scholarly journals Interventional Indirect Effects: A Novel Approach to Optimise Complex Psychological Therapies to Treat Depression for Scale-up in Goa, India

2021 ◽  
Author(s):  
Nadine Seward ◽  
Stijn Vansteelandt ◽  
Darío Moreno-Agostino ◽  
Vikram Patel ◽  
Ricardo Araya
Keyword(s):  
Indirect Effects ◽  
Psychological Intervention ◽  
Short Form ◽  
Scale Up ◽  
Total Effect ◽  
Depression Symptoms ◽  
Behavioural Activation ◽  
Direct Effects ◽  
Psychological Therapies ◽  
Healthy Activity

Abstract Introduction: Understanding how and under what circumstances complex psychological therapies work (or not) is important to bring evidence-informed intervention to scale, especially in resource poor settings. However, current methods do not apply methodology that account for the underlying complexity of these interventions including the interplay between implementation outcomes, implementation strategies and mechanisms. Here we apply a robust mediation analysis to address these issues to data from the Healthy Activity Program (HAP) trial –a psychological intervention for depression delivered using task-shifting with lay counsellors in Goa India.Methods: Interventional in(direct) effects were used to simultaneously decompose the total effect of the intervention on depression symptoms measured through the Patient Health Questionnaire (PHQ-9). The following indirect effects were considered: fidelity of receipt including number of sessions and homework completed; behavioural activation according to an adapted version of the Behavioural Activation for Depression Short Form (BADS-SF), and extra sessions offered to participants who did not respond to the intervention. Results: Of the total effect of the intervention measured through the difference in PHQ-9 scores between treatment arms (mean difference: -2.2, 95% bias-corrected CI: -3.2, -0.8), 45% was mediated through improved levels of behavioural activation (-1.0, -1.3, -0.6). There was little evidence to support the mediating role of characteristics of the sessions nor the extra sessions offered to participants who did not respond to the treatment. ConclusionsFindings from our analyses have demonstrated how interventional (in)direct effects can be applied to understand how implementation research programmes can be optimised for scale-up. Our results highlight the importance of sessions focusing on behavioural activation to improve symptoms of depression. Targeting non-responders with strategies other than extra therapy sessions has the potential to improve depression outcomes at a population level.

scholarly journals Causal meditation analysis to understand how different components of a complex psychological intervention improved symptoms (or not) of depression in Goa, India

2021 ◽  
Author(s):  
Nadine Seward ◽  
Stijn Vansteelandt ◽  
Darío Moreno-Agostino ◽  
Vikram Patel ◽  
Ricardo Araya
Keyword(s):  
Indirect Effects ◽  
Psychological Intervention ◽  
Short Form ◽  
Total Effect ◽  
Depression Symptoms ◽  
Behavioural Activation ◽  
Mediation Analyses ◽  
Symptoms Of Depression ◽  
The Difference ◽  
Healthy Activity

AbstractBackgroundUnderstanding how and under what circumstances a highly effective psychological intervention, improved symptoms of depression is important to bring this evidence-informed intervention to scale, particularly in resource-poor settings. We aim to estimate the indirect effects of potentially important mediators to improve symptoms of depression in the Healthy Activity Program (HAP) trial.MethodsInterventional in(direct) effects were used to simultaneously decompose the total effect of the intervention on depression symptoms measured through the Patient Health Questionnaire (PHQ-9). The following indirect effects were considered: characteristics of sessions including the number of sessions and homework completed; behavioural activation according to an adapted version of the Behavioural Activation for Depression Short Form (BADS-SF), and extra sessions offered to participants who did not respond to the intervention.ResultsOf the total effect of the intervention measured through the difference in PHQ-9 scores between treatment arms (mean difference: -2.2, 95% bias-corrected CI: -3.2, -0.8), 45% was mediated through improved levels of behavioural activation (−1.0, -1.3, -0.6). There was no evidence to support the mediating role of characteristics of the sessions nor the extra sessions offered to participants who did not respond to the treatment.ConclusionsFindings from our robust mediation analyses, confirmed the importance of behavioural activation in improving depression symptoms. Contrary to published literature, our findings suggest that neither the number of sessions nor proportion of homework completed, improved outcomes. Moreover, results indicate that the extra sessions were insufficient to improve symptoms of depression for participants who did not respond to the intervention.

scholarly journals The Influence of Depression, Anxiety and Cognition on the Treatment Effects of Ginkgo biloba Extract EGb 761® in Patients with Tinnitus and Dementia: A Mediation Analysis

