Depression Prevention Intervention Research Articles

Employ the 5H Model, Evaluate its Efficacy, And Illustrate the Change in Elderly Depression Levels and Symptoms

Introduction: Age-related disorders include mental health. This reduction in intergenerational cohesion and filial responsibilities has caused older people's dissatisfaction, sadness, and grief. Depression and dementia impair elderly people worldwide by taking away their independence and autonomy. Methodology: The authors use the experimental approach to implement the 5H model, evaluate its efficacy, and show the change in depression levels and symptoms in Quang Ngai's elderly. The author chose 26 senior persons from Truong Quang Trong Ward and 23 from Tinh Thien Village to engage in the intervention study. The semi-experimental study compared N=60 samples (Experimental Group=30 and Control Group=30). The elderly control group receives conventional therapy according to the local program, whereas the experimental group receives community intervention. The GDS-15 and ICD-10 examined the intervention's efficacy. Results: This study found that I mild depression had a significant change post-intervention; (ii) the mean score of depression through 2 assessments (GDS-15 scale and ICD-10 clinical assessment) both showed a significant reduction; (iii) females tended to change more than males; (iv) elderly aged 60-70 were easier to change than those over 80 years old; and (v) community-based psychosocial therapy had a significant impact on depression. Conclusion: Considering the aforementioned favourable results, the Quang Ngai city depression prevention intervention program for the elderly is practical and can reduce symptoms, severity, and reverse depression. Hence, the model is applicable across Quang Ngai City.

Does outcome expectancy predict outcomes in online depression prevention? Secondary analysis of randomised‐controlled trials

AbstractBackgroundEvidence shows that online interventions could prevent depression. However, to improve the effectiveness of preventive online interventions in individuals with subthreshold depression, it is worthwhile to study factors influencing intervention outcomes. Outcome expectancy has been shown to predict treatment outcomes in psychotherapy for depression. However, little is known about whether this also applies to depression prevention. The aim of this study was to investigate the role of participants' outcome expectancy in an online depression prevention intervention.MethodsA secondary data analysis was conducted using data from two randomised‐controlled trials (N = 304). Multilevel modelling was used to explore the effect of outcome expectancy on depressive symptoms and close‐to‐symptom‐free status postintervention (6–7 weeks) and at follow‐up (3–6 months). In a subsample (n = 102), Cox regression was applied to assess the effect on depression onset within 12 months. Explorative analyses included baseline characteristics as possible moderators. Outcome expectancy did not predict posttreatment outcomes or the onset of depression.ResultsSmall effects were observed at follow‐up for depressive symptoms (β = −.39, 95% confidence interval [CI]: [−0.75, −0.03], p = .032, padjusted = .130) and close‐to‐symptom‐free status (relative risk = 1.06, 95% CI: [1.01, 1.11], p = .013, padjusted = 0.064), but statistical significance was not maintained when controlling for multiple testing. Moderator analyses indicated that expectancy could be more influential for females and individuals with higher initial symptom severity.ConclusionMore thoroughly designed, predictive studies targeting outcome expectancy are necessary to assess the full impact of the construct for effective depression prevention.Patient or Public ContributionThis secondary analysis did not involve patients, service users, care‐givers, people with lived experience or members of the public. However, the findings incorporate the expectations of participants using the preventive online intervention, and these exploratory findings may inform the future involvement of participants in the design of indicated depression prevention interventions for adults.Clinical Trial RegistrationOriginal studies: DRKS00004709, DRKS00005973; secondary analysis: osf.io/9xj6a.

Understanding the protective effect of social support on depression symptomatology from a longitudinal network perspective

BackgroundHigher social support protects people from developing mental disorders. Limited evidence is available on the mechanism through which social support plays this protective role.ObjectiveTo investigate the stress-buffering process of social...

