Synchronous telehealth technologies in psychotherapy for depression: a meta-analysis.

BACKGROUND: Many patients suffering from depression lack immediate access to care. The use of synchronous telehealth modalities to deliver psychotherapy is one solution to this problem. This meta-analysis examined differences in treatment efficacy for psychotherapy administered via synchronous telehealth as compared to standard nontelehealth approaches. METHOD: We located 14 articles that met inclusion criteria of the use of a synchronous telehealth modality for treatment compared to a standard nontelehealth modality comparison group. RESULTS: Overall, a statistically significant systematic difference between modes of delivery was not identified (g = 0.14, SE = 0.08, 95% CI = [-0.03, 0.30], P = .098, I(2) = 49.74%). Stratification methods and metaregression were used to analyze the contributions of type of comparison group, intervention modality, and targeted mental health outcome to moderation of effect size (ES) estimates and heterogeneity. Type of comparison group (face-to-face versus care-as-usual) had the strongest influence on observed heterogeneity and moderated the summary ES. The only detectable difference in efficacy was restricted to studies that used care-as-usual as the comparison group (g = 0.29, SE = 0.06, 95% CI = [0.16, 0.41], P < .001, I(2) = 5.14%). CONCLUSIONS: Overall, we found no evidence to suggest that the delivery of psychotherapy via synchronous telehealth modalities is less effective than nontelehealth means in reducing depression symptoms.

Legal events as predictors of posttraumatic stress in injured trauma survivors.

Prior research suggests that involvement in a lawsuit may be associated with the development of enduring posttraumatic stress disorder (PTSD) symptoms as well as inflated and potentially invalid symptom reports. This research aimed to describe the spectrum of legal events experienced by injured trauma survivors and prospectively assessed the association between legal events and PTSD symptoms. Over a nine month period, hospitalized injury survivors were randomly screened for study participation. Legal events were prospectively assessed, and PTSD symptoms were reported twelve months after the injury. Linear regression was used to determine the association between legal events and higher PTSD symptom levels. Increasing numbers of legal events were associated with significantly higher PTSD symptom levels. Seeking legal counsel (34%), being a victim of non-violent crime (14%), and involvement in a lawsuit (9%) were the most common legal events reported. None of these categories of legal events, however, were associated with significantly higher PTSD symptom levels. Because injury survivors are frequently involved in a spectrum of legal events, it is important for future research to assess the cumulative burden of legal events, as these experiences may represent recurring stressful life events that have the potential to exacerbate PTSD symptoms.

A systematic review of technology-based interventions for co-occurring substance use and trauma symptoms.

Introduction Technology-based mental health interventions are becoming increasingly common, and several have begun to target multiple outcomes in a single intervention. Recent developments in the treatment of co-occurring posttraumatic stress disorder and substance use disorder has led to the development and testing of technology-based interventions for these disorders. The current systematic review examined technology-based interventions designed to improve mental health outcomes among patients with co-occurring trauma symptoms and substance use. Methods Of 601 articles reviewed, 14 included a technology-based intervention for patients with these co-occurring problems. Results Seven of these studies provided preliminary evidence that technology-based interventions are likely to be efficacious in reducing either trauma symptoms or substance use. The seven remaining studies demonstrated that technology-based interventions for co-occurring trauma symptoms and substance use are feasible. Discussion This review suggests that technology-based interventions for co-occurring trauma symptoms and substance use are feasible, but more work is needed to assess efficacy using scientifically rigorous studies.

Exploring the longitudinal trajectories of posttraumatic stress disorder in injured trauma survivors.

OBJECTIVE: The goal of this study was to examine the longitudinal trajectories of posttraumatic stress disorder (PTSD) symptoms in a sample of acutely injured hospitalized civilian trauma survivors who participated in a randomized clinical trial. Prior longitudinal descriptive research has shown that there are distinct trajectories of PTSD symptoms over time in trauma survivors. Limited clinical trial research exists that describes the patterns of the trajectories as well as the risk factors that influence the trajectories for seriously injured trauma-exposed patients. METHOD: Semiparametric, group-based approach trajectory modeling was used to examine four group trajectories of a subset of data obtained from a previous longitudinal clinical trial. Trajectories examined included resilience, recovery, relapsing/remitting, and chronic symptom patterns. One hundred and ninety-four patients who participated in the randomized clinical trial were assessed at baseline in the days and weeks after injury and then randomized. The associations between previously identified PTSD risk factors and the four trajectories were examined. RESULTS: The risk factors of ethnocultural minority status, psychiatric history, additional life stressors, and depressive symptoms, as well as intervention versus control group status, were found to significantly affect the probability of trajectory group membership for PTSD symptom severity. CONCLUSIONS: These findings suggest that there is a need for early PTSD interventions that anticipate differences in injured patients' PTSD trajectory profiles. Stepped care intervention procedures may optimally address the diverse PTSD trajectory patterns observed in injured trauma survivors through the tailoring of intervention timing and dosing.