scholarly journals Causal meditation analysis to understand how different components of a complex psychological intervention improved symptoms (or not) of depression in Goa, India

2021 ◽  
Author(s):  
Nadine Seward ◽  
Stijn Vansteelandt ◽  
Darío Moreno-Agostino ◽  
Vikram Patel ◽  
Ricardo Araya
Keyword(s):  
Indirect Effects ◽  
Psychological Intervention ◽  
Short Form ◽  
Total Effect ◽  
Depression Symptoms ◽  
Behavioural Activation ◽  
Mediation Analyses ◽  
Symptoms Of Depression ◽  
The Difference ◽  
Healthy Activity

AbstractBackgroundUnderstanding how and under what circumstances a highly effective psychological intervention, improved symptoms of depression is important to bring this evidence-informed intervention to scale, particularly in resource-poor settings. We aim to estimate the indirect effects of potentially important mediators to improve symptoms of depression in the Healthy Activity Program (HAP) trial.MethodsInterventional in(direct) effects were used to simultaneously decompose the total effect of the intervention on depression symptoms measured through the Patient Health Questionnaire (PHQ-9). The following indirect effects were considered: characteristics of sessions including the number of sessions and homework completed; behavioural activation according to an adapted version of the Behavioural Activation for Depression Short Form (BADS-SF), and extra sessions offered to participants who did not respond to the intervention.ResultsOf the total effect of the intervention measured through the difference in PHQ-9 scores between treatment arms (mean difference: -2.2, 95% bias-corrected CI: -3.2, -0.8), 45% was mediated through improved levels of behavioural activation (−1.0, -1.3, -0.6). There was no evidence to support the mediating role of characteristics of the sessions nor the extra sessions offered to participants who did not respond to the treatment.ConclusionsFindings from our robust mediation analyses, confirmed the importance of behavioural activation in improving depression symptoms. Contrary to published literature, our findings suggest that neither the number of sessions nor proportion of homework completed, improved outcomes. Moreover, results indicate that the extra sessions were insufficient to improve symptoms of depression for participants who did not respond to the intervention.

scholarly journals Interventional Indirect Effects: A Novel Approach to Optimise Complex Psychological Therapies to Treat Depression for Scale-up in Goa, India

2021 ◽  
Author(s):  
Nadine Seward ◽  
Stijn Vansteelandt ◽  
Darío Moreno-Agostino ◽  
Vikram Patel ◽  
Ricardo Araya
Keyword(s):  
Indirect Effects ◽  
Psychological Intervention ◽  
Short Form ◽  
Scale Up ◽  
Total Effect ◽  
Depression Symptoms ◽  
Behavioural Activation ◽  
Direct Effects ◽  
Psychological Therapies ◽  
Healthy Activity

Abstract Introduction: Understanding how and under what circumstances complex psychological therapies work (or not) is important to bring evidence-informed intervention to scale, especially in resource poor settings. However, current methods do not apply methodology that account for the underlying complexity of these interventions including the interplay between implementation outcomes, implementation strategies and mechanisms. Here we apply a robust mediation analysis to address these issues to data from the Healthy Activity Program (HAP) trial –a psychological intervention for depression delivered using task-shifting with lay counsellors in Goa India.Methods: Interventional in(direct) effects were used to simultaneously decompose the total effect of the intervention on depression symptoms measured through the Patient Health Questionnaire (PHQ-9). The following indirect effects were considered: fidelity of receipt including number of sessions and homework completed; behavioural activation according to an adapted version of the Behavioural Activation for Depression Short Form (BADS-SF), and extra sessions offered to participants who did not respond to the intervention. Results: Of the total effect of the intervention measured through the difference in PHQ-9 scores between treatment arms (mean difference: -2.2, 95% bias-corrected CI: -3.2, -0.8), 45% was mediated through improved levels of behavioural activation (-1.0, -1.3, -0.6). There was little evidence to support the mediating role of characteristics of the sessions nor the extra sessions offered to participants who did not respond to the treatment. ConclusionsFindings from our analyses have demonstrated how interventional (in)direct effects can be applied to understand how implementation research programmes can be optimised for scale-up. Our results highlight the importance of sessions focusing on behavioural activation to improve symptoms of depression. Targeting non-responders with strategies other than extra therapy sessions has the potential to improve depression outcomes at a population level.

