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1.
NPJ Digit Med ; 5(1): 175, 2022 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-36424463

RESUMO

In view of the staggering disease and economic burden of mental disorders, internet and mobile-based interventions (IMIs) targeting mental disorders have often been touted to be cost-effective; however, available evidence is inconclusive and outdated. This review aimed to provide an overview of the cost-effectiveness of IMIs for mental disorders and symptoms. A systematic search was conducted for trial-based economic evaluations published before 10th May 2021. Electronic databases (including MEDLINE, PsycINFO, CENTRAL, PSYNDEX, and NHS Economic Evaluations Database) were searched for randomized controlled trials examining IMIs targeting mental disorders and symptoms and conducting a full health economic evaluation. Methodological quality and risk of bias were assessed. Cost-effectiveness was assumed at or below £30,000 per quality-adjusted life year gained. Of the 4044 studies, 36 economic evaluations were reviewed. Guided IMIs were likely to be cost-effective in depression and anxiety. The quality of most evaluations was good, albeit with some risks of bias. Heterogeneity across studies was high because of factors such as different costing methods, design, comparison groups, and outcomes used. IMIs for anxiety and depression have potential to be cost-effective. However, more research is needed into unguided (preventive) IMIs with active control conditions (e.g., treatment as usual) and longer time horizon across a wider range of disorders.Trial registration: PROSPERO Registration No. CRD42018093808.

2.
JMIR Ment Health ; 9(11): e39122, 2022 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-36350684

RESUMO

BACKGROUND: Internet-based interventions (IBIs) are effective for the prevention and treatment of mental disorders and are valuable additions for improving routine care. However, the uptake of and adherence to IBIs are often limited. To increase the actual use of IBIs, it is important to identify factors for engaging with and adhering to IBIs. OBJECTIVE: We qualitatively evaluated barriers and facilitators regarding a portfolio of guided IBIs in green professions (farmers, gardeners, and foresters). METHODS: Interview participants were selected from 2 randomized controlled trials for either the prevention of depression (Prevention of Depression in Agriculturists [PROD-A]) or the reduction of pain interference (Preventive Acceptance and Commitment Therapy for Chronic Pain in Agriculturists [PACT-A]) in green professions. The intervention group in PROD-A (N=180) participated in an IBI program, receiving access to 1 of 6 symptom-tailored IBIs. The intervention group in PACT-A (N=44) received access to an IBI for chronic pain. Overall, 41 semistructured qualitative interviews were conducted and transcribed verbatim. Barriers and facilitators were identified via inductive qualitative content analysis, with 2 independent coders reaching almost perfect intercoder reliability (Cohen κ=0.92). A quantitative follow-up survey (30/41, 73%) was conducted to validate the results. Subgroup analyses were performed based on intervention characteristics. RESULTS: We identified 42 barriers and 26 facilitators, which we assigned to 4 superordinate categories related to the intervention (20 barriers; 17 facilitators), work (4 barriers; 1 facilitator), individual (13 barriers; 8 facilitators), and technical (5 barriers; 0 facilitators) aspects. Key barriers (identified by at least 50% of the interviewees) were time-consuming work life (29/40, 73%) and time-consuming private life (23/40, 58%). Similarly, the most frequently identified facilitators included presence of motivation, curiosity, interest and perseverance (30/40, 75%), flexible time management at work (25/40, 63%), and support from family and friends (20/40, 50%). Although agreement with barriers in the quantitative follow-up survey was rather low (mean 24%, SD 11%), agreement with facilitators was substantially higher (mean 80%, SD 13%). Differences in agreement rates were found particularly between intervention completers and noncompleters. Completers agreed significantly more often that perceived IBI success; being motivated, curious, interested, and perseverant; and having a persisting level of psychological strain have been facilitating. Noncompleters agreed more often with experiencing the e-coach contact as insufficient and technical problems as hindering for intervention completion. CONCLUSIONS: Based on these results, strategies such as customization of modules for more flexible and adaptive use; video chat options with the e-coach; options to facilitate social support by family, friends, or other participants; or using prompts to facilitate training completion can be derived. These approaches could be evaluated in further quantitative research designs in terms of their potential to enhance intervention use in this occupational group. TRIAL REGISTRATION: German Clinical Trials Register DRKS00014000, https://tinyurl.com/3bukfr48; German Clinical Trials Register DRKS0001461, https://tinyurl.com/ebsn4sns.

