scholarly journals Effectiveness of psychological treatments for depression and alcohol use disorder delivered by community-based counsellors: two pragmatic randomised controlled trials within primary healthcare in Nepal

2019 ◽  
Vol 215 (2) ◽  
pp. 485-493 ◽  
Author(s):  
Mark J. D. Jordans ◽  
Nagendra P. Luitel ◽  
Emily Garman ◽  
Brandon A. Kohrt ◽  
Sujit D. Rathod ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Alcohol Use ◽  
Randomised Controlled Trials ◽  
Alcohol Use Disorder ◽  
Controlled Trials ◽  
Community Based ◽  
Psychological Treatments ◽  
Randomised Controlled ◽  
Healthy Activity

BackgroundEvidence shows benefits of psychological treatments in low-resource countries, yet few government health systems include psychological services.AimEvaluating the clinical value of adding psychological treatments, delivered by community-based counsellors, to primary care-based mental health services for depression and alcohol use disorder (AUD), as recommended by the Mental Health Gap Action Programme (mhGAP).MethodTwo randomised controlled trials, separately for depression and AUD, were carried out. Participants were randomly allocated (1:1) to mental healthcare delivered by mhGAP-trained primary care workers (psychoeducation and psychotropic medicines when indicated), or the same services plus individual psychological treatments (Healthy Activity Program for depression and Counselling for Alcohol Problems). Primary outcomes were symptom severity, measured using the Patient Health Questionnaire – 9 item (PHQ-9) for depression and the Alcohol Use Disorder Identification Test for AUD, and functional impairment, measured using the World Health Organization Disability Assessment Schedule (WHODAS), at 12 months post-enrolment.ResultsParticipants with depression in the intervention arm (n = 60) had greater reduction in PHQ-9 and WHODAS scores compared with participants in the control (n = 60) (PHQ-9: M = −5.90, 95% CI −7.55 to −4.25, β = −3.68, 95% CI −5.68 to −1.67, P < 0.001, Cohen's d = 0.66; WHODAS: M = −12.21, 95% CI −19.58 to −4.84, β = −10.74, 95% CI −19.96 to −1.53, P= 0.022, Cohen's d = 0.42). For the AUD trial, no significant effect was found when comparing control (n = 80) and intervention participants (n = 82).ConclusionAdding a psychological treatment delivered by community-based counsellors increases treatment effects for depression compared with only mhGAP-based services by primary health workers 12 months post-treatment.Declaration of interestNone.

scholarly journals Effects of COVID-19 Mental Health Interventions among Community-based Children, Adolescents, and Adults: A Living Systematic Review of Randomised Controlled Trials

2021 ◽  
Author(s):  
Olivia Bonardi ◽  
Yutong Wang ◽  
Kexin Li ◽  
Xiaowen Jiang ◽  
Ankur Krishnan ◽  
...  
Keyword(s):  
Mental Health ◽  
Randomised Controlled Trials ◽  
Risk Of Bias ◽  
Health Interventions ◽  
Controlled Trials ◽  
Post Intervention ◽  
Community Based ◽  
Adolescents And Adults ◽  
Mental Health Interventions ◽  
Randomised Controlled

