Problem-solving Intervention Research Articles

Effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression: A pragmatic cluster randomized controlled trial.

PurposeGiven the public health significance of poorly treatable co-morbid major depressive disorders (MDD) among patients with type 2 diabetes mellitus (DM2) and coronary heart disease (CHD), we need to investigate whether strategies to prevent the development of major depression could reduce its burden of disease. We therefore evaluated the effectiveness of a stepped-care program for subthreshold depression in comparison with usual care in patients with DM2 and/or CHD.MethodsA cluster randomized controlled trial, with 27 primary care centers serving as clusters. A total of 236 DM2 and/or CHD patients with subthreshold depression (nine item Patient Health Questionnaire (PHQ-9) score ≥ 6, no current MDD according to DSM-IV criteria) were allocated to the intervention group (N = 96) or usual care group (n = 140). The stepped-care program was delivered by trained practice nurses during one year and consisted of four sequential treatment steps: watchful waiting, guided self-help, problem solving treatment and referral to the general practitioner. The primary outcome was the 12-month cumulative incidence of MDD as measured with the Mini International Neuropsychiatric Interview (MINI). Secondary outcomes included severity of depression (measured by PHQ-9) at 3, 6, 9 and 12 months.ResultsOf 236 patients (mean age, 67,5 (SD 10) years; 54.7% men), 210 (89%) completed the MINI at 12 months. The cumulative incidence of MDD was 9 of 89 (10.1%) participants in the intervention group and 12 of 121 (9.9%) participants in the usual care group. We found no statistically significant overall effect of the intervention (OR = 1.21; 95% confidence interval (0.12 to 12.41)) and there were no statistically significant differences in the course or severity of depressive symptoms between the two groups.ConclusionsThis study suggest that Step-Dep was not more effective in preventing MDD than usual care in a primary care population with DM2 and/or CHD and subthreshold depression.

Youth and Parent Perspectives of an Environment Problem-Solving Intervention for Transition-Age Youth With Disabilities

Abstract Date Presented 3/31/2017 Project TEAM empowers transition-age youth with disabilities to identify environment barriers and generate solutions to increase participation. Youths with developmental disabilities and their parents reported that the purpose, procedures, and perceived benefits of Project TEAM supported the youths’ current and future participation. Primary Author and Speaker: Jessica Kramer Additional Authors and Speakers: I-Ting Hwang Contributing Authors: Christine Helfrich, Preethy Samuel

Evaluating the Social Validity of Project TEAM: A Problem-Solving Intervention to Teach Transition Age Youth with Developmental Disabilities to Resolve Environmental Barriers

Project TEAM teaches transition-age youth with developmental disabilities (DD) to identify physical and social environmental barriers and supports, generate solutions to barriers, and request modifications to increase participation. Establishing the social validity of this environment focused intervention with youth and their parents is critical, given the significant shift the intervention represents from rehabilitation’s more traditional focus on body structures and function. University researchers and youth research collaborators conducted a participatory evaluation of the purpose, procedures, and perceived benefits of Project TEAM. Youth with DD (n = 42) provided feedback using three methods: activity voting, a survey, and a focus group. Parents (n = 37) also provided feedback. Results suggest that both youth and parents find Project TEAM acceptable and relevant to youth’s current and future lives. The majority of youth and parents felt Project TEAM fostered independence and empowerment, although some youth and parents reported challenges with the unique environment-focused approach.

A problem-solving intervention for cardiovascular disease risk reduction in veterans: Protocol for a randomized controlled trial

