network meta-analysis (IPD-cNMA) methodology to assess the efficacy of individual components (or combinations thereof) according to participant-level prognostic factors and effect modifiers. ETHICS AND DISSEMINATION Ethics approval is not applicable for this study since no original data will be collected. Results from this study will be published in peer-reviewed journals and presented at relevant conferences.
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Affiliation(s)
- Davide Papola
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Efthimiou Orestis
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
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Bosmans JE, Bruijniks SJE, El Alili M, Hollon SD, Peeters FPML, Arntz A, Cuijpers P, Lemmens LHJM, Dingemanse P, Willems L, van Oppen P, van den Boogaard M, Spijker J, Twisk JWR, Huibers MJH. Cost-effectiveness of twice-weekly versus once-weekly sessions of cognitive-behavioural therapy and interpersonal psychotherapy for depression at 12 months after start of treatment: randomised controlled trial. BJPsych Open 2023; 9:e186. [PMID: 37830493 PMCID: PMC10594223 DOI: 10.1192/bjo.2023.548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Cost-effective treatments are needed to reduce the burden of depression. One way to improve the cost-effectiveness of psychotherapy might be to increase session frequency, but keep the total number of sessions constant. AIM To evaluate the cost-effectiveness of twice-weekly compared with once-weekly psychotherapy sessions after 12 months, from a societal perspective. METHOD An economic evaluation was conducted alongside a randomised controlled trial comparing twice-weekly versus once-weekly sessions of psychotherapy (cognitive-behavioural therapy or interpersonal psychotherapy) for depression. Missing data were handled by multiple imputation. Statistical uncertainty was estimated with bootstrapping and presented with cost-effectiveness acceptability curves. RESULTS Differences between the two groups in depressive symptoms, physical and social functioning, and quality-adjusted life-years (QALY) at 12-month follow-up were small and not statistically significant. Total societal costs in the twice-weekly session group were higher, albeit not statistically significantly so, than in the once-weekly session group (mean difference €2065, 95% CI -686 to 5146). The probability that twice-weekly sessions are cost-effective compared with once-weekly sessions was 0.40 at a ceiling ratio of €1000 per point improvement in Beck Depression Inventory-II score, 0.32 at a ceiling ratio of €50 000 per QALY gained, 0.23 at a ceiling ratio of €1000 per point improvement in physical functioning score and 0.62 at a ceiling ratio of €1000 per point improvement in social functioning score. CONCLUSIONS Based on the current results, twice-weekly sessions of psychotherapy for depression are not cost-effective over the long term compared with once-weekly sessions.
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Affiliation(s)
- Judith E. Bosmans
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Sanne J. E. Bruijniks
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Germany; and Department of Clinical Psychology, Utrecht University, The Netherlands
| | - Mohamed El Alili
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | | | - Frenk P. M. L. Peeters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Lotte H. J. M. Lemmens
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
| | - Pieter Dingemanse
- Division of Affective Disorders, Mental Health Care Altrecht, The Netherlands
| | - Linda Willems
- Department of Mood Disorders, GGZ Oost-Brabant, The Netherlands
| | - Patricia van Oppen
- Department of Research and Innovation, GGZ InGeest Specialized Mental Health Care, The Netherlands; and Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | | | - Jan Spijker
- Depression Expertise Centre, Pro Persona Mental Health Care, The Netherlands; and Behavioral Science Institute, Radboud University, The Netherlands
| | - Jos W. R. Twisk
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Marcus J. H. Huibers
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Germany; and Department of Clinical Psychology, Utrecht University, The Netherlands
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Liu X, Li M, Xie X, Li Y, Li K, Fan J, He J, Zhuang L. Efficacy of manual acupuncture vs. placebo acupuncture for generalized anxiety disorder (GAD) in perimenopausal women: a randomized, single-blinded controlled trial. Front Psychiatry 2023; 14:1240489. [PMID: 37854443 PMCID: PMC10579903 DOI: 10.3389/fpsyt.2023.1240489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/07/2023] [Indexed: 10/20/2023] Open
Abstract
