Exposures to Potentially Psychologically Traumatic Events Among Provincial Correctional Workers in Ontario, Canada.

We know little about potentially psychologically traumatic events (PPTE) exposures among provincial correctional workers in diverse occupational positions and even less regarding how exposure to events are associated with mental health disorders. We designed the current study to unpack and quantify estimates of the frequencies that correctional workers, across occupational roles, experience exposure to diverse incidents. We categorized 1,338 of our 1,487 participants into six occupational categories and our measures included established self-report items measuring PPTE exposure and mental disorder symptoms. Almost all correctional workers reported exposures to most PPTE types. Correctional workers collectively report exposures to physical assault (90.2%) and sudden violent death (81.8%), with many (3.1%-46%) reporting 11+ exposures (M = 10.01, SD = 4.29). We found significant differences in exposure patterns across correctional worker categories; specifically, we found a higher prevalence of exposure to toxic substances, physical assault, assault with a weapon, severe human suffering, sudden accidental or sudden violent death, among those working in institutional correctional services (e.g., governance, correctional officers). PPTE exposure and all assessed mental health disorder symptom profiles were closely related, as correctional workers report high exposure to PPTE. Population attributable fractions indicated that the burden of mental disorders among provincial correction workers might be reduced by between 38%-70% if PPTE exposures were eliminated from the population. We conclude with recommendations for mental health related policies, such as investing in peer and psychologically support, as well as interventions for exposure to PPTE and readiness to inform strategies for employee mental health and well-being.

Exploring the effect of neurofeedback on postcancer cognitive impairment and fatigue: A pilot feasibility study.

Purpose: Postcancer cognitive impairment (PCCI) and fatigue are adverse effects that often persist following cancer treatment, and impact quality of life. The study purpose was to evaluate feasibility and effect of neurofeedback on cognitive functioning and fatigue in cancer survivors. Specifically, we aimed to test feasibility of recruitment strategies and our study protocol including outcome measures. Design: This pilot feasibility study used a 10-week wait-list design. Participants served as their own controls and received neurofeedback training twice a week for 10 weeks. Participants: The sample consisted of breast cancer survivors from Kingston, Ontario (n = 16). Methods: Outcomes were assessed using validated, self-report scales and neuropsychological tests before, during, and after neurofeedback. Findings: The neurofeedback protocol was feasible and resulted in significant decreases in perceived cognitive deficits, fatigue, sleep, and psychological symptoms. Implications for psychosocial providers: Neurofeedback may be an effective, non-invasive complementary therapy for PCCI in breast cancer survivors.

A Cross-Sectional Study of the Relationship between Previous Military Experience and Mental Health Disorders in Currently Serving Public Safety Personnel in Canada.

OBJECTIVE: There is an increased incidence of some mental health disorders such as post-traumatic stress disorder (PTSD) in some members of the military and in some public safety personnel (PSP) such as firefighters, police officers, paramedics, and dispatchers. Upon retirement from the armed forces, many individuals go on to second careers as PSP. Individuals with prior military experience may be at even greater risk than nonveterans for developing mental health disorders. The present study was designed to examine the relationship between prior military service and symptoms of mental health disorders in PSP. METHODS: This is a cross-sectional, observational study. Data for this study were collected from an anonymous, web-based, self-report survey of PSP in Canada. Invitations to participate were sent to PSP via their professional organizations. Indications of mental disorder(s) and symptom severity were assessed using well-validated self-report screening measures. RESULTS: Of the survey respondents who provided this information, 631 (6.8%) had prior armed forces experience; however, not all responses were complete. Ex-military PSP reported significantly more exposure to traumatic events and were approximately 1.5 times more likely to screen positive for indications of PTSD, mood, anxiety, or acute stress disorders and to have contemplated suicide than those without prior armed forces experience. CONCLUSIONS: In our study, individuals in PSP with prior service experience in the armed forces were more likely to screen positive for indicators of some mental health disorders. Accordingly, mental health practitioners should inquire about previous service in the armed forces when screening, assessing, and treating PSP.

Comparison of characteristics of children and adolescents with and without a history of abuse assessed in an urgent psychiatric clinic.

