Codesigned online cognitive bias modification of interpretations for anxiety and depression in children: study protocol of a randomised controlled trial

INTRODUCTION

Previous research has shown that cognitive bias modification of interpretations (CBM-I) may be a promising intervention for anxiety in youth; however, results are mixed. Given the high comorbidity between anxiety and depression in youth, it is surprising that no child studies have targeted biases associated with both. This study aims to evaluate the effectiveness and acceptability of an online CBM-I intervention (Mindmaster) for children with symptom scores of anxiety or depression above a borderline or clinical threshold. The intervention has been codesigned with children, parents and mental health professionals to promote user engagement.

METHODS AND ANALYSIS

The study is a randomised controlled trial, with two parallel arms. Participants are 143 children aged 8-10 years with scores of anxiety and/or depressive symptoms above a borderline or clinical threshold. They will be allocated to either the intervention group or the waitlist control group. The intervention consists of 2 weeks of online CBM-I training, with four sessions (10-15 min) per week. Outcome assessments will be conducted at baseline, 4 weeks after baseline (post-training/post-waitlist) and 8 weeks after baseline (follow-up) for the intervention group only. The primary outcome is interpretation bias. Secondary outcomes are anxiety and depressive symptoms and life interference. Analyses will be conducted within an intention-to-treat framework using mixed models for repeated measures.

ETHICS AND DISSEMINATION

The study was approved by the University of New South Wales Human Research Ethics Committee (HC220758). Findings will be reported to (1) participating families; (2) presented at scientific conferences and (3) disseminated to peer-review publications. Data will be available from the corresponding author on request.

TRIAL REGISTRATION NUMBER

ACTRN12622001493730.

Did the COVID-19 pandemic affect levels of burnout, anxiety and depression among doctors and nurses in Bangladesh? A cross-sectional survey study

INTRODUCTION

COVID-19 has caused severe disruption to clinical services in Bangladesh but the extent of this, and the impact on healthcare professionals is unclear. We aimed to assess the perceived levels of anxiety, depression and burnout among doctors and nurses during COVID-19 pandemic.

METHODS

We undertook an online survey using RedCap, directed at doctors and nurses across four institutions in Bangladesh (The Sheikh Russel Gastro Liver Institute & Hospital (SRNGIH), Dhaka Medical College Hospital (DMCH), Mugda Medical College Hospital (MMCH) and M Abdur Rahim Medical College (MARMC) Hospital). We collected information on demographics, awareness of well-being services, COVID-19-related workload, as well as anxiety, depression and burnout using two validated questionnaires: the Hospital Anxiety and Depression Scale (HADS) and the Maslach Burnout Inventory (MBI).

RESULTS

Of the 3000 participants approached, we received responses from 2705 (90.2%). There was a statistically significant difference in anxiety, depression and burnout scores across institutions (p<0.01). Anxiety, depression and burnout scores were statistically worse in COVID-19 active staff compared with those not working on COVID-19 activities (p<0.01 for HADS anxiety and depression and MBI emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA)). Over half of the participants exhibited some level of anxiety (SRNGIH: 52.2%; DMCH: 53.9%; MMCH: 61.3%; MARMC: 68%) with a high proportion experiencing depression (SRNGIH: 39.5%; DMCH: 38.7%; MMCH: 53.7%; MARMC: 41.1%). Although mean burnout scores were within the normal range for each institution, a high proportion of staff (almost 20% in some instances) were shown to be classified as experiencing burnout by their EE, DP and PA scores.

CONCLUSION

We identified a high prevalence of perceived anxiety, depression and burnout among doctors and nurses during the COVID-19 pandemic. This was worse in staff engaged in COVID-19-related activities. These findings could help healthcare organisations to plan for future similar events.

'One Is Too Many' preventing self-harm and suicide in military veterans: a quantitative evaluation

INTRODUCTION

In 2021, the Armed Forces Covenant Fund Trust allocated over £2 million to programmes designed to have a clear and demonstrable impact on suicide prevention. Four grant holders delivered a combination of psychotherapeutic interventions, group activities, social prescribing, peer support mentoring, life skills coaching, educational courses and practical help with housing and employment. The evaluation was completed between August 2021 and July 2023.

METHODS

A survey was completed by 503 participants at entry and 423 at exit. It captured data regarding demographic and military-specific details, health status, situational stressors, predisposing symptoms, help-seeking behaviour, social engagement, housing, living arrangements and employment status. The questionnaire included a number of validated psychometric questionnaires.

RESULTS

This evaluation revealed reductions in situational stressors, symptoms and mental health illnesses. Seventy-six per cent of participants had completed an Operational Tour, and 77% were exposed to a traumatic event during service. It was the negative impact of unresolved traumatic effects that influenced service-users to require support. Forty-nine per cent delayed seeking help, and 36% self-referred to the One Is Too Many programme which demonstrates the importance of this option. There were improvements in the participants' social networking, social activities, club membership and having people to rely on. Only 4% of participants were women which reinforces the requirement to explore initiatives to engage with female veterans.

CONCLUSIONS

Timely therapeutic and social prescribing interventions in a safe environment lowered depression, anxiety and the associated situational stressors leading to self-harming and may have reduced suicide. It presented another option to veterans and their families regarding where they can obtain support, care and therapeutic interventions. The programme provided a strong foundation for delivery organisations to forge lasting collaborative partnerships that can be extended to working with other authorities and institutes. The results highlight pathways for prevention and intervention strategies to inform policymakers, healthcare professionals and third-sector organisations.

Immunosuppressant medication behaviours in solid organ transplant recipients: a cross-sectional study from south-central China during COVID-19 reopening period

OBJECTIVE

Medication non-adherence to immunosuppressants threatens allograft survival and function maintenance among solid organ transplant (SOT) recipients. This study aimed to investigate the prevalence of immunosuppressant medication non-adherence and associated factors during the COVID-19 reopening period among Chinese SOT recipients.

DESIGN

Cross-sectional study.

SETTING

South-central China.

POPULATION

Adult patients who received SOT with functioning graft.

METHODS

Sociodemographic questionnaire and scales to measure physical activity, depression and medication non-adherence were used to collect data. Logistic regression analysis was conducted to identify factors associated with medication non-adherence. Mediation and moderated mediation analyses were performed to examine the potential mechanisms influencing medication behaviour during the pandemic reopening period using SPSS PROCESS macro 4.3 software.

RESULTS

A total of 1121 participants were recruited and the prevalence of medication non-adherence was 36.3% in this study. Recipients who were men, had a higher monthly income, lived alone, had received transplantation for a minimum of 3 years, had received COVID-19 vaccination and experienced depressive symptoms exhibited an increased risk of non-adherence. Contrarily, those who engaged in high-intensity physical activity exhibited a decreased risk. Physical activity was negatively associated with medication non-adherence (r=-0.124, p<0.001) with depression fully mediating this relationship (B=-0.014, 95% CI: -0.032 to -0.003). COVID-19 vaccination significantly moderated the relationship between physical activity and depression (B=-0.303, 95% CI: -0.515 to -0.090).

CONCLUSION

This study investigated the prevalence of medication non-adherence among SOT recipients during the COVID-19 reopening period in China, its associated factors and a potential mechanism. Depression fully mediated the association between physical activity and medication non-adherence, and COVID-19 vaccination moderated the relationship between physical activity and depression. These findings provide some insights for managing medication behaviour when confronting public health emergencies. However, relationships displayed in the moderated mediation model should be tracked after returning to normal life and other potential relationships should be explored to deeply understand medication non-adherent behaviour.

Internet-based behavioural activation therapy versus online psychoeducation for self-reported suicidal ideation in individuals with depression in Indonesia: a secondary analysis of an RCT

BACKGROUND

Southeast Asia has the highest suicide mortality worldwide. To improve our knowledge on the effectiveness of interventions for suicidal ideation (SI) in individuals with depression in Indonesia, we conducted a secondary analysis of a randomised controlled trial.

OBJECTIVE

We explored whether an internet-based behavioural activation (BA) intervention ('Guided Act and Feel Indonesia' (GAF-ID)) was superior in targeting SI compared with online-delivered psychoeducation (PE).

METHODS

In total, 313 participants were randomised between treatment allocation. The SI item of the Patient Health Questionnaire-9 was the primary outcome measure. Mediation analyses were conducted to identify if BA at week 10 mediated the relationship between intervention and SI at week 24.

FINDINGS

The GAF-ID intervention was not superior in reducing SI compared with online minimal PE at week 10 (OR 0.61, 95% CI (0.37 to 1.01)), nor at week 24 (OR 0.84, 95% CI (0.47 to 1.52)). SI at week 24 was not mediated by BA at week 10 (b=-0.03, 95% CI (-0.05 to 0.00), p=0.07).

CONCLUSIONS

In individuals with depression in Indonesia, the GAF-ID intervention was not superior in reducing self-reported SI compared with PE. Also, the association between treatment condition and SI at week 24 was not mediated via BA at week 10.

CLINICAL IMPLICATIONS

This study supports the need for further research on the efficacy of psychological treatments targeting SI in the Southeast Asia context.

Genome-wide DNA methylation risk scores for schizophrenia derived from blood and brain tissues further explain the genetic risk in patients stratified by polygenic risk scores for schizophrenia and bipolar disorder

BACKGROUND

Genetic and environmental factors contribute to the pathogenesis of schizophrenia (SZ) and bipolar disorder (BD). Among genetic risk groups stratified by combinations of Polygenic Risk Score (PRS) deciles for SZ, BD and SZ versus BD, genetic SZ risk groups had high SZ risk and prominent cognitive impairments. Furthermore, epigenetic alterations are implicated in these disorders. However, it was unclear whether DNA Methylation Risk Scores (MRSs) for SZ risk derived from blood and brain tissues were associated with SZ risk, particularly the PRS-stratified genetic SZ risk group.

METHODS

Epigenome-wide association studies (EWASs) of SZ risk in whole blood were preliminarily conducted between 66 SZ patients and 30 healthy controls (HCs) and among genetic risk groups (individuals with low genetic risk for SZ and BD in HCs (n=30) and in SZ patients (n=11), genetic BD risk in SZ patients (n=25) and genetic SZ risk in SZ patients (n=30)) stratified by combinations of PRSs for SZ, BD and SZ versus BD. Next, differences in MRSs based on independent EWASs of SZ risk in whole blood, postmortem frontal cortex (FC) and superior temporal gyrus (STG) were investigated among our case‒control and PRS-stratified genetic risk status groups.

