Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 12.256
Filtrar
1.
Lancet Psychiatry ; 7(9): 775-787, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32828167

RESUMO

BACKGROUND: Maternal depression has a recurring course that can influence offspring outcomes. Evidence on how to treat maternal depression to improve longer-term maternal outcomes and reduce intergenerational transmission of psychopathology is scarce, particularly for task-shifted, low-intensity, and scalable psychosocial interventions. We evaluated the effects of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years postnatal. METHODS: 40 village clusters in Pakistan were randomly allocated using a computerised randomisation sequence to receive a group-based, psychosocial intervention and enhanced usual care for 36 months, or enhanced usual care alone. Pregnant women (≥18 years) were screened for moderate or severe symptoms of depression (patient health questionnaire-9 [PHQ-9] score ≥10) and were recruited into the trial (570 participants), and a cohort without depression (PHQ-9 score <10) was also enrolled (584 participants). Including the non-depressed dyads enabled us to determine how much of the excess risk due to maternal depression exposure the intervention could mitigate. Research teams responsible for identifying, obtaining consent, and recruiting trial participants were blind to the allocation status throughout the duration of the study, and principal investigators, site coordinators, statisticians, and members of the trial steering committee were also blinded to the allocation status until the analysis of 6-month data for the intervention. Primary outcomes were maternal depression symptoms and remission (PHQ-9 score <10) and child socioemotional skills (strengths and difficulties questionnaire [SDQ-TD]) at 36-months postnatal. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, NCT02658994. FINDINGS: From Oct 15, 2014 to Feb 25, 2016 46 village clusters were assessed for eligibility, of which 40 (including 1910 mothers were enrolled. After exclusions, 288 women were randomly assigned to the enhanced usual care group and 284 to the intervention group, and 1159 women were included in a group without prenatal depression. At 36-months postnatal, complete data were available from 889 mother-child dyads: 206 (72·5%) in the intervention group, 216 (75·3%) in the enhanced usual care group, and 467 (80·0%) women who did not have prenatal-depression. We did not observe significant outcome differences between the intervention group and the enhanced usual care group for the primary outcomes. The standardised mean difference of PHQ-9 total score was -0·13 (95% CI -0·33 to 0·07), relative risk of patient health questionnaire-9 remission was 1·00 (95% CI 0·88 to 1·14), and the SDQ-TD treatment estimate was -0·10 (95% CI -1·39 to 1·19). INTERPRETATION: Reduced symptom severity and high remission rates were seen across both the intervention and enhanced usual care groups, possibly masking any effects of the intervention. A multi-year, psychosocial intervention can be task-shifted via peers but might be susceptible to reductions in fidelity and dosage over time (which were not among the outcomes of this trial). Early intervention efforts might need to rely on multiple models (eg, collaborative care), be of greater intensity, and potentially targeted at mothers who are at high risk for depression to reduce the intergenerational transmission of psychopathology from mothers to children. FUNDING: National Institutes of Health.


Assuntos
Desenvolvimento Infantil , Depressão Pós-Parto/terapia , Relações Mãe-Filho , Mães/psicologia , Grupo Associado , Psicoterapia de Grupo/métodos , Adolescente , Adulto , Comportamento Infantil , Pré-Escolar , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/psicologia , Feminino , Humanos , Paquistão , Escalas de Graduação Psiquiátrica , Resultado do Tratamento , Adulto Jovem
2.
Am J Geriatr Psychiatry ; 28(9): 983-988, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32622730

RESUMO

BACKGROUND: Societal measures in context of the COVID-19 outbreak forced us to transform our schema therapy based day-treatment for older adults with chronic affective disorders and personality problems into an online program. The objective of this paper is to present first impressions of this transformation. METHODS: Using over-the-phone instructions initially, all patients were able to participate with the online therapy program. To reduce screen-time for patients, the nonverbal therapies were shortened. Four patients, aged 64-70 years, started our online program. RESULTS: Therapists were positive about the online capabilities and resilience of patients to adapt to the new situation. Prejudices on limited effectiveness of online psychotherapy were counteracted. Sending homework by email and mail seems to facilitate therapy adherence. Nonverbal therapy could be important to stimulate the online group process. CONCLUSION: We were positively surprised by the online capabilities of our geriatric mental healthcare patients and encourage further formal effectiveness studies.


