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Wuthrich VM, Dickson SJ, Pehlivan M, Chen JTH, Zagic D, Ghai I, Neelakandan A, Johnco C. Efficacy of low intensity interventions for geriatric depression and anxiety - A systematic review and meta-analysis. J Affect Disord 2024; 344:592-599. [PMID: 37858732 DOI: 10.1016/j.jad.2023.10.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND This systematic review and meta-analysis examined the efficacy of low intensity psychological interventions for older adults (60+ years) with clinical anxiety and/or depressive disorders. METHOD Systematic review and meta-analysis of randomised control trials of low-intensity psychological interventions for anxiety and/or depression with an active or passive control condition (e.g., waitlist, treatment-as-usual or active control) in any setting. Low intensity psychological interventions (e.g., cognitive behaviour therapy [CBT]) targeted anxiety and/or depression as primary outcomes, were primarily self-help, and included support from trained practitioners/facilitators with <6 h total contact time (typically <30 min p/contact). RESULTS Seven studies consisting of 304 older adults (65-78 years, Mage = 70, SD = 4) were identified and six included in the meta-analysis of depression outcomes and three for anxiety. A random effects meta-analysis of group differences in symptom change from pre-post treatment found evidence favouring low intensity psychological interventions over passive control groups for the treatment of depressive and anxiety symptoms, with moderate effect sizes for depression (Cohen's d = -0.62) and large effect sizes for anxiety (Cohen's d = -0.84) at post-treatment. LIMITATIONS Results are limited by study design of included studies such that the efficacy of interventions compared to treatment-as-usual, non-CBT approaches, in adults >80 years and long-term effects are unknown. CONCLUSIONS There is some evidence supporting the clinical benefits of low intensity psychological interventions for depressive and anxiety symptoms in older adults compared to passive controls. More research is needed to examine efficacy compared to active control conditions, and among those over 80 years.
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Affiliation(s)
- Viviana M Wuthrich
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia.
| | - Sophie J Dickson
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Melissa Pehlivan
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Jessamine T-H Chen
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Dino Zagic
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Ishaan Ghai
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Aswathi Neelakandan
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Carly Johnco
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
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Siette J, Dodds L, Dawes P, Richards D, Savage G, Strutt P, Ijaz K, Johnco C, Wuthrich V, Heger I, Deckers K, Köhler S, Armitage CJ. Protocol for a pre-post, mixed-methods feasibility study of the Brain Bootcamp behaviour change intervention to promote healthy brain ageing in older adults. PLoS One 2022; 17:e0272517. [PMID: 36445869 PMCID: PMC9707764 DOI: 10.1371/journal.pone.0272517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/15/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Behaviour change interventions represent key means for supporting healthy ageing and reducing dementia risk yet brief, scalable behaviour change interventions targeting dementia risk reduction in older adults is currently lacking. Here we describe the aims and design of the three-month Brain Bootcamp initiative that seeks to target multiple dementia risk and protective factors (healthy eating, physical, social and cognitive inactivity), through the use of multiple behaviour change techniques, including goal-setting for behaviour, information about health consequences and physical prompts to change behaviours that reduce dementia risk among older adults. Our secondary aim is to understand participants' views of dementia prevention and explore the acceptability and integration of this campaign into daily life. METHODS Brain Bootcamp is a pre-post feasibility trial conducted in Sydney, Australia beginning in January 2021 until late August. Participants aged ≥65 years living independently in the community (n = 252), recruited through social media and flyers, will provide information about their demographics, medical history, alcohol consumption, smoking habits, mental health, physical activity, cognitive activity, and diet to generate a dementia risk profile at baseline and assess change therein at three-month follow-up. During the intervention, participants will receive a resource pack containing their individual risk profile, educational booklet on dementia risk factors and four physical items designed to prompt physical, social and mental activity, and better nutrition. Outcome measures include change in dementia risk scores, dementia awareness and motivation. A qualitative process evaluation will interview a sample of participants on the acceptability and feasibility of the intervention. DISCUSSION This will be the first short-term multi-domain intervention targeting dementia risk reduction in older adults. Findings will generate a new evidence base on how to best support efforts targeting lifestyle changes and to identify ways to optimise acceptability and effectiveness towards brain health for older adults. TRIAL REGISTRATION NUMBER ACTRN 381046 (registered 17/02/2021); Pre-results.
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Affiliation(s)
- Joyce Siette
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, New South Wales, Australia
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- * E-mail:
| | - Laura Dodds
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Piers Dawes
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Deborah Richards
- Department of Computing, Faculty of Science and Engineering, Macquarie University, Sydney, New South Wales, Australia
| | - Greg Savage
- Department of Psychology, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia
| | - Paul Strutt
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia
- Department of Cognitive Science, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Kiran Ijaz
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Carly Johnco
- Department of Psychology, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia
| | - Viviana Wuthrich
- Department of Psychology, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia
| | - Irene Heger
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Kay Deckers
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Christopher J. Armitage
- Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
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Chen JTH, Wuthrich VM, Rapee RM, Draper B, Brodaty H, Cutler H, Low LF, Georgiou A, Johnco C, Jones M, Meuldijk D, Partington A. Improving mental health and social participation outcomes in older adults with depression and anxiety: Study protocol for a randomised controlled trial. PLoS One 2022; 17:e0269981. [PMID: 35759476 PMCID: PMC9236237 DOI: 10.1371/journal.pone.0269981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/28/2022] [Indexed: 11/22/2022] Open
Abstract
Background Increasing both the frequency and quality of social interactions within treatments for anxiety and depressive disorders in older adults may improve their mental health outcomes and quality of life. This study aims to evaluate the clinical efficacy and cost utility of an enhanced cognitive behavioural therapy (CBT) plus social participation program in a sample of older adults with depression and/or anxiety. Methods A total of 172 community-dwelling adults aged 65 years or older with an anxiety and/or depressive disorder will be randomly allocated to either an enhanced CBT plus social participation program (n = 86) or standard CBT (n = 86). Both treatments will be delivered during 12 weekly individual sessions utilising structured manuals and workbooks. Participants will be assessed at pre-treatment, post-treatment, and 12-month follow-up. The primary outcome evaluates mean change in clinician-rated diagnostic severity of anxiety and depressive disorders from baseline to post-treatment (primary endpoint) based on a semi-structured diagnostic interview. Secondary outcomes evaluate changes in symptomatology on self-report anxiety and depression measures, as well as changes in social/community participation, social network, and perceived social support, loneliness, quality of life, and use of health services. Economic benefits will be evaluated using a cost-utility analysis to derive the incremental cost utility ratios for the enhanced CBT program. Discussion Outcomes from this study will provide support for the establishment of improved psychosocial treatment for older adults with anxiety and/or depression. Study outcomes will also provide health systems with a clear means to reduce the impact of poor emotional health in older age and its associated economic burden. In addition to the empirical validation of a novel treatment, the current study will contribute to the current understanding of the role of social participation in older adult wellbeing. Trial registration Prospectively registered on the Australian New Zealand Clinical Trials Registry (ID: ACTRN12619000242123; registered 19th February 2019) and the ISRCTN registry (ID: ISRCTN78951376; registered 10th July 2019).
