The Effectiveness of Mindfulness-Based Cognitive Therapy in Primary Care and the Role of Depression Severity and Treatment Attendance

Abstract Objectives Evidence suggests the efficacy of mindfulness-based cognitive therapy (MBCT) to prevent depression relapse and decrease depressive symptoms during the acute phase. However, the effectiveness of MBCT in real-world heterogeneous samples treated in clinical health settings, including primary care, has received little attention. This study had two aims: (1) to evaluate the effectiveness of MBCT delivered in primary care considering pre-treatment depression scores and (2) to explore the role of participants’ characteristics on symptom improvement. Methods Data were obtained from 433 individuals who received MBCT. Participants completed the Personality Inventory for ICD-11 (PiCD) pretreatment and the Beck Depression Inventory (BDI-II) pre- and post-treatment. Results Sixty percent presented moderate-to-severe depression according to scores on the BDI-II, 18.1% presented mild depression, and 21.7% were in the non-depressed range. The severity of pre-treatment depressive symptoms was associated with outcomes. Most individuals who lacked depressive symptoms at baseline remained in the non-clinical range after the treatment. Those in the severe group benefited the most from the intervention, since 35.6% were considered recovered. Rates of deterioration ranged from 2.1 to 2.7%, depending on the depression-baseline scores. Depression severity at the entrance, attendance, and age, but not personality traits, appear to be related to symptom improvement. Conclusions According to our results, MBCT can be effectively and safely delivered in primary care.

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Transdiagnostic Mobile Health: Smartphone Intervention Reduces Depressive Symptoms in People With Mood and Psychotic Disorders

JMIR Mental Health ◽

10.2196/13202 ◽

2019 ◽

Vol 6 (4) ◽

pp. e13202 ◽

Cited By ~ 11

Author(s):

Dror Ben-Zeev ◽

Benjamin Buck ◽

Phuonguyen Vu Chu ◽

Lisa Razzano ◽

Nicole Pashka ◽

...

Keyword(s):

Depressive Symptoms ◽

Severe Depression ◽

Patient Characteristics ◽

Psychotic Symptoms ◽

Depression Severity ◽

Mild Depression ◽

Significant Group ◽

Schizophrenia Spectrum ◽

Smartphone Intervention

Background Depression is the most prevalent mental health problem. The need for effective treatments for depression far outstrips the availability of trained mental health professionals. Smartphones and other widely available technologies are increasingly being leveraged to deliver treatments for depression. Whether there are patient characteristics that affect the potency of smartphone interventions for depression is not well understood. Objective This study aimed to evaluate whether patient characteristics including clinical diagnosis, depression severity, psychosis status, and current use of antidepressant medications impact the effects of an evidence-based smartphone intervention on depressive symptoms. Methods Data were collected as part of a 2-arm randomized controlled trial comparing a multimodal smartphone intervention called FOCUS with a clinic-based intervention. Here, we report on 82 participants assigned to 12 weeks of FOCUS treatment. We conducted assessments of depressive symptoms using the Beck Depression Inventory-second edition (BDI-II) at baseline, postintervention (3 months), and follow-up (6 months). We tested for differences in the amount of improvement in BDI-II scores from baseline to posttreatment and 6-month follow-up between each of the following patient subgroups using 2 (group) × 2 (time) mixed effects models: diagnosis (ie, schizophrenia spectrum disorder vs bipolar disorder vs major depressive disorder), depression severity (ie, minimal-mild vs moderate-severe depression), psychosis status (ie, presence vs absence of psychotic symptoms), and antidepressant use (ie, taking antidepressants vs not taking antidepressants). Results The majority of participants were male (60%, 49/82), African American (65%, 53/82), and middle-aged (mean age 49 years), with a high school education or lower (62%, 51/82). There were no differences in patient demographics across the variables that were used to stratify the analyses. There was a significant group × time interaction for baseline depression severity (F1,76.8=5.26, P=.02 [posttreatment] and F1,77.4=6.56, P=.01 [6-month follow-up]). Participants with moderate or severe depression had significant improvements (t42=3.20, P=.003 [posttreatment] and t42=4.20, P<.001 [6-month follow-up]), but participants with minimal or mild depression did not (t31=0.20, P=.84 [posttreatment] and t30=0.43, P=.67 [6-month follow-up]). There were no significant group × time interactions for diagnosis, psychosis status, or antidepressant medication use. Participants with minimal or mild depression had negligible nonsignificant improvements (<1 point on the BDI-II). Reduction in depression in all other groups was larger (range 1.7-6.5 points on the BDI-II). Conclusions Our results suggest that FOCUS can be deployed to treat moderate to severe depressive symptoms among people with schizophrenia spectrum disorders, bipolar disorder, and major depressive disorder, in concert with antidepressant medications or without them, in both people with and without active psychotic symptoms. The study results are consistent with research on transdiagnostic models in psychotherapy and extend our knowledge about the potential of transdiagnostic mobile health. Trial Registration ClinicalTrials.gov NCT02421965; http://clinicaltrials.gov/ct2/show/NCT02421965 (Archived by WebCite at http://www.webcitation.org/76pyDlvAS)

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Transdiagnostic Mobile Health: Smartphone Intervention Reduces Depressive Symptoms in People With Mood and Psychotic Disorders (Preprint)

10.2196/preprints.13202 ◽

2018 ◽

Author(s):

Dror Ben-Zeev ◽

Benjamin Buck ◽

Phuonguyen Vu Chu ◽

Lisa Razzano ◽

Nicole Pashka ◽

...

Keyword(s):

Depressive Symptoms ◽

Severe Depression ◽

Patient Characteristics ◽

Psychotic Symptoms ◽

Depression Severity ◽

Mild Depression ◽

Significant Group ◽

Schizophrenia Spectrum ◽

Smartphone Intervention

BACKGROUND Depression is the most prevalent mental health problem. The need for effective treatments for depression far outstrips the availability of trained mental health professionals. Smartphones and other widely available technologies are increasingly being leveraged to deliver treatments for depression. Whether there are patient characteristics that affect the potency of smartphone interventions for depression is not well understood. OBJECTIVE This study aimed to evaluate whether patient characteristics including clinical diagnosis, depression severity, psychosis status, and current use of antidepressant medications impact the effects of an evidence-based smartphone intervention on depressive symptoms. METHODS Data were collected as part of a 2-arm randomized controlled trial comparing a multimodal smartphone intervention called FOCUS with a clinic-based intervention. Here, we report on 82 participants assigned to 12 weeks of FOCUS treatment. We conducted assessments of depressive symptoms using the Beck Depression Inventory-second edition (BDI-II) at baseline, postintervention (3 months), and follow-up (6 months). We tested for differences in the amount of improvement in BDI-II scores from baseline to posttreatment and 6-month follow-up between each of the following patient subgroups using 2 (group) × 2 (time) mixed effects models: diagnosis (ie, schizophrenia spectrum disorder vs bipolar disorder vs major depressive disorder), depression severity (ie, minimal-mild vs moderate-severe depression), psychosis status (ie, presence vs absence of psychotic symptoms), and antidepressant use (ie, taking antidepressants vs not taking antidepressants). RESULTS The majority of participants were male (60%, 49/82), African American (65%, 53/82), and middle-aged (mean age 49 years), with a high school education or lower (62%, 51/82). There were no differences in patient demographics across the variables that were used to stratify the analyses. There was a significant group × time interaction for baseline depression severity (F1,76.8=5.26, P=.02 [posttreatment] and F1,77.4=6.56, P=.01 [6-month follow-up]). Participants with moderate or severe depression had significant improvements (t42=3.20, P=.003 [posttreatment] and t42=4.20, P<.001 [6-month follow-up]), but participants with minimal or mild depression did not (t31=0.20, P=.84 [posttreatment] and t30=0.43, P=.67 [6-month follow-up]). There were no significant group × time interactions for diagnosis, psychosis status, or antidepressant medication use. Participants with minimal or mild depression had negligible nonsignificant improvements (<1 point on the BDI-II). Reduction in depression in all other groups was larger (range 1.7-6.5 points on the BDI-II). CONCLUSIONS Our results suggest that FOCUS can be deployed to treat moderate to severe depressive symptoms among people with schizophrenia spectrum disorders, bipolar disorder, and major depressive disorder, in concert with antidepressant medications or without them, in both people with and without active psychotic symptoms. The study results are consistent with research on transdiagnostic models in psychotherapy and extend our knowledge about the potential of transdiagnostic mobile health. CLINICALTRIAL ClinicalTrials.gov NCT02421965; http://clinicaltrials.gov/ct2/show/NCT02421965 (Archived by WebCite at http://www.webcitation.org/76pyDlvAS)

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DEPRESSION SEVERITY AND OBSTRUCTIVE SLEEP APNEA IN OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.596 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S167-S167

Author(s):

Nicholas C Boston ◽

Ryan Bennett ◽

Nikolas Cirillo ◽

Andrew Solow ◽

Nicole Fornalski ◽

...

Keyword(s):

Older Adults ◽

Obstructive Sleep Apnea ◽

Depressive Symptoms ◽

Sleep Apnea ◽

Muscle Tone ◽

Univariate Analysis ◽

Severe Depression ◽

Depression Severity ◽

Mild Depression ◽

Obstructive Sleep

Abstract Objective: The connection between obstructive sleep apnea and depression in older adults is well documented; however, to date the relationship between severity of these depressive symptoms in this population remains under-explored. As such, the current analysis examined a potential relationship between varying levels of depression severity among older adults with sleep apnea. Participants and Methods: Data was derived from a de-identified database of older adults (age>=65) from the National Alzheimer’s Coordinating Center (NACC). The sample (N=90; 50% female; 97.8% Caucasian; Mage=77 years; SDage=10.4 years) was sorted into three groups using the Neuropsychiatric Inventory Questionnaire (NPI-Q): 1) Mild Depression [n=56], 2) Moderate Depression [n=29], and 3) Severe Depression [n=5]. Results: A univariate analysis revealed an overall significant omnibus effect between sleep apnea and depression severity (F[2,4041])=16.231, p<.001), while controlling for age, race, and sex. Post-hoc comparison found that those with severe depression had significantly higher levels of sleep apnea compared to those with mild (Mdif =-.499, p = .029) and moderate (Mdif =-.597, p = .009). Conclusions: These data support the possible association between depression severity and obstructive sleep apnea. Results may be attributable to two different theories: that low serotonin levels may simultaneously influence depression, respiratory muscle-tone, and sleep disturbance, and that intermittent hypoxia may create a cascade effect of neurovascular pathology resulting in depressive symptoms. Implications of the current findings suggest it may prove beneficial to keep in mind the risks associated with sleep apnea, and more severe depression, should an individual present with either.

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AB1192 THE UNDERWORLD OF DEPRESSIVE SYMPTOMS IN RHEUMATIC DISEASES: OVERLOOKED, UNRECOGNIZED OR UNPERCEIVED?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.1998 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1886.2-1887

Author(s):

F. Ingegnoli ◽

T. Schioppo ◽

T. Ubiali ◽

V. Bollati ◽

S. Ostuzzi ◽

...

Keyword(s):

Depressive Symptoms ◽

Rheumatic Diseases ◽

Real Life ◽

Severe Depression ◽

Mild Depression ◽

Cross Sectional ◽

Online Study ◽

Social Burden ◽

Patient Health ◽

The University

Background:The concomitant presence of depressive symptoms and rheumatic diseases (RDs) impose a considerable economic and social burden on the communities as they are associated with numerous deleterious outcomes such as increased mortality, work disability, higher disease activity and worsening physical function, higher pain levels and fatigue. Despite growing interest on depressive symptoms burden in RDs, current patient perception on this topic is unknown.Objectives:Italian patients with RDs were invited to participate in an online study gauging the presence and the perception of depressive symptoms using the Patient Health Questionnaire (PHQ-9).Methods:This was a cross-sectional no-profit online study to screen the presence and the perception of depressive symptoms in RDs patients. All participants gave their consent to complete the PHQ-9 and they were not remunerated. Completion was voluntary and anonymous. The PHQ-9 rates the frequency of symptoms over the past 2 weeks on a 0-3 Likert-type scale. It contains the following items: anhedonia, depressed mood, trouble sleeping, feeling tired, change inappetite, guilt or worthlessness, trouble concentrating, feeling slowed down or restless, and suicidal thoughts. Patients were stratified as: <4 not depressed, 5-9 sub-clinical or mild depression, 10-14 moderate depression, 15-19 moderately severe depression and 20-27 severe depression. The survey was disseminated by ALOMAR (Lombard Association for Rheumatic Diseases) between June and October 2019.Results:192 patients took part in the study: 170 female with median age 50 years. Among respondents only 35 (18.2%) were not depressed. Depression was sub-clinical or mild in 68 (35.4%), moderate in 42 (21.9%), moderately severe in 30 (15.6%), and severe in 17 (8.9%). 16 (8.3%) of respondents declared to have depressive symptoms and 7 of 16 were under psychiatric therapy.Moreover, patients were grouped according to diagnosis.124 respondents had inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis). 23 (18.5%) were not depressed. Depression was sub-clinical or mild in 41 (33%), moderate in 26 (21%), moderately severe in 21 (17%), and severe in 13 (10.5%). Among them, 8 (6.5%) declared to have depressive symptoms depressed and 3 of 8 were under psychiatric therapy.49 respondents had a connective tissue disease or vasculitis. 11 (22.5%) were not depressed. Depression was sub-clinical or mild in 19 (38.8%), moderate in 13 (26.5%), moderately severe in 2 (4%), and severe in 4 (8.2%). Among them, 3 (6%) declared to have depressive symptoms and 1 of 6 were under psychiatric therapy.19 respondents had other rheumatic diseases. 1 (5.3%) was not depressed. Depression was sub-clinical or mild in 8 (42.1%), moderate in 3 (15.8%), moderately severe in 7 (36.8%). Among them, 5 (26.3%) declared to be depressed and 3 of 5 were under psychiatric therapy.Conclusion:Our study confirmed that the overall real-life burden of depressive symptoms is relevant in all RDs. At the same time, these results highlighted that depressive symptoms are overlook by physicians and unperceived by patients since fewer that half of respondents (46.4%) had a clinical depression (PHQ-9>10). These results suggested that screening for depression should form part of the routine clinical assessment of RD patients.Acknowledgments:We thank the Lombard Association of Rheumatic Diseases (ALOMAR) for its contribution to design and disseminate the survey, the group that sustain systemic sclerosis (GILS), and the IT service of the University of Milan.Disclosure of Interests:Francesca Ingegnoli: None declared, Tommaso Schioppo: None declared, Tania Ubiali: None declared, Valentina Bollati: None declared, Silvia Ostuzzi: None declared, Massimiliano Buoli: None declared, Roberto Caporali Consultant of: AbbVie; Gilead Sciences, Inc.; Lilly; Merck Sharp & Dohme; Celgene; Bristol-Myers Squibb; Pfizer; UCB, Speakers bureau: Abbvie; Bristol-Myers Squibb; Celgene; Lilly; Gilead Sciences, Inc; MSD; Pfizer; Roche; UCB

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PMH50 THE ROLE OF PRE-TREATMENT EXPECTANCY ON THE OUTCOME OF PRIMARY CARE TREATMENTS FOR DEPRESSION

Value in Health ◽

10.1016/s1098-3015(10)66951-3 ◽

2008 ◽

Vol 11 (6) ◽

pp. A595-A596

Author(s):

SAH Gerhards ◽

MEJB Goossens ◽

MJH Huibers ◽

LE de Graaf ◽

SMAA Evers

Keyword(s):

Primary Care ◽

Pre Treatment

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Variability in Depressive Symptoms of Cognitive Deficit and Cognitive Bias During the First 2 Years After Diagnosis in Australian Men With Prostate Cancer

American Journal of Men s Health ◽

10.1177/1557988314552669 ◽

2014 ◽

Vol 10 (1) ◽

pp. 6-13

Author(s):

Christopher F. Sharpley ◽

Vicki Bitsika ◽

David R. H. Christie

Keyword(s):

Prostate Cancer ◽

Depressive Symptoms ◽

Cognitive Bias ◽

Cognitive Deficit ◽

Depression Scale ◽

Severe Depression ◽

Background Information ◽

Cognitive Symptoms ◽

Depression Severity ◽

Symptoms Of Depression

The incidence and contribution to total depression of the depressive symptoms of cognitive deficit and cognitive bias in prostate cancer (PCa) patients were compared from cohorts sampled during the first 2 years after diagnosis. Survey data were collected from 394 patients with PCa, including background information, treatments, and disease status, plus total scores of depression and scores for subscales of the depressive symptoms of cognitive bias and cognitive deficit via the Zung Self-Rating Depression Scale. The sample was divided into eight 3-monthly time-since-diagnosis cohorts and according to depression severity. Mean scores for the depressive symptoms of cognitive deficit were significantly higher than those for cognitive bias for the whole sample, but the contribution of cognitive bias to total depression was stronger than that for cognitive deficit. When divided according to overall depression severity, patients with clinically significant depression showed reversed patterns of association between the two subsets of cognitive symptoms of depression and total depression compared with those patients who reported less severe depression. Differences in the incidence and contribution of these two different aspects of the cognitive symptoms of depression for patients with more severe depression argue for consideration of them when assessing and diagnosing depression in patients with PCa. Treatment requirements are also different between the two types of cognitive symptoms of depression, and several suggestions for matching treatment to illness via a personalized medicine approach are discussed.

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Predictors of Depression 12 Months after Cardiac Hospitalization: The Identifying Depression as a Comorbid Condition Study

Australian & New Zealand Journal of Psychiatry ◽

10.1080/j.1440-1614.2006.01927.x ◽

2006 ◽

Vol 40 (11-12) ◽

pp. 1025-1030 ◽

Cited By ~ 1

Author(s):

Geoff Schrader ◽

Frida Cheok ◽

Ann-Louise Hordacre ◽

Julie Marker

Keyword(s):

Depressive Symptoms ◽

Emotional Health ◽

Past History ◽

Depression Scale ◽

Severe Depression ◽

Self Report ◽

Comorbid Condition ◽

Multinomial Regression ◽

Mild Depression ◽

History Of

Objective: To determine characteristics which predict depression at 12 months after cardiac hospitalization, and track the natural history of depression. Method: Depressive symptoms were monitored at baseline, 3 and 12 months in a cohort of 785 patients, using the self-report Center for Epidemiological Studies Depression Scale. Multinomial regression analyses of baseline clinical and demographic variables identified characteristics associated with depression at 12 months. Results: Three baseline variables predicted moderate to severe depression at 12 months: depression during index admission, past history of emotional health problems and current smoking. For those who were depressed during cardiac hospitalization, 51% remained depressed at both 3 and 12 months. Persistence was more evident in patients who had moderate to severe depressive symptoms when hospitalized. Mild depression was as likely to persist as to remit. Conclusions: Three clinically accessible characteristics at the time of cardiac hospitalization can assist in predicting depression at 12 months and may aid treatment decisions. Depressive symptoms persist in a substantial proportion of cardiac patients up to 12 months after hospitalization.

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Subjective Social Status and Anxiety and Depressive Symptoms and Disorders among Low Income Latinos in Primary Care: The Role of Emotion Dysregulation

Cognitive Therapy and Research ◽

10.1007/s10608-017-9844-y ◽

2017 ◽

Vol 41 (5) ◽

pp. 686-698 ◽

Cited By ~ 6

Author(s):

Michael J. Zvolensky ◽

Daniel J. Paulus ◽

Jafar Bakhshaie ◽

Andres G. Viana ◽

Monica Garza ◽

...

Keyword(s):

Primary Care ◽

Depressive Symptoms ◽

Social Status ◽

Low Income ◽

Emotion Dysregulation ◽

Subjective Social Status

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Decreased Plasma Hydrogen Sulfide Level Is Associated With the Severity of Depression in Patients With Depressive Disorder

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.765664 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yuan-Jian Yang ◽

Chun-Nuan Chen ◽

Jin-Qiong Zhan ◽

Qiao-Sheng Liu ◽

Yun Liu ◽

...

Keyword(s):

Hydrogen Sulfide ◽

Synaptic Plasticity ◽

Depressive Symptoms ◽

Rating Scale ◽

Linear Regression Analysis ◽

Severe Depression ◽

Reversed Phase ◽

Multivariate Linear Regression Analysis ◽

Healthy Individuals ◽

Mild Depression

Accumulating evidence has suggested a dysfunction of synaptic plasticity in the pathophysiology of depression. Hydrogen sulfide (H2S), an endogenous gasotransmitter that regulates synaptic plasticity, has been demonstrated to contribute to depressive-like behaviors in rodents. The current study investigated the relationship between plasma H2S levels and the depressive symptoms in patients with depression. Forty-seven depressed patients and 51 healthy individuals were recruited in this study. The 17-item Hamilton Depression Rating Scale (HAMD-17) was used to evaluate depressive symptoms for all subjects and the reversed-phase high-performance liquid chromatography (RP-HPLC) was used to measure plasmaH2S levels. We found that plasma H2S levels were significantly lower in patients with depression relative to healthy individuals (P < 0.001). Compared with healthy controls (1.02 ± 0.34 μmol/L), the plasma H2S level significantly decreased in patients with mild depression (0.84 ± 0.28 μmol/L), with moderate depression (0.62 ± 0.21μmol/L), and with severe depression (0.38 ± 0.18 μmol/L). Correlation analysis revealed that plasma H2S levels were significantly negatively correlated with the HAMD-17 scores in patients (r = −0.484, P = 0.001). Multivariate linear regression analysis showed that plasma H2S was an independent contributor to the HAMD-17 score in patients (B = −0.360, t = −2.550, P = 0.015). Collectively, these results suggest that decreased H2S is involved in the pathophysiology of depression, and plasma H2S might be a potential indicator for depression severity.

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A pilot study of depression, stigma, and attitudes towards seeking professional psychological help among Arab adolescents

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh-2016-0070 ◽

2016 ◽

Vol 30 (4) ◽

Cited By ~ 8

Author(s):

Latefa A. Dardas ◽

Susan Silva ◽

Devon Noonan ◽

Leigh Ann Simmons

Keyword(s):

Public Schools ◽

Depressive Symptoms ◽

Pilot Study ◽

Severe Depression ◽

Self Report ◽

Future Research ◽

Mild Depression ◽

Cross Sectional ◽

Professional Help ◽

Moderate Depression

Abstract The Arab region has the largest proportion of young people in the world and many of the factors that contribute to the onset of depression. Yet, very little is known about the current situation of depression and its associated stigma in this region. The purpose of this pilot study was to obtain preliminary data examining clinically significant depressive symptoms, depression stigma, and attitudes towards seeking professional help for depression among a sample of Arab adolescents from Jordan. Cross-sectional data were collected from 88 adolescents attending public schools in Jordan using self-report questionnaires that were available in, or translated into, Arabic. Among the 88 adolescents, 22% reported scores suggesting mild depression and 19% reported scores suggesting moderate depression, while 24% reported scores suggesting severe depression. The most frequently reported depressive symptoms were changes in sleep patterns (76%), changes in appetite (63%), agitation (62%), and crying (61%). The majority (73%) had moderate depression stigma, and 43% had negative attitudes towards seeking professional help. Yet, 67% believed they would find relief in psychotherapy if they ever had a serious emotional crisis. Findings suggest that the prevalence of depressive symptoms may be high among Jordanian adolescents. Further, many of these adolescents may experience depression-related stigma that affects their attitudes and willingness to seek professional help. To determine the true scope of these issues, including the prevalence of depression among Jordanian adolescents, future research should obtain data from a nationally representative sample.

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