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1.
J Med Internet Res ; 23(12): e26584, 2021 12 17.
Article in English | MEDLINE | ID: covidwho-1592825

ABSTRACT

BACKGROUND: Disrupted social connections may negatively affect youth mental health. In contrast, sustained quality social connections (QSCs) can improve mental health outcomes. However, few studies have examined how these quality connections affect depression and anxiety outcomes within digital interventions, and conceptualization is limited. OBJECTIVE: The aim of this study is to conceptualize, appraise, and synthesize evidence on QSC within digital interventions (D-QSC) and the impact on depression and anxiety outcomes for young people aged 14-24 years. METHODS: A systematic scoping review and meta-analysis was conducted using the Joanna Briggs Institute methodological frameworks and guided by experts with lived experience. Reporting was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The MEDLINE, Embase, PsycINFO, and CINAHL databases were searched against a comprehensive combination of key concepts on June 24, 2020. The search concepts included young people, digital intervention, depression, anxiety, and social connection. Google was also searched. A reviewer independently screened abstracts and titles and full text, and 9.99% (388/3882) of these were screened by a second reviewer. A narrative synthesis was used to structure the findings on indicators of D-QSC and mechanisms that facilitate the connection. Indicators of D-QSC from the included studies were synthesized to produce a conceptual framework. RESULTS: Of the 5715 publications identified, 42 (0.73%) were included. Among the included studies, there were 23,319 participants. Indicators that D-QSC was present varied and included relatedness, having a sense of belonging, and connecting to similar people. However, despite the variation, most of the indicators were associated with improved outcomes for depression and anxiety. Negative interactions, loneliness, and feeling ignored indicated that D-QSC was not present. In 24% (10/42) of the applicable studies, a meta-analysis showed a significant decrease in depression (-25.6%, 95% CI -0.352 to -0.160; P<.001) and anxiety (-15.1%, 95% CI -0.251 to -0.051; P=.003) after a D-QSC. Digital mechanisms that helped create a quality connection included anonymity, confidentiality, and peer support. In contrast, mechanisms that hindered the connection included disconnection from the real world and inability to see body language. Data synthesis also identified a 5-component conceptual framework of D-QSC that included rapport, identity and commonality, valued interpersonal dynamic, engagement, and responded to and accepted. CONCLUSIONS: D-QSC is an important and underconsidered component for youth depression and anxiety outcomes. Researchers and developers should consider targeting improved QSC between clinicians and young people within digital interventions for depression. Future research should build on our framework to further examine relationships among individual attributes of QSC, various digital interventions, and different populations.


Subject(s)
Anxiety Disorders , Depression , Adolescent , Anxiety/therapy , Depression/therapy , Humans , Loneliness , Mental Health
2.
J Cyst Fibros ; 20 Suppl 3: 31-38, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1587346

ABSTRACT

BACKGROUND: Depression and anxiety are two to four times more prevalent in people with CF (pwCF) than the general population. COVID-19 may exacerbate mental health challenges, increasing demand for psychological services, while decreasing their availability. We assessed the impact of the pandemic on depression and anxiety in pwCF, including how COVID-19 affected the frequency of mental health screening and the types of services provided. METHODS: A 38-item internet survey, completed in June 2020, assessed how COVID-19 affected: 1) the mental health clinician's role and screening processes; 2) barriers to screening and resource needs; 3) impact of COVID-19 on depression and anxiety, and 4) positive outcomes and confidence in sustaining mental health screening and treatment, including telehealth services, after the pandemic. RESULTS: Responses were obtained from 131 of the 289 US CF programs. Overall, 60% of programs (n=79) continued mental health screening and treatment, although less frequently; 50% provided individual tele-mental health interventions, and 9% provided telehealth group therapy. Clinically elevated depression symptoms (PHQ-9≥10; moderate to severe), were found in 12% of 785 pwCF, with 3.1% endorsing suicidal ideation. Similarly, elevated anxiety (moderate to severe; GAD-7≥10) was found in 13% of pwCF (n=779). CONCLUSIONS: The COVID-19 pandemic created an opportunity to implement innovative solutions to disruptions in mental health screening and treatment in CF programs. We found that pwCF had increased access to psychological interventions during the pandemic via telehealth, supporting the continued integration of tele-mental health screening and treatment into CF care.


