Minimal clinically important difference in the World Health Organization Quality of Life Brief (WHOQOL-BREF) for adults with neurofibromatosis

PURPOSE

This study aimed to estimate minimal clinically important difference (MCID) values for the World Health Organization Quality of Life Brief version (WHOQOL-BREF) among adults with neurofibromatosis (NF). An MCID is needed to demonstrate clinical meaningfulness of interventions for NF.

METHODS

We estimated MCID for the WHOQOL-BREF: the quality of life (QoL) measure recommended by the Response Evaluation in Neurofibromatosis and Schwannomatosis International Collaboration. We used data from 228 clinical trial participants with NF type 1, NF type 2-related schwannomatosis, or schwannomatosis (SCHWN) who completed 10 weeks of a virtual group mind-body program targeting resiliency or a time- and attention-matched control. Following established guidelines, we estimated MCIDs using both anchor-based and distribution-based methods for physical, psychological, social relationships, and environmental domains of the WHOQOL-BREF.

RESULTS

MCID results varied across method and QoL domain. Three anchor-based methods, average change (AC), change difference (CD), and regression (REG), yielded the most consistent and comparable MCID across QoL domains. Based on these methods, we recommend ranges for each QoL domain: Physical QoL (3.9-7.3), Psychological QoL (4.7-8.1), Social QoL (2.6-5.9), and Environmental QoL (4.1-6.6).

CONCLUSION

Establishing a rigorous MCID for QoL in NF is a critical step toward evaluating meaningful change in response to psychosocial interventions.

Improving mental health in chronic care in general practice: study protocol for a cluster-randomised controlled trial of the Healthy Mind intervention

BACKGROUND

Mental health issues are common among patients with chronic physical conditions, affecting approximately one in five patients. Poor mental health is associated with worse disease outcomes and increased mortality. Problem-solving therapy (PST) may be a suitable treatment for targeting poor mental health in these patients. This study protocol describes a randomised controlled trial of the Healthy Mind intervention, a general practice-based intervention offering PST to patients with type 2 diabetes and/or ischaemic heart disease and poor mental well-being.

METHODS

A stepped-wedge cluster-randomised controlled trial with 1-year follow-up will be conducted in Danish general practice. At the annual chronic care consultation, patients with type 2 diabetes and/or chronic ischaemic heart disease will be screened for poor mental well-being. Patients in the control group will be offered usual care while patients in the intervention group will be offered treatment with PST provided by general practitioners (GPs) or general practice staff, such as nurses, who will undergo a 2-day PST course before transitioning from the control to the intervention group. The primary outcome is change in depressive symptoms after 6 and 12 months. Secondary outcomes include change in mental well-being, anxiety, and diabetes distress (patients with type 2 diabetes) after 6 and 12 months as well as change in total cholesterol levels, low-density lipoprotein (LDL) levels, and blood glucose levels (patients with diabetes) after 12 months. Process outcomes include measures of implementation and mechanisms of impact. We aim to include a total of 188 patients, corresponding to approximately 14 average-sized general practices.

DISCUSSION

The Healthy Mind trial investigates the impact of PST treatment for patients with chronic disease and poor mental well-being in general practice. This will be the first randomised controlled trial determining the effect of PST treatment for patients with chronic diseases in general practice. The results of this study will provide relevant insights to aid GPs, and general practice staff manage patients with poor mental well-being.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05611112. Registered on October 28, 2022.

Experience with the use of the DIALOG+ intervention in patients with severe mental illness in outpatient services in Colombia

INTRODUCTION

Severe mental disorders can cause significant and lasting distress for patients and their families and generate high costs through the need for care and loss of productivity. This study tests DIALOG+, an app-based intervention to make routine patient-clinician meetings therapeutically effective. It combines a structured evaluation of patient satisfaction with a solution-focused approach.

METHODS

We conducted a qualitative study, based on a controlled clinical trial, in which 9 psychiatrists and 18 patients used DIALOG+ monthly over a six-month period. Semi-structured interviews were used to explore the experiences of participants and analysed in an inductive thematic analysis focusing on the feasibility and effects of the intervention in the Colombian context.

RESULTS

Experiences were grouped into five overall themes: a) impact of the intervention on the consultation and the doctor-patient relationship; b) impact on patients and in promoting change; c) use of the supporting app, and d) adaptability of the intervention to the Colombian healthcare system.

CONCLUSIONS

DIALOG+ was positively valued by most of the participants. Participants felt that it was beneficial to the routine consultation, improved communication and empowered patients to take a leading role in their care. More work is required to identify the patient groups that most benefit from DIALOG+, and to adjust it, particularly to fit brief consultation times, so that it can be rolled out successfully in the Colombian healthcare system.

Effectiveness of structured group psychoeducation for people with bipolar disorder in Rwanda: A randomized open-label superiority trial

BACKGROUND

Psychoeducation is a cornerstone as an add-on to pharmacotherapy in standard care for individuals with bipolar disorder. However, evidence of the effectiveness of psychoeducation in low-resource settings is scarce.

AIMS

We aimed to assess the effectiveness of structured group psychoeducation versus waiting list on relapse prevention for individuals with bipolar disorder in Rwanda, a low-income country.

METHODS

This was a randomized open-label superiority trial. Participants aged 18 years or older with bipolar disorder were recruited at the two referral hospitals for mental health in Rwanda and randomly assigned 12 sessions of group psychoeducation or a waiting list. The program was tailored to the setting and co-designed with patients and clinicians. The follow-up period was 12 months, and the primary outcome mean number of psychiatric hospitalizations.

RESULTS

In February and March 2021, 154 participants were randomly assigned to receive group psychoeducation (n = 78) or to a waiting list (n = 76). The retention rate was high, with only three discontinuing the psychoeducation once they had received a session. Despite limited use of first-line pharmacotherapy, the psychoeducation reduced the risk of hospitalization by half during the 12-month follow-up (RR: 0.50(95 % CI 0.26-0.95)). Yet, no change in medical adherence was observed.

LIMITATION

Weekly assessment of clinical status was not feasible.

CONCLUSION

Structured group psychoeducation for bipolar disorder in a low-resource setting has a protective effect against readmission despite limited access to first-line pharmacotherapy. Further studies are needed to assess the effectiveness of the program in more decentralized settings with less highly trained staff.

TRIAL REGISTRATION

NCT04671225.

Depressive symptoms and neuroticism mediate the association between traumatic events and suicidality - A latent class mediation analysis of UK Biobank Database

BACKGROUND

Mental disorders that follow traumatic experience may increase risk of suicidality, but a comprehensive approach to understand how these mental disorders mediate the association between psychological traumatic experience and suicidality should be elucidated. In this study, we attempted to provide comprehensive evidence on how depressive symptoms and neuroticism can mediate the association between psychological traumatic experiences and suicidal behaviours including suicidal ideation, suicidal planning, and suicide attempts.

METHODS

We analyzed 111,931 participants from UK Biobank who had completed mental health web-based questionnaire from 2016 to 2017. "Self-harm and suicidal behaviour and ideation (SSBI) score" was calculated by the response from suicidal behaviours and self-harm questionnaires. Conducting multivariate linear regression, depressive symptoms, anxiety symptoms, and neuroticism were selected as potential mediators. We constructed a latent class mediation model estimated direct effect of psychological traumatic events on suicidality and indirect effect of psychological traumatic events mediated by depressive symptoms and neuroticism.

RESULTS

Psychological traumatic events were positively associated with suicidal behaviours. Depressive symptoms and neuroticism significantly mediated the effect of psychological traumatic events on suicidality. Anxiety symptoms did not mediate the association between psychological traumatic events and suicidality.

CONCLUSION

Psychological traumatic events, irrespective of life stage of occurrence, are associated with suicidality. The association between psychological traumatic events and suicidality can be partially explained by depressive symptoms and neuroticism of those who were exposed to psychological trauma.

Nurse-Led Psychological Interventions For Depression In Adult Cancer Patients: A Systematic Review And Meta-Analysis of Randomized Controlled Trials

OBJECTIVES

Depression, frequently associated with cancer, significantly impacts health outcomes, necessitating effective treatments. This systematic review and meta-analysis aim to synthesize and critically evaluate the evidence from randomized controlled trials (RCTs) for the efficacy of nurse-led psychological interventions in managing depression among adult cancer patients. It focuses on the unique contribution of these interventions to improving depression management in oncology care, an underrepresented area in the existing literature.

METHODS

We conducted a comprehensive search in databases including Scopus, Medline, CINAHL, and PsycINFO, applying strict criteria to select RCTs assessing nurse-led psychological interventions for depression in cancer patients. We used the Cochrane Risk of Bias 2 tool to assess study quality.

RESULTS

Out of 425 screened abstracts, nine papers describing seven distinct interventions involving 1463 participants were selected. The overall effect size estimate of -0.75 (95% confidence interval: -1.23 to -0.27) indicates significant effectiveness of these interventions in reducing depression compared to treatment as usual. Additionally, the calculated prediction interval highlights the variability in effectiveness across different settings, suggesting that contextual factors play a crucial role in the success of these interventions.

CONCLUSION

The findings advocate for the integration of nurse-led psychological interventions into standard cancer care, highlighting their efficacy in improving depressive symptoms in adult cancer patients. These interventions show promise but require further refinement and research to optimize their effectiveness across diverse patient groups and healthcare settings. This review underscores the potential of nurse-led psychological interventions in enriching oncology care and addresses a critical gap in the existing body of research.

Characterizing psychosocial services in a pediatric urology practice

INTRODUCTION

Psychosocial needs, which encompass behavioral health and social determinants of health (SDOH), are important mediators of the patient experience and health outcomes. However, many practices have limited experience with systematically assessing the non-billable psychosocial services provided to patients and families.

OBJECTIVE

To characterize the non-billable activities of three psychosocial providers in a pediatric urology practice at a freestanding children's hospital.

