Psychological interventions for depression and anxiety in patients with coronary heart disease, heart failure or atrial fibrillation.

BACKGROUND: Depression and anxiety occur frequently (with reported prevalence rates of around 40%) in individuals with coronary heart disease (CHD), heart failure (HF) or atrial fibrillation (AF) and are associated with a poor prognosis, such as decreased health-related quality of life (HRQoL), and increased morbidity and mortality. Psychological interventions are developed and delivered by psychologists or specifically trained healthcare workers and commonly include cognitive behavioural therapies and mindfulness-based stress reduction. They have been shown to reduce depression and anxiety in the general population, though the exact mechanism of action is not well understood. Further, their effects on psychological and clinical outcomes in patients with CHD, HF or AF are unclear. OBJECTIVES: To assess the effects of psychological interventions (alone, or with cardiac rehabilitation or pharmacotherapy, or both) in adults who have a diagnosis of CHD, HF or AF, compared to no psychological intervention, on psychological and clinical outcomes. SEARCH METHODS: We searched the CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL databases from 2009 to July 2022. We also searched three clinical trials registers in September 2020, and checked the reference lists of included studies. No language restrictions were applied. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing psychological interventions with no psychological intervention for a minimum of six months follow-up in adults aged over 18 years with a clinical diagnosis of CHD, HF or AF, with or without depression or anxiety. Studies had to report on either depression or anxiety or both. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were depression and anxiety, and our secondary outcomes of interest were HRQoL mental and physical components, all-cause mortality and major adverse cardiovascular events (MACE). We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS: Twenty-one studies (2591 participants) met our inclusion criteria. Sixteen studies included people with CHD, five with HF and none with AF. Study sample sizes ranged from 29 to 430. Twenty and 17 studies reported the primary outcomes of depression and anxiety, respectively. Despite the high heterogeneity and variation, we decided to pool the studies using a random-effects model, recognising that the model does not eliminate heterogeneity and findings should be interpreted cautiously. We found that psychological interventions probably have a moderate effect on reducing depression (standardised mean difference (SMD) -0.36, 95% confidence interval (CI) -0.65 to -0.06; 20 studies, 2531 participants; moderate-certainty evidence) and anxiety (SMD -0.57, 95% CI -0.96 to -0.18; 17 studies, 2235 participants; moderate-certainty evidence), compared to no psychological intervention. Psychological interventions may have little to no effect on HRQoL physical component summary scores (PCS) (SMD 0.48, 95% CI -0.02 to 0.98; 12 studies, 1454 participants; low-certainty evidence), but may have a moderate effect on improving HRQoL mental component summary scores (MCS) (SMD 0.63, 95% CI 0.01 to 1.26; 12 studies, 1454 participants; low-certainty evidence), compared to no psychological intervention. Psychological interventions probably have little to no effect on all-cause mortality (risk ratio (RR) 0.81, 95% CI 0.39 to 1.69; 3 studies, 615 participants; moderate-certainty evidence) and may have little to no effect on MACE (RR 1.22, 95% CI 0.77 to 1.92; 4 studies, 450 participants; low-certainty evidence), compared to no psychological intervention. AUTHORS' CONCLUSIONS: Current evidence suggests that psychological interventions for depression and anxiety probably result in a moderate reduction in depression and anxiety and may result in a moderate improvement in HRQoL MCS, compared to no intervention. However, they may have little to no effect on HRQoL PCS and MACE, and probably do not reduce mortality (all-cause) in adults who have a diagnosis of CHD or HF, compared with no psychological intervention. There was moderate to substantial heterogeneity identified across studies. Thus, evidence of treatment effects on these outcomes warrants careful interpretation. As there were no studies of psychological interventions for patients with AF included in our review, this is a gap that needs to be addressed in future studies, particularly in view of the rapid growth of research on management of AF. Studies investigating cost-effectiveness, return to work and cardiovascular morbidity (revascularisation) are also needed to better understand the benefits of psychological interventions in populations with heart disease.