RESULTS

Among case‒control and genetic risk status groups, 33 and 351 genome-wide significant differentially methylated positions (DMPs) associated with SZ were identified, respectively, many of which were hypermethylated. Compared with the low genetic risk in HCs group, the genetic SZ risk in SZ group had 39 genome-wide significant DMPs, while the genetic BD risk in SZ group had only six genome-wide significant DMPs. The MRSs for SZ risk derived from whole blood, FC and STG were higher in our SZ patients than in HCs in whole blood and were particularly higher in the genetic SZ risk in SZ group than in the low genetic risk in HCs and genetic BD risk in SZ groups. Conversely, the MRSs for SZ risk based on our whole-blood EWASs among genetic risk groups were also associated with SZ in the FC and STG. There were no correlations between the MRSs and PRSs.

CONCLUSIONS

These findings suggest that the MRS is a potential genetic marker in understanding SZ, particularly in patients with a genetic SZ risk.

A chatbot to improve adherence to internet-based cognitive-behavioural therapy among workers with subthreshold depression: a randomised controlled trial

BACKGROUND

Internet-based cognitive-behavioural therapy (iCBT) is effective for subthreshold depression. However, iCBT has problems with adherence, especially when unaccompanied by human guidance. Knowledge on how to enhance adherence to iCBT without human involvement can contribute to improving the effectiveness of iCBT.

OBJECTIVE

This is an implementation study to examine the effect of an automated chatbot to improve the adherence rate of iCBT.

METHODS

We developed a chatbot to increase adherence to an existing iCBT programme, and a randomised controlled trial was conducted with two groups: one group using iCBT plus chatbot (iCBT+chatbot group) and one group not using the chatbot (iCBT group). Participants were full-time employees with subthreshold depression working in Japan (n=149, age mean=41.4 (SD=11.1)). The primary endpoint was the completion rate of the iCBT programme at 8 weeks.

FINDINGS

We analysed data from 142 participants for the primary outcome. The completion rate of the iCBT+chatbot group was 34.8% (24/69, 95% CI 23.5 to 46.0), that of the iCBT group was 19.2% (14/73, 95% CI 10.2 to 28.2), and the risk ratio was 1.81 (95% CI 1.02 to 3.21).

CONCLUSIONS

Combining iCBT with a chatbot increased participants' iCBT completion rate.

CLINICAL IMPLICATIONS

Encouraging messages from the chatbot could improve participation in an iCBT programme. Further studies are needed to investigate whether chatbots can improve adherence to the programme in the long term and to assess their impact on depression, anxiety and well-being.

TRIAL REGISTRATION NUMBER

UMIN000047621.

Associations of academic environment, lifestyle, sense of coherence and social support with self-reported mental health status among dental students at a university in Brazil: a cross-sectional study

OBJECTIVES

The study evaluated the association of academic environment, lifestyle, sense of coherence (SOC) and social support with self-reported mental health status among dental students.

DESIGN

Secondary analysis of data from a cross-sectional, questionnaire-based survey conducted from August to October 2018.

SETTING

Dental school of a public-funded university in the south-eastern region of Brazil.

PARTICIPANTS

233 undergraduate dental students recruited across all years of the course.

OUTCOME MEASURES

Socioeconomic and demographic characteristics, city of origin and student's academic semester were obtained through self-completed questionnaires. Perception of the academic environment (Dundee Ready Education Environment Measure (DREEM)), individual lifestyle (Individual Lifestyle Profile Questionnaire (ILPQ)), SOC (SOC Scale (SOC-13)), social support (Medical Outcomes Study Scale (MOS)), and depression, anxiety and stress (Depression, Anxiety and Stress Scale-21 (DASS-21)) were assessed using validated instruments. The relationships between variables were investigated through multivariable negative binomial regression to obtain the rate ratios (RRs) and 95% CIs.

RESULTS

Female sex was associated with greater scores of anxiety (RR 1.74, 95% CI 1.10 to 1.97) and stress (RR 1.52, 95% CI 1.12 to 2.06). Students who perceived a better academic environment and those reporting a greater SOC had a lower probability of depression, anxiety and stress. Furthermore, a favourable lifestyle was associated with lower depression scores (RR 0.99, 95% CI 0.97 to 0.99). Social support did not remain associated with depression, anxiety and stress after adjustment.

CONCLUSIONS

The present findings suggest that self-reported mental health status is associated with students' sex, academic environment, SOC and lifestyle. Enhancing the educational environment and SOC, and promoting a healthy lifestyle may improve the psychological health of dental students.

Effect of adverse perinatal outcomes on postpartum maternal mental health in low-income and middle-income countries: a protocol for systematic review

INTRODUCTION

More than three-fourths of adverse perinatal outcomes (preterm, small for gestational age, low birth weight, congenital anomalies, stillbirth and neonatal death) occur in low-income and middle-income countries. These adverse perinatal outcomes can have both short-term and long-term consequences on maternal mental health. Even though there are few empirical studies on the effect of perinatal loss on maternal mental illness, comprehensive information on the impact of adverse perinatal outcomes in resource-limited settings is scarce. Therefore, we aim to systematically review and synthesise evidence on the effect of adverse perinatal outcomes on maternal mental health.

METHODS AND ANALYSIS

The primary outcome of our review will be postpartum maternal mental illness (anxiety, depression, post-traumatic stress disorder and postpartum psychosis) following adverse perinatal outcomes. All peer-reviewed primary studies published in English will be retrieved from databases: PubMed, MEDLINE, CINAHL Ultimate (EBSCO), PsycINFO, Embase, Scopus and Global Health through the three main searching terms-adverse perinatal outcomes, maternal mental illness and settings, with a variant of subject headings and keywords. We will follow the Joanna Briggs Institute critical appraisal checklist to assess the quality of the studies we are including. The review findings will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. Estimate-based meta-analysis will be performed. We will assess heterogeneity between studies using the I2 statistics and publication bias will be checked using funnel plots and Egger's test. A subgroup analysis will be conducted to explore potential sources of heterogeneity (if available). Finally, the certainty of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation approach.

ETHICS AND DISSEMINATION

Since this systematic review does not involve human participants, ethical approval is not required. The review will be submitted for publication in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42023405980.

Comparing the efficacies of transcranial magnetic stimulation treatments using different targeting methods in major depressive disorder: protocol for a network meta-analysis

INTRODUCTION

Transcranial magnetic stimulation (TMS) over the left dorsolateral prefrontal cortex (lDLPFC) has been widely used as a treatment for major depressive disorder (MDD) in the past two decades. Different methods for localising the lDLPFC target include the '5 cm' method, the F3 method and the neuro-navigational method. However, whether TMS efficacies differ between the three targeting methods remains unclear. We present a protocol for a systematic review and network meta-analysis (NMA) to compare the efficacies of TMS treatments using these three targeting methods in MDD.

METHODS AND ANALYSIS

Relevant studies reported in English or Chinese and published up to May 2023 will be identified from searches of the following databases: PubMed, Cochrane Central Register of Controlled Trials, Embase, PsycINFO, China National Knowledge Infrastructure, Wan Fang Database, Chinese BioMedical Literature Database, and China Science and Technology Journal Database. We will include all randomised controlled trials assessing the efficacy of an active TMS treatment using any one of the three targeting methods compared with sham TMS treatment or comparing efficacies between active TMS treatments using different targeting methods. Interventions must include a minimum of 10 sessions of high-frequency TMS over the lDLPFC. The primary outcome is the reduction score of the 17-item Hamilton Depression Rating Scale, 24-item Hamilton Depression Rating Scale or Montgomery-Asberg Depression Rating Scale. The dropout rate is a secondary outcome representing the TMS treatment's acceptability. Pairwise meta-analyses and a random-effects NMA will be conducted using Stata. We will use the surface under the cumulative ranking curve to rank the different targeting methods in terms of efficacy and acceptability.

ETHICS AND DISSEMINATION

This systematic review and NMA does not require ethics approval. The results will be submitted for publication in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42023410273.

Add-on pramipexole for anhedonic depression: study protocol for a randomised controlled trial and open-label follow-up in Lund, Sweden

INTRODUCTION

Many depressed patients do not achieve remission with available treatments. Anhedonia is a common residual symptom associated with treatment resistance as well as low function and quality of life. There are currently no specific and effective treatments for anhedonia. Some trials have shown that dopamine agonist pramipexole is efficacious for treating depression, but more data is needed before it could become ready for clinical prime time. Given its mechanism of action, pramipexole might be a useful treatment for a depression subtype characterised by significant anhedonia and lack of motivation-symptoms associated with dopaminergic hypofunction. We recently showed, in an open-label pilot study, that add-on pramipexole is a feasible treatment for depression with significant anhedonia, and that pramipexole increases reward-related activity in the ventral striatum. We will now confirm or refute these preliminary results in a randomised controlled trial (RCT) and an open-label follow-up study.

METHODS AND ANALYSIS

Eighty patients with major depression (bipolar or unipolar) or dysthymia and significant anhedonia according to the Snaith Hamilton Pleasure Scale (SHAPS) are randomised to either add-on pramipexole or placebo for 9 weeks. Change in anhedonia symptoms per the SHAPS is the primary outcome, and secondary outcomes include change in core depressive symptoms, apathy, sleep problems, life quality, anxiety and side effects. Accelerometers are used to assess treatment-associated changes in physical activity and sleep patterns. Blood and brain biomarkers are investigated as treatment predictors and to establish target engagement. After the RCT phase, patients continue with open-label treatment in a 6-month follow-up study aiming to assess long-term efficacy and tolerability of pramipexole.

ETHICS AND DISSEMINATION

The study has been approved by the Swedish Ethical Review Authority and the Swedish Medical Products Agency. The study is externally monitored according to Good Clinical Practice guidelines. Results will be disseminated via conference presentations and peer-reviewed publications.

TRIAL REGISTRATION NUMBER

NCT05355337 and NCT05825235.

Understanding the protective effect of social support on depression symptomatology from a longitudinal network perspective

BACKGROUND

Higher social support protects people from developing mental disorders. Limited evidence is available on the mechanism through which social support plays this protective role.

OBJECTIVE

To investigate the stress-buffering process of social support on depressive symptoms using a novel longitudinal dynamic symptom network approach.