PURPOSE: The objective was 1) to describe the clinical characteristics of children referred for an urgent psychiatric consult with and without, a history of abuse; 2) to study differences in demographic and clinical variables between the groups; and 3) to examine the relationship between different types of abuse and disposition after assessment. METHODS: This is a 2-year retrospective cohort study of all patients aged 12 to 17 years referred to a hospital urgent psychiatric clinic. Patients were divided into two groups, those with a history of abuse and those without. Study variables included demographics, reason for referral, history of emotional, physical, sexual abuse, substance use, bullying victimization, DSM-5 diagnoses, and disposition. The study population was described using means, frequencies, and percentages, while relationships between types of abuse and clinical and demographic variables were assessed using Mann-Whitney U statistics, Spearman correlations, and logistic regression. RESULTS: The prevalence of any type of abuse was 30.4% (227 of 746 referrals). The abused group were older, more likely to be female, to have a history of substance use, bullying victimization, diagnosis of an externalizing disorder, and more likely to be admitted. Among the abused group, males were significantly more likely to report physical/emotional abuse, and female sexual abuse. There was no difference between different kinds of abuse and final diagnoses. CONCLUSIONS: Almost one-third of children and adolescents referred for urgent psychiatric consultation reported a history of abuse. Awareness of the association between abuse and emergency visits may assist physicians in triaging for urgent psychiatric assessment.

Mental Disorder Symptoms among Public Safety Personnel in Canada.

BACKGROUND: Canadian public safety personnel (PSP; e.g., correctional workers, dispatchers, firefighters, paramedics, police officers) are exposed to potentially traumatic events as a function of their work. Such exposures contribute to the risk of developing clinically significant symptoms related to mental disorders. The current study was designed to provide estimates of mental disorder symptom frequencies and severities for Canadian PSP. METHODS: An online survey was made available in English or French from September 2016 to January 2017. The survey assessed current symptoms, and participation was solicited from national PSP agencies and advocacy groups. Estimates were derived using well-validated screening measures. RESULTS: There were 5813 participants (32.5% women) who were grouped into 6 categories (i.e., call center operators/dispatchers, correctional workers, firefighters, municipal/provincial police, paramedics, Royal Canadian Mounted Police). Substantial proportions of participants reported current symptoms consistent with 1 (i.e., 15.1%) or more (i.e., 26.7%) mental disorders based on the screening measures. There were significant differences across PSP categories with respect to proportions screening positive based on each measure. INTERPRETATION: The estimated proportion of PSP reporting current symptom clusters consistent with 1 or more mental disorders appears higher than previously published estimates for the general population; however, direct comparisons are impossible because of methodological differences. The available data suggest that Canadian PSP experience substantial and heterogeneous difficulties with mental health and underscore the need for a rigorous epidemiologic study and category-specific solutions.

Supporting Quality Integrated Care for Adolescent Depression in Primary Care: A Learning System Approach.

Background: Quality integrated care, which involves primary care and mental health clinicians working together, can help identify and treat adolescent depression early. We explored systemic barriers to quality integrated care at the provincial level in Ontario, Canada using a learning system approach. Methods: Two Ontario Health Teams (OHTs), regional networks designed to support integrated care, completed the Practice Integration Profile (PIP) and participated in focus groups. Results: The OHTs had a median PIP score of 69 out of 100. Among the PIP domains, the lowest median score was case identification (50), and the highest one was workspace (100). The focus groups generated 180 statements mapped to the PIP domains. Workflow had the highest number of coded statements (59, 32.8%). Discussion: While the primary care practices included mental health clinicians on-site, the findings highlighted systemic barriers with adhering to the integrated care pathway for adolescent depression. These include limited access to mental health expertise for assessment and diagnosis, long wait times for treatment, and shortages of clinicians trained in evidence-based behavioral therapies. These challenges contributed to the reliance on antidepressants as the first line of treatment due to their accessibility rather than evidence-based guidelines. Conclusion: Primary care practices, within regional networks such as OHTs, can form learning systems to continuously identify the strategies needed to support quality integrated care for adolescent depression based on real-world data.

Mental health of Canadian children growing up in military families: The parent perspective.