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Affiliation(s)
- Jessamine Tsan-Hsiang Chen
- Centre for Emotional Health, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- * E-mail:
| | - Viviana M. Wuthrich
- Centre for Emotional Health, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Ronald M. Rapee
- Centre for Emotional Health, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Brian Draper
- Older Persons’ Mental Health Services, Prince of Wales Hospital, Sydney, New South Wales, Australia
- Centre of Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Henry Brodaty
- Older Persons’ Mental Health Services, Prince of Wales Hospital, Sydney, New South Wales, Australia
- Centre of Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Henry Cutler
- Macquarie Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
| | - Lee-Fay Low
- Ageing, Work and Health Research Unit, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Carly Johnco
- Centre for Emotional Health, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Michael Jones
- Centre for Emotional Health, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Denise Meuldijk
- Centre for Emotional Health, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Partington
- Macquarie Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
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Abstract
BACKGROUND Medical practitioners experience high levels of mental disorders but may be reluctant to seek care. AIMS To determine medical practitioner attitudes towards other doctors with anxiety/depression, barriers to seeking mental healthcare, treatments received for depression and the effects of age. METHODS Data from the National Mental Health Survey of Doctors and Medical Students, conducted in Australia, were analysed (N = 10 038 medical practitioners). Attitudes to anxiety/depression were assessed with 12 statements (total stigma score, range 12-60). Barriers to seeking professional help, and coping strategies used, for anxiety/depression were measured. Practitioners with a history of depression were asked what personal supports and treatments were received. Practitioners were compared by age-younger (40 years and younger), middle-aged (41-60) and older (61+). RESULTS Attitudes and help-seeking behaviours varied with age. Older doctors had a more positive outlook and less total stigma, with the exception that they believed a doctor with anxiety/depression was less reliable. Younger practitioners were most likely to report barriers, such as confidentiality, impact on career progression and registration, to seeking help. For practitioners with depression, counselling and counselling plus medication were most likely to be received by the younger and middle-aged groups, whereas medication alone was most likely to be received by the middle-aged and older groups. CONCLUSIONS Stigmatizing attitudes towards mental disorder and barriers to help-seeking remain prevalent within the medical profession. Our results suggest doctors' health programs should address mental health stigma in younger practitioners and facilitate education about psychological treatments in older practitioners.
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Affiliation(s)
- C Wijeratne
- Sydney School of Medicine, University of Notre Dame Australia, Sydney, New South Wales 2010, Australia.,School of Psychiatry, University of New South Wales 2052, Sydney, New South Wales, Australia
| | - C Johnco
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales 2109, Australia.,Centre for Cognition, Ageing and Wellbeing, Macquarie University, Sydney, New South Wales 2052, Australia
| | - B Draper
- School of Psychiatry, University of New South Wales 2052, Sydney, New South Wales, Australia
| | - J Earl
- Centre for Cognition, Ageing and Wellbeing, Macquarie University, Sydney, New South Wales 2052, Australia
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Smith R, Wuthrich V, Johnco C, Belcher J. Effect of Group Cognitive Behavioural Therapy on Loneliness in a Community Sample of Older Adults: A Secondary Analysis of a Randomized Controlled Trial. Clin Gerontol 2021; 44:439-449. [PMID: 33100187 DOI: 10.1080/07317115.2020.1836105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Research suggests a link between loneliness, depression, and anxiety. Multiple studies have examined treatment programs for loneliness; however, none have examined the efficacy of Cognitive Behavioral Therapy (CBT) for depression and anxiety in reducing loneliness. METHODS Change in loneliness in sixty-two older adults (≥60 yrs; 65% female) who took part in a previously reported randomized controlled trial for the treatment of comorbid depression and anxiety was examined. Older adults were randomized to a 12-week group CBT or waitlist control condition. Participants who took part in CBT were followed-up three months later. RESULTS Linear Mixed Model analyses indicated that after controlling for baseline cognition, depression, and anxiety, participants who completed CBT experienced a significant decrease in loneliness while the control group did not. This reduction was maintained at follow-up. CONCLUSIONS CBT programs for depression and anxiety are likely to be effective at reducing loneliness. This may be due to shared underlying cognitive and behavioral mechanisms between loneliness, depression, and anxiety such as sensitivity to perceived threat and social withdrawal. Further research is needed to understand if specific loneliness interventions are more effective. CLINICAL IMPLICATIONS CBT may be effective at reducing loneliness among older adults with depression and anxiety.
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Affiliation(s)
- Ronald Smith
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Viviana Wuthrich
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Carly Johnco
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Jessica Belcher
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
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Siette J, Seaman K, Dodds L, Ludlow K, Johnco C, Wuthrich V, Earl JK, Dawes P, Strutt P, Westbrook JI. A national survey on COVID-19 second-wave lockdowns on older adults' mental wellbeing, health-seeking behaviours and social outcomes across Australia. BMC Geriatr 2021; 21:400. [PMID: 34193070 PMCID: PMC8243046 DOI: 10.1186/s12877-021-02352-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/17/2021] [Indexed: 11/30/2022] Open
Abstract
Background The impact of severe second lockdown measures on older adults’ wellbeing is unknown. We aimed to (i) identify the impact of the second lockdown that resulted from the second wave of COVID-19 cases on older Australians’ quality of life; (ii) compare the impact of second wave lockdowns in Victoria, Australia’s second most populous State, to those in other States and Territories not in lockdown. Methods A national cross-sectional study of community-dwelling older adults completed online questionnaires for quality of life, social networks, healthcare access, and perceived impact of COVID-19 between July to September 2020. Tobit regression was used to measure the relationships of healthcare service access and social networks with quality of life of older adults in Victoria compared to those in the rest of Australia. Results A total of 2,990 respondents (mean [SD] age, 67.3 [7.0]; 66.8 % female) participated. At time of data collection, Victoria’s second COVID-19 lockdown had been in force for an average 51.7 days. Median quality of life scores were significantly higher in Victoria compared to the rest of Australia (t2,827=2.25 p = 0.025). Being female (95 % CI, -0.051–0.020), having lower educational attainment (95 % CI, -0.089–-0.018), receiving government benefits (95 % CI, -0.054–-0.024), having small social networks (95 % CI, 0.006–0.009) and self-reported physical chronic health conditions were all independent predictors of lower quality of life. Conclusions Longer-term studies are required to provide more robust evidence of the impact as restrictions lift and normal social conventions return. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02352-1.
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Affiliation(s)
- Joyce Siette
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, New South Wales, 2109, Macqaurie Park, Australia. .,Centre for Ageing, Cognition and Wellbeing, Macquarie University, New South Wales, 2109, Macqaurie Park, Australia.
| | - Karla Seaman
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, New South Wales, 2109, Macqaurie Park, Australia
| | - Laura Dodds
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, New South Wales, 2109, Macqaurie Park, Australia
| | - Kristiana Ludlow
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, New South Wales, 2109, Macqaurie Park, Australia
| | - Carly Johnco
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, New South Wales, 2109, Macqaurie Park, Australia.,Department of Psychology, Faculty of Medicine, Health & Human Sciences, Macquarie University, New South Wales, 2109, Macqaurie Park, Australia
| | - Viviana Wuthrich
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, New South Wales, 2109, Macqaurie Park, Australia.,Department of Psychology, Faculty of Medicine, Health & Human Sciences, Macquarie University, New South Wales, 2109, Macqaurie Park, Australia
| | - Joanne K Earl
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, New South Wales, 2109, Macqaurie Park, Australia.,Department of Psychology, Faculty of Medicine, Health & Human Sciences, Macquarie University, New South Wales, 2109, Macqaurie Park, Australia
| | - Piers Dawes
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, New South Wales, 2109, Macqaurie Park, Australia.,Department of Linguistics, Faculty of Medicine, Health & Human Sciences, Macquarie University, New South Wales, 2109, Macqaurie Park, Australia
| | - Paul Strutt
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, New South Wales, 2109, Macqaurie Park, Australia.,Department of Cognitive Science, Faculty of Medicine, Health & Human Sciences, Macquarie University, New South Wales, 2109, Macqaurie Park, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, New South Wales, 2109, Macqaurie Park, Australia
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Richardson C, Magson N, Fardouly J, Oar E, Johnco C, Rapee R. A longitudinal investigation of sleep and technology use in early adolescence: does parental control of technology use protect adolescent sleep? Sleep Med 2021; 84:368-379. [PMID: 34247125 DOI: 10.1016/j.sleep.2021.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE A bi-directional relationship between technology use and adolescent sleep is likely, yet findings are mixed, and it is not known whether parental control of technology use can protect sleep. The current study examined bi-directionality between technology use on school nights and morning/eveningness, sleep duration and daytime sleepiness in early adolescents. We also examined whether time spent using technology mediated the relationship between parental control of technology and adolescent sleep. METHODS Adolescents and their primary caregiver (96% mothers) completed questionnaire measures of sleep, technology use and parental control across three, annual waves: Wave 1 (N = 528, Mage = 11.18, SD = 0.56, range = 10-12, 51% male), Wave 2 (N = 502, Mage = 12.19, SD = 0.53, 52% male) and Wave 3 (N = 478, Mage = 13.19, SD = 0.53, 52% male). RESULTS When examining the direct relationship between sleep and technology use, cross-lagged panel models showed that time spent using technology predicted shorter sleep duration and greater daytime sleepiness in adolescence, and evening diurnal preference and shorter sleep duration contributed to increased technology use over time. The relationship between technology use and sleep duration was bi-directional. Time spent using technology and adolescent sleep predicted, yet were not predicted by, parental control of technology use. CONCLUSIONS While normative changes in sleep (eg, increased eveningness) may promote increased technology use, technology use may further impinge upon sleep. Results suggest it may be pertinent to instead find creative ways in which adolescents themselves can mitigate their risk of inadequate sleep.
