scholarly journals Improving Usual Care Outcomes in Major Depression in Youth by Targeting Memory Specificity: A Randomized Controlled Trial of Adjunct Computerised Memory Specificity Training (c-MeST)

2021 ◽  
Author(s):  
David John Hallford ◽  
David W. Austin ◽  
Keisuke Takano ◽  
Joseph Yeow ◽  
Danielle Rusanov ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Controlled Trial ◽  
Major Depressive ◽  
Significant Group ◽  
Significant Group Difference ◽  
Memory Specificity ◽  
Antidepressant Effects ◽  
Personal Experiences ◽  
Care Outcomes ◽  
Specificity Effects

Objective: Memory Specificity Training (MeST) improves the recall of past personal experiences, an impairment in Major Depressive Disorder (MDD). Extending on previous findings that computerised MeST (c-MeST) improves memory specificity and depressive symptoms in adults, this study aimed to answer two questions: 1) does c-MeST improve memory specificity and depressive symptoms in youth with MDD; and 2) does c-MeST improve memory specificity and depression in addition to other treatment? Methods: Participants aged 15-25 (N=359, 76.5% female; M age=19.2, SD=3.1), receiving predominantly psychological therapy or counselling (85%) and/or antidepressants (52.9%) were randomised to c-MeST or wait-list. Cognitive and clinical outcomes were assessed at baseline and at one, three, and six-month follow-ups. Results: The c-MeST group reported higher memory specificity at one-month (M change=1.13, 95%CI [0.16,2.10], d=.42, p=.022), but not other follow-ups. There was no significant group difference for Major Depressive Episode diagnosis at six-months (55.6% c-MeST vs. 68.8% control, odds ratio=0.56 95%CI [0.21,1.53], p=.266), but the c-MeST group did report lower depressive symptoms at one (M change=-1.84, 95%CI[-3.42,-0.25], d = .42, p = .023) and six-month follow-ups (M change=-3.91, 95%CI [-6.19,-1.63], d = .84, p = .001). Conclusions: c-MeST reduces symptoms in youth with MDD when provided alongside other treatments. There was some evidence that change in memory specificity drives these changes. Contrary to previous findings, specificity effects were not maintained, potentially due to the low intensity of c-MeST in this study. Further study is needed to understand more about co-occurring mechanisms that produce antidepressant effects.

OS10.4.A The effects of SmartCare on neuro-oncology family caregivers’ distress: a randomized controlled trial

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii13-ii13
Author(s):  
F W Boele ◽  
J M Weimer ◽  
J Proudfoot ◽  
A L Marsland ◽  
T S Armstrong ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Family Caregivers ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Intervention Group ◽  
Symptom Burden ◽  
Significant Group ◽  
Intention To Treat ◽  
Secondary Outcomes ◽  
Physical Consequences

Abstract BACKGROUND Patients with primary malignant brain tumors have high symptom burden and commonly rely on family caregivers for practical and emotional support. This can lead to negative mental and physical consequences for caregivers. We investigated effectiveness of an 8-week nurse-led online needs-based support program (SmartCare©) with and without online self-guided cognitive behavioral therapy (CBT) for depression compared to enhanced care as usual (ECAU) on depressive symptoms, caregiving-specific distress, anxiety, mastery, and burden. MATERIAL AND METHODS Family caregivers with depressive symptoms were randomized to three groups: SmartCare© plus/minus self-guided CBT, or ECAU. Primary outcomes (depressive symptoms (CES-D); caregiving-specific distress (Caregiver Needs Screen)) and secondary outcomes (anxiety (POMS-A), caregiver mastery (Caregiver Mastery Scale), and caregiver burden (Caregiver Reactions Assessment)) were assessed online. Intention to treat analyses of covariance corrected for baseline scores were performed for outcomes at four months. RESULTS In total, 120 family caregivers participated. Accrual and CBT engagement were lower than expected, therefore intervention groups were combined (n=80) and compared to ECAU (n=40). For depressive symptoms, no statistically significant group differences were found. Caregiving-specific distress decreased in the intervention group compared with ECAU (p=0.01, partial ɳ 2=0.08). Among secondary outcomes, there was a trend towards improvement in mastery for the intervention group compared with ECAU (p=0.08, partial ɳ 2=0.04). CONCLUSION SmartCare©, with or without self-guided CBT, reduced caregiving-specific distress with a trend towards improving mastery. SmartCare© has the potential to improve the lives of families coping with a brain tumor diagnosis.