Subject(s)
Anxiety , COVID-19 , Cystic Fibrosis , Depression , Mental Health , Psychosocial Intervention , Telemedicine , Anxiety/diagnosis , Anxiety/physiopathology , Anxiety/therapy , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Cystic Fibrosis/epidemiology , Cystic Fibrosis/psychology , Cystic Fibrosis/therapy , Delivery of Health Care/methods , Delivery of Health Care/trends , Depression/diagnosis , Depression/physiopathology , Depression/therapy , Health Services Accessibility/standards , Health Services Accessibility/statistics & numerical data , Humans , Mass Screening/methods , Needs Assessment , Psychosocial Intervention/methods , Psychosocial Intervention/trends , Psychosocial Support Systems , SARS-CoV-2 , Surveys and Questionnaires , Telemedicine/methods , Telemedicine/organization & administration , United States/epidemiology
3.
Int J Environ Res Public Health ; 18(24)2021 12 09.
Article in English | MEDLINE | ID: covidwho-1572446

ABSTRACT

Introduction: Face-to-face therapy is unavailable to many young people with mental health difficulties in the UK. Internet-based treatments are a low-cost, flexible, and accessible option that may be acceptable to young people. This pilot study examined the feasibility, acceptability and effectiveness of an English-language adaptation of internet-based psychodynamic treatment (iPDT) for depressed adolescents, undertaken during the COVID-19 pandemic in the UK. Methods: A single-group, uncontrolled design was used. A total of 23 adolescents, 16-18 years old and experiencing depression, were recruited to this study. Assessments were made at baseline and end of treatment, with additional weekly assessments of depression and anxiety symptoms. Results: Findings showed that it was feasible to recruit to this study during the pandemic, and to deliver the iPDT model with a good level of treatment acceptability. A statistically significant reduction in depressive symptoms and emotion dysregulation was found, with large effect size, by the end of treatment. Whilst anxiety symptoms decreased, this did not reach statistical significance. Conclusions: The findings suggest that this English-language adaptation of iPDT, with some further revisions, is feasible to deliver and acceptable for adolescents with depression. Preliminary data indicate that iPDT appears to be effective in reducing depressive symptoms in adolescents.


Subject(s)
COVID-19 , Depression , Pandemics , Adolescent , COVID-19/psychology , Depression/epidemiology , Depression/therapy , Humans , Internet , Pilot Projects , United Kingdom
4.
Psychol Bull ; 147(8): 749-786, 2021 08.
Article in English | MEDLINE | ID: covidwho-1569212

ABSTRACT

The high global prevalence of depression, together with the recent acceleration of remote care owing to the COVID-19 pandemic, has prompted increased interest in the efficacy of digital interventions for the treatment of depression. We provide a summary of the latest evidence base for digital interventions in the treatment of depression based on the largest study sample to date. A systematic literature search identified 83 studies (N = 15,530) that randomly allocated participants to a digital intervention for depression versus an active or inactive control condition. Overall heterogeneity was very high (I2 = 84%). Using a random-effects multilevel metaregression model, we found a significant medium overall effect size of digital interventions compared with all control conditions (g = .52). Subgroup analyses revealed significant differences between interventions and different control conditions (WLC: g = .70; attention: g = .36; TAU: g = .31), significantly higher effect sizes in interventions that involved human therapeutic guidance (g = .63) compared with self-help interventions (g = .34), and significantly lower effect sizes for effectiveness trials (g = .30) compared with efficacy trials (g = .59). We found no significant difference in outcomes between smartphone-based apps and computer- and Internet-based interventions and no significant difference between human-guided digital interventions and face-to-face psychotherapy for depression, although the number of studies in both comparisons was low. Findings from the current meta-analysis provide evidence for the efficacy and effectiveness of digital interventions for the treatment of depression for a variety of populations. However, reported effect sizes may be exaggerated because of publication bias, and compliance with digital interventions outside of highly controlled settings remains a significant challenge. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Subject(s)
COVID-19 , Depression , Depression/therapy , Humans , Pandemics , SARS-CoV-2
5.
Psychiatr Danub ; 33(3): 411-417, 2021.
Article in English | MEDLINE | ID: covidwho-1527118

ABSTRACT

BACKGROUND: To investigate the intervention effect of dance therapy based on the Satir Model on the mental health of adolescents with depression during the COVID-19 epidemic. SUBJECTS AND METHODS: A total of 62 adolescents with depression were selected using Symptom Checklist 90 and randomly divided into two groups according to the matching of male and female participants; the experiment group had 32 members and the control group had 30 members. The experiment group received group psychological intervention and dance therapy based on the Satir Model, whereas the control group was not given any intervention. RESULTS: After the intervention, the scores of the experiment group in anxiety and depression are lower than those prior to intervention (p<0.01) and of the control group (p<0.01); the scores of the experiment group in life satisfaction, psychological resilience and their dimensions are higher than those prior to intervention (p<0.01) and higher than those of the control group (p<0.01). CONCLUSIONS: The combination of group intervention and dance therapy based on the Satir Model is a feasible method to effectively alleviate adolescents' anxiety and depression, promote their life satisfaction and psychological resilience, and thus improve their mental health.


