scholarly journals Adapting and Testing a Brief Intervention to Reduce Maternal Anxiety During Pregnancy (ACORN): Report of a Feasibility Randomized Controlled Trial

2021 ◽  
Author(s):  
Heather A O’Mahen ◽  
Paul G Ramchandani ◽  
Dorothy X King ◽  
Leonie Lee-Carbon ◽  
Esther L Wilkinson ◽  
...  
Keyword(s):  
Brief Intervention ◽  
Large Scale ◽  
Controlled Trial ◽  
Child Outcomes ◽  
Health Benefit ◽  
Treatment As Usual ◽  
Public Health Benefit ◽  
Care Services ◽  
Primary Care Services ◽  
Intervention Treatment

Abstract Background. We investigated the acceptability and feasibility of a new brief intervention for maternal prenatal anxiety within maternity services. Results. 114 pregnant women attending their 12-week scan at a prenatal clinic with elevated symptoms of anxiety (GAD-7 score of ≥ 7) were randomly assigned to either the ACORN intervention + Treatment as usual (TAU) (n=57) or to usual care only (n= 57). The ACORN intervention consisted of 3 group sessions, led by a midwife and psychological therapist, for women and their partners. The intervention included psychoeducation about anxiety, strategies for problem-sovling and tolerating uncertainty during pregnancy, including communicating about these with others, and mindfulness exercises. Engagement rates with ACORN met or exceeded those in primary care services in England. In the intervention arm, 77% (n= 44) of participants attended at least one session, 51% (n=29) were adherent, defined as attending two or more sessions. Feedback was positive, and women in the ACORN treatment group demonstrated some evidence of a larger drop in their levels of anxiety than the women in the TAU-only group (Cohen’s d = 0.42). Conclusion. The ACORN intervention was acceptable to women and their partners and resulted in reductions in anxiety. With further evaluation in a larger-scale trial with child outcomes, there is significant potential for large scale public health benefit.

scholarly journals The Impact of an Early Eclectic Rehabilitative Intervention on Symptoms in First Episode Depression among Employed People

2013 ◽  
Vol 2013 ◽  
pp. 1-8
Author(s):  
Tero Raiskila ◽  
Sanna Blanco Sequeiros ◽  
Jorma Kiuttu ◽  
Marja-Liisa Kauhanen ◽  
Kristian Läksy ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Intervention Group ◽  
First Episode ◽  
Control Group ◽  
Treatment As Usual ◽  
Intervention Treatment ◽  
Working Age ◽  
Rehabilitative Intervention ◽  
One Year ◽  
The Impact

Objective. To evaluate the effect of an early vocational-orientated eclectic intervention on beck depression inventory (BDI) scores compared to treatment as usual in first ever depressive episode among employed people.Design. A randomized controlled trial comparing the rehabilitative intervention and the conventional treatment.Subjects. The subjects came from occupational health care units.Methods. Employees were sent to a rehabilitation center after being screened for depression using the BDI. They were diagnosed using the structured clinical interview for DSM-IV. The participating subjects (N=283) were randomized into intervention and control groups. The intervention group received eclectic early depression intervention treatment (N=134) and the control group was treated in the conventional way (N=100). They were followed for one year.Results. The mean decrease in BDI scores within the intervention group was from 20.8 to 11.6 and within the control group from 19.3 to 10.8. BDI score decreased by 10 or more points in 64% of the participants in the intervention group and in 53% of the control group (P=0.013).Conclusions. There was some evidence that early eclectic intervention in first ever episode depression may be more effective than conventional treatments among working age people in employment.

scholarly journals Group interpersonal psychotherapy for depression in rural Uganda: 6-month outcomes

2006 ◽  
Vol 188 (6) ◽  
pp. 567-573 ◽  
Author(s):  
Judith Bass ◽  
Richard Neugebauer ◽  
Kathleen F. Clougherty ◽  
Helen Verdeli ◽  
Priya Wickramaratne ◽  
...  
Keyword(s):  
Functional Impairment ◽  
Controlled Trial ◽  
Health Benefit ◽  
Interpersonal Psychotherapy ◽  
Control Group ◽  
Depression Symptom ◽  
Treatment As Usual ◽  
Randomised Controlled