STUDY DESIGN

Following Institutional Review Board approval, an adapted version of the Care Coordination Measurement Tool (CCMT) was used to collect data prospectively on non-billable activities performed by a psychologist, social worker (SW), and certified child life specialist (CCLS) in a pediatric urology department. Variables included activity type, time spent per activity, and outcomes affected. Demographic data included age, sex, race, state, zip code, insurance type, and language.

RESULTS

From April to October 2022, 3096 activities were performed in support of psychosocial needs over 947 encounters for 527 patients. The median patient age was 9.2 years (IQR 4.8-12.4); 48.4 % were male. The psychosocial providers most commonly identified care coordination needs related to delivery of urologic care (73.4 %), mental/behavioral/developmental health (29.1 %), and referral and appointment management (19.9 %). The largest proportion of time was spent on providing direct psychosocial support (45.9 %), consisting of psychosocial assessments, education, and other behavioral health interventions. A large proportion of time was also spent on care coordination activities, namely logistics and navigation support (35.9 %). Relative time allocation across activities varied by provider type (p < 0.001); care coordination constituted 64.2 % of non-billable activities for the psychologist, 57.8 % for the SW, and 12.3 % for the CCLS. Activities were associated with treatment plan modification in 37.7 % (n = 357), outpatient coordination in 22.5 % (n = 213), and treatment plan adherence in 19.0 % (n = 180) of encounters.

DISCUSSION

This study enhances our understanding of psychosocial needs of patients in a pediatric urology practice by assessing non-billable psychosocial services not otherwise captured in the clinical workflow. In addition to direct psychosocial support, care coordination activities constitute a large proportion of such services. These data provide valuable insight into the range of activities necessary for the provision of specialty pediatric medical care.

CONCLUSION

Psychosocial providers in a pediatric urology practice perform many non-billable care coordination and psychosocial support activities. Characterizing these activities is important for beginning to understand patients' psychosocial needs and informing resource deployment.

Acceptability of a pilot motivational interviewing intervention at public health facilities to improve the HIV treatment cascade among people who inject drugs in Indonesia

BACKGROUND

HIV-positive people who inject drugs (PWID) experience challenges in initiating and adhering to antiretroviral treatment (ART). Counselling using motivational interviewing (MI) techniques may help them formulate individualised strategies, and execute actions to address these challenges collaboratively with their providers. We evaluated the acceptability of MI from a pilot implementation at three public health facilities in Indonesia.

METHODS

Adapting the acceptability constructs developed by Sekhon (2017) we assessed the acceptability to HIV-positive PWID clients (n = 12) and providers (n = 10) in four synthesised constructs: motivation (attributes that inspire engagement); cost consideration (sacrifices made to engage in MI); learned understanding (mechanism of action); and outcomes (ability to effect change with engagement). We included all providers and clients who completed ≥ 2 MI encounters. Qualitative analysis with an interpretive paradigm was used to extract and categorise themes by these constructs.

RESULTS

In motivation, clients valued the open communication style of MI, while providers appreciated its novelty in offering coherent structure with clear boundaries. In cost consideration, both groups faced a challenge in meeting MI encounters due to access or engagement in other health care areas. In learned understanding, clients understood that MI worked to identify problematic areas of life amenable to change to support long-term ART, with reconciliation in family life being the most targeted change. By contrast, providers preferred targeting tangible health outcomes to such behavioural proxies. In outcomes, clients were confident in their ability to develop behaviours to sustain ART uptakes, whereas providers doubted the outcome of MI on younger PWID or those with severe dependence.

CONCLUSIONS

There is broad acceptability of MI in motivating engagement for both actors. Relative to providers, clients were more acceptable in its mechanism and had greater confidence to perform behaviours conducive to ART engagement. Design innovations to improve the acceptability of MI for both actors are needed.

Identification of patient subgroups who benefit from a behavioral intervention to improve adjuvant endocrine therapy adherence: a randomized-controlled trial

PURPOSE

Adjuvant endocrine therapy (AET) reduces breast cancer morbidity and mortality; however, adherence is suboptimal. Interventions exist, yet few have improved adherence. Patient characteristics may alter uptake of an intervention to boost adherence. We examined moderators of the effect of a virtual intervention (STRIDE; #NCT03837496) on AET adherence after breast cancer.

METHODS

At a large academic medical center, patients taking AET (N = 100; Mage = 56.1, 91% White) were randomized to receive STRIDE versus medication monitoring. All stored their medication in digital pill bottles (MEMS Caps) which captured objective adherence. Participants self-reported adherence (Medication Adherence Report Scale) at 12 weeks post-baseline. Moderators included age, anxiety, and depressive symptoms (Hospital Anxiety and Depression Scale), AET-related symptom distress (Breast Cancer Prevention Trial Symptom Scale), and AET-specific concerns (Beliefs about Medications Questionnaire). We used hierarchical linear modeling (time × condition × moderator) and multiple regression (condition × moderator) to test the interaction effects on adherence.

RESULTS

Age (B = 0.05, SE = 0.02, p = 0.003) and AET-related symptom distress (B = -0.04, SE = 0.02, p = 0.02) moderated condition effect on self-reported adherence while anxiety (B = -1.20, SE = 0.53, p = 0.03) and depressive symptoms (B = -1.65, SE = 0.65, p = 0.01) moderated objective adherence effects. AET-specific concerns approached significance (B = 0.91, SE = 0.57, p = 0.12). Participants who received STRIDE and were older or presented with lower anxiety and depressive symptoms or AET-related symptom distress exhibited improved adherence. Post hoc analyses revealed high correlations among most moderators.

CONCLUSIONS

A subgroup of patients who received STRIDE exhibited improvements in AET adherence. The interrelatedness of moderators suggests an underlying profile of patients with lower symptom burden who benefitted most from the intervention.

STUDY REGISTRATION

NCT03837496.

Effects of nurses-led multidisciplinary-based psychological management in spinal surgery: a retrospective, propensity-score-matching comparative study

BACKGROUND

Patients in spine surgery often have emotional disorders which is caused by multi-factors. Therefore, a multidisciplinary and multimodal intervention program is required to improve emotional disorders during the perioperative period. However, related studies were rare. This study aimed to confirm that the multidisciplinary-based psychological management leading by nurses was effective in treating emotional disorders and show the assignments of the members of the multidisciplinary team with the orientations of nurses.

DESIGN

A retrospective, comparative study.

METHOD

This study was a retrospective cohort research and compared the results between the intervention group and control group using the Huaxi Emotional Distress Index (HEI) which was used to evaluate emotional disorders. The intervention group consisted of patients who underwent surgery between January 2018 and December 2020 after psychological management was implemented. The control group consisted of patients with regular care who underwent surgery between January 2015 and December 2017. To improve comparability between the two groups, baseline data from the recruited patients were analyzed using propensity-score-matching (PSM) based on age, sex, marital status, education, and disease region.

RESULTS

A total of 539 (11.5%) people developed emotional disorders, of which 319 (6.8%), 151 (3.2%) and 69 (1.5%) had mild, moderate mood and severe emotional disorders, respectively. 2107 pairs of patients were matched after PSM. Scores of HEI in the intervention group were heightened compared with those in the control group (P<0.001) after matching. Moreover, the incidence of emotional disorders in patients decreased after implementing psychological management (P = 0.001). The severity of emotional disorders was alleviated with statistical significance as well (P = 0.010).

CONCLUSIONS

Nurses-led Multidisciplinary-Based psychological management was able to reduce the incidence of emotional disorders and improve the severity of these in spine surgery patients.

The effectiveness of digital psychosocial interventions on psychological distress, depression, anxiety, and health-related quality of life in patients with gynaecological cancer: a systematic review and meta-analysis

PURPOSE

Patients with gynaecological cancer often experience psychological issues due to multiple stressors. Psychological disturbances have debilitating effects on patients with gynaecological cancer. In recent decades, digital psychosocial interventions have rapidly advanced and been incorporated into mental health interventions. Digital psychosocial interventions could provide patients with several benefits over traditional in-person interventions, including convenience, anonymity, flexible scheduling, and geographic mobility. The aim of this systematic review was to synthesize the effectiveness of digital psychosocial intervention in reducing psychological distress, depression, and anxiety and improving health-related quality of life in patients with gynaecological cancer.

METHODS

Three-step extensive search was performed on 22 December 2022 from nine bibliographic databases, trial registries and grey literature. Experimental studies involving patients with gynaecological cancer utilizing digital psychosocial interventions for the improvement of mental health outcomes were included. Meta-analysis was conducted using RevMan 5.4 software. Heterogeneity was analysed by Cochran's Q test and I2. Subgroup analyses were attempted to evaluate relative effect sizes of subgroup features.

RESULTS

Meta-analysis of nine studies revealed small effect size in reduction of depression post-intervention (d = 0.24, 95% CI - 0.46 to - 0.02) and medium effect size in reduction of psychological distress post-intervention (d = 0.51, 95% CI - 0.81 to - 0.21) and follow-up (d = 0.65, 95% CI - 1.25 to - 0.05) compared to the control group. The effects of digital psychosocial interventions on anxiety and health-related quality of life were not statistically significant.

CONCLUSIONS

Digital psychosocial interventions probably reduced psychological distress and slightly reduced depression amongst patients with gynaecological cancer compared to the control group, which can be integrated into clinical practice. Additional trials with rigorous methodology and bigger sample sizes are needed to validate findings.

TRIAL REGISTRATION

PROSPERO (CRD42023389502).

Promising Directions: A Systematic Review of Psychosocial and Behavioral Interventions with Cultural Incorporation for Advanced and Metastatic Cancer

BACKGROUND

Improving quality of life (QOL) in advanced and metastatic cancer is a priority with increasing survivorship. This systematic review synthesizes psychosocial and behavioral interventions incorporating culture with the goal of examining their benefit for understudied and medically underserved populations with advanced and metastatic cancer.