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Affiliation(s)
- C Richardson
- Centre for Sleep Science, School of Psychological Science, University of Western Australia, Perth, WA, Australia; Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia.
| | - N Magson
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - J Fardouly
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - E Oar
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - C Johnco
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - R Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
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8
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Wijeratne C, Johnco C, Draper B, Earl JK. Older Physicians' Reporting of Psychological Distress, Alcohol Use, Burnout and Workplace Stressors. Am J Geriatr Psychiatry 2021; 29:478-487. [PMID: 33023799 DOI: 10.1016/j.jagp.2020.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Most of the published data on the psychological health of physicians has focused on the youngest members of the profession. The aims of this analysis were to determine how psychological morbidity changes across the career cycle. METHODS We report data from the cross-sectional National Mental Health Survey of Doctors and Medical Students, conducted in Australia. Age differences in psychological distress, suicidal ideation, alcohol use, burnout, workplace, and personal stressors were examined for younger (40 years and younger), middle aged (41-60), and older (61+) physicians. RESULTS A total of 10,038 physicians responded. Older physicians reported significantly less psychological distress, burnout and suicidal ideation than younger and middle aged colleagues, findings that were maintained after adjusting for sex and excluding trainees. There were no group differences in overall alcohol use and high risk drinking. On multivariate analysis, the largest contributor to psychological distress in older physicians was a past history of mental disorder. There was a decline across age groups in the endorsement as "very stressful" of work-life conflict and work-anxiety stressors such as fear of making mistakes. Older physicians were least likely to feel very stressed by all workplace stressors. CONCLUSION The better psychological health of older physicians highlights the need to consider physician health according to age and career stage. Apart from the decline in work stressors, in particular work-life conflict, there may be a survivor effect such that physicians who practice into older age have developed greater resilience and professional maturation.
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Affiliation(s)
- Chanaka Wijeratne
- Sydney School of Medicine (CW), University of Notre Dame Australia, Sydney, Australia.
| | - Carly Johnco
- Centre for Emotional Health, Department of Psychology (CJ), Macquarie University, Sydney, Australia; Centre for Cognition, Ageing and Wellbeing (CJ), Macquarie University, Sydney, Australia
| | - Brian Draper
- School of Psychiatry (BD), University of New South Wales, Sydney, Australia
| | - Joanne K Earl
- Department of Psychology (JKE), Macquarie University, Sydney, Australia
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Siette J, Dodds L, Seaman K, Wuthrich V, Johnco C, Earl J, Dawes P, Westbrook JI. The impact of COVID-19 on the quality of life of older adults receiving community-based aged care. Australas J Ageing 2021; 40:84-89. [PMID: 33682315 PMCID: PMC8250074 DOI: 10.1111/ajag.12924] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/05/2021] [Accepted: 01/14/2021] [Indexed: 11/27/2022]
Abstract
Objective To investigate the impact of the COVID‐19 pandemic on the quality of life and social networks of older adults receiving community care services. Methods Quality of life and social network questionnaires were completed by older adults (n = 21) receiving home care services at three time points (2018, 2019, and during the first Australian COVID‐19 lockdown in 2020). Additional questions about technology use were included in 2020. Results Older adults’ quality of life significantly decreased during the pandemic compared to the prior year. During the pandemic, over 80% used technology to maintain contact with family and friends, and social networks did not change. Conclusion Government messages and support initiatives directed towards technology adoption among older adults receiving home care may assist with maintaining social connection during COVID‐19. Our findings add to the relatively limited understanding of the impact of the COVID‐19 pandemic on the socio‐emotional well‐being of older people.
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Affiliation(s)
- Joyce Siette
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia.,Centre for Cognition, Ageing and Wellbeing, Macquarie University, Macquarie Park, NSW, Australia
| | - Laura Dodds
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia
| | - Karla Seaman
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia
| | - Viviana Wuthrich
- Centre for Cognition, Ageing and Wellbeing, Macquarie University, Macquarie Park, NSW, Australia
| | - Carly Johnco
- Centre for Cognition, Ageing and Wellbeing, Macquarie University, Macquarie Park, NSW, Australia
| | - Joanne Earl
- Centre for Cognition, Ageing and Wellbeing, Macquarie University, Macquarie Park, NSW, Australia
| | - Piers Dawes
- Centre for Cognition, Ageing and Wellbeing, Macquarie University, Macquarie Park, NSW, Australia.,Department of Linguistics, Faculty of Medicine, Health & Human Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia
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Dawes P, Siette J, Earl J, Johnco C, Wuthrich V. Challenges of the COVID-19 pandemic for social gerontology in Australia. Australas J Ageing 2020; 39:383-385. [PMID: 32965077 PMCID: PMC7537083 DOI: 10.1111/ajag.12845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Piers Dawes
- Department of Linguistics, Macquarie University, Sydney, New South Wales, Australia.,Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia
| | - Joyce Siette
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Joanne Earl
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia.,Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Carly Johnco
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia.,Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Viviana Wuthrich
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia.,Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
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11
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Salloum A, Johnco C, Zepeda-Burgos RM, Cepeda SL, Guttfreund D, Novoa JC, Schneider SC, Lastra A, Hurtado A, Katz CL, Storch EA. Parents' Knowledge, Attitudes, and Experiences in Child Sexual Abuse Prevention in El Salvador. Child Psychiatry Hum Dev 2020; 51:343-354. [PMID: 31813063 DOI: 10.1007/s10578-019-00946-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Childhood sexual abuse (CSA), a global public health problem, is often underreported especially in low-income countries such as El Salvador, and prevention efforts are needed. The purpose of this study was to examine knowledge, attitudes and experiences of CSA prevention and characteristics related to greater knowledge and openness to engaging in child abuse prevention among Salvadoran parents. Salvadoran parents (N = 478) completed questionnaires regarding demographics, definition and signs and symptoms of child abuse, personal experiences of CSA, CSA prevention training, and knowledge, attitudes and practices about preventing CSA. Most parents were knowledgeable about CSA, viewed CSA prevention as their responsibility, and had talked with their children about CSA, although 65.7% incorrectly believed that children are more likely to be abused by strangers. Parents with lower income were less knowledgeable and willing to participate in CSA prevention. CSA programing needs to involve parents and specifically target low-income parents.