A recent scoping review found that stressors involved in the military lifestyle (i.e., frequent relocation, parental absence, and risk of parental injury) may be associated with mental health issues among military-children. However, most of the included studies were conducted in the United States with little Canadian representation. To examine the degree to which the scoping review findings are relevant to the Canadian context, we conducted a qualitative study and interviewed 37 parents in Canadian military families. Through the use of a qualitative description approach and content analysis, three themes were identified: 1. Military lifestyle factors have an impact on child mental health; 2. Military life can promote both resilience and vulnerability; and 3. Military lifestyle impacts on parental mental health had an impact on children. These themes align with the scoping review findings asserting that military lifestyle factors can influence child mental health and have significant implications for health care providers working with military-connected children.

Evaluating the Efficacy of Web-Based Cognitive Behavioral Therapy for the Treatment of Patients With Bipolar II Disorder and Residual Depressive Symptoms: Protocol for a Randomized Controlled Trial.

BACKGROUND: Bipolar disorder (BD) is a highly prevalent psychiatric condition that can significantly impact every aspect of a person's life if left untreated. A subtype of BD, bipolar disorder type II (BD-II), is characterized by long depressive episodes and residual depression symptoms, with short-lived hypomanic episodes. Medication and psychotherapy, such as cognitive behavioral therapy (CBT), are the main treatment options for BD-II. CBT specific for BD-II involves the recognition of warning signs, potentially triggering stimuli, and the development of coping skills to increase euthymic periods and improve global functioning. However, access to in-person CBT may be limited by several barriers, including low availability, high costs, and geographical limitations. Thus, web-based adaptations of CBT (e-CBT) have become a promising solution to address these treatment barriers. Nevertheless, e-CBT for the treatment of BD-II remains understudied. OBJECTIVE: The proposed study aims to establish the first e-CBT program specific for the treatment of BD-II with residual depressive symptoms. The primary objective of this study will be to determine the effect of e-CBT in managing BD symptomatology. The secondary objective will be to assess the effects of this e-CBT program on quality of life and resilience. The tertiary objective will involve gathering user feedback using a posttreatment survey to support the continuous improvement and optimization of the proposed program. METHODS: Adult participants (N=170) with a confirmed diagnosis of BD-II experiencing residual depressive symptoms will be randomly assigned to either the e-CBT and treatment as usual (TAU; n=85) group or the TAU (n=85) control group. Participants in the control group will be able to participate in the web-based program after the first 13 weeks. The e-CBT program will consist of 13 weekly web-based modules designed following a validated CBT framework. Participants will complete module-related homework and receive asynchronous personalized feedback from a therapist. TAU will consist of standard treatment services conducted outside of this research study. Depression and manic symptoms, quality of life, and resiliency will be assessed using clinically validated symptomatology questionnaires at baseline, week 6, and week 13. RESULTS: The study received ethics approval in March 2020, and participant recruitment is expected to begin in February 2023 through targeted advertisements and physician referrals. Data collection and analysis are expected to conclude by December 2024. Linear and binomial regression (continuous and categorical outcomes, respectively) will be conducted along with qualitative interpretive methods. CONCLUSIONS: The findings will be the first on the effectiveness of delivering e-CBT for patients with BD-II with residual depressive symptoms. This approach can provide an innovative method to address barriers to in-person psychotherapy by increasing accessibility and decreasing costs. TRIAL REGISTRATION: ClinicalTrials.gov NCT04664257; https://clinicaltrials.gov/ct2/show/NCT04664257. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/46157.

Comparison of Social Media Use Among Adolescents with Autism Spectrum Disorder and Non-ASD Adolescents.

