Predicting Persistent Orofacial Pain: The Role of Illness Perceptions, Anxiety, and Depression

Introduction: Persistent orofacial pain (POFP) can be caused by a range of conditions affecting the mouth and face and is often associated with significant disability. Biopsychosocial factors are known to be important predictors and have not yet been fully explored in this population. Objectives: This study aimed to explore whether illness perceptions and psychological distress (anxiety and depression) could predict long-term outcome in a community-based sample of patients receiving routine care for POFP. Methods: A longitudinal cohort design study assessed 198 patients recruited from primary or secondary health care settings on 5 separate occasions over a 2-y period. Outcome was measured by the Graded Chronic Pain Scale and dichotomized into good or poor outcome categories. Independent variables included subscale scores of the psychometrically shortened Illness Perception Questionnaire and the Patient Health Questionnaire–4 (PHQ-4, assessing anxiety and depressive symptomatology). Logistic regressions were performed to test whether scores on each subscale would be associated with different outcomes for patients at 12 and 24 mo and overall. Results: Beliefs about consequences predicted outcome category (good vs. poor) above and beyond other illness perception subscales, anxiety, and depressive symptomatology (z = 3.78; P < 0.000; odds ratio [OR], 3.05; 95% confidence interval [CI], 1.71–5.43). Both depressive symptomatology, measured by the PHQ-2 (P = 0.001; OR, 4.06; 95% CI, 1.74–9.52), and psychological distress (mixed anxiety and depression; P = 0.029; OR, 2.88; 95% CI, 1.12–7.41), measured by the PHQ-4, were also predictive of poor outcome, but these effects were no longer significant once measures of illness perceptions were added. Conclusion: Beliefs about the consequences of POFP are important predictors of outcome independent of other variables and can easily and briefly be included in assessments to inform management decisions. Knowledge Transfer Statement: The results of this study are relevant because they will allow clinicians to consider the use of brief and easy-to-administer self-report measures to identify POFP patients at higher risk of poor outcome so that management can be planned accordingly.

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What are the illness perceptions of people with dysphonia: a pilot study

The Journal of Laryngology & Otology ◽

10.1017/s0022215106004002 ◽

2006 ◽

Vol 121 (1) ◽

pp. 31-39 ◽

Cited By ~ 9

Author(s):

F Buck ◽

M Drinnan ◽

J Wilson ◽

I S Barnard

Keyword(s):

Psychological Distress ◽

Help Seeking ◽

Illness Perceptions ◽

Illness Perception ◽

Depression Scale ◽

Self Report ◽

Vocal Performance ◽

Cross Sectional ◽

Illness Perception Questionnaire ◽

The Impact

Background: Patients do not respond to treatment in a predictable manner. Individual preconceptions determine help seeking, compliance and treatment outcome, yet clinicians rarely explore these issues. The illness perception approach sees the patient as an active participant in the healthcare process.Aims: The aim of this study was to investigate the illness perceptions of people with dysphonia. The subsidiary aims were to correlate the Illness Perception Questionnaire with any psychological distress identified and a self-report measure of dysphonia, and to consider any potential implications for patient management.Design: Prospective, cross-sectional observation.Setting: Primary and secondary care, two general and four community hospitals.Participants: Fifty adult patients with dysphonia due to benign disease completed three self-administered questionnaires, which investigated their illness perceptions, psychological distress and perceptions of the impact of the presenting ‘illness’.Measures: The dysphonia was categorised as being due to functional (n=40) or organic (n=10) causes. All the voices were rated by an expert listener according to the GRBAS (grade, roughness, breathiness, aesthenia, strain) scale. Participants completed the Illness Perception Questionnaire, the Vocal Performance Questionnaire and the Hospital Anxiety and Depression scale.Results: Patients showed a wide variation in perception of causation. They had no strong perceptions about the causes, consequences or duration of the presenting dysphonia. Functional dysphonics reported greater consequences, lower perceived control and increased anxiety when compared to patients with organic dysphonia. In terms of cure/control, all patients expected treatment to be helpful but this expectancy reduced as time increased. Anxiety was more associated with functional dysphonia, however, only 17 per cent of the subjects in this group showed clinically significant levels of signs of psychological distress.Conclusions: Lay illness representations often diverge from the clinician's understanding of the presenting problem and strongly influence treatment behaviour. Early exploration of illness perceptions may enhance health behaviour and maximise the impact of intervention.

