scholarly journals A feasibility study of a novel work-focused relational group CBT treatment programme for moderate to severe recurrent depression

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Nicola Walker ◽  
Madeleine Vernon-Smith ◽  
Michael Townend
Keyword(s):  
Depressive Symptoms ◽  
Severe Depression ◽  
Job Retention ◽  
Positive Outcomes ◽  
Treatment Programme ◽  
Recurrent Depression ◽  
Content Type ◽  
Cognitive Behavioural ◽  
Interpersonal Difficulties ◽  
Secondary Outcomes

Purpose No current psychotherapeutic intervention is designed to enhance job retention in employees with moderate–severe recurrent depression. The aim of this study is to test the feasibility of a new, interdisciplinary work-focused relational group cognitive behavioural therapy (CBT) treatment programme for moderate–severe depression. Design/methodology/approach The programme was based on a theoretical integration of occupational stress, psychological, social/interpersonal and bio-medical theories. It consisted of up to four 1:1 psychotherapy sessions; 12 work-focused, full-day, weekly CBT sessions facilitated by a cognitive behavioural therapist and occupational therapist; and up to four optional 1:1 sessions with an occupational therapist. Depression severity (primary outcome) and a range of secondary outcomes were assessed before (first CBT session) and after (twelfth CBT session) therapy using validated instruments. Findings Eight women (26–49 years) with moderate–severe depression participated. Five were on antidepressant medication. While there was no statistically significant change in Hamilton Depression Rating Scale depression scores after therapy (n = 5; p = 0.313), Beck Depression Inventory-II depression scores significantly decreased after therapy (n = 8; –20.0 median change, p = 0.016; 6/8 responses, 7/8 minimal clinically important differences, two remissions). There were significant improvements in the secondary outcomes of overall psychological distress, coping self-efficacy, health-related quality of life and interpersonal difficulties after therapy. All clients in work at the start of therapy remained in work at the end of therapy. The intervention was safe and had 100% retention. Research limitations/implications A major limitation was recruitment shortfall, resulting in a small sample of middle-aged women, which reduces representativeness and increases the possibility of methodological weaknesses in terms of the statistical analysis. A definitive trial would need much larger samples to improve statistical power and increase confidence in the findings. Another major limitation was that two of the authors were involved in delivering the intervention such that its generalisability is uncertain. Practical implications This novel programme was evaluated and implemented in the real world of clinical practice. It showed promising immediate positive outcomes in terms of depressive symptoms, interpersonal difficulties and job retention that warrant further exploration in a longer-term definitive study. Social implications Empirical studies focused on enhancing job retention in employees with moderate–severe recurrent depression are lacking, so this study was highly relevant to a potentially marginalised community. Originality/value While limited by a recruitment shortfall, missing data and client heterogeneity, this study showed promising immediate positive outcomes for the new programme in terms of depressive symptoms, interpersonal difficulties and job retention that warrant exploration in a definitive study.

The effect of Internet-delivered cognitive behavioural therapy vs. psychoeducation only on psychological distress in patients with non-cardiac chest pain: a randomized controlled trial (Preprint)

2021 ◽  
Author(s):  
Ghassan Mourad ◽  
Magda Eriksson-Liebon ◽  
Patric Karlström ◽  
Peter Johansson
Keyword(s):  
Physical Activity ◽  
Psychological Distress ◽  
Depressive Symptoms ◽  
Chest Pain ◽  
Cognitive Behavioural Therapy ◽  
Behavioural Therapy ◽  
Cardiac Anxiety ◽  
Cognitive Behavioural ◽  
Secondary Outcomes

