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Fabiano N, Gupta A, Fiedorowicz JG, Solmi M. On the value of meta-research for early career researchers: A commentary. JCPP ADVANCES 2024; 4:e12235. [PMID: 38827987 PMCID: PMC11143950 DOI: 10.1002/jcv2.12235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
Meta-research, also known as "research on research" is a field of study that investigates the methods, reporting, reproducibility, evaluation, and incentives along the research continuum. Meta-research literacy is imperative to ensure high quality, transparent and reproducible primary data or meta-research products. In this commentary, we propose that early career researchers should be trained in meta-research as a foundation to develop a deeper understanding of the research process and ability to appraise the research literature and design high-quality original studies, irrespective of their chosen field of study. We discuss the importance of meta-research and open science from the perspective of an early career trainee, highlighting essential areas for growth and obstacles one may encounter.
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Affiliation(s)
| | - Arnav Gupta
- Department of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- College of Public HealthKent State UniversityKentOhioUSA
| | - Jess G. Fiedorowicz
- Department of PsychiatryUniversity of OttawaOttawaOntarioCanada
- Department of Mental HealthThe Ottawa HospitalOttawaOntarioCanada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology ProgramUniversity of OttawaOttawaOntarioCanada
- Faculty of MedicineSchool of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Marco Solmi
- Department of PsychiatryUniversity of OttawaOttawaOntarioCanada
- Department of Mental HealthThe Ottawa HospitalOttawaOntarioCanada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology ProgramUniversity of OttawaOttawaOntarioCanada
- Faculty of MedicineSchool of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
- Department of Child and Adolescent PsychiatryCharité – Universitätsmedizin BerlinBerlinGermany
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2
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Phuljhele S. Biases which begin at the end. Indian J Ophthalmol 2024; 72:S333-S334. [PMID: 38648450 DOI: 10.4103/ijo.ijo_863_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Affiliation(s)
- Swati Phuljhele
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Shanok NA, Muzac S, Brown L, Barrera M, Rodriguez R. Synergistic use of deep TMS therapy with IV ketamine infusions for major depressive disorder: a pilot study. Psychopharmacology (Berl) 2024:10.1007/s00213-024-06573-1. [PMID: 38472415 DOI: 10.1007/s00213-024-06573-1] [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: 01/16/2024] [Accepted: 03/05/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE Major Depressive Disorder (MDD) is a pervasive psychiatric condition effecting approximately 21 million adults in the U.S. (8.4%). An estimated 30-60% of patients are resistant to traditional treatment approaches (medications and talk-therapy), alluding to the need for additional options. Two promising treatment modalities include transcranial magnetic stimulation (TMS) and ketamine infusions; both have shown efficacy in standalone studies but have scarcely been investigated synergistically in the same group of participants. METHOD In the current study, 169 participants with treatment-resistant MDD received 36 treatments of Deep TMS-only (H1 + H7 protocols), while 66 received 36 treatments of Deep TMS (H1 + H7 protocols) and 6 IV infusions of ketamine over the course of 9 weeks. Depressive symptoms were compared pre- and -post treatment in both conditions using the PHQ-9. RESULTS In both treatment groups, depressive symptoms were significantly reduced from pre-to-post and there were no significant differences in response between the TMS + ketamine condition and the TMS-only condition. The TMS + ketamine condition had an 80.30% response rate (53 out of 66) and 43.42% remission rate (28 out of 66) compared to a 76.92% response (130 out of 169) and 39.64% remission (67 out of 16) in the TMS-only condition. CONCLUSION These results support the notion that TMS treatments yield high response rates in treatment-resistant cases; however, in this investigation there was no added benefit for including 6 sessions of IV ketamine in conjunction with TMS. Future investigations using randomized-control designs and robust outcome measures are warranted.
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Affiliation(s)
| | - Sabrina Muzac
- Delray Center for Brain Science, Delray Beach, FL, USA
| | - Leah Brown
- Delray Center for Brain Science, Delray Beach, FL, USA
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Kowalczyk E, Borysowski J, Ordak M, Kniotek M, Radziwoń-Zaleska M, Siwek M. Placebo-controlled randomized clinical trials of antidepressants for major depressive disorder: Analysis of ClinicalTrials.gov, 2008-2022. Psychiatry Res 2024; 333:115730. [PMID: 38245978 DOI: 10.1016/j.psychres.2024.115730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/23/2024]
Abstract
The purpose of this study was to analyze the key aspects of the design of contemporary placebo-controlled randomized clinical trials (RCTs) of antidepressants enrolling patients with major depressive disorder (MDD) aged 18 years or older, especially the outcome measures and the eligibility criteria. The study included 122 RCTs registered with ClinicalTrials.gov and started from 2008 through 2022. Most RCTs assessed only clinical remission, with proportion of trials with outcome measures related to functional remission being rather low (n = 34; 28 %). Clinical remission was mostly evaluated in acute phase of depression, and only 7 (6 %) trials assessed the prevention of relapse. Proportion of trials utilizing self-report questionnaires that provide important information complementary to clinician-rated scales was moderate (n = 66; 54 %). Another problem in included RCTs was common use of stringent eligibility criteria. For instance, minimal symtpom severity required for the patient's inclusion was listed in 104 RCTs (85 %), and 41 RCTs (34 %) excluded patients based on comorbid anxiety disorders. Most RCTs (n = 103; 84 %) excluded older patients, and only 6 (5 %) trials were dedicated exclusively to them. To ensure optimal development of clinical pharmacotherapy of MDD, the investigators should consider modification of some of the key aspects of the design of RCTs of antidepressants.
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Affiliation(s)
- Ewa Kowalczyk
- Clinical Research Development Centre, Medical Research Agency, Moniuszki 1A 00-014, Warsaw, Poland
| | - Jan Borysowski
- Department of Clinical Immunology, Medical University of Warsaw, Nowogrodzka 59 02-006, Warsaw, Poland.
| | - Michał Ordak
- Department of Pharmacotherapy and Pharmaceutical Care, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1 02-097, Warsaw, Poland
| | - Monika Kniotek
- Department of Clinical Immunology, Medical University of Warsaw, Nowogrodzka 59 02-006, Warsaw, Poland
| | - Maria Radziwoń-Zaleska
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27 00-665, Warsaw, Poland
| | - Marcin Siwek
- Department of Affective Disorders, Chair of Psychiatry, Jagiellonian University Medical College, M. Kopernika 21 A 31-501, Kraków, Poland
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Grant S, Mayo-Wilson E, Kianersi S, Naaman K, Henschel B. Open Science Standards at Journals that Inform Evidence-Based Policy. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1275-1291. [PMID: 37178346 DOI: 10.1007/s11121-023-01543-z] [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] [Accepted: 04/19/2023] [Indexed: 05/15/2023]
Abstract
Evidence-based policy uses intervention research to inform consequential decisions about resource allocation. Research findings are often published in peer-reviewed journals. Because detrimental research practices associated with closed science are common, journal articles report more false-positives and exaggerated effect sizes than would be desirable. Journal implementation of standards that promote open science-such as the transparency and openness promotion (TOP) guidelines-could reduce detrimental research practices and improve the trustworthiness of research evidence on intervention effectiveness. We evaluated TOP implementation at 339 peer-reviewed journals that have been used to identify evidence-based interventions for policymaking and programmatic decisions. Each of ten open science standards in TOP was not implemented in most journals' policies (instructions to authors), procedures (manuscript submission systems), or practices (published articles). Journals implementing at least one standard typically encouraged, but did not require, an open science practice. We discuss why and how journals could improve implementation of open science standards to safeguard evidence-based policy.
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Affiliation(s)
- Sean Grant
- HEDCO Institute for Evidence-Based Educational Practice, College of Education, University of Oregon, OR, 97403-1215, Eugene, USA.
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA.
| | - Evan Mayo-Wilson
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Sina Kianersi
- School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Kevin Naaman
- School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
- Indiana University, School of Education, Bloomington, IN, USA
| | - Beate Henschel
- School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
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van Elk M, Fried EI. History repeating: guidelines to address common problems in psychedelic science. Ther Adv Psychopharmacol 2023; 13:20451253231198466. [PMID: 37766730 PMCID: PMC10521293 DOI: 10.1177/20451253231198466] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/11/2023] [Indexed: 09/29/2023] Open
Abstract
Research in the last decade has expressed considerable optimism about the clinical potential of psychedelics for the treatment of mental disorders. This optimism is reflected in an increase in research papers, investments by pharmaceutical companies, patents, media coverage, as well as political and legislative changes. However, psychedelic science is facing serious challenges that threaten the validity of core findings and raise doubt regarding clinical efficacy and safety. In this paper, we introduce the 10 most pressing challenges, grouped into easy, moderate, and hard problems. We show how these problems threaten internal validity (treatment effects are due to factors unrelated to the treatment), external validity (lack of generalizability), construct validity (unclear working mechanism), or statistical conclusion validity (conclusions do not follow from the data and methods). These problems tend to co-occur in psychedelic studies, limiting conclusions that can be drawn about the safety and efficacy of psychedelic therapy. We provide a roadmap for tackling these challenges and share a checklist that researchers, journalists, funders, policymakers, and other stakeholders can use to assess the quality of psychedelic science. Addressing today's problems is necessary to find out whether the optimism regarding the therapeutic potential of psychedelics has been warranted and to avoid history repeating itself.
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Affiliation(s)
- Michiel van Elk
- Cognitive Psychology Unit, Institute of Psychology, Leiden University, PO Box 9555, Leiden 2300 RB, The Netherlands
| | - Eiko I. Fried
- Clinical Psychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
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de Vries YA, Schoevers RA, Higgins JPT, Munafò MR, Bastiaansen JA. Statistical power in clinical trials of interventions for mood, anxiety, and psychotic disorders. Psychol Med 2023; 53:4499-4506. [PMID: 35588241 PMCID: PMC10388329 DOI: 10.1017/s0033291722001362] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 04/15/2022] [Accepted: 04/26/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Previous research has suggested that statistical power is suboptimal in many biomedical disciplines, but it is unclear whether power is better in trials for particular interventions, disorders, or outcome types. We therefore performed a detailed examination of power in trials of psychotherapy, pharmacotherapy, and complementary and alternative medicine (CAM) for mood, anxiety, and psychotic disorders. METHODS We extracted data from the Cochrane Database of Systematic Reviews (Mental Health). We focused on continuous efficacy outcomes and estimated power to detect predetermined effect sizes (standardized mean difference [SMD] = 0.20-0.80, primary SMD = 0.40) and meta-analytic effect sizes (ESMA). We performed meta-regression to estimate the influence of including underpowered studies in meta-analyses. RESULTS We included 256 reviews with 10 686 meta-analyses and 47 384 studies. Statistical power for continuous efficacy outcomes was very low across intervention and disorder types (overall median [IQR] power for SMD = 0.40: 0.32 [0.19-0.54]; for ESMA: 0.23 [0.09-0.58]), only reaching conventionally acceptable levels (80%) for SMD = 0.80. Median power to detect the ESMA was higher in treatment-as-usual (TAU)/waitlist-controlled (0.49-0.63) or placebo-controlled (0.12-0.38) trials than in trials comparing active treatments (0.07-0.13). Adequately-powered studies produced smaller effect sizes than underpowered studies (B = -0.06, p ⩽ 0.001). CONCLUSIONS Power to detect both predetermined and meta-analytic effect sizes in psychiatric trials was low across all interventions and disorders examined. Consistent with the presence of reporting bias, underpowered studies produced larger effect sizes than adequately-powered studies. These results emphasize the need to increase sample sizes and to reduce reporting bias against studies reporting null results to improve the reliability of the published literature.
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Affiliation(s)
- Ymkje Anna de Vries
- Department of Developmental Psychology, University of Groningen, Groningen, the Netherlands
- Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Robert A. Schoevers
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- University of Groningen, Research School of Behavioural and Cognitive Neurosciences (BCN), Groningen, the Netherlands
| | - Julian P. T. Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Marcus R. Munafò
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Jojanneke A. Bastiaansen
- Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Education and Research, Friesland Mental Health Care Services, Leeuwarden, the Netherlands
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O'Connor EA, Perdue LA, Coppola EL, Henninger ML, Thomas RG, Gaynes BN. Depression and Suicide Risk Screening: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2023; 329:2068-2085. [PMID: 37338873 DOI: 10.1001/jama.2023.7787] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Importance Depression is common and associated with substantial burden. Suicide rates have increased over the past decade, and both suicide attempts and deaths have devastating effects on individuals and families. Objective To review the benefits and harms of screening and treatment for depression and suicide risk and the accuracy of instruments to detect these conditions among primary care patients. Data Sources MEDLINE, PsychINFO, Cochrane library through September 7, 2022; references of existing reviews; ongoing surveillance for relevant literature through November 25, 2022. Study Selection English-language studies of screening or treatment compared with control conditions, or test accuracy of screening instruments (for depression, instruments were selected a priori; for suicide risk, all were included). Existing systematic reviews were used for treatment and test accuracy for depression. Data Extraction and Synthesis One investigator abstracted data; a second checked accuracy. Two investigators independently rated study quality. Findings were synthesized qualitatively, including reporting of meta-analysis results from existing systematic reviews; meta-analyses were conducted on original research when evidence was sufficient. Main Outcomes and Measures Depression outcomes; suicidal ideation, attempts, and deaths; sensitivity and specificity of screening tools. Results For depression, 105 studies were included: 32 original studies (N=385 607) and 73 systematic reviews (including ≈2138 studies [N ≈ 9.8 million]). Depression screening interventions, many of which included additional components beyond screening, were associated with a lower prevalence of depression or clinically important depressive symptomatology after 6 to 12 months (pooled odds ratio, 0.60 [95% CI, 0.50-0.73]; reported in 8 randomized clinical trials [n=10 244]; I2 = 0%). Several instruments demonstrated adequate test accuracy (eg, for the 9-item Patient Health Questionnaire at a cutoff of 10 or greater, the pooled sensitivity was 0.85 [95% CI, 0.79-0.89] and specificity was 0.85 [95% CI, 0.82-0.88]; reported in 47 studies [n = 11 234]). A large body of evidence supported benefits of psychological and pharmacologic treatment of depression. A pooled estimate from trials used for US Food and Drug Administration approval suggested a very small increase in the absolute risk of a suicide attempt with second-generation antidepressants (odds ratio, 1.53 [95% CI, 1.09-2.15]; n = 40 857; 0.7% of antidepressant users had a suicide attempt vs 0.3% of placebo users; median follow-up, 8 weeks). Twenty-seven studies (n = 24 826) addressed suicide risk. One randomized clinical trial (n=443) of a suicide risk screening intervention found no difference in suicidal ideation after 2 weeks between primary care patients who were and were not screened for suicide risk. Three studies of suicide risk test accuracy were included; none included replication of any instrument. The included suicide prevention studies generally did not demonstrate an improvement over usual care, which typically included specialty mental health treatment. Conclusions and Relevance Evidence supported depression screening in primary care settings, including during pregnancy and postpartum. There are numerous important gaps in the evidence for suicide risk screening in primary care settings.
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Affiliation(s)
- Elizabeth A O'Connor
- Kaiser Permanente Evidence-based Practice Center, Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Leslie A Perdue
- Kaiser Permanente Evidence-based Practice Center, Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Erin L Coppola
- Kaiser Permanente Evidence-based Practice Center, Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Michelle L Henninger
- Kaiser Permanente Evidence-based Practice Center, Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Rachel G Thomas
- Kaiser Permanente Evidence-based Practice Center, Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Bradley N Gaynes
- Gillings School of Global Public Health, University of North Carolina School of Medicine, Chapel Hill
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Dietch DM, Kerr-Gaffney J, Hockey M, Marx W, Ruusunen A, Young AH, Berk M, Mondelli V. Efficacy of low carbohydrate and ketogenic diets in treating mood and anxiety disorders: systematic review and implications for clinical practice. BJPsych Open 2023; 9:e70. [PMID: 37066662 PMCID: PMC10134254 DOI: 10.1192/bjo.2023.36] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 02/01/2023] [Accepted: 02/16/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND There is mounting interest in the potential efficacy of low carbohydrate and very low carbohydrate ketogenic diets in various neurological and psychiatric disorders. AIMS To conduct a systematic review and narrative synthesis of low carbohydrate and ketogenic diets (LC/KD) in adults with mood and anxiety disorders. METHOD MEDLINE, Embase, PsycINFO and Cochrane databases were systematically searched for articles from inception to 6 September 2022. Studies that included adults with any mood or anxiety disorder treated with a low carbohydrate or ketogenic intervention, reporting effects on mood or anxiety symptoms were eligible for inclusion. PROSPERO registration CRD42019116367. RESULTS The search yielded 1377 articles, of which 48 were assessed for full-text eligibility. Twelve heterogeneous studies (stated as ketogenic interventions, albeit with incomplete carbohydrate reporting and measurements of ketosis; diet duration: 2 weeks to 3 years; n = 389; age range 19 to 75 years) were included in the final analysis. This included nine case reports, two cohort studies and one observational study. Data quality was variable, with no high-quality evidence identified. Efficacy, adverse effects and discontinuation rates were not systematically reported. There was some evidence for efficacy of ketogenic diets in those with bipolar disorder, schizoaffective disorder and possibly unipolar depression/anxiety. Relapse after discontinuation of the diet was reported in some individuals. CONCLUSIONS Although there is no high-quality evidence of LC/KD efficacy in mood or anxiety disorders, several uncontrolled studies suggest possible beneficial effects. Robust studies are now needed to demonstrate efficacy, to identify clinical groups who may benefit and whether a ketogenic diet (beyond low carbohydrate) is required and to characterise adverse effects and the risk of relapse after diet discontinuation.
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Affiliation(s)
- Daniel M. Dietch
- Lonsdale Medical Centre, London, UK; and Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jess Kerr-Gaffney
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Meghan Hockey
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Wolfgang Marx
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Anu Ruusunen
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia; Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland; and Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; and National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, London, UK
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Schmaling KB, Kaplan RM. Depression trial results: A cross-sectional study of ClinicalTrials.gov. J Psychiatr Res 2023; 161:461-466. [PMID: 37059031 DOI: 10.1016/j.jpsychires.2023.04.004] [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: 01/06/2023] [Revised: 03/24/2023] [Accepted: 04/05/2023] [Indexed: 04/16/2023]
Abstract
Published clinical trials represent a subsample of the objective information needed to appraise treatments for depression. We characterize the extent of selective and delayed reporting in a systematic review (PROSPERO #CRD42020173606) of depression trial results registered on ClinicalTrials.gov. Inclusion criteria were studies registered on ClinicalTrials.gov with depression as the condition, had enrolled ages 18 and over, were completed between January 1, 2008 and May 1, 2019, and had posted results by February 1, 2022. Cox regression analyses of time to result posting from registration and from study completion included enrollment as a covariate. Among 442 protocols, median result posting occurred over two years after study completion and five years after registration. Among protocols with incomplete results, effect sizes (d or W) were calculated for 134 protocols. Median effect sizes for protocols with incomplete results were small (0.16, 95% CI 0.08, 0.21). For 28% of protocols, observed effects were contrary to the expected direction. Between-group effect size calculations were based on post-treatment data as pre-treatment data were inconsistently provided. Although drug and device trials in the U.S. are required to register on ClinicalTrials.gov, compliance is imperfect, and submissions are not peer reviewed. For depression treatment trials, long intervals between study completion and posting of results are common. Further, investigators often fail to report the results of statistical tests. Failure to post trial results in a timely manner and omission of statistical test reporting may lead to overestimates of treatment effects in systematic literature reviews.
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Affiliation(s)
| | - Robert M Kaplan
- Clinical Excellence Research Center, Stanford University School of Medicine, USA
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11
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van Dijk SDM, Veenstra MS, van den Brink RHS, van Alphen SPJ, Oude Voshaar RC. A Systematic Review of the Heterogeneity of Schema Therapy. J Pers Disord 2023; 37:233-262. [PMID: 37002933 DOI: 10.1521/pedi.2023.37.2.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
We aimed to explore the heterogeneity of schema therapy regarding (a) patient characteristics, (b) content, and (c) way of delivering schema therapy. A search was conducted of the electronic databases EMBASE, PsycINFO, Web of Science, MEDLINE, and COCHRANE up to June 15, 2022. Treatment studies were eligible if they (a) used schema therapy as (component of) the intervention examined, and (b) reported an outcome measure quantitatively. A total of 101 studies met the inclusion criteria, including randomized controlled trials (n = 30), non-randomized controlled trials (n = 8), pre-post designs (n = 22), cases series (n = 13), and case reports (n = 28), including 4006 patients. Good feasibility was consistently reported irrespective of format (group versus individual), setting (outpatient, day-treatment, inpatient), intensity of treatment, and the specific therapeutic components included. Schema therapy was applied to various (psychiatric) disorders. All studies presented promising results. Effectiveness of the different models of schema therapy as well as application beyond personality disorders should be examined more rigorously.
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Affiliation(s)
- Silvia D M van Dijk
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Martine S Veenstra
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Rob H S van den Brink
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Sebastiaan P J van Alphen
- Department of Clinical & Life Span Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Medical & Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Richard C Oude Voshaar
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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12
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Woodhead A, North JS, Hill J, Murphy CP, Kidgell DJ, Tallent J. Corticospinal and spinal adaptations following lower limb motor skill training: a meta-analysis with best evidence synthesis. Exp Brain Res 2023; 241:807-824. [PMID: 36740653 DOI: 10.1007/s00221-023-06563-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 01/21/2023] [Indexed: 02/07/2023]
Abstract
Motor skill training alters the human nervous system; however, lower limb motor tasks have been less researched compared to upper limb tasks. This meta-analysis with best evidence synthesis aimed to determine the cortical and subcortical responses that occur following lower limb motor skill training, and whether these responses are accompanied by improvements in motor performance. Following a literature search that adhered to the PRISMA guidelines, data were extracted and analysed from six studies (n = 172) for the meta-analysis, and 11 studies (n = 257) were assessed for the best evidence synthesis. Pooled data indicated that lower limb motor skill training increased motor performance, with a standardised mean difference (SMD) of 1.09 being observed. However, lower limb motor skill training had no effect on corticospinal excitability (CSE), Hoffmann's reflex (H-reflex) or muscle compound action potential (MMAX) amplitude. The best evidence synthesis found strong evidence for improved motor performance and reduced short-interval cortical inhibition (SICI) following lower limb motor skill training, with conflicting evidence towards the modulation of CSE. Taken together, this review highlights the need for further investigation on how motor skill training performed with the lower limb musculature can modulate corticospinal responses. This will also help us to better understand whether these neuronal measures are underpinning mechanisms that support an improvement in motor performance.
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Affiliation(s)
- Alex Woodhead
- Faculty of Sport, Allied Health and Performance Science, St. Mary's University, Middlesex, Twickenham, TW1 4SX, UK.
| | - Jamie S North
- Faculty of Sport, Allied Health and Performance Science, St. Mary's University, Middlesex, Twickenham, TW1 4SX, UK
| | - Jessica Hill
- Faculty of Sport, Allied Health and Performance Science, St. Mary's University, Middlesex, Twickenham, TW1 4SX, UK
| | - Colm P Murphy
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Dawson J Kidgell
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, 3199, Australia
| | - Jamie Tallent
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, 3199, Australia.,School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, UK
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Plessen CY, Karyotaki E, Miguel C, Ciharova M, Cuijpers P. Exploring the efficacy of psychotherapies for depression: a multiverse meta-analysis. BMJ MENTAL HEALTH 2023; 26:e300626. [PMID: 36914209 PMCID: PMC10035781 DOI: 10.1136/bmjment-2022-300626] [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: 11/08/2022] [Accepted: 02/20/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Hundreds of randomised controlled trials and dozens of meta-analyses have examined psychotherapies for depression-yet not all points in the same direction. Are these discrepancies a result of specific meta-analytical decisions or do most analytical strategies reaching the same conclusion? OBJECTIVE We aim to solve these discrepancies by conducting a multiverse meta-analysis containing all possible meta-analyses, using all statistical methods. STUDY SELECTION AND ANALYSIS We searched four bibliographical databases (PubMed, EMBASE, PsycINFO and Cochrane Register of Controlled Trials), including studies published until 1 January 2022. We included all randomised controlled trials comparing psychotherapies with control conditions without restricting the type of psychotherapy, target group, intervention format, control condition and diagnosis. We defined all possible meta-analyses emerging from combinations of these inclusion criteria and estimated the resulting pooled effect sizes with fixed-effect, random-effects, 3-level, robust variance estimation, p-uniform and PET-PEESE (precision-effect test and precision-effect estimate with SE) meta-analysis models. This study was preregistered (https://doi.org/10.1136/bmjopen-2021-050197). FINDINGS A total of 21 563 records were screened, and 3584 full texts were retrieved; 415 studies met our inclusion criteria containing 1206 effect sizes and 71 454 participants. Based on all possible combinations between inclusion criteria and meta-analytical methods, we calculated 4281 meta-analyses. The average summary effect size for these meta-analyses was Hedges' g mean=0.56, a medium effect size, and ranged from g=-0.66 to 2.51. In total, 90% of these meta-analyses reached a clinically relevant magnitude. CONCLUSIONS AND CLINICAL IMPLICATIONS The multiverse meta-analysis revealed the overall robustness of the effectiveness of psychotherapies for depression. Notably, meta-analyses that included studies with a high risk of bias, compared the intervention with wait-list control groups, and not correcting for publication bias produced larger effect sizes.
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Affiliation(s)
- Constantin Yves Plessen
- Department of Psychosomatic Medicine, Charite University Hospital Berlin, Berlin, Germany
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam Faculty of Behavioural and Movement Sciences, Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam Faculty of Behavioural and Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Clara Miguel
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam Faculty of Behavioural and Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marketa Ciharova
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam Faculty of Behavioural and Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam Faculty of Behavioural and Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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14
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Hadden LM, Penny H, Jones AL, Partridge AM, Lancaster TM, Allen C. Pre-frontal stimulation does not reliably increase reward responsiveness. Cortex 2023; 159:268-285. [PMID: 36669446 PMCID: PMC10823575 DOI: 10.1016/j.cortex.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/17/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022]
Abstract
Depression is the leading cause of disability worldwide and its effects can be fatal, with over 800,000 people dying by suicide each year. Neuromodulatory treatments such as transcranial magnetic stimulation (TMS) are being used to treat depression. Despite its endorsement by two regulatory bodies: NICE (2016) and the FDA (2008), there are major questions about the treatment efficacy and biological mechanisms of TMS. Ahn et al.'s (2013) justified the use of TMS in a clinical context in an important study indicating that excitatory TMS increases reward responsiveness. A pseudo-replication of this study by Duprat et al., (2016) also found a similar effect of active TMS, but only with the addition of an exploratory covariate to the analyses-trait reward responsiveness. Here we replicate Ahn et al.'s (2013) key study, and to test the reliability of the effects, and their dependency on trait reward responsiveness as described by Duprat et al., (2016). Using excitatory and sham TMS, we tested volunteers using the probabilistic learning task to measure their reward responsiveness both before and after stimulation. We also examined affect (positive, negative) following stimulation. Irrespective of TMS, the task was shown to be sensitive to reward responsiveness. However, we did not show TMS to be effective in increasing reward responsiveness and we did not replicate Ahn et al., (2013) or Duprat et al., (2016)'s key findings for TMS efficacy, where we provide evidence favouring the null. Moreover, exploratory analyses suggested following active stimulation, positive affect was reduced. Given our findings, we question the basic effects, which support the use of TMS for depression, particularly considering potential deleterious effects of reduced positive affect in patients with depression.
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Affiliation(s)
- L M Hadden
- Cardiff University, School of Psychology, Tower Building, Park Place, Cardiff, CF10 3AT, UK
| | - H Penny
- Cardiff University, School of Psychology, Tower Building, Park Place, Cardiff, CF10 3AT, UK; Aneurin Bevan University Health Board, St Cadoc's Hospital, Lodge Road, Caerleon, NP18 3XQ, UK
| | - A L Jones
- School of Psychology, Faculty of Medicine, Health, and Life Sciences, Singleton Park, Swansea University, SA2 8PP, UK
| | - A M Partridge
- University of Sheffield, Research Services, New Spring House, 231 Glossop Road, Sheffield, S10 2GW, UK
| | - T M Lancaster
- Cardiff University, School of Psychology, Tower Building, Park Place, Cardiff, CF10 3AT, UK; University of Bath, Department of Psychology, Claverton Down, BA2 7AY, UK
| | - C Allen
- Cardiff University, School of Psychology, Tower Building, Park Place, Cardiff, CF10 3AT, UK; Department of Psychology, Durham University, Durham, DH1 3LE, UK.
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15
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Bandelow B, Allgulander C, Baldwin DS, Costa DLDC, Denys D, Dilbaz N, Domschke K, Eriksson E, Fineberg NA, Hättenschwiler J, Hollander E, Kaiya H, Karavaeva T, Kasper S, Katzman M, Kim YK, Inoue T, Lim L, Masdrakis V, Menchón JM, Miguel EC, Möller HJ, Nardi AE, Pallanti S, Perna G, Rujescu D, Starcevic V, Stein DJ, Tsai SJ, Van Ameringen M, Vasileva A, Wang Z, Zohar J. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders - Version 3. Part I: Anxiety disorders. World J Biol Psychiatry 2023; 24:79-117. [PMID: 35900161 DOI: 10.1080/15622975.2022.2086295] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AIM This is the third version of the guideline of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Posttraumatic Stress Disorders (published in 2002, revised in 2008). METHOD A consensus panel of 33 international experts representing 22 countries developed recommendations based on efficacy and acceptability of available treatments. In total, 1007 RCTs for the treatment of these disorders in adults, adolescents, and children with medications, psychotherapy and other non-pharmacological interventions were evaluated, applying the same rigorous methods that are standard for the assessment of medications. RESULT This paper, Part I, contains recommendations for the treatment of panic disorder/agoraphobia (PDA), generalised anxiety disorder (GAD), social anxiety disorder (SAD), specific phobias, mixed anxiety disorders in children and adolescents, separation anxiety and selective mutism. Selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are first-line medications. Cognitive behavioural therapy (CBT) is the first-line psychotherapy for anxiety disorders. The expert panel also made recommendations for patients not responding to standard treatments and recommendations against interventions with insufficient evidence. CONCLUSION It is the goal of this initiative to provide treatment guidance for these disorders that has validity throughout the world.
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Affiliation(s)
- Borwin Bandelow
- Department of Psychiatry and Psychotherapy, University Medical Center, Göttingen, Germany
| | | | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Daniel Lucas da Conceição Costa
- Department and Institute of Psychiatry, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Damiaan Denys
- Afdeling Psychiatrie, Universitair Medische Centra, Amsterdam, The Netherlands
| | - Nesrin Dilbaz
- Psikiyatri Uzmanı, Üsküdar Üniversitesi Tıp Fakültesi Psikiyatri ABD, İstanbul, Turkey
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elias Eriksson
- Department of Pharmacology, University of Gothenburg, Gothenburg, Sweden
| | - Naomi A Fineberg
- School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, United Kingdom
| | | | | | - Hisanobu Kaiya
- Department of Psychiatry, Kyoto Prefactual Medical College, Kyoto, Japan
| | - Tatiana Karavaeva
- V. M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Ministry of Health, Federal State Budgetary Institution of Higher Education, St. Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - Siegfried Kasper
- Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Martin Katzman
- S.T.A.R.T. Clinic, Toronto, Canada.,Adler Graduate Professional School, Toronto, Canada.,Department of Psychiatry, Northern Ontario School of Medicine, Thunder Bay, Canada.,Department of Psychology, Lakehead University, Thunder Bay, Canada
| | - Yong-Ku Kim
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea
| | - Takeshi Inoue
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | - Leslie Lim
- Department of Psychiatry, Singapore General Hospital, Bukit Merah, Singapore
| | - Vasilios Masdrakis
- First Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - José M Menchón
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, University of Barcelona, Cibersam, Barcelona, Spain
| | - Euripedes C Miguel
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, University of München, Munich, Germany
| | - Antonio E Nardi
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Stefano Pallanti
- Istituto die Neuroscienze, University of Florence, Firenze, Italy
| | - Giampaolo Perna
- Department of Biological Sciences, Humanitas University Pieve Emanuele, Milano, Italy
| | - Dan Rujescu
- Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Vladan Starcevic
- Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, University of Sydney, Sydney, Australia
| | - Dan J Stein
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Michael Van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Anna Vasileva
- V. M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Ministry of Health, I.I. Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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16
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Mårtensson E, Coumoundouros C, Sörensdotter R, von Essen L, Woodford J. Psychological interventions for symptoms of depression among informal caregivers of older adult populations: A systematic review and meta-analysis of randomized controlled trials. J Affect Disord 2023; 320:474-498. [PMID: 36174787 DOI: 10.1016/j.jad.2022.09.093] [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: 01/27/2022] [Revised: 08/31/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Symptoms of depression are commonly experienced by informal caregivers of older adults, however there is uncertainty concerning effectiveness of psychological interventions targeting symptoms of depression in this population. Further, there is uncertainty concerning important clinical moderators, including intervention type and care recipient health condition. This review examined the effectiveness of psychological interventions targeting symptoms of depression in informal caregivers of older adults. METHODS PubMed, CINAHL, Embase, PsycINFO, Cochrane Library and Web of Science were searched. Risk of bias was assessed using the Cochrane Risk of Bias tool version 2. RESULTS Fifteen studies were identified and twelve (1270 participants) provided data for the meta-analysis. Interventions included cognitive behavioral therapy (4 studies), problem-solving therapy (4 studies); non-directive supportive therapy (4 studies) and behavioral activation (3 studies). A small effect size favouring the intervention was found for symptoms of depression (g = -0.49, CI = -0.79, -0.19, I2 = 83.42 %) and interventions were effective in reducing incidence of major depression (OR = 0.177, CI = 0.08, 0.38), caregiver burden (g = -0.35, CI = -0.55, -0.15) and psychological distress (g = -0.49, CI = -0.70, -0.28). Given high heterogeneity, findings should be interpreted with caution. Overall risk of bias was high. LIMITATIONS Studies were limited to those in English or Swedish. CONCLUSION Psychological interventions may be effective in reducing symptoms of depression among informal caregivers of older adults. However, evidence is inconclusive due to heterogeneity, high risk of bias, and indirectness of evidence.
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Affiliation(s)
- Erika Mårtensson
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, 752 37 Uppsala, Sweden; Centre for Gender Research, Uppsala University, 752 36 Uppsala, Sweden.
| | - Chelsea Coumoundouros
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, 752 37 Uppsala, Sweden.
| | | | - Louise von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, 752 37 Uppsala, Sweden.
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, 752 37 Uppsala, Sweden.
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17
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Stricker J, Kröger L, Johann AF, Küskens A, Gieselmann A, Pietrowsky R. Multidimensional perfectionism and poor sleep: A meta-analysis of bivariate associations. Sleep Health 2022; 9:228-235. [PMID: 36400679 DOI: 10.1016/j.sleh.2022.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/24/2022] [Accepted: 09/28/2022] [Indexed: 11/18/2022]
Abstract
The link between perfectionism and poor sleep has been intensively debated, and previous studies on perfectionism-sleep associations have yielded mixed results. Recent research suggests that the two-dimensional perfectionism model, differentiating perfectionistic concerns (centered around concerns over imperfections) and perfectionistic strivings (centered around excessively high personal standards), may reconcile previously inconclusive findings, as both dimensions might be differentially related to sleep. Thus, to clarify the perfectionism-sleep link, this meta-analysis investigated relations of perfectionistic concerns and strivings with two well-established self-report measures of poor sleep. A systematic literature search yielded 55 effect sizes from 15 studies (N = 10,275) for inclusion in this meta-analysis. Perfectionistic concerns correlated positively with the Insomnia Severity Index (r+ = 0.221, 95% CI [0.102, 0.333], p = .004) and the Pittsburgh Sleep Quality Index (r+ = 0.248, 95% CI [0.172, 0.321], p < .001). Perfectionistic strivings correlated positively, albeit less strongly, with the Insomnia Severity Index (r+ = 0.114, 95% CI [0.039, 0.189], p = .010), but not significantly with the Pittsburgh Sleep Quality Index (r+ = 0.028, 95% CI [-0.026, 0.082], p = .247). These meta-analytic findings indicate that perfectionistic concerns are substantially linked to poor sleep, whereas the relation of perfectionistic strivings with sleep is less evident. Although the identified associations were less robust for perfectionistic strivings than for perfectionistic concerns, previously used labels like "positive" or "adaptive" appear inappropriate for perfectionistic strivings in the context of sleep.
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Affiliation(s)
- Johannes Stricker
- Department of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
| | - Lasse Kröger
- Department of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Anna F Johann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anna Küskens
- Department of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Annika Gieselmann
- Department of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Reinhard Pietrowsky
- Department of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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18
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O'Daffer A, Colt SF, Wasil AR, Lau N. Efficacy and Conflicts of Interest in Randomized Controlled Trials Evaluating Headspace and Calm Apps: Systematic Review. JMIR Ment Health 2022; 9:e40924. [PMID: 36125880 PMCID: PMC9533203 DOI: 10.2196/40924] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/15/2022] [Accepted: 08/28/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although there are thousands of mental health apps, 2 apps, Headspace and Calm, claim a large percentage of the marketplace. These two mindfulness and meditation apps have reached tens of millions of active users. To guide consumers, clinicians, and researchers, we performed a systematic review of randomized controlled trials (RCTs) of Headspace and Calm. OBJECTIVE Our study aimed to evaluate intervention efficacy, risk of bias, and conflicts of interest (COIs) in the evidence base for Headspace and Calm, the two most popular mental health apps at the time of our search. METHODS To identify studies, we searched academic databases (Google Scholar, MEDLINE, and PsycINFO) and the websites of Headspace and Calm in May 2021 for RCTs of Headspace and Calm testing efficacy via original data collection, published in English in peer-reviewed journals. For each study, we coded (1) study characteristics (eg, participants, sample size, and outcome measures), (2) intervention characteristics (eg, free vs paid version of the app and intended frequency of app usage), (3) all study outcomes, (4) Cochrane risk of bias variables, and (5) COI variables (eg, presence or absence of a preregistration and the presence or absence of a COI statement involving the company). RESULTS We identified 14 RCTs of Headspace and 1 RCT of Calm. Overall, 93% (13/14) of RCTs of Headspace and 100% (1/1) of RCTs of Calm recruited participants from a nonclinical population. Studies commonly measured mindfulness, well-being, stress, depressive symptoms, and anxiety symptoms. Headspace use improved depression in 75% of studies that evaluated it as an outcome. Findings were mixed for mindfulness, well-being, stress, and anxiety, but at least 40% of studies showed improvement for each of these outcomes. Studies were generally underpowered to detect "small" or "medium" effect sizes. Furthermore, 50% (7/14) of RCTs of Headspace and 0% (0/1) of RCTs of Calm reported a COI that involved Headspace or Calm (the companies). The most common COI was the app company providing premium app access for free for participants, and notably, 14% (2/14) of RCTs of Headspace reported Headspace employee involvement in study design, execution, and data analysis. Only 36% (5/14) of RCTs of Headspace were preregistered, and the 1 RCT of Calm was not preregistered. CONCLUSIONS The empirical research on Headspace appears promising, whereas there is an absence of randomized trials on Calm. Limitations of this study include an inability to compare Headspace and Calm owing to the dearth of RCTs studying Calm and the reliance on author reports to evaluate COIs. When determining whether or not mental health apps are of high quality, identification of high-quality apps and evaluation of their effectiveness and investigators' COIs should be ensured.
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Affiliation(s)
- Alison O'Daffer
- Palliative Care and Resilience Research Program, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, United States
| | - Susannah F Colt
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Akash R Wasil
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
| | - Nancy Lau
- Palliative Care and Resilience Research Program, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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19
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Bruckner T, Wieschowski S, Heider M, Deutsch S, Drude N, Tölch U, Bleich A, Tolba R, Strech D. Measurement challenges and causes of incomplete results reporting of biomedical animal studies: Results from an interview study. PLoS One 2022; 17:e0271976. [PMID: 35960759 PMCID: PMC9374215 DOI: 10.1371/journal.pone.0271976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background Existing evidence indicates that a significant amount of biomedical research involving animals remains unpublished. At the same time, we lack standards for measuring the extent of results reporting in animal research. Publication rates may vary significantly depending on the level of measurement such as an entire animal study, individual experiments within a study, or the number of animals used. Methods Drawing on semi-structured interviews with 18 experts and qualitative content analysis, we investigated challenges and opportunities for the measurement of incomplete reporting of biomedical animal research with specific reference to the German situation. We further investigate causes of incomplete reporting. Results The in-depth expert interviews revealed several reasons for why incomplete reporting in animal research is difficult to measure at all levels under the current circumstances. While precise quantification based on regulatory approval documentation is feasible at the level of entire studies, measuring incomplete reporting at the more individual experiment and animal levels presents formidable challenges. Expert-interviews further identified six drivers of incomplete reporting of results in animal research. Four of these are well documented in other fields of research: a lack of incentives to report non-positive results, pressures to ‘deliver’ positive results, perceptions that some data do not add value, and commercial pressures. The fifth driver, reputational concerns, appears to be far more salient in animal research than in human clinical trials. The final driver, socio-political pressures, may be unique to the field. Discussion Stakeholders in animal research should collaborate to develop a clear conceptualisation of complete reporting in animal research, facilitate valid measurements of the phenomenon, and develop incentives and rewards to overcome the causes for incomplete reporting.
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Affiliation(s)
- Till Bruckner
- QUEST Center for Responsible Research, Berlin Institute of Health at Charité –Universitätsmedizin, Berlin, Germany
- Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Susanne Wieschowski
- QUEST Center for Responsible Research, Berlin Institute of Health at Charité –Universitätsmedizin, Berlin, Germany
- Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Miriam Heider
- Institute for Laboratory Animal Science, Hannover Medical School, Hannover, Germany
| | - Susanne Deutsch
- Institute for Laboratory Animal Science, RWTH Aachen University, Faculty of Medicine, Aachen, Germany
| | - Natascha Drude
- QUEST Center for Responsible Research, Berlin Institute of Health at Charité –Universitätsmedizin, Berlin, Germany
| | - Ulf Tölch
- QUEST Center for Responsible Research, Berlin Institute of Health at Charité –Universitätsmedizin, Berlin, Germany
| | - André Bleich
- Institute for Laboratory Animal Science, Hannover Medical School, Hannover, Germany
| | - René Tolba
- Institute for Laboratory Animal Science, RWTH Aachen University, Faculty of Medicine, Aachen, Germany
| | - Daniel Strech
- QUEST Center for Responsible Research, Berlin Institute of Health at Charité –Universitätsmedizin, Berlin, Germany
- Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
- * E-mail:
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20
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Vrljičak Davidović N, Komić L, Mešin I, Kotarac M, Okmažić D, Franić T. Registry versus publication: discrepancy of primary outcomes and possible outcome reporting bias in child and adolescent mental health. Eur Child Adolesc Psychiatry 2022; 31:757-769. [PMID: 33459886 DOI: 10.1007/s00787-020-01710-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
Outcome reporting bias is one of the fundamental forms of publication bias. It implies publishing only outcomes that have positive results. The aim of this observational study was to explore primary outcome discrepancies between registry of clinical trials and their corresponding publications, since these can indicate outcome reporting bias in child mental health. Data were extracted from completed interventional clinical trials from ClinicalTrial.gov registry and its Archive site. Trials were registered under "Behaviours and Mental Disorders" category, and conducted on underage participants (0-17 years). Their primary outcomes were compared to those published in publication which had a corresponding NCT number stated in the text. Sixteen percent of trials did not have the minimum information on primary outcome stated in the registry-neither the measure used nor the measurement time points; 38.9% of trials had the minimum information stated to describe primary outcome, while only 3.3% of trials had all the necessary elements stated in the registry. Most of the publication in our sample had positive results (66.4%). Half of the trials registered before completion had non-matching primary outcomes in the registry and publication; 85.4% of trials with non-matching outcomes indicated possible outcome reporting bias for some of the primary outcome. Middle-sized trials and industry-funded trials were related with higher quality of primary outcome registration. Industry funding was related with positive findings in publication. Non-industry funding proved to be the only significant predictor of discrepancy between registered and published primary outcomes, and possible outcome reporting bias. Journal impact factor was not related with any of the outcome measures. The main limitation of the study is that it primarily offers an insight into discrepancy of registered and published outcomes. The methodology does not imply an access to results of unpublished outcomes - therefore, it was not possible to determine the presence of the bias with sufficient certainty in large number of trials. Further research should be done with improved methodology and additional data.
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Affiliation(s)
| | - Luka Komić
- School of Medicine, University of Split, Šoltanska 2, 21000, Split, Croatia
| | - Ivana Mešin
- School of Medicine, University of Split, Šoltanska 2, 21000, Split, Croatia
| | - Mihaela Kotarac
- School of Medicine, University of Split, Šoltanska 2, 21000, Split, Croatia
| | - Donald Okmažić
- School of Medicine, University of Split, Šoltanska 2, 21000, Split, Croatia
| | - Tomislav Franić
- School of Medicine, University of Split, Šoltanska 2, 21000, Split, Croatia.,Department of Psychiatry, Clinical Hospital Centre Split, Spinčićeva 1, 21000, Split, Croatia
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21
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Herrman H, Patel V, Kieling C, Berk M, Buchweitz C, Cuijpers P, Furukawa TA, Kessler RC, Kohrt BA, Maj M, McGorry P, Reynolds CF, Weissman MM, Chibanda D, Dowrick C, Howard LM, Hoven CW, Knapp M, Mayberg HS, Penninx BWJH, Xiao S, Trivedi M, Uher R, Vijayakumar L, Wolpert M. Time for united action on depression: a Lancet-World Psychiatric Association Commission. Lancet 2022; 399:957-1022. [PMID: 35180424 DOI: 10.1016/s0140-6736(21)02141-3] [Citation(s) in RCA: 266] [Impact Index Per Article: 133.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Sangath, Goa, India; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Christian Kieling
- Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Michael Berk
- Deakin University, IMPACT Institute, Geelong, VIC, Australia
| | - Claudia Buchweitz
- Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Mario Maj
- Department of Psychiatry, University of Campania L Vanvitelli, Naples, Italy
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Myrna M Weissman
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Dixon Chibanda
- Department of Psychiatry, University of Zimbabwe, Harare, Zimbabwe; Centre for Global Mental Health, The London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Louise M Howard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christina W Hoven
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Helen S Mayberg
- Departments of Neurology, Neurosurgery, Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Shuiyuan Xiao
- Central South University Xiangya School of Public Health, Changsha, China
| | - Madhukar Trivedi
- Peter O'Donnell Jr Brain Institute and the Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Lakshmi Vijayakumar
- Sneha, Suicide Prevention Centre and Voluntary Health Services, Chennai, India
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22
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Grant S, Wendt KE, Leadbeater BJ, Supplee LH, Mayo-Wilson E, Gardner F, Bradshaw CP. Transparent, Open, and Reproducible Prevention Science. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:701-722. [PMID: 35175501 PMCID: PMC9283153 DOI: 10.1007/s11121-022-01336-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 01/20/2023]
Abstract
The field of prevention science aims to understand societal problems, identify effective interventions, and translate scientific evidence into policy and practice. There is growing interest among prevention scientists in the potential for transparency, openness, and reproducibility to facilitate this mission by providing opportunities to align scientific practice with scientific ideals, accelerate scientific discovery, and broaden access to scientific knowledge. The overarching goal of this manuscript is to serve as a primer introducing and providing an overview of open science for prevention researchers. In this paper, we discuss factors motivating interest in transparency and reproducibility, research practices associated with open science, and stakeholders engaged in and impacted by open science reform efforts. In addition, we discuss how and why different types of prevention research could incorporate open science practices, as well as ways that prevention science tools and methods could be leveraged to advance the wider open science movement. To promote further discussion, we conclude with potential reservations and challenges for the field of prevention science to address as it transitions to greater transparency, openness, and reproducibility. Throughout, we identify activities that aim to strengthen the reliability and efficiency of prevention science, facilitate access to its products and outputs, and promote collaborative and inclusive participation in research activities. By embracing principles of transparency, openness, and reproducibility, prevention science can better achieve its mission to advance evidence-based solutions to promote individual and collective well-being.
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Affiliation(s)
- Sean Grant
- Department of Social & Behavioral Sciences, Fairbanks School of Public Health, Indiana University Richard M, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA.
| | - Kathleen E Wendt
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | | | | | - Evan Mayo-Wilson
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Frances Gardner
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Catherine P Bradshaw
- School of Education & Human Development, University of Virginia, Charlottesville, VA, USA
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23
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Leichsenring F, Steinert C, Rabung S, Ioannidis JP. The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta-analytic evaluation of recent meta-analyses. World Psychiatry 2022; 21:133-145. [PMID: 35015359 PMCID: PMC8751557 DOI: 10.1002/wps.20941] [Citation(s) in RCA: 123] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mental disorders represent a worldwide public health concern. Psychotherapies and pharmacotherapies are recommended as first line treatments. However, evidence has emerged that their efficacy may be overestimated, due to a variety of shortcomings in clinical trials (e.g., publication bias, weak control conditions such as waiting list). We performed an umbrella review of recent meta-analyses of randomized controlled trials (RCTs) of psychotherapies and pharmacotherapies for the main mental disorders in adults. We selected meta-analyses that formally assessed risk of bias or quality of studies, excluded weak comparators, and used effect sizes for target symptoms as primary outcome. We searched PubMed and PsycINFO and individual records of the Cochrane Library for meta-analyses published between January 2014 and March 2021 comparing psychotherapies or pharmacotherapies with placebo or treatment-as-usual (TAU), or psychotherapies vs. pharmacotherapies head-to-head, or the combination of psychotherapy with pharmacotherapy to either monotherapy. One hundred and two meta-analyses, encompassing 3,782 RCTs and 650,514 patients, were included, covering depressive disorders, anxiety disorders, post-traumatic stress disorder, obsessive-compulsive disorder, somatoform disorders, eating disorders, attention-deficit/hyperactivity disorder, substance use disorders, insomnia, schizophrenia spectrum disorders, and bipolar disorder. Across disorders and treatments, the majority of effect sizes for target symptoms were small. A random effect meta-analytic evaluation of the effect sizes reported by the largest meta-analyses per disorder yielded a standardized mean difference (SMD) of 0.34 (95% CI: 0.26-0.42) for psychotherapies and 0.36 (95% CI: 0.32-0.41) for pharmacotherapies compared with placebo or TAU. The SMD for head-to-head comparisons of psychotherapies vs. pharmacotherapies was 0.11 (95% CI: -0.05 to 0.26). The SMD for the combined treatment compared with either monotherapy was 0.31 (95% CI: 0.19-0.44). Risk of bias was often high. After more than half a century of research, thousands of RCTs and millions of invested funds, the effect sizes of psychotherapies and pharmacotherapies for mental disorders are limited, suggesting a ceiling effect for treatment research as presently conducted. A paradigm shift in research seems to be required to achieve further progress.
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and PsychotherapyUniversity of GiessenGiessenGermany,Department of Psychosomatics and PsychotherapyUniversity of RostockRostockGermany
| | - Christiane Steinert
- Department of Psychosomatics and PsychotherapyUniversity of GiessenGiessenGermany,International Psychoanalytic UniversityBerlinGermany
| | - Sven Rabung
- Department of PsychologyUniversity of KlagenfurtKlagenfurtAustria
| | - John P.A. Ioannidis
- Department of MedicineStanford University School of MedicineStanfordCAUSA,Department of Epidemiology and Population HealthStanford University School of MedicineStanfordCAUSA,Department of Biomedical Data ScienceStanford University School of MedicineStanfordCAUSA
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24
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Frank RA, Fabiano N, Hallgrimson Z, Korevaar DA, Cohen JF, Bossuyt PM, Leeflang MMG, Moher D, McInnes MDF, Treanor L, Salameh JP, McGrath TA, Sharifabadi AD, Atyani A, Kazi S, Choo-Foo J, Asraoui N, Alabousi M, Ha W, Prager R, Rooprai P, Pozdnyakov A, John S, Osman H, Islam N, Li N, Gauthier ID, Absi M, Kraaijpoel N, Ebrahimzadeh S, Port JD, Stoker J, Klein JS, Schweitzer M. Association of Accuracy, Conclusions, and Reporting Completeness With Acceptance by Radiology Conferences and Journals. J Magn Reson Imaging 2022; 56:380-390. [PMID: 34997786 DOI: 10.1002/jmri.28046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/29/2021] [Accepted: 12/16/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Preferential publication of studies with positive findings can lead to overestimation of diagnostic test accuracy (i.e. publication bias). Understanding the contribution of the editorial process to publication bias could inform interventions to optimize the evidence guiding clinical decisions. PURPOSE/HYPOTHESIS To evaluate whether accuracy estimates, abstract conclusion positivity, and completeness of abstract reporting are associated with acceptance to radiology conferences and journals. STUDY TYPE Meta-research. POPULATION Abstracts submitted to radiology conferences (European Society of Gastrointestinal and Abdominal Radiology (ESGAR) and International Society for Magnetic Resonance in Medicine (ISMRM)) from 2008 to 2018 and manuscripts submitted to radiology journals (Radiology, Journal of Magnetic Resonance Imaging [JMRI]) from 2017 to 2018. Primary clinical studies evaluating sensitivity and specificity of a diagnostic imaging test in humans with available editorial decisions were included. ASSESSMENT Primary variables (Youden's index [YI > 0.8 vs. <0.8], abstract conclusion positivity [positive vs. neutral/negative], number of reported items on the Standards for Reporting of Diagnostic Accuracy Studies [STARD] for Abstract guideline) and confounding variables (prospective vs. retrospective/unreported, sample size, study duration, interobserver agreement assessment, subspecialty, modality) were extracted. STATISTICAL TESTS Multivariable logistic regression to obtain adjusted odds ratio (OR) as a measure of the association between the primary variables and acceptance by radiology conferences and journals; 95% confidence intervals (CIs) and P-values were obtained; the threshold for statistical significance was P < 0.05. RESULTS A total of 1000 conference abstracts (500 ESGAR and 500 ISMRM) and 1000 journal manuscripts (505 Radiology and 495 JMRI) were included. Conference abstract acceptance was not significantly associated with YI (adjusted OR = 0.97 for YI > 0.8; CI = 0.70-1.35), conclusion positivity (OR = 1.21 for positive conclusions; CI = 0.75-1.90) or STARD for Abstracts adherence (OR = 0.96 per unit increase in reported items; CI = 0.82-1.18). Manuscripts with positive abstract conclusions were less likely to be accepted by radiology journals (OR = 0.45; CI = 0.24-0.86), while YI (OR = 0.85; CI = 0.56-1.29) and STARD for Abstracts adherence (OR = 1.06; CI = 0.87-1.30) showed no significant association. Positive conclusions were present in 86.7% of submitted conference abstracts and 90.2% of journal manuscripts. DATA CONCLUSION Diagnostic test accuracy studies with positive findings were not preferentially accepted by the evaluated radiology conferences or journals. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Robert A Frank
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Nicholas Fabiano
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Zachary Hallgrimson
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Daniël A Korevaar
- Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Jérémie F Cohen
- Department of Pediatrics and Inserm UMR 1153 (Centre of Research in Epidemiology and Statistics), Necker - Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
| | - Patrick M Bossuyt
- Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mariska M G Leeflang
- Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Matthew D F McInnes
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | | | - Lee Treanor
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Jean-Paul Salameh
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.,Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Trevor A McGrath
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | - Almohannad Atyani
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Sakib Kazi
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Jade Choo-Foo
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Nabil Asraoui
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | - Winston Ha
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Ross Prager
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Paul Rooprai
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Alex Pozdnyakov
- Department of Radiology, McMaster University, Hamilton, Canada
| | - Susan John
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Heba Osman
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Nayaar Islam
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Nicole Li
- Department of Radiology, McMaster University, Hamilton, Canada
| | - Isabelle D Gauthier
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Marissa Absi
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Noëmie Kraaijpoel
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Sanam Ebrahimzadeh
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - John D Port
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jeffrey S Klein
- Department of Radiology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Mark Schweitzer
- Department of Radiology, Wayne State University School of Medicine, Detroit, Michigan, USA
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25
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More treatment but no less depression: The treatment-prevalence paradox. Clin Psychol Rev 2021; 91:102111. [PMID: 34959153 DOI: 10.1016/j.cpr.2021.102111] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/28/2021] [Accepted: 12/06/2021] [Indexed: 12/28/2022]
Abstract
Treatments for depression have improved, and their availability has markedly increased since the 1980s. Mysteriously the general population prevalence of depression has not decreased. This "treatment-prevalence paradox" (TPP) raises fundamental questions about the diagnosis and treatment of depression. We propose and evaluate seven explanations for the TPP. First, two explanations assume that improved and more widely available treatments have reduced prevalence, but that the reduction has been offset by an increase in: 1) misdiagnosing distress as depression, yielding more "false positive" diagnoses; or 2) an actual increase in depression incidence. Second, the remaining five explanations assume prevalence has not decreased, but suggest that: 3) treatments are less efficacious and 4) less enduring than the literature suggests; 5) trial efficacy doesn't generalize to real-world settings; 6) population-level treatment impact differs for chronic-recurrent versus non-recurrent cases; and 7) treatments have some iatrogenic consequences. Any of these seven explanations could undermine treatment impact on prevalence, thereby helping to explain the TPP. Our analysis reveals that there is little evidence that incidence or prevalence have increased as a result of error or fact (Explanations 1 and 2), and strong evidence that (a) the published literature overestimates short- and long-term treatment efficacy, (b) treatments are considerably less effective as deployed in "real world" settings, and (c) treatment impact differs substantially for chronic-recurrent cases relative to non-recurrent cases. Collectively, these a-c explanations likely account for most of the TPP. Lastly, little research exists on iatrogenic effects of current treatments (Explanation 7), but further exploration is critical.
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26
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Cuijpers P, Karyotaki E. The effects of psychological treatment of perinatal depression: an overview. Arch Womens Ment Health 2021; 24:801-806. [PMID: 34228202 PMCID: PMC8492555 DOI: 10.1007/s00737-021-01159-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/23/2021] [Indexed: 11/06/2022]
Abstract
Perinatal depression is an important public health problem. Psychological interventions play an essential role in the treatment of depression. In the current paper, we will present the results of a series of meta-analyses on psychological treatments of perinatal depression. We report the results of a series of meta-analyses on psychological treatments of depression, including perinatal depression. The meta-analyses are based on a database of randomized trials on psychotherapies for depression that has been systematically developed and updated every year. Psychological interventions are effective in the treatment of perinatal depression with a moderate effect size of g = 0.67, corresponding with a NNT of about 4. These effects were still significant at 12 months after the start of the treatment. These interventions also have significant effects on social support, anxiety, functional impairment, parental stress, and marital stress. Possibly the effects are overestimated because of the use of waiting list control groups, the low quality of the majority of trials and publication bias. Research on psychotherapies for depression in general has shown that there are no significant differences between the major types of therapy, except for non-directive counseling that may have somewhat smaller effects. CBT can also be delivered in individual, group, telephone, and guided self-help format. Interventions in subthreshold depression are also effective and may prevent the onset of a full-blown depressive disorder, while therapies may be less effective in chronic depression. Psychological interventions are effective and deserve their place as first-line treatment of perinatal depression.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7-9, 1081 BT, Amsterdam, The Netherlands.
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
- Faculty of Medicine, University of Turku, Turku, Finland.
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7-9, 1081 BT, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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27
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Miguel C, Karyotaki E, Cuijpers P, Cristea IA. Selective outcome reporting and the effectiveness of psychotherapies for depression. World Psychiatry 2021; 20:444-445. [PMID: 34505363 PMCID: PMC8429345 DOI: 10.1002/wps.20900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Ioana A. Cristea
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly,IRCCS Mondino FoundationPaviaItaly
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28
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Grapin SL, Collier-Meek MA, January SAA, Yang C, Portillo NL. Reconceptualizing Mentorship for the 21st Century: A Systematic Mapping of Research in School Psychology. SCHOOL PSYCHOLOGY REVIEW 2021. [DOI: 10.1080/2372966x.2021.1910861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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29
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Schoevers RA, van Borkulo CD, Lamers F, Servaas M, Bastiaansen JA, Beekman ATF, van Hemert AM, Smit JH, Penninx BWJH, Riese H. Affect fluctuations examined with ecological momentary assessment in patients with current or remitted depression and anxiety disorders. Psychol Med 2021; 51:1906-1915. [PMID: 32234092 PMCID: PMC8381239 DOI: 10.1017/s0033291720000689] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/18/2019] [Accepted: 03/06/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is increasing interest in day-to-day affect fluctuations of patients with depressive and anxiety disorders. Few studies have compared repeated assessments of positive affect (PA) and negative affect (NA) across diagnostic groups, and fluctuation patterns were not uniformly defined. The aim of this study is to compare affect fluctuations in patients with a current episode of depressive or anxiety disorder, in remitted patients and in controls, using affect instability as a core concept but also describing other measures of variability and adjusting for possible confounders. METHODS Ecological momentary assessment (EMA) data were obtained from 365 participants of the Netherlands Study of Depression and Anxiety with current (n = 95), remitted (n = 178) or no (n = 92) DSM-IV defined depression/anxiety disorder. For 2 weeks, five times per day, participants filled-out items on PA and NA. Affect instability was calculated as the root mean square of successive differences (RMSSD). Tests on group differences in RMSSD, within-person variance, and autocorrelation were performed, controlling for mean affect levels. RESULTS Current depression/anxiety patients had the highest affect instability in both PA and NA, followed by remitters and then controls. Instability differences between groups remained significant when controlling for mean affect levels, but differences between current and remitted were no longer significant. CONCLUSIONS Patients with a current disorder have higher instability of NA and PA than remitted patients and controls. Especially with regard to NA, this could be interpreted as patients with a current disorder being more sensitive to internal and external stressors and having suboptimal affect regulation.
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Affiliation(s)
- R. A. Schoevers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center for Psychopathology and Emotion regulation, Groningen, The Netherlands
| | - C. D. van Borkulo
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center for Psychopathology and Emotion regulation, Groningen, The Netherlands
- University of Amsterdam, Department of Psychological Methods, Amsterdam, The Netherlands
| | - F. Lamers
- Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - M.N. Servaas
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center for Psychopathology and Emotion regulation, Groningen, The Netherlands
| | - J. A. Bastiaansen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center for Psychopathology and Emotion regulation, Groningen, The Netherlands
- Department of Education and Research, Friesland Mental Health Care Services, Leeuwarden, The Netherlands
| | - A. T. F. Beekman
- Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - A. M. van Hemert
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - J. H. Smit
- Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - B. W. J. H. Penninx
- Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - H. Riese
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center for Psychopathology and Emotion regulation, Groningen, The Netherlands
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30
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Fu Z, Brouwer M, Kennis M, Williams A, Cuijpers P, Bockting C. Psychological factors for the onset of depression: a meta-analysis of prospective studies. BMJ Open 2021; 11:e050129. [PMID: 34326055 PMCID: PMC8323350 DOI: 10.1136/bmjopen-2021-050129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/14/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES A comprehensive overview of the evidence for factors derived from leading psychological theories of the onset of major depressive disorder (MDD) that underpin psychological interventions is scarce . We aimed to systematically investigate the prospective evidence for factors derived from the behavioural, cognitive, diathesis-stress, psychodynamic and personality-based theories for the first onset of MDD. DESIGN Systematic review and meta-analysis. METHODS Databases PubMed, PsycINFO, Cochrane and Embase and published articles were systematically searched from inception up to August 2019. Prospective, longitudinal studies that investigated theory-derived factors before the first onset of MDD, established by a clinical interview, were included. Screening, selection and data extraction of articles were conducted by two screeners. The Grading of Recommendations Assessment, Development and Evaluation criteria were used to estimate level of confidence and risk of bias. Meta-analysis was conducted using random-effects models and mixed-method subgroup analyses. PRIMARY AND SECONDARY OUTCOME MEASURES Effect size of a factor predicting the onset of MDD (OR, risk ratio or HR). RESULTS From 42 133 original records published to August 2019, 26 studies met the inclusion criteria. Data were only available for the cognitive (n=6585) and personality-based (n=14 394) theories. Factors derived from cognitive theories and personality-based theories were related to increased odds of MDD onset (pooled OR=2.12, 95% CI: 1.12 to 4.00; pooled OR=2.43, 95% CI: 1.41 to 4.19). Publication bias and considerable heterogeneity were observed. CONCLUSION There is some evidence that factors derived from cognitive and personality-based theories indeed predict the onset of MDD (ie, dysfunctional attitudes and negative emotionality). There were no studies that prospectively studied factors derived from psychodynamic theories and not enough studies to examine the robust evidence for behavioural and diathesis-stress theories. Overall, the prospective evidence for psychological factors of MDD is limited, and more research on the leading psychological theories is needed. PROSPERO REGISTRATION NUMBER CRD42017073975.
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Affiliation(s)
- Zhongfang Fu
- Department of Psychiatry, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Marlies Brouwer
- Department of Psychiatry, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Mitzy Kennis
- ARQ National Psychotrauma Centre, ARQ centre of Expertise for the Impact of Disasters and Crises, Diemen, The Netherlands
| | - Alishia Williams
- Department of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Pim Cuijpers
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Claudi Bockting
- Department of Psychiatry, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
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Finazzi E, MacBeth A. Service users experience of psychological interventions in primary care settings: A qualitative meta-synthesis. Clin Psychol Psychother 2021; 29:400-423. [PMID: 34260121 DOI: 10.1002/cpp.2650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 11/07/2022]
Abstract
Primary care mental health services play a crucial role in public mental health by providing local and accessible psychological interventions that meet individuals' needs. Despite growing research investigating service users' perspectives of psychological interventions, a qualitative systematic review in this context is not available. The present meta-synthesis collates the existing articles and gives a thematic synthesis of qualitative studies on service users' experience of psychological interventions in primary care. Multiple databases (CINAHL, EMBASE, PsychINFO, MEDLINE, and Cochrane Library) were searched for published qualitative studies of service users' experiences of psychological interventions delivered in primary care. Articles were included if they met inclusion criteria. Study quality was assessed using the Critical Appraisal Skills Programme tool. All types of psychological interventions were considered across model and delivery format (e.g., face-to-face, computerised programmes, and group). NVIVO was used to code the dataset and themes were extracted following thematic synthesis. Twenty-two studies were included. Four analytical themes and 10 subthemes emerged. The identified themes were as follows: (1) 'Access and Acceptability: facilitators and barriers', (2) 'Structural aspects'; (3) 'Therapeutic process' and (4) 'Outcomes'. A model of interrelationships between themes is proposed. Findings suggest several 'essential ingredients' across psychological interventions and modalities. The crucial role of relational factors, the importance of assessing service users' perceptions of treatment features (e.g., remote delivery) and of tailoring the intervention to their needs were emphasised. Results also suggest involving service users more in discussions and decisions about psychological interventions offered might enhance access, acceptability, and engagement. Recommendations for practice and research are provided.
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Affiliation(s)
- Emilia Finazzi
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, UK.,Department of Clinical and Counselling Psychology, NHS Grampian, Aberdeen, UK
| | - Angus MacBeth
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, UK
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Eggart M, Todd J, Valdés-Stauber J. Validation of the Multidimensional Assessment of Interoceptive Awareness (MAIA-2) questionnaire in hospitalized patients with major depressive disorder. PLoS One 2021; 16:e0253913. [PMID: 34170963 PMCID: PMC8232409 DOI: 10.1371/journal.pone.0253913] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/16/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Interoception refers to the sensation, interpretation, and integration of internal somatic signals. Abnormalities in self-reported interoception are prevalent features of major depressive disorder (MDD) and may affect treatment outcomes. In the present study, we investigated the psychometric properties of the revised eight-dimensional and 37-item Multidimensional Assessment of Interoceptive Awareness questionnaire (the MAIA-2) in a severely depressed sample, after translating two updated scales (Not-Distracting, Not-Worrying) into German. Specifically, we examined the measure's internal consistency reliability, sensitivity to change, and minimal important differences (MID) with a focus on patient's antidepressive responses to treatment. METHODS The study enrolled 110 participants (age: M = 46.85, SD = 11.23; female: 55.45%) undergoing hospital treatment, of whom 87 were included in the pre-post analysis. Participants completed a German translation of MAIA-2 and the Beck Depression Inventory-II (pre-/post-treatment). Internal consistency reliability was determined by Cronbach's α/McDonalds's ω, sensitivity to change was determined by effect sizes, and MIDs were determined by distribution- (0.5*SD) and anchor-based approaches (mean change method; ROC curve cut-points). RESULTS Depression severity reduced over the course of treatment (Median = -65.22%), and 34.48% of patients achieved remission. Reliability was appropriate for post-treatment (range of ω: .70-.90), but questionable for two pre-treatment scales (Noticing: ω = .64; Not-Distracting: ω = .66). The eight dimensions of MAIA-2 were sensitive to change (standardized response mean: .32-.81; Cohen's effect size: .30-.92). Distribution-based MIDs (.38-.61) and anchor-based mean change MIDs (remission vs. partial response: .00-.85; partial response vs. nonresponse: .08-.88) were established on the group level. For six scales, ROC cut-points (remission: .00-1.33; response: -.20-1.00) demonstrated accurate classification to treatment response groups on the individual level. CONCLUSIONS This study demonstrated the applicability of the MAIA-2 questionnaire in MDD. The updated version may have led to reliability improvements regarding the revised scales, but subthreshold reliability was evident prior to treatment. The measure's dimensions were sensitive to change. MIDs were established that corresponded with antidepressive treatment outcomes. Our findings are consistent with a growing area of research which considers somatic feelings as key contributors to mental health.
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Affiliation(s)
- Michael Eggart
- Department of Psychiatry and Psychotherapy I, Ulm University and Center for Psychiatry Südwürttemberg, Ravensburg, Germany
- Faculty Social Work, Health and Nursing, Ravensburg-Weingarten University of Applied Sciences, Weingarten, Germany
| | - Jennifer Todd
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, United Kingdom
- Centre for Psychological Medicine, Perdana University, Kuala Lumpur, Malaysia
| | - Juan Valdés-Stauber
- Department of Psychiatry and Psychotherapy I, Ulm University and Center for Psychiatry Südwürttemberg, Ravensburg, Germany
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Hollon SD, Andrews PW, Singla DR, Maslej MM, Mulsant BH. Evolutionary theory and the treatment of depression: It is all about the squids and the sea bass. Behav Res Ther 2021; 143:103849. [PMID: 34102409 DOI: 10.1016/j.brat.2021.103849] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/21/2021] [Accepted: 03/15/2021] [Indexed: 02/07/2023]
Abstract
According to the analytical rumination hypothesis, depression is an evolved adaptation (like pain or anxiety) that served in our ancestral past to keep people focused on complex interpersonal problems until they could arrive at a resolution (spontaneous remission). If this is true, then those clinical treatments that most facilitate the functions that depression evolved to serve are likely to be more advantageous in the long run than others that simply relieve distress. For example, antidepressant medications may be efficacious in the treatment of depression but only work for so long as they are taken. They may also have an iatrogenic effect that prolongs the duration of the underlying episode. Cognitive and behavioral interventions are as efficacious as medications in terms of reducing acute distress and also appear to have an enduring effect that protects against the return of subsequent symptoms. However, the bulk of the evidence for this effect comes from comparisons to prior medication treatment and it remains unclear whether these psychosocial interventions are truly preventative, or antidepressant medications iatrogenic. A study is described that could resolve this issue and test evolutionary theory with respect to the purported role of rumination in bringing about spontaneous remission.
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Affiliation(s)
| | - Paul W Andrews
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Canada
| | - Daisy R Singla
- Sinai Health & Department of Psychiatry, University of Toronto, Canada
| | | | - Benoit H Mulsant
- Centre for Addiction and Mental Health & Department of Psychiatry, University of Toronto, Canada
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Cuijpers P, Quero S, Papola D, Cristea IA, Karyotaki E. Care-as-usual control groups across different settings in randomized trials on psychotherapy for adult depression: a meta-analysis. Psychol Med 2021; 51:634-644. [PMID: 31843031 DOI: 10.1017/s0033291719003581] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Care-as-usual (CAU) is often used as a control condition in psychotherapy research, but it may vary considerably what that entails, ranging from no treatment, to routine treatment in primary care, general medical care, perinatal care, and specialized mental health care. METHODS We conducted a meta-analysis of trials comparing psychotherapy for depression to CAU, with a focus on the different categories of CAU and countries where the studies were conducted. We used an existing database of randomized trials on psychotherapy for depression that is updated every year. RESULTS A total of 140 studies with 15 419 patients were included. We found no significant differences in effects between categories of CAU (effect sizes ranging from g = 0.43 for CAU in primary care to g = 0.73 for no treatment), but heterogeneity was high in all CAU categories. After stratifying effects across specific countries (within CAU categories) we found that heterogeneity was considerably lower and there were several significant differences between countries. Overall, effects were larger in non-Western countries (g = 0.84 to 1.28) compared to those in Western countries (g = 0.52; p for difference = 0.002). Effects were smaller in studies with risk of bias (p = 0.01). CONCLUSIONS There are no significant differences between major categories of CAU when compared to psychotherapy conditions in randomized trials. However, effects of psychotherapy differ considerably across CAU conditions in specific countries. CAU therefore is a heterogeneous control condition in psychotherapy research.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Soledad Quero
- Department of Basic, Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Davide Papola
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Ioana A Cristea
- Department of Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, Hopwood M, Lyndon B, Mulder R, Porter R, Singh AB, Murray G. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2021; 55:7-117. [PMID: 33353391 DOI: 10.1177/0004867420979353] [Citation(s) in RCA: 232] [Impact Index Per Article: 77.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. METHODS Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. CONCLUSION The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.
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Affiliation(s)
- Gin S Malhi
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | | | - Philip Boyce
- Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.,Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Bill Lyndon
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
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Gruijters SLK, Peters GJY. Meaningful change definitions: sample size planning for experimental intervention research. Psychol Health 2020; 37:1-16. [DOI: 10.1080/08870446.2020.1841762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Stefan L. K. Gruijters
- Faculty of Psychology, General Psychology, Open University of the Netherlands, Heerlen, the Netherlands
| | - Gjalt-Jorn Y. Peters
- Faculty of Psychology, Methodology & Statistics, Open University of the Netherlands, Heerlen, the Netherlands
- Faculty of Psychology and Neuroscience, Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
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Ijaz S, Blanca Bolea, Davies S, Savović J, Richards A, Sullivan S, Moran P. Antipsychotic Polypharmacy and Metabolic Syndrome in Schizophrenia: A Review of Systematic Reviews. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2020; 18:482-492. [PMID: 33343261 DOI: 10.1176/appi.focus.18307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
(Reprinted with permission from BMC Psychiatry (2018) 18:275).
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Tremain H, Fletcher K, Scott J, McEnery C, Berk M, Murray G. The influence of stage of illness on functional outcomes after psychological treatment in bipolar disorder: A systematic review. Bipolar Disord 2020; 22:666-692. [PMID: 32621794 DOI: 10.1111/bdi.12974] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study was to advance understanding of stage of illness in bipolar disorder (BD), by interrogating the literature for evidence of an influence of stage of illness on functional (ie non-symptom) outcomes following psychosocial intervention. METHODS A systematic literature search following PRISMA guidelines was conducted to identify empirical studies of psychosocial interventions for established BD. To investigate stage as a predictor of three functional outcomes (general/social functioning, cognitive functioning and quality of life [QoL]), study samples were dichotomised into earlier and later stage using proxy measures identified in existing staging models. Findings were integrated using data-based convergent synthesis. RESULTS A total of 88 analyses from 62 studies were identified. Synthesis across studies suggested that psychosocial intervention was more likely to be effective for general functioning outcomes earlier in the course of established BD. No stage-related differences were found for cognitive or QoL outcomes. Exploratory investigations found some evidence of an interaction between specific intervention type and stage of illness in predicting outcomes. CONCLUSIONS A novel systematic review provided preliminary evidence that benefits general/social functioning may be more pronounced in earlier versus later stages of established BD. The review also generated hypotheses about a potential three-way interaction, whereby specific psychosocial interventions may be best placed to target functional outcomes in earlier versus later stage BD. The strength of conclusions is limited by the overall low-quality and significant heterogeneity of studies. Further research is urgently required to understand the impact of illness stage on the effectiveness of psychosocial interventions.
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Affiliation(s)
- Hailey Tremain
- Centre for Mental Health, Faculty of Health Arts and Design, Swinburne University, Melbourne, Vic, Australia
| | - Kathryn Fletcher
- Centre for Mental Health, Faculty of Health Arts and Design, Swinburne University, Melbourne, Vic, Australia
| | - Jan Scott
- Centre for Mental Health, Faculty of Health Arts and Design, Swinburne University, Melbourne, Vic, Australia.,Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Carla McEnery
- Centre for Mental Health, Faculty of Health Arts and Design, Swinburne University, Melbourne, Vic, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Vic, Australia
| | - Michael Berk
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Vic, Australia.,IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Vic, Australia.,The Department of Psychiatry and the Florey Institute for Neuroscience and Mental Health, the University of Melbourne, Parkville, Vic, Australia
| | - Greg Murray
- Centre for Mental Health, Faculty of Health Arts and Design, Swinburne University, Melbourne, Vic, Australia
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Marks-Anglin A, Chen Y. A historical review of publication bias. Res Synth Methods 2020; 11:725-742. [PMID: 32893970 DOI: 10.1002/jrsm.1452] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 12/12/2022]
Abstract
Publication bias is a well-known threat to the validity of meta-analyses and, more broadly, the reproducibility of scientific findings. When policies and recommendations are predicated on an incomplete evidence base, it undermines the goals of evidence-based decision-making. Great strides have been made in the last 50 years to understand and address this problem, including calls for mandatory trial registration and the development of statistical methods to detect and correct for publication bias. We offer an historical account of seminal contributions by the evidence synthesis community, with an emphasis on the parallel development of graph-based and selection model approaches. We also draw attention to current innovations and opportunities for future methodological work.
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Affiliation(s)
- Arielle Marks-Anglin
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yong Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Amad A, Jardri R, Rousseau C, Larochelle Y, Ioannidis JPA, Naudet F. Excess Significance Bias in Repetitive Transcranial Magnetic Stimulation Literature for Neuropsychiatric Disorders. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 88:363-370. [PMID: 31590171 DOI: 10.1159/000502805] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/17/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Repetitive transcranial magnetic stimulation (rTMS) has been widely tested and promoted for use in multiple neuropsychiatric conditions, but as for many other medical devices, some gaps may exist in the literature and the evidence base for the clinical efficacy of rTMS remains under debate. OBJECTIVE We aimed to test for an excess number of statistically significant results in the literature on the therapeutic efficacy of rTMS across a wide range of meta-analyses and to characterize the power of studies included in these meta-analyses. METHODS Based on power calculations, we computed the expected number of "positive" datasets for a medium effect size (standardized mean difference, SMD = 0.30) and compared it with the number of observed "positive" datasets. Sensitivity analyses considered small (SMD = 0.20), modest (SMD = 0.50), and large (SMD = 0.80) effect sizes. RESULTS A total of 14 meta-analyses with 228 datasets (110 for neurological disorders and 118 for psychiatric disorders) were assessed. For SMD = 0.3, the number of observed "positive" studies (n = 94) was larger than expected (n = 35). We found evidence for an excess of significant findings overall (p < 0.0001) and in 8/14 meta-analyses. Evidence for an excess of significant findings was also observed for SMD = 0.5 for neurological disorders. Of the 228 datasets, 0 (0%), 0 (0%), 3 (1%), and 53 (23%) had a power >0.80, respectively, for SMDs of 0.30, 0.20, 0.50, and 0.80. CONCLUSION Most studies in the rTMS literature are underpowered. This results in fragmentation and waste of research efforts. The somewhat high frequency of "positive" results seems spurious and may reflect bias. Caution is warranted in accepting rTMS as an established treatment for neuropsychiatric conditions.
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Affiliation(s)
- Ali Amad
- Psychiatry Department and CURE Platform, Fontan Hospital, CHU Lille, Lille, France, .,Psychiatry and Beliefs Team, SCALab, CNRS UMR-9193, University of Lille, Lille, France, .,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom,
| | - Renaud Jardri
- Psychiatry Department and CURE Platform, Fontan Hospital, CHU Lille, Lille, France.,Psychiatry and Beliefs Team, SCALab, CNRS UMR-9193, University of Lille, Lille, France
| | - Chloé Rousseau
- Inserm, CIC 1414 - Centre d'Investigation Clinique de Rennes, CHU Rennes, University of Rennes, Rennes, France
| | - Yann Larochelle
- Inserm, CIC 1414 - Centre d'Investigation Clinique de Rennes, CHU Rennes, University of Rennes, Rennes, France
| | - John P A Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA.,Departments of Medicine, Health Research and Policy, Biomedical Data Science, and Statistics, Stanford University, Stanford, California, USA
| | - Florian Naudet
- Inserm, CIC 1414 - Centre d'Investigation Clinique de Rennes, CHU Rennes, University of Rennes, Rennes, France
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Silote GP, de Oliveira SFS, Ribeiro DE, Machado MS, Andreatini R, Joca SRL, Beijamini V. Ketamine effects on anxiety and fear-related behaviors: Current literature evidence and new findings. Prog Neuropsychopharmacol Biol Psychiatry 2020; 100:109878. [PMID: 31982463 DOI: 10.1016/j.pnpbp.2020.109878] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/16/2020] [Accepted: 01/23/2020] [Indexed: 12/19/2022]
Abstract
Ketamine, a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist, presents a rapid and sustained antidepressant effect in clinical and preclinical studies. Regarding ketamine effects on anxiety, there is a widespread discordance among pre-clinical studies. To address this issue, the present study reviewed the literature (electronic database MEDLINE) to summarize the profile of ketamine effects in animal tests of anxiety/fear. We found that ketamine anxiety/fear-related effects may depend on the anxiety paradigm, schedule of ketamine administration and tested species. Moreover, there was no report of ketamine effects in animal tests of fear related to panic disorder (PD). Based on that finding, we evaluated if treatment with ketamine and another NMDA antagonist, MK-801, would induce acute and sustained (24 hours later) anxiolytic and/or panicolytic-like effects in animals exposed to the elevated T-maze (ETM). The ETM evaluates, in the same animal, conflict-evoked and fear behaviors, which are related, respectively, to generalized anxiety disorder and PD. Male Wistar rats were systemically treated with racemic ketamine (10, 30 and 80 mg/kg) or MK-801 (0.05 and 0.1 mg/kg) and tested in the ETM in the same day or 24 hours after their administration. Ketamine did not affect the behavioral tasks performed in the ETM acutely or 24 h later. MK-801 impaired inhibitory avoidance in the ETM only at 45 min post-injection, suggesting a rapid but not sustained anxiolytic-like effect. Altogether our results suggest that ketamine might have mixed effects in anxiety tests while it does not affect panic-related behaviors.
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Affiliation(s)
- Gabriela P Silote
- Biochemistry and Pharmacology Graduate Program, Federal University of Espirito Santo, Vitoria, ES, Brazil; Department of Biomolecular Sciences, School of Pharmaceutical Sciences, University of São Paulo, Ribeirão Preto, SP, Brazil; Translational Neuropsychiatry Unit (TNU), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sabrina F S de Oliveira
- Department of Pharmaceutical Sciences, Health Science Center, Federal University of Espirito Santo, Vitoria, ES, Brazil
| | - Deidiane E Ribeiro
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Mayara S Machado
- Department of Pharmaceutical Sciences, Health Science Center, Federal University of Espirito Santo, Vitoria, ES, Brazil
| | - Roberto Andreatini
- Department of Pharmacology, Federal University of Paraná, Curitiba, PR, Brazil
| | - Sâmia R L Joca
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences, University of São Paulo, Ribeirão Preto, SP, Brazil; Aarhus Institute of Advanced Studies (AIAS), Aarhus University, Denmark
| | - Vanessa Beijamini
- Biochemistry and Pharmacology Graduate Program, Federal University of Espirito Santo, Vitoria, ES, Brazil; Department of Pharmaceutical Sciences, Health Science Center, Federal University of Espirito Santo, Vitoria, ES, Brazil; Pharmaceutical Sciences Graduate Program, Health Sciences Center, Federal University of Espirito Santo, Vitoria, ES, Brazil.
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Low dissemination rates, non-transparency of trial premature cessation and late registration in child mental health: observational study of registered interventional trials. Eur Child Adolesc Psychiatry 2020; 29:813-825. [PMID: 31486894 DOI: 10.1007/s00787-019-01392-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/16/2019] [Indexed: 10/26/2022]
Abstract
The aim of this observational study was to explore trial premature cessation, non-publication and trial registration time in child mental health. Data were extracted for "closed" trials in Clinicaltrials.gov registry and European Union Clinical Trial Register (EUCTR) and corresponding publications of completed trials indexed in three data bases (PubMed, Scopus and Google Scholar). We restricted the extraction to the 'Behaviours and Mental Disorders' category and participants' age of 0-17 years. Outcome measures were trial completion, results reporting within a year after the trial completion, publishing an article in a peer-reviewed journal within an average time to publish (729 days), and registration time. The number of EUCTR trials was relatively small (n = 35) and with many inconsistencies. Out of 827 "closed" trials extracted from ClinicalTrials.gov, 69% were completed, 24.2% of prematurely ceased trials did not report reasons for early termination, 12.2% of the completed trials had results reported within a year, and 29.3% had an article published within 24 months after completion. Middle-sized (100-499 participants) and behavioural trials had higher chances of being successfully completed. Middle-sized and industry-funded trials were associated with results reporting. Chances for publishing an article were lower for industry-funded trials. Industry funding and drug interventions were related to timely registration. Large sample and non-industry funding were related to retrospective registration, which was recorded more often in recent years than before (we observed trials registered from 2002 until 2017). This study found low dissemination rates in the field of child mental health, with worrying under-reporting of premature termination causes. These findings indicate that more children are being subjected to unnecessary risk that comes with trial participation.
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Dowdy A, Tincani M, Schneider WJ. Evaluation of publication bias in response interruption and redirection: A meta‐analysis. J Appl Behav Anal 2020; 53:2151-2171. [DOI: 10.1002/jaba.724] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/20/2020] [Accepted: 03/28/2020] [Indexed: 01/12/2023]
Affiliation(s)
- Art Dowdy
- College of Education Temple University
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Lopes RT, Meyer B, Berger T, Svacina MA. Effectiveness of an internet-based self-guided program to treat depression in a sample of Brazilian users: a study protocol. BRAZILIAN JOURNAL OF PSYCHIATRY 2020; 42:322-328. [PMID: 32159711 PMCID: PMC7236154 DOI: 10.1590/1516-4446-2019-0582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 10/22/2019] [Indexed: 01/02/2023]
Abstract
Although psychological treatments for depressive disorders are available, they are often expensive or inaccessible for many. Web-based interventions that require minimal or no contact with therapists have been shown effective. To the best of our knowledge, no study using this treatment format has been conducted in Brazil. The Deprexis program was designed using empirically established principles of cognitive-behavioral therapy to reduce depressive symptoms. The objective of this study was to evaluate the effectiveness of Deprexis in Brazil. This randomized controlled trial will include 128 Brazilians with clinically significant depression symptoms or who have been diagnosed with depressive disorder (major depressive disorder or dysthymia), recruited over the internet (Brazilian forums, social networks, or e-mail lists). Individuals with other psychiatric diagnoses that require significant attention (e.g., bipolar disorder, psychosis) will not be included in the trial. Participants will be randomly assigned to 1) treatment as usual plus immediate access to Deprexis or 2) treatment as usual plus delayed access to Deprexis (after 8 weeks). Participants will be able to obtain other treatment types in addition to the online intervention. If found effective, this web-based intervention would increase the evidence-based care options for depression treatment in Brazil. RBR-6kk3bx, UTN U1111-1212-8998.
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Affiliation(s)
| | | | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
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Treanor L, Frank RA, Cherpak LA, Dehmoobad Sharifabadi A, Salameh JP, Hallgrimson Z, Fabiano N, McGrath TA, Kraaijpoel N, Yao J, Korevaar DA, Bossuyt PM, McInnes MDF. Publication bias in diagnostic imaging: conference abstracts with positive conclusions are more likely to be published. Eur Radiol 2020; 30:2964-2972. [PMID: 31953657 DOI: 10.1007/s00330-019-06568-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/24/2019] [Accepted: 10/31/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate whether imaging diagnostic test accuracy conference abstracts with positive conclusions or titles are more likely to reach full-text publication than those with negative (or neutral) conclusions or titles. METHODS Diagnostic accuracy research abstracts were included if they were presented at the 2011 or 2012 Radiological Society of North America conference. Full-text publication status at 5 years post conference abstract submission was determined. Conclusion and title positivity of conference abstracts were extracted, as well as potential confounding factors. The associations of conclusion and title positivity with publication status at 5 years post conference abstract submission were assessed using a multivariable logistic regression model. Conditional odds ratios were calculated to express the strength of associations, adjusting for the confounders. RESULTS In total, 282/400 (71%) of included conference abstracts reached full-text publication. A total of 246 out of 337 (74%) conference abstracts with positive conclusions resulted in full-text publications, compared with 26/48 (54%) with neutral conclusions and 5/15 (33%) with negative conclusions. In multivariable logistic regression, conclusion positivity was significantly associated with full-text publication (odds ratio 3.6; 95% CI 1.9-6.7 for conference abstracts with positive conclusions, compared with those with non-positive conclusions); this did not apply to title positivity (odds ratio 1.2; 95% CI 0.47-3.0). CONCLUSION Imaging conference abstracts with positive conclusions were more likely to be published as full-text articles. Title positivity was not associated with publication. This preferential publication pattern may lead to an overrepresentation of positive studies in the literature. An overrepresentation of positive studies may contribute to inflated estimates of test accuracy and has the potential to adversely influence patient care. KEY POINTS • Imaging diagnostic test accuracy conference abstracts with positive conclusions were more likely to be reported as full-text articles than those with non-positive conclusions. • The majority (75%) of imaging diagnostic test accuracy conference abstracts with positive conclusions were published, compared with only 53% and 33% with neutral and negative conclusions, respectively. • Conclusion positivity remained associated with the full-text publication of conference abstracts when controlling for multiple potential confounding variables.
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Affiliation(s)
- Lee Treanor
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Robert A Frank
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Lindsay A Cherpak
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | - Jean-Paul Salameh
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Zachary Hallgrimson
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Nicholas Fabiano
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Trevor A McGrath
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Noemie Kraaijpoel
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jason Yao
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Daniel A Korevaar
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Patrick M Bossuyt
- Clinical Epidemiology and Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthew D F McInnes
- Department of Radiology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Room c159 Ottawa Hospital Civic Campus, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada.
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Ormel J, Spinhoven P, de Vries YA, Cramer AOJ, Siegle GJ, Bockting CLH, Hollon SD. The antidepressant standoff: why it continues and how to resolve it. Psychol Med 2020; 50:177-186. [PMID: 31779735 DOI: 10.1017/s0033291719003295] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Antidepressant medications (ADMs) are widely used and long-term use is increasing. Given this extensive use and recommendation of ADMs in guidelines, one would expect ADMs to be universally considered effective. Surprisingly, that is not the case; fierce debate on their benefits and harms continues. This editorial seeks to understand why the controversy continues and how consensus can be achieved. METHODS 'Position' paper. Critical analysis and synthesis of relevant literature. RESULTS Advocates point at ADMs impressive effect size (number needed to treat, NNT = 6-8) in acute phase treatment and continuation/maintenance ADM treatment prevention relapse/recurrence in acute phase ADM responders (NNT = 3-4). Critics point at the limited clinically significant surplus value of ADMs relative to placebo and argue that effectiveness is overstated. We identified multiple factors that fuel the controversy: certainty of evidence is low to moderate; modest efficacy on top of strong placebo effects allows critics to focus on small net efficacy and advocates on large gross efficacy; ADM withdrawal symptoms masquerade as relapse/recurrence; lack of association between ADM treatment and long-term outcome in observational databases. Similar problems affect psychological treatments as well, but less so. We recommend four approaches to resolve the controversy: (1) placebo-controlled trials with relevant long-term outcome assessments, (2) inventive analyses of observational databases, (3) patient cohort studies including effect moderators to improve personalized treatment, and (4) psychological treatments as universal first-line treatment step. CONCLUSIONS Given the public health significance of depression and increased long-term ADM usage, new approaches are needed to resolve the controversy.
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Affiliation(s)
- Johan Ormel
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Netherlands Institute for Advanced Study KNAW, Amsterdam, The Netherlands
| | - Philip Spinhoven
- Netherlands Institute for Advanced Study KNAW, Amsterdam, The Netherlands
- Department of Psychiatry, Leiden University, Institute of Psychology, Leiden, The Netherlands
| | - Ymkje Anna de Vries
- Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands
| | - Angélique O J Cramer
- Netherlands Institute for Advanced Study KNAW, Amsterdam, The Netherlands
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Greg J Siegle
- University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Claudi L H Bockting
- Netherlands Institute for Advanced Study KNAW, Amsterdam, The Netherlands
- Department of Psychiatry, University of Amsterdam, Amsterdam University Medical Centres, AMC, Amsterdam, The Netherlands
| | - Steven D Hollon
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
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Vogt KS, Norman P. Is mentalization-based therapy effective in treating the symptoms of borderline personality disorder? A systematic review. Psychol Psychother 2019; 92:441-464. [PMID: 30099834 PMCID: PMC6900007 DOI: 10.1111/papt.12194] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This review sought to systematically review evidence on the efficacy of mentalization-based therapy (MBT) for the treatment of borderline personality disorder (BPD), in particular, in decreasing psychiatric symptoms associated with BPD and its comorbid disorders. METHOD Fourteen papers were included in the review which examined the effectiveness of MBT in the context of BPD; these included 11 original studies and three follow-up papers. RESULTS Mentalization-based therapy was found to achieve either superior or equal reductions in psychiatric symptoms when compared with other treatments (supportive group therapy, treatment as usual/standard psychiatric care, structured clinical management, and specialized clinical management). DISCUSSION Mentalization-based therapy can achieve significant reductions in BPD symptom severity and the severity of comorbid disorders as well as increase quality of life. However, caution is required, as the need for better quality research such as randomized controlled trials is pressing. Research is also needed on the proposed mediators of MBT. PRACTITIONER POINTS Mentalization-based therapy (MBT) is increasingly being considered as a treatment for people with borderline personality disorder (BPD), and a systematic review was required to investigate its effectiveness. MBT was found to be equally as effective or superior to well-established comparison treatments of BPD, however, the majority of studies was of unsatisfying quality. Little is known about the mechanisms of MBT. Further, better quality trials are needed to investigate its efficacy in treating BPD.
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Affiliation(s)
- Katharina Sophie Vogt
- Sheffield Institute of Translational Neuroscience (SiTran)The University of SheffieldUK
- Department of PsychologyThe University of SheffieldUK
| | - Paul Norman
- Department of PsychologyThe University of SheffieldUK
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Luyten P, Leichsenring F, Abbass A, Hilsenroth M, Rabung S, Steinert C. What to conclude from a non-randomized clinical trial comparing dialectical behavior therapy and mentalization-based treatment in patients with borderline personality disorder? Psychol Med 2019; 49:2810-2811. [PMID: 31535604 DOI: 10.1017/s0033291719001922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Patrick Luyten
- Faculty of Psychology and Educational Sciences, University of Leuven, Tiensestraat 102 - PO Box 3722, 3000 Leuven, Belgium
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London WC1E 6BT, UK
| | - Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Ludwigstr. 76, 35392 Giessen, Germany
| | - Allan Abbass
- Department of Psychiatry, Dalhousie University, Centre for Emotions and Health, Halifax, 8203 5909 Veterans Memorial Lane, Halifax, NS, Canada B3H 2E2
| | - Mark Hilsenroth
- Derner School of Psychology, Adelphi University, Hy Weinberg Center, 1 South Avenue, Garden City, NY 11530-0701, USA
| | - Sven Rabung
- Department of Psychology, Alpen-Adria-Universität Klagenfurt, Universitätsstr. 65-67, A-9020 Klagenfurt, Austria
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Ludwigstr. 76, 35392 Giessen, Germany
- Department of Psychology, MSB Medical School Berlin, Calandrellistr. 1-9, 12247 Berlin, Germany
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Abstract
PURPOSE OF REVIEW We give an overview of recent developments on psychological treatments of depression in primary care. RECENT FINDINGS In recent years, it has become clear that psychotherapies can effectively be delivered through e-health applications. Furthermore, several studies in low and middle income countries have shown that lay health counselors can effectively deliver psychological therapies. Behavioral activation, a relatively simple form of therapy, has been found to be as effective as cognitive behavior therapy. Treatment of subthreshold depression has been found to not only reduce depressive symptoms but also prevent the onset of major depression. In addition, therapies are effective in older adults, patients with general medical disorders and in perinatal depression. Psychological therapies are effective in the treatment of depression in primary care, have longer lasting effects than drugs, are preferred by the majority of patients, and can be applied flexibly with different formats and across different target groups.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7-9, 1081 BT, Amsterdam, The Netherlands.
| | - Soledad Quero
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Christopher Dowrick
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Bruce Arroll
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
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Arnow KD, King AC, Wagner TH. Characteristics of mental health trials registered in ClinicalTrials.gov. Psychiatry Res 2019; 281:112552. [PMID: 31627072 DOI: 10.1016/j.psychres.2019.112552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 08/31/2019] [Indexed: 12/29/2022]
Abstract
The ClinicalTrials.gov registry was established in 2000 to address concerns about publication bias and public access to information about clinical trials. We aimed to evaluate differences between for-profit and non-profit sponsors of efficacy mental health trials registered in ClinicalTrials.gov on key trial characteristics that relate to data integrity. We also sought to evaluate whether the registry is fulfilling its purpose as a means of promoting transparency between researchers and the public by providing complete and quality information about the trials it contains. We found that trials tend to be small, use a placebo instead of an active comparator, and employ randomization and blinding. We discuss the implications of these design characteristics and the limitations of the registry.
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Affiliation(s)
- Katherine D Arnow
- Division of Epidemiology, Department of Health Research & Policy, 150 Governor's Lane, Stanford, CA, United States; Division of Public Health, Policy, and Planning, San Mateo County, 225 37th Ave, San Mateo, CA, United States.
| | - Abby C King
- Division of Epidemiology, Department of Health Research & Policy, 150 Governor's Lane, Stanford, CA, United States; Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Palo Alto, CA, United States
| | - Todd H Wagner
- Veterans Affairs, Palo Alto Veterans Affairs Medical Center, 795 Willow Rd, Menlo Park, CA, United States; Department of Surgery, Stanford University School of Medicine, 1070 Arastradero Rd, Stanford, CA, United States
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