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INTRODUCTION: Evidence on effects of Internet-based interventions to treat subthreshold depression (sD) and prevent the onset of major depression (MDD) is inconsistent. OBJECTIVE: We conducted an individual participant data meta-analysis to determine differences between intervention and control groups (IG, CG) in depressive symptom severity (DSS), treatment response, close to symptom-free status, symptom deterioration and MDD onset as well as moderators of intervention outcomes. METHODS: Randomized controlled trials were identified through systematic searches via PubMed, PsycINFO, Embase and Cochrane Library. Multilevel regression analyses were used to examine efficacy and moderators. RESULTS: Seven trials (2,186 participants) were included. The IG was superior in DSS at all measurement points (posttreatment: 6-12 weeks; Hedges' g = 0.39 [95% CI: 0.25-0.53]; follow-up 1: 3-6 months; g = 0.30 [95% CI: 0.15-0.45]; follow-up 2: 12 months, g = 0.27 [95% CI: 0.07-0.47], compared with the CG. Significantly more participants in the IG than in the CG reached response and close to symptom-free status at all measurement points. A significant difference in symptom deterioration between the groups was found at the posttreatment assessment and follow-up 2. Incidence rates for MDD onset within 12 months were lower in the IG (19%) than in the CG (26%). Higher initial DSS and older age were identified as moderators of intervention effect on DSS. CONCLUSIONS: Our findings provide evidence for Internet-based interventions to be a suitable low-threshold intervention to treat individuals with sD and to reduce the incidence of MDD. This might be particularly true for older people with a substantial symptom burden.
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Transtorno Depressivo Maior , Intervenção Baseada em Internet , Adulto , Idoso , Depressão , Transtorno Depressivo Maior/terapia , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: The use of psychotropic drugs for depression during pregnancy has increased over the past decades, but it is unclear whether women are becoming more depressed over time. METHODS: We investigated the occurrence of depressive symptoms during pregnancy in four cohorts (N 300-2000) in the same area in the Netherlands over a period of 25 years using a similar study design. Depressive symptoms were assessed using the Edinburgh Depression Scale (EDS) at various time points during pregnancy. Demographics, lifestyle factors, obstetric characteristics and EDS scores were compared between the four cohorts. RESULTS: From 1988 to 2014, Mean EDS scores during the first and third trimester of pregnancy increased significantly (P < 0.001). The number of women with elevated EDS scores doubled from 7% in 1988-1989 to 14% in 2012-2014 (Pâ¯=â¯0.001). The number of highly educated women increased from 23% to 66% and those with paid employment from 75% to 95%, while smoking and alcohol use decreased significantly (all Ps < 0.001). These trends were similar to those of the National Statistics. A previous history of depression, multi-parity and paid employment were associated with higher EDS scores. LIMITATIONS: Women were highly educated, predominantly Caucasian and had a partner. CONCLUSIONS: Paradoxically, there was a significant increase in depressive symptomatology during pregnancy over a period of 25 years, while protective factors for depression during pregnancy improved. Potential explanations could be greater awareness, high societal expectations, use of social media or the stressful combination of paid work and children at home.
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Comorbidade/tendências , Depressão/epidemiologia , Complicações na Gravidez/epidemiologia , Adulto , Estudos de Coortes , Depressão/diagnóstico , Feminino , Humanos , Estilo de Vida , Países Baixos/epidemiologia , Gravidez , Complicações na Gravidez/psicologia , Escalas de Graduação Psiquiátrica , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: No validated instruments for the evaluation of patient satisfaction in colposcopy do exist. Therefore, this study reports on the development of a Patient's Experience and Attitude to Colposcopy questionnaire. METHODS: Patients who recently received colposcopy participated in a focus group. A panel of experts evaluated the transcriptions and agreed on a 15-item draft questionnaire. The draft questionnaire was completed by 68 women who subsequently came for a colposcopy. For construct validation, Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were performed as well as reliability analysis. Concurrent validity was assessed with the 4-item Patient Health questionnaire (PHQ-4). RESULTS: Construct validation resulted in an 8-item patient perception scale with good psychometric properties (Cronbach's alpha: 0.76) and excellent model fit. Two subscales could be discriminated: patient procedure perception scale (alpha: 0.89) and caregiver attitude perception scale (alpha: 0.71). Both subscales intercorrelated moderately (r = 0.28, p = 0.045). The subscale patient perception correlated significantly with the PHQ-4 scale and its anxiety subscale, not with the depression subscale. CONCLUSIONS: We developed a Patient's Experience and Attitude to Colposcopy questionnaire with adequate psychometric properties. Future application in out-patient clinics should further evaluate its clinical relevance.