QOLP-29. THE EFFECTS OF AN ONLINE, NURSE-LED NEEDS-BASED SUPPORT PROGRAM ON NEURO-ONCOLOGY FAMILY CAREGIVERS' DISTRESS: A RANDOMIZED CONTROLLED TRIAL

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi189-vi189
Author(s):  
Florien Boele ◽  
Paula Sherwood ◽  
Jason Weimer ◽  
Judith Proudfoot ◽  
Anna Marsland ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Family Caregivers ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Intervention Group ◽  
Symptom Burden ◽  
Support Program ◽  
Significant Group ◽  
Intention To Treat ◽  
Secondary Outcomes

Abstract BACKGROUND Patients with primary malignant brain tumors have high symptom burden and commonly rely on family caregivers for practical and emotional support. This can lead to negative mental and physical consequences for caregivers. We investigated effectiveness of an 8-week nurse-led online needs-based support program (SmartCare©) with and without online self-guided cognitive behavioral therapy (CBT) for depression compared to enhanced care as usual (ECAU) on depressive symptoms, caregiving-specific distress, anxiety, mastery, and burden. METHODS Family caregivers with depressive symptoms were randomized to three groups: SmartCare© plus/minus self-guided CBT, or ECAU. Primary outcomes (depressive symptoms (CES-D); caregiving-specific distress (Caregiver Needs Screen)) and secondary outcomes (anxiety (POMS-A), caregiver mastery (Caregiver Mastery Scale), and caregiver burden (Caregiver Reactions Assessment)) were assessed online. Intention to treat analyses of covariance corrected for baseline scores were performed for outcomes at four months. RESULTS In total, 120 family caregivers participated. Accrual and CBT engagement were lower than expected, therefore intervention groups were combined (n=80) and compared to ECAU (n=40). For depressive symptoms, no statistically significant group differences were found. Caregiving-specific distress decreased in the intervention group compared with ECAU (p=0.01, partial ɳ 2=0.08). Among secondary outcomes, there was a trend towards improvement in mastery for the intervention group compared with ECAU (p=0.08, partial ɳ 2=0.04). CONCLUSION SmartCare©, with or without self-guided CBT, reduced caregiving-specific distress with a trend towards improving mastery. SmartCare© has the potential to improve the lives of families coping with a brain tumor diagnosis.

scholarly journals Cognitive and psychosocial effects of an acute sun salutation intervention among adults with stress

2021 ◽  
Author(s):  
Madhura Phansikar ◽  
Sean Patrick Mullen
Keyword(s):  
Controlled Trial ◽  
Well Being ◽  
Moderate Intensity ◽  
Psychosocial Effects ◽  
Significant Group ◽  
Significant Group Difference ◽  
Performance Improvements ◽  
Randomized Controlled ◽  
Yoga Group ◽  
Before And After

Evidence suggests that yoga can improve executive functioning (EF) and psychological well-being, but there is no evidence whether flow-based, moderate-intensity forms of yoga can deliver similar benefits. The purpose of this randomized controlled trial was to test the aforementioned effects of engaging in a 30-minute, video-guided sun salutation exercise (n = 25), relative to aerobic exercise (n = 22) and attentional control (n = 24). Low-active participants (Mage = 27.84; 87.3% female) completed psychosocial assessments and tasks assessing EF, before and after the session. Results showed a significant group difference for state anxiety (p = .01, ηp² = .13) and stress (p < .05, ηp² = .09), in favor of the yoga group. No significant between-groups differences in EF were observed. Results suggest that video-guided, flow-based forms of yoga can induce immediate improvements in well-being, yet extended involvement may be required to realize performance improvements in memory and processing speed.

scholarly journals Effectiveness of a nurse-led hospital-to-home transitional care intervention for older adults with multimorbidity and depressive symptoms: A pragmatic randomized controlled trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254573
Author(s):  
Maureen Markle-Reid ◽  
Carrie McAiney ◽  
Kathryn Fisher ◽  
Rebecca Ganann ◽  
Alain P. Gauthier ◽  
...  
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Usual Care ◽  
Patient Experience ◽  
Service Use ◽  
Transitional Care ◽  
Controlled Trial ◽  
Mental Functioning ◽  
Significant Group ◽  
Secondary Outcomes