Exploring Social Work professionals' Experiences of the Mindfulness-Based Social Work and Self-Care Programme: A Focus Group Study.

The evidence for the potential of mindfulness-based programmes to support improved social work practice and self-care is growing. The aim of this focus group study was to explore social workers' (n = 13) experiences of the Mindfulness-based Social Work and Self-care programme (MBSWSC). Thematic analysis highlighted two superordinate themes: benefits to direct social work practice and coping with the social work role. Four subordinate themes highlighted the different social work practice components that were enhanced through MBSWSC participation: social work assessment, service user engagement and team working, working to social work values, and social work skills. Three subordinate themes identified improvements in individual processes which supported enhanced stress coping: moving from avoidant to approach coping, improved boundaries, increased emotional awareness and reduced negative thinking. Our findings indicate that the MBSWSC programme can have a multi-faceted positive effect on social work practice, and on social work professional's capacity to cope with their role.

A randomised trial of Mindfulness-based Social Work and Self-Care with social workers.

Abstract: The primary objective of this study was to examine the effects of a bespoke and innovative six-week online Mindfulness-based Social Work and Self-Care (MBSWSC) programme on the stress, feelings of burnout, anxiety, depression, and well-being of a sample of social workers. This secondary objective was to examine the effectiveness of MBSWSC at improving a number of potentially important mindfulness-based programme mechanisms of action, including mindfulness, attention regulation (decentering), acceptance, self-compassion, non-attachment, aversion, worry and rumination. A randomised controlled trial with repeated measures (pre-post intervention) was conducted to evaluate the effects of MBSWSC against an active control. The active control was a modified mindfulness-based programme which focussed on supporting increases in mindfulness and self-compassion in social workers with a view to improving the same primary study outcomes. Sixty-two participants were randomly allocated to MBSWSC (n = 33) or the active control (n = 29). When compared to the active control group, the MBSWSC programme was found to be significantly superior at improving stress, emotional exhaustion, anxiety, and depression. MBSWSC was also superior to the active control at improving acceptance, mindfulness, non-attachment, attention regulation (decentering) and worry of the social workers in this study. The results suggest that MBSWSC is a very useful therapeutic programme, which has the capacity to improve a range of important mental health and well-being outcomes for social workers. The results also indicate that the MBSWSC programme has the capacity to improve a range of important mindfulness-based mechanisms of action. Trial registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05519267 (retrospectively registered).

Families' expectations of an eHealth family-based cardiovascular disease-risk reduction programme.

AIM: Research has shown that families' participation in a cardiovascular disease (CVD) prevention programme could boost early adoption of healthy lifestyle behaviours in families. Behaviour-based, eHealth interventions are a potential means of achieving this. This study aimed to explore expectations of families-parents and children-at risk of CVD towards the design and functionality of an eHealth family-based CVD-risk reduction programme 'Health-e-Hearts'. METHODS AND RESULTS: Three online focus groups were conducted with six families comprising at least one parent at risk of CVD and at least one child aged 5-17 years. The focus groups were video and audio recorded and transcribed. Content analysis was used to synthesize and identify key categories and subcategories regarding development of and engagement with an eHealth programme. Three categories emerged: experiences of health apps and devices; eHealth application needs of family members; and motivators for using an eHealth programme. Experiences included using health apps individually and inconsistently. Needs included personalization, free and easy-to-use, time efficient, and multiple content formats. Motivators for engaging with the programme included goal setting, rewards, and competition. CONCLUSION: Families' expectations of an eHealth family-based CVD-risk reduction programme include the incorporation of personalized, easy-to-use design features and motivators for engaging with the programme. Family involvement in the development of an eHealth programme such as 'Health-e-Hearts' has the potential to boost early adoption of healthy lifestyle behaviours among all family members.

Estimating and examining the costs of inpatient diabetes care in an Irish Public Hospital.

