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Bakos B, Solymosi T, Szili B, Vincze Á, Mészáros S, Stempler M, Ármós R, Kiss A, Bakos A, Szücs N, Reismann P, Tőke J, Pusztai P, Lakatos P, Takács I. Psychological factors and obesity, not thyroid biomarkers, predict thyroid-dependent quality of life in treated hypothyroidism: a cross-sectional study. BMC Endocr Disord 2025; 25:136. [PMID: 40420021 DOI: 10.1186/s12902-025-01962-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 05/19/2025] [Indexed: 05/28/2025] Open
Abstract
BACKGROUND A significant number of patients with primary hypothyroidism report persistent symptoms and decreased quality of life (QoL) despite biochemically adequate levothyroxine replacement. Individual variations in thyroxine conversion, autoimmune inflammation, and psychological factors have all been implicated as a potential cause. METHODS In this cross-sectional study we have examined the association of numerous demographic, disease-specific, and laboratory parameters as well as three patient reported outcome measures with thyroid-dependent QoL as measured by the Underactive Thyroid-Dependent Quality of Life Questionnaire. Patients were stringently selected to minimize the confounding effect of comorbidities or inadequate hormone replacement. We used validated questionnaires to assess somatosensory amplification, depression, and symptom number. Determinants of QoL were evaluated using uni- and multivariable linear modeling, and mediation analysis. RESULTS Our final sample consisted of 157 patients. 70.7% had Hashimoto's, whereas 29.3% had iatrogenic hypothyroidism. Mean age was 49.5 ± 14.5 years, disease duration: 11.2 ± 8.2 years, thyroxine dose: 1.2 ug/kg bodyweight, TSH: 1.8 ± 0.9 mIU/L. Thyroid-specific biomarkers including TSH, FT3, FT4, rT3, SPINA-GD, anti-TPO, and SHBG had no association with thyroid-dependent QoL. Somatosensory amplification was a strong predictor of the presence and perceived bother of the most common hypothyroidism-associated symptoms. In our final multivariable model (r2 = 0.31) the factors associated with thyroid-dependent QoL were somatosensory amplification (p = 0.002), BMI (p = 0.021), and depression (p < 0.001). CONCLUSION These results suggest that psychological factors, particularly somatosensory amplification, might play a major role in influencing QoL in hypothyroid individuals on adequate levothyroxine replacement. Our findings do not corroborate a significant role for autoimmune inflammation or tissue-level hypothyroidism.
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Affiliation(s)
- Bence Bakos
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Korányi Sándor U. 2/a, Budapest, Hungary.
| | - Tibor Solymosi
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Korányi Sándor U. 2/a, Budapest, Hungary
| | - Balázs Szili
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Korányi Sándor U. 2/a, Budapest, Hungary
| | - Ágnes Vincze
- Department of Haematology and Internal Medicine, Semmelweis University, 1088 Szentkirályi U. 46, Budapest, Hungary
| | - Szilvia Mészáros
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Korányi Sándor U. 2/a, Budapest, Hungary
| | - Márk Stempler
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Korányi Sándor U. 2/a, Budapest, Hungary
| | - Richárd Ármós
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Korányi Sándor U. 2/a, Budapest, Hungary
| | - András Kiss
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Korányi Sándor U. 2/a, Budapest, Hungary
| | - Anna Bakos
- Department of Clinical Psychology, Semmelweis University, 1091 Üllői Út 25, Budapest, Hungary
| | - Nikolette Szücs
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Korányi Sándor U. 2/a, Budapest, Hungary
| | - Péter Reismann
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Korányi Sándor U. 2/a, Budapest, Hungary
| | - Judit Tőke
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Korányi Sándor U. 2/a, Budapest, Hungary
| | - Péter Pusztai
- Department of Haematology and Internal Medicine, Semmelweis University, 1088 Szentkirályi U. 46, Budapest, Hungary
| | - Péter Lakatos
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Korányi Sándor U. 2/a, Budapest, Hungary
| | - István Takács
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Korányi Sándor U. 2/a, Budapest, Hungary
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Schachtner JN, Dahill-Fuchel JF, Allen KE, Bawiec CR, Hollender PJ, Ornellas SB, Konecky SD, Achrol AS, Allen JJB. Transcranial focused ultrasound targeting the default mode network for the treatment of depression. Front Psychiatry 2025; 16:1451828. [PMID: 40256163 PMCID: PMC12006932 DOI: 10.3389/fpsyt.2025.1451828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 02/26/2025] [Indexed: 04/22/2025] Open
Abstract
Introduction Up to 50% of individuals fail to respond to current depression treatments. Repetitive negative thought and default mode network hyperconnectivity are central in depression and can potentially be targeted using novel neuromodulation techniques. This community-based study assessed whether a treatment using non-invasive transcranial focused ultrasound targeting the default mode network can decrease depression symptoms and repetitive negative thought, and improve quality of life. Methods Study recruitment began in August 2023 and ended in February 2024. Twenty individuals aged 18 - 50 were enrolled from among 247 screened. Exclusion criteria included history of psychosis/mania, acute suicidality, MRI contraindications, pregnancy, and medical and neurological factors that may complicate diagnosis or brain function. Participants completed up to three weeks of transcranial ultrasound (11 sessions) targeting the anterior medial prefrontal cortex; ten minutes per session. Depression severity (Beck Depression Inventory - II and the Hamilton Depression Rating Scale), repetitive negative thought (Perseverative Thinking Questionnaire), and quality of life (World Health Organization Quality of Life Scale) were outcomes. Results This sample was young (mean 30.4 years ± 10.0), predominantly female (75%), with moderate to severe depression and high comorbidity. Fifty percent of participants endorsed current psychiatric medication use. Ten percent of subjects dropped out of the study due to time constraints. Significant decreases in depression were observed over the course of treatment on self-report, 10.9 (p < 0.001, CI = -13.55, -7.92) and interview depression ratings, 4.2 (p < 0.001, CI = -5.85, -2.62), as well as significant decreases in repetitive negative thought, 8.4 (p <0.001, CI = -10.55, -6.03). Improvements in physical and psychological well-being were also observed over the course of treatment, 7.2 (p < 0.001, CI = 3.64, 10.63) and 11.2 (p < 0.001, CI = 7.79, 14.49), respectively, as well as improvements in environment satisfaction, 5.0 (p =0.001, CI = 2.24, 7.56). Discussion Non-invasive transcranial focused ultrasound holds promise as a treatment for depression holds promise as a treatment for depression, however, future work including control arms is required to ascertain its causal role in depression. Clinical trial registration https://clinicaltrials.gov/study/NCT06320028intr=Ultrasound&cond=depression&locStr=Arizona&country=United%20States&state=Arizona&rank=1, identifier NCT06320028.
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Affiliation(s)
- Jessica N. Schachtner
- Psychology Department, Psychophysiology Lab, University of Arizona, Tucson, AZ, United States
| | - Jacob F. Dahill-Fuchel
- Psychology Department, Psychophysiology Lab, University of Arizona, Tucson, AZ, United States
| | - Katja E. Allen
- Psychology Department, Psychophysiology Lab, University of Arizona, Tucson, AZ, United States
| | | | | | | | | | | | - John J. B. Allen
- Psychology Department, Psychophysiology Lab, University of Arizona, Tucson, AZ, United States
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Peipert A, Adams S, Lorenzo-Luaces L. Heterogeneity in Item Content of Quality of Life Assessments Used in Depression Psychotherapy Research. Assessment 2025:10731911251326399. [PMID: 40130506 DOI: 10.1177/10731911251326399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2025]
Abstract
Quality of life (QOL) broadly encompasses constructs including health, well-being, life satisfaction, and psychosocial functioning. Depression, a major cause of global disability, is linked to lower QOL. Despite the rise of measurement-based care and patient-reported outcomes, there is no consensus on QOL definitions or models, resulting in varied assessments. This study aims to describe the item content overlap among commonly used QOL measures in depression research. We analyzed 10 QOL measures from a meta-analysis, calculating Jaccard indices to quantify overlap, and used two coding approaches: one for similarly worded items and another for exact word matches. We also categorized items into broader themes. At the most, average Jaccard similarity was M = 0.14 (SD = 0.12), indicating significant heterogeneity among QOL measures in depression. This suggests that QOL outcomes may not be reproducible across different scales. Future research should examine the relationships between the content assessed by various QOL measures.
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Gülpen J, Breedvelt JJ, van Dis EA, Geurtsen GJ, Warren FC, van Heeringen C, Hitchcock C, Holländare F, Huijbers MJ, Jarrett RB, Jermann F, de Jonge M, Klein DN, Klein NS, Ma SH, Moore MT, Denys DA, Williams JMG, Kuyken W, Bockting CL. Psychological interventions for preventing relapse in individuals with partial remission of depression: a systematic review and individual participant data meta-analysis. Psychol Med 2025; 55:e50. [PMID: 39957508 PMCID: PMC12080647 DOI: 10.1017/s0033291725000157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 12/16/2024] [Accepted: 01/22/2025] [Indexed: 02/18/2025]
Abstract
Partial remission after major depressive disorder (MDD) is common and a robust predictor of relapse. However, it remains unclear to which extent preventive psychological interventions reduce depressive symptomatology and relapse risk after partial remission. We aimed to identify variables predicting relapse and to determine whether, and for whom, psychological interventions are effective in preventing relapse, reducing (residual) depressive symptoms, and increasing quality of life among individuals in partial remission. This preregistered (CRD42023463468) systematic review and individual participant data meta-analysis (IPD-MA) pooled data from 16 randomized controlled trials (n = 705 partial remitters) comparing psychological interventions to control conditions, using 1- and 2-stage IPD-MA. Among partial remitters, baseline clinician-rated depressive symptoms (p = .005) and prior episodes (p = .012) predicted relapse. Psychological interventions were associated with reduced relapse risk over 12 months (hazard ratio [HR] = 0.60, 95% confidence interval [CI] 0.43-0.84), and significantly lowered posttreatment depressive symptoms (Hedges' g = 0.29, 95% CI 0.04-0.54), with sustained effects at 60 weeks (Hedges' g = 0.33, 95% CI 0.06-0.59), compared to nonpsychological interventions. However, interventions did not significantly improve quality of life at 60 weeks (Hedges' g = 0.26, 95% CI -0.06 to 0.58). No moderators of relapse prevention efficacy were found. Men, older individuals, and those with higher baseline symptom severity experienced greater reductions in symptomatology at 60 weeks. Psychological interventions for individuals with partially remitted depression reduce relapse risk and residual symptomatology, with efficacy generalizing across patient characteristics and treatment types. This suggests that psychological interventions are a recommended treatment option for this patient population.
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Affiliation(s)
- Joost Gülpen
- Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Josefien J.F. Breedvelt
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
- King’s College London, Department of Child and Adolescent Psychiatry, Institute for Psychiatry, Psychology and Neuroscience, London, UK
| | - Eva A.M. van Dis
- Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands
| | - Gert J. Geurtsen
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC, location University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
| | - Fiona C. Warren
- Exeter Collaboration for Academic Primary Care (APEx), University of Exeter, Exeter, UK
| | - Cornelis van Heeringen
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - Caitlin Hitchcock
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Fredrik Holländare
- Department of Psychiatry, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Marloes J. Huijbers
- Department of Psychiatry, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robin B. Jarrett
- University of Texas Southwestern Medical Center, Department of Psychiatry, Dallas, Texas, USA
| | - Françoise Jermann
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Margo de Jonge
- Arkin Mental Health Institute, Amsterdam, The Netherlands
| | - Daniel N. Klein
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Nicola S. Klein
- GGZ Drenthe Mental Health Institute, Department Traumacentre, Beilen, The Netherlands
| | - S. Helen Ma
- Hong Kong Centre for Mindfulness, Hong Kong, China
| | - Michael T. Moore
- Gordon F. Derner School of Psychology, Adelphi University, Garden City, New York, USA
| | - Damiaan A.J.P. Denys
- Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | | | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Claudi L. Bockting
- Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
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Hsiao FH, Ho CC, Yu CJ, Shih JY, Lin ZZ, Huang FY, Chen YT, Hsieh CC. The Mindful Compassion Program Integrated with Body-Mind-Spirit Empowerment for Reducing Depression in Lung Cancer Patient-Caregiver Dyads. PSYCHOSOCIAL INTERVENTION 2025; 34:1-9. [PMID: 39781016 PMCID: PMC11705433 DOI: 10.5093/pi2025a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 09/30/2024] [Indexed: 01/11/2025]
Abstract
Objective: This study compared the long-term effects of a mindful compassion program on improving depression in lung cancer patients, both in patient-caregiver dyads and in patient-only groups, and examined the moderating roles of anxiety and quality of life (QOL). Method: Participants consisted of 56 dyads, who were randomly assigned to either the dyadic or patient-only groups. Data collection included various assessments at different time points: baseline (T0), end of intervention (T1), and follow-up at the 5th month (T2), 8th month (T3), and 14th month (T4). Results: Patients in the dyadic group experienced a significant reduction in depressive symptoms. The dyadic intervention was particularly beneficial for younger patients and those with higher baseline QOL symptom distress. Improvements in patients' mindfulness and self-compassion contributed to reduced depression by enhancing general health and lowering anxiety. Additionally, caregivers' self-compassion played a role in reducing patients' depression by improving patients' QOL functioning and decreasing anxiety. Conclusions: Mindfulness and compassion interventions, whether provided dyadically or individually, can be tailored to each patient's specific condition.