Factors associated with return-to-work outcomes in inpatient rehabilitation – a systematic scoping review

ABSTRACT Inpatient rehabilitation is common in Germany to improve return-to-work outcomes. The objective of this systematic scoping review was to identify factors associated with return-to-work outcomes in musculoskeletal, psychological and oncological health conditions to improve tailoring of rehabilitation therapies. A search was completed in Embase, Medline, PsycInfo and AMED until May 2023 for articles investigating inpatient rehabilitation including working-age patients with oncological, musculoskeletal, or psychological diseases using a quantitative design and reporting factors associated with return-to-work outcomes. Screening of all titles and abstracts was completed by one reviewer, full texts were read by two reviewers. Quality appraisal and data extraction was completed by two reviewers. Data was analysed using a narrative synthesis. Eighteen studies of moderate quality were included. The review identified a wide range of return-to-work parameters including employment status, work ability, sickness absence, retirement status and duration of employment since rehabilitation. In addition, 48 psychological, health- and work-related factors associated with return-to-work parameters were identified. Only one RCT investigated the relationship between a depression prevention intervention and a return-to-work outcome (work ability), which showed a significant effect. In addition to the depression prevention intervention, only the factor ‘health literacy’ could be considered modifiable and be addressed as part of an inpatient rehabilitation programme. Furthermore, gradual work reintegration programs and/or workplace interventions in addition to inpatient rehabilitation should be further explored to improve return-to-work outcomes.

Examining Feasibility, Acceptability, and Preliminary Outcomes of a Culturally Adapted Evidence-Based Postpartum Depression Preventive Intervention for Women in Doha, Qatar: Protocol for a Randomized Controlled Trial.

Postpartum depression and anxiety are the 2 most common perinatal mental health disorders, with prevalence rates higher among women living in the Middle East than in most Western countries. The negative outcomes associated with postpartum depression and anxiety are profound and include less responsive parenting and compromised infant and young child development. Although interventions exist to prevent postpartum depression and anxiety, to date, there have been no studies that have attempted to prevent postpartum depression or anxiety among Arabic-speaking women in the Middle East, including Qatar. The purpose of this study is to conduct a randomized controlled trial (RCT) of an evidence-based postpartum depression preventive intervention-Mothers and Babies (MB)-culturally adapted for use with Arabic-speaking women in Doha, Qatar. MB is guided by a cognitive behavioral therapy framework that focuses on increasing pleasant activities, promoting healthy thought patterns, and increasing the type and frequency of personal contacts. MB is tailored to specific needs and issues related to pregnancy and the postpartum period. A multidisciplinary and multiethnic investigator team adapted MB to promote cultural and contextual fit for Arabic-speaking women. Intervention concepts were reviewed to ensure core content would be understood by Arabic-speaking women in Qatar. Subsequently, images, activities, and examples in the intervention manuals were adapted, as needed, to make the content more relevant to Arab culture. To deliver the adapted intervention, 30 Arabic-speaking individuals with mental health backgrounds were trained. The adapted intervention was subsequently pilot-tested with 10 pregnant women receiving prenatal care at Sidra Hospital in Doha. We are now conducting an RCT to examine the effectiveness of the adapted intervention. We plan to enroll 210 pregnant individuals who are Arabic-speaking, with 1:1 randomization to the MB intervention or usual prenatal care. Among the enrolled participants, a stratified subsample of 40 pregnant women with diabetes is being recruited. Data collection will take place at baseline and a 6-month follow-up. The primary outcomes are depressive and anxiety symptoms and perceived stress. Diabetes self-care is the exploratory outcome for the subsample of individuals with diabetes. Intervention implementation will be assessed via client and provider surveys during and after intervention delivery. Power and sample size were calculated using a 2-sided 5% effort rate and assumed analyses on the individual level, accounting for attrition of 20%. The cultural adaptation and pilot study of the adapted MB intervention are completed. A total of 157 women have been enrolled in the RCT as of March 31, 2023. This study is highly innovative, as it is the first study to our knowledge to examine the effectiveness of an evidence-based postpartum depression preventive intervention in the Middle East. Limitations include a single follow-up time point and a small subsample of individuals with diabetes. ClinicalTrials.gov NCT04442529; https://www.clinicaltrials.gov/study/NCT04442529. DERR1-10.2196/11623.