METHOD

Reports were systematically screened for (1) a focus on advanced and metastatic cancer survivors, (2) psychosocial or behavioral intervention intended to improve QOL, (3) evidence of incorporating the culture(s) of understudied/underserved populations, and (4) availability in English. Bias was evaluated using the JBI Critical Appraisal Checklist and the Methodological index for non-randomized studies. Qualitative synthesis and quantitative meta-analyses were completed.

RESULTS

Eighty-six reports containing 5981 participants' data were examined. Qualitative synthesis of 23 studies identified four overarching themes relevant for incorporating culture in interventions. Meta-analysis of 19 RCTs and 4 quasi-experimental studies containing considerable heterogeneity indicated greater improvements in QOL (g = 0.84), eudaimonic well-being (g = 0.53), distress (g = -0.49), and anxiety (g = -0.37) for main intervention conditions compared to controls. Meta-analysis of 10 single-arm trials containing minimal to moderate heterogeneity found benefit for anxiety (g = -0.54), physical symptoms (g = -0.39), and depression (g = -0.38).

CONCLUSION

Psychosocial and behavioral interventions with cultural incorporation appear beneficial for improving QOL-related outcomes in advanced and metastatic cancer. Studies incorporating culture in psychosocial or behavioral interventions offer noteworthy insight and suggestions for future efforts such as attending to deep cultural structure.

The short- and longer-term effects of brief behavioral parent training versus care as usual in children with behavioral difficulties: study protocol for a randomized controlled trial

BACKGROUND

The access to and uptake of evidence-based behavioral parent training for children with behavioral difficulties (i.e., oppositional, defiant, aggressive, hyperactive, impulsive, and inattentive behavior) are currently limited because of a scarcity of certified therapists and long waiting lists. These problems are in part due to the long and sometimes perceived as rigid nature of most evidence-based programs and result in few families starting behavioral parent training and high dropout rates. Brief and individually tailored parenting interventions may reduce these problems and make behavioral parent training more accessible. This protocol paper describes a two-arm, multi-center, randomized controlled trial on the short- and longer-term effectiveness and cost-effectiveness of a brief, individually tailored behavioral parent training program for children with behavioral difficulties.

METHODS

Parents of children aged 2-12 years referred to a child mental healthcare center are randomized to (i) three sessions of behavioral parent training with optional booster sessions or (ii) care as usual. To evaluate effectiveness, our primary outcome is the mean severity of five daily ratings by parents of four selected behavioral difficulties. Secondary outcomes include measures of parent and child behavior, well-being, and parent-child interaction. We explore whether child and parent characteristics moderate intervention effects. To evaluate cost-effectiveness, the use and costs of mental healthcare and utilities are measured. Finally, parents' and therapists' satisfaction with the brief program are explored. Measurements take place at baseline (T0), one week after the brief parent training, or eight weeks after baseline (in case of care as usual) (T1), and six months (T2) and twelve months (T3) after T1.

DISCUSSION

The results of this trial could have meaningful societal implications for children with behavioral difficulties and their parents. If we find the brief behavioral parent training to be more (cost-)effective than care as usual, it could be used in clinical practice to make parent training more accessible.

TRIAL REGISTRATION

The trial is prospectively registered at ClinicalTrials.gov (NCT05591820) on October 24th, 2022 and updated throughout the trial.

Costs and benefits of scaling psychosocial interventions during the perinatal period in England: A simulation modelling study

BACKGROUND

Globally, guidance recommends the integration of mental health into maternal and child healthcare to address common maternal mental health problems during the perinatal period. However, implementing this in the real-world requires substantial resource allocations.

OBJECTIVE

The aim of this study was to estimate the likely costs and consequences linked to scaling the delivery of treatment (in the form of psychosocial interventions) during the perinatal period.

DESIGN

Simulation modelling.

SETTING(S)

England.

METHODS

Costs and consequences were modelled for three scenarios of assumed provision of services, whereby one referred to the projected provision under current government plans, with no additional scaling up of treatment. The other two scenarios referred to additional scaling of treatment: in one scenario, this referred to the provision of treatment by midwives and health visitors trained in the routine enquiry about mental health and delivery of psychosocial interventions; in the other scenario this referred to an expanded provision by primary mental health services. For each scenario and in yearly intervals (covering a ten-year period, 2015 to 2024), unit cots and outcomes were assigned to the activities women were assumed to receive (routine enquiry, assessment, treatment, care coordination). All costs were in 2020 pounds sterling. Data sources for the modelling included: published findings from randomised controlled trials; national unit cost source; national statistics; and expert consultation.

RESULTS

If the projected treatment gap was to be addressed, an estimated additional 111,154 (50,031) women would be accessing treatment in 2015 (2024). Estimated total costs (including cost offsets) in the scenario of projected provision under current government plans would be £73.5 million in 2015 and £95.2 million in 2024, whilst quality-adjusted life years gained would be 901 and 928 respectively. Addressing the treatment gap through provision by trained midwives and health visitors could mean additional costs of £7.3 million in 2015 but lower costs of £18.4 million in 2024. The additional quality-adjusted life years gained are estimated at 2096 in 2015 and 1418 in 2024. A scenario in which the treatment gap would be met by primary mental health services was likely to be more costly and delivered less health gains.

CONCLUSIONS

Findings from this modelling study suggest that scaling the integration of mental health care into routinely delivered care for women during the perinatal period might be economically viable.

REGISTRATION

N/A.

TWEETABLE ABSTRACT

Integrating mental health into maternal and child healthcare might generate economic benefits new study by @a_annettemaria and @knappem @CPEC_LSE finds #increasing access to treatment for women with perinatal mental health problems.

The impact of self-monitoring physical and mental health via an mHealth application on postpartum weight retention: Data from the INTER-ACT RCT

Background

Postpartum weight retention (PPWR) has many health risks. Digital self-monitoring of weight can potentially make postpartum weight management easier. We aim to test to what extent the self-monitoring of weight, steps and mental health through an mHealth application increases postpartum weight loss and reduces the odds of substantial PPWR (≥5 kg).

Methods

Participants were mothers in the intervention arm of the INTER-ACT multicenter randomized controlled trial (RCT), an inter-pregnancy lifestyle intervention among mothers with excessive gestational weight gain. Participants (n=288) had access to an mHealth application to log their weight, steps and mental health between 6 weeks and 6 months postpartum. A linear multiple regression model and a logistic regression model were run to test to what extent self-monitoring via the app increases postpartum weight loss and reduces the risk of substantial PPWR.

Results

Women who logged their weight more often lost more weight (B=0.03, β=0.26, CIB =[0.01,0.05], P<0.01), and had reduced odds of substantive PPWR (OR=0.99, CIOR =[0.98, 0.999], P<.05). Mental health logging reduced the odds of substantive PPWR (OR=0.98, CIOR =[0.97, 1.00], P<0.05), but was unrelated to the amount of weight loss. Steps logging was unrelated to either weight loss or substantive PPWR.

Conclusion

Mothers with excessive gestational weight gain can benefit from app-based lifestyle interventions to reduce PPWR by self-monitoring their weight. More attention to mental health in PPWR interventions is needed.

"I Wish I Had That!": A Qualitative Analysis of Psychosocial Treatment Preferences Among Young Adults With Recent Concussion and Anxiety

OBJECTIVE

To assess psychosocial treatment preferences and factors that may affect treatment participation among young adults with a recent concussion and co-occurring anxiety.

DESIGN

In-depth, semi-structured individual qualitative interviews, followed by thematic analysis using a hybrid deductive-inductive approach.

SETTING

Academic medical center in the US Northeast.

PARTICIPANTS

Seventeen young adults (18-24y) who sustained a concussion within the past 3-10 weeks and reported at least mild anxiety (≥5 on the Generalized Anxiety Disorder-7 questionnaire).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Primary outcomes include preferences for program content (eg, topics and skills), delivery modality, format, and barriers and facilitators to participation.

RESULTS

We identified 4 domains characterizing participants' perceptions of and preferences for treatment. (1) Program content: Participants preferred a program early after injury that included psychoeducation and coping skills (eg, activity pacing, deep breathing, mindfulness). (2) Therapeutic processes: Participants preferred a person-centered approach in which clinicians normalized anxiety postconcussion and reassured them of recovery. (3) Program logistics: Participants endorsed that a brief, virtual program would be acceptable. They preferred access to program components through multiple modalities (eg, audio, video) and accommodations to manage concussion symptoms. (4) Barriers and facilitators to participation: Barriers included acute concussion symptoms (eg, screen sensitivity), time constraints, and forgetting sessions. Facilitators included a program that is flexible (format, scheduling), personalized (self-chosen mode for reminders, measure of accountability), and accessible (ie, advertising through health care professionals or social media).

CONCLUSIONS

Participants need psychosocial support that normalizes their experiences and provides education and coping tools. Treatments should be accessible, flexible, and person centered. Psychosocial treatments meeting these preferences may help optimize the recovery of young adults with recent concussion and anxiety.

Effect of telehealth interventions on adherence to endocrine therapy among patients with breast cancer: a systematic review and meta-analysis

PURPOSE

To evaluate the effect of telehealth interventions on adherence to endocrine therapy among patients with breast cancer.

METHODS

A systematic search of five English databases (PubMed, Web of Science, Embase, the American Psychological Association PsycNet, and the Cochrane Library) and four Chinese databases (Chinese National Knowledge Infrastructure, SinoMed, WanFang Data, and WeiPu Data) was performed from inception to March 31, 2023. Two investigators independently screened the available studies for eligibility and extracted relevant data. Quality assessment was conducted using the Cochrane Risk of Bias Tool. The effect size was computed based on the risk ratio for dichotomous data and standardized mean difference for continuous data using Review Manager 5.4.

