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Ali R, Hoque E, Duberstein P, Schubert L, Razavi SZ, Kane B, Silva C, Daks JS, Huang M, Van Orden K. Aging and Engaging: A Pilot Randomized Controlled Trial of an Online Conversational Skills Coach for Older Adults. Am J Geriatr Psychiatry 2021; 29:804-815. [PMID: 33308893 PMCID: PMC8140061 DOI: 10.1016/j.jagp.2020.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/29/2020] [Accepted: 11/12/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Communication difficulties negatively impact relationship quality and are associated with social isolation and loneliness in later life. There is a need for accessible communication interventions offered outside specialty mental health settings. DESIGN Pilot randomized controlled trial. SETTING Assessments in the laboratory and intervention completed in-home. PARTICIPANTS Twenty adults age 60 and older from the community and a geriatric psychiatry clinic. INTERVENTION A web-based communication coach that provides automated feedback on eye contact, facial expressivity, speaking volume, and negative content (Aging and Engaging Program, AEP), delivered with minimal assistance in the home (eight brief sessions over 4-6 weeks) or control (education and videos on communication). MEASUREMENTS System Usability Scale and Social Skills Performance Assessment, an observer-rated assessment of social communication elicited through standardized role-plays. RESULTS Ninety percent of participants completed all AEP sessions and the System Usability Scale score of 68 was above the cut-off for acceptable usability. Participants randomized to AEP demonstrated statistically and clinically significant improvement in eye contact and facial expressivity. CONCLUSION The AEP is acceptable and feasible for older adults with communication difficulties to complete at home and may improve eye contact and facial expressivity, warranting a larger RCT to confirm efficacy and explore potential applications to other populations, including individuals with autism and social anxiety.
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Affiliation(s)
- Rafayet Ali
- Department of Computer Science, University of Rochester
| | - Ehsan Hoque
- Department of Computer Science, University of Rochester
| | - Paul Duberstein
- Department of Health Behavior, Society & Policy, Rutgers University School of Public Health
| | | | | | - Benjamin Kane
- Department of Computer Science, University of Rochester
| | - Caroline Silva
- Department of Psychiatry, University of Rochester School of Medicine & Dentistry
| | | | - Meghan Huang
- Department of Psychology, University of Rochester
| | - Kim Van Orden
- Department of Psychiatry (CS, KVO), University of Rochester School of Medicine & Dentistry, Rochester, NY.
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Walsh LM, Roddy MK, Scott K, Lewis CC, Jensen-Doss A. A meta-analysis of the effect of therapist experience on outcomes for clients with internalizing disorders. Psychother Res 2019; 29:846-859. [PMID: 29724135 PMCID: PMC6602872 DOI: 10.1080/10503307.2018.1469802] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 04/20/2018] [Indexed: 01/07/2023] Open
Abstract
Objective: This meta-analysis synthesized the literature regarding the effect of therapist experience on internalizing client outcomes to evaluate the utility of lay providers in delivering treatment and to inform therapist training. Method: The analysis included 22 studies, contributing 208 effect sizes. Study and client characteristics were coded to examine moderators. We conducted subgroup meta-analyses examining the relationship of therapist experience across a diverse set of internalizing client outcomes. Results: Results demonstrated a small, but significant relationship between therapist experience and internalizing client outcomes. There was no relationship between therapist experience and outcomes in clients with primary anxiety disorders. In samples of clients with primary depressive disorders and in samples of clients with mixed internalizing disorders, there was a significant relationship between experience and outcomes. The relationship between therapist experience and outcomes was stronger when clients were randomized to therapists, treatment was not manualized, and for measures of client satisfaction and "other" outcomes (e.g., dropout). Conclusions: It appears that therapist experience may matter for internalizing clients under certain circumstances, but this relationship is modest. Continuing methodological concerns in the literature are noted, as well as recommendations to address these concerns.