Subject(s)
COVID-19 , Dance Therapy , Epidemics , Adolescent , Anxiety , Depression/epidemiology , Depression/therapy , Female , Humans , Male , Mental Health , SARS-CoV-2
6.
Eur J Psychotraumatol ; 12(1): 1984049, 2021.
Article in English | MEDLINE | ID: covidwho-1506934

ABSTRACT

Background: Frontline healthcare workers, recovered COVID+ patients who had severe illness, and close others of COVID+ patients who have recovered or died are at risk for clinical levels of mental health symptoms in the context of the COVID-19 pandemic. RESTORE (Recovering from Extreme Stressors Through Online Resources and E-health) was specifically designed for this context. RESTORE is a transdiagnostic guided online intervention adapted from evidence-based cognitive-behavioural therapies. Objectives: RESTORE was designed to address depression, anxiety, and posttraumatic stress disorder symptoms associated with exposure to COVID-19-related traumatic and extreme stressors, and to overcome multiple barriers to accessing psychotherapies. Method: This paper describes the intervention components and platform, as well as the principles used to develop RESTORE. Current research and future directions in developing and testing RESTORE are outlined. Results: Preliminary data from an initial uncontrolled trial evaluating RESTORE in frontline healthcare workers is highly promising. Conclusion: We believe RESTORE has great potential to provide accessible, evidence-based psychological intervention to those in great need.


Antecedentes: Los trabajadores de salud de primera línea, los pacientes de COVID positivo recuperados que tenían una enfermedad grave y las personas cercanas a los pacientes de COVID positivo que se han recuperado o fallecido están en riesgo de presentar niveles clínicos de síntomas de salud mental en el contexto de la pandemia de COVID-19. RESTORE (por sus siglas en inglés: Recovering from Extreme Stressors Through Online Resources and E-health: Recuperación de estresores extremos a través de recursos en línea y salud electrónica) fue diseñada específicamente para este contexto. RESTORE es una intervención en línea guiada transdiagnóstica adaptada de terapias cognitivo-conductuales basadas en la evidencia.Objetivos: RESTORE fue diseñado para abordar la depresión, la ansiedad y los síntomas del trastorno de estrés postraumático asociados con la exposición a factores estresantes traumáticos y extremos relacionados con COVID-19, y para superar múltiples barreras para acceder a psicoterapias.Método: Este artículo describe los componentes y la plataforma de la intervención, así como los principios utilizados para desarrollar RESTORE. Se describen las investigaciones actuales y las direcciones futuras para desarrollar y testear RESTORE.Resultados: Los datos preliminares de un ensayo inicial no controlado que evalúa RESTORE en trabajadores de salud de primera línea son muy prometedores.Conclusión: Creemos que RESTORE tiene un gran potencial para brindar una intervención psicológica accesible y basada en la evidencia a quienes más lo necesitan.背景: 在 COVID-19 疫情背景下, 一线医护人员, 重症 COVID+ 康复患者以及已康复或死亡的 COVID+ 患者的其他亲友都有出现临床心理健康症状的风险。 RESTORE (通过在线资源和电子健康从极端应激源中恢复) 专为这种情况而设计。 RESTORE 是一种改编自循证认知行为疗法的跨诊断指导的在线干预。目的: RESTORE 旨在致力于 COVID-19 相关创伤性和极端应激源暴露相关的抑郁, 焦虑和创伤后应激障碍症状, 并克服心理治疗可得性的多种障碍。方法: 本文介绍了干预组成和平台, 以及用于开发RESTORE的原则。概述了开发和测试 RESTORE 的当前研究和未来方向。结果: 来自评估一线医护人员 RESTORE 的初始非对照试验的初步数据大有前景。结论: 我们相信 RESTORE 有很大的潜力为急需帮助者提供易得, 询证的心理干预。.


Subject(s)
Anxiety/therapy , COVID-19/psychology , Cognitive Behavioral Therapy , Depression/therapy , Health Personnel/psychology , Internet-Based Intervention , Stress Disorders, Post-Traumatic/therapy , Anxiety/psychology , COVID-19/epidemiology , Depression/psychology , Humans , Mental Health , Pandemics , SARS-CoV-2 , Stress Disorders, Post-Traumatic/psychology
7.
BMJ Open ; 11(10): e053971, 2021 10 25.
Article in English | MEDLINE | ID: covidwho-1484035

