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1.
J Dent Hyg ; 94(5): 6-13, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33008944

RESUMO

Purpose: Depression is a rising global health concern manifesting bidirectional relationships between chronic disease conditions such as type 2 diabetes and oral health. The purpose of this study was to explore the knowledge, attitudes, and practices of oral health care professionals towards individuals with depression.Methods: A 24-item, validated Knowledge Attitudes and Practices (KAP) survey was used for this descriptive, cross-sectional study. Non-probability, convenience and snowball sampling was used to recruit oral health care professionals (dentists, dental hygienists and dental assistants) to participate in an electronic survey. Descriptive statistics were used to analyze the data.Results: A total of 288 oral health care professionals (n=288) met the inclusion criteria. Age of the provider was positively correlated with reviewing or assisting in reviewing patient's depression history during routine dental visits (r=.16, p=.007), and referring or assisting in referring a patient to a mental health specialist (r=.30, p<.001). Number of years of practice was positively associated with referring or assisting in the referral of a patient to a mental health specialist (r=.29, p=.001). Oral health care professionals who indicated having had mental health during their education were more likely to indicate reviewing a history of depression with the patient (rho=.17, p=.004).Conclusion: Age, lack of practice experience and education may influence oral health care professionals' attitudes and practices when providing care for patients with depression. Mental health and its relationship to oral and systemic health may be an appropriate addition to dental program curricula. Oral health care providers should consider modifying routine practices to include the special needs of patients with depression.


Assuntos
Diabetes Mellitus Tipo 2 , Saúde Bucal , Estudos Transversais , Depressão/terapia , Conhecimentos, Atitudes e Prática em Saúde , Humanos
2.
Rev Esp Salud Publica ; 942020 Oct 14.
Artigo em Espanhol | MEDLINE | ID: mdl-33056957

RESUMO

Between March and May 2020, the Spanish Ministry of Health and the Spanish Psychological Association created the Psychological First Care Service (Servicio de Primera Ayuda Psicológica-SPAP), a national helpline designed to provide early psychological intervention to those people affected by COVID-19. This service attended more than 15,000 calls and carried out more than 11,000 interventions and 9,500 follow-ups with the general population, healthcare and other essential professionals and the patients and relatives of the sick or deceased. Results show that the majority of calls (45.7%) came from the Autonomous Community of Madrid, that women significantly used this service in a higher proportion than men (73.5%) and that the commonest age range among users was 40-59. 75.9% of consultations were related to psychological problems linked to anxiety and depressive symptoms. However, grief symptoms also stood out among the patients or relatives of the sick and deceased and, to a lesser extent, stress symptoms were prevalent in the group of professionals. These data show the usefulness of this early psychological care service and the need for similar resources to be implemented in coordination with or within the National Health System.


Assuntos
Betacoronavirus , Infecções por Coronavirus/psicologia , Intervenção na Crise/métodos , Utilização de Instalações e Serviços/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Pneumonia Viral/psicologia , Telemedicina/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , Ansiedade/etiologia , Ansiedade/terapia , Criança , Infecções por Coronavirus/terapia , Intervenção na Crise/organização & administração , Intervenção na Crise/estatística & dados numéricos , Depressão/epidemiologia , Depressão/etiologia , Depressão/terapia , Feminino , Pesar , Humanos , Masculino , Serviços de Saúde Mental/organização & administração , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Pandemias , Pneumonia Viral/terapia , Prevalência , Espanha/epidemiologia , Estresse Psicológico/diagnóstico , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia , Telemedicina/organização & administração , Telemedicina/estatística & dados numéricos , Telefone , Adulto Jovem
4.
Medicine (Baltimore) ; 99(38): e22380, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957418

RESUMO

INTRODUCTION: As a major public health problem, depression has a negative impact on individuals and society. The aim of this well-designed trial is to evaluate the efficacy and safety of electroacupuncture (EA) treatment for depression. METHODS/DESIGN: A 3-arm parallel, nonblinded, randomized controlled trial will be performed in 4 hospitals (centers). A total of 144 participants will be divided into 3 groups: EA group, manual acupuncture (MA) group, and western medicine group. Participants in EA group and MA group will receive 12 sessions of acupuncture treatment for 4 weeks. Participants allocated to western medicine group will only take 20 mg fluoxetine orally per day for 4 weeks. The primary outcome is Hamilton Depression Scale. Secondary outcomes are Self-Rating Depression Scale, Depression Scale of traditional Chinese medicine (Depression Scale of Traditional Chinese Medicine), brain fMRI and blood biomarkers including neurotransmitters serotonin, dopamine, noradrenaline, inflammatory cytokines inerleukin (IL)-1ß, tumor necrosis factor-α, IL-6, and neurotrophin BDNF. All the outcomes will be assessed at baseline, 4 weeks after EA treatment onset and 6-month follow-up. DISCUSSION: The results of this trial will verify the efficacy and safety of EA treatment for depressive patients and provide acupuncturists and clinicians with robust clinical evidence. TRIAL REGISTRATION: Chinese Clinical Trial Registry identifier: ChiCTR1900023420. Version 1. Registered on 26 May 2019. http://www.chictr.org.cn/edit.aspx?pid=37621&htm=4.


Assuntos
Depressão/terapia , Eletroacupuntura/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
5.
Medicine (Baltimore) ; 99(38): e22384, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957419

RESUMO

BACKGROUND: Depression as a clinically significant and growing public health issue is the third leading cause of disability. Adolescent-onset depression has been associated with psychiatric, anxiety disorders, suicidality, medical comorbidities, and an elevated risk of major depressive disorder episodes later in life. How to effectively identify, prevent, and treat depression has become one of the key points of discussion among medical institutions/departments. With the importance of depression being emphasized, countries/organizations around the world have developed guidelines for clinical practice related to depression for different groups of people to guide medical staff to implement scientific, effective, and standardized depression management. However, the quality of such guidelines is not yet clear, which is not conducive to the selection of medical staff and affects clinical application to a certain extent. This study aims to evaluate the rigor of the development of clinical practice guidelines (CPGs) for depression in children and adolescents and will identify, in these documents, the recommendations for depression in children and adolescents. METHODS: Electronic databases and specific databases of CPGs will be searched. Study selection and data extraction will be performed independently by 2 reviewers. The AGREE II Instrument and RIGHT checklist will be used to assess the methodological quality and reporting quality of included CPGs about depression in children and adolescents. We will also analyze consistency and inconsistency of the recommendations in CPGs, including assessment, diagnosis, screening, treatment, and management. Bubble charts will be used to show the differences in methodological and reporting quality. Subgroup analysis will be conducted according to the result of evaluation. Excel and Endnote X9 will be used. RESULTS: Using the search drafts of electronic databases, we included 6 CPGs. The results of our study will be published in a peer-reviewed journal. CONCLUSIONS: Our study will provide systematic evidence for existing CPGs for depression in children and adolescents and provide a guidance for CPGs users. PROTOCOL REGISTRATION: INPLASY202080002.


Assuntos
Depressão/terapia , Guias de Prática Clínica como Assunto/normas , Adolescente , Criança , Humanos , Revisões Sistemáticas como Assunto
6.
Medicine (Baltimore) ; 99(39): e22262, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991424

RESUMO

BACKGROUND: Anxiety and depression, complications of cancer, are prevalent but often overlooked mental illnesses. Studies have demonstrated that massage therapy is useful in relieving anxiety and depression of cancer survivors. However, the mechanism is still unclear and no systematic review has provided sufficient evidence for the treatment. Therefore, this protocol is carried out to comprehensively evaluate the reliability of cancer patients with anxiety and depression treated by massage. METHODS: We will systematically search the relevant literature from PubMed, Cochrane Library, EMBASE, Web of Science, Wanfang, Chongqing VIP, CNKI and Chinese Biomedical Literature Database from the establishment of the databases to June 1, 2020. In addition, we will only include randomized controlled trials about massage for cancer survivors with anxiety and depression, regardless of language and publication status. Two experienced researchers will separately screen the literature, collect data, analyze data and synthesize data using RevMan V.5.3 software. The quality of the included trials in the study will be assessed by the Cochrane bias risk assessment tool. RESULTS: The protocol for the meta-analysis will systematically evaluate the reliability of massage therapy for cancer patients with anxiety and depression. CONCLUSION: This conclusion will provide an important basis for evaluating whether massage is reliable in treating cancer survivors who feel anxious and depressed. INPLASY REGISTRATION NUMBER: INPLASY202060101.


Assuntos
Ansiedade/etiologia , Ansiedade/terapia , Depressão/etiologia , Depressão/terapia , Massagem/métodos , Neoplasias/complicações , Emoções , Humanos , Massagem/efeitos adversos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
7.
Medicine (Baltimore) ; 99(39): e22344, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991449

RESUMO

BACKGROUND: Depression is a disease with a high incidence and easy to relapse. It not only affects the work and life of patients, but also brings a heavy economic burden. University is the peak of depression, and the prevalence of depression among college students is much higher than that of ordinary people. The purpose of this research is to evaluate depression symptoms, life satisfaction, self-confidence, substance use, social adjustment, and dropout rates of the use of psychological intervention for college students. METHODS: We will identify relevant trials from systematic searches in the following electronic databases: PubMed, Embase, Web of Science and The Cochrane Library. We will also search Clinical Trials.gov, the WHO International Clinical Trials Registry Platform for unpublished data. Additional relevant studies will be searched through search engines (such as Google), and references included in the literature will be tracked. All relevant randomized controlled trials (RCTs) will be included. There are no date restrictions. Use Cochrane Collaboration's Risk of bias tool to conduct risk of bias analysis. Use the Grades of Recommendation, Assessment, Development, and Evaluation to assess the quality of evidence. All statistical analysis will be performed using Stata (V.15.0.) and Review Manager (V.5.2.0). RESULTS: A total of 6238 records were obtained by searching the database and 27 records were obtained by other sources. After removing duplicate records, there are 4225 records remaining. We excluded 3945 records through abstract and title, leaving 280 full-text articles. CONCLUSION: This will be the first study to compare the effects of different psychological treatments on depression in college students. We hope that this study will guide clinical decision-making of psychotherapy to better treat depression in college students. PROTOCOL REGISTRATION: INPLASY202070134.


Assuntos
Depressão/terapia , Psicoterapia/métodos , Estudantes/psicologia , Adolescente , Adulto , Depressão/epidemiologia , Depressão/psicologia , Feminino , Carga Global da Doença/economia , Humanos , Incidência , Masculino , Metanálise em Rede , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Satisfação Pessoal , Prevalência , Psicoterapia/tendências , Qualidade de Vida/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Autoimagem , Ajustamento Social , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Universidades , Adulto Jovem
8.
Medicine (Baltimore) ; 99(38): e21995, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957317

RESUMO

BACKGROUND: Poststroke depression (PSD) is an important complication of stroke, resulting in increased disability and mortality, which is a great threat to stroke survivors and public health. Complementary and alternative medicine (CAM) therapies is widely used in the treatment of PSD, However, the selection strategies of different CAM approaches in clinical practice is still not clear, and the purpose of this protocol is to compare the efficacy and acceptability of different CAM therapies using systematic review and network meta-analysis. METHODS: According to the strategy, the authors will retrieve a total of seven electronic databases by August 2020, including PubMed, the Cochrane Library, EMbase, China National Knowledge Infrastructure, China Biological Medicine, Chinese Scientific Journals Database, and Wan-fang databases. The network meta-analysis will be performed using Aggregate Data Drug Information System 1.16.8 and Stata 13.0 software. In addition, the Cochrane Collaboration's tool is employed for the methodological quality, and the quality of evidence will be evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation system. RESULTS: This study will provide a reliable evidence for the selection strategy of CAM therapies for PSD. CONCLUSION: The results of this study will provide references for evaluating the effects of different CAM therapies on PSD, and provide decision-making references for clinical practitioners, patients, and health policy makers. ETHICS AND DISSEMINATION: This study does not require ethical approval. the results will be disseminated through a peer-reviewed publication. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/TNGH6.


Assuntos
Depressão/etiologia , Depressão/terapia , Acidente Vascular Cerebral/complicações , Terapia Combinada , Terapias Complementares , Humanos , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
9.
Rev Med Suisse ; 16(708): 1818-1821, 2020 Sep 30.
Artigo em Francês | MEDLINE | ID: mdl-32997453

RESUMO

This study focuses on the management of chronic depression at the general practitioner's office and the collaboration between general practitioner (GP)-psychiatrist. Our study's highlights two different situations: patients able to verbalize their psychological suffering and who can be directly referred to the psychiatrist and patients expressing their psychological suffering mainly by physical symptoms. GPs consider they first have to work with their patient to help them connect their somatic symptoms and their psychological suffering, which will allow them to refer their patient to the psychiatrist. If this work does not succeed, the GP remains at the forefront of medical care. Long-term support continues, where the GP sometimes ends up giving up on curing and focusing on the doctor/patient relationship.


Assuntos
Depressão/terapia , Medicina de Família e Comunidade , Clínicos Gerais , Psiquiatria , Doença Crônica/psicologia , Doença Crônica/terapia , Depressão/psicologia , Humanos , Relações Médico-Paciente , Estresse Psicológico
10.
JAMA ; 324(7): 651-662, 2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32809002

RESUMO

Importance: Mental health comorbidities are increasing worldwide and worsen outcomes for people with diabetes, especially when care is fragmented. Objective: To assess whether collaborative care vs usual care lowers depressive symptoms and improves cardiometabolic indices among adults with diabetes and depression. Design, Setting, and Participants: Parallel, open-label, pragmatic randomized clinical trial conducted at 4 socioeconomically diverse clinics in India that recruited patients with type 2 diabetes; a Patient Health Questionnaire-9 score of at least 10 (range, 0-27); and hemoglobin A1c (HbA1c) of at least 8%, systolic blood pressure (SBP) of at least 140 mm Hg, or low-density lipoprotein (LDL) cholesterol of at least 130 mg/dL. The first patient was enrolled on March 9, 2015, and the last was enrolled on May 31, 2016; the final follow-up visit was July 14, 2018. Interventions: Patients randomized to the intervention group (n = 196) received 12 months of self-management support from nonphysician care coordinators, decision support electronic health records facilitating physician treatment adjustments, and specialist case reviews; they were followed up for an additional 12 months without intervention. Patients in the control group (n = 208) received usual care over 24 months. Main Outcomes and Measures: The primary outcome was the between-group difference in the percentage of patients at 24 months who had at least a 50% reduction in Symptom Checklist Depression Scale (SCL-20) scores (range, 0-4; higher scores indicate worse symptoms) and a reduction of at least 0.5 percentage points in HbA1c, 5 mm Hg in SBP, or 10 mg/dL in LDL cholesterol. Prespecified secondary outcomes were percentage of patients at 12 and 24 months who met treatment targets (HbA1c <7.0%, SBP <130 mm Hg, LDL cholesterol <100 mg/dL [<70 mg/dL if prior cardiovascular disease]) or had improvements in individual outcomes (≥50% reduction in SCL-20 score, ≥0.5-percentage point reduction in HbA1c, ≥5-mm Hg reduction in SBP, ≥10-mg/dL reduction in LDL cholesterol); percentage of patients who met all HbA1c, SBP, and LDL cholesterol targets; and mean reductions in SCL-20 score, Patient Health Questionnaire-9 score, HbA1c, SBP, and LDL cholesterol. Results: Among 404 patients randomized (mean [SD] age, 53 [8.6] years; 165 [40.8%] men), 378 (93.5%) completed the trial. A significantly greater percentage of patients in the intervention group vs the usual care group met the primary outcome (71.6% vs 57.4%; risk difference, 16.9% [95% CI, 8.5%-25.2%]). Of 16 prespecified secondary outcomes, there were no statistically significant between-group differences in improvements in 10 outcomes at 12 months and in 13 outcomes at 24 months. Serious adverse events in the intervention and usual care groups included cardiovascular events or hospitalizations (4 [2.0%] vs 7 [3.4%]), stroke (0 vs 3 [1.4%]), death (2 [1.0%] vs 7 [3.4%]), and severe hypoglycemia (8 [4.1%] vs 0). Conclusions and Relevance: Among patients with diabetes and depression in India, a 12-month collaborative care intervention, compared with usual care, resulted in statistically significant improvements in a composite measure of depressive symptoms and cardiometabolic indices at 24 months. Further research is needed to understand the generalizability of the findings to other low- and middle-income health care settings. Trial Registration: ClinicalTrials.gov Identifier: NCT02022111.


Assuntos
Pressão Sanguínea , LDL-Colesterol/sangue , Depressão/terapia , Diabetes Mellitus Tipo 2/terapia , Hemoglobina A Glicada/análise , Adulto , Idoso , Comportamento Cooperativo , Depressão/complicações , Países em Desenvolvimento , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Autogestão , Fatores Socioeconômicos
11.
Medicine (Baltimore) ; 99(31): e21583, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756214

RESUMO

BACKGROUND: There are numerous studies worldwide on the use of acupuncture as complementary therapy for chronic stable angina pectoris (CSAP). However, the high morbidity of CSAP-associated anxiety and depression is often overlooked. This protocol of systematic review and meta-analysis aims to assess whether acupuncture is effective as a complementary therapy for anxiety and depression in patients with CSAP. METHODS: The following 8 databases will be searched from inception to February 2020 with no language restrictions: PubMed, Excerpt Medical Database, Web of Science, the Cochrane Library, Chinese Biomedical Database, China National Knowledge Infrastructure, VIP Database and Wanfang Database. Eligible randomized controlled trials and controlled clinical trials will be included. Study selection, data extraction, and risk of bias assessment will be performed independently by 2 reviewers, differences will be resolved by the third reviewer. The primary outcomes include the level of anxiety or depression measured by qualified scales, angina attack frequency, and angina pain intensity. Revman 5.3 software will be used to perform the assessment of the risk of bias and data synthesis. The review will grade the quality of the evidence based on the Grading of Recommendation, Assessment, Development, and Evaluation system. RESULTS: This systematic review and meta-analysis will provide reliable evidence about the effect and safety of acupuncture as a complementary therapy for CSAP-associated anxiety and depression. CONCLUSION: The conclusion of this study will be published in a peer-reviewed journal. ETHICS AND DISSEMINATION: This review will not involve private information of participants, so the ethical approval will not be required. The results will be disseminated in a peer-reviewed journal or conference presentation. Important protocol modifications will be updated on PROSPERO. PROSPERO REGISTRATION NUMBER: CRD42020165492.


Assuntos
Terapia por Acupuntura/métodos , Angina Estável/complicações , Ansiedade/etiologia , Ansiedade/terapia , Depressão/etiologia , Depressão/terapia , Doença Crônica , Ensaios Clínicos como Assunto , Humanos , Qualidade de Vida , Projetos de Pesquisa
12.
Medicine (Baltimore) ; 99(32): e21493, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769884

RESUMO

BACKGROUND: Depression, a common psychiatric disorder in elderly, serves as a remarkable precipitating factor for suicide among the elderly people. Here, a randomized double-blinded study was performed to investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) on improving the clinical symptoms and reducing suicidal ideation in elderly patients with depression. METHODS: In this study, 103 elderly patients with depression and suicidal ideation were randomly divided into 2 groups, 48 cases in the rTMS group and 55 cases in the control group (sham rTMS). Both groups received routine drug therapy with rTMS or sham rTMS. The patients received evaluation by Hamilton depression scale and self-rating idea of suicide scale before treatment and after 2 and 4 weeks of treatment, respectively. RESULTS: The measurement from the present study demonstrated that Hamilton depression scale and self-rating idea of suicide scale scores decreased to varying degrees in the 2 groups after treatment, and the decrease was more significant in rTMS group. The rate of marked effectiveness was much higher in rTMS group after 2 weeks of treatment compared with the control group. Furthermore, the rate of moderate effectiveness at 4 weeks after treatment was significantly higher in rTMS group compared with the control group. CONCLUSION: Together, the present study shows that rTMS with routine drug therapy exhibited effect with quick onset to improve the clinical symptoms and reduce suicidal ideation in elderly patients with depression.


Assuntos
Antidepressivos/uso terapêutico , Depressão/terapia , Ideação Suicida , Estimulação Magnética Transcraniana/métodos , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Depressão/psicologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Resultado do Tratamento
13.
Cochrane Database Syst Rev ; 8: CD013461, 2020 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-32841367

RESUMO

BACKGROUND: Depression is common in people with non-communicable diseases (NCDs) such as cardiovascular disease, diabetes, cancer, and chronic respiratory conditions. The co-existence of depression and NCDs may affect health behaviours, compliance with treatment, physiological factors, and quality of life. This in turn is associated with worse outcomes for both conditions. Behavioural activation is not currently indicated for the treatment of depression in this population in the UK, but is increasingly being used to treat depression in adults. OBJECTIVES: To examine the effects of behavioural activation compared with any control group for the treatment of depression in adults with NCDs. To examine the effects of behavioural activation compared with each control group separately (no treatment, waiting list, other psychological therapy, pharmacological treatment, or any other type of treatment as usual) for the treatment of depression in adults with NCDs. SEARCH METHODS: We searched CCMD-CTR, CENTRAL, Ovid MEDLINE, Embase, four other databases, and two trial registers on 4 October 2019 to identify randomised controlled trials (RCTs) of behavioural activation for depression in participants with NCDs, together with grey literature and reference checking. We applied no restrictions on date, language, or publication status to the searches. SELECTION CRITERIA: We included RCTs of behavioural activation for the treatment of depression in adults with one of four NCDs: cardiovascular disease, diabetes, cancer, and chronic respiratory conditions. Only participants with a formal diagnosis of both depression and an NCD were eligible. Studies were included if behavioural activation was the main component of the intervention. We included studies with any comparator that was not behavioural activation, and regardless of reported outcomes. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane, including independent screening of titles/abstracts and full-text manuscripts, data extraction, and risk of bias assessments in duplicate. Where necessary, we contacted study authors for more information. MAIN RESULTS: We included two studies, contributing data from 181 participants to the analyses. Both studies recruited participants from US hospital clinics; one included people who were recovering from a stroke and the other women with breast cancer. For both studies, the intervention consisted of eight weeks of face-to-face behavioural therapy, with one study comparing to poststroke treatment as usual and the other comparing to problem-solving therapy. Both studies were at risk of performance bias and potential conflict of interest arising from author involvement in the development of the intervention. For one study, risks of selection bias and reporting bias were unclear and the study was judged at high risk of attrition bias. Treatment efficacy (remission) was greater for behavioural activation than for comparators in the short term (risk ratio (RR) 1.53, 95% confidence interval (CI) 0.98 to 2.38; low-certainty evidence) and medium term (RR 1.76, 95% CI 1.01 to 3.08; moderate-certainty evidence), but these estimates lacked precision and effects were reduced in the long term (RR 1.42, 95% CI 0.91 to 2.23; moderate-certainty evidence). We found no evidence of a difference in treatment acceptability in the short term (RR 1.81, 95% CI 0.68 to 4.82) and medium term (RR 0.88, 95% CI 0.25 to 3.10) (low-certainty evidence). There was no evidence of a difference in depression symptoms between behavioural activation and comparators (short term: MD -1.15, 95% CI -2.71 to 0.41; low-certainty evidence). One study found no difference for quality of life (short term: MD 0.40, 95% CI -0.16 to 0.96; low-certainty evidence), functioning (short term: MD 2.70, 95% CI -6.99 to 12.39; low-certainty evidence), and anxiety symptoms (short term: MD -1.70, 95% CI -4.50 to 1.10; low-certainty evidence). Neither study reported data on adverse effects. AUTHORS' CONCLUSIONS: Evidence from this review was not sufficient to draw conclusions on the efficacy and acceptability of behavioural activation for the treatment of depression in adults with NCDs. A future review may wish to include, or focus on, studies of people with subthreshold depression or depression symptoms without a formal diagnosis, as this may inform whether behavioural activation could be used to treat mild or undiagnosed (or both) depressive symptoms in people with NCDs. Evidence from low-resource settings including low- and middle-income countries, for which behavioural activation may offer a feasible alternative to other treatments for depression, would be of interest.


Assuntos
Terapia Comportamental/métodos , Neoplasias da Mama/psicologia , Depressão/terapia , Doenças não Transmissíveis/psicologia , Acidente Vascular Cerebral/psicologia , Adulto , Viés , Conflito de Interesses , Feminino , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Resolução de Problemas , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
14.
BMJ Open ; 10(8): e039646, 2020 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-32792455

RESUMO

INTRODUCTION: The SARS-CoV-2 (COVID-19) pandemic poses immense challenges for national and international healthcare systems. Especially in times of social isolation and governmental restrictions, mental health should not be neglected. Innovative approaches are required to support psychologically burdened people. The e-mental health intervention 'CoPE It' has been developed to offer manualised and evidence-based psychotherapeutic support adapted to COVID-19-related issues in order to overcome psychological distress. In our study, we aim to assess the efficacy of the e-mental health intervention 'CoPE It' in terms of reducing distress (primary outcome), depression and anxiety symptoms as well as improving self-efficacy, quality of life and mindfulness (secondary outcomes). Furthermore, we want to evaluate the programme's usability, feasibility and participants' satisfaction with 'CoPE It' (tertiary outcome). METHODS AND ANALYSIS: The e-mental health intervention 'CoPE It' consists of four 30 min modules, conducted every other day, involving psychotherapeutic techniques of mindfulness-based stress reduction and cognitive-behavioural therapy. The widely applied and previously established content has been adapted to the context of the COVID-19 pandemic by experts in psychosomatic medicine and stress prevention. In our longitudinal study, adult participants-with adequate German language and computer skills, and who have provided informed consent-will be recruited via emergency support hotlines in Germany. Flyers will be distributed, and online channels will be used. Participants will complete a baseline assessment (T0), a postintervention assessment (T1) and assessments 1 and 3 months later (T2 and T3, respectively). We will perform repeated measures analysis of covariance, mixed linear models, standard analyses of variance and regression, and correlation coefficients. In case of binary outcome variables, either mixed logistic regression or χ² tests will be used. ETHICS AND DISSEMINATION: The Ethics Committees of the University of Duisburg-Essen (20-9243-BO) and University of Tübingen (469/2020BO) approved the study. Results will be published in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER: DRKS00021301.


Assuntos
Adaptação Psicológica , Terapia Cognitivo-Comportamental/métodos , Infecções por Coronavirus/psicologia , Aconselhamento à Distância/métodos , Atenção Plena/métodos , Pneumonia Viral/psicologia , Estresse Psicológico/terapia , Ansiedade/prevenção & controle , Ansiedade/terapia , Betacoronavirus , Depressão/prevenção & controle , Depressão/terapia , Humanos , Pandemias , Satisfação do Paciente , Qualidade de Vida , Autoeficácia , Estresse Psicológico/prevenção & controle
15.
Gen Hosp Psychiatry ; 66: 96-102, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32763640

RESUMO

BACKGROUND: Psychological morbidity in both patients and family members related to the intensive care unit (ICU) experience is an often overlooked, and potentially persistent, healthcare problem recognized by the Society of Critical Care Medicine as Post-intensive Care Syndrome (PICS). ICU diaries are an intervention increasingly under study with potential to mitigate ICU-related psychological morbidity, including ICU-related post-traumatic stress disorder (PTSD), depression and anxiety. As we encounter a growing number of ICU survivors, in particular in the wake of the coronavirus pandemic, clinicians must be equipped to understand the severity and prevalence of significant psychiatric complications of critical illness. METHODS: We compared the efficacy of the ICU diary, written by family and healthcare workers during the patient's intensive care course, versus education alone in reducing acute PTSD symptoms after discharge. Patients with an ICU stay >72 h, who were intubated and mechanically ventilated over 24 h, were recruited and randomized to either receive a diary at bedside with psychoeducation or psychoeducation alone. Intervention patients received their ICU diary within the first week of admission into the intensive care unit. Psychological symptom screening with IES-R, PHQ-8, HADS and GAD-7 was conducted at baseline within 1 week of ICU discharge and at weeks 4, 12, and 24 after ICU discharge. Change from baseline in these scores was assessed using Wilcoxon rank sum tests. RESULTS: From September 26, 2017 to September 25, 2018, our team screened 265 patients from the surgical and medical ICUs at a single large academic urban hospital. 60 patients were enrolled and randomized, of which 35 patients completed post-discharge follow-up, (n = 18) in the diary intervention group and (n = 17) in the education-only control group. The control group had a significantly greater decrease in PTSD, hyperarousal, and depression symptoms at week 4 compared to the intervention group. There were no significant differences in other measures, or at other follow-up intervals. Both study groups exhibited clinically significant PTSD symptoms at all timepoints after ICU discharge. Follow-up phone interviews with patients revealed that while many were interested in getting follow-up for their symptoms, there were many barriers to accessing appropriate therapy and clinical attention. CONCLUSIONS: Results from psychological screening tools demonstrate no benefit of ICU diaries versus bedside education-alone in reducing PTSD symptoms related to the intensive care stay. However, our study finds an important gap in clinical practice - patients at high risk for PICS are infrequently connected to appropriate follow-up care. Perhaps ICU diaries would prove beneficial if utilized to support the work within a program providing wrap-around services and close psychiatric follow up for PICS patients. This study demonstrates the high prevalence of ICU-related PTSD in our cohort of survivors, the high barrier to accessing care for appropriate treatment of PICS, and the consequence of that barrier-prolonged psychological morbidity. TRIAL REGISTRATION: NCT04305353. GRANT IDENTIFICATION: GH-17-022 (Arnold P. Gold Foundation).


Assuntos
Centros Médicos Acadêmicos/organização & administração , Ansiedade , Cuidados Críticos , Estado Terminal/psicologia , Depressão , Unidades de Terapia Intensiva/organização & administração , Transtornos de Estresse Pós-Traumáticos , Assistência ao Convalescente , Ansiedade/diagnóstico , Ansiedade/etiologia , Ansiedade/terapia , Infecções por Coronavirus/psicologia , Cuidados Críticos/métodos , Cuidados Críticos/organização & administração , Cuidados Críticos/psicologia , Depressão/diagnóstico , Depressão/etiologia , Depressão/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/psicologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Sobreviventes
16.
PLoS Med ; 17(8): e1003131, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32810147

RESUMO

BACKGROUND: Intimate partner violence (IPV) is linked to substance use by male perpetrators and is associated with an increased risk of depression for women who experience violence. Unite for a Better Life (UBL) is a gender-transformative intervention delivered to men, women, and couples in Ethiopia; previous evidence demonstrated the intervention significantly reduced experience of and perpetration of IPV when delivered to men and led to more equitable household task-sharing when delivered to men and couples. The aim of this analysis is to assess engagement in the UBL intervention and to examine the relationship between random assignment to the intervention and men's past-year substance use and women's reported depressive symptoms as measured at the individual level. METHODS AND FINDINGS: A sample of 64 villages in Gurague zone, Ethiopia, was randomly allocated to 4 arms (men's UBL, women's UBL, couples' UBL, or control). In each village, 106 households were randomly sampled, and households in the intervention arms were invited to participate in UBL, consisting of 14 sessions delivered by trained facilitators. Households in the control arm were offered a short educational session on IPV. Descriptive data on participant engagement in the intervention are reported, and outcomes assessed in an intention-to-treat (ITT) analysis include male use of substances (alcohol and khat) and women's depressive symptoms as measured by the Patient Health Questionnaire (PHQ-9). Results from both adjusted and unadjusted specifications are reported, the latter adjusting for baseline covariates including age, education level, marriage length, polygamy, socioeconomic status, months between intervention and endline, and the baseline level of the outcome variable. The baseline sample includes 6,770 respondents surveyed in 2014-2015, and follow-up data were available from 88% of baseline respondents surveyed in 2017-2018; the majority of respondents report no education, and 61% are Muslim. Respondents reported high attendance rates and engagement in the intervention. In addition, there was evidence of a significant reduction in frequent past-year alcohol intoxication self-reported by men (adjusted odds ratio [AOR] = 0.56, 95% CI 0.36-0.85, p = 0.007), and a significant increase in the probability of frequent khat use self-reported by men (AOR = 3.09, 95% CI 1.37-6.96, p = 0.007), both observed in the couples' UBL arm at 24 months' follow-up relative to the control arm. There was a significant increase in symptoms of moderate depression among women in the women's UBL arm only (AOR = 1.65, 95% CI 1.13-2.41, p = 0.010), again relative to the control arm. There was no evidence of shifts in symptoms of mild or severe depression. The primary limitation of this study is the reliance on self-reported data around sensitive behaviors. CONCLUSIONS: The findings suggest that the UBL intervention was associated with a reduction in men's use of alcohol when delivered to couples, but there was no evidence of a decrease in reported symptoms of depression among women in any experimental arm, and some evidence of an increase in symptoms of moderate depression in the women's UBL arm. Further research should explore how to optimize IPV prevention interventions to target related risks of mental health and substance use. TRIAL REGISTRATION: Clinicaltrials.gov NCT02311699; Socialscienceregistry.org AEARCTR-0000211.


Assuntos
Depressão/psicologia , Depressão/terapia , Violência por Parceiro Íntimo/prevenção & controle , Violência por Parceiro Íntimo/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Análise por Conglomerados , Depressão/epidemiologia , Etiópia/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Autorrelato , Parceiros Sexuais/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Inquéritos e Questionários , Adulto Jovem
17.
Cerebrovasc Dis Extra ; 10(2): 94-104, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32854098

RESUMO

BACKGROUND AND PURPOSE: Rates of depression after ischemic stroke (IS) and myocardial infarction (MI) are significantly higher than in the general population and associated with morbidity and mortality. There is a lack of nationally representative data comparing depression and suicide attempt (SA) after these distinct ischemic vascular events. METHODS: The 2013 Nationwide Readmissions Database contains >14 million US admissions for all payers and the uninsured. Using International Classification of Disease, 9th Revision, Clinical Modification Codes, we identified index admission with IS (n = 434,495) or MI (n = 539,550) and readmission for depression or SA. We calculated weighted frequencies of readmission. We performed adjusted Cox regression to calculate hazard ratio (HR) for readmission for depression and SA up to 1 year following IS versus MI. Analyses were stratified by discharge home versus elsewhere. RESULTS: Weighted depression readmission rates were higher at 30, 60, and 90 days in patients with IS versus MI (0.04%, 0.09%, 0.12% vs. 0.03%, 0.05%, 0.07%, respectively). There was no significant difference in SA readmissions between groups. The adjusted HR for readmission due to depression was 1.49 for IS versus MI (95% CI 1.25-1.79, p < 0.0001). History of depression (HR 3.70 [3.07-4.46]), alcoholism (2.04 [1.34-3.09]), and smoking (1.38 [1.15-1.64]) were associated with increased risk of depression readmission. Age >70 years (0.46 [0.37-0.56]) and discharge home (0.69 [0.57-0.83]) were associated with reduced hazards of readmission due to depression. CONCLUSIONS: IS was associated with greater hazard of readmission due to depression compared to MI. Patients with a history of depression, smoking, and alcoholism were more likely to be readmitted with depression, while advanced age and discharge home were protective. It is unclear to what extent differences in type of ischemic tissue damage and disability contribute, and further investigation is warranted.


Assuntos
Afeto , Isquemia Encefálica/psicologia , Depressão/psicologia , Infarto do Miocárdio/psicologia , Readmissão do Paciente , Acidente Vascular Cerebral/psicologia , Tentativa de Suicídio , Fatores Etários , Idoso , Alcoolismo/epidemiologia , Alcoolismo/psicologia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Bases de Dados Factuais , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/terapia , Feminino , Humanos , Masculino , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Alta do Paciente , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Fumar/psicologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Estados Unidos/epidemiologia
19.
Med Care ; 58 Suppl 2 9S: S94-S100, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32826778

RESUMO

BACKGROUND: Chronic pain and associated symptoms are debilitating for veterans. Medical costs of treatments are high and current treatment options, most notably with opioid medications, have been associated with significant risk. Mindfulness-based interventions appear promising for chronic pain, but require additional testing in veteran care settings. OBJECTIVE: This project was designed to test the feasibility of engaging and retaining veterans with chronic lower back pain in a new mindfulness protocol tailored for veterans, mindfulness-based care for chronic pain (MBCP). Clinical outcomes were also assessed. DESIGN: An open pilot trial of an 8-week MBCP course that included meditation, gentle yoga, and psychoeducation. SUBJECTS: Twenty-two veterans (mean age=49.77; 18% women) were recruited from a VA Medical Center in the Northeastern US. After screening for inclusion/exclusion criteria, 20 were eligible at baseline. MEASURES: Veterans were assessed at baseline and postintervention for functional impairment, pain intensity and bothersomeness, depression, and mindfulness. RESULTS: The average number of sessions completed was 5; only 4 (20%) attended all sessions. Eleven of the 20 participants (55%) attended 5 or more sessions and had complete preintervention and postintervention visits. Five of the 11 had a clinically meaningful decrease in pain intensity and in depressive symptoms, while 6 of 11 had a meaningful decrease in pain bothersomeness and functional impairment. CONCLUSIONS: It was challenging to enroll and retain participants in this study, even with our intervention designed for veterans. We discuss possible adaptations and refinements in MBCP for veterans with chronic pain to enhance feasibility and improve upon these interventions.


Assuntos
Dor Lombar/terapia , Terapias Mente-Corpo/métodos , Adulto , Idoso , Doença Crônica , Protocolos Clínicos , Depressão/epidemiologia , Depressão/terapia , Avaliação da Deficiência , Feminino , Nível de Saúde , Humanos , Dor Lombar/epidemiologia , Masculino , Meditação/métodos , Pessoa de Meia-Idade , Atenção Plena/métodos , Medição da Dor , Educação de Pacientes como Assunto/métodos , Desempenho Físico Funcional , Projetos Piloto , Índice de Gravidade de Doença , Fatores Socioeconômicos , Veteranos , Saúde dos Veteranos , Ioga
20.
Prax Kinderpsychol Kinderpsychiatr ; 69(4): 289-304, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32615896

RESUMO

School-based Mindfulness Programs for Children and Adolescents Mindfulness is a mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting one's bodily sensations, sensory feedback, thoughts, and feelings. Mindfulness interventions can improve proprioception, direction of attention, and emotion regulation. An accepting attitude towards thoughts and feelings reduces the experience of stress so that it is easier to cope with stressful situations. The regular practice of mindfulness exercises affects neurobiological mechanisms, which can lead to an improvement of executive functions as well as psychological health. Metaanalyses provide evidence of small effects of mindfulness interventions in schools, both in cognitive areas (executive functions, concentration, memory) and in emotional areas (anxiety, depressivity, wellbeing). The focus of this review article is on German and English-language mindfulness programmes for children and adolescents in schools, which have already been the subject of initial evaluation studies. This study presents the programmes Paws b, Mind Up, and Mehr Ruhe for children, and .b, Mind Up, AISCHU, and 8sam for adolescents, together with their evaluation results. The conclusion discusses open questions concerning conceptual and methodological issues.


Assuntos
Saúde Mental , Atenção Plena , Psicologia do Adolescente , Psicologia da Criança , Serviços de Saúde Mental Escolar , Adolescente , Ansiedade/prevenção & controle , Ansiedade/terapia , Criança , Cognição , Depressão/prevenção & controle , Depressão/terapia , Emoções , Função Executiva , Humanos , Instituições Acadêmicas
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