METHODS

A total of 4242 adult participants who completed the first two waves (from May to October 2020) of the International Covid Mental Health Survey were included in the study. Cross-lagged panel network modelling was used to estimate a longitudinal network of self-reported social support, loneliness and depressive symptoms. Standardised regression coefficients from regularised cross-lagged regressions were estimated as edge weights of the network.

FINDINGS

The results support a unidirectional protective effect of social support on key depressive symptoms, partly mediated through loneliness: A higher number of close confidants and accessible practical help was associated with decreased anhedonia (weight=-0.033) and negative self-appraisal symptoms (weight=-0.038). Support from others was also negatively associated with loneliness, which in turn associated with decreased depressed mood (weight=0.086) and negative self-appraisal (weight=0.077). We identified a greater number of direct relationships from social support to depressive symptoms among men compared with women. Also, the edge weights from social support to depression were generally stronger in the men's network.

CONCLUSIONS

Reductions in negative self-appraisal might function as a bridge between social support and other depressive symptoms, and, thus, it may have amplified the protective effect of social support. Men appear to benefit more from social support than women.

CLINICAL IMPLICATIONS

Building community-based support networks to deliver practical support, and loneliness reduction components are critical for depression prevention interventions after stressful experiences.

Longitudinal survey of UK veterans with pre-existing mental health difficulties: mental health during the COVID-19 pandemic

INTRODUCTION

At the start of the COVID-19 pandemic, individuals with pre-existing mental health difficulties were thought to be vulnerable to mental health deterioration due to the emerging threat and the actions taken to control infection rates. Yet, there remained a paucity of research investigating changes in veteran well-being, a population facing higher rates of mental health difficulties compared with the general public. This longitudinal study aimed to investigate the mental health and well-being of UK veterans with pre-existing mental health difficulties at two time points during the COVID-19 pandemic.

METHODS

UK treatment-seeking veterans (N=121) completed an online survey administered towards the end of the first UK lockdown in June 2020 and 1 year later. Data were gathered on sociodemographic characteristics as well as psychometric measures of post-traumatic stress disorder (PTSD), common mental disorders (CMDs), anger difficulties and alcohol misuse.

RESULTS

The proportion of veterans meeting criteria of PTSD, anger and alcohol misuse remained similar across the two time points, while significantly fewer veterans met criteria for CMDs 1 year later. A notable proportion of the sample reported challenges in attending mental and physical health appointments, which was positively associated with not working and negatively associated with more COVID-19-related stressors.

CONCLUSIONS

These findings suggest that, to date, veterans with pre-existing mental health difficulties appear to demonstrate resilience as the COVID-19 pandemic progressed. However, as the pandemic continued, veterans faced significantly more COVID-19-related stressors, less social support, as well as difficulties attending health appointments.

Chain mediation model of consultation empathy, resilience and resignation coping on depression: a cross-sectional study among patients with COVID-19 in China

OBJECTIVES

This study aimed to explore the mediating role of resilience and resignation coping in the relationship between consultation empathy and depression in patients with COVID-19.

DESIGN

Cross-sectional study.

SETTING

Participants were recruited from a tertiary hospital in Guangzhou, Guangdong province.

PARTICIPANTS

A total of 215 patients were recruited for this study.

OUTCOME MEASURES

A total of 215 patients completed the Consultation and Relational Empathy Measure, Connor-Davidson Resilience Scale, Medical Coping Modes Questionnaire and Hospital Anxiety and Depression Scale. PROCESS 4.1 model 6 was used to analyse the moderated mediating effects.

RESULTS

Consultation empathy had a positive correlation with resilience (r=0.34, p<0.001), and a negative correlation with resignation (r=-0.288, p<0.001) and depression (r=-0.379, p<0.001). Resilience had a negative correlation with resignation (r=-0.463, p<0.001) and depression (r=-0.605, p<0.001). Resignation had a positive correlation (r=0.547, p<0.001) with depression. In the moderated mediating model, consultation empathy had significant indirect predictive effects on depression through resilience (95% CI -0.093 to -0.030) or resignation (95% CI -0.043 to -0.005). Consultation empathy had significant indirect predictive effects on depression through both resilience and resignation (95% CI -0.030 to -0.008).

CONCLUSIONS

Consultation empathy not only predicted depression directly, but also indirectly predicted depression through the chain mediating effects of resilience and resignation coping.

Treatments for partial remission of major depressive disorder: a systematic review and meta-analysis

QUESTION

Partial remission of major depressive disorder (MDD) is a debilitating and distressing clinical state related to chronicity, morbidity and relapse. Although one-third of patients remit partially, evidence for treatment efficacy is unclear. We provide an overview of treatment options and their efficacy.

STUDY SELECTION AND ANALYSIS

Embase, PsycINFO, Medline and SCOPUS were systematically searched through February 2023. Included were randomised controlled trials (RCTs) examining any treatment in patients with partially remitted MDD aged 13-65 years, reporting data on severity, remission or relapse.

FINDINGS

Seven RCTs examining psychotherapy including 1024 patients were eligible. There were not enough RCTs to examine effects of pharmacotherapy. Psychotherapy was associated with lower depressive symptom severity at post-treatment (Hedges' g=0.50; 95% CI 0.23 to 0.76), but not at follow-up up to 1 year (Hedges' g=0.36; 95% CI -0.30 to 1.02) or longer (Hedges' g=0.02; 95% CI -0.09 to 0.12). Psychotherapy was associated with superior remission rates at post-treatment (OR 2.57; 95% CI 1.71 to 3.87) and follow-up 6 months or longer (OR 1.75; 95% CI 1.21 to 2.53), although not with improved relapse rates at post-treatment (OR 0.17; 95% CI 0.01 to 4.83) or follow-up 6 months or longer (OR 0.46; 95% CI 0.21 to 1.03). Overall methodological quality was poor.

CONCLUSIONS

Psychotherapy targeting partial remission may be effective in lowering depressive symptom severity and patients may potentially achieve full remission twice as likely. Yet, long-term and prophylactic effects are lacking. Given the risk of chronicity, more high-quality RCTs are needed.

PROSPERO REGISTRATION NUMBER

CRD42020188451.

Comparative analysis of algorithm-guided treatment and predefined duration treatment programmes for depression: exploring cost-effectiveness using routine care data

BACKGROUND

More knowledge on the cost-effectiveness of various depression treatment programmes can promote efficient treatment allocation and improve the quality of depression care.

OBJECTIVE

This study aims to compare the real-world cost-effectiveness of an algorithm-guided programme focused on remission to a predefined duration, patient preference-centred treatment programme focused on response using routine care data.

METHODS

A naturalistic study (n=6295 in the raw dataset) was used to compare the costs and outcomes of two programmes in terms of quality-adjusted life years (QALY) and depression-free days (DFD). Analyses were performed from a healthcare system perspective over a 2-year time horizon. Incremental cost-effectiveness ratios were calculated, and the uncertainty of results was assessed using bootstrapping and sensitivity analysis.

FINDINGS

The algorithm-guided treatment programme per client yielded more DFDs (12) and more QALYs (0.013) at a higher cost (€3070) than the predefined duration treatment programme. The incremental cost-effectiveness ratios (ICERs) were around €256/DFD and €236 154/QALY for the algorithm guided compared with the predefined duration treatment programme. At a threshold value of €50 000/QALY gained, the programme had a probability of <10% of being considered cost-effective. Sensitivity analyses confirmed the robustness of these findings.

CONCLUSIONS

The algorithm-guided programme led to larger health gains than the predefined duration treatment programme, but it was considerably more expensive, and hence not cost-effective at current Dutch thresholds. Depending on the preferences and budgets available, each programme has its own benefits.

CLINICAL IMPLICATION

This study provides valuable information to decision-makers for optimising treatment allocation and enhancing quality of care cost-effectively.

Postpartum stress in the first 6 months after delivery: a longitudinal study in Nantong, China

OBJECTIVES

The objective is to to explore the longitudinal change trajectories of postpartum stress and its related factors.

DESIGN

A longitudinal study with follow-ups from 42 days to 6 months after delivery.

SETTINGS AND PARTICIPANTS

A total of 406 postpartum women were recruited at baseline (42 days after delivery) from 6 hospitals in Nantong, Jiangsu Province, China, and followed up at 3 and 6 months. After the follow-ups, 358 postpartum women were retained for further analysis.

METHODS

Postpartum stress was evaluated using the Maternal Postpartum Stress Scale (MPSS) at baseline (42 days) and 3 and 6 months after delivery. MPSS has three dimensions, such as: personal needs and fatigue, infant nurturing and body changes and sexuality. Postpartum depression and anxiety were measured using the Edinburgh Postnatal Depression Scale and the short-form Depression, Anxiety and Stress Scale, respectively. The MPSS scores were normalised using a rank-based inverse normal transformation.

RESULTS

Postpartum stress decreased significantly after 3 months, and postpartum stress reduced further after 6 months. Additionally, the scores for all three dimensions reduced after 6 months, while infant nurturing reduced after both 3 and 6 months. Older age (β=0.028, p=0.049), higher education level (β=0.153, p=0.005) and higher body mass index (BMI) (β=0.027, p=0.008) of the postpartum women were significantly associated with higher postpartum stress levels in corresponding dimensions at 42 days. Older age was also associated with higher postpartum stress at 3 (β=0.030, p=0.033) and 6 months (β=0.050, p<0.001) in the dimension of personal needs and fatigue. Postpartum stress levels were significantly higher in women with depression or anxiety symptoms.

CONCLUSIONS

Postpartum stress continuously declined from 42 days to 6 months after delivery. Postpartum women with older age, higher education levels, higher BMI and anxiety or depression symptoms should be the target population for early intervention.

Predictors of and healthcare utilisation of depressive symptoms among middle-aged and older adults in Thailand: a national cross-sectional community-based study in 2015

OBJECTIVE

The prevalence of depressive symptoms and healthcare utilisation among the ageing population in Thailand is unclear. The study assessed the predictors of and healthcare utilisation of depressive symptoms among an ageing population in Thailand.

DESIGN

Cross-sectional, population-based study.

SETTING

National sample of people aged 45 years and older in Thailand from the 2015 Health, Ageing and Retirement in Thailand (HART) study.

PARTICIPANTS

The sample included 5135 individuals (≥45 years) with complete depressive symptoms data from the 2015 HART study.