Background: Scalable interventions to address COVID-19 mental health are needed. Our objective was to assess effects of mental health interventions for community-based children, adolescents, and adults. Methods: We searched 9 databases (2 Chinese-language) from December 31, 2019 to March 22, 2021. We included randomised controlled trials with non-hospitalised, non-quarantined participants of interventions to address COVID-19 mental health challenges. We synthesized results descriptively but did not pool quantitatively due to substantial heterogeneity of populations and interventions and concerns about risk of bias. Findings: We identified 9 eligible trials, including 3 well-conducted, well-reported trials that tested interventions designed specifically for COVID-19 mental health challenges, plus 6 trials of standard interventions (e.g., individual or group therapy, expressive writing, mindfulness recordings) minimally adapted for COVID-19, all with risk of bias concerns. Among the 3 COVID-19-specific intervention trials, one (N = 670) found that a self-guided, internet-based cognitive-behavioural intervention targeting dysfunctional COVID-19 worry significantly reduced COVID-19 anxiety (standardized mean difference [SMD] 0.74, 95% CI 0.58 to 0.90) and depression symptoms (SMD 0.38, 95% CI 0.22 to 0.55) in Swedish general population participants. A lay-delivered telephone intervention for homebound older adults in the United States (N = 240) and a peer-moderated education and support intervention for people with a rare autoimmune condition from 12 countries (N = 172) significantly improved anxiety (SMD 0.35, 95% CI 0.09 to 0.60; SMD 0.31, 95% CI 0.03 to 0.58) and depressive symptoms (SMD 0.31, 95% CI 0.05 to 0.56; SMD 0.31, 95% CI 0.07 to 0.55) 6-weeks post-intervention, but these were not significant immediately post-intervention. No trials in children or adolescents were identified. Interpretation: Internet-based programs for the general population and lay- or peer-delivered interventions for vulnerable groups may be effective, scalable options for public mental health in COVID-19. More well-conducted trials, including for children and adolescents, are needed.

A priori consent within pragmatic randomised controlled trials: a web-based survey of statin use in primary care

2017 ◽  
Vol 3 (4) ◽  
pp. 206-211 ◽  
Author(s):  
Alex Semprini ◽  
Thomas Hills ◽  
Irene Braithwaite ◽  
Mark Weatherall ◽  
Richard Beasley
Keyword(s):  
Primary Care ◽  
Randomised Controlled Trials ◽  
A Priori ◽  
Controlled Trials ◽  
Web Based ◽  
Randomised Controlled ◽  
Statin Use

scholarly journals Psychological interventions for positive symptoms in schizophrenia: protocol for a network meta-analysis of randomised controlled trials

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e019280 ◽  
Author(s):  
Irene Bighelli ◽  
Georgia Salanti ◽  
Cornelia Reitmeir ◽  
Sofia Wallis ◽  
Corrado Barbui ◽  
...  
Keyword(s):  
Randomised Controlled Trials ◽  
Psychological Intervention ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Evaluation Framework ◽  
Sensitivity Analyses ◽  
Controlled Trials ◽  
Positive Symptoms ◽  
Psychological Treatments ◽  
Randomised Controlled

IntroductionThere is rising awareness that we need multidisciplinary approaches integrating psychological treatments for schizophrenia, but a comprehensive evidence based on their relative efficacy is lacking. We will conduct a network meta-analysis (NMA), integrating direct and indirect comparisons from randomised controlled trials (RCTs) to rank psychological treatments for schizophrenia according to their efficacy, acceptability and tolerability.Methods and analysisWe will include all RCTs comparing a psychological treatment aimed at positive symptoms of schizophrenia with another psychological intervention or with a no treatment condition (waiting-list and treatment as usual). We will include studies on adult patients with schizophrenia, excluding specific subpopulations (eg, first-episode patients or patients with psychiatric comorbidities). Primary outcome will be the change in positive symptoms on a published rating scale. Secondary outcomes will be acceptability (dropout), change in overall and negative symptoms of schizophrenia, response, relapse, adherence, depression, quality of life, functioning and adverse events. Published and unpublished studies will be sought through database searches, trial registries and websites. Study selection and data extraction will be conducted by at least two independent reviewers. We will conduct random-effects NMA to synthesise all evidences for each outcome and obtain a comprehensive ranking of all treatments. NMA will be conducted in Stata and R within a frequentist framework. The risk of bias in studies will be evaluated using the Cochrane Risk of Bias tool and the credibility of the evidence will be evaluated using an adaptation of the Grading of Recommendations Assessment, Development and Evaluation framework to NMA, recommended by the Cochrane guidance. Subgroup and sensitivity analyses will be conducted to assess the robustness of the findings.Ethics and disseminationNo ethical issues are foreseen. Results from this study will be published in peer-reviewed journals and presented at relevant conferences.PROSPERO registration numberCRD42017067795.

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