scholarly journals Individualized Web-Based Attention Training with Evidence-Based Counseling: Exploratory Study to Address HIV Treatment Adherence and Psychological Distress (Preprint)

2020 ◽  
Author(s):  
Eric Houston ◽  
Javad Salehi Fadardi ◽  
Nina T. Harawa ◽  
Chris Argueta ◽  
Sukrit Mukherjee
Keyword(s):  
Psychological Distress ◽  
Depressive Symptoms ◽  
Treatment Adherence ◽  
Service Providers ◽  
The United States ◽  
Hiv Treatment ◽  
Attention Training ◽  
Control Group ◽  
Evidence Based ◽  
Web Based

BACKGROUND The prevalence of mood and trauma-stress-related disorders is disproportionately higher among people living HIV compared to individuals without the virus. Poor adherence to HIV treatment and heightened psychological distress have been linked to symptoms associated with these disorders. OBJECTIVE The objective of this exploratory pilot study was to develop and implement an intervention that combined individualized web-based attention training with evidence-based counseling to promote HIV treatment adherence and reduce psychological distress. The study targeted African American and Latino young men who have sex with men (YMSM), two population groups in the United States that continue to experience disparities in HIV treatment outcomes. METHODS Study participants with elevated symptoms of depression and suboptimal adherence to antiretroviral therapy (ART) were recruited primarily through referrals from Los Angeles health and social service providers as well as postings on social media. Participants enrolled in the four-week intervention received weekly counseling for adherence and daily access to web-based attention training via their own mobile devices or computers. RESULTS Of the 14 participants who began the intervention, twelve (86%) completed all sessions and study procedures. Using a pretest-posttest design, findings indicate significant improvements in adherence, depressive symptoms, and attention processing. Overall, the proportion of participants reporting low adherence to ART declined from 42% at baseline to 25% at intervention completion (P=.02, phi = .68). Mean depressive symptoms measured by the Patient Health Questionnaire (PHQ-9) showed a substantial reduction of 36% (P=.002, d=1.2). In addition, participant attentional processing speeds for all types of stimuli pairings presented during attention training improved significantly (Ps = .01 and .02), and were accompanied by large effect sizes ranging from -.78 to -1.0. CONCLUSIONS Findings support the feasibility of web-based attention training combined with counseling to improve ART adherence among patients with psychological distress. Future research should include a larger sample, a control group, and longer-term follow-up. CLINICALTRIAL

scholarly journals Implementation of NAVIGATE Coordinated Specialty Care for First Episode Psychosis: the Michigan Experience

CNS Spectrums ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 177-178
Author(s):  
Eric D. Achtyes ◽  
Kari Kempema ◽  
Zhehui Luo ◽  
Katharine N. Thakkar ◽  
Catherine Adams ◽  
...  
Keyword(s):  
Mental Health ◽  
Clinical Symptoms ◽  
The United States ◽  
First Episode Psychosis ◽  
Specialty Care ◽  
First Episode ◽  
Control Group ◽  
Evidence Based ◽  
Block Grant ◽  
Episode Psychosis

