Implementing Videoconference CBT for Depression in Routine Outpatient Care: Outcome, Working Alliance, and Influence of Patients’ Technology Commitment

2021 ◽  
pp. 1-9
Author(s):  
Ulrich Voderholzer ◽  
Ina Beintner ◽  
Bernhard Backes ◽  
Elisa Esguerra ◽  
Johannes Baltasar Hessler-Kaufmann
Keyword(s):  
Life Satisfaction ◽  
Depressive Symptoms ◽  
Working Alliance ◽  
Outpatient Care ◽  
Depressive Disorders ◽  
Behavioral Therapy ◽  
Positive Association ◽  
Routine Care ◽  
Before And After ◽  
Technology Commitment

<b><i>Background:</i></b> While videoconference cognitive behavioral therapy (V-CBT) has shown promising results in controlled studies, data from routine care are rare. We examined (1) changes in depressive symptoms and life satisfaction during V-CBT in German routine outpatient care for patients with depressive disorders, (2) the quality of the established working alliance, and (3) the influence of working alliance and the patients’ technology commitment on outcomes. <b><i>Patients and Methods:</i></b> Patients with primary diagnoses of depressive disorders were treated with V-CBT and concurrent internet-guided self-help via the MindDoc program, which operates within the regulations of the German health care system. The patients completed the 9-item Patient Health Questionnaire (PHQ-9) for depressive symptoms, an item on life satisfaction before and after treatment, the Working Alliance Inventory (WAI), and the Technology Commitment questionnaire for beliefs about handling technology. <b><i>Results:</i></b> Fifty-nine patients (71.2% female) with a mean age of 44.46 years (SD = 12.86) were included in the analyses. Longitudinal multilevel mixed models revealed improvements in depressive symptoms (Cohen’s <i>d</i> = 1.27) and life satisfaction (<i>d</i> = 0.80). The working alliance was good and showed a positive association with outcome, while technology commitment did not. <b><i>Conclusion:</i></b> V-CBT seems effective in reducing depressive symptoms, increasing life satisfaction, and establishing a good working alliance in routine care.

scholarly journals Effectiveness of Usual-Care Cognitive-Behavioral Therapy for Adolescents with Depressive Disorders Rated by Parents and Patients

2020 ◽  
Author(s):  
Daniel Walter ◽  
Jana Buschsieweke ◽  
Lydia Dachs ◽  
Hildegard Goletz ◽  
Anja Goertz-Dorten ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Depressive Disorders ◽  
Behavioral Therapy ◽  
Routine Care ◽  
Self Report ◽  
Cognitive Behavioral ◽  
Effect Sizes ◽  
Control Group ◽  
Parent Rating ◽  
Wide Range

Abstract BackgroundDepressive disorders are common in adolescence and are associated with a wide range of negative long-term outcomes. Highly controlled randomized controlled trials (RCT) provide considerable evidence for the efficacy of cognitive-behavioral therapy (CBT) as a treatment for depression, but the effectiveness of CBT under routine care conditions remains unproven.MethodsIn the present observational study, the changes achieved through routine CBT in adolescents with depressive disorders treated in a university outpatient clinic were analyzed, and compared to a historical control group of adolescents with depressive disorders who had received treatment as usual. At the start and end of treatment (pre- and post-assessment), parent and self-ratings of the German versions of the Youth Self-Report (YSR), the Child Behavior Checklist (CBCL) and rating scales for depressive symptoms (FBB-DES, SBB-DES) were assessed. A total of 331 adolescents aged 11–18 years with complete data were assessed for the main analysis.ResultsThe analysis yielded small to large pre-post effect sizes (Cohen’s d) for the total sample (d = 0.33 to d = 0.82) and large effect sizes for adolescents who were rated in the clinical range on each (sub)scale at the start of treatment (d = 0.85 to d = 1.30). When comparing patients in the clinical range with historical controls, medium to large net effect sizes (d = 0.53 to d = 2.09) emerged for the total scores in self- and parent rating. However, a substantial proportion of the sample remained in the clinical range at the end of treatment.ConclusionsThese findings suggest that CBT is effective for adolescents with depressive disorders when administered under routine care conditions, but the results must be interpreted with caution due to the lack of a direct control condition.Trial registrationDRKS, DRKS00021518. Registered 27 April 2020 - Retrospectively registered, http://drks.de

scholarly journals Nonpharmacological Treatment for Supporting Social Participation of Adults with Depression