OUTCOME MEASURES

Depressive symptoms were measured with the Centre for Epidemiological Studies Depression Scale. Logistic regression was used to estimate the associations between sociodemographic factors, health factors and depressive symptoms, and the associations between depressive symptoms and different types of healthcare utilisation.

RESULTS

The study population included 5135 participants with a median age of 66 years. The prevalence of depressive symptoms was 13.9%. The proportion of past 2 year hospital admission was 12.8%, hospital outpatient 49.7%, health centre outpatient 26.2%, private clinic 8.4%, traditional medical practitioner 2.8%, medical home visit 4.9% and past-year medical check-up 50.3%. In adjusted logistic regression analysis, low income, residing in the Southern region, history of a cardiovascular disease, brain diseases and/or psychiatric problems and functional disability were positively associated with depressive symptoms. Male sex, being a Buddhist, urban residence, high religious involvement, moderate and high physical activity were negatively associated with depressive symptoms. In fully adjusted logistic regression models, depressive symptoms were positively associated with hospital inpatient utilisation, hospital outpatient utilisation, health centre utilisation and utilisation of a traditional medicine practitioner.

CONCLUSIONS

More than one in 10 participants had depressive symptoms. Chronic conditions, sociodemographic factors, physical inactivity and low religious involvement increased the odds of depressive symptoms. Furthermore, depressive symptoms increased the odds of conventional and traditional healthcare utilisation.

Quantifying the mental health and economic impacts of prospective Universal Basic Income schemes among young people in the UK: a microsimulation modelling study

OBJECTIVE

Universal Basic Income (UBI)-a largely unconditional, regular payment to all adults to support basic needs-has been proposed as a policy to increase the size and security of household incomes and promote mental health. We aimed to quantify its long-term impact on mental health among young people in England.

METHODS

We produced a discrete-time dynamic stochastic microsimulation that models a close-to-reality open cohort of synthetic individuals (2010-2030) based on data from Office for National Statistics and Understanding Society. Three UBI scheme scenarios were simulated: Scheme 1-Starter (per week): £41 per child; £63 per adult over 18 and under 65; £190 per adult aged 65+; Scheme 2-Intermediate (per week): £63 per child; £145 per adult under 65; £190 per adult aged 65+; Scheme 3-Minimum Income Standard level (per week): £95 per child; £230 per adult under 65; £230 per adult aged 65+. We reported cases of anxiety and depression prevented or postponed and cost savings. Estimates are rounded to the second significant digit.

RESULTS

Scheme 1 could prevent or postpone 200 000 (95% uncertainty interval: 180 000 to 210 000) cases of anxiety and depression from 2010 to 2030. This would increase to 420 000(400 000 to 440 000) for Scheme 2 and 550 000(520 000 to 570 000) for Scheme 3. Assuming that 50% of the cases are diagnosed and treated, Scheme 1 could save £330 million (£280 million to £390 million) to National Health Service (NHS) and personal social services (PSS), over the same period, with Scheme 2 (£710 million (£640 million to £790 million)) or Scheme 3 (£930 million (£850 million to £1000 million)) producing more considerable savings. Overall, total cost savings (including NHS, PSS and patients' related costs) would range from £1.5 billion (£1.2 billion to £1.8 billion) for Scheme 1 to £4.2 billion (£3.7 billion to £4.6 billion) for Scheme 3.

CONCLUSION

Our modelling suggests that UBI could substantially benefit young people's mental health, producing substantial health-related cost savings.

Seasonal trends in antidepressant prescribing, depression, anxiety and self-harm in adolescents and young adults: an open cohort study using English primary care data

BACKGROUND

There is an increasing demand for mental health services for young people, which may vary across the year.

OBJECTIVE

To determine whether there are seasonal patterns in primary care antidepressant prescribing and mental health issues in adolescents and young adults.

METHODS

This cohort study used anonymised electronic health records from general practices in England contributing to QResearch. It included 5 081 263 males and females aged 14-18 (adolescents), 19-23 and 24-28 years between 2006 and 2019. The incidence rates per 1000 person-years and the incidence rate ratios (IRRs) were calculated for the first records of a selective serotonin reuptake inhibitor (SSRI) prescription, depression, anxiety and self-harm. The IRRs were adjusted for year, region, deprivation, ethnic group and number of working days.

FINDINGS

There was an increase in SSRI prescribing, depression and anxiety incidence in male and female adolescents in the autumn months (September-November) that was not seen in older age groups. The IRRs for SSRI prescribing for adolescents peaked in November (females: 1.75, 95% CI 1.67 to 1.83, p<0.001; males: 1.72, 95% CI 1.61 to 1.84, p<0.001, vs in January) and for depression (females: 1.29, 95% CI 1.25 to 1.33, p<0.001; males: 1.29, 95% CI 1.23 to 1.35, p<0.001). Anxiety peaked in November for females aged 14-18 years (1.17, 95% CI 1.13 to 1.22, p<0.001) and in September for males (1.19, 95% CI 1.12 to 1.27, p<0.001).

CONCLUSIONS

There were higher rates of antidepressant prescribing and consultations for depression and anxiety at the start of the school year among adolescents.

CLINICAL IMPLICATIONS

Support around mental health issues from general practitioners and others should be focused during autumn.

Depression, anxiety, psychological distress and associated factors among students attending Nemelifen Secondary and Preparatory School, Afar regional state, Ethiopia: a cross-sectional study

OBJECTIVES

This study aimed to assess the magnitude of depression, anxiety, psychological distress and associated factors in Nemelifen Secondary and Preparatory School at Awash 7 Kilo, zone 3, Afar, Ethiopia.

DESIGN

An institutional-based cross-sectional study design was implemented.

SETTING

This research was conducted in Afar regional state, zone 3, Awash 7 Kilo town.

PARTICIPANTS

A pretested, structured, self-administered questionnaire was used to gather information from 392 study participants. For the purpose of identifying risk variables for depression, anxiety and psychological distress, bivariate and multivariate binary logistic regression analyses were used.

OUTCOME MEASURES

The primary outcome of the study was magnitude of depression, anxiety and psychological distress and the secondary outcome was factors associated with depression, anxiety and psychological distress.

RESULTS

Overall, 109 study participants showed symptoms of depression (28.91%; 95% CI: 24.3%, 33.2%), 85 had symptoms of anxiety disorder (22.55%; 95% CI: 18.7%, 27.3%) and 168 had symptoms of psychological distress (44.56%; 95% CI: 39.6%, 49.6%). While anxiety was linked to ever drinking alcohol (adjusted OR (AOR)=2.87; 95% CI: 1.13, 7.28) and suicidal ideation (AOR=3.23; 95% CI: 1.80, 5.79), depression was significantly associated with having very good relationships with classmates (AOR=0.22; 95% CI: 0.09, 0.55) and suicidal ideation (AOR=2.26; 95% CI: 1.29, 3.94). The level of education (being in the ninth grade) and suicidal ideation (AOR=2.86; 95% CI: 1.49, 4.86) were also related to psychological distress.

CONCLUSION

High levels of depression, anxiety and psychological distress were discovered. Very positive relationships with classmates were significantly linked to depression, while ever drinking was linked to anxiety. Likewise, the level of educational was related to psychological distress. All three of the dependent variables were linked to suicidal ideation. Above all, there was a connection among psychological distress, anxiety and depression.

Prevalence of psychological distress and associated factors among Omani women diagnosed with breast cancer: a single-centre, cross-sectional study

OBJECTIVES

To determine the prevalence of psychological distress (ie, anxiety and depressive symptoms) among Omani women diagnosed with breast cancer (BC) and to investigate associations with socio-demographic factors.

DESIGN

A cross-sectional, self-administered survey was conducted between September 2021 and June 2022.

SETTING

Sultan Qaboos Comprehensive Cancer Care and Research Centre (Muscat, Oman).

PARTICIPANTS

Adult Omani women diagnosed with BC during the study period.

OUTCOME MEASURES

Data regarding anxiety and depressive symptoms were collected using an Arabic version of the Hospital Anxiety and Depression Scale (HADS). Socio-demographic and clinical information was obtained from the participants and their hospital medical records.

RESULTS

190 Omani women diagnosed with BC were invited to participate in the study, of whom 171 participated (response rate: 90.0%). The mean age was 50.3±10.9 years. 52.3% of participants had been diagnosed with BC at stages III or IV and 28.9% had metastasis. 29 women (17.0%) exhibited depressive symptoms (HADS-D score: ≥8), while 37 (21.6%) exhibited anxiety symptoms (HADS-A score: ≥8). Women with anxiety symptoms were almost 15-times more likely to have depressive symptoms than those without anxiety symptoms (OR: 14.87, p<0.001). Younger women were less likely to exhibit depressive symptoms than older women (≤39 vs ≥60 years, p=0.050; 40-59 vs ≥60 years, p=0.005). Women at the school/diploma education level were less likely to have depressive symptoms than those at college/university level (OR: 0.19, p=0.017).

CONCLUSIONS

More than half of the women surveyed had been diagnosed at an advanced stage, with up to 21.6% presenting with symptoms of anxiety and depression. Healthcare professionals in Oman should consider additional screening for anxiety and depressive symptoms in this group and encourage patients with BC to disclose emotional information during consultations, particularly for those aged ≥60 years.

Effects of mass casualty incidents on anxiety, depression and PTSD among doctors and nurses: a systematic review protocol

INTRODUCTION

Both doctors and nurses showed a greater risk of being exposed to different mental health conditions following mass casualties. This systematic review aims to synthesise the existing evidence on the prevalence of anxiety, depression and post-traumatic stress disorder and their associated risk factors among doctors and nurses following mass casualty incidents.

METHODS AND ANALYSIS

Seven electronic databases (PubMed, PsycINFO, MEDLINE Ovid, Embase, CINAHL, Web of Science and Nursing & Allied Health database) will be searched from 2010 to 2022 with peer-reviewed articles in English language using the predefined keywords. Two reviewers will independently screen the titles and abstracts, as well as review the full texts using the eligibility criteria, then extract data independently. The National Institutes of Health Quality Assessment Tools (NIH-QAT) for quantitative studies, the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies and the Mixed-Methods Appraisal Tool (MMAT) for mixed-method studies will be used to measure the quality appraisal of eligible studies. A third reviewer will resolve the discrepancies when the two reviewers cannot reach an agreement in any step. The result from the eligible studies will be described following narrative synthesis with the key characteristics and findings of the included studies, and meta-analysis will be performed, if applicable.

