Feasibility and Preliminary Efficacy of a Transdiagnostic Internet Intervention for Adolescents with Anxiety and Depressive Disorders (Preprint)

2021 ◽  
Author(s):  
Costina-Ruxandra Păsărelu ◽  
Anca Dobrean ◽  
Gerhard Andersson ◽  
Gabriela Corina Zaharie
Keyword(s):  
Depressive Symptoms ◽  
Depressive Disorders ◽  
Rational Emotive Behavior Therapy ◽  
Internet Intervention ◽  
Effect Sizes ◽  
Access To Treatment ◽  
Face To Face ◽  
Randomized Controlled ◽  
Internet Interventions ◽  
Recent Developments

BACKGROUND Transdiagnostic interventions delivered for children and adolescents show promising results. In order to increase access to treatment, recent developments in technology has led to alternatives to face to face interventions. Transdiagnostic Internet interventions can be effective for adult anxiety and depressive disorders, but research is more limited regarding the efficacy of such treatments for young populations diagnosed with anxiety and or depressive disorders. OBJECTIVE This study aims to investigate the feasibility and preliminary efficacy of a transdiagnostic internet intervention for adolescents diagnosed with anxiety and depressive disorders based on Rational emotive behavior therapy. METHODS We tested the preliminary efficacy of a six-week intervention in an open trial, pre-post design including 15 participants. RESULTS Our results suggest that the intervention is feasible and can be included as a treatment for adolescents with anxiety and depressive disorders, being associated with moderate to large pre-post effect sizes on self-reported anxiety and depressive symptoms, as well as on negative patterns of thinking and knowledge acquisition. Satisfaction with the intervention was high. CONCLUSIONS Transdiagnostic Internet interventions for adolescents with anxiety and depressive symptoms are feasible. Future testing of the efficacy of such interventions in randomized controlled trials should be conducted.

scholarly journals Effects of n-3 Polyunsaturated Fatty Acid Supplementation in the Prevention and Treatment of Depressive Disorders—A Systematic Review and Meta-Analysis

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1070
Author(s):  
Maike Wolters ◽  
Annkathrin von der Haar ◽  
Ann-Kristin Baalmann ◽  
Maike Wellbrock ◽  
Thomas L. Heise ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Treatment Duration ◽  
Depressive Disorders ◽  
Meta Analysis ◽  
Pufa Supplementation ◽  
Depressive Symptomology ◽  
Beneficial Effects ◽  
Randomized Controlled ◽  
Significant Difference

N-3 polyunsaturated fatty acids (PUFAs) have been suggested to affect depressive disorders. This review aims to determine the effect of n-3 PUFAs on depressive symptoms in people with or without diagnosed depression. Medline, PsycINFO, and Cochrane CENTRAL databases were searched for randomized controlled trials (RCTs) assessing the association between n-3 PUFAs and depressive symptoms or disorders as outcomes. A random-effects meta-analysis of standardized mean difference (SMD) with 95% confidence intervals (CI) was performed. Twenty-five studies (7682 participants) were included. Our meta-analysis (20 studies) indicated that n-3 PUFA supplementation lowered depressive symptomology as compared with placebo: SMD = −0.34, 95% CI: −0.55, −0.12, I2 = 86%, n = 5836, but a possible publication bias cannot be ruled out. Subgroup analyses indicated no statistically significant difference by treatment duration of <12 vs. ≥12 weeks, presence of comorbidity, or severity of depressive symptoms. Nevertheless, beneficial effects were seen in the subgroups of studies with longer treatment duration and with no depression and mild to moderate depression. Subgroup analysis by eicosapentaenoic acid (EPA) dosage revealed differences in favor of the lower EPA dosage. Sensitivity analysis including studies with low risk of bias seems to confirm the overall result. Supplementation of n-3 PUFA appears to have a modest beneficial effect on depressive symptomology, although the quality of evidence is still insufficient.

scholarly journals The COvid-19 Pandemic and Exercise (COPE) Trial: A multi-group randomized controlled trial comparing effects of an app-based, at-home exercise program to waitlist control on depressive symptoms

2021 ◽  
Author(s):  
Eli Puterman ◽  
Benjamin Hives ◽  
Nicole Mazara ◽  
Nikol Grishin ◽  
Joshua Webster ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Depressive Symptoms ◽  
Controlled Trial ◽  
Effect Sizes ◽  
Home Exercise ◽  
Global Public Health ◽  
Economic Implications ◽  
Waitlist Control ◽  
Randomized Controlled ◽  
At Home

Background: The number of adults across the globe with significant depressive symptoms has grown substantially during the COVID-19 pandemic. The extant literature supports exercise as a potent behavior that can significantly reduce depressive symptoms in clinical and non-clinical populations. Objective: Using a suite of mobile applications, at-home exercise, including high intensity interval training (HIIT) and/or yoga, was completed to reduce depressive symptoms in the general population in the early months of the pandemic. Methods: A 6-week, parallel, multi-arm, randomized controlled trial was completed with 4 groups: [1] HIIT, [2] Yoga, [3] HIIT+Yoga, and [4] waitlist control (WLC). Low active, English-speaking, non-retired Canadians aged 18-64 years were included. Depressive symptoms were measured at baseline and weekly following randomization. Results: A total of 334 participants were randomized to one of four groups. No differences in depressive symptoms were evident at baseline. The results of latent growth modeling showed significant treatment effects for each active group compared to the WLC, with small effect sizes in the community-based sample of participants. Treatment groups were not significantly different from each other. Effect sizes were very large when restricting analyses only to participants with high depressive symptoms at baseline. Conclusions: At-home exercise is a potent behavior to improve mental health in adults during the pandemic, especially in those with increased levels of depressive symptoms. Promotion of at-home exercise may be a global public health target with important personal, social, and economic implications as the world emerges scathed by the pandemic.

scholarly journals A Group-Based Online Intervention to Prevent Postpartum Depression (Sunnyside): Feasibility Randomized Controlled Trial

10.2196/10778 ◽  
2019 ◽  
Vol 6 (5) ◽  
pp. e10778
Author(s):  
Jennifer Duffecy ◽  
Rebecca Grekin ◽  
Hannah Hinkel ◽  
Nicholas Gallivan ◽  
Graham Nelson ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Postpartum Depression ◽  
Peer Support ◽  
Controlled Trial ◽  
Internet Intervention ◽  
Health Questionnaire ◽  
Randomized Controlled ◽  
Internet Interventions ◽  
Patient Health ◽  
Internet Support

Background Postpartum depression (PPD) has a 20% 3-month prevalence rate. The consequences of PPD are significant for the mother, infant, and the family. There is a need for preventive interventions for PPD, which are effective and accessible; however, many barriers exist for women who attempt to access perinatal depression prevention programs. Internet interventions for the treatment and prevention of depression are widely accepted as efficacious and may overcome some of the issues pertaining to access to treatment barriers perinatal women face. However, internet interventions offered without any human support tend to have low adherence but positive outcomes for those who do complete treatment. Internet support groups often have high levels of adherence but minimal data supporting efficacy as a treatment for depression. Taken together, these findings suggest that combining the treatment components of individual interventions with the support provided by an internet support group might create an intervention with the scalability and cost-effectiveness of an individual intervention and the better outcomes typically found in supported interventions. Objectives This study aimed to describe the development of a cognitive behavioral therapy (CBT) internet intervention with peer support to prevent PPD and examine preliminary depression and site usage outcomes. Methods User-centered design groups were used to develop the internet intervention. Once the intervention was developed, women who were 20 to 28 weeks pregnant with symptoms of depression (Patient Health Questionnaire-8 scores of 5-14) but who had no major depression diagnosis were enrolled in a randomized controlled trial (RCT) to compare 8 weeks of a CBT-based internet intervention with peer support to an individual internet intervention designed to prevent PPD. Assessments took place at baseline, 4 weeks, 8 weeks (end of treatment), and then 4 weeks and 6 weeks postpartum. Results A total of 25 women were randomized. Of these, 24 women completed the RCT. Patient Health Questionnaire-9 scores at 6 weeks postpartum remained below the clinical threshold for referral for treatment in both groups, with depression measures showing a decrease in symptoms from baseline to postpartum. At 6 weeks postpartum, only 4% (1/24) met the criteria for PPD. There was no difference between groups in adherence to the intervention, with an average of 14.55 log-ins over the course of treatment. Conclusions Results suggest women were responsive to both peer support and individual internet interventions to prevent PPD and that peer support may be a useful feature to keep participants adherent. Trial Registration ClinicalTrials.gov NCT02121015; https://clinicaltrials.gov/ct2/show/NCT02121015 (archived by WebCite at http://www.webcitation.org/765a7qBKy)

scholarly journals The Association of Therapeutic Alliance With Long-Term Outcome in a Guided Internet Intervention for Depression: Secondary Analysis From a Randomized Control Trial (Preprint)

2019 ◽  
Author(s):  
Juan Martín Gómez Penedo ◽  
Anna Margarete Babl ◽  
Martin grosse Holtforth ◽  
Fritz Hohagen ◽  
Tobias Krieger ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Therapeutic Alliance ◽  
Hierarchical Linear Modeling ◽  
Well Being ◽  
Rate Of Change ◽  
Internet Intervention ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Internet Interventions

BACKGROUND Therapeutic alliance has been well established as a robust predictor of face-to-face psychotherapy outcomes. Although initial evidence positioned alliance as a relevant predictor of internet intervention success, some conceptual and methodological concerns were raised regarding the methods and instruments used to measure the alliance in internet interventions and its association with outcomes. OBJECTIVE The aim of this study was to explore the alliance-outcome association in a guided internet intervention using a measure of alliance especially developed for and adapted to guided internet interventions, showing evidence of good psychometric properties. METHODS A sample of 223 adult participants with moderate depression received an internet intervention (ie, Deprexis) and email support. They completed the Working Alliance Inventory for Guided Internet Intervention (WAI-I) and a measure of treatment satisfaction at treatment termination and measures of depression severity and well-being at termination and 3- and 9-month follow-ups. For data analysis, we used two-level hierarchical linear modeling that included two subscales of the WAI-I (ie, <i>tasks and goals</i> agreement with the program and <i>bond</i> with the supporting therapist) as predictors of the estimated values of the outcome variables at the end of follow-up and their rate of change during the follow-up period. The same models were also used controlling for the effect of patient satisfaction with treatment. RESULTS We found significant effects of the <i>tasks and goals</i> subscale of the WAI-I on the estimated values of residual depressive symptoms (γ<sub>02</sub>=−1.74, standard error [SE]=0.40, 95% CI −2.52 to −0.96, t<sub>206</sub>=−4.37, <i>P</i>&lt;.001) and patient well-being (γ<sub>02</sub>=3.10, SE=1.14, 95% CI 0.87-5.33, t<sub>198</sub>=2.72, <i>P</i>=.007) at the end of follow-up. A greater score in this subscale was related to lower levels of residual depressive symptoms and a higher level of well-being. However, there were no significant effects of the <i>tasks and goals</i> subscale on the rate of change in these variables during follow-up (depressive symptoms, <i>P</i>=.48; patient well-being, <i>P</i>=.26). The effects of the <i>bond</i> subscale were also nonsignificant when predicting the estimated values of depressive symptoms and well-being at the end of follow-up and the rate of change during that period (depressive symptoms, <i>P</i>=.08; patient well-being, <i>P</i>=.68). CONCLUSIONS The results of this study point out the importance of attuning internet interventions to patients’ expectations and preferences in order to enhance their agreement with the tasks and goals of the treatment. Thus, the results support the notion that responsiveness to a patient’s individual needs is crucial also in internet interventions. Nevertheless, these findings need to be replicated to establish if they can be generalized to different diagnostic groups, internet interventions, and supporting formats.

scholarly journals Does providing a brief internet intervention for hazardous alcohol use to people seeking online help for depression reduce both alcohol use and depression symptoms among participants with these co-occurring disorders? Study protocol for a randomised controlled trial

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e022412 ◽  
Author(s):  
John A Cunningham ◽  
Christian S Hendershot ◽  
Frances Kay-Lambkin ◽  
Clayton Neighbors ◽  
Kathleen M Griffiths ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Alcohol Consumption ◽  
Alcohol Use ◽  
Controlled Trial ◽  
Internet Intervention ◽  
Depression Symptoms ◽  
Hazardous Alcohol Use ◽  
Internet Interventions ◽  
Hazardous Alcohol ◽  
Hazardous Alcohol Consumption

IntroductionHazardous alcohol consumption is common among people experiencing depression, often acting to exacerbate depressive symptoms. While many people with these co-occurring disorders do not seek face-to-face treatment, they do seek help online. There are effective internet interventions that target hazardous alcohol consumption or depression separately but none that combine these online interventions without the involvement of a therapist. In order to realise the potential of internet interventions, we need to develop an evidence base supporting the efficacy of internet interventions for co-occurring depression and hazardous alcohol use without any therapist involvement. This study aims to evaluate the effects on drinking, and on depressive symptoms, of combining an internet intervention targeting hazardous alcohol consumption with one for depression.Methods and analysisA double blinded, parallel group randomised controlled trial will be used. Participants with current depression who also drink in a hazardous fashion (n=986) will be recruited for a study to ‘help improve an online intervention for depression’. Participants will be randomised either to receive an established online intervention for depression (MoodGYM) or to receive MoodGYM plus a brief internet intervention for hazardous alcohol consumption (Check Your Drinking; CYD). Participants will be contacted 3 and 6 months after receiving the interventions to assess changes in drinking and depression symptoms. It is predicted that participants receiving the CYD intervention in addition to MoodGYM will report greater postintervention reductions in alcohol consumption and depressive symptoms compared with those who received MoodGYM only. Hypothesised mediation and moderation effects will also be investigated. Using an intention-to-treat basis for the analyses, the hypotheses will be tested using a generalised linear hypothesis framework, and longitudinal analyses will use either generalised linear mixed modelling or generalised estimating equation approach where appropriate.Ethics and disseminationThis research comprises the crucial first steps in developing lower-cost and efficacious internet interventions for people suffering from depression who also drink in a hazardous fashion—promoting the widespread availability of care for those in need. This study has been approved by the standing ethics review committee of the Centre for Addiction and Mental Health, and findings will be disseminated in the form of at least one peer-reviewed article and presentations at conferences.Trial registration numberNCT03421080; Pre-results.

scholarly journals A Mobile Health App to Improve HIV Medication Adherence: Protocol for a Pilot Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Susan Ramsey ◽  
Evan Ames ◽  
Julia Uber ◽  
Samia Habib ◽  
Seth Clark
Keyword(s):  
Controlled Trial ◽  
Phase 1 ◽  
Effect Sizes ◽  
Art Adherence ◽  
Phase 2 ◽  
Face To Face ◽  
Mhealth Intervention ◽  
Randomized Controlled ◽  
Persons Living With Hiv ◽  
Living With Hiv

BACKGROUND Adherence to antiretroviral therapy (ART) is essential for allowing persons living with HIV to live longer, healthier lives. However, a large portion of this population has suboptimal adherence and are not virally suppressed. Conventional interventions aimed at improving ART adherence lack portability and scalability, and improvements in adherence are not often sustained. Mobile health (mHealth) ART interventions offer a low-cost and accessible method of improving adherence, but many have limited functionality and do not offer comprehensive support. The combination of an mHealth intervention with a face-to-face adherence intervention and interactive health coaching feature may offer sufficient support in a manner that is sensitive to resource limitations that are often found in HIV treatment settings. This paper details the protocol of a study designed to evaluate the potential of an enhanced mHealth intervention for improving ART adherence. OBJECTIVE The primary objective of this study is to assess the feasibility and acceptability of the Fitbit Plus app enhanced with a face-to-face LifeSteps session (Fitbit Plus condition) for improving ART adherence. In addition, we will determine the preliminary efficacy of the intervention by calculating treatment effect sizes. METHODS This study will be conducted in 2 phases. The intervention will be developed and piloted with a small group of participants during phase 1. Pilot participants will provide feedback that will be used to refine the intervention for phase 2. In phase 2, a preliminary randomized controlled trial (RCT) comparing Fitbit Plus with a condition that approximates the standard of care (SOC) will be conducted with 60 persons living with HIV. Interviews will be conducted with RCT participants at baseline, and follow-up interviews will be conducted at 1, 3, 6, and 12 months. ART adherence is the primary outcome and will be monitored throughout the study via electronic pill boxes. Effect sizes will be generated using a fractional logit model estimated by generalized estimating equations. RESULTS Phase 1 of this trial is complete; data collection for phase 2 is ongoing. Follow-ups with enrolled participants will conclude in January 2020. CONCLUSIONS This study will contribute to the literature on ART adherence and may produce an efficacious intervention. Owing to a small sample size, there may be insufficient power to detect statistically significant differences between Fitbit Plus and SOC. However, if Fitbit Plus is found to be acceptable and feasible and yields promising effect size estimates, this pilot study could serve as the foundation for a larger, fully powered trial of Fitbit Plus. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/15356

scholarly journals Pragmatic Quasi-Experimental Controlled Trial Evaluating the Outcomes of Blended CBT Compared to Face-to-Face CBT and Treatment as Usual for Adolescents with Depressive Disorders

2021 ◽  
Vol 18 (6) ◽  
pp. 3102
Author(s):  
Sanne P.A. Rasing ◽  
Yvonne A.J. Stikkelbroek ◽  
Wouter den Hollander ◽  
Heleen Riper ◽  
Maja Deković ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Depressive Disorders ◽  
Controlled Trial ◽  
Post Intervention ◽  
Global Functioning ◽  
Treatment As Usual ◽  
Face To Face ◽  
Quasi Experimental ◽  
Secondary Outcomes

Depression is a major problem in youth mental health. Current treatment is on average effective, but adolescents are hesitant to seek help. Blended treatment could lower the barriers to seeking treatment. Evidence on effectiveness is, however, scarce. The present pragmatic quasi-experimental controlled trial aimed to compare the outcomes of blended cognitive behavioral therapy (CBT) to face-to-face CBT and treatment as usual. A total of 129 adolescents with clinical depression (82.2% female), aged 13–22 (M = 16.60, SD = 2.03) received blended CBT, face-to-face CBT or treatment as usual. Clinical diagnosis, depressive symptoms, and secondary outcomes were assessed at baseline, post-intervention, and six-months follow-up. Participants receiving blended CBT were, compared to participants receiving face-to-face CBT and treatment as usual, evenly likely to be in remission from their depressive disorder at post-intervention and at six-month follow-up. Depressive symptoms decreased significantly over time in all three conditions, and changes were not significantly different between conditions. Other secondary outcomes (suicide risk, internalizing and externalizing symptoms, severity of depression, and global functioning) did not differ between treatment conditions at post-intervention and six-month follow-up. Since there was no evidence for favorable outcomes for face-to-face therapies above blended CBT, blended CBT may also be an effective treatment format in clinical practice.

scholarly journals A Group-Based Online Intervention to Prevent Postpartum Depression (Sunnyside): Feasibility Randomized Controlled Trial (Preprint)

2018 ◽  
Author(s):  
Jennifer Duffecy ◽  
Rebecca Grekin ◽  
Hannah Hinkel ◽  
Nicholas Gallivan ◽  
Graham Nelson ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Postpartum Depression ◽  
Peer Support ◽  
Controlled Trial ◽  
Internet Intervention ◽  
Health Questionnaire ◽  
Randomized Controlled ◽  
Internet Interventions ◽  
Patient Health ◽  
Internet Support

BACKGROUND Postpartum depression (PPD) has a 20% 3-month prevalence rate. The consequences of PPD are significant for the mother, infant, and the family. There is a need for preventive interventions for PPD, which are effective and accessible; however, many barriers exist for women who attempt to access perinatal depression prevention programs. Internet interventions for the treatment and prevention of depression are widely accepted as efficacious and may overcome some of the issues pertaining to access to treatment barriers perinatal women face. However, internet interventions offered without any human support tend to have low adherence but positive outcomes for those who do complete treatment. Internet support groups often have high levels of adherence but minimal data supporting efficacy as a treatment for depression. Taken together, these findings suggest that combining the treatment components of individual interventions with the support provided by an internet support group might create an intervention with the scalability and cost-effectiveness of an individual intervention and the better outcomes typically found in supported interventions. OBJECTIVES This study aimed to describe the development of a cognitive behavioral therapy (CBT) internet intervention with peer support to prevent PPD and examine preliminary depression and site usage outcomes. METHODS User-centered design groups were used to develop the internet intervention. Once the intervention was developed, women who were 20 to 28 weeks pregnant with symptoms of depression (Patient Health Questionnaire-8 scores of 5-14) but who had no major depression diagnosis were enrolled in a randomized controlled trial (RCT) to compare 8 weeks of a CBT-based internet intervention with peer support to an individual internet intervention designed to prevent PPD. Assessments took place at baseline, 4 weeks, 8 weeks (end of treatment), and then 4 weeks and 6 weeks postpartum. RESULTS A total of 25 women were randomized. Of these, 24 women completed the RCT. Patient Health Questionnaire-9 scores at 6 weeks postpartum remained below the clinical threshold for referral for treatment in both groups, with depression measures showing a decrease in symptoms from baseline to postpartum. At 6 weeks postpartum, only 4% (1/24) met the criteria for PPD. There was no difference between groups in adherence to the intervention, with an average of 14.55 log-ins over the course of treatment. CONCLUSIONS Results suggest women were responsive to both peer support and individual internet interventions to prevent PPD and that peer support may be a useful feature to keep participants adherent. CLINICALTRIAL ClinicalTrials.gov NCT02121015; https://clinicaltrials.gov/ct2/show/NCT02121015 (archived by WebCite at http://www.webcitation.org/765a7qBKy)

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