Assuntos
Infecções por Coronavirus/psicologia , Transtornos da Personalidade/terapia , Pneumonia Viral/psicologia , Psicoterapia de Grupo/métodos , Psicoterapia/métodos , Telemedicina/métodos , Idoso , Betacoronavirus , Surtos de Doenças , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Pandemias
3.
Psychol Trauma ; 12(S1): S113-S114, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32525388

RESUMO

Although COVID-19 is a physical illness, it has had large impacts on mental health. For many individuals, social distancing has led to social isolation; individuals with posttraumatic stress disorder and substance use disorders are at a particular risk for negative outcomes due to the global pandemic. Here, we discuss the impacts we have noticed and procedures we have implemented to care for this population during the pandemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Assistência Ambulatorial , Infecções por Coronavirus , Serviços de Saúde Mental , Pandemias , Pneumonia Viral , Transtornos de Estresse Pós-Traumáticos/terapia , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Humanos , Terapia Implosiva , Psicoterapia de Grupo , Telemedicina
4.
Clin Child Psychol Psychiatry ; 25(3): 672-686, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32594756

RESUMO

The impact of COVID-19 has challenged the long accepted 'norm' in delivery of psychological therapy. Public policies designed to reduce transmission have made it extremely difficult to meet with service-users safely in the traditional face-to-face context. E-therapies have existed in theory and practice since technological progress has made them possible. They can offer a host of advantages over face-to-face equivalents, including improved access, greater flexibility for service-users and professionals, and cost savings. However, despite the emerging evidence and anticipated positive value, implementation has been slower than anticipated. Concerns have been raised by service-users, clinicians, and public health organisations, identifying significant barriers to the wide spread use of e-therapies. In the current climate, many clinicians are offering e-therapies for the first time, without prior arrangement or training, as the only viable option to continue to support their clients. This paper offers a clinically relevant review of the e-therapies literature, including effectiveness and acceptability dilemmas and challenges that need to be addressed to support the safe use and growth of e-therapies in psychology services. Further research is needed to better understand what might be lost and what gained in comparison to face-to-face therapy, and for which client groups and settings it might be most effective.


Assuntos
Atitude do Pessoal de Saúde , Infecções por Coronavirus/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Pneumonia Viral/epidemiologia , Psiquiatria , Psicologia , Telemedicina , Adulto , Betacoronavirus , Criança , Humanos , Pandemias , Psicoterapia de Grupo , Telefone , Resultado do Tratamento , Comunicação por Videoconferência
5.
N Z Med J ; 133(1515): 104-111, 2020 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-32438382

RESUMO

The COVID-19 pandemic requires us to rethink how virtual approaches might work for people who use alcohol and other drugs. Are virtual clinics only suitable for clients with whom clinicians have already formed a therapeutic relationship? How well would virtual clinics work for new clients presenting to services, for clients in acute distress, and for those with complex problems? Addressing the sustained change required to maintain substance-free lives or a safe substance-use life requires robust psychotherapeutic approaches, which have traditionally been delivered through physical contact, whether they are one-to-one or group-based interventions. The challenge during this time of the COVID-19 pandemic is to deliver effective talking therapies while avoiding physical contact. How then should services continue to offer counselling and support in such an environment? How can we learn from the COVID-19 situation to deliver treatment to individuals who may have difficulties attending traditional clinic-based care, such as those in more rural areas with transport difficulties? This article focuses on identifying practical issues and providing some solutions.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Psicoterapia/métodos , Transtornos Relacionados ao Uso de Substâncias/terapia , Betacoronavirus , Confidencialidade , Humanos , Nova Zelândia , Pandemias , Psicoterapia de Grupo , Transtornos Relacionados ao Uso de Substâncias/psicologia , Telemedicina
6.
Prax Kinderpsychol Kinderpsychiatr ; 69(3): 203-217, 2020 May.
Artigo em Alemão | MEDLINE | ID: mdl-32394821

RESUMO

Evaluation of a Manualized Group Program for Siblings of Children with Diseases or Disabilities This study evaluates a manualized group program for siblings of children with life-threatening/life-limiting diseases or disabilities. The program aims to activate resources and to reduce emotional and behavioral problems, using cognitive-behavioral methods and experience-based interventions. In this multi-center study, 13 GeschwisterTREFFs were conducted by 11 study sites in Germany. Prior to and after the intervention 97 siblings aged 7 to 14 years and their parents were examined with standardized questionnaires. At baseline, the siblings of children with diseases or disabilities showed significant more emotional and behavioral problems compared to the respective norm samples. After the intervention, the siblings reported declined problem behavior scores that were mostly in the range of the particular norm values. Furthermore, the children indicated a significant improvement of self-esteem, self-efficacy, school competences and relations to their siblings. However, parents reported more problem behavior and less health-related quality of life of their children at both assessments. The present multi-center study showed the interventions' feasibility in different settings and confirmed expected improvements of target variables during the intervention period. Randomized-controlled trails are warranted to verify our results.


