Although major depressive disorder (MDD) is characterized by a pervasive negative mood, research indicates that the mood of depressed patients is rarely entirely stagnant. It is often dynamic, ...distinguished by highs and lows, and it is highly responsive to external and internal regulatory processes. Mood dynamics can be defined as a combination of mood variability (the magnitude of the mood changes) and emotional inertia (the speed of mood shifts). The purpose of this study is to explore various distinctive profiles in real-time monitored mood dynamics among MDD patients in routine mental healthcare.
Ecological momentary assessment (EMA) data were collected as part of the cross-European E-COMPARED trial, in which approximately half of the patients were randomly assigned to receive the blended Cognitive Behavioral Therapy (bCBT). In this study a subsample of the bCBT group was included (
= 287). As part of bCBT, patients were prompted to rate their current mood (on a 1-10 scale) using a smartphone-based EMA application. During the first week of treatment, the patients were prompted to rate their mood on three separate occasions during the day. Latent profile analyses were subsequently applied to identify distinct profiles based on average mood, mood variability, and emotional inertia across the monitoring period.
Overall, four profiles were identified, which we labeled as: (1) "very negative and least variable mood" (
= 14) (2) "negative and moderate variable mood" (
= 204), (3) "positive and moderate variable mood" (
= 41), and (4) "negative and highest variable mood" (
= 28). The degree of emotional inertia was virtually identical across the profiles.
The real-time monitoring conducted in the present study provides some preliminary indications of different patterns of both average mood and mood variability among MDD patients in treatment in mental health settings. Such varying patterns were not found for emotional inertia.
Depressive disorders are highly prevalent in the working population and are associated with excessive costs for both society and companies. Effective treatment for employees with depressive symptoms ...in occupational health care is limited. The purpose of this study is to investigate the effectiveness and cost-effectiveness of an indicated preventive web-based guided self-help course for employees with depressive symptoms.
The study is a two-arm randomized controlled trial comparing a web-based guided self-help course with care-as-usual. The self-help course consists of 6 weekly lessons. Weekly support will be provided by a coach via the website. Subjects in the care-as-usual group do not receive any treatment in addition to regular care. 200 white collar workers from several national and international companies in the Netherlands will be recruited via different methods such as banners on the company's intranet, pamphlets and posters. Subjects will be included when they: have elevated depressive symptoms (score ≥16 on the Center for Epidemiologic Studies Depression scale), are 18 years of age or older, have access to the Internet and can be contacted via e-mail. Exclusion criteria are: partial or full work absenteeism, a legal labor dispute with the employer and receiving treatment from the company's occupational health care at study entrance.The primary outcome is depressive symptoms. Secondary outcomes include work absenteeism, work performance, burnout, anxiety, quality of life, health care use and production losses. Outcome data will be collected at 8 weeks, 6 months, and 12 months after baseline. Analyses will be based on the intention-to-treat principle. The cost-effectiveness analyses will be performed from a societal and a company's perspective. A process evaluation will be conducted alongside the study.
This study evaluates the effectiveness and cost-effectiveness of a web-based guided self-help course for employees with depressive symptoms. This study could stimulate the use of e-mental health interventions in the worksite setting.
Nederlands Trial Register (NTR): TC2993.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Young adults' drinking habits often exceed low-risk drinking guidelines. As young adults show increased access, use, and interest in personalized content related to physical and mental well-being, ...mobile applications might be a suitable tool to reach this target group. This study investigates the effectiveness of "Boozebuster", a self-guided mobile application incorporating various therapeutic principles to reduce young adults' alcohol consumption to not exceeding low-risk drinking guideline levels, compared to an educational website condition.
Young adults aged 18-30 wanting to reduce their alcohol consumption entered a two-arm, parallel-group RCT. There were no minimum drinking severity inclusion criteria. Primary outcomes included alcohol consumption quantity and frequency. Secondary outcomes included binge drinking frequency and alcohol-related problem severity. Baseline, 6-week postbaseline, and 3-month post-baseline assessments were analyzed using linear mixed model analyses. Sex, treatment adherence, experienced engagement and motivation to change alcohol use behavior were investigated as moderators. Sub-group analyses contained problem drinkers and binge drinkers.
503 participants were randomized to the intervention or control condition. Results showed no intervention effects on primary or secondary outcomes compared to the control group. Both groups showed within-group reductions on all outcomes. Sub-group analyses in problem drinkers or binge drinkers showed similar results. Motivation to change drinking behavior and experienced engagement with the application significantly moderated the intervention effect regarding the quantity or frequency of alcohol consumption, respectively. Exploratory analyses showed that participants who indicated they wanted to change their drinking patterns during the initial PNF/MI module showed a significantly greater reduction in drinking quantity compared to those who indicated not wanting to change their drinking patterns.
