RESUMO
BACKGROUND: Depression is a common mental disorder and is associated with work disability. For the implementation of evidence-based interventions, such as Individual Placement and Support (IPS) for people with depression in Germany, the aim of this study was to investigate client variables that predict return to work. METHODS: The sample consisted of 129 participants, initially treated in a psychiatric hospital due to major depression, who participated in IPS as part of a German clinical trial. Baseline demographic (age, sex, education, sickness absence days, employment status), psychiatric (symptom severity, comorbidity, general physical and mental health, disability), and neuropsychological (self-rated deficits, test performance) variables were included. Return to work within one year was predicted using separate and overall binary logistic regression analyses. RESULTS: A total of 70 participants (56 %) returned to work within the one-year follow-up period. >100 days of sick leave in the year prior to study entry (vs. <100 days) and higher self-rated cognitive deficits were significantly associated with reduced odds of return to work within one year of IPS. LIMITATIONS: The sample consisted of participants with a relatively good work history who were assigned to IPS by the treatment team, thus, the generalizability of the results is limited. CONCLUSIONS: People with depression who participate in IPS interventions might benefit from specifically targeting perceived cognitive deficits. Factors associated with prolonged sick leave due to depression and their role in return to work with IPS need further investigation.
Assuntos
Transtorno Depressivo Maior , Readaptação ao Emprego , Retorno ao Trabalho , Licença Médica , Humanos , Masculino , Feminino , Retorno ao Trabalho/estatística & dados numéricos , Retorno ao Trabalho/psicologia , Transtorno Depressivo Maior/reabilitação , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/epidemiologia , Alemanha , Adulto , Readaptação ao Emprego/estatística & dados numéricos , Licença Médica/estatística & dados numéricos , Pessoa de Meia-IdadeRESUMO
The present research sought to examine whether hatha yoga, implemented as an adjunctive intervention for major depression, influences markers of inflammation. A subset of 84 participants who were enrolled in a randomized controlled trial (RCT) of hatha yoga vs. health education control provided blood samples at baseline (pre-treatment) and at 3-(during treatment) and 10-week (end of treatment) follow-up visits. To be eligible for the RCT, participants met criteria for a current or recent (past two years) major depressive episode, had current elevated depression symptoms, and current antidepressant medication use. Venous blood was drawn between 2 and 6 pm and following at least one hour of fasting, and inflammatory markers (IL-6, CRP, and TNF-α) were assayed. Effects of participation in yoga relative to health education on inflammatory markers over time were examined with latent growth analyses. We observed a significant reduction in IL-6 concentrations in the yoga treatment group relative to the health education control group as demonstrated by a negative interaction between treatment group and slope of IL-6. TNF-α and CRP did not evidence significant interactions of treatment group by mean slope or intercept. In addition to the benefits of hatha yoga as an adjunctive intervention for individuals who have shown inadequate response to antidepressant medications, our findings point to possible benefits of yoga on IL-6 in depressed populations. Further research is needed to explore the effects of hatha yoga on immune function over time.
Assuntos
Transtorno Depressivo Maior/sangue , Transtorno Depressivo Maior/reabilitação , Interleucina-6/sangue , Yoga , Adulto , Proteína C-Reativa/metabolismo , Feminino , Seguimentos , Humanos , Inflamação/sangue , Inflamação/terapia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Reabilitação Psiquiátrica , Fator de Necrose Tumoral alfa/sangueRESUMO
BACKGROUND: People living with serious mental illness (SMI) experience debilitating symptoms that worsen their physical health and quality of life. Regular physical activity (PA) may bring symptomatic improvements and enhance wellbeing. When undertaken in community-based group settings, PA may yield additional benefits such as reduced isolation. Initiating PA can be difficult for people with SMI, so PA engagement is commonly low. Designing acceptable and effective PA programs requires a better understanding of the lived experiences of PA initiation among people with SMI. METHODS: This systematic review of qualitative studies used the meta-ethnography approach by Noblit and Hare (1988). Electronic databases were searched from inception to November 2017. Eligible studies used qualitative methodology; involved adults (≥18 years) with schizophrenia, bipolar affective disorder, major depressive disorder, or psychosis; reported community-based group PA; and captured the experience of PA initiation, including key features of social support. Study selection and quality assessment were performed by four reviewers. RESULTS: Sixteen studies were included in the review. We identified a "journey" that depicted a long sequence of phases involved in initiating PA. The journey demonstrated the thought processes, expectations, barriers, and support needs of people with SMI. In particular, social support from a trusted source played an important role in getting people to the activity, both physically and emotionally. DISCUSSION: The journey illustrated that initiation of PA for people with SMI is a long complex transition. This complex process needs to be understood before ongoing participation in PA can be addressed. Registration-The review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) on 22/03/2017 (registration number CRD42017059948).