ETHICS AND DISSEMINATION

This systematic review deals with existing published studies without any personally identifiable information of participants. Therefore, ethical approval from the research committee is not required. Findings from this review will be disseminated in peer-reviewed journals and presented at relevant international conferences.

PROSPERO REGISTRATION NUMBER

CRD42023412852.

Sequential multiple assignment randomised controlled trial protocol for developing an adaptive intervention to improve depressive symptoms among family caregivers of people with dementia

OBJECTIVES

Family caregivers of people with dementia (FC-of-PWD) suffer from a high level of stress and depressive symptoms, which usually require different interventions at different stages. Although some standalone interventions such as behavioural activation (BA) and mindfulness practice (MP) have been shown to be potentially effective at reducing depressive symptoms, the best sequence and combination of these interventions for caregivers are unknown. This study aims to develop and identify a two-stage adaptive intervention with prespecified rules guiding whether, how or when to offer different interventions initially/over time to reduce depressive symptoms in FG-of-PWD.

METHODS

A sequential multiple assignment randomised trial design will be adopted. 272 FG-of-PWD with mild to moderate depressive symptoms will be recruited from the community. Four two-stage, embedded adaptive interventions involving BA and MP of different sequences and dosages (eg, 8 weeks of BA followed by booster sessions for responders and 8 weeks of MP for non-responders) will be assigned to the participants following a set of decision rules. The primary outcomes will be depressive symptoms (measured using the Patient Health Questionnaire-9), assessed after the second stage of the intervention. Other outcomes, such as positive aspects of caregiving (measured using the Positive Aspects of Caregiving Scale), sleep quality (measured using the Pittsburgh Sleep Quality Index) and time points will also be assessed. The analyses will follow the intention-to-treat principle. Several process indicators (eg, engagement in meaningful activities and level of mindfulness) will also be assessed. The findings will have strong implications for the further development of psychosocial adaptive interventions to reduce depressive symptoms among FC-of-PWD.

ETHICS AND DISSEMINATION

This study has received ethical approval from the Human Research Ethics Committee at The Hong Kong Polytechnic University (HSEARS20211223001). The findings will be presented at academic conferences and submitted to peer-reviewed journals for publication.

TRIAL REGISTRATION NUMBER

NCT05634317.

Can a nation-wide e-cohort of ADHD and ASD in childhood be established using Welsh routinely available datasets?

OBJECTIVES

We investigated the feasibility and validity of establishing a nationwide e-cohort of individuals with a diagnosis of attention deficit hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD) for future longitudinal research.

DESIGN

Individuals with a childhood diagnosis of ADHD/ASD as recorded on routinely available healthcare datasets were compared with matched controls and a sample of directly assessed individuals with ADHD.

SETTING

This study used data from the Welsh Secure Anonymised Information Linkage Databank in Wales, UK. Routinely collected data from primary care, emergency department and hospital admissions were linked at person level.

PARTICIPANTS

All individuals in Wales, UK born between 1 January 1991 and 31 December 2000. Individuals with a recorded diagnosis of ADHD and/or ASD by age 18 years were identified using International Classification of Diseases, 10th Revision and National Health Service (NHS) READ codes and matched to 3 controls each and 154 individuals with ADHD recruited from an established research study.

OUTCOME MEASURES

Recorded service use for anxiety and depression, alcohol and drug use and self-harm including emergency department use in young adulthood (age 16-25 years).

RESULTS

7726 individuals had a recorded diagnosis of ADHD (80% male) and 5001 of ASD (79% male); 1.4% and 0.9% of the population, respectively. Cox's regression analyses showed ADHD was associated with increased risks of anxiety/depression (HR: 2.36, 95% CI: 2.20 to 2.53), self-harm (HR: 5.70, 95% CI: 5.07 to 6.40), alcohol (HR: 3.95, 95% CI: 3.42 to 4.56), drug use (HR: 5.88, 95% CI: 5.08 to 6.80) and emergency department service use (HR: 1.36, 95% CI: 1.31 to 1.41). Those with ASD were at increased risk of anxiety/depression (HR: 2.11, 95% CI: 1.91 to 2.34), self-harm (HR: 2.93, 95% CI: 2.45 to 3.50) and drug use (HR: 2.21, 95% CI: 1.66 to 2.95) but not alcohol use. The ADHD e-cohort were similar to the directly assessed cohort.

CONCLUSIONS

Our identification strategy demonstrated the feasibility of establishing a large e-cohort of those with ADHD/ASD with expected patterns of poorer early adult outcomes, demonstrating a valid method of identifying large samples for future longitudinal studies without selective attrition.

Are large prospective trials on antidepressants in mental disorders seeding trials? A descriptive study of trials registered on ClinicalTrials.gov

OBJECTIVES

This descriptive study of registered trials aimed to identify large clinical trials on antidepressants for mental disorders: (1) to assess what proportion could be labelled as 'seeding trials' (trials for marketing purposes) and (2) to describe their methodological characteristics and outcomes.

DESIGN

A search was conducted across all trials registered on ClinicalTrials.gov by drug name in March 2017.

SETTING

All trials registered in the database of ClinicalTrials.gov were screened. Large registered studies were received and studies focusing prospectively on the effects of antidepressants in mental health disorders. Specific data items were extracted automatically, and subsequently inspected, corrected and completed by hand.

PARTICIPANTS

Prospective studies were selected focusing on the effects of antidepressants in any mental health disorder with 800 participants or more planned for inclusion.

MAIN OUTCOME MEASURES

Three members from the study team independently assessed the following 'seeding trial' characteristics in each registered study: a high level of involvement of the product manufacturer in the study design, in the data analysis and reporting of the study, an abnormally low ratio of patient numbers to study site, spin and/or omissions of clinically relevant findings in the abstracts, and conclusions that focused on secondary endpoints and surrogate markers. Secondary outcomes were the exploration of a functional outcome and suicidality.

RESULTS

31 trials were identified from clinical trials database. 18/31 were published (58%). 8 of these 18 (44%) studies were identified as possible seeding trials. 13/31 (42%) large trials planned to explore functioning and 5/31 (16%) suicidality.

CONCLUSIONS

Large trials are rare in the field of antidepressant research. Some could be 'seeding trials'. Few explored suicidality. Identifying seeding trials from incomplete data entries in registries, especially when almost half of the studies were still unpublished, posed considerable challenges. The delay between our research and publication limits the strength of our conclusions.

PROSPERO REGISTRATION NUMBER

CRD42017065591.

Depression, anxiety and quality of life of Afghan women living in urban areas under the Taliban government: a cross-sectional study

OBJECTIVES

According to the World Health Organization, depression is a common mental health illness that is characterised by a persistent feeling of sadness and loss of interest. The present study examined the association of two mental health variables (ie, depression, anxiety) with quality of life (QoL) and the sociodemographic characteristics of Afghan women living in urban areas under the rule of Taliban government in Afghanistan.

DESIGN

Cross-sectional study administered between 10 November 2021 to 25 December 2021 among women.

SETTING

Across major provinces of Afghanistan (Herat, Mazar-e-Sharif, Kabul and Samangan).

MEASUREMENTS

Data were collected using a pretested structured questionnaire. Data entry was carried out using Microsoft Excel 2016. And then exported to IBM SPSS V.26 for Microsoft Windows. Logistic regression models were used to examine the association of depression, anxiety with QoL and sociodemographic characteristics among women (N=438).

RESULTS

The prevalence of depression symptoms was 80.4%, and the prevalence of mild to extremely severe anxiety was 81.0%. Depression symptoms among Afghan women were associated with being older, having more children, lower education level, other individuals' bad behaviour, bad events experienced in the past month, and feeling physically ill. Multiple regression analysis indicated that low monthly household income (adjusted OR, AOR 2.260; 95% CI 1.179 to 4.331, p=0.014) poor physical domain of QoL (AOR 4.436; 95% CI 1.748 to 11.256, p=0.002) and poor psychological domain of QoL (AOR 23.499; 95% CI 7.737 to 71.369, p<0.001) were significantly associated with depression.

CONCLUSION

The prevalence of depression was high among women living under the government of the Taliban in Afghanistan. Considering the high prevalence of depression, anxiety and their impact on QoL and the overall quality of healthcare services, international health organisations should implement programmes for regular screening of depression and anxiety, and there should be psychological counselling services available for vulnerable women living under the government of the Taliban.

A pilot study of the depression, anxiety and stress in Greek military personnel during the first year of the COVID-19 pandemic

INTRODUCTION

The ongoing SARS-CoV-2 pandemic is a global health crisis which poses many psychological research challenges. The objective of this study was to evaluate the responsiveness and validity of depression, anxiety and stress in a representative cohort of Hellenic military personnel using the short version of the Greek military version of the Depression-Anxiety-Stress Scales-21 (DASS-21) questionnaire.

METHODS

A total of 158 participants were voluntarily surveyed using an electronically developed structured questionnaire. The anonymous e-questionnaire included a social demographic section and the DASS-21 scale section. It was distributed in September 2020 to the military personnel of the Hellenic Tactical Air Force Units using an intranet network during government restrictive measures due to the COVID-19 crisis.

RESULTS

Our DASS-21 survey indicated a positive outcome at the psychometric level of our military sample population. Age, sex and systemic medications were statistically correlated with anxiety. Inter-correlations between the DASS-21 statements showed that individuals with low-level depression also experienced some degree of stress. Factor analysis indicated the reliability and validity of the questionnaire.

CONCLUSIONS

The low levels of depression and stress among our military sample population demonstrate the importance of periodic monitoring of the psychometric items of the DASS-21 subscales to design and implement psychological prevention strategies, especially during the ongoing and future healthcare crises.

Depressive symptom networks in the UK general adolescent population and in those looked after by local authorities

BACKGROUND

Despite the importance of understanding depressive symptom constellations during adolescence and specifically in looked-after children, studies often only apply sum score models to understand depression in these populations, neglecting associations among single symptoms that can be elucidated in network analysis. The few network analyses in adolescents have relied on different measures to assess depressive symptoms, contributing to inconsistent cross-study results.

OBJECTIVE

In three population-based studies using the Short Mood and Feelings Questionnaire, we used network analyses to study depressive symptoms during adolescence and specifically in looked-after children.