AbstractStudy ObjectivesCoordinated specialty care (CSC) is widely accepted as an evidence-based treatment for first episode psychosis (FEP). The NAVIGATE intervention from the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) study is a CSC intervention which offers a suite of evidence-based treatments shown to improve engagement and clinical outcomes, especially in those with shorter duration of untreated psychosis (DUP). Coincident with the publication of this study, legislation was passed by the United States Congress in 2014–15 to fund CSC for FEP via a Substance Abuse and Mental Health Services Administration (SAMHSA) block grant set-aside for each state. In Michigan (MI) the management of this grant was delegated to Network180, the community mental health authority in Kent County, with the goal of making CSC more widely available to the 10 million people in MI. Limited research describes the outcomes of implementation of CSC into community practices with no published accounts evaluating the use of the NAVIGATE intervention in a naturalistic setting. We describe the outcomes of NAVIGATE implementation in the state of MI.MethodsIn 2014, 3 centers in MI were selected and trained to provide NAVIGATE CSC for FEP. In 2016 a 4th center was added, and 2 existing centers were expanded to provide additional access to NAVIGATE. Inclusion: age 18–31, served in 1 of 4 FEP centers in MI. Data collection began in 2015 for basic demographics, global illness (CGI q3 mo), hospital/ED use and work/school (SURF q3 mo) and was expanded in 2016 to include further demographics, diagnosis, DUP, vital signs; and in 2018 for clinical symptoms with the modified Colorado Symptom Inventory (mCSI q6 mo), reported via an online portal. This analysis used data until 12/31/19. Mixed effects models adjusted by age, sex and race were used to account for correlated data within patients.ResultsN=283 had useable demographic information and were included in the analysis. Age at enrollment was 21.6 ± 3.0 yrs; 74.2% male; 53.4% Caucasian, 34.6% African American; 12.9 ± 1.7 yrs of education (N=195). 18 mo retention was 67% with no difference by sex or race. CGI scores decreased 20% from baseline (BL) to 18 mo (BL=3.5, N=134; 15–18 mo=2.8, N=60). Service utilization via the SURF was measured at BL (N=172) and 18 mo (N=72): psychiatric hospitalizations occurred in 37% at BL and 6% at 18 mo (p<0.01); ER visits occurred in 40% at BL and 13% at 18 mo (p<0.01). 44% were working or in school at BL and 68% at 18 mo (p<0.01). 21% were on antipsychotics (AP) at BL (N=178) and 85% at 18 mo (N=13) with 8% and 54% on long acting injectable-AP at BL and 18 mo, respectively. Limitations include missing data and lack of a control group.ConclusionThe implementation of the NAVIGATE CSC program for FEP in MI resulted in meaningful clinical improvement for enrollees. Further support could make this evidence-based intervention available to more people with FEP.FundingSupported by funds from the SAMHSA Medicaid State Block Grant set-aside awarded to Network180 (Achtyes, Kempema). The funders had no role in the design of the study, the analysis or the decision to publish the results.

scholarly journals Characteristics, Outcomes, and Statistical Solutions of Missing Cases in Web-Based Psychotherapy: A methodological replication and elaboration (Preprint)

2020 ◽  
Author(s):  
Eyal Karin ◽  
Monique Francis Crane ◽  
Blake Farran Dear ◽  
Olav Nielssen ◽  
Gillian Ziona Heller ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Treatment Outcomes ◽  
Clinical Outcomes ◽  
Treatment Adherence ◽  
Statistical Models ◽  
Post Treatment ◽  
Symptom Change ◽  
Web Based ◽  
Reduction Effect

BACKGROUND Missing cases present a challenge to our ability to evaluate the effects of web-based psychotherapy trials. As missing cases are often lost to follow up, less is known about their characteristics, their likely clinical outcomes, or the likely effect of the treatment being trialled. OBJECTIVE To explore the characteristics of missing cases, their likely treatment outcomes, and the ability of different statistical models to approximate missing post-treatment data. METHODS A sample of internet-delivered cognitive behavioural therapy participants, in routine care (n = 6701 with 36% missing cases at post-treatment), was used to identify predictors of dropping out of treatment and predictors that moderated clinical outcomes, such as psychological distress, anxiety and depressive symptoms. These variables were then incorporated into a range of statistical models that approximated replacement outcomes for missing cases, with the results compared using sensitivity and cross-validation analyses. RESULTS Treatment adherence, as measured by the rate of an individual’s progress through the treatment modules, and higher symptom scores at pre-treatment, were identified as the dominant predictors of missing cases probability (Nagelkerke R2 = 60.8%), as well as the rate of symptom change. Low treatment adherence, in particular, was associated with increased odds for presenting as missing cases during post-treatment assessment (eg, OR = 161.1:1) and at the same time, attenuate the rate of symptom change across anxiety (up to 28% of the total symptom 48% reduction effect), depression (up to 41% of the total 48% symptom reduction effect) and psychological distress symptom outcomes (up to 52% of the total 37% symptom reduction effect) at the end of an eight week window. Reflecting this pattern of results, statistical replacement methods that overlooked the features of treatment adherence, and baseline severity, underestimated missing case symptom outcomes by as much as 40% at post-treatment. CONCLUSIONS The treatment outcomes of the cases that were missing at follow up were distinct from the remaining observed sample. Thus, overlooking the features of missing cases is likely to result in an inaccurate estimate of the effect of treatment. CLINICALTRIAL

scholarly journals Revised guidelines for HIV testing, counselling, and screening in the United States