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Affiliation(s)
- Fei-Hsiu Hsiao
- National Taiwan UniversityCollege of MedicineSchool of NursingTaipeiTaiwanSchool of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan;
- National Taiwan University HospitalDepartment of NursingTaipeiTaiwanDepartment of Nursing, National Taiwan University Hospital, Taipei, Taiwan;
| | - Chao-Chi Ho
- National Taiwan University HospitalDepartment of Internal MedicineTaipeiTaiwanDepartment of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan;
| | - Chong-Jen Yu
- National Taiwan UniversityHospital Hsinchu BranchTaiwanNational Taiwan University, Hospital Hsinchu Branch, Taiwan;
- National Taiwan University College of MedicineDepartment of Internal MedicineTaipeiTaiwanDepartment of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan;
| | - Jin-Yuan Shih
- National Taiwan University HospitalDepartment of Internal MedicineTaipeiTaiwanDepartment of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan;
| | - Zhong-Zhe Lin
- National Taiwan University College of MedicineDepartment of Internal MedicineTaipeiTaiwanDepartment of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan;
- National Taiwan University Cancer CenterDepartment of Medical OncologyTaipeiTaiwanDepartment of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan;
| | - Feng-Ying Huang
- National Taipei University of EducationCollege of EducationDepartment of EducationTaipeiTaiwanDepartment of Education, College of Education, National Taipei University of Education, Taipei, Taiwan;
| | - Yu-Ting Chen
- Chang Gung UniversityCollege of MedicineSchool of NursingTaoyuan CityTaiwanSchool of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan;
- New Taipei Municipal TuCheng HospitalNew Taipei CityTaiwanDepartment of Psychiatry, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan;
| | - Chia-Chen Hsieh
- Taipei Medical UniversityCollege of NursingSchool of NursingTaipeiTaiwanSchool of Nursing, College of Nursing, Taipei Medical University, Taiwan
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El-Haj-Mohamad R, Stein J, Stammel N, Nesterko Y, Wagner B, Böttche M, Knaevelsrud C. Efficacy of internet-based cognitive behavioral and interpersonal treatment for depression in Arabic speaking countries: A randomized controlled trial. J Affect Disord 2025; 368:573-583. [PMID: 39293602 DOI: 10.1016/j.jad.2024.09.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 09/12/2024] [Accepted: 09/13/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND Politically and economically unstable contexts have been associated with increased prevalence rates of depression. Despite high demand, the availability of mental health experts and care systems is limited in Arabic-speaking countries. Internet-based interventions might provide an opportunity to treat patients independently of location. Therefore, we investigated the efficacy of internet-based cognitive behavioral treatment (iCBT) and interpersonal treatment (iIPT) for depression in Arabic-speaking countries. METHODS In total, 743 Arabic-speaking adults with depression were randomly allocated to iCBT (n = 243), iIPT (n = 247), or waitlist (n = 253). Depressive, anxiety, and somatoform symptoms, perceived social support and quality of life (QoL) were assessed at pre-, and post-treatment and at three months follow-up. Multiple imputation was performed for missing data. Changes associated with treatment were analyzed using regression in the completer and intention-to-treat sample. RESULTS Participants in both treatment groups showed lower depressive and anxiety symptom severity, higher QoL, and perceived social support compared to the waitlist group (p < .001). Somatoform symptom severity was significantly lower in participants receiving iIPT compared to waitlist (p < .001). Differences between the two treatments in all outcomes were non-significant (p > .05). Three-month follow-up treatment effects regarding depressive symptoms were indicated. LIMITATIONS The sample mainly consists of educated, single, female adults. Three-month follow-up results rely on a small subsample and must be interpreted with caution. CONCLUSIONS This is the first randomized controlled trial to demonstrate the efficacy of iCBT and iIPT for depression in Arabic-speaking countries. It provides first indications that internet-based interventions might help specific individuals in this region.
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Affiliation(s)
- Rayan El-Haj-Mohamad
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany; Center ÜBERLEBEN, Berlin, Germany.
| | - Jana Stein
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany; Center ÜBERLEBEN, Berlin, Germany
| | - Nadine Stammel
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Yuriy Nesterko
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany; Center ÜBERLEBEN, Berlin, Germany; Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
| | - Birgit Wagner
- Clinical Psychology and Psychotherapy, Medical School Berlin, Germany
| | - Maria Böttche
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Christine Knaevelsrud
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
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Hayasaka T, Nagashima I, Hoshino M, Teruya K, Matumoto Y, Murao M, Maruki T, Watanabe M, Katagiri T, Imamura Y, Kurihara M, Oe Y, Takaesu Y, Tsuboi T, Watanabe K, Sakurai H. Discriminant analysis of occupational performance characteristics in patients with major depressive disorders and healthy individuals. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2024; 3:e70038. [PMID: 39605926 PMCID: PMC11598739 DOI: 10.1002/pcn5.70038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 11/02/2024] [Accepted: 11/11/2024] [Indexed: 11/29/2024]
Abstract
Aim Assessing symptoms and daily functioning in patients with major depressive disorder (MDD) can be challenging, as their limited self-monitoring abilities may result in behavior observed during structured interviews not accurately reflecting their daily lives. This study aimed to determine if specific occupational behaviors could distinguish individuals with MDD from healthy individuals. Methods Baseline data were collected from medical records and activity programs. Three occupational therapists conducted content analysis to assess occupational performance characteristics. Chi-squared tests compared the prevalence of these characteristics between patients with MDD and healthy controls. Multivariable logistic regression controlled for potential confounders, with independent variables selected based on clinical relevance and sample size (p < 0.01). Discriminant analysis was used to enhance group differentiation, assessing prediction rates using area under the curve (AUC) values. Results A total of 69 occupational performance characteristics were identified, with 12 showing significant differences between 27 patients with MDD and 43 healthy controls. Key discriminators included "Ask questions and consult" (p < 0.001, odds ratio [OR] = 0.051, 95% confidence interval [CI] = 0.009-0.283), "Concentrate on work" (p = 0.003, OR = 0.078, 95% CI = 0.015-0.416), "Choose simple work" (p = 0.004, OR = 17.803, 95% CI = 2.446-129.597), and "Punctual" (p = 0.017, OR = 0.030, 95% CI = 0.002-0.530). Discriminant analysis using these variables yielded a Wilks' λ of 0.493 (p < 0.001), achieving an 88.6% accuracy rate. The receiver operating characteristic curve's AUC value was 0.911 (sensitivity = 95.3%, specificity = 77.8%). Conclusion This study highlights the importance of occupational performance characteristics in tailoring treatment strategies for MDD, providing insights beyond traditional assessment methods.
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Affiliation(s)
- Tomonari Hayasaka
- Department of RehabilitationKyorin University Faculty of Health SciencesTokyoJapan
- Department of NeuropsychiatryKyorin University Faculty of MedicineTokyoJapan
| | - Izumi Nagashima
- Department of RehabilitationKyorin University Faculty of Health SciencesTokyoJapan
- Department of NeuropsychiatryKyorin University Faculty of MedicineTokyoJapan
| | - Miku Hoshino
- Department of NeuropsychiatryKyorin University HospitalTokyoJapan
| | - Koji Teruya
- Department of Health and WelfareKyorin University Faculty of Health SciencesTokyoJapan
| | - Yasuyuki Matumoto
- Department of NeuropsychiatryKyorin University Faculty of MedicineTokyoJapan
| | - Masami Murao
- Department of NeuropsychiatryKyorin University Faculty of MedicineTokyoJapan
| | - Taku Maruki
- Department of NeuropsychiatryKyorin University Faculty of MedicineTokyoJapan
| | - Masako Watanabe
- Department of NeuropsychiatryKyorin University Faculty of MedicineTokyoJapan
| | - Takeshi Katagiri
- Department of NeuropsychiatryKyorin University Faculty of MedicineTokyoJapan
| | - Yayoi Imamura
- Department of NeuropsychiatryKyorin University Faculty of MedicineTokyoJapan
| | - Mariko Kurihara
- Department of NeuropsychiatryKyorin University Faculty of MedicineTokyoJapan
| | - Yuki Oe
- Department of NeuropsychiatryKyorin University Faculty of MedicineTokyoJapan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of MedicineUniversity of the RyukyusOkinawaJapan
| | - Takashi Tsuboi
- Department of NeuropsychiatryKyorin University Faculty of MedicineTokyoJapan
| | - Koichiro Watanabe
- Department of NeuropsychiatryKyorin University Faculty of MedicineTokyoJapan
| | - Hitoshi Sakurai
- Department of NeuropsychiatryKyorin University Faculty of MedicineTokyoJapan
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Hoa TTM, Ngan TT, Mai VQ, Van Minh H, Thu NK, Nhu TK. Health-related quality of life of people with depression: pre-post intervention compared with age-matched general population in Vietnam. BMC Psychol 2024; 12:565. [PMID: 39420390 PMCID: PMC11487768 DOI: 10.1186/s40359-024-02067-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 10/08/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND In Vietnam, there is a paucity of health-related quality of life (HRQoL) research on people with depression as well as a lack of evidence on supported self-management (SSM) intervention for depression on HRQoL. This study aimed to compare the HRQoL of people with depression and age-matched people in the Vietnamese population, evaluate the effects of Tele-SSM intervention on HRQoL, and examine the association between the changes in HRQoL score and mental health well-being (depression, anxiety, and stress). METHODS This study was a pre- and post-study involving Vietnamese adults aged 18-64 who had depression symptoms (score ≥ 5 points in the PHQ-9). Participants (N = 58) completed Tele-SSM-a supported self-management intervention incorporating cognitive behavioral therapy and non-violent communication and using a task-shifting approach. To compare with the general population, we conducted a 1-to-1 matching by age with an EQ-5D-5L valuation study with a nationally representative sample of the Vietnamese general population. RESULTS HRQoL was significantly impaired in people with depression compared to the age-matched general population. Regarding health profile, participants reported the most difficulties in usual activities, pain/discomfort, and anxiety/depression dimensions. Significant improvements were observed in HRQoL scores post-intervention compared to pre-intervention in both EQ-VAS scores (from 59.84 to 79.48) and utility scores (from 0.79 to 0.90). These results remained lower than the age-matched general population (EQ-VAS score = 83.28, utility score = 0.96). Depression was associated with lower HRQoL while controlling for stress, anxiety symptoms and sociodemographic characteristics. CONCLUSIONS These results indicate that HRQoL is significantly impaired in people with depression and contribute to providing empirical evidence of Tele-SSM intervention in improving HRQoL. Further randomized controlled trials should be conducted to evaluate the effectiveness and cost-effectiveness of the Tele-SSM intervention.
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Affiliation(s)
- Truong Thi My Hoa
- Caring From Distance Center for Research and Community Development, Hanoi, Vietnam
| | - Tran Thu Ngan
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.
| | - Vu Quynh Mai
- Centre for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam
| | - Hoang Van Minh
- Centre for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam
| | | | - Tran Kieu Nhu
- Institute for Social Development Studies, Hanoi, Vietnam
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Vernmark K, Hursti T, Blom V, Asplund RP, Nathanson E, Engelro L, Radvogin E, Andersson G. The Effects of Mindfulness-Focused Internet-Based Cognitive Behavioral Therapy on Elevated Levels of Stress and Symptoms of Exhaustion Disorder: A Randomized Controlled Trial. CLINICAL PSYCHOLOGY IN EUROPE 2024; 6:e12899. [PMID: 39678314 PMCID: PMC11636741 DOI: 10.32872/cpe.12899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 05/06/2024] [Indexed: 12/17/2024] Open
Abstract
Background Internet-based Cognitive Behavior Therapy (ICBT) and mindfulness interventions are commonly used to treat elevated levels of stress. There are however few high-quality studies that examine ICBT with integrated mindfulness components for symptoms of stress and exhaustion, and the role of mindfulness exercises in digital treatment. Method The aim of the present study was to evaluate if a mindfulness-focused ICBT-program could reduce symptoms of stress and exhaustion, and increase quality of life, in a randomized controlled trial including 97 self-referred participants between 18 and 65 years who experienced elevated levels of stress. Results The intervention group had significantly reduced symptoms of stress and exhaustion, and increased quality of life, compared to the control group. Compared with the controls, participants in the intervention group showed a significant improvement with moderate to large effects on the primary outcome measure perceived stress (d = 0.79), and the secondary outcomes, exhaustion (d = 0.65), and quality of life (d = 0.40). Participants in the ICBT group also increased their level of mindfulness (d = 0.66) during the program. The amount of mindfulness training was significantly associated with an increased level of mindfulness, which in turn was significantly associated with reduced stress symptoms. Conclusions Mindfulness-focused ICBT can be an effective method to reduce stress-related mental health problems and the amount of mindfulness training seems to be of importance to increase the level of experienced mindfulness after treatment.
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Affiliation(s)
- Kristofer Vernmark
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Timo Hursti
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Victoria Blom
- The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Robert Persson Asplund
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Elise Nathanson
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Linda Engelro
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | | | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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10
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Feng Q, Yang S, Ye S, Wan C, Wang H, You J. Mediation of depressive symptoms in the association between blood urea nitrogen to creatinine ratio and cognition among middle-aged and elderly adults: evidence from a national longitudinal cohort study. BMC Psychiatry 2024; 24:515. [PMID: 39030588 PMCID: PMC11264492 DOI: 10.1186/s12888-024-05941-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 07/01/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND The relationships between BUNCr (blood urea nitrogen and creatinine ratio) and cognitive function, as well as depressive symptoms, remain unclear. We aim to investigate the association between BUNCr and cognition, as well as depressive symptoms, and to identify the mechanisms underlying these relationships. METHODS We utilized data from the China Health and Retirement Longitudinal Study (CHARLS) from 2015 to 2020. Cognitive function was assessed using the Telephone Interview of Cognitive Status (TICS) scale, while depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). We employed multivariate linear regression models to examine the association between BUNCr and cognitive function, as well as depressive symptoms. Additionally, causal mediation analysis was conducted to identify potential mediation effects of depressive symptoms between BUNCr and cognition. RESULTS We observed a negative association between BUNCr and cognitive function (coefficient: -0.192; 95% confidence interval [CI]: -0.326 ∼ -0.059) and a positive relationship between BUNCr and depressive symptoms (coefficient: 0.145; 95% CI: 0.006 ∼ 0.285). In addition, the causal mediation analysis revealed that depressive symptoms (proportion mediated: 7.0%) significantly mediated the association between BUNCr and cognition. CONCLUSION Our study has unveiled that BUNCr is inversely associated with cognitive function and positively linked to depressive symptoms. Moreover, we found that depressive symptoms significantly mediated the association between BUNCr and cognition. These findings provide new evidence and insights for the prevention and management of cognitive function and dementia.
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Affiliation(s)
- Qiaoduan Feng
- The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Shaokun Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Shaohua Ye
- The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Can Wan
- Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Hongjian Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jinsong You
- Department of Cerebrovascular Disease, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.
