scholarly journals Evidence-Based Therapist-Supported Digital Mental Health Intervention for Patients Experiencing Medical Multimorbidity: A Retrospective Cohort Intent-to-Treat Study

2021 ◽  
Author(s):  
Benjamin W Nelson ◽  
Nicholas Peiper ◽  
Kirstin Aschbacher ◽  
Valerie Forman-Hoffman
Keyword(s):  
Mental Health ◽  
Symptom Severity ◽  
Retrospective Cohort ◽  
Medical Condition ◽  
Treatment Resistance ◽  
Anxiety Symptoms ◽  
Evidence Based ◽  
Symptom Trajectories ◽  
Treatment Dose ◽  
Intent To Treat

Objective: Multimorbidity or the co-occurrence of multiple health conditions is increasing globally and associated with significant psychological complications. It is unclear whether digital mental health (DMH) interventions for patients experiencing medical multimorbidity (MMB) are effective, particularly given that this patient population faces more treatment resistance. Therefore, there is a need for initial preliminary research to examine whether DMH interventions are associated with reductions on depressive and anxiety symptoms in the context of MMB.Methods: This preregistered retrospective cohort intent-to-treat study with 2,819 patients enrolled in a therapist-supported DMH (TS-DMH) intervention examined the associations between MMB and mental health. Results: Results indicated that more MMB was significantly associated with greater presenting mental health symptom severity. MMB did not have a deleterious influence on depressive symptom trajectories across treatment, although having one medical condition was associated with a steeper decrease in anxiety symptoms compared to patients with no medical conditions. Finally, MMB was not associated with time to dropout, but was associated with higher dropout and was differentially associated with fewer beneficial treatment outcomes, although this is likely attributable to higher presenting symptom severity, rather than lesser symptom reductions during treatment. Conclusions: The MHP showed preliminary effectiveness as an evidence-based treatment for patients experiencing depression and anxiety in the context of MMB. Future DMH treatments and research might investigate tailored barrier reduction and extended treatment lengths for patients experiencing MMB to allow for greater treatment dose to reduce symptoms below clinical outcome thresholds.

scholarly journals Mental Health Trajectories of Fathers Following Very Preterm Birth: Associations With Parenting

2020 ◽  
Vol 45 (7) ◽  
pp. 725-735
Author(s):  
Grace E McMahon ◽  
Peter J Anderson ◽  
Rebecca Giallo ◽  
Carmen C Pace ◽  
Jeanie L Cheong ◽  
...  
Keyword(s):  
Mental Health ◽  
Latent Class ◽  
Parenting Behaviors ◽  
Anxiety Symptoms ◽  
Regression Equations ◽  
Very Preterm ◽  
Symptom Trajectories ◽  
Mental Health Difficulties ◽  
Symptom Trajectory ◽  
Ongoing Support

Abstract Objective Mothers of infants born very preterm (VPT) are at high risk of mental health difficulties. However, less is known about the course of fathers’ depressive and anxiety symptoms over time, and the implications this may have for early parenting behaviors. Methods In total, 100 fathers of 125 infants born VPT (<30 weeks’ gestation) completed questionnaires assessing depressive and anxiety symptoms shortly after their infant’s birth, and when their infant reached term-equivalent age, 3 months, 6 months, and 12 months’ corrected age. At 12 months’ corrected age, fathers’ parenting behaviors were assessed using the Emotional Availability Scales. Longitudinal latent class analysis was used to identify trajectories of fathers’ depressive and anxiety symptoms, and linear regression equations examined relationships between these trajectories and fathers’ parenting behaviors. Results For both depressive and anxiety symptoms, two distinct trajectories were identified. For depression, most fathers were assigned to the persistently low symptom trajectory (82%), while the remainder were assigned to the persistently high symptom trajectory (18%). For anxiety, 49% of fathers were assigned to the persistently low symptom trajectory, while 51% were assigned to the trajectory characterized by moderate symptoms over the first postnatal year. There were no significant differences in parenting behaviors between fathers assigned to the different depressive and anxiety symptom trajectories. Conclusions Fathers of infants born VPT are at risk of chronic depressive and anxiety symptoms over the first postnatal year, highlighting the need for screening and ongoing support.

Evaluation of a commercial mobile health app for depression and anxiety: A retrospective cohort study of AbleTo Digital+ users (Preprint)

2021 ◽  
Author(s):  
Margaret T Anton ◽  
Heidi Mochari-Greenberger ◽  
Evie Andreopoulos ◽  
Reena L Pande
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
Social Anxiety ◽  
Real World ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Mental Health Problems ◽  
Anxiety Symptoms ◽  
Generalized Anxiety ◽  
Depression And Anxiety

BACKGROUND Digital solutions, such as web-based and mobile interventions, have the potential to streamline pathways to mental health services and improve access to mental health care. Although there are a growing number of randomized trials establishing the efficacy of digital interventions for common mental health problems, less is known about the real world impact of these tools. AbleTo Digital+, a commercially available mental health application for depression and anxiety, offers a unique opportunity to understand the clinical impact of such tools delivered in real world contexts. OBJECTIVE The primary objective of this study was to examine the magnitude of change in depression and anxiety symptoms among individuals who used AbleTo Digital+ programs, as well as to evaluate Digital+ module completion and use of 1:1 coaching. METHODS In this retrospective cohort study, we analyzed previously collected and permanently de-identified data from a consecutive cohort of 1,896 adults who initiated use in one of the three Digital+ eight-module programs (Depression, Generalized Anxiety, or Social Anxiety) between January 1 and June 30, 2020. Depression, generalized anxiety, and social anxiety symptoms were assessed within each program using the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), and the Social Phobia Inventory (SPIN) respectively. Linear mixed effects models were built to assess the association between module completion and symptom change among users who completed at least four modules and had at least mild baseline symptom elevations, controlling for age, gender, and baseline symptom severity. Digital+ use, including module completion, 1:1 coaching calls, and in-app coach messaging were also evaluated. RESULTS Large effects were observed among Depression (d=1.5), Generalized Anxiety (d=1.2), and Social Anxiety (d=1.0) program participants who completed at least four modules and had mild baseline elevations (n=470). Associations between module completion and change in depression (????=-1.2; P<.001), generalized anxiety (????=-1.1; P<.001), and social anxiety (????=-2.4; P<.0001) symptom scores retained significance with covariate adjustment. Participants completed an average of 2.6 (SD=2.7) modules. The average total length of app use was 7.5 weeks (SD=11.9). Approximately two-thirds of users engaged in 1:1 coaching calls (66.8%) or in-app text messaging (66.10%). Participants who completed at least four modules participated in significantly more coaching calls per module (M=1.1; SD=0.7)than users who completed fewer than four modules (M=1.0; SD=1.2; t=-2.1, P=.03). CONCLUSIONS This study demonstrated that AbleTo Digital+ users experienced significant reductions in depression, generalized anxiety, and social anxiety symptoms over the course of the program.

scholarly journals Comparison of Mental Health Symptoms Prior to and During COVID-19 among Patients with Systemic Sclerosis from Four Countries: A Scleroderma Patient-centered Intervention Network (SPIN) Cohort Study

2020 ◽  
Author(s):  
Brett D. Thombs ◽  
Linda Kwakkenbos ◽  
Richard S. Henry ◽  
Marie-Eve Carrier ◽  
Scott Patten ◽  
...  
Keyword(s):  
Mental Health ◽  
United States ◽  
United Kingdom ◽  
Systemic Sclerosis ◽  
Medical Condition ◽  
Anxiety Symptoms ◽  
Depression Symptoms ◽  
Mental Health Symptoms ◽  
Health Symptoms ◽  
The United Kingdom

ABSTRACTBackgroundNo studies have reported comparisons of mental health symptoms prior to and during COVID-19 in vulnerable populations. Objectives were to compare anxiety and depression symptoms among people with a pre-existing medical condition, the autoimmune disease systemic sclerosis (SSc; scleroderma), including continuous change scores, proportion with change ≥ 1 minimal clinically important difference (MCID), and factors associated with changes, including country.MethodsPre-COVID-19 Scleroderma Patient-centered Intervention Network Cohort data were linked to COVID-19 data collected April 9 to April 27, 2020. Anxiety symptoms were assessed with the PROMIS Anxiety 4a v1.0 scale (MCID = 4 points) and depression symptoms with the Patient Health Questionnaire-8 (MCID = 3 points). Multiple linear and logistic regression were used to assess factors associated with continuous change and change ≥ 1 MCID.FindingsAmong 435 participants (Canada = 98; France = 159; United Kingdom = 50; United States = 128), mean anxiety symptoms increased 4.9 points (95% confidence interval [CI] 4.0 to 5.7). Depression symptom change was negligible (0.3 points; 95% CI −0.7 to 0.2). Compared to France, adjusted scores from the United States and United Kingdom were 3.8 points (95% CI 1.7 to 5.9) and 2.9 points higher (95% CI 0.0 to 5.7); scores for Canada were not significantly different. Odds of increasing by ≥ 1 MCID were twice as high for the United Kingdom (2.0, 95% CI 1.0 to 4.2) and United States (1.9, 95% CI 1.1 to 3.2). Participants who used mental health services pre-COVID had adjusted increases 3.7 points (95% CI 1.7 to 5.7) less than other participants.InterpretationAnxiety symptoms, but not depression symptoms, increased dramatically during COVID-19 among people with a pre-existing medical condition. Increase was larger in the United Kingdom and United States than in Canada and France but substantially less for people with pre-COVID-19 mental health treatment.RESEARCH IN CONTEXTEvidence before this studyWe referred to a living systematic review that is evaluating mental health changes from pre-COVID-19 to COVID-19 by searching 7 databases, including 2 Chinese language databases, plus preprint servers, with daily updates (https://www.depressd.ca/covid-19-mental-health). As of June 13, 2020, only 5 studies had compared mental health symptoms prior to and during COVID-19. In 4 studies of university students, there were small increases in depression or general mental health symptoms but minimal or no increases in anxiety symptoms. A general population study from the United Kingdom reported a small increase in general mental health symptoms but did not differentiate between types of symptoms. No studies have reported changes from pre-COVID-19 among people vulnerable due to pre-existing medical conditions. No studies have compared mental health changes between countries, despite major differences in pandemic responses.Added value of this studyWe evaluated changes in anxiety and depression symptoms among 435 participants with the autoimmune condition systemic sclerosis and compared results from Canada, France, the United Kingdom, and the United States. To our knowledge, this is the first study to compare mental health symptoms prior to and during COVID-19 in any vulnerable population. These are the first data to document the substantial degree to which anxiety symptoms have increased and the minimal changes in depression symptoms among vulnerable individuals. It is also the first study to examine the association of symptom changes with country of residence and to identify that people receiving pre-COVID-19 mental health services may be more resilient and experience less substantial symptom increases than others.Implications of all the available evidenceAlthough this was an observational study, it provided evidence that vulnerable people with a pre-existing medical condition have experienced substantially increased anxiety symptoms and that these increases appear to be associated with where people live and, possibly, different experiences of the COVID-19 pandemic across countries. By comparing with evidence from university samples, which found that depression symptoms were more prominent, these data underline the need for accessible interventions tailored to specific needs of different populations. They also suggest that mental health treatments may help people to develop skills or create resilience, which may reduce vulnerability to major stressors such as COVID-19.

scholarly journals Trajectories of depression and anxiety symptoms over time in the transition to university: Their co-occurrence and the role of self-critical perfectionism

2021 ◽  
Author(s):  
Shelby L. Levine ◽  
Nassim Tabri ◽  
Marina Milyavskaya
Keyword(s):  
Mental Health ◽  
Risk Factor ◽  
Latent Class ◽  
Mental Health Problems ◽  
Anxiety Symptoms ◽  
Depression And Anxiety ◽  
Symptom Development ◽  
Transition To University ◽  
Symptom Trajectories ◽  
Over Time

Little is known about how mental health symptoms develop during the transition to university. Most anxiety and depression research fail to consider how symptom development differs over time across different individuals, and how symptom co-occurrence influences the severity of mental heath problems. Students (N = 658) completed online surveys on mental health prior to starting university and every 2 months until April. To better understand mental health problems during this transitional period, latent class growth curve analyses were run to determine how anxiety and depressive symptoms co-develop over time, as well, if self-critical perfectionism was a transdiagnostic risk factor for more severe symptom trajectories in this transition. About 40% of students experienced depression and anxiety symptoms prior to entering/ during the transition to university. There is substantial variation between students in terms of how they experience depression and anxiety symptoms, and research needs to take this heterogeneity into account to properly identify which students might benefit most from resources. Self-critical perfectionism was a transdiagnostic risk factor, such that students higher in this trait experienced more severe anxiety and depressive symptom trajectories during this transition. This research further implicates the importance of understanding and studying individual differences in symptom development.

Ten-week Intensive Group Program (IGP) for borderline personality disorder: making the case for more accessible and affordable psychotherapy

2021 ◽  
pp. ebmental-2020-300195
Author(s):  
Dervila Gec ◽  
Jillian Helen Broadbear ◽  
David Bourton ◽  
Sathya Rao
Keyword(s):  
Mental Health ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Symptom Severity ◽  
Integrated Treatment ◽  
Borderline Personality ◽  
Self Report ◽  
Evidence Based ◽  
Short Term ◽  
Intensive Group

BackgroundThe availability of specialist psychotherapies for treating borderline personality disorder (BPD) is limited by costs associated with training, resourcing and treatment duration. Developing a programme that incorporates effective strategies from a range of evidence-based specialist treatments, concentrates their delivery and uses a group-based format will improve treatment access.ObjectiveTo assess the short-term clinical efficacy, acceptability and feasibility of a bespoke manualised programme for the treatment of BPD. This 10-week group-based outpatient programme was delivered 2 days per week in 4 hour sessions; participants received 80 hours of treatment in total.MethodsForty-three participants, many having severe BPD symptomatology, were assessed before and after the 10-week programme using a range of validated self-report questionnaires and a self-appraisal feedback form. The primary outcome measured was BPD symptom severity.FindingsStatistically significant improvements were measured in BPD symptom severity, depression, trait anxiety, emotional regulation, general health, hopefulness, self-compassion and anger, several with moderate to large effect sizes. Many of these improvements remained at 4–6 months post treatment. More than 90% of surveyed participants expressed a moderate or high level of satisfaction with the programme.ConclusionsThis integrated treatment programme delivered in a highly concentrated format demonstrated short-term efficacy across many BPD-relevant endpoints; its acceptability was endorsed by most clients.Clinical implicationsIncorporation of key aspects of evidence-based treatment using a time-intensive group format could greatly enhance the capacity of mental health services to meet the needs of people who experience BPD within a population-based mental health service framework.

scholarly journals Loneliness, Circulating Endocannabinoid Concentrations, and Grief Trajectories in Bereaved Older Adults: A Longitudinal Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Minhi Kang ◽  
Luisa Bohorquez-Montoya ◽  
Timothy McAuliffe ◽  
Stacy A. Claesges ◽  
Nutta-On Blair ◽  
...  
Keyword(s):  
Mental Health ◽  
Mass Spectrometry ◽  
Older Adults ◽  
Symptom Severity ◽  
Rating Scales ◽  
Liquid Chromatography Mass Spectrometry ◽  
Clinical Assessments ◽  
Symptom Trajectories ◽  
Depressive Symptom Severity

Background: Loneliness is one of the most distressing grief symptoms and is associated with adverse mental health in bereaved older adults. The endocannabinoid signaling (ECS) system is stress-responsive and circulating endocannabinoid (eCB) concentrations are elevated following bereavement. This study examined the association between loneliness and circulating eCB concentrations in grieving older adults and explored the role of eCBs on the association between baseline loneliness and grief symptom trajectories.Methods: A total of 64 adults [grief with high loneliness: n = 18; grief with low loneliness: n = 26; and healthy comparison (HC): n = 20] completed baseline clinical assessments for the UCLA loneliness scale. In grief participants, longitudinal clinical assessments, including the Inventory of Complicated Grief and 17-item Hamilton Depression Rating scales, were collected over 6 months. Baseline circulating eCB [N-arachidonoylethanolamine (AEA) and 2-arachidonoylglycerol (2-AG)] concentrations were quantified in the serum using isotope dilution, liquid chromatography-mass spectrometry; cortisol concentrations were measured in the same samples using radioimmunoassay.Results: Circulating AEA concentrations were higher in severely lonely grieving elders than in HC group; cortisol concentrations were not different among the groups. Cross-sectionally, loneliness scores were positively associated with AEA concentrations in grievers; this finding was not significant after accounting for depressive symptom severity. Grieving individuals who endorsed high loneliness and had higher 2-AG concentrations at baseline showed faster grief symptom resolution.Conclusions: These novel findings suggest that in lonely, bereaved elders, increased circulating eCBs, a reflection of an efficient ECS system, are associated with better adaptation to bereavement. Circulating eCBs as potential moderators and mediators of the loneliness-grief trajectory associations should be investigated.

scholarly journals Trajectories of depression and anxiety symptoms over time in the transition to university: Their co-occurrence and the role of self-critical perfectionism

2021 ◽  
pp. 1-12
Author(s):  
Shelby L. Levine ◽  
Nassim Tabri ◽  
Marina Milyavskaya
Keyword(s):  
Mental Health ◽  
Risk Factor ◽  
Mental Health Problems ◽  
Health Problems ◽  
Anxiety Symptoms ◽  
Depression And Anxiety ◽  
Symptom Development ◽  
Transition To University ◽  
Symptom Trajectories ◽  
Over Time

Abstract Little is known about how mental health symptoms develop during the transition to university. Most anxiety and depression research fails to consider how symptom development differs over time across different individuals, and how symptom co-occurrence influences the severity of mental health problems. Students (N = 658) completed online surveys on mental health prior to starting university and every 2 months until April. To better understand mental health problems during this transitional period, latent class growth curve analyses were run to determine how anxiety and depressive symptoms co-develop over time, as well, if self-critical perfectionism was a transdiagnostic risk factor for more severe symptom trajectories in this transition. About 40% of students experienced depression and anxiety symptoms prior to entering/during the transition to university. There is substantial variation between students in terms of how they experience depression and anxiety symptoms, and research needs to take this heterogeneity into account to properly identify which students might benefit most from resources. Self-critical perfectionism was a transdiagnostic risk factor, such that students higher in this trait experienced more severe anxiety and depressive symptom trajectories during this transition. This research further implicates the importance of understanding and studying individual differences in symptom development.

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