ABSTRACT

INTRODUCTION: Approximately 30% of people with long-term physical health conditions (LTCs) experience mental health problems, with negative consequences and costs for individuals and healthcare services. Access to psychological treatment is scarce and, when available, often focuses on treating primary mental health problems rather than illness-related anxiety/depression. The aim of this study is to evaluate the clinical efficacy of a newly developed, therapist-supported, digital cognitive-behavioural treatment (COMPASS) for reducing LTC-related psychological distress (anxiety/depression), compared with standard charity support (SCS). METHODS AND ANALYSIS: A two-arm, parallel-group randomised controlled trial (1:1 ratio) with nested qualitative study will be conducted. Two-hundred adults with LTC-related anxiety and depression will be recruited through national LTC charities. They will be randomly allocated to receive COMPASS or SCS only. An independent administrator will use Qualtrics randomiser for treatment allocation, to ensure allocation concealment. Participants will access treatment from home over 10 weeks. The COMPASS group will have access to the digital programme and six therapist contacts: one welcome message and five fortnightly phone calls. Data will be collected online at baseline, 6 weeks and 12 weeks post-randomisation for primary outcome (Patient Health Questionnaire Anxiety and Depression Scale) and secondary outcomes (anxiety, depression, daily functioning, COVID-19-related distress, illness-related distress, quality of life, knowledge and confidence for illness self-management, symptom severity and improvement). Analyses will be conducted following the intention-to-treat principle by a data analyst blinded to treatment allocation. A purposively sampled group of COMPASS participants and therapists will be interviewed. Interviews will be thematically analysed. ETHICS AND DISSEMINATION: The study is approved by King's College London's Psychiatry, Nursing and Midwifery Research Ethics Subcommittee (reference: LRS-19/20-20347). All participants will provide informed consent to take part if eligible. Findings will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER: NCT04535778.


Subject(s)
COVID-19 , Cognitive Behavioral Therapy , Adult , Anxiety/therapy , Depression/therapy , Humans , Quality of Life , Randomized Controlled Trials as Topic , SARS-CoV-2 , Treatment Outcome
8.
Anat Rec (Hoboken) ; 304(11): 2566-2578, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1460147

ABSTRACT

COVID-19 (coronavirus) has spread all over the world with a high infection rate. Currently, there are no targeted therapeutic drugs for COVID-19 as well as for stress induced by COVID-19. The unpredictable events of COVID-19 can trigger feelings of fear, worry, or unease in people, leading to stress-related disorders such as depression and anxiety. It has been reported that individuals, including COVID-19 patients, medical staff, and ordinary people, are under both physical and psychological pressure, and many of them have developed depression or anxiety during this pandemic. Traditional Chinese medicine (TCM) has been widely used in treating depression with relatively better safety and efficacy and may have an important role in treating stress-related disorders induced by COVID-19. In this review, we collected the common TCM treatment methods including Qigong, Acupuncture, Five Elements Musical Therapy, Five Elements Emotional Therapy, and Chinese herbal medicine from the databases of PubMed and the China National Knowledge Internet to illustrate the effect of TCM on depression. The better knowledge of TCM and implementation of TCM in COVID-19 clinics may help to effectively improve depression induced by COVID-19, may assist people to maintain a healthy physical and mental quality, and may alleviate the current shortage of medical resources.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Depression/epidemiology , Depression/therapy , Medicine, Chinese Traditional/methods , Acupuncture Therapy/methods , Drugs, Chinese Herbal/therapeutic use , Humans , Qigong/methods , Treatment Outcome
9.
J Pediatr Psychol ; 46(8): 912-914, 2021 08 19.
Article in English | MEDLINE | ID: covidwho-1455326
10.
Psychiatry Res ; 305: 114222, 2021 11.
Article in English | MEDLINE | ID: covidwho-1433745

ABSTRACT

The COVID-19 pandemic has had adverse mental health effects for many groups in British society, especially young adults and university students. The present study reports secondary outcomes (i.e., symptoms of anxiety and depression) from a randomized waitlist controlled trial, with a one-month post-intervention follow-up, on the effects of a guided, eight-week mindfulness program delivered online during the COVID-19 pandemic among students at the University of Oxford. Longitudinal multilevel models showed greater reductions in anxiety but not depression symptoms for participants in the mindfulness condition relative to participants in the waitlist control condition (time X group B=-0.36, p=.025).


Subject(s)
COVID-19 , Mindfulness , Anxiety/therapy , Depression/therapy , Humans , Pandemics , SARS-CoV-2 , Students , Universities , Young Adult
11.
Yearb Med Inform ; 30(1): 172-175, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1392952

ABSTRACT

OBJECTIVES: To summarize research contributions published in 2020 in the field of clinical decision support systems (CDSS) and computerized provider order entry (CPOE), and select the best papers for the Decision Support section of the International Medical Informatics Association (IMIA) Yearbook 2021. METHODS: Two bibliographic databases were searched for papers referring to clinical decision support systems. From search results, section editors established a list of candidate best papers, which were then peer-reviewed by seven external reviewers. The IMIA Yearbook editorial committee finally selected the best papers on the basis of all reviews including the section editors' evaluation. RESULTS: A total of 1,919 articles were retrieved. 15 best paper candidates were selected, the reviews of which resulted in the selection of two best papers. One paper reports on the use of electronic health records to support a public health response to the COVID-19 pandemic in the United States. The second paper proposes a combination of CDSS and telemedicine as a technology-based intervention to improve the outcomes of depression as part of a cluster trial. CONCLUSIONS: As shown by the number and the variety of works related to clinical decision support, research in the field is very active. This year's selection highlighted the application of CDSS to fight COVID-19 and a combined technology-based strategy to improve the treatment of depression.