BackgroundHealth behaviors related to diet, tobacco usage, physical activity, medication adherence, and alcohol use are highly determinative of risk for developing cardiovascular disease. This paper describes a study protocol to evaluate a problem-solving intervention that aims to help patients at risk for developing cardiovascular disease address barriers to adopting positive health behaviors in order to reduce cardiovascular risk. MethodsEligible patients are adults enrolled in Veterans Affairs (VA) health care who have not experienced a cardiovascular event but are at elevated risk based on their Framingham Risk Score (FRS). Participants in this two-site study are randomized to either the intervention or care as usual, with a target of 400 participants. The study intervention, Healthy Living Problem-Solving (HELPS), consists of six group sessions conducted approximately monthly interspersed with individualized coaching calls to help participants apply problem-solving principles. The primary outcome is FRS, analyzed at the beginning and end of the study intervention (6months). Participants also complete measures of physical activity, caloric intake, self-efficacy, group cohesion, problem-solving capacities, and demographic characteristics. ConclusionResults of this trial will inform behavioral interventions to change health behaviors in those at risk for cardiovascular disease and other health conditions.Trial registration: ClinicalTrials.gov identifier NCT01838226

The CIPRUS study, a nurse-led psychological treatment for patients with undifferentiated somatoform disorder in primary care: study protocol for a randomised controlled trial

BackgroundUp to a third of patients presenting medically unexplained physical symptoms in primary care may have a somatoform disorder, of which undifferentiated somatoform disorder (USD) is the most common type. Psychological interventions can reduce symptoms associated with USD and improve functioning. Previous research has either been conducted in secondary care or interventions have been provided by general practitioners (GPs) or psychologists in primary care. As efficiency and cost-effectiveness are imperative in primary care, it is important to investigate whether nurse-led interventions are effective as well. The aim of this study is to examine the effectiveness and cost-effectiveness of a short cognitive behavioural therapy (CBT)-based treatment for patients with USD provided by mental health nurse practitioners (MHNPs), compared to usual care.MethodsIn a cluster randomised controlled trial, 212 adult patients with USD will be assigned to the intervention or care as usual. The intervention group will be offered a short, individual CBT-based treatment by the MHNP in addition to usual GP care. The main goal of the intervention is that patients become less impaired by their physical symptoms and cope with symptoms in a more effective way. In six sessions patients will receive problem-solving treatment. The primary outcome is improvement in physical functioning, measured by the physical component summary score of the RAND-36. Secondary outcomes include health-related quality of life measured by the separate subscales of the RAND-36, somatization (PHQ-15) and symptoms of depression and anxiety (HADS). Problem-solving skills, health anxiety, illness perceptions, coping, mastery and working alliance will be assessed as potential mediators. Assessments will be done at 0, 2, 4, 8 and 12 months. An economic evaluation will be conducted from a societal perspective with quality of life as the primary outcome measure assessed by the EQ-5D-5L. Health care, patient and lost productivity costs will be assessed with the Tic-P.DiscussionWe expect that the intervention will improve physical functioning and is cost-effective compared to usual care. If so, more patients might successfully be treated in general practice, decreasing the number of referrals to specialist care.Trial registrationDutch Trial Registry, identifier: NTR4686, Registered on 14 July 2014.

Problem-Solving After Traumatic Brain Injury in Adolescence: Associations With Functional Outcomes

ObjectiveTo examine the association of problem-solving with functioning in youth with traumatic brain injury (TBI). DesignCross-sectional evaluation of pretreatment data from a randomized controlled trial. SettingFour children's hospitals and 1 general hospital, with level 1 trauma units. ParticipantsYouth, ages 11 to 18 years, who sustained moderate or severe TBI in the last 18 months (N=153). Main Outcome MeasuresProblem-solving skills were assessed using the Social Problem-Solving Inventory (SPSI) and the Dodge Social Information Processing Short Stories. Everyday functioning was assessed based on a structured clinical interview using the Child and Adolescent Functional Assessment Scale (CAFAS) and via adolescent ratings on the Youth Self Report (YSR). Correlations and multiple regression analyses were used to examine associations among measures. ResultsThe TBI group endorsed lower levels of maladaptive problem-solving (negative problem orientation, careless/impulsive responding, and avoidant style) and lower levels of rational problem-solving, resulting in higher total problem-solving scores for the TBI group compared with a normative sample (P<.001). Dodge Social Information Processing Short Stories dimensions were correlated (r=.23–.37) with SPSI subscales in the anticipated direction. Although both maladaptive (P<.001) and adaptive (P=.006) problem-solving composites were associated with overall functioning on the CAFAS, only maladaptive problem-solving (P<.001) was related to the YSR total when outcomes were continuous. For the both CAFAS and YSR logistic models, maladaptive style was significantly associated with greater risk of impairment (P=.001). ConclusionsProblem-solving after TBI differs from normative samples and is associated with functional impairments. The relation of problem-solving deficits after TBI with global functioning merits further investigation, with consideration of the potential effects of problem-solving interventions on functional outcomes.