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Affiliation(s)
- Lucia M Walsh
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - McKenzie K Roddy
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Kelli Scott
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, USA
| | - Cara C Lewis
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, USA
- MacColl Center for Health Care Innovation, Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Wong MHM, Keng SL, Buck PJ, Suthendran S, Wessels A, Østbye T. Effects of Mental Health Paraprofessional Training for Filipina Foreign Domestic Workers in Singapore. J Immigr Minor Health 2019; 22:571-579. [PMID: 31183593 DOI: 10.1007/s10903-019-00907-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Research has found that 24% of foreign domestic workers (FDWs) in Singapore have poor mental health (24%), with depressive symptoms being identified as the second most severe psychological symptoms [1]. The study assessed the acceptability and effectiveness of a 4-week cognitive behavioral therapy (CBT)-based paraprofessional training program for FDWs in Singapore on depression literacy and CBT knowledge (primary outcomes), depression-related stigma, as well as attitudes towards seeking professional help (secondary outcomes) immediately and 2 months following the training. Forty female Filipino FDWs were recruited and randomized into either a CBT-based paraprofessional training program or wait-list (WL) group. Participants completed outcome measures before, after, and 2 months following their training. No significant difference was found on changes on any of the outcome variables in the intervention group as compared to the WL group. Following training, both groups showed significantly improved depression literacy, CBT knowledge, and attitudes towards seeking professional help. These changes were sustained at 2-month follow-up. All participants indicated a high level of satisfaction with the training program. While findings from between-group analyses do not support the efficacy of the CBT-based paraprofessional training program in improving depression literacy and related outcomes, participation in the program was associated with improvements in several outcomes within the training group. Future research should explore adaptations to the program (e.g., in terms of training duration and modes of delivery) that would increase its efficacy in improving depression literacy and CBT knowledge among FDWs.
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Affiliation(s)
- M H M Wong
- Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Shian-Ling Keng
- Division of Social Science, Yale-NUS College, 16 College Avenue West, Singapore, 138527, Singapore.
| | - P J Buck
- Portland Dialectical Behavior Therapy Institute, Portland, OR, USA
| | - S Suthendran
- Humanitarian Organization for Migration Economics, Singapore, Singapore
| | - A Wessels
- Research Across Borders, Sydney, NSW, Australia
| | - T Østbye
- Center for Aging Research and Education, Duke-NUS Medical School, Singapore, Singapore
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Lewinsohn PM, Steinmetz JL, Antonuccio D, Teri L. Group Therapy for Depression: The Coping with Depression Course. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2015. [DOI: 10.1080/00207411.1984.11448974] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ward E, Brown RL. A culturally adapted depression intervention for African American adults experiencing depression: Oh Happy Day. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2015; 85:11-22. [PMID: 25420141 PMCID: PMC4314356 DOI: 10.1037/ort0000027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The purpose of this article is to describe development of a culturally adapted depression intervention (Oh Happy Day Class, OHDC) designed for African American adults experiencing major depressive disorder (MDD). This project included 2 pilot studies testing the feasibility and acceptability of the OHDC and examining short-term effects of the OHDC in reducing symptoms of MDD. The OHDC is a 2.5-hr weekly, culturally specific, cognitive behavioral, group counseling intervention for 12 weeks. Cultural adaptations of the OHDC are based on the ecological validity and culturally sensitive framework, along with an Afrocentric paradigm. Fifty African American participants with MDD were enrolled (15 in Pilot I and 35 in Pilot II). All participants in Pilots I and II received the 12-week intervention and completed assessments at baseline, mid-intervention, end-intervention, and 3 months postintervention. General linear mixed modeling for assessment of pre-post longitudinal data analysis was conducted. Results for Pilot I showed 73% of participants completed the full OHDC, a statistically significant decline in depression symptoms from pre- to postintervention, and a 0.38 effect size. Participants were very satisfied with the OHDC. In Pilot II, 66% of participants completed the full OHDC, and there was a significant pre-post intervention decrease in depression symptoms. For men, the OHDC showed a 1.01 effect size and for women, a 0.41 effect size. Both men and women were very satisfied with the OHDC based on the satisfaction measure. These promising findings are discussed with a focus on future plans for examining efficacy of the OHDC in a large-scale, randomized, control trial.