BackgroundA randomised controlled trial comparing group interpersonal psychotherapy with treatment as usual among rural Ugandans meeting symptom and functional impairment criteria for DSM–IV major depressive disorder or sub-threshold disorder showed evidence of effectiveness immediately following the intervention.AimsTo assess the long-term effectiveness of this therapy over a subsequent 6-month period.MethodA follow-up study of trial participants was conducted in which the primary outcomes were depression diagnosis, depressive symptoms and functional impairment.ResultsAt 6 months, participants receiving the group interpersonal psychotherapy had mean depression symptom and functional impairment scores respectively 14.0 points (95% CI 12.2–15.8; P < 0.0001) and 5.0 points (95% CI 3.6–6.4; P < 0.0001) lower than the control group. Similarly, the rate of major depression among those in the treatment arm (11.7%) was significantly lower than that in the control arm (54.9%) (P < 0.0001).ConclusionsParticipation in a 16-week group interpersonal psychotherapy intervention continued to confer a substantial mental health benefit 6 months after conclusion of the formal intervention.

scholarly journals AQUEDUCT Intervention for Crisis Team Quality and Effectiveness in Dementia: Protocol for a Feasibility Study

10.2196/18971 ◽  
2020 ◽  
Vol 9 (10) ◽  
pp. e18971
Author(s):  
Emma Elizabeth Broome ◽  
Donna Maria Coleston-Shields ◽  
Tom Dening ◽  
Esme Moniz-Cook ◽  
Fiona Poland ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Feasibility Study ◽  
Large Scale ◽  
Best Practice ◽  
Controlled Trial ◽  
Practice Model ◽  
Treatment As Usual ◽  
Randomized Controlled ◽  
People With Dementia ◽  
Need To Evaluate

Background Specialist community teams often support people with dementia who experience crisis. These teams may vary in composition and models of practice, which presents challenges when evaluating their effectiveness. A best practice model for dementia crisis services could be used by teams to improve the quality and effectiveness of the care they deliver. Objective The aim of this study is to examine the feasibility of conducting a large-scale randomized controlled trial comparing the AQUEDUCT (Achieving Quality and Effectiveness in Dementia Using Crisis Teams) Resource Kit intervention to treatment as usual. Methods This is a multisite feasibility study in preparation for a future randomized controlled trial. Up to 54 people with dementia (and their carers) and 40 practitioners will be recruited from 4 geographically widespread teams managing crisis in dementia. Quantitative outcomes will be recorded at baseline and at discharge. This study will also involve a nested health economic substudy and qualitative research to examine participant experiences of the intervention and acceptability of research procedures. Results Ethical approval for this study was granted in July 2019. Participant recruitment began in September 2019, and as of September 2020, all data collection has been completed. Results of this study will establish the acceptability of the intervention, recruitment rates, and will assess the feasibility and appropriateness of the outcome measures in preparation for a large-scale randomized controlled trial. Conclusions There is a need to evaluate the effectiveness of crisis intervention teams for older people with dementia. This is the first study to test the feasibility of an evidence-based best practice model for teams managing crisis in dementia. The results of this study will assist in the planning and delivery of a large-scale randomized controlled trial. International Registered Report Identifier (IRRID) DERR1-10.2196/18971

scholarly journals The Effectiveness of a Guided Internet-Based Tool for the Treatment of Depression and Anxiety in Pregnancy (MamaKits Online): Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Hanna M Heller ◽  
Adriaan W Hoogendoorn ◽  
Adriaan Honig ◽  
Birit FP Broekman ◽  
Annemieke van Straten
Keyword(s):  
Pregnant Women ◽  
Controlled Trial ◽  
Child Outcomes ◽  
Depression Scale ◽  
Internet Intervention ◽  
Control Group ◽  
Treatment As Usual ◽  
Randomized Controlled ◽  
Affective Symptoms ◽  
In Pregnancy