Subject(s)
Decision Support Systems, Clinical , Medical Order Entry Systems , Telemedicine , COVID-19 , Depression/therapy , Humans
12.
J Affect Disord ; 295: 316-322, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1370556

ABSTRACT

BACKGROUND: Decades of research indicate that when social connectedness is threatened, mental health is at risk. However, extant interventions to tackle loneliness have had only modest success, and none have been trialled under conditions of such threat. METHOD: 174 young people with depression and loneliness were randomised to one of two evidence-based treatments: cognitive behaviour therapy (CBT) or Groups 4 Health (G4H), an intervention designed to increase social group belonging. Depression, loneliness, and well-being outcomes were evaluated at one-year follow-up; COVID-19 lockdown restrictions were imposed partway through follow-up assessments. This provided a quasi-experimental test of the utility of each intervention in the presence (lockdown group) and absence (control group) of a threat to social connectedness. RESULTS: At one-year follow-up, participants in lockdown reported significantly poorer wellbeing than controls who completed follow-up before lockdown, t(152)=2.41, p=.017. Although both CBT and G4H led to symptom improvement, the benefits of G4H were more robust following an unanticipated threat to social connectedness for depression (χ2(16)=31.35, p=.001), loneliness (χ2(8)=21.622, p=.006), and wellbeing (χ2(8)=22.938, p=.003). LIMITATIONS: Because the COVID-19 lockdown was unanticipated, this analysis represents an opportunistic use of available data. As a result, we could not measure the specific impact of restrictions on participants, such as reduced income, degree of isolation, or health-related anxieties. CONCLUSIONS: G4H delivered one year prior to COVID-19 lockdown offered greater protection than CBT against relapse of loneliness and depression symptoms. Implications are discussed with a focus on how these benefits might be extended to other life stressors and transitions.


Subject(s)
COVID-19 , Loneliness , Adolescent , Communicable Disease Control , Depression/therapy , Humans , Mental Health , SARS-CoV-2
13.
Medicine (Baltimore) ; 100(32): e26898, 2021 Aug 13.
Article in English | MEDLINE | ID: covidwho-1358519

ABSTRACT

ABSTRACT: To investigate the anxiety and depression of patients with the coronavirus disease 2019 (COVID-19) who participated in Baduanjin exercise.From February 20, 2020 to March 7, 2020, the Hospital Anxiety and Depression scale (HAD) were used to investigate the anxiety and depression levels of patients with COVID-19 who participated in Baduanjin exercise. Ninety one questionnaires were received, including 40 males and 51 females. Stepwise regression analysis was used to analyze the effects of related factors on anxiety and depression levels.In Square cabin hospital, 91% of patients participated in Baduanjin exercise had no obvious anxiety and 82% had no obvious depression. The scores of anxiety and depression of female patients were significantly higher than that of male patients. Bachelor degree or above with low scores for anxiety and depression. The frequency of Baduanjin exercise was negatively correlated with anxiety and depression score.The development of Baduanjin exercise has a certain positive influence on the COVID-19 patients in the Square cabin hospital, which is conducive to alleviate anxiety and depression symptoms of the patients.


Subject(s)
Anxiety/therapy , COVID-19/complications , Depression/therapy , Exercise Therapy/standards , Adult , Anxiety/psychology , COVID-19/psychology , Cross-Sectional Studies , Depression/psychology , Exercise Therapy/methods , Exercise Therapy/statistics & numerical data , Female , Humans , Male , Middle Aged , Psychometrics/instrumentation , Psychometrics/methods , Surveys and Questionnaires
14.
PLoS One ; 16(8): e0255594, 2021.
Article in English | MEDLINE | ID: covidwho-1344156

ABSTRACT

INTRODUCTION: Implementation of evidence-based care for heavy drinking and depression remains low in global health systems. We tested the impact of providing community support, training, and clinical packages of varied intensity on depression screening and management for heavy drinking patients in Latin American primary healthcare. MATERIALS AND METHODS: Quasi-experimental study involving 58 primary healthcare units in Colombia, Mexico and Peru randomized to receive: (1) usual care (control); (2) training using a brief clinical package; (3) community support plus training using a brief clinical package; (4) community support plus training using a standard clinical package. Outcomes were proportion of: (1) heavy drinking patients screened for depression; (2) screen-positive patients receiving appropriate support; (3) all consulting patients screened for depression, irrespective of drinking status. RESULTS: 550/615 identified heavy drinkers were screened for depression (89.4%). 147/230 patients screening positive for depression received appropriate support (64%). Amongst identified heavy drinkers, adjusting for country, sex, age and provider profession, provision of community support and training had no impact on depression activity rates. Intensity of clinical package also did not affect delivery rates, with comparable performance for brief and standard versions. However, amongst all consulting patients, training providers resulted in significantly higher rates of alcohol measurement and in turn higher depression screening rates; 2.7 times higher compared to those not trained. CONCLUSIONS: Training using a brief clinical package increased depression screening rates in Latin American primary healthcare. It is not possible to determine the effectiveness of community support on depression activity rates due to the impact of COVID-19.