RESULTS

A total of 1,780 participants from eight randomized controlled trials were included. These studies involved treatment with aromatase inhibitors only (n = 3) or aromatase inhibitors plus tamoxifen (n = 5). Telehealth interventions involved web-based interventions, telephone-based interventions, interventions via mobile applications, and interventions based on technology. In three studies, subjective measures were used, while objective measures were utilized in another three. Two studies incorporated a combination of both subjective and objective measures. The duration of the interventions varied among studies, ranging from a week to 36 months. The follow-up duration ranged from 4 weeks to 36 months. The quality of included studies was moderate to high. The meta-analysis of the five studies reporting dichotomous data showed that telehealth interventions had a significant effect on adherence to endocrine therapy (RR = 0.86, 95% CI = 0.76-0.97). Moreover, four studies reported continuous data. The meta-analysis demonstrated that telehealth interventions significantly improved adherence to endocrine therapy at 1 month (SMD = 0.50, 95% CI = 0.10-0.90), 3 months (SMD = 0.58, 95% CI = 0.17-0.99), and 6 months (SMD = 0.27, 95% CI = 0.08-0.47) of follow-up.

CONCLUSION

Telehealth interventions may facilitate adherence to endocrine therapy among patients with breast cancer. Further research should adopt a theory-based design and explore the longer-term effects.

Effective interventions to reduce burnout in nurses: A meta-analysis

BACKGROUND

To examine the effectiveness of interventions to ameliorate burnout, secondary traumatic stress, and emotional exhaustion in nurses and midwives. The systematic review was completed with all available studies that reported data on the effect of interventions that targeted burnout using the outcome measures of the Professional Quality of Life scale (ProQOL), or the Maslach Burnout Inventory (MBI).

METHODS

We used a systematic review methodology, which included a meta-analysis. A total of 2103 articles resulted from the systematic search; 688 were removed as duplicates, and 1415 articles were reviewed by the title and abstract, of which 255 were eligible for full-text screening. Only 66 met the inclusion criteria and were included in the analysis. The final meta-analysis consisted of 33 reports divided into 12 studies for ProQOL and 21 studies for the MBI.

RESULTS

The results provide an overall effect in studies using the ProQOL measurement was Z = 2.07 (P = 0.04) and a positive improvement mean difference of 9.32. The overall effect in studies using MBI was Z = 3.13 (P = 0.002) and a positive improvement mean difference of 6.58.

CONCLUSIONS

Whilst most studies indicated a positive difference, the most effective interventions included clinical supervision or activities that addressed the personal physical and mental well-being of nurses. Less effective interventions were managerial interventions or ones that used a strictly educational approach.

Long-term effects of psychosocial interventions for adolescents on depression and anxiety: a systematic review and meta-analysis

Background

Adolescence represents a distinctive phase of development, and variables linked to this developmental period could affect the efficiency of prevention and treatment for depression and anxiety, as well as the long-term prognosis. The objectives of this study were to investigate the long-term effectiveness of psychosocial interventions for adolescents on depression and anxiety symptoms and to assess the influence of different intervention parameters on the long-term effects.

Methods

In this systematic review and meta-analysis, we searched five databases (Cochrane Library, Embase, Medline, PsychInfo, Web of Science) and trial registers for relevant papers published between database inception and Aug 11, 2022, with no restrictions on the language or region in which the study was conducted. An updated search was performed on Oct 3, 2023. Randomised controlled trials of psychosocial interventions targeting specifically adolescents were included if they assessed outcomes at 1-year post-intervention or more. The risk of bias in the results was assessed using the Cochrane RoB 2.0. Between-study heterogeneity was estimated using the I2 statistic. The primary outcome was depression and studies were pooled using a standardised mean difference, with associated 95% confidence interval, p-value and I2. The study protocol was pre-registered on PROSPERO (CRD42022348668).

Findings

57 reports (n = 46,678 participants) were included in the review. Psychosocial interventions led to small reductions in depressive symptoms, with standardised mean difference (SMD) at 1-year of -0.08 (95% CI: -0.20 to -0.03, p = 0.002, I2 = 72%), 18-months SMD = -0.12, 95% CI: -0.22 to -0.01, p = 0.03, I2 = 63%) and 2-years SMD = -0.12 (95% CI: -0.20 to -0.03, p = 0.01, I2 = 68%). Sub-group analyses indicated that targeted interventions produced stronger effects, particularly when delivered by trained mental health professionals (K = 18, SMD = -0.24, 95% CI: -0.38 to -0.10, p = 0.001, I2 = 60%). No effects were detected for anxiety at any assessment.

Interpretation

Psychosocial interventions specifically targeting adolescents were shown to have small but positive effects on depression symptoms but not anxiety symptoms, which were sustained up to 2 years. These findings highlight the potential population-level preventive effects if such psychosocial interventions become widely implemented in accessible settings, such as schools. Future trials should include a longer term-follow-up at least at 12 months, in order to determine whether the intervention effects improve, stay the same or wear off over time.

Funding

UKRIMedical Research Council.

Individualized Coordination and Empowerment for Care Partners of Persons with Dementia (ICECaP): Study rationale and protocol

The majority of care for >10 million older adults with dementia (PWD) in the United States depends on at least on 11 million unpaid care partners (CPs). CPs are at greater risk of adverse physical, psychological, and cognitive health outcomes relative to non-caregiving peers. The goal of this paper is to establish the rationale, design, and protocol for a pilot randomized control trial to test the efficacy of the CP-focused intervention, ICECaP: Individualized Coordination and Empowerment for Care Partners of Persons with Dementia. ICECaP involves the assignment of a trained dementia care coordinator to a CP. The care coordinator maintains at least monthly contact with the CP with hybrid delivery (in-person, phone, e-mail, and video calls) and provides individualized support with care coordination for the CP navigating the PWD's care in a complex healthcare system, as well as supportive counseling, psychoeducation, and skills training for the CP. This trial will compare outcomes from baseline to 12-months among CPs who receive ICECaP versus routine care (controls). Outcomes include CP depression, burden, anxiety, and quality of life; CPs' reactions to the behavioral symptoms of dementia; and use of support services for the PWD. This trial will also assess mechanisms of intervention efficacy including changes in CP dementia knowledge, caregiving preparedness, self-efficacy, and optimism. Publication of this intervention protocol will benefit other dementia care teams seeking to support CPs and PWDs.

Promising Effect of the Children in Disaster: Evaluation and Recovery Intervention on Trauma Symptoms and Quality of Life for Children and Adolescents: A Controlled Study

OBJECTIVE

The Children in Disaster: Evaluation and Recovery (CIDER) program in Korea was developed to treat children and adolescents exposed to trauma. This study aimed to demonstrate the effectiveness of the CIDER through a comparison with controls.

METHODS

A total of 85 participants consisted of the intervention group (n=41) and control group (n=44). We assessed the changes in trauma-related symptoms, depression, anxiety, and improvements in quality of life before and after the intervention.

RESULTS

In total, bullying and school violence (44.7%) were the most common trauma, followed by sexual abuse (17.6%). Acute stress disorder and post-traumatic stress disorder (PTSD) accounted for 41.2%, and attention-deficit/hyperactivity disorder (ADHD) and developmental disorder were the most common comorbidities (51.8%). The symptoms of trauma, depression, anxiety, and quality of life improved significantly in the intervention group, while the control group did not show significant changes.

CONCLUSION

Compared with the control group, the CIDER improved symptoms and quality of life in children and adolescents who had experienced trauma. The CIDER program was practical and easy to apply, even for different ages, types of traumas, and comorbidities.

Language and communication rehabilitation in patients with schizophrenia: A narrative review

Language impairments often appear in patients with schizophrenia and are potential targets for rehabilitation. Clinical practice and research should be intimately connected. The aim was to perform a narrative review of the assessment and intervention tools that have been used for the rehabilitation of schizophrenia patients with language and communication impairments. Two types of tools, general and specific, were developed for both purposes. General tools include the Positive and Negative Syndrome Scale for assessment, and the Integrated Psychological Therapy for intervention. The specific tools used to evaluate language and communication impairments include the Scale for the Assessment of Thought, Language and Communication, the Formal Thought Disorder scales (for caregivers and patients), and the Thought and Language Disorder scale. The most recent language-specific intervention tools include the Cognitive Pragmatic Treatment, Conecta-2, Let's talk! Multimodal Speech-Gesture training, Speech Therapy Intervention Group, and PragmaCom. These tools primarily involve psychopathology/psychiatry, psychology, linguistics, speech and language therapy, and nursing. In conclusion, a wide range of assessment and intervention tools are available for the rehabilitation of language and communication impairments associated with schizophrenia. An integrative and interdisciplinary approach should always be considered for rehabilitation of language and communication in patients with schizophrenia throughout their lifetime.

Psychosocial interventions for people with amyotrophic lateral sclerosis and motor neuron disease and their caregivers: a scoping review

BACKGROUND

As amyotrophic lateral sclerosis/motor neuron disease (ALS/MND) is a fatal progressive neurodegenerative disorder, patients experience severe impairments, with patients and family caregivers facing emotional distress and exhaustion. Several psychosocial interventions are aimed at providing tailored support for ALS/MND patients and caregivers. The aim of this study was to conduct a scoping review and present a comprehensive overview of psychosocial interventions designed for individuals and families affected by ALS/MND, while also pinpointing research gaps.

METHODS

This scoping review utilized Arksey and O'Malley's methodological framework to investigate psychosocial interventions designed for individuals with ALS/MND and their families. The study adhered to the PRISMA-ScR checklist for reporting.

RESULTS

A total of 27 articles describing 25 interventions met the inclusion criteria. The predominant interventions observed in the research encompassed education-related strategies, closely followed by behavior therapy, counseling, social support interventions, and psychotherapy interventions. Across the majority of the studies, findings indicated promising feasibility and acceptability of these interventions. Notably, a significant proportion of quantitative investigations yielded one or more statistically significant effects, while qualitative studies consistently reported favorable outcomes, including enhancements in well-being and heightened awareness of individual circumstances.

