RESUMO
Los trastornos depresivos son una de las principales causas de discapacidad global y la presencia de déficits cognitivos se relacionan con un peor pronóstico. Dado que la rehabilitación cognitiva en este trastorno está poco estudiada, y menos sus efectos a largo plazo, nuestro objetivo fue investigar sus beneficios en la mejora cognitiva y funcional de estos pacientes. Veintidós participantes fueron asignados aleatoriamente a: a) terapia cognitivo conductual grupal; y b) terapia cognitivo conductual grupal+terapia de rehabilitación cognitiva. Se realizó una evaluación al inicio del tratamiento, a los 3 y 6 meses de la finalización del mismo. Los participantes asignados al grupo con terapia de rehabilitación cognitiva mejoraron más su funcionamiento ejecutivo y estos efectos se mantenían en el tiempo. Sin embargo, no se encontraron diferencias entre ambos grupos en funcionamiento psicosocial. Estos resultados apoyan la importancia de seguir investigando la utilidad de la rehabilitación cognitiva en la recuperación de pacientes con trastornos depresivos
Depressive disorders are one of the main causes of global burden disease and cognitive impairment is associated with worse prognosis. Cognitive Remediation Therapy (CRT) and its long-term effects are understudied; our aim is to investigate the benefits of CRT in the cognitive and functional improvement and maintenance of theses patients. Twenty-two participants were randomly assigned to: a) Group Cognitive Behavioral Therapy (CBT-G) and b) CBT-G plus CRT. Patients were evaluated before treatment, at 3 and 6 months after the end of the treatment. Participants assigned to the TRC group improved more in executive function and its effects remain over time. However, no differences were found between groups in psychosocial functioning improving. These results support the relevance of continue investigating the usefulness of CRT in depression patients recovery
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Transtorno Depressivo/complicações , Transtorno Depressivo/reabilitação , Transtornos Cognitivos/reabilitação , Escalas de Graduação Psiquiátrica Breve , Resultado do Tratamento , Fatores SocioeconômicosRESUMO
An integrative patient-centered care concept is increasingly demanded for treatment of cardiac patients with concomitant mental disorders. The present study aims to investigate the effect of an integrated concept of psycho-cardiac care (PK) versus a monodisciplinary cardiac (K) or psychosomatic (PSO) care. Patients were examined at baseline (T0), at the time of discharge from the rehabilitation program (T1) and after 6 month (T2). General anxiety, depression (HADS), cardiac anxiety (HAF) and quality of life (SF-12) were evaluated using computer-assisted questionnaires. A total of 93 patients were included (PK: n=37, 55.5 years SD=8.0, 43.2% female; K: n=32, 53.6 years SD=8.2, 34.4% female; PSO: n=24, 55.5 years SD=5.0, 45.8% female). Patients in the PK-group showed a significant reduction of heart-focused anxiety (HAF fear p=0.004) and a significant improvement in quality of life (SF-12 physical p=0.034) during follow-up. In contrast, these parameters remained unchanged in patients in the K- and PSO-groups. The results indicate that cardiac-patients with concomitant mental disorders benefit only from an integrated psycho-cardiac treatment concept. The findings provide first data to psycho-cardiac treatment in stationary rehabilitation and support previous clinical experiences. But further research is required to show the advantage of a psycho-cardiac concept towards monodisciplinary care.
Assuntos
Cardiopatias/psicologia , Cardiopatias/reabilitação , Transtornos Mentais/psicologia , Transtornos Mentais/reabilitação , Admissão do Paciente , Assistência Centrada no Paciente , Adulto , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/reabilitação , Terapia Combinada , Comorbidade , Transtorno Depressivo/psicologia , Transtorno Depressivo/reabilitação , Feminino , Seguimentos , Humanos , Medicina Integrativa , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Projetos Piloto , Transtornos Psicofisiológicos/psicologia , Transtornos Psicofisiológicos/reabilitação , Qualidade de Vida/psicologia , Resultado do TratamentoRESUMO
A study was conducted on South African college students using the Transcendental Meditation technique to reduce posttraumatic stress disorder. Students meeting the criteria for possible posttraumatic stress disorder were included. Thirty-four students at the experimental university in South Africa clinically diagnosed with posttraumatic stress disorder were instructed in and practiced the Transcendental Meditation technique twice daily compared to 34 diagnosed posttraumatic stress disorder comparison students at the comparison university. The multivariate effect was significant for both the posttraumatic stress disorder symptomatology and depression. Results were significantly associated with regularity of practice. The study replicates recent findings and offers an alternative educational treatment for higher education.
Assuntos
Transtorno Depressivo/reabilitação , Meditação , Transtornos de Estresse Pós-Traumáticos/reabilitação , Estudantes , Adulto , Transtorno Depressivo/fisiopatologia , Feminino , Humanos , Masculino , África do Sul , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Resultado do Tratamento , Universidades , Adulto JovemRESUMO
OBJECTIVE: To evaluate feasibility and potential effectiveness of work-directed rehabilitation in people with common mental disorders. DESIGN: Pilot randomized controlled trial. SETTING: Primary healthcare, Sweden. SUBJECTS: Working adults (n = 42) of mean age 46.2 ± 11.1 years with depression or anxiety disorder. INTERVENTIONS: Eight weeks of work-directed rehabilitation (n = 21) or physical activity (n = 21). Work-directed rehabilitation included sessions with a physiotherapist and/or an occupational therapist, to develop strategies to cope better at work. Physical activity included a planning session and access to a local gym. MAIN MEASURES: Feasibility: attendance, discontinuation and adverse events. Measurements were the Work Ability Index, the Global Assessment of Functioning, the Montgomery-Asberg Depression Rating Scale, the Beck Anxiety Inventory and the World Health Organization-Five Well-Being Index. RESULTS: Attendance to rehabilitation sessions was 88% (n = 147/167) and discontinuation rate was 14% (n = 3/21). No serious adverse events were reported. Within both groups, there was a significant improvement in Work Ability Index score (mean change: 3.6 (95% confidence interval (CI): 0.45, 6.7) in work-directed rehabilitation and 3.9 (95% CI: 0.9, 7.0) in physical activity) with no significant difference between groups. For the other outcomes, significant improvements were found within but not between groups. Per-protocol analysis showed a trend toward the antidepressant effect of work-directed rehabilitation compared to physical activity (mean difference in depression score -3.1 (95% CI: -6.8, 0.4), P = 0.075). CONCLUSION: Work-directed rehabilitation was feasible to persons with common mental disorders and improved their work ability and mental health. Comparable improvements were seen in the physical activity group. Suggested modifications for a larger trial include adding a treatment-as-usual control.
Assuntos
Transtornos de Ansiedade/reabilitação , Transtorno Depressivo/reabilitação , Terapia por Exercício/métodos , Exercício Físico , Saúde Mental , Adulto , Transtornos de Ansiedade/fisiopatologia , Transtornos de Ansiedade/psicologia , Transtorno Depressivo/fisiopatologia , Transtorno Depressivo/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Qualidade de Vida , Suécia , Avaliação da Capacidade de TrabalhoRESUMO
There is a need for interventions supporting patients with mental health conditions in coping with stigma and discrimination. A psycho-educational group therapy module to promote stigma coping and empowerment (STEM) was developed and tested for efficacy in patients with schizophrenia or depression. 30 clinical centers participated in a cluster-randomized clinical trial, representing a broad spectrum of mental health care settings: in-patient (acute treatment, rehabilitation), out-patient, and day-hospitals. As randomized, patients in the intervention group clusters/centers received an illness-specific eight sessions standard psychoeducational group therapy plus three specific sessions on stigma coping and empowerment ('STEM'). In the control group clusters the same standard psychoeducational group therapy was extended to 11 sessions followed by one booster session in both conditions. In total, N = 462 patients were included in the analysis (N = 117 with schizophrenia spectrum disorders, ICD-10 F2x; N = 345 with depression, ICD-10 F31.3-F31.5, F32-F34, and F43.2). Clinical and stigma-related measures were assessed before and directly after treatment, as well as after 6 weeks, 6 months, and 12 months (M12). Primary outcome was improvement in quality of life (QoL) assessed with the WHO-QOL-BREF between pre-assessment and M12 analyzed by mixed models and adjusted for pre-treatment differences. Overall, QoL and secondary outcome measures (symptoms, functioning, compliance, internalized stigma, self-esteem, empowerment) improved significantly, but there was no significant difference between intervention and control group. The short STEM module has proven its practicability as an add-on in different settings in routine mental health care. The overall increase in empowerment in both, schizophrenia and depression, indicates patients' treatment benefit. However, factors contributing to improvement need to be explored.The study has been registered in the following trial registers. ClinicalTrials.gov: https://register.clinicaltrials.gov/ Registration number: NCT01655368. DRKS: https://www.drks.de/drks_web/ Registration number: DRKS00004217.
Assuntos
Adaptação Psicológica , Transtorno Depressivo/reabilitação , Empoderamento , Pessoas Mentalmente Doentes/psicologia , Avaliação de Resultados em Cuidados de Saúde , Psicoterapia de Grupo , Esquizofrenia/reabilitação , Estigma Social , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Qualidade de Vida , AutoimagemRESUMO
BACKGROUND.: Occupational therapy groups have been carried out as interventions in mental health settings across a variety of populations. Limited research explores the lived experience of individuals with depression following participation in recovery oriented occupational therapy groups. PURPOSE.: To better understand how recovery oriented occupational therapy groups shape participants' personal experience of daily life, including recovery. METHOD.: Five individuals who had previously completed at least one recovery oriented occupational therapy group each participated in two in-depth semi-structured interviews. Analyses of the transcripts were completed using interpretative phenomenological analysis (IPA). FINDINGS.: Participants' experiences of the recovery oriented occupational therapy groups ranged from positive to negative, with variable impacts on their lived experiences. Two major themes emerged: (a) participants' perception of "normal" and (b) navigation of meaningful participation. IMPLICATIONS.: Increased understanding of what aspects of recovery oriented occupational therapy groups are meaningful to individuals with depression can help support their personal recovery process.
Assuntos
Transtorno Depressivo/psicologia , Transtorno Depressivo/reabilitação , Terapia Ocupacional/organização & administração , Grupos de Autoajuda/organização & administração , Adulto , Feminino , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Pesquisa Qualitativa , Normas SociaisRESUMO
AIMS: To clarify the specific impact paths among physical activity, activity of daily living, depression and quality of life among dementia patients. DESIGN: A descriptive, cross-sectional design. METHODS: Dementia patients and their caregivers from five tertiary general hospitals and one dementia patients' club were recruited. A total of 216 valid questionnaires were collected from November 2018 - March 2019. Path analysis was performed by Mplus 7.0 to test the casual relationship among physical activity, activity of daily living, depression and quality of life. RESULTS: Most patients with dementia presented a low level of physical activity and suffered from impaired quality of life. The modified model presented a good model fit and revealed that physical activity had indirect positive effects on quality of life mediated by activity of daily living and depression. CONCLUSION: The results showed that physical activity was a promising non-pharmacological method to improve the performance of activity of daily living and reduce depressive symptoms and then enhance the quality of life among dementia patients. IMPACT: The findings were beneficial to elevate the awareness of physical activity among patients and professionals. This study was helpful to understand how physical activity exerted effects on life quality of dementia patients. This study provided a new perspective for researchers to elucidate the causal relationship of variables among dementia patients.
Assuntos
Atividades Cotidianas/psicologia , Demência/psicologia , Demência/reabilitação , Transtorno Depressivo/reabilitação , Exercício Físico/psicologia , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The HIV epidemic in Vietnam has been primarily driven by injection drug use. HIV-infected people who inject drugs (PWID) in Vietnam have very high rates of mental health problems, which can accelerate progression to AIDS and increase mortality rates. No research has explored the barriers and facilitators of mental health care for HIV-infected PWID in Vietnam. METHODS: We conducted 28 in-depth interviews among HIV-infected PWID (n = 16), HIV and MMT (methadone maintenance treatment) providers (n = 8), and health officials (n = 4) in Hanoi. We explored participants' perceptions of mental health disorders, and barriers and facilitators to seeking and receiving mental health care. RESULTS: HIV-infected PWID were perceived by both PWID, HIV/MMT providers, and health officials to be vulnerable to mental health problems and to have great need for mental health care. Perceived social, physical, and economical barriers included stigma towards HIV, injection drug use, and mental illnesses; lack of awareness around mental health issues; lack of human resources, facilities and information on mental health services; and limited affordability of mental health services. Social support from family and healthcare providers was a perceived facilitator of mental health care. CONCLUSIONS: Interventions should raise self-awareness of HIV-infected PWID about common mental health problems; address social, physical, economic barriers to seeking mental health services; and increase social support for patients.
Assuntos
Infecções por HIV/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/reabilitação , Adulto , Atitude Frente a Saúde , Negação em Psicologia , Transtorno Depressivo/economia , Transtorno Depressivo/psicologia , Transtorno Depressivo/reabilitação , Utilização de Instalações e Serviços , Feminino , Infecções por HIV/economia , Infecções por HIV/psicologia , Gastos em Saúde , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Masculino , Transtornos Mentais/economia , Transtornos Mentais/psicologia , Transtornos Mentais/reabilitação , Serviços de Saúde Mental/economia , Pessoa de Meia-Idade , Avaliação das Necessidades , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Educação de Pacientes como Assunto , Percepção , Pesquisa Qualitativa , Apoio Social , Abuso de Substâncias por Via Intravenosa/economia , Abuso de Substâncias por Via Intravenosa/psicologia , Vietnã , Adulto JovemRESUMO
Importance: Individual placement and support (IPS) seems to be an effective vocational intervention for people with severe mental illness, but its effects have not yet been shown in the Danish welfare model. Also, effects may be enhanced by adding cognitive remediation and work-focused social skills training (IPS with enhancements [IPSE]). Objectives: To investigate the effects of IPS vs IPSE vs service as usual (SAU) on a population of individuals with severe mental illness in Denmark. Design, Setting, and Participants: This was an investigator-initiated, 3-group, parallel, assessor-blinded randomized clinical trial that used early-intervention teams or community mental health services in 3 Danish cities to recruit participants with severe mental illness. Participants were randomly assigned to receive IPS, IPSE, or SAU from November 2012 to February 2016, and follow-up continued until August 2017. Interventions: Participants allocated to the IPS intervention received vocational support per the principles of the IPS model. Participants in the IPSE arm received cognitive remediation and social skills training in addition to IPS. The group receiving SAU received vocational rehabilitation at the Danish job centers. Main Outcomes and Measures: The primary outcome was the number of hours in competitive employment or education during the 18-month follow-up. Secondary outcomes included intergroup differences in employment or education at any point during follow-up; time to employment or education; and cognitive and social functioning, self-esteem, and self-efficacy. Results: Of the 720 included participants (mean [SD] age, 32.8 [9.9] years; 276 [38.3%] women), 243 received IPS, 238 received IPSE, and 239 received SAU. Most participants (551 [76.5%]) were diagnosed with a schizophrenia spectrum disorder. During the 18-month follow-up, the IPSE group worked or studied a mean (SD) of 488.1 (735.6) hours, compared with 340.8 (573.8) hours in the group receiving SAU (success-rate difference [SRD], 0.151 [95% CI, 0.01-0.295]; P = .016). The mean (SD) in the IPS group was 411 (656.9) (SRD, 0.127 [95% CI, -0.017 to 0.276]; P = .004). There was no difference between IPS and IPSE in any vocational outcomes, and the 3 groups showed no differences in any nonvocational outcomes, except that the IPS and IPSE groups were more satisfied with the services received than the group receiving SAU (IPS vs SAU: SRD, 0.310 [95% CI, 0.167-0.445]); IPSE vs SAU: SRD, 0.341 [95% CI, 0.187-0.478]). Conclusions and Relevance: Compared with SAU, IPS and IPSE seem to be viable routes to increase employment and education rates in people with severe mental illness in Denmark, but no additional effects were observed by enhancing IPS. Trial Registration: ClinicalTrials.gov identifier: NCT01722344.
Assuntos
Transtorno Bipolar/reabilitação , Remediação Cognitiva/métodos , Transtorno Depressivo/reabilitação , Educação , Emprego , Avaliação de Resultados em Cuidados de Saúde , Reabilitação Vocacional/métodos , Esquizofrenia/reabilitação , Habilidades Sociais , Adulto , Serviços Comunitários de Saúde Mental , Dinamarca , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Adulto JovemRESUMO
Background: This paper draws on a longitudinal study exploring the outcomes of an arts referral programme in General Practice in the South West of England since 2009. It focuses on the qualitative responses of the patient cohort Methods: Using qualitative methods and thematic analysis, this paper explores and considers the responses from n = 1297 participants who provided feedback from an open-ended questionnaire on self-reported benefits of the arts referral programme. Results: Participant reactions demonstrate that the programme provided a range of personal and social benefits rarely considered or explored in comparative studies. The analysis suggests participants were able to self-manage aspects of their health-related conditions, and were able to make progress towards a better physical and/or mental health. Conclusions: The evidence suggests that arts-based referral programmes, have a range of benefits for participants that may not have been fully appreciated. The consequences on self-management requires further investigation.
Assuntos
Arteterapia , Transtorno Depressivo/reabilitação , Humanos , Estudos Longitudinais , Avaliação de Programas e Projetos de Saúde , Autorrelato , Inquéritos e QuestionáriosRESUMO
WHAT IS KNOWN ON THE SUBJECT?: Mindful yoga combines yoga techniques with the mindfulness-based stress reduction approach. Previous studies on mindful yoga have reported improvements in depression for working-age adults, but no studies have been conducted with older people. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Mindful yoga may be a safe and acceptable intervention to improve the mental and physical health of older adults with depression. The beneficial therapeutic ingredients of mindful yoga, included calmness, being non-judgmental, letting go and seizing the day. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Single-sex mindful yoga groups may be more acceptable for some people. Well-conducted feasibility studies comparing mindful yoga with an alternative group-based approach are necessary. Abstract Introduction Mindful yoga combines yoga techniques with the mindfulness-based stress reduction approach. Previous studies on mindful yoga have reported improvements in depression for working-age adults, but no studies have been conducted with older people. Aims To explore the experiences of older adults with depression participating in a mindful yoga group to establish whether the approach has potential as a future intervention for this client group. Method This study adopted a qualitative descriptive method and used inductive content analysis. Eighteen in-depth individual interviews were conducted with nine participants (each participant had one interview following the programme and another four weeks later). Results Six main themes emerged: "improved physical status," "actively involved in the community," "positive psychological effects," "perceived therapeutic ingredients," "facilitators of practising mindful yoga" and "barriers to practising mindful yoga.". Discussion Most participants reported benefitting from the programme. Two male participants expressed that exercises were too challenging and more suited to women, suggesting single-sex groups may be more acceptable. Implications for practice Mindful yoga may be an acceptable/useful intervention for older adults with depression, but future studies are required to establish its feasibility and potential efficacy.
Assuntos
Envelhecimento , Depressão/reabilitação , Transtorno Depressivo/reabilitação , Atenção Plena , Yoga , Idoso , Feminino , Humanos , Masculino , Avaliação de Resultados da Assistência ao Paciente , Pesquisa QualitativaRESUMO
Innovative strategies are needed to reduce the impact of stigma as a barrier to mental health services for older adults living with a mental illness. The purpose of this brief report was to examine the impact of a 3-month peer educator (PE) intervention on stigma reduction in a sample of depressed older adults. PEs are individuals of similar age, and racial and socioeconomic backgrounds who have been previously treated for depression, and are trained to provide support and education to depressed individuals within their community. Participants (N = 21) aged 60 and older completed a demographic questionnaire, public stigma, and internalized stigma measures pre- and post-PE intervention. The results of paired samples t tests indicated that the use of PEs significantly reduced both public and internalized stigma among depressed older adults. PEs may be an effective strategy toward alleviating stigma and increasing mental health service utilization among older adults with depression.
Assuntos
Depressão/reabilitação , Transtorno Depressivo/reabilitação , Educação de Pacientes como Assunto/métodos , Grupo Associado , Estigma Social , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Entrevista Motivacional/métodos , Projetos Piloto , Autoimagem , Apoio Social , EstereotipagemRESUMO
AIM: There is lack of research on the study of clinical personality traits in recent onset of psychosis (ROP) patients. The aims of this research were to study the relations among psychosocial, personality and clinical characteristics in ROP patients and also the effect that significant variables had on the different domains of Quality of Life (QoL). METHODS: Data for these analyses were obtained from 81 ROP patients. The Millon Clinical Multiaxial Inventory, the Positive and Negative Syndrome Scale and the World Health Organization Quality of Life Brief Scale were used to assess personality, symptoms and QoL. RESULTS: Correlations between the negative symptoms and the physical, psychological and social domains of QoL, and the disorganized symptoms and physical domain, were found. Furthermore, the physical, psychological and social relationship domains of QoL were lower in patients with schizoid traits and the psychological domain was lower in patients with depressive traits. In contrast, the psychological and social domains were higher in patients with histrionic traits, while the physical domain was higher for patients with narcissistic traits. Multiple linear regressions demonstrated that negative symptoms and narcissistic and depressive traits explained 16.9% of the physical domain. Narcissistic and depressive traits explained 15% of the psychological domain. Finally, the negative symptoms and histrionic traits explained 13.7% of the social domain. CONCLUSIONS: QoL seems to be better explained by negative psychotic symptoms and some clinical personality traits. Our results support the importance of integrated intervention approaches that consider personality.
Assuntos
Caráter , Transtornos Psicóticos/psicologia , Qualidade de Vida/psicologia , Adulto , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Transtorno Depressivo/reabilitação , Feminino , Humanos , Masculino , Determinação da Personalidade , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Psicometria , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/reabilitação , Transtorno da Personalidade Esquizoide/diagnóstico , Transtorno da Personalidade Esquizoide/psicologia , Transtorno da Personalidade Esquizoide/reabilitação , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Ajustamento Social , Fatores Socioeconômicos , Adulto JovemRESUMO
OBJECTIVE: A pilot study was conducted to develop and provide a formative evaluation of a group intervention for women with serious mental illness, Women's Empowerment and Recovery-Oriented Care (WE-ROC). METHOD: Ten women with serious mental illness were recruited from a mental health center to take part in the pilot study. Several measures were utilized to assess prepost changes in recovery and empowerment and to elicit participant feedback. RESULTS: Results reflected a significant increase in recovery scores as well as empowerment scores. High attendance rates as well as satisfaction and effectiveness scores provided potential support for feasibility and acceptability of the study, respectively. Content analysis of qualitative feedback suggests positive impacts of group, particularly with regard to peer support and self-esteem. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Future implementation, refinement, and evaluation of the intervention can include a waitlist control group, additional postintervention assessment, and larger sample size. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Assuntos
Transtorno Bipolar/reabilitação , Transtorno Depressivo/reabilitação , Avaliação de Processos e Resultados em Cuidados de Saúde , Poder Psicológico , Reabilitação Psiquiátrica/métodos , Esquizofrenia/reabilitação , Mulheres , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Adulto JovemRESUMO
We address a key issue at the intersection of emotion, psychopathology, and public health-the startling lack of attention to people who experience benign outcomes, and even flourish, after recovering from depression. A rereading of the epidemiological literature suggests that the orthodox view of depression as chronic, recurrent, and lifelong is overstated. A significant subset of people recover and thrive after depression, yet research on such individuals has been rare. To facilitate work on this topic, we present a generative research framework. This framework includes (a) a proposed definition of healthy end-state functioning that goes beyond a reduction in clinical symptoms, (b) recommendations for specific measures to assess high functioning, and (c) a road map for a research agenda aimed at discovering how and why people flourish after emotional disturbance. Given that depression remains the most burdensome health condition worldwide, focus on what makes these excellent outcomes possible has enormous significance for the public health.
Assuntos
Depressão/reabilitação , Transtorno Depressivo/reabilitação , Satisfação Pessoal , HumanosRESUMO
OBJECTIVE: We sought to describe the occupational performance issues of a sample of bariatric surgery candidates and to explore the relationships among occupational performance, satisfaction with performance, demographic characteristics, and mental health factors. METHOD: We reviewed the health records of 241 bariatric surgery candidates and analyzed their scores on the Canadian Occupational Performance Measure (COPM) and standardized mental health questionnaires. RESULTS: Exercise and eating behavior were the most common occupational performance issues. Cognitive and affective issues were reported more frequently than physical issues. Occupational performance and satisfaction correlated negatively with anxiety and depression and positively with self-esteem. Self-esteem contributed 27% of the variance in occupational performance. CONCLUSION: COPM scores revealed a wide range of occupational performance issues and significant associations with mental health factors, supporting a psychosocial approach to occupational therapy with this population. Routine mental health screening can help ensure that mental health factors are adequately addressed.
Assuntos
Cirurgia Bariátrica/reabilitação , Avaliação de Desempenho Profissional , Obesidade Mórbida/reabilitação , Adulto , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/reabilitação , Cirurgia Bariátrica/psicologia , Canadá , Comorbidade , Demografia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Transtorno Depressivo/reabilitação , Exercício Físico/psicologia , Comportamento Alimentar/psicologia , Feminino , Humanos , Satisfação no Emprego , Masculino , Obesidade Mórbida/psicologia , Satisfação Pessoal , Psicometria , Autoimagem , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: We investigated the mental health impact of participation for youth with disabilities (YWD) in the child welfare system who had experienced victimization in the previous year. METHOD: Nationally representative data were obtained from the second National Survey of Child and Adolescent Well-Being. Our sample consisted of 247 YWD ages 11-17 yr. Multivariable probit regression analysis and a robust variance estimator were used to test the relationships among disability status, participation, and clinical depression. RESULTS: The probability of reporting clinical depression was 4 times higher for victimized YWD who reported lower breadth of participation than for victimized YWD who reported higher breadth of participation (6% vs. 26%; p = .03). CONCLUSION: Occupational therapy aimed at increasing opportunities for engagement in activities may enhance the mental health of the most vulnerable YWD. Participation in meaningful activities can improve both overall health and transition to independence for vulnerable YWD.
Assuntos
Serviços de Proteção Infantil , Proteção da Criança/psicologia , Vítimas de Crime/reabilitação , Crianças com Deficiência/reabilitação , Saúde Mental , Terapia Ocupacional , Adolescente , Criança , Vítimas de Crime/psicologia , Transtorno Depressivo/psicologia , Transtorno Depressivo/reabilitação , Avaliação da Deficiência , Crianças com Deficiência/psicologia , Feminino , Humanos , Masculino , Participação do Paciente , Probabilidade , AutoimagemRESUMO
BACKGROUND: In 2013 vocational rehabilitation programmes (VRP) were given official and legal approval under Danish law to assist occupationally marginalized citizens in gaining general life skills, building their work ability, and increasing their chances of entering the work force. The project's aim is to develop a detailed understanding of the health, psychosocial and work circumstances of participating citizens, and of the important processes and mechanisms underlying the potential effects of participating in the VRP. METHODS: This study uses an exploratory mixed methods approach with sequential use of quantitative and qualitative methods. Participants are citizens assigned to an individually tailored VRP in the municipality of Sonderborg, Denmark. The quantitative part of the study consists of a longitudinal survey in which participants complete questionnaires at baseline and at follow-up one year later. Variables include demographic and personal characteristics, the latter ascertained through validated questionnaires on well-being, physical activity, interpersonal problems, general health, work ability, kinesiophobia, self-efficacy, depression and anxiety. The qualitative part of the study consists of semi-structured interviews and observations that explore experiences related to VRP. Participants will be recruited and data collected from questionnaires, interviews and observations in the period February 2016 - March 2018. DISCUSSION: This research will assemble a unique corpus of knowledge about the characteristics, experiences and outcomes of occupationally marginalized citizens participating in a VRP. It will identify potential enablers and barriers to a successful outcome, and ultimately this knowledge will help inform the future design of individually tailored VRP's. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02641704 , date of registration December 29, 2015.
Assuntos
Transtornos de Ansiedade/reabilitação , Transtorno Depressivo/reabilitação , Estudos Observacionais como Assunto , Reabilitação Vocacional/métodos , Marginalização Social , Adolescente , Adulto , Idoso , Dinamarca , Exercício Físico/fisiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Projetos de Pesquisa , Autoeficácia , Licença Médica/estatística & dados numéricos , Inquéritos e Questionários , Desemprego/psicologia , Desemprego/estatística & dados numéricos , Avaliação da Capacidade de Trabalho , Adulto JovemRESUMO
Depression is the most frequent comorbid psychiatric condition among individuals with traumatic brain injury (TBI). Yet, little is known about changes in the brain associated with reduced depressive symptoms following rehabilitation for TBI. We identified whether cognitive training alleviates comorbid depressive symptoms in chronic TBI (>6 months post-injury) as a secondary effect. Further, we elucidated neural correlates of alleviated depressive symptoms following cognitive training. A total of seventy-nine individuals with chronic TBI (53 depressed and 26 non-depressed individuals, measured using the Beck Depressive Inventory [BDI]), underwent either strategy- or information-based cognitive training in a small group for 8 weeks. We measured psychological functioning scores, cortical thickness, and resting-state functional connectivity (rsFC) for these individuals before training, immediately post-training, and 3 months post-training. After confirming that changes in BDI scores were independent of training group affiliation, we identified that the depressive-symptoms group showed reductions in BDI scores over time relative to the non-depressed TBI controls (p < .01). Within the depressive-symptoms group, reduced BDI scores was associated with improvements in scores for post-traumatic stress disorder, TBI symptom awareness, and functional status (p < .00625), increases in cortical thickness in four regions within the right prefrontal cortex (pvertex < .01, pcluster <.05), and decreases in rsFC with each of these four prefrontal regions (pvertex < .01, pcluster < .0125). Overall, these findings suggest that cognitive training can reduce depressive symptoms in TBI even when the training does not directly target psychiatric symptoms. Importantly, cortical thickness and brain connectivity may offer promising neuroimaging markers of training-induced improvement in mental health status in TBI.
Assuntos
Lesões Encefálicas Traumáticas/reabilitação , Remediação Cognitiva/métodos , Conectoma/métodos , Transtorno Depressivo/reabilitação , Córtex Pré-Frontal/patologia , Córtex Pré-Frontal/fisiopatologia , Adulto , Idoso , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/patologia , Lesões Encefálicas Traumáticas/fisiopatologia , Doença Crônica , Transtorno Depressivo/diagnóstico por imagem , Transtorno Depressivo/patologia , Transtorno Depressivo/fisiopatologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Córtex Pré-Frontal/diagnóstico por imagem , Resultado do Tratamento , Adulto JovemRESUMO
Background In Western countries, work disability due to depression is a widespread problem that generates enormous costs. Objective The goal of this study was to determine the types and prevalence of supervisor contributions during the different phases of the return-to-work (RTW) process (before and during the sick-leave absence, and during the RTW preparations) of employees diagnosed with depression. Moreover, we sought to determine which contributions actually facilitate employees' RTW, and to identify the work accommodations most frequently implemented by supervisors at the actual time of their employee's RTW. Methods Telephone interviews were conducted in Québec (Canada) with 74 supervisors working with employees who were already back at work or still on sick leave due to depression. A sub-sample of 46 supervisors who had already taken measures to facilitate their employees' RTW was questioned about the work accommodations implemented. Results Most of the supervisors got along well with their employees before their sick leave and 72% stayed in contact with them during their leave. Nearly 90% of the supervisors encouraged their employees to focus primarily on their recovery before their RTW, but 43% pressured their employees to RTW as soon as possible. Cox regression analyses performed for the entire sample revealed that "the supervisors' intention to take measures to facilitate their employees' RTW" was the only significant predictor of the RTW at the time of the interview. The Kaplan-Meier survival curve showed that 50% of the employees were expected to RTW within the first 8 months of absence. Four of the most frequently implemented work accommodations were actions directly involving the supervisor (i.e. providing assistance, feedback, recognition, and emotional support to the employee). Conclusions This study shed light on the less explored point of view of the supervisor involved in the RTW process of employees post-depression. It highlighted the most frequent and effective supervisor contributions to the process. These results can be used to develop concrete action plans for training supervisors to contribute to the sustainable RTW of employees on sick leave due to depression.