Effects of a brief problem-solving intervention for parents of children with cancer

ABSTRACTThis study examines a problem-solving intervention for parents of children with cancer. It was hypothesized that the intervention would improve problem-solving ability and decrease symptoms of caregiving stress and posttraumatic stress compared controls. 39 parents were assessed at baseline, one month, and three months post-intervention. No significant results were found. This study adds to research on problem-solving interventions for parents of children with cancer. Future studies should consider timing of interventions and target parents under the highest levels of distress.

Comment: Interactive Problem-Solving Interventions as Instrument of Conflict Transformation: Prospects and Challenges

Even though wars between states were historically the major forms of conflict, civil strife based on questions of identity, ethnicity, religion and other similar grounds has become the order of the day after the end of the Second World War. The complexity of mostly overlapping, social, economic, cultural, political and religious factors in these conflicts makes them difficult to deal with. This structural and conceptual metamorphosis in the international conflict paradigm has required the international community to rethink the traditional and formal conflict management and third party intervention techniques and instruments such as negotiation and mediation. In the course of achieving these goals, conflict scholars have focused on multiple but concurrent multi-track diplomacy instruments. Track II of this multi-track diplomacy and its conflict transformation instruments are based on the concerted efforts of unofficial actors to establish unofficial communication channels and facilitate the relations between the conflicting parties. One of the most commonly used instruments of Track II diplomacy is interactive problem-solving. The primary (but not the only) instrument of interactive problem-solving is a problem-solving workshop. This interdisciplinary comment deals with pertinent issues of relevance with regard to the nature and effectiveness of this conflict transformation instrument. In doing so, it makes a practical effectiveness assessment test against one of such methods, i.e., the Kumi method. Key termsConflict, conflict transformation, multi-track diplomacy, Track II diplomacy, interactive problem-solving, problem-solving workshop, Kumi Method

Feasibility of electronic peer mentoring for transition-age youth and young adults with intellectual and developmental disabilities: Project Teens making Environment and Activity Modifications.

There is a need for mentoring interventions in which transition-age youth and young adults with intellectual and/or developmental disabilities (I/DD) participate as both mentors and mentees. Project TEAM (Teens making Environment and Activity Modifications) is a problem-solving intervention that includes an electronic peer-mentoring component. Forty-two mentees and nine mentors with I/DD participated. The present authors analysed recorded peer-mentoring calls and field notes for mentee engagement, mentor achievement of objectives and supports needed to implement peer mentoring. Overall, mentees attended 87% of scheduled calls and actively engaged during 94% of call objectives. Across all mentoring dyads, mentors achieved 87% of objectives and there was a significant relationship between the use of supports (mentoring script, direct supervision) and fidelity. Transition-age mentees with I/DD can engage in electronic peer mentoring to further practice problem-solving skills. Mentors with I/DD can implement electronic peer mentoring when trained personnel provide supports and individualized job accommodations.

Developing a Problem-Solving Treatment for Gulf War Illness: Cognitive Rehabilitation of Veterans with Complex Post-Deployment Health Concerns

Social workers play an essential role in facilitating veterans’ reintegration into their communities and daily lives. Many veterans, particularly those who have been deployed, experience comorbid physical, psychological, and neurocognitive problems that significantly impact their health function in multiple domains. Veterans deployed to Operation Desert Shield/Operation Desert Storm have reported a wide range of persistent, diverse, medically unexplained symptoms that have come to be known as Gulf War Illness (GWI). These symptoms make it difficult for veterans to participate in daily activities, thereby impacting health function. There are few effective treatments to improve the health function for those with GWI. The goals of this article are to provide social workers with information about GWI, and describe how we modified an evidence-based treatment, problem-solving therapy, for veterans with GWI. This tailoring of an existing treatment may serve as a model for adapting evidence-based treatments for veterans and civilians with multiple chronic symptoms and other complex health concerns. Furthermore, the detailed description provided may facilitate dissemination of problem-solving therapy among social workers and trainees.