2002 ◽  
Vol 6 (1) ◽  
Author(s):  
K. A. Fenton ◽  
C McGarrigle
Keyword(s):  
United States ◽  
Pregnant Women ◽  
Service Providers ◽  
The United States ◽  
Hiv Treatment ◽  
Hiv Screening ◽  
Policy Makers ◽  
Treatment And Prevention ◽  
Perinatally Acquired ◽  
Clinical Advances

The Centers for Disease Control (CDC) in the United States has published a report containing revised guidelines for HIV counselling, testing, and referral (CTR), and revised recommendations for HIV screening of pregnant women (1). The CTR guidelines replace the existing 1994 guidelines (2) and contain recommendations for policy-makers and service providers of HIV CTR. The revised recommendations for HIV screening for pregnant women replace the 1995 guidelines (3). The revision was prompted by recent advances in both HIV CTR and HIV treatment and prevention and clinical advances in preventing perinatally acquired HIV.

Interventions for Students with Autism and Asperger’s Syndrome

2017 ◽  
Author(s):  
Michelle S. Ballan ◽  
Molly Burke Freyer ◽  
Lauren Powledge
Keyword(s):  
Video Modeling ◽  
The United States ◽  
Autism Spectrum ◽  
Attention Training ◽  
Evidence Based ◽  
Activity Schedules ◽  
Training Video ◽  
Integral Role ◽  
Students With Autism

Evidence-based interventions for students with autism spectrum disorder (ASD) are explored, and trends and changes in the diagnosis of ASD in the United States are examined. Evidence-based interventions in various settings and modalities are discussed, with detailed descriptions of several effective evidence-based interventions including joint attention training, video modeling, story-based interventions, and activity schedules. The integral role of social workers in the lives of children with ASD in multiple settings, particularly the classroom, is emphasized. Social work must be vigilant to keep pace with the ever-changing field of autism, with its frequent improvements in understanding, diagnosis, and treatment.

scholarly journals A Web-based Survey for the Association Between Food Allergy and Depression/psychological Distress in 11,876 Japanese (P18-019-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Shinsuke Hidese ◽  
Shun Nogawa ◽  
Kenji Saito ◽  
Hiroshi Kunugi
Keyword(s):  
Food Allergy ◽  
Psychological Distress ◽  
Control Group ◽  
Food Allergens ◽  
Kiwi Fruit ◽  
Web Based ◽  
Funding Sources ◽  
Depression Group ◽  
Japanese Sample ◽  
History Of

Abstract Objectives The aim of this study is to examine whether food allergy (FA) is associated with depression/psychological distress in a large Japanese sample. Methods This web-based survey was conducted on a platform of “Yahoo! JAPAN -HealthData Lab” and the Genequest Inc. (Tokyo, Japan). Participants were 1000 individuals with self-reported history of depression (mean age: 41.4 years, 501 men and 499 women) and the remaining 10,876 controls (mean age: 45.1 years, 5691 men and 5185 women). Six-item Kessler scale (K6) test cut-off score ≥13 was used to estimate severe psychological distress. We gained self-reported information on FA and 27 specific food allergens. Results The proportion of individuals with FA, 2 or more, 3 or more, and 4 or more allergens was higher in the depression group compared to the control group (odds ratio [OR] = 1.64, 1.75, 2.02, and 2.27, respectively; P < 0.001). Allergen analyses revealed that allergies for shrimp, egg, mackerel, crab, kiwi fruit, milk, banana, and squid were more common in the depression group compared to the control group (P < 0.05). Individuals who had severe psychological distress was more common in the FA group than in the non-FA group, in the total participants (OR = 1.32, 1.62, 2.04 and 2.51; 1, 2, 3, and 4 or more allergens, respectively; P < 0.001). Conclusions We suggest that FA is likely to be a risk factor for depression and severe psychological distress, which is dependent on the number of food allergens. Funding Sources This work was supported by an Intramural Research Grant for Neurological and Psychiatric Disorders of National Center of Neurology and Psychiatry.