3.
Artigo em Inglês | MEDLINE | ID: mdl-36360738

RESUMO

Musculoskeletal symptoms are increased in farmers, whereas the prevalence of chronified pain is unknown. Online interventions based on acceptance and commitment therapy (ACT) have shown encouraging results in the general population, representing a promising approach for reducing pain interference in green professions (i.e., farmers, foresters, gardeners). We conducted a pragmatic RCT comparing a guided ACT-based online intervention to enhanced treatment-as-usual in entrepreneurs, contributing spouses, family members and pensioners in green professions with chronic pain (CPG: ≥grade II, ≥6 months). Recruitment was terminated prematurely after 2.5 years at N = 89 (of planned N = 286). Assessments were conducted at 9 weeks (T1), 6 months (T2) and 12 months (T3) post-randomization. The primary outcome was pain interference (T1). The secondary outcomes encompassed pain-, health- and intervention-related variables. No treatment effect for reduction of pain interference was found at T1 (ß = -0.16, 95%CI: -0.64-0.32, p = 0.256). Improvements in cognitive fusion, pain acceptance, anxiety, perceived stress and quality of life were found only at T3. Intervention satisfaction as well as therapeutic and technological alliances were moderate, and uptake and adherence were low. Results are restricted by low statistical power due to recruitment issues, high study attrition and low intervention adherence, standing in contrast to previous studies. Further research is warranted regarding the use of ACT-based online interventions for chronic pain in this occupational group. Trial registration: German Clinical Trial Registration: DRKS00014619. Registered: 16 April 2018.


Assuntos
Terapia de Aceitação e Compromisso , Dor Crônica , Intervenção Baseada em Internet , Humanos , Dor Crônica/terapia , Dor Crônica/psicologia , Qualidade de Vida , Ocupações , Resultado do Tratamento
4.
Int J Biol Macromol ; 223(Pt A): 1094-1106, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36372109

RESUMO

Shark-like rays (order Rhinopristiformes) are among the most threatened cartilaginous fish globally. Despite this, unresolved taxonomic issues still exist within the group. To date, no studies have used complete mitochondrial genomes to assess the phylogenetic placement of Acroteriobatus within the non-monophyletic family Rhinobatidae. The current study reports the first complete mitochondrial genomes for Acroteriobatus annulatus and A. blochii. Similar to other rhinopristiforms, the complete sequences of A. annulatus (16,773 bp) and A. blochii (16,771 bp) were circular molecules with gene organisations identical to that of the typical vertebrate mitogenome. The A + T content was higher than the G + C content, with a bias towards A and C nucleotides observed in all complete mitogenomes. The stem-and-loop secondary structures of the putative origin of light-strand replication were found to have highly conserved synthesis and stem regions, with all substitutions and indels restricted to the loop structure. The ratios of non-synonymous to synonymous substitution rates indicated that purifying selection has been the dominant driver of evolution in rhinopristiform mitogenomes. Phylogenetic reconstructions placed Acroteriobatus as a sister-group to Rhinobatos, confirming its affiliation with the family Rhinobatidae. However, based on its apparent polyphyly with the aforementioned genera, the familial assignment of Pseudobatos is not fully resolved and requires further investigation.

5.
J Med Internet Res ; 24(10): e40488, 2022 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-36264607

RESUMO

BACKGROUND: Work stress is highly prevalent and puts employees at risk for adverse health consequences. Web-based stress management interventions (SMIs) promoting occupational self-efficacy might be a feasible approach to aid employees to alleviate this burden and to enable them to improve an unbalanced situation between efforts and rewards at work. OBJECTIVE: The first aim of this randomized controlled trial was to investigate the efficacy of a web-based SMI for employees perceiving elevated stress levels and an effort-reward imbalance in comparison to a waitlist control (WLC) group. Second, we investigated whether the efficacy of an SMI could be explained by an increase in occupational self-efficacy and whether this personal resource enables employees to change adverse working conditions. METHODS: A total of 262 employees reporting effort-reward imbalance scores over 0.715 and elevated stress levels (10-item Perceived Stress Scale [PSS-10] score ≥22) were randomly assigned to either the intervention group (IG; SMI) or the WLC group. The primary outcome was perceived stress measured using the PSS-10. The secondary outcomes included mental and work-related health measures. Four different mediation analyses were conducted with occupational self-efficacy, efforts, and rewards as mediators. After eligibility screening, data were collected web based at baseline (T1), 7 weeks (T2) and 6 months (T3). RESULTS: Study participation was completed by 80% (105/130, 80.8%) in the IG and 90% (119/132, 90.2%) in the WLC group. Analyses of covariance revealed that stress reduction was significantly higher for the SMI group compared with the WLC group at T2 (d=0.87, 95% CI 0.61-1.12, P<.001) and T3 (d=0.65, 95% CI 0.41-0.90, P<.001). Mediation analyses indicated that occupational self-efficacy mediated the beneficial effect of the SMI on stress directly. Furthermore, the analyses revealed a significant indirect effect of occupational self-efficacy via rewards (b=0.18, t259=4.52, P<.001), but not via efforts (b=0.01, t259=0.27, P>.05) while efforts still had a negative impact on stress (b=0.46, t257=2.32, P<.05). CONCLUSIONS: The SMI was effective in reducing stress and improving occupational self-efficacy in employees despite them experiencing an effort-reward imbalance at work. Results from mediation analyses suggest that fostering personal resources such as occupational self-efficacy contributes to the efficacy of the SMI and enables employees to achieve positive changes regarding the rewarding aspects of the workplace. However, the SMI seemed to neither directly nor indirectly impact efforts, suggesting that person-focused interventions might not be sufficient and need to be complemented by organizational-focused interventions to comprehensively improve mental health in employees facing adverse working conditions. TRIAL REGISTRATION: German Clinical Trials Register DRKS00005990; https://tinyurl.com/23fmzfu3.