CONCLUSIONS

Given the progressive and debilitating nature of this condition, coupled with the absence of a cure, the adoption of a psychosocial approach can prove beneficial for both ALS/MND patients and their families. However, high-quality RCTs with a large sample size are recommended to examine and confirm the effectiveness.

What do spontaneous coronary artery dissection survivors want to support their recovery? a qualitative study

AIMS

Spontaneous coronary artery dissection (SCAD) is increasingly recognized as an important cause of myocardial infarction predominantly affecting women aged younger than 50 years. There is limited research addressing female and male SCAD survivors' experience of, or requirements for, support post-SCAD. This study explored what SCAD survivors wanted to support recovery.

METHODS AND RESULTS

A qualitative study using semi-structured video and telephone interviews. Data were analysed through thematic analysis using the framework approach. We interviewed 20 participants (19 females) with a mean age of 54.6 (+/-SD 8.5 years). Three overarching themes encapsulated participants' views about support requirements. (i) Education and information. Participants thought healthcare professionals involved in diagnosis and supporting recovery required greater awareness of SCAD and the psychological effect of SCAD. They wanted accessible SCAD information immediately post-event and during the educational component of cardiac rehabilitation. (ii) Physical activity. Requirements were for advice tailored to individuals' specific needs, physical capabilities, and physical activity preferences. Participants suggested that utilizing wearable technology was helpful to encourage a safe return to activity. (iii) Psychosocial support. Participants wanted formal psychosocial support immediately post-event, during cardiac rehabilitation and in the longer term.

CONCLUSION

Better healthcare professional training may improve diagnosis, and increase support and awareness of SCAD. SCAD support programmes should provide early SCAD specific education utilizing online sources, individually tailor physical activity prescription, offer wearable technology to support a return to being active, and provide short- and long-term psychosocial support. As SCAD is predominately a female condition, programmes should consider female physical activity preferences.

Effects of internet-based, psychosocial, and early medical interventions on professional burnout in health care workers: Systematic literature review and meta-analysis

Background

The prevalence of professional burnout increased among healthcare workers during the coronavirus 2019 (COVID-19) pandemic, with negative effects on their mental health. Consequently, research interest in methods to decrease the prevalence of burnout and reduce the effects of burnout on healthcare workers has increased. Objective: This study was designed to evaluate the effects of Internet-based, psychosocial, and early medical interventions on professional burnout among healthcare workers.

Methodology

This systematic review and meta-analysis involved 8004 articles identified from four databases: Cochrane, Web of Science, PubMed/Medline, and clinical trials.

Results

Four articles were included in the systematic review, of which two could be meta-analyzed. The pooled effect of the group of interventions compared to control conditions was not statistically significant.

Discussion

Evaluating therapeutic effectiveness requires more clinical trials that allow its evaluation. Although we did not find improvements in the three intervention categories, the methodological heterogeneity in each intervention and the need for a standardized intervention guide for managing and decreasing professional burnout, subject to the evaluation of its impact, are highlighted.

Psychosocial interventions for teenagers with adolescent idiopathic scoliosis: A systematic literature review

OBJECTIVES

Psychosocial interventions can improve teenagers' self-esteem, mental health and bracing compliance. There is a need to compile available evidence of psychosocial care in adolescent idiopathic scoliosis. This systematic review aimed to identify and evaluate the effects of existing interventional studies of psychosocial care for the adolescent idiopathic scoliosis population.

METHODS

A comprehensive search of relevant literature published from the inception to March 2023 was conducted using nine databases. A google scholar search was performed on 1 July 2023, to update the searching results. Two reviewers independently assessed the methodological quality and extracted details of the included studies. Given the heterogeneity of the selected articles, the findings were synthesized narratively without conducting a meta-analysis.

RESULTS

Four randomized controlled trials reported in six articles involving 385 teenagers were included. The interventions appeared acceptable with high recruitment rates and low dropout rates reported. Psychosocial interventions had shown significant positive effects on postoperative pain, engagement in daily and social activities as well as brace use, coping abilities and anxiety.

CONCLUSION

Psychosocial interventions are generally feasible and acceptable among the adolescent idiopathic scoliosis population and have produced positive effects on a variety of physical and psychosocial outcomes. Study findings need to be interpreted with caution due to the limited number of available articles and the methodological concerns of the reviewed articles.

PRACTICAL IMPLICATIONS

Well-designed clinical trials are warranted in people from cultural backgrounds to develop and implement effective psychosocial interventions for teenagers with adolescent idiopathic scoliosis, not only for those at the post-surgery stage but also for those receiving conservative treatment.

Privacy Concerns in Group Format Lifestyle Interventions for Obesity

BACKGROUND

Group format weight loss interventions have benefits over individual format, but privacy concerns may limit their uptake.

METHOD

In this study, adults with obesity and interest in losing weight were recruited nationally online and randomly assigned to view one of eight videos describing a hypothetical, group behavioral weight loss intervention. Based on three fully crossed factors, the videos varied on privacy features of intervention (present or not); matching participants to group based on weight loss barriers (matched or not); and intervention format (online or in-person). Participants rated their willingness to join, privacy concerns, and perceived effectiveness of these interventions. They further reported preference for individual or group format interventions and reason for preferences.

RESULTS

Description of privacy features, matching of participants, and format did not affect willingness to join, privacy concerns, or perceived effectiveness of the intervention. Privacy concerns were associated with lower willingness to join and lower perceived intervention effectiveness, and greater social anxiety and weight stigma. More participants preferred individual over group format (40.1% vs 33.9%; 26% selected neither) and preference for individual format was associated with greater privacy concerns.

CONCLUSION

Strategies to address privacy concerns in group-based interventions warrant further attention.

Pilot randomized trial of an acceptance-based telehealth intervention for women with ovarian cancer and PARP inhibitor-related fatigue

OBJECTIVE

Poly(ADP-ribose) polymerase inhibitors (PARPi) have dramatically changed treatment for advanced ovarian cancer, but nearly half of patients experience significant fatigue. We conducted a two-site pilot randomized trial to evaluate the feasibility, acceptability, and preliminary efficacy of a brief, acceptance-based telehealth intervention (REVITALIZE) designed to reduce fatigue interference in patients on PARPi.

METHODS

From June 2021 to April 2022, 44 participants were randomized 1:1 to REVITALIZE (6 weekly one-on-one sessions+booster) or enhanced usual care. Feasibility was defined as: ≥50% approach-to-consent among potentially eligible patients and ≥70% completion of 12-week follow-up assessment; acceptance was <20% participants reporting burden and <20% study withdrawal. Fatigue, anxiety, depression, and quality of life were assessed at baseline, 4-, 8- and 12-weeks.

RESULTS

Among 44 participants (mean age = 62.5 years, 81.8% stage III/IV disease), the study was feasible (56.4% approach-to-consent ratio, 86.3% completion of 12-week assessment) and acceptable (0% reporting burden, 11.3% study withdrawal). At 12-week follow-up, REVITALIZE significantly reduced fatigue interference (Cohen's d = 0.94, p = .008) and fatigue severity (d = 0.54, p = .049), and improved fatigue levels (d = 0.62, p = .04) relative to enhanced usual care. REVITALIZE also showed promise for improved fatigue self-efficacy, fatigue catastrophizing, anxiety, depression, and quality of life (ds = 0.60-0.86, p ≥ .05). Compared with enhanced usual care, REVITALIZE participants had fewer PARPi dose reductions (6.7% vs. 19.0%), and dose delays (6.7% vs. 23.8%).

CONCLUSIONS

Among fatigued adults with ovarian cancer on PARPi, a brief, acceptance-based telehealth intervention was feasible, acceptable, and demonstrated preliminary efficacy in improving fatigue interference, severity, and levels. REVITALIZE is a novel, scalable telehealth intervention worthy of further investigation.

A systematic review of interventions to ameliorate the impact of adversity on brain development

Adversity, including abuse, neglect, and poverty, impacts child brain development. However, the developing brain is highly plastic, and some of the impacts of childhood adversity may be mitigated by psychosocial interventions. The purpose of this review is to synthesize literature on neural outcomes of childhood interventions among individuals exposed to adversity. A systematic literature search identified 36 reports of 13 interventions. Overall, these studies provide evidence for experience-dependent plasticity in the developing brain. We synthesize studies in light of three themes. First, there was mixed evidence for a benefit of a younger age at intervention. Second, interventions tended to accelerate functional brain development, but the impact of interventions on the pace of structural brain development was less clear. Third, individual differences in intervention response were difficult to predict, in part due to small samples. However, there was significant variability in intervention type and timing, neuroimaging outcomes, and follow-up timing. Together, the studies reviewed here hold promise for the role of psychosocial interventions in ameliorating the neurodevelopmental consequences of childhood adversity.

Family-Based Psychosocial Care for Transgender and Gender-Diverse Children and Youth

Parental and caregiver inclusion is critical in providing psychosocial care for transgender and gender-diverse (TGD) children and adolescents. High levels of trauma among TGD youth call for the use of evidence-based models and resources to decrease family rejection and increase affirmation and support while healing trauma that is both related to and unrelated to the child's gender identity and expression. The integrated Family Acceptance Project-Trauma-Focused Cognitive Behavioral Therapy treatment model provides a structured and effective approach to engaging TGD youth with trauma and their parents.

Effectiveness of telemedicine-based psychosocial intervention for breast cancer patients: a systematic review and meta-analysis

OBJECTIVES

This review aimed to synthesize the available evidence on the effectiveness of telemedicine-based psychosocial interventions among breast cancer (BC) patients regarding quality of life (QOL), depression, anxiety, distress, fatigue, sleep disorders, sexual function, and fear of cancer recurrence (FCR).