Effect of a Telephone Intervention on Measures of Psychiatric and Nonpsychiatric Medication Adherence in Outpatients With Schizophrenia Spectrum Disorders.

Telephone intervention may address the need for problem-solving interventions to improve medication adherence in patients with schizophrenia spectrum disorders (SSDs). The current randomized controlled trial examined the effect of weekly telephone intervention problem solving (TIPS) on quantitative measures of psychiatric and nonpsychiatric medication adherence over 6 months in 105 stable outpatients with SSDs. Independent samples t test revealed no significant differences in psychiatric or nonpsychiatric pill count adherence between groups at 6 months; however, 54.7% of experimental participants versus 32.7% of controls had serum antipsychotic levels within therapeutic range at 6 months (χ2 = 5.2, df = 1, p = 0.023). The current study extends the literature on adherence in patients with SSDs by describing a clinical sample of stable outpatients over 6 months and examining adherence to psychiatric and nonpsychiatric medications. [Journal of Psychosocial Nursing and Mental Health Services, 55(1), 29-36.].

Problem Solving Therapy in Young Adult:A Case Report

Humans face day to day challenges in our personal, academic and professional life. It is almost impossible to lead any sphere of our life which is problem free. So, it becomes utmost important to learn the skills to resolve our day to day issues effectively. Most of our day to day issues can be handled effectively if proper skills are used to solve them. It is important to remember, however, that some problems will be easy to resolve and some will require more efforts and need more time to solve. There are always multiple effective ways to handle problems. So, it is important that we continue to focus on different ways to find the solution. The core idea is that we all should become problem solvers and solution oriented rather than just pondering about the problem (s).When we arejust fixed at the problem only, we are feeding negativity to our brain and it will generate negative emotions which in turn further block our decision making skills and hinder the possibility of generating solutions. So, remain focused on solution finding is the key for handling the issue. It is also important to remember that most if not all all human day to day challenges can be solved to a significant extent if effective skills are used. There are some cardinal rules and steps that are important to remember while solving any issue (s).These are as follows.* Understanding the problem clearly* Being very specific about the problem at hand only* Thinking and writing down/discussing various possible solutions without discarding any one of them* Always try to write the possible barriers that might come in to solve the issue (s) and how that barrier can be effectively removed* Implementing the possible solutions being thought of one by one from most probable solution to least probable one* Check how much the stated problem is solved or how near you have come to finding the solution of the problemIt is important to remain flexible in the process of solving any problem. It is essential to have adaptive thinking skills for effective problem solving. We all the ability to think but skillful thinking is more quality thinking which facilitates solving day to day challenges. Thinking skills are tools that help us to go beyond the mere acquisition of knowledge in order to deepen their understanding and apply ideas, generate new possibilities and make decisions as well as to plan, monitor and evaluate their progress.Problem solving therapy (PST) is a brief and focused psychological intervention that has been used with a variety of client groups including people with depression, chronic illness, and suicidal thoughts and behaviours. Problem solving therapy involves patients learning new problem solving skills or reactivating previously learned ones. These skills can then be applied to specific life problems. It is important that the patients learn the skills to find the solution to their problems themselves so that they can continue to use the skills on their own. Problem-solving therapy is a cognitive behavioural intervention developed to improve an individual's ability to cope with stressful life experiences. The assumption of this approach is that symptoms of psychopathology can be understood as the result of ineffective or maladaptive coping. The goals of this therapy are to reduce or prevent psychopathology and improve the positive well-being through coping with their daily life problems it includes acceptance, tolerance, making something good come from problem, reducing physical tension. PST is based on two interrelated (conceptual models: 1 the social problem solving model & 2) the relational/problem solving model of stress and well-being.Problem-solving therapy aims to help individuals adopt a realistically optimistic view of coping, understand the role of emotions more effectively, and creatively develop an action plan and helps the individual to reduce distress and improves well-being. Problem solving therapy or interventions include psychoeducation, interactive problem-solving exercises, homework assignments. …

