Evaluation of a spirituality informed e-mental health tool as an intervention for major depressive disorder in adolescents and young adults - a randomized controlled pilot trial.

BACKGROUND: Depression in adolescents and young adults is a major mental health condition that requires attention. Research suggests that approaches that include spiritual concepts and are delivered through an online platform are a potentially beneficial approach to treating/managing depression in this population. The purpose of this study was to evaluate the effectiveness of an 8-week online spirituality informed e-mental health intervention (the LEAP Project) on depression severity, and secondary outcomes of spiritual well-being and self-concept, in adolescents and young adults with major depressive disorder of mild to moderate severity. METHODS: A parallel group, randomized, waitlist controlled, assessor-blinded clinical pilot trial was conducted in Calgary, Alberta, Canada. The sample of 62 participants with major depressive disorder (DSM-IV-TR) was defined by two age subgroups: adolescents (ages 13 to 18 years; n = 31) and young adults (ages 19 to 24 years; n = 31). Participants in each age subgroup were randomized into the study arm (intervention initiated upon enrolment) or the waitlist control arm (intervention initiated after an 8-week wait period). Comparisons were made between the study and waitlist control arms at week 8 (the point where study arm had completed the intervention and the waitlist control arm had not) and within each arm at four time points over 24-week follow-up period. RESULTS: At baseline, there was no statistical difference between study and waitlist participants for both age subgroups for all three outcomes of interest. After the intervention, depression severity was significantly reduced; comparison across arms at week 8 and over time within each arm and both age subgroups. Spiritual well-being changes were not significant, with the exception of an improvement over time for the younger participants in the study arm (p = 0.01 at week 16 and p = 0.0305 at week 24). Self-concept improved significantly for younger participants immediately after the intervention (p = 0.045 comparison across arms at week 8; p = 0.0175 in the waitlist control arm) and over time in the study arm (p = 0.0025 at week 16). In the older participants, change was minimal, with the exception of a significant improvement in one of six factors (vulnerability) in study arm over time (p = 0.025 at week 24). CONCLUSIONS: The results of the LEAP Project pilot trial suggest that it is an effective, online intervention for youth ages 13 to 24 with mild to moderate major depressive disorder with various life situations and in a limited way on spiritual well-being and self-concept. TRIAL REGISTRATION: ClinicalTrials.gov NCT00985686. Registered 24 September 2009.

Reduced health resource use after acupuncture for low-back pain.

OBJECTIVES: Acupuncture is commonly used to treat low-back pain (LBP) and clinical trials have demonstrated its efficacy. However, less is known about how the utilization of acupuncture impacts public health service utilization in the real world. This study investigates the association between acupuncture utilization for LBP and health care utilization by assessing whether patients who undergo acupuncture subsequently use fewer health care resources and whether those patients differ in their health care use from the general population with LBP. DESIGN: This study employed the design of a two-group pre/post secondary data analysis. SETTING AND SUBJECTS: There were two study populations. To identify patients who received acupuncture for LBP in 2000, patient charts at Alberta registered acupuncture clinics were reviewed. The comparison group was identified from the Alberta physician claims administrative database. Acupuncture group cases were matched with four comparison cases from the general population with LBP based on gender and age. OUTCOME MEASURES: Number of physician visits and physician service cost for LBP-related services for 1 year pre- and postacupuncture treatment period were calculated from the physician claims data for both study groups. RESULTS: For the 201 cases and 804 controls, the mean age was 48 years and 54% were female. The number of physician visits for the 1-year period postacupuncture decreased 49% for the acupuncture group (p<0.01) compared to the 1-year period preacupuncture. For the comparison there was a decrease of 2% in physician visits (p=0.59) for the same time periods. Corresponding to the decrease, physician services cost declined 37% for the case group (p=0.01) and 1% for the comparison (p=0.86). CONCLUSIONS: Results suggest that patients with LBP were less likely to visit physicians for LBP after acupuncture treatment. This led to reduced health services spending on LBP.

A spirituality teaching program for depression: qualitative findings on cognitive and emotional change.

OBJECTIVES: This study was conducted with participants from a trial evaluating an 8-week spirituality teaching program to treat unipolar major depression. The objectives of this study were to understand the nature of the observed mood following participation in the spirituality based intervention. DESIGN: This study used the methods of a naturalistic inquiry. SETTING: A total of 15 interviewees were purposefully sampled from the trial population. INTERVENTION: The intervention consisted of audio CDs for home-based use that delivered lectures and stories about spirituality, suggested behavioural applications and included relaxation practices. MAIN OUTCOME MEASURES: In-depth, semi-structured interviews were conducted with each participant 6 months post program completion. Interviews were audio recorded and transcribed verbatim. The data were coded for patterns of substantive core meaning in terms of the participants' subjective and behavioural experiences of the program materials. RESULTS: Participants described an expanded spiritual awareness, characterized by a sense of connection with self, others, the world and universal energy. The primary influences participants reported occurred as a result of practicing forgiveness, compassion, gratitude and acceptance in their daily lives and included reduced negative thinking patterns, being less judgmental, reduced ego-centricity, and improved self-esteem. Concurrent with these shifts, participants experienced an improved mood characterized by reduced anxiety and/or depression, mental clarity, calmness and improved relationships. CONCLUSION: Findings suggest that the spirituality teaching program impacts depression by expanding spiritual beliefs and shifting perspectives of life situations, oneself and others. Spiritual teachings and practices could be an innovative and valuable adjunct intervention to treat depression.