METHOD

We computed cross-sectional networks (Gaussian Graphical Model) in three separate datasets: the Mental Health of Children and Young People in Great Britain 1999 survey (n=4235, age 10-15 years), the mental health of young people looked after by local authorities in Great Britain 2002 survey (n=643, age 11-17 years) and the Millennium Cohort Study in the UK 2015 (n=11 176, age 14 years).

FINDINGS

In all three networks, self-hate emerged as a key symptom, which aligns with former network studies. I was no good anymore was also among the most central symptoms. Among looked-after children, I was a bad person constituted a central symptom, while this was among the least central symptom in the other two datasets. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition symptom I did not enjoy anything was not central.

CONCLUSIONS

Findings indicate that looked-after children's depressive symptoms may be more affected by negative self-evaluation compared with the general population.

CLINICAL IMPLICATIONS

Intervention efforts may benefit from being tailored to negative self-evaluations.

Physical sleeping environment is related to insomnia risk and measures of readiness in US army special operations soldiers

BACKGROUND

US military service members have characteristically poor sleep, even when 'in garrison' or at one's home base. The physical sleeping environment, which is often poor in military-provided housing or barracks, may contribute to poor sleep quality in soldiers. The current study aimed to assess whether the sleeping environment in garrison is related to sleep quality, insomnia risk and military readiness.

METHODS

Seventy-four US army special operations soldiers participated in a cross-sectional study. Soldiers were queried on their sleeping surface comfort and the frequency of being awakened at night by excess light, abnormal temperatures and noise. Subjective sleep quality and insomnia symptoms were also queried, via the Pittsburgh Sleep Quality Index and Insomnia Severity Index, respectively. Lastly, measures of soldier readiness, including morale, motivation, fatigue, mood and bodily pain, were assessed.

RESULTS

Soldiers reporting temperature-related and light-related awakenings had poorer sleep quality higher fatigue and higher bodily pain than soldiers without those disturbances. Lower ratings of sleeping surface comfort were associated with poorer sleep quality and lower motivation, lower morale, higher fatigue and higher bodily pain. Each 1-point increase in sleeping surface comfort decreased the risk for a positive insomnia screen by 38.3%, and the presence of temperature-related awakenings increased risk for a positive insomnia screen by 78.4%. Those living on base had a poorer sleeping environment than those living off base.

CONCLUSION

Optimising the sleep environment-particularly in on-base, military-provided housing-may improve soldier sleep quality, and readiness metrics. Providers treating insomnia in soldiers should rule out environment-related sleep disturbances prior to beginning more resource-intensive treatment.

Awareness and related factors of depressive symptoms in breastfeeding people in South Korea: a survey-based cross-sectional study

OBJECTIVES

This study identifies depressive symptoms and the factors that could explain its presence in breastfeeding people.

DESIGN

This study is a cross-sectional study from national survey data.

SETTING AND PARTICIPANTS

Data were derived from the 2019 Korean Community Health Survey. The study subjects were breastfeeding people under the age of 50.

PRIMARY OUTCOME MEASURES

Depressive symptoms in breastfeeding people were classified according to the Patient Health Questionnaire-9 (PHQ-9) score. Physical and health behaviours were considered as factors related to depressive symptoms. A multilevel logistic regression analysis was used.

RESULTS

Among 497 participants, 19.4% (n=97) of breastfeeding people were depressed. We found that depressive symptoms were associated with age (31-35, OR: 0.79, 95% CI: 0.67 to 0.94; 35-49, OR: 0.42, 95% CI: 0.32 to 0.56), rural setting (OR: 0.62, 95% CI: 0.51 to 0.76), economic activity (OR: 0.75, 95% CI: 0.61 to 0.91) and physical health (diabetus mellitus or hypertension, OR: 5.17, 95% CI: 3.78 to 7.06).

CONCLUSIONS

This study implies that socioeconomic factors, physical health and health behaviours may influence depressive symptoms in breastfeeding people. These findings should be used as descriptive data to support the development of education programmes to help breastfeeding people.

Level of education and sustainable return to work among long-term sick-listed workers with depression: a register-based cohort study (The Norwegian GP-DEP Study)

OBJECTIVES

Sick-listed workers with depression are at higher risk of long-term, recurrent sickness absence and work disability, suggesting reduced likelihood of sustainable return to work (SRTW). Though likelihood of RTW has been associated with education level, less is known about the association over time, post-RTW. We aimed to investigate associations between educational level and SRTW among long-term sick-listed workers with depression.

METHODS

Nationwide cohort study, based on linked data from Norwegian health and population registries, including all inhabitants of Norway aged 20-64 years on long-term sick leave with a depression diagnosis given in general practice between 1 January 2009 and 10 April 2011 (n=13.624, 63.7% women). Exposure was the highest attained education level (five groups). Three outcome measures for SRTW were used, with 0 days, ≤30 days and ≤90 days of accumulated sickness absence post-RTW during a 2-year follow-up. Associations between exposure and outcomes were estimated in gender-stratified generalised linear models, adjusting for sociodemographic factors and duration of sick leave.

RESULTS

Higher-educated workers had a higher likelihood of SRTW 0, SRTW ≤30 and SRTW ≤90 than the lowest-educated groups in the crude models. Among men, this association was mainly explained when adjusting for occupation. Among women, the highest educated group had a higher likelihood of SRTW 0 (RR=1.45, 95% CI 1.23 to 1.71) and SRTW ≤30 and SRTW ≤90 in the fully adjusted models.

CONCLUSIONS

An educational gradient in SRTW was mainly explained by occupation among men but not among women. These findings suggest gendered differences in associations between education level and SRTW, which could inform interventions aiming to promote equal opportunities for SRTW.

One-year recovery rates for young people with depression and/or anxiety not receiving treatment: a systematic review and meta-analysis

OBJECTIVES

To systematically review 1-year recovery rates for young people experiencing depression and/or anxiety who are not receiving any specific mental health treatment.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE, Embase, PsycINFO, Web of Science and Global Health were searched for articles published from 1980 through to August 2022.

ELIGIBILITY CRITERIA

Articles were peer-reviewed, published in English and had baseline and 1-year follow-up depression and/or anxiety outcomes for young people aged 10-24 years without specific treatment.

DATA EXTRACTION AND SYNTHESIS

Three reviewers extracted relevant data. Meta-analysis was conducted to calculate the proportion of individuals classified as recovered after 1 year. The quality of evidence was assessed by the Newcastle-Ottawa Scale.

RESULTS

Of the 17 250 references screened for inclusion, five articles with 1011 participants in total were included. Studies reported a 1-year recovery rate of between 47% and 64%. In the meta-analysis, the overall pooled proportion of recovered young people is 0.54 (0.45 to 0.63).

CONCLUSIONS

The findings suggest that after 1 year about 54% of young people with symptoms of anxiety and/or depression recover without any specific mental health treatment. Future research should identify individual characteristics predicting recovery and explore resources and activities which may help young people recover from depression and/or anxiety.

PROSPERO REGISTRATION NUMBER

CRD42021251556.

Meta-review of the barriers and facilitators to women accessing perinatal mental healthcare

Perinatal mental health (PMH) problems are common and can have an adverse impact on women and their families. However, research suggests that a substantial proportion of women with PMH problems do not access care.

OBJECTIVES

To synthesise the results from previous systematic reviews of barriers and facilitators to women to seeking help, accessing help, and engaging in PMH care, and to suggest recommendations for clinical practice and policy.

DESIGN

A meta-review of systematic reviews.

REVIEW METHODS

Seven databases were searched and reviewed using a Preferred Reporting Items for Systematic Reviews and Meta Analyses search strategy. Studies that focused on the views of women seeking help and accessing PMH care were included. Data were analysed using thematic synthesis. Assessing the Methodological Quality of Systematic Reviews-2 was used to assess review methodology. To improve validity of results, a qualitative sensitivity analysis was conducted to assess whether themes remained consistent across all reviews, regardless of their quality rating.

RESULTS

A total of 32 reviews were included. A wide range of barriers and facilitators to women accessing PMH care were identified. These mapped across a multilevel model of influential factors (individual, healthcare professional, interpersonal, organisational, political and societal) and across the care pathway (from decision to consult to receiving care). Evidence-based recommendations to support the design and delivery of PMH care were produced based on identified barriers and facilitators.

CONCLUSION

The identified barriers and facilitators point to a complex interplay of many factors, highlighting the need for an international effort to increase awareness of PMH problems, reduce mental health stigma, and provide woman-centred, flexible care, delivered by well trained and culturally sensitive primary care, maternity, and psychiatric health professionals.

PROSPERO REGISTRATION NUMBER

CRD42019142854.

Are trajectories of depressive symptoms during the first half of drug-sensitive pulmonary tuberculosis treatment associated with loss to follow-up? A secondary analysis of longitudinal data

OBJECTIVE

The objective of this study was to identify trajectories of depressive symptoms (DSs) during the first half of drug-sensitive pulmonary tuberculosis (PTB) treatment and examine their association with loss to follow-up (LTFU) in the second half.

DESIGN

This study involved a secondary analysis of longitudinal data to identify potential trajectories of DS and their relationship with LTFU.

SETTING

The study was conducted in first and second-level health centres located in San Juan de Lurigancho, Lima, Peru.

PARTICIPANTS

Anonymised data from 265 individuals, including monthly measures of DSs from diagnosis to the completion of treatment, initiation of treatment for multidrug resistant TB, LTFU or death, were collected.

RESULTS

Three trajectories were identified: 'declining', 'growth' and 'high'. These trajectories were observed in 182 (68.7%), 53 (20%) and 30 (11.3%) of the 265 individuals, respectively, during the first half of PTB treatment. Compared with those with a 'declining' trajectory, individuals with a 'growth' trajectory had a higher likelihood of experiencing LTFU during the second half of PTB treatment, after controlling for sociodemographic factors and at least weekly alcohol use (OR 3.9; 95% CI 1.09 to 13.97, p=0.036).

CONCLUSIONS

The findings suggest that a trajectory of increasing DSs during the first half of PTB treatment is associated with a higher risk of LTFU during the second half.

Evaluation of the NHS England 'Op COURAGE' High Intensity Service for military veterans with significant mental health problems

INTRODUCTION

In November 2020, The NHS for England launched a pilot High Intensity Service (HIS) programme for treating military veterans complex mental health problems. Seven regional grants were awarded to manage the HIS, including NHS Solent, in South East England. This paper details an evaluation of the HIS, which was conducted from February 2021 to August 2022.

