The effect of cognitive behavior therapy on anxiety and depression during COVID-19 pandemic: a systematic review and meta-analysis

Effect of an Innovative Online Ayurveda Program for Detox and Lifestyle on Mental and Physical Health in Home-Based Adults: A Pilot Study

Background and Objective: Mental health complaints have significantly increased in Europe over recent years. This study evaluated the effects and safety of a 4-month online, multimodal, complementary intervention on the mental and physical health of home-based adults. Method: Ninety-eight home-based adults with mild to severe mental health and related physical symptoms were recruited across Europe through digital advertisements. This single-arm repeated-measures study utilized three individualized treatment groups to evaluate the impact of the Ayurveda Program for Detox and Lifestyle. The online program included a personalized Ayurveda diet, daily routine, yoga exercise, herbal detoxification procedures, and herbal preparations. Standardized online tests were administered monthly for 4 months to assess anxiety, depression, physical symptoms (Patient Health Questionnaire for Somatic, Anxiety, and Depressive Symptoms), fatigue (PROMIS), and body mass index (BMI). Results: The study population was predominantly female (85%), with a mean age of 58 years. By the end of the fourth month, primary outcomes indicated a significant decrease in anxiety (55%, p < 0.001) and depression symptoms (45%, p < 0.001). The secondary outcomes showed a significant reduction in physical symptoms, including musculoskeletal, neurological, and digestive issues (42%, p < 0.001); fatigue (31%, p < 0.001); and BMI (2%, p < 0.001). Improvements were consistent across all treatment groups, with no significant differences observed. The intervention was feasible and generally safe, with 91% retention, 70% compliance, and 6% adverse effects. Conclusion: The initial results suggest that the Ayurveda Program for Detox and Lifestyle is safe and is associated with significant improvements in the mental and physical health of participants. This trial highlights the potential benefits of integrating complementary lifestyle protocols into standard primary and mental health care practices. Future randomized controlled trials are recommended to control for confounding factors and validate these findings in larger clinical populations.

Effectiveness of Cognitive Behavioral Therapy in Reducing Psychological Distress in Nurses: A Systematic Review and Meta-Analysis of Experimental Studies

Work-related stress, a major contributor to physical and mental health issues of nurses, has a direct impact on patient safety and nurses' well-being. However, few studies have investigated the effectiveness of cognitive behavioral therapy in reducing psychological distress in nurses. Systematic search of six databases including CINAHL Plus with Full Text, Cochrane Library, Embase, Medline, PubMed, and Web of Science from their inception to February 27, 2024. The primary outcomes assessed were reductions in stress, anxiety, and depression following the implementation of cognitive behavioral therapy. A random effects model, accounting for study differences, was applied in the meta-analyses. Egger's regression test was utilized to assess potential publication bias in the pooled analyses. The meta-analysis included 10 studies that demonstrated the intervention's beneficial effects in reducing stress, anxiety, and depression among nurses. Despite the positive effects observed with cognitive behavioral therapy (CBT) in alleviating psychological distress among nurses, the generalizability of these findings may require further confirmation due to the diversity of cognitive behavioral therapies.

Systematic review on attitudes towards death and dying in adults 50 years and older living in countries with community transmission of COVID-19

BACKGROUND

The COVID-19 pandemic has underscored older adults' vulnerability to severe illness or death. Increased public awareness of mortality, with daily reminders of preventive measures, spurred interest in understanding the impact on death-related thoughts. This systematic review analyses existing literature on death attitudes among individuals aged 50 and older during the COVID-19 pandemic and focuses on associated factors.

METHODS

A systematic literature search was conducted using the WHO COVID database without any language limit, up until April 2023. The review protocol was registered in PROSPERO and PRISMA guidelines were followed. Included studies were systematically analysed and summarized using a predefined data extraction sheet.

RESULTS

Of the 2297 studies identified, 9 met inclusion criteria. The review showed moderate to high levels of death anxiety during the pandemic, linked to direct health risks from COVID-19 rather than mitigation measures. The impact of health and personal factors on older people's death anxiety was complex, with a range of health and personal factors such as chronic conditions, loss of capacity, loneliness, occupation, and resilience associated with it, suggesting potential intervention avenues.

CONCLUSION

The systematic review shows a significant link between COVID-19 and heightened death anxiety among individuals aged 50 and above. Negative attitudes to death can harm physical and mental health, diminish life satisfaction, increase avoidance behaviour, impair coping mechanism and undermine end-of-life decision making. Findings underscore the need for further research into risk and protective factors (personal, health, and environmental) and the importance of standardized data collection to guide interventions and public health strategies aimed at mitigating death anxiety.