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Affiliation(s)
- Alison Salloum
- University of South Florida, 13301 Bruce B. Downs Blvd., MHC1400, Tampa, FL, 33612-3807, USA.
| | - Carly Johnco
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Raquel Marina Zepeda-Burgos
- Universidad Dr. José Matía Delgado, San Salvador, El Salvador.,Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Sandra L Cepeda
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Sophie C Schneider
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Anne Lastra
- University of South Florida, 13301 Bruce B. Downs Blvd., MHC1400, Tampa, FL, 33612-3807, USA
| | - Alicia Hurtado
- Department of Psychiatry and Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Craig L Katz
- Department of Psychiatry, Medical Education, and Health System Design & Global Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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12
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Johnco C, McGuire JF, Roper T, Storch EA. A meta-analysis of dropout rates from exposure with response prevention and pharmacological treatment for youth with obsessive compulsive disorder. Depress Anxiety 2020; 37:407-417. [PMID: 31778595 DOI: 10.1002/da.22978] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/15/2019] [Accepted: 11/03/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Beliefs that exposure with response prevention (ERP) is excessively distressing and will result in client dropout from treatment are commonly-cited reasons for clinicians not providing evidence-based treatment. This meta-analysis examined treatment attrition for ERP for youth with obsessive compulsive disorder (OCD) compared with other treatment modalities. METHOD A systematic literature search identified 11 randomized controlled trials (RCTs) comparing ERP to active or waitlist control conditions, 9 comparing pharmacotherapy to control, and 3 comparing ERP to pharmacotherapy for youth with OCD. RESULTS Attrition rates were low for ERP (10.24%) compared to pharmacotherapy (17.29%), active control (e.g., relaxation, metacognitive therapy; 20.63%), and pill placebo (23.49%). ERP had lower risk of attrition compared to active control conditions (RR = 0.60; p = .02), and was not significantly different to waitlist (RR = 0.80; p = .59). In head-to-head trials, there was no difference between the risk of attrition from ERP and pharmacotherapy (RR = 1.26; p = .74). Of the pharmacotherapy trials, risk of attrition from serotonin reuptake inhibitors treatment was not significantly different compared to placebo (RR = 0.94; p = .76), with no difference between antidepressants and clomipramine (p = .19). Attrition from ERP was primarily for logistical reasons, compared to lack of efficacy for relaxation and/or adverse reactions from pharmacotherapy. CONCLUSIONS Attrition from ERP is low, and is generally lower than non-ERP interventions. Given favorable attrition and efficacy data, there is little justification for appropriately-trained clinicians not to offer ERP as a first-line treatment for youth with OCD.
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Affiliation(s)
- Carly Johnco
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Joseph F McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tegan Roper
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
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13
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Johnco C, Salloum A, McBride NM, Cepeda S, Guttfreund D, Novoa JC, Storch EA. Child trauma exposure and subsequent emotional functioning in El Salvador. ACTA ACUST UNITED AC 2020. [DOI: 10.1037/trm0000193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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14
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Richardson C, Oar E, Fardouly J, Magson N, Johnco C, Forbes M, Rapee R. The Moderating Role of Sleep in the Relationship Between Social Isolation and Internalising Problems in Early Adolescence. Child Psychiatry Hum Dev 2019; 50:1011-1020. [PMID: 31152375 DOI: 10.1007/s10578-019-00901-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Social isolation may be a unique risk factor for depression and anxiety in early adolescence. However, optimal sleep may protect adolescents from the emotional sequela of social isolation. The present study aimed to investigate whether sleep moderates the relationship between social isolation and symptoms of anxiety and depression in early adolescence. Five hundred and twenty eight early adolescents (M = 11.18 years, SD = 0.56, range 10-12 years, 51% male) completed online questionnaires assessing social isolation, sleep duration, daytime sleepiness and symptoms of generalised anxiety, social anxiety, separation anxiety and depression. Sleep duration moderated the effect of social isolation on symptoms of generalised anxiety, social anxiety and depression, but not separation anxiety. Daytime sleepiness emerged as an additional sleep-related risk factor in the relationship between social isolation and depressive symptoms. Therefore, sleep may be an important modifiable risk or protective factor to target, in the prevention of depression and anxiety in adolescence.
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Affiliation(s)
- C Richardson
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia.
| | - E Oar
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - J Fardouly
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - N Magson
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - C Johnco
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - M Forbes
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - R Rapee
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
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15
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Richardson C, Oar E, Fardouly J, Magson N, Johnco C, Forbes M, Rapee R. The moderating role of sleep in the relationship between social isolation and internalising problems in early adolescence. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Johnco C, Salloum A, McBride NM, Cepeda SL, Guttfreund D, Novoa JC, Storch EA. Mental health literacy, treatment preferences, and barriers in Salvadorian parents. International Journal of Mental Health 2019. [DOI: 10.1080/00207411.2019.1629376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Carly Johnco
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Alison Salloum
- School of Social Work, University of South Florida, Tampa, FL, USA
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Nicole M. McBride
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Sandra L. Cepeda
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | | | | | - Eric A. Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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17
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Johnco C, Rapee RM. Depression literacy and stigma influence how parents perceive and respond to adolescent depressive symptoms. J Affect Disord 2018; 241:599-607. [PMID: 30172212 DOI: 10.1016/j.jad.2018.08.062] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/19/2018] [Accepted: 08/12/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aimed to: (1) validate a measure of parental reactions, attitudes and understanding of adolescent depressive symptoms (PRAUD) and (2) examine the impact of adolescent and parent depressive symptoms, parental knowledge about adolescent depression (depression literacy), and parental depression stigma on parental responses to adolescent depression. METHOD Parents (N = 440) of adolescents aged 13-17 years completed an anonymous online questionnaire. RESULTS Factor analysis suggested four patterns of parental responses to adolescent depressive symptoms: overprotection, criticism, distress and support. Internal consistency was good for all PRAUD subscales (α = 0.80-0.88). Higher parent and adolescent depressive symptoms, greater depression stigma and lower depression literacy were associated with more negative parental responses. Higher adolescent depressive symptoms and poorer parent depression literacy predicted overprotective responses, and depression stigma moderated the effect of parent depressive symptoms. Depression literacy moderated the effect of parent depression on supportive parental responses, and stigma moderated the effect of adolescent depression. Higher levels of depression stigma and parent depression predicted critical responses, and depression literacy moderated the effect of adolescent depressive symptoms. Distress responses were predicted by higher stigma, and depression literacy moderated the effect of parent and adolescent depressive symptoms. LIMITATIONS Differences between the two sample recruitment sites. CONCLUSIONS There was evidence of more negative parental attitudes and responses among depressed parents and parents of depressed youth. Improving parental depression literacy and reducing depression stigma during treatment of adolescent depression may facilitate parental responsiveness, and in some circumstances, may help buffer against the negative impact of parental depression.
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Affiliation(s)
- Carly Johnco
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia.
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
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Abstract
The purpose of this study was to examine differences in: (1) mental health emotional and behavioral problems between young children experiencing PTSD with and without MDD; (2) the incidence of caregiver PTSD and MDD between children with PTSD ± MDD; and (3) the number of traumatic events and interpersonal versus non-interpersonal nature of trauma events among children whose parents sought child trauma-focused treatment. Sixty-six caregivers of children aged 3-7 with PTSD completed semi-structured interviews regarding caregiver and child diagnoses, and caregivers completed self-report measures regarding child symptomatology. Results indicated that young children with PTSD + MDD had significantly higher internalizing symptoms, dissociative symptoms, and posttraumatic stress severity than those without comorbid MDD. There were no significant group differences in the incidence of caregiver PTSD or MDD, or the number or types of traumatic events. Future research to understand the unique contributors to the etiology of MDD in the context of PTSD among young children is needed.
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Affiliation(s)
- Alison Salloum
- School of Social Work, College of Behavioral and Community Sciences, University of South Florida, 13301 Bruce B. Downs Blvd., MHC 1400, Tampa, FL, 33612-3870, USA.
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA.
| | - Carly Johnco
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Kristin M Smyth
- Department of Social Work, Western Carolina University, Cullowhee, NC, USA
| | - Tanya K Murphy
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
- Department of Psychiatry & Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- All Children's Hospital - Johns Hopkins Medicine, St. Petersburg, FL, USA
| | - Eric A Storch
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
- Department of Psychiatry & Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- All Children's Hospital - Johns Hopkins Medicine, St. Petersburg, FL, USA
- Rogers Behavioral Health, Tampa, FL, USA
- Department of Health Policy and Management, University of South Florida, Tampa, FL, USA
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19
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Zavrou S, Rudy B, Johnco C, Storch EA, Lewin AB. Preliminary study of family accommodation in 4–7 year-olds with anxiety: frequency, clinical correlates, and treatment response. J Ment Health 2018; 28:365-371. [DOI: 10.1080/09638237.2018.1466034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Sophia Zavrou
- Department of Health, University of South Florida, Tampa, FL, USA,
| | | | - Carly Johnco
- Department of Human Sciences, Macquarie University, Sydney, Australia,
| | - Eric A. Storch
- Department of Health, University of South Florida, Tampa, FL, USA,
- Rogers Behavioral Health-Tampa Bay, Tampa, FL, USA, and
- All Children’s Hospital-Johns Hopkins Medicine, St. Petersburg, FL, USA
| | - Adam B. Lewin
- Department of Health, University of South Florida, Tampa, FL, USA,
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20
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Abstract
Anxiety and depression are highly prevalent disorders in youth. Assessments for these disorders in young people typically include clinician-administered instruments such as diagnostic interviews and parent- and youth-report questionnaires. Cognitive behavioral therapy is considered a well-established treatment for both anxiety and depression. Latest research in the field is exploring innovative methods to enhance treatment outcome and improve access to evidence-based treatments.