Objective To evaluate the effectiveness of a nurse-led hospital-to-home transitional care intervention versus usual care on mental functioning (primary outcome), physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service use costs in older adults with multimorbidity (≥ 2 comorbidities) and depressive symptoms. Design and setting Pragmatic multi-site randomized controlled trial conducted in three communities in Ontario, Canada. Participants were allocated into two groups of intervention and usual care (control). Participants 127 older adults (≥ 65 years) discharged from hospital to the community with multimorbidity and depressive symptoms. Intervention This evidence-based, patient-centred intervention consisted of individually tailored care delivery by a Registered Nurse comprising in-home visits, telephone follow-up and system navigation support over 6-months. Outcome measures The primary outcome was the change in mental functioning, from baseline to 6-months. Secondary outcomes were the change in physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service use cost, from baseline to 6-months. Intention-to-treat analysis was performed using ANCOVA modeling. Results Of 127 enrolled participants (63-intervention, 64-control), 85% had six or more chronic conditions. 28 participants were lost to follow-up, leaving 99 (47 -intervention, 52-control) participants for the complete case analysis. No significant group differences were seen for the baseline to six-month change in mental functioning or other secondary outcomes. Older adults in the intervention group reported receiving more information about health and social services (p = 0.03) compared with the usual care group. Conclusions Although no significant group differences were seen for the primary or secondary outcomes, the intervention resulted in improvements in one aspect of patient experience (information about health and social services). The study sample fell below the target sample (enrolled 127, targeted 216), which can account for the non-significant findings. Further research on the impact of the intervention and factors that contribute to the results is recommended. Trial registration clinicaltrials.gov Identifier: NCT03157999.

scholarly journals Computerised Memory Specificity Training (c-MeST) for Major Depression: A Randomised Controlled Trial

2020 ◽  
Author(s):  
David John Hallford ◽  
David W. Austin ◽  
Keisuke Takano ◽  
Matthew Fuller-Tyszkiewicz ◽  
Filip Raes
Keyword(s):  
Depressive Symptoms ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Control Group ◽  
Time Points ◽  
Memory Specificity ◽  
Randomised Controlled ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Background: Given modest response and high relapse after treatment for Major Depressive Episodes (MDE), the development and refinement of treatments to target cognitive vulnerabilities is indicated. Memory Specificity Training (MeST) remediates deficits in recalling detailed memories of past experiences through repeated practice of autobiographical memory retrieval. This randomised controlled trial aimed to assess the efficacy of an online, computerised version of MeST (c-MeST) for MDE. Methods: Adults (N = 146, 89.7% female) aged 18 and over (M age = 46.1, SD = 13.3) with a current MDE were randomised to the c-MeST program or wait-list control group. Primary outcomes were diagnostic status of MDE and self-reported depressive symptoms at baseline, post-training, one-month, and three-month follow-up. Memory specificity was assessed, as well as other variables thought to contribute to reduced memory specificity, such as rumination and cognitive avoidance. Results: Significantly fewer participants in the c-MeST group, relative to control, met criteria for an MDE at one-month follow-up (35.7% c-MeST vs. 60.6% control), but not at other time-points. The c-MeST group scored significantly higher on memory specificity at all time-points following baseline (d = 0.51 – 0.97), and lower on depressive symptoms at one (d = 0.53) and three-month follow-up (d = 0.67). Changes in memory specificity mediated the effect of c-MeST on depressive symptoms at follow-up. Few differences were noted on secondary measures.Conclusion: c-MeST can improve memory specificity and depressive symptoms in people with a MDE, and may speed the rate of recovery. Future studies can further examine the mechanisms through which this occurs.

Everyday Emotional Experiences in Current and Remitted Major Depressive Disorder: An Experience-Sampling Study

2021 ◽  
pp. 216770262199208
Author(s):  
Renee J. Thompson ◽  
Natasha H. Bailen ◽  
Tammy English
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Emotional Disturbances ◽  
Control Group ◽  
Emotional Experiences ◽  
Major Depressive ◽  
Significant Group ◽  
Significant Group Difference ◽  
Major Depressive Episodes ◽  
Depressive Episodes

The emotional experiences of people with major depressive disorder (MDD) are characterized by emotional disturbances. We examined whether these patterns characterize people with MDD in remission. Participants included individuals who had experienced at least two major depressive episodes (remitted-MDD group; n = 80), had current MDD (current-MDD group; n = 48), or were control participants ( n = 87). Participants reported their momentary affect five times per day for 14 days, from which we computed the mean (i.e., intensity), standard deviation (i.e., variability), and autocorrelation (i.e., inertia). Negative affect (NA) intensity and variability, but not inertia, differed between groups; the current-MDD group had the highest levels, the control group had the lowest, and the remitted-MDD group fell in between. Differences in NA variability held after accounting for mean NA. The only significant group difference for positive affect (PA) was that PA intensity was lower in the current-MDD group compared with the other two groups. Emotional disturbances of participants with remitted MDD appear limited to NA.

