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Janssen NP, Hendriks GJ, Sens R, Lucassen P, Oude Voshaar RC, Ekers D, van Marwijk H, Spijker J, Bosmans JE. Cost-effectiveness of behavioral activation compared to treatment as usual for depressed older adults in primary care: A cluster randomized controlled trial. J Affect Disord 2024; 350:665-672. [PMID: 38244792 DOI: 10.1016/j.jad.2024.01.109] [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: 05/23/2023] [Revised: 12/23/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024]
Abstract
INTRODUCTION Depression in older adults is associated with decreased quality of life and increased utilization of healthcare services. Behavioral activation (BA) is an effective treatment for late-life depression, but the cost-effectiveness compared to treatment as usual (TAU) is unknown. METHODS An economic evaluation was performed alongside a cluster randomized controlled multicenter trial including 161 older adults (≥65 years) with moderate to severe depressive symptoms (PHQ-9 ≥ 10). Outcome measures were depression (response on the QIDS-SR), quality-adjusted life-years (QALYs) and societal costs. Missing data were imputed using multiple imputation. Cost and effect differences were estimated using bivariate linear regression models, and statistical uncertainty was estimated with bootstrapping. Cost-effectiveness acceptability curves showed the probability of cost-effectiveness at different ceiling ratios. RESULTS Societal costs were statistically non-significantly lower in BA compared to TAU (mean difference (MD) -€485, 95 % CI -3861 to 2792). There were no significant differences in response on the QIDS-SR (MD 0.085, 95 % CI -0.015 to 0.19), and QALYs (MD 0.026, 95 % CI -0.0037 to 0.055). On average, BA was dominant over TAU (i.e., more effective and less expensive), although the probability of dominance was only 0.60 from the societal perspective and 0.85 from the health care perspective for both QIDS-SR response and QALYs. DISCUSSION Although the results suggest that BA is dominant over TAU, there was considerable uncertainty surrounding the cost-effectiveness estimates which precludes firm conclusions.
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Affiliation(s)
- Noortje P Janssen
- Behavioural Science Institute, Radboud University, 6525 XZ Nijmegen, the Netherlands; Department of Primary and Community Care, Research Institute of Health Sciences, Radboud University Medical Centre Nijmegen, 6525 EZ Nijmegen, the Netherlands; Institute for Integrated Mental Health Care Pro Persona, 6525 DX Nijmegen, the Netherlands.
| | - Gert-Jan Hendriks
- Behavioural Science Institute, Radboud University, 6525 XZ Nijmegen, the Netherlands; Institute for Integrated Mental Health Care Pro Persona, 6525 DX Nijmegen, the Netherlands
| | - Renate Sens
- Department of Health Sciences, VU University, 1081 HV Amsterdam, the Netherlands
| | - Peter Lucassen
- Department of Primary and Community Care, Research Institute of Health Sciences, Radboud University Medical Centre Nijmegen, 6525 EZ Nijmegen, the Netherlands
| | - Richard C Oude Voshaar
- University of Groningen, Department of Psychiatry, University Medical Centre Groningen, 9713 GZ Groningen, the Netherlands
| | - David Ekers
- Mental Health and Addictions Research Group, Tees Esk and Wear Valleys NHS FT/University of York, TS60SZ York, UK
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, BN1 9PH Brighton, United Kingdom
| | - Jan Spijker
- Behavioural Science Institute, Radboud University, 6525 XZ Nijmegen, the Netherlands; Institute for Integrated Mental Health Care Pro Persona, 6525 DX Nijmegen, the Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, VU University, 1081 HV Amsterdam, the Netherlands
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Yaffe MJ, McCusker J, Lambert SD, Haggerty J, Meguerditchian AN, Pineault M, Barnabé A, Belzile E, Minotti S, de Raad M. 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. PLoS One 2024; 19:e0297937. [PMID: 38358971 PMCID: PMC10868770 DOI: 10.1371/journal.pone.0297937] [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: 02/02/2023] [Accepted: 01/10/2024] [Indexed: 02/17/2024] Open
Abstract
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.
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Affiliation(s)
- Mark J. Yaffe
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- St. Mary’s Hospital Department of Family Medicine, Montreal, Quebec, Canada
- St. Mary’s Research Centre, Montreal, Quebec, Canada
| | - Jane McCusker
- St. Mary’s Research Centre, Montreal, Quebec, Canada
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Sylvie D. Lambert
- St. Mary’s Research Centre, Montreal, Quebec, Canada
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- St. Mary’s Research Centre, Montreal, Quebec, Canada
| | - Ari N. Meguerditchian
- St. Mary’s Research Centre, Montreal, Quebec, Canada
- Departments of Surgery and Oncology, McGill University, Montreal, Quebec, Canada
| | | | - Alexandra Barnabé
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Eric Belzile
- St. Mary’s Research Centre, Montreal, Quebec, Canada
| | - Simona Minotti
- St. Mary’s Research Centre, Montreal, Quebec, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Manon de Raad
- St. Mary’s Research Centre, Montreal, Quebec, Canada
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Mushtaq A, Khan MA. Social isolation, loneliness, and mental health among older adults during COVID-19: a scoping review. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024; 67:143-156. [PMID: 37501381 DOI: 10.1080/01634372.2023.2237076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023]
Abstract
COVID-19 continues to have detrimental effects worldwide, especially on vulnerable populations. The burden of mental health concerns and psychological well-being resulting from social isolation and loneliness induced by COVID-19 are increasingly recognized in old age. The aim is to determine the extent of social isolation and loneliness among older adults, the methodologies used, the effect on mental health during COVID-19, and review intervention strategies and lifestyle changes to improve the current situation through the recommendations of the studies included. The articles published on PubMed, ProQuest, and Scopus databases from December 2019 to December 2021 with the following keywords ("Older Adults" "Social Isolation," "Loneliness," "Mental Health," "COVID-19") in English were included. Older adults have faced a serious burden of social isolation and adverse mental health effects during COVID-19. Anxiety, depression, stress, and insomnia are the major mental health concerns among older adults worldwide. It is suggested that spousal support and social networks, adaptive organizational change, and a responsive public sector are critical in reducing the obstacles to older adults. COVID-19 resilience among the aging population can be remarkable if adequately cared for with senior-friendly pandemic-related intervention strategies, policies and legislation.