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11
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Alemu WG, Due C, Muir-Cochrane E, Mwanri L, Azale T, Ziersch A. Quality of life among people living with mental illness and predictors in Africa: a systematic review and meta-analysis. Qual Life Res 2024; 33:1191-1209. [PMID: 37906348 PMCID: PMC11045618 DOI: 10.1007/s11136-023-03525-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 11/02/2023]
Abstract
INTRODUCTION Quality of life (QoL) of patients with mental illness has been examined internationally but to a lesser extent in developing countries, including countries in Africa. Improving QoL is vital to reducing disability among people with mental illness. Therefore, this systematic review and meta-analysis aimed to assess the prevalence of QoL and associated factors among people living with mental illness in Africa. METHODS Using the PICOT approach, Scopus, MEDLINE, PsycINFO, CINAHL, Embase, the Web of Science, and Google Scholar were searched. A structured search was undertaken, comprising terms associated with mental health, mental illness, QoL, and a list of all African countries. The Joanna Briggs Institute Quality Appraisal Checklist is used to evaluate research quality. Subgroup analysis with Country, domains of QoL, and diagnosis was tested using a random-effect model, and bias was assessed using a funnel plot and an inspection of Egger's regression test. A p value, OR, and 95% CI were used to demonstrate an association. RESULTS The pooled prevalence of poor QoL was 45.93% (36.04%, 55.83%), I2 = 98.6%, p < 0.001). Subgroup analysis showed that Ethiopia (48.09%; 95% CI = 33.73, 62.44), Egypt (43.51%; 95% CI = 21.84, 65.18), and Nigeria (43.49%; 95% CI = 12.25, 74.74) had the highest mean poor QoL prevalence of the countries. The pooled prevalence of poor QoL by diagnosis was as follows: bipolar disorder (69.63%; 95% CI = 47.48, 91.77), Schizophrenia (48.53%; 95% CI = 29.97, 67.11), group of mental illnesses (40.32%; 95% CI = 23.98, 56.66), and depressive disorders (38.90%; 95% CI = 22.98, 54.81). Being illiterate (3.63; 95% CI = 2.35, 4.91), having a comorbid medical illness (4.7; 95% CI = 2.75, 6.66), having a low monthly income (3.62; 95% CI = 1.96, 5.27), having positive symptoms (0.32; 95% CI = 0.19, 0.55), and having negative symptoms (0.26; 95% CI = 0.16, 0.43) were predictors of QoL. Thus, some factors are significantly associated with pooled effect estimates of QoL. CONCLUSIONS The current systematic review and meta-analysis showed that almost half of patients with mental illness had poor QoL. Being illiterate, having a comorbid medical condition, having a low monthly income, having positive symptoms, and having negative symptoms of mental illness were independent predictors of poor QoL. This systematic review and meta-analysis emphasize that poor QoL of people with mental illness in Africa needs attention to reduce its negative consequences.
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Affiliation(s)
- Wondale Getinet Alemu
- College of Medicine and Public Health, Flinders University Adelaide, Adelaide, Australia.
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Clemence Due
- School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Eimear Muir-Cochrane
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Lillian Mwanri
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide Campus, Adelaide, SA, Australia
| | - Telake Azale
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Anna Ziersch
- College of Medicine and Public Health, Flinders University Adelaide, Adelaide, Australia
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12
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Schefft C, Krämer R, Haaf R, Jedeck D, Schumacher A, Köhler S. Evaluation of the internet-based intervention "Selfapy" in participants with unipolar depression and the impact on quality of life: a randomized, parallel group study. Qual Life Res 2024; 33:1275-1286. [PMID: 38403818 PMCID: PMC11045620 DOI: 10.1007/s11136-024-03606-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE Depressive disorders cause a major burden of disease worldwide and often lead to a loss of social functioning. Patients suffering from depressive disorders report a lower quality of life (QOL) than people without a history of mental health issues. Internet-based interventions (IBIs) based on cognitive behavioral therapy (CBT) are effective in reducing symptom severity but data on their impact on quality of life in clinically depressed patients so far is scarce. METHODS Selfapy is a CBT-based IBI for depressive disorders. 401 participants (332 female, mean age 37 (SD = 11) with a diagnosis of major depressive disorder (MDD) or dysthymia were enrolled in a randomized, parallel, three-arm trial comparing a therapist-guided Selfapy intervention with an unguided Selfapy intervention and a waiting list control. QOL was measured using the WHOQOL-BREF at baseline, post-treatment (12 weeks) and at 24-week follow-up. The effects of the interventions on QOL were calculated using linear mixed effects models. RESULTS At post-treatment (12 weeks) the guided and unguided intervention groups reported an increase in QOL on physical and psychological health domains compared to controls (significant group*time interaction). The gain in QOL was maintained over the follow-up period only for psychological health. QOL decreased in the social relationships and environment domains over the course of treatment and during the follow-up treatment for all participants. There were no differences between the guided and the unguided intervention. CONCLUSION Selfapy proved to positively affect psychological and physical QOL in a sample of participants suffering from depressive disorders and can therefore be considered an effective and highly scalable therapeutic tool. The pattern of results might partly be attributable to effects of the COVID-19 pandemic and public health measures that coincided with the trial. TRIAL REGISTRATION German Clinical Trials Register (DRKS): DRKS00017191. Registered June 14th, 2019, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017191 .
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Affiliation(s)
- Cora Schefft
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.
| | - Rico Krämer
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Raoul Haaf
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - David Jedeck
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - Anna Schumacher
- Department of Psychology, Sigmund-Freud Privat Universität, Berlin, Germany
| | - Stephan Köhler
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
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13
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Linka L, Nephuth S, Gorny I, Krause K, Michael Mross P, Tsalouchidou PE, Zahnert F, Fuest S, Menzler K, Knake S, Habermehl L. First epileptic seizure and quality of life - A prospective study. Epilepsy Behav 2024; 153:109704. [PMID: 38401415 DOI: 10.1016/j.yebeh.2024.109704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/19/2024] [Accepted: 02/15/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE Impaired QoL and depression are common in patients with chronic epilepsies; however, data on the impact of a first seizure on QoL are sparse. According to the current ILAE-definition of epilepsy, patients may be diagnosed with epilepsy immediately after the first seizure, if EEG and/or imaging findings are abnormal. Patients with normal findings in imaging and EEG are not diagnosed as having epilepsy. We investigated QoL in patients after a first seizure with and without a consecutive diagnosis of epilepsy to detect differences between groups within the first year after seizure. METHODS We examined patients (n = 152) after a first epileptic seizure and six and 12 months thereafter using demographic, clinical and QoL-related questionnaire data (Short Form-36 Health Survey (SF-36), Quality of Life in Epilepsy Inventory-31 (QOLIE-31), Beck's depression inventory II (BDI-II)). RESULTS Patients diagnosed with epilepsy after the first seizure showed a tendency of reduced mental health-related QoL six (p =.098) and 12 months (p =.092) after the first seizure compared to patients who were not diagnosed with epilepsy, but were diagnosed as having had a single first seizure. There were no significant differences between the two groups in physical health-related QoL. Multiple regression analyses showed that especially depressive symptoms explained 22.0 - 48.7 % of the variance in mental health-related QoL six (p <.001) and 12 months (p <.001) after the first seizure. Physical health-related QoL was especially predicted by age (p <.001), group (p =.002) and recurrent seizures (p = < 0.001). In PWE, there was a statistical trend with improving QOLIE-31 overall scores from six to 12 months (p =.086). CONCLUSION Our results suggest that QoL may be impaired in patients diagnosed with epilepsy early, immediately after the onset of disease. Early follow-up monitoring from the beginning of patient career is important for possible interventions and to improve patients' daily life in the long term.
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Affiliation(s)
- Louise Linka
- Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany.
| | - Selina Nephuth
- Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany
| | - Iris Gorny
- Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany
| | - Kristina Krause
- Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany
| | | | | | - Felix Zahnert
- Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany
| | - Sven Fuest
- Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany
| | - Katja Menzler
- Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany
| | - Susanne Knake
- Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany; Center for Mind, Brain and Behavior, CMBB, Philipps-University Marburg, Germany
| | - Lena Habermehl
- Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany
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14
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Pan MR, Dong M, Zhang SY, Liu L, Li HM, Wang YF, Qian QJ. One-year follow-up of the effectiveness and mediators of cognitive behavioural therapy among adults with attention-deficit/hyperactivity disorder: secondary outcomes of a randomised controlled trial. BMC Psychiatry 2024; 24:207. [PMID: 38491411 PMCID: PMC10943890 DOI: 10.1186/s12888-024-05673-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The long-term effectiveness of cognitive behavioural therapy (CBT) in medicated attention-deficit/hyperactivity disorder (ADHD) adults with residual symptoms needs to be verified across multiple dimensions, especially with respect to maladaptive cognitions and psychological quality of life (QoL). An exploration of the mechanisms underlying the additive benefits of CBT on QoL in clinical samples may be helpful for a better understanding of the CBT conceptual model and how CBT works in medicated ADHD. METHODS We conducted a secondary analysis of a randomised controlled trial including 98 medicated ADHD adults with residual symptoms who were randomly allocated to the CBT combined with medication (CBT + M) group or the medication (M)-only group. Outcomes included ADHD-core symptoms (ADHD Rating Scale), depression symptoms (Self-rating Depression Scale), maladaptive cognitions (Automatic Thoughts Questionnaire and Dysfunctional Attitude Scale), and psychological QoL (World Health Organization Quality of Life-Brief Version-psychological domain). Mixed linear models (MLMs) were used to analyse the long-term effectiveness at one-year follow-up, and structural equation modeling (SEM) was performed to explore the potential mechanisms of CBT on psychological QoL. RESULTS ADHD patients in the CBT + M group outperformed the M-only group in reduction of ADHD core symptoms (d = 0.491), depression symptoms (d = 0.570), a trend of reduction of maladaptive cognitions (d = 0.387 and 0.395, respectively), and improvement of psychological QoL (d = - 0.433). The changes in above dimensions correlated with each other (r = 0.201 ~ 0.636). The influence of CBT on QoL was mediated through the following four pathways: 1) changes in ADHD core symptoms; 2) changes in depressive symptoms; 3) changes in depressive symptoms and then maladaptive cognitions; and 4) changes firstly in depressive symptoms, maladaptive cognitions, and then ADHD core symptoms. CONCLUSIONS The long-term effectiveness of CBT in medicated ADHD adults with residual symptoms was further confirmed. The CBT conceptual model was verified in clinical samples, which would be helpful for a deeper understanding of how CBT works for a better psychological QoL outcome. TRIAL REGISTRATION ChiCTR1900021705 (2019-03-05).
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Affiliation(s)
- Mei-Rong Pan
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Min Dong
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Shi-Yu Zhang
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Lu Liu
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Hai-Mei Li
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Yu-Feng Wang
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Qiu-Jin Qian
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, China.
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China.
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15
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Muhetaer S, Mijiti P, Aierken K, Ziyin H, Talapuhan W, Tuoheti K, Lixia Y, Shuang Q, Jingjing W. A network approach to investigating the inter-relationship between health-related quality of life dimensions and depression in 1735 Chinese patients with heterogeneous cancers. Front Public Health 2024; 11:1325986. [PMID: 38322361 PMCID: PMC10844480 DOI: 10.3389/fpubh.2023.1325986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/28/2023] [Indexed: 02/08/2024] Open
Abstract
Background We aimed to explore the inter-connection between depression and HRQOL dimensions in cancer patients using a network approach, which might provide new insights for precise interventions to improve cancer patients' overall HRQOL. Methods Between June 1, 2016, and August 31, 2017, a total of 1735 eligible patients with heterogeneous types of cancer were recruited. The Zung Self-Rating Depression Scale (SDS) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were used to measure patients' depression status and HRQOL, respectively. A regularized partial correlation network was established. Central and bridge symptoms/functions were identified using expected influence and bridge expected influence. A directed acyclic graph (DAG) was used to explore the possible causal relationship between depression and HRQOL dimensions. Results In this study, depression and 15 dimensions of the EORTC-QLQ-C30 scale were highly inter-correlated and could be represented as a network. We found that nearly two-thirds of cancer patients experienced various degrees of depression, and depression was consistently the central symptom in the network, in addition to nausea/vomiting, pain, and physical function. DAG and bridge symptoms indicated that depression might influence overall HRQOL in cancer patients mainly through emotional function, pain, physical function, and sleeplessness, particularly in cancer patients with moderate-to-severe depression. The disparity in network structures between mild and moderate-to-severe depression suggested that the relationship between depression and HRQOL dimensions might be bidirectional. Conclusion The prevalence of depression remained high in Chinese patients with cancer, and depression may influence various symptoms and functions within the HRQOL network. Screening and early treatment of depression were warranted to improve the overall HRQOL of cancer patients, in addition to adequate treatment of pain and nausea/vomiting and improvement in physical function.
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Affiliation(s)
- Sulaiman Muhetaer
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Peierdun Mijiti
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Kaibinuer Aierken
- Department of Gynecological Radiotherapy, The Third Hospital Affiliated to Xinjiang Medical University (Affiliated Cancer Hospital), Urumqi, Xinjiang, China
| | - Huang Ziyin
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Wulan Talapuhan
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Kaibinuer Tuoheti
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Ye Lixia
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Qi Shuang
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Wei Jingjing
- Department of Health Policy and Management, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
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Ikawa H, Takeda Y, Osawa R, Sato A, Mizuno H, Noda Y. A Retrospective Case-Control Study on the Differences in the Effectiveness of Theta-Burst Stimulation Therapy for Depression with and without Antidepressant Medication. J Clin Med 2024; 13:399. [PMID: 38256534 PMCID: PMC10816069 DOI: 10.3390/jcm13020399] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Transcranial magnetic stimulation (TMS) therapy has few side effects and comparable therapeutic effects to antidepressant treatment, but few studies have introduced TMS therapy as an initial treatment for MDD. The objective of this study was to retrospectively compare the clinical outcomes between 50 MDD patients without antidepressants (i.e., TMS monotherapy) and 50 MDD patients with antidepressants plus TMS therapy, matched for age, sex, and depression severity. The presence or absence of antidepressant therapy in first-line treatment was determined via a detailed interview by psychiatrists. The study design was a retrospective observational case-control study using the TMS registry data. The key inclusion criteria were adult patients who met the diagnosis of MDD and received 20-30 sessions of intermittent theta-burst stimulation (iTBS) therapy to the left dorsolateral prefrontal cortex (DLPFC). In this study, the Montgomery-Åsberg Depression Rating Scale (MADRS) was used as the primary outcome measure. No significant group differences existed in the baseline MADRS total score between the unmedicated and medicated patient groups. Following TMS therapy, no significant group differences in response rate, remission rate, or relative total score change in the MADRS were observed. The main limitations were the retrospective design and the use of registry data as a source. Our findings suggest that TMS monotherapy may be as effective as TMS add-on therapy to antidepressants when used as the first-line therapy for MDD, but randomized controlled trials are needed.