Prenatal depression and risk of child autism-related traits among participants in the Environmental influences on Child Health Outcomes program.

This study evaluated the association between prenatal depression and offspring autism-related traits. The sample comprised 33 prenatal/pediatric cohorts participating in the Environmental influences on Child Health Outcomes program who contributed information on prenatal depression and autism-related traits. Autism-related traits were assessed continuously and at the diagnostic cut-off using the Social Responsiveness Scale for children up to 12 years of age. Main analyses included 3994 parent-child pairs with prenatal depression diagnoses data; secondary analyses included 1730 parent-child pairs with depression severity data. After confounder adjustment, we observed an increase in autism-related traits among children of individuals with prenatal depression compared to those without (adjusted β = 1.31 95% CI: 0.65, 1.98). Analyses stratified by child sex documented a similar significant association among boys (aβ = 1.34 95%CI: 0.36, 2.32) and girls (aβ = 1.26 95% CI: 0.37, 2.15). Prenatal depression was also associated with increased odds of moderate to severe autism-related traits (adjusted odds ratio: 1.64, 95%CI: 1.09, 2.46), the screening threshold considered high risk of autism spectrum disorder (ASD) diagnosis. Findings highlight the importance of prenatal depression screening and preventive interventions for children of pregnant individuals with depression to support healthy development. Future research is needed to clarify whether these findings reflect overlap in genetic risk for depression and ASD-related traits or another mechanism.

COVID stress and depressive symptoms among high school students: a moderated mediation model of sleep quality and optimism

PurposeThis study aimed to investigate whether optimism buffers an indirect relationship between COVID stress and depressive symptoms via poor sleep quality among Vietnamese high school students.Design/methodology/approachSix hundred and eighty-five participants completed the Coronavirus Stress Measure, the Life Orientation Test-Revised, the Pittsburgh Sleep Quality Index and the Depression, Anxiety and Stress Scales. Process Macro 3.5 for SPSS (Model 4 and Model 14) was used to analyze the mediating effect and moderated mediation effect.FindingsThe results indicated that COVID stress was associated with an increase in depressive symptoms via the indirect pathway of poor sleep quality. Furthermore, optimism moderated the indirect relationship between COVID stress and depressive symptoms through poor sleep quality among Vietnamese students.Originality/valueThe study's findings may serve as a basis for the development of depression prevention interventions for students with high COVID stress in the COVID-19 pandemic.

An optimization for postpartum depression risk assessment and preventive intervention strategy based machine learning approaches

BackgroundPostpartum depression (PPD) is one of the most common psychiatric disorders for women after delivery. The establishment of an effective PPD prediction model helps to distinguish high-risk groups, and verifying whether such high-risk groups can benefit from drug intervention is very important for clinical guidance. MethodsWe collected data of parturients that underwent a cesarean delivery. The Control group was divided into a training cohort and a testing cohort. Six different ML models were constructed and we compared their prediction performance in the testing cohort. For model interpretation, we introduced SHapley Additive exPlanations (SHAP). Then, training cohort, ketamine group and dexmedetomidine (DEX) group were classified as high or low risk for PPD by the model. A 1:1 propensity score matching (PSM) was performed to compare the incidence of PPD between two groups in different risk cohorts. ResultsExtreme gradient enhancement (XGB) had the best recognition effect, with an area under the receiver operating characteristic curve (AUROC) of 0.789 (95 % CI 0.742–0.836) in the training cohort and 0.744 (95 % CI 0.655–0.823) in the testing cohort, respectively. A threshold of 21.5 % PPD risk probability was determined. After PSM, the results showed that the incidence of PPD in the two intervention groups was significantly different from the control group in the high-risk cohort (P < 0.001) but not in the low-risk cohort (P > 0.001). ConclusionOur study demonstrated that the XGB algorithm provided a more accurate in prediction of PPD risk, and it was beneficial to receive early intervention for the high-risk groups distinguished by the model.

Regaining control of your emotions? Investigating the mechanisms underlying effects of cognitive control training for remitted depressed patients.