BACKGROUND: It has been well documented that social media use among adolescents is rising. However, most research has focused on social media use among typically developing adolescents and less on its use among adolescents with autism spectrum disorder (ASD). The goal of this study was to compare the time spent as well as to identify the purpose of social media use in adolescents with ASD compared to non-ASD adolescents. METHODS: This was a cross-sectional study of adolescents between ages 13-18 who were attending a hospital-based child and adolescents psychiatry clinic. Participants completed a self-report 18-item questionnaire to assess the pattern and reasons for using social media sites. The sample size was 26 for ASD and 24 for the non-ASD group. RESULTS: We found that the time spent on social media among adolescents with ASD was comparable to those without ASD diagnosis. However, participants with ASD differed from their non-ASD counterparts in both preferred social media sites as well as reasons for use. The most favourable social media site for ASD adolescents was YouTube. In contrast, the preferred social media site among adolescents without ASD was Snapchat. About 92.3% of participants without ASD reported using social media sites for primarily social interactions. In contrast, 59.1% of participants with ASD reported entertainment purposes as their primary reason for choosing a social media site. CONCLUSION: Although the current study is based on a small sample of participants, the findings suggest that the pattern of usage and reasons for using social media differ significantly between the two groups. There is, therefore, a definite need for further research with a larger sample size to examine the implications of these differences and to determine how social media could be used as a tool for learning social skills and its efficacy and safety in the ASD population.

Achieving Quality Integrated Care for Adolescent Depression: A Scoping Review.

INTRODUCTION: While primary care is often the first point of contact for adolescents with depression, more than half of depressed adolescents are either untreated or undertreated. A scoping review had been completed to summarize approaches for achieving quality integrated care in primary care focused on adolescent depression. METHODS: The scoping review followed the methodological framework for scoping studies from Arksey and O'Malley. Articles were grouped into themes and mapped to 6 quality domains for integrated care from the practice integration profile survey and 3 levels of stakeholders based on WHO's definition for health systems (patient/family, primary care team, and national/sub-national health system). RESULTS: A total of 868 records were screened resulting in 22 articles at the patient/family-level (5/22), the primary care team-level (18/22), and the national/sub-national health system-level (16/22). The results highlighted multilevel approaches to support the delivery of quality integrated care for adolescent depression in primary care: (1) population-focused using patient registries, routine screening based on standardized algorithms, and patient-centered strategies, (2) team-driven where primary care clinicians collaborate with mental health clinicians as part of a primary care team, (3) evidence-based delivery of mental health services across the integrated care pathway from screening to follow-up visits, and (4) measurement-guided by leveraging the electronic health record infrastructure to learn from patient outcomes. CONCLUSION: More research is needed on how to provide quality integrated care for adolescent depression, specifically on patient engagement and retention, grounded in the frontline experiences of patients, families, and clinicians and supported by national and/or sub-national guidelines. A learning system could help integrate mental health services in primary care in a way that is consistent across the national and/or sub-national health system.

Psychological interventions for post-traumatic stress injuries among public safety personnel: a systematic review and meta-analysis.

BACKGROUND: Public safety personnel (PSP) are exposed to potentially psychologically traumatic events (PPTE) far more often than the general public, which increases the risk for various post-traumatic stress injuries (PTSIs). While there are many evidence-based psychological interventions for PTSI, the effectiveness of each intervention for PSP remains unclear. OBJECTIVES: The current study assessed the effectiveness and acceptability of psychological interventions for PTSI among PSPs. METHODS: A systematic review and random-effects meta-analysis were performed on the effectiveness and acceptability of psychotherapies for PTSIs (i.e., symptoms of depression, anxiety, post-traumatic stress disorder) among PSP. The review adhered to the PRISMA reporting guidelines and used standardized mean differences (Cohen's d), rate ratios (RR), and their 95% confidence intervals (95% CI) to measure pooled effect sizes across studies; negative d values and RR values less than one indicated a reduction in symptoms compared to baseline or control groups. In addition, heterogeneity was quantified using I2, and publication bias was evaluated using Egger's test. RESULTS: The analyses included data from eight randomized controlled trials representing 402 PSP (79.4% male, 35.3 years). Psychological interventions included narrative exposure therapy (n = 1), cognitive behavioral therapy (n = 2), eclectic psychotherapy (n = 2), eye-movement desensitization and reprocessing (n = 1), supportive counseling (n = 2), and group critical incident stress debriefing (n = 1). The interventions were associated with statistically significant reductions in symptoms associated with PTSD (d = - 1.23; 95% CI - 1.81, - 0.65; 7 studies; I2 = 81%), anxiety (- 0.76; 95% CI - 1.28, - 0.24; 3 studies; I2 = 47%), and depression (d = - 1.10; 95% CI - 1.62, - 0.58; 5 studies; I2 = 64%). There were smaller but statistically significant improvements at follow-up for symptoms of PTSD (d = - 1.29 [- 2.31, - 0.27]), anxiety (d = - 0.82 [- 1.20, - 0.44]), and depression (d = - 0.46 [- 0.77, - 0.14]). There were no statistically significant differences in dropout rates (RR = 1.00 [0.96, 1.05]), suggesting high acceptability across interventions. CONCLUSIONS: There is preliminary evidence that psychotherapies help treat PTSIs in PSP; however, the shortage of high-quality studies on PSP indicates a need for additional research into treating PTSI among PSP. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD42019133534.