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Affiliation(s)
- Aiman Mushtaq
- Department of Social Work, Aligarh Muslim University, Aligarh, India
| | - Mohd Arif Khan
- Department of Social Work, Aligarh Muslim University, Aligarh, India
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Jimenez DE, Weinstein ER, Carrico AW. Is Behavioral Activation Higher Ground for the Silver Tsunami? Am J Geriatr Psychiatry 2024; 32:256-258. [PMID: 37949802 DOI: 10.1016/j.jagp.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Daniel E Jimenez
- Department of Psychiatry and Behavioral Sciences (D.E.J.), University of Miami Miller School of Medicine, Miami, FL.
| | | | - Adam W Carrico
- Robert Stempel College of Public Health and Social Work (A.W.C.), Florida International University, Miami, FL
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5
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Gilbody S, Littlewood E, McMillan D, Atha L, Bailey D, Baird K, Brady S, Burke L, Chew-Graham CA, Coventry P, Crosland S, Fairhurst C, Henry A, Hollingsworth K, Newbronner E, Ryde E, Shearsmith L, Wang HI, Webster J, Woodhouse R, Clegg A, Dexter-Smith S, Gentry T, Hewitt C, Hill A, Lovell K, Sloan C, Traviss-Turner G, Pratt S, Ekers D. Behavioural activation to mitigate the psychological impacts of COVID-19 restrictions on older people in England and Wales (BASIL+): a pragmatic randomised controlled trial. THE LANCET. HEALTHY LONGEVITY 2024; 5:e97-e107. [PMID: 38310902 PMCID: PMC10834375 DOI: 10.1016/s2666-7568(23)00238-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/27/2023] [Accepted: 11/09/2023] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Older adults were more likely to be socially isolated during the COVID-19 pandemic, with increased risk of depression and loneliness. We aimed to investigate whether a behavioural activation intervention delivered via telephone could mitigate depression and loneliness in at-risk older people during the COVID-19 pandemic. METHODS BASIL+ (Behavioural Activation in Social Isolation) was a pragmatic randomised controlled trial conducted among patients recruited from general practices in England and Wales, and was designed to assess the effectiveness of behavioural activation in mitigating depression and loneliness among older people during the COVID-19 pandemic. Eligible participants were aged 65 years and older, socially isolated, with a score of 5 or higher on the Patient Health Questionnaire-9 (PHQ-9), and had multiple long-term conditions. Participants were allocated in a 1:1 ratio to the intervention (behavioural activation) or control groups by use of simple randomisation without stratification. Behavioural activation was delivered by telephone; participants were offered up to eight weekly sessions with trained BASIL+ Support Workers. Behavioural activation was adapted to maintain social connections and encourage socially reinforcing activities. Participants in the control group received usual care with existing COVID-19 wellbeing resources. The primary clinical outcome was self-reported depression severity, assessed by the PHQ-9, at 3 months. Outcomes were assessed masked to allocation and analysis was by treatment allocation. This trial is registered with the ISRCTN registry (ISRCTN63034289). FINDINGS Between Feb 8, 2021, and Feb 28, 2022, 449 eligible participants were identified and 435 from 26 general practices were recruited and randomly assigned (1:1) to the behavioural activation intervention (n=218) or to the control group (usual care with signposting; n=217). The mean age of participants was 75·7 years (SD 6·7); 270 (62·1%) of 435 participants were female, and 418 (96·1%) were White. Participants in the intervention group attended an average of 5·2 (SD 2·9) of eight remote behavioural activation sessions. The adjusted mean difference in PHQ-9 scores between the control and intervention groups at 3 months was -1·65 (95% CI -2·54 to -0·75, p=0·0003). No adverse events were reported that were attributable to the behavioural activation intervention. INTERPRETATION Behavioural activation is an effective and potentially scalable intervention that can reduce symptoms of depression and emotional loneliness in at-risk groups in the short term. The findings of this trial add to the range of strategies to improve the mental health of older adults with multiple long-term conditions. These results can be helpful to policy makers beyond the pandemic in reducing the global burden of depression and addressing the health impacts of loneliness, particularly in at-risk groups. FUNDING UK National Institute for Health and Care Research.
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Affiliation(s)
- Simon Gilbody
- Department of Health Sciences, University of York, York, UK; Hull York Medical School, University of York, York, UK.
| | - Elizabeth Littlewood
- Department of Health Sciences, University of York, York, UK; Tees, Esk and Wear Valleys NHS Foundation Trust, Research & Development, Flatts Lane Centre, Middlesbrough, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK; Hull York Medical School, University of York, York, UK; Tees, Esk and Wear Valleys NHS Foundation Trust, Research & Development, Flatts Lane Centre, Middlesbrough, UK
| | - Lucy Atha
- Department of Health Sciences, University of York, York, UK
| | - Della Bailey
- Department of Health Sciences, University of York, York, UK
| | - Kalpita Baird
- Department of Health Sciences, University of York, York, UK
| | - Samantha Brady
- Department of Health Sciences, University of York, York, UK
| | - Lauren Burke
- Department of Health Sciences, University of York, York, UK
| | | | - Peter Coventry
- Department of Health Sciences, University of York, York, UK; York Environmental Sustainability Institute, University of York, York, UK
| | | | | | - Andrew Henry
- Department of Health Sciences, University of York, York, UK; Tees, Esk and Wear Valleys NHS Foundation Trust, Research & Development, Flatts Lane Centre, Middlesbrough, UK
| | - Kelly Hollingsworth
- Department of Health Sciences, University of York, York, UK; Tees, Esk and Wear Valleys NHS Foundation Trust, Research & Development, Flatts Lane Centre, Middlesbrough, UK
| | | | - Eloise Ryde
- Department of Health Sciences, University of York, York, UK; Tees, Esk and Wear Valleys NHS Foundation Trust, Research & Development, Flatts Lane Centre, Middlesbrough, UK
| | | | - Han-I Wang
- Department of Health Sciences, University of York, York, UK
| | | | | | - Andrew Clegg
- School of Medicine, University of Leeds, Leeds, UK
| | - Sarah Dexter-Smith
- Tees, Esk and Wear Valleys NHS Foundation Trust, Research & Development, Flatts Lane Centre, Middlesbrough, UK
| | | | | | - Andrew Hill
- School of Medicine, University of Leeds, Leeds, UK
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
| | - Claire Sloan
- Department of Health Sciences, University of York, York, UK
| | | | | | - David Ekers
- Department of Health Sciences, University of York, York, UK; Tees, Esk and Wear Valleys NHS Foundation Trust, Research & Development, Flatts Lane Centre, Middlesbrough, UK
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Chua CMS, Chua JYX, Shorey S. Effectiveness of home-based interventions in improving loneliness and social connectedness among older adults: a systematic review and meta-analysis. Aging Ment Health 2024; 28:1-10. [PMID: 37466183 DOI: 10.1080/13607863.2023.2237919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 06/29/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVES To evaluate the effectiveness of home-based interventions in improving loneliness and social connectedness (primary outcomes), and depressive symptoms (secondary outcome) among older adults. METHODS Eight electronic databases were searched from inception dates to February 2022. Meta-analyses were conducted using a random-effect model. Heterogeneity was assessed using I2 statistics and Cochran's Q chi-squared test. The Cochrane risk of bias tool and the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to appraise the included studies. RESULTS Fourteen randomized controlled trials were included. Home-based interventions were found to significantly increase older adults' social connectedness (social support and social engagement) and reduce their loneliness and depressive symptoms. Subgroup analyses suggested that interventions which lasted more than three months and were delivered using mixed platforms were more favorable. Both professional-led and volunteer-led interventions showed favorable results. CONCLUSIONS Future studies could be conducted in varied geographical regions and consider carrying out follow-up assessments. Home-based interventions could be improved by being more than months, delivered by mixed personnel, and using mixed platforms. Considering the low-quality rating by the GRADE approach, future research is needed to confirm current findings.