Studies suggest that cognitive control training shows potential as a preventive intervention for depression. At the same time, little is known regarding the mechanisms underlying effects of cognitive control training. Informed by theoretical frameworks of cognitive risk for recurrent depression (De Raedt & Koster, 2010; Siegle et al., 2007), the current study sought to model direct effects of cognitive control training on the complex interplay between affect, emotion regulation, residual symptomatology, and resilience in a sample of remitted depressed patients (n = 92). Combining a 4-week experience sampling procedure with an experimental manipulation of cognitive control, we observed beneficial effects of cognitive control training on deployment of rumination. In addition, we obtained evidence for the causal involvement of cognitive control in efficacy of emotion regulation. In contrast to our expectations, cognitive control training did not exert immediate effects on residual symptomatology or resilience when compared with an active control condition, nor did cognitive control training impact the complex interplay between these variables. Overall, immediate effects of cognitive control training on functioning in daily life were limited. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

1.35 Examining Primary Care Provider Attitudes in an Internet-Based Adolescent Depression Preventive Intervention

Pediatric primary care clinics can be an important point of access for mental health care. Despite the recent introduction of guidelines to support pediatric primary care providers (PCPs) in managing depression, implementation within primary care has been limited. To identify barriers, we examined healthcare providers’ attitudes regarding depression in adolescents.

Examining Participant Dosage and Skill Utilization Associated with Receipt of a Perinatal Depression Preventive Intervention

This study assessed participant, facilitator, and program-level characteristics associated with intervention dosage among women receiving an evidence-based perinatal depression preventive intervention, Mothers and Babies (MB). We also explored how intervention dosage affected the use and maintenance of core skills taught in the six-session group-based intervention. We conducted a secondary analysis of data from a cluster-randomized controlled trial in which 679 women enrolled in home visiting (HV) programs received MB prenatally. High dose of intervention was defined as attendance at > 50% of MB sessions, while MB skill utilization was measured by asking participants to indicate at 12 and 24weeks postpartum the extent to which they used 12 core MB skills taught during the intervention. Age and racial concordance between participant and facilitator were significantly associated with intervention dosage. Those receiving higher intervention dosage tended to be older (27.25 ± 5.96 vs. 24.99 ± 5.60, p < 0.01, OR = 1.068 [1.038-1.098]), and received MB from a facilitator with a self-identified race similar to their own (58% vs. 48%, p = 0.04, OR = 1.485 [1.014-2.176]). Primary language of participants was marginally associated with dosage. Participants receiving a higher dose of intervention tended to exhibit greater MB skill utilization, on average at 24weeks postpartum. These results can be used to identify strategies to promote intervention engagement. They further suggest that greater intervention dosage leads to increased use of core intervention skills that can promote improvements in participants' behaviors and thoughts.

Results from an effectiveness-implementation evaluation of a postpartum depression prevention intervention delivered in home visiting programs

BackgroundBuilding on growing research examining lay health professionals delivering postpartum depression preventive interventions, we conducted a hybrid effectiveness-implementation Type 2 trial to examine implementation metrics and determine whether pregnant women receiving Mothers and Babies 1-on-1 delivered by lay home visitors exhibit greater reductions in depressive symptoms and perceived stress than women receiving usual home visiting. Methods1229 (672 control, 557 intervention) pregnant women were enrolled, with intervention participants receiving Mothers and Babies 1-on-1 delivered by a lay home visitor and control participants receiving usual home visiting services. Baseline and six-month follow-up assessments measured client mental health outcomes, with management information system data collected to assess intervention dosage. Surveys were administered nine months post-training to agency managers as well as home visitors who delivered any intervention content. ResultsIntent-to-treat analyses indicated a significant reduction in perceived stress among intervention participants compared to controls, while as-treated analyses showed significant reductions in perceived stress and depressive symptoms. Although all study sites adopted the intervention, <50 % of eligible women received the intervention. Over two-thirds of home visitors made at least one fidelity-consistent adaptation, with client recruitment and retention in home visiting highlighted as challenges to delivery. LimitationsUnmeasured historical events may have affected study outcomes and caution should be used generalizing to perinatal women from different racial/ethnic groups and home visiting models. ConclusionMothers and Babies 1-on-1 delivered by lay home visitors leads to reductions in perceived stress and depressive symptoms, suggesting task shifting to non-mental health professionals is viable when appropriate training and supervision is provided.