BACKGROUND Patients with recurrent episodes of non-cardiac chest pain (NCCP) suffer from cardiac anxiety, as they misinterpret the pain to be cardiac-related and avoid physical activity that they think could threaten their lives. Psychological interventions, such as Internet-delivered cognitive behavioural therapy (iCBT), targeting anxiety can be a feasible solution by supporting patients to learn how to perceive and handle their chest pain. OBJECTIVE To evaluate the effects of a nurse-led iCBT program on cardiac anxiety and other patient-reported outcomes in patients with NCCP. METHODS Patients with at least two healthcare consultations due to NCCP during the last 6 months, and who were suffering from cardiac anxiety (Cardiac Anxiety Questionnaire (CAQ) score ≥24), were randomized into 5 weeks of iCBT (n=54) or psychoeducation (n=55). Patients were 54 (±17) vs 57 (±16) years old and mainly women (59% vs 64%). The iCBT program comprised psychoeducation, mindfulness, and exposure to physical activity, with weekly homework assignments. The primary outcome was cardiac anxiety. The secondary outcomes were fear of body sensations, depressive symptoms, health-related quality of life (HRQoL), and chest pain frequency. Intention-to-treat analysis was applied, and patients were followed-up for three months. A mixed model analysis was used to determine between-group differences in primary and secondary outcomes. RESULTS No significant differences were found between the iCBT and psychoeducation groups regarding cardiac anxiety or any of the secondary outcomes in terms of interaction effect of time and group over the 3-months follow-up. iCBT demonstrated a small effect size on cardiac anxiety (Cohen’s d=0.31). In the iCBT group, 16 patients (36%) reported a positive reliable change score (≥11 points on the CAQ), and thus an improvement in cardiac anxiety, to be compared with 13 patients (27 %) in the psychoeducation group. Within-group analysis showed further significant improvement in cardiac anxiety (p=.037), depressive symptoms (p=.007) and of NCCP frequency (p=.005) at 3-months follow-up compared to 5-weeks follow-up in the iCBT group, but not in the psychoeducation group. CONCLUSIONS iCBT was not superior to psychoeducation in decreasing cardiac anxiety in patients with NCCP. However, iCBT tends to have better long-term effects on psychological distress, including cardiac anxiety, HRQoL and NCCP frequency than psychoeducation. The effects need to be followed up in order to draw more reliable conclusions. CLINICALTRIAL The study was registered at ClinicalTrials.gov, NCT03336112; https://www.clinicaltrials.gov/ct2/show/NCT03336112

scholarly journals A redesigned training and staff support programme to enhance job retention in employees with moderate-severe depression

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Nicola Walker ◽  
Rachel Dobbing
Keyword(s):  
Focus Groups ◽  
Severe Depression ◽  
Treatment Programme ◽  
Programme Theory ◽  
Staff Support ◽  
Convenience Sample ◽  
Content Type ◽  
Support Programme ◽  
Peer Facilitators ◽  
Group Cbt

Purpose Closing the treatment gap in depression is vital to prevent people from losing their jobs. Delivering group-based interventions at work could reach more employees than delivering 1:1 interventions in a clinical setting. This study aims to redesign a Treatment Programme to make it more acceptable and accessible for employees with depression. Design/methodology/approach A mixed-methods exploratory sequential design with a high level of stakeholder consultation was used to redesign an interdisciplinary Work-focussed Relational Group CBT Treatment Programme for moderate-severe depression. Qualitative data from focus groups and quantitative data from a small feasibility study were integrated to develop the new Training (and Staff Support) Programme (TSSP), which was fully specified and manualised in line with the Template for Intervention Description and Replication (TIDieR) for future delivery. Findings Focus groups identified a need for improved acceptability and accessibility of the tertiary preventative Work-focussed Relational Group CBT Treatment Programme. This programme was, therefore, simplified for delivery by peer facilitators at the worksite as an intervention for all employees rather than an indicated/targeted intervention for only those with symptoms/risk of depression. The TSSP comprised a compulsory trauma-informed educational/experiential workshop over four days plus optional open-ended, peer-led base groups set up and run by volunteer peer facilitators. Research limitations/implications The focus groups comprised a convenience sample who knew the researchers as a colleague or therapist, so there is a risk of selection or relationship bias. They were not involved in the data analysis which undermines the element of co-production and increases the risk of analytic or confirmation bias. Practical implications Delivering the new intervention in a group format will require peer facilitators to acquire skills in co-facilitation using a structured-directive leadership style and an awareness of the potential side effects of group-based interventions. Social implications The worksite TSSP provides a democratic learning space and empowers employees to stay at work by self-managing their symptoms and by challenging the interpersonal dynamics and organisational structures that might precipitate and perpetuate depression. Originality/value This intervention is fully specified and manualised with an explicit programme theory, unlike most universal worksite-based CBT programmes.