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Affiliation(s)
- Haruki Ikawa
- Tokyo Yokohama TMS Clinic, Kawasaki 211-0063, Japan
| | - Yuya Takeda
- Tokyo Yokohama TMS Clinic, Kawasaki 211-0063, Japan
| | - Ryota Osawa
- Tokyo Yokohama TMS Clinic, Kawasaki 211-0063, Japan
| | - Akiko Sato
- Tokyo Yokohama TMS Clinic, Kawasaki 211-0063, Japan
| | | | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo 160-8582, Japan
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17
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Davis CH, Donahue ML, Gaudiano BA, Uebelacker LA, Twohig MP, Levin ME. Adding online storytelling-based acceptance and commitment therapy to antidepressant treatment for primary care patients: a randomized clinical trial. Cogn Behav Ther 2024; 53:48-69. [PMID: 37855277 PMCID: PMC10841889 DOI: 10.1080/16506073.2023.2265560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023]
Abstract
Depression is most often treated in primary care, where the prevailing treatment is antidepressant medication. Primary care patients with depression are less likely to be exposed to psychosocial interventions, despite evidence suggesting many of these treatments are effective. An example is acceptance and commitment therapy (ACT), a behavioral treatment for depression with a growing evidence base. A self-guided ACT intervention with a peer narrative (i.e. storytelling) format was developed with the intention of creating a treatment option for primary care patients that was more accessible than traditional psychotherapy. Titled LifeStories, the online program features videos of real individuals sharing coping skills for depression based on lived experiences and key ACT principles. A total of 93 primary care patients taking antidepressants were randomized to either continued antidepressant treatment alone or antidepressant treatment plus LifeStories for 4 weeks. There were no differences over time on depression severity and psychological inflexibility. However, LifeStories led to greater improvements in quality of life and increased patients' interest in additional treatment compared to antidepressant medication alone.Clinical trial pre-registration: ClinicalTrials.gov (NCT04757961).
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Affiliation(s)
| | | | - Brandon A. Gaudiano
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
- Butler Hospital, Providence, RI
| | - Lisa A. Uebelacker
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
- Butler Hospital, Providence, RI
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Karyotaki E, Miguel C, Panagiotopoulou OM, Harrer M, Seward N, Sijbrandij M, Araya R, Patel V, Cuijpers P. Digital interventions for common mental disorders in low- and middle-income countries: A systematic review and meta-analysis. Glob Ment Health (Camb) 2023; 10:e68. [PMID: 38024798 PMCID: PMC10643260 DOI: 10.1017/gmh.2023.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/26/2023] [Accepted: 09/02/2023] [Indexed: 12/01/2023] Open
Abstract
Background In low-resource settings, e-mental health may substantially increase access to evidence-based interventions for common mental disorders. We conducted a systematic literature search to identify randomised trials examining the effects of digital interventions with or without therapeutic guidance compared to control conditions in individuals with anxiety and/or depression symptoms in low- and middle-income countries (LMICs). Methods The main outcome was the reduction in symptoms at the post-test. Secondary outcomes included improvements in quality of life and longer-term effects (≥20 weeks post-randomisation). The effect size Hedges' g was calculated using the random effects model. Results A total of 21 studies (23 comparisons) with 5.296 participants were included. Digital interventions were more effective than controls in reducing symptoms of common mental disorders at the post-test (g = -0.89, 95% confidence interval [CI] -1.26 to -0.52, p < 0.001; NNT = 2.91). These significant effects were confirmed when examining depressive (g = -0.77, 95% CI -1.11; -0.44) and anxiety symptoms separately (g = -1.02, 95% CI -1.53 to -0.52) and across all other sensitivity analyses. Digital interventions also resulted in a small but significant effect in improving quality of life (g = 0.32, 95% CI 0.19 to 0.45) at the post-test. Over the longer term, the effects were smaller but remained significant for all examined outcomes. Heterogeneity was moderate to high in all analyses. Subgroup and meta-regression analyses did not result in significant outcomes in any of the examined variables (e.g., guided vs. unguided interventions). Conclusions Digital interventions, with or without guidance, may effectively bridge the gap between treatment supply and demand in LMICs. Nevertheless, more studies are needed to draw firm conclusions regarding the magnitude of the effects of digital interventions.
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Affiliation(s)
- Eirini Karyotaki
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Clara Miguel
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Olga M. Panagiotopoulou
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Department of Health Sciences, Technical University Munich, Munich, Germany
- Department of Clinical Psychology & Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Nadine Seward
- Center for Global Mental Health and Primary Care Research, Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Marit Sijbrandij
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ricardo Araya
- Center for Global Mental Health and Primary Care Research, Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Zhang P, Liu X, Zhang R, Xia N. Depression mediates the relationship between social capital and health-related quality of life among Chinese older adults in the context of the COVID-19 pandemic: A cross-sectional study. Nurs Open 2023; 10:6517-6526. [PMID: 37400957 PMCID: PMC10416043 DOI: 10.1002/nop2.1904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/08/2023] [Accepted: 06/05/2023] [Indexed: 07/05/2023] Open
Abstract
AIM To explore the association between social capital and health-related quality of life (HRQoL) and to determine whether depression mediates the association among Chinese older adults in the context of the COVID-19 pandemic. DESIGN A descriptive cross-sectional research design. METHODS The Geriatric Depression Scale-15, Social Capital Questionnaire and 12-item Short-Form Health Survey were used to investigate 1201 older adults selected from Jinan, Shandong Province, China, using a multistage stratified cluster random sampling method. RESULTS Pearson's correlation analysis revealed a significant positive correlation between social capital and HRQoL (r = 0.269, p < 0.01). Multivariate linear regression analyses demonstrated that social capital was significantly negatively associated with depression (β = -0.072, p < 0.001) and that depression was associated with HRQoL (β = -1.031, p < 0.001). The mediation analyses showed that depression mediated the association between social capital and HRQoL, and the indirect effect size was 0.073 (95% confidence interval: 0.050, 0.100).
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Affiliation(s)
- Ping Zhang
- Department of Transplantation, Second Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Xiao‐Li Liu
- Department of Transplantation, Second Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Rong‐Mei Zhang
- Department of Transplantation, Second Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Ning Xia
- Department of Transplantation, Second Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
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20
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McPherson S, Oute J, Speed E. Quality-of-life measurement in depression trials: A consumerist relic. Health (London) 2023; 27:647-663. [PMID: 35088607 PMCID: PMC10423430 DOI: 10.1177/13634593221074887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Quality-of-life measurement in depression is advocated as a patient-centred indicator of recovery, but may instead enhance the mimetic authority of randomised controlled trials (RCTs) which have been roundly critiqued in mental health. In this paper we draw on the social life of methods approach to extend the well-developed critique of RCTs into the field of quality-of-life measurement. We accomplish this through consideration and critique of the conceptual and epistemological development of quality-of-life measurement in depression, including the role of psychometrics in its development. Examining conceptual developments from the 1970s onwards, we consider how the scientific literature on quality-of-life in depression aligns with behavioural economics and consumerism but falls short of engaging with genuinely patient-centred approaches to recovery. We argue that quality-of-life measures in depression were developed within a consumerist model of healthcare in which the medical model was a central pillar and 'choice' a rhetorical device only. While quality-of-life instrument development was largely funded by industry, psychometrics provided no coherent solution to the 'affective fallacy' (high correlations between quality-of-life and depressive symptoms). Industry has largely abandoned the measures, while psychotherapy research has increasingly endorsed them. We argue that in their design and implementation, quality-of-life measures for depression remain based on a commercial model of healthcare, are conceptually flawed and do not support concepts of patient-centred healthcare.
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Affiliation(s)
| | - Jeppe Oute
- University of South-Eastern Norway, Norway
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21
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Atik E, Stricker J, Schückes M, Pittig A. Efficacy of a Brief Blended Cognitive Behavioral Therapy Program for the Treatment of Depression and Anxiety in University Students: Uncontrolled Intervention Study. JMIR Ment Health 2023; 10:e44742. [PMID: 37624631 PMCID: PMC10492172 DOI: 10.2196/44742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/25/2023] [Accepted: 06/25/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Blended cognitive behavioral therapy (bCBT)-the combination of cognitive behavioral therapy and digital mental health applications-has been increasingly used to treat depression and anxiety disorders. As a resource-efficient treatment approach, bCBT appears promising for addressing the growing need for mental health care services, for example, as an early intervention before the chronification of symptoms. However, further research on the efficacy and feasibility of integrated bCBT interventions is needed. OBJECTIVE This study aimed to evaluate the efficacy of a novel bCBT program comprising short (25 min), weekly face-to-face therapy sessions combined with a smartphone-based digital health app for treating mild to moderate symptoms of depression or anxiety. METHODS This prospective uncontrolled trial comprised 2 measurement points (before and after treatment) and 2 intervention groups. We recruited university students with mild to moderate symptoms of depression or anxiety. On the basis of the primary symptoms, participants were assigned to either a depression intervention group (n=67 completers) or an anxiety intervention group (n=33 completers). Participants in each group received 6 weekly individual psychotherapy sessions via videoconference and completed modules tailored to their respective symptoms in the smartphone-based digital health app. RESULTS The depression group displayed medium to large improvements in the symptoms of depression (Cohen d=-0.70 to -0.90; P<.001). The anxiety group experienced significant improvements in the symptoms of generalized anxiety assessed with the Generalized Anxiety Disorder-7 scale with a large effect size (Cohen d=-0.80; P<.001) but not in symptoms of anxiety assessed with the Beck Anxiety Inventory (Cohen d=-0.35; P=.06). In addition, both groups experienced significant improvements in their perceived self-efficacy (Cohen d=0.50; P<.001 in the depression group and Cohen d=0.71; P<.001 in the anxiety group) and quality of life related to psychological health (Cohen d=0.87; P<.001 in the depression group and Cohen d=0.40; P=.03 in the anxiety group). Work and social adjustment of patients improved significantly in the depression group (Cohen d=-0.49; P<.001) but not in the anxiety group (Cohen d=-0.06; P=.72). Patients' mental health literacy improved in the anxiety group (Cohen d=0.45; P=.02) but not in the depression group (Cohen d=0.21; P=.10). Patient satisfaction with the bCBT program and ratings of the usability of the digital app were high in both treatment groups. CONCLUSIONS This study provides preliminary evidence for the feasibility and efficacy of a novel brief bCBT intervention. The intervention effects were generalized across a broad spectrum of patient-reported outcomes. Hence, the newly developed bCBT intervention appears promising for treating mild to moderate depression and anxiety in young adults.
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Affiliation(s)
- Ece Atik
- Translational Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany
| | - Johannes Stricker
- Clinical Psychology Research Group, Department of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Andre Pittig
- Translational Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany
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22
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Cuijpers P, Miguel C, Harrer M, Plessen CY, Ciharova M, Papola D, Ebert D, Karyotaki E. Psychological treatment of depression: A systematic overview of a 'Meta-Analytic Research Domain'. J Affect Disord 2023; 335:141-151. [PMID: 37178828 DOI: 10.1016/j.jad.2023.05.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Over the past 16 years, we have developed a 'Meta-analytic Research Domain' (MARD) of all randomized trials of psychological treatments of depression. A MARD is a living systematic review of a research field, that cannot be otherwise covered by one (network) meta-analysis and includes multiple PICOs. In this paper we give an overview of the findings of this MARD. METHODS A narrative review of the results of the 118 meta-analyses on psychotherapies for depression that were published within our MARD. RESULTS Most research has been conducted on cognitive-behavioral therapy (CBT), but several other psychotherapies are also effective, with few differences between therapies. They can be effectively delivered in individual, group, telephone and guided self-help format and are effective in many different target groups and across different age groups, although the effects are significantly smaller in children and adolescents. Psychotherapies have comparable effects as pharmacotherapy at the short term but are probably more effective at the longer term. Combined treatment is more effective than either psychotherapy or pharmacotherapy alone at the short, but also at the longer term. LIMITATIONS We did not summarize all published meta-analyses (protocols, methodological studies) and have not compared our results to those found in other meta-analyses on comparable subjects. CONCLUSION Psychotherapies can contribute considerably to a reduction of the disease burden of depression. MARDs are an important next step in the aggregation of knowledge from randomized controlled trials in psychological treatments of depression as well as in other healthcare sectors.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands; Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania.
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Department of Health Sciences, Technical University Munich, Munich, Germany; Department of Clinical Psychology & Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Constantin Yves Plessen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands; Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Davide Papola
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Italy; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - David Ebert
- Psychology & Digital Mental Health Care, Department of Health Sciences, Technical University Munich, Munich, Germany
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
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23
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Bhatti NA, Jobilal A, Asif K, Jaramillo Villegas M, Pandey P, Tahir AN, Balla N, Arellano Camargo MP, Ahmad S, Kataria J, Abdin ZU, Ayyan M. Exploring Novel Therapeutic Approaches for Depressive Disorders: The Role of Allopregnanolone Agonists. Cureus 2023; 15:e44038. [PMID: 37746458 PMCID: PMC10517642 DOI: 10.7759/cureus.44038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
Depressive disorders are caused due to the impaired functioning of important brain networks. Recent studies have also shown that it is caused by a significant reduction in the levels of allopregnanolone, which is a progesterone metabolite. Newer treatment modalities are now focusing on the usage of neuroactive steroids, such as allopregnanolone, in various depressive disorders. Our aim was to provide a comprehensive literature review on the clinical aspects of the allopregnanolone agonists brexanolone and zuranolone with reference to the physiological role of allopregnanolone. Brexanolone was approved by the FDA in 2019 for the treatment of postpartum depression and has greatly influenced further research into potential drugs such as zuranolone, which is currently undergoing phase 3 of clinical trials. Although these drugs exhibit improvement in symptoms of depressive disorders along with notable side effects, further research is required for their future clinical use.