Mothers and Babies Online Course: Participant Characteristics and Behaviors in a Web-Based Prevention of Postpartum Depression Intervention.

Despite the availability of evidence-based postpartum depression (PPD) prevention and treatment interventions, perinatal persons continue to suffer. eHealth and mHealth tools to address mental health issues have grown exponentially, especially given the ubiquity of technology and the increased demand for telemental health resources. The Mothers and Babies Online Course (eMB), an 8-lesson prevention of PPD intervention, was digitally adapted to expand the reach of evidence-based interventions to perinatal persons with limited access to maternal mental health resources. This report describes the characteristics, behaviors, and feedback provided by users of the updated eMB website. Two hundred eight predominantly English-speaking U.S. residents enrolled in the eMB. Thirty-seven percent were either pregnant (n = 38) or postpartum (n = 39) women interested in learning skills to manage changes in their mood during and after pregnancy; 63% were health providers (n = 131) interested in learning how to support their patient communities. Seventy-six percent (n = 159) viewed at least one of the eight eMB lessons, with 50.9% exclusively viewing Lesson 1. Few (4.4%) viewed all eight lessons. The lessons were rated favorably on usefulness and understanding. Perinatal women engaged with interactive content at higher rates than health providers. Examining user behaviors and feedback is an essential developmental step before empirically testing the efficacy of digital tools. Future iterations of the eMB will incorporate these preliminary findings to provide perinatal persons with accessible web-based interventions that will hopefully reduce the incidence and negative consequences of postpartum depression.

Development of an Online-Coaching Blended Couple-Oriented Intervention for Preventing Depression in Middle Adulthood: An Intervention Mapping Study.

BackgroundAlthough middle-aged adults in Korea are vulnerable to depression, there are few preventive interventions for depression in middle adulthood. Studies consistently suggest that interventions that include both spouses are effective in decreasing depression and relationship distress. Considering the busy lives of middle-aged couples, it is essential to develop an online-coaching blended couple-oriented intervention. This study aimed to describe the development, implementation, and evaluation of an online-coaching blended couple-oriented intervention using an online program and coaching via videoconference to prevent middle-aged couples' depression; this was done using an intervention mapping (IM) protocol.MethodsSix steps of IM were used to systematically develop a tailored multi-level intervention specific to middle-aged couples' depression. These steps of the IM protocol involve needs assessment, formulation of change objectives, theory-based methods, and practical strategies for program design, program development, program implementation, and program evaluation.ResultsThe results of the six steps were as follows: (a) middle-aged couples' needs and mental health problems were identified through a scoping review study, mixed-method study, and expert interviews; (b) six performance objectives (POs) were formulated based on the results of Step 1, and intrapersonal, interpersonal, and temporal/transpersonal determinants were identified based on the self-transcendence theory. Change objectives were developed by combining POs with determinants; (c) self-regulated learning was chosen for theoretical teaching methods and practical strategies to change the determinants of each level; (d) four modules consisting of 16 sessions were developed based on the self-transcendence theory; (e) experts evaluated the program and coaches were trained; and (f) the evaluation plan for the program's feasibility, acceptability, usability, and preliminary effects was developed.DiscussionThe systematic process using IM allowed us to develop an online-coaching blended couple-oriented intervention to prevent depression and promote couples' relationships. The primary effects of this newly developed program should be evaluated in future studies. This may lead to the increased adoption and implementation of evidence-based and tailored interventions for psychological wellbeing in middle adulthood.