Association of severity of depressive symptoms with sleep quality, social support and stress among Pakistani medical and dental students: A cross-sectional study

2019 ◽  
Vol 2 (2) ◽  
pp. 211-220
Author(s):  
Ahmed Waqas ◽  
Aqsa Iftikhar ◽  
Zahra Malik ◽  
Kapil Kiran Aedma ◽  
Hafsa Meraj ◽  
...  
Keyword(s):  
Social Support ◽  
Depressive Symptoms ◽  
Medical Students ◽  
Sleep Quality ◽  
Severe Depression ◽  
Dental Students ◽  
Poor Sleep ◽  
Poor Sleep Quality ◽  
Cross Sectional ◽  
Medical And Dental Students

AbstractObjectivesThis study has been designed to elucidate the prevalence of stress, depression and poor sleep among medical students in a Pakistani medical school. There is a paucity of data on social support among medical students in Pakistan; an important predictor of depressive symptoms. Therefore, this study was also aimed to demonstrate the direct and indirect impact of social support in alleviating depressive symptoms in the study sample.MethodsThis observational cross-sectional study was conducted in Lahore, Pakistan, where a total of 400 students at a medical school were approached between 1st January to 31st March 2018 to participate in the study. The study sample comprised of medical and dental students enrolled at a privately financed Pakistani medical and dental school. The participants responded to a self-administered survey comprising of five parts: a) demographics, b) Pittsburgh Sleep Quality Index (PSQI), c) Patient Health Questionnaire-9 (PHQ-9), d) Multidimensional Scale of Perceived Social Support (MSPSS) and e) Perceived Stress Scale-4 (PSS-4). All data were analysed using SPSS v. 20. Linear regression analysis was used to reveal the predictors of depression.ResultsIn total, 353 medical students participated, yielding a response rate of 88.25%. Overall, poor sleep quality was experienced by 205 (58.1%) students. Mild to severe depression was reported by 83% of the respondents: mild depression by 104 (29.5%), moderate depression by 104 (29.5%), moderately severe depression by 54 (15.3%) and severe depression by 31 (8.8%) respondents. Subjective sleep quality, sleep latency, daytime dysfunction and stress levels were significantly associated with depression symptoms. Social support was not significantly associated with depressive symptoms in the regression model (Beta = -0.08, P < 0.09); however, it acted as a significant mediator, reducing the strength of the relationship between depressive symptoms and sleep quality and stress.ConclusionsAccording to our study, a large proportion of healthcare (medical and dental) students were found to be suffering from mild to moderate depression and experienced poor sleep quality. It is concluded that social support is an important variable in predicting depressive symptomatology by ameliorating the effects of poor sleep quality and high stress levels.

scholarly journals Systematic review: Symptoms of parental depression and anxiety and offspring overweight

2020 ◽  
Vol 54 ◽  
pp. 49
Author(s):  
Paula Lobo Marco ◽  
Inaê Dutra Valério ◽  
Christian Loret de Mola Zanatti ◽  
Helen Gonçalves
Keyword(s):  
Depressive Symptoms ◽  
Childhood Obesity ◽  
Mental Disorder ◽  
Common Mental Disorder ◽  
Positive Association ◽  
Depression And Anxiety ◽  
Recurrent Depression ◽  
Child Feeding ◽  
Middle Income ◽  
Symptoms Of Depression