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Colposcopia/normas , Satisfação do Paciente , Inquéritos e Questionários/normas , Adulto , Idoso , Ansiedade/psicologia , Colposcopia/psicologia , Análise Fatorial , Feminino , Grupos Focais , Humanos , Pessoa de Meia-Idade , Países Baixos , Psicometria , Reprodutibilidade dos TestesRESUMO
OBJECTIVES: The prevalence of maternal stress in early years of parenting can negatively impact child development. Therefore, there is a need for an early intervention that is easily accessible and low in costs. The current study examined the effectiveness of an 8-session online mindful parenting training for mothers with elevated levels of parental stress. METHODS: A total of 76 mothers were randomized into an intervention (n = 43) or a waitlist control group (n = 33). The intervention group completed pretest assessment prior to the online intervention. Participants completed a post intervention assessment after the 10 weeks intervention and a follow-up assessment 10 weeks later. The waitlist group completed waitlist assessment, followed by a 10-week waitlist period. After these 10 weeks, a pretest assessment took place, after which the waitlist group participants also started the intervention, followed by the posttest assessment. Participating mothers completed questionnaires on parental stress (parent-child interaction problems, parenting problems, parental role restriction) and other maternal (over-reactive parenting discipline, self-compassion, symptoms of depression and anxiety) and child outcomes (aggressive behavior and emotional reactivity) while the non-participating parents (father or another mother) were asked to also report on child outcomes. RESULTS: The online mindful parenting intervention was shown to be significantly more effective at a 95% level than a waitlist period with regard to over-reactive parenting discipline and symptoms of depression and anxiety (small and medium effect sizes), and significantly more effective at a 90% level with regard to self-compassion, and mother-rated child aggressive behavior and child emotional reactivity (small effect sizes). The primary outcome, parental stress, was found to have a 95% significant within-group effect only for the subscale parental role restriction (delayed small effect size improvement at follow-up). No significant improvements on child outcomes were found for the non-participating parent. CONCLUSION: To conclude, the results provide first evidence that an online mindful parenting training may be an easily accessible and valuable intervention for mothers with elevated levels of parental stress.
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BACKGROUND: Type D personality is associated with unfavorable outcomes in patients with cardiovascular diseases (CVD). However, there is no valid Type D Scale in Russian language. The purpose of the study was to examine the factor structure of a new Russian version of 14-item Type D Scale (DS14-RU), and to evaluate the reliability and construct validity of the DS14-RU in clinical research. METHODS: The study included 929 participants, 496 (53.4%) of which had coronary artery disease, 195 (21.0%) congestive heart failure, 84 (9.0%) arterial hypertension and 154 (16.6%) were relatively healthy volunteers. The mean age was 57.5 years, 565 (60.8%) participants were males. The respondents filled out an extended Russian version of the Type D scale and new DS14-RU, as well as the Hospital Anxiety and Depression Scale, Multidimensional Scale of Perceived Social Support, Reeder Stress Inventory, and State-Trait Personality Inventory. RESULTS: The new Russian version of DS14-RU was internally consistent with Cronbach's α = .80 for both the negative affectivity and social inhibition subscales. The prevalence of Type D personality, as measured with the DS14-RU, was 21.4% among patients with CVD, and 20.0% among relatively healthy participants. The mean scores for anxiety, depression, psychosocial stress and anger were significantly higher in patients with Type D personality and they had significantly lower levels of social support and curiosity. CONCLUSIONS: The new DS14-RU is consistent with the original DS14 in terms of reliability, factor structure and construct validity. The DS14-RU can be used for the reliable assessment of Type D in Russian-speaking respondents.