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Affiliation(s)
- Earlise Ward
- Associate Professor, University of Wisconsin-Madison, School of Nursing, 608-263-0745
| | - Roger. L. Brown
- Professor of Research Methodology, Director of Research Design and Statistics Unit, Schools of Nursing, Medicine and Public Health, Clinical Science Center H6/273, 600 Highland Ave., University of Wisconsin-Madison, Madison, WI 53792, Phone: 608-263-5281, FAX: 608-263-5310, SKYPE: rogerbrown1029
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The Coping With Depression Course: A Group Psychoeducational Intervention for Unipolar Depression. BEHAVIOUR CHANGE 2014. [DOI: 10.1017/s0813483900007592] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cognitive-behavioural interventions developed from a variety of theoretical orientations have been demonstrated to be safe and effective treatments for unipolar depression. In this article, one specific intervention is described: the Coping With Depression (CWD) Course, a multi-modal group psychoeducational treatment. The theoretical rationale and development of the CWD Course is reviewed, as well as the specific course content. Evidence for the efficacy of the CWD Course is presented and discussed. Also described are several modifications of the CWD Course, developed for use with special populations such as depressed adolescents, caretakers of frail elderly, health-impaired Native Americans, and English and Spanish-speaking medical outpatients. Future research and development directions for the CWD Course are examined, including replication of outcome results, generalization to real-life clinical settings and to diagnostically co-morbid populations, and the prevention of depression among individuals at elevated risk of affective disorder.
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Woo SM, Hepner KA, Gilbert EA, Osilla KC, Hunter SB, Muñoz RF, Watkins KE. Training Addiction Counselors to Implement an Evidence-Based Intervention: Strategies for Increasing Organizational and Provider Acceptance. COGNITIVE AND BEHAVIORAL PRACTICE 2013; 20:232-244. [PMID: 23734072 DOI: 10.1016/j.cbpra.2012.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
One barrier to widespread public access to empirically supported treatments (ESTs) is the limited availability and high cost of professionals trained to deliver them. Our earlier work from two clinical trials demonstrated that front-line addiction counselors could be trained to deliver a manualized, group-based cognitive behavioral therapy (GCBT) for depression, a prototypic example of an EST, with a high level of adherence and competence. This follow-up article provides specific recommendations for the selection and initial training of counselors, and for the structure and process of their ongoing clinical supervision. Unique challenges in working with counselors unaccustomed to traditional clinical supervision are highlighted. The recommendations are based on comprehensive feedback derived from clinician notes taken throughout the clinical trials, a focus group with counselors conducted one year following implementation, and interviews with key organization executives and administrators.
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McLaughlin KA. The public health impact of major depression: a call for interdisciplinary prevention efforts. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2011; 12:361-71. [PMID: 21732121 PMCID: PMC3219837 DOI: 10.1007/s11121-011-0231-8] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Major depression is a consequential public health problem in the United States. Depression has long been recognized as an important target of intervention in psychology and psychiatry, but these fields have focused efforts primarily on treatment rather than prevention. Although effective preventive interventions targeting high-risk groups have been developed, they have thus far had poor reach and sustainability in the community. The development of sustainable preventive interventions that have the potential to impact population health represents a critical goal for the field. To this end, a research agenda incorporating the perspectives of both mental health disciplines and public health is proposed as a guide for future depression prevention research. Increased interdisciplinary collaboration between mental health disciplines and public health is recommended to develop, enact, and evaluate multilevel preventive interventions aimed at reducing the population health burden of major depression.
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Affiliation(s)
- Katie A McLaughlin
- Division of General Pediatrics, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Hepner KA, Hunter SB, Paddock SM, Zhou AJ, Watkins KE. Training addiction counselors to implement CBT for depression. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2011; 38:313-23. [PMID: 21626444 DOI: 10.1007/s10488-011-0359-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Many clients in publicly funded substance abuse treatment programs suffer from depression yet lack access to effective mental health treatment. This study sought to examine whether addiction counselors could be effectively trained to deliver group CBT for depression and to ascertain client perceptions of the treatment. Five counselors were trained in the therapy and treated 113 clients with depression symptoms. Counselors demonstrated high fidelity to the therapy and client perceptions of the therapy were positive. Our results suggest that training addiction counselors to deliver group CBT for depression is a promising integrated treatment approach for co-occurring depression and substance disorders.
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Affiliation(s)
- Kimberly A Hepner
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, USA.