AIM: To estimate and examine hospitalisation costs of Type 1 and Type 2 diabetes in an Irish public hospital. METHODS: A retrospective audit of hospital inpatient admissions over a 5-year period was undertaken, and a wide range of admission-related data were collected for a sample of 7,548 admissions. Hospitalisations were costed using the diagnosis-related group methodology. A series of descriptive, univariate and multivariate regression analyses were undertaken. RESULTS: The mean hospitalisation cost for Type 1 diabetes was €4,027 and for Type 2 diabetes was €5,026 per admission. Sex, admission type and length of stay were significantly associated with hospitalisation costs for admissions with a primary diagnosis of Type 1 diabetes. Age, admission type, diagnosis status, complications status, discharge destination, length of stay and year were significantly associated with hospitalisation costs for admissions with a primary diagnosis of Type 2 diabetes. Length of stay was associated with higher mean costs, with each additional day increasing Type 1 diabetes costs by €260 (p = 0.001) and Type 2 diabetes by €216 (p < 0.001). Unscheduled admissions were associated with significantly lower costs than elective admissions; €1,578 (p = 0.035) lower for Type 1 diabetes and €2,108 (p < 0.001) lower for Type 2 diabetes. CONCLUSIONS: This study presents estimates of the costs of diabetes care in the Irish public hospital system and identifies the factors which influence costs for Type 1 and Type 2 diabetes. These findings may be of interest to patients, the public, researchers and those with influence over diabetes policy and practice in Ireland and internationally.

Moderating the relationship between diabetes distress and mastery: the role of depression and empowerment.

Type 2 diabetes is a chronic condition primarily self-managed by the individual. Mastery is a protective factor linked to better control of chronic conditions, effective self-management and improved medication adherence. Mastery appears increasingly important as treatment regimens and self-management demands become more complex and burdensome. Diabetes distress negatively impacts self-management, glycaemic control and treatment adherence. Understanding the relationship between diabetes distress and mastery may provide opportunities to improve condition management and adherence . This relationship may be impacted by other factors affecting the individual's perceived sense of control over their condition. This study examined the role of diabetes empowerment and depression in the relationship between diabetes distress and mastery. Data were drawn from a randomised controlled trial of 131 adults with type 2 diabetes transitioning to injection therapy. Participants completed measures of diabetes distress , mastery , depression and empowerment . Diabetes distress and depression were negatively associated with mastery, whilst diabetes empowerment was positively associated . A significant interaction effect (b = .024, t(112) = 3.79, p = <.005) confirmed the relationship between diabetes distress and mastery was moderated by depression. Findings highlight the additive deleterious effects of depression. Interventions to improve mastery among those living with type 2 diabetes should address diabetes distress and depression to optimise outcomes.

Exploration of Caregiver Experiences of Conservatively Managed End-Stage Kidney Disease to Inform Development of a Psychosocial Intervention: The ACORN Study Protocol.

BACKGROUND: End-stage kidney disease (ESKD) is an overwhelming illness that impacts not just patients, but also their informal carers. Patients who opt for conservative management rather than dialysis experience difficult symptoms and the psychosocial consequences of their condition. Informal carers of patients who choose conservative management can also experience high levels of psychosocial burden, yet there is little guidance on how best to support informal carers, and no evidence on psychosocial interventions to address unmet needs. AIM: The aim of this study is to explore the experiences and unmet needs of informal carers of patients with ESKD receiving conservative management in order to inform the development of a psychosocial intervention. METHODS: This qualitative study will consist of three stages: (I) semi-structured interviews with informal carers in England and Northern Ireland, (II) focus groups with healthcare professionals and informal carers, and (III) national workshops to refine the components of a psychosocial intervention. DISCUSSION: Informal carers of patients with ESKD who are receiving conservative management experience a high psychosocial burden, but there is limited evidence on how best to provide support, particularly as the patient nears the end of life. To our knowledge this study will be the first to address this gap by exploring the experiences and unmet needs of informal carers, with the aim of informing the development of a psychosocial intervention to support the health and wellbeing of informal carers.