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Affiliation(s)
| | - Anna Jobilal
- Internal Medicine, Sri Ramaswamy Memorial Medical College Hospital and Research Centre, Kattankulathur, IND
| | - Kainat Asif
- Internal Medicine, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, PAK
| | | | - Priyanka Pandey
- Anatomical Sciences, Hind Institute of Medical Sciences, Sitapur, IND
| | | | - Neeharika Balla
- Internal Medicine, Maharajah's Institute of Medical Sciences, Vizianagaram, IND
| | | | - Sana Ahmad
- Psychiatry, TIME Organization Inc, Baltimore, USA
| | | | - Zain U Abdin
- Family Medicine, IMG Helping Hands, Chicago, USA
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24
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Braillon A, Bewley S, Blumsohn A, Naudet F. Comment on: "Should Antidepressants be Avoided in Pregnancy?". Drug Saf 2023; 46:615-616. [PMID: 37103644 DOI: 10.1007/s40264-023-01308-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 04/28/2023]
Affiliation(s)
| | - Susan Bewley
- Obstetrics and Women's Health, King's College London, London, UK
| | | | - Florian Naudet
- Therapeutics, Adult Psychiatry Department and Clinical Investigation Center (INSERM 1414), University Hospital, Rennes, France
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25
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Miguel C, Karyotaki E, Ciharova M, Cristea IA, Penninx BW, Cuijpers P. Psychotherapy for comorbid depression and somatic disorders: a systematic review and meta-analysis. Psychol Med 2023; 53:2503-2513. [PMID: 34792017 PMCID: PMC10123840 DOI: 10.1017/s0033291721004414] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 09/01/2021] [Accepted: 10/11/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The treatment of depression in patients with somatic disorders is crucial, given its negative impact on quality of life (QoL), functioning, and even on the somatic disease prognosis. We aimed to examine the most updated evidence on the effects of psychotherapy in patients with depression and somatic disorders, including HIV, oncological, cardiometabolic, and neurological disorders. METHODS We conducted a meta-analysis of 75 randomized trials (8209 participants) of psychotherapy for adults with somatic disorders and a diagnosis or elevated symptoms of depression. Outcomes included depression, QoL, somatic health-related outcomes, and mortality. RESULTS Psychotherapy significantly reduced the severity of depression at post-treatment across all categories of somatic disorders (Hedges'g = 0.65; 95% CI 0.52-0.79), with sustained effects at 6-11 months (g = 0.38; 95% CI 0.22-0.53) and at 12 months follow-up or longer (g = 0.13; 95% CI 0.04-0.21). Psychotherapy also showed significant effects on QoL (g = 0.26; 95% CI 0.17-0.35), maintained up to 11 months follow-up (g = 0.25; 95% CI 0.16-0.34). No significant effects were observed on the most frequently reported somatic health-related outcomes (glycemic control, pain), and neither on mortality. Heterogeneity in most analyses was very high, and only 29 (38%) trials were rated at low risk of bias (RoB). CONCLUSIONS Psychotherapy may be an effective treatment option for patients with depression and somatic disorders, with long-term effects on depression severity and QoL. However, these results should be interpreted with caution due to heterogeneity and RoB.
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Affiliation(s)
- Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, The Netherlands
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Ioana A. Cristea
- Department of Brain and Behavioral Sciences, University of Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - Brenda W.J.H. Penninx
- Department of Psychiatry, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, The Netherlands
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26
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Cuijpers P, Franco P, Ciharova M, Miguel C, Segre L, Quero S, Karyotaki E. Psychological treatment of perinatal depression: a meta-analysis. Psychol Med 2023; 53:2596-2608. [PMID: 37310303 PMCID: PMC10123831 DOI: 10.1017/s0033291721004529] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 06/08/2021] [Accepted: 10/18/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Depression during pregnancy and after the birth of a child is highly prevalent and an important public health problem. Psychological interventions are the first-line treatment and, although a considerable number of randomized trials have been conducted, no recent comprehensive meta-analysis has evaluated treatment effects. METHODS We used an existing database of randomized controlled trials of psychotherapies for adult depression and included studies aimed at perinatal depression. Random effects models were used in all analyses. We examined the effects of the interventions in the short and long term, and also examined secondary outcomes. RESULTS Forty-three studies with 49 comparisons and 6270 participants between an intervention and control group were included. The overall effect size was g = 0.67 [95% confidence interval (CI) 0.45~0.89; numbers needed-to-be-treated = 4.39] with high heterogeneity (I2 = 80%; 95% CI 75~85). This effect size remained largely unchanged and significant in a series of sensitivity analyses, although some publication bias was found. The effects remained significant at 6-12 months follow-up. Significant effects were also found for social support, anxiety, functional limitations, parental stress and marital stress, although the number of studies for each outcome was low. All results should be considered with caution because of the high levels of heterogeneity in most analyses. CONCLUSIONS Psychological interventions are probably effective in the treatment of perinatal depression, with effects that last at least up to 6-12 months and probably also have effects on social support, anxiety, functional impairment, parental stress, and marital stress.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pamela Franco
- Department of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lisa Segre
- College of Nursing, University of Iowa, Iowa City, USA
| | - Soledad Quero
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
- CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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27
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Symptoms of internet gaming disorder and depression in Chinese adolescents: A network analysis. Psychiatry Res 2023; 322:115097. [PMID: 36822036 DOI: 10.1016/j.psychres.2023.115097] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 02/08/2023]
Abstract
The current study aimed to investigate comorbidity among symptoms of depression and internet gaming disorder (IGD) utilizing symptom network analysis in a sample of Chinese adolescents. A total of 1,362 Chinese adolescents (Mean age = 15.19 ± 1.67; range 13-21; 39.79% female, 56.02% male, 4.19% not disclosed) were recruited from 11 local secondary schools between June and July 2020. Symptoms of depression and IGD were assessed by the 7-item DASS-21 depression subscale and the 9-item Internet Gaming Disorder Scale. We conducted network analysis to estimate network models and the most central symptoms of depression and IGD and computed a combined network model of both depression and IGD symptoms to find bridge symptoms and illustrate the comorbidity between depression and IGD. We found that feeling 'Worthless', 'Meaningless', and 'Down-hearted' were identified as the most central symptoms of depression, whereas 'Preoccupation' and 'Tolerance' were the two most central symptoms of IGD. The bridge symptoms in the combined network model were 'Gaming for escape or mood relief' from the IGD cluster and 'No initiative' and 'Down-hearted" from the depression cluster. The current study was the first to investigate the relationship between depression and IGD symptoms among adolescents utilizing a symptom network perspective. Also, it highlighted key bridge symptoms in understanding how IGD and depression contribute to each other.
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28
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da Silva Machado R, Vieira IS, Scaini C, Molina ML, Barbosa LP, da Silva GDG, Ores L, de Mattos Souza LD, Jansen K, da Silva RA. Ego-defense mechanisms and brief psychotherapies for the management of major depressive disorder in adults: A longitudinal and quasi-experimental study. J Affect Disord 2023; 330:291-299. [PMID: 36871912 DOI: 10.1016/j.jad.2023.02.141] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE To evaluate the effect of psychotherapies on ego defense mechanisms and the reduction of depressive symptoms in a 12-month follow-up period. METHODS This longitudinal and quasi-experimental study nested within a randomized clinical trial included a clinical sample of adults (18-60 years) diagnosed with major depressive disorder using the Mini-International Neuropsychiatric Interview. Two models of psychotherapy were used: Supportive Expressive Dynamic Psychotherapy (SEDP) and Cognitive Behavioral Therapy (CBT). Defense Style Questionnaire 40 was used to analyze defense mechanisms and the Beck Depression Inventory was used to measure the depressive symptoms. RESULTS The total sample comprised 195 patients (113 SEDP and 82 CBT), with the mean age was 35.63 (11.44) years. After adjustments, increased mature defenses was significantly associated with reduced depressive symptoms at all follow-up times (p < 0.001) and the decrease in immature defenses was significantly associated with the reduction of depressive symptoms at all follow-up times (p < 0.001). While neurotic defenses were not associated with a reduction in depressive symptoms at any time of follow-up (p > 0.05). CONCLUSION Both models of psychotherapy were effective in increasing mature defenses and decreasing immature ones, as well as decreasing depressive symptoms at all evaluation times. With this, it is understood that a greater understanding of these interactions will allow a more adequate diagnostic and prognostic evaluation and the design of useful strategies that adapt to the patient's reality.
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Affiliation(s)
- Rosiene da Silva Machado
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil
| | - Igor Soares Vieira
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil; Centro Universitário Estácio de Sergipe, SE, Brazil
| | - Carolina Scaini
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil
| | - Mariane Lopez Molina
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil; Faculdade Anhanguera do Rio Grande, RS, Brazil
| | - Luana Porto Barbosa
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil
| | - Giovana Del Grande da Silva
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil
| | | | - Luciano Dias de Mattos Souza
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil
| | - Karen Jansen
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil
| | - Ricardo Azevedo da Silva
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil.
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A Narrative Review on REM Sleep Deprivation: A Promising Non-Pharmaceutical Alternative for Treating Endogenous Depression. J Pers Med 2023; 13:jpm13020306. [PMID: 36836540 PMCID: PMC9960519 DOI: 10.3390/jpm13020306] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023] Open
Abstract
Endogenous depression represents a severe mental health condition projected to become one of the worldwide leading causes of years lived with disability. The currently available clinical and non-clinical interventions designed to alleviate endogenous depression-associated symptoms encounter a series of inconveniences, from the lack of intervention effectiveness and medication adherence to unpleasant side effects. In addition, depressive individuals tend to be more frequent users of primary care units, which markedly affects the overall treatment costs. In parallel with the growing incidence of endogenous depression, researchers in sleep science have discovered multiple links between rapid eye movement (REM) sleep patterns and endogenous depression. Recent findings suggest that prolonged periods of REM sleep are associated with different psychiatric disorders, including endogenous depression. In addition, a growing body of experimental work confidently describes REM sleep deprivation (REM-D) as the underlying mechanism of most pharmaceutical antidepressants, proving its utility as either an independent or adjuvant approach to alleviating the symptoms of endogenous depression. In this regard, REM-D is currently being explored for its potential value as a sleep intervention-based method for improving the clinical management of endogenous depression. Therefore, this narrative review represents a comprehensive inventory of the currently available evidence supporting the potential use of REM-D as a reliable, non-pharmaceutical approach for treating endogenous depression, or as an adjuvant practice that could improve the effectiveness of currently used medication.
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Freidl M, Wegerer M, Litvan Z, König D, Alexandrowicz RW, Portela-Millinger F, Gruber M. Determinants of quality of life improvements in anxiety and depressive disorders-A longitudinal study of inpatient psychotherapy. Front Psychiatry 2022; 13:937194. [PMID: 36590609 PMCID: PMC9798124 DOI: 10.3389/fpsyt.2022.937194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
Background Quality of life (QoL) is substantially impaired in patients with anxiety disorders (AD) and depressive disorders (DD) and improvements in symptom burden after psychotherapy are not always paralleled by similar improvements in QoL. So far, little is known about treatment outcome in terms of QoL and predictors of QoL improvements following inpatient psychotherapy with a focus on cognitive behavior therapy (CBT). The current study aimed at investigating the relationship between changes in symptoms and QoL across different life domains. Additionally, predictors of a positive treatment outcome were evaluated. Methods 122 patients with AD and/or DD undergoing an 8-weeks inpatient CBT program completed self-report measures of psychopathological symptoms and QoL at pre- and post-treatment. Mixed effects models were used to investigate changes, a confirmatory factor analysis was applied to analyze the latent factor structure of the anxiety sensitivity index and binary logistic regression analyses were performed for predictors of QoL improvements. Results Patients showed moderate to strong decreases in anxious and depressive symptoms and moderate to strong improvements in general QoL, particularly in the psychological and physical QoL subdomains. Changes in symptom burden correlated most strongly with psychological and physical QoL. In addition, poor QoL before treatment and low levels of specific anxiety sensitivity symptoms (items 1 and 5) significantly predicted improvement in QoL. Conclusion Patients with poor QoL who are not as inhibited to openly express their anxious feelings particularly benefit from inpatient psychotherapy (individual and group) to improve their QoL. In contrast, our research suggests that patients who are too anxious to openly express their nervousness should receive additional social skills training, more focused treatment to build sufficient self-confidence to better engage in the treatment program.
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Affiliation(s)
- Marion Freidl
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Melanie Wegerer
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Zsuzsa Litvan
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Daniel König
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Filipe Portela-Millinger
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Maria Gruber
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Strege MV, Richey JA, Siegle GJ. What does "staying well" after depression mean? Chronic low grade symptomatology after treatment for depression is common. J Affect Disord 2022; 317:228-235. [PMID: 36029878 PMCID: PMC10012845 DOI: 10.1016/j.jad.2022.08.075] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 05/25/2022] [Accepted: 08/22/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Persistent low grade depression symptoms are common and impairing in major depressive disorder (MDD) yet rarely reported in treatment follow-up studies (Judd et al., 1998a; Kennedy et al., 2004), suggesting that extant sustained remission rates may not reflect this important clinical feature. Furthermore, no long-term MDD treatment follow-up study has reported on quality of life ratings across functioning levels and years throughout the follow-up period, thus the severity, breadth, and persistence of functional impairment remain unclear. Accordingly, the current study evaluated the course of MDD with consideration of low grade depressive symptomatology and holistic features (e.g., quality of life). METHODS We report long-term (9-14 years) follow-up data from individuals with MDD (N = 37) who underwent either Cognitive Therapy (CBT) or a course of selective serotonin reuptake inhibitor (SSRI) treatment. Patients provided retrospective reports of depression symptoms and quality of life in the years following treatment. RESULTS Chronic depression symptoms (most often mild in severity) and decreased quality of life in multiple domains are frequent and suggest poorer sustained remission rates than previously observed in the literature. LIMITATIONS Study limitations include small sample size recruited via convenience sampling methods. CONCLUSIONS Findings support a conceptualization of depression recovery that entails persistent symptoms and vulnerabilities. Clinical recommendations are provided for discussing these features of depression recovery with patients.
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Affiliation(s)
- Marlene V Strege
- University of Pittsburgh, Department of Psychiatry, United States of America.
| | - John A Richey
- Virginia Polytechnic Institute and State University, Department of Psychology, United States of America
| | - Greg J Siegle
- University of Pittsburgh, Department of Psychiatry, United States of America
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Sit HF, Li G, Chen W, Sou EKL, Wong M, Burchert S, Hong IW, Sit HY, Lam AIF, Hall BJ. A protocol for a type 1 effectiveness-implementation randomized controlled trial of the WHO digital mental health intervention Step-by-Step to address depression among Chinese young adults in Macao (SAR), China. Internet Interv 2022; 30:100579. [PMID: 36217366 PMCID: PMC9547191 DOI: 10.1016/j.invent.2022.100579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/27/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Among Chinese college students, the burden of depression is considerably high, affecting up to 30 % of the population. Despite this burden, few Chinese students seek mental health treatment. In addition, depression is highly comorbid with other mental health disorders, such as anxiety. Scalable, transdiagnostic, evidence-based interventions are needed for this population. OBJECTIVE The study will evaluate the effectiveness of a World Health Organization transdiagnostic digital mental health intervention, Step-by-Step, to reduce depressive and anxiety symptoms and improve well-being compared with enhanced care as usual and its implementation in a Chinese university community. METHODS A type 1 effectiveness-implementation two-arm, parallel, randomized controlled trial will be conducted. The two conditions are 1) the 5-session Step-by-Step program with minimal guidance by trained peer-helpers and 2) psychoeducational information on depression and anxiety and referrals to local community services. A total of 334 Chinese university students will be randomized with a 1:1 ratio to either of the two groups. Depression, anxiety, wellbeing, and client defined problems will be assessed at pre-intervention, post-intervention, and 3-month follow-up. Endline qualitative interviews and focus group discussions will be conducted to explore SbS implementation among service users, university staff, and stakeholders. Data will be analysed based on the intent-to-treat principle. DISCUSSION Step-by-Step is an innovative approach to address common mental health problems in populations with sufficient digital literacy. It is a promising intervention that can be embedded to scale mental health services within a university setting. It is anticipated that after successful evaluation of the program and its implementation in the type 1 hybrid design RCT study, Step-by-Step can be scaled and maintained as a low-intensity treatment in universities, and potentially extended to other populations within the Chinese community. TRIAL REGISTRATION ChiCTR2100050214.