Police legitimacy and disrupting overt drug markets

Purpose Overt drug markets are particularly difficult to address using traditional law enforcement tactics alone; disrupting these markets often requires substantial community cooperation. Enhancing police-community relations has been offered as a promising strategy for closing overt markets, demonstrating sustained success in several settings. The purpose of this paper is to examine theoretical mechanisms hypothesized to create immediate and sustained disruption in overt drug markets, focusing on the role of strengthened police/community relations, and greater police legitimacy. Design/methodology/approach The manuscript describes a series of focus groups with community residents across three sites over 15-months after a drug market intervention. A repeated cross-sectional design enabled in-depth analysis of study participants’ views regarding mechanisms of change over time. Findings Study participants remained ambivalent about police legitimacy; they expressed appreciation regarding local policing efforts to improve neighborhood conditions, but maintained many negative feelings about the overall policing profession. Further, residents worried that the increased police presence might lead to greater harassment. Regardless of their misgivings, however, the findings reveal increases in police cooperation and improvements in some previously identified components of police legitimacy. Practical implications There is partial support for several underlying mechanisms of change over time. Study participants perceived a more focused police response, resulting in disruptions of the market and sustained improvements in neighborhood conditions. Originality/value This reflects original work not published elsewhere. It contributes to a growing body of literature on the role of police legitimacy in problem-solving interventions.

Can we address depression in vision rehabilitation settings? Professionals’ perspectives on the barriers to integrating problem-solving treatment

Purpose: Low vision rehabilitation (LVR) is a pertinent context for integrating early, evidence-based psychological interventions given the high prevalence of untreated depression in adults with vision impairment. This study aims to identify the perceived barriers and facilitators to staff-delivered telephone-based problem-solving treatment for primary care (PST-PC) offered as an integrated component of LVR.Methods: Qualitative semi-structured interviews, developed using the theoretical domains framework (TDF) and Consolidated Framework for Implementation Research (CFIR), were conducted with 21 LVR professionals and a clinical psychologist involved in the delivery of PST-PC. Barriers and facilitators at the practitioner, client, intervention, and organizational level were identified with thematic analysis using a “theoretical” approach.Results: Prominent barriers were a lack of role recognition for PST-PC practitioners (n = 32), unmet client expectation with PST-PC (n = 28), dissatisfaction with telephone delivery (n = 27), and limited organizational awareness of PST-PC (n = 39). Facilitating factors included a recognized need for evidence-based psychological services (n = 28), clients experiencing benefits in early sessions (n = 38), PST-PC promoting practical skills (n = 26), and comprehensive PST-PC training (n = 36).Conclusions: PST-PC may provide an accessible early intervention for LVR clients with depressive symptoms. Ongoing practitioner training, clinical support, and screening potential LVR clients for treatment suitability are likely to enhance delivery in this setting.Implications for rehabilitationDepression is highly prevalent in adults engaged in low vision rehabilitation (LVR) programs, yet few receive support.Clinical guidelines recommend integrated models of care be offered within rehabilitation settings as early intervention for mild to moderate levels of depressive symptoms.Integrated telephone-based problem-solving treatment for primary care (PST-PC) delivered by trained LVR practitioners is a practical, skills-based model that has potential to increase access to an early psychological intervention in LVR clients with depressive symptoms.LVR clients are often older in age, have multiple comorbid health conditions and a significant level of functional disability, requiring flexibility in the delivery of PST-PC and specialized staff training, and support in working with older and more complex clients.

Telephone Problem Solving for Service Members with Mild Traumatic Brain Injury: A Randomized, Clinical Trial.