Assuntos
Exercício Físico/psicologia , Transtornos Mentais/psicologia , Transtornos Mentais/reabilitação , Apoio Social , Adulto , Transtorno Bipolar/psicologia , Transtorno Bipolar/reabilitação , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/reabilitação , Humanos , Transtornos Psicóticos/psicologia , Transtornos Psicóticos/reabilitação , Pesquisa Qualitativa , Qualidade de Vida/psicologia , Esquizofrenia/reabilitação , Índice de Gravidade de DoençaRESUMO
OBJECTIVES: This study aimed to describe the recovery journeys of people with a history of recurrent depression who took part in a psychosocial programme designed to teach skills to prevent depressive relapse (mindfulness-based cognitive therapy (MBCT)), alongside maintenance antidepressant medication (ADM). DESIGN: A qualitative study embedded within a multicentre, single blind, randomised controlled trial (the PREVENT trial). SETTING: Primary care urban and rural settings in the UK. PARTICIPANTS: 42 people who participated in the MBCT arm of the parent trial were purposively sampled to represent a range of recovery journeys. INTERVENTIONS: MBCT involves eight weekly group sessions, with four refresher sessions offered in the year following the end of the programme. It was adapted to offer bespoke support around ADM tapering and discontinuation. METHODS: Written feedback and structured in-depth interviews were collected in the 2 years after participants undertook MBCT. Data were analysed using thematic analysis and case studies constructed to illustrate the findings. RESULTS: People with recurrent depression have unique recovery journeys that shape and are shaped by their pharmacological and psychological treatment choices. Their journeys typically include several over-arching themes: (1) beliefs about the causes of depression, both biological and psychosocial; (2) personal agency, including expectations about their role in recovery and treatment; (3) acceptance, both of depression itself and the recovery journey; (4) quality of life; (5) experiences and perspectives on ADM and ADM tapering-discontinuation; and (6) the role of general practitioners, both positive and negative. CONCLUSIONS: People with recurrent depression describe unique, complex recovery journeys shaped by their experiences of depression, treatment and interactions with health professionals. Understanding how several themes coalesce for each individual can both support their recovery and treatment choices as well as health professionals in providing more accessible, collaborative, individualised and empowering care. TRIAL REGISTRATION NUMBER: Clinical trial number ISRCTN26666654; post results.
Assuntos
Antidepressivos/uso terapêutico , Terapia Cognitivo-Comportamental/métodos , Depressão/terapia , Transtorno Depressivo Maior/terapia , Atenção Plena , Adulto , Idoso , Antidepressivos/administração & dosagem , Atitude , Doença Crônica , Depressão/tratamento farmacológico , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/reabilitação , Feminino , Clínicos Gerais , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Psicoterapia de Grupo , Pesquisa Qualitativa , Qualidade de Vida , Recidiva , Método Simples-Cego , Reino UnidoRESUMO
OBJECTIVE: The Remission Evaluation and Mood Inventory Tool (REMIT) was developed as a brief complementary measure to provide a more robust assessment of depression improvement than tracking DSM-V symptom improvement alone. This study provides further validation of the REMIT tool and examines its utility in predicting depression improvement. METHODS: The sample comprised 294 primary care patients enrolled in a telecare trial of pain plus depression and/or anxiety. Assessments collected included: REMIT, PHQ-9 and measures assessing anxiety, pain, sleep, fatigue, somatization, health-related quality of life and disability. Data was analyzed to assess the REMIT's validity, its minimally important difference (MID), and its utility in predicting 6-month depression improvement. RESULTS: Convergent and construct validity of REMIT was supported by moderate correlations with mental health measures and weaker correlation with physical health measures. MID of approximately 2 points for REMIT was estimated by two metrics: 0.5 standard deviation and 1 standard error of measurement. Both baseline and 3-month change in REMIT scores predicted depression improvement at 6â¯months. Indeed, REMIT was as good or better predictor than the PHQ-9. CONCLUSION: The REMIT measure is a brief 5-item tool that augments core DSM-V symptom-oriented metrics in assessing and predicting recovery from major depression.