Assuntos
Terapia Cognitivo-Comportamental , Pessoas com Deficiência , Comportamento Problema/psicologia , Psicoterapia de Grupo , Irmãos/psicologia , Sucesso Acadêmico , Adolescente , Criança , Estudos de Viabilidade , Alemanha , Humanos , Pais/psicologia , Qualidade de Vida , Autoimagem , Autoeficácia , Inquéritos e Questionários
7.
Epidemiol Psychiatr Sci ; 29: e130, 2020 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-32452336

RESUMO

AIMS: Psychological interventions that are brief, acceptable, effective and can be delivered by non-specialists are especially necessary in low- and middle-income countries, where mental health systems are unable to address the high level of psychosocial needs. Problem Management Plus (PM+) is a five-session intervention designed for those impaired by psychological distress while living in communities affected by adversity. Individual PM+ has demonstrated effectiveness in reducing distress in Kenya and Pakistan, and a group version of PM+ (Group PM+) was effective for conflict-affected women in Pakistan. This paper describes a feasibility and acceptability trial of locally adapted Group PM+ for women and men in an earthquake-affected region of rural Nepal. METHODS: In this feasibility cluster randomised controlled trial, participants in the experimental arm were offered five sessions of Group PM+ and participants in the control arm received enhanced usual care (EUC), which entailed brief psycho-education and providing referral options to primary care services with health workers trained in the mental health Gap Action Programme Intervention Guide (mhGAP-IG). A mixed-methods design was used to assess the feasibility and acceptability of Group PM+. Feasibility was assessed with criteria including fidelity and retention of participants. Acceptability was assessed through in-depth interviews with participants, family members, programme staff and other stakeholders. The primary clinical outcome was depression symptoms assessed using the Patient Health Questionnaire (PHQ-9) administered at baseline and 8-8.5 weeks post-baseline (i.e. after completion of Group PM+ or EUC). RESULTS: We recruited 121 participants (83% women and 17% men), with equal allocation to the Group PM+ and EUC arms (1:1). Group PM+ was delivered over five 2.5-3 hour sessions by trained and supervised gender-matched local non-specialists, with an average attendance of four out of five sessions. The quantitative and qualitative results demonstrated feasibility and acceptability for non-specialists to deliver Group PM+. Though the study was not powered to assess for effectiveness, for all five key outcome measures, including the primary clinical outcome, the estimated mean improvement was larger in the Group PM+ arm than the EUC arm. CONCLUSION: The intervention and trial procedures were acceptable to participants, family members, and programme staff. The communities and participants found the intervention to be beneficial. Because feasibility and acceptability were established in this trial, a fully powered randomised controlled trial will be conducted for larger scale implementation to determine the effectiveness of the intervention in Nepal.


Assuntos
Depressão/terapia , Terremotos , Educação de Pacientes como Assunto/métodos , Psicoterapia de Grupo/métodos , População Rural , Sobreviventes/psicologia , Adulto , Depressão/psicologia , Estudos de Viabilidade , Feminino , Humanos , Entrevistas como Assunto , Masculino , Nepal , Aceitação pelo Paciente de Cuidados de Saúde , Sobreviventes/estatística & dados numéricos , Resultado do Tratamento
8.
Psychiatr Danub ; 32(1): 115-121, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32303041