METHODS

A search of 10 databases was conducted to identify RCTs of the effects of telemedicine-based psychosocial interventions on outcomes. Selection of studies, quality appraisal, and data extraction were performed by two reviewers independently. GRADE and Cochrane risk of bias assessment tools were used for quality appraisal. Heterogeneity was determined by I2, standardized mean differences (SMD) were used to determine intervention effects, and meta-analyses, subgroup analysis, and sensitivity analysis were performed.

RESULTS

In total, 29 RCTs were included. Telemedicine-based psychosocial interventions improved the primary outcomes of QOL (SMD = 0.32), distress (SMD =  - 0.22), and anxiety (SMD =  - 0.16) in BC patients with moderate effect size. There were some improvements in the secondary outcomes of sleep disorders (SMD =  - 056), sexual function (SMD = 0.19), and FCR (SMD =  - 0.41). After sensitivity analysis, the effect size of fatigue was moderate (SMD =  - 0.24).

CONCLUSION

Telemedicine-based psychosocial interventions are superior to usual care in BC patients with improved QOL, sexual function, and less distress, anxiety, fatigue, sleep disorders, and FCR. Due to the heterogeneity of the results for QOL, anxiety, fatigue, sleep disturbance, and FCR, these results should be interpreted cautiously. In the future, more rigorous RCTs need to be designed to identify better delivery models and intervention times to further test their effectiveness.

A roadmap for early psychosocial support in palliative care for people impacted by ALS-reducing suffering, building resiliency, and setting the stage for delivering timely transdiagnostic psychosocial care

This commentary describes the current state of psychosocial care for people with amyotrophic lateral sclerosis and their caregivers. We provide recommendations for developing a roadmap for future research based on existing literature and our group's clinical and research experience to inform next steps to expand evidence-based psychosocial care for people with amyotrophic lateral sclerosis and their caregivers, with potential implications for a range of advanced illnesses.

Technology-assisted cognitive-behavior therapy delivered by peers versus standard cognitive behavior therapy delivered by community health workers for perinatal depression: study protocol of a cluster randomized controlled non-inferiority trial

BACKGROUND

The lack of trained mental health professionals is a key barrier to scale-up of evidence-based psychological interventions in low and middle-income countries. We have developed an app that allows a peer with no prior experience of health-care delivery to deliver the cognitive therapy-based intervention for perinatal depression, the Thinking Healthy Programme (THP). This trial aims to assess the effectiveness and cost-effectiveness of this Technology-assisted peer-delivered THP versus standard face-to-face Thinking Healthy Programme delivered by trained health workers.

METHODS

We will employ a non-inferiority stratified cluster randomized controlled trial design comparing the two formats of intervention delivery. A total of 980 women in the second or third trimester of pregnancy with a diagnosis of Major Depressive Episode, evaluated with the Structured Clinical Interview for DSM-V Disorders (SCID), will be recruited into the trial. The unit of randomization will be 70 village clusters randomly allocated in a 1:1 ratio to the intervention and control arms. The primary outcome is defined as remission from major depressive episode at 3 months postnatal measured with the SCID. Data will also be collected on symptoms of anxiety, disability, quality of life, service use and costs, and infant-related outcomes such as exclusive breastfeeding and immunization rates. Data will be collected on the primary outcome and selected secondary outcomes (depression and anxiety scores, exclusive breastfeeding) at 6 months postnatal to evaluate if the improvements are sustained in the longer-term. We are especially interested in sustained improvement (recovery) from major depressive episode.

DISCUSSION

This trial will evaluate the effectiveness and cost-effectiveness of a technology-assisted peer-delivered cognitive behavioral therapy-based intervention in rural Pakistan. If shown to be effective, the novel delivery format could play a role in reducing the treatment gap for perinatal depression and other common mental disorders in LMIC.

TRIAL REGISTRATION

The trial was registered at Clinicaltrials.gov (NCT05353491) on 29 April 2022.

Implementing the framed portrait experience with Italian breast cancer survivors: a pilot study assessing short term effects of an existential approach to body image, coping skills, and self-efficacy

PURPOSE

Breast cancer (BC) and its treatments significantly impact the psychological wellbeing of women. Interventions offered during cancer survivorship have documented positive consequences for quality of life. However, limited evidence is available regarding the implementation of therapeutic photography. This study investigated the efficacy of the framed portrait experience (FPE) when implemented to BC survivors.

METHODS

A quasi-experimental study was conducted. Participants were enrolled in a non-randomized pre-post intervention with a comparison group. Forty BC survivors were recruited using a convenience sampling approach; of these, 20 were subsequently allocated to the intervention (FPE group) and 20 to the comparison group. Participants were assessed at pretest and posttest (3 weeks later) using self-reported measures of body image, coping, self-esteem, and self-efficacy. Independent samples t-tests compared group composition at pretest. Mixed between-within 2 × 2 repeated-measures ANOVAs examined pretest-posttest changes in the variables of interest.

RESULTS

No differences were detected between groups at pretest. A significant interaction effect on body image, problem-focused coping, emotion-focused coping, and in self-efficacy competence subscale (p < 0.05) was identified. Post hoc pairwise comparisons with the Bonferroni correction indicated improvement on these domains in the FPE group vs. comparison group. Additionally, significant main effects of time on self-efficacy total score and magnitude subscale (p < 0.05) were found.

CONCLUSIONS

Preliminary results support the efficacy of FPE, but further research is needed.

IMPLICATIONS FOR CANCER SURVIVORS

Existential approaches inclusive of self-portraits and illness narratives can be utilized to support BC survivors in the management of the psychological consequences of the illness.

Exploratory RCT of a group psychological intervention for postnatal depression in British mothers of South Asian origin - ROSHNI-D

BACKGROUND

Postnatal depression (PND) is a global public health problem. There is a high prevalence of PND amongst ethnic minority women and major ethnic inequalities in mental health care in the U.K. Language and cultural barriers pose a significant challenge for access to timely treatment and interventions for British South Asian (BSA) women with PND.

METHODS

The study, carried out in Manchester and Lancashire, England, was a two-arm single-blind exploratory randomised controlled trial. BSA women (N = 83) having a baby <12 months were randomised either to the group receiving the culturally adapted Positive Health Programme (PHP) (n = 42) or to the group receiving treatment as usual (TAU) (n = 41). Follow-up assessments were at 3 months (end of intervention) and 6 months after randomisation.

RESULTS

Using an intention to treat analysis, there was no significant difference between PHP intervention and TAU groups in depression measured using Hamilton Depression Rating Scale both at 3 and 6 months follow up. Using modified intention to treat analysis, women who attended four or more sessions showed significant reduction in depression in the PHP group compared to the TAU group and the greater number of sessions attended was associated with greater reductions in depression scores.

LIMITATIONS

The sample was relatively small and the study was conducted in one geographical area in Northwest England; hence, these results may not be generalizable to other regions and populations.

CONCLUSION

The recruitment and trial retention figures highlighted the ability of the research team to engage with BSA women, having implications in planning services for this group.

TRIAL REGISTRATION

Clinicaltrials.govNCT01838889.

The impact of a stress management intervention including cultural components on stress biomarker levels and mental health indicators among indigenous women

We examined the effectiveness of a 26-week culture-inclusive intervention on reducing salivary stress biomarker levels, and perceived stress, depressive, and post-traumatic stress disorder (PTSD) symptoms measured using scales in 53 Indigenous women in Ontario, Canada. Statistical analyses compared the average biomarker levels, and the area under the curve (AUC) of biomarkers. Differences in biomarkers and mental health scale scores pre- and post-intervention were compared using mixed models with a random intercept. Interaction terms were included between the intervention and age, education, disability, and HIV status, individually, to test for sub-group differences. Cortisol AUC post-intervention was decreased compared to pre-intervention (β -1.29 µg/dL; 95%CI -2.35, -0.23). There was a slight decrease in perceived stress levels (aOR: -2.80; 95%CI -5.09, -0.50). The associations were stronger among women of younger age, higher education, and no disabilities. These interventions can be effective, but future interventions should target Indigenous population sub-groups to address individual needs.

Protocol of a feasibility randomised controlled trial of Empowered Conversations: training family carers to enhance their relationships and communication with people living with dementia

Background

Communication difficulties can cause frustration, low mood, and stress for people living with dementia and their carer. Carers should be offered training on adapting their communication skills. However, it is not common for skills-based education to examine emotional aspects of care and the effect of dementia on relationships. The Empowered Conversations (EC) training course was developed in response to a gap in service provision and has been adapted to a virtual format (Zoom). It addresses the specific psychological, relationship, and communication needs of informal and family dementia carers. The primary aim of the study is to investigate the feasibility of conducting a multi-centre randomised controlled evaluation trial of EC. Secondary aims include exploring the acceptability of delivering the intervention online and examining the optimum way of establishing cost-effectiveness.

Methods

The feasibility trial uses a pragmatic data-collector blind parallel two-group RCT design with two arms (EC intervention plus treatment as usual, and treatment as usual waitlist control). There will be a 2:1 allocation in favour of the EC-training intervention arm. 75 participants will complete baseline outcome measures exploring their role as a carer, including their physical and mental health, attitudes to caring, quality of life, and use of health and social care services. These will be repeated after six-months. Participants allocated to the treatment group who complete the course will be invited to participate in a qualitative interview discussing their experience of EC.

Conclusions

The study will investigate recruitment pathways (including facilitators and barriers to recruitment), estimate retention levels and response rates to questionnaires, obtain additional evidence regarding proof of concept, and consider the most appropriate primary outcome measures and methods for evaluating cost-effectiveness. The results of the feasibility study will be used to inform the development of a multicentre randomised controlled trial in the United Kingdom.

Registration

ISRCTN15261686 (02/03/2022).