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Affiliation(s)
- Crystal Min Siu Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Joelle Yan Xin Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Chen S, Lan X, Yu H. A social network analysis: mental health scales used during the COVID-19 pandemic. Front Psychiatry 2023; 14:1199906. [PMID: 37706038 PMCID: PMC10495585 DOI: 10.3389/fpsyt.2023.1199906] [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] [Received: 04/04/2023] [Accepted: 08/11/2023] [Indexed: 09/15/2023] Open
Abstract
Introduction The focus on psychological issues during COVID-19 has led to the development of large surveys that involve the use of mental health scales. Numerous mental health measurements are available; choosing the appropriate measurement is crucial. Methods A rule-based named entity recognition was used to recognize entities of mental health scales that occur in the articles from PubMed. The co-occurrence networks of mental health scales and Medical Subject Headings (MeSH) terms were constructed by Gephi. Results Five types of MeSH terms were filtered, including research objects, research topics, research methods, countries/regions, and factors. Seventy-eight mental health scales were discovered. Discussion The findings provide insights on the scales used most often during the pandemic, the key instruments used to measure healthcare workers' physical and mental health, the scales most often utilized for assessing maternal mental health, the tools used most commonly for assessing older adults' psychological resilience and loneliness, and new COVID-19 mental health scales. Future studies may use these findings as a guiding reference and compass.
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Affiliation(s)
| | - Xue Lan
- Department of Health Management, China Medical University, Shenyang, China
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Brinkhof LP, Ridderinkhof KR, Murre JMJ, Krugers HJ, de Wit S. Improving goal striving and resilience in older adults through a personalized metacognitive self-help intervention: a protocol paper. BMC Psychol 2023; 11:223. [PMID: 37542308 PMCID: PMC10403928 DOI: 10.1186/s40359-023-01259-3] [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: 04/26/2023] [Accepted: 07/21/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Successful aging is often linked to individual's ability to demonstrate resilience: the maintenance or quick recovery of functional ability, well-being, and quality of life despite losses or adversity. A crucial element of resilience is behavioral adaptability, which refers to the adaptive changes in behavior in accordance with internal or external demands. Age-related degradation of executive functions can, however, lead to volition problems that compromise flexible adjustment of behavior. In contrast, the reliance on habitual control has been shown to remain relatively intact in later life and may therefore provide an expedient route to goal attainment among older adults. In the current study, we examine whether a metacognitive self-help intervention (MCSI), aimed at facilitating goal striving through the gradual automatization of efficient routines, could effectively support behavioral adaptability in favor of resilience among older adults with and without (sub-clinical) mental health problems. METHODS This metacognitive strategy draws on principles from health and social psychology, as well as clinical psychology, and incorporates elements of established behavioral change and activation techniques from both fields. Additionally, the intervention will be tailored to personal needs and challenges, recognizing the significant diversity that exist among aging individuals. DISCUSSION Despite some challenges that may limit the generalizability of the results, our MCSI program offers a promising means to empower older adults with tools and strategies to take control of their goals and challenges. This can promote autonomy and independent functioning, and thereby contribute to adaptability and resilience in later life. TRIAL REGISTRATION Pre-registered, partly retrospectively. This study was pre-registered before the major part of the data was collected, created, and realized. Only a small part of the data of some participants (comprising the baseline and other pre-intervention measures), and the full dataset of the first few participants, was collected prior to registration, but it was not accessed yet. See: https://osf.io/5b9xz.
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Affiliation(s)
- Lotte P Brinkhof
- Department of Psychology, Faculty of Behavioral and Social Sciences, University of Amsterdam, Amsterdam, Netherlands.
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands.
- Amsterdam Brain & Cognition (ABC), University of Amsterdam, Amsterdam, Netherlands.
| | - K Richard Ridderinkhof
- Department of Psychology, Faculty of Behavioral and Social Sciences, University of Amsterdam, Amsterdam, Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Brain & Cognition (ABC), University of Amsterdam, Amsterdam, Netherlands
| | - Jaap M J Murre
- Department of Psychology, Faculty of Behavioral and Social Sciences, University of Amsterdam, Amsterdam, Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Brain & Cognition (ABC), University of Amsterdam, Amsterdam, Netherlands
| | - Harm J Krugers
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Brain & Cognition (ABC), University of Amsterdam, Amsterdam, Netherlands
- Faculty of Science, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Sanne de Wit
- Department of Psychology, Faculty of Behavioral and Social Sciences, University of Amsterdam, Amsterdam, Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Brain & Cognition (ABC), University of Amsterdam, Amsterdam, Netherlands
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Bryant R, Dawson K, Azevedo S, Yadav S, Tran J, Choi-Christou J, Andrew E, Beames J, Keyan D. Positive affect training to reduce mental health problems during the COVID-19 pandemic: a proof-of-concept randomised clinical trial. BMJ MENTAL HEALTH 2023; 26:e300737. [PMID: 37385663 PMCID: PMC10577780 DOI: 10.1136/bmjment-2023-300737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/12/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND The social restrictions occurring during the pandemic contributed to loss of many sources of reward, which contributes to poor mental health. OBJECTIVE This trial evaluated a brief positive affect training programme to reduce anxiety, depression and suicidality during the pandemic. METHODS In this single-blind, parallel, randomised controlled trial, adults who screened positive for COVID-19-related psychological distress across Australia were randomly allocated to either a 6-session group-based programme based on positive affect training (n=87) or enhanced usual care (EUC, n=87). Primary outcome was total score on the Hospital Anxiety and Depression Scale-anxiety and depression subscales assessed at baseline, 1-week post-treatment, 3 months (primary outcome time point) as well as secondary outcome measures of suicidality, generalised anxiety disorder, sleep impairment, positive and negative mood and COVID-19-related stress. FINDINGS Between 20 September 2020 and 16 September 2021, 174 participants were enrolled into the trial. Relative to EUC, at 3-month follow-up the intervention led to greater reduction on depression (mean difference 1.2 (95% CI 0.4 to 1.9)), p=0.003), with a moderate effect size (0.5 (95% CI 0.2 to 0.9)). There were also greater reduction of suicidality and improvement in quality of life. There were no differences in anxiety, generalised anxiety, anhedonia, sleep impairment, positive or negative mood or COVID-19 concerns. CONCLUSIONS This intervention was able to reduce depression and suicidality during adverse experiences when rewarding events were diminished, such as pandemics. CLINICAL IMPLICATIONS Strategies to improve positive affect may be useful to reduce mental health issues. TRIAL REGISTRATION NUMBER ACTRN12620000811909.
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Affiliation(s)
- Richard Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Katie Dawson
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Suzanna Azevedo
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Srishti Yadav
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Jenny Tran
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Jasmine Choi-Christou
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Elpiniki Andrew
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Joanne Beames
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Dharani Keyan
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
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Li M, Rao W, Su Y, Sul Y, Caron G, D'Arcy C, Fleury MJ, Meng X. Psychological interventions for loneliness and social isolation among older adults during medical pandemics: a systematic review and meta-analysis. Age Ageing 2023; 52:7192245. [PMID: 37290121 DOI: 10.1093/ageing/afad076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVES There is little research conducted to systematically synthesize the evidence on psychological interventions for social isolation and loneliness among older adults during medical pandemics. This systematic review aims to address this information gap and provides guidance for planning and implementing interventions to prevent and reduce loneliness and social isolation for older adults, especially during medical pandemics. METHODS Four electronic databases (EMBASE, PsychoInfo, Medline and Web of Science) and grey literature from 1 January 2000 to 13 September 2022 were searched for eligible studies on loneliness and social isolation. Data extraction and methodological quality assessment on key study characteristics were conducted independently by two researchers. Both qualitative synthesis and meta-analysis were used. RESULTS The initial search yielded 3,116 titles. Of the 215 full texts reviewed, 12 intervention articles targeting loneliness during the COVID-19 pandemic met the inclusion criteria. No studies were found concerning intervention with respect to social isolation. Overall, interventions targeting social skills and the elimination of negativities effectively alleviated the feelings of loneliness in the older population. However, they had only short-term effects. CONCLUSION This review systematically summarised the key characteristics and the effectiveness of existing interventions addressing loneliness in older adults during the COVID-19 pandemic. Future interventions should focus on social skills and eliminating negativities and be tailored to the needs and characteristics of older people. Repeated larger-scale randomized controlled trials and long-term effectiveness evaluations on this topic are warranted.
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Affiliation(s)
- Muzi Li
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec H3A1A1, Canada
- Douglas Research Centre, Montreal, Quebec H4H 1R3, Canada
| | - Wenwang Rao
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec H3A1A1, Canada
- Douglas Research Centre, Montreal, Quebec H4H 1R3, Canada
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong 515041, China
| | - Yingying Su
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec H3A1A1, Canada
- Douglas Research Centre, Montreal, Quebec H4H 1R3, Canada
| | - Youngjoo Sul
- Department of Anatomy & Cell Biology, McGill University, Montreal, Quebec H3A0G4, Canada
| | - Gabriel Caron
- Douglas Research Centre, Montreal, Quebec H4H 1R3, Canada
| | - Carl D'Arcy
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan S7N5E5, Canada
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan S7N5E5, Canada
| | - Marie-Josee Fleury
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec H3A1A1, Canada
- Douglas Research Centre, Montreal, Quebec H4H 1R3, Canada
| | - Xiangfei Meng
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec H3A1A1, Canada
- Douglas Research Centre, Montreal, Quebec H4H 1R3, Canada
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11
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Ribeiro-Gonçalves JA, Costa PA, Leal I. Double Stigma in Portuguese Lesbian, Gay, and Bisexual Older Adults: A Study of Health Status. JOURNAL OF SEX & MARITAL THERAPY 2023; 49:886-901. [PMID: 37222608 DOI: 10.1080/0092623x.2023.2215258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The double stigma-sexual stigma and ageism-can affect the health status of lesbian, gay, and bisexual (LGB) older adults, but little is known about this topic in Portugal and internationally. The aim of this study was to assess the health status and the prevalence of chronic diseases of Portuguese LGB older adults, as well as to assess the relationship between double stigma and health status. A sample of 280 Portuguese LGB older adults completed a chronic disease questionnaire, the Homosexuality-Related Stigma Scale, the Ambivalent Ageism Scale, and the SF-12 Short Form Health Survey. A structural equation model was performed using the double stigma variables as independent variables and health status as outcome. The mental health status of Portuguese LGB older adults was lower when compared to people from studies from more than 10 countries. Higher sexual self-stigma, sexual enacted stigma related to health care, and benevolent ageism significantly explained the worse general health status. The double stigma significantly affects the health status of these older adults in a profile of internalization of sexual stigma and benevolent age discrimination, and not necessarily by a hostile/aggressive profile. More research is needed on the double stigma.
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Affiliation(s)
| | | | - Isabel Leal
- William James Center for Research, ISPA - University Institute, Lisbon, Portugal
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12
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Yu DSF, Li PWC, Lin RSY, Kee F, Chiu A, Wu W. Effects of non-pharmacological interventions on loneliness among community-dwelling older adults: A systematic review, network meta-analysis, and meta-regression. Int J Nurs Stud 2023; 144:104524. [PMID: 37295285 DOI: 10.1016/j.ijnurstu.2023.104524] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND The highly prevalent late-life loneliness, together with its deleterious health impacts, calls for increasing attention to the need for effective interventions targeting on this growing public health problem. With the increasing evidence on interventions for combating loneliness, it is timely to identify their comparative effectiveness. OBJECTIVE This systematic review, meta-analysis and network meta-analysis was to identify and compare the effects of various non-pharmacological interventions on loneliness in community-dwelling older adults. METHODS Systematic search was conducted in nine electronic databases from inception to 30th March 2023 for studies investigating the effects of non-pharmacological interventions on loneliness among community-dwelling older adults. The interventions were categorized according to the nature and purpose of use. Pairwise meta-analysis and network meta-analyses were sequentially performed to identify the effects of each category of interventions and their comparative intervention effectiveness, respectively. Meta-regression was performed to examine any influence of study design and participants' characteristics on the intervention effectiveness. The study protocol was registered at PROSPERO (CRD42022307621). RESULTS A total of 60 studies with 13,295 participants were included. The interventions were categorized as psychological interventions, social support interventions (by digital and non-digital means), behavioral activation, exercise intervention with and without social engagement, multi-component intervention and health promotion. Pairwise meta-analysis identified the positive effect of psychological interventions (Hedges' g = -2.33; 95%CI [-4.40, -0.25]; Z = -2.20, p = 0.003), non-digital social support interventions (Hedges' g = -0.63; 95%CI [-1.16, -0.10]; Z = 2.33, p = 0.02) and multi-component interventions (Hedges' g = -0.28 95%CI [-0.54, -0.03]; Z = -2.15, p = 0.03) on reducing loneliness. Subgroup analysis provided additional insights: i) social support and exercise interventions which integrated active strategies to optimize the social engagement demonstrated more promising intervention effects; ii) behavioral activation and multicomponent interventions worked better for older adults who were male or reported loneliness, respectively, and iii) counseling-based psychological interventions was more effective than mind-body practice. Network meta-analysis consistently pointed to the greatest therapeutic benefits of psychological interventions, and this was followed by exercise-based interventions, non-digital social support interventions and behavioral activation. Meta-regression further suggested that the therapeutic effects of the tested interventions were independent of the various factors relating to study design and participants' characteristics. CONCLUSIONS This review highlights the more superior effects of psychological interventions in improving loneliness among older adults. Interventions which have an attribute to optimize social dynamic and connectivity may also be effective. TWEETABLE ABSTRACT Psychological intervention is the best to beat late-life loneliness, but increasing social dynamic and connectivity may add an impact.
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Affiliation(s)
- Doris Sau-Fung Yu
- School of Nursing, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong.
| | - Polly Wai-Chi Li
- School of Nursing, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Rose Sin-Yi Lin
- School of Nursing, University of Rochester, United States of America
| | - Frank Kee
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, Queen's University Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Alice Chiu
- Improving Health Outcomes Together Team, Alberta Health Services, Calgary, Alberta, Canada
| | - Wendy Wu
- School of Nursing, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
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Shearsmith L, Coventry PA, Sloan C, Henry A, Newbronner L, Littlewood E, Bailey D, Gascoyne S, Burke L, Ryde E, Woodhouse R, McMillan D, Ekers D, Gilbody S, Chew-Graham C. Acceptability of a behavioural intervention to mitigate the psychological impacts of COVID-19 restrictions in older people with long-term conditions: a qualitative study. BMJ Open 2023; 13:e064694. [PMID: 36914198 PMCID: PMC10015671 DOI: 10.1136/bmjopen-2022-064694] [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: 03/14/2023] Open
Abstract
OBJECTIVES The COVID-19 pandemic heightened the need to address loneliness, social isolation and associated incidence of depression among older adults. Between June and October 2020, the Behavioural Activation in Social IsoLation (BASIL) pilot study investigated the acceptability and feasibility of a remotely delivered brief psychological intervention (behavioural cctivation) to prevent and reduce loneliness and depression in older people with long-term conditions during the COVID-19 pandemic. DESIGN An embedded qualitative study was conducted. Semi-structured interviews generated data that was analysed inductively using thematic analysis and then deductively using the theoretical framework of acceptability (TFA). SETTING NHS and third sector organisations in England. PARTICIPANTS Sixteen older adults and nine support workers participating in the BASIL pilot study. RESULTS Acceptability of the intervention was high across all constructs of the TFA: Older adults and BASIL Support Workers described a positive Affective Attitude towards the intervention linked to altruism, however the activity planning aspect of the intervention was limited due to COVID-19 restrictions. A manageable Burden was involved with delivering and participating in the intervention. For Ethicality, older adults valued social contact and making changes, support workers valued being able to observe those changes. The intervention was understood by older adults and support workers, although less understanding in older adults without low mood (Intervention Coherence). Opportunity Cost was low for support workers and older adults. Behavioural Activation was perceived to be useful in the pandemic and likely to achieve its aims (Perceived Effectiveness), especially if tailored to people with both low mood and long-term conditions. Self-efficacy developed over time and with experience for both support workers and older adults. CONCLUSIONS Overall, BASIL pilot study processes and the intervention were acceptable. Use of the TFA provided valuable insights into how the intervention was experienced and how the acceptability of study processes and the intervention could be enhanced ahead of the larger definitive trial (BASIL+).
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Affiliation(s)
| | - Peter A Coventry
- Department of Health Sciences, University of York, York, UK
- York Environmental Sustainability Institute, University of York, York, UK
| | - Claire Sloan
- Department of Health Sciences, University of York, York, UK
| | - Andrew Henry
- Department of Health Sciences, University of York, York, UK
- Research and Development, Tees Esk and Wear Valleys NHS Foundation Trust, Flatts Lane Centre, Middlesbrough, UK
| | - Liz Newbronner
- Department of Health Sciences, University of York, York, UK
| | | | - Della Bailey
- Department of Health Sciences, University of York, York, UK
| | | | - Lauren Burke
- Department of Health Sciences, University of York, York, UK
| | - Eloise Ryde
- Department of Health Sciences, University of York, York, UK
- Research and Development, Tees Esk and Wear Valleys NHS Foundation Trust, Flatts Lane Centre, Middlesbrough, UK
| | | | - Dean McMillan
- Department of Health Sciences, University of York, York, UK
- Mental Health and Addiction Research Group, Hull York Medical School, Hull, UK
| | - David Ekers
- Department of Health Sciences, University of York, York, UK
- Research and Development, Tees Esk and Wear Valleys NHS Foundation Trust, Flatts Lane Centre, Middlesbrough, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
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14
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Hao X, Qin Y, Lv M, Zhao X, Wu S, Li K. Effectiveness of telehealth interventions on psychological outcomes and quality of life in community adults during the COVID-19 pandemic: A systematic review and meta-analysis. Int J Ment Health Nurs 2023. [PMID: 36808863 DOI: 10.1111/inm.13126] [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] [Received: 05/11/2022] [Revised: 11/09/2022] [Accepted: 01/24/2023] [Indexed: 02/22/2023]
Abstract
Physical distancing and contact restrictions have been implemented in most countries and territories due to the rapid spread of SARS-CoV-2. This has caused physical, emotional, and psychological distress for adults living in the community. Diversified telehealth interventions have been widely applied in health care and have proven to be cost-effective and well accepted by patients and health professionals. Currently, the effectiveness of telehealth interventions on psychological outcomes and quality of life among community adults during the COVID-19 pandemic remains unclear. A literature search was conducted using PubMed, PsycINFO, CINAHL, EMBASE, MEDLINE, and the Cochrane Library from 2019 to October 2022. Twenty-five randomized controlled trials with 3228 subjects were finally included in this review. Two independent reviewers performed the screening, extraction of key data points, and appraisal of the methodological quality. There were positive effects of telehealth interventions on anxiety, stress, loneliness, and well-being among community adults. Participants who were women or older adults were more likely to recover from negative emotions, increase well-being, and improve quality of life. The real-time and interactive interventions and remote cognitive-behavioural therapy (CBT) may be better choices during the COVID-19 pandemic. Based on the findings of this review, health professionals have more options and alternatives for delivering telehealth interventions in the future. Rigorously designed randomized controlled trials (RCTs) with higher statistical power and long-term follow-up should be conducted in the future to strengthen the currently weak evidence.
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Affiliation(s)
- Xiaonan Hao
- School of Nursing, Jilin University, Changchun, China
| | - Yuan Qin
- School of Nursing, Jilin University, Changchun, China
| | - Miaohua Lv
- School of Nursing, Jilin University, Changchun, China
| | - Xuetong Zhao
- School of Nursing, Jilin University, Changchun, China
| | - Shuang Wu
- School of Nursing, Jilin University, Changchun, China
| | - Kun Li
- School of Nursing, Jilin University, Changchun, China
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15
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Rojo-Perez F, Rodriguez-Rodriguez V, Fernandez-Mayoralas G, Sánchez-González D, Perez de Arenaza Escribano C, Rojo-Abuin JM, Forjaz MJ, Molina-Martínez MÁ, Rodriguez-Blazquez C. Residential Environment Assessment by Older Adults in Nursing Homes during COVID-19 Outbreak. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16354. [PMID: 36498426 PMCID: PMC9739633 DOI: 10.3390/ijerph192316354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
The most vulnerable residential settings during the COVID-19 pandemic were older adult's nursing homes, which experienced high rates of incidence and death from this cause. This paper aims to ascertain how institutionalized older people assessed their residential environment during the pandemic and to examine the differences according to personal and contextual characteristics. The COVID-19 Nursing Homes Survey (Madrid region, Spain) was used. The residential environment assessment scale (EVAER) and personal and contextual characteristics were selected. Descriptive and multivariate statistical analysis were applied. The sample consisted of 447 people (mean age = 83.8, 63.1% = women, 50.8% = widowed, 40% = less than primary studies). Four residential assessment subscales (relationships, mobility, residential aspects, privacy space) and three clusters according to residential rating (medium-high with everything = 71.5% of cases, low with mobility = 15.4%, low with everything = 13.1%) were obtained. The logistic regression models for each cluster category showed to be statistically significant. Showing a positive affect (OR = 1.08), fear of COVID-19 (OR = 1.06), high quality of life (OR = 1.05), not having suspicion of depression (OR = 0.75) and performing volunteer activities (OR = 3.67) were associated with the largest cluster. It is concluded that a better residential evaluation was related to more favourable personal and contextual conditions. These results can help in the design of nursing homes for older adults in need of accommodation and care to facilitate an age-friendly environment.
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Affiliation(s)
- Fermina Rojo-Perez
- Grupo de Investigacion sobre Envejecimiento (GIE), IEGD, CSIC, 28037 Madrid, Spain
| | | | | | - Diego Sánchez-González
- Department of Geography, National Distance Education University (UNED), 28040 Madrid, Spain
| | | | | | - Maria João Forjaz
- National Centre of Epidemiology and Health Service Research Network on Chronic Diseases (REDISSEC) and Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Carlos III Institute of Health, 28029 Madrid, Spain
| | - María-Ángeles Molina-Martínez
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, National Distance Education University (UNED), 28040 Madrid, Spain
| | - Carmen Rodriguez-Blazquez
- National Centre of Epidemiology and Network Centre for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, 28029 Madrid, Spain
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16
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Grenier C, Loniewski M, Plazy M, Onaisi R, Doucet MH, Joseph JP, Duvignaud A, Malvy D, Anglaret X, Orne-Gliemann J. Implementing an outpatient clinical trial on COVID-19 treatment in an emergency epidemic context: a mixed methods study among operational and research stakeholders within the Coverage trial, Bordeaux (France). Arch Public Health 2022; 80:245. [PMID: 36463300 PMCID: PMC9719237 DOI: 10.1186/s13690-022-00999-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 11/09/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The emergency set-up and implementation of outpatient clinical trials on epidemic emerging infectious diseases such as COVID-19 raise many issues in terms of research structuration, regulations, and health systems organization. We aimed to describe the experience and points of view of different stakeholders involved in a French home-based outpatient trial on COVID-19 and to identify the early barriers and facilitators to the trial implementation. METHODS We conducted a mixed-methods study in July 2020. A self-administered questionnaire was emailed to 213 clinical, operational and research stakeholders involved in the Coverage trial; individual semi-directed interviews were conducted among 14 stakeholders. Questionnaire data and written interview notes are presented together by key theme. RESULTS One hundred fifty six stakeholders responded to the questionnaire. 53.4% did not have prior experience in clinical research. The motivation of most stakeholders to participate in the Coverage trial was to feel useful during the pandemic. 87.9% agreed that the trial had an unusual set-up timeframe, and many regretted a certain lack of regulatory flexibility. Mobile medical teams and specific professional skills were perceived as instrumental for outpatient research. CONCLUSIONS The implementation of a home-based outpatient clinical trial on COVID-19 was perceived as relevant and innovative although requiring important adaptations of usual professional responsibilities and standard research procedures. Lessons learned from the Coverage trial underline the need for improved networks between hospital and community medicine, and call for a dedicated and reactive outpatient research platform on emerging or threatening infectious diseases.
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Affiliation(s)
- Carine Grenier
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Research Centre, Bordeaux, France ,Research Institute for Sustainable Development (IRD) EMR 271, GHiGS, Bordeaux, France
| | - Macha Loniewski
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Research Centre, Bordeaux, France ,Research Institute for Sustainable Development (IRD) EMR 271, GHiGS, Bordeaux, France
| | - Mélanie Plazy
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Research Centre, Bordeaux, France ,Research Institute for Sustainable Development (IRD) EMR 271, GHiGS, Bordeaux, France
| | - Racha Onaisi
- grid.412041.20000 0001 2106 639XDepartment of General Practice, University of Bordeaux, Bordeaux, France
| | - Marie-Hélène Doucet
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Research Centre, Bordeaux, France ,Research Institute for Sustainable Development (IRD) EMR 271, GHiGS, Bordeaux, France
| | - Jean-Philippe Joseph
- grid.412041.20000 0001 2106 639XDepartment of General Practice, University of Bordeaux, Bordeaux, France
| | - Alexandre Duvignaud
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Research Centre, Bordeaux, France ,Research Institute for Sustainable Development (IRD) EMR 271, GHiGS, Bordeaux, France ,grid.42399.350000 0004 0593 7118Department of Infectious Diseases and Tropical Medicine, Division of Tropical Medicine and Clinical International Health, CHU Bordeaux, Bordeaux, France
| | - Denis Malvy
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Research Centre, Bordeaux, France ,Research Institute for Sustainable Development (IRD) EMR 271, GHiGS, Bordeaux, France ,grid.42399.350000 0004 0593 7118Department of Infectious Diseases and Tropical Medicine, Division of Tropical Medicine and Clinical International Health, CHU Bordeaux, Bordeaux, France
| | - Xavier Anglaret
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Research Centre, Bordeaux, France ,Research Institute for Sustainable Development (IRD) EMR 271, GHiGS, Bordeaux, France
| | - Joanna Orne-Gliemann
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Research Centre, Bordeaux, France ,Research Institute for Sustainable Development (IRD) EMR 271, GHiGS, Bordeaux, France
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17
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Littlewood E, McMillan D, Chew Graham C, Bailey D, Gascoyne S, Sloane C, Burke L, Coventry P, Crosland S, Fairhurst C, Henry A, Hewitt C, Baird K, Ryde E, Shearsmith L, Traviss-Turner G, Woodhouse R, Webster J, Meader N, Churchill R, Eddy E, Heron P, Hicklin N, Shafran R, Almeida O, Clegg A, Gentry T, Hill A, Lovell K, Dexter-Smith S, Ekers D, Gilbody S. Can we mitigate the psychological impacts of social isolation using behavioural activation? Long-term results of the UK BASIL urgent public health COVID-19 pilot randomised controlled trial and living systematic review. EVIDENCE-BASED MENTAL HEALTH 2022; 25:e49-e57. [PMID: 36223980 PMCID: PMC9811092 DOI: 10.1136/ebmental-2022-300530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Behavioural and cognitive interventions remain credible approaches in addressing loneliness and depression. There was a need to rapidly generate and assimilate trial-based data during COVID-19. OBJECTIVES We undertook a parallel pilot RCT of behavioural activation (a brief behavioural intervention) for depression and loneliness (Behavioural Activation in Social Isolation, the BASIL-C19 trial ISRCTN94091479). We also assimilate these data in a living systematic review (PROSPERO CRD42021298788) of cognitive and/or behavioural interventions. METHODS Participants (≥65 years) with long-term conditions were computer randomised to behavioural activation (n=47) versus care as usual (n=49). Primary outcome was PHQ-9. Secondary outcomes included loneliness (De Jong Scale). Data from the BASIL-C19 trial were included in a metanalysis of depression and loneliness. FINDINGS The 12 months adjusted mean difference for PHQ-9 was -0.70 (95% CI -2.61 to 1.20) and for loneliness was -0.39 (95% CI -1.43 to 0.65).The BASIL-C19 living systematic review (12 trials) found short-term reductions in depression (standardised mean difference (SMD)=-0.31, 95% CI -0.51 to -0.11) and loneliness (SMD=-0.48, 95% CI -0.70 to -0.27). There were few long-term trials, but there was evidence of some benefit (loneliness SMD=-0.20, 95% CI -0.40 to -0.01; depression SMD=-0.20, 95% CI -0.47 to 0.07). DISCUSSION We delivered a pilot trial of a behavioural intervention targeting loneliness and depression; achieving long-term follow-up. Living meta-analysis provides strong evidence of short-term benefit for loneliness and depression for cognitive and/or behavioural approaches. A fully powered BASIL trial is underway. CLINICAL IMPLICATIONS Scalable behavioural and cognitive approaches should be considered as population-level strategies for depression and loneliness on the basis of a living systematic review.
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Affiliation(s)
| | - Dean McMillan
- Health Sciences, University of York, York, UK
- Centre for Health and Population Science, Hull York Medical School, Hull, UK
| | | | | | | | | | | | - Peter Coventry
- Health Sciences, University of York, York, UK
- York Environmental Sustainability Institute, University of York, York, UK
| | | | | | | | | | | | - Eloise Ryde
- Health Sciences, University of York, York, UK
- Research and Development Unit, Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | | | | | | | - Judith Webster
- Research and Development Unit, Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - Nick Meader
- Faculty of Medical Sciences, University of Newcastle, Newcastle upon Tyne, UK
| | - Rachel Churchill
- Cochrane Common Mental Disorders Group, University of York, York, UK
| | - Elizabeth Eddy
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Paul Heron
- Health Sciences, University of York, York, UK
| | - Nisha Hicklin
- Department of Psychology, Royal Holloway University of London, Egham, UK
| | - Roz Shafran
- PPP, University College London Institute of Child Health, London, UK
- Paediatric Psychology Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Osvaldo Almeida
- UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Andrew Clegg
- Faculty of Medicine and Health, University of Leeds, Leeds, UK
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Tom Gentry
- Health and Care Policy, Age UK, London, UK
| | - Andrew Hill
- Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Sarah Dexter-Smith
- Research and Development Unit, Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - David Ekers
- Health Sciences, University of York, York, UK
- Research and Development Unit, Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - Simon Gilbody
- Health Sciences, University of York, York, UK
- Centre for Health and Population Sciences, Hull York Medical School, York, UK
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18
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Almeida OP, Patel H, Velasquez D, Kelly R, Lai R, Ford AH, Curran E, Flicker L, Chong TWH, Etherton-Beer C, LoGiudice D, Ellis KA, Martini A, Westphal A, Ekers D, Gilbody S, Lautenschlager NT. Behavioral Activation in Nursing Homes to Treat Depression (BAN-Dep): Results From a Clustered, Randomized, Single-Blinded, Controlled Clinical Trial. Am J Geriatr Psychiatry 2022; 30:1313-1323. [PMID: 35680539 DOI: 10.1016/j.jagp.2022.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To determine if behavioral activation (BA) delivered by trained staff decreases prevalence of clinically significant symptoms of depression among older adults living in residential aged care facilities (RACFs). METHODS Clustered, randomized, single-blinded, controlled trial of BA for adults aged over 60 years living permanently in a RACF with symptoms of depression (Patient Health Questionnaire, PHQ-9 ≥ 5). BA was delivered over 8-12 weeks using a structured workbook. The proportion of residents with PHQ-9 ≥ 10 at weeks 12, 26, and 52, as well as anxiety symptoms (GAD-7), physical (PCS), and mental (MCS) quality of life, loneliness, and loss to follow-up were main outcomes of interest RESULTS: We recruited 54 RACFs (26 intervention) and 188 of their residents (89 intervention). Participants were aged 61-100 years and 132 (70.2%) were women. PHQ-9 ≥ 10 interacted with BA at week 12 (OR = 0.34, 95%CI = 0.11-1.07), but differences between the groups were not statistically significant at any time-point. GAD-7 ≥ 10 interacted with BA at week 26 (OR = 0.12, 95%CI = 0.02-0.58), but not at any other time-point. Overall, the intervention had no effect on the scores of the PHQ-9, GAD-7, PCS, MCS, and loneliness scale. Loss to follow-up was similar between groups. Adherence to all stages of the intervention was poor (36.2%). CONCLUSIONS Disruption by the COVID-19 pandemic and staffing issues in RACFs undermined recruitment and adherence. In such a context, a BA program delivered by RACF staff was not associated with better mental health outcomes for residents over 52 weeks.
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Affiliation(s)
- Osvaldo P Almeida
- Medical School (OPA, HP, RK, AHF, LF, CE-B), University of Western Australia, Perth, Australia.
| | - Hema Patel
- Medical School (OPA, HP, RK, AHF, LF, CE-B), University of Western Australia, Perth, Australia
| | - Diana Velasquez
- Department of Psychiatry (DV, RL, EC, TWHC, KAE, AW, NTL), University of Melbourne, Melbourne, Australia
| | - Rachael Kelly
- Medical School (OPA, HP, RK, AHF, LF, CE-B), University of Western Australia, Perth, Australia
| | - Rhoda Lai
- Department of Psychiatry (DV, RL, EC, TWHC, KAE, AW, NTL), University of Melbourne, Melbourne, Australia
| | - Andrew H Ford
- Medical School (OPA, HP, RK, AHF, LF, CE-B), University of Western Australia, Perth, Australia
| | - Eleanor Curran
- Department of Psychiatry (DV, RL, EC, TWHC, KAE, AW, NTL), University of Melbourne, Melbourne, Australia; NorthWestern Mental Health (EC, NTL), Royal Melbourne Hospital, Melbourne, Australia
| | - Leon Flicker
- Medical School (OPA, HP, RK, AHF, LF, CE-B), University of Western Australia, Perth, Australia
| | - Terence W H Chong
- Department of Psychiatry (DV, RL, EC, TWHC, KAE, AW, NTL), University of Melbourne, Melbourne, Australia; St Vincent's Hospital Melbourne (TWHC), Melbourne, Australia
| | | | - Dina LoGiudice
- Department of Medicine (DL), University of Melbourne, Melbourne, Australia
| | - Kathryn A Ellis
- Department of Psychiatry (DV, RL, EC, TWHC, KAE, AW, NTL), University of Melbourne, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | | | - Alissa Westphal
- Department of Psychiatry (DV, RL, EC, TWHC, KAE, AW, NTL), University of Melbourne, Melbourne, Australia
| | - David Ekers
- Tees Esk and Wear Valleys NHS FT/MHARG (KAE, DE), University of York, York, UK
| | - Simon Gilbody
- Mental Health and Addictions Research Group (SG), HYMS & University of York, York, UK
| | - Nicola T Lautenschlager
- Department of Psychiatry (DV, RL, EC, TWHC, KAE, AW, NTL), University of Melbourne, Melbourne, Australia; NorthWestern Mental Health (EC, NTL), Royal Melbourne Hospital, Melbourne, Australia
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19
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Geng J, Cheng C, Chen S, Wang Y, Du Y, Long J, Jin Y, Yang H, Duan G. Anxiety, depression, insomnia symptoms & associated factors among young to middle-aged adults during the resurgent epidemic of COVID-19: a cross-sectional study. PSYCHOL HEALTH MED 2022; 28:1336-1346. [PMID: 36334084 DOI: 10.1080/13548506.2022.2143542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is a public health emergency of international concern. However, its stress on the mental health of young to middle-aged adults is largely unexplored. This study aimed to evaluate the mental health difficulties during the resurgent phase of COVID-19 among young to middle-aged adults in China. There were 1,478 participants with a median age of 26 years (IQR, 23 - 30), including 535 males (36.2%). The prevalence of anxiety, depression, and insomnia were 8.6%, 11.4%, and 13.7%, respectively. Participants aged 29 - 59 years (OR, 95% CI: 2.46, 1.23 - 4.91) and females (2.49, 1.55 - 4.01) had a higher risk of anxiety. Education status, worried level about the current COVID-19, and the level of COVID-19's impact on life were significantly associated with the prevalence of anxiety. Besides, the level of COVID-19's impact on life was positively related to the prevalence of depression and insomnia. Our study provided novel evidence of psychological difficulties among young to middle-aged adults during the resurgent stage of the COVID-19 epidemic. Psychological intervention should be continuously implemented to prevent long-term psychological comorbidities during the COVID-19 epidemic.
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Affiliation(s)
- Juan Geng
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Cheng Cheng
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Shuaiyin Chen
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ya Wang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yazhe Du
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Jinzhao Long
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yuefei Jin
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Haiyan Yang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Guangcai Duan
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
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20
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Mind over what matters: How training in emotional self-regulation can strengthen the immune response in lonely elders. Brain Behav Immun 2022; 106:231-232. [PMID: 36058420 DOI: 10.1016/j.bbi.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/22/2022] Open
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21
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Burke L, Littlewood E, Gascoyne S, McMillan D, Chew-Graham CA, Bailey D, Sloan C, Fairhurst C, Baird K, Hewitt C, Henry A, Ryde E, Shearsmith L, Coventry P, Crosland S, Newbronner E, Traviss-Turner G, Woodhouse R, Clegg A, Gentry T, Hill A, Lovell K, Dexter Smith S, Webster J, Ekers D, Gilbody S. Behavioural Activation for Social IsoLation (BASIL+) trial (Behavioural activation to mitigate depression and loneliness among older people with long-term conditions): Protocol for a fully-powered pragmatic randomised controlled trial. PLoS One 2022; 17:e0263856. [PMID: 35324908 PMCID: PMC8947398 DOI: 10.1371/journal.pone.0263856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Depression is a leading mental health problem worldwide. People with long-term conditions are at increased risk of experiencing depression. The COVID-19 pandemic led to strict social restrictions being imposed across the UK population. Social isolation can have negative consequences on the physical and mental wellbeing of older adults. In the Behavioural Activation in Social IsoLation (BASIL+) trial we will test whether a brief psychological intervention (based on Behavioural Activation), delivered remotely, can mitigate depression and loneliness in older adults with long-term conditions during isolation. Methods We will conduct a two-arm, parallel-group, randomised controlled trial across several research sites, to evaluate the clinical and cost-effectiveness of the BASIL+ intervention. Participants will be recruited via participating general practices across England and Wales. Participants must be aged ≥65 with two or more long-term conditions, or a condition that may indicate they are within a ‘clinically extremely vulnerable’ group in relation to COVID-19, and have scored ≥5 on the Patient Health Questionnaire (PHQ9), to be eligible for inclusion. Randomisation will be 1:1, stratified by research site. Intervention participants will receive up to eight intervention sessions delivered remotely by trained BASIL+ Support Workers and supported by a self-help booklet. Control participants will receive usual care, with additional signposting to reputable sources of self-help and information, including advice on keeping mentally and physically well. A qualitative process evaluation will also be undertaken to explore the acceptability of the BASIL+ intervention, as well as barriers and enablers to integrating the intervention into participants’ existing health and care support, and the impact of the intervention on participants’ mood and general wellbeing in the context of the COVID-19 restrictions. Semi-structured interviews will be conducted with intervention participants, participant’s caregivers/supportive others and BASIL+ Support Workers. Outcome data will be collected at one, three, and 12 months post-randomisation. Clinical and cost-effectiveness will be evaluated. The primary outcome is depressive symptoms at the three-month follow up, measured by the PHQ9. Secondary outcomes include loneliness, social isolation, anxiety, quality of life, and a bespoke health services use questionnaire. Discussion This study is the first large-scale trial evaluating a brief Behavioural Activation intervention in this population, and builds upon the results of a successful external pilot trial. Trial registration ClinicalTrials.Gov identifier ISRCTN63034289, registered on 5th February 2021.
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Affiliation(s)
- Lauren Burke
- Department of Health Sciences, University of York, York, United Kingdom
| | | | - Samantha Gascoyne
- Department of Health Sciences, University of York, York, United Kingdom
| | - Dean McMillan
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
| | | | - Della Bailey
- Department of Health Sciences, University of York, York, United Kingdom
| | - Claire Sloan
- Department of Health Sciences, University of York, York, United Kingdom
| | | | - Kalpita Baird
- Department of Health Sciences, University of York, York, United Kingdom
| | - Catherine Hewitt
- Department of Health Sciences, University of York, York, United Kingdom
| | - Andrew Henry
- Department of Health Sciences, University of York, York, United Kingdom
- Tees, Esk and Wear Valleys NHS FT, Research & Development, Flatts Lane Centre, Middlesbrough, United Kingdom
| | - Eloise Ryde
- Department of Health Sciences, University of York, York, United Kingdom
- Tees, Esk and Wear Valleys NHS FT, Research & Development, Flatts Lane Centre, Middlesbrough, United Kingdom
| | - Leanne Shearsmith
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Peter Coventry
- Department of Health Sciences, University of York, York, United Kingdom
| | - Suzanne Crosland
- Department of Health Sciences, University of York, York, United Kingdom
| | | | | | - Rebecca Woodhouse
- Department of Health Sciences, University of York, York, United Kingdom
| | - Andrew Clegg
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Tom Gentry
- Age UK, Tavis House, 1–6 Tavistock Square, London United Kingdom
| | - Andrew Hill
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, United Kingdom
| | - Sarah Dexter Smith
- Tees, Esk and Wear Valleys NHS FT, Research & Development, Flatts Lane Centre, Middlesbrough, United Kingdom
| | | | - David Ekers
- Department of Health Sciences, University of York, York, United Kingdom
- Tees, Esk and Wear Valleys NHS FT, Research & Development, Flatts Lane Centre, Middlesbrough, United Kingdom
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
- * E-mail:
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