BACKGROUND Pregnant women with symptoms of depression or anxiety often do not receive adequate treatment. In view of the high incidence of these symptoms in pregnancy and their impact on pregnancy outcomes, getting treatment is of the utmost importance. A guided internet self-help intervention may help to provide more women with appropriate treatment. OBJECTIVE This study aimed to examine the effectiveness of a guided internet intervention (MamaKits online) for pregnant women with moderate to severe symptoms of anxiety or depression. Assessments took place before randomization (T0), post intervention (T1), at 36 weeks of pregnancy (T2), and 6 weeks postpartum (T3). We also explored effects on perinatal child outcomes 6 weeks postpartum. METHODS This randomized controlled trial included pregnant women (&lt;30 weeks) with depressive symptoms above threshold (ie, Center for Epidemiological Studies Depression scale [CES-D] &gt;16) or anxiety above threshold (ie, Hospital Anxiety and Depression Scale-Anxiety subscale [HADS-A] &gt;8) or both of them. Participants were recruited via general media and flyers in prenatal care waiting rooms or via obstetricians and midwives. After initial assessment, women were randomized to (1) MamaKits online in addition to treatment as usual or (2) treatment as usual (control condition). MamaKits online is a 5-week guided internet intervention based on problem solving treatment. Guidance was was provided by trained students pursuing a Master's in Psychology. Outcomes were based on a Web-based self-report. Women in the control condition were allowed to receive the intervention after the last assessment (6 weeks postpartum). RESULTS Of the 159 included women, 79 were randomized to MamaKits online, 47% (79/37) of whom completed the intervention. Both groups showed a substantial decrease in affective symptoms on the CES-D, HADS-A, and Edinburgh Postnatal Depression Scale over time. In the intervention group, affective symptoms decreased more than that in the control group, but between-group effect sizes were small to medium (Cohen <i>d</i> at T3=0.45, 0.21, and 0.23 for the 3 questionnaires, respectively) and statistically not significant. Negative perinatal child outcomes did not differ between the 2 groups (χ<sup>2</sup><sub>1</sub>=0.1; <i>P</i>=.78). Completer analysis revealed no differences in outcome between the treatment completers and the control group. The trial was terminated early for reasons of futility based on the results of an interim analysis, which we performed because of inclusion problems. CONCLUSIONS Our study did show a significant reduction in affective symptoms in both groups, but the differences in reduction of affective symptoms between the intervention and control groups were not significant. There were also no differences in perinatal child outcomes. Future research should examine for which women these interventions might be effective or if changes in the internet intervention might make the intervention more effective. CLINICALTRIAL Netherlands Trial Register NL4162; https://tinyurl.com/sdckjek

scholarly journals AQUEDUCT Intervention for Crisis Team Quality and Effectiveness in Dementia: Protocol for a Feasibility Study (Preprint)

2020 ◽  
Author(s):  
Emma Elizabeth Broome ◽  
Donna Maria Coleston-Shields ◽  
Tom Dening ◽  
Esme Moniz-Cook ◽  
Fiona Poland ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Feasibility Study ◽  
Large Scale ◽  
Best Practice ◽  
Controlled Trial ◽  
Practice Model ◽  
Treatment As Usual ◽  
Randomized Controlled ◽  
People With Dementia ◽  
Need To Evaluate

BACKGROUND Specialist community teams often support people with dementia who experience crisis. These teams may vary in composition and models of practice, which presents challenges when evaluating their effectiveness. A best practice model for dementia crisis services could be used by teams to improve the quality and effectiveness of the care they deliver. OBJECTIVE The aim of this study is to examine the feasibility of conducting a large-scale randomized controlled trial comparing the AQUEDUCT (Achieving Quality and Effectiveness in Dementia Using Crisis Teams) Resource Kit intervention to treatment as usual. METHODS This is a multisite feasibility study in preparation for a future randomized controlled trial. Up to 54 people with dementia (and their carers) and 40 practitioners will be recruited from 4 geographically widespread teams managing crisis in dementia. Quantitative outcomes will be recorded at baseline and at discharge. This study will also involve a nested health economic substudy and qualitative research to examine participant experiences of the intervention and acceptability of research procedures. RESULTS Ethical approval for this study was granted in July 2019. Participant recruitment began in September 2019, and as of September 2020, all data collection has been completed. Results of this study will establish the acceptability of the intervention, recruitment rates, and will assess the feasibility and appropriateness of the outcome measures in preparation for a large-scale randomized controlled trial. CONCLUSIONS There is a need to evaluate the effectiveness of crisis intervention teams for older people with dementia. This is the first study to test the feasibility of an evidence-based best practice model for teams managing crisis in dementia. The results of this study will assist in the planning and delivery of a large-scale randomized controlled trial. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/18971

scholarly journals The Provision of Private Healthcare Services in European Countries: Recent Data and Lessons for Universal Health Coverage in Other Settings