Trauma-specific mindfulness-based cognitive therapy for women with post-traumatic stress disorder and a history of domestic abuse: intervention refinement and a randomised feasibility trial (coMforT study)

BACKGROUND

Women who have experienced domestic violence and abuse (DVA) are at increased risk of developing post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD). In 2014-2015, we developed a prototype trauma-specific mindfulness-based cognitive therapy curriculum (TS-MBCT) for the treatment of PTSD in a DVA population. This study aimed to refine the prototype TS-MBCT and evaluate the feasibility of conducting a randomised controlled trial (RCT) testing its effectiveness and cost-effectiveness.

METHODS

Intervention refinement phase was informed by evidence synthesis from a literature review, qualitative interviews with professionals and DVA survivors, and a consensus exercise with experts in trauma and mindfulness. We tested the refined TS-MBCT intervention in an individually randomised parallel group feasibility trial with pre-specified progression criteria, a traffic light system, and embedded process and health economics evaluations.

RESULTS

The TS-MBCT intervention consisted of eight group sessions and home practice. We screened 109 women in a DVA agency and recruited 20 (15 TS-MBCT, 5 self-referral to National Health Service (NHS) psychological treatment), with 80% follow-up at 6 months. Our TS-MBCT intervention had 73% uptake, 100% retention, and high acceptability. Participants suggested recruitment via multiple agencies, and additional safety measures. Randomisation into the NHS control arm did not work due to long waiting lists and previous negative experiences. Three self-administered PTSD/CPTSD questionnaires produced differing outcomes thus a clinician administered measure might work better. We met six out of nine feasibility progression criteria at green and three at amber targets demonstrating that it is possible to conduct a full-size RCT of the TS-MBCT intervention after making minor amendments to recruitment and randomisation procedures, the control intervention, primary outcomes measures, and intervention content. At 6 months, none of the PTSD/CPTSD outcomes ruled out a clinically important difference between trial arms indicating that it is reasonable to proceed to a full-size RCT to estimate these outcomes with greater precision.

CONCLUSIONS

A future RCT of the coMforT TS-MBCT intervention should have an internal pilot, recruit from multiple DVA agencies, NHS and non-NHS settings, have an active control psychological treatment, use robust randomisation and safety procedures, and clinician-administered measures for PTSD/CPTSD.

TRIAL REGISTRATION

ISRCTN64458065 11/01/2019.

The Selah Pilot Study of Spiritual, Mindfulness, and Stress Inoculation Practices on Stress-Related Outcomes Among United Methodist Clergy in the United States

The job-demand-control-support model indicates that clergy are at high risk for chronic stress and adverse health outcomes. A multi-group pre-test-post-test design was used to evaluate the feasibility, acceptability, and range of outcome effect sizes for four potentially stress-reducing interventions: stress inoculation training, mindfulness-based stress reduction (MBSR), the Daily Examen, and Centering Prayer. All United Methodist clergy in North Carolina were eligible and recruited via email to attend their preferred intervention. Surveys at 0, 3, and 12 weeks assessed symptoms of stress, anxiety, and perceived stress reactivity. Heart rate variability (HRV) was assessed at baseline and 12 weeks using 24 h ambulatory heart rate monitoring data. A subset of participants completed in-depth interviews and reported skill practice using daily text messages. Standardized mean differences with 95% and 75% confidence intervals were calculated for the change observed in each intervention from baseline to 3 and 12 weeks post-baseline to determine the range of effect sizes likely to be observed in a definitive trial. 71 clergy participated in an intervention. The daily percentage of participants engaging in stress management practices ranged from 47% (MBSR) to 69% (Examen). Results suggest that participation in Daily Examen, stress inoculation, or MBSR interventions could plausibly result in improvement in stress and anxiety at 12 weeks with small-to-large effect sizes. Small effect sizes on change in HRV were plausible for MBSR and Centering Prayer from baseline to 12 weeks. All four interventions were feasible and acceptable, although Centering Prayer had lower enrollment and mixed results.

Alcohol reduction interventions for transgender and non-binary people: A PRISMA-ScR-adherent scoping review

INTRODUCTION

Transgender and non-binary people use more alcohol and report a greater need for help to reduce their consumption than their cisgender counterparts. They experience anticipated and enacted discrimination when seeking alcohol reduction healthcare. This study aimed to identify any alcohol reduction interventions for trans and non-binary people.

METHODS

A systematic scoping review was completed according to PRISMA-ScR guidelines. Following an extensive search across five databases, two independent reviewers carried out abstract screening, full-text screening, data extraction and quality assessment. Findings were synthesised narratively.

RESULTS

The search generated 1399 unique records. Ten texts were reviewed in full, and the final sample comprised six studies of moderate quality. Included records all reported adaptations of various psychosocial interventions including individual therapies, group therapy, a trans-affirmative clinical environment, and a specialist inpatient rehabilitation service. Four interventions resulted in alcohol reduction with modest effect size. However, the change in alcohol consumption was not statistically significant in two studies. Trans women were disproportionately investigated through the lens of HIV risk reduction.

CONCLUSION

Interventions developed for one population cannot be presumed effective in another, particularly those as heterogeneous as trans and non-binary communities. There is some suggestion that psychosocial interventions adapted for the needs of the trans community are effective in achieving alcohol reduction. However, it is unclear how these will fare with trans men and non-binary people and specialist interventions may be needed.

Group psychological intervention for emotional distress in haematopoietic stem cell transplantation: A feasibility randomised clinical trial

PURPOSE

Haematopoietic stem cell transplantation (HSCT) is an intensive procedure associated with elevated psychological distress, particularly during the initial stages. Based on self-regulatory theory, a prophylactic group intervention was developed to mitigate this distress by targeting perceptions of HSCT and coping. This study evaluated the feasibility of delivering the intervention and of conducting a randomised clinical trial to assess efficacy.

METHODS

Adults from consecutive referrals at two transplant centres were randomised to the intervention or to treatment as usual at each site. Psychological distress (primary outcome), HSCT perceptions, and coping were assessed at baseline, on transplant day, and two and four weeks after transplantation.

RESULTS

Of 99 eligible patients, 45 consented. Main barriers to consent were insufficient time prior to transplantation, competing priorities, being unwell, and travel distance. Of 21 participants randomised to the intervention, five attended. Main barriers to attendance included insufficient time prior to transplantation and having competing priorities. Groups could not be held sufficiently frequently to enable attendance prior to transplantation, as randomising participants to the control group limited accrual. Anxiety peaked two weeks following transplantation. Depression increased throughout the acute phase. Clinical levels of distress were observed in 42% of patients during HSCT. Intervention effects were small but sample sizes for a full trial appeared feasible.

CONCLUSIONS

Multimodal prehabilitation is required but there are specific barriers to delivering a group-based intervention and conducting a trial. Group prehabilitation requires customisation and better integration with routine care, such as patient screening, personalisation, and options for remote delivery.

Meaningful Activities and Recovery (MA&R): a co-led peer occupational therapy intervention for people with psychiatric disabilities. Results from a randomized controlled trial

BACKGROUND

Activity and participation are critical to health and wellbeing. Limited evidence exists on how to support people with mental illness in participating in everyday activities.

AIM

To investigate the effectiveness of Meaningful Activities and Recovery (MA&R), a co-led peer occupational therapy intervention focusing on activity engagement, functioning, quality of life, and personal recovery.

METHODS

In a statistician blinded, multicenter RCT including 139 participants from seven community and municipal mental health services in Denmark, participants were randomly assigned to 1) MA&R and standard mental health care or 2) standard mental health care. The MA&R intervention lasted 8 months and consisted of 11 group sessions, 11 individual sessions, and support to engage in activities. The primary outcome, activity engagement, was measured using Profile of Occupational Engagement in People with Severe Mental Illness (POES-S). Outcomes were measured at baseline and post-intervention follow-up.

RESULTS

Meaningful Activities and Recovery was delivered with high fidelity and 83% completed the intervention. It did not demonstrate superiority to standard mental health care, as intention-to treat analysis revealed no significant differences between the groups in activity engagement or any of the secondary outcomes.

CONCLUSION

We did not find positive effects of MA&R, possibly because of COVID-19 and related restrictions. Fidelity assessments and adherence rates suggest that MA&R is feasible and acceptable. However, future studies should focus on refining the intervention before investigating its effectiveness.

TRIAL REGISTRATION

The trial was registered 24/05/2019 at ClinicalTrials.gov NCT03963245.

Impact of pharmaceutical care integrated at a psychosocial intervention to reduce caregiver's burden in Alzheimer's disease or related dementias: Negative results at 18 months and difficulties to conduct PHARMAID RCT

Background

Psychosocial interventions for caregivers of patients with Alzheimer disease and relative dementias (ADRD) reported a caregiver burden improvement. Multicomponent intervention integrating pharmaceutical care has not yet been evaluated while ADRD patients and their caregivers are exposed to high risk of drug-related problems. The PHARMAID study aimed to assess the impact of personalized pharmaceutical care integrated to a psychosocial program on the burden of ADRD caregivers at 18 months.

Methods

The PHARMAID RCT was conducted between September 2016 and June 2020 [ClinicalTrials.gov: NCT02802371]. PHARMAID study planned to enroll 240 dyads, i.e. ADRD patients and caregivers, whose inclusion criteria were: outpatient with mild or major neurocognitive disorders due to ADRD, living at home, receiving support from a family caregiver. Three parallel groups compared a control group with two interventional groups: psychosocial intervention and integrated pharmaceutical care at a psychosocial intervention. The main outcome was the caregiver burden assessed by the Zarit Burden Index (ZBI, score range 0-88) at 18 months.

Results

Overall, 77 dyads were included (32% of the expected sample size). At 18 months, the mean ZBI scores were 36.7 ± 16.8 in the control group, 30.3 ± 16.3 for the group with psychosocial intervention, and 28.8 ± 14.1 in group with integrated pharmaceutical care at psychosocial intervention. No significant difference was demonstrated between the three groups (p = 0.326).