Assuntos
Estresse Ocupacional , Autoeficácia , Humanos , Psicoterapia/métodos , Estresse Ocupacional/terapia , Saúde Mental , Internet
6.
Behav Ther ; 53(6): 1205-1218, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36229117

RESUMO

Persistent somatic symptoms of varying etiology are very common in emerging adults and can lead to distress and impairment. Internet-delivered interventions could help to prevent the burden and chronicity of persistent somatic symptoms. This study investigated the impact of therapist guidance on the effectiveness of a cognitive-behavioral Internet intervention for somatic symptom distress (iSOMA) in emerging adults, as a secondary analysis of a two-armed randomized controlled trial. We included 149 university students (83.2% female, 24.60 yrs) with varying degrees of somatic symptom distress who were either allocated to the 8-week intervention with regular, written therapeutic guidance (iSOMA guided) or to the control group (waitlist), which was afterwards crossed over to receive iSOMA with guidance-on-demand (iSOMA-GoD). Primary outcomes were somatic symptom distress (assessed by the PHQ-15) and psychobehavioral symptoms of the somatic symptom disorder (assessed by the SSD-12) at pre- and post-treatment. Secondary outcomes included depression, anxiety, and disability. Both treatments showed statistically significant pre-post improvements in primary (iSOMA-guided: d = 0.86-0.92, iSOMA-GoD: d = 0.55-0.63) and secondary outcomes. However, intention-to-treat analysis revealed non-significant between-group effects for all outcomes (ps ≥ .335), after controlling for confounding variables, and effect sizes were marginal (d = -0.06 to 0.12). Overall, our findings indicate that Internet-delivered cognitive behavioral therapy with regular guidance is not unequivocally superior to guidance-on-demand in alleviating somatic symptom distress and associated psychopathology in emerging adults. As a next step, non-inferiority studies are needed to test the robustness of these findings and their impact on clinical populations.


Assuntos
Terapia Cognitivo-Comportamental , Intervenção Baseada em Internet , Sintomas Inexplicáveis , Adulto , Ansiedade/terapia , Transtornos de Ansiedade/terapia , Feminino , Humanos , Internet , Masculino , Resultado do Tratamento
7.
Front Psychiatry ; 13: 899115, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36262633

RESUMO

Introduction: The efficacy and effectiveness of digital interventions for depression are both well-established. However, precise effect size estimates for mediators transmitting the effects of digital interventions are not available; and integrative insights on the specific mechanisms of change in internet- and mobile-based interventions (IMIs)-as related to key features like delivery type, accompanying support and theoretical foundation-are largely pending. Objective: We will conduct a systematic review and individual participant data meta-analysis (IPD-MA) evaluating the mediators associated with therapeutic change in various IMIs for depression in adults. Methods: We will use three electronic databases (i.e., Embase, Medline/PubMed, PsycINFO) as well as an already established database of IPD to identify relevant published and unpublished studies. We will include (1) randomized controlled trials that examine (2) mediators of (3) guided and unguided (4) IMIs with (5) various theoretical orientations for (6) adults with (7) clinically relevant symptoms of depression (8) compared to an active or passive control condition (9) with depression symptom severity as primary outcome. Study selection, data extraction, as well as quality and risk of bias (RoB) assessment will be done independently by two reviewers. Corresponding authors of eligible primary studies will be invited to share their IPD for this meta-analytic study. In a 1-stage IPD-MA, mediation analyses (e.g., on potential mediators like self-efficacy, emotion regulation or problem solving) will be performed using a multilevel structural equation modeling approach within a random-effects framework. Indirect effects will be estimated, with multiple imputation for missing data; the overall model fit will be evaluated and statistical heterogeneity will be assessed. Furthermore, we will investigate if indirect effects are moderated by different variables on participant- (e.g., age, sex/gender, symptom severity), study- (e.g., quality, studies evaluating the temporal ordering of changes in mediators and outcomes), and intervention-level (e.g., theoretical foundation, delivery type, guidance). Discussion: This systematic review and IPD-MA will generate comprehensive information on the differential strength of mediators and associated therapeutic processes in digital interventions for depression. The findings might contribute to the empirically-informed advancement of psychotherapeutic interventions, leading to more effective interventions and improved treatment outcomes in digital mental health. Besides, with our novel approach to mediation analyses with IPD-MA, we might also add to a methodological progression of evidence-synthesis in psychotherapy process research. Study registration with Open Science Framework OSF: https://osf.io/md7pq/.