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Paddock SM, Hunter SB, Watkins KE, McCaffrey DF. ANALYSIS OF ROLLING GROUP THERAPY DATA USING CONDITIONALLY AUTOREGRESSIVE PRIORS. Ann Appl Stat 2011; 5:605-627. [PMID: 21857889 DOI: 10.1214/10-aoas434] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Group therapy is a central treatment modality for behavioral health disorders such as alcohol and other drug use (AOD) and depression. Group therapy is often delivered under a rolling (or open) admissions policy, where new clients are continuously enrolled into a group as space permits. Rolling admissions policies result in a complex correlation structure among client outcomes. Despite the ubiquity of rolling admissions in practice, little guidance on the analysis of such data is available. We discuss the limitations of previously proposed approaches in the context of a study that delivered group cognitive behavioral therapy for depression to clients in residential substance abuse treatment. We improve upon previous rolling group analytic approaches by fully modeling the interrelatedness of client depressive symptom scores using a hierarchical Bayesian model that assumes a conditionally autoregressive prior for session-level random effects. We demonstrate improved performance using our method for estimating the variance of model parameters and the enhanced ability to learn about the complex correlation structure among participants in rolling therapy groups. Our approach broadly applies to any group therapy setting where groups have changing client composition. It will lead to more efficient analyses of client-level data and improve the group therapy research community's ability to understand how the dynamics of rolling groups lead to client outcomes.
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Dennhag I, Ybrandt H, Armelius K. Self-image patterns as predictors of change and outcome of trainee-led psychotherapy. Psychother Res 2011; 21:201-9. [DOI: 10.1080/10503307.2010.542783] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abstract
AbstractAs an initial step in the improvement of interventions for the depressed elderly, the present study attempts to identify the strategies they spontaneously use to cope with depressive feelings. Fifty two older persons answered two questionnaires, one measuring the intensity of depressive symptomatology, the other dealing with coping strategies and their usefulness. Results suggest that, as a whole, coping strategies used by the elderly do not fundamentally differ from the ones advocated by younger individuals, in that they favor strategies involving goal-oriented action. The subjects who reported the most depressive feelings differed from the others on two points: they less frequently relied on the strategy of problem solving and they considered general activity as less useful in their struggle against depressive feelings. Implications for the development of services for the elderly, in particular the secondary prevention of depression, are drawn.
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Herrera AP, Snipes SA, King DW, Torres-Vigil I, Goldberg DS, Weinberg AD. Disparate inclusion of older adults in clinical trials: priorities and opportunities for policy and practice change. Am J Public Health 2010; 100 Suppl 1:S105-12. [PMID: 20147682 PMCID: PMC2837461 DOI: 10.2105/ajph.2009.162982] [Citation(s) in RCA: 216] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2009] [Indexed: 11/04/2022]
Abstract
Older adults are vastly underrepresented in clinical trials in spite of shouldering a disproportionate burden of disease and consumption of prescription drugs and therapies, restricting treatments' generalizability, efficacy, and safety. Eliminating Disparities in Clinical Trials, a national initiative comprising a stakeholder network of researchers, community advocates, policymakers, and federal representatives, undertook a critical analysis of older adults' structural barriers to clinical trial participation. We present practice and policy change recommendations emerging from this process and their rationale, which spanned multiple themes: (1) decision making with cognitively impaired patients; (2) pharmacokinetic differences and physiological age; (3) health literacy, communication, and aging; (4) geriatric training; (5) federal monitoring and accountability; (6) clinical trial costs; and (7) cumulative effects of aging and ethnicity.
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Montgomery EC, Kunik ME, Wilson N, Stanley MA, Weiss B. Can paraprofessionals deliver cognitive-behavioral therapy to treat anxiety and depressive symptoms? Bull Menninger Clin 2010; 74:45-62. [DOI: 10.1521/bumc.2010.74.1.45] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Psychoeducational treatment and prevention of depression: the "Coping with Depression" course thirty years later. Clin Psychol Rev 2009; 29:449-58. [PMID: 19450912 DOI: 10.1016/j.cpr.2009.04.005] [Citation(s) in RCA: 156] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Revised: 04/03/2009] [Accepted: 04/10/2009] [Indexed: 11/23/2022]
Abstract
The "Coping with Depression" course (CWD) is by the far the best studied psychoeducational intervention for the treatment and prevention of depression, and is used in routine practice in several countries. The CWD is a highly structured cognitive-behavioral intervention, which has been adapted for several goals, contexts, and target populations. The efficacy of the CWD has been examined in 25 randomized controlled trials. We conducted a meta-analysis of these studies. The 6 studies aimed at the prevention of new cases of major depression were found to result in a reduced risk of getting major depression of 38% (incidence rate ratio was 0.62). The 18 studies examining the CWD as a treatment of depression found a mean effect size (Cohen's d) of 0.28. Direct comparisons with other psychotherapies did not result in any indication that the CWD was less efficacious. The CWD is a flexible treatment which can easily be adapted for different populations and this may have led researchers to use this intervention for complex target groups, which in turn may have resulted in a lower mean effect size. The CWD has contributed considerably to the development and innovation of prevention and treatment of depression in many target populations.