Assessing Relative Stressors and Mental Disorders among Canadian Provincial Correctional Workers.

In the current study, we quantified the mean stress levels of 43 occupational stressors for 868 Correctional Workers (CWs) and analyzed the relationships between occupational stressors, exposure to potentially psychologically traumatic events (PPTEs), and mental health disorders. Our findings emphasize the importance of the occupational environment in relation to CW mental health and indicate that occupational stressors (e.g., staff shortages, inconsistent leadership style, bureaucratic red tape) are more salient contributors to CW mental health than exposure to PPTEs. Finding strategies to ameliorate staff shortages, improve leadership style and communication, and support CWs to maintain physical, mental, and social well-being would be interventions tied to significant organizational and operational stressors within the current study.

Coping among public safety personnel: A systematic review and meta-analysis.

Public safety personnel (PSP) are routinely exposed to potentially psychologically traumatic events (PPTEs) that, in turn, can result in posttraumatic stress injuries (PTSI), including burnout and increased symptoms of depression and anxiety. However, the longitudinal impact of PPTEs on PSP coping remains unclear. Coping can be operationalized as various strategies (i.e., behaviours, skills, thought and emotion regulation) for dealing with stressors, which are broadly categorized as either approach (adaptive, positive, social support) or avoidant coping strategies (maladaptive withdrawal, avoidance, substance use). This systematic review and meta-analysis aims to evaluate longitudinal coping outcomes among PSP. Thirteen eligible repeated-measures studies explicitly evaluated coping in 1854 police officers, firefighters, and rescue and recovery workers. Study designs included randomized-control trials, within-subject interventions and observational studies. Effect sizes (Cohen's d) at follow-up were described in 11 studies. Separate meta-analyses reveal small (d < 0.2) but non-significant improvements in approach and avoidant coping. Studies were of moderate quality and low risk of publication bias. Heterogeneity in outcome measures, follow-up durations, and study types precluded subgroup analyses. The current findings can inform the development and evaluation of organizational training programs that effectively promote sustained adaptive coping for PSP and mitigate PTSIs.

Proactive psychological programs designed to mitigate posttraumatic stress injuries among at-risk workers: a systematic review and meta-analysis.

BACKGROUND: Public safety personnel and frontline healthcare professionals are at increased risk of exposure to potentially psychologically traumatic events (PPTE) and developing posttraumatic stress injuries (PTSI, e.g., depression, anxiety) by the nature of their work. PTSI are also linked to increased absenteeism, suicidality, and performance decrements, which compromise occupational and public health and safety in trauma-exposed workers. Evidence is lacking regarding the effectiveness of "prevention" programs designed to mitigate PTSI proactively. The purpose of this review is to measure the effectiveness of proactive PTSI mitigation programs among occupational groups exposed to PPTE on measures of PTSI symptoms, absenteeism, and psychological wellness. METHODS: Five electronic databases were searched per PRISMA guidelines for English or French peer-reviewed studies from 2008 to 2019 evaluating PTSI and psychological wellness in adults exposed to occupational PPTE. The risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS: We identified 42 studies evaluating 3182 public safety and frontline healthcare professionals, PPTE-exposed educational staff, and miners. Significant overlap was found across program themes that included mindfulness, psychoeducation, resilience promotion, and stress management strategies. Post-program effect sizes were small (SMD < 0.5) to moderate (SMD < 0.8) for reductions in PTSI symptoms and for promoting measures of well-being as indicated by a meta-analysis on 36 studies. There was no evidence for significant reductions in substance use, absenteeism, or biomarkers of distress except for heart rate. Subgroup analyses indicated that multimodal programs effectively improved general psychological health, while resilience programs improved measures of depression, burnout, coping, and resilience. Effect sizes for resilience, depression, and general psychological health improvements were greatest immediately or 1-month post-training, while improvements in PTSD symptoms and coping were larger at longer follow-up. Studies were of moderate quality and risk of bias. CONCLUSIONS: The current results showcase modest evidence for time-limited reductions in PTSI following participation in holistic programs that promote resilience, stress, and emotion regulation among at-risk workers. Implications for organizational implementation of proactive PTSI mitigation programs and areas of future research are discussed. SYSTEMATIC REVIEW REGISTRATION: PROSPERO (CRD42019133534).