Assuntos
Afeto , Transtorno Depressivo Maior/terapia , Avaliação de Resultados em Cuidados de Saúde/normas , Escalas de Graduação Psiquiátrica/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtorno Depressivo Maior/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Indução de RemissãoRESUMO
OBJECTIVE: Among people with severe mental illnesses, neuropsychological abilities may contribute to vocational outcomes, such as job attainment, job tenure, and wages earned. The current study aimed to determine the strongest neuropsychological and other modifiable predictors of work outcomes in 153 people with severe mental illness (schizophrenia, 38%; bipolar disorder, 24%; and major depression, 38%) who participated in a 2-year supported employment study. METHODS: Assessments of neuropsychological performance, functional capacity, social skills, and psychiatric symptom severity were administered at baseline; work outcomes (job attainment, weeks worked, and wages earned) were collected weekly for 2 years. RESULTS: Independent of education, diagnosis, and estimated intellectual functioning, more recent work history and less severe negative symptoms significantly predicted job attainment during the 2-year study. Among the 47% who obtained jobs, better global neuropsychological performance (i.e., lower global deficit score) was a significant predictor of greater weeks worked. Both global neuropsychological performance and more recent work history predicted higher wages earned. CONCLUSIONS: Modifiable predictors of supported employment outcomes included cognitive functioning and negative symptom severity; thus, interventions to improve these factors may improve work outcomes and decrease the loss of productivity associated with severe mental illness.
Assuntos
Transtorno Bipolar/reabilitação , Disfunção Cognitiva/reabilitação , Transtorno Depressivo Maior/reabilitação , Readaptação ao Emprego/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Esquizofrenia/reabilitação , Adulto , Transtorno Bipolar/complicações , Disfunção Cognitiva/etiologia , Transtorno Depressivo Maior/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Esquizofrenia/complicaçõesRESUMO
INTRODUCTION: Major depressive disorder (MDD) is a common debilitating illness worldwide. The vast majority of patients with MDD will not achieve remission with first-line treatment and despite the availability of different treatment modalities, at least one-third of patients experience treatment-resistant depression (TRD). There continues to be a paucity of research focused on treatment options for patients with TRD thus treatment decisions are largely based on patient and clinician preference as opposed to evidence-based practice. Herein we propose a systematic review and network meta-analysis (NMA) of available pharmacological and psychological augmentation treatments for TRD, to inform evidence-based management of TRD. METHODS AND ANALYSIS: We plan to conduct a search of electronic databases (MEDLINE and ISIWEB) of all dates from inception for randomised controlled trials of pharmacological and psychological augmentation interventions for adults with TRD. Articles for review will be included based upon consensus from two authors. Pharmaceutical companies will be contacted for access to any unpublished data. An NMA will compare the effectiveness pharmacological adjunctive agents for TRD using preanalysis/postanalysis, assuming consistency and transitivity. ETHICS AND DISSEMINATION: This project does not require research ethics board approval. The dissemination plan is to present findings at international scientific meetings and publishing results in a peer-reviewed academic journal. PROSPERO REGISTRATION NUMBER: CRD42019132588.
Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/terapia , Transtorno Depressivo Resistente a Tratamento/terapia , Metanálise em Rede , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Psicoterapia/estatística & dados numéricos , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Terapia Combinada , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/reabilitação , Transtorno Depressivo Resistente a Tratamento/psicologia , Transtorno Depressivo Resistente a Tratamento/reabilitação , Humanos , Resultado do TratamentoRESUMO
BACKGROUND: Peers are people with lived experience of mental illness. Peer support is an established intervention in which peers offer support to others with mental illness. A large proportion of people living with severe mental illness receive no care. The care gap is largest in low- and middle-income countries, with detrimental effects on individuals and societies. The global shortage of human resources for mental health is an important driver of the care gap. Peers are an under-used resource in global mental health. OBJECTIVES: To describe rationale and methodology of an international multicentre study which will scale-up peer support for people with severe mental illness in high-, middle-, and low-income countries through mixed-methods implementation research. METHODS: UPSIDES is an international community of research and practice for peer support, including peer support workers, mental health researchers, and other relevant stakeholders in eight study sites across six countries in Europe, Africa, and Asia. During the first two years of UPSIDES, a series of qualitative studies and systematic reviews will explore stakeholders' perceptions and the current state of peer support at each site. Findings will be incorporated into a conceptual framework to guide the development of a culturally appropriate peer support intervention to be piloted across all study sites. All intervention and study materials will be translated according to internationally recognised guidelines.Expected Impact: UPSIDES: will leverage the unique expertise of people with lived experience of mental illness to strengthen mental health systems in high-, middle- and low-income countries. UPSIDES will actively involve and empower service users and embed patient-centeredness, recovery orientation, human rights approaches, and community participation into services. The focus on capacity-building of peers may prove particularly valuable in low-resource settings in which shortages of human capital are most severe.