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Atkins DC, Christensen A. Is professional training worth the bother? A review of the impact of psychotherapy training on client outcome. AUSTRALIAN PSYCHOLOGIST 2007. [DOI: 10.1080/00050060108259644] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cuijpers P, Smit F, Voordouw I, Kramer J. Outcome of cognitive behaviour therapy for minor depression in routine practice. Psychol Psychother 2005; 78:179-88. [PMID: 16004697 DOI: 10.1348/147608304x22391] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To examine (1) whether the improvement in depressive symptomatology in subjects participating in psychoeducational groups for minor depression in routine practice is comparable to the improvement realized in a randomized efficacy trial; and (2) whether the level of depressive symptoms of subjects who participated in this intervention is similar after treatment to the level of depressive symptoms of the general population. DESIGN Participants (N = 187) of 20 psychoeducational groups in routine practice in the Netherlands were examined before and after the intervention using the Centre for Epidemiological Studies - Depression scale (CES-D). METHODS The standardized improvement from pre- to post-test in subjects was compared to the improvement found in subjects participating in a randomized trial of the same intervention. Furthermore, we compared the post-test scores to the scores of the general population. RESULTS The improvement of depressive symptoms in routine practice was of the same magnitude as the improvement in the randomized trial. However, a considerable proportion of the participants (54.5%) still scored above the cut-off score of the CES-D at post-test, and the mean CES-D score of the participants (M = 17.0; SD = 9.8) differed significantly (p < .01) from the mean score in the general population (M = 9.7; SD = 8.6). CONCLUSION Psychoeducational intervention can be an important help for people with depressive symptoms. The improvement in terms of depressive symptoms in routine practice does not differ from the improvement found in a randomized trial. However, participants remained considerably more depressed than the general population and this intervention is, for many, not sufficient as a form of treatment.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, The Netherlands.
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Wang PS, Schneeweiss S, Brookhart MA, Glynn RJ, Mogun H, Patrick AR, Avorn J. Suboptimal antidepressant use in the elderly. J Clin Psychopharmacol 2005; 25:118-26. [PMID: 15738742 DOI: 10.1097/01.jcp.0000155819.67209.e5] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ongoing changes in available agents and health care delivery systems have made it imperative to study the quality of antidepressant use in vulnerable and traditionally underserved elderly. We conducted a retrospective cohort study among 12,130 new antidepressant users aged > or =65 years with a recent diagnosis of depression in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly Program from January 1, 1994, to December 31, 1999. Additional use information was available through Medicare data. Potentially hazardous antidepressant regimens were defined as use of highly anticholinergic agents or daily dosages in excess of geriatric prescribing guidelines. Low-intensity regimens were defined by lower than recommended daily dosages, too-short durations of therapy, or lack of follow-up. Of all elderly antidepressant users, 43.3% were taking suboptimal regimens. Potentially hazardous regimens were used by 11.9%, including 7.3% taking highly anticholinergic agents and 5.3% using excessively high daily dosages. Low-intensity regimens were used by 34.8% of patients, including 7.6% with excessively low daily dosages, 19.3% with short durations of therapy, and 14.8% with inadequate follow-up. Potentially hazardous regimens were associated with ages 65 to 74 years, nursing home residence, cancer diagnoses, less comorbidity, use of other psychiatric medications, making more physician visits, and earlier calendar years. Low-intensity regimens were associated with ages > or =85 years, nonwhite race, greater comorbidity, fewer physician visits or inpatient days in the baseline 6 months, and not using other psychiatric medications. Suboptimal antidepressant use remains common in the elderly, especially the use of inadequately intensive regimens. Interventions are needed to improve the quality and outcomes of antidepressant use in this vulnerable population.
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Affiliation(s)
- Philip S Wang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120, USA.