Mild traumatic brain injury (mTBI) is a common injury for service members in recent military conflicts. There is insufficient evidence of how best to treat the consequences of mTBI. In a randomized, clinical trial, we evaluated the efficacy of telephone-delivered problem-solving treatment (PST) on psychological and physical symptoms in 356 post-deployment active duty service members from Joint Base Lewis McChord, Washington, and Fort Bragg, North Carolina. Members with medically confirmed mTBI sustained during deployment to Iraq and Afghanistan within the previous 24 months received PST or education-only (EO) interventions. The PST group received up to 12 biweekly telephone calls from a counselor for subject-selected problems. Both groups received 12 educational brochures describing common mTBI and post-deployment problems, with follow-up for all at 6 months (end of PST), and at 12 months. At 6 months, the PST group significantly improved on a measure of psychological distress (Brief Symptom Inventory; BSI-18) compared to the EO group (p = 0.005), but not on post-concussion symptoms (Rivermead Post-Concussion Symptoms Questionnaire [RPQ]; p = 0.19), the two primary endpoints. However, these effects did not persist at 12-month follow-up (BSI, p = 0.54; RPQ, p = 0.45). The PST group also had significant short-term improvement on secondary endpoints, including sleep (p = 0.01), depression (p = 0.03), post-traumatic stress disorder (p = 0.04), and physical functioning (p = 0.03). Participants preferred PST over EO (p < 0.001). Telephone-delivered PST appears to be a well-accepted treatment that offers promise for reducing psychological distress after combat-related mTBI and could be a useful adjunct treatment post-mTBI. Further studies are required to determine how to sustain its effects. (Trial registration: ClinicalTrials.gov Identifier: NCT01387490 https://clinicaltrials.gov ).

The clinical utility of social information processing theory in assessing and treating offenders with autism spectrum disorder

Purpose Social deficits are central within conceptualisations of autism spectrum disorder (ASD), and separately linked to offending behaviour. Social problem-solving interventions are often used with offenders, but little research has examined the social information processing (SIP) skills of individuals with ASD and a history of criminal offending behaviours. The paper aims to discuss this issue. Design/methodology/approach This conceptual paper will introduce the SIP model, review SIP research as applied to those with ASD and in forensic populations, and further consider the relevance to the assessment and treatment of offenders with ASD. Findings Difficulties in all areas of the SIP model are noted in ASD and research suggests these difficulties may be directly linked to behaviour. Practical implications It is possible that identifying SIP abilities and deficits could improve the effectiveness of rehabilitation programmes for this group. Originality/value This paper reviews the utility of social information models in the offending behaviour of people with ASD.

Internet-based treatment for depression in multiple sclerosis: A randomized controlled trial

Background: Depression in multiple sclerosis (MS) patients is common but may stay untreated. Physical limitations impede face-to-face treatment. Internet-based treatment is therefore a promising tool for treating depression in MS. Objectives: To investigate effectiveness of a guided Internet-based problem-solving treatment (IPST) for depressed MS patients. Methods: MS patients with moderate or severe depressive symptoms were randomly assigned to IPST or a wait list control. Primary outcome was the change in depressive symptoms defined by a change in sum score on the Beck Depression Inventory Second Edition (BDI-II). Assessments took place at baseline (T0), within a week after the intervention (T1), and at 4 months follow-up (T2). Analyses were based on the intention-to-treat principle. Results: A total of 171 patients were randomized to IPST (n = 85) or a wait list control (n = 86). T1 was completed by 152 (89%) and T2 by 131 patients (77%). The IPST group and wait list control showed large significant improvements in depressive symptoms, but no differences were found between groups at T1 (d = 0.23; 95% confidence interval (CI) = (−4.03, 1.08); p = 0.259) and T2 (d = 0.01; 95% CI = (−2.80, 2.98); p = 0.953). Conclusion: We found no indication that IPST for MS patients with moderate or severe depression is effective in reducing depressive symptoms compared to a waiting list. Large improvements in the wait list control were unexpected and are discussed.

Effects of problem-solving interventions on aggressive behaviours among primary school pupils in Ibadan, Nigeria.