scholarly journals N-acetylcysteine for major depressive episodes in bipolar disorder

2011 ◽  
Vol 33 (4) ◽  
pp. 374-378 ◽  
Author(s):  
Pedro V Magalhães ◽  
Olívia M Dean ◽  
Ashley I Bush ◽  
David L Copolov ◽  
Gin S Malhi ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Depressive Symptoms ◽  
Functional Outcomes ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Randomised Clinical Trial ◽  
Outcome Data ◽  
Major Depressive ◽  
Major Depressive Episodes ◽  
Depressive Episodes

OBJECTIVE: In this report, we aimed to evaluate the effect of add-on N-acetylcysteine (NAC) on depressive symptoms and functional outcomes in bipolar disorder. To that end, we conducted a secondary analysis of all patients meeting full criteria for a depressive episode in a placebo controlled trial of adjunctive NAC for bipolar disorder. METHOD: Twenty-four week randomised clinical trial comparing adjunctive NAC and placebo in individuals with bipolar disorder experiencing major depressive episodes. Symptomatic and functional outcome data were collected over the study period. RESULTS: Seventeen participants were available for this report. Very large effect sizes in favor of NAC were found for depressive symptoms and functional outcomes at endpoint. Eight of the ten participants on NAC had a treatment response at endpoint; the same was true for only one of the seven participants allocated to placebo. DISCUSSION: These results indicate that adjunctive NAC may be useful for major depressive episodes in bipolar disorder. Further studies designed to confirm this hypothesis are necessary.

scholarly journals Educational Intervention Reduced Family Medicine Residents’ Intention to Request Diagnostic Tests: Results of a Controlled Trial

2021 ◽  
Vol 41 (3) ◽  
pp. 329-339
Author(s):  
Antonius Schneider ◽  
Markus Bühner ◽  
Therese Herzog ◽  
Siona Laverty ◽  
Stefanie Ziehfreund ◽  
...  
Keyword(s):  
Family Medicine ◽  
Educational Intervention ◽  
Diagnostic Tests ◽  
Controlled Trial ◽  
Diagnostic Reasoning ◽  
Significant Group ◽  
Significant Group Difference ◽  
The Impact ◽  
Family Medicine Residents

Objective Dealing with uncertainty is a core competence for physicians. To evaluate the impact of an educational intervention on family medicine residents’ (FMRs’) intention to request diagnostic tests and their attitudes toward uncertainty. Methods Nonrandomized controlled trial. Intervention group (IG) FMRs participated in interactive “dealing with uncertainty” seminars comprising statistical lessons and diagnostic reasoning. Control group (CG) FMRs participated in seminars without in-depth diagnostic lessons. FMRs completed the Dealing with Uncertainty Questionnaire (DUQ), comprising the Diagnostic Action and Diagnostic Reasoning scales. The Physicians’ Reaction to Uncertainty (PRU) questionnaire, comprising 4 scales (Anxiety Due to Uncertainty, Concern about Bad Outcomes, Reluctance to Disclose Uncertainty to Patients, and Reluctance to Disclose Mistakes to Physicians) was also completed. Follow-up was performed 3 months later. Differences were calculated with repeated-measures analysis of variance. Results In total, 107 FMRs of the IG and 102 FMRs of the CG participated at baseline and follow-up. The mean (SD) Diagnostic Action scale score decreased from 24.0 (4.8) to 22.9 (5.1) in the IG and increased in the CG from 23.7 (5.4) to 24.1 (5.4), showing significant group difference ( P = 0.006). The Diagnostic Reasoning scale increased significantly ( P = 0.025) without a significant group difference ( P = 0.616), from 19.2 (2.6) to 19.7 (2.4) in the IG and from 18.1 (3.3) to 18.8 (3.2) in the CG. The PRU scale Anxiety Due to Uncertainty decreased significantly ( P = 0.029) without a significant group difference ( P = 0.116), from 20.5 (4.8) to 18.5 (5.5) in the IG and from 19.9 (5.5) to 19.0 (6.0) in the CG. Conclusion The structured seminar reduced self-rated diagnostic test requisition. The change in Anxiety Due to Uncertainty and Diagnostic Reasoning might be due to an unspecific accompanying effect of the extra-occupational seminars for residents.

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