OBJECTIVE: To evaluate the existing literature on the association between parents’ depression and anxiety and their influence on their children’s weight during childhood, identifying possible mechanisms involved in this association. METHODS: A systematic search of the literature was conducted in the PubMed, PsycINFO and SciELO databases, using the following descriptors: (maternal OR mother* OR parent* OR paternal OR father) AND (“common mental disorder” OR “mental health” OR “mental disorder” OR “depressive disorder” OR depress* OR anxiety OR “anxiety disorder”) AND (child* OR pediatric OR offspring) AND (overweight OR obes* OR “body mass index” OR BMI). A total of 1,187 articles were found after peer selection. RESULTS: In total, 16 articles that met the inclusion criteria were selected for the review. Most of them investigated depressive symptoms and only three, symptoms of maternal anxiety. The evaluated studies suggested a positive association between symptoms of maternal depression and higher risk of childhood obesity. The results diverged according to the chronicity of depressive symptoms (episodic or recurrent depression) and income of the investigated country (high or middle income). Mechanisms were identified passing by quality of parenthood, affecting behaviors related to physical activity and child-feeding, as mediators of the association. CONCLUSIONS: We conclude there is evidence of a positive relationship between the occurrence of maternal symptoms of depression and anxiety and childhood obesity. It is emphasized the need for a better understanding on the effect of depressive symptoms and the contextual factors involved in this relationship so that effective intervention strategies can be implemented.

Exploring the effects of physical punishment on aggressive behavior and peer victimization: a conditional process analysis

2016 ◽  
Vol 8 (1) ◽  
pp. 21-32 ◽  
Author(s):  
Patrik Söderberg ◽  
Kaj Bjorkqvist ◽  
Karin Österman
Keyword(s):  
Depressive Symptoms ◽  
Aggressive Behavior ◽  
Peer Victimization ◽  
Online Survey ◽  
Process Analysis ◽  
Physical Punishment ◽  
Process Models ◽  
Content Type ◽  
Conditional Process Analysis

Purpose – Recent studies indicate that exposure to physical punishment is associated with both aggressive behavior and peer victimization at school. The purpose of this paper is to explore the bidirectional relationship between aggressive behavior and peer victimization as outcomes of physical punishment, as well as the role of depressive symptoms. Design/methodology/approach – A sample of 2,424 Finnish upper primary school pupils (1,282 girls, 1,148 boys, mean age=14.2, SD=1.0) completed an online survey during class. Two conditional process models were applied using a macro for SPSS developed by Hayes (2012). Findings – Exposure to physical punishment was found to be associated with both aggressive behavior and peer victimization at school. The effect on victimization was partially mediated by aggressive behavior and depressive symptoms, whereas the effect on aggressive behavior was partially mediated by peer victimization experiences but not by depressive symptoms. The relationship between physical punishment and peer victimization was somewhat stronger for girls than for boys, but this effect was not accounted for by gender differences in depressive symptoms or aggressive behavior. Originality/value – Few studies to date have addressed the connection between aggressive behavior and peer victimization as outcomes of physical punishment. In addition, the study expands on the concept of “victim personality” by examining the mediating role of depressive symptoms. Methodologically, the study is an example of how the statistical software SPSS can be used for multiple mediation and conditional process analysis as an alternative to SEM analyses.

scholarly journals A randomized controlled trial on a self-guided Internet-based intervention for gambling problems

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Lara Bücker ◽  
Josefine Gehlenborg ◽  
Steffen Moritz ◽  
Stefan Westermann
Keyword(s):  
Randomized Controlled Trial ◽  
Depressive Symptoms ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Group Differences ◽  
Control Group ◽  
Gambling Problems ◽  
Randomized Controlled ◽  
Secondary Outcomes ◽  
Internet Based Intervention

AbstractThe majority of individuals with problematic and pathological gambling remain untreated, and treatment barriers are high. Internet-based interventions can help to address existing barriers, and first studies suggest their potential for this target group. Within a randomized controlled trial (N = 150) with two assessment times (baseline and post-intervention), we aimed to investigate the feasibility, acceptance, and effectiveness of a self-guided Internet-based intervention targeted at gambling problems. We expected a significant reduction in gambling symptoms (primary outcome) and depressive symptoms as well gambling-specific dysfunctional thoughts (secondary outcomes) in the intervention group (IG) compared to a wait-list control group with access to treatment-as-usual (control group, CG) after the intervention period of 8 weeks. Results of the complete cases, per protocol, intention-to-treat (ITT), and frequent user analyses showed significant improvements in both groups for primary and secondary outcomes but no significant between-group differences (ITT primary outcome, F(1,147) = .11, p = .739, ηp2 < .001). Moderation analyses indicated that individuals in the IG with higher gambling and depressive symptoms, older age, and comorbid anxiety symptoms showed significant improvement relative to the CG. The intervention was positively evaluated (e.g., 96.5% rated the program as useful). Possible reasons for the nonsignificant between-group differences are discussed. Future studies should include follow-up assessments and larger samples to address limitations of the present study. Trial Registration ClinicalTrials.gov (NCT03372226), http://clinicaltrials.gov/ct2/show/NCT03372226, date of registration (13/12/2017).