Comparison of Estimated Incentives for Preventing Postpartum Depression in Value-Based Payment Models Using the Net Present Value of Care vs Total Cost of Care

Strong financial incentives are critical to promoting widespread implementation of interventions that prevent postpartum depression. Value-based payment (VBP) approaches could be adapted to capture longer-term value and offer stronger incentives for postpartum depression prevention by sharing the expected future health care savings estimated by reduced postpartum depression incidence with clinicians. To evaluate whether sharing 5-year expected savings estimated by reduced postpartum depression incidence offers stronger incentives for prevention than traditional VBP under a variety of circumstances. This decision analytic model used a simulated cohort of 1000 Medicaid-enrolled pregnant individuals. Health care costs for individuals receiving postpartum depression preventive intervention or not, over 1 or 5 years post partum, in a variety of scenarios, including varying rates of Medicaid churn (ie, transitions to a new Medicaid managed care plan, commercial insurance plan, or loss of coverage) were estimated for the period 2020 to 2025. The model was developed between March 5 and July 30, 2021. Sharing 100% of 1-year actual health care cost saving vs 50% of 5-year estimated health care cost savings associated with reduced postpartum depression incidence. The main outcome was the amount of clinician incentive shared in a VBP model from providing preventive interventions. The likelihood of the health care payer realizing a positive return on investment if it shared 50% of 5-year expected savings with a clinician up front was also measured. The simulated cohort was designed to be reflective of the demographics characteristics of pregnant individuals receiving Medicaid; however, no specific demographic features were simulated. Providing preventive interventions for postpartum depression resulted in an estimated 5-year savings of $734.12 (95% credible interval [CrI], $217.21-$1235.67) per person. Without health insurance churn, sharing 50% of 5-year expected savings could offer more than double the financial incentives for clinicians to prevent postpartum depression compared with traditional VBP ($367.06 [95% CrI, $108.61-$617.83] vs $177.74 [95% CrI, $52.66-$296.60], respectively), with a high likelihood of positive return for the health care payer (91%). As health insurance churn increased, clinician incentives from sharing estimated savings decreased (73% reduction with 50% annual churn). In this decision analytic model of VBP approaches to incentivizing postpartum depression prevention, VBP based on 5-year expected savings offered stronger incentives when churn was low. Policy should support health care payers and clinicians to share estimated savings and overcome health insurance churn issues to promote wide-scale implementation of interventions to prevent perinatal mental health conditions.

Undertaking specific stress-reducing activities are associated with reduced fatigue and depression, and increased mastery, in people with multiple sclerosis

BackgroundMultiple sclerosis is a demyelinating autoimmune disease, presenting with heterogenous symptoms that impact daily living. Undertaking stress-reducing activities may reduce symptoms including depression and fatigue, and enhance mastery, the sense of control of one's life. We assessed cross-sectional associations of undertaking stress-reducing activities or meditation on depression, fatigue, and mastery, and 5-year prospective relationships between meditation and these outcomes. MethodsData were extracted from the longitudinal Health Outcomes and Lifestyle In a Sample of people with Multiple sclerosis (HOLISM) study. Stress-reducing activities were categorised to relaxation, physical, mind-body, and spiritual. Meditation was analysed as a dichotomous term, and for duration and frequency of practice. Depression, fatigue, and mastery were assessed by Patient's Health Questionnaire-9, Fatigue Severity Scale, and Pearlin Mastery Scale, respectively. Associations with depression, fatigue and mastery were assessed by log-binomial regression. Models were adjusted for age, sex, symptoms due to relapse, socioeconomic status, employment status, and antidepressant and anti-fatigue medication use, as appropriate. ResultsCross-sectionally, physical and relaxation activities were associated with 40% and 33% lower frequencies of depression, respectively. Physical activities were additionally associated with 19% lower frequency of fatigue. Meditation was associated with 30% lower frequency of depression and 17% higher mastery. Prospectively, meditation was associated with 28% decreased depression, and 48% reduction of developing depression at 5-year follow-up. ConclusionPotential benefits of undertaking stress-reducing activities, or meditation, on depression, fatigue, and mastery are promising and should be further assessed prospectively. Meditation practice should be encouraged as a safe and inexpensive intervention for prevention of depression.