2021 ◽  
Vol 2021 ◽  
pp. 1-13
Author(s):  
Supaluck Phadsri ◽  
Rieko Shioji ◽  
Atsuko Tanimura ◽  
Jeerawit Jaknissai ◽  
Sopida Apichai ◽  
...  
Keyword(s):  
Life Satisfaction ◽  
Depressive Symptoms ◽  
Social Participation ◽  
Behavioral Change ◽  
Social Withdrawal ◽  
Behavioral Therapy ◽  
Exercise Program ◽  
Risk Of Bias ◽  
Intervention Programs ◽  
Online Library

Background. Social withdrawal is predominantly seen among adults with depression. However, a dearth of reviews exists that explore nonpharmacological treatments, especially occupational therapy (OT) interventions and their effect in promoting social participation. The aim of this research was to review what intervention programs are conducted to support the social participation of adults with depression and their effectiveness. Method. A systematic review was performed wherein relevant articles were searched in PubMed, CINAHL, Wiley Online Library, PsycINFO, and OTseeker databases and AJOT, BJOT, SJOT, and OTMH journals. Only English articles published from January 2010 to December 2018, which tackled intervention for adults aged 20–60 years with depression, were considered. Ten out of 918 studies met the screening criteria. Result. Among the ten studies, the effective intervention programs were categorized as either occupation-based intervention (OBI) or cognitive behavioral therapy-based intervention (CBT-BI). These programs sought the following outcomes: behavioral change in social participation ( n = 4 ), reduction of depression or depressive symptoms ( n = 13 ), life satisfaction ( n = 4 ), and quality of life (QoL) ( n = 1 ). Studies showed moderate ( n = 3 ) to strong ( n = 7 ) level of certainty, whereas they also revealed high to unclear ( n = 3 ) and low ( n = 7 ) risk of bias. Conclusion. Both OBI such as animal-assisted therapy and CBT-BI such as behavioral change program and health education have a strong level of certainty and low risk of bias in promoting social participation by supporting positive behavioral change and reducing depressive symptoms. Furthermore, the sport and exercise program of OBI was popular in encouraging participation and engagement with other people. Other programs were suggested for combined interventions to support social participation, life satisfaction, and QoL.

scholarly journals Fecal Short Chain Fatty Acid ratios are related to both Depressive and Gastrointestinal Symptoms in Young Adults

2020 ◽  
Author(s):  
Bettina Müller ◽  
Annica J. Rasmusson ◽  
David Just ◽  
Shishanthi Jayarathna ◽  
Ali Moazzami ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Young Adults ◽  
Depressive Symptoms ◽  
Gut Microbiota ◽  
Depressive Disorders ◽  
Gastrointestinal Symptoms ◽  
Positive Association ◽  
Short Chain Fatty Acids ◽  
Short Chain ◽  
Chain Fatty Acids

AbstractObjectiveShort chain fatty acids (SCFAs) are produced by the gut microbiota and may reflect health. Gut symptoms are common in individuals with depressive disorders and recent data indicates relationships between gut microbiota and psychiatric health. We aimed to investigate potential associations between SCFAs and self-reported depressive and gut symptoms in young adults.MethodFecal samples from 164 individuals, of which 125 were patients with psychiatric disorders, were analyzed for the short chain fatty acids (SCFA) acetate, butyrate and propionate by nuclear magnetic resonance (NMR) spectroscopy. We then compared SCFA ratios to dimensional measures of self-reported depressive and gut symptoms.ResultsDepressive symptoms showed a positive association to acetate levels and negative associations to both butyrate and propionate levels in relation to total SCFA levels. Furthermore, symptoms of diarrhea and bloating showed positive associations to acetate and negative associations to propionate in relation to total SCFA levels. Cluster analysis revealed a heterogeneous pattern where shifts in SCFA ratios were seen for individuals with either elevated levels of depressive symptoms, elevated levels of gut symptoms or both.ConclusionShifts in SCFAs may have relevance for both depressive symptoms and gut symptoms in young adults.