RESUMO

BACKGROUND: Group interventions can have negative effects for patients with anxiety disorders. Stimuli which provoke side effects may be the group setting, the content, or the interaction between the participants in the group. This study is the first to report negative effects from a cognitive behavioral group intervention, in comparison with an unspecific, recreational group for anxiety patients. SUBJECTS AND METHODS: 107 patients with work-related anxiety disorders were randomized to either a cognitive behavioral group therapy (work-coping group WG) or an unspecific group encounter aimed at increasing recreational activities (recreational group RG). Patients completed the Unwanted Events in Group Therapy Scale (UE-G scale). RESULTS: In the work-coping group, 41.9% of the patients reported at least one relevant side effect, as compared to 28.9% in the recreational group. These included an increase in the perception of anxiety and work-problems, feelings of exposure to criticism and the development of negative views on group therapy as such. CONCLUSIONS: This is the first randomized, controlled, therapy study in anxiety patients to systematically investigate side effects. Work-coping group interventions have, despite their useful main effects, specific negative effects, when compared with group encounters. Group psychotherapists or group moderators should be aware of the potential side effects in anxiety patients.


Assuntos
Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental , Psicoterapia de Grupo , Recreação/psicologia , Adaptação Psicológica , Ansiedade/psicologia , Ansiedade/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
BMC Psychol ; 8(1): 34, 2020 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-32303260

RESUMO

BACKGROUND: Depression and obesity are significant global health concerns that commonly occur together. An integrated group cognitive behavioural therapy program was therefore developed to simultaneously address comorbid depression and obesity. METHODS: Twenty-four participants (63% women, mean age 46 years) who screened positively for depression with a body mass index ≥25 were recruited from a self-referred general population sample. The group therapy program (10 two-hour weekly sessions) was examined in a single-arm, before-after pilot trial, conducted in a behavioural health clinic in Adelaide, Australia. Primary outcomes included survey and assessment-based analyses of depression, anxiety, body image, self-esteem, and weight (kg), assessed at four time-points: baseline, post-intervention, three-months and 12-months post program. Eighteen participants (75%) completed the program and all assessments. RESULTS: Significant improvements in depression, anxiety, self-esteem and body shape concern scores, several quality of life domains, eating behaviours and total physical activity (among others) - but not weight - were observed over the course of the trial. CONCLUSIONS: Results from this pilot trial suggest that combining interventions for depression and obesity may be useful. Further development of the program, particularly regarding the potential for physical health benefits, and a randomised controlled trial, are warranted. TRIAL REGISTRATION: Trial registration: ANZCTR, ACTRN12617001079336, 13 July 2017. Retrospectively registered after date of the first consent (6 July 2017), but before the date of the first intervention session (20 July 2017).


Assuntos
Terapia Cognitivo-Comportamental , Depressão/terapia , Obesidade/terapia , Psicoterapia de Grupo , Adulto , Idoso , Ansiedade/terapia , Austrália/epidemiologia , Índice de Massa Corporal , Comorbidade , Depressão/complicações , Depressão/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Obesidade/psicologia , Projetos Piloto , Psicoterapia de Grupo/métodos , Qualidade de Vida
10.
Medicine (Baltimore) ; 99(17): e18034, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332591

RESUMO

BACKGROUND/OBJECTIVES: The level of psychological distress among awaiting-trial inmates is rapidly increasing in Nigeria. Studies have recommended increasing attention and additional psychological intervention that could improve the psychological wellbeing of prisoners. This study evaluates the effect of cognitive behavioral therapy on psychological distress among awaiting-trial prison inmates in Nigeria. METHODS: A total of 34 awaiting-trial prison inmates in Enugu state Nigeria were used as the study participants. Two measures (perceived emotional distress inventory and general health Questionnaire) were used for data collection. Repeated measures with analysis of variance (ANOVA) were used to examine the effects of the intervention. Effect sizes were also reported with partial Eta Squared ((Equation is included in full-text article.)). RESULTS: The result showed that there was no significant difference in psychological distress between the treatment and no-intervention groups. The results showed that CBT had a significant effect on psychological distress of awaiting-trial prison inmates when compared to their counterparts in the no-intervention group at Time 2. Additionally, the efficacy of CBT on the psychological distress of awaiting-trial prison inmates was significantly sustained at the follow-up measurements (Time 3). CONCLUSION: This study suggests that cognitive behavioral therapy is an effective intervention for decreasing psychological distress among awaiting-trial prison inmates. Additionally, the impactful benefit of the intervention can persist in overtime. Therefore, cognitive behavioral therapists can further explore the efficacy of CBT using various cultures.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Prisioneiros/psicologia , Psicoterapia de Grupo/métodos , Estresse Psicológico/terapia , Adulto , Feminino , Humanos , Masculino , Nigéria , Angústia Psicológica , Adulto Jovem
11.
Rev Infirm ; 69(257): 43-44, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-32146967

RESUMO

In the field of addictology, care integrates activities that reactivate forgotten senses, emotions and postures. A "Photographs" workshop, led by a nurse in the addictology department, was modulated into a "Brief group photo-motivational intervention" to help people quit smoking. From this experience emerged an educational sequence of "Photo-Expression" integrated into the patient's therapeutic education programme "Help to stop smoking".