2021 ◽  
Vol 9 ◽  
Author(s):  
Dominic Montagu
Keyword(s):  
Private Sector ◽  
Universal Health Coverage ◽  
Large Scale ◽  
Healthcare Services ◽  
Health Coverage ◽  
Health Delivery ◽  
Care Services ◽  
Primary Care Services ◽  
Minimal Importance ◽  
Universal Health

Universal Health Coverage (UHC) exists in all of the countries of Europe, despite variation on the ownership structure of health delivery systems. As countries around the world seek to advance UHC and manage the private sector within their health systems, the European experiences can offer useful insights. We found four different models for the provision of healthcare, with the private sector predominant in some countries, and of minimal importance in others. The European experiences indicate that UHC can be effectively provided with, or without, large-scale private sector provision in hospital, specialty, and primary care services, and that moreover it can be provided with high levels of patient satisfaction. These findings offer regulatory models for countries in other regions to review as they advance UHC.

scholarly journals Paris MEM: a study protocol for an effectiveness and efficiency trial on the treatment of traumatic stress in France after the 2015–16 terrorist attacks

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
A. Brunet ◽  
A. Ayrolles ◽  
L. Gambotti ◽  
R. Maatoug ◽  
C. Estellat ◽  
...  
Keyword(s):  
Study Protocol ◽  
Large Scale ◽  
Traumatic Event ◽  
Controlled Trial ◽  
Pragmatic Trial ◽  
Cost Utility ◽  
Terrorist Attacks ◽  
First Line ◽  
Treatment As Usual ◽  
One Year

Abstract Background The Paris and Nice terrorist attacks affected a thousand of trauma victims and first-line responders. Because there were concerns that this might represent the first of several attacks, there was a need to quickly enhance the local capacities to treat a large number of individuals suffering from trauma-related disorders. Since Reconsolidation Therapy (RT) is brief, relatively easy to learn, well tolerated and effective, it appeared as the ideal first-line treatment to teach to clinicians in this context. Methods This study protocol is a two-arm non-randomized, multicenter controlled trial, comparing RT to treatment as usual for the treatment of trauma-related disorders. RT consists of actively recalling one’s traumatic event under the influence of the ß-blocker propranolol, once a week, for 10–25 min with a therapist, over 6 consecutive weeks. This protocol evaluates the feasibility, effectiveness, and cost-utility of implementing RT as part of a large multi-center (N = 400) pragmatic trial with a one-year follow-up. Discussion Paris MEM is the largest trial to date assessing the efficiency of RT in the aftermath of a large-scale man-made disaster. RT could possibly reinforce the therapeutic arsenal for the treatment of patients suffering from trauma-related disorders, not only for communities in western countries but also worldwide for terror- or disaster-stricken communities. Trial registration Clinical Trials (ClinicalTrials.gov). June 3, 2016. NCT02789982.

scholarly journals Morita Therapy for depression (Morita Trial): an embedded qualitative study of acceptability

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e023873
Author(s):  
Holly Victoria Rose Sugg ◽  
Julia Frost ◽  
David A Richards
Keyword(s):  
Qualitative Study ◽  
Large Scale ◽  
Controlled Trial ◽  
Future Research ◽  
Treatment As Usual ◽  
Morita Therapy ◽  
Semistructured Interviews ◽  
Framework Approach ◽  
Randomised Controlled ◽  
The Uk