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Thirty-year outcome of anxiety and depressive disorders and personality status: comprehensive evaluation of mixed symptoms and the general neurotic syndrome in the follow-up of a randomised controlled trial

Psychological Medicine ◽

10.1017/s0033291721000878 ◽

2021 ◽

pp. 1-10

Author(s):

Peter Tyrer ◽

Helen Tyrer ◽

Tony Johnson ◽

Min Yang

Keyword(s):

Randomised Controlled Trial ◽

Panic Disorder ◽

Controlled Trial ◽

Anxiety And Depression ◽

Term Outcome ◽

Long Term Outcome ◽

Personality Dysfunction ◽

Randomised Controlled ◽

Anxiety Depression

Abstract Background Cohort studies of the long-term outcome of anxiety, depression and personality status rarely join together. Methods Two hundred and ten patients recruited with anxiety and depression to a randomised controlled trial between 1983 and 1987 (Nottingham Study of Neurotic Disorder) were followed up over 30 years. At trial entry personality status was assessed, together with the general neurotic syndrome, a combined diagnosis of mixed anxiety–depression (cothymia) linked to neurotic personality traits. Personality assessment used a procedure allowing conversion of data to the ICD-11 severity classification of personality disorder. After the original trial, seven further assessments were made. Observer and self-ratings of psychopathology and global outcome were also made. The primary outcome at 30 years was the proportion of those with no Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis. Data were analysed using multilevel repeated measures models that adjusted for age and gender. Missing data were assumed to be missing at random, and the models allowed all subjects to be included in the analysis with missing data automatically handled in the model estimation. Results At 30 years, 69% of those with a baseline diagnosis of panic disorder had no DSM diagnosis compared to 37–47% of those with generalised anxiety disorder, dysthymia or mixed symptoms (cothymia) (p = 0.027). Apart from those with no personality dysfunction at entry all patients had worse outcomes after 30 years with regard to total psychopathology, anxiety and depression, social function and global outcome. Conclusions The long-term outcome of disorders formerly called ‘neurotic’ is poor with the exception of panic disorder. Personality dysfunction accentuates poor recovery.

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Prescribing practices of Indian psychiatrists in the treatment of bipolar disorder

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867419826718 ◽

2019 ◽

Vol 53 (5) ◽

pp. 458-469 ◽

Cited By ~ 2

Author(s):

YC Janardhan Reddy ◽

Venugopal Jhanwar ◽

Rajesh Nagpal ◽

MS Reddy ◽

Nilesh Shah ◽

...

Keyword(s):

Bipolar Disorder ◽

Maintenance Treatment ◽

Bipolar Depression ◽

Mood Stabilizer ◽

Self Report ◽

Mood Stabilizers ◽

Prescribing Practices ◽

Term Outcome ◽

Cross Sectional ◽

Long Term Outcome

Objective: The treatment of bipolar disorder is challenging because of its clinical complexity and availability of multiple treatment options, none of which are ideal mood stabilizers. This survey studies prescription practices of psychiatrists in India and their adherence to guidelines. Method: In total, 500 psychiatrists randomly selected from the Indian Psychiatric Society membership directory were administered a face-to-face 22-item questionnaire pertaining to the management of bipolar disorder. Results: For acute mania, most practitioners preferred a combination of a mood stabilizer and an atypical antipsychotic to monotherapy. For acute depression, there was a preference for a combination of an antidepressant and a mood stabilizer over other alternatives. Electroconvulsive therapy was preferred in the treatment of severe episodes and to hasten the process of recovery. Approximately, 50% of psychiatrists prescribe maintenance treatment after the first bipolar episode, but maintenance therapy was rarely offered lifelong. While the majority (85%) of psychiatrists acknowledged referring to various clinical guidelines, their ultimate choice of treatment was also significantly determined by personal experience and reference to textbooks. Limitations: The study did not study actual prescriptions. Hence, the responses to queries in the survey are indirect measures from which we have tried to understand the actual practices, and of course, these are susceptible to self-report and social-desirability biases. This was a cross-sectional study; therefore, temporal changes in responses could not be considered. Conclusion: Overall, Indian psychiatrists seemed to broadly adhere to recommendations of clinical practice guidelines, but with some notable exceptions. The preference for antidepressants in treating depression is contrary to general restraint recommended by most guidelines. Therefore, the efficacy of antidepressants in treating bipolar depression in the context of Indian psychiatrists’ practice needs to be studied systematically. Not initiating maintenance treatment early in the course of illness may have serious implications on the long-term outcome of bipolar disorder.