Assuntos
Saúde Global , Transtornos Mentais/reabilitação , Recuperação da Saúde Mental , Serviços de Saúde Mental , Grupo Associado , Apoio Social , Transtorno Bipolar/reabilitação , Assistência à Saúde Culturalmente Competente , Transtorno Depressivo Maior/reabilitação , Alemanha , Humanos , Ciência da Implementação , Índia , Israel , Participação do Paciente , Transtornos Psicóticos/reabilitação , Esquizofrenia/reabilitação , Participação dos Interessados , Tanzânia , Uganda , Reino UnidoRESUMO
This qualitative study explored the experiences and patterns of recovery of Chinese-born women living in Canada with a history of suicidal behaviour. It explores a number of dimensions of recovery including clinical, existential, functional, physical, and social. The women described engaging in "survival" recovery in the short term and "thriving" recovery in the long term, with survival strategies extending into the thriving phase of recovery during their complex path to it. The survival recovery phase included accessing culturally sensitive mental health care and obtaining social and instrumental support to help ensure safety, manage stress, and treat psychiatric symptoms. The thriving phase of recovery was described as involving six components: developing an explanatory model with their health care provider; undertaking a process of narrative reflection and prioritizing self-care; engaging in interdisciplinary care team support; engaging the support of family and friends; exploring spiritual and existential supports; and creating goals for the future and a sense of mastery. Through these six avenues, the women began to experience a sense of self-efficacy and agency that improved their ability to cope with stress and pressure, leading to building a life with meaning. The interviews provided insights into how clinical care can be improved and how practitioners can implement a more recovery-oriented approach to practice.
Assuntos
Adaptação Psicológica , Transtorno Bipolar/reabilitação , Transtorno Depressivo Maior/reabilitação , Apoio Social , Prevenção do Suicídio , Adulto , Povo Asiático , Transtorno Bipolar/psicologia , Canadá , Transtorno Depressivo Maior/psicologia , Família , Feminino , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Pesquisa Qualitativa , Adulto JovemRESUMO
Treatments for cognitive and functional impairments associated with severe mental illnesses are urgently needed. We tested a 12-week, manualized, Compensatory Cognitive Training (CCT) intervention targeting prospective memory, attention, learning/memory, and executive functioning in the context of supported employment for people with severe mental illnesses who were seeking work. 153 unemployed, work-seeking outpatients with schizophrenia/schizoaffective disorder (n=58), bipolar disorder (n=37), or major depression (n=58) were randomized to receive supported employment plus CCT or enhanced supported employment, a robust control group. Assessments of neuropsychological performance, functional capacity, psychiatric symptom severity, and self-reported functioning and quality of life were administered at baseline and multiple follow-up assessments over two years; work outcomes were collected for two years. Forty-seven percent of the participants obtained competitive work, but there were no differences in work attainment, weeks worked, or wages earned between the CCT and the enhanced supported employment group. ANCOVAs assessing immediate post-treatment effects demonstrated significant, medium to large, CCT-associated improvements on measures of working memory (p=0.038), depressive symptom severity (p=0.023), and quality of life (p=0.003). Longer-term results revealed no statistically significant CCT-associated improvements, but a trend (p=0.058) toward a small to medium CCT-associated improvement in learning. Diagnostic group (schizophrenia-spectrum vs. mood disorder) did not affect outcomes. We conclude that CCT has the potential to improve cognitive performance, psychiatric symptom severity, and quality of life in people with severe mental illnesses. Receiving CCT did not result in better work outcomes, suggesting that supported employment can result in competitive work regardless of cognitive status.