BackgroundAggressive patterns of behavior often start early in childhood, and tend to remain stable into adulthood. The negative consequences include poor academic performance, disciplinary problems and encounters with the juvenile justice system. Early school intervention programs can alter this trajectory for aggressive children. However, there are no studies evaluating the feasibility of such interventions in Africa. This study therefore, assessed the effect of group-based problem-solving interventions on aggressive behaviors among primary school pupils in Ibadan, Nigeria.MethodsThis was an intervention study with treatment and wait-list control groups. Two public primary schools in Ibadan Nigeria were randomly allocated to an intervention group and a waiting list control group. Teachers rated male Primary five pupils in the two schools on aggressive behaviors and the top 20 highest scorers in each school were selected. Pupils in the intervention school received 6 twice-weekly sessions of group-based intervention, which included problem-solving skills, calming techniques and attribution retraining. Outcome measures were; teacher rated aggressive behaviour (TRAB), self-rated aggression scale (SRAS), strengths and difficulties questionnaire (SDQ), attitude towards aggression questionnaire (ATAQ), and social cognition and attribution scale (SCAS).ResultsThe participants were aged 12 years (SD = 1.2, range 9–14 years). Both groups had similar socio-demographic backgrounds and baseline measures of aggressive behaviors. Controlling for baseline scores, the intervention group had significantly lower scores on TRAB and SRAS 1-week post intervention with large Cohen’s effect sizes of 1.2 and 0.9 respectively. The other outcome measures were not significantly different between the groups post-intervention.ConclusionsGroup-based problem solving intervention for aggressive behaviors among primary school students showed significant reductions in both teachers’ and students’ rated aggressive behaviours with large effect sizes. However, this was a small exploratory trial whose findings may not be generalizable, but it demonstrates that psychological interventions for children with high levels of aggressive behaviour are feasible and potentially effective in Nigeria.

Depression in Visual Impairment Trial (DEPVIT): A Randomized Clinical Trial of Depression Treatments in People With Low Vision.

The purpose of this study was to compare two interventions for depression, problem solving treatment (PST) and referral to the patient's physician, with a waiting-list control group in people with sight loss and depressive symptoms. This was an assessor-masked, exploratory, multicenter, randomized clinical trial, with concurrent economic analysis. Of 1008 consecutive attendees at 14 low-vision rehabilitation centers in Britain, 43% (n = 430) screened positive for depressive symptoms on the Geriatric Depression Scale and 85 of these attendees participated in the trial. Eligible participants were randomized in the ratio 1:1:1 to PST, referral to their physician, or a waiting-list control arm. PST is a manualized talking intervention delivered by a trained therapist who teaches people over six to eight sessions to implement a seven-step method for solving their problems. Referral to the physician involved sending a referral letter to the person's physician, encouraging him or her to consider treatment according to the stepped care protocol recommended by the U.K.'s National Institute of Health and Care Excellence. The primary outcome was change in depressive symptoms (6 months after baseline) as determined by the Beck Depression Inventory. At 6 months, Beck Depression Inventory scores reduced by 1.05 (SD 8.85), 2.11 (SD 7.60), and 2.68 (SD 7.93) in the waiting-list control, referral, and PST arms, respectively. The cost per patient of the PST intervention was £1176 in Wales and £1296 in London. Depressive symptoms improved most in the PST group and least in the control group. However, the change was small and the uncertainty of the measurements relatively large.

“In this thing I have everything I need”: perceived acceptability of a brief alcohol-focused intervention for people living with HIV

ABSTRACTAlthough hazardous/harmful alcohol use impacts response to HIV treatment, there have been few attempts to deliver alcohol-reduction interventions within South African HIV treatment services. As a first step towards implementing alcohol-focused interventions in these settings, we explored patients’ views of the acceptability of a brief motivational interviewing and problem-solving intervention. In-depth interviews were conducted with 11 patients recruited from three HIV treatment sites in Tshwane, South Africa, who had completed the intervention. Participants noted that the intervention was acceptable and appropriate. As a result of the intervention, participants reported less use of alcohol as a coping mechanism. They described greater use of problem-focused and emotional coping strategies for dealing with mutable and immutable problems, respectively. Their only recommendation for improving the intervention was the addition of booster sessions. Findings suggest that this intervention is acceptable to patients receiving HIV treatment and is perceived to be helpful for reducing their use of alcohol.