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Doenças Cardiovasculares/psicologia , Determinação da Personalidade , Personalidade Tipo D , População Branca/psicologia , Adulto , Afeto , Idoso , Idoso de 80 Anos ou mais , Ira , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Ansiedade/psicologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etnologia , Estudos de Casos e Controles , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/psicologia , Comportamento Exploratório , Feminino , Humanos , Inibição Psicológica , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Prognóstico , Reprodutibilidade dos Testes , Federação Russa , Comportamento Social , Apoio Social , Estresse Psicológico/diagnóstico , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia , Adulto JovemRESUMO
BACKGROUND: Knowledge of the level of healthcare utilization (HCU) and the predictors of high HCU use in patients with an implantable cardioverter defibrillator (ICD) is lacking. We examined the level of HCU and predictors associated with increased HCU in first-time ICD patients, using a prospective study design. METHODS: ICD patients (N = 201) completed a set of questionnaires at baseline and 3, 6, and 12 months after inclusion. A hierarchical multiple linear regression with three models was performed to examine predictors of HCU. RESULTS: HCU was highest between baseline and 3 months postimplantation and gradually decreased during 12 months follow-up. During the first year postimplantation, only depression (ß = 0.342, P = 0.002) was a significant predictor. Between baseline and 3 months follow-up, younger age (ß = -0.220, P < 0.01), New York Heart Association class III/IV (ß = 0.705, P = 0.01), and secondary indication (ß = 0.148, P = 0.05) were independent predictors for increased HCU. Between 3 and 6 months follow-up, younger age (ß = -0.151, P = 0.05) and depression (ß = 0.370, P < 0.001) predicted increased HCU. Between 6 and 12 months only depression (ß = 0.355, P = 0.001) remained a significant predictor. CONCLUSIONS: Depression was an important predictor of increased HCU in ICD patients in the first year postimplantation, particularly after 3 months postimplantation. Identifying patients who need additional care and provide this on time might better meet patients' needs and lower future HCU.
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Desfibriladores Implantáveis , Aceitação pelo Paciente de Cuidados de Saúde , Ansiedade/diagnóstico , Desfibriladores Implantáveis/psicologia , Depressão/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inventário de Personalidade , Estudos Prospectivos , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To examine whether individual differences in Type D personality (combination of negative affectivity (NA) and social inhibition (SI)) could explain heterogeneity in perceived social support and relationship adjustment (intimate partner relationship) among people living with diabetes. DESIGN: In the Diabetes MILES-The Netherlands survey, 621 adults with type 1 or type 2 diabetes (54% female, age: 56 ± 14 years) completed measures of Type D personality (DS14), perceived social support and relationship adjustment. We used established DS14 cut-off scores to indicate Type D personality, high NA only, high SI only and reference groups. RESULTS: Participants from the Type D and NA only groups perceived lower levels of social support (Welch[3,259] = 37.27, p < 0.001), and relationship adjustment (Welch[3,191] = 14.74; p < 0.01) than those from the SI only and reference groups. Type D was associated with lower social support (lowest quartile; adjusted OR = 8.73; 95%CI = 5.05 â¼ 15.09; p < 0.001) and lower relationship adjustment (lowest quartile; adjusted OR = 3.70; 95%CI = 2.10 â¼ 6.53; p < 0.001). Type D was also associated with increased levels of loneliness. CONCLUSION: Participants with Type D and participants with high NA only tend to experience less social support and less relationship adjustment. Type D personality was also associated with more loneliness. Experiencing lower social support and relationship adjustment may complicate coping and self-management in people with diabetes.