A psychological intervention by community pharmacies to prevent depression in adults with subthreshold depression and long-term conditions: the CHEMIST pilot RCT

Background Depression is common in people with long-term health conditions, and this combination can lead to worsened health outcomes and increased health-care costs. Subthreshold depression, a risk factor for major depression, is prevalent in this population, but many people remain untreated due to the demand on services. The community pharmacy may be an alternative setting to offer mental health support; however, insufficient evidence exists to support implementation. Objectives To conduct a feasibility study and pilot randomised controlled trial of a community pharmacy-delivered psychological intervention aimed at preventing depression in adults with long-term health conditions. Design A feasibility study with nested qualitative evaluation and an external pilot, two-arm, 1 : 1 individually randomised controlled trial with nested process and economic evaluations. Setting Community pharmacies in the north of England. Participants Adults aged ≥ 18 years with subthreshold depression and at least one long-term health condition. Intervention A bespoke enhanced support intervention (behavioural activation within a collaborative care framework) involving up to six sessions delivered by trained community pharmacy staff (intervention facilitators) compared with usual care. Main outcome measures Recruitment and retention rates, completeness of outcome measures and intervention engagement. The intended primary outcome was depression severity at 4 months, assessed by the Patient Health Questionnaire-9. Results In the feasibility study, 24 participants were recruited. Outcome measure completeness was 95–100%. Retention at 4 months was 83%. Seventeen participants (71%) commenced intervention sessions and all completed two or more sessions. Depression symptoms reduced slightly at 4 months. The process evaluation suggested that the intervention was acceptable to participants and intervention facilitators. In the pilot randomised controlled trial, 44 participants (target of 100 participants) were randomised (intervention, n = 24; usual care, n = 20). Outcome measure completeness was 100%. Retention at 4 months was 93%. Eighteen participants (75%) commenced intervention sessions and 16 completed two or more sessions. Depression symptoms reduced slightly at 4 months, with a slightly larger reduction in the usual-care arm, although the small sample size limits any conclusions. The process evaluation reported good acceptability of the intervention and identified barriers associated with study implementation and its impact on core pharmacy functions. The economic analysis revealed some indication of reduced resource use/costs associated with the intervention, but this is limited by the small sample size. Intervention costs were low. Limitations The main limitation is the small sample size due to difficulties with recruitment and barriers to implementing the study within existing pharmacy practices. Conclusions The community pharmacy represents a new setting to deliver a depression prevention intervention. Recruitment was a challenge and pharmacy staff encountered barriers to effective implementation of the study within busy pharmacy practice. Despite these challenges, good retention rates and intervention engagement were demonstrated, and process evaluation suggested that the intervention was acceptable in this setting. To the best of our knowledge, this is the first study to demonstrate that community pharmacy staff can be trained to deliver a depression prevention intervention. Future work Further work is needed to address barriers to recruitment, intervention delivery and implementation of psychological interventions in the community pharmacy setting. Trial registration This trial is registered as ISRCTN11290592. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 5. See the NIHR Journals Library website for further project information.

EHealth Interventions for Treatment and Prevention of Depression, Anxiety, and Insomnia During Pregnancy: Systematic Review and Meta-analysis.