Subject(s)
Alcohol Drinking/psychology , Alcoholics/psychology , Depression/therapy , Adult , Alcohol Drinking/adverse effects , Alcohol Drinking/prevention & control , Alcoholic Intoxication/psychology , Alcoholism/diagnosis , Colombia/epidemiology , Comorbidity , Delivery of Health Care , Depression/psychology , Depressive Disorder/psychology , Depressive Disorder/therapy , Female , Humans , Male , Mass Screening/methods , Mexico/epidemiology , Middle Aged , Peru/epidemiology , Primary Health Care/methods , Primary Health Care/trends , Referral and Consultation , Substance Abuse Detection/methods
15.
Int J Environ Res Public Health ; 18(15)2021 08 02.
Article in English | MEDLINE | ID: covidwho-1335089

ABSTRACT

The aim of this study is to investigate the effectiveness of a novel self-administered at-home daily virtual reality (VR)-based intervention (COVID Feel Good) for reducing the psychological burden experienced during the COVID-19 lockdown in Italy. A total of 40 individuals who had experienced at least two months of strict social distancing measures followed COVID Feel Good between June and July 2020 for one week. Primary outcome measures were depression, anxiety, and stress symptoms, perceived stress levels, and hopelessness. Secondary outcomes were the experienced social connectedness and the level of fear experienced during the COVID-19 pandemic. Linear mixed-effects models were fitted to evaluate the effectiveness of the intervention. Additionally, we also performed a clinical change analysis on primary outcome measures. As concerning primary outcome measures, participants exhibited improvements from baseline to post-intervention for depression levels, stress levels, general distress, and perceived stress (all p < 0.05) but not for the perceived hopelessness (p = 0.110). Results for the secondary outcomes indicated an increase in social connectedness from T0 to T1 (p = 0.033) but not a significant reduction in the perceived fear of coronavirus (p = 0.412). Among these study variables, these significant improvements were maintained from post-intervention to the 2-week follow-up (p > 0.05). Results indicated that the intervention was associated with good clinical outcomes, low-to-no risks for the treatment, and no adverse effects or risks. Globally, evidence suggests a beneficial effect of the proposed protocol and its current availability in 12 different languages makes COVID Feel Good a free choice for helping individuals worldwide to cope with the psychological distress associated with the COVID-19 crisis, although large scale trials are needed to evaluate its efficacy.


Subject(s)
COVID-19 , Psychological Distress , Virtual Reality , Communicable Disease Control , Depression/therapy , Follow-Up Studies , Humans , Pandemics , SARS-CoV-2 , Stress, Psychological/therapy
16.
J Med Internet Res ; 23(7): e27619, 2021 07 30.
Article in English | MEDLINE | ID: covidwho-1334871

ABSTRACT

BACKGROUND: Mental health disorders affect 1 in 10 people globally, of whom approximately 300 million are affected by depression. At least half of the people affected by depression remain untreated. Although cognitive behavioral therapy (CBT) is an effective treatment, access to mental health specialists, habitually challenging, has worsened because of the COVID-19 pandemic. Internet-based CBT is an effective and feasible strategy to increase access to treatment for people with depression. Mental health apps may further assist in facilitating self-management for people affected by depression; however, accessing the correct app may be cumbersome given the large number and wide variety of apps offered by public app marketplaces. OBJECTIVE: This study aims to systematically assess the features, functionality, data security, and congruence with evidence of self-guided CBT-based apps targeting users affected by depression that are available in major app stores. METHODS: We conducted a systematic assessment of self-guided CBT-based apps available in Google Play and the Apple App Store. Apps launched or updated since August 2018 were identified through a systematic search in the 42matters database using CBT-related terms. Apps meeting the inclusion criteria were downloaded and assessed using a Samsung Galaxy J7 Pro (Android 9) and iPhone 7 (iOS 13.3.1). Apps were appraised using a 182-question checklist developed by the research team, assessing their general characteristics, technical aspects and quality assurance, and CBT-related features, including 6 evidence-based CBT techniques (ie, psychoeducation, behavioral activation, cognitive restructuring, problem solving, relaxation, and exposure for comorbid anxiety) as informed by a CBT manual, CBT competence framework, and a literature review of internet-based CBT clinical trial protocols. The results were reported as a narrative review using descriptive statistics. RESULTS: The initial search yielded 3006 apps, of which 98 met the inclusion criteria and were systematically assessed. There were 20 well-being apps; 65 mental health apps, targeting two or more common mental health disorders, including depression; and 13 depression apps. A total of 28 apps offered at least four evidence-based CBT techniques, particularly depression apps. Cognitive restructuring was the most common technique, offered by 79% (77/98) of the apps. Only one-third of the apps offered suicide risk management resources, whereas 17% (17/98) of the apps offered COVID-19-related information. Although most apps included a privacy policy, only a third of the apps presented it before account creation. In total, 82% (74/90) of privacy policies stated sharing data with third-party service providers. Half of the app development teams included academic institutions or health care providers. CONCLUSIONS: Only a few self-guided CBT-based apps offer comprehensive CBT programs or suicide risk management resources. Sharing of users' data is widespread, highlighting shortcomings in health app market governance. To fulfill their potential, self-guided CBT-based apps should follow evidence-based clinical guidelines, be patient centered, and enhance users' data security.