The intervention group did not show a greater reduction in alcohol-related outcomes compared to the control group, but both groups showed a similar decrease. Potential explanations include similar effectiveness of both condition due to using a minimal active control in participants predominantly in the action stage of motivation to change. Future research should further explore the effectiveness of using mobile application to reduce young adults' drinking behavior to not exceed low-risk drinking guideline levels and identify factors that motivate participants to engage with such an intervention.
Background
Internet-based interventions can be effective in the treatment of depression. However, internet-based interventions for older adults with depression are scarce, and little is known about ...their feasibility and effectiveness.
Objective
To present the design of 2 studies aiming to assess the feasibility of internet-based cognitive behavioral treatment for older adults with depression. We will assess the feasibility of an online, guided version of the Moodbuster platform among depressed older adults from the general population as well as the feasibility of a blended format (combining integrated face-to-face sessions and internet-based modules) in a specialized mental health care outpatient clinic.
Methods
A single-group, pretest-posttest design will be applied in both settings. The primary outcome of the studies will be feasibility in terms of (1) acceptance and satisfaction (measured with the Client Satisfaction Questionnaire-8), (2) usability (measured with the System Usability Scale), and (3) engagement (measured with the Twente Engagement with eHealth Technologies Scale). Secondary outcomes include (1) the severity of depressive symptoms (measured with the 8-item Patient Health Questionnaire depression scale), (2) participant and therapist experience with the digital technology (measured with qualitative interviews), (3) the working alliance between patients and practitioners (from both perspectives; measured with the Working Alliance Inventory–Short Revised questionnaire), (4) the technical alliance between patients and the platform (measured with the Working Alliance Inventory for Online Interventions–Short Form questionnaire), and (5) uptake, in terms of attempted and completed modules. A total of 30 older adults with mild to moderate depressive symptoms (Geriatric Depression Scale 15 score between 5 and 11) will be recruited from the general population. A total of 15 older adults with moderate to severe depressive symptoms (Geriatric Depression Scale 15 score between 8 and 15) will be recruited from a specialized mental health care outpatient clinic. A mixed methods approach combining quantitative and qualitative analyses will be adopted. Both the primary and secondary outcomes will be further explored with individual semistructured interviews and synthesized descriptively. Descriptive statistics (reported as means and SDs) will be used to examine the primary and secondary outcome measures. Within-group depression severity will be analyzed using a 2-tailed, paired-sample t test to investigate differences between time points. The interviews will be recorded and analyzed using thematic analysis.
Results
The studies were funded in October 2019. Recruitment started in September 2022.
Conclusions
The results of these pilot studies will show whether this platform is feasible for use by the older adult population in a blended, guided format in the 2 settings and will represent the first exploration of the size of the effect of Moodbuster in terms of decreased depressive symptoms.
International Registered Report Identifier (IRRID)
PRR1-10.2196/41445
Depressive disorder is a major societal challenge. Despite the availability of clinically and cost-effective treatments including Internet interventions, the number of patients receiving treatment is ...limited. Evidence-based Internet interventions promise wide availability and high efficiency of treatments. However, these interventions often do not enter routine mental healthcare delivery at a large scale. The MasterMind project aims to provide insight into the factors that promote or hinder the uptake and implementation of evidence-based Internet interventions by mental healthcare practice. Internet-based Cognitive Behaviour Therapy (iCBT) and videoconferencing facilitating collaborative care (ccVC) will be implemented in routine mental healthcare. The services will be offered to 5230 depressed adults in 15 European regions. The current paper describes the evaluation protocol for this large-scale implementation project.
Current summative evaluation study follows a naturalistic one-group pretest–posttest design and assesses three distinct stakeholders: patients, mental healthcare professionals, and mental healthcare organisations. The Model for Assessment of Telemedicine applications (MAST) will be employed to structure the implementation and evaluation study. The primary focal points of interest are reach, clinical effect, acceptability, appropriateness, implementation costs, and sustainability of the interventions in practice. Mixed-methods are used to provide an understanding of what (quantitative) the implementation projects have achieved and their meaning to various stakeholders (qualitative).
The use of Internet interventions in routine practice is limited. MasterMind attempts to bridge the gap between routine practice and effectiveness research by evaluating the implementation of evidence-based Internet interventions for depressive disorders in routine mental healthcare settings in Europe.
•Up-take of evidence-based eMental health by routine practice is limited.•This protocol describes the evaluation of large-scale implementation of iCBT and videoconferencing in routine practice across Europe targeting at 5,230 patients.•Multidisciplinary evaluation: reach, clinical effect, acceptability, appropriateness, and sustainability (including costs).•Mixed-methods assessing three stakeholders: a) patients, b) healthcare professionals, and c) healthcare organisations.•The study will reveal facilitating and hampering factors related to implementation of evidence-based eMental health in routine practice.
