Preliminary clinical and cost effectiveness of augmented depression therapy versus cognitive behavioural therapy for the treatment of anhedonic depression (ADepT): a single-centre, open-label, parallel-group, pilot, randomised, controlled trial.

Background: Anhedonia (reduced interest/pleasure) symptoms and wellbeing deficits are core to depression and predict a poor prognosis. Current depression psychotherapies fail to target these features adequately, contributing to sub-optimal outcomes. Augmented Depression Therapy (ADepT) has been developed to target anhedonia and wellbeing. We aimed to establish clinical and economic proof of concept for ADepT and to examine feasibility of a future definitive trial comparing ADepT to Cognitive Behavioural Therapy (CBT). Methods: In this single-centre, open-label, parallel-group, pilot randomised controlled trial, adults meeting diagnostic criteria for a current major depressive episode, scoring ≥10 on the Patient Health Questionnaire (PHQ-9) and exhibiting anhedonic features (PHQ-9 item 1 ≥ 2) were recruited primarily from high intensity Improving Access to Psychological Therapy (IAPT) service waiting lists in Devon, UK. Participants were randomised to receive 20 sessions of CBT or ADepT, using a mimimisation algorithm to balance depression severity and antidepressant use between groups. Treatment was delivered in an out-patient university-based specialist mood disorder clinic. Researcher-blinded assessments were completed at intake and six, 12, and 18 months. Co-primary outcomes were depression (PHQ-9) and wellbeing (Warwick Edinburgh Mental Wellbeing Scale) at 6 months. Primary clinical proof-of-concept analyses were intention to treat. Feasibility (including safety) and health economic analyses used complete case data. This trial is registered at the ISRCTN registry, ISRCTN85278228. Findings: Between 3/29/2017 and 7/31/2018, 82 individuals were recruited (102% of target sample) and 41 individuals were allocated to each arm. A minimum adequate treatment dose was completed by 36/41 (88%) of CBT and 35/41 (85%) of ADepT participants. There were two serious adverse events in each arm (primarily suicide attempts; none of which were judged to be trial- or treatment-related), with no other evidence of harms. Intake and six-month primary outcome data was available for 37/41 (90%) CBT participants and 32/41 (78%) ADepT participants. Between-group effects favoured ADepT over CBT for depression (meanΔ = -1.35, 95% CI = -3.70, 1.00, d = 0.23) and wellbeing (meanΔ = 2.64, 95% CI = -1.71, 6.99, d = 0.27). At 18 months, the advantage of ADepT over CBT was preserved and ADepT had a >80% probability of cost-effectiveness. Interpretation: These findings provide proof of concept for ADepT and warrant continuation to definitive trial. Funding: NIHR Career Development Fellowship.

Development, psychometric validation, and cross-cultural comparison of the "Instagram Motives Questionnaire" (IMQ) and the "Instagram Uses and Patterns Questionnaire" (IUPQ).

Background and aims: Social network use is widespread, and the study of Instagram seems to have captured more attention in recent years. However, scale development and validation in the field has fallen short of providing sound scales of Instagram motives and usage patterns that consider the uniqueness of Instagram-related behavior. This paper describes the development, psychometric and cross-cultural validation of two new measurement instruments: the "Instagram Motives Questionnaire" (IMQ) and the "Instagram Uses and Patterns Questionnaire" (IUPQ). Methods and results: A preliminary set of items was developed for each questionnaire based on a previous qualitative interview study on Instagram motives, uses, and consequences. In the first study, the questionnaires were distributed to a sample of 312 participants aged 18-35 years (M = 23.81; SD = 4.49), and an exploratory factor analysis was performed. A parsimonious and interpretable 6-factor solution that displayed adequate factor loadings and adequate Omega coefficients for both instruments were found. In a second study, the two instruments and other measures of known social network usage correlates and mental health consequences were administered online to 1,418 English-speaking participants aged 18-34 years (M = 21.35; SD = 3.89). Both scales showed good psychometric properties and the factor structure identified in study 1 was reproduced through confirmatory factor analysis. Omega reliability coefficients were adequate. Finally, when performing multi-group CFA along with a French (n = 1,826) and a Spanish (n = 3,040) sample, language and gender invariance were supported. Correlations with other relevant measures indicate good convergent validity of both scales. Conclusions: The present research provides psychometrically sound instruments for further investigations on Instagram use behaviors.