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Key Words
- AE, adverse event
- Behavioral activation
- CONSORT, Consolidated Standards of Reporting Trials
- CSQ, Client Satisfaction Questionnaire
- College students
- DASS-21, Depression, Anxiety, and Stress Scale – 21 items
- Depression
- Digital intervention
- ECAU, enhanced care as usual
- GAD-7, Generalized Anxiety Disorder
- ITT, intention-to-treat
- Implementation
- PCC, Psychological Counselling Center
- PCL, PTSD Checklist for DSM-5
- PHQ, Patient Health Questionnaire
- PSYCHLOPS, Psychological Outcomes Profile Instrument
- RCT, randomized controlled trial
- RE-AIM, Reach, Effectiveness, Adoption, Implementation, and Maintenance
- Randomized controlled trial
- SAE, serious adverse event
- SPIRIT, Standard Protocol Items: Recommendations for Interventional Trials
- SbS, Step-by-Step
- WHO, World Health Organization
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Affiliation(s)
- Hao Fong Sit
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong (SAR), People's Republic of China
| | - Gen Li
- Center for Global Health Equity, New York University (Shanghai), Shanghai, People's Republic of China
| | - Wen Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Zhongshan Road 2, Guangzhou, People's Republic of China,Sun Yat-sen Centre for Migrant Health Policy, Sun Yat-sen University, Zhongshan Road 2, Guangzhou, People's Republic of China
| | - Elvo Kuai Long Sou
- Student Affairs Office, University of Macau, Macao (SAR), People's Republic of China
| | - Mek Wong
- Student Affairs Office, University of Macau, Macao (SAR), People's Republic of China
| | - Sebastian Burchert
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin (FUB), Germany
| | - Ieng Wai Hong
- Moon Chun Memorial College, University of Macau, Macao (SAR), People's Republic of China
| | - Ho Yi Sit
- Shiu Pong College, University of Macau, Macao (SAR), People's Republic of China
| | - Agnes Iok Fong Lam
- Centre for Macau Studies, University of Macau, Macao (SAR), People's Republic of China
| | - Brian J. Hall
- Center for Global Health Equity, New York University (Shanghai), Shanghai, People's Republic of China,Corresponding author at: Center for Global Health Equity, New York University Shanghai, Shanghai, People's Republic of China.
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Bortenschlager F, Büsselmann M, Wolstein J. Eine hohe Lebensqualität reduziert depressive Symptome von Maßregelvollzugspatientinnen und -patienten. FORENSISCHE PSYCHIATRIE, PSYCHOLOGIE, KRIMINOLOGIE 2022. [PMCID: PMC9491250 DOI: 10.1007/s11757-022-00732-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Einleitung Die restriktiven Unterbringungsbedingungen im Maßregelvollzug beeinflussen die Lebensqualität und Depressivität der Untergebrachten und damit die psychische Gesundheit und den Behandlungserfolg therapeutischer Maßnahmen. Ziele Ziel der Arbeit ist es, eine Übersicht über die Lebensqualität und die Belastung durch depressive Symptome aus Patientensicht zu erhalten. Es soll analysiert werden, welche Bereiche der Lebensqualität im Zusammenhang mit Depressivität stehen, und ob die Dauer der Maßregel Einfluss auf die Depressivität der Untergebrachten nimmt. Methode Die Lebensqualität wurde mittels einer an die Gegebenheiten des Maßregelvollzugs adaptierten Version des Fragebogens Measuring the Quality of Prison Life (MQPL) erhoben. Depressivität wurde anhand der Allgemeinen Depressionsskala (ADS) erfragt. Insgesamt nahmen N = 73 Personen an der Studie teil. Ergebnisse Die Lebensqualität wurde im Mittel als positiv bewertet. Am höchsten wurde die Beziehung zum therapeutischen Personal eingeschätzt. Es zeigten sich signifikante Unterschiede in der Lebensqualität zwischen depressiv auffälligen und nichtauffälligen Untergebrachten. Die Dauer der Unterbringung war signifikanter Prädiktor für die Depressionswerte suchterkrankter Untergebrachter. Fazit Lebensqualität und Depressivität stehen in signifikant negativem Zusammenhang. Zur Verbesserung der Unterbringungs- und Versorgungsqualität sollte das Klinikpersonal die Lebensqualität der Untergebrachten in den identifizierten Bereichen bestmöglich fördern und besonders zum Aufnahmezeitpunkt sowie bei längeren Behandlungsdauern depressive Symptome identifizieren und behandeln. Hierbei sollte ein Augenmerk auf das Erreichen einer stabilen therapeutischen Allianz gelegt werden.
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Affiliation(s)
- Ferdinand Bortenschlager
- Institut für Psychologie, Professur für Pathopsychologie, Universität Bamberg, Bamberg, Deutschland
| | - Michael Büsselmann
- Abteilung für Forensische Psychiatrie und Psychotherapie, Universität Ulm, Ulm, Deutschland
| | - Jörg Wolstein
- Institut für Psychologie, Professur für Pathopsychologie, Universität Bamberg, Bamberg, Deutschland
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Emotion-Based Interventions for Clinicians. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2022. [DOI: 10.1007/s10879-022-09546-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Callahan C, Bloom J, Fonseca J, Ramsey K, DeMaio V, Deichmeister M, Register-Mihalik J. Presence of persistent parent reported emotional and behavioral-related concussion symptoms is associated with lower health-related quality of life in adolescent athletes. J Neurotrauma 2022; 39:1214-1221. [PMID: 35481782 DOI: 10.1089/neu.2021.0398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Persistent concussion symptoms in adolescents are associated with lower health-related quality of life (HRQOL). However, the association between persistent emotional and behavioral-related concussion symptoms (EBS) and HRQOL is unknown. This study was a prospective cohort of adolescent athletes presenting to a concussion clinic within three days post-concussion and completing a one-month follow up. The independent variable in these analyses was parent reported EBS symptom presence grouped as: 1) no EBS; 2) EBS present at pre-concussion levels; and 3) EBS worse than pre-concussion. EBS included the following concussion symptoms: feeling irritable, depressed, frustrated/impatient, restless, reduced tolerance to stress/emotion, poor concentration, and fear of permanent symptoms. Dependent variables were parent reported psychosocial, physical, and total HRQOL. Separate multivariable linear regression models controlling for age, sex, and concussion history were used to assess the association between EBS and HRQOL. Estimated adjusted mean differences (MD) and 95% confidence intervals (CI) were used to assess associations; MDs with a 95%CI excluding 0.0 were considered statistically significant. Overall, n=245 presented to the study clinic three days post-concussion and completed the one-month follow-up (Mage=14.28±2.09 years, 59.02% male, 90.64% Caucasian, 31.84% with concussion history). At one-month post-concussion, adolescents with pre-concussion EBS levels had significantly lower psychosocial, physical, and total HRQOL than those with no EBS. Additionally, those with EBS worse than pre-concussion had significantly lower psychosocial, physical, and total HRQOL than those with no EBS and EBS at pre-concussion levels. These findings highlight the importance of HRQOL assessments and that targeted interventions may be needed for those with EBS at one-month post-concussion to improve HRQOL.
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Affiliation(s)
- Christine Callahan
- The University of North Carolina at Chapel Hill, 2331, Exercise and Sports Science, 2207 Stallings-Evans Sports Medicine Complex Campus Box 8700, Chapel Hill, North Carolina, United States, 27599;
| | - Josh Bloom
- Carolina Family Practice & Sports Medicine, Cary, North Carolina, United States;
| | - Janna Fonseca
- Carolina Family Practice & Sports Medicine, Cary, North Carolina, United States;
| | - Kristen Ramsey
- Carolina Family Practice & Sports Medicine, Cary, North Carolina, United States;
| | - Valerie DeMaio
- The University of North Carolina at Chapel Hill, 2331, Department of Emergency Medicine, Chapel Hill, North Carolina, United States;
| | - Margaret Deichmeister
- University of North Carolina at Chapel Hill School of Medicine, 6797, Chapel Hill, North Carolina, United States;
| | - Johna Register-Mihalik
- University of North Carolina at Chapel Hill, 2331, Department of Exercise and Sport Science, Chapel Hill, North Carolina, United States, 27515;
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Almohammed OA, Alsalem AA, Almangour AA, Alotaibi LH, Al Yami MS, Lai L. Antidepressants and health-related quality of life (HRQoL) for patients with depression: Analysis of the medical expenditure panel survey from the United States. PLoS One 2022; 17:e0265928. [PMID: 35442954 PMCID: PMC9020683 DOI: 10.1371/journal.pone.0265928] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/10/2022] [Indexed: 12/25/2022] Open
Abstract
Background Despite the empirical literature demonstrating the efficacy of antidepressant medications for treatment of depression disorder, these medications’ effect on patients’ overall well-being and health-related quality of life (HRQoL) remains controversial. This study investigates the effect of antidepressant medication use on patient-reported HRQoL for patients who have depression. Methods A comparative cohort, secondary database analysis was conducted using data from the United States’ Medical Expenditures Panel Survey for patients who had depression. HRQoL was measured using the SF-12 and reported as physical and mental component summaries (PCS and MCS). A cohort of patients that used antidepressant medications were compared to a cohort of patients that did not. Univariate and multivariate difference-in-differences (D-I-D) analyses were used to assess the significance of the mean difference of change on the PCS and MCS from baseline to follow-up. Results On average, 17.5 million adults were diagnosed with depression disorder each year during the period 2005–2016. The majority were female (67.9%), a larger proportion of whom received antidepressant medications (60.5% vs. 51.5% of males). Although use of antidepressants was associated with some improvement on the MCS, D-I-D univariate analysis revealed no significant difference between the two cohorts in PCS (–0.35 vs. –0.34, p = 0.9595) or MCS (1.28 vs. 1.13, p = 0.6405). The multivariate D-I-D analyses ensured the robustness of these results. Conclusion The real-world effect of using antidepressant medications does not continue to improve patients’ HRQoL over time. Future studies should not only focus on the short-term effect of pharmacotherapy, it should rather investigate the long-term impact of pharmacological and non-pharmacological interventions on these patients’ HRQoL.
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Affiliation(s)
- Omar A. Almohammed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- * E-mail:
| | - Abdulaziz A. Alsalem
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah A. Almangour
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Lama H. Alotaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Majed S. Al Yami
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Clinical Pharmacy, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Leanne Lai
- Department of Sociobehavioral and Administrative Pharmacy, College of Pharmacy, Nova Southeastern University, Davie, Florida, United States of America
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Kamran M, Bibi F, ur. Rehman A, Morris DW. Major Depressive Disorder: Existing Hypotheses about Pathophysiological Mechanisms and New Genetic Findings. Genes (Basel) 2022; 13:646. [PMID: 35456452 PMCID: PMC9025468 DOI: 10.3390/genes13040646] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 01/08/2023] Open
Abstract
Major depressive disorder (MDD) is a common mental disorder generally characterized by symptoms associated with mood, pleasure and effectiveness in daily life activities. MDD is ranked as a major contributor to worldwide disability. The complex pathogenesis of MDD is not yet understood, and this is a major cause of failure to develop new therapies and MDD recurrence. Here we summarize the literature on existing hypotheses about the pathophysiological mechanisms of MDD. We describe the different approaches undertaken to understand the molecular mechanism of MDD using genetic data. Hundreds of loci have now been identified by large genome-wide association studies (GWAS). We describe these studies and how they have provided information on the biological processes, cell types, tissues and druggable targets that are enriched for MDD risk genes. We detail our understanding of the genetic correlations and causal relationships between MDD and many psychiatric and non-psychiatric disorders and traits. We highlight the challenges associated with genetic studies, including the complexity of MDD genetics in diverse populations and the need for a study of rare variants and new studies of gene-environment interactions.
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Affiliation(s)
- Muhammad Kamran
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad 45320, Pakistan; (M.K.); (A.u.R.)