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Affiliation(s)
- Ella L Oar
- Centre for Emotional Health, Department of Psychology, Macquarie University, Level 1 Australian Hearing Hub, 16 University Avenue, Sydney, New South Wales 2109, Australia.
| | - Carly Johnco
- Centre for Emotional Health, Department of Psychology, Macquarie University, Level 1 Australian Hearing Hub, 16 University Avenue, Sydney, New South Wales 2109, Australia
| | - Thomas H Ollendick
- Child Study Center, Virginia Polytechnic Institute and State University, Suite 207, 460 Turner Street, Blacksburg, VA 24060, USA
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21
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Murphy TK, Brennan EM, Johnco C, Parker-Athill EC, Miladinovic B, Storch EA, Lewin AB. A Double-Blind Randomized Placebo-Controlled Pilot Study of Azithromycin in Youth with Acute-Onset Obsessive-Compulsive Disorder. J Child Adolesc Psychopharmacol 2017; 27:640-651. [PMID: 28358599 DOI: 10.1089/cap.2016.0190] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Sudden and severe onset of obsessive-compulsive disorder (OCD) may present secondary to infectious and/or immune-mediated triggers. We assessed the preliminary efficacy, tolerability, and safety of azithromycin compared with placebo in the treatment of OCD and associated symptoms in children with pediatric acute-onset neuropsychiatric syndrome (PANS). METHODS Thirty-one youth aged 4-14 years (M = 8.26 ± 2.78 years, 62.5% male) were randomized to receive either placebo or azithromycin for 4 weeks (10 mg/kg up to 500 mg per day). Both groups were administered twice daily probiotics. The primary outcome, obsessive-compulsive symptom severity, was assessed using the OCD Clinical Global Impressions Severity (CGI-S OCD) and Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). RESULTS Participants in the azithromycin group (n = 17) showed significantly greater reductions in OCD severity on the CGI-S OCD than the placebo group (n = 14) posttreatment (p = 0.003), although there were no significant differences on the CY-BOCS. Significantly more participants in the azithromycin condition met treatment responder criteria on the CGI-I OCD at the end of week 4 (41.2%, n = 7) in comparison to the placebo group (7.1%, n = 1; p = 0.045). Tic severity moderated treatment response, with greater tic severity being associated with enhanced treatment response on the CGI-S OCD. Azithromycin was well tolerated with minimal adverse effects and no study dropouts due to side effects. However, the azithromycin group showed a trend toward significantly greater electrocardiography QTc (p = 0.060) at the end of week 4, and significantly more reports of loose or abnormal stools (p = 0.009). CONCLUSION This double blind pilot study suggests that azithromycin may be helpful in treating youth meeting the PANS diagnosis, especially those with elevated levels of both OCD and tic symptoms. Azithromycin was well tolerated, but the potential for cardiac risks suggests that additional monitoring may be needed to ensure safety.
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Affiliation(s)
- Tanya K Murphy
- 1 Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida , St. Petersburg, Florida.,2 Department of Psychiatry & Behavioral Sciences, University of South Florida , St. Petersburg, Florida.,3 All Children's Hospital-Johns Hopkins Medicine , St. Petersburg, Florida
| | - Erin M Brennan
- 1 Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida , St. Petersburg, Florida
| | - Carly Johnco
- 4 Department of Psychology-Macquarie University , Sydney, New South Wales
| | - Ellisa Carla Parker-Athill
- 1 Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida , St. Petersburg, Florida
| | - Branko Miladinovic
- 5 Department of Internal Medicine, Center for Comparative Effectiveness Research, University of South Florida Morsani College of Medicine , Tampa, Florida
| | - Eric A Storch
- 1 Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida , St. Petersburg, Florida.,2 Department of Psychiatry & Behavioral Sciences, University of South Florida , St. Petersburg, Florida.,3 All Children's Hospital-Johns Hopkins Medicine , St. Petersburg, Florida.,6 Department of Health Policy and Management, University of South Florida , St. Petersburg, Florida.,7 Rogers Memorial Hospital , Tampa, Florida
| | - Adam B Lewin
- 1 Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida , St. Petersburg, Florida.,2 Department of Psychiatry & Behavioral Sciences, University of South Florida , St. Petersburg, Florida
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22
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Salloum A, Bjoerke A, Johnco C. The Associations of Complicated Grief, Depression, Posttraumatic Growth, and Hope Among Bereaved Youth. Omega (Westport) 2017; 79:157-173. [DOI: 10.1177/0030222817719805] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Research on the association between complicated grief (CG), hope, and posttraumatic growth (PTG) among bereaved youth is limited. Measures of CG, depression, hope, and PTG were completed by 85 youth (aged 7–18 years). Results indicated a strong positive relationship between CG and depressive symptoms, an inverse relationship between hope and depressive symptoms, and a moderate positive relationship between hope and PTG. There was no significant association between CG and hope or between CG and PTG. Higher levels of CG and lower levels of hope independently predicted greater depressive symptoms, but PTG did not. Results have implications for assessing positive outcomes in bereaved youth.
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Affiliation(s)
| | | | - Carly Johnco
- Center for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
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23
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Johnco C. Implementing and Adapting Cognitive Behavioral Therapy for Anxiety Across the Life Span: Introduction to the Special Issue. J Cogn Psychother 2017; 31:4-6. [PMID: 32755914 DOI: 10.1891/0889-8391.31.1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Carly Johnco
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
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Storch EA, Johnco C, McGuire JF, Wu MS, McBride NM, Lewin AB, Murphy TK. An initial study of family accommodation in children and adolescents with chronic tic disorders. Eur Child Adolesc Psychiatry 2017; 26:99-109. [PMID: 27277754 DOI: 10.1007/s00787-016-0879-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/01/2016] [Indexed: 12/15/2022]
Abstract
This initial study examined the nature, incidence, and clinical correlates of family accommodation in youth with tic disorders, and validated a brief self-report measure of tic-related family accommodation, the Tic Family Accommodation Scale (TFAS). Seventy-five youth aged 6-18 who were diagnosed with a tic disorder and their parent completed a diagnostic clinical interview, and clinician and parent-report measures of tic severity, depressive symptoms, anxiety symptoms, behavioral problems, family accommodation and impairment. An exploratory factor analysis of the TFAS showed a two-factor structure, with good internal consistency for the Total score, Modification of Child Environment and Modification of Parent Environment subscales (α = 0.88, 0.86, and 0.81, respectively). Family accommodation was not associated with tic severity. Family accommodation was associated with increased anxiety and depressive symptoms, higher externalizing, rule breaking, aggressive behaviors and social problems, and with greater tic-related functional impairment. Anxiety and externalizing problems (but not depressive symptoms) predicted family accommodation when controlling for tic severity. Family accommodation predicted high levels of functional impairment over and above the effect of tic severity, anxiety, depression and externalizing problems. Family accommodation is a common phenomenon for youth with tic disorders, with modifications typically encompassing changes to the child and/or parent environments. Accommodation was not associated with tic severity, but was related to higher levels of anxiety, depressive symptoms, externalizing symptoms, aggression, and rule breaking behaviors. Results suggest that other emotional symptoms are more likely to drive accommodation practices than the tic symptoms per se.