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Long-term Outcome After Survival of a Cardiac Arrest: A Prospective Longitudinal Cohort Study

Neurorehabilitation and Neural Repair ◽

10.1177/1545968317697032 ◽

2017 ◽

Vol 31 (6) ◽

pp. 530-539 ◽

Cited By ~ 20

Author(s):

Véronique R. M. Moulaert ◽

Caroline M. van Heugten ◽

Ton P. M. Gorgels ◽

Derick T. Wade ◽

Jeanine A. Verbunt

Keyword(s):

Quality Of Life ◽

Cardiac Arrest ◽

Cohort Study ◽

Anxiety And Depression ◽

Term Outcome ◽

Long Term Outcome ◽

Prospective Longitudinal ◽

Prospective Longitudinal Cohort

Background. A cardiac arrest can lead to hypoxic brain injury, which can affect all levels of functioning. Objective. To investigate 1-year outcome and the pattern of recovery after surviving a cardiac arrest. Methods. This was a multicenter, prospective longitudinal cohort study with 1 year of follow-up (measurements 2 weeks, 3 months, 1 year). On function level, physical/cardiac function (New York Heart Association Classification), cognition (Cognitive Log [Cog-log], Cognitive Failures Questionnaire), emotional functioning (Hospital Anxiety and Depression Scale, Impact of Event Scale), and fatigue (Fatigue Severity Scale) were assessed. In addition, level of activities (Frenchay Activities Index, FAI), participation (Community Integration Questionnaire [CIQ] and return to work), and quality of life (EuroQol 5D, EuroQol Visual Analogue Scale, SF-36, Quality of Life after Brain Injury) were measured. Results. In this cohort, 141 cardiac arrest survivors were included. At 1 year, 14 (13%) survivors scored below cutoff on the Cog-log. Both anxiety and depression were present in 16 (15%) survivors, 29 (28%) experienced posttraumatic stress symptoms and 55 (52%), severe fatigue. Scores on the FAI and the CIQ were, on average, respectively 96% and 92% of the prearrest scores. Of those previously working, 41 (72%) had returned to work. Most recovery of cognitive function and quality of life occurred within the first 3 months, with further improvement on some domains of quality of life up to 12 months. Conclusions. Overall, long-term outcome in terms of activities, participation, and quality of life after cardiac arrest is reassuring. Nevertheless, fatigue is common; problems with cognition and emotions occur; and return to work can be at risk.

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Measuring attachment and parental bonding in psychosis and its clinical implications

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796014000730 ◽

2014 ◽

Vol 25 (2) ◽

pp. 142-149 ◽

Cited By ~ 4

Author(s):

S. Mathews ◽

J. Onwumere ◽

S. Bissoli ◽

M. Ruggeri ◽

E. Kuipers ◽

...

Keyword(s):