Frontiers and hotspots in anxiety disorders: A bibliometric analysis from 2004 to 2024

Objective

This study aimed to analyze research on anxiety disorders using VOSviewer and CiteSpace to identify research hotspots and future directions.

Methods

We conduct ed a comprehensive search on the Web of Science Core Collection (WoSCC) for relevant studies about anxiety disorders published within the past two decades (from 2004 to 2024). VOSviewer and CiteSpace were mainly used to analyze the authors, institutions, countries, publishing journals, reference co-citation patterns, keyword co-occurrence, keyword clustering, and other aspects to construct a knowledge atlas.

Results

A total of 22,267 publications related to anxiety disorders were retrieved. The number of publications about anxiety disorders has generally increased over time, with some fluctuations. The United States emerged as the most productive country, with Harvard University identified as the most prolific institution and Brenda W. J. H. Penninx as the most prolific author in the field.

Conclusion

This research identified the most influential publications, authors, journals, institutions, and countries in the field of anxiety research. Future research directions are involved advanced treatments based on pharmacotherapy, psychotherapy and digital interventions, mechanism exploration to anxiety disorders based on neurobiological and genetic basis, influence of social and environmental factors on the onset of anxiety disorders.

The prevalence, determinants, and consequences of post-COVID in healthcare workers: A cross-sectional survey

Data on post-coronavirus disease (COVID) in healthcare workers (HCWs) are scarce. We aimed to assess prevalence, determinants, and consequences of post-COVID in HCWs. In fall 2022, we performed a cross-sectional survey in a tertiary care hospital with a web-based questionnaire sent to HCWs. Post-COVID was defined as persistent/new symptoms 3 months after acute COVID. Propensity score weighting was performed to assess the impact of post-COVID on return-to-work. 1062 HCWs completed the questionnaire, 713 (68%) reported at least one COVID, and 109 (10%) met the definition for post-COVID, with workplace contamination reported in 51 (47%). On multivariable analysis, risk factors for post-COVID were female gender (p = 0.047), ≥50 years (p = 0.007), immunosuppression (p = 0.004), ≥2 COVID episodes (p = 0.003), and ≥5 symptoms during acute COVID (p = 0.005). Initial sick leave was prescribed for 94 HCWs (86% post-COVID), for a median duration of 7 [7-9] days, and extended for 23. On return-to-work, 91 (84%) had residual symptoms, primarily asthenia/fatigue (72%) and cognitive impairment (25%). Cognitive impairment at return-to-work was associated with post-COVID. Ten HCWs (9%) received a medical diagnosis of post-COVID, 8 consulted the occupational physician, and four required work adaptation. Post-COVID affected 10% of HCWs. Long-term consequences included repeated sick leaves and residual symptoms on return-to-work.

Self-care interventions to assist family physicians with mental health care of older patients during the COVID-19 pandemic: Feasibility, acceptability, and outcomes of a pilot randomized controlled trial

BACKGROUND

The COVID-19 pandemic has required family physicians to rapidly address increasing mental health problems with limited resources. Vulnerable home-based seniors with chronic physical conditions and commonly undermanaged symptoms of anxiety and depression were recruited in this pilot study to compare two brief self-care intervention strategies for the management of symptoms of depression and/or anxiety.

METHODS

We conducted a pilot RCT to compare two tele-health strategies to address mental health symptoms either with 1) validated CBT self-care tools plus up to three telephone calls from a trained lay coach vs. 2) the CBT self-guided tools alone. The interventions were abbreviated from those previously trialed by our team, to enable their completion in 2 months. Objectives were to assess the feasibility of delivering the interventions during a pandemic (recruitment and retention); and assess the comparative acceptability of the interventions across the two groups (satisfaction and tool use); and estimate preliminary comparative effectiveness of the interventions on severity of depression and anxiety symptoms. Because we were interested in whether the interventions were acceptable to a wide range of older adults, no mental health screening for eligibility was performed.

RESULTS

90 eligible patients were randomized. 93% of study completers consulted the self-care tools and 84% of those in the coached arm received at least some coaching support. Satisfaction scores were high among participants in both groups. No difference in depression and anxiety outcomes between the coached and non-coached participants was observed, but coaching was found to have a significant effect on participants' use and perceived helpfulness of the tools.

CONCLUSION

Both interventions were feasible and acceptable to patients. Trained lay coaching increased patients' engagement with the tools. Self-care tools offer a low cost and acceptable remote activity that can be targeted to those with immediate needs. While effectiveness results were inconclusive, this may be due to the lack of eligibility screening for mental health symptoms, abbreviated toolkit, and fewer coaching sessions than those used in our previous effective interventions.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT0460937.