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Affiliation(s)
- Eric A Storch
- Department of Pediatrics, University of South Florida, Box 7523, 880 6th Street South, St. Petersburg, FL, 33701, USA.
- Department of Health Policy and Management, University of South Florida, Tampa, USA.
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, USA.
- Department of Psychology, University of South Florida, Tampa, USA.
- Rogers Behavioral Health, Tampa Bay, Tampa, USA.
- All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, USA.
| | - Carly Johnco
- Department of Pediatrics, University of South Florida, Box 7523, 880 6th Street South, St. Petersburg, FL, 33701, USA
| | - Joseph F McGuire
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA
| | - Monica S Wu
- Department of Pediatrics, University of South Florida, Box 7523, 880 6th Street South, St. Petersburg, FL, 33701, USA
- Department of Psychology, University of South Florida, Tampa, USA
| | - Nicole M McBride
- Department of Pediatrics, University of South Florida, Box 7523, 880 6th Street South, St. Petersburg, FL, 33701, USA
| | - Adam B Lewin
- Department of Pediatrics, University of South Florida, Box 7523, 880 6th Street South, St. Petersburg, FL, 33701, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, USA
- Department of Psychology, University of South Florida, Tampa, USA
| | - Tanya K Murphy
- Department of Pediatrics, University of South Florida, Box 7523, 880 6th Street South, St. Petersburg, FL, 33701, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, USA
- All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, USA
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25
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McGuire JF, McBride N, Piacentini J, Johnco C, Lewin AB, Murphy TK, Storch EA. The premonitory urge revisited: An individualized premonitory urge for tics scale. J Psychiatr Res 2016; 83:176-183. [PMID: 27643476 PMCID: PMC5107126 DOI: 10.1016/j.jpsychires.2016.09.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/27/2016] [Accepted: 09/08/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Premonitory urge ratings have advanced our understanding of urge phenomenology among individuals with tic disorders (TD). However, these ratings have been limited by their reliance on a single global dimension of urge severity. This study examined the psychometric properties of a novel scale called the Individualized Premonitory Urge for Tics Scale (I-PUTS) that assesses urge severity across multiple dimensions (number, frequency, and intensity). METHOD Seventy-five youth with a TD and their parents participated. Clinicians assessed youth's tic severity, depression severity, rages, and premonitory urges. Parents completed ratings of youth's anxiety, affect lability, and general psychopathology. Youth completed self-report ratings of anxiety, urge severity, and distress tolerance. RESULTS The I-PUTS identified that youth experienced an average of three distinct urges, but had an average of seven tics over the past week. Urges were primarily localized in the head/face, neck/throat, and arm regions. All I-PUTS dimensions exhibited excellent inter-rater reliability. The I-PUTS dimensions exhibited good convergent validity with global urge ratings and tic severity, and appropriate divergent validity from other clinical constructs. Youth who exhibited discrepant reports between clinician-administered and self-report urge ratings had less anxiety and tic severity, and greater inattention and externalizing problems compared to youth who exhibited good agreement. CONCLUSIONS The I-PUTS is a reliable and valid assessment of urge phenomena, which provides additional and complementary information to existing urge scales. It highlights the existence of multiple dimensions of urge severity, and presents particular utility when assessing urges in youth with TD who have inattention and externalizing problems.
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Affiliation(s)
- Joseph F McGuire
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA.
| | - Nicole McBride
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - John Piacentini
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Carly Johnco
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Adam B Lewin
- Department of Pediatrics, University of South Florida, Tampa, FL, USA; Department of Psychiatry and Behavioral Neuroscience, University of South Florida, Tampa, FL, USA; All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL, USA
| | - Tanya K Murphy
- Department of Pediatrics, University of South Florida, Tampa, FL, USA; Department of Psychiatry and Behavioral Neuroscience, University of South Florida, Tampa, FL, USA; All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL, USA
| | - Eric A Storch
- Department of Pediatrics, University of South Florida, Tampa, FL, USA; Department of Psychiatry and Behavioral Neuroscience, University of South Florida, Tampa, FL, USA; All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL, USA; Rogers Behavioral Health - Tampa Bay, Tampa, FL, USA; Department of Health Policy and Management, University of South Florida, Tampa, FL, USA
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Abstract
Family accommodation is a common and widely studied phenomenon in families of youth with obsessive‐compulsive disorder (OCD). Family accommodation has been associated with increased symptom severity, poorer functional outcomes, and reduced treatment response. While family accommodation is increasingly targeted in family‐based treatment of OCD, there are cases where youth refuse treatment. In these circumstances, parent‐focused treatments that target reduction of family accommodation can be used to improve outcomes for youth with OCD. This case study illustrates the conceptualization and treatment of family accommodation in childhood OCD in the context of treatment refusal. Treatment was implemented without explicit involvement of the child. Parents reported moderate improvement in OCD symptoms at the end of treatment and a decrease in overall parent–child conflict. The findings illustrate how exposure and response principles can be implemented without direct involvement of the child in cases where youth show low motivation or refusal of treatment.
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Affiliation(s)
- Carly Johnco
- Centre for Emotional Health, Department of Psychology, Macquarie University.
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Abstract
BACKGROUND This study examined the incidence and clinical correlates of suicidal ideation (SI) in youth with tic disorders (TD). The independent contribution of tics, anxiety, depressive and externalizing symptoms on SI severity in youth with TD was assessed. METHOD Participants were 75 treatment-seeking youth with a TD (N=75) aged 6-18. Participants completed diagnostic assessments, clinician-ratings, self- and parent-report measures of emotional functioning and the presence and/or severity of suicidal ideation. RESULTS Based on youth-report, 61% of youth endorsed at least some symptoms of SI, and 8% endorsed symptoms that exceeded the clinically significant cut-off. Parents reported SI in 11% of cases, with generally poor agreement between parent- and youth-report. Suicidal ideation correlated with higher anxiety, depressive and externalizing symptoms, affective lability, and with poorer distress tolerance and overall functioning. Anxiety, depressive and externalizing symptoms showed an independent relationship with SI. Tic severity was not associated with SI. Rather, higher tic severity was associated with an increase in anxiety symptoms, which in turn, was associated with greater SI severity. LIMITATIONS Cross-sectional data limits causal conclusions. Diagnosis was based on unstructured assessments by expert clinicians, including consensus diagnosis, rather than structured clinical interviews. CONCLUSIONS Around 8-11% of youth with TD experienced SI. Tic severity did not have any direct influence on SI, however the presence of comorbid anxiety and depressive symptoms significantly increases this risk. Results suggest that it is psychiatric comorbidity, rather than tics themselves, that predispose youth with tic disorders to increased risk of suicidality.