Keeping up with the Wangs: A cross-sectional multilevel analysis of individual and contextual influences on mental wellbeing and depressive symptoms in China

2020 ◽  
Author(s):  
R. Adele H. Wang ◽  
CMA Haworth ◽  
Qiang Ren
Keyword(s):  
Life Satisfaction ◽  
Depressive Symptoms ◽  
Social Comparison ◽  
Depressive Symptomatology ◽  
Marriage Rate ◽  
Contextual Effects ◽  
Mental Wellbeing ◽  
Population Census ◽  
Cross Sectional ◽  
Average Education

BackgroundIn recent decades, China has experienced dramatic changes to its social and economic environment, which has affected the distribution of wellbeing across its citizens. While several studies have investigated individual level predictors of wellbeing in the Chinese population, less research has been done looking at contextual effects. This cross-sectional study looks at the individual and contextual effects of (regional) education, unemployment and marriage (rate) on individual happiness, life satisfaction and depressive symptomatology. MethodsData were collected from over 29,000 individuals (aged 18 to 110, 51.91% female) in the China Family Panel Studies, and merged with county level census data obtained from the 2010 China Population Census and Statistical Yearbook. To explore contextual effects, we used multilevel models accounting for the hierarchical structure of the data. ResultsWe found that a one-year increase in education was associated with a 0.17% increase in happiness and a 0.16% decrease in depressive symptoms. Unemployed men were 1% less happy, 1% less satisfied with life and reported 0.84% more depressive symptoms than employed men while minimal effects were seen for women. Single, divorced and widowed individuals had worse outcomes than married individuals (ranging from 2.96% to 21% differences). We found interaction effects for education and employment. Less educated individuals had greater happiness and less depressive symptoms in counties with higher average education compared to counterparts in less educated counties. In contrast, more educated individuals were less satisfied with life in more educated counties, an effect that is possibly due to social comparison. Employed individuals had lower life satisfaction in areas of high unemployment, while levels were constant for the unemployed. A 1% increase in county marriage rate was associated with 0.33% and 0.24% increases in happiness and life satisfaction respectively, with no interactions. We speculate that this effect could be due to greater social cohesion in the neighbourhood.ConclusionsOur results show that policies designed to improve employment and marriage rates will be beneficial for all, while interventions to encourage positive social comparison strategies may help to offset the negative effects of increasing neighbourhood average education on the highly educated.

日本における抑うつ症状に対する心理学的介入を目的とした スマートフォン用アプリケーション・プログラムのレビュー

2020 ◽  
Author(s):  
Hikari Takashina ◽  
Kengo Yokomitsu
Keyword(s):  
Depressive Symptoms ◽  
Daily Life ◽  
Behavioral Therapy ◽  
Mobile Apps ◽  
Evaluation Model ◽  
Ease Of Use ◽  
Background Information ◽  
Evidence Based ◽  
Privacy And Security ◽  
Current State

There are thousands of mobile apps delivering information and offering support and intervention in situations of daily life. The aim of this study was to identify the current state of apps for depressive symptoms or prevention of depression within the official Android and iOS app stores in Japan. The 47 apps for depression available for download from the app stores were evaluated by the App Evaluation Model regarding background information, risk/ privacy and security, evidence, ease of use, and interoperability. Also, we evaluated their primary purpose, technology components, and cognitive-behavioral therapy components. The results suggest that in general few apps have been developed that are evidence-based, secure, and provide the services that users expect. In the future, it will be necessary to develop a framework for developing and disseminating more effective apps. This study is the first review of apps for depression available in Japan and seeks to help create a framework for such apps.