Mental Health of Canadian Firefighters: The Impact of Sleep.

Volunteer and career firefighters are at risk of major depressive disorders, posttraumatic stress disorder (PTSD), alcohol use disorder, and other mental health disorders due to the demanding and unpredictable nature of their employment. The mental health risks are exacerbated by the need to work extended hours, night shifts, and/or rotating schedules, or the competing demands of other employment, especially in volunteer firefighters. The mental health disorders and risk factors interact with altered sleeping patterns. In the current study, we examined volunteer and career firefighters regarding the association between mental health and sleep, drawing from a national Canadian mental health survey of 1217 firefighters. Most (69%) of the firefighters reported less than ideal sleep quality and 21% screened positive for clinical insomnia, with no significant difference between volunteer and career subgroups. Firefighters with insomnia had higher odds ratios (OR) and frequencies for PTSD (OR = 4.98), generalized anxiety disorder (OR = 7.15), panic disorder (OR = 6.88), social phobia (OR = 4.98), and major depressive disorder (OR = 7.91), than firefighters without insomnia. The burden of sleep disorders and their association with mental health disorders suggests that sleep should be considered in health monitoring and self-management, environmental design, fire service work-organization policies, and health programming.

Brief Mental Health Disorder Screening Questionnaires and Use with Public Safety Personnel: A Review.

Brief mental health disorder screening questionnaires (SQs) are used by psychiatrists, physicians, researchers, psychologists, and other mental health professionals and may provide an efficient method to guide clinicians to query symptom areas requiring further assessment. For example, annual screening has been used to help identify military personnel who may need help. Nearly half (44.5%) of Canadian public safety personnel (PSP) screen positive for one or more mental health disorder(s); as such, regular mental health screenings for PSP may be a valuable way to support mental health. The following review was conducted to (1) identify existing brief mental health disorder SQs; (2) review empirical evidence of the validity of identified SQs; (3) identify SQs validated within PSP populations; and (4) recommend appropriately validated brief screening questionnaires for five common mental health disorders (i.e., generalized anxiety disorder (GAD), major depressive depression (MDD), panic disorder, posttraumatic stress disorder, alcohol use disorder). After reviewing the psychometric properties of the identified brief screening questionnaires, we recommend the following four brief screening tools for use with PSP: the Patient Health Questionnaire-4 (screening for MDD and GAD), the Brief Panic Disorder Symptom Screen-Self-Report, the Short-Form Posttraumatic Checklist-5, and the Alcohol Use Disorders Identification Test-Consumption.

Determining the Efficacy of Electronic Cognitive Behavioral Therapy for Generalized Anxiety Disorder Compared to Pharmaceutical Interventions: Protocol for a Quasi-Experimental Study.