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Affiliation(s)
- Carly Johnco
- Department of Pediatrics, University of South Florida, USA; Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
| | - Joseph F McGuire
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, USA
| | | | - Tanya K Murphy
- Department of Pediatrics, University of South Florida, USA; Department of Psychiatry & Behavioral Neurosciences, University of South Florida, USA; All Children's Hospital - Johns Hopkins Medicine, St Petersburg, FL, USA
| | - Adam B Lewin
- Department of Pediatrics, University of South Florida, USA; Department of Psychiatry & Behavioral Neurosciences, University of South Florida, USA; Department of Psychology, University of South Florida, USA
| | - Eric A Storch
- Department of Pediatrics, University of South Florida, USA; Department of Psychiatry & Behavioral Neurosciences, University of South Florida, USA; All Children's Hospital - Johns Hopkins Medicine, St Petersburg, FL, USA; Department of Psychology, University of South Florida, USA; Department of Health Policy and Management, University of South Florida, USA; Rogers Behavioral Health - Tampa Bay, Tampa, FL, USA
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Salloum A, Johnco C, Lewin AB, McBride NM, Storch EA. Barriers to access and participation in community mental health treatment for anxious children. J Affect Disord 2016; 196:54-61. [PMID: 26901657 DOI: 10.1016/j.jad.2016.02.026] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 12/01/2015] [Accepted: 02/07/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Anxiety disorders are the most common psychiatric disorders among children in the United States; yet many children do not receive treatment due to barriers to treatment access and participation. This study examined common barriers to treatment access and participation among anxious children who participated in computer-assisted cognitive behavioral therapy. Differences in barriers reported by treatment completers/non-completers were examined, as was the association with sociodemographic characteristics, anxiety severity, and impairment. The impact of barriers on treatment response was assessed, as well as the relationship with treatment expectancy and satisfaction. METHOD Barriers to access and participation, demographics, anxiety severity/impairment, treatment credibility and satisfaction were assessed among parents and children with anxiety (N=100; ages 7-13) who were enrolled in a community-based randomized clinical trial. RESULTS The most common access barrier was parents not knowing where or from whom to seek services (66%). Differences among completers and non-completers were related to stigma, confidentiality, and costs. The most common parent-reported barrier to participating was stress (32.4%) and child-reported barrier to participation was not having enough time to complete homework (22.1%). Of the sociodemographic, clinical and treatment characteristics, minority status, satisfaction, and treatment response were associated with barriers to treatment participation, although these associations varied by barriers related to treatment and external factors. LIMITATIONS Cross sectional design and lack of well-established psychometric properties for barriers measures were limitations. CONCLUSION Findings suggest that accessible, time-efficient, cost-effective service delivery methods that minimize stigma and maximize engagement when delivering evidence-based treatment for pediatric anxiety are needed.
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Affiliation(s)
- Alison Salloum
- School of Social Work, University of South Florida, United States; Department of Pediatrics, University of South Florida, United States.
| | - Carly Johnco
- Department of Pediatrics, University of South Florida, United States
| | - Adam B Lewin
- Department of Pediatrics, University of South Florida, United States; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, United States; Department of Psychology, University of South Florida, United States
| | - Nicole M McBride
- Department of Pediatrics, University of South Florida, United States
| | - Eric A Storch
- Department of Pediatrics, University of South Florida, United States; Department of Health Policy and Management, University of South Florida, United States; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, United States; Department of Psychology, University of South Florida, United States; Rogers Behavioral Health - Tampa Bay, United States; All Children's Hospital - Johns Hopkins Medicine, United States
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Abstract
Potential negative sequelae for survivors of child sexual abuse is well documented. However, growing evidence suggests that some individuals who actively cope with traumatic events can progress from a negative trajectory toward positive psychological change, often termed posttraumatic growth. Current posttraumatic growth theories may be of limited applicability to developmental considerations involved in child sexual abuse. This explorative study examines posttraumatic growth among adult female survivors of child sexual abuse. In-depth interviews were conducted with six participants who believed they had grown through coping with their abuse. Data was analyzed using interpretative phenomenological analysis. Three superordinate and nine subordinate themes were identified and explored. Some participants reported experiencing growth and distress simultaneously. Theoretical and clinical implications are examined in relation to the study's findings.
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Affiliation(s)
- Sarah Hartley
- a University of Oxford, Institute of Clinical Psychology Training, Isis Education Centre, Warneford Hospital, Headington , Oxford , UK
| | - Carly Johnco
- b University of South Florida , St. Petersburg , Florida , USA
| | | | - Alexis Berry
- d Older People's Clinical Psychology Service , Northampton , UK
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Jacob ML, Johnco C, Dane BF, Collier A, Storch EA. Psychosocial functioning in Barth syndrome: Assessment of individual and parental adjustment. Children's Health Care 2015. [DOI: 10.1080/02739615.2015.1124768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Anxiety disorders are one of the most common psychiatric comorbidities among children and adolescents with autism spectrum disorders (ASD). There has been a recent proliferation of research examining the prevalence, phenomenology, assessment and treatment of anxiety disorders among youth with ASD. While there is currently very limited support for the use of pharmacological agents to treat anxiety among youth with ASD and comorbid anxiety, there has been overwhelming support across numerous modestly sized controlled studies for the efficacy of cognitive behavioral therapy. This review discusses advances in the treatment literature for anxiety in youth with ASD, and discusses the current evidence base for whether standard treatment needs to be adapted for this population.
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Affiliation(s)
- Carly Johnco
- Department of Pediatrics, University of South Florida
| | - Eric A. Storch
- Department of Pediatrics, University of South Florida
- Department of Psychology, University of South Florida
- Department of Psychiatry & Behavioral Neurosciences, University of South Florida
- Department of Health Policy and Management, University of South Florida
- Rogers Behavioral Health – Tampa Bay
- All Children’s Hospital – Johns Hopkins Medicine
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Johnco C, Wuthrich VM, Rapee RM. THE IMPACT OF LATE-LIFE ANXIETY AND DEPRESSION ON COGNITIVE FLEXIBILITY AND COGNITIVE RESTRUCTURING SKILL ACQUISITION. Depress Anxiety 2015; 32:754-62. [PMID: 26014612 DOI: 10.1002/da.22375] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/31/2015] [Accepted: 04/02/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Studies examining treatment moderators and mediators in late-life anxiety and depression are sparse. Executive functioning skills decrease with age, and are poorer in the context of anxiety and depression. One of the key cognitive behavioral therapy techniques for anxiety and depression is cognitive restructuring (CR), which teaches people to identify and dispute maladaptive thoughts. There is evidence that cognitive flexibility (CF), one aspect of executive functioning, has a negative impact on CR skill acquisition in nonclinical older adults, and this warrants extension in a clinical sample. METHOD This study assessed CR skill acquisition in a clinical sample of 47 older adults with anxiety and depression and 53 nonclinical controls during an experimental paradigm, and investigated the influence of CF on this relationship. A battery of neuropsychological tests assessing CF were administered and CR was learned during a brief intervention. RESULTS The clinical sample showed poorer CF on some measures, as well as poorer CR quality and efficacy (reduction in subjective distress). CF partially mediated the relationship between clinical status and CR quality, and between clinical status and CR efficacy. CONCLUSION These results provide preliminary evidence that older adults with anxiety and depression are worse at learning and benefiting from CR with a brief intervention and this is partially due to having poorer CF skills. These findings warrant further examination in a treatment context to assess whether CR skill acquisition improves over treatment.
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Affiliation(s)
- Carly Johnco
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Viviana M Wuthrich
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Ronald M Rapee
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
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Storch EA, Salloum A, Johnco C, Dane BF, Crawford EA, King MA, McBride NM, Lewin AB. Phenomenology and clinical correlates of family accommodation in pediatric anxiety disorders. J Anxiety Disord 2015; 35:75-81. [PMID: 26398305 DOI: 10.1016/j.janxdis.2015.09.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 08/09/2015] [Accepted: 09/05/2015] [Indexed: 10/23/2022]
Abstract
Despite evidence documenting high prevalence of family accommodation in pediatric obsessive-compulsive disorder, examination in other pediatric anxiety disorders is limited. Preliminary evidence suggests that family accommodation is common amongst children with anxiety disorders; however, the impact on clinical presentation and functional impairment has not been addressed. This study assessed the nature and clinical correlates of family accommodation in pediatric anxiety, as well as validating a mechanistic model. Participants included 112 anxious youth and their parents who were administered a diagnostic clinical interview and measure of anxiety severity, as well as questionnaires assessing internalizing and externalizing symptoms, family accommodation and functional impairment. Some form of accommodation was present in all families. Family accommodation was associated with increased anxiety severity and externalizing behaviors, having a diagnosis of separation anxiety, and increased functional impairment. Family accommodation partially mediated the relationship between anxiety severity and functional impairment, as well as externalizing behaviors and functional impairment. Family accommodation is common in pediatric anxiety disorders, and is associated with more severe clinical presentations and functional impairment. These findings highlight the importance of parental involvement in treatment and the need to specifically target accommodation practices during interventions to mitigate negative outcomes in anxious youth. Further studies utilizing longitudinal data are needed to validate mechanistic models.