Behavioral activation (BA), either as a stand-alone treatment or as part of cognitive behavioral therapy, has been shown to be effective for treating depression. The theoretical underpinnings of BA ...derive from Lewinsohn et al's theory of depression. The central premise of BA is that having patients engage in more pleasant activities leads to them experiencing more pleasure and elevates their mood, which, in turn, leads to further (behavioral) activation. However, there is a dearth of empirical evidence about the theoretical framework of BA.
This study aims to examine the assumed (temporal) associations of the 3 constructs in the theoretical framework of BA.
Data were collected as part of the "European Comparative Effectiveness Research on Internet-based Depression Treatment versus treatment-as-usual" trial among patients who were randomly assigned to receive blended cognitive behavioral therapy (bCBT). As part of bCBT, patients completed weekly assessments of their level of engagement in pleasant activities, the pleasure they experienced as a result of these activities, and their mood over the course of the treatment using a smartphone-based ecological momentary assessment (EMA) application. Longitudinal cross-lagged and cross-sectional associations of 240 patients were examined using random intercept cross-lagged panel models.
The analyses did not reveal any statistically significant cross-lagged coefficients (all P>.05). Statistically significant cross-sectional positive associations between activities, pleasure, and mood levels were identified. Moreover, the levels of engagement in activities, pleasure, and mood slightly increased over the duration of the treatment. In addition, mood seemed to carry over, over time, while both levels of engagement in activities and pleasurable experiences did not.
The results were partially in accordance with the theoretical framework of BA, insofar as the analyses revealed cross-sectional relationships between levels of engagement in activities, pleasurable experiences deriving from these activities, and enhanced mood. However, given that no statistically significant temporal relationships were revealed, no conclusions could be drawn about potential causality. A shorter measurement interval (eg, daily rather than weekly EMA reports) might be more attuned to detecting potential underlying temporal pathways. Future research should use an EMA methodology to further investigate temporal associations, based on theory and how treatments are presented to patients.
ClinicalTrials.gov, NCT02542891, https://clinicaltrials.gov/ct2/show/NCT02542891; German Clinical Trials Register, DRKS00006866, https://tinyurl.com/ybja3xz7; Netherlands Trials Register, NTR4962, https://www.trialregister.nl/trial/4838; ClinicalTrials.Gov, NCT02389660, https://clinicaltrials.gov/ct2/show/NCT02389660; ClinicalTrials.gov, NCT02361684, https://clinicaltrials.gov/ct2/show/NCT02361684; ClinicalTrials.gov, NCT02449447, https://clinicaltrials.gov/ct2/show/NCT02449447; ClinicalTrials.gov, NCT02410616, https://clinicaltrials.gov/ct2/show/NCT02410616; ISRCTN registry, ISRCTN12388725, https://www.isrctn.com/ISRCTN12388725.
Abstract Context We know little about how many outpatients of a modern cancer center suffer from clinically significant unrelieved pain and the characteristics of these patients to guide better care. ...Objectives To determine the prevalence of clinically significant pain (CSP) in the outpatients of a regional cancer center and the association with distress and other variables. Methods A secondary analysis of cross-sectional, self-reported and clinical data from 2768 patients reattending selected clinics of a regional National Health Service cancer center in the U.K. Pain was measured using the pain severity scale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, emotional distress was measured by the Hospital Anxiety and Depression Scale, and demographic and clinical data were taken from medical records. Results Fifty-four percent (95% confidence interval CI 52–56) of patients reported pain at least “a little” in the previous week and 18% (95% CI 17–20) at least “quite a bit” (CSP). The strongest independent associations of CSP were active disease (odds ratio OR 1.95, 95% CI 1.5–2.5) and emotional distress (OR 4.8, 95% CI 4–6). Conclusion CSP is surprisingly common in outpatients of specialist cancer services, and it is strongly and independently associated with emotional distress. Better symptom management should consider pain and distress together.
The mechanisms linking depression to mortality were found to be related to biological dysregulations or lifestyle factors rather than disease specific in this unprecedented meta-analysis of 247 ...studies—which included 105,986 depressed and 578,503 nondepressed participants from 31 countries.