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

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

scholarly journals Depressive Symptoms in Older African Immigrants: A Descriptive Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 335-335
Author(s):  
Manka Nkimbeng ◽  
Zachary Baker ◽  
Janiece Taylor ◽  
Sarah Szanton ◽  
Tetyana Shippee ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Insurance Coverage ◽  
Severe Depression ◽  
Secondary Data ◽  
African Immigrants ◽  
Health Insurance Coverage ◽  
The United States ◽  
Health Study ◽  
Related Factors ◽  
Significant Difference

Abstract In FY 2018-2019, the National Institutes of Health devoted $2,387,505,711 to projects studying depression. Before and following their arrival into the United States stressful life circumstances may render African immigrants particularly at risk for depression. The objective of this study is to provide an estimate and identify correlates of depressive symptoms in older (≥50 years) African immigrants. We performed secondary data analyses of the Older African Immigrant Health study (n = 148). Bivariate analyses evaluated associations between depressive symptoms and sociodemographic and immigration-related factors. Depressive symptoms were measured with the PHQ-8 scale and scores of ≥ 5 were considered indicative of depressive symptoms. The mean age of participants was 62 years (SD:8.2), 61% were female, 30% had less than high school education, and 58% reported having health insurance coverage. Thirty percent of the sample had depressive symptoms (PHQ-8 score of ≥ 5) but only one individual would be classified as having moderately severe or severe depression (PHQ-8 ≥15). Depressive symptoms did not differ by age, marital status, education, or income. There was a statistically significant difference in depressive symptoms by reason for migration, recruitment location, and employment status. Although only one participant would be classified as severely depressive, a large proportion of this sample had depressive symptoms. Mental health concerns were reported as a significant health problem for African immigrants visiting a community service organization in New York. More research is needed to examine the prevalence, immigration-related correlates, predictors, and health ramifications of depression in older African immigrants.

Diversity, equity and inclusion: organizational strategies during and beyond the COVID-19 pandemic

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Sangeeta Lamba ◽  
M. Bishr Omary ◽  
Brian L. Strom
Keyword(s):  
Community Building ◽  
People Of Color ◽  
Positive Outcomes ◽  
Organizational Strategies ◽  
Healthcare Organizations ◽  
Content Type ◽  
Institutional Values ◽  
The Impact ◽  
Equity And Inclusion

PurposeThe coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented health, economic and social ramifications. Cumulative stressors for healthcare organizations during the pandemic have an impact on the morale of the workforce. The impact of magnified health disparities with ongoing disproportionate loss of lives of people of color combined with the racial injustices has left many colleagues and communities traumatized and seeking solutions. This is a moment in time for organizations to lean into the strengths of their diversity leadership to strengthen a culture of inclusion and build resilience for their employees.Design/methodology/approachThe authors use an organizational case study to describe the initiatives and experiences related to fostering a culture of inclusion and belonging at an academic health center during the initial epicenter of the pandemic.FindingsThe authors weekly community building virtual cafes, leveraging funding for diversity initiatives and visible ways to showcase the work of colleagues have been feasible, sustainable and had positive outcomes. Similar processes may assist other institutions and organizations seeking to enhance efforts for inclusion while distancing.Research limitations/implicationsStrategies described are generalizable but the authors report on one organization's experience.Originality/valueIntentional strategies that help build a deeper sense of community are essential for institutions during the disruption of pandemic related physical distancing. Inclusive decisions anchored in equity and inclusion as core institutional values will be essential to sustain resilience as the authors seek to build the new “equitable” normal.

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