Background Generalized anxiety disorder (GAD) is common among perimenopausal women. Acupuncture may be an effective treatment for GAD, but evidence is limited. The pathogenesis of GAD is not yet clear, but it is related to the hypothalamic-pituitary-adrenal axis and its excretion, cortisol (CORT), and the adrenocorticotropic hormone (ACTH). The objective of this study is to evaluate the efficacy of manual acupuncture (MA) vs. placebo acupuncture (PA) for perimenopausal women with GAD. Methods This study is a single-center, randomized, single-blind clinical trial conducted in the First Affiliated Hospital of Guangzhou University of Chinese Medicine. A total of 112 eligible patients with GAD were randomly assigned (1:1) to receive MA (n = 56) or PA (n = 56) three times per week for 4 weeks. The primary outcome measure was the HAMA score. The secondary outcome measures were the GAD-7 and PSQI scores and the levels of CORT and ACTH. The evaluation will be executed at the baseline, 2 weeks, the end of the treatment, and a follow-up 3-month period. Results Significant improvements in HAMA (p < 0.001, η2p = 0.465), GAD-7 (p < 0.001, η2p = 0.359) and ACTH (p = 0.050) values were found between T0 and T2 in the MA group compared to the PA group. No difference in PSQI (p = 0.613, η2p = 0.011) and CORT (p = 0.903) was found between T0 and T2 in the MA group compared to the PA group. Long-term improvements in HAMA (p < 0.001, p < 0.001) were found in the MA group and PA group. Conclusion This study was the first completed study to evaluate the efficacy of acupuncture and placebo acupuncture for GAD in perimenopausal patients. Results suggested that placebo acupuncture has a therapeutic effect, however, acupuncture had a greater therapeutic effect than placebo acupuncture. This study supports the effectiveness of acupuncture and thereby contributes to extended treatment options for GAD.Clinical trial registration:http://www.chictr.org.cn, Chinese Clinical Trial Registry, ID: ChiCTR2100046604. Registered on 22 May 2021.
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Affiliation(s)
- Xin Liu
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Meichen Li
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoyan Xie
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yingjia Li
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Keyi Li
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jingqi Fan
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jun He
- Lingnan Institute of Acupuncture and Rehabilitation, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lixing Zhuang
- Lingnan Institute of Acupuncture and Rehabilitation, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Borrelli B, Endrighi R, Dunsiger S, Busch AM, Bock BC, Risica PM, Hughes RB, Lasater T. Greater engagement in valued activities is associated with less barriers to quitting smoking among smokers with mobility impairments. Disabil Health J 2023; 16:101480. [PMID: 37236878 PMCID: PMC10524132 DOI: 10.1016/j.dhjo.2023.101480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/13/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Individuals with mobility impairments (MI; use equipment to ambulate) have a high prevalence of both smoking and depression. Behavioral activation (BA) purports that depressed mood is remediated through valued activity engagement and may facilitate smoking cessation in MI populations. OBJECTIVE We examined cross-sectional associations between activity engagement and variables important for smoking cessation among a high-risk group of smokers (people with MIs) and also describe a smoking cessation intervention based on BA, given the lack of studies on smokers with MIs. METHODS This study used data from a smoking cessation trial enrolling smokers with MIs (n = 263). We assessed valued activities, activity type, activity restriction due to MI, and replacement of restricted activities. Motivation and confidence to quit smoking, number of cigarettes per day, and mood were also assessed. Analysis was performed with generalized linear (or logistic) regression models adjusted for age and physical functioning using aggregated data at baseline. RESULTS Greater number and frequency of valued activities was associated with less smoking, depression, negative affect, and stress and higher positive affect and self-efficacy to quit. Activity restriction was associated with greater odds of major depression, and activity replacement with lower odds of major depression, lower stress, and higher positive affect and self-efficacy. Strength of associations varied by activity type. CONCLUSIONS Consistent with our theoretical model, BA activity constructs were associated with several mediators of smoking outcomes in the expected directions. Smokers engaging in valued activities have more favorable profiles for smoking cessation and mood management.