ObjectiveSeveral hundred studies have shown that depression is associated with an elevated risk of dying at follow-up. It is not clear, however, whether the mechanisms for this association are disease specific, leading to higher mortality in specific patient groups, or generic, resulting in comparable mortality rates in all patient groups as well as in community samples. The authors conducted a comprehensive meta-analysis of prospective studies of community as well as patient samples associating depression at baseline with excess mortality at follow-up.MethodThe authors conducted systematic searches of PubMed, PsycINFO, and Embase. Studies were included if depression was measured with a standardized instrument and mortality was reported for both depressed and nondepressed participants at follow-up.ResultsA total of 293 studies including 1,813,733 participants (135,007 depressed and 1,678,726 nondepressed) from 35 countries were included. The overall unadjusted relative risk of mortality in depressed relative to nondepressed participants was 1.64 (95% CI=1.56–1.76), with high heterogeneity (I2=83, 95% CI=80–84). After adjustment for publication bias, the overall relative risk was reduced to 1.52 (95% CI=1.45–1.59). No strong indications were found that the pooled relative risk was different across the relatively healthy community samples and specific patient samples with heart disease, cancer, kidney disease, or other disease, except for a significantly higher risk in patients with chronic obstructive pulmonary disease (p<0.05). Also, the relative risk was lower when the follow-up period was longer and when the quality of the study was higher.ConclusionsThe authors could confirm the presence of a significant association between depression and excess mortality, although this association may have been overestimated because of publication bias and low study quality. Few indications were found that this association is stronger in community or specific patient samples.
Depression has a high impact on both patients and the people around them. These non-professional caregivers often experience overburdening and are at risk for developing psychological symptoms ...themselves. Internet interventions have the potential to be accessible and (cost)-effective in terms of reducing and preventing psychological symptoms. Less is known about their potential to decrease psychological distress among caregivers. The primary aim of this study is to evaluate (1) the user-friendliness and (2) the initial short-term effects on psychological distress of ‘E-care for caregivers’, an internet based guided self-management intervention for non-professional caregivers of depressed patients.
A pilot randomized controlled trial (RCT: n=80) comparing ‘E-care for caregivers’ (n=41) with a waitlist-control group (n=39). The primary outcome measure (user-friendliness) was assessed with the System Usability Scale (SUS) and semi-structured telephone interviews among participants. Interviews were qualitatively analyzed with thematic content analysis. Secondary outcomes were assessed through online questionnaires administered at baseline and post-intervention at six weeks among caregivers. Statistical analyses were conducted according to the intention-to-treat principle using regression techniques for the secondary outcomes.
All participants were recruited within six weeks through online advertising. Two-thirds of participants experienced higher levels of psychological distress (K10>20). The internet intervention was evaluated as user-friendly by caregivers (average score of 81.5, range 0–100). Results did not show a reduction in psychological distress or other secondary outcome measures. Sensitivity analyses showed a decreased quality of life in the control condition compared to the intervention condition (p=0.02, Cohen's d=0.44) and higher levels of mastery (p=0.02, Cohen's d=0.48) in the intervention condition compared to controls.
The internet intervention was evaluated positively for usability and was considered as easy to use. The study did not show a reduction in symptoms of psychological distress. However, there were some indications that those completing the internet intervention perceived higher levels of mastery and a protective effect in quality of life post-intervention.
As far as we know, this study is the first to examine the user-friendliness and initial effects of an internet intervention specifically designed for non-professional caregivers of depressed patients. As this was a pilot study, the findings should be interpreted with caution. We recommend investigating the possibilities of providing a (partially) sequential design as well as incorporating themes like stigma and expressed emotion in the online course and subsequent evaluation of the internet intervention in a full-scale RCT, with a six-month follow-up.
Netherlands Trial Register: NTR5268. Registered on 30 June 2015.
•Non-professional caregivers caring for depressed patients experience high levels of psychological distress and caregiver burden.•The internet intervention ‘Ecare 4 caregivers’ is an acceptable and feasible method to reach this group of caregivers and was evaluated positively.•The study did not show a reduction in symptoms of psychological distress.•Evaluation of the internet intervention in a full-scale RCT with a six-month follow-up is recommended.
A variety of effective psychotherapies for depression are available, but patients who suffer from depression vary in their treatment response. Combining face-to-face therapies with internet-based ...elements in the sense of blended treatment is a new approach to treatment for depression. The goal of this study was to answer the following research questions: (1) What are the most important predictors determining optimal treatment allocation to treatment as usual or blended treatment? and (2) Would model-determined treatment allocation using this predictive information and the personalized advantage index (PAI)-approach result in better treatment outcomes? Bayesian model averaging (BMA) was applied to the data of a randomized controlled trial (RCT) comparing the efficacy of treatment as usual and blended treatment in depressive outpatients. Pre-treatment symptomatology and treatment expectancy predicted outcomes irrespective of treatment condition, whereas different prescriptive predictors were found. A PAI of 2.33 PHQ-9 points was found, meaning that patients who would have received the treatment that is optimal for them would have had a post-treatment PHQ-9 score that is two points lower than if they had received the treatment that is suboptimal for them. For 29% of the sample, the PAI was five or greater, which means that a substantial difference between the two treatments was predicted. The use of the PAI approach for clinical practice must be further confirmed in prospective research; the current study supports the identification of specific interventions favorable for specific patients.
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