Assuntos
Abandono do Hábito de Fumar/métodos , Humanos , Entrevista Motivacional , Educação de Pacientes como Assunto , Fotografação , Psicoterapia Breve , Psicoterapia de Grupo
12.
BMC Health Serv Res ; 20(1): 189, 2020 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-32143644

RESUMO

BACKGROUND: Perinatal depression is a prevalent public health concern. Although preventive interventions exist, there is limited literature on the acceptability and appropriateness of these interventions, especially those delivered by paraprofessionals. The Mothers and Babies Program (MB) is a group-based perinatal depression preventive intervention delivered prenatally. A cluster-randomized controlled trial examined the acceptability, appropriateness, and effectiveness of MB delivered by mental health professionals compared to paraprofessional staff from home visiting programs. METHODS: The full study enrolled 874 pregnant women. Fifty-three facilitators were trained and delivered the MB intervention to women in one of seven states in the United States. Semi-structured interviews were attempted with a randomly-selected subset of the full sample of pregnant women who received the MB intervention and with all facilitators. Specifically, interviews were conducted with 88 women who received the MB group intervention (45 in the paraprofessional-led arm and 43 in the mental health professional-led arm) and 46 women who facilitated the groups (27 home visiting staff and 19 mental health professionals). Interviews were conducted over the phone in English or Spanish and audio recorded. The recordings were translated into English, as needed, and transcribed. Thematic analysis was conducted using NVIVO to identify key themes related to intervention acceptability and appropriateness. Similarities and differences between study arms were explored. RESULTS: Clients and facilitators found the MB content and group format acceptable. Challenges included maintaining group attendance, transportation issues, and managing group discussion. Overall, facilitators found the intervention appropriate for pregnant clients with some challenges presented for clients in crisis situations, experiencing housing instability, and with literacy and learning challenges. Participants provided suggestions for improvement, both for the course content and implementation. There were no significant differences found between study arms. CONCLUSIONS: Overall, clients and facilitators enjoyed MB irrespective of study arm, and facilitators found the intervention appropriate for the population. These findings add to the qualitative literature on perinatal depression preventive interventions, specifically those delivered by paraprofessionals. TRIAL REGISTRATION: This trial is registered on ClinicalTrials.gov (Initial post: December 1, 2016; identifier: NCT02979444).


Assuntos
Depressão/prevenção & controle , Mães/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gestantes/psicologia , Psicoterapia de Grupo , Adulto , Atitude do Pessoal de Saúde , Feminino , Pesquisa sobre Serviços de Saúde , Visita Domiciliar , Humanos , Serviços de Saúde Mental , Mães/estatística & dados numéricos , Gravidez , Pesquisa Qualitativa
13.
BMJ ; 368: m512, 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-32144210

RESUMO

The studyHewlett S, Almeida C, Ambler N, et al. Reducing arthritis fatigue impact: two-year randomised controlled trial of cognitive behavioural approaches by rheumatology teams (RAFT). Ann Rheum Dis 2019;78:465-72.Hewlett S, Almeida C, Ambler N, et al. Group cognitive behavioural programme to reduce the impact of rheumatoid arthritis fatigue: the RAFT RCT with economic and qualitative evaluations. Health Technol Assess 2019;23:57.This project was funded by the NIHR Health Technology Assessment Programme (project number 11/112/01).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000860/group-cognitive-behavioural-courses-may-reduce-fatigue-from-rheumatoid-arthritis.