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Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 2/psicologia , Relações Interpessoais , Personalidade Tipo D , Adaptação Psicológica , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Apoio Social , Cônjuges/psicologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Both adverse early life-events and distressed personality are associated with an increased cardiovascular risk. As there is an important link between these psychological factors, we investigated how these might cluster in sex-specific psychological profiles. We further examined the association of these profiles with cardiovascular risk markers. METHOD: 446 women (mean ageâ¯=â¯49.8⯱â¯17.9â¯years) and 431 men (mean ageâ¯=â¯49.4⯱â¯17.5â¯years) from the Dutch general population completed questionnaires on demographics, adverse early life-events (ETI), Type D personality (DS14), anxiety (GAD-7) and depressive (PHQ-9) symptoms, and traditional cardiovascular risk markers. RESULTS: A step-3 latent profile analysis identified three profiles in women (Reference, Type D & trauma, and Type D/no trauma) and four in men (Reference, Type D & trauma, Type D/no trauma, and Physical abuse). In women, the Type D/no trauma was associated with highest levels of emotional symptoms (ORâ¯=â¯2.47; 95% CI: 2.11-2.89), lipid abnormalities (ORâ¯=â¯3.69; 95% CI: 1.47-9.27), and increased levels of alcohol use (ORâ¯=â¯3.63; 95% CI: 1.42-9.30). The Type D & trauma profile was associated with increased levels of emotional symptoms (ORâ¯=â¯2.03; 95% CI: 1.70-2.42), highest levels of smoking (ORâ¯=â¯3.30; 95% CI: 1.21-8.97) and alcohol use (ORâ¯=â¯7.63; 95% CI: 2.86-20.33). Women in both profiles were older as compared to the Reference group (ORâ¯=â¯1.03; 95% CI: 1.01-1.05). In men, the Type D & trauma profile was associated with increased levels of emotional symptoms (ORâ¯=â¯1.11; 95% CI: 1.03-1.20). There were no significant differences between the profiles in lifestyle factors and cardiometabolic factors. CONCLUSIONS: In women, the Type D/no trauma profile and the Type D & trauma profile were associated with a specific combination of cardiovascular risk markers. In men, the Type D & trauma profile was associated with an increased level of emotional symptoms.
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Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/psicologia , Trauma Psicológico/epidemiologia , Trauma Psicológico/psicologia , Caracteres Sexuais , Personalidade Tipo D , Adulto , Experiências Adversas da Infância/tendências , Idoso , Doenças Cardiovasculares/diagnóstico , Estudos Transversais , Emoções/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Trauma Psicológico/diagnóstico , Fatores de Risco , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Little is known about potential harmful effects as a consequence of self-guided internet-based cognitive behaviour therapy (iCBT), such as symptom deterioration rates. Thus, safety concerns remain and hamper the implementation of self-guided iCBT into clinical practice. We aimed to conduct an individual participant data (IPD) meta-analysis to determine the prevalence of clinically significant deterioration (symptom worsening) in adults with depressive symptoms who received self-guided iCBT compared with control conditions. Several socio-demographic, clinical and study-level variables were tested as potential moderators of deterioration. METHODS: Randomised controlled trials that reported results of self-guided iCBT compared with control conditions in adults with symptoms of depression were selected. Mixed effects models with participants nested within studies were used to examine possible clinically significant deterioration rates. RESULTS: Thirteen out of 16 eligible trials were included in the present IPD meta-analysis. Of the 3805 participants analysed, 7.2% showed clinically significant deterioration (5.8% and 9.1% of participants in the intervention and control groups, respectively). Participants in self-guided iCBT were less likely to deteriorate (OR 0.62, p < 0.001) compared with control conditions. None of the examined participant- and study-level moderators were significantly associated with deterioration rates. CONCLUSIONS: Self-guided iCBT has a lower rate of negative outcomes on symptoms than control conditions and could be a first step treatment approach for adult depression as well as an alternative to watchful waiting in general practice.
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Terapia Cognitivo-Comportamental , Depressão/terapia , Transtorno Depressivo/terapia , Internet , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Telemedicina , HumanosRESUMO
OBJECTIVES: Mindfulness skills have been associated with better mood and several health related outcomes. Because depressed mood during pregnancy has been related to worse child outcomes, the aim was to examine the association of mindfulness skills during pregnancy with the mother's depressive symptoms, gestational age, and neonatal birth weight. METHODS: A subsample of 905 pregnant women who participated in the longitudinal cohort HAPPY study (Holistic Approach to Pregnancy and the first Postpartum Year) completed the 12-item Three Facet Mindfulness-Questionnaire-Short Form at 22weeks of gestation. The Edinburgh Depression Scale was completed to assess depressive symptoms at 12, 22 and 32weeks. The obstetric medical records were examined for gestational age and birth weight. RESULTS: Mindfulness skills Acting with Awareness and Nonjudging at 22weeks were associated with less depressive symptoms at 22weeks and at 32weeks. When controlled for depressive symptoms at 22weeks, the association was still significant for Nonjudging predicting depressive symptoms at 32weeks (Beta=-0.12, p<0.01). Regarding the obstetric medical records, only Nonreacting was (positively) associated with birth weight (Beta=0.09, p<0.01). Controlling for gestational age, sex, parity, depressive symptoms, and health behavior, Nonreacting predicted a normal birth weight (OR=1.12, 95% CI=1.06-1.19), in contrast to low birth weight. CONCLUSION: It seems that different mindfulness skills during pregnancy are important in predicting mother's depressive symptoms compared to the prediction of child's birth weight. Potential mechanisms are discussed.