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Affiliation(s)
- Belinda Borrelli
- Center for Behavioral Science Research, Boston University, Henry M. Goldman School of Dental Medicine, USA.
| | - Romano Endrighi
- Center for Behavioral Science Research, Boston University, Henry M. Goldman School of Dental Medicine, USA
| | - Shira Dunsiger
- The Miriam Hospital and Brown University School of Public Health, USA
| | - Andrew M Busch
- Department of Psychiatry and Human Behavior, Brown University School of Medicine and The Miriam Hospital, USA; Department of Medicine, University of Minnesota Medical School and Hennepin Healthcare Research Institute, Minnesota, USA
| | - Beth C Bock
- Department of Psychiatry and Human Behavior, Brown University School of Medicine and The Miriam Hospital, USA
| | - Patricia Markham Risica
- Departments of Behavioral and Social Sciences and of Epidemiology, Center for Health Equity Research, Brown University School of Public Health, USA
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Dohi Y, Imamura K, Sasaki N, Komase Y, Sakuraya A, Nakamura Y, Maejima M, Aoyama M, Kawakami N, Miyamoto Y. Effects of an Internet Delivered Behavioral Activation Program on Improving Work Engagement Among Japanese Workers: A Pretest and Posttest Study. J Occup Environ Med 2023; 65:e654-e659. [PMID: 37505082 DOI: 10.1097/jom.0000000000002933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
OBJECTIVE The aim of the study is to examine the effect of a newly developed Internet-delivered behavioral activation (iBA) program on work engagement and well-being among Japanese workers with elevated psychological distress. METHODS Participants were recruited via an Internet survey company ( N = 3299). The eligibility criteria were as follows: (1) Japanese employees aged 20 to 59 years, (2) having psychological distress, and (3) not self-employed. This iBA program was a 3-week web-based training course using behavioral activation techniques. Work engagement, psychological distress, and eudemonic well-being at work were measured at baseline and postintervention period. A paired sample t test was conducted to assess the intervention effect. RESULTS Of the 568 eligible participants, 120 were randomly selected. A total of 108 participants completed the baseline survey and received the iBA program. Eighty respondents completed the postintervention survey and were included in analyses. The iBA program did not show a significant intervention effect on work engagement ( P = 0.22, Cohen d = 0.14), while psychological distress ( P < 0.01, d = -0.40) and role-oriented future prospects ( P = 0.02, Cohen d = 0.27) were significantly improved. CONCLUSIONS The effect of the iBA program on work engagement may be limited.
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Affiliation(s)
- Yuri Dohi
- From the Department of Psychiatric Nursing, Graduate school of Medicine, University of Tokyo, Tokyo, Japan (Y.D., Y.M.); Department of Mental health, Graduate school of Medicine, University of Tokyo, Tokyo, Japan (K.I., N.S., A.S., N.K.); and Fujitsu Japan Limited, Tokyo, Japan (Y.K., Y.N., M.M., M.A.)
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Hayward M, Berry K, Bremner S, Cavanagh K, Dodgson G, Fowler D, Gage H, Greenwood K, Hazell C, Bibby-Jones AM, Robertson S, Touray M, Dailey N, Strauss C. Increasing access to CBT for psychosis patients: study protocol for a randomised controlled trial evaluating brief, targeted CBT for distressing voices delivered by assistant psychologists (GiVE3). Trials 2023; 24:588. [PMID: 37715255 PMCID: PMC10503006 DOI: 10.1186/s13063-023-07611-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/28/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND The National Institute for Health and Care Excellence (NICE) recommends that cognitive behaviour therapy (CBT) is offered to all patients with a psychosis diagnosis. However, only a minority of psychosis patients in England and Wales are offered CBT. This is attributable, in part, to the resource-intensive nature of CBT. One response to this problem has been the development of CBT in brief formats that are targeted at a single symptom and are deliverable by briefly trained therapists. We have developed Guided self-help CBT (the GiVE intervention) as a brief form of CBT for distressing voices and reported evidence for the feasibility of a randomised controlled trial (RCT) when the intervention was delivered by briefly trained therapists (assistant psychologists). This study will investigate the clinical and cost-effectiveness of the GiVE intervention when delivered by assistant psychologists following a brief training. METHODS This study is a pragmatic, two-arm, parallel group, superiority RCT comparing the GiVE intervention (delivered by assistant psychologists) and treatment as usual to treatment as usual alone, recruiting across three sites, using 1:1 allocation and blind post-treatment and follow-up assessments. A nested qualitative study will develop a model for implementation. DISCUSSION If the GiVE intervention is found to be effective when delivered by assistant psychologists, this intervention could significantly contribute to increasing access to evidence-based psychological interventions for psychosis patients. Furthermore, implementation across secondary care services within the UK's National Health Service may pave the way for other symptom-specific and less resource-intensive CBT-informed interventions for psychosis patients to be developed and evaluated. TRIAL REGISTRATION Current Controlled Trials ISRCTN registration number: 12748453. Registered on 28 September 2022.