Assuntos
Artrite Reumatoide/complicações , Terapia Cognitivo-Comportamental/métodos , Fadiga/prevenção & controle , Fadiga/terapia , Psicoterapia de Grupo/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
BMC Public Health ; 20(1): 390, 2020 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-32216762

RESUMO

BACKGROUND: Accessing quality mental health care poses significant challenges for persons affected by adversity, especially in low- and middle-income countries where resources are scarce. To mitigate this, the World Health Organization has developed group problem management plus (gPM+), a low-intensity psychological intervention for adults experiencing psychological distress. gPM+ is a group-based intervention consisting of five-sessions, and can be delivered by non-specialist providers. This paper outlines the study protocol for a trial of gPM+ in Jordan. METHODS: We will conduct a single-blind, two-arm, randomized controlled trial in a Syrian refugee camp in Jordan. We aim to enrol 480 adults into the trial. Participants will be eligible for the trial if they screen positive for levels of psychological distress. Following screening, those eligible will be randomly assigned to receive the gPM+ intervention or enhanced treatment as usual. The primary outcome is reduction in levels of psychological distress at 3-months post-treatment. Secondary outcomes include anxiety, depression, prodromal psychotic symptoms, posttraumatic stress disorder, prolonged grief, daily functioning, economic effectiveness, and change in parenting behaviour. Secondary outcomes also include the reduction in psychological distress of the participant's child. DISCUSSION: The trial aims to deliver a template for affordable and scalable psychosocial interventions that can readily be implemented in refugee settings, and that can benefit both the participant and their child. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12619001386123. Registered prospectively on 10/10/2019.


Assuntos
Transtornos Mentais/terapia , Angústia Psicológica , Psicoterapia de Grupo/métodos , Campos de Refugiados , Refugiados/psicologia , Adulto , Protocolos Clínicos , Feminino , Humanos , Jordânia , Masculino , Refugiados/estatística & dados numéricos , Método Simples-Cego , Síria/etnologia , Resultado do Tratamento
15.
BMC Psychol ; 8(1): 9, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32005288

RESUMO

BACKGROUND: This study intended to examine the comprehensive clinical effects of school sandplay group counseling on the emotions and behaviors of children for the first time in Korea. METHODS: To this objective, 10 sessions of in-school sandplay group counseling were administered to 113 fourth- to sixth-graders in an elementary school located in Cheonan city for 12 weeks from March to July 2015. Each small group consisted of 10 to 16 children and the entire 12 sessions were composed of a baseline test, 10 therapy sessions, and a post-test and evaluation session. The study subjects consisted of 56 boys (49.6%) and 57 girls (50.4%). As the evaluation instruments, an epidemiologic questionnaire and the Korea Child & Youth Personality Test were used during the baseline phase and after the termination of the counseling. RESULTS: The comparison of the scores according to the KCYP clinical scales and detailed evaluation scales before and after the 12-week counseling showed an increase in the self-esteem and a significant decline in depression in the elementary students after the counseling. CONCLUSION: It is deemed that school sandplay group counseling can help elementary school students to solve emotional problems and improve their self-esteem.


Assuntos
Testes de Personalidade , Ludoterapia , Psicoterapia de Grupo , Estudantes/psicologia , Criança , Depressão , Emoções , Feminino , Humanos , Masculino , República da Coreia , Instituições Acadêmicas , Autoimagem , Inquéritos e Questionários
16.
Lancet Glob Health ; 8(3): e387-e398, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32035035

RESUMO

BACKGROUND: WHO recommends the use of psychological interventions as first-line treatment for depression in low-income and middle-income countries. However, evaluations of the effectiveness and cost-effectiveness of such interventions among people with HIV are scarce. Our aim was to establish the effectiveness of group support psychotherapy (GSP) delivered by lay health workers for depression treatment among people living with HIV in a rural area of Uganda on a large scale. METHODS: In this cluster-randomised trial, we included 30 health centres offering HIV care. These were randomly assigned to deliver either GSP or group HIV education (GHE). Randomisation, in a ratio of 1:1, was achieved by health centre managers separately picking a paper containing the intervention allocation from a basket. Participants were people living with HIV, aged 19 years and older, with mild to moderate major depression assessed with the Mini International Neuropsychiatric Interview depression module, taking antiretroviral therapy, and antidepressant-naive. Group sessions were led by trained lay health workers once a week for 8 weeks. The primary outcomes were the proportion of participants with major depression and function scores at 6 months post-treatment, analysed by intention to treat by means of multilevel random effect regression analyses adjusting for clustering in health centres. This trial is registered with the Pan African Clinical Trials Registry, PACTR201608001738234. FINDINGS: Between Sept 13 and Dec 15, 2016, we assessed 1473 individuals, of whom 1140 were recruited from health centres offering GSP (n=578 [51%]) or GHE (n=562 [49%]). Two (<1%) participants in the GSP group were diagnosed with major depression 6 months post-treatment compared with 160 (28%) in the GHE group (adjusted odds ratio=0·01, 95% CI 0·003-0·012, p<0·0001). The mean function scores 6 months post-treatment were 9·85 (SD 0·76) in the GSP group and 6·83 (2·85) in the GHE group (ß=4·12; 95% CI 3·75-4·49, p<0·0001). 36 individuals had 63 serious adverse events, which included 25 suicide attempts and 22 hospital admissions for medical complications. The outcomes of these serious adverse events included 16 deaths, 4 of which were completed suicides (GSP=2; GHE=2), and 12 of which were HIV-related medical complications (GSP=8; GHE=4). Cost-effectiveness estimates showed an incremental cost-effectiveness ratio of US$13·0 per disability-adjusted life-year averted, which can be considered very cost-effective in Uganda. INTERPRETATION: Integration of cost-effective psychological treatments such as group support psychotherapy into existing HIV interventions might improve the mental health of people living with HIV. FUNDING: MQ Transforming Mental Health and Grand Challenges Canada.