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Afeto , Peso ao Nascer , Atenção Plena , Mães/psicologia , Adulto , Parto Obstétrico/psicologia , Depressão/psicologia , Feminino , Humanos , Recém-Nascido , Estudos Longitudinais , Período Pós-Parto/psicologia , Gravidez , Complicações na Gravidez/psicologia , Escalas de Graduação Psiquiátrica , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Carpal tunnel syndrome (CTS) is a common, compressive nerve-entrapment disorder with symptoms of numbness, paresthesia, and pain. Carpal tunnel release surgery is the only known long-term effective treatment. However, surgery is invasive and up to 30% of patients report recurrence or persistence of symptoms or suffer from post-surgical complications. A promising non-surgical treatment for CTS is mechanical wrist traction. The purpose of this study was to evaluate clinical outcomes following mechanical traction in patients with CTS compared to care as usual. METHODS: Adult patients (N = 181, mean age 58.1 (13.0) years, 67% women) with electrodiagnostically confirmed CTS were recruited from an outpatient neurology clinic in the Netherlands between October 2013 and April 2015. After baseline assessments, patients were randomized to either the intervention group (12 treatments with mechanical traction, twice a week for a period of 6 weeks) or "care as usual". The main clinical outcome measure was surgery during 6 months' follow-up. In addition, symptom severity was measured using the Boston Carpal Tunnel Questionnaire (BCTQ) at baseline, 3, and 6 months' follow-up. Baseline characteristics and severity of CTS symptoms at follow-up were compared between the intervention and care-as-usual groups using a t test and χ 2 tests. Time to event (surgery) between the groups was analyzed using Kaplan-Meier survival analysis and Cox proportional hazards analysis. RESULTS: The intervention group had fewer surgeries (28%) compared to the care-as-usual group (43%) during follow-up (χ21 = 4.40, p = .036). Analyses of the survival curves revealed a statistically significant difference between the groups over time (log-rank test χ 21 = 6.94, p = .008). At 6 months' follow-up, symptom severity and functional status scores had significantly decreased from baseline in both groups (p < .001) and the improvements did not differ between the two groups. CONCLUSIONS: Mechanical traction is associated with fewer surgical interventions compared to care as usual in CTS patients. Reductions in patient-reported symptoms at 6 months' follow-up was similar in both groups. The long-term effects of mechanical traction require further evaluation. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NL44692.008.13 . Registered on 19 September 2013.
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Síndrome do Túnel Carpal/terapia , Tração/métodos , Articulação do Punho/fisiopatologia , Adulto , Idoso , Fenômenos Biomecânicos , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/fisiopatologia , Síndrome do Túnel Carpal/cirurgia , Distribuição de Qui-Quadrado , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Países Baixos , Modelos de Riscos Proporcionais , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Inquéritos e Questionários , Fatores de Tempo , Tração/efeitos adversos , Resultado do Tratamento , Articulação do Punho/cirurgiaRESUMO
Recently, the US Preventive Services Task Force has advocated to screen pregnant and postpartum women for depression. However, we questioned the meaning of a single elevated depression score: does it represent just one episode of depression or do these symptoms persist throughout the entire pregnancy? This study assessed depressive symptoms at each trimester in a cohort of 1813 pregnant women and evaluated whether women with different patterns of depressive symptoms showed other characteristics. Depending on the trimester, elevated depression scores were prevalent in 10-15% of the pregnant women. Up to 4% reported persistent symptoms of depression throughout pregnancy. Different patterns of depressive symptoms were observed, for which persistent symptoms were related to other characteristics than incidentally elevated symptoms. Besides a previous history of mental health problems as best overall predictor, incidentally elevated depression scores were related to major life events. Furthermore, persistently depressive symptoms were related to unplanned pregnancy and multiparity. An EDS assessment at 12 weeks of gestation including three additional items (history of mental health problems, unplanned pregnancy and multiparity) enabled us to identify 83% of the women with persistent depressive symptoms. A depression screening strategy in pregnant women should take into account the potential chronicity of depressive symptoms by repeated assessments in order to offer an intervention to the most vulnerable women.