Attachment Theory ◽

Attachment Style ◽

Attachment Styles ◽

Parental Bonding ◽

Insecure Attachment ◽

Self Report ◽

Future Research ◽

Clinical Implications ◽

Term Outcome ◽

Long Term Outcome

Background.Attachment theory proposes that psychological functioning and affect regulations are influenced by the attachment we form with others. Early relationships with parents or caregivers lay the foundations for attachment styles. These styles are proposed to influence how we relate to others during our life can be modified by the relationships and events we experience in our lifespan. A secure attachment style is associated with a capacity to manage distress, comfort with autonomy and the ability to form relationships with others, whereas insecure attachment can lead to dysfunctional relationships, emotional and behaviour avoidance. Attachment theory provides a useful framework to inform our understanding of relationship difficulties in people with psychosis. This paper aims to complement recent systematic reviews by providing an overview of attachment theory, its application to psychosis, including an understanding of measurement issues and the clinical implications offered.Method.A narrative review was completed of the measures of attachment and parental bonding in psychosis. Its clinical implications are also discussed. The paper also explores the link between insecure attachment styles and illness course, social functioning and symptomatology. The following questions are addressed: What are the key attachment measures that have been used within the attachment and psychosis literature? What are the results of studies that have measured attachment or parental bonding in psychosis and what clinical implications can we derive from it? What are some of the key questions for future research from these findings in relation to the onset of psychosis research field?Results.The most commonly used measures of attachment in psychosis research are reviewed. Self-report questionnaires and semi-structured interviews have mainly been used to examine attachment styles in adult samples and in recent years comprise a measure specifically developed for a psychosis group. The review suggests that insecure attachment styles are common in psychosis samples. Key relationships were observed between insecure, avoidant and anxious attachment styles and psychosis development, expression and long-term outcome.Conclusions.Attachment theory can provide a useful framework to facilitate our understanding of interpersonal difficulties in psychosis that may predate its onset and impact on observed variability in outcomes, including treatment engagement. Greater attention should be given to the assessment of attachment needs and to the development of interventions that seek to compensate for these difficulties. However, further investigations are required on specifying the exact mechanisms by which specific attachment styles impact on the development of psychosis and its course.

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Tubercular meningitis with hydrocephalus with HIV co-infection: role of cerebrospinal fluid diversion procedures

Journal of Neurosurgery ◽

10.3171/2014.12.jns14257 ◽

2015 ◽

Vol 122 (5) ◽

pp. 1087-1095 ◽

Cited By ~ 12

Author(s):

Raman Mohan Sharma ◽

Nupur Pruthi ◽

Arivazhagan Arimappamagan ◽

Sampath Somanna ◽

Bhagavathula Indira Devi ◽

...

Keyword(s):

Hiv Positive ◽

Short Term ◽

Tubercular Meningitis ◽

Term Outcome ◽

Long Term Outcome ◽

Shunt Placement ◽

Poor Outcome ◽

Hiv Negative

OBJECT Hydrocephalus is one of the commonest complications of tubercular meningitis (TBM), and its incidence is increasing with the HIV epidemic. Literature evaluating the role of ventriculoperitoneal shunts in HIV-positive patients with TBM and their long-term prognosis is scarce. METHODS Between June 2002 and October 2012, 30 HIV-positive patients with TBM and hydrocephalus underwent ventriculoperitoneal shunt placement. Thirty age-, sex-, and grade-matched HIV-negative patients with TBM and hydrocephalus were randomly selected as the control group. Outcome was analyzed at discharge (short-term outcome) and at follow-up (long-term outcome). Univariate and multivariate analyses were performed to look for predictors of outcome; p < 0.05 was considered significant. RESULTS There were no differences in the clinical, radiological, or biochemical parameters between the 2 groups. Short-term outcome was better in the HIV-negative group (76.7% improvement) than in the HIV-positive group (70%). However, the long-term outcome in HIV-positive patients was very poor (66.7% mortality and 76.2% poor outcome) compared with HIV-negative patients (30.8% mortality and 34.6% poor outcome). Seropositivity for HIV is an independent predictor of poor outcome both in univariate and multivariate analyses (p = 0.038). However, in contrast to previous reports, of 5 patients with TBM in good Palur grades among the HIV-positive patients, 4 (80%) had good outcome following shunt placement. CONCLUSIONS The authors recommend that shunt treatment should not be performed in HIV-positive patients in poor Palur grade with hydrocephalus. A trial of external ventricular drainage should be undertaken in such patients, and shunt treatment should be performed only if there is any improvement. However, HIV-positive patients in good Palur grades should undergo VP shunt placement, as these patients have better outcomes than previously reported.

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Decreased Time to Evacuation Improves Long Term Functional Outcome in Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation

Neurosurgery ◽

10.1093/neuros/nyz310_304 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Christopher P Kellner ◽

Rui Song ◽

Dominic A Nistal ◽

Ian T McNeill ◽

Hasitha M Samarage ◽

...