Effectiveness of family-based eHealth interventions in cardiovascular disease risk reduction: A systematic review.

Family-based eHealth interventions to reduce cardiovascular disease risk have potential as a primary prevention strategy to improve the health of parents and their children. This systematic review evaluated the effectiveness of such interventions in modifying parent and child/adolescent risk factors such as body mass index, physical activity, dietary intakes and alcohol use. Five electronic databases were searched up to April 2020. Of 2193 articles identified, seven randomised controlled trials met inclusion criteria and were reviewed. Data were extracted regarding study setting, design, methods, eHealth technology used, intervention and control group components, retention rates, outcome measures, incentives and limitations. Risk of bias and quality assessment were carried out using Cochrane methods. A qualitative narrative data synthesis of the studies was conducted. Our review found that three studies showed an improvement in alcohol use among parents and adolescents as a result of the eHealth intervention. Among children/adolescents, two studies showed an improvement in dietary intake, one study showed an improvement in physical activity, and one study showed an improvement in body mass index as a result of the eHealth intervention. Interventions appeared more likely to be effective if they were theory-based, had longer follow-up periods, were incentivised and included regular interaction. Our findings suggest that, despite a paucity of high-quality trials, there is some evidence that family-based eHealth interventions have potential to reduce cardiovascular disease risk. However, more sufficiently powered, higher-quality trials with theory driven, clearly described interventions and unambiguous outcomes are needed.

Overcoming Barriers to Injectable Therapies: Development of the ORBIT Intervention Within a Behavioural Change Framework.

It is estimated among individuals with type 2 diabetes (T2D) requiring injectable therapies to achieve optimal glycaemic control, one-third are reluctant to initiate therapies, with approximately 80% choosing to discontinue or interrupt injectable regimens soon after commencement. Initiation of injectables is a complex issue, with effectiveness of such treatments undermined by non-adherence or poor engagement. Poor engagement and adherence are attributed to psychological aspects such as individuals' negative perceptions of injectables, depression, anxiety, feelings of shame, distress and perceived lack of control over their condition. The aim of this study was to describe the development of a structured diabetes intervention to address psychological barriers to injectable treatments among a cohort of those with T2D; conducted within a behavioural change framework. An evidence base was developed to inform on key psychological barriers to injectable therapies. A systematic review highlighted the need for theory-based, structured diabetes education focussed on associated psychological constructs to inform effective, patient-centric provisions to improve injectable initiation and persistence. Findings from the focus groups with individuals who had recently commenced injectable therapies, identified patient-centric barriers to initiation and persistence with injectables. Findings from the systematic review and focus groups were translated via Behavioural Change Wheel (BCW) framework to develop an intervention for people with T2D transitioning to injectable therapies: Overcoming and Removing Barriers to Injectable Treatment in T2D (ORBIT). This article describes how psychological barriers informed the intervention with these mapped onto relevant components, intervention functions and selected behaviour change techniques, and finally aligned with behaviour change techniques. This article outlines the systematic approach to intervention development within the BCW framework; guiding readers through the practical application of each stage. The use of the BCW framework has ensured the development of the intervention is theory driven, with the research able to be evaluated and validated through replication due to the clarity around processes and tasks completed at each stage.

The long-term psychological impact of Bloody Sunday on families of the victims as measured by The Revised Impact of Event Scale.

OBJECTIVES: In 1972, 13 civil rights marchers were killed in Londonderry, Northern Ireland, on what is known as Bloody Sunday. This study aimed to assess the psychological impact of this event on the families of victims as measured by the Revised Impact of Event Scale. DESIGN: Cross-sectional self-report based study. METHODS: The Impact of Event Scale-Revised was administered to 72 members of the families (immediate family, children of immediate family, cousins, and second cousins) of those killed on Bloody Sunday. RESULTS: High levels of intrusion, avoidance, and hyperarousal were found. In addition, significant group differences were found. Those family members closest to the victims reported the highest levels of psychological distress. CONCLUSION: The findings were discussed within the transgenerational trauma context.