2021 ◽  
Vol 10 (14) ◽  
pp. 3151
Author(s):  
Petra Brüggemann ◽  
Marília Grando Sória ◽  
Juliette Brandes-Schramm ◽  
Birgit Mazurek
Keyword(s):  
Ginkgo Biloba ◽  
Mediation Analysis ◽  
Indirect Effects ◽  
Neuropsychiatric Symptoms ◽  
Ginkgo Biloba Extract ◽  
Total Effect ◽  
Egb 761 ◽  
Direct Effects ◽  
Symptoms Of Depression ◽  
Tinnitus Severity

Background: Comorbid occurrence of tinnitus and emotional symptoms of anxiety and depression is highly prevalent. The Ginkgo biloba extract EGb 761® has been shown to be effective in reducing neuropsychiatric symptoms in patients with dementia and tinnitus. Methods: We performed a mediation analysis to evaluate direct effects of EGb 761® on tinnitus severity, as well as indirect effects mediated by symptoms of depression and anxiety and by changed cognition. We pooled data from subsets of patients suffering from tinnitus that were enrolled in three double-blind, randomized, placebo-controlled clinical trials, which investigated the efficacy of EGb 761® (240 mg/day for 22–24 weeks) in dementia with concomitant neuropsychiatric symptoms. Results: In total, 594 patients suffered from tinnitus (EGb 761®, 289; placebo, 305). Direct effects of EGb 761® on tinnitus severity (p < 0.001) in patients with mild to moderate dementia were found to represent about 60% of the total effect, whereas the indirect effects (p < 0.001) mediated by improvement of anxiety, depression and cognition represented about 40% of the total effect. Conclusions: EGb 761® could be considered as a supporting treatment for tinnitus in elderly patients suffering from dementia, with added benefit in those with symptoms of depression or anxiety.

scholarly journals The Multiple Effects of Procurement Price on Production and Procurement of Wheat in Pakistan

1989 ◽  
Vol 28 (2) ◽  
pp. 95-120 ◽  
Author(s):  
Thomas C. Pinckney
Keyword(s):  
Indirect Effects ◽  
Wholesale Price ◽  
Government Procurement ◽  
Total Effect ◽  
Direct Effects ◽  
Procurement Price ◽  
The Impact

An increase in the procurement price affects government procurement of wheat in at least four ways. Properly estimating the total effect requires taking account of both the direct effects of an increased share of marketed surplus being procured and the indirect effects through the impact on production, marketed surplus, and the wholesale price. Estimates are that a real one-rupee increase per 40 kilograms - approximately 1.25 percent - will raise procurement by about 90 thousand tons.

Interpersonal Stress and Poor Health

2010 ◽  
Vol 15 (1) ◽  
pp. 3-11 ◽  
Author(s):  
Mette M. Aanes ◽  
Maurice B. Mittelmark ◽  
Jørn Hetland
Keyword(s):  
Psychological Distress ◽  
Depressive Symptoms ◽  
Social Relationships ◽  
Indirect Effects ◽  
Social Connectedness ◽  
Somatic Symptoms ◽  
Total Effect ◽  
Subjective Feeling ◽  
Interpersonal Stress ◽  
The Relationship

This paper investigated whether the lack of social connectedness, as measured by the subjective feeling of loneliness, mediates the well-known relationship between interpersonal stress and psychological distress. Furthermore, a relationship between interpersonal stress and somatic symptoms was hypothesized. The study sample included 3,268 women and 3,220 men in Western Norway. The main findings were that interpersonal stress was significantly related to psychological distress as well as to somatic symptoms, both directly and indirectly via paths mediated by loneliness. The size of the indirect effects varied, suggesting that the importance of loneliness as a possible mediator differs for depressive symptoms, anxiety symptoms, and somatic symptoms. In the case of depressive symptoms, more than 75% of the total effect was mediated through loneliness, while in the case of somatic symptoms just over 40% of the total effect was mediated through loneliness. This study supports the hypotheses that social connectedness mediates a relationship between interpersonal stress and psychological distress. The study also provides the first link between interpersonal stress, as measured by the Bergen Social Relationships Scale, and somatic symptoms, extending earlier research on the relationship between interpersonal stress and psychological distress.