Assuntos
Transtorno Bipolar/reabilitação , Disfunção Cognitiva/reabilitação , Remediação Cognitiva/métodos , Transtorno Depressivo Maior/reabilitação , Readaptação ao Emprego , Reabilitação Psiquiátrica/métodos , Transtornos Psicóticos/reabilitação , Esquizofrenia/reabilitação , Adulto , Transtorno Bipolar/complicações , Disfunção Cognitiva/etiologia , Transtorno Depressivo Maior/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Transtornos Psicóticos/complicações , Esquizofrenia/complicaçõesRESUMO
BACKGROUND: Therapeutic Climbing is applied in physiological as well as in psychological rehabilitation programs. Systematic reviews have been conducted, evaluating the physiological effects of therapeutic climbing. The aim of the following article is a review on existing literature about the psychological effects of climbing therapy. METHODS: We searched the databases of PubMed, Scholar and ScienceDirect up to December 2017 in German and English language. Trials were included if they assessed psychological variables in climbing interventions. RESULTS: Seven articles were included in the following review. Effectiveness of climbing therapy was studied in a) adult inpatients with mental disorders (nâ¯= 3), b) adult outpatients with mental disorders (nâ¯= 1), c) children with motoric deficits and disabilities (nâ¯= 2), d) healthy adults (nâ¯= 1). All trials had major methodological limitations. Control groups if present, were defined differently. Three trials assessed self-efficacy and revealed enhanced self-efficacy after the climbing intervention. No psychological differences were seen between aerobic exercise and climbing therapy in healthy adults. Acute positive affective changes were seen in in-patients with major depressive disorders after a climbing session compared to a relaxation session. CONCLUSION: The effectiveness of climbing therapy on psychological outcomes remains unclear. Limited evidence with varying age groups (children and adults) and a high risk of bias shows enhanced self-efficacy through climbing therapy. There is a need for further studies in children and adults on psychological outcomes through climbing therapy, especially in comparison with aerobic activity interventions.
Assuntos
Terapia por Exercício , Transtornos Mentais/reabilitação , Transtornos Mentais/terapia , Saúde Mental , Estudos de Casos e Controles , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/reabilitação , Transtorno Depressivo Maior/terapia , Exercício Físico , Humanos , Transtornos Mentais/psicologia , Resultado do TratamentoRESUMO
BACKGROUND: Individuals with serious mental illness (SMI) such as schizophrenia and bipolar disorder face a higher risk of early death due to cardiovascular disease and other preventable chronic illnesses. Young adulthood is a critical window of development for lifestyle interventions to improve the long-term health and quality of life in this population. Fit Forward is an NIH-funded randomized clinical trial examining the effectiveness of a group lifestyle intervention (PeerFIT) enhanced with mobile health technology compared to one-on-one mobile lifestyle coaching with Basic Education in fitness and nutrition supported by a wearable Activity Tracking device (BEAT) in achieving clinically significant weight loss and improved cardiorespiratory fitness in young adults with SMI. METHODS: Fit Forward targets 144 young adults (18 to 35â¯years) with SMI and a body mass index (BMI) of ≥25 receiving public mental health services. In a two-arm randomized clinical trial, participants will be randomly assigned with equal probability to PeerFIT or BEAT, stratified by birth sex and psychiatric diagnosis. Participants will be assessed at baseline, 6, and 12â¯months. The primary outcome is cardiovascular risk reduction indicated by either clinically significant weight loss (5% or greater) or increased fitness (>50â¯m on the 6-Minute Walk Test). Secondary outcomes include change in BMI, lipids, and hemoglobin A1c. Perceived self-efficacy for exercise and peer support will be evaluated as mechanisms underlying intervention effects. CONCLUSION: If effective, PeerFIT will provide a potentially scalable approach to addressing health risks among young adults with SMI in mental health settings. TRIALS REGISTRATION: ClinicalTrials.gov, NCT02815813.
