Problem-solving Therapy Research Articles

Abstract 4128549: Feasibility and Acceptability of a Combined Contingency Management and Problem-Solving Therapy Intervention to Enhance Alcohol Abstinence: A Pilot Single-Arm Mixed Methods Randomized Controlled Trial

Introduction/Background: It is crucial to develop and implement innovative behavior-change therapies that specifically target young adults with alcohol use disorder, as the prevalence of this issue is on the rise, and it has serious long-term health consequences. Research Questions/Hypothesis: How does the newly developed Contingency Management and Problem-Solving Therapy (CM-PST) intervention impact the levels of alcohol misuse or abstinence in young adults at follow-up compared to baseline.Young adults who receive the newly developed CM-PST will have lower levels of alcohol misuse or abstain from alcohol. Goals/Aims: We aimed to examine the feasibility, acceptability, and efficacy of an integrated behavior therapy of CM-PST for young adults with alcohol use disorder. Methods/Approach: This mixed methods study employed a single-arm design with post-intervention and 12-week follow-up assessments. Young adults aged 18-24 were recruited from July 2023 to May 2024. Participants underwent the newly developed integrated CM-PST intervention for 8 weeks. The assessment of feasibility was conducted by evaluating the rates of recruitment and retention, and adherence to the intervention. Acceptability was assessed by analyzing participants’ feedback and engagement data. Participants completed the Alcohol Use Disorders Identification Test (AUDIT) and the 90-day Timeline Follow back (TLFB) at baseline and 12 weeks after the intervention. Furthermore, they participated in a twice daily breathalyzer test, post-intervention interview and completed a client satisfaction scale questionnaire. Results: A total of 28 participants were recruited, with 71.43% (20/28) completing all the study procedures. Adherence to the CM-PST was 100%, indicating strong engagement. Participant feedback highlighted the influence of CM on behavior and decision-making and the efficacy of PST in addressing life challenges as well. Alcohol consumption at 12 weeks was significantly lower than those at baseline ( t =3.042, p =.007). Overall, the newly developed intervention was well-received, and 95% of participants indicated that the interventions were acceptable. Conclusions: This study showed that the integrated CM-PST intervention to promote alcohol abstinence and reduce alcohol related problems is both feasible and acceptable. Study findings indicated that the intervention has potential as a supplementary care for individuals seeking support in reducing alcohol consumption.

Evaluating the Efficacy of Telehealth-Based Treatments for Depression in Adults: A Rapid Review and Meta-Analysis.

Major depressive disorder (MDD) is one of the leading causes of work-related disability, and accessing telehealth therapies can be a promising modality for workers with MDD. Barriers to accessing in-person mental healthcare, such as limited availability and accessibility in rural and remote communities, financial constraints, and stigma, have highlighted the need for alternative approaches like telehealth. This study investigated the efficacy of telehealth interventions including CBT for adults over 18 diagnosed with MDD. This rapid review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure a transparent methodology. Out of the 2549 studies screened, 19 were incorporated into the rapid review, and of those, 10 were included in the subsequent meta-analyses. Articles were screened independently by two reviewers, with the disagreements reconciled through discussion. A reviewer extracted data from eligible articles. Descriptive statistics and narrative syntheses were used to describe outcomes. Two meta-analyses were conducted to investigate the efficacy of cognitive behavioral therapy (CBT) delivered by telehealth (tCBT). The first compared tCBT to in-person CBT (pCBT). The second meta-analysis compared tCBT to a control group that did not receive CBT or another telehealth-based treatment. Non-CBT interventions investigated within the non-CBT group included somatic rhythm therapy, problem-solving therapy, psychiatry, behavioral activation, and interpersonal psychotherapy. Overall, individuals with MDD who received tCBT showed significant improvement in depression symptoms. However, the efficacy of tCBT compared to non-telehealth control groups varied across studies. The first meta-analysis indicated the magnitudes of effect were similar for both interventions in reducing depression symptoms 0.023 (95% CI -0.120 to 0.166); p = 1.00. In the second meta-analysis, the ratio of means comparing tCBT (0.51 ± 0.14 SD) to the control group (0.68 ± 0.12 SD) exhibited a statistically significant 25% reduction with regard to depression scores (one-sided p = 0.002), favouring tCBT to non-telehealth, non-CBT study groups. Telehealth-based CBT demonstrated positive effects on depression symptoms; it was generally superior when compared to control groups not receiving CBT and was on par with pCBT. The growing mental health burden in the community underscores the need for accessible telehealth services like tCBT. Effective policy formulation and implementation in national health agendas are essential to meet the increasing demand for mental health support.

Feasibility and acceptability findings from a pilot study of the adapted Ziba Ufa intervention for late life depression and chronic conditions in Tanzania.

ObjectiveTo conduct a pilot study of the adapted Ziba Ufa intervention for the treatment of late life depression, to assess feasibility and acceptability. DesignA pilot clinical trial, using a single group design over eight months, using qualitative and quantitative methods. SettingFour rural and urban outpatient health clinics in Kilimanjaro, Tanzania. ParticipantsIndividuals aged 60 years and above, with chronic health conditions and mild-moderate depression symptoms, with no cognitive impairment or severe frailty. Intervention‘Ziba Ufa’ (‘Repair the Crack’) was adapted for Tanzania from the Depression in Late Life (DIL) intervention. It is a hybrid model of problem-solving therapy and healthy lifestyle advice. MeasurementsA locally validated depression screener (MOSHI-D) was used to screen for mild-moderate depression symptoms. Feasibility was assessed using recruitment and retention