scholarly journals The Influence of Depression, Anxiety and Cognition on the Treatment Effects of Ginkgo biloba Extract EGb 761® in Patients with Tinnitus and Dementia: A Mediation Analysis

2021 ◽  
Vol 10 (14) ◽  
pp. 3151
Author(s):  
Petra Brüggemann ◽  
Marília Grando Sória ◽  
Juliette Brandes-Schramm ◽  
Birgit Mazurek
Keyword(s):  
Ginkgo Biloba ◽  
Mediation Analysis ◽  
Indirect Effects ◽  
Neuropsychiatric Symptoms ◽  
Ginkgo Biloba Extract ◽  
Total Effect ◽  
Egb 761 ◽  
Direct Effects ◽  
Symptoms Of Depression ◽  
Tinnitus Severity

Background: Comorbid occurrence of tinnitus and emotional symptoms of anxiety and depression is highly prevalent. The Ginkgo biloba extract EGb 761® has been shown to be effective in reducing neuropsychiatric symptoms in patients with dementia and tinnitus. Methods: We performed a mediation analysis to evaluate direct effects of EGb 761® on tinnitus severity, as well as indirect effects mediated by symptoms of depression and anxiety and by changed cognition. We pooled data from subsets of patients suffering from tinnitus that were enrolled in three double-blind, randomized, placebo-controlled clinical trials, which investigated the efficacy of EGb 761® (240 mg/day for 22–24 weeks) in dementia with concomitant neuropsychiatric symptoms. Results: In total, 594 patients suffered from tinnitus (EGb 761®, 289; placebo, 305). Direct effects of EGb 761® on tinnitus severity (p < 0.001) in patients with mild to moderate dementia were found to represent about 60% of the total effect, whereas the indirect effects (p < 0.001) mediated by improvement of anxiety, depression and cognition represented about 40% of the total effect. Conclusions: EGb 761® could be considered as a supporting treatment for tinnitus in elderly patients suffering from dementia, with added benefit in those with symptoms of depression or anxiety.

scholarly journals Intolerance of Uncertainty Mediates Symptoms of PTSD and Depression in African American Veterans With Comorbid PTSD and Substance Use Disorders

2018 ◽  
Vol 44 (7) ◽  
pp. 667-688 ◽  
Author(s):  
David W. Hollingsworth ◽  
Jami M. Gauthier ◽  
Adam P. McGuire ◽  
Kelly R. Peck ◽  
Kathryn S. Hahn ◽  
...  
Keyword(s):  
Substance Use ◽  
African American ◽  
Substance Use Disorders ◽  
Medical Center ◽  
Intolerance Of Uncertainty ◽  
Health Concern ◽  
Depression Symptoms ◽  
Mediation Analyses ◽  
Symptoms Of Depression ◽  
The Relationship

Posttraumatic stress disorder (PTSD) is a major health concern among veterans, specifically African American veterans, and is commonly comorbid with other negative mental health outcomes including substance use disorders (SUD) and symptoms of depression. The current study examined intolerance of uncertainty as a mediator of the relationship between PTSD and depression symptoms in a sample of African American veterans with a dual diagnosis of PTSD and SUD. Participants included 113 African American veterans who were in treatment for PTSD and SUD at a Veterans Affairs Medical Center. Five mediation analyses were conducted to examine the mediational effect of intolerance of uncertainty on the relationship between PTSD symptom clusters (i.e., total, hyperarousal, numbness, avoidance, and intrusion) and depression symptoms. Findings indicated that intolerance of uncertainty mediated the relationship between four of the five mediation models (i.e., total symptoms, hyperarousal, numbness, and intrusion). These results imply that for African American veterans, higher levels of certain PTSD symptoms were associated with higher levels of intolerance of uncertainty, which in turn were related to increased levels of depression symptoms.

Longitudinal Predictions of Depression Symptoms Using the Activation and Avoidance Subscales of the Japanese Behavioral Activation for Depression Scale-Short Form

2016 ◽  
Vol 120 (1) ◽  
pp. 130-140 ◽  
Author(s):  
Yusuke Shudo ◽  
Tatsuya Yamamoto ◽  
Makoto Sakai
Keyword(s):  
Behavioral Activation ◽  
Short Form ◽  
Depression Scale ◽  
Epidemiologic Studies ◽  
Depression Symptoms ◽  
Symptoms Of Depression ◽  
Client Behavior ◽  
Behavioral Activation Therapy ◽  
Activation Therapy ◽  
Relationship Of

The Behavioral Activation for Depression Scale-Short Form (BADS-SF) is a questionnaire containing two subscales: Activation and Avoidance and was developed to measure changes in client behavior over the course of behavioral activation therapy. This study examines whether the subscales of the Japanese BADS-SF predict the future development of depression. Japanese university students ( N = 129) completed the BADS-SF and the Center for Epidemiologic Studies Depression Scale (CES-D) at the baseline and second test conducted eight weeks later, with no intervention in between. Multiple regression analyses revealed that baseline avoidance scores predicted the scores of CES-D during the second test, after controlling for baseline CES-D and the other BADS-SF subscale scores, but the relationship of the Activation subscale with the CES-D scores was not significant. Therefore, the results indicate that the avoidance scale predicts the occurrence of symptoms of depression.

scholarly journals Grief, depression, and the DSM-5: a review and reflections upon the debate

2015 ◽  
Vol 18 (3) ◽  
pp. 540-550 ◽  
Author(s):  
Peter Zachar
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Scientific Literature ◽  
Depression Symptoms ◽  
Major Depressive ◽  
Loved One ◽  
Symptoms Of Depression ◽  
Dsm 5 ◽  
Dsm Iv ◽  
The Difference

Every side in the debate about eliminating or retaining the bereavement exclusion for diagnosing major depressive disorder agreed that the DSM-IV was inconsistent. It exempted symptoms of depression from a depressive disorder diagnosis if they were a response to the loss of a loved one, but diagnosed depression symptoms in response to any other kind of loss or stress as a disorder. The participants in the debate did not agree how to resolve the inconsistency — eliminate the exemption for bereavement, leave it in place, or extend it to all cases with loss & stress-triggered depression symptoms. The difference between how the debate was presented to the general public and the issues debated in the scientific literature is described, as are the facts upon which the various sides readily agreed. Scientific research that casts doubt upon some common assumptions about the psychology of grieving is also reviewed. The article concludes by taking note of both the scientific-empirical and metaphysical facets of the debate, and suggests a pragmatic, verbal solution for one of the metaphysical facets.

Interpersonal Stress and Poor Health

2010 ◽  
Vol 15 (1) ◽  
pp. 3-11 ◽  
Author(s):  
Mette M. Aanes ◽  
Maurice B. Mittelmark ◽  
Jørn Hetland
Keyword(s):  
Psychological Distress ◽  
Depressive Symptoms ◽  
Social Relationships ◽  
Indirect Effects ◽  
Social Connectedness ◽  
Somatic Symptoms ◽  
Total Effect ◽  
Subjective Feeling ◽  
Interpersonal Stress ◽  
The Relationship

This paper investigated whether the lack of social connectedness, as measured by the subjective feeling of loneliness, mediates the well-known relationship between interpersonal stress and psychological distress. Furthermore, a relationship between interpersonal stress and somatic symptoms was hypothesized. The study sample included 3,268 women and 3,220 men in Western Norway. The main findings were that interpersonal stress was significantly related to psychological distress as well as to somatic symptoms, both directly and indirectly via paths mediated by loneliness. The size of the indirect effects varied, suggesting that the importance of loneliness as a possible mediator differs for depressive symptoms, anxiety symptoms, and somatic symptoms. In the case of depressive symptoms, more than 75% of the total effect was mediated through loneliness, while in the case of somatic symptoms just over 40% of the total effect was mediated through loneliness. This study supports the hypotheses that social connectedness mediates a relationship between interpersonal stress and psychological distress. The study also provides the first link between interpersonal stress, as measured by the Bergen Social Relationships Scale, and somatic symptoms, extending earlier research on the relationship between interpersonal stress and psychological distress.

Examining the Temporal Dynamics of Anxiety and Depressive Symptoms During a Therapist-Supported, Smartphone-Based Intervention for Major Depression (Preprint)

2020 ◽  
Author(s):  
Santiago Allende ◽  
Valerie Forman-Hoffman ◽  
Philippe Goldin
Keyword(s):  
Depressive Symptoms ◽  
Temporal Relationship ◽  
Temporal Dynamics ◽  
Digital Health ◽  
Quadratic Function ◽  
Depression Symptoms ◽  
Symptoms Of Depression ◽  
Effect Model ◽  
End Of Treatment ◽  
Highly Correlated

UNSTRUCTURED Background: Anxiety and depression symptoms are highly correlated in adults with depression; however, little is known about their interaction and temporal dynamics of change during treatment. Thus, the primary aim of this study was to examine the temporal dynamics of anxiety and depressive symptoms during a 12-week therapist-supported, smartphone-delivered digital health intervention for symptoms of depression and anxiety, the Meru Health Program (MHP). Method: A total of 290 participants from the MHP were included in the present analyses (age Mean = 39.64, SD = 10.25 years; 79% female; 54% self-reported psychotropic medication use). A variance components model was used to examine whether (1) reporting greater anxiety during the current week relative to anxiety reported in other weeks would be associated with greater reporting of depressive symptoms during the current week, while a time-varying effect model was used to examine whether, (2) consistent with findings reported by Wright et al. (2014), the temporal relationship between anxiety and depressive symptoms during the intervention would be expressed as a quadratic function marked by a weak association at baseline, followed by an increase to a peak before demonstrating a negligible decrease until the end of treatment. Results: In support of hypothesis 1, we found that reporting greater anxiety symptoms during the current week relative to other weeks was associated with greater depressive symptoms during the current week. Contrary to hypothesis 2, the temporal relationship between anxiety and depressive symptoms evidenced a recurring pattern, with the association increasing during the initial weeks, decreasing during mid-treatment and sharply increasing toward the end of treatment. Conclusions: The present findings demonstrate that anxiety and depressive symptoms overlap and fluctuate in concert during a smartphone-based intervention for anxiety and depressive symptoms. The present findings may warrant more refined intervention strategies specifically tailored to co-occurring patterns of change in symptoms.

scholarly journals Brief Behavioural Activation (Brief BA) for Adolescent Depression: A Pilot Study

2017 ◽  
Vol 46 (2) ◽  
pp. 182-194 ◽  
Author(s):  
Laura Pass ◽  
Carl W. Lejuez ◽  
Shirley Reynolds
Keyword(s):  
Mental Health ◽  
Pilot Study ◽  
Young People ◽  
Adolescent Depression ◽  
Psychological Intervention ◽  
Clinical Effectiveness ◽  
Evidence Based ◽  
Behavioural Activation ◽  
Evidence Based Treatments ◽  
The Uk

Background: Depression in adolescence is a common and serious mental health problem. In the UK, access to evidence-based psychological treatments is limited, and training and employing therapists to deliver these is expensive. Brief behavioural activation for the treatment of depression (BATD) has great potential for use with adolescents and to be delivered by a range of healthcare professionals, but there is limited empirical investigation with this group. Aims: To adapt BATD for depressed adolescents (Brief BA) and conduct a pilot study to assess feasibility, acceptability and clinical effectiveness. Method: Twenty depressed adolescents referred to the local NHS Child and Adolescent Mental Health service (CAMHs) were offered eight sessions of Brief BA followed by a review around one month later. Self- and parent-reported routine outcome measures (ROMs) were collected at every session. Results: Nineteen of the 20 young people fully engaged with the treatment and all reported finding some aspect of Brief BA helpful. Thirteen (65%) required no further psychological intervention following Brief BA, and both young people and parents reported high levels of acceptability and satisfaction with the approach. The pre–post effect size of Brief BA treatment was large. Conclusions: Brief BA is a promising innovation in the treatment of adolescent depression. This approach requires further evaluation to establish effectiveness and cost effectiveness compared with existing evidence-based treatments for adolescent depression. Other questions concern the effectiveness of delivery in other settings and when delivered by a range of professionals.

scholarly journals The English and Chinese language versions of the Short Form 12-item Health Survey are equivalent

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Daniel Y. T. Fong ◽  
Janet Y. H. Wong ◽  
Edmond P. H. Choi ◽  
K. F. Lam ◽  
C. Kwok
Keyword(s):  
Measurement Invariance ◽  
Health Survey ◽  
Short Form ◽  
Cross Sectional Study ◽  
Measurement Properties ◽  
University Campus ◽  
Cross Sectional ◽  
Multiple Group ◽  
Confirmatory Factor ◽  
The Difference

Abstract Background The Short Form 12-item Health Survey (SF-12v2) was originally developed in English, but it is also available in Hong Kong (HK) Chinese. While both language versions had their measurement properties well assessed in their respective populations, their measurement invariance in scores has not been examined. Therefore, we aimed to assess their measurement invariance. Methods We conducted a cross-sectional study on individuals aged 18 years or older at a university campus. Those who were bilingual in English and Chinese were randomly assigned to self-complete either the standard English or the HK Chinese SF-12v2. Measurement invariance of the two components and eight scales of the SF-12v2 was concluded if the corresponding 90% confidence interval (CI) for the difference between the two language versions entirely fell within the minimal clinically important difference of ± 3 units. Multiple-group confirmatory factor analysis (CFA) was also performed. Results A total of 1013 participants completed the SF-12v2 (496 in English and 517 in HK Chinese), with a mean age of 22 years (Range 18–58), and 626 participants (62%) were female. There were no significant differences in demographics. Only the physical and mental components and the mental health (MH) scale had their 90% CIs (0.21 to 1.61, − 1.00 to 0.98, and − 0.86 to 2.84, respectively) completely fall within the ± 3 units. The multiple-group CFA showed partial strict invariance. Conclusions The English and HK Chinese versions of the SF-12v2 can be used in studies with their two components and MH scores pooled in the analysis.

scholarly journals Age Cohort Differences and Depressive Symptoms Among Community-Dwelling Older Americans

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 61-61
Author(s):  
Ethan Siu Leung Cheung ◽  
Ada Mui
Keyword(s):  
Depressive Symptoms ◽  
Short Form ◽  
Cognitive Status ◽  
Community Dwelling ◽  
Independent Effect ◽  
Depression Symptoms ◽  
Older Americans ◽  
Age Cohorts ◽  
Cohort Differences ◽  
Age Cohort

Abstract This study uses Wave 3 National Social Life, Health and Aging Project to examine the correlation between age cohorts [60s (n=1204); 70s (n=1176); 80 and older (n= 724)], cognitive status, and depression symptoms. In the total sample, 53.90% were females, 76.15% Whites, 15.29% Blacks, and 8.56% Asians. Compared to the 60s and 70s cohorts, 80+ cohort was cognitively more impaired [Mean (SD) of MoCA Short Form were 10.7(2.9), 10.0(3.2), and 8.1(3.6)]. There were no age cohorts’ differences in depressive symptoms experienced (Mean of CESD Short Form = 21.03; SD = 4.06). In order to identify predictors of depression, multiple hierarchical regressions were performed. The 60s sample was the reference group to compare with 70s and 80s cohorts. Results showed that age cohort variables had a significant independent effect as well as a joint effect with cognitive status in explaining depression scores. For each age cohort group, parallel regression analyses were conducted and all models were significant. Findings suggest that ADL impairment was the only common predictor for depressive symptoms for the three cohort groups, and the association was the strongest for the 60s cohort (b = .31). Other unique predictors for 60s cohort were lower-income, more IADLs impairment, higher stress and cognitive impairment. For the 70s cohort, unique predictors of depressive symptoms were female gender, unmarried, and less socialization. For the 80 and above group, correlates of depression are female, White, and high stress level. Findings highlight the necessity of age-sensitive programs on depression support for community-dwelling older Americans.

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