Assuntos
Agentes Comunitários de Saúde/educação , Depressão/terapia , Infecções por HIV/psicologia , Psicoterapia de Grupo , Apoio Social , Adulto , Análise Custo-Benefício , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Psicoterapia de Grupo/economia , População Rural , Resultado do Tratamento , Uganda/epidemiologia
17.
BMC Public Health ; 20(1): 80, 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31959151

RESUMO

BACKGROUND: Perinatal women accessing prevention of mother-to-child transmission of HIV (PMTCT) services are at an increased risk of depression; however, in Tanzania there is limited access to services provided by mental health professionals. This paper presents a protocol and baseline characteristics for a study evaluating a psychosocial support group intervention facilitated by lay community-based health workers (CBHWs) for perinatal women living with HIV and depression in Dar es Salaam. METHODS: A cluster randomized controlled trial (RCT) is conducted comparing: 1) a psychosocial support group intervention; and 2) improved standard of mental health care. The study is implemented in reproductive and child health (RCH) centers providing PMTCT services. Baseline characteristics are presented by comparing sociodemographic characteristics and primary as well as secondary outcomes for the trial for intervention and control groups. The trial is registered under clinicaltrials.gov (NCT02039973). RESULTS: Among 742 women enrolled, baseline characteristics were comparable for intervention and control groups, although more women in the control group had completed secondary school (25.2% versus 18.2%). Overall, findings suggest that the population is highly vulnerable with over 45% demonstrating food insecurity and 17% reporting intimate partner violence in the past 6 months. CONCLUSIONS: Baseline characteristics for the cluster RCT were comparable for intervention and control groups. The trial will examine the effectiveness of a psychosocial support group intervention for the treatment of depression among women living with HIV accessing PMTCT services. A reduction in the burden of depression in this vulnerable population has implications in the short-term for improved HIV-related outcomes and for potential long-term effects on child growth and development. TRIAL REGISTRATION: The trial is registered under clinicaltrials.gov (NCT02039973). Retrospectively registered on January 20, 2014.


Assuntos
Depressão/terapia , Infecções por HIV/terapia , Assistência Perinatal , Psicoterapia de Grupo , Adolescente , Adulto , Depressão/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Humanos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Pessoa de Meia-Idade , Gravidez , Fatores Socioeconômicos , Tanzânia/epidemiologia , Adulto Jovem
18.
J Acquir Immune Defic Syndr ; 83(4): 405-414, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31904707