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Depressão/epidemiologia , Complicações na Gravidez/psicologia , Trimestres da Gravidez/psicologia , Gestantes/psicologia , Adolescente , Estudos de Coortes , Depressão/diagnóstico , Depressão/psicologia , Feminino , Humanos , Programas de Rastreamento , Países Baixos/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Primeiro Trimestre da Gravidez/psicologia , Segundo Trimestre da Gravidez/psicologia , Terceiro Trimestre da Gravidez/psicologia , Prevalência , Escalas de Graduação Psiquiátrica , Fatores de Risco , Adulto JovemAssuntos
Síndrome do Túnel Carpal/fisiopatologia , Dor Crônica/etiologia , Depressão/etiologia , Complicações na Gravidez/fisiopatologia , Transtornos Psicomotores/etiologia , Adulto , Síndrome do Túnel Carpal/complicações , Síndrome do Túnel Carpal/epidemiologia , Síndrome do Túnel Carpal/psicologia , Dor Crônica/complicações , Dor Crônica/epidemiologia , Dor Crônica/fisiopatologia , Estudos de Coortes , Depressão/complicações , Depressão/epidemiologia , Depressão/psicologia , Depressão Pós-Parto/complicações , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/etiologia , Depressão Pós-Parto/psicologia , Transtorno Depressivo/complicações , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/etiologia , Transtorno Depressivo/psicologia , Feminino , Seguimentos , Humanos , Países Baixos , Período Pós-Parto , Gravidez , Complicações na Gravidez/psicologia , Prevalência , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Transtornos Psicomotores/complicações , Transtornos Psicomotores/epidemiologia , Transtornos Psicomotores/fisiopatologia , Autorrelato , Índice de Gravidade de Doença , Adulto JovemRESUMO
IMPORTANCE: Self-guided internet-based cognitive behavioral therapy (iCBT) has the potential to increase access and availability of evidence-based therapy and reduce the cost of depression treatment. OBJECTIVES: To estimate the effect of self-guided iCBT in treating adults with depressive symptoms compared with controls and evaluate the moderating effects of treatment outcome and response. DATA SOURCES: A total of 13â¯384 abstracts were retrieved through a systematic literature search in PubMed, Embase, PsycINFO, and Cochrane Library from database inception to January 1, 2016. STUDY SELECTION: Randomized clinical trials in which self-guided iCBT was compared with a control (usual care, waiting list, or attention control) in individuals with symptoms of depression. DATA EXTRACTION AND SYNTHESIS: Primary authors provided individual participant data from 3876 participants from 13 of 16 eligible studies. Missing data were handled using multiple imputations. Mixed-effects models with participants nested within studies were used to examine treatment outcomes and moderators. MAIN OUTCOMES AND MEASURES: Outcomes included the Beck Depression Inventory, Center for Epidemiological Studies-Depression Scale, and 9-item Patient Health Questionnaire scores. Scales were standardized across the pool of the included studies. RESULTS: Of the 3876 study participants, the mean (SD) age was 42.0 (11.7) years, 2531 (66.0%) of 3832 were female, 1368 (53.1%) of 2574 completed secondary education, and 2262 (71.9%) of 3146 were employed. Self-guided iCBT was significantly more effective than controls on depressive symptoms severity (ß = -0.21; Hedges g = 0.27) and treatment response (ß = 0.53; odds ratio, 1.95; 95% CI, 1.52-2.50; number needed to treat, 8). Adherence to treatment was associated with lower depressive symptoms (ß = -0.19; P = .001) and greater response to treatment (ß = 0.90; P < .001). None of the examined participant and study-level variables moderated treatment outcomes. CONCLUSIONS AND RELEVANCE: Self-guided iCBT is effective in treating depressive symptoms. The use of meta-analyses of individual participant data provides substantial evidence for clinical and policy decision making because self-guided iCBT can be considered as an evidence-based first-step approach in treating symptoms of depression. Several limitations of the iCBT should be addressed before it can be disseminated into routine care.