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Affiliation(s)
- Mark Hayward
- School of Psychology, University of Sussex, Brighton, BN1 9RH, UK.
- Research and Development Department, Sussex Partnership NHS Foundation Trust, Hove, BN3 7HZ, UK.
| | - Katherine Berry
- Faculty of Biology, University of Manchester, Medicine & Health, Manchester, M13 9PL, UK
| | - Stephen Bremner
- Brighton & Sussex Medical School, University of Sussex, Brighton, BN1 9RH, UK
| | - Kate Cavanagh
- School of Psychology, University of Sussex, Brighton, BN1 9RH, UK
| | - Guy Dodgson
- Department of Psychology, University of Durham, Durham, DH1 3LE, UK
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, BN1 9RH, UK
| | - Heather Gage
- School of Biosciences & Medicine, University of Surrey, Guildford, GU2 7XH, UK
| | | | - Cassie Hazell
- School of Psychology, University of Surrey, Guildford, GU2 7HX, UK
| | - Anna-Marie Bibby-Jones
- Research and Development Department, Sussex Partnership NHS Foundation Trust, Hove, BN3 7HZ, UK
| | - Sam Robertson
- Research and Development Department, Sussex Partnership NHS Foundation Trust, Hove, BN3 7HZ, UK
| | - Morro Touray
- School of Biosciences & Medicine, University of Surrey, Guildford, GU2 7XH, UK
| | - Natalie Dailey
- Brighton & Sussex Medical School, University of Sussex, Brighton, BN1 9RH, UK
| | - Clara Strauss
- School of Psychology, University of Sussex, Brighton, BN1 9RH, UK
- Research and Development Department, Sussex Partnership NHS Foundation Trust, Hove, BN3 7HZ, UK
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Kor PPK, Chou KL, Zarit SH, Gallagher D, Galante J, Wong SYS, Cheung DSK, Leung AYM, Chu LW. Sequential multiple assignment randomised controlled trial protocol for developing an adaptive intervention to improve depressive symptoms among family caregivers of people with dementia. BMJ Open 2023; 13:e072410. [PMID: 37673447 PMCID: PMC10496708 DOI: 10.1136/bmjopen-2023-072410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 08/15/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVES Family caregivers of people with dementia (FC-of-PWD) suffer from a high level of stress and depressive symptoms, which usually require different interventions at different stages. Although some standalone interventions such as behavioural activation (BA) and mindfulness practice (MP) have been shown to be potentially effective at reducing depressive symptoms, the best sequence and combination of these interventions for caregivers are unknown. This study aims to develop and identify a two-stage adaptive intervention with prespecified rules guiding whether, how or when to offer different interventions initially/over time to reduce depressive symptoms in FG-of-PWD. METHODS A sequential multiple assignment randomised trial design will be adopted. 272 FG-of-PWD with mild to moderate depressive symptoms will be recruited from the community. Four two-stage, embedded adaptive interventions involving BA and MP of different sequences and dosages (eg, 8 weeks of BA followed by booster sessions for responders and 8 weeks of MP for non-responders) will be assigned to the participants following a set of decision rules. The primary outcomes will be depressive symptoms (measured using the Patient Health Questionnaire-9), assessed after the second stage of the intervention. Other outcomes, such as positive aspects of caregiving (measured using the Positive Aspects of Caregiving Scale), sleep quality (measured using the Pittsburgh Sleep Quality Index) and time points will also be assessed. The analyses will follow the intention-to-treat principle. Several process indicators (eg, engagement in meaningful activities and level of mindfulness) will also be assessed. The findings will have strong implications for the further development of psychosocial adaptive interventions to reduce depressive symptoms among FC-of-PWD. ETHICS AND DISSEMINATION This study has received ethical approval from the Human Research Ethics Committee at The Hong Kong Polytechnic University (HSEARS20211223001). The findings will be presented at academic conferences and submitted to peer-reviewed journals for publication. TRIAL REGISTRATION NUMBER NCT05634317.