A spirituality teaching program for depression: a randomized controlled trial.

OBJECTIVE: This randomized controlled trial assessed the efficacy of a Spirituality Teaching Program to treat unipolar major depression. METHOD: A randomized controlled, assessor blinded trial design was used. A total of 84 individuals aged 18 years or older with unipolar major depression of mild to moderate severity were recruited in Calgary, Canada and randomized to two study arms: 1) Spirituality Teaching Program Group (8 week, home-based Spirituality Teaching Program); and 2) Waitlist Control Group (no intervention followed by Spirituality Teaching Program starting at week 9). Outcome measures (depression severity, response rate, remission rate) were assessed at baseline, 8, 16, and 24 weeks using the Hamilton Depression Rating Scale (HAM-D). RESULTS: The two trial groups were similar in their demographic and disease characteristics at baseline. At the 8-week point, the change in depression severity was significantly different between the two groups (change in HAM-D score: 8.5 for the Spirituality Group and 2.3 for the Waitlist Control Group, p < 0.001). The Spirituality Teaching Program Group had significantly higher response (36% vs. 4.4%, p < 0.001) and remission rates (31% vs. 4.4%, p < 0.001) than the Waitlist Control Group. The benefits remained throughout the observation period for the Spirituality Teaching Program Group participants with response rates of 56.4% at 16 weeks and 58.9% at 24 weeks. CONCLUSION: The Spirituality Program significantly reduced depression severity and increased response and remission rates. This non-drug treatment program should be investigated further as a treatment option for depression.

A home study-based spirituality education program decreases emotional distress and increases quality of life--a randomized, controlled trial.

CONTEXT: Although epidemiological studies have reported protective effects of religion and spirituality on mental health, it is unknown whether spirituality can be used as an intervention to improve psychological well-being. OBJECTIVE: To evaluate the efficacy of a home study-based spirituality program on mood disturbance in emotionally distressed patients. DESIGN, SETTING, AND PARTICIPANTS: A non-blinded, randomized, wait list-controlled trial of 165 individuals with mood disturbance [score of >40 on the Profile of Mood States (POMS)] were recruited from primary care clinics in a Canadian city between August 2000 and March 2001. INTERVENTIONS: Participants were randomized to a spirituality group (an 8-week audiotaped spirituality home-study program), a mindfulness meditation-based stress reduction group (attendance at facilitated classes for 8 weeks), or a wait-list control group (no intervention for 12 weeks). MAIN OUTCOME MEASURES: Primary outcomes were mood disturbance, measured using POMS, and quality of life, measured using the SF-36, a short-form health survey with 36 questions. The POMS and the SF-36 were completed at baseline, at 8 weeks, and at 12 weeks. RESULTS: At the end of the 8-week intervention period, the mean POMS score improvement was -43.1 (-45.7%) for the spirituality group, -22.6 (-26.3%) for the meditation group, and -10.3 (11.3%) for the control group (P<.001 for spirituality vs control group; P=.034 for spirituality vs meditation group). Mean improvement in the SF-36 mental component summary score was 14.4 (48.6%) for the spirituality group, 7.1 (22.3%) for the meditation group, and 4.7 (16.1%) for the control group (P<.001 for spirituality vs control group; P=.029 for spirituality vs meditation group). At 12 weeks, POMS and SF-36 scores remained significantly different from baseline for the spirituality group.

Mental disorders and reasons for using complementary therapy.

OBJECTIVE: To compare patients with and without mental disorders who seek services from a complementary therapy practitioner with regard to quality of life, reasons for seeking complementary therapies, complaints, and physical conditions. METHOD: We studied new patients who attended a complementary therapy clinic offering acupuncture treatment between July 1, 1993, and March 31, 1995. We collected data from a self-administered questionnaire and from a physician-conducted psychiatric assessment. RESULTS: Of the 826 new patients at the clinic, 578 (70%) presented with a mental disorder. Patients with a mental disorder perceived their quality of life as poorer and reported greater levels of stress than did those without a mental disorder. However, the groups did not differ in their self-reported reasons for seeking complementary therapies, in their complaints, or in their physical conditions. Among patients with a mental disorder, the major reasons for choosing complementary therapies were personal preference, interest, or belief in complementary therapies (44.3%) and perceiving complementary therapies as a last resort (30.7%). Most patients with a mental disorder saw a complementary practitioner for musculoskeletal and connective-tissue disorders (44.1%), fatigue (26.6%), and headache (15.2%). The most frequent physical illnesses among patients with a mental disorder were diseases of the musculoskeletal system and connective tissue (42.6%). CONCLUSION: Like their counterparts without a mental disorder, individuals with a mental disorder use complementary therapies because of personal beliefs. The wide use of complementary therapies among individuals with a mental disorder may be ascribed to a poor quality of life and high levels of distress.