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Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo/terapia , Internet , Terapia Assistida por Computador/métodos , Adulto , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
On July 17, 2014, Malaysia Airlines flight MH17 was shot down, a tragedy that shocked the Dutch population. As part of a large longitudinal survey on mental health in pregnant women that had a study inclusion period of 19 months, we were able to evaluate the possible association of that incident with mood changes using pre- and postdisaster data. We compared mean Edinburgh Depression Scale (EDS) scores from a group of women (n = 126 cases) at 32 weeks' gestation during the first month after the crash with mean scores from a control group (n = 102) with similar characteristics who completed the EDS at 32 weeks' gestation during the same summer period in 2013. The mean EDS scores of the 126 case women in the first month after the crash were significantly higher than the scores of 102 control women. There were no differences in mean EDS scores between the 2 groups at the first and second trimesters. The present study is among the first in which perinatal mental health before and after the occurrence of a disaster has been investigated, and the results suggest that national disasters might lead to emotional responses.
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Aeronaves , Depressão/epidemiologia , Desastres , Complicações na Gravidez/epidemiologia , Gestantes/psicologia , Adulto , Feminino , Humanos , Acontecimentos que Mudam a Vida , Saúde Mental , Países Baixos , Gravidez , Terceiro Trimestre da Gravidez , Escalas de Graduação Psiquiátrica , Fatores de RiscoRESUMO
BACKGROUND: Rapid cycling mood symptoms during the first postpartum week are an important aspect of maternity blues. The aim of this study is to identify women with these rapid cycling mood symptoms in the general population and to investigate possible risk factors of these symptoms. METHODS: The Maternity Blues Scale (MBS) was validated in The Netherlands in 949 women at one week postpartum. Personal and family history of mood disorders and obstetric demographics were collected and the Edinburgh Postnatal Depression Scale (EPDS) was completed. A 16-item three-factor MBS solution was found: depression, negative and positive affect. The latter two were used to define a rapid cycling mood symptoms group. RESULTS: Using the 75th percentile cut-off, 20 (2%) women reported high negative/high positive affect (rapid cycling mood group) and 65 (7%) women were depressed (EPDS≥11). A previous episode of depression, major life events and instrumental delivery were independently related to depression (OR 3.5, 2.5 and 2.3, respectively) while only a history of depression in first-degree relatives was independently related to rapid cycling mood (OR 3.4, 95% CI 1.2-9.8). Limitations First, no syndromal diagnoses were obtained for depression and rapid cycling mood disorder. Second, history of depression was self-reported (not based on structural psychiatric interviews). Third, our study was not designed to study the longitudinal follow-up of women with rapid cycling mood symptoms. Conclusion the 16-item MBS could be useful in screening programs in detecting postpartum women at risk for (severe) mood disorders. Postpartum women with 'rapid cycling mood symptoms' can be identified with a possible more familiar form of mood disorder.
Assuntos
Depressão Pós-Parto/epidemiologia , Transtornos do Humor/epidemiologia , Adulto , Comorbidade , Depressão Pós-Parto/psicologia , Feminino , Humanos , Transtornos do Humor/psicologia , Países Baixos/epidemiologia , Gravidez , Fatores de Risco , Inquéritos e Questionários , Adulto JovemRESUMO
UNLABELLED: The Web-based distress management program for patients with an implantable cardioverter-defibrillator (ICD; WEBCARE) was developed to mitigate distress and enhance health-related quality of life in ICD patients. This study investigated the treatment effectiveness at 3-month follow-up for generic and disease-specific outcome measures. METHODS: Consecutive patients implanted with a first-time ICD from six hospitals in the Netherlands were randomized to either the "WEBCARE" or the "usual care" group. Patients in the WEBCARE group received a 12-week fixed, six-lesson behavioral treatment based on the problem-solving principles of cognitive behavioral therapy. RESULTS: Two hundred eighty-nine patients (85% response rate) were randomized. The prevalence of anxiety and depression ranged between 11% and 30% and 13% and 21%, respectively. No significant intervention effects were observed for anxiety (ß = 0.35; p = .32), depression (ß = -0.01; p = .98) or health-related quality of life (Mental Component Scale: ß = 0.19; p = .86; Physical Component Scale: ß = 0.58; p = .60) at 3 months, with effect sizes (Cohen d) being small (range, 0.06-0.13). There were also no significant group differences as measured with the disease-specific measures device acceptance (ß = -0.37; p = .82), shock anxiety (ß = 0.21; p = .70), and ICD-related concerns (ß = -0.08; p = .90). No differences between treatment completers and noncompleters were observed on any of the measures. CONCLUSIONS: In this Web-based intervention trial, no significant intervention effects on anxiety, depression, health-related quality of life, device acceptance, shock anxiety, or ICD-related concerns were observed. A more patient tailored approach targeting the needs of different subsets of ICD patients may be warranted. TRIAL REGISTRATION: clinicaltrials.gov. Identifier: NCT00895700.