BackgroundPregnancy is associated with an increased risk for depression, anxiety, and insomnia. eHealth interventions provide a promising and accessible treatment alternative to face-to-face interventions.ObjectiveThe objective of this systematic review and meta-analysis is to determine the effectiveness of eHealth interventions in preventing and treating depression, anxiety, and insomnia during pregnancy. Secondary aims are to identify demographic and intervention moderators of effectiveness.MethodsA total of 5 databases (PsycINFO, Medline, CINAHL, Embase, and Cochrane) were searched from inception to May 2021. Terms related to eHealth, pregnancy, randomized controlled trials (RCTs), depression, anxiety, and insomnia were included. RCTs and pilot RCTs were included if they reported an eHealth intervention for the prevention or treatment of depression, anxiety, or insomnia in pregnant women. Study screening, data extractions, and quality assessment were conducted independently by 2 reviewers from an 8-member research team (KAS, PRS, Hangsel Sanguino, Roshni Sohail, Jasleen Kaur, Songyang (Mark) Jin, Makayla Freeman, and Beatrice Valmana). Random-effects meta-analyses of pooled effect sizes were conducted to determine the effect of eHealth interventions on prenatal mental health. Meta-regression analyses were conducted to identify potential moderators.ResultsIn total, 17 studies were included in this review that assessed changes in depression (11/17, 65%), anxiety (10/17, 59%), and insomnia (3/17, 18%). Several studies included both depression and anxiety symptoms as outcomes (7/17, 41%). The results indicated that during pregnancy, eHealth interventions showed small effect sizes for preventing and treating symptoms of anxiety and depression and a moderate effect size for treating symptoms of insomnia. With the exception of intervention type for the outcome of depressive symptoms, where mindfulness interventions outperformed other intervention types, no significant moderators were detected.ConclusionseHealth interventions are an accessible and promising resource for treating symptoms of anxiety, depression, and insomnia during pregnancy. However, more research is necessary to identify ways to increase the efficacy of eHealth interventions for this population.Trial RegistrationPROSPERO (International Prospective Register of Systematic Reviews) CRD42020205954; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=205954

Cultural Adaptation of the Mothers and Babies Intervention for Use in Tribal Communities.

ObjectiveWhile one in five women may experience mood and anxiety disorders during pregnancy and postpartum, Indigenous identity increases that risk by 62%, especially among younger Indigenous women. The need for evidence-based perinatal mental health interventions that provide culturally relevant well-being perspectives and practices is critical to improving maternal, child, and community outcomes for Indigenous peoples, and reducing health inequities.MethodsThrough a collaboration between community maternal and child health professionals, intervention researchers, and a cultural consultant, our workgroup developed cultural adaptations to Mothers and Babies, an evidence-based perinatal depression prevention intervention. Applying a cultural interface model, the workgroup identified existing intervention content for surface adaptations, as well as deep, conceptual adaptations to incorporate traditional teachings into this evidence-based intervention.ResultsThis collaboration developed a culturally adapted facilitator manual for intervention providers, including guidance for implementation and further adaptation to represent local tribal culture, and a culturally adapted participant workbook for Indigenous perinatal women that reflects cultural teachings and traditional practices to promote well-being for mother and baby.ImplicationsCommitting to a culturally respectful process to adapt Mothers and Babies is likely to increase the reach of the intervention into Indigenous communities, reengage communities with cultural practice, improve health outcomes among parents, children, and the next generation's elders, and reduce disparities among Indigenous groups. Replication of this community-engaged process can further the science and understanding of cultural adaptations to evidence-based interventions, while also further reducing health inequities. Future steps include evaluating implementation of the culturally adapted intervention among tribal home visiting organizations.

A potential syndemic effect associated with symptoms of depression among men who have sex with men.

Introduction:Globally, depression rates are high among men who have sex with men (MSM). Multiple factors may interact synergistically to increase this risk. This analysis assessed the prevalence of symptoms of depression among MSM in Brazil and synergistic effects of several factors.Methods:Cross-sectional study conducted in 12 cities using respondent-driven sampling. Sociodemographic and behavioral characteristics were collected. The PHQ-9 was used to screen for depression. Having moderate-severe depressive symptoms was compared to none-mild using logistic regression. The syndemic factor was a composite of hazardous alcohol use, sexual violence, and discrimination due to sexual orientation. Those with one to three of these factors were compared to those with none.Results:The weighted prevalence of moderate-severe depressive symptoms was 24.9% (95%CI = 21.8-28.8) and 16.2%, 22.9%, 46.0% and 51.0% when none, one, two, or three syndemic factors were present, respectively, indicating a dose-response effect. Perception of HIV risk, high level of HIV knowledge, known HIV infection, and health self-rated as poor or very poor were also associated with depressive symptoms.Conclusion:The prevalence of moderate-severe depressive symptoms among MSM in Brazil is high, and selected factors act synergistically in increasing their prevalence. Public health policies should consider holistic depression prevention and treatment interventions for this population.