Keyword(s):

Minimally Invasive ◽

Intracerebral Hemorrhage ◽

Functional Outcome ◽

National Institutes Of Health ◽

Term Outcome ◽

Long Term Outcome ◽

Clinical Criteria ◽

Poor Outcome ◽

Deep Location

Abstract INTRODUCTION Preclinical and preliminary clinical data suggests that early minimally invasive intracerebral hemorrhage evacuation may convey a functional outcome benefit. Ongoing clinical trials permit an operative window extending out to 72 h. Here we present long term functional outcome after MIS endoscopic ICH evacuation with a focus on time to evacuation. METHODS Minimally invasive endoscopic ICH evacuation was performed on patients with supratentorial ICH who fit previously published clinical criteria including age = 18, National Institutes of Health Stroke Scale (NIHSS) = 6, hematoma volume = 15, and baseline modified Rankin Score (mRS) = 3 with a CTA negative for vascular malformation. Retrospective review was performed on patients who were treated in a single health system from December 2015 to August 2018. Demographic, clinical and radiographic previously demonstrated to impact ICH outcome were included in a multivariate logistic regression to identify factors predicting poor outcome (modified Rankin scale (mRS) 4-6) at 6 mo. RESULTS A total of 97 patients underwent minimally invasive endoscopic ICH evacuation. In a multivariate analysis, factors that predicted poor outcome included age (OR 1.81 (CI 1.15-3.08) P = .016), deep location (OR 11.1 (2.41-67.8) P = .004), presence of intraventricular hemorrhage (OR 5.81 (1.765-22.39) P = .006) and increased time to evacuation measured in hours (OR 1.048 (CI 1.017-1.084) P = .004). CONCLUSION Time to evacuation significantly impacts long term outcome in minimally invasive endoscopic ICH evacuation. Every minute counts.

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The Influence of Cultural Background on Experiences and Beliefs about Traumatic Brain Injury and their Association with Outcome

Brain Impairment ◽

10.1375/brim.9.1.1 ◽

2008 ◽

Vol 9 (1) ◽

pp. 1-13 ◽

Cited By ~ 16

Author(s):

Helen Saltapidas ◽

Jennie Ponsford

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Injury Severity ◽

Emotional Adjustment ◽

Illness Perception ◽

Emotional Reactions ◽

Term Outcome ◽

Long Term Outcome ◽

Illness Perception Questionnaire ◽

English Speaking

AbstractThe aim of the study was to compare beliefs and experiences of traumatic brain injury (TBI) in patients with TBI from the dominant English-speaking culture in Australia versus those from minority culturally and linguistically diverse (CALD) backgrounds and examine the relative influence of beliefs, acculturation, along with demographic and injury-related variables on outcome. The primary measures included the Illness Perception Questionnaire-Revised (IPQ-R), and the Craig Handicap Assessment and Reporting Technique (CHART). Participants were 70 individuals with mild to severe TBI, including 38 of English-speaking background (ESB) and 32 from CALD backgrounds. Although similar to the ESB participants in education, preinjury employment status, injury severity and experience of TBI, the CALD participants differed significantly from ESB participants on acculturation variables. CALD participants also experienced greater negative emotions and were less likely to have internal locus of control causal beliefs than ESB participants. Regression analyses indicated that describing one's value system as other than Australian, poorer understanding of TBI and greater negative emotional reactions, along with fewer years of education were associated with poorer outcomes on the CHART. Thus, in treating patients from different cultural backgrounds it is important for health professionals to understand beliefs about and responses to TBI, as they could potentially impact on coping, emotional adjustment and long-term outcome.

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Psychosocial functioning in relation to symptomatic remission: A longitudinal study of first episode schizophrenia

European Psychiatry ◽

10.1016/j.eurpsy.2015.08.001 ◽

2015 ◽

Vol 30 (8) ◽

pp. 907-913 ◽

Cited By ~ 15

Author(s):

K. Jaracz ◽

K. Górna ◽

J. Kiejda ◽

B. Grabowska-Fudala ◽

J. Jaracz ◽

...

