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1.
BMJ Open ; 11(9): e046017, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34489269

RESUMO

OBJECTIVE: Positive psychotherapy (PPT) aims at increasing positive affect, meaning and engagement. We aimed to synthesise the available evidence on PPT efficacy. DESIGN: We conducted a preregistered systematic literature search and meta-analysis of randomised controlled trials examining the efficacy of PPT for increasing positive (eg, satisfaction with life) or decreasing negative psychological outcomes (eg, depression). DATA SOURCES: Medline, PsycINFO and Web of Science from 2006 (ie, inception of PPT) to February 2020 as well as related systematic reviews and meta-analyses. RESULTS: We included 20 randomised controlled trial with a total of 1360 participants. Moderate effect sizes were found for increasing positive outcomes (g=-0.72, 95% CI: -1.31 to -0.14, k=10, numbers needed to treat (NNT)=2.55) and reducing negative outcomes (g=0.48, 95% CI: 0.18 to 0.78, k=8, NNT=3.76) when PPT was compared with waitlist control conditions at post-treatment assessment. When compared with active control conditions, PPT yielded large effect sizes for increasing positive outcomes (g=-0.92, 95% CI: -1.74 to -0.11, k=6, NNT=2.05) and reducing depression (g=0.94, 95% CI: 0.18 to 1.70, k=6, NNT=2.03) at post-treatment assessment. No significant differences in efficacy were found when compared with established treatments such as cognitive-behavioural therapy. Evidence was found to support an association between trial quality and effect sizes. For positive outcomes, higher trial quality was related to larger effect size. Whereas higher trial quality was associated with smaller effect size for depression. Follow-up assessments remained too scarce for most planned analyses. CONCLUSIONS: Our findings support the short-term efficacy of PPT. However, results are to be regarded with due caution in the light of low number of trials. More high-quality trials that assess efficacy at follow-ups are needed to draw firmer conclusions on the long-term efficacy of PPT. PROSPERO REGISTRATION NUMBER: CRD42020173567.


Assuntos
Terapia Cognitivo-Comportamental , Depressão , Depressão/terapia , Humanos , Psicoterapia , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Medicine (Baltimore) ; 100(35): e27090, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477144

RESUMO

BACKGROUND: Glaucoma is the second most-common blinding ophthalmic disease in the world, and its incidence has been rising year by year in recent years. Currently, the main treatment of glaucoma still relies on surgery. Glaucoma patients often suffer from various psychological problems like anxiety and depression not only because of the lack of understanding of the surgical treatment of glaucoma, but also the long-term stress and the poor prognosis. As alternative therapies, non-pharmacological interventions can greatly alleviate psychological burdens and improve sleep quality in surgically treated glaucoma patients. Randomized controlled trials of non-pharmacologic interventions for glaucoma have been reported, although the results remain conflicting. Evidences for determining the efficacy of non-pharmacologic interventions for glaucoma are scant. This study aims to assess the effects of non-pharmacological interventions on anxiety, depression, and sleep quality in patients with postoperative glaucoma through a network meta-analysis. METHODS: A systematic search of relevant literatures published before August 2021 about the effects of non-pharmacological interventions on anxiety, depression, and sleep quality in patients with postoperative glaucoma will be performed in Wanfang, VP Information Chinese Journal Service Platform, China National Knowledge Infrastructure, Chinese BioMedicine Literature Database, Pubmed, Embase, Cochrane, and Web of science. Two reviewers will be independently responsible for literature screening and selection, quality assessment, and data extraction. WinBUGS 1.4 will be used for the network meta-analysis. RESULTS: This meta-analysis will provide additional and stronger evidences for non-pharmacological interventions on anxiety, depression, and sleep quality in patients with postoperative glaucoma, which will help clinicians and decision makers to make an optimal therapeutic strategy. CONCLUSION: This study will provide a reliable evidence-based basis for the clinical application of non-pharmacological interventions on anxiety, depression, and sleep quality in patients with postoperative glaucoma. ETHICS AND DISSEMINATION: Ethical approval was not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms. This review would be disseminated in a peer-reviewed journal or conference presentations. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/TYJPK.


Assuntos
Ansiedade/terapia , Protocolos Clínicos , Depressão/terapia , Glaucoma/complicações , Transtornos do Sono-Vigília/terapia , Ansiedade/psicologia , Depressão/psicologia , Glaucoma/terapia , Humanos , Metanálise como Assunto , Transtornos do Sono-Vigília/psicologia , Revisões Sistemáticas como Assunto
3.
Zhongguo Zhen Jiu ; 41(9): 1049-54, 2021 Sep 12.
Artigo em Chinês | MEDLINE | ID: mdl-34491657

RESUMO

OBJECTIVE: To analyze the literature knowledge structure and acupoint matching rules of acupuncture for depression. METHODS: The articles regarding acupuncture for depression published from January 1 of 1984 to October 19 of 2020 were searched in CNKI database. CiteSpace5.7.R2 software was used to import the literature data, and the keyword cluster analysis, emergence analysis and time-zone analysis of articles and acupoints were conducted, and the map of scientific knowledge was draw. RESULTS: A total of 3524 articles were included to the knowledge structure analysis, while 601 articles into the acupoint matching rules analysis. There were 13 keyword clusters of acupuncture for depression, with "post-stroke depression" and "electroacupuncture treatment" as high-frequency keywords, and "electroacupuncture treatment" and "Hamilton depression scale" had high centrality, and "electroacupuncture treatment" had the highest emergence intensity. The keywords such as "electroacupuncture treatment" and "Hamilton depression scale", etc. appeared the earliest, followed by "post-stroke depression", "fluoxetine" and "auricular point therapy", etc. According to traditional Chinese medicine theory, acupoint keywords were divided into four clusters: ①core acupoint, ②replenishing-spleen and dispelling phlegm, dispersing-liver and relieving depression, reinforcing qi and nourishing blood, ③back-shu points, five-zhi points, ④inducing-resuscitation and opening-closes. CONCLUSION: The main knowledge structure of acupuncture for depression includes five parts: treatment method, depression type, TCM-related diseases, literature type and curative effect index. Clinical acupoint matching should adhere to the principle of "focusing the disease before syndrome" and "combination of disease and syndrome", and treatment should be modified for the syndromes of phlegm stagnation blocking, liver-stagnation and qi-stagnation, and deficiency of both qi and blood.


Assuntos
Terapia por Acupuntura , Eletroacupuntura , Pontos de Acupuntura , Depressão/terapia , Medicina Tradicional Chinesa
4.
Trials ; 22(1): 630, 2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34530894

RESUMO

BACKGROUND: Malawi is a low-income country in sub-Saharan Africa that has limited resources to address a significant burden of disease-including HIV/AIDS. Additionally, depression is a leading cause of disability in the country but largely remains undiagnosed and untreated. The lack of cost-effective, scalable solutions is a fundamental barrier to expanding depression treatment. Against this backdrop, one major success has been the scale-up of a network of more than 700 HIV clinics, with over half a million patients enrolled in antiretroviral therapy (ART). As a chronic care system with dedicated human resources and infrastructure, this presents a strategic platform for integrating depression care and responds to a robust evidence base outlining the bi-directionality of depression and HIV outcomes. METHODS: We will evaluate a stepped model of depression care that combines group-based Problem Management Plus (group PM+) with antidepressant therapy (ADT) for 420 adults with moderate/severe depression in Neno District, Malawi, as measured by the Patient Health Questionnaire-9 (PHQ-9) and Mini-International Neuropsychiatric Interview (MINI). Roll-out will follow a stepped-wedge cluster randomized design in which 14 health facilities are randomized to implement the model in five steps over a 15-month period. Primary outcomes (depression symptoms, functional impairment, and overall health) and secondary outcomes (e.g., HIV: viral load, ART adherence; diabetes: A1C levels, treatment adherence; hypertension: systolic blood pressure, treatment adherence) will be measured every 3 months through 12-month follow-up. We will also evaluate the model's cost-effectiveness, quantified as an incremental cost-effectiveness ratio (ICER) compared to baseline chronic care services in the absence of the intervention model. DISCUSSION: This study will conduct a stepped-wedge cluster randomized trial to compare the effects of an evidence-based depression care model versus usual care on depression symptom remediation as well as physical health outcomes for chronic care conditions. If determined to be cost-effective, this study will provide a model for integrating depression care into HIV clinics in additional districts of Malawi and other low-resource settings with high HIV prevalence. TRIAL REGISTRATION: ClinicalTrials.gov NCT04777006 . Registered on 1 March, 2021.


Assuntos
Depressão , Infecções por HIV , Adulto , Análise Custo-Benefício , Depressão/diagnóstico , Depressão/terapia , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Malaui , Ensaios Clínicos Controlados Aleatórios como Assunto , Carga Viral
5.
Am J Psychother ; 74(3): 103-111, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34521212

RESUMO

OBJECTIVE: Patient choice is recognized as a factor that influences clinical outcomes and treatment evaluation in mental health care. However, research on how having a choice affects patients with depression has been rare. This Dutch study examined whether patients randomly selected to choose between two types of depression psychotherapy benefited more from treatment than patients randomly assigned to an intervention. METHODS: Data were derived from a trial of outpatients with depression who were randomly assigned to cognitive therapy (CT), interpersonal psychotherapy (IPT), or a 2-month waitlist control condition followed by the patient's choice of CT or IPT. Treatment groups were combined into a no-choice condition (N=151), with the waitlist as the choice condition (N=31). Multilevel regression was used to compare depression severity (measured with the Beck Depression Inventory-II [BDI-II]) and general psychological distress (measured with the Brief Symptom Inventory [BSI]) posttreatment and at the 5-month follow-up. Differences in patients' pretreatment expectations, beliefs about treatment credibility, and posttreatment evaluation were examined. RESULTS: No significant differences in clinical outcomes were found between the choice and no-choice conditions (mean difference: BDI-II posttreatment=-0.55, 95% confidence interval [CI]=-5.25 to 4.15; follow-up=2.10, 95% CI=-4.01 to 8.20; BSI posttreatment=-1.89, 95% CI=-15.35 to 11.58; follow-up=3.13, 95% CI=-12.32 to 18.57). Patients in both groups reported comparable scores on pretreatment expectations, credibility beliefs, and posttreatment evaluation. Neither expectations nor credibility beliefs were predictive of clinical outcomes. CONCLUSIONS: Our findings did not support the value of patient choice. Considering the exploratory nature of the trial, future studies designed to examine the effects of choice in depression treatment are recommended.


Assuntos
Terapia Cognitivo-Comportamental , Depressão , Depressão/terapia , Humanos , Preferência do Paciente , Psicoterapia , Resultado do Tratamento
6.
Yearb Med Inform ; 30(1): 172-175, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34479388

RESUMO

OBJECTIVES: To summarize research contributions published in 2020 in the field of clinical decision support systems (CDSS) and computerized provider order entry (CPOE), and select the best papers for the Decision Support section of the International Medical Informatics Association (IMIA) Yearbook 2021. METHODS: Two bibliographic databases were searched for papers referring to clinical decision support systems. From search results, section editors established a list of candidate best papers, which were then peer-reviewed by seven external reviewers. The IMIA Yearbook editorial committee finally selected the best papers on the basis of all reviews including the section editors' evaluation. RESULTS: A total of 1,919 articles were retrieved. 15 best paper candidates were selected, the reviews of which resulted in the selection of two best papers. One paper reports on the use of electronic health records to support a public health response to the COVID-19 pandemic in the United States. The second paper proposes a combination of CDSS and telemedicine as a technology-based intervention to improve the outcomes of depression as part of a cluster trial. CONCLUSIONS: As shown by the number and the variety of works related to clinical decision support, research in the field is very active. This year's selection highlighted the application of CDSS to fight COVID-19 and a combined technology-based strategy to improve the treatment of depression.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Sistemas de Registro de Ordens Médicas , Telemedicina , COVID-19 , Depressão/terapia , Humanos
7.
Zhen Ci Yan Jiu ; 46(7): 580-5, 2021 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-34369678

RESUMO

OBJECTIVE: To observe the effect of transcutaneous auricular vagus nerve stimulation (taVNS) on the depressive behavior in depression rats, so as to explore its mechanism underlying improvement of depression. METHODS: A total of 24 male Sprague Dawley rats were randomly divided into normal, depression model, taVNS, tnVNS (transcutaneous auricular none-vagus nerve stimulaton) groups (n=6 in each group). The depression model was established by chronic unpredictable mild stimulation combined with solitary raising for 35 consecutive days. After 14 days modeling, transcutaneous electrostimulation (2 mA, 2 Hz/15 Hz) was applied to auricular concha or auricular margin, respectively. Each intervention was conducted for 30 minutes, once daily for 21 days. The depression-like behavior was evaluated by forced swimming immobility time and body weight. The expression levels of Toll-like receptor 4 (TLR4), myeloid differentiation factor 88 (MyD88) and interleukin-18 (IL-18) protein in the prefrontal cortex were detected by Western blot. RESULTS: Following modeling, the increase amount of body weight was decreased, the forced swimming immobility time and expression TLR4, MyD88 and IL-18 protein in the prefrontal cortex were increased in the model group than those in the normal group (P<0.01). Following the treatment and compared with the model group, the increase amount of body weight in the taVNS group was obviously increased (P<0.05), the swimming immobility time and the expression of TLR4, MyD88, IL-18 protein in the taVNS and tnVNS groups were significantly decreased (P<0.01). CONCLUSION: TaVNS is able to improve depression in depression rats, which is probably related to its effect in inhibiting inflammatory response of TLR4/MyD88 signaling pathway in prefrontal cortex.


Assuntos
Estimulação Elétrica Nervosa Transcutânea , Estimulação do Nervo Vago , Animais , Depressão/genética , Depressão/terapia , Interleucina-18/genética , Masculino , Fator 88 de Diferenciação Mieloide/genética , Córtex Pré-Frontal , Ratos , Ratos Sprague-Dawley , Receptor 4 Toll-Like/genética , Nervo Vago
8.
Zhongguo Zhen Jiu ; 41(8): 877-82, 2021 Aug 12.
Artigo em Chinês | MEDLINE | ID: mdl-34369698

RESUMO

OBJECTIVE: To observe the clinical therapeutic effect on mild and moderate postpartum depression treated with acupuncture of Tiaoren Tongdu (regulating the conception vessel and unblocking the governor vessel) on the base of real world. METHODS: A total of 116 patients with mild and moderate postpartum depression were divided into an acupuncture group (103 cases) and a non-acupuncture group (13 cases) according to treatment regimen provided. In the acupuncture group, acupuncture of Tiaoren Tongdu was applied to Baihui (GV 20), Yintang (GV 29), Zhongwan (CV 12), Qihai (CV 6), Guanyuan (CV 4), Neiguan (PC 6), Shenmen (HT 7), Hegu (LI 4), Zusanli (ST 36), Sanyinjiao (SP 6) and Taichong (LR 3). Needles were retained for 30 min each time, the treatment was given once every other day, 3 times a week. In the non-acupuncture group, psychotherapy was provided, once daily. The duration of treatment in the two groups was 8 weeks. According to the treatment times of acupuncture, the acupuncture group was subdivided into an acupuncture A group (60 cases with total treatments ≥ 6 times) and an acupuncture B group (43 cases with total treatments<6 times). Using propensity score matching method, the patients of the acupuncture A and B groups were matched each other. Finally, 31 pairs of cases were matched successfully. Before treatment, at 1st, 2nd, 4th and 8th weeks of treatment, as well as at 3-month follow-up, the scores of Hamilton depression scale (HAMD) were compared in patients among the three groups. Using Logistic regression, the impact of acupuncture frequencies on the therapeutic effect was analyzed and the clinical therapeutic effect was assessed. RESULTS: The total effective rate of the acupuncture A group was 100.0% (31/31), better than 76.9% (10/13) in the non-acupuncture group and 58.1% in the acupuncture B group (18/31) (P<0.05). HAMD score at each time point after treatment was lower than that before treatment in the patients of each group (P<0.05). But HAMD score at each time point after treatment in either the acupuncture A group or the acupuncture B group was lower than that in the non-acupuncture group separately (P<0.05), HAMD scores in the acupuncture A group at the 4th and 8th weeks of treatment and at follow-up were lower than those in the acupuncture B group (P<0.05). Logistic regression analysis showed that the total times of acupuncture treatment and the persistent days of treatment had a certain relation to therapeutic effect (P<0.05). CONCLUSION: Acupuncture of Tiaoren Tongdu effectively improves in mild and moderate postpartum depression and its therapeutic effect is closely related to treatment course.


Assuntos
Terapia por Acupuntura , Depressão Pós-Parto , Pontos de Acupuntura , Depressão/terapia , Depressão Pós-Parto/terapia , Feminino , Humanos , Agulhas , Resultado do Tratamento
9.
Artigo em Inglês | MEDLINE | ID: mdl-34360479

RESUMO

The aim of this study is to investigate the effectiveness of a novel self-administered at-home daily virtual reality (VR)-based intervention (COVID Feel Good) for reducing the psychological burden experienced during the COVID-19 lockdown in Italy. A total of 40 individuals who had experienced at least two months of strict social distancing measures followed COVID Feel Good between June and July 2020 for one week. Primary outcome measures were depression, anxiety, and stress symptoms, perceived stress levels, and hopelessness. Secondary outcomes were the experienced social connectedness and the level of fear experienced during the COVID-19 pandemic. Linear mixed-effects models were fitted to evaluate the effectiveness of the intervention. Additionally, we also performed a clinical change analysis on primary outcome measures. As concerning primary outcome measures, participants exhibited improvements from baseline to post-intervention for depression levels, stress levels, general distress, and perceived stress (all p < 0.05) but not for the perceived hopelessness (p = 0.110). Results for the secondary outcomes indicated an increase in social connectedness from T0 to T1 (p = 0.033) but not a significant reduction in the perceived fear of coronavirus (p = 0.412). Among these study variables, these significant improvements were maintained from post-intervention to the 2-week follow-up (p > 0.05). Results indicated that the intervention was associated with good clinical outcomes, low-to-no risks for the treatment, and no adverse effects or risks. Globally, evidence suggests a beneficial effect of the proposed protocol and its current availability in 12 different languages makes COVID Feel Good a free choice for helping individuals worldwide to cope with the psychological distress associated with the COVID-19 crisis, although large scale trials are needed to evaluate its efficacy.


Assuntos
COVID-19 , Angústia Psicológica , Realidade Virtual , Controle de Doenças Transmissíveis , Depressão/terapia , Seguimentos , Humanos , Pandemias , SARS-CoV-2 , Estresse Psicológico/terapia
10.
Zhongguo Ying Yong Sheng Li Xue Za Zhi ; 37(3): 327-331, 2021 May.
Artigo em Chinês | MEDLINE | ID: mdl-34374248

RESUMO

Objective: To investigate the effects and mechanisms of massage on the depressive behavior of rats with chronic stress. Methods: The rats were subjected to chronic unpredictable mild stress for 21 days and then treated with massage for 14 days. They were divided into the following groups: blank control group, model group, massage group and fluoxetine group, with 10 rats in each group. The important acupoints of bladder meridian were massaged for 10 minutes every day (with an interval of 2 minutes, 2 times in total). Body weight, open field test, sucrose intake test and water maze test were used to evaluate the behavioral changes. The expressions of Erk/p-ERK (Extracellular signal-related kinases/Phosphorylation extracellular signal-related kinases) and BDNF in prefrontal cortex were detected by Western Blot. Results: The body weight, open field sucrose intake test and water maze data of the model group were significantly lower than those of the Control Group (P<0.01), and the contents of p-ERK and BDNF protein in prefrontal cortex were decreased significantly (P<0.01). The body weight, open field test, sucrose intake test and water maze test data of rats in massage group and fluoxetine group were significantly higher than those in model group(P<0.01). The contents of p-ERK and BDNF in frontal cortex were increased significantly (P<0.05, P<0.01), especially in fluoxetine group (P<0.01). Conclusion: Massage may increase the phosphorylation level of ERK protein in hippocampus and prefrontal cortex, activate ERK signaling pathway, promote the expression of BDNF, and improve the depression behavior of chronic stress rats.


Assuntos
Depressão , Estresse Psicológico , Animais , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Depressão/terapia , Modelos Animais de Doenças , Hipocampo/metabolismo , Massagem , Ratos , Ratos Sprague-Dawley
11.
BMJ Open ; 11(8): e048481, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-34400456

RESUMO

INTRODUCTION: Despite carrying a disproportionately high burden of depression, patients in low-income countries lack access to effective care. The collaborative care model (CoCM) has robust evidence for clinical effectiveness in improving mental health outcomes. However, evidence from real-world implementation of CoCM is necessary to inform its expansion in low-resource settings. METHODS: We conducted a 2-year mixed-methods study to assess the implementation and clinical impact of CoCM using the WHO Mental Health Gap Action Programme protocols in a primary care clinic in rural Nepal. We used the Capability Opportunity Motivation-Behaviour (COM-B) implementation research framework to adapt and study the intervention. To assess implementation factors, we qualitatively studied the impact on providers' behaviour to screen, diagnose and treat mental illness. To assess clinical impact, we followed a cohort of 201 patients with moderate to severe depression and determined the proportion of patients who had a substantial clinical response (defined as ≥50% decrease from baseline scores of Patient Health Questionnaire (PHQ) to measure depression) by the end of the study period. RESULTS: Providers experienced improved capability (enhanced self-efficacy and knowledge), greater opportunity (via access to counsellors, psychiatrist, medications and diagnostic tests) and increased motivation (developing positive attitudes towards people with mental illness and seeing patients improve) to provide mental healthcare. We observed substantial clinical response in 99 (49%; 95% CI: 42% to 56%) of the 201 cohort patients, with a median seven point (Q1:-9, Q3:-2) decrease in PHQ-9 scores (p<0.0001). CONCLUSION: Using the COM-B framework, we successfully adapted and implemented CoCM in rural Nepal, and found that it enhanced providers' positive perceptions of and engagement in delivering mental healthcare. We observed clinical improvement of depression comparable to controlled trials in high-resource settings. We recommend using implementation research to adapt and evaluate CoCM in other resource-constrained settings to help expand access to high-quality mental healthcare.


Assuntos
Transtornos Mentais , Psiquiatria , Depressão/diagnóstico , Depressão/terapia , Humanos , Nepal , População Rural
12.
BMC Psychol ; 9(1): 126, 2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34446114

RESUMO

BACKGROUND: Recent studies have suggested that therapeutic climbing/bouldering may have positive effects on perceived self-efficacy. Nevertheless, there is still an urgent need for high-quality studies, as many existing studies have suffered from methodological problems. Therefore, the current work was aimed at investigating the effect of a manualized bouldering psychotherapy (BPT) on perceived self-efficacy in people with depression, compared with a home-based physical exercise program (EP) and state-of-the-art cognitive behavioral group therapy (CBT). METHODS: In a prospective, multicenter, randomized controlled trial, 233 people with depression were randomly assigned to one group (BPT, EP, or CBT). Perceived self-efficacy was assessed at baseline (t0) and directly after the 10-week intervention period (t1) with the GSE. In addition, depression was assessed with the PHQ-9 and the MADRS. We computed t tests, analyses of variance (ANOVAs), confounder-adjusted hierarchical regression analyses, mediation analyses, and several sensitivity analyses. RESULTS: BPT participants showed a significantly larger increase in perceived self-efficacy on the GSE compared with the EP (an increase of 3.04 vs. 1.26 points, p = .016, Cohen's d = 0.39). In the confounder-adjusted hierarchical multiple regression analysis, group allocation (BPT vs. EP) was found to be the only significant predictor of the postintervention GSE score (ß = .16, p = .014) besides the baseline GSE score (ß = .69, p < .001). No differences were found between BPT and CBT participants regarding the effect on perceived self-efficacy. Only in the CBT group, the relationship between depression at baseline and postintervention was partially mediated (23%) by perceived self-efficacy. CONCLUSIONS: Participation in the manualized BPT in a group setting leads to a clinically relevant enhancement of perceived self-efficacy in people with depression. This effect is superior to that of physical exercise alone. The results provide also initial indications that BPT is comparable to CBT in enhancing perceived self-efficacy, suggesting a strong case for a broader use of BPT as a supplement to existing health services. Future studies should focus on the modes of action of BPT and its effect on perceived self-efficacy in people with other mental or physical disorders. Trial registration ISRCTN12457760, registered partly retrospectively, 26 July 2017.


Assuntos
Depressão , Autoeficácia , Depressão/terapia , Humanos , Estudos Prospectivos , Psicoterapia , Estudos Retrospectivos , Resultado do Tratamento
13.
PLoS One ; 16(8): e0255594, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34352012

RESUMO

INTRODUCTION: Implementation of evidence-based care for heavy drinking and depression remains low in global health systems. We tested the impact of providing community support, training, and clinical packages of varied intensity on depression screening and management for heavy drinking patients in Latin American primary healthcare. MATERIALS AND METHODS: Quasi-experimental study involving 58 primary healthcare units in Colombia, Mexico and Peru randomized to receive: (1) usual care (control); (2) training using a brief clinical package; (3) community support plus training using a brief clinical package; (4) community support plus training using a standard clinical package. Outcomes were proportion of: (1) heavy drinking patients screened for depression; (2) screen-positive patients receiving appropriate support; (3) all consulting patients screened for depression, irrespective of drinking status. RESULTS: 550/615 identified heavy drinkers were screened for depression (89.4%). 147/230 patients screening positive for depression received appropriate support (64%). Amongst identified heavy drinkers, adjusting for country, sex, age and provider profession, provision of community support and training had no impact on depression activity rates. Intensity of clinical package also did not affect delivery rates, with comparable performance for brief and standard versions. However, amongst all consulting patients, training providers resulted in significantly higher rates of alcohol measurement and in turn higher depression screening rates; 2.7 times higher compared to those not trained. CONCLUSIONS: Training using a brief clinical package increased depression screening rates in Latin American primary healthcare. It is not possible to determine the effectiveness of community support on depression activity rates due to the impact of COVID-19.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Alcoólicos/psicologia , Depressão/terapia , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/prevenção & controle , Intoxicação Alcoólica/psicologia , Alcoolismo/diagnóstico , Colômbia/epidemiologia , Comorbidade , Atenção à Saúde , Depressão/psicologia , Transtorno Depressivo/psicologia , Transtorno Depressivo/terapia , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , México/epidemiologia , Pessoa de Meia-Idade , Peru/epidemiologia , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Encaminhamento e Consulta , Detecção do Abuso de Substâncias/métodos
14.
BMJ Open ; 11(8): e048115, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34408044

RESUMO

INTRODUCTION: The fatigue-sleep disturbance-depression symptom cluster (FSDSC) is one of the most common and debilitating side effects in patients with breast cancer (BC) throughout their treatment trajectory. Tai chi has been supported as a promising non-pharmacological intervention for the individual symptom relief of cancer-related fatigue, sleep disturbance and depression. However, relevant evidence of using tai chi for FSDSC management in patients with BC has been lacking. METHODS: This study will be a two-arm, single-blinded pilot randomised controlled trial involving an 8-week intervention and a 4-week follow-up. Seventy-two patients with BC experiencing the FSDSC will be recruited from two tertiary medical centres in China. The participants will be randomised to either a tai chi group (n=36) or a control group (n=36). The participants in the tai chi group will receive an 8-week tai chi intervention in addition to standard care, while the participants in the control group will receive standard care only consisting of a booklet on the self-management of cancer symptoms. The primary outcomes will include a series of feasibility assessments of the study protocol in relation to the study's methodological procedures, including subject recruitment and follow-up process, completion of study questionnaires and the feasibility, acceptability and safety of the intervention. The secondary outcomes will be the clinical outcomes regarding the effects of tai chi on the FSDSC and quality of life, which will be evaluated by the Brief Fatigue Inventory, the Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale and the Functional Assessment of Cancer Therapy-Breast questionnaires. ETHICS AND DISSEMINATION: Ethics approval was obtained from relevant sites (H19094, KY2019133, 201932). The findings of the study will be published in peer-reviewed scientific journals and at conferences. TRAIL REGISTRATION NUMBER: NCT04190342; Pre-results.


Assuntos
Neoplasias da Mama , Tai Ji , Neoplasias da Mama/complicações , Neoplasias da Mama/terapia , Depressão/terapia , Fadiga/etiologia , Fadiga/terapia , Estudos de Viabilidade , Feminino , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Sono , Síndrome
15.
Medicine (Baltimore) ; 100(33): e26858, 2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34414936

RESUMO

BACKGROUND: The proportion of women is higher than men in depression. This is mainly due to women's physiological regulation is different from men, especially in puberty, menstruation, pregnancy, menopause, among others. Therefore, treating depressive women is still a health challenge. Besides, recent studies of exercise therapy have a more outstanding performance in treating depression, especially in contrast to drug therapy and psychotherapy. Its main advantages are convenience, quickness, no side effects, real-time, and long-term effectiveness. OBJECTIVE: The aim of this study was to systematically review the clinical efficacy of exercise on women with depressive symptoms. METHODS: Searching PubMed, The Cochrane Library, and Embase databases to collect randomized controlled trials about exercise in the treatment of depressive women. After literature screening, data extraction, and literature quality evaluation, the meta-analysis of acquirement data was performed with RevMan5.3 software. RESULTS: A total of 2294 patients were included in 25 different articles totally. Meta-analysis shows that compared with the control group, exercise could relieve female depression (standard mean difference [95% confidence interval, CI] = -0.64 [-0.89 to -0.39], Z = 4.99, P < .001). Subgroup analysis shows that different types of exercise have significant effects in improving depression symptoms. Exercise therapy has better effect on depressive patients induced by physiology or disease than ordinary depressive patients. CONCLUSION: Exercise can significantly improve depressive symptoms in women.


Assuntos
Depressão/terapia , Terapia por Exercício , Feminino , Humanos , Resultado do Tratamento
16.
BMC Psychiatry ; 21(1): 398, 2021 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-34380440

RESUMO

BACKGROUND: The incidence of depression is increasing worldwide. Depression can lead to poor physical health and even suicide. However, in high-income countries, only about 50% of the people with depression receive appropriate therapy, and the detection rate of depression in low- and middle-income countries is relatively lower. Web-based self-management enables remote treatment and solves the problem of insufficient psychological treatment resources. Many past studies have evaluated the effectiveness of web-based self-management of depression, but there has been no synthesis of evidence. Therefore, this study conducted a meta-analysis of the effectiveness of web-based self-management for depressive symptoms. METHOD: Six electronic databases (Cochrane Central Register of Controlled Trials, PubMed, Web of Science, Embase, CINAHL, and PsycINFO) were searched in September 2020. All literature referring to the effects of web-based self-management on depression were shortlisted by performing the medical subject headings (MeSH) search combined with a text word search. RESULTS: A total of 18 eligible randomized controlled trials were identified, and the results from 3055 participants were consolidated. The web-based self-management group exhibited a greater reduction in depressive symptoms than the control group (g = - 0.46; 95% CI: 0.62,0.30), and there was no evidence of publication bias. Subgroup analysis revealed that patients with moderate-to-severe depression benefited from web-based self-management interventions. In terms of interventions, those based on cognitive behavioral therapy (CBT) were highly effective. We noted that the longer the intervention time, the better was the improvement in the status of depression. Furthermore, it was established that participants who communicated with therapists and showed greater adherence to the intervention experienced significant improvement in their symptoms. The results of the intervention group were better than those of the waiting-list, treatment-as-usual, and online psychoeducation groups. CONCLUSIONS: Web-based self-management is a promising therapy for depression. Future research should aim to refine these aspects of the intervention to achieve a beneficial impact.


Assuntos
Depressão , Autogestão , Depressão/terapia , Humanos , Internet , Psicoterapia , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
BMC Psychiatry ; 21(1): 418, 2021 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-34419010

RESUMO

BACKGROUND: Depression and chronic diseases are frequently comorbid public health problems. However, clinical guidelines often fail to consider comorbidities. This study protocol describes a cluster randomized trial (CRT) aimed to compare the effectiveness of a collaborative, computer-assisted, psycho-educational intervention versus enhanced usual care (EUC) in the treatment of depressed patients with hypertension and/or diabetes in primary care clinics (PCC) in Santiago, Chile. METHODS: Two-arm, single-blind, CRT carried out at two municipalities in Santiago, Chile. Eight PCC will be randomly assigned (1:1 ratio within each municipality, 4 PCC in each municipality) to the INTERVENTION or EUC. A total of 360 depressed patients, aged at least 18 years, with Patient Health Questionnaire-9 Item [PHQ-9] scores ≥15, and enrolled in the Cardiovascular Health Program at the participating PCC. Patients with alcohol/substance abuse; current treatment for depression, bipolar disorder, or psychosis; illiteracy; severe impairment; and resident in long-term care facilities, will be excluded. Patients in both arms will be invited to use the Web page of the project, which includes basic health education information. Patients in the INTERVENTION will receive eight sessions of a computer-assisted, psycho-educational intervention delivered by trained therapists, a structured telephone calls to monitor progress, and usual medical care for chronic diseases. Therapists will receive biweekly and monthly supervision by psychologist and psychiatrist, respectively. A monthly meeting will be held between the PCC team and a member of the research team to ensure continuity of care. Patients in EUC will receive depression treatment according to clinical guidelines and usual medical care for chronic diseases. Outcome assessments will be conducted at 3, 6, and 12 months after enrollment. The primary outcome will be depression improvement at 6 months, defined as ≥50% reduction in baseline PHQ-9 scores. Intention-to-treat analyses will be performed. DISCUSSION: This study will be one of the first to provide evidence for the effectiveness of a collaborative, computer-assisted, psycho-educational intervention for depressed patients with chronic disease at primary care in a Latin American country. TRIAL REGISTRATION: retrospectively registered in ClinicalTrials.gov , first posted: November 3, 2020, under identifier: NCT04613076 .


Assuntos
Depressão , Atenção Primária à Saúde , Adolescente , Adulto , Doença Crônica , Computadores , Depressão/terapia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego
18.
BMC Psychiatry ; 21(1): 397, 2021 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-34425770

RESUMO

BACKGROUND: Problem-solving training is a common ingredient of evidence-based therapies for youth depression and has shown effectiveness as a versatile stand-alone intervention in adults. This scoping review provided a first overview of the evidence supporting problem solving as a mechanism for treating depression in youth aged 14 to 24 years. METHODS: Five bibliographic databases (APA PsycINFO, CINAHL, Embase, MEDLINE, Web of Science) and the grey literature were systematically searched for controlled trials of stand-alone problem-solving therapy; secondary analyses of trial data exploring problem-solving-related concepts as predictors, moderators, or mediators of treatment response within broader therapies; and clinical practice guidelines for youth depression. Following the scoping review, an exploratory meta-analysis examined the overall effectiveness of stand-alone problem-solving therapy. RESULTS: Inclusion criteria were met by four randomized trials of problem-solving therapy (524 participants); four secondary analyses of problem-solving-related concepts as predictors, moderators, or mediators; and 23 practice guidelines. The only clinical trial rated as having a low risk of bias found problem-solving training helped youth solve personal problems but was not significantly more effective than the control at reducing emotional symptoms. An exploratory meta-analysis showed a small and non-significant effect on self-reported depression or emotional symptoms (Hedges' g = - 0.34; 95% CI: - 0.92 to 0.23) with high heterogeneity. Removing one study at high risk of bias led to a decrease in effect size and heterogeneity (g = - 0.08; 95% CI: - 0.26 to 0.10). A GRADE appraisal suggested a low overall quality of the evidence. Tentative evidence from secondary analyses suggested problem-solving training might enhance outcomes in cognitive-behavioural therapy and family therapy, but dedicated dismantling studies are needed to corroborate these findings. Clinical practice guidelines did not recommend problem-solving training as a stand-alone treatment for youth depression, but five mentioned it as a treatment ingredient. CONCLUSIONS: On its own, problem-solving training may be beneficial for helping youth solve personal challenges, but it may not measurably reduce depressive symptoms. Youth experiencing elevated depressive symptoms may require more comprehensive psychotherapeutic support alongside problem-solving training. High-quality studies are needed to examine the effectiveness of problem-solving training as a stand-alone approach and as a treatment ingredient.


Assuntos
Terapia Cognitivo-Comportamental , Depressão , Adolescente , Adulto , Depressão/terapia , Emoções , Terapia Familiar , Humanos , Resolução de Problemas
19.
Medicine (Baltimore) ; 100(32): e26898, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397916

RESUMO

ABSTRACT: To investigate the anxiety and depression of patients with the coronavirus disease 2019 (COVID-19) who participated in Baduanjin exercise.From February 20, 2020 to March 7, 2020, the Hospital Anxiety and Depression scale (HAD) were used to investigate the anxiety and depression levels of patients with COVID-19 who participated in Baduanjin exercise. Ninety one questionnaires were received, including 40 males and 51 females. Stepwise regression analysis was used to analyze the effects of related factors on anxiety and depression levels.In Square cabin hospital, 91% of patients participated in Baduanjin exercise had no obvious anxiety and 82% had no obvious depression. The scores of anxiety and depression of female patients were significantly higher than that of male patients. Bachelor degree or above with low scores for anxiety and depression. The frequency of Baduanjin exercise was negatively correlated with anxiety and depression score.The development of Baduanjin exercise has a certain positive influence on the COVID-19 patients in the Square cabin hospital, which is conducive to alleviate anxiety and depression symptoms of the patients.


Assuntos
Ansiedade/terapia , COVID-19/complicações , Depressão/terapia , Terapia por Exercício/normas , Adulto , Ansiedade/psicologia , COVID-19/psicologia , Estudos Transversais , Depressão/psicologia , Terapia por Exercício/métodos , Terapia por Exercício/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Psicometria/métodos , Inquéritos e Questionários
20.
Behav Ther ; 52(5): 1286-1295, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34452680

RESUMO

Cognitive behavioral therapy (CBT) of depression is hypothesized to achieve its effects by correcting negative biases. However, little research has tested how biases change over the course of CBT. We focus on biases in interpersonal judgments and examine whether changes in biases occur in CBT and are associated with symptom improvements. A sample of 126 adults (60% women, mean age 31.7, 83% White) participated in CBT of depression. Observers provided ratings of patients participating in two interpersonal tasks on three occasions. Patients were asked to predict observers' ratings. In a thin slice (TS) task, observers evaluated how patients came across in a brief segment in which patients talked about themselves. In a Standard Interaction Task (SIT), observers rated the social skills patients displayed in challenging role plays. The difference between patient predictions and observer ratings provided measures of bias in these interpersonal judgments. TS and SIT bias became significantly less pessimistic and more realistic over the course of CBT. Improvements in TS bias were associated with a faster reduction in symptoms, whereas there was a non-significant trend for improvement in SIT bias being associated with faster symptom reduction. Consistent with the CBT model, negative interpersonal biases became more realistic throughout a course of CBT for depression and at least some of the changes in bias were related to therapeutic outcomes. We encourage future researchers to continue examining for whom and under which conditions correcting such biases produces the greatest benefits.


Assuntos
Terapia Cognitivo-Comportamental , Depressão , Adulto , Viés , Depressão/terapia , Feminino , Humanos , Masculino , Habilidades Sociais , Resultado do Tratamento
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