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1.
Sr Care Pharm ; 36(1): 11-21, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33384030

RESUMO

Depression is common in older people, and while the approach to treatment is similar to a younger population, there are several additional treatment considerations to make based on comorbidities and cognitive impairment. Evidence-based psychotherapies such as cognitive behavioral therapy, interpersonal psychotherapy, and problem-solving therapy are recommended for mild-moderate depression in older people; however, the efficacy of these are limited in very old patients (older than 75 years of age) and those with cognitive impairment. Additionally, neuromodulation treatments such as electroconvulsive therapy and transcranial magnetic stimulation could prove beneficial for specific older people with depression. Use of pharmacotherapy that has demonstrated to be safe in older adults, as well as agents with adequate clinical experience in this population, should be considered based on patient-specific characteristics. Because of generally more complex medication regimens, risks of pharmacotherapy should be minimized with careful dosing strategies and special attention to avoid significant drug-drug interactions. While some data are available, antidepressant combination or augmentation strategies are less well studied in older people who fail to achieve remission or those with treatment-resistant depression, compared with younger populations.


Assuntos
Terapia Cognitivo-Comportamental , Depressão , Transtorno Depressivo , Idoso , Idoso de 80 Anos ou mais , Antidepressivos/uso terapêutico , Depressão/terapia , Transtorno Depressivo/terapia , Humanos , Psicoterapia
3.
Medicine (Baltimore) ; 99(50): e23510, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327293

RESUMO

BACKGROUND: Percutaneous coronary intervention (PCI) has been increasingly applied as an effective revascularization strategy in patients with coronary artery disease (CAD). However, recent studies had indicated a higher incidence of depression on post-PCI patients. Acupuncture therapy is effective for depression. However, the treatment effect of depression on post-PCI patients is still not clear. Therefore, this systematic review and meta-analysis protocol is planned to evaluate the efficacy and safety of acupuncture for depression in post-PCI patients. METHODS: Six English databases (PubMed, Web of science, Medline, EMBASE, Springer Cochrane Library and WHO International Clinical Trials Registry Platform) and 4 Chinese databases (Wan fang Database, Chinese Scientific Journal Database, China National Knowledge Infrastructure Database (CNKI) and Chinese Biomedical Literature Database) will be searched normatively according to the rule of each database from the inception to August 1, 2020. Two reviewers will independently conduct article selection, data collection, and risk of bias evaluation. Any disagreement will be resolved by discussion with the third reviewer. Either the fixed-effects or random-effects model will be used for data synthesis based on the heterogeneity test. The change in the scores on the Hamilton depression scale (HAMD) and the Self-rating depression scale (SDS) will be used as the main outcome measure. All-cause mortality, cardiac mortality, Major Adverse Cardiovascular Events (MACEs), rehospitalisation rate and Quality of Life Scale (SF-36) as the secondary outcome. Treatment Emergent Symptom Scale (TESS), General physical examination (temperature, pulse, respiration, blood pressure), Routine examination of blood, urine and stool, Electrocardiogram, Liver and kidney function examination as the security indexs. RevMan5.3.5 will be used for meta-analysis. RESULTS: This study will provide high-quality evidence to assess the efficacy and safety of acupuncture for depression in post-PCI patients. CONCLUSION: This systematic review will explore whether acupuncture is an effective and safe intervention for depression in post-PCI patients.


Assuntos
Terapia por Acupuntura , Transtorno Depressivo/terapia , Intervenção Coronária Percutânea , Humanos , Complicações Pós-Operatórias/terapia
4.
PLoS One ; 15(10): e0240466, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33045002

RESUMO

Depressive symptoms are a serious problem in workplaces. Hospital staff members, such as newly licensed registered nurses (NLRNs), are at particularly increased risk of these symptoms owing to their limited experience. Previous studies have shown that a brief program-based cognitive behavioral therapy program (CBP) can offer effective treatment. Here, we conducted a longitudinal observational study of 683 NLRNs (CBP group, n = 522; no-CBP group, n = 181) over a period of 1 year (six times surveys were done during this period). Outcomes were assessed on the basis of surveys that covered the Beck Depression Inventory-I (BDI). The independent variables were CBP attendance (CBP was conducted 3 months after starting work), personality traits, personal stressful life events, workplace adversity, and pre-CBP change in BDI in the 3 months before CBP (ΔBDIpre-CBP). All factors were included in Cox proportional hazards models with time-dependent covariates for depressive symptoms (BDI ≥10), and we reported hazard ratios (HRs). Based on this analysis, we detected that CBP was significantly associated with benefit for depressive symptoms in all NLRNs (Puncorrected = 0.0137, HR = 0.902). To identify who benefitted most from CBP, we conducted a subgroup analysis based on the change in BDI before CBP (ΔBDIpre-CBP). The strongest association was when BDI scores were low after starting work and increased before CBP (Puncorrected = 0.00627, HR = 0.616). These results are consistent with previous findings, and indicate that CBP may benefit the mental health of NLRNs. Furthermore, selective prevention based on the pattern of BDI change over time may be important in identifying who should be offered CBP first. Although CBP is generally effective for all nurses, such a selective approach may be most appropriate where cost-effectiveness is a prominent concern.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo/terapia , Recursos Humanos de Enfermagem no Hospital/psicologia , Estresse Psicológico/complicações , Adulto , Transtorno Depressivo/etiologia , Transtorno Depressivo/psicologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Prognóstico , Inquéritos e Questionários , Adulto Jovem
5.
Medicina (Kaunas) ; 56(9)2020 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-32867260

RESUMO

The positive impact of probiotic strains on human health has become more evident than ever before. Often delivered through food, dietary products, supplements, and drugs, different legislations for safety and efficacy issues have been prepared. Furthermore, regulatory agencies have addressed various approaches toward these products, whether they authorize claims mentioning a disease's diagnosis, prevention, or treatment. Due to the diversity of bacteria and yeast strains, strict approaches have been designed to assess for side effects and post-market surveillance. One of the most essential delivery systems of probiotics is within food, due to the great beneficial health effects of this system compared to pharmaceutical products and also due to the increasing importance of food and nutrition. Modern lifestyle or various diseases lead to an imbalance of the intestinal flora. Nonetheless, as the amount of probiotic use needs accurate calculations, different factors should also be taken into consideration. One of the novelties of this review is the presentation of the beneficial effects of the administration of probiotics as a potential adjuvant therapy in COVID-19. Thus, this paper provides an integrative overview of different aspects of probiotics, from human health care applications to safety, quality, and control.


Assuntos
Infecções por Coronavirus/prevenção & controle , Suplementos Nutricionais/normas , Gastroenteropatias/terapia , Hepatopatias/terapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Probióticos/uso terapêutico , Betacoronavirus , Doença Celíaca/terapia , Infecções por Clostridium/terapia , Constipação Intestinal/terapia , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/terapia , Transtorno Depressivo/terapia , Doenças Diverticulares/terapia , Disenteria/terapia , Enterocolite Necrosante/terapia , Alimentos e Bebidas Fermentados , Hipersensibilidade Alimentar/terapia , Infecções por Helicobacter/terapia , Encefalopatia Hepática/terapia , Humanos , Doenças Inflamatórias Intestinais/terapia , Hepatopatia Gordurosa não Alcoólica/terapia , Pneumonia Viral/terapia , Probióticos/efeitos adversos , Probióticos/normas , Controle de Qualidade
6.
J Clin Psychiatry ; 81(6)2020 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-32965804

RESUMO

OBJECTIVE: This study used commercial claims data to examine the effects of ADHD and sex on the prevalence of depression, suicidal ideation, and suicide attempts in a sample of young adult men and women (aged 18-25 years) with and without attention-deficit/hyperactivity disorder (ADHD). Patterns of treatment use for these conditions was also explored. METHODS: Young adults with ADHD (162,263 women and 225,705 men) having at least 2 claims with the International Classification of Diseases, Ninth Revision (ICD-9), code for ADHD and a sex- and age-matched group of young adults without an ICD-9 code for ADHD (162,263 women and 225,705 men) were identified. The prevalence of ICD-9 depression and suicidal behavior along with the use and cost of related treatment were compared between young adults with and without ADHD using 2014 claims data. RESULTS: Compared to young adults without ADHD, young adults with ADHD were more frequently identified with depression, suicidal ideation, and suicide attempts. Depression and suicidal ideation were identified more frequently among women with ADHD compared to all other groups. Young adults with ADHD were more frequently engaged in outpatient and inpatient mental health care compared to young adults without ADHD (P < .0001 in each instance). Furthermore, overall costs of outpatient and inpatient care were greater among young adults with ADHD compared to young adults without ADHD (P < .0001 in each instance). CONCLUSIONS: These findings highlight the substantial burden of depression and suicidal behavior among young adults with ADHD, particularly women, and underlie the need for more research focused on mitigating risk for depression and suicidal behavior among both men and women with ADHD.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtorno Depressivo , Seguro Saúde , Serviços de Saúde Mental , Ideação Suicida , Tentativa de Suicídio , Adolescente , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/economia , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Comorbidade , Transtorno Depressivo/economia , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/terapia , Feminino , Custos de Cuidados de Saúde , Humanos , Seguro Saúde/economia , Seguro Saúde/estatística & dados numéricos , Classificação Internacional de Doenças , Masculino , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/estatística & dados numéricos , Prevalência , Fatores Sexuais , Tentativa de Suicídio/economia , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto Jovem
7.
Lancet Psychiatry ; 7(10): 851-864, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32866459

RESUMO

BACKGROUND: The effectiveness of digital psychological interventions in low-income and middle-income countries (LMICs) remains unclear. We aimed to systematically investigate the available evidence for digital psychological interventions in reducing mental health problems in LMICs. METHODS: In this systematic review and meta-analysis, we searched PubMed, PsycINFO, Embase, and Cochrane databases for articles published in English from database inception to March 9, 2020. We included randomised controlled trials investigating digital psychological interventions in individuals with mental health problems in LMICs. We extracted data on demographics, inclusion and exclusion criteria, details of the intervention, including the setting, digital delivery method, control group conditions, number of sessions, therapeutic orientation (eg, cognitive therapy or behaviour therapy), presence or absence of guidance, and length of follow-up, and statistical information to calculate effect sizes. If a study reported insufficient data to calculate effect sizes, the corresponding authors were contacted to provide data that could be aggregated. We did random-effects meta-analyses, and calculated the standardised mean difference in scores of digital psychological interventions versus control conditions (Hedges'g). Quality of evidence was assessed by use of the Grading of Recommendations Assessment, Development, and Evaluation approach. The primary outcome was post-intervention mental health problems, as measured by self-reporting instruments or clinical interviews. This study is registered with PROSPERO, CRD42019137755. FINDINGS: We identified 22 eligible studies that were included in the meta-analysis. The included studies involved a total of 4104 participants (2351 who received a digital psychological intervention and 1753 who were in the control group), and mainly focused on young adults (mean age of the study population was 20-35 years) with depression or substance misuse. The results showed that digital psychological interventions are moderately effective when compared with control interventions (Hedges'g 0·60 [95% CI 0·45-0·75]; Hedges'g with treatment as usual subgroup for comparison 0·54 [0·35-0·73]). Heterogeneity between studies was substantial (I2=74% [95% CI 60-83]). There was no evidence of publication bias, and the quality of evidence according to the GRADE criteria was generally high. INTERPRETATION: Digital psychological interventions, which have been mostly studied in individuals with depression and substance misuse, are superior to control conditions, including usual care, and are moderately effective in LMICs. However, the considerable heterogeneity observed in our analysis highlights the need for more studies to be done, with standardised implementation of digital psychological intervention programmes to improve their reproducibility and efficiency. Digital psychological interventions should be considered for regions where usual care for mental health problems is minimal or absent. FUNDING: None. TRANSLATIONS: For the Persian, Chinese, Hindi, Portuguese, Bahasa, Turkish, Romanian, Spanish and Thai translations of the abstract see Supplementary Materials section.


Assuntos
Transtorno Depressivo/terapia , Psicoterapia/métodos , Transtornos Relacionados ao Uso de Substâncias/terapia , Telemedicina/métodos , Países em Desenvolvimento , Humanos , Avaliação de Resultados em Cuidados de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
Medicine (Baltimore) ; 99(39): e22375, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991457

RESUMO

BACKGROUND: Depressive disorder has gradually become one of the most commonly reported disabling psychiatric complication that occurs after traumatic brain injury (TBI). Currently classical antidepressant medications may not have the same effectiveness in patients with TBI as in patients without TBI. Non-pharmacological interventions have been considered to be effective for managing depressive symptoms or treating depressive disorder. But to date the comparative effectiveness of various types of non-pharmacological interventions has been synthesized in few studies, the evidence remains inconclusive. Thus, the purpose of this systematic review and network meta-analyses is to summarize high-quality evidence and identify the most effective non-pharmacological intervention when applied to treat the depressive disorder in patients after TBI. METHODS: The comprehensive literature search in electronic database including PubMed, Ovid Medline, Cochrane Library, Web of Science database, Embase Database, China National Knowledge Infrastructure (CNKI), and Wanfang Data Chinese database from inception to the search date. Only high-quality randomized controlled trials (RCTs) that have used non-pharmacological interventions to treat depressive disorder after TBI will be considered. Two independent reviewers will identify eligible studies, extract and manage data information, and then determine methodical quality of included studies. Overall efficacy will be assessed as primary outcome. Secondary outcomes involved treatment response, remission rate, overall acceptability, tolerability of treatment, social functioning, occurrence of adverse events, and suicide-related outcome. Cochrane risk of bias assessment tool will be adopted to assess the risk of bias. Study heterogeneity will be measured by the I statistic. Traditional pairwise meta-analyses will be performed using STATA, while WinBUGS with GeMTC package of R software will be used to carry out network meta-analysis. RESULTS: This systematic review will examine the relative efficacy, effectiveness, safety, tolerability and acceptability of non-pharmacological interventions, and then to identify the most effective non-pharmacological intervention for depressive disorder after TBI. EXPECTED CONCLUSION: Our work could be used to give clinical recommendations for practice guideline developers, psychiatrist, neurologist, policymakers, researchers as well as individual with depressive disorder after TBI, and will also identify gaps in knowledge that could be the subject of future research. ETHICS AND DISSEMINATION: Neither ethics approval nor patient informed consent is necessary since this protocol was designed based on the existing literature. The results will be disseminated electronically or in print through publications in peer-reviewed scientific journal. INPLASY REGISTRATION: INPLASY202080022.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Transtorno Depressivo/terapia , Transtorno Depressivo/etiologia , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
11.
Medicine (Baltimore) ; 99(33): e21451, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871992

RESUMO

BACKGROUND: Mental health is closely related to the occurrence of hypertension, particularly the prognosis of hypertension patients. The role of psychotherapy in the occurrence, development, prevention, and prognosis of hypertension, remains to be clarified. METHODS/DESIGN: We will conduct a prospective, double-blind, randomized, multiple-centers study. Eighty patients enrolled in this trial will be randomized at 1:1 ratio. The primary endpoint is will be the reduction of the patient psychological scale (PHQ-9) score. Secondary endpoints will be the drop in blood pressure, awareness of physical and mental health and self-efficacy scale. Measurements will be performed at baseline, 5-week (questionnaires only), 10-week (primary endpoint), using the Anxiety Screening Questionnaire (GAD-7) and Depression Scale (PHQ-9). Data analysis will be carried out using the SPSS v.25 software assuming a level of significance of 5%. Results will be analyzed using multilevel, regression analysis and hierarchical linear models. DISCUSSION: We hope to provide some insight in the understanding the underlying mechanism of the novel mindfulness in the management of hypertension related psychological stress/disturbance, and will enable us to develop novel approach to manage essential hypertension and its related psychological disorders. CLINICAL TRIAL REGISTRY:: http://www.chictr.org.cn (ChiCTR1900028258).


Assuntos
Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Transtorno Depressivo/psicologia , Transtorno Depressivo/terapia , Hipertensão/psicologia , Hipertensão/terapia , Psicoterapia/métodos , Método Duplo-Cego , Humanos , Prognóstico , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Ensaios Clínicos Controlados Aleatórios como Assunto
12.
BMC Psychiatry ; 20(1): 427, 2020 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-32859177

RESUMO

BACKGROUND: Depression is associated with major patient burden. Its treatment requires complex and collaborative approaches. A stepped care model based on the German National Clinical Practice Guideline "Unipolar Depression" has been shown to be effective. In this study we assess the cost-effectiveness of this guideline based stepped care model versus treatment as usual in depression. METHODS: This prospective cluster-randomized controlled trial included 737 depressive adult patients. Primary care practices were randomized to an intervention (IG) or a control group (CG). The intervention consisted of a four-level stepped care model. The CG received treatment as usual. A cost-utility analysis from the societal perspective with a time horizon of 12 months was performed. We used quality-adjusted life years (QALY) based on the EQ-5D-3L as effect measure. Resource utilization was assessed by patient questionnaires. Missing values were imputed by 'multiple imputation using chained equations' based on predictive mean matching. We calculated adjusted group differences in costs and effects as well as incremental cost-effectiveness ratios. To describe the statistical and decision uncertainty cost-effectiveness acceptability curves were constructed based on net-benefit regressions with bootstrapped standard errors (1000 replications). The complete sample and subgroups based on depression severity were considered. RESULTS: We found no statically significant differences in costs and effects between IG and CG. The incremental total societal costs (+€5016; 95%-CI: [-€259;€10,290) and effects (+ 0.008 QALY; 95%-CI: [- 0.030; 0.046]) were higher in the IG in comparison to the CG. Significantly higher costs were found in the IG for outpatient physician services and psychiatrist services in comparison to the CG. Significantly higher total costs and productivity losses in the IG in comparison to the CG were found in the group with severe depression. Incremental cost-effectiveness ratios for the IG in comparison to the CG were unfavourable (complete sample: €627.000/QALY gained; mild depression: dominated; moderately severe depression: €645.154/QALY gained; severe depression: €2082,714/QALY gained) and the probability of cost-effectiveness of the intervention was low, except for the group with moderate depression (ICER: dominance; 70% for willingness-to-pay threshold of €50,000/QALY gained). CONCLUSIONS: We found no evidence for cost-effectiveness of the intervention in comparison to treatment as usual. TRIAL REGISTRATION: NCT, NCT01731717 . Registered 22 November 2012 - Retrospectively registered.


Assuntos
Depressão , Transtorno Depressivo , Adulto , Análise Custo-Benefício , Depressão/terapia , Transtorno Depressivo/terapia , Humanos , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida
13.
Artigo em Inglês | MEDLINE | ID: mdl-32854200

RESUMO

Obesity is currently becoming a serious global public health problem due to its high prevalence and continuous increase. This condition is associated with different physical and mental health problems. The presence of emotional disorders (anxiety, depression and related disorders) among candidates for bariatric surgery is very high and predicts worse physical and psychological results. The present study aims to explore the feasibility and clinical usefulness of the Unified Protocol, a transdiagnostic emotion regulation-based intervention, delivered in an online group format to patients with emotional disorder diagnosis or symptoms, who are waiting for bariatric surgery. We will conduct a pilot study with a repeated single-case experimental design (multiple baseline design) in a public mental health service. The sample will consist of 60 participants, who will be randomized to three baseline conditions: 8, 12 or 15 evaluation days before the intervention. Diagnostic criteria, symptomatology and body mass index are the primary outcome measures, and we will include affectivity, personality, quality of life, body image, eating behavior and surgical complications like secondary measures. An analysis of treatment satisfaction will be also performed. Assessment points will include pre-treatment, baseline, treatment, post-treatment, and follow-ups every three months until two years after post-treatment. The results obtained in this study may have important clinical, social and economic implications for public mental health.


Assuntos
Transtornos de Ansiedade/terapia , Cirurgia Bariátrica/psicologia , Assistência à Saúde , Transtorno Depressivo/terapia , Internet , Obesidade/psicologia , Psicoterapia/métodos , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Protocolos Clínicos , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Emoções , Estudos de Viabilidade , Humanos , Obesidade/cirurgia , Projetos Piloto , Qualidade de Vida , Projetos de Pesquisa
14.
BMC Psychol ; 8(1): 57, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503649

RESUMO

BACKGROUND: The aim of this randomized wait-list controlled trial was to explore the effects of Mindfulness-Based Cognitive Therapy (MBCT) on risk and protective factors for depressive relapse within the domains of cognition, emotion and self-relatedness. METHODS: Sixty-eight individuals with recurrent depressive disorder were randomized to MBCT or a wait-list control condition (WLC). RESULTS: Completers of MBCT (N = 26) improved significantly on measures assessing risk and protective factors of recurrent depression compared to WLC (N = 30) on measures of rumination (d = 0.59, p = .015), emotion regulation (d = 0.50, p = .028), emotional reactivity to stress (d = 0.32, p = .048), self-compassion (d = 1.02, p < .001), mindfulness (d = 0.59, p = .010), and depression (d = 0.40, p = .018). In the Intention To Treat sample, findings were attenuated, but there were still significant results on measures of rumination, self-compassion and depression. CONCLUSIONS: Findings from the present trial contribute to evidence that MBCT can lead to reduction in risk factors of depressive relapse, and strengthening of factors known to be protective of depressive relapse. The largest changes were found in the domain of self-relatedness, in the form of large effects on the participants' ability to be less self-judgmental and more self-compassionate. TRIAL REGISTRATION: ISRCTN, ISRCTN18001392. Registered 29 June 2018.


Assuntos
Terapia Cognitivo-Comportamental , Transtorno Depressivo/terapia , Atenção Plena , Adulto , Idoso , Doença Crônica , Transtorno Depressivo/psicologia , Empatia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Plena/métodos , Recidiva , Resultado do Tratamento , Listas de Espera
15.
J Consult Clin Psychol ; 88(8): 757-773, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32551725

RESUMO

OBJECTIVE: The study explored the presence of different patterns of change in a sample of patients who received cognitive therapy for depression sequentially in two different formats: group and individual. Our hypothesis was that patients' baseline characteristics (e.g., symptom severity, self-esteem) would discriminate patterns of response to group and individual therapy. METHOD: 108 adults who met criteria for depression and completed the treatments included in a randomized controlled trial (RCT) were assessed with the Beck Depression Inventory-II (BDI-II), the Clinical Outcome in Routine Evaluation-Short Form B (CORE-SFB), the Global Assessment of Functioning (GAF), and the repertory grid technique. Growth mixture modeling was carried out to identify the patterns of change. Mixed linear models and repeated measures analysis of variance were performed to compare patients' characteristics in each pattern. Multinomial logistic regression was used to compute predictive models for the patterns from patients' characteristics. Finally, hierarchical linear regression was used to establish the power of each pattern to predict treatment outcome. RESULTS: A 3-class solution was obtained: group therapy improvers, individual therapy improvers, and nonimprovers. Group therapy improvers started therapy with less severe levels of depression and psychological distress, higher functioning and self-esteem, lower perceived social isolation, and lower dilemmatic construction of the self than the other groups. Individual therapy improvers and nonimprovers presented similar characteristics at baseline. However, a significant proportion of nonimprovers presented a concurrent diagnosis of fibromyalgia. CONCLUSION: The greater the impairment that patients present at baseline, the more likely they are to benefit from individual therapy after group therapy. A diagnosis of fibromyalgia can be considered a risk factor for therapy failure in the treatment of depression. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Terapia Cognitivo-Comportamental , Transtorno Depressivo/terapia , Avaliação de Resultados em Cuidados de Saúde , Psicoterapia de Grupo , Adulto , Terapia Cognitivo-Comportamental/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Psicoterapia de Grupo/métodos
16.
BMC Public Health ; 20(1): 936, 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32539708

RESUMO

BACKGROUND: The United States experienced severe mental health budget cuts in many states across the nation during the years of the largest recession since the Great Depression. Illinois had one of the hardest hit mental health budgets in the country. The massive mental health funding cuts in Illinois, combined with the state's budget impasse, left fewer facilities available to provide treatment and support to those in need. Many of Illinois's most vulnerable populations either had reduced access, or no access to care. Serious spillover effects were felt by emergency rooms, community hospitals, and the criminal justice system. Therefore, the purpose of this research is to examine disparities in Health Related Quality of Life for those with depression after the funding cuts in Illinois. METHODS: Data from the 2017 Behavior Risk Factor Surveillance System was analyzed by using multivariate logistic regression models of the Health Related Quality of Life measures for Illinoisans diagnosed with depressive disorders. RESULTS: According to the regression models in this study, disparities exist in HRQOL for Illinoisans with depressive disorders. In all of the HRQOL models, income was associated with a reduction in HRQOL. Additionally, disparities exist in HRQOL for certain age groups and those who are unemployed. Interestingly, the models did not show any racial disparities as anticipated. CONCLUSION: Without the basic policy-level deficiencies addressed, disparities in Health Related Quality of Life for Illinois's most vulnerable populations will continue to exist as will costly economic spillover effects.


Assuntos
Transtorno Depressivo/economia , Transtorno Depressivo/terapia , Acesso aos Serviços de Saúde/economia , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Saúde Mental/economia , Qualidade da Assistência à Saúde/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Sistema de Vigilância de Fator de Risco Comportamental , Transtorno Depressivo/epidemiologia , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Illinois/epidemiologia , Masculino , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde/estatística & dados numéricos , Qualidade de Vida , Adulto Jovem
17.
Lancet Psychiatry ; 7(7): 581-601, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32563306

RESUMO

BACKGROUND: Depressive disorders are common in children and adolescents. Antidepressants, psychotherapies, and their combination are often used in routine clinical practice; however, available evidence on the comparative efficacy and safety of these interventions is inconclusive. Therefore, we sought to compare and rank all available treatment interventions for the acute treatment of depressive disorders in children and adolescents. METHODS: We did a systematic review and network meta-analysis. We searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, PsycINFO, ProQuest, CINAHL, LiLACS, international trial registries, and the websites of regulatory agencies for published and unpublished randomised controlled trials from database inception until Jan 1, 2019. We included placebo-controlled and head-to-head trials of 16 antidepressants, seven psychotherapies, and five combinations of antidepressant and psychotherapy that are used for the acute treatment of children and adolescents (≤18 years old and of both sexes) with depressive disorder diagnosed according to standard operationalised criteria. Trials recruiting participants with treatment-resistant depression, bipolar disorder, psychotic depression, treatment duration of less than 4 weeks, or an overall sample size of fewer than ten patients were excluded. We extracted data following a predefined hierarchy of outcome measures, and assessed risk of bias and certainty of evidence using validated methods. Primary outcomes were efficacy (change in depressive symptoms) and acceptability (treatment discontinuation due to any cause). We estimated summary standardised mean differences (SMDs) or odds ratios (ORs) with credible intervals (CrIs) using network meta-analysis with random effects. This study was registered with PROSPERO, number CRD42015020841. FINDINGS: From 20 366 publications, we included 71 trials (9510 participants). Depressive disorders in most studies were moderate to severe. In terms of efficacy, fluoxetine plus cognitive behavioural therapy (CBT) was more effective than CBT alone (-0·78, 95% CrI -1·55 to -0·01) and psychodynamic therapy (-1·14, -2·20 to -0·08), but not more effective than fluoxetine alone (-0·22, -0·86 to 0·42). No pharmacotherapy alone was more effective than psychotherapy alone. Only fluoxetine plus CBT and fluoxetine were significantly more effective than pill placebo or psychological controls (SMDs ranged from -1·73 to -0·51); and only interpersonal therapy was more effective than all psychological controls (-1·37 to -0·66). Nortriptyline (SMDs ranged from 1·04 to 2·22) and waiting list (SMDs ranged from 0·67 to 2·08) were less effective than most active interventions. In terms of acceptability, nefazodone and fluoxetine were associated with fewer dropouts than sertraline, imipramine, and desipramine (ORs ranged from 0·17 to 0·50); imipramine was associated with more dropouts than pill placebo, desvenlafaxine, fluoxetine plus CBT, and vilazodone (2·51 to 5·06). Most of the results were rated as "low" to "very low" in terms of confidence of evidence according to Confidence In Network Meta-Analysis. INTERPRETATION: Despite the scarcity of high-quality evidence, fluoxetine (alone or in combination with CBT) seems to be the best choice for the acute treatment of moderate-to-severe depressive disorder in children and adolescents. However, the effects of these interventions might vary between individuals, so patients, carers, and clinicians should carefully balance the risk-benefit profile of efficacy, acceptability, and suicide risk of all active interventions in young patients with depression on a case-by-case basis. FUNDING: National Key Research and Development Program of China.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo/terapia , Psicoterapia/métodos , Adolescente , Antidepressivos/efeitos adversos , Criança , Medicina Baseada em Evidências , Humanos , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto
18.
J Fam Pract ; 69(5): 221-227, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32555752

RESUMO

Conventional medications and psychotherapy are still first-line treatments, but certain complementary and alternative strategies have value as adjunctive measures.


Assuntos
Transtornos de Ansiedade/terapia , Terapias Complementares , Transtorno Depressivo/terapia , Adulto , Humanos
19.
Complement Ther Med ; 50: 102202, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32444032

RESUMO

PURPOSE: To provide an overview of existing meta-analysis (MAs) on the efficacy and safety of acupuncture for depression, and assess the methodological quality and the strength of evidence of the included MAs. METHODS: We searched MAs of randomized trials that have evaluated the effects of acupuncture on depression in three international and three Chinese databases from their inception until August 2019. The methodological quality of included MAs was evaluated with the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), and the strength of evidence with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). We used the intra-class correlation coefficient (ICC) to assess reviewer agreement in the pre-experiment. RESULTS: We included 31 MAs and 59 RCTs. The results of included MAs were conflicting, our meta-analyses found that acupuncture may confer small benefit in reducing the severity of depression by end of treatment than no treatment/wait list/treatment as usual(SMD -0.74, 95% CI -1.06 to -0.41, eight trials, 624 participants), control acupuncture (invasive, non-invasive sham controls) (SMD 0.27, 95% CI -0.51 to -0.04, 20 trials, 1055 participants), antidepressants(Selective serotonin reuptake inhibitors (SSRI)/ Tetracyclic antidepressants(TCAs)) (SMD -0.28, 95% CI -0.46 to -0.10, 30 trials, 3068 participants), acupuncture plus antidepressants versus antidepressants(SSRI/TCAs) (SMD -0.99, 95% CI -1.37 to -0.61, 17 trials, 1110 participants). Subgroup analyses showed that there was no difference between electro-acupuncture and invasive control (P = 0.37), electro-acupuncture and non-invasive control (P = 0.90), manual acupuncture and Tetracyclic antidepressants (P = 0.57), electro-acupuncture and Tetracyclic antidepressants (P = 0.07). Six MAs concluded that acupuncture reduced the incidence of adverse events compared with antidepressants. The evaluation with AMSTAR-2 showed that the quality of included MAs was low or critically low. The results of the GRADE evaluation showed that the strength of evidence was low to very low for most outcomes. CONCLUSIONS: Although acupuncture appears to be more effective and safer than no treatment, control acupuncture and antidepressants, the quality of the available evidence was very low. Further methodologically rigorous and adequately powered primary studies are needed to confirm the effectiveness of acupuncture for depression.


Assuntos
Terapia por Acupuntura , Transtorno Depressivo/terapia , Humanos , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto
20.
Encephale ; 46(3S): S40-S42, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32370981

RESUMO

The recent COVID-19 pandemic has led to major organisational changes in health care settings, especially in psychiatric hospitals. We conducted a national online survey to assess the evolution of electroconvulsive therapy (ECT) in the different centres practicing this treatment. 65 responses from all over France were analysed. More than 90 % of the centres practising ECT experienced a decrease in their activity. Half of the centres experienced a total cessation of activity and 25 % of the centres experienced a decrease of more than half of their usual activity. Post-pandemic COVID-19 psychiatric care is expected to be difficult. It is essential not to add to this difficulty the complications, often serious, that will be associated with delaying or stopping the practice of ECT. It will also be necessary to remain vigilant with regard to the specific neuropsychiatric consequences that will follow the pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Eletroconvulsoterapia/tendências , Hospitais Psiquiátricos/organização & administração , Pandemias , Pneumonia Viral , Transtorno Bipolar/terapia , Controle de Doenças Transmissíveis , Continuidade da Assistência ao Paciente , Assistência à Saúde , Transtorno Depressivo/terapia , Eletroconvulsoterapia/estatística & dados numéricos , França , Humanos , Utilização de Procedimentos e Técnicas
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