Subject(s)
COVID-19 , Cognitive Behavioral Therapy , Mobile Applications , Telemedicine , Depression/therapy , Humans , Pandemics , SARS-CoV-2
17.
Int J Environ Res Public Health ; 18(14)2021 07 20.
Article in English | MEDLINE | ID: covidwho-1323255

ABSTRACT

AIMS: Previous research has shown the efficacy of culturally adapted Cognitive Behavioral Therapy (CA-CBT) in reducing depression, yet its effect on increasing sexual satisfaction is not well documented. In this study, an embedded randomized controlled trial design was used to examine the effect of group and individual CA-CBT on depression and sexual satisfaction among perimenopausal women. METHOD: A total of 64 depressed Iranian perimenopausal women were randomly assigned to two formats of treatments; sixteen sessions of group CA-CBT and eight sessions of individual CA-CBT, as well as a waitlist control group. Depression and sexual satisfaction were measured using BDI-II and ENRICH, respectively, at T1 (pre-treatment), T2 (post-treatment) and T3 (follow-up). RESULTS: Repeated measures ANOVA indicated that the women who underwent both group and individual CA-CBT had effectively reduced depression and increased sexual satisfaction between pre-treatment and post-treatment, and it was sustained after six months of follow-ups with large effect sizes of significant differences (p < 0.001), but the control group did not. CONCLUSION: The results showed promising evidence for the efficacy of both treatment groups of CA-CBT for depression and sexual satisfaction among perimenopausal women. The population mental health burden among perimenopausal women may likely be reduced by propagating this effective treatment.


Subject(s)
Cognitive Behavioral Therapy , Depression , Depression/therapy , Female , Humans , Iran , Orgasm , Perimenopause , Treatment Outcome
18.
PLoS Med ; 18(6): e1003625, 2021 06.
Article in English | MEDLINE | ID: covidwho-1315879

ABSTRACT

John Naslund and Eirini Karyotaki discuss Mark Jordans and colleagues' accompanying research study on therapy for people with psychological distress in Nepal.


Subject(s)
Depression , Psychological Distress , Depression/diagnosis , Depression/epidemiology , Depression/therapy , Emergencies , Humans , Nepal , Stress, Psychological/therapy
19.
PLoS Med ; 18(6): e1003621, 2021 06.
Article in English | MEDLINE | ID: covidwho-1315878