Assuntos
Dietoterapia , Exercício Físico , Transtornos Mentais/reabilitação , Obesidade/terapia , Grupo Associado , Apoio Social , Adulto , Transtorno Bipolar/reabilitação , Doenças Cardiovasculares , Transtorno Depressivo Maior/reabilitação , Monitores de Aptidão Física , Humanos , Transtornos Mentais/complicações , Obesidade/complicações , Educação de Pacientes como Assunto , Aptidão Física , Risco , Comportamento de Redução do Risco , Esquizofrenia/reabilitação , Telemedicina , Adulto JovemRESUMO
To address the consequences of past torture experiences as well as current traumas and daily stressors, the Centre for the Study of Violence and Reconciliation (CSVR) developed a contextually appropriate psychosocial framework for the rehabilitation of individuals who have been affected by torture. METHOD: To test the efficacy of this framework, a quasiexperimental study was conducted with torture survivor clients of the CSVR who met the 1985 United Nations Convention Against Torture (UNCAT) definition. A comparison group of clients (n=38) was initially included on a waiting list and thereafter received treatment, whilst the treatment group of clients (n=44) entered straight into treatment. RESULTS: Baseline t-test comparisons conducted on 13 outcome indicators revealed significantly better initial psychological health and functioning of clients in the treatment group than those in the comparison group, with moderately large differences on PTSD, trauma and anxiety, and strong difference in depression scores. Three-month follow-up comparisons using the conservative Wilcoxon test revealed significantly greater improvement on the functioning and anxiety indicators of the treatment group relative to the waiting-list comparison group (odds ratios = 2.49 and 2.61 respectively). After a further three months, when treatment was based on the CSVR framework for both groups, fewer than half the respondents remained in the study (n=20 in the treatment group; n=16 in the comparison group), and the Wilcoxon repeated measures test results on changes since baseline were counter-intuitive: for these remaining clients, there were now more significant outcome improvements for the comparison group than for the treatment group. However, the relative odds ratios for the groups were not significant for these indicators. Furthermore, the clients who dropped out from the treatment group had shown overall improvement in their psychological health and functioning in the initial three months of the study, whereas those who dropped out from the comparison group had shown improvements on fewer indicators. Thus, the research findings on the efficacy of the framework are inconclusive. DISCUSSION: We suggest that this inconclusiveness can be explained by the severe challenges and ethical complexities of psychosocial research on vulnerable groups. The study highlights the serious problem of attrition of participants in the treatment programme which affected the overall study, and which may explain findings that at first appear counter-intuitive.
Assuntos
Transtorno Depressivo Maior/reabilitação , Reabilitação Psiquiátrica/métodos , Trauma Psicológico/reabilitação , Refugiados/psicologia , Transtornos de Estresse Pós-Traumáticos/reabilitação , Estresse Psicológico/reabilitação , Sobreviventes/psicologia , Tortura/psicologia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Terapia Cognitivo-Comportamental , Congo/etnologia , Transtorno Depressivo Maior/psicologia , Países em Desenvolvimento , Terapia do Comportamento Dialético , Etiópia/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Poder Psicológico , Resolução de Problemas , Trauma Psicológico/psicologia , Psicoterapia Breve , Somália/etnologia , África do Sul , Transtornos de Estresse Pós-Traumáticos/psicologia , Estresse Psicológico/psicologia , Resultado do Tratamento , Listas de Espera , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVES: Poly-substance use and psychiatric comorbidity are common among individuals receiving substance detoxification services. Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are the most common co-occurring psychiatric disorders with substance use disorder (SUD). Current treatment favors a one-size-fits-all approach to treating addiction focusing on one substance or one comorbidity. Research examining patterns of substance use and comorbidities can inform efforts to effectively identify and differentially treat individuals with co-occurring conditions. METHODS: Using latent class analysis, the current study identified four patterns of PTSD, MDD, and substance use among 375 addiction treatment seekers receiving medically supervised detoxification. RESULTS: The four identified classes were: 1) a PTSD-MDD-Poly SUD class characterized by PTSD and MDD occurring in the context of opioid, cannabis, and tobacco use disorders; 2) an MDD-Poly SUD class characterized by MDD and alcohol, opioid, tobacco, and cannabis use disorders; 3) an alcohol-tobacco class characterized by alcohol and tobacco use disorders; and 4) an opioid-tobacco use disorder class characterized by opioid and tobacco use disorders. The observed classes differed on gender and clinical characteristics including addiction severity, trauma history, and PTSD/MDD symptom severity. DISCUSSION AND CONCLUSIONS: The observed classes likely require differing treatment approaches. For example, people in the PTSD-MDD-Poly SUD class would likely benefit from treatment approaches targeting anxiety sensitivity and distress tolerance, while the opioid-tobacco class would benefit from treatments that incorporate motivational interviewing. Appropriate matching of treatment to class could optimize treatment outcomes for polysubstance and comorbid psychiatric treatment seekers. These findings also underscore the importance of well-developed referral networks to optimize outpatient psychotherapy for detoxification treatment-seekers to enhance long-term recovery, particularly those that include transdiagnostic treatment components.