RESUMO

BACKGROUND: Tobacco use has emerged as the leading killer of persons living with HIV (PLWH) in the United States. Little is known about the efficacy of tobacco treatment strategies in PLWH. DESIGN: Randomized controlled trial comparing Positively Smoke Free (PSF), an intensive group therapy intervention targeting HIV-infected smokers, to brief advice to quit. All participants were offered a 12-week supply of nicotine patches. METHODS: A cohort of 450 PLWH smokers, recruited from HIV-care centers in the Bronx, New York, and Washington, DC, were randomized 1:1 into the PSF or brief advice to quit conditions. PSF is an 8-session program tailored to address the needs and concerns of HIV-infected smokers and delivered by a trained smoking cessation counselor and PLWH ex-smoker peer pair. The primary outcome was biochemically confirmed, 7-day point-prevalence abstinence at 6 months. RESULTS: In the intention to treat analysis, PSF condition subjects had nearly double the quit rate of controls, 13% vs. 6.6% [odds ratio = 2.10 (95% confidence interval = 1.10 to 4.14), P = 0.04], at 3 months, but no significant difference in abstinence was observed at 6 months. PSF participants exhibited lower nicotine dependence and higher self-efficacy to resist smoking temptations at both 3 and 6 months compared with controls. Lower educational attainment, current cocaine use, past use of nicotine patches, and higher distress tolerance were significant predictors of continued smoking at 6 months. CONCLUSIONS: These findings suggest a role for group therapy among tobacco treatments for PLWH smokers, but strategies to augment the durability of early effects are needed.


Assuntos
Fumar Cigarros/terapia , Infecções por HIV/complicações , Psicoterapia de Grupo , Tabagismo/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
Res Q Exerc Sport ; 91(3): 500-513, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31990633

RESUMO

Purpose: Physical activity (PA) is increasingly being used in hospice care as a rehabilitation strategy to help patients manage symptoms and improve quality of life. However, little is known about how to design and deliver interventions that promote uptake and maintenance of PA in this population. Single-level approaches (i.e., psychological models) have primarily been used to study factors that influence PA engagement among patients with advanced, incurable disease and therefore offer a limited perspective on strategies that target changes beyond the individual level. This study explored perspectives on factors perceived important for influencing PA participation in hospice care using a social-ecological framework. Method: Patients (n = 27) and health providers (n = 5) from multiple hospices (n = 5) across the UK were involved in this study. Data were collected using focus group and individual semi-structured interviews and analyzed using a thematic framework approach. Results: Eight main themes were perceived to be important for influencing PA engagement at the individual, interpersonal, physical environment, community, and policy levels including: (1) PA as therapy; (2) apprehension about PA-induced harm; (3) group-based PA with peers; (4) supervised PA sessions; (5) limited facilities and access; (6) patient-centered approach; (7) lack of a strong PA culture and; (8) absence of a policy and guidance for PA provision. Conclusion: Hospice-based PA interventions that target multiple levels simultaneously may be more effective at successfully changing and sustaining patients' PA behavior. Study findings provide evidence-based recommendations that may facilitate the effective delivery of PA interventions in hospice care.


Assuntos
Terapia por Exercício/psicologia , Cuidados Paliativos na Terminalidade da Vida/organização & administração , Política Organizacional , Qualidade de Vida , Meio Social , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Grupos Focais , Acesso aos Serviços de Saúde , Humanos , Entrevista Psicológica , Masculino , Pessoa de Meia-Idade , Cultura Organizacional , Assistência Centrada no Paciente , Psicoterapia de Grupo , Pesquisa Qualitativa , Reino Unido
20.
Psychol Trauma ; 12(4): 422-430, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31318250

RESUMO

OBJECTIVE: The purpose of the present study was to detail the patient flow and establish the feasibility of a brief 3-week intensive treatment program (ITP) for veterans with posttraumatic stress disorder (PTSD). METHOD: The present study examined data from 648 veterans referred to a non-Veterans Affairs ITP for PTSD from January 2016 to February 2018 to determine the flow of patients into and through the ITP and evaluate individuals' satisfaction with treatment. RESULTS: On average, 25.9 individuals contacted the ITP each month expressing interest in the program. A large proportion of individuals who completed an intake evaluation were accepted (72.2%) into the ITP. Of those accepted, 70.6% ultimately attended the ITP, and the vast majority of veterans who attended the ITP completed treatment (91.6%). Logistic regression results suggested that among veterans who were accepted to the program, those who were legally separated or divorced had significantly greater odds of attending the program compared to single veterans. Veterans were highly satisfied with the 3-week ITP and rated cognitive processing therapy components as the most helpful part of the program. CONCLUSIONS: The present study demonstrates that ITP formats for PTSD are of interest and acceptable to veterans, and this format allows individuals to receive high doses of evidence-based treatments in a short amount of time. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Terapia Cognitivo-Comportamental , Militares/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicoterapia de Grupo , Estados Unidos , United States Department of Veterans Affairs , Veteranos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA