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Ciuca AM, Berger T, Crişan LG, Miclea M. Internet-based treatment for panic disorder: A three-arm randomized controlled trial comparing guided (via real-time video sessions) with unguided self-help treatment and a waitlist control. PAXPD study results. J Anxiety Disord 2018; 56:43-55. [PMID: 29625834 DOI: 10.1016/j.janxdis.2018.03.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 03/16/2018] [Accepted: 03/23/2018] [Indexed: 10/17/2022]
Abstract
A growing body of evidence suggests that Internet-based cognitive behavioral treatments (ICBT) are effective to treat anxiety disorders. However, the effect of therapist guidance in ICBT is still under debate and guided ICBT offered in a real-time audio-video communication format has not yet been systematically investigated. This three-arm RCT compared the efficacy of guided with unguided ICBT (12 weeks intervention) and a waitlist (WL). A total of 111 individuals meeting the diagnostic criteria for panic disorder (PD) were randomly assigned to one of three conditions. Primary outcomes were the severity of self-report panic symptoms and diagnostic status. Secondary outcomes were symptoms of depression, functional impairment, catastrophic cognitions, fear of sensations and body vigilance. At post-treatment, both active conditions showed superior outcomes regarding PD and associated symptoms (guided ICBT vs. WL: d = 1.04-1.36; unguided ICBT vs. WL: d = 0.70-1.06). At post-treatment, the two active conditions did not differ significantly in self-reported symptom reduction (d = 0.21-0.54, all ps > 0.05), but the guided treatment was superior to the unguided treatment in terms of diagnostic status (χ2 (1) = 13.15, p < 0.01). Treatment gains were maintained at successive follow-ups and the guided treatment became superior to the unguided treatment at 6 months follow-up (d = 0.72-1.05, all ps < 0.05).
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Affiliation(s)
- Amalia M Ciuca
- Department of Psychology, Babeş-Bolyai University, Republicii 37, 400015, Cluj-Napoca, Romania; Department of Clinical Psychology and Psychotherapy, Bern University, Fabrikstrasse 8, 3012, Bern, Switzerland.
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, Bern University, Fabrikstrasse 8, 3012, Bern, Switzerland.
| | - Liviu G Crişan
- Department of Psychology, Babeş-Bolyai University, Republicii 37, 400015, Cluj-Napoca, Romania.
| | - Mircea Miclea
- Department of Psychology, Babeş-Bolyai University, Republicii 37, 400015, Cluj-Napoca, Romania.
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Paina L, Ungureanu M, Olsavszky V. Implementing the Code of Practice on International Recruitment in Romania - exploring the current state of implementation and what Romania is doing to retain its domestic health workforce. HUMAN RESOURCES FOR HEALTH 2016; 14:22. [PMID: 27381198 PMCID: PMC4943505 DOI: 10.1186/s12960-016-0119-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND The Romanian health system is struggling to retain its health workers, who are currently facing strong incentives for migration to Western European health systems. Retention issues, coupled with high levels of migration, complicate Romania's efforts in providing basic health services for rural, underserved, and marginalized populations, as well as in achieving equitable health access for all. The WHO Global Code of Practice on International Recruitment of Health Personnel (the Code) aims to promote ethical international recruitment and health systems strengthening. We explore Romania's implementation of the Code's principles and recommendations. METHODS We analysed peer-reviewed and grey literature, in English and Romanian, and sought secondary data from the websites of Romania's largest medical universities. The analysis was guided by the following themes and recommendations in the Code: health personnel development and health systems sustainability, international cooperation, data gathering, information exchange, and implementation and monitoring of the Code. RESULTS Romania's implementation of the Code was observed to be limited. Gaps were identified with regards to several aspects of the Romanian health system, including the lack of support to health personnel training, recruitment, and retention in order to increase the appeal for health providers to practice in Romania and in underserved areas. In terms of international cooperation, the Code recommends various policy instruments to guide recruitment, including bilateral agreements. However, we could not determine which of these instruments were used as a result of the Code and whether or not they were effective. We identified little evidence of initiatives for health workers' professional and personal support. Insufficient data and few information exchange platforms exist on health workforce issues, hindering active sharing of data on migration with European Union and WHO audiences. We could not identify any evidence of monitoring of the Code's implementation to date. CONCLUSIONS In the absence of major system reforms, health workers will continue to migrate to urban areas and abroad. Romanian policymakers should address more of the Code's recommendations by developing a national policy for human resources for health, a central database to aid health workforce planning and management, stronger platforms for information exchange and civil society engagement, and updated and transparent bilateral agreements.
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Affiliation(s)
- Ligia Paina
- Department of International Health, Health Systems Program, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Marius Ungureanu
- Department of Public Health and Management, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Cluj School of Public Health, College of Political Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
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Ciuca AM, Berger T, Crişan LG, Miclea M. Internet-based treatment for Romanian adults with panic disorder: protocol of a randomized controlled trial comparing a Skype-guided with an unguided self-help intervention (the PAXPD study). BMC Psychiatry 2016; 16:6. [PMID: 26769021 PMCID: PMC4714451 DOI: 10.1186/s12888-016-0709-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 01/06/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Efficacy of self-help internet-based cognitive behavior therapy (ICBT) for anxiety disorders has been confirmed in several randomized controlled trials. However, the amount and type of therapist guidance needed in ICBT are still under debate. Previous studies have shown divergent results regarding the role of therapist guidance and its impact on treatment outcome. This issue is central to the development of ICBT programs and needs to be addressed directly. The present study aims to compare the benefits of regular therapist guidance via online real-time audio-video communication (i.e. Skype) to no therapist guidance during a 12-week Romanian self-help ICBT program for Panic Disorder. Both treatments are compared to a waiting-list control group. METHODS/DESIGN A parallel group randomized controlled trial is proposed. The participants, 192 Romanian adults fulfilling diagnostic criteria for panic disorder according to a diagnostic interview, conducted via secured Skype or telephone, are randomly assigned to one of the three conditions: independent use of the internet-based self-help program PAXonline, the same self-help treatment with regular therapist support via secured Skype, and waiting-list control group. The primary outcomes are severity of self-report panic symptoms (PDSS-SR) and diagnostic status (assessors are blind to group assignment), at the end of the intervention (12 weeks) and at follow-up (months 3 and 6). The secondary measures address symptoms of comorbid anxiety disorders, depression, quality of life, adherence and satisfaction with ICBT. Additional measures of socio-demographic characteristics, personality traits, treatment expectancies, catastrophic cognitions, body vigilance and working alliance are considered as potential moderators and/ or mediators of treatment outcome. DISCUSSION To the best of our knowledge, the present study is the first effort to investigate the efficacy of a self-help internet-based intervention with therapist guidance via real-time video communication. A direct comparison between therapist guided versus unguided self-directed intervention for panic disorder will also be addressed for the first time. Findings from this study will inform researchers and practitioners about the added value of online video-therapy guidance sessions and the type of patients who may benefit the most from guided and unguided ICBT for Panic disorder. TRIAL REGISTRATION ACTRN12614000547640 (Australian New Zealand Clinical Trials Registry). Registered 22/05/2014.
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Affiliation(s)
- Amalia Maria Ciuca
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland. .,Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania.
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
| | | | - Mircea Miclea
- Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania.
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McDowell RD, Ryan A, Bunting BP, O'Neill SM, Alonso J, Bruffaerts R, de Graaf R, Florescu S, Vilagut G, de Almeida JMC, de Girolamo G, Haro JM, Hinkov H, Kovess-Masfety V, Matschinger H, Tomov T. Mood and anxiety disorders across the adult lifespan: a European perspective. Psychol Med 2014; 44:707-722. [PMID: 23721650 DOI: 10.1017/s0033291713001116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The World Mental Health Survey Initiative (WMHSI) has advanced our understanding of mental disorders by providing data suitable for analysis across many countries. However, these data have not yet been fully explored from a cross-national lifespan perspective. In particular, there is a shortage of research on the relationship between mood and anxiety disorders and age across countries. In this study we used multigroup methods to model the distribution of 12-month DSM-IV/CIDI mood and anxiety disorders across the adult lifespan in relation to determinants of mental health in 10 European Union (EU) countries. METHOD Logistic regression was used to model the odds of any mood or any anxiety disorder as a function of age, gender, marital status, urbanicity and employment using a multigroup approach (n = 35500). This allowed for the testing of specific lifespan hypotheses across participating countries. RESULTS No simple geographical pattern exists with which to describe the relationship between 12-month prevalence of mood and anxiety disorders and age. Of the adults sampled, very few aged ≥ 80 years met DSM-IV diagnostic criteria for these disorders. The associations between these disorders and key sociodemographic variables were relatively homogeneous across countries after adjusting for age. CONCLUSIONS Further research is required to confirm that there are indeed stages in the lifespan where the reported prevalence of mental disorders is low, such as among younger adults in the East and older adults in the West. This project illustrates the difficulties in conducting research among different age groups simultaneously.