ObjectiveTo explore the views of UK-based recipients of Morita Therapy (MT) on the acceptability of MT.DesignQualitative study nested within a pilot randomised controlled trial of MT (a Japanese psychological therapy largely unknown in the UK) versus treatment as usual, using post-treatment semistructured interviews analysed with a framework approach.Setting and participantsParticipants who received MT as part of the Morita Trial, recruited for the trial from General Practice record searches in Devon, UK. Data from 16 participants were purposively sampled for analysis.ResultsWe identified five themes which, together, form a model of how different participants viewed and experienced MT. Overall, MT was perceived as acceptable by many participants who emphasised the value of the approach, often in comparison to other treatments they had tried. These participants highlighted how accepting and allowing difficulties as natural phenomena and shifting attention from symptoms to external factors had facilitated symptom reduction and a sense of empowerment. We found that how participants understood and related to the principles of MT, in light of their expectations of treatment, was significantly tied to the extent to which MT was perceived as acceptable. Our findings also highlighted the distinction between MT in principle and practice, with participants noting challenges of engaging with the process of therapy such as fear and discomfort around rest, needing sufficient support from the therapist and others, and the commitment of treatment.ConclusionsPeople in the UK can accept the premise of MT, and consider the approach beneficial and novel. Therefore, proceeding to a large-scale trial of MT is appropriate with minor modifications to our clinical protocol. Participants’ expectations and understandings of treatment play a key role in acceptability, and future research may investigate these potential moderators of acceptability in MT.Trial registration numberCISRCTN17544090; Pre-results.

scholarly journals The Effectiveness of a Guided Internet-Based Tool for the Treatment of Depression and Anxiety in Pregnancy (MamaKits Online): Randomized Controlled Trial

10.2196/15172 ◽  
2020 ◽  
Vol 22 (3) ◽  
pp. e15172 ◽  
Author(s):  
Hanna M Heller ◽  
Adriaan W Hoogendoorn ◽  
Adriaan Honig ◽  
Birit F P Broekman ◽  
Annemieke van Straten
Keyword(s):  
Pregnant Women ◽  
Controlled Trial ◽  
Child Outcomes ◽  
Depression Scale ◽  
Internet Intervention ◽  
Control Group ◽  
Treatment As Usual ◽  
Randomized Controlled ◽  
Affective Symptoms ◽  
In Pregnancy

Background Pregnant women with symptoms of depression or anxiety often do not receive adequate treatment. In view of the high incidence of these symptoms in pregnancy and their impact on pregnancy outcomes, getting treatment is of the utmost importance. A guided internet self-help intervention may help to provide more women with appropriate treatment. Objective This study aimed to examine the effectiveness of a guided internet intervention (MamaKits online) for pregnant women with moderate to severe symptoms of anxiety or depression. Assessments took place before randomization (T0), post intervention (T1), at 36 weeks of pregnancy (T2), and 6 weeks postpartum (T3). We also explored effects on perinatal child outcomes 6 weeks postpartum. Methods This randomized controlled trial included pregnant women (<30 weeks) with depressive symptoms above threshold (ie, Center for Epidemiological Studies Depression scale [CES-D] >16) or anxiety above threshold (ie, Hospital Anxiety and Depression Scale-Anxiety subscale [HADS-A] >8) or both of them. Participants were recruited via general media and flyers in prenatal care waiting rooms or via obstetricians and midwives. After initial assessment, women were randomized to (1) MamaKits online in addition to treatment as usual or (2) treatment as usual (control condition). MamaKits online is a 5-week guided internet intervention based on problem solving treatment. Guidance was was provided by trained students pursuing a Master's in Psychology. Outcomes were based on a Web-based self-report. Women in the control condition were allowed to receive the intervention after the last assessment (6 weeks postpartum). Results Of the 159 included women, 79 were randomized to MamaKits online, 47% (79/37) of whom completed the intervention. Both groups showed a substantial decrease in affective symptoms on the CES-D, HADS-A, and Edinburgh Postnatal Depression Scale over time. In the intervention group, affective symptoms decreased more than that in the control group, but between-group effect sizes were small to medium (Cohen d at T3=0.45, 0.21, and 0.23 for the 3 questionnaires, respectively) and statistically not significant. Negative perinatal child outcomes did not differ between the 2 groups (χ21=0.1; P=.78). Completer analysis revealed no differences in outcome between the treatment completers and the control group. The trial was terminated early for reasons of futility based on the results of an interim analysis, which we performed because of inclusion problems. Conclusions Our study did show a significant reduction in affective symptoms in both groups, but the differences in reduction of affective symptoms between the intervention and control groups were not significant. There were also no differences in perinatal child outcomes. Future research should examine for which women these interventions might be effective or if changes in the internet intervention might make the intervention more effective. Trial Registration Netherlands Trial Register NL4162; https://tinyurl.com/sdckjek

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