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Affiliation(s)
- Eric A Storch
- Department of Pediatrics, University of South Florida, United States; Department of Health Policy and Management, University of South Florida, United States; Department of Psychiatry & Behavioral Neurosciences, University of South Florida, United States; Department of Psychology, University of South Florida, United States; Rogers Behavioral Health, Tampa Bay, United States; All Children's Hospital, Johns Hopkins Medicine, United States.
| | - Alison Salloum
- School of Social Work, University of South Florida, United States
| | - Carly Johnco
- Department of Pediatrics, University of South Florida, United States
| | - Brittney F Dane
- Department of Pediatrics, University of South Florida, United States
| | | | - Morgan A King
- Department of Pediatrics, University of South Florida, United States
| | - Nicole M McBride
- Department of Pediatrics, University of South Florida, United States
| | - Adam B Lewin
- Department of Pediatrics, University of South Florida, United States; Department of Psychiatry & Behavioral Neurosciences, University of South Florida, United States; Department of Psychology, University of South Florida, United States
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35
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Johnco C, Salloum A, De Nadai AS, McBride N, Crawford EA, Lewin AB, Storch EA. Incidence, clinical correlates and treatment effect of rage in anxious children. Psychiatry Res 2015; 229:63-9. [PMID: 26235476 PMCID: PMC4561508 DOI: 10.1016/j.psychres.2015.07.071] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 07/10/2015] [Accepted: 07/27/2015] [Indexed: 10/23/2022]
Abstract
Episodic rage represents an important and underappreciated clinical feature in pediatric anxiety. This study examined the incidence and clinical correlates of rage in children with anxiety disorders. Change in rage during treatment for anxiety was also examined. Participants consisted of 107 children diagnosed with an anxiety disorder and their parents. Participants completed structured clinical interviews and questionnaire measures to assess rage, anxiety, functional impairment, family accommodation and caregiver strain, as well as the quality of the child's relationship with family and peers. Rage was a common feature amongst children with anxiety disorders. Rage was associated with a more severe clinical profile, including increased anxiety severity, functional impairment, family accommodation and caregiver strain, as well as poorer relationships with parents, siblings, extended family and peers. Rage was more common in children with separation anxiety, comorbid anxiety, attention deficit/hyperactivity disorder and behavioral disorders, but not depressive symptoms. Rage predicted higher levels of functional impairment, beyond the effect of anxiety severity. Rage severity reduced over treatment in line with changes in anxiety symptoms. Findings suggest that rage is a marker of greater psychopathology in anxious youth. Standard cognitive behavioral treatment for anxiety appears to reduce rage without adjunctive treatment.
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Affiliation(s)
- Carly Johnco
- Department of Pediatrics, University of South Florida, USA.
| | | | | | - Nicole McBride
- Department of Pediatrics, University of South Florida, USA
| | | | - Adam B Lewin
- Department of Pediatrics, University of South Florida, USA; Department of Psychology, University of South Florida, USA; Department of Psychiatry & Behavioral Neurosciences, University of South Florida, USA
| | - Eric A Storch
- Department of Pediatrics, University of South Florida, USA; Department of Psychology, University of South Florida, USA; Department of Psychiatry & Behavioral Neurosciences, University of South Florida, USA; Rogers Behavioral Health - Tampa Bay, USA; All Children's Hospital-Johns Hopkins Medicine, USA; Department of Health Policy and Management, University of South Florida, USA
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Johnco C, Wuthrich VM, Rapee RM. Reliability and validity of two self-report measures of cognitive flexibility. Psychol Assess 2014; 26:1381-1387. [DOI: 10.1037/a0038009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wuthrich VM, Johnco C, Knight A. Comparison of the Penn State Worry Questionnaire (PSWQ) and abbreviated version (PSWQ-A) in a clinical and non-clinical population of older adults. J Anxiety Disord 2014; 28:657-63. [PMID: 25124502 DOI: 10.1016/j.janxdis.2014.07.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/24/2014] [Accepted: 07/04/2014] [Indexed: 10/25/2022]
Abstract
The Penn State Worry Questionnaire (PSWQ) is a widely used measure of worry severity. An 8-item abbreviated version (PSWQ-A) has been developed as a brief screening measure, although there are limited studies assessing the psychometric properties of this measure in a large geriatric population. The aim of this study was to assess the utility of the PSWQ-A compared to the full PSWQ, to identify pathological worry in an older adult sample (N=108) of clinically anxious and depressed older adults, compared to a non-clinical sample (N=53). The PSWQ and PSWQ-A were found to have similarly adequate reliability and validity. The factor structure of the PSWQ-A was replicated, but not for the PSWQ. Both measures accurately distinguished between clinical and non-clinical status with similar sensitivity and specificity. These findings indicate the PSWQ-A is a useful measure for screening or epidemiological studies assessing worry in geriatric populations.
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Affiliation(s)
- Viviana M Wuthrich
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
| | - Carly Johnco
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Ashleigh Knight
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
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Johnco C, Wuthrich VM, Rapee RM. The influence of cognitive flexibility on treatment outcome and cognitive restructuring skill acquisition during cognitive behavioural treatment for anxiety and depression in older adults: Results of a pilot study. Behav Res Ther 2014; 57:55-64. [PMID: 24828838 DOI: 10.1016/j.brat.2014.04.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 04/04/2014] [Accepted: 04/16/2014] [Indexed: 12/12/2022]
Abstract
There is some evidence that cognitive flexibility negatively impacts cognitive restructuring skill acquisition with brief training; however, there is little understanding of how this relates to learning cognitive restructuring over the course of a therapy program, and how it relates to overall treatment outcome. This study assessed the impact of cognitive flexibility on cognitive restructuring skill acquisition following group CBT, and on treatment outcome, along with changes in cognitive flexibility over treatment. 44 older participants with anxiety and depression completed self-report and neuropsychological tests of cognitive flexibility and a clinical interview at pre and post-treatment. Qualitative and quantitative measures of cognitive restructuring were completed at post-treatment. Pre-treatment cognitive flexibility was not related to the quality of cognitive restructuring at post-treatment or overall treatment outcome. However, it did predict reduction in subjective units of distress from using cognitive restructuring and therapist ratings of cognitive restructuring ability at post-treatment. Few participants showed changes in cognitive flexibility over treatment. Those with poorer cognitive flexibility may not find cognitive restructuring as useful to alleviate emotional distress as those with better cognitive flexibility. However, those with poorer cognitive flexibility can still benefit from standardised CBT, even if their use of cognitive restructuring is less effective.
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Affiliation(s)
- C Johnco
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney 2109, Australia.
| | - V M Wuthrich
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney 2109, Australia.
| | - R M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney 2109, Australia.
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Johnco C, Wuthrich VM, Rapee RM. The role of cognitive flexibility in cognitive restructuring skill acquisition among older adults. J Anxiety Disord 2013; 27:576-84. [PMID: 23253357 DOI: 10.1016/j.janxdis.2012.10.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 10/11/2012] [Accepted: 10/13/2012] [Indexed: 10/27/2022]
Abstract
Cognitive flexibility is one aspect of executive functioning that encompasses the ability to produce diverse ideas, consider response alternatives, and modify behaviors to manage changing circumstances. These processes are likely to be important for implementing cognitive restructuring. The present study investigated the impact of cognitive flexibility on older adults' ability to learn cognitive restructuring. Neuropsychological measures of cognitive flexibility were administered to 40 normal community-dwelling older adult volunteers and their ability to implement cognitive restructuring was coded and analyzed. Results indicated that the majority of participants showed good cognitive restructuring skill acquisition with brief training. The multiple regression analysis suggested that those with poorer cognitive flexibility on neuropsychological testing demonstrated poorer quality cognitive restructuring. In particular, perseverative thinking styles appear to negatively impact the ability to learn cognitive restructuring. Further research is needed to clarify whether older adults with poor cognitive flexibility can improve their cognitive restructuring skills with repetition over treatment or whether alternative skills should be considered.
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Affiliation(s)
- C Johnco
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney 2109, Australia.
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Johnco C, Wheeler L, Taylor A. They do get prettier at closing time: A repeated measures study of the closing-time effect and alcohol. Social Influence 2010. [DOI: 10.1080/15534510.2010.487650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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