scholarly journals A protocol for a multicentre, parallel-group, pragmatic randomised controlled trial to evaluate the NEVERMIND system in preventing and treating depression in patients with severe somatic conditions

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Vladimir Carli ◽  
Danuta Wasserman ◽  
Gergö Hadlaczky ◽  
Nuhamin Gebrewold Petros ◽  
Sara Carletto ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Well Being ◽  
Physiological Data ◽  
Control Group ◽  
Evidence Based ◽  
Treatment As Usual ◽  
Randomised Controlled ◽  
Pragmatic Randomised Controlled Trial

Abstract Background Depressive symptoms are common in individuals suffering from severe somatic conditions. There is a lack of interventions and evidence-based interventions aiming to reduce depressive symptoms in patients with severe somatic conditions. The aim of the NEVERMIND project is to address these issues and provide evidence by testing the NEVERMIND system, designed to reduce and prevent depressive symptoms in comparison to treatment as usual. Methods The NEVERMIND study is a parallel-groups, pragmatic randomised controlled trial to assess the effectiveness of the NEVERMIND system in reducing depressive symptoms among individuals with severe somatic conditions. The NEVERMIND system comprises a smart shirt and a user interface, in the form of a mobile application. The system is a real-time decision support system, aiming to predict the severity and onset of depressive symptoms by modelling the well-being condition of patients based on physiological data, body movement, and the recurrence of social interactions. The study includes 330 patients who have a diagnosis of myocardial infarction, breast cancer, prostate cancer, kidney failure, or lower limb amputation. Participants are randomised in blocks of ten to either the NEVERMIND intervention or treatment as usual as the control group. Clinical interviews and structured questionnaires are administered at baseline, at 12 weeks, and 24 weeks to assess whether the NEVERMIND system is superior to treatment as usual. The endpoint of primary interest is Beck Depression Inventory II (BDI-II) at 12 weeks defined as (i) the severity of depressive symptoms as measured by the BDI-II. Secondary outcomes include prevention of the onset of depressive symptoms, changes in quality of life, perceived stigma, and self-efficacy. Discussion There is a lack of evidence-based interventions aiming to reduce and prevent depressive symptoms in patients with severe somatic conditions. If the NEVERMIND system is effective, it will provide healthcare systems with a novel and innovative method to attend to depressive symptoms in patients with severe somatic conditions. Trial registration DRKS00013391. Registered 23 November 2017.

scholarly journals Efficacy of web-based self-management interventions for depressive symptoms: a meta-analysis of randomized controlled trials

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yue Pang ◽  
Xin Zhang ◽  
Ruitong Gao ◽  
Linqi Xu ◽  
Meidi Shen ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Self Management ◽  
Control Group ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Web Based ◽  
Randomized Controlled ◽  
Management Interventions