Assuntos
Benchmarking , Transtorno Depressivo Maior/reabilitação , Aceitação pelo Paciente de Cuidados de Saúde , Transtornos de Estresse Pós-Traumáticos/reabilitação , Centros de Tratamento de Abuso de Substâncias/normas , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto , Comorbidade , Transtorno Depressivo Maior/complicações , Feminino , Humanos , Masculino , Ohio , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos Relacionados ao Uso de Substâncias/complicaçõesRESUMO
Heart rate variability (HRV) is a significant marker of health outcomes with decreased HRV predicting increased disease risk. HRV is decreased in major depressive disorder (MDD) but existing treatments for depression do not return heart rate variability to normal levels even with successful treatment of depression. Heart rate variability biofeedback (HRVB) increases heart rate variability but no studies to date have examined whether combining HRVB with psychotherapy improves outcome in MDD treatment. The present study used a randomized controlled design to compare the effects of HRVB combined with psychotherapy on MDD relative to a psychotherapy treatment as usual group and to a non-depressed control group. The HRVB+psychotherapy group showed a larger increase in HRV and a larger decrease in depressive symptoms relative to the other groups over a six-week period, whereas the psychotherapy group only did not improve HRV. Results support the supplementation of psychotherapy with HRVB in the treatment of MDD.
Assuntos
Biorretroalimentação Psicológica/métodos , Transtorno Depressivo Maior/fisiopatologia , Transtorno Depressivo Maior/reabilitação , Frequência Cardíaca/fisiologia , Adolescente , Adulto , Barorreflexo/fisiologia , Feminino , Seguimentos , Humanos , Testes Neuropsicológicos , Escalas de Graduação Psiquiátrica , Resultado do Tratamento , Adulto JovemRESUMO
Black consumers with serious mental illness (SMI) face significant challenges in obtaining quality mental health care and are at risk for experiencing significant disparities in mental health care outcomes, including recovery from mental illness. Patient-provider interactions may partly contribute to this disparity. The purpose of the current study was to understand the effects of race, psychosis, and therapeutic alliance on mental health recovery orientation among Veterans with SMI. Participants were Veterans who had an SMI being treated at two Veteran Affairs outpatient mental health clinics by a psychiatrist or nurse practitioner. Participants completed the Behavior and Symptom Identification Scale (BASIS-24), Mental Health Recovery Measure, and patient-report Scale to Assess the Therapeutic Relationship (STAR-P) which includes three subscales: positive collaboration, positive clinician input, and non-supportive clinician input. Regression analyses were used to determine interactive effects of race, psychosis severity, and therapeutic alliance variables. The sample was 226 Veterans (50% black, 50% white). Black participants were slightly older (p < .05), had higher baseline psychosis (p < .05), higher mental health recovery (p < .05), and perceived less non-supportive clinician input (p < .01) than white participants. Regression analyses indicated a significant three-way interaction among race, psychosis, and positive collaboration (p < .01). Greater positive collaboration attenuated the negative effect of higher levels of psychosis on mental health recovery orientation for black participants. Conversely, for white participants, positive collaboration had little effect on the negative relationship between psychosis severity and mental health recovery orientation. Increased levels of psychosis may inhibit patients' perceptions of their ability to recover from SMI. However, for black participants, positive collaboration with mental health providers may moderate the effects of psychotic symptomatology.