Assuntos
Terapia Cognitivo-Comportamental/métodos , Desfibriladores Implantáveis/psicologia , Estresse Psicológico/prevenção & controle , Telemedicina/métodos , Ansiedade/epidemiologia , Ansiedade/terapia , Depressão/epidemiologia , Depressão/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Escalas de Graduação Psiquiátrica , Qualidade de Vida/psicologia , Estresse Psicológico/etiologia , Estresse Psicológico/psicologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Self-efficacy beliefs are an important determinant of (changes in) health behaviors. In the area of smoking cessation, there is a need for a short, feasible, and validated questionnaire measuring self-efficacy beliefs regarding smoking cessation. PURPOSE: The purpose of this study is to investigate the psychometric properties of a six-item questionnaire to assess smoking cessation self-efficacy. METHODS: We used longitudinal data from a smoking cessation study. A total of 513 smokers completed the Smoking Abstinence Self-efficacy Questionnaire (SASEQ) and questionnaires assessing depressive symptoms and motivation to quit smoking. After that, they set a quit date and attempted to stop smoking. One year after the quit date, smoking status of participants was assessed by self report. The psychometric properties of the SASEQ were studied and we investigated whether SASEQ scores predicted successful smoking cessation. RESULTS: Factor analysis yielded one factor, with an Eigenvalue of 3.83, explaining 64% of variance. All factor loadings were ≥0.73. We found a Cronbach's alpha of 0.89 for the SASEQ, low correlations for the SASEQ with depressive symptoms, and motivation to quit, indicating that self-efficacy is measured independently of these concepts. Furthermore, high baseline SASEQ scores significantly predicted smoking abstinence at 52 weeks after the quit date (OR = 1.85; 95% CI = 1.20~2.84). CONCLUSIONS: The SASEQ appeared to be a short, reliable, and valid questionnaire to assess self-efficacy beliefs regarding smoking abstinence. In the present study, this instrument also had good predictive validity. The short SASEQ can easily be used in busy clinical practice to guide smoking cessation interventions.
Assuntos
Autoeficácia , Abandono do Hábito de Fumar/psicologia , Fumar/psicologia , Inquéritos e Questionários/normas , Tabagismo/psicologia , Adulto , Idoso , Ansiedade/psicologia , Depressão/psicologia , Análise Fatorial , Feminino , Promoção da Saúde , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Motivação , Psicometria/métodos , Psicometria/normas , Adulto JovemRESUMO
BACKGROUND: Knowledge of the factors associated with individual differences in patient-reported outcomes is essential to identify high-risk patients and improve secondary prevention. DESIGN: In this meta-analysis, we examined the association between Type D personality and the individual differences in patient-reported physical and mental health status among cardiovascular patients. METHODS: A computerized search of the literature through PUBMED and PsychINFO (from 1995 to May 2011) was performed and prospective studies were selected that analysed the association between Type D personality and health status in cardiovascular patients. Two separate meta-analyses were performed for the association of Type D personality with physical and mental health status, respectively. RESULTS: Of all identified studies, ten studies met the selection criteria. The meta-analyses showed that Type D was associated with a two-fold increased odds for impaired physical health status (3035 patients, OR 1.94, 95% CI 1.49-2.52) and a 2.5-fold increased odds for impaired mental health status (2213 patients, OR 2.55, 95% CI 1.57-4.16). There was no significant heterogeneity between the studies on physical health status (Q = 12.78; p = 0.17; I(2 )= 29.59), but there was between those on mental health status (Q = 21.91; p = 0.003; I(2 )= 68.04). Subgroup analyses showed that the association between Type D and mental health status decreased yet remained significant when adjusting for baseline health status. CONCLUSION: Type D personality was shown to be an independent correlate of impaired patient-reported physical and mental health status in various cardiovascular patient groups. Clinicians should be aware of the association between chronic psychological distress and poor patient-reported outcomes.