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Gregory RJ, Schwer Canning S, Lee TW, Wise JC. Cognitive Bibliotherapy for Depression: A Meta-Analysis. ACTA ACUST UNITED AC 2004. [DOI: 10.1037/0735-7028.35.3.275] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gallagher-Thompson D, Coon DW, Solano N, Ambler C, Rabinowitz Y, Thompson LW. Change in indices of distress among Latino and Anglo female caregivers of elderly relatives with dementia: site-specific results from the REACH national collaborative study. THE GERONTOLOGIST 2003; 43:580-91. [PMID: 12937336 DOI: 10.1093/geront/43.4.580] [Citation(s) in RCA: 170] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Few empirical studies have compared the efficacy between psychoeducational (skill-building) approaches for reducing caregivers' psychological distress and interventions modeled after typical community-based support groups. We compare the impact of two distinct interventions on Anglo and Latino caregivers of elderly relatives with dementia. DESIGN AND METHODS The change from preassessment to postassessment (baseline to 3 months) for 213 female caregivers (122 Anglo and 91 Latino) is presented. They were seen weekly for 10 weeks in either the Coping With Caregiving psychoeducational program (instruction and practice in small groups to learn specific cognitive and behavioral skills) or in the Enhanced Support Group condition (guided discussion and empathic listening to develop reciprocal support within the group). Both programs were tailored to be sensitive to the cultural concerns of Anglo and Latino caregivers, and they were delivered in either English or Spanish by trained interventionists. RESULTS Overall, participants in the Coping With Caregiving condition reported a significant reduction in depressive symptoms, increased use of adaptive coping strategies, and a trend toward decreased use of negative coping strategies when compared with those in the Enhanced Support Group condition. Results were similar for both ethnic groups: there were no main effects for ethnicity, and no significant ethnicity by treatment interaction effects. IMPLICATIONS This study provides empirical support that female caregivers benefit more from a skill-building approach to managing their distress than from support group membership alone. We find it very encouraging that the Latino caregivers responded well on key outcome variables, suggesting that Latinos will participate in clinical research and will benefit from their involvement when services are provided to meet their specific needs.
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Affiliation(s)
- Dolores Gallagher-Thompson
- Older Adult and Family Center, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine and VA Palo Alto Health Care System, 795 Willow Road, mail code 182C/MP, Menlo Park, CA 94025, USA.
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Abstract
This article provides an overview of current challenges in the diagnosis and treatment of depressed older adults in primary care and considers suggestions for clinicians, researchers, and policy makers to improve care for this population. Despite the enormous toll of depression on individuals and society and the availability of effective treatments, depressed older adults remain largely untreated or undertreated. They rarely see mental health professionals, but have relatively frequent contact with primary care providers. In primary care, the chronic and recurrent nature of depression and a number of patient, provider, and policy-related barriers interfere with effective depression treatment. Recent research suggests that improving care for individuals with late life depression will require education and engagement of older adults and their primary care providers as active partners in caring for depression. It will also require additional human resources and systematic models of care dedicated to proactively managing depression as a chronic illness. Finally, it will require training of mental health professionals to effectively collaborate with their colleagues in primary care in treating depressed older adults. Further improvement in depression care would likely result from the implementation of true parity for mental health treatments for older adults.
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Affiliation(s)
- Jürgen Unützer
- University of California, Los Angeles Neuropsychiatric Institute, 90024, USA
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McDermut W, Miller IW, Brown RA. The efficacy of group psychotherapy for depression: A meta-analysis and review of the empirical research. ACTA ACUST UNITED AC 2001. [DOI: 10.1093/clipsy.8.1.98] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Grant JS, Bartolucci AA, Elliot TR, Giger JN. Sociodemographic, physical, and psychosocial characteristics of depressed and non-depressed family caregivers of stroke survivors. Brain Inj 2000; 14:1089-100. [PMID: 11147581 DOI: 10.1080/02699050050203586] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
A variety of sociodemographic, physical, and psychosocial variables are linked to depressive behaviour in family caregivers. This study was conducted to determine the best predictors of caregiver depression at onset of the caregiver role among persons providing care to a stroke survivor. The relative contributions of stroke survivor and caregiver sociodemographic characteristics, as well as caregiver general health, physical functioning, social support, life satisfaction, preparedness, and reaction in the prediction of depression status, were examined. A correlational study of 52 primary family caregivers of individuals who had a cerebrovascular accident was conducted. General health and physical functioning scales from the SF-36, and measures of caregiver social support, life satisfaction, preparedness, and reaction were used. Caregiver depression was best predicted by lower life satisfaction, lower physical functioning, and a lack of tangible social support.
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Affiliation(s)
- J S Grant
- University of Alabama at Birmingham, 35294-1210, USA.