Keyword(s):

Social Functioning ◽

Psychosocial Functioning ◽

Early Stage ◽

First Episode ◽

Term Outcome ◽

Long Term Outcome ◽

Poor Outcome ◽

Remission Status ◽

Symptomatic Remission

AbstractObjectivesThe aims of the study were: (1) to evaluate longitudinally symptomatic remission in first-episode (FE) schizophrenia, (2) to describe symptoms, social functioning and quality of life (Qol) in relation to remission status, and (3) to determine the long-term outcome of schizophrenia and its early predictors.MethodsSixty-four patients were assessed 1 month after a first hospitalization (T1), 12 months (T2), 4–6 years (T3), and 7–11 years (T4) after T1. The patients were allocated to three remission groups according to their remission status over the whole observation period, e.g. stable remission (SR), unstable remission (UR) and non-remission (NR). The PANSS, Social Functioning Scale and WHOQoL were used to evaluate the patients’ psychosocial functioning levels, symptomatic and functional remissions and satisfying QoL. A good outcome was defined as meeting, simultaneously, the criteria of symptomatic and functional remissions and satisfying QoL at T4, while failure to meet all of these criteria was defined as a poor outcome.ResultsAmong them, 17.2% patients were in stable remission, 57.8% in unstable remission and 25.0% were unremitted at all time points. The SR group had lower levels of psychopathological symptoms and reported better social functioning and QoL than the NR group. During the follow-up, the symptoms increased, social functioning slightly improved and QoL did not change. At T4, 53% of the sample had a poor outcome, which was independently predicted by the longer duration of untreated psychosis and a lack of satisfying QoL at T1.ConclusionsOur results demonstrate that: (1) the long-term course in schizophrenia is heterogeneous and that three illness trajectories exist, (2) social functioning and QoL are only partially connected with symptomatic remission (3), the risk of a poor outcome may potentially be reduced by appropriate interventions at an early stage of the illness.

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Internet-based psychodynamic therapy versus cognitive behavior therapy for adolescents with depression: Study protocol for a non-inferiority randomized controlled trial (the ERiCA study)

10.21203/rs.3.rs-20548/v1 ◽

2020 ◽

Author(s):

Jakob Mechler ◽

Karin Lindqvist ◽

Per Carlbring ◽

Peter Lilliengren ◽

Fredrik Falkenström ◽

...

Keyword(s):

Young People ◽

Adolescent Depression ◽

Primary Outcome ◽

Depressive Symptomatology ◽

Controlled Trial ◽

Text Messages ◽

Evidence Based ◽

Term Outcome ◽

Long Term Outcome ◽

End Of Treatment

Abstract Background: Adolescent depression is a common mental health problem and there is an urgent need for effective and accessible treatments. Internet-based interventions solve many obstacles for seeking and receiving treatment, thus increasing access to effective treatments. Internet-based cognitive behavioural therapy (ICBT) for adolescent depression has demonstrated efficacy in previous trials. In order to broaden the range of evidence-based treatments for young people we evaluated a newly developed affect-focused internet-based psychodynamic treatment (IPDT) in a previous study with promising results. The purpose of the planned study is to evaluate the efficacy of IPDT for adolescent depression in a non-inferiority trial, comparing it to ICBT. Methods: The study will employ a parallel randomized non-inferiority design (ratio 1:1; n = 210). Eligible participants are adolescents 15-19 years suffering from depression. The primary hypothesis is that IPDT will be non-inferior to ICBT in reducing depressive symptoms from pre-treatment to end of treatment. Secondary research questions include comparing outcomes of IPDT and ICBT regarding anxiety symptoms, emotion regulation and self-compassion. Additional data will be collected to evaluate cost-effectiveness as well as investigating predictors, moderators and mediators of outcome. In addition, we will examine long-term outcome up to one year after end of treatment. Diagnostic interviews with MINI 7.0 will be used to establish primary diagnosis of depression as well as ruling out any exclusion criteria. Both treatments consist of eight modules over ten weeks, complemented with therapist support through text messages and weekly chat sessions. Primary outcome measure is the Quick Inventory of Depressive Symptomatology in Adolescents Self-Rated (QIDS-A17-SR). Primary outcome will be analyzed using data from all participants entering the study using a multilevel growth curve strategy based on the weekly measurements of QIDS-A17-SR. The non-inferiority margin is defined as d = 0.30. Discussion: This trial will demonstrate whether IPDT is non-inferior to ICBT in the treatment of adolescent depression. The study might therefore broaden the range of evidence-based treatment alternatives for young people struggling with depression. Further analyses of data from this trial may increase our knowledge about "what works for whom" and the pathways of change for two distinct types of interventions.

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