Assuntos
Transtorno Bipolar/reabilitação , Transtorno Depressivo Maior/reabilitação , Disparidades em Assistência à Saúde/etnologia , Recuperação da Saúde Mental , Transtornos Psicóticos/reabilitação , Qualidade da Assistência à Saúde , Transtornos de Estresse Pós-Traumáticos/reabilitação , Aliança Terapêutica , Adulto , Negro ou Afro-Americano , Feminino , Humanos , Masculino , Transtornos Mentais/reabilitação , Pessoa de Meia-Idade , Veteranos , População BrancaRESUMO
OBJECTIVE: To explore the effect of exercise on cognition in depression as well as the impact of potential moderators and intervention type. METHOD: Controlled and uncontrolled interventional studies that described an exercise intervention and cognitive outcomes in participants with major depressive disorder (MDD) were included following a search of Pubmed, Ovid Medline, PsycInfo and Embase from inception to January 2017. Meta-analyses were conducted to calculate Hedges' g using a random-effects model. Meta-regression explored the relationships among age, baseline cognition, frequency and duration of exercise, and cognitive outcomes. Subgroup analyses were also conducted according to type and intensity of exercise interventions. RESULTS: Of 12 controlled studies and 3 uncontrolled studies that met inclusion criteria, 9 (642 patients) were included in the meta-analysis. No significant effect of exercise was found on global cognition (Hedges' g = 0.08, P = 0.33, I2 = 0%) or on individual cognitive domains. Meta-regression analyses failed to find significant relationships among participant age, baseline cognition, number of exercise sessions per wk, duration of exercise per wk, total duration of exercise during the intervention, or improvement in global cognition. Interventions combining physical with cognitive activity significantly improved global cognition ( P = 0.048), whereas low-intensity interventions were also positive ( P = 0.048). CONCLUSIONS: No impact of physical exercise was found on cognition in MDD overall. However, we found that interventions combining physical and cognitive activities had a positive impact, and that lower-intensity interventions, where adherence was improved, also impacted positively. There remains a lack of high-quality data in this population.
Assuntos
Estudos Clínicos como Assunto , Disfunção Cognitiva/reabilitação , Transtorno Depressivo Maior/reabilitação , Terapia por Exercício/métodos , Disfunção Cognitiva/etiologia , Transtorno Depressivo Maior/complicações , HumanosRESUMO
OBJECTIVE: The Personalized Intervention for Depressed Patients with Chronic Obstructive Pulmonary Disease (PID-C) is an intervention aiming to help patients adhere to their rehabilitation and care. This study tested the hypothesis that the Problem-Solving Adherence (PSA) intervention, which integrates problem-solving into adherence enhancement procedures, reduces dyspnea-related disability more than PID-C. Exploratory analyses sought to identify patients with distinct dyspnea-related disability trajectories and to compare their clinical profiles. METHODS: In this randomized controlled trial in an acute inpatient rehabilitation and community, 101 participants diagnosed with chronic obstructive pulmonary disease (COPD) and major depression were included after screening 633 consecutive admissions for acute inpatient rehabilitation. Participants underwent 14 sessions of PID-C versus PSA over 26 weeks using the Pulmonary Functional Status and Dyspnea Questionnaire. RESULTS: The study hypothesis was not supported. Exploratory latent class growth modeling identified two distinct disability trajectories. Dyspnea-related disability improved in 39% of patients and remained unchanged in the rest. Patients whose dyspnea-related disability improved had more severe disability and less sense of control over their condition at baseline. CONCLUSION: Improvement or no worsening of disability was noted in both treatment groups. This is a favorable course for depressed patients with a severe, deteriorating medical illness. PID-C is compatible with the expertise of clinicians working in community-based rehabilitation programs, and after further testing in the community, it can be integrated in the care of depressed COPD patients.
Assuntos
Terapia Comportamental/métodos , Transtorno Depressivo Maior/reabilitação , Dispneia/reabilitação , Avaliação de Processos e Resultados em Cuidados de Saúde , Cooperação do Paciente , Resolução de Problemas , Doença Pulmonar Obstrutiva Crônica/reabilitação , Adulto , Comorbidade , Transtorno Depressivo Maior/epidemiologia , Dispneia/epidemiologia , Feminino , Humanos , Masculino , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Índice de Gravidade de DoençaRESUMO
INTRODUCTION: Despite empirical evidence for the efficacy of body-oriented yoga as add-on treatment for major depressive disorder (MDD), the specific mechanisms by which yoga leads to therapeutic changes remain unclear. By means of a systematic review, we evaluate how the field is progressing in its empirical investigation of mechanisms of change in yoga for MDD. METHODS: To identify relevant studies, a systematic search was conducted. RESULTS: The search produced 441 articles, of which 5 were included, that empirically examined 2 psychological mechanisms (mindfulness, rumination) and 3 biological mechanisms (vagal control, heart rate variability [HRV], brain-derived neurotrophic factor [BDNF], cortisol). 2 studies found that decreased rumination and 1 study that increased mindfulness was associated with the effect of yoga on treatment outcome. In addition, preliminary studies suggest that alterations in cortisol, BDNF, and HRV may play a role in how yoga exerts its clinical effect. DISCUSSION: The results suggest that body-oriented yoga could work through some of the theoretically predicted mechanisms. However, there is a need for more rigorous designs that can assess greater levels of causal specificity.