- Centre for Neuroimaging, Cognition and Genomics (NICOG), Discipline of Biochemistry, National University of Ireland Galway, H91 CF50 Galway, Ireland
| | - Farhana Bibi
- Department of Microbiology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad 45320, Pakistan;
| | - Asim. ur. Rehman
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad 45320, Pakistan; (M.K.); (A.u.R.)
| | - Derek W. Morris
- Centre for Neuroimaging, Cognition and Genomics (NICOG), Discipline of Biochemistry, National University of Ireland Galway, H91 CF50 Galway, Ireland
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Herrman H, Patel V, Kieling C, Berk M, Buchweitz C, Cuijpers P, Furukawa TA, Kessler RC, Kohrt BA, Maj M, McGorry P, Reynolds CF, Weissman MM, Chibanda D, Dowrick C, Howard LM, Hoven CW, Knapp M, Mayberg HS, Penninx BWJH, Xiao S, Trivedi M, Uher R, Vijayakumar L, Wolpert M. Time for united action on depression: a Lancet-World Psychiatric Association Commission. Lancet 2022; 399:957-1022. [PMID: 35180424 DOI: 10.1016/s0140-6736(21)02141-3] [Citation(s) in RCA: 489] [Impact Index Per Article: 163.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Sangath, Goa, India; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Christian Kieling
- Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Michael Berk
- Deakin University, IMPACT Institute, Geelong, VIC, Australia
| | - Claudia Buchweitz
- Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Mario Maj
- Department of Psychiatry, University of Campania L Vanvitelli, Naples, Italy
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Myrna M Weissman
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Dixon Chibanda
- Department of Psychiatry, University of Zimbabwe, Harare, Zimbabwe; Centre for Global Mental Health, The London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Louise M Howard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christina W Hoven
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Helen S Mayberg
- Departments of Neurology, Neurosurgery, Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Shuiyuan Xiao
- Central South University Xiangya School of Public Health, Changsha, China
| | - Madhukar Trivedi
- Peter O'Donnell Jr Brain Institute and the Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Lakshmi Vijayakumar
- Sneha, Suicide Prevention Centre and Voluntary Health Services, Chennai, India
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Psychological Status, Compliance, Serum Brain-Derived Neurotrophic Factor, and Nerve Growth Factor Levels of Patients with Depression after Augmented Mindfulness-Based Cognitive Therapy. Genet Res (Camb) 2022; 2022:1097982. [PMID: 35069013 PMCID: PMC8752293 DOI: 10.1155/2022/1097982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/22/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Mindfulness-based cognitive therapy (MBCT) is a cost-effective psychosocial program that prevents relapse/recurrence in major depression. The present study aimed to analyze the effects of augmented MBCT along with standard treatment dominated by pharmacotherapy on psychological state, compliance, brain-derived neurotrophic factor (BDNF), and nerve growth factor (NGF) expression levels in patients with depression. Methods A total of 160 eligible patients with depression in The First Affiliated Hospital of Zhengzhou University were included in this study. The study randomly assigned the patients to the experimental group (n = 80) and control group (n = 80). All participants were assessed with the questionnaires including the 17-item Hamilton Depression Rating Scale (HAMD-17), Rosenberg Self-esteem Scale (RSES), Self-Acceptance Questionnaire (SAQ), and Stigma Scale (Scale of Stigma in People with Mental Illness, SSPM). The serum levels of BDNF and NGF were detected by enzyme-linked immunosorbent assay (ELISA). Results After 8 weeks of treatment, the experimental group showed significant lower HAMD-17 score, higher RSES, and SAQ score, as well as lower SSPM score compared with the control group (P < 0.01). Furthermore, ELISA revealed that the serum levels of BDNF and NGF remarkably increased in the experimental group after treatment (P < 0.001). Conclusions Our data showed that augmented MBCT combined with pharmacotherapy contributed to improvement on patients' psychological state, compliance, and disease recurrence.
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Wedema D, Siero J, Korevaar EL, Wardenaar KJ, Alma MA, Schoevers RA. Storytelling and training to advance individual recovery skills (STAIRS). A feasibility study of a blended program to support personal recovery among patients with a major depressive disorder in remission. Front Psychiatry 2022; 13:984104. [PMID: 36213919 PMCID: PMC9539704 DOI: 10.3389/fpsyt.2022.984104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/02/2022] [Indexed: 12/03/2022] Open
Abstract
Because major depressive disorder (MDD) has a strong negative impact on patients' lives, well-designed treatment programs are needed that address the lasting effects of MDD. Previous work has shown that such programs should not only focus on symptomatic recovery, but also on the subsequent personal recovery process. Currently, few programs with this specific focus exist. Therefore, this study aimed to assess the feasibility of a newly developed blended program to support the personal recovery process of MDD patients: Storytelling and Training to Advance Individual Recovery Skills (STAIRS). STAIRS is a program using peer support and guidance by experts by experience and clinicians, which can be added to regular depression treatment when symptomatic recovery is almost reached. Topics addressed in this program are: (1) effects of depression and treatment; (2) structure; (3) (self) stigma; (4) self-image; (5) meaning of life; (6) connection to others; (7) physical health; (8) relaxation; and (9) preventing relapse. Experiences with the STAIRS program were collected from five participating patients with questionnaires and a focus-group interview, as well as from four trainers using semi-structured interviews. Participants valued the topics addressed in STAIRS, the used working methods, the presence of an expert by experience and the ability to share experiences with peers. The use of an online platform and the involvement of others is seen as potentially supportive but turned out to be more challenging. Perceived effects of STAIRS include positive changes in participants' daily lives and their contacts with others. Overall, the results indicate that when implemented accessibly, STAIRS is a promising and feasible program to foster personal recovery among patients recovering from MDD.
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Affiliation(s)
- David Wedema
- Research and Innovation Center for Rehabilitation, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Joanieke Siero
- Research School of Behavioural and Cognitive Neurosciences (BCN), Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Eliza L Korevaar
- Research and Innovation Center for Rehabilitation, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Klaas J Wardenaar
- Research School of Behavioural and Cognitive Neurosciences (BCN), Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Manna A Alma
- Department of Health Sciences, Applied Health Research, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Robert A Schoevers
- Research School of Behavioural and Cognitive Neurosciences (BCN), Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Slatina Murga S, Janković S, Muhić M, Sikira H, Burn E, Priebe S, Džubur Kulenović A. Effectiveness of a structured intervention to make routine clinical meetings therapeutically effective (DIALOG+) for patients with depressive and anxiety disorders in Bosnia and Herzegovina: A cluster randomised controlled trial. PSYCHIATRY RESEARCH COMMUNICATIONS 2021; 1:None. [PMID: 35028649 PMCID: PMC8721954 DOI: 10.1016/j.psycom.2021.100010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022]
Abstract
Background DIALOG+ is a patient-centred, solution-focused intervention, which aims to make routine patient-clinician meetings therapeutically effective. Existing evidence suggests that it is effective for patients with psychotic disorders in high-income countries. We tested the effectiveness of DIALOG + for patients with depressive and anxiety disorders in Bosnia and Herzegovina, a middle-income country. Methods We conducted a parallel-group, cluster randomised controlled trial of DIALOG+ in an outpatient clinic in Sarajevo. Patients inclusion criteria were: 18 years and older, a diagnosis of depressive or anxiety disorders, and low quality of life. Clinicians and their patients were randomly allocated to either the DIALOG + intervention or routine care in a 1:1 ratio. The primary outcome, quality of life, and secondary outcomes, psychiatric symptoms and objective social outcomes, were measured at 6- and 12-months by blinded assessors. Results Fifteen clinicians and 72 patients were randomised. Loss to follow-up was 12% at 6-months and 19% at 12-months. Quality of life did not significantly differ between intervention and control group after six months, but patients receiving DIALOG + had significantly better quality of life after 12 months, with a medium effect size (Cohen's d = 0.632, p = 0.007). General symptoms as well as specifically anxiety and depression symptoms were significantly lower after six and 12 months, and the objective social situation showed a statistical trend after 12 months, all in favour of the intervention group. No adverse events were reported. Limitations Delivery of the intervention was variable and COVID-19 affected 12-month follow-up assessments in both groups. Conclusion The findings suggest DIALOG + could be an effective treatment option for improving quality of life and reducing psychiatric symptoms in patients with depressive and anxiety disorders in a low-resource setting.
As DIALOG+ is used within routine clinical meeting, no additional staff or resources are required for implementation. DIALOG+ utilises existing patient resources, is not difficult to implement and is inexpensive. Eighty patients met our inclusion criteria and 72 agreed to participate and completed a baseline assessment. At 12 months, the intervention group showed a significantly better quality of life. Patients in the intervention group had significantly lower levels of symptoms time with medium to large effect sizes. The objective social situation did not differ significantly between the two groups after six months. The objective social situation showed a statistical trend towards a more positive outcome in the intervention group. Findings suggest DIALOG + could be an effective treatment for improving quality of life and reducing psychiatric symptoms.
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Affiliation(s)
- S Slatina Murga
- Department of Psychiatry, Clinical Centre University of Sarajevo, Bosnia and Herzegovina
| | - S Janković
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - M Muhić
- Department of Psychiatry, Clinical Centre University of Sarajevo, Bosnia and Herzegovina
| | - H Sikira
- Department of Psychiatry, Clinical Centre University of Sarajevo, Bosnia and Herzegovina
| | - E Burn
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, United Kingdom
| | - S Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, United Kingdom
| | - A Džubur Kulenović
- Department of Psychiatry, Clinical Centre University of Sarajevo, Bosnia and Herzegovina
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Pano O, Martínez-Lapiscina EH, Sayón-Orea C, Martinez-Gonzalez MA, Martinez JA, Sanchez-Villegas A. Healthy diet, depression and quality of life: A narrative review of biological mechanisms and primary prevention opportunities. World J Psychiatry 2021; 11:997-1016. [PMID: 34888169 PMCID: PMC8613751 DOI: 10.5498/wjp.v11.i11.997] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/19/2021] [Accepted: 08/27/2021] [Indexed: 02/06/2023] Open
Abstract
Unipolar depressive disorder (UDD) affects more than 264 million people worldwide and was projected well before the severe acute respiratory syndrome coronavirus 2 pandemic to be the leading cause of disability-adjusted life years lost in 2030. It is imperative for leading economies to implement preventive strategies targeted towards UDD, given consistent policies are currently lacking. Recently established similarities between the aetiological hypotheses of depression and cardiometabolic diseases are shifting paradigms within this field. It is believed that dietary practices could potentially reduce the incidence of depression; similar to their effects on metabolism. Thus, the aim of this review was to compile current evidence on healthy dietary patterns as suitable contributors towards primary prevention strategies against UDD. Most of the well-known biological mechanisms behind depression have been positively associated with healthful diets and dietary patterns to varying degrees. Interestingly, a common factor of UDD is the production and overall effects of inflammatory cytokines, such as interleukin-6, tumor necrosis factor-α, and C-reactive protein. These compounds have been associated with depressive symptoms, disturbances in neuroendocrine function, leaky gut, monoamine activity and brain function, while also being key factors in the development of cardiometabolic diseases. The Mediterranean diet (MD) in particular, is well supported by first-level evidence regarding its preventive qualities against metabolic and cardiovascular diseases and thus considered a model for healthy eating by various organizations. In one of the few clinical trials investigating these associations, the PREDIMED trial, individuals with diabetes assigned to a MD supplemented with mixed tree nuts experienced a 41% relative risk reduction for developing depression. Lastly, there is a need to include health related quality of life as an indicator of physical and mental well-being, considering its putative associations with depression and suicide risk. Going forward, focusing on clinical trials, using precise nutritional assessments, and identifying nutritional biomarkers which may be related to depression are needed to fully support the implementation of dietary recommendations in the field of psychiatry.
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Affiliation(s)
- Octavio Pano
- Preventive Medicine and Public Health, University of Navarre, Pamplona 31008, Spain
| | - Elena H Martínez-Lapiscina
- Department of Neurology Center of Neuroimmunology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi Sunyer, Barcelona 08036, Spain
| | - Carmen Sayón-Orea
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona 31008, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona 31008, Spain
- Department of Public Health, Navarra Institute of Public Health and Epidemiology, Pamplona 31003, Spain
| | - Miguel Angel Martinez-Gonzalez
- Preventive Medicine and Public Health, University of Navarre, Pamplona 31008, Spain
- CIBER Pathophysiology of Obesity and Nutrition, Institute of Health Carlos III, Madrid 28049, Spain
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Jose Alfredo Martinez
- IdiSNA, Navarra Institute for Health Research, Pamplona 31008, Spain
- CIBER Pathophysiology of Obesity and Nutrition, Institute of Health Carlos III, Madrid 28049, Spain
- Department of Food Sciences and Physiology, University of Navarre, Pamplona 31008, Spain
- Precision Nutrition and Cardiometabolic Health Program, IMDEA Food Institute, Madrid 28049, Spain
| | - Almudena Sanchez-Villegas
- CIBER Pathophysiology of Obesity and Nutrition, Institute of Health Carlos III, Madrid 28049, Spain
- Department of Clinical Sciences, University of Las Palmas Gran Canaria, Las Palmas Gran Canaria 35080, Spain
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Karrouri R, Hammani Z, Benjelloun R, Otheman Y. Major depressive disorder: Validated treatments and future challenges. World J Clin Cases 2021; 9:9350-9367. [PMID: 34877271 PMCID: PMC8610877 DOI: 10.12998/wjcc.v9.i31.9350] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/02/2021] [Accepted: 10/11/2021] [Indexed: 02/06/2023] Open
Abstract
Depression is a prevalent psychiatric disorder that often leads to poor quality of life and impaired functioning. Treatment during the acute phase of a major depressive episode aims to help the patient reach a remission state and eventually return to their baseline level of functioning. Pharmacotherapy, especially selective serotonin reuptake inhibitors antidepressants, remains the most frequent option for treating depression during the acute phase, while other promising pharmacological options are still competing for the attention of practitioners. Depression-focused psychotherapy is the second most common option for helping patients overcome the acute phase, maintain remission, and prevent relapses. Electroconvulsive therapy is the most effective somatic therapy for depression in some specific situations; meanwhile, other methods have limits, and their specific indications are still being studied. Combining medications, psychotherapy, and somatic therapies remains the most effective way to manage resistant forms of depression.
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Affiliation(s)
- Rabie Karrouri
- Department of Psychiatry, Moulay Ismaïl Military Hospital, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez 30070, Morocco
| | - Zakaria Hammani
- Department of Psychiatry, Moulay Ismaïl Military Hospital, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez 30070, Morocco
| | - Roukaya Benjelloun
- Department of Psychiatry, Faculty of Medicine, Mohammed VI University of Health Sciences, Casablanca 20000, Morocco
| | - Yassine Otheman
- Department of Psychiatry, Moulay Ismaïl Military Hospital, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez 30070, Morocco
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Prinholato da Silva C, Oliveira DD, Benincasa BI, Barbar B, Facchin AL, Beleboni RO. Antidepressant activity of Riparin A in murine model. Behav Pharmacol 2021; 32:599-606. [PMID: 34483245 DOI: 10.1097/fbp.0000000000000654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Depression and anxiety are common neuropsychiatric disorders that usually appear as comorbidities. The development of new drugs is crucial for safer and more effective clinical management of both disorders. Riparin A is a synthetic chemical analog of riparins that naturally occur in several medicinal plants. Marked pharmacological effects such as anxiolytic and antidepressant properties characterize this class of compounds. However, little is known about the potential anxiolytic and antidepressant effects of Riparin A. In this work, we showed that, unlike other riparins, Riparin A exerts only a very mild anxiolytic-like effect as demonstrated by the results of classical behavioral tests such as the elevated plus-maze, light-dark box and open-field tests in rats. However, all doses of Riparin A (2.5; 5.0 and 10 mg/kg; intraperitoneal) have shown significant antidepressant activity in rats submitted to forced swimming test. In addition to this interesting pharmacological property, Riparin A did not promote any important alterations in the locomotor performance of the animals as specifically demonstrated by the rotarod test. Furthermore, Riparin A did not induce sedation in treated animals; instead, this compound appears to increase the animal's state of alertness as measured by the latency time to loss of reflexes and time to recovery from sleep in rats submitted to the pentobarbital-induced sleep time test. The present results point to an antidepressant effect of Riparin A and reinforce the pharmaceutical interest in the group of riparins, particularly their high potential for use in new studies investigating the structure-activity relationships between member compounds.