METHODS

This mixed-methods study gained quantitative data from a specifically designed questionnaire that included a number of validated psychometric questionnaires. These were completed by either HIS staff or beneficiaries at entry and exit from the HIS, and qualitative data were gained from semi-structured interviews with the HIS staff.

RESULTS

Data were sourced from 45 pre-questionnaires, 25 post programme questionnaires and 11 interviews. This evaluation identified reductions in situational stressors, symptoms and reported illnesses for veterans in crisis. There were reductions in depression, anxiety and post-traumatic stress disorder following programme exit. Staff reported that there was no notable changes in stress levels which appeared to remain high at programme exit. Staff interviews highlighted the importance of simultaneously understanding the social and psychological needs of veterans in mental health crisis. The benefits of integrating veteran staff members into military veteran health services were identified, demonstrating improvements in education around military culture in civilian services.

CONCLUSIONS

The importance of collaboration between clinical and veteran staff members in veteran health services was noted, demonstrating the positive impact social care provision has on veteran's overall health and well-being. Veteran engagement with the service was advocated as a result of veterans accessing the service feeling understood. This first independent evaluation of the HIS provides a positive reflection, and adds to the limited empirical evidence exploring veteran engagement in health services.

Role of optical coherence tomography in depression detection: a protocol of systematic review and meta-analysis

INTRODUCTION

Optical coherence tomography (OCT) is a non-invasive approach for detecting changes in the retinal layers, which may also reflect changes in brain structure and function. As one of the leading causes of disability worldwide, depression has been associated with alteration of brain neuroplasticity. However, the role of OCT measurements in detecting depression remains unknown. This study aims to employ a systematic review and meta-analysis approach to explore ocular biomarkers measured by OCT for detecting depression.

METHODS AND ANALYSIS

We will search studies describing the relationship between OCT and depression across seven electronic databases, and retrieve articles published from database inception to date. We will also manually search grey literature and reference lists included in the retrieved studies. Two independent reviewers will screen studies, extract data and assess risk of bias. Target outcomes will include peripapillary retinal nerve fibre layer thickness, macular ganglion cell complex thickness and macular volume, as well as other related indicators. Next, we will conduct subgroup analysis and meta-regression to explore study heterogeneity, then perform sensitivity analysis to investigate the robustness of the synthesised results. Meta-analysis will be performed using Review Manager (V.5.4.1) and STATA (V.12.0), and the certainty of evidence will be graded according to the Grading of Recommendations Assessment, Development and Evaluation system.

ETHICS AND DISSEMINATION

Ethics approval is not necessary because the data used in this systematic review and meta-analysis will be extracted from published studies. Study results will be disseminated by publishing our findings in a peer-reviewed journal.

Bidirectional association between depressive symptoms and cardiovascular disease in the middle-aged and elderly Chinese: a 5-year longitudinal study

OBJECTIVE

Depressive symptoms and cardiovascular diseases (CVDs) are important issues affecting the health of the middle-aged and elderly population in China. This study aimed to investigate the bidirectional association between depressive symptoms and CVD in middle-aged and elderly people in China.

DESIGN

A 5-year longitudinal study.

SETTING AND PARTICIPANTS

We included 6702 middle-aged and elderly participants from China Health and Retirement Longitudinal Study (CHARLS), which is a nationwide longitudinal household survey that started in 2011 (T1) and followed up every 2 years in 2013 (T2) and 2015 (T3).

OUTCOME MEASURES

Depressive symptoms were measured by the Center for Epidemiological Studies Depression Scale. Binary logistic regression was used to identify the influencing factors of depressive symptoms and CVD at T1. The cross-lagged panel model was used to analyse the association between depressive symptoms and CVD at T1, T2 and T3.

RESULTS

The CHARLS is a representative longitudinal survey of people aged ≥45 years. Using data extracted from the CHARLS, overall, at T1, 2621 (39.10%) participants had depressive symptoms and 432 (6.4%) had CVD, and at T3, 2423 (36.2%) had depressive symptoms and 760 (11.3%) had CVD, respectively. Depressive symptoms at T1 had a effect on CVD at T2 (β=0.015, p=0.009), and depressive symptoms at T2 had an effect on CVD at T3 (β=0.015, p=0.034). CVD at T1 predicted depressive symptoms at T2 (β=0.036, p=0.002).

CONCLUSIONS

There is a bidirectional predictive effect between depressive symptoms and CVD. The effect of depressive symptoms on CVD is stable, and CVD has an effect on depressive symptoms in a short period of time.

Moral injury and quality of life among military veterans

INTRODUCTION

Moral injury concerns transgressive harms and the outcomes that such experiences may cause. A gap in the literature surrounding moral injury, and an outcome that may be important to include in the mounting evidence toward the need for the formal clinical acknowledgement of moral injury, has to do with the relationship between moral injury and quality of life. No studies have examined this relationship in US military veterans-a population that is disproportionately exposed to potentially morally injurious events.

METHODS

A nationwide cross-sectional survey was conducted yielding 1495 military veterans. Participants were asked questions about moral injury and quality of life, among other things. Multivariable linear regression was used to characterise the adjusted relationship between moral injury and quality of life.

RESULTS

Moral injury (mean=40.1 out of 98) and quality-of-life (mean=69.5 out of 100) scores were calculated for the sample. Moral injury was inversely associated with quality of life in an adjusted model, indicating that worsening moral injury was associated with decreased quality of life (adjusted unstandardised beta coefficient (b)=-0.3, p<0.001). Results showed that age moderated said relationship, such that ageing veterans experienced an increasingly worse quality of life with increasingly severe moral injury (b=-0.1, p=0.003).

CONCLUSIONS

Results of the study showed that moral injury was inversely associated with quality of life and that this relationship rapidly worsens with age. More work is needed to more precisely understand this relationship and to determine the best strategies for intervention.

Effectiveness of internet-based and mobile-based interventions for adults with overweight or obesity experiencing symptoms of depression: a systematic review protocol

INTRODUCTION

Internet-based and mobile-based interventions (IMIs) provide innovative low-threshold and cost-effective prevention and self-management options for mental health problems complementary to standard treatment. The objective of this systematic review is to summarise the effectiveness and to critically evaluate studies on IMIs addressing comorbid depressive symptoms in adults with overweight or obesity.

METHODS AND ANALYSIS

The study authors will systematically search the databases MEDLINE, Cochrane Library, PsycINFO, Web of Science, Embase and Google Scholar (for grey literature) for randomised controlled trials (RCTs) of IMIs for individuals with overweight or obesity and comorbid depressive symptoms without restrictions on publication date (planned inception 1 June 2023 to 1 December 2023). Two reviewers will independently extract and evaluate data from studies eligible for inclusion by assessing quality of evidence and qualitatively synthesising results. Preferred Reporting Items for Systematic reviews Meta-Analyses (PRISMA) standards and the revised Cochrane Risk of Bias tool in RCTs (RoB 2) will be applied.

ETHICS AND DISSEMINATION

Ethical approval is not required as no primary data will be collected. Study results will be disseminated through publication in a peer-reviewed journal and presentations on conferences.

PROSPERO REGISTRATION NUMBER

CRD42023361771.

Effects of the COVID-19 pandemic on the mental health of clinically extremely vulnerable children and children living with clinically extremely vulnerable people in Wales: a data linkage study

OBJECTIVES

To determine whether clinically extremely vulnerable (CEV) children or children living with a CEV person in Wales were at greater risk of presenting with anxiety or depression in primary or secondary care during the COVID-19 pandemic compared with children in the general population and to compare patterns of anxiety and depression during the pandemic (23 March 2020-31 January 2021, referred to as 2020/2021) and before the pandemic (23 March 2019-31 January 2020, referred to as 2019/2020), between CEV children and the general population.

DESIGN

Population-based cross-sectional cohort study using anonymised, linked, routinely collected health and administrative data held in the Secure Anonymised Information Linkage Databank. CEV individuals were identified using the COVID-19 shielded patient list.

SETTING

Primary and secondary healthcare settings covering 80% of the population of Wales.

PARTICIPANTS

Children aged 2-17 in Wales: CEV (3769); living with a CEV person (20 033); or neither (415 009).

PRIMARY OUTCOME MEASURE

First record of anxiety or depression in primary or secondary healthcare in 2019/2020 and 2020/2021, identified using Read and International Classification of Diseases V.10 codes.

RESULTS

A Cox regression model adjusted for demographics and history of anxiety or depression revealed that only CEV children were at greater risk of presenting with anxiety or depression during the pandemic compared with the general population (HR=2.27, 95% CI=1.94 to 2.66, p<0.001). Compared with the general population, the risk among CEV children was higher in 2020/2021 (risk ratio 3.04) compared with 2019/2020 (risk ratio 1.90). In 2020/2021, the period prevalence of anxiety or depression increased slightly among CEV children, but declined among the general population.

CONCLUSIONS

Differences in the period prevalence of recorded anxiety or depression in healthcare between CEV children and the general population were largely driven by a reduction in presentations to healthcare services by children in the general population during the pandemic.

Fibromyalgia and mental health in rheumatoid arthritis: a cross-sectional prevalence study from the COVID-19 pandemic

OBJECTIVES

This study evaluated the prevalence of fibromyalgia (FM), anxiety and depression in patients with rheumatoid arthritis (RA) and their effects on the clinical parameters of RA during the COVID-19 pandemic.

DESIGN

Cross-sectional, outpatient clinic, observational, non-interventional.

SETTING

Single-centre, tertiary care, multispecialty, service and research hospital, north-central India.

PARTICIPANTS

Adult patients with RA, controls.

RESULTS

This cross-sectional study included 200 patients with RA diagnosed with the American College of Rheumatology/European League Against Rheumatism 2010 (ACR) criteria and 200 controls. FM was diagnosed using the revised 2016 ACR FM Criteria. Disease activity, quality of life and functional disability in patients with RA were assessed using multiple Disease Activity Scores. The presence of depression and anxiety was determined using the Hospital Anxiety and Depression Scale. FM was present in 31% of patients with RA compared with 4% of controls in our study. Patients with RA with FM were older, predominantly females with longer disease duration, and more likely to be on steroids. Patients with RA with FM had a higher disease activity, and none of our RA with FM patients were in remission. The multivariable analysis found FM to be an independent predictor of the Simplified Disease Activity Index for RA. Patients with RA with FM had worse functional ability and poorer quality of life. The prevalence of anxiety and depression was 12.5% and 30%, significantly higher in RA with FM patients.