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Affiliation(s)
| | - Kee Lee Chou
- Department of Asian and Policy Studies, The Education University of Hong Kong, New Territories, China
| | - Steven H Zarit
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Dolores Gallagher
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Julieta Galante
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Samuel Y S Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, China
| | | | - Angela Y M Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
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Lorenzo-Luaces L. Identifying active ingredients in cognitive-behavioral therapies: What if we didn't? Behav Res Ther 2023; 168:104365. [PMID: 37453179 PMCID: PMC10534234 DOI: 10.1016/j.brat.2023.104365] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/24/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
Identifying active ingredients of psychological interventions is a major goal of psychotherapy researchers that is often justified by the promise that it will lead to improved patient outcomes. Much of this "active ingredients" research is conducted within randomized controlled trials (RCTs) with patient populations, putting it in Phase T2 of the clinical-translational spectrum. I argue that RCTs in patient populations are very "messy laboratories" in which to conduct active ingredient work and that T0 and T1 research provide more controlled contexts. However, I call attention to the long road from identifying active ingredients of CBTs, whether in T0, T1, or T2 research, to improving outcomes. Dissemination and implementation research (T3 and T4 approaches) may be conceptually closer to improving outcomes. Given how common and disabling mental health symptoms are, I argue that if researchers want to improve patient outcomes, these research programs must receive more attention including work on the uptake of psychological interventions as well as work on optimal ordering of existing interventions.
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Renn BN, Sams N, Areán PA, Raue PJ. A low-intensity behavioral intervention for depression in older adults delivered by lay coaches: proof-of-concept trial. Aging Ment Health 2023; 27:1403-1410. [PMID: 35694856 PMCID: PMC9741665 DOI: 10.1080/13607863.2022.2084709] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 05/27/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES A broader workforce is necessary to expand U.S. geriatric mental health services. We examined (1) feasibility of training undergraduate students to deliver Do More, Feel Better (DMFB), an evidence-informed program for depression; and (2) feasibility, acceptability, and outcomes in a single-arm proof-of-concept trial. METHOD In Study 1, we taught DMFB to 18 upper-level undergraduate students and assessed fidelity using role plays. In Study 2, four students delivered six weekly DMFB sessions to 12 community-dwelling older adults (M = 66.83 years old, SD = 10.39) with depression (PHQ ≥ 10). Patient outcomes were change in pre- to post-treatment depressive symptoms, disability, and the target mechanism of increased activity. RESULTS Fidelity was high in the course (Study 1; 82.4% of role plays rated as 'passing') and the trial (Study 2; 100% of 24 sessions rated as 'passing'). The majority (83.3%) of patients were retained and evidenced statistically and clinically significant improvement in depressive symptoms (Hamilton Rating Scale for Depression [HAM-D]), disability (World Health Organization's Disability Assessment Schedule 2.0 [WHODAS 2.0], and activity (Behavioral Activation for Depression Scale [BADS]). CONCLUSION It is feasible to train bachelor's-level students to deliver a brief, structured intervention for depression. Future research should consider implementation strategies and stakeholder feedback.
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Affiliation(s)
- Brenna N Renn
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Nichole Sams
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Patricia A Areán
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Patrick J Raue
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Dunn BD, Widnall E, Warbrick L, Warner F, Reed N, Price A, Kock M, Courboin C, Stevens R, Wright K, Moberly NJ, Geschwind N, Owens C, Spencer A, Campbell J, Kuyken W. Preliminary clinical and cost effectiveness of augmented depression therapy versus cognitive behavioural therapy for the treatment of anhedonic depression (ADepT): a single-centre, open-label, parallel-group, pilot, randomised, controlled trial. EClinicalMedicine 2023; 61:102084. [PMID: 37528846 PMCID: PMC10388573 DOI: 10.1016/j.eclinm.2023.102084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 08/03/2023] Open
Abstract
Background Anhedonia (reduced interest/pleasure) symptoms and wellbeing deficits are core to depression and predict a poor prognosis. Current depression psychotherapies fail to target these features adequately, contributing to sub-optimal outcomes. Augmented Depression Therapy (ADepT) has been developed to target anhedonia and wellbeing. We aimed to establish clinical and economic proof of concept for ADepT and to examine feasibility of a future definitive trial comparing ADepT to Cognitive Behavioural Therapy (CBT). Methods In this single-centre, open-label, parallel-group, pilot randomised controlled trial, adults meeting diagnostic criteria for a current major depressive episode, scoring ≥10 on the Patient Health Questionnaire (PHQ-9) and exhibiting anhedonic features (PHQ-9 item 1 ≥ 2) were recruited primarily from high intensity Improving Access to Psychological Therapy (IAPT) service waiting lists in Devon, UK. Participants were randomised to receive 20 sessions of CBT or ADepT, using a mimimisation algorithm to balance depression severity and antidepressant use between groups. Treatment was delivered in an out-patient university-based specialist mood disorder clinic. Researcher-blinded assessments were completed at intake and six, 12, and 18 months. Co-primary outcomes were depression (PHQ-9) and wellbeing (Warwick Edinburgh Mental Wellbeing Scale) at 6 months. Primary clinical proof-of-concept analyses were intention to treat. Feasibility (including safety) and health economic analyses used complete case data. This trial is registered at the ISRCTN registry, ISRCTN85278228. Findings Between 3/29/2017 and 7/31/2018, 82 individuals were recruited (102% of target sample) and 41 individuals were allocated to each arm. A minimum adequate treatment dose was completed by 36/41 (88%) of CBT and 35/41 (85%) of ADepT participants. There were two serious adverse events in each arm (primarily suicide attempts; none of which were judged to be trial- or treatment-related), with no other evidence of harms. Intake and six-month primary outcome data was available for 37/41 (90%) CBT participants and 32/41 (78%) ADepT participants. Between-group effects favoured ADepT over CBT for depression (meanΔ = -1.35, 95% CI = -3.70, 1.00, d = 0.23) and wellbeing (meanΔ = 2.64, 95% CI = -1.71, 6.99, d = 0.27). At 18 months, the advantage of ADepT over CBT was preserved and ADepT had a >80% probability of cost-effectiveness. Interpretation These findings provide proof of concept for ADepT and warrant continuation to definitive trial. Funding NIHR Career Development Fellowship.
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Affiliation(s)
- Barnaby D. Dunn
- Mood Disorders Centre, University of Exeter, Exeter, EX4 4QQ, UK
| | - Emily Widnall
- Population Health Sciences, University of Bristol, Canynge Hall, Bristol, BS8 2PN, UK
| | - Laura Warbrick
- Mood Disorders Centre, University of Exeter, Exeter, EX4 4QQ, UK
| | - Faith Warner
- Mood Disorders Centre, University of Exeter, Exeter, EX4 4QQ, UK
| | - Nigel Reed
- Mood Disorders Centre, University of Exeter, Exeter, EX4 4QQ, UK
| | - Alice Price
- School of Psychology, Cardiff University, 70 Park Place, Cardiff, CF10 3AT, UK
| | - Merle Kock
- Centre for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Tiensetraat 102, Box 3712, 3000, Leuven, Belgium
| | - Clara Courboin
- Université libre de Bruxelles, Avenue Franklin Roosevelt 50, 1050, Bruxelles, Belgium
| | - Rosie Stevens
- Department of Health Sciences (MHARG), University of York, York, Y010 5DD, UK
| | - Kim Wright
- Mood Disorders Centre, University of Exeter, Exeter, EX4 4QQ, UK
| | | | - Nicole Geschwind
- Clinical Psychological Science, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands
| | - Christabel Owens
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Anne Spencer
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - John Campbell
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Warneford Hospital Oxford, OX3 7JX, UK
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Hirayama T, Ogawa Y, Yanai Y, Shindo A, Tanaka M, Suzuki SI. Feasibility and Preliminary Effectiveness of Behavioral Activation for Patients with Cancer and Depression in Japan. Palliat Med Rep 2023; 4:150-160. [PMID: 37457329 PMCID: PMC10345282 DOI: 10.1089/pmr.2023.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 07/18/2023] Open
Abstract
Background Though the effectiveness of behavioral activation (BA) for patients with cancer and depression were reported, there is no evidence in Japan. Objectives This study aimed at examining the feasibility and preliminary effectiveness of BA for patients with cancer and depression in Japan. Methods This pre-post study without a control group was conducted in patients with cancer and depression in Japan. The program completion rate was compared with those of previous studies to examine feasibility. To examine the preliminary effectiveness, outcomes were evaluated four times: before and immediately after the program, and two weeks and three months after the program ended. The primary outcome was the remission rate of depression using the 17-item version of the GRID Hamilton Rating Scale for Depression (HAMD17). Secondary outcomes were self-reported depression, anxiety, quality of life, changes in behavior, values, and perceived reward of activity and environmental factors. Pre- and post-program data were compared using paired-samples t-tests, and data obtained at four time points were analyzed using one-way repeated-measures analysis of variance. Results Of the 68 patients recruited from February 2018 to January 2022, 32 were registered. The completion rate was 75% (24/32), which was similar to previous studies. The total HAMD17 score significantly improved after the program. The remission rate of depression was 62.5% (20/32), which was above the defined threshold value (30%). All but two secondary outcomes significantly improved after the program (p < 0.05). Conclusions The feasibility and preliminary effectiveness of BA for patients with cancer and depression in Japan were suggested. The Clinical Trial Registration number: UMIN 000036104.
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Affiliation(s)
- Takatoshi Hirayama
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Ogawa
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Yanai
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Akie Shindo
- Department of Palliative Care, National Center for Global Health and Medicine, Tokyo, Japan
| | - Moeko Tanaka
- Department of Psychology and Welfare, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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Kitchen CEW, Lewis S, Ekers D, Gega L, Tiffin PA. Barriers and enablers for young people, parents and therapists undertaking behavioural activation for depression: A qualitative evaluation within a randomised controlled trial. Psychol Psychother 2023; 96:504-524. [PMID: 36808208 PMCID: PMC10952148 DOI: 10.1111/papt.12452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/03/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Adolescent depression is common, long-lasting and debilitating. Behavioural Activation (BA) is a brief, evidence-based therapy for depression in adults with promising outcomes for young people. OBJECTIVES We sought to understand how young people, their parents and therapists experienced manualised BA for depression within Child and Adolescent Mental Health Services. DESIGN Participants in a randomised controlled trial aged 12 to17 with depression, their parents and therapists were invited to a semi-structured interview with a researcher to explore their experiences of receiving, supporting or delivering BA. METHODS Six young people, five parents and five therapists were interviewed. Verbatim interview transcripts were coded using thematic analysis. RESULTS Factors that may optimise delivery of BA were: boosting the young person's motivation, tailoring parental input to the young person's needs/wishes and developing a positive collaboration between the young person and therapist. Engagement with treatment may be hindered by a mismatch between BA delivery and young person's preferences, concurrent mental health comorbidities that are not addressed within a wider care package, lack of parental support and therapist preconceptions against manualised therapy or BA. CONCLUSIONS Manualised BA for young people requires flexibility and adjustment to meet individual and family needs. Therapist preparation could dispel hindering preconceptions about the suitability and potential value of this brief and simple intervention for young people with complex needs and different learning styles.
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Affiliation(s)
| | - Sue Lewis
- School of Health in Social ScienceUniversity of EdinburghEdinburghUK
| | - David Ekers
- Department of Health SciencesUniversity of YorkYorkUK
- Tees, Esk and Wear Valleys NHS Foundation TrustDurhamUK
| | - Lina Gega
- Department of Health SciencesUniversity of YorkYorkUK
- Hull York Medical SchoolUniversity of YorkYorkUK
| | - Paul A. Tiffin
- Department of Health SciencesUniversity of YorkYorkUK
- Tees, Esk and Wear Valleys NHS Foundation TrustDurhamUK
- Hull York Medical SchoolUniversity of YorkYorkUK
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