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Félix-Ortiz M, Salazar MR, González JR, Sorensen JL, Plock D. A qualitative evaluation of an assisted self-help group for drug-addicted clients in a structured outpatient treatment setting. Community Ment Health J 2000; 36:339-50. [PMID: 10917270 DOI: 10.1023/a:1001983527309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We conducted a qualitative evaluation of a semi-structured, client-led support group that addressed drug use recovery issues and was assisted by a psychological consultant. Seven regular group members and their counselors were interviewed about the effect of the assisted self-help group on drug use and the clients' quality of life, and these interviews were content analyzed. In addition, the psychological consultant made group process observations for each session of the first three months. Clients reported group strengths as: Feeling supported and understood, being able to speak freely without fear of staff reprisals, obtaining information/feedback, improved mood, and decreased drug use. With the provision of professional support and guidance, this group shows promise as an adjunct to standard outpatient drug abuse treatment by allowing for some degree of client independence and extending the scarce resource of professional counseling.
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Affiliation(s)
- M Félix-Ortiz
- Department of Psychology, Substance Abuse Research Center, University of California, Los Angeles 90095-1563, USA.
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Powers CB, Wisocki PA. An examination of the therapeutic benefits of focus groups on elderly worriers. Int J Aging Hum Dev 1997; 45:159-67. [PMID: 9395927 DOI: 10.2190/5ghq-qfwr-jvyj-tnhp] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study examines the effects on elderly worriers, of a focus group discussion about the topic of worry. All subjects (N = 21) were self-designated worriers, and at least seventy years of age. Pretest and-Posttest measures included questionnaires on worry, life satisfaction, and psychological symptom domains unrelated to the focus group topic. The percentage of the day spent worrying variable, which was the criterion variable for admittance into the groups, showed a significant reduction from pre to post. The focus group participants also evaluated the focus group experience as positive and beneficial. The value of focus groups for therapeutic effectiveness and data collection with the elderly are discussed.
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Abstract
Nursing assistants are responsible for 80% to 90% of all direct resident care in nursing homes, but are the least well trained personnel. Even with currently mandated training, specific skills to meet mental health needs are not taught. Training in behavior management skills prepares aides to observe and respond to problem behaviors more effectively. Aides view their own use of skills as increased by this training. To be practically useful, mental health training programs for nurse aides should be provided by professional personnel in brief, concrete, self-contained units that model the skills they present.
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Abstract
The ideal interface between self-help group and professional being of both theoretical and practical interest, this paper reviews the conceptual underpinnings of the interface issue and empirical studies in which the professional or self-help group member perspective on this issue was elicited or comparative analyses were conducted. Empirical studies measuring self-help group members' perceptions and studies of professionals' views indicate that professional interaction with self-help groups is desirable but that professional lack of information concerning self-help groups and lack of preparation for appropriate roles are perceived as barriers to such interaction. These studies clearly show that the indirect, non-authoritarian role of the professional as consultant receives the most support. Consultation and collaboration are recurrent themes in the empirical investigations of the professional interface with self-help groups. Balance and exchange theories could provide useful theoretical foundations for this collaborative practice. Clearly, educational preparation is needed to enable health professionals to embark on the essential transition from provider to partner with self-help groups.
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Affiliation(s)
- M J Stewart
- Dalhousie University, School of Nursing, Halifax, Nova Scotia, Canada
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Abstract
This article reviews the process of intervention research, with particular emphasis on interventions with and for older adults. First, we consider the context of intervention research: What are the resources and constraints that shape the process of intervention and research? Second, we outline a taxonomy of interventions, reflecting different combinations of level and timing of interventions. Third, we consider the types of research designs that are most appropriate in the different contexts of applied research.
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31
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Cognitive variables and the prediction of outcome following an intervention for controlling depression. COGNITIVE THERAPY AND RESEARCH 1985. [DOI: 10.1007/bf01173006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lewinsohn PM, Breckenridge JS, Antonuccio DO, Teri L. A Behavioral Group Therapy Approach to the Treatment of Depression. APPLIED CLINICAL PSYCHOLOGY 1985. [DOI: 10.1007/978-1-4684-4958-7_11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Thompson LW, Gallagher D. Efficacy of psychotherapy in the treatment of late-life depression. ACTA ACUST UNITED AC 1984. [DOI: 10.1016/0146-6402(84)90007-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lewinsohn PM, Clarke GN. Group treatment of depressed individuals: The ‘coping with depression’ course. ACTA ACUST UNITED AC 1984. [DOI: 10.1016/0146-6402(84)90005-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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