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Affiliation(s)
| | | | | | - Bruna Barbar
- Department of Biotechnology
- School of Medicine, University of Ribeirão Preto, Ribeirão Preto, Brazil
| | - Ana Lúcia Facchin
- Department of Biotechnology
- School of Medicine, University of Ribeirão Preto, Ribeirão Preto, Brazil
| | - Rene Oliveira Beleboni
- Department of Biotechnology
- School of Medicine, University of Ribeirão Preto, Ribeirão Preto, Brazil
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Li Z, Ruan M, Chen J, Fang Y. Major Depressive Disorder: Advances in Neuroscience Research and Translational Applications. Neurosci Bull 2021; 37:863-880. [PMID: 33582959 PMCID: PMC8192601 DOI: 10.1007/s12264-021-00638-3] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/30/2020] [Indexed: 02/07/2023] Open
Abstract
Major depressive disorder (MDD), also referred to as depression, is one of the most common psychiatric disorders with a high economic burden. The etiology of depression is still not clear, but it is generally believed that MDD is a multifactorial disease caused by the interaction of social, psychological, and biological aspects. Therefore, there is no exact pathological theory that can independently explain its pathogenesis, involving genetics, neurobiology, and neuroimaging. At present, there are many treatment measures for patients with depression, including drug therapy, psychotherapy, and neuromodulation technology. In recent years, great progress has been made in the development of new antidepressants, some of which have been applied in the clinic. This article mainly reviews the research progress, pathogenesis, and treatment of MDD.
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Affiliation(s)
- Zezhi Li
- Clinical Research Center and Division of Mood Disorders of Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Meihua Ruan
- Shanghai Institute of Nutrition and Health, Shanghai Information Center for Life Sciences, Chinese Academy of Science, Shanghai, 200031, China
| | - Jun Chen
- Clinical Research Center and Division of Mood Disorders of Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 201108, China
| | - Yiru Fang
- Clinical Research Center and Division of Mood Disorders of Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
- Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Science, Shanghai, 200031, China.
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 201108, China.
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Morton E, Bhat V, Giacobbe P, Lou W, Michalak EE, Chakrabarty T, Frey BN, Milev RV, Müller DJ, Parikh SV, Rotzinger S, Kennedy SH, Lam RW. Impacts on Quality of Life with Escitalopram Monotherapy and Aripiprazole Augmentation in Patients with Major Depressive Disorder: A CAN-BIND Report. PHARMACOPSYCHIATRY 2021; 54:225-231. [PMID: 33652477 DOI: 10.1055/a-1385-0263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Many individuals with major depressive disorder (MDD) do not respond to initial antidepressant monotherapy. Adjunctive aripiprazole is recommended for treatment non-response; however, the impacts on quality of life (QoL) for individuals who receive this second-line treatment strategy have not been described. METHODS We evaluated secondary QoL outcomes in patients with MDD (n=179). After 8 weeks of escitalopram, non-responders (<50% decrease in clinician-rated depression) were treated with adjunctive aripiprazole for 8 weeks (n=97); responders continued escitalopram (n=82). A repeated-measures ANOVA evaluated change in Quality of Life Enjoyment and Satisfaction Short Form scores. QoL was described relative to normative benchmarks. RESULTS Escitalopram responders experienced the most QoL improvements in the first treatment phase. For non-responders, QoL improved with a large effect during adjunctive aripiprazole treatment. At the endpoint, 47% of patients achieving symptomatic remission still had impaired QoL. DISCUSSION Individuals who were treated with adjunctive aripiprazole after non-response to escitalopram experienced improved QoL, but a substantial degree of QoL impairment persisted. Since QoL deficits may predict MDD recurrence, attention to ways to support this outcome is required.
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Affiliation(s)
- Emma Morton
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Venkat Bhat
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Wendy Lou
- Dalla Lane School of Public Health, University of Toronto, ON, Canada
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Roumen V Milev
- Departments of Psychiatry and Psychology, Queen's University, Kingston, ON, Canada
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Morton E, Michalak EE, Levitt A, Levitan RD, Cheung A, Morehouse R, Ramasubbu R, Yatham LN, Tam EM, Lam RW. Quality of Life Impacts of Bright Light Treatment, Fluoxetine, and the Combination in Patients with Nonseasonal Major Depressive Disorder: A Randomized Clinical Trial. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:289-297. [PMID: 32573396 PMCID: PMC7958199 DOI: 10.1177/0706743720936470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Bright light therapy is increasingly recommended (alone or in combination with antidepressant medication) to treat symptoms of nonseasonal major depressive disorder (MDD). However, little is known about its impacts on quality of life (QoL), a holistic, patient-valued outcome. METHODS This study utilizes secondary outcome data from an 8-week randomized, controlled, double blind trial comparing light monotherapy (n = 32), fluoxetine monotherapy (n = 30), and the combination of these (n = 27) to placebo (n = 30). QoL was assessed using the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF). Treatment-related differences in QoL improvements were assessed using a repeated measures analysis of variance. The influence of potential predictors of QoL (demographic variables and change in depressive symptoms) were investigated via hierarchical linear regression. RESULTS Q-LES-Q-SF scores significantly improved across all treatment conditions; however, no significant differences were observed between treatment arms. QoL remained poor relative to community norms by the end of the trial period: Across conditions, 70.6% of participants had significantly impaired QoL at the 8-week assessment. Reduction in depressive scores was a significant predictor of improved QoL, with the final model accounting for 54% of variance in QoL change scores. CONCLUSION The findings of this study emphasize that improvement in QoL and reduction in depressive symptoms in MDD, while related, cannot be taken to be synonymous. Adjunctive therapies may be required to address unmet QoL needs in patients with MDD receiving antidepressant or light therapies. Further research is required to explore additional predictors of QoL in order to better refine treatments for MDD.
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Affiliation(s)
- Emma Morton
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada.,Swinburne University of Technology, Hawthorn, Victoria Australia
| | - Erin E Michalak
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada.,Mood Disorders Centre, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Anthony Levitt
- Department of Psychiatry, 7938University of Toronto, Ontario, Canada.,Mood Disorders Program, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Robert D Levitan
- Department of Psychiatry, 7938University of Toronto, Ontario, Canada.,Mood and Anxiety Disorders Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Amy Cheung
- Department of Psychiatry, 7938University of Toronto, Ontario, Canada.,Mood Disorders Program, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rachel Morehouse
- Department of Psychiatry, 3688Dalhousie University, Saint John, New Brunswick, Canada
| | - Rajamannar Ramasubbu
- Department of Psychiatry/Clinical Neurosciences, Mathison Center for Mental Health Research and Education, Hotchkiss Brain Institute, 2129University of Calgary, Alberta, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada.,Mood Disorders Centre, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Edwin M Tam
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada.,Mood Disorders Centre, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Raymond W Lam
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada.,Mood Disorders Centre, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
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Erkkilä J, Brabant O, Hartmann M, Mavrolampados A, Ala-Ruona E, Snape N, Saarikallio S, Gold C. Music Therapy for Depression Enhanced With Listening Homework and Slow Paced Breathing: A Randomised Controlled Trial. Front Psychol 2021; 12:613821. [PMID: 33664693 PMCID: PMC7920974 DOI: 10.3389/fpsyg.2021.613821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/22/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction: There is evidence from earlier trials for the efficacy of music therapy in the treatment of depression among working-age people. Starting therapy sessions with relaxation and revisiting therapeutic themes outside therapy have been deemed promising for outcome enhancement. However, previous music therapy trials have not investigated this issue. Objective: To investigate the efficacy of two enhancers, resonance frequency breathing (RFB) and listening homework (LH), when combined with an established music therapy model (trial registration number ISRCTN11618310). Methods: In a 2 × 2 factorial randomised controlled trial, working-age individuals with depression were allocated into groups based on four conditions derived from either the presence or absence of two enhancers (RFB and LH). All received music therapy over 6 weeks. Outcomes were observed at 6 weeks and 6 months. The primary outcome was the Montgomery Åsberg Depression Rating Scale (MADRS) score. Results: There was a significant overall effect of treatment for the primary outcome favouring the breathing group (d = 0.50, 95% CI 0.07 to 0.93, p = 0.02). The effect was larger after adjustment for potential confounders (d = 0.62, 95% CI 0.16 to 1.08, p = 0.009). Treatment effects for secondary outcomes, including anxiety (anxiety scale of Hospital Anxiety and Depression Scale) and quality of life (RAND-36), were also significant, favouring the breathing group. The homework enhancer did not reach significant treatment effects. Conclusion: We found that the addition of RFB to a music therapy intervention resulted in enhanced therapeutic outcome for clients with depression.
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Affiliation(s)
- Jaakko Erkkilä
- Faculty of Information Technology, University of Jyväskylä, Jyväskylä, Finland
| | - Olivier Brabant
- Faculty of Information Technology, University of Jyväskylä, Jyväskylä, Finland
| | - Martin Hartmann
- Faculty of Information Technology, University of Jyväskylä, Jyväskylä, Finland
| | | | - Esa Ala-Ruona
- Faculty of Information Technology, University of Jyväskylä, Jyväskylä, Finland
| | - Nerdinga Snape
- Faculty of Information Technology, University of Jyväskylä, Jyväskylä, Finland
| | - Suvi Saarikallio
- Faculty of Information Technology, University of Jyväskylä, Jyväskylä, Finland
| | - Christian Gold
- NORCE Norwegian Research Centre AS, Bergen, Norway.,Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
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Ravindran AV, McKay MS, Silva TD, Tindall C, Garfinkel T, Paric A, Ravindran L. Breathing-focused Yoga as Augmentation for Unipolar and Bipolar Depression: A Randomized Controlled Trial: Le yoga axé sur la respiration comme traitement d'appoint pour la dépression unipolaire et bipolaire: Un essai randomisé contrôlé. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:159-169. [PMID: 32677851 PMCID: PMC7918867 DOI: 10.1177/0706743720940535] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Patients with depression frequently experience persistent residual symptoms even with optimal interventions. These patients often use complementary treatments, including yoga, as a preferred alternative or adjunctive treatment. There is evidence for the benefit of yoga for depression, but this has not been rigorously evaluated, particularly in bipolar depression. We aimed to determine the feasibility and benefit of manualized breathing-focused yoga in comparison to psychoeducation as augmentation to pharmacotherapy for improving residual symptoms of depression in unipolar and bipolar patients. METHODS Using a randomized single-blind crossover design, 72 outpatients with unipolar or bipolar depression were augmented with the two 8-week interventions at separate times, as add-ons to current first-line antidepressants and mood stabilizers. The primary outcome measure was the Montgomery-Åsberg Depression Rating Scale (MADRS). Due to the high dropout of participants after crossover at Week 8, analysis focused on between-group comparisons of yoga and psychoeducation during the initial 8 weeks of the study. RESULTS There was a significant decline in depressive symptoms, as measured by the MADRS, following 8 weeks of yoga. However, there was no significant difference in MADRS ratings between intervention groups. Similar improvements in self-rated depressive symptoms and well-being were also observed across time. CONCLUSIONS Both yoga and psychoeducation may improve residual symptoms of unipolar and bipolar depression as add-on to medications. In-class group sessions and long study durations may reduce feasibility for this population. Larger trials with parallel group design and shorter duration may be more feasible.
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Affiliation(s)
- Arun V Ravindran
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Martha S McKay
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Tricia da Silva
- Institute of Medical Science, University of Toronto, Ontario, Canada
| | - Claudia Tindall
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Angela Paric
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lakshmi Ravindran
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
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Vittengl JR, Jha MK, Minhajuddin A, Thase ME, Jarrett RB. Quality of life after response to acute-phase cognitive therapy for recurrent depression. J Affect Disord 2021; 278:218-225. [PMID: 32971314 PMCID: PMC7704560 DOI: 10.1016/j.jad.2020.09.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/28/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Adults with major depressive disorder (MDD) often experience reduced quality of life (QOL). Efficacious acute-phase treatments, including cognitive therapy (CT) or medication, decrease depressive symptoms and, to a lesser degree, increase QOL. We tested longer-term changes in QOL after response to acute-phase CT, including the potential effects of continuation treatment for depression and time-lagged relations between QOL and depressive symptoms. METHODS Responders to acute-phase CT (N = 290) completed QOL and depressive symptom assessments repeatedly for 32 post-acute months. Higher-risk responders were randomized to 8 months of continuation treatment (CT, fluoxetine, or pill placebo) and then entered a 24-month follow-up. Lower-risk responders were only assessed for 32 months. RESULTS On average, large gains in QOL made during acute-phase CT response were maintained for 32 months. Continuation CT or fluoxetine did not improve QOL relative to pill placebo. Controlling for residual depressive symptoms, higher QOL after acute-phase CT response was a protective factor against MDD relapse and recurrence. Higher QOL predicted subsequent reductions in depressive symptom severity, but depressive symptom severity did not predict subsequent changes in QOL. LIMITATIONS Generalization of results to other patient populations, treatments, and measures is uncertain. The clinical trial was not designed to test relations between QOL and depression. Replication is needed before clinical application of these results. CONCLUSIONS Gains in QOL made during response to acute-phase CT are relatively stable and may help protect against relapse/recurrence. Continuation CT or fluoxetine may not further improve QOL among acute-phase CT responders.
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Affiliation(s)
- Jeffrey R. Vittengl
- Address correspondence to either author: Jeffrey R. Vittengl, Department of Psychology, Truman State University, 100 East Normal Street, Kirksville, MO 63501-4221, USA. Telephone: 1-660-785-6041. FAX: 1-660-785-7128. . Robin B. Jarrett, Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9149, USA.
| | - Manish K. Jha
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai
| | - Abu Minhajuddin
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center
| | - Michael E. Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Robin B. Jarrett
- Address correspondence to either author: Jeffrey R. Vittengl, Department of Psychology, Truman State University, 100 East Normal Street, Kirksville, MO 63501-4221, USA. Telephone: 1-660-785-6041. FAX: 1-660-785-7128. . Robin B. Jarrett, Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9149, USA.
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