8.
NPJ Digit Med ; 5(1): 139, 2022 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-36085306

RESUMO

Sexual dysfunctions are highly prevalent and undertreated. Internet- and mobile-based psychological interventions (IMIs) could be a promising addition to close this treatment gap, given their accessibility, anonymity, and scalability. This systematic review and meta-analysis investigated the efficacy of IMIs for sexual dysfunctions. A comprehensive literature search was conducted in August 2021 on randomized controlled trials investigating the effects of IMIs on sexual functioning and satisfaction compared to a control condition. Twelve RCTs with 14 comparisons were reviewed with six IMIs targeting female and six IMIs targeting male sexual dysfunctions and n = 952 participants were evaluated in the meta-analysis. IMIs were significantly more effective than control conditions (k = 11 waitlist control group, k = 3 online discussion board) at post-treatment for female sexual functioning (g = 0.59, CI: 0.28-0.90, I2 = 0%) and satisfaction (g = 0.90, CI: 0.02-1.79, I2 = 82%), and male sexual functioning (g = 0.18, CI: 0.02-0.34, I2 = 0%). No significant effect was found for male sexual satisfaction (g = 0.69, CI: -0.13-1.51, I2 = 88%) with substantial heterogeneity in studies. Most studies showed high dropout, with ten studies indicating some concern of risk of bias, and two studies showing high risk of bias. The results suggest that IMIs can be an effective treatment for sexual dysfunctions, although additional high-quality research is needed. Given the limited availability of specialized treatment for sexual dysfunctions and individual preferences for discrete treatment options, IMIs seem to be a valuable addition to routine care, empowering individuals to promote their sexual health on a guided self-help basis.

9.
Zootaxa ; 5155(1): 1-51, 2022 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-36095597

RESUMO

Centrophorus uyato (Rafinesque, 1810) has a complicated nomenclatural history which has led to multiple scientific names being ascribed to this species. In the Mediterranean Sea, and elsewhere in its range, this species was previously referred to as C. granulosus (Bloch Schneider, 1801). The first paper in this revision series clarified that C. granulosus refers to a much larger species of gulper shark which attains at least 1.7 m length and is absent from the Mediterranean Sea. Further complicating the nomenclature of this species is the fact that the original description clearly refers to a Squalus species, and not a Centrophorus species. In this third part of the revision of the genus Centrophorus, this problematic species is redescribed. A detailed synonymy is provided and it is confirmed that C. machiquensis, C. bragancae and C. zeehaani are junior synonyms of this species. To preserve nomenclatural stability within the genus, the name Centrophorus uyato is retained for this species with a neotype from close to the original type locality off Italy being designated. Intraspecific variation within Centrophorus uyato is also discussed, particularly relating to denticle morphology and body morphology.


Assuntos
Tubarões , Squalus , Animais
10.
Zootaxa ; 5142(1): 1-89, 2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-36095770

RESUMO

Softnose skates (Rajiformes: Arhynchobatidae: Bathyraja Ishiyama) are the most diverse skate genus, with 54 species, and are readily distinguishable from other genera in the family by their poorly calcified, flexible rostral cartilages. Six Bathyraja species are considered valid in the eastern North Pacific, including: B. abyssicola, B. aleutica, B. kincaidii, microtrachys, B. spinosissima, and B. trachura. Similar to other skate genera, eastern North Pacific Bathyraja lack a robust species-specific identification, which leads to issues with setting catch limits and creating management plans. This study identifies and formally redescribes the eastern North Pacific softnose skate species based on morphometric and meristic measurements and includes an Alaskan species, Bering Skate, B. interrupta due to its close morphological relationship to B. kincaidii. A lectotype for B. interrupta is designated. Multivariate tests determined that significant differences existed between the study species. Parsimonious phylogenetic trees showed that B kincaidii represents the basal condition, with B. abyssicola and B. aleutica being the most derived species in the study. The formerly synonymized species B. interrupta and B. kincaidii were shown to be separate, as were the previously synonymized species B. microtrachys and B. trachura. Improved Bathyraja species identification will hopefully assist fisheries managers in developing conservation policies easing the impacts of deep-sea fishing expansion.


Assuntos
Rajidae , Animais , Pesqueiros , Filogenia , Especificidade da Espécie
11.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 2627-2630, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-36086268

RESUMO

Digital health applications are becoming increasingly important for assessing and monitoring the wellbeing of people suffering from mental health conditions like depression. A common target of said applications is to predict the results of self-assessed Patient-Health-Questionnaires (PHQ), indicating current symptom severity of depressive individuals. Many of the currently available approaches to predict PHQ scores use passive data, e.g., from smartphones. However, there are several other scores and data besides PHQ, e.g., the Behavioral Activation for Depression Scale-Short Form (BADSSF), the Center for Epidemiologic Studies Depression Scale (CESD), or the Personality Dynamics Diary (PDD), all of which can be effortlessly collected on a daily basis. In this work, we explore the potential of using actively-collected data to predict and forecast daily PHQ-2 scores on a newly-collected longitudinal dataset. We obtain a best MAE of 1.417 for daily prediction of PHQ-2 scores, which specifically in the used dataset have a range of 0 to 12, using leave-one-subject-out cross-validation, as well as a best MAE of 1.914 for forecasting PHQ-2 scores using data from up to the last 7 days. This illustrates the additive value that can be obtained by incorporating actively-collected data in a depression monitoring application.


Assuntos
Depressão , Questionário de Saúde do Paciente , Depressão/diagnóstico , Humanos , Inquéritos e Questionários
12.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 4679-4682, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-36086527

RESUMO

Previous studies have shown the correlation be-tween sensor data collected from mobile phones and human depression states. Compared to the traditional self-assessment questionnaires, the passive data collected from mobile phones is easier to access and less time-consuming. In particular, passive mobile phone data can be collected on a flexible time interval, thus detecting moment-by-moment psychological changes and helping achieve earlier interventions. Moreover, while previous studies mainly focused on depression diagnosis using mobile phone data, depression forecasting has not received sufficient attention. In this work, we extract four types of passive features from mobile phone data, including phone call, phone usage, user activity, and GPS features. We implement a long short-term memory (LSTM) network in a subject-independent 10-fold cross-validation setup to model both a diagnostic and a forecasting tasks. Experimental results show that the forecasting task achieves comparable results with the diagnostic task, which indicates the possibility of forecasting depression from mobile phone sensor data. Our model achieves an accuracy of 77.0 % for major depression forecasting (binary), an accuracy of 53.7 % for depression severity forecasting (5 classes), and a best RMSE score of 4.094 (PHQ-9, range from 0 to 27).


Assuntos
Telefone Celular , Transtorno Depressivo , Depressão/diagnóstico , Humanos , Inquéritos e Questionários
13.
Internet Interv ; 29: 100566, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36039069

RESUMO

Introduction: Farmers, forest workers and gardeners have a higher risk of developing depression compared to other occupational populations. As part of the German pilot project "With us in balance", the potential of six guided internet- and mobile-based interventions (IMIs) to prevent depression among their insurants is examined. The IMI program is tailored to various risk factors of depression, individual symptoms, and needs. Although IMIs have been shown to be effective in reducing depressive symptoms, there is little qualitative research about the acceptance of digital preventive IMIs. The aim of this qualitative study is to gain insights into participants' experiences with the guided IMIs by focusing on determinants for acceptance and satisfaction. Methods: Semi-structured interviews were conducted with 22/171 (13 %) intervention group (IG) participants of a randomized controlled trial. The interview guide was developed based on theoretical models of user acceptance (Unified Theory of Acceptance and Use of Technology) and patient satisfaction (evaluation model, discrepancy theory). The interviews were evaluated independently by two coders performing a deductive-inductive content analysis and attaining a substantial level of agreement (K = 0.73). Results: The qualitative analysis revealed 71 determinants for acceptance and satisfaction across ten dimensions: performance expectancy, organisation, e-coach, usability, training content and structure, training usage, training outcome, financing, social influence, and behavioural intention. The most frequently identified drivers for the IMI use include "location independence", "positive relationship to the e-coach" (each n = 19, 86 %), "personal e-coach guidance", "expertise of the e-coach", "target group specific adaptation" (each n = 18, 82 %), "flexibility", "high willingness for renewed participation" (each n = 17, 77 %), "fast and easy availability", "training of health enhancing attitudes and behaviours" and "content with figurative expressions" (each n = 16, 73 %). Discussion: The qualitative findings predominantly suggest the acceptance of and satisfaction with the IMI program for the prevention of depression in famers and related lines of work. Many identified positive drivers are related to the e-coach guidance, which emphasizes its importance in the preventive setting from the perspective of the participants. Nevertheless, some negative aspects have been identified which help to understand potential weaknesses of the IMI program. Participants indicated different needs in terms of IMI content and usage, which points towards the potential benefit of individualisation. The possibility of being able to use IMIs anonymously, flexibly and independently of location might be highly relevant for this specific target group.

14.
J Med Internet Res ; 24(8): e38261, 2022 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-36040780

RESUMO

BACKGROUND: Depression is a common comorbid condition in individuals with chronic back pain (CBP), leading to poorer treatment outcomes and increased medical complications. Digital interventions have demonstrated efficacy in the prevention and treatment of depression; however, high dropout rates are a major challenge, particularly in clinical settings. OBJECTIVE: This study aims to identify the predictors of dropout in a digital intervention for the treatment and prevention of depression in patients with comorbid CBP. We assessed which participant characteristics may be associated with dropout and whether intervention usage data could help improve the identification of individuals at risk of dropout early on in treatment. METHODS: Data were collected from 2 large-scale randomized controlled trials in which 253 patients with a diagnosis of CBP and major depressive disorder or subclinical depressive symptoms received a digital intervention for depression. In the first analysis, participants' baseline characteristics were examined as potential predictors of dropout. In the second analysis, we assessed the extent to which dropout could be predicted from a combination of participants' baseline characteristics and intervention usage variables following the completion of the first module. Dropout was defined as completing <6 modules. Analyses were conducted using logistic regression. RESULTS: From participants' baseline characteristics, lower level of education (odds ratio [OR] 3.33, 95% CI 1.51-7.32) and both lower and higher age (a quadratic effect; age: OR 0.62, 95% CI 0.47-0.82, and age2: OR 1.55, 95% CI 1.18-2.04) were significantly associated with a higher risk of dropout. In the analysis that aimed to predict dropout following completion of the first module, lower and higher age (age: OR 0.60, 95% CI 0.42-0.85; age2: OR 1.59, 95% CI 1.13-2.23), medium versus high social support (OR 3.03, 95% CI 1.25-7.33), and a higher number of days to module completion (OR 1.05, 95% CI 1.02-1.08) predicted a higher risk of dropout, whereas a self-reported negative event in the previous week was associated with a lower risk of dropout (OR 0.24, 95% CI 0.08-0.69). A model that combined baseline characteristics and intervention usage data generated the most accurate predictions (area under the receiver operating curve [AUC]=0.72) and was significantly more accurate than models based on baseline characteristics only (AUC=0.70) or intervention usage data only (AUC=0.61). We found no significant influence of pain, disability, or depression severity on dropout. CONCLUSIONS: Dropout can be predicted by participant baseline variables, and the inclusion of intervention usage variables may improve the prediction of dropout early on in treatment. Being able to identify individuals at high risk of dropout from digital health interventions could provide intervention developers and supporting clinicians with the ability to intervene early and prevent dropout from occurring.


Assuntos
Depressão , Transtorno Depressivo Maior , Dor nas Costas/prevenção & controle , Pré-Escolar , Depressão/terapia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
15.
BMJ Open ; 12(8): e058212, 2022 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-35922096

RESUMO

INTRODUCTION: It is unclear how internet-delivered cognitive-behavioural therapy for insomnia (CBT-I) can be integrated into healthcare systems, and little is known about the optimal level of therapist guidance. The aim of this study is to investigate three different versions of a stepped care model for insomnia (IG1, IG2, IG3) versus treatment as usual (TAU). IG1, IG2 and IG3 rely on treatment by general practitioners (GPs) in the entry level and differ in the amount of guidance by e-coaches in internet-delivered CBT-I. METHODS AND ANALYSIS: In this randomised controlled trial, 4268 patients meeting International Classification of Diseases, Tenth Revision (ICD-10) criteria for insomnia will be recruited. The study will use cluster randomisation of GPs with an allocation ratio of 3:3:3:1 (IG1, IG2, IG3, TAU). In step 1 of the stepped care model, GPs will deliver psychoeducational treatment; in step 2, an internet-delivered CBT-I programme will be used; in step 3, GPs will refer patients to specialised treatment. Outcomes will be collected at baseline, and 4 weeks, 12 weeks and 6 months after baseline assessment. The primary outcome is insomnia severity at 6 months. An economic evaluation will be conducted and qualitative interviews will be used to explore barriers and facilitators of the stepped care model. ETHICS AND DISSEMINATION: The study protocol was approved by the Ethics Committee of the Medical Centre-University of Freiburg. The results of the study will be published irrespective of the outcome. TRIAL REGISTRATION NUMBER: DRKS00021503.


Assuntos
Terapia Cognitivo-Comportamental , Distúrbios do Início e da Manutenção do Sono , Terapia Cognitivo-Comportamental/métodos , Humanos , Internet , Ensaios Clínicos Controlados Aleatórios como Assunto , Sono , Distúrbios do Início e da Manutenção do Sono/terapia , Resultado do Tratamento
16.
Eur J Psychotraumatol ; 13(2): 2101345, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35923687

RESUMO

Introduction: Although evidence-based treatments for posttraumatic stress disorder (PTSD) in adolescents and young adults exist, affected youth do not have sufficient access to these treatments due to structural and attitudinal barriers. Internet- and mobile-based interventions (IMIs) can help fill this healthcare gap, but such programmes have not yet been sufficiently evaluated in youth with PTSD. Aim: This study aims to investigate the feasibility of an IMI for youth with PTSD in a one-arm, non-randomised, prospective proof-of-concept feasibility study. Methods: We aim to recruit 32 youth between 15 and 21 years old with clinically relevant posttraumatic stress symptoms (CATS ≥ 21), who will receive access to the IMI. The IMI consists of nine sessions involving psychoeducation, emotion regulation and coping skills, written-based imaginal exposure, cognitive restructuring and relapse prevention. Participants will be guided by an eCoach, who provides weekly semi-standardised written feedback on completed sessions and adherence reminders. We will use a formal feasibility framework to assess different dimensions of feasibility: (1) recruitment capability and resulting sample characteristics, (2) data collection procedures and outcome measures, (3) acceptability of the IMI and study procedures, (4) resources and ability to manage and implement the study and IMI and (5) participants' responses to the IMI in terms of symptom severity and satisfaction. Additionally, potential negative effects related to the intervention will be assessed. Assessments take place pre-, mid- and post-intervention and at follow-up, including semi-structured clinical telephone interviews for PTSD diagnostics at pre- and post-intervention assessment. Qualitative interviews will be conducted to investigate the youth perspectives on the IMI. Discussion: This study aims to determine the feasibility of a guided IMI for youth with PTSD to adapt the IMI as closely as possible to youth needs and to inform the design, procedure and safety management of a large-scale efficacy RCT. Trial registration: German Clinical Trials Register identifier: DRKS00023341. HIGHLIGHTS: Evidence-based care for adolescents after trauma is not widely available.• This study evaluates the feasibility of a guided trauma-focused Internet intervention as a time- and location-independent low-threshold treatment option for adolescents and young adults with posttraumatic stress disorder.


Introducción: Aunque existen tratamientos basados en la evidencia para el trastorno de estrés postraumático (TEPT) en adolescentes y adultos jóvenes, los jóvenes afectados no tienen suficiente acceso a estos tratamientos debido a barreras estructurales y actitudinales. Las intervenciones basadas en Internet y dispositivos móviles (IMI en su sigla en inglés) pueden ayudar a llenar este vacío en la atención de salud, pero tales programas aún no se han evaluado suficientemente en jóvenes con TEPT.Objetivo: Este estudio tiene como objetivo investigar la factibilidad de una IMI para jóvenes con TEPT en un estudio de factibilidad de prueba de concepto prospectivo, no aleatorio, de un solo brazo.Métodos: Nuestro objetivo es reclutar a 32 jóvenes entre 15 y 21 años con síntomas de estrés postraumático clínicamente relevantes (CATS > 21), que recibirán acceso a la IMI. La IMI consta de nueve sesiones que involucran psicoeducación, regulación emocional y habilidades de afrontamiento, exposición imaginada basada en escritos, reestructuración cognitiva y prevención de recaídas. Los participantes serán guiados por un eCoach, que proporcionará comentarios escritos semiestandarizados semanales sobre las sesiones completadas y recordatorios de adherencia. Usaremos un marco de factibilidad formal para evaluar las diferentes dimensiones de factibilidad: (1) capacidad de reclutamiento y características de la muestra resultante, (2) procedimientos de recopilación de datos y de las medidas del resultado, (3) aceptabilidad de la IMI y los procedimientos del estudio, (4) recursos y capacidad para gestionar e implementar el estudio y la IMI y (5) las respuestas de los participantes a la IMI en términos de la gravedad de los síntomas y la satisfacción. Además, se evaluarán los posibles efectos negativos relacionados con la intervención. Las evaluaciones se realizan antes, durante y después de la intervención y durante el seguimiento, incluyendo entrevistas telefónicas clínicas semiestructuradas para el diagnóstico de TEPT en la evaluación previa y posterior a la intervención. Se realizarán entrevistas cualitativas para investigar las perspectivas de los jóvenes sobre la IMI.Discusión: Este estudio tiene como objetivo determinar la factibilidad de una IMI guiada para jóvenes con TEPT para adaptar la IMI lo más cerca posible a las necesidades de los jóvenes y para informar el diseño, el procedimiento y la gestión de la seguridad de un ECA de eficacia a gran escala.


Assuntos
Terapia Cognitivo-Comportamental , Internet , Transtornos de Estresse Pós-Traumáticos , Terapia Cognitivo-Comportamental/métodos , Estudos de Viabilidade , Humanos , Estudos Prospectivos , Transtornos de Estresse Pós-Traumáticos/terapia
17.
Internet Interv ; 28: 100457, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35646604

RESUMO

Chronic medical conditions are increasingly common and associated with a high burden for persons affected by them. Digital health interventions might be a viable way to support persons with a chronic illness in their coping and self-management. The present special issue's editorial on digital health interventions in chronic medical conditions summarizes core findings and discusses next steps needed to further the field while avoiding to reinvent the wheel, thereby elaborating on four topics extracted from the special issue's articles: 1) Needs assessment and digital intervention development, 2) Efficacy and (cost-)effectiveness, 3) Dissemination and implementation research: reach and engagement as well as 4) next generation of digital interventions.

18.
Addict Behav Rep ; 16: 100437, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35694108

RESUMO

Given prevalent alcohol misuse-emotional comorbidities among young adults, we developed an internet-based integrated treatment called Take Care of Me. Although the treatment had an impact on several secondary outcomes, effects were not observed for the primary outcome. Therefore, the goal of the current study was to examine heterogeneity in treatment responses. The initial RCT randomized participants to either a treatment or psychoeducational control condition. We conducted an exploratory latent class analysis to distinguish individuals based on pre-treatment risk and then used moderated regressions to examine differential treatment responses based on class membership. We found evidence for three distinct groups. Most participants fell in the "low severity" group (n = 123), followed by the "moderate severity" group (n = 57) who had a higher likelihood of endorsing a previous mental health diagnosis and treatment and higher symptom severity than the low group. The "high severity" group (n = 42) endorsed a family history of alcoholism, and the highest symptom severity and executive dysfunction. Moderated regressions revealed significant class differences in treatment responses. In the treatment condition, high severity (relative to low) participants reported higher alcohol consumption and hazardous drinking and lower quality of life at follow-up, whereas moderate severity (relative to low) individuals had lower alcohol consumption at follow-up, and lower hazardous drinking at end-of-treatment. No class differences were found for participants in the control group. Higher risk individuals in the treatment condition had poorer responses to the program. Tailoring interventions to severity may be important to examine in future research.

19.
Sleep Epidemiol ; 2: 100017, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35673330

RESUMO

The internet network continues to be a major source of health-related information. Our research provides insights into the online health-seeking behaviors of the general population, and evaluates the potential relationship between the COVID-19 pandemic and public interest and awareness of general sleep health, mental health and wellbeing. Google Trends' weekly relative search volumes (RSVs) were examined during 2020 for searches specifically related to COVID-19 symptoms, and for searches related to general health, sleep and wellbeing, in the United Kingdom, the United States of America, France, Italy and Japan. To obtain insight into the association between the initiation of public restrictions and online search trends, we assessed a six-week period; the 'early pandemic period' (EPP) (01 March 2020 - 11 April 2020). To provide a meaningful pre-pandemic comparison, a similar period during 2019 (03 March - 13 April 2019) was compared for RSV and median difference analysis. The EPP was associated with increased online searches related to COVID-19 symptoms, as compared with those related to more general sleep health, mental health and wellbeing. The latter search terms frequently showed a decrease or minimal change in RSV during the EPP compared with the equivalent period in 2019. This finding illustrates the potential link between the COVID-19 pandemic and online search behavior and corroborates existing findings regarding internet searches during this period. Proactive communication by healthcare professionals during future pandemics and as an ongoing measure could help prevent public neglect of general health and wellbeing symptoms, and encourage reporting and early intervention.

20.
J Telemed Telecare ; : 1357633X221106027, 2022 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-35695234

RESUMO

INTRODUCTION: Farmers have a high risk for depression (MDD). Preventive measures targeting this often remotely living population might reduce depression burden. The study aimed to evaluate the effectiveness of personalized telephone coaching in reducing depressive symptom severity and preventing MDD in farmers compared to enhanced treatment as usual (TAU + ). METHODS: In a two-armed, pragmatic randomized controlled trial (N = 314) with post-treatment at 6 months, farming entrepreneurs, collaborating family members and pensioners with elevated depressive symptoms (PHQ-9 ≥ 5) were randomized to personalized telephone coaching or TAU + . The coaching was provided by psychologists and consists on average of 13 (±7) sessions a 48 min (±15) over 6 months. The primary outcome was depressive symptom severity (QIDS-SR16). RESULTS: Coaching participants showed a significantly greater reduction in depressive symptom severity compared to TAU + (d = 0.39). Whereas reliable symptom deterioration was significantly lower in the intervention group compared to TAU + , no significant group differences were found for reliable improvement and in depression onset. Further significant effects in favor of the intervention group were found for stress (d = 0.34), anxiety (d = 0.30), somatic symptoms (d = 0.39), burnout risk (d = 0.24-0.40) and quality of life (d = 0.28). DISCUSSION: Limiting, we did not apply an upper cutoff score for depressive symptom severity or controlled for previous MDD episodes, leaving open whether the coaching was recurrence/relapse prevention or early treatment. Nevertheless, personalized telephone coaching can effectively improve mental health in farmers. It could play an important role in intervening at an early stage of mental health problems and reducing disease burden related to MDD. TRIAL REGISTRATION NUMBER AND TRIAL REGISTER: German Clinical Trial Registration: DRKS00015655.

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