Neighborhood Engagement, Dogs, and Life Satisfaction in Older Adulthood

2020 ◽  
pp. 073346482095372
Author(s):  
Angela L. Curl ◽  
Jessica Bibbo ◽  
Rebecca A. Johnson
Keyword(s):  
Life Satisfaction ◽  
Social Engagement ◽  
Positive Association ◽  
Older Adulthood ◽  
Dog Walking ◽  
Dog Ownership ◽  
Using Data ◽  
Indirect Relationship ◽  
Analysis Models ◽  
Retirement Study

Objectives This study examined the relationships between dog ownership, dog walking, and the emotional bond with a dog to neighborhood engagement and life satisfaction among those over age 50. Method Using data from the Health and Retirement Study ( N = 476), two path analysis models were conducted to test the research hypotheses. Results Findings indicated that dog ownership did not have a direct or indirect relationship on life satisfaction. However, time spent in dog walking was associated with frequency of social interactions, which itself had a positive association with life satisfaction. The bond with a dog was not directly associated with life satisfaction but was associated with dog walking. Discussion Dog walking is a promising strategy for simultaneously promoting better health and social engagement, and these factors in turn can promote greater life satisfaction of older adults.

Trial by Triad: substituted judgment, mental illness and the right to die

2021 ◽  
pp. medethics-2020-107154
Author(s):  
Jacob M Appel
Keyword(s):  
Depressive Symptoms ◽  
Depressive Disorders ◽  
Substituted Judgment ◽  
Diminished Capacity ◽  
Accepted Standard ◽  
The Usa ◽  
Aid In Dying ◽  
Incapacitated Patients ◽  
The Right

Substituted judgment has increasingly become the accepted standard for rendering decisions for incapacitated adults in the USA. A broad exception exists with regard to patients with diminished capacity secondary to depressive disorders, as such patients’ previous wishes are generally not honoured when seeking to turn down life-preserving care or pursue aid-in-dying. The result is that physicians often force involuntary treatment on patients with poor medical prognoses and/or low quality of life (PMP/LQL) as a result of their depressive symptoms when similarly situated incapacitated patients without such depressive symptoms would have their previous wishes honoured via substituted judgment. This commentary argues for reconsidering this approach and for using a substituted judgment standard for a subset of EMP/LQL patients seeking death.

scholarly journals Effects of n-3 Polyunsaturated Fatty Acid Supplementation in the Prevention and Treatment of Depressive Disorders—A Systematic Review and Meta-Analysis

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1070
Author(s):  
Maike Wolters ◽  
Annkathrin von der Haar ◽  
Ann-Kristin Baalmann ◽  
Maike Wellbrock ◽  
Thomas L. Heise ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Treatment Duration ◽  
Depressive Disorders ◽  
Meta Analysis ◽  
Pufa Supplementation ◽  
Depressive Symptomology ◽  
Beneficial Effects ◽  
Randomized Controlled ◽  
Significant Difference

N-3 polyunsaturated fatty acids (PUFAs) have been suggested to affect depressive disorders. This review aims to determine the effect of n-3 PUFAs on depressive symptoms in people with or without diagnosed depression. Medline, PsycINFO, and Cochrane CENTRAL databases were searched for randomized controlled trials (RCTs) assessing the association between n-3 PUFAs and depressive symptoms or disorders as outcomes. A random-effects meta-analysis of standardized mean difference (SMD) with 95% confidence intervals (CI) was performed. Twenty-five studies (7682 participants) were included. Our meta-analysis (20 studies) indicated that n-3 PUFA supplementation lowered depressive symptomology as compared with placebo: SMD = −0.34, 95% CI: −0.55, −0.12, I2 = 86%, n = 5836, but a possible publication bias cannot be ruled out. Subgroup analyses indicated no statistically significant difference by treatment duration of <12 vs. ≥12 weeks, presence of comorbidity, or severity of depressive symptoms. Nevertheless, beneficial effects were seen in the subgroups of studies with longer treatment duration and with no depression and mild to moderate depression. Subgroup analysis by eicosapentaenoic acid (EPA) dosage revealed differences in favor of the lower EPA dosage. Sensitivity analysis including studies with low risk of bias seems to confirm the overall result. Supplementation of n-3 PUFA appears to have a modest beneficial effect on depressive symptomology, although the quality of evidence is still insufficient.

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