ABSTRACT

BACKGROUND: Globally, 235 million people are impacted by humanitarian emergencies worldwide, presenting increased risk of experiencing a mental disorder. Our objective was to test the effectiveness of a brief group psychological treatment delivered by trained facilitators without prior professional mental health training in a disaster-prone setting. METHODS AND FINDINGS: We conducted a cluster randomized controlled trial (cRCT) from November 25, 2018 through September 30, 2019. Participants in both arms were assessed at baseline, midline (7 weeks post-baseline, which was approximately 1 week after treatment in the experimental arm), and endline (20 weeks post-baseline, which was approximately 3 months posttreatment). The intervention was Group Problem Management Plus (PM+), a psychological treatment of 5 weekly sessions, which was compared with enhanced usual care (EUC) consisting of a family psychoeducation meeting with a referral option to primary care providers trained in mental healthcare. The setting was 72 wards (geographic unit of clustering) in eastern Nepal, with 1 PM+ group per ward in the treatment arm. Wards were eligible if they were in disaster-prone regions and residents spoke Nepali. Wards were assigned to study arms based on covariate constrained randomization. Eligible participants were adult women and men 18 years of age and older who met screening criteria for psychological distress and functional impairment. Outcomes were measured at the participant level, with assessors blinded to group assignment. The primary outcome was psychological distress assessed with the General Health Questionnaire (GHQ-12). Secondary outcomes included depression symptoms, posttraumatic stress disorder (PTSD) symptoms, "heart-mind" problems, social support, somatic symptoms, and functional impairment. The hypothesized mediator was skill use aligned with the treatment's mechanisms of action. A total of 324 participants were enrolled in the control arm (36 wards) and 319 in the Group PM+ arm (36 wards). The overall sample (N = 611) had a median age of 45 years (range 18-91 years), 82% of participants were female, 50% had recently experienced a natural disaster, and 31% had a chronic physical illness. Endline assessments were completed by 302 participants in the control arm (36 wards) and 303 participants in the Group PM+ arm (36 wards). At the midline assessment (immediately after Group PM+ in the experimental arm), mean GHQ-12 total score was 2.7 units lower in Group PM+ compared to control (95% CI: 1.7, 3.7, p < 0.001), with standardized mean difference (SMD) of -0.4 (95% CI: -0.5, -0.2). At 3 months posttreatment (primary endpoint), mean GHQ-12 total score was 1.4 units lower in Group PM+ compared to control (95% CI: 0.3, 2.5, p = 0.014), with SMD of -0.2 (95% CI: -0.4, 0.0). Among the secondary outcomes, Group PM+ was associated with endline with a larger proportion attaining more than 50% reduction in depression symptoms (29.9% of Group PM+ arm versus 17.3% of control arm, risk ratio = 1.7, 95% CI: 1.2, 2.4, p = 0.002). Fewer participants in the Group PM+ arm continued to have "heart-mind" problems at endline (58.8%) compared to the control arm (69.4%), risk ratio = 0.8 (95% CI, 0.7, 1.0, p = 0.042). Group PM+ was not associated with lower PTSD symptoms or functional impairment. Use of psychosocial skills at midline was estimated to explain 31% of the PM+ effect on endline GHQ-12 scores. Adverse events in the control arm included 1 suicide death and 1 reportable incidence of domestic violence; in the Group PM+ arm, there was 1 death due to physical illness. Study limitations include lack of power to evaluate gender-specific effects, lack of long-term outcomes (e.g., 12 months posttreatment), and lack of cost-effectiveness information. CONCLUSIONS: In this study, we found that a 5-session group psychological treatment delivered by nonspecialists modestly reduced psychological distress and depression symptoms in a setting prone to humanitarian emergencies. Benefits were partly explained by the degree of psychosocial skill use in daily life. To improve the treatment benefit, future implementation should focus on approaches to enhance skill use by PM+ participants. TRIAL REGISTRATION: ClinicalTrials.gov NCT03747055.


Subject(s)
Depression/therapy , Mental Health , Natural Disasters , Problem Solving , Psychotherapy, Brief , Psychotherapy, Group , Relief Work , Stress Disorders, Post-Traumatic/therapy , Stress, Psychological/therapy , Adaptation, Psychological , Adolescent , Adult , Aged , Aged, 80 and over , Depression/diagnosis , Depression/etiology , Depression/psychology , Female , Functional Status , Humans , Male , Middle Aged , Nepal , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/psychology , Stress, Psychological/diagnosis , Stress, Psychological/etiology , Stress, Psychological/psychology , Time Factors , Treatment Outcome , Young Adult
20.
Transl Behav Med ; 11(9): 1691-1698, 2021 09 15.
Article in English | MEDLINE | ID: covidwho-1303938

ABSTRACT

More than one third of adults in the United States (U.S.) live with multiple chronic conditions that affect their physical and mental health, functional outcomes, independence, and mortality. The COVID-19 pandemic has exposed not only an increased risk for infection, morbidity, and mortality among those with chronic conditions but long-standing health inequities by age, race, sex, and other social determinants. Obesity plus depression represent one such prevalent comorbidity for which few effective integrated interventions exist, prompting concern about the potential for secondary physical and mental health pandemics post COVID-19. Translational behavioral medicine research can play an important role in studying integrated collaborative healthcare approaches and advancing scientific understanding on how to engage and more effectively treat diverse populations with physical and mental health comorbidities. The RAINBOW (Research Aimed at Improving Both Mood and Weight) clinical trial experience offers a wealth of insights into the potential of collaborative care interventions to advance behavior therapy research and practice. Primary care patients with co-occurring obesity and depression were assigned to either Integrated Coaching for Mood and Weight (I-CARE), which blended Group Lifestyle Balance (GLB) for weight management and the Program to Encourage Active Rewarding Lives (PEARLS) for depression, or usual care, to examine clinical, cost-effectiveness, and implementation outcomes. This commentary highlights the empirical findings of eight RAINBOW research papers and discusses implications for future studies, including their relevance in the U.S. COVID-19 context. Organized by key principles of translational behavioral medicine research, the commentary aims to examine and embrace the heterogeneity of baseline and intervention response differences among those living with multiple chronic conditions. We conclude that to prevent health and healthcare disparities from widening further, tailored engagement, dissemination, and implementation strategies and flexible delivery formats are essential to improve treatment access and outcomes among underrepresented populations.


Subject(s)
COVID-19 , Health Equity , Behavior Therapy , Depression/therapy , Humans , Obesity/epidemiology , Obesity/therapy , Pandemics , SARS-CoV-2 , United States/epidemiology
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