CONCLUSION

During the COVID-19 pandemic, around one-third of our study patients had FM and depression, significantly higher than pre-COVID-19 times. Thus, mental health assessment should be incorporated into the routine management of patients with RA.

Well-being and flourishing mental health in adults with inflammatory bowel disease, multiple sclerosis and rheumatoid arthritis in Manitoba, Canada: a cross-sectional study

OBJECTIVES

Among people with immune-mediated inflammatory disease (IMID), including multiple sclerosis (MS), inflammatory bowel disease (IBD) and rheumatoid arthritis (RA) most research has focused on mental illness rather than on mental health. We assessed dimensions of mental health among persons with IMID and compared them across IMID. We also evaluated demographic and clinical characteristics associated with flourishing mental health.

DESIGN

Participants: Adults with an IMID (MS, 239; IBD, 225; RA 134; total 598) who were participating in a cohort study.

SETTING

Tertiary care centre in Manitoba, Canada.

PRIMARY OUTCOME MEASURE

Participants completed the Mental Health Continuum Short-Form (MHC-SF), which measures emotional, psychological and social well-being, and identifies flourishing mental health. This outcome was added midway through the study on the advice of the patient advisory group. Depression, anxiety, pain, fatigue and physical function were also assessed.

RESULTS

Total MHC-SF and subscale scores were similar across IMID groups. Nearly 60% of participants were considered to have flourishing mental health, with similar proportions across disease types (MS 56.5%; IBD 58.7%; RA 59%, p=0.95). Older age was associated with a 2% increased odds of flourishing mental health per year of age (OR 1.02; 95% CI: 1.01 to 1.04). Clinically meaningful elevations in anxiety (OR 0.25; 95% CI: 0.12 to 0.51) and depressive symptoms (OR 0.074; 95% CI: 0.009 to 0.61) were associated with lower odds. Higher levels of pain, anxiety and depressive symptoms were associated with lower total Mental Health Continuum scores at the 50th quantile.

CONCLUSIONS

Over half of people with MS, IBD and RA reported flourishing mental health, with levels similar across the disease groups. Interventions targeting symptoms of depression and anxiety, and upper limb impairments, as well as resilience training may help a higher proportion of the IMID population achieve flourishing mental health.

Eye-tracking in adult depression: protocol for a systematic review and meta-analysis

INTRODUCTION

In recent years, eye-tracking has been proposed as a promising tool to identify potential biomarkers for mental disorders, including major depression. We will conduct an updated systematic review and meta-analysis on eye-tracking research in adults with major depressive disorder or other clinically diagnosed depressive disorders.

METHODS AND ANALYSIS

This protocol follows all reporting items in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol extension. We will conduct a systematic search of PubMed, PsycINFO, Google Scholar and EMBASE for sources published up until March 2023. Abstract and full-text review will be completed independently by two reviewers. Non-randomised studies using eye movement tasks in individuals with a depressive disorder versus controls will be included. Eye movement tasks of interest include, but are not limited to, saccade, smooth pursuit, fixation, free-viewing, attentional disengagement, visual search and attentional blink tasks. Results will be categorised by eye movement task. Risk of bias will be assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and confidence in cumulative evidence will be assessed using Grading of Recommendations, Assessment, Development and Evaluation criteria.

ETHICS AND DISSEMINATION

Ethics approval is not required due to the nature of the proposed analysis. Results will be disseminated through a journal article, conference presentations and/or dissertations.

Positive affect training to reduce mental health problems during the COVID-19 pandemic: a proof-of-concept randomised clinical trial

BACKGROUND

The social restrictions occurring during the pandemic contributed to loss of many sources of reward, which contributes to poor mental health.

OBJECTIVE

This trial evaluated a brief positive affect training programme to reduce anxiety, depression and suicidality during the pandemic.

METHODS

In this single-blind, parallel, randomised controlled trial, adults who screened positive for COVID-19-related psychological distress across Australia were randomly allocated to either a 6-session group-based programme based on positive affect training (n=87) or enhanced usual care (EUC, n=87). Primary outcome was total score on the Hospital Anxiety and Depression Scale-anxiety and depression subscales assessed at baseline, 1-week post-treatment, 3 months (primary outcome time point) as well as secondary outcome measures of suicidality, generalised anxiety disorder, sleep impairment, positive and negative mood and COVID-19-related stress.

FINDINGS

Between 20 September 2020 and 16 September 2021, 174 participants were enrolled into the trial. Relative to EUC, at 3-month follow-up the intervention led to greater reduction on depression (mean difference 1.2 (95% CI 0.4 to 1.9)), p=0.003), with a moderate effect size (0.5 (95% CI 0.2 to 0.9)). There were also greater reduction of suicidality and improvement in quality of life. There were no differences in anxiety, generalised anxiety, anhedonia, sleep impairment, positive or negative mood or COVID-19 concerns.

CONCLUSIONS

This intervention was able to reduce depression and suicidality during adverse experiences when rewarding events were diminished, such as pandemics.

CLINICAL IMPLICATIONS

Strategies to improve positive affect may be useful to reduce mental health issues.

TRIAL REGISTRATION NUMBER

ACTRN12620000811909.

Effectiveness of a mental health stepped-care programme for healthcare workers with psychological distress in crisis settings: a multicentre randomised controlled trial

BACKGROUND

Evidence-based mental health interventions to support healthcare workers (HCWs) in crisis settings are scarce.

OBJECTIVE

To evaluate the capacity of a mental health intervention in reducing anxiety and depression symptoms in HCWs, relative to enhanced care as usual (eCAU), amidst the COVID-19 pandemic.

METHODS

We conducted an analyst-blind, parallel, multicentre, randomised controlled trial. We recruited HCWs with psychological distress from Madrid and Catalonia (Spain). The intervention arm received a stepped-care programme consisting of two WHO-developed interventions adapted for HCWs: Doing What Matters in Times of Stress (DWM) and Problem Management Plus (PM+). Each intervention lasted 5 weeks and was delivered remotely by non-specialist mental health providers. HCWs reporting psychological distress after DWM completion were invited to continue to PM+. The primary endpoint was self-reported anxiety/depression symptoms (Patient Health Questionnaire-Anxiety and Depression Scale) at week 21.

FINDINGS

Between 3 November 2021 and 31 March 2022, 115 participants were randomised to stepped care and 117 to eCAU (86% women, mean age 37.5). The intervention showed a greater decrease in anxiety/depression symptoms compared with eCAU at the primary endpoint (baseline-adjusted difference 4.4, 95% CI 2.1 to 6.7; standardised effect size 0.8, 95% CI 0.4 to 1.2). No serious adverse events occurred.

CONCLUSIONS

Brief stepped-care psychological interventions reduce anxiety and depression during a period of stress among HCWs.

CLINICAL IMPLICATIONS

Our results can inform policies and actions to protect the mental health of HCWs during major health crises and are potentially rapidly replicable in other settings where workers are affected by global emergencies.

TRIAL REGISTRATION NUMBER

NCT04980326.

Psychometric properties of Hamilton Depression Rating Scale among people with epilepsy in Jimma University Medical Center, Neurology Clinic, Southwest Ethiopia, 2020: cross-sectional study

OBJECTIVE

It is crucial to use clinically validated instruments to detect and treat depression in people with epilepsy. Therefore, this study aimed to describe the psychometric properties of the Afaan Oromo version of the Hamilton Depression Rating Scale 17-item (HAMD-17) among these individuals in Ethiopia.

DESIGN

A cross-sectional validation study.

SETTING

A tertiary hospital, Southwest Ethiopia.

PARTICIPANTS

A total of 133 people with epilepsy were included in this study using a consecutive sampling technique from 1 September 2020 to 30 September 2020.

OUTCOME

The psychometric property of the HAMD-17. Criterion validity was assessed using the Mini-International Neuropsychiatric Interview (MINI). The internal consistency was determined using Cronbach's alpha. The receiver operating characteristic (ROC) analysis was used in determining the cut-off score, sensitivity, specificity and positive predictive value (PPV) and negative predictive value (NPV). The tools were translated into the local language (Afaan Oromo) and back into English and pretested before the data collection.

RESULTS

The mean age of the participants was 31.7 years, SD±10.7. Eighty-six (64.7%), 55 (48.1%), 68 (51.1%) and 62 (46.6%) of them were male, unmarried, urban residents and completed primary school, respectively. The internal consistency of HAMD-17 was α=0.74. The Pearson's correlation coefficient for criterion validity was r=0.88. The ROC analysis showed 0.92 and 0.91 sensitivity and specificity of the HAMD-17, respectively. It also revealed α=0.96 NPV and α=0.87 PPV at a cut score of ≥9. The area under the ROC curve was 0.96.

CONCLUSIONS

The Afaan Oromo version of the HAMD-17 was considered valid and reliable for assessing depression in people with epilepsy, and the tool is not difficult to understand. The diagnostic performance using the gold standard MINI showed a good discriminatory capacity of the instrument. It can be used by any health professional to screen depression in people with epilepsy.

Veterans' experiences of moral injury, treatment and recommendations for future support

INTRODUCTION

Moral injury (MI) significantly impacts the lives of many UK military veterans however, there is a lack of manualised treatment to address the needs of this population. To develop future treatments that are acceptable and well tolerated, veterans should be consulted on their experiences of existing psychological treatments and suggestions for future treatments.

METHODS

10 UK military veterans were interviewed about their experiences of receiving treatment for psychological difficulties after MI, and beliefs about core components of future treatments. Thematic analysis of these interviews were conducted.

RESULTS

2 superordinate themes were identified: experiences of previous mental health treatment and perceptions of the proposed treatments. Reflections on cognitive behavioural therapy were mixed, with some describing that it did not ameliorate their guilt or shame. In future treatments, focusing on values, using written letters and including therapy sessions with close companions were considered beneficial. Veterans reported that a strong rapport with therapist was key for MI treatment.

CONCLUSION

Findings provide a useful account of how current post-trauma treatments may be experienced by patients with MI. Although limited by sample size, the results highlight therapeutic approaches that may be helpful in future and provide important considerations for therapists treating MI.