Abstract Background The incidence of depression is increasing worldwide. Depression can lead to poor physical health and even suicide. However, in high-income countries, only about 50% of the people with depression receive appropriate therapy, and the detection rate of depression in low- and middle-income countries is relatively lower. Web-based self-management enables remote treatment and solves the problem of insufficient psychological treatment resources. Many past studies have evaluated the effectiveness of web-based self-management of depression, but there has been no synthesis of evidence. Therefore, this study conducted a meta-analysis of the effectiveness of web-based self-management for depressive symptoms. Method Six electronic databases (Cochrane Central Register of Controlled Trials, PubMed, Web of Science, Embase, CINAHL, and PsycINFO) were searched in September 2020. All literature referring to the effects of web-based self-management on depression were shortlisted by performing the medical subject headings (MeSH) search combined with a text word search. Results A total of 18 eligible randomized controlled trials were identified, and the results from 3055 participants were consolidated. The web-based self-management group exhibited a greater reduction in depressive symptoms than the control group (g = − 0.46; 95% CI: 0.62,0.30), and there was no evidence of publication bias. Subgroup analysis revealed that patients with moderate-to-severe depression benefited from web-based self-management interventions. In terms of interventions, those based on cognitive behavioral therapy (CBT) were highly effective. We noted that the longer the intervention time, the better was the improvement in the status of depression. Furthermore, it was established that participants who communicated with therapists and showed greater adherence to the intervention experienced significant improvement in their symptoms. The results of the intervention group were better than those of the waiting-list, treatment-as-usual, and online psychoeducation groups. Conclusions Web-based self-management is a promising therapy for depression. Future research should aim to refine these aspects of the intervention to achieve a beneficial impact.

scholarly journals Brief Web-Based Intervention for Depression: Randomized Controlled Trial on Behavioral Activation (Preprint)

2019 ◽  
Author(s):  
Lena Jelinek ◽  
Sönke Arlt ◽  
Steffen Moritz ◽  
Johanna Schröder ◽  
Stefan Westermann ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Active Control ◽  
Behavioral Activation ◽  
Dysfunctional Attitudes ◽  
Patient Health Questionnaire ◽  
Control Group ◽  
Health Questionnaire ◽  
Web Based ◽  
Treatment Of Depression ◽  
Patient Health

BACKGROUND Web-based interventions have been shown to be effective for the treatment of depression. However, interventions are often complex and include a variety of elements, making it difficult to identify the most effective component(s). OBJECTIVE The aim of this pilot study was to shed light on mechanisms in the online treatment of depression by comparing a single-module, fully automated intervention for depression (internet-based behavioral activation [iBA]) to a nonoverlapping active control intervention and a nonactive control group. METHODS We assessed 104 people with at least mild depressive symptoms (Patient Health Questionnaire-9, &gt;4) via the internet at baseline (t<sub>0</sub>) and 2 weeks (t<sub>1</sub>) and 4 weeks (t<sub>2</sub>) later. After the t<sub>0</sub> assessment, participants were randomly allocated to one of three groups: (1) iBA (n=37), (2) active control using a brief internet-based mindfulness intervention (iMBI, n=32), or (3) care as usual (CAU, n=35). The primary outcome was improvement in depressive symptoms, as measured using the Patient Health Questionnaire-9. Secondary parameters included changes in activity, dysfunctional attitudes, and quality of life RESULTS While groups did not differ regarding the change in depression from t<sub>0</sub> to t<sub>1</sub> (η<sub>p</sub><sup>2</sup>=.007, <i>P</i>=.746) or t<sub>0</sub> to t<sub>2</sub> (η<sub>p</sub><sup>2</sup>=.008, <i>P</i>=.735), iBA was associated with a larger decrease in dysfunctional attitudes from t<sub>0</sub> to t<sub>2</sub> in comparison to CAU (η<sub>p</sub><sup>2</sup>=.053, <i>P</i>=.04) and a larger increase in activity from t<sub>0</sub> to t<sub>1</sub> than the pooled control groups (η<sub>p</sub><sup>2</sup>=.060, <i>P</i>=.02). A change in depression from t<sub>0</sub> to t<sub>2</sub> was mediated by a change in activity from t<sub>0</sub> to t<sub>1</sub>. At t<sub>1</sub>, 22% (6/27) of the participants in the iBA group and 12% (3/25) of the participants in the iMBI group indicated that they did not use the intervention. CONCLUSIONS Although we did not find support for the short-term efficacy of the single-module iBA regarding depression, long-term effects are still conceivable, potentially initiated by changes in secondary outcomes. Future studies should use a longer intervention and follow-up interval. CLINICALTRIAL DKRS (#DRKS00011562)

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