Maori cultural adaptation of a brief mental health intervention in primary care

INTRODUCTION: There are no brief psychological mental health interventions designed specifically for Maori in a primary care setting. AIM: To adapt an existing cognitive behavioural therapybased, guided self-management intervention for near-threshold mental health syndromes in primary care, for Maori, and to examine its acceptability and effectiveness. METHODS: Semi-structured interviews with primary care clinicians and Maori patients were conducted to inform adaptations to the intervention. Clinicians were then trained in intervention delivery. Patients were recruited if they self-identified as Maori, were aged 1865 years, were experiencing stress or distress and scored =35 on the Kessler-10 (K10) measure of global psychological distress. Patient and clinician satisfaction was measured through a questionnaire and semi-structured interviews. Post-intervention, patients mental health status was measured at two weeks, six weeks and three months. RESULTS: Maori adaptations included increased emphasis on forming a relationship; spirituality; increased use of Maori language and changes to imagery in the self-management booklets. Nine of the 16 patients recruited into the study completed the intervention. Patients and clinicians rated the intervention favourably and provided positive feedback. Improvement was seen in patients K10 scores using intention-to-treat rated global psychological distress following intervention. DISCUSSION: This study found that it was not difficult to adapt an existing approach and resources, and they were well received by both providers and Maori patients. Further research is required with a larger sample utilising a randomised controlled trial, to establish whether this approach is effective. KEYWORDS: Primary health care; Maori mental health; patient satisfaction; brief intervention

Download Full-text

Digital cognitive–behavioural therapy for insomnia compared with digital patient education about insomnia in individuals referred to secondary mental health services in Norway: protocol for a multicentre randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2021-050661 ◽

2021 ◽

Vol 11 (6) ◽

pp. e050661

Author(s):

Håvard Kallestad ◽

Simen Saksvik ◽

Øystein Vedaa ◽

Knut Langsrud ◽

Gunnar Morken ◽

...

Keyword(s):

Mental Health ◽

Randomised Controlled Trial ◽

Patient Education ◽

Cognitive Behavioural Therapy ◽

Controlled Trial ◽

Behavioural Therapy ◽

Group Differences ◽

Post Intervention ◽

Cognitive Behavioural ◽

Randomised Controlled

IntroductionInsomnia is highly prevalent in outpatients receiving treatment for mental disorders. Cognitive–behavioural therapy for insomnia (CBT-I) is a recommended first-line intervention. However, access is limited and most patients with insomnia who are receiving mental healthcare services are treated using medication. This multicentre randomised controlled trial (RCT) examines additional benefits of a digital adaptation of CBT-I (dCBT-I), compared with an online control intervention of patient education about insomnia (PE), in individuals referred to secondary mental health clinics.Methods and analysisA parallel group, superiority RCT with a target sample of 800 participants recruited from treatment waiting lists at Norwegian psychiatric services. Individuals awaiting treatment will receive an invitation to the RCT, with potential participants undertaking online screening and consent procedures. Eligible outpatients will be randomised to dCBT-I or PE in a 1:1 ratio. Assessments will be performed at baseline, 9 weeks after completion of baseline assessments (post-intervention assessment), 33 weeks after baseline (6 months after the post-intervention assessment) and 61 weeks after baseline (12 months after the post-intervention assessment). The primary outcome is between-group difference in insomnia severity 9 weeks after baseline. Secondary outcomes include between-group differences in levels of psychopathology, and measures of health and functioning 9 weeks after baseline. Additionally, we will test between-group differences at 6-month and 12-month follow-up, and examine any negative effects of the intervention, any changes in mental health resource use, and/or in functioning and prescription of medications across the duration of the study. Other exploratory analyses are planned.Ethics and disseminationThe study protocol has been approved by the Regional Committee for Medical and Health Research Ethics in Norway (Ref: 125068). Findings from the RCT will be disseminated via peer-reviewed publications, conference presentations, and advocacy and stakeholder groups. Exploratory analyses, including potential mediators and moderators, will be reported separately from main outcomes.Trial registration numberClinicalTrials.gov Registry (NCT04621643); Pre-results.

Download Full-text

A randomized controlled trial of a cognitive behavioural therapy-based self-management intervention for irritable bowel syndrome in primary care

Psychological Medicine ◽

10.1017/s0033291709990195 ◽

2009 ◽

Vol 40 (1) ◽

pp. 85-94 ◽

Cited By ~ 79

Author(s):

R. Moss-Morris ◽

L. McAlpine ◽

L. P. Didsbury ◽

M. J. Spence

Keyword(s):

Primary Care ◽

Irritable Bowel Syndrome ◽

Controlled Trial ◽

Behavioural Therapy ◽

The Self ◽

Self Management ◽

Randomized Controlled ◽

Management Group ◽

Cognitive Behavioural ◽

Irritable Bowel

BackgroundRecent guidelines for the treatment of irritable bowel syndrome (IBS) emphasize the need for research to facilitate home-based self-management for these patients in primary care. The aim of the current study was to test the efficacy of a manualized cognitive behavioural therapy (CBT)-based self-management programme for IBS in a pilot randomized controlled trial (RCT).MethodSixty-four primary-care patients meeting Rome criteria for IBS were randomized into either self-management plus treatment as usual (TAU) (n=31) or a TAU control condition (n=33). The self-management condition included a structured 7-week manualized programme that was self-administered in conjunction with a 1-hour face-to-face therapy session and two 1-hour telephone sessions. The primary outcome measures were the Subject's Global Assessment (SGA) of Relief and the Irritable Bowel Syndrome Severity Scoring System (IBS-SSS) assessed at baseline, end of treatment (2 months), and 3 and 6 months post-treatment.ResultsAnalysis was by intention-to-treat. Twenty-three (76.7%) of the self-management group rated themselves as experiencing symptom relief across all three time periods compared to seven (21.2%) of the TAU controls [odds ratio (OR) 12.2, 95% confidence interval (CI) 3.72–40.1]. At 8 months, 25 (83%) of the self-management group showed a clinically significant change on the IBS-SSS compared to 16 (49%) of the control group (OR 5.3, 95% CI 1.64–17.26).ConclusionsThis study provides preliminary evidence that CBT-based self-management in the form of a structured manual and minimal therapist contact is an effective and acceptable form of treatment for primary-care IBS patients.

Download Full-text

Management of irritable bowel syndrome in primary care: feasibility randomised controlled trial of mebeverine, methylcellulose, placebo and a patient self-management cognitive behavioural therapy website. (MIBS trial)

BMC Gastroenterology ◽

10.1186/1471-230x-10-136 ◽

2010 ◽

Vol 10 (1) ◽

Cited By ~ 23

Author(s):

Hazel A Everitt ◽

Rona E Moss-Morris ◽

Alice Sibelli ◽

Laura Tapp ◽

Nicholas S Coleman ◽

...

Keyword(s):

Primary Care ◽

Irritable Bowel Syndrome ◽

Randomised Controlled Trial ◽

Controlled Trial ◽

Behavioural Therapy ◽

Self Management ◽

Feasibility Randomised Controlled Trial ◽

Cognitive Behavioural ◽

Irritable Bowel ◽

Randomised Controlled

Download Full-text

A Family-Focused Intervention for Parental Mental Illness: A Practitioner Perspective

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.783161 ◽

2021 ◽

Vol 12 ◽

Author(s):

Mairead Furlong ◽

Christine Mulligan ◽

Sharon McGarr ◽

Siobhan O'Connor ◽

Sinead McGilloway

Keyword(s):

Mental Health ◽

Primary Care ◽

Mental Illness ◽

Qualitative Study ◽

Child Protection ◽

Service Providers ◽

Controlled Trial ◽

Parental Mental Illness ◽

Structured Interviews ◽

Mental Health Settings

Background: Parental mental illness (PMI) is common and can lead to children developing mental disorders. Family Talk (FT) is a well-known and widely implemented intervention designed to reduce the risk of transgenerational psychopathology. However, given the research to practise “gap,” very little qualitative research, to date, has investigated practitioner experiences in implementing FT. This study aimed to explore the practitioner-perceived barriers and facilitators to the implementation and sustainability of FT within mainstream mental health settings.Methods: This qualitative study was nested within a randomised controlled trial (RCT) of Family Talk [N = 86 families (139 parents, 221 children)] within 15 adult (AMHS), child (CAMHS), primary care mental health, and child protection sites in Ireland. Semi-structured interviews and focus groups were undertaken with a purposive sample of clinicians (n = 31) and managers (n = 10), based on their experiences of implementing FT. Interview data were transcribed verbatim, analysed using constructivist grounded theory, and informed by Fixsen's implementation science framework.Results: Service providers highlighted a number of benefits for approximately two thirds of families across different diagnoses and mental health settings (AMHS/CAMHS/primary care). Sites varied in their capacity to embed FT, with key enablers identified as acquiring managerial and organisational support, building clinician skill, and establishing interagency collaboration. Implementation challenges included: recruitment difficulties, stresses in working with multiply-disadvantaged families, disruption in delivery due to the COVID-19 global pandemic, and sustainability concerns (e.g., perceived fit of FT with organisational remit/capacity, systemic and cultural barriers to change).Conclusion: This study is only the second qualitative study ever conducted to explore practitioner experiences in implementing FT, and the first conducted within the context of an RCT and national research programme to introduce family-focused practise (FFP) for families living with PMI. The findings illuminate the successes and complexities of implementing FFP in a country without a “think family” infrastructure, whilst highlighting a number of important generalisable lessons for the implementation of FT, and other similar interventions, elsewhere.

Download Full-text

Faculty Opinions recommendation of Optimized antidepressant therapy and pain self-management in primary care patients with depression and musculoskeletal pain: a randomized controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1161063.621527 ◽

2009 ◽

Author(s):

Dan Blazer

Keyword(s):

Primary Care ◽

Randomized Controlled Trial ◽

Musculoskeletal Pain ◽

Controlled Trial ◽

Antidepressant Therapy ◽

Self Management ◽

Randomized Controlled ◽

Primary Care Patients

Download Full-text

A Prospective, Non-randomized Feasibility and Preliminary Efficacy Study of a Telemedicine-Enabled Co-management Intervention for Adults With Type 2 Diabetes and Moderate Anxiety and/or Depression

The Science of Diabetes Self-Management and Care ◽

10.1177/0145721721996305 ◽

2021 ◽

Vol 47 (2) ◽

pp. 144-152

Author(s):

Michelle F. Magee ◽

Stacey I. Kaltman ◽

Mihriye Mete ◽

Carine M. Nassar

Keyword(s):

Mental Health ◽

Type 2 Diabetes ◽

Management Program ◽

Post Intervention ◽

Convenience Sample ◽

Intervention Delivery ◽

Management Intervention ◽

Moderate Depression ◽

Patient Health

Purpose The primary aim of this pilot study was to examine the feasibility of codelivering a mental health intervention with an evidence-based type 2 diabetes (T2DM) boot camp care management program. The preliminary impact of participation on symptom scores for depression and anxiety and A1C was also examined. Methods This was a 12-week, non-randomized pilot intervention conducted with a convenience sample of adults with uncontrolled T2DM and moderate depression and/or anxiety at an urban teaching hospital. Co-management intervention delivery was via in-person and telehealth visits. Participants were assessed at baseline and 90 days. Results Participants (n = 18) were African American, majority female (83%), and age 50.7 ± 13.4 years. Significant improvements in mental health outcomes were demonstrated, as measured by a reduction in Patient Health Questionnaire − 9 scores of 2.4 ± 2.9 ( P = .01) and in Generalized Anxiety Disorder − 7 scores of 2.3 ± 1.9 ( P = .001). The pre-post intervention mean A1C improved by 3.4 ± 2.1 units from 12% ± 1.4% to 8.5% ± 1.7% ( P < .001). Conclusion The data generated in this pilot support the feasibility of delivering a diabetes and mental health co-management intervention using a combination of in-person and telemedicine visits to engage adults with T2DM and coexisting moderate depression and/or anxiety. Further research is warranted.

Download Full-text

EXPRESS: Telehealth coaching to improve self-management for secondary prevention after stroke: A randomized controlled trial of Stroke Coach

International Journal of Stroke ◽

10.1177/17474930211017699 ◽

2021 ◽

pp. 174749302110176

Author(s):

Brodie M Sakakibara ◽

Scott A Lear ◽

Susan I Barr ◽

Charles Goldsmith ◽

Amy Schneeberg ◽

...

Keyword(s):

Risk Factors ◽

Controlled Trial ◽

Cognitive Status ◽

Self Management ◽

Community Living ◽

Memory Training ◽

Stroke Survivors ◽

Post Intervention ◽

Lifestyle Behaviour ◽

Mild Stroke

Background: Stroke Coach is a lifestyle coaching telehealth program to improve self-management of stroke risk factors. Aims: To examine the efficacy of Stroke Coach on lifestyle behaviour and risk factor control among community-living stroke survivors within one-year post stroke. Methods: Participants were randomized to Stroke Coach or an attention control Memory Training group. Lifestyle behaviour was measured using the Health Promoting Lifestyle Profile II. Secondary outcomes included specific behavioural and cardiometabolic risk factors, health-related quality of life (HRQoL), cognitive status, and depressive symptoms. Measurements were taken at baseline, post-intervention (6 months), and retention (12 month). Linear mixed-effects models were used to test the study hypotheses (p<0.05). All analyses were intention-to-treat. Results: The mean age of the Stroke Coach (n=64) and Memory Training (n=62) groups was 67.2 and 69.1 years, respectively. The majority of participants (n = 100) had mild stroke (modified Rankin Scale = 1 or 2), were active, with controlled blood pressure (mean = 129/79 mmHg) at baseline. At post-intervention, there were no significant differences in lifestyle (b = -2.87; 95%CI -8.03 to 2.29; p=0.28). Glucose control, as measured by HbA1c (b = 0.17; 95%CI 0.17 to 0.32; p=0.03), and HRQoL, measured using SF-36 Physical Component Summary (b = -3.05; 95%CI -5.88 to -0.21; p=0.04), were significantly improved in Stroke Coach compared to Memory Training, and the improvements were maintained at retention. Conclusion: Stroke Coach did not improve lifestyle behaviour, however, there were improvements to HbA1c and HRQoL among community-living stroke survivors with mild stroke-related disability. (ClinicalTrials.gov identifier: NCT02207023)

Download Full-text

WHO Parents Skills Training (PST) programme for children with developmental disorders and delays delivered by Family Volunteers in rural Pakistan: study protocol for effectiveness implementation hybrid cluster randomized controlled trial

Global Mental Health ◽

10.1017/gmh.2017.7 ◽

2017 ◽

Vol 4 ◽

Cited By ~ 11

Author(s):

S. U. Hamdani ◽

P. Akhtar ◽

Zill-e-Huma ◽

H. Nazir ◽

F. A. Minhas ◽

...

Keyword(s):

Mental Health ◽

Developmental Disorders ◽

Controlled Trial ◽

Public Mental Health ◽

Skills Training ◽

Well Being ◽

Evidence Based ◽

Post Intervention ◽

Hybrid Cluster ◽

Rural Pakistan

Background.Development disorders and delays are recognised as a public health priority and included in the WHO mental health gap action programme (mhGAP). Parents Skills Training (PST) is recommended as a key intervention for such conditions under the WHO mhGAP intervention guide. However, sustainable and scalable delivery of such evidence based interventions remains a challenge. This study aims to evaluate the effectiveness and scaled-up implementation of locally adapted WHO PST programme delivered by family volunteers in rural Pakistan.Methods.The study is a two arm single-blind effectiveness implementation-hybrid cluster randomised controlled trial. WHO PST programme will be delivered by ‘family volunteers’ to the caregivers of children with developmental disorders and delays in community-based settings. The intervention consists of the WHO PST along with the WHO mhGAP intervention for developmental disorders adapted for delivery using the android application on a tablet device. A total of 540 parent-child dyads will be recruited from 30 clusters. The primary outcome is child's functioning, measured by WHO Disability Assessment Schedule – child version (WHODAS-Child) at 6 months post intervention. Secondary outcomes include children's social communication and joint engagement with their caregiver, social emotional well-being, parental health related quality of life, family empowerment and stigmatizing experiences. Mixed method will be used to collect data on implementation outcomes. Trial has been retrospectively registered at ClinicalTrials.gov (NCT02792894).Discussion.This study addresses implementation challenges in the real world by incorporating evidence-based intervention strategies with social, technological and business innovations. If proven effective, the study will contribute to scaled-up implementation of evidence-based packages for public mental health in low resource settings.Trial registration.Registered with ClinicalTrials.gov as Family Networks (FaNs) for Children with Developmental Disorders and Delays. Identifier: NCT02792894 Registered on 6 July 2016.

Download Full-text