Trophic Cascades in Grasslands

2018 ◽  
Author(s):  
Brian J. Wilsey
Keyword(s):  
Indirect Effects ◽  
Prey Species ◽  
Trophic Levels ◽  
Herbaceous Plant ◽  
Direct Effects ◽  
Temperate Grasslands ◽  
Cascading Effect ◽  
Top Predators ◽  
Invertebrate Predators ◽  
Ecology Of Fear

Top predators have effects that can ‘cascade down’ on lower trophic levels. Because of this cascading effect, it matters how many trophic levels are present. Predators are either ‘sit and wait’ or ‘active’. Wolves are top predators in temperate grasslands and can alter species composition of smaller-sized predators, prey, and woody and herbaceous plant species, either through direct effects or indirect effects (‘Ecology of Fear’). In human derived grasslands, invertebrate predators fill a similar ecological role as wolves. Migrating populations of herbivores tend to be more limited by food than non-migratory populations. The phenology and synchrony of births vary among prey species in a way that is consistent with an adaptation to predation. Precocious species have highly synchronous birth dates to satiate predators. Non-precocious species (‘hiders’) have asynchronous births. Results from studies that manipulate both predators and food support the hypothesis that bottom-up and top-down effects interact.

scholarly journals Brief Behavioural Activation (Brief BA) for Adolescent Depression: A Pilot Study

2017 ◽  
Vol 46 (2) ◽  
pp. 182-194 ◽  
Author(s):  
Laura Pass ◽  
Carl W. Lejuez ◽  
Shirley Reynolds
Keyword(s):  
Mental Health ◽  
Pilot Study ◽  
Young People ◽  
Adolescent Depression ◽  
Psychological Intervention ◽  
Clinical Effectiveness ◽  
Evidence Based ◽  
Behavioural Activation ◽  
Evidence Based Treatments ◽  
The Uk

Background: Depression in adolescence is a common and serious mental health problem. In the UK, access to evidence-based psychological treatments is limited, and training and employing therapists to deliver these is expensive. Brief behavioural activation for the treatment of depression (BATD) has great potential for use with adolescents and to be delivered by a range of healthcare professionals, but there is limited empirical investigation with this group. Aims: To adapt BATD for depressed adolescents (Brief BA) and conduct a pilot study to assess feasibility, acceptability and clinical effectiveness. Method: Twenty depressed adolescents referred to the local NHS Child and Adolescent Mental Health service (CAMHs) were offered eight sessions of Brief BA followed by a review around one month later. Self- and parent-reported routine outcome measures (ROMs) were collected at every session. Results: Nineteen of the 20 young people fully engaged with the treatment and all reported finding some aspect of Brief BA helpful. Thirteen (65%) required no further psychological intervention following Brief BA, and both young people and parents reported high levels of acceptability and satisfaction with the approach. The pre–post effect size of Brief BA treatment was large. Conclusions: Brief BA is a promising innovation in the treatment of adolescent depression. This approach requires further evaluation to establish effectiveness and cost effectiveness compared with existing evidence-based treatments for adolescent depression. Other questions concern the effectiveness of delivery in other settings and when delivered by a range of professionals.

scholarly journals Age Cohort Differences and Depressive Symptoms Among Community-Dwelling Older Americans

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 61-61
Author(s):  
Ethan Siu Leung Cheung ◽  
Ada Mui
Keyword(s):  
Depressive Symptoms ◽  
Short Form ◽  
Cognitive Status ◽  
Community Dwelling ◽  
Independent Effect ◽  
Depression Symptoms ◽  
Older Americans ◽  
Age Cohorts ◽  
Cohort Differences ◽  
Age Cohort

Abstract This study uses Wave 3 National Social Life, Health and Aging Project to examine the correlation between age cohorts [60s (n=1204); 70s (n=1176); 80 and older (n= 724)], cognitive status, and depression symptoms. In the total sample, 53.90% were females, 76.15% Whites, 15.29% Blacks, and 8.56% Asians. Compared to the 60s and 70s cohorts, 80+ cohort was cognitively more impaired [Mean (SD) of MoCA Short Form were 10.7(2.9), 10.0(3.2), and 8.1(3.6)]. There were no age cohorts’ differences in depressive symptoms experienced (Mean of CESD Short Form = 21.03; SD = 4.06). In order to identify predictors of depression, multiple hierarchical regressions were performed. The 60s sample was the reference group to compare with 70s and 80s cohorts. Results showed that age cohort variables had a significant independent effect as well as a joint effect with cognitive status in explaining depression scores. For each age cohort group, parallel regression analyses were conducted and all models were significant. Findings suggest that ADL impairment was the only common predictor for depressive symptoms for the three cohort groups, and the association was the strongest for the 60s cohort (b = .31). Other unique predictors for 60s cohort were lower-income, more IADLs impairment, higher stress and cognitive impairment. For the 70s cohort, unique predictors of depressive symptoms were female gender, unmarried, and less socialization. For the 80 and above group, correlates of depression are female, White, and high stress level. Findings highlight the necessity of age-sensitive programs on depression support for community-dwelling older Americans.

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