BACKGROUND: Generalized anxiety disorder (GAD) is an extremely prevalent and debilitating mental health disorder. Currently, the gold standard treatment for GAD is cognitive behavioral therapy (CBT) and/or pharmacotherapy. The most common medications used to treat GAD are selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors. While CBT is the gold standard treatment for GAD, it is costly, time-consuming, and often inaccessible. Fortunately, the electronic delivery of CBT (e-CBT) has emerged as a promising solution to address these barriers. e-CBT has shown to offer comparable results to in-person CBT while improving accessibility for patients and time efficiency for clinicians. OBJECTIVE: This study aims to investigate the treatment efficacy of e-CBT compared to and in conjunction with pharmacotherapy for GAD. METHODS: This study will use a quasi-experimental design to allow patients the freedom to choose which treatment modality they would like to receive. Participants with a diagnosis of GAD will be enrolled in 1 of 3 possible treatment arms: (1) e-CBT, (2) medication, or (3) a combination of e-CBT and medication. The e-CBT program will include a 12-week psychotherapy program delivered through the Online Psychotherapy Tool-a secure, cloud-based, digital mental health platform. The treatment efficacy of e-CBT will be compared with that of medication alone and medication in combination with e-CBT. RESULTS: The study received ethics approval in April 2019 and participant recruitment began in June 2019. Participant recruitment has been conducted through social media advertisements, physical advertisements, and physician referrals. To date, 146 participants (e-CBT: n=53; medication: n=49; combination: n=44) have been recruited. Data collection is expected to conclude by June 2021, and data analysis is expected to be completed by October 2021. Linear regression (for continuous outcomes) and binomial regression (for categorical outcomes) analysis will be conducted using interpretive qualitative methods. CONCLUSIONS: If either the efficacy of e-CBT is shown to be comparable to that of medication or the effects of both treatments are augmented when used in tandem, these findings could have major implications on the mental health care system. e-CBT is a more accessible and affordable treatment that could increase mental health care capacity 4-fold if proven viable. TRIAL REGISTRATION: ClinicalTrials.gov NCT04478526; https://clinicaltrials.gov/ct2/show/NCT04478526. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/27772.

Developing and Implementing a Web-Based Psychotherapy Program to Address Mental Health Challenges Among Patients Receiving Oncologic and Palliative Care: Protocol for an Open-Label Randomized Controlled Trial.

BACKGROUND: The demand for mental health care, particularly for depression and anxiety, is 3-fold greater among patients receiving oncologic and palliative care than for the general population. This population faces unique barriers, making them more susceptible to mental health challenges. Various forms of psychotherapy have been deemed effective in addressing mental health challenges in this population, including supportive psychotherapy, cognitive behavioral therapy, problem-based therapy, and mindfulness; however, their access to traditional face-to-face psychotherapy resources is limited owing to their immunocompromised status, making frequent hospital visits dangerous. Additionally, patients can face hospital fatigue from numerous appointments and investigations or may live in remote areas, which makes commutes both physically and financially challenging. Web-based psychotherapy is a promising solution to address these accessibility barriers. Moreover, web-based psychotherapy has been proven effective in addressing depression and anxiety in other populations and may be implementable among patients receiving oncologic and palliative care. OBJECTIVE: The study will investigate the feasibility and effectiveness of web-based psychotherapy among patients receiving oncologic and palliative care, who have comorbid depression or anxiety. We hypothesized that this program will be a viable and efficacious treatment modality compared to current treatment modalities in addressing depression and anxiety symptoms in this population. METHODS: Participants (n=60) with depression or anxiety will be recruited from oncology and palliative care settings in Kingston (Ontario, Canada). Participants will be randomly allocated to receive either 8 weeks of web-based psychotherapy plus treatment as usual (treatment arm) or treatment as usual exclusively (control arm). The web-based psychotherapy program will incorporate cognitive behavioral therapy, mindfulness, and problem-solving skills, and homework assignments with personalized feedback from a therapist. All web-based programs will be delivered through a secure platform specifically designed for web-based psychotherapy delivery. To evaluate treatment efficacy, all participants will complete standardized symptomology questionnaires at baseline, midpoint (week 4), and posttreatment. RESULTS: The study received ethics approval in February 2021 and began recruiting participants in April 2021. Participant recruitment has been conducted through social media advertisements, physical advertisements, and physician referrals. To date, 11 participants (treatment, n=5; control, n=4; dropout, n=2) have been recruited. Data collection and analysis are expected to conclude by December 2021 and January 2022, respectively. Linear regression (for continuous outcomes) will be conducted with interpretive qualitative methods. CONCLUSIONS: Our findings can be incorporated into clinical policy and help develop more accessible mental health treatment options for patients receiving oncologic and palliative care. Asynchronous and web-based psychotherapy delivery is a more accessible, scalable, and financially feasible treatment that could have major implications on the health care system. TRIAL REGISTRATION: ClinicalTrials.gov NCT04664270; https://clinicaltrials.gov/ct2/show/NCT04664270. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/30735.