Conclusions

The findings suggest that PHARMAID program had no significant impact on caregiver burden at 18 months. Several limitations have been highlighted and discussed by the authors in order to formulate recommendations for further research.

The psychological and psychosocial effects of facial paralysis: A review

Facial nerve function is essential for a multitude of processes in the face, including facial movement; expression; and functions, such as eating, smiling, and blinking. When facial nerve function is disrupted, facial paralysis may occur and various complications for the patient may result. Much research has been conducted on the physical diagnosis, management, and treatment of facial paralysis. However, there is a lack of knowledge of the psychological and social effects of the condition. Patients may be at an increased risk for anxiety and depression, as well as negative self and social perceptions. This review analyzes the current literature on the various adverse psychological and psychosocial effects of facial paralysis, factors that may play a role, and treatment options that may help improve patients' quality of life.

Cognitive-behavioral rehabilitation in patients with cardiovascular diseases: a randomized controlled trial (CBR-CARDIO, DRKS00029295)

BACKGROUND

Depression, generalized and cardiac anxiety, and posttraumatic stress disorder negatively affect disease severity, participation, and mortality in patients with cardiovascular disease. Psychological treatments within cardiac rehabilitation may improve the outcomes of these patients. We therefore developed a cognitive-behavioral rehabilitation program for patients with cardiovascular disease and mild or moderate mental illness or stress or exhaustion. In Germany, similar programs are well established in musculoskeletal rehabilitation and cancer rehabilitation. However, no randomized controlled trials have evaluated if such programs achieve better outcomes in patients with cardiovascular disease compared with standard cardiac rehabilitation.

METHODS

Our randomized controlled trial compares cognitive-behavioral cardiac rehabilitation with standard cardiac rehabilitation. The cognitive-behavioral program complements standard cardiac rehabilitation with additional psychological and exercise interventions. Both rehabilitation programs last for four weeks. We enroll 410 patients with cardiovascular disease and mild or moderate mental illness or stress or exhaustion aged 18 to 65 years. Half of the individuals are randomly assigned to cognitive-behavioral rehabilitation and the other half to standard cardiac rehabilitation. Our primary outcome is cardiac anxiety 12 months after the end of rehabilitation. Cardiac anxiety is assessed with the German 17-item version of the Cardiac Anxiety Questionnaire. Secondary outcomes cover outcomes assessed by clinical examinations and medical assessments and a range of patient-reported outcome measures.

DISCUSSION

This randomized controlled trial is designed to determine the effectiveness of cognitive-behavioral rehabilitation at decreasing cardiac anxiety in patients with cardiovascular disease and mild or moderate mental illness or stress or exhaustion.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS00029295, June 21, 2022).

Effectiveness of psychological interventions delivered by physiotherapists in the management of neck pain: a systematic review with meta-analysis

Physiotherapists are increasingly using psychological treatments for musculoskeletal conditions. We assessed the effects of physiotherapist-delivered psychological interventions on pain, disability, and quality of life in neck pain. We evaluated quality of intervention reporting. We searched databases for randomized controlled trials (RCTs) comprising individuals with acute or chronic whiplash-associated disorder (WAD) or nontraumatic neck pain (NTNP), comparing physiotherapist-delivered psychological interventions to standard care or no treatment. Data were extracted regarding study characteristics and outcomes. Standardised mean difference (SMD) was calculated by random-effects meta-analysis. We evaluated certainty of evidence using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) and intervention reporting using TIDieR. Fourteen RCTs (18 articles-4 detail additional outcome/follow-up data) were included comprising 2028 patients, examining acute WAD (n = 4), subacute/mixed NTNP (n = 3), chronic WAD (n = 2), and chronic NTNP (n = 5). Treatment effects on pain favoured psychological interventions in chronic NTNP at short-term (SMD -0.40 [95% CI -0.73, -0.07]), medium-term (SMD -0.29 [95% CI -0.57, 0.00]), and long-term (SMD -0.32 [95% CI -0.60, -0.05]) follow-up. For disability, effects favoured psychological interventions in acute WAD at short-term follow-up (SMD -0.39 [95% CI -0.72, -0.07]) and chronic NTNP at short-term (SMD -0.53 [95% CI -0.91, -0.15]), medium-term (SMD -0.49 [95% CI -0.77, -0.21]), and long-term (SMD -0.60 [95% CI -0.94, -0.26]) follow-up. GRADE ratings were typically moderate, and intervention reporting often lacked provision of trial materials and procedural descriptions. Psychological interventions delivered by physiotherapists were more effective than standard physiotherapy for chronic NTNP (small-to-medium effects) and, in the short term, acute WAD.

Medical clowning influences the emotions of parents of children undergoing cancer treatment: A quasi-experimental study

BACKGROUND

Medical clowning for children has been found to be effective at enhancing parents' psychological well-being during preoperative preparation, but has not been found during cancer treatment. This study aimed to examine whether and how medical clowning influenced the emotions of parents of children undergoing cancer treatment.

METHODS

In this quasi-experimental study, 96 parents of children receiving inpatient cancer treatment were recruited, from June 2018 through April 2020. A demographic questionnaire measuring characteristics of parent and dyadic child, Brief Symptom Rating Scale measuring psychological distress of the parent, and Mood Assessment Scale measuring emotional status of parent and child were administered 1 day before a clowning service. The day after the clowning service, the Mood Assessment Scale again collected emotional status for parent and child. Descriptive analysis, bivariate analysis, and structural equation modeling to fit the actor-partner, cross-lagged model were used.

FINDINGS

Parents experienced a low degree of psychological distress that called for emotional management. The indirect effect of medical clowning on parents' emotions through children's emotions was significant, as were the direct effect and total effect of medical clowning on parents' emotions.

DISCUSSION

Parents experienced psychological distress during their child's inpatient cancer treatment. Medical clowning can directly improve children's emotions and through this pathway indirectly improve their parents' emotions.

APPLICATION TO PRACTICE

There is need to monitor psychological distress and provide interventions for parents of children undergoing cancer treatment. Medical clowns should continue to serve parent-child dyads in pediatric oncology practice and become members of multidisciplinary health care teams.

Adaptation and integration of the thinking healthy programme into pregnancy schools in Istanbul, Turkey

BACKGROUND

Perinatal mental health is a major public health concern. In Turkey, public hospitals operate pregnancy schools which provides an opportunity to integrate an evidence-based Thinking Healthy Programme (THP) for perinatal depression. The aim of this study is to adapt the THP for universal use in the group setting and to understand its acceptability and feasibility for integration into the existing antenatal care programme for both face-to-face and online delivery.

METHODS

Following an expert-led adaptation process using the Bernal Framework, field testing was conducted on a group of women and facilitators followed by in-depth interviews (n:8) and group discussions (n = 13). Data were analysed using Thematic Framework Analysis.

RESULTS

Minor but significant adaptations were made to the individually delivered THP for use in the universal group pregnancy schools. Initial findings indicate that the THP-group version was acceptable to its target population and could be integrated into the antenatal care plan for delivery during face-to-face and online group classes.

CONCLUSION

THP is transferable to the Turkish cultural and healthcare context. The THP-group version has the potential to add value to Turkey's existing perinatal healthcare programme.

Marital status and perceived stress in men with advanced prostate cancer: A randomized-controlled trial of cognitive behavioral stress management

OBJECTIVE

Relationship status predicts numerous outcomes among medical populations. Few interventions evaluate the role of marital status on response to psychosocial treatment, and no such studies exist within advanced prostate cancer (APC). This study examined whether marital status modified the effect of a cognitive behavioral stress management (CBSM) intervention on perceived stress.

METHODS

Men with APC (N = 190) were randomized to 10-week CBSM or a health promotion (HP) intervention (#NCT03149185). The Perceived Stress Scale assessed perceived stress at baseline and 12-month follow-up. Medical status and sociodemographics were captured at enrollment.

RESULTS

Participants were mostly White (59.5%), non-Hispanic (97.4%), heterosexual (97.4%) men, 66.8% of whom were partnered. Neither condition nor marital status predicted perceived stress change at follow-up. However, a significant interaction was found between condition and marital status (p = 0.014; Cohen's f = 0.07), such that partnered men who received CBSM and unpartnered men who received HP reported greater reductions in perceived stress.

CONCLUSION

This is the first study to assess the impact of marital status on psychosocial intervention effects among men with APC. Partnered men derived greater benefit from a cognitive-behavioral intervention and unpartnered men equally benefitted from a HP intervention. Further research is necessary to understand the mechanisms underlying these relationships.

The effect of psychosocial interventions on depression, anxiety, and quality of life in hemodialysis patients: a systematic review and a meta-analysis

PURPOSE

Hemodialysis has become a standard therapy for adults with end-stage renal diseases. Adults undergoing hemodialysis have to cope with unique psychological issues that make their care journey particularly fatiguing. In this systematic review and meta-analysis, we aimed to summarize and evaluate the effects of psychosocial interventions on the reduction of anxiety and depression in adults with HDs.

METHODS

We included randomized controlled trials and quasi-experimental studies that measure change in depression, anxiety, and quality of life.

RESULTS

We identify three categories of psychosocial interventions delivered to adults undergoing hemodialysis. Based on our analysis, there was a medium effect of psychosocial intervention on depression (SMD - 0.85, 95%CI - 1.17; - 0.52, I² = 80%, p < 0.01) and anxiety (SMD - 0.99, 95%CI - 1.65; - 0.33, I² = 88%, p < 0.01) in adults undergoing hemodialysis.

CONCLUSIONS

Psychosocial interventions, such as psychological support or relaxation-based therapy, seems all to reduce depression and anxiety in adults undergoing HD. Preliminary evidence suggests that there may be a benefit of psychosocial interventions on the quality of life for adults undergoing HD.