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Affiliation(s)
- R D McDowell
- Institute of Nursing & Health Research, University of Ulster, Coleraine, N. Ireland
| | - A Ryan
- Institute of Nursing & Health Research, University of Ulster, Coleraine, N. Ireland
| | - B P Bunting
- Psychology Research Institute, University of Ulster, Londonderry, N. Ireland
| | - S M O'Neill
- Psychology Research Institute, University of Ulster, Londonderry, N. Ireland
| | - J Alonso
- Health Services Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
| | - R Bruffaerts
- Universitair Psychiatrisch Centrum - KU Leuven (UPC-KUL), KU Leuven, Leuven, Belgium
| | - R de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - S Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - G Vilagut
- Health Services Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - J M C de Almeida
- Departamento de Saúde Mental, Faculdade de Ciências Médicas, Portugal
| | - G de Girolamo
- IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Italy
| | - J M Haro
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, CIBER en Salud Mental, Spain
| | - H Hinkov
- National Center for Public Health Protection, Bulgaria
| | | | | | - T Tomov
- Department of Psychiatry, Alexandrovsaka Hospital, Bulgaria
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Breslau J, Miller E, Jin R, Sampson NA, Alonso J, Andrade LH, Bromet EJ, de Girolamo G, Demyttenaere K, Fayyad J, Fukao A, Gălăon M, Gureje O, He Y, Hinkov HR, Hu C, Kovess-Masfety V, Matschinger H, Medina-Mora ME, Ormel J, Posada-Villa J, Sagar R, Scott KM, Kessler RC. A multinational study of mental disorders, marriage, and divorce. Acta Psychiatr Scand 2011; 124:474-86. [PMID: 21534936 PMCID: PMC4011132 DOI: 10.1111/j.1600-0447.2011.01712.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Estimate predictive associations of mental disorders with marriage and divorce in a cross-national sample. METHOD Population surveys of mental disorders included assessment of age at first marriage in 19 countries (n = 46,128) and age at first divorce in a subset of 12 countries (n = 30,729). Associations between mental disorders and subsequent marriage and divorce were estimated in discrete time survival models. RESULTS Fourteen of 18 premarital mental disorders are associated with lower likelihood of ever marrying (odds ratios ranging from 0.6 to 0.9), but these associations vary across ages of marriage. Associations between premarital mental disorders and marriage are generally null for early marriage (age 17 or younger), but negative associations come to predominate at later ages. All 18 mental disorders are positively associated with divorce (odds ratios ranging from 1.2 to 1.8). Three disorders, specific phobia, major depression, and alcohol abuse, are associated with the largest population attributable risk proportions for both marriage and divorce. CONCLUSION This evidence adds to research demonstrating adverse effects of mental disorders on life course altering events across a diverse range of socioeconomic and cultural settings. These effects should be included in considerations of public health investments in preventing and treating mental disorders.
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Affiliation(s)
- J. Breslau
- Department of Internal Medicine, University of California, Davis, CA
| | - E. Miller
- Department of Pediatrics, University of California, Davis, CA
| | - R. Jin
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - N. A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - J. Alonso
- Health Services Research Unit, Institut Municipal d’Investigació Mèdica (IMIM-Hospital del Mar); CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Catalonia, Spain
| | - L. H. Andrade
- Department & Institute of Psychiatry, University of Sao Paulo, School of Medicine, Sao Paulo, Brazil
| | - E. J. Bromet
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - G. de Girolamo
- IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Bologna, Italy
| | - K. Demyttenaere
- Department of Psychiatry, University Hospital Gasthuisberg, Leuven, Belgium
| | - J. Fayyad
- Department of Psychiatry and Clinical Psychology, Institute for Development, Research, Advocacy and Applied Care (IDRAAC), St. George Hospital University Medical Center and Faculty of Medicine, Balamand University, Beirut, Lebanon
| | - A. Fukao
- Department of Public Health, Yamagata University Graduate School of Medicine, Yamagata, Japan
| | - M. Gălăon
- Scoala Nationala de Sanatate Publica, Management si Perfectionare in Domeniul Sanitar Bucharest, (SNSPMPDSB), Romania
| | - O. Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Y. He
- Shanghai Mental Health Center, Shanghai, China
| | - H. R. Hinkov
- Department of Global Mental Health, National Center for Public Health Protection, Sofia, Bulgaria
| | - C. Hu
- Shenzhen Institute of Mental Health, Shenzhen, Guangdong, China
| | | | - H. Matschinger
- Clinic of Psychiatry, University of Leipzig, Leipzig, Germany
| | | | - J. Ormel
- Interdisciplinary Center for Psychiatric Epidemiology, University Medical Center, Groningen, the Netherlands
| | - J. Posada-Villa
- Instituto Colombiano del Sistema Nervioso, Bogota D.C. Colombia
| | - R. Sagar
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - K. M. Scott
- Department of Psychological Medicine, Wellington School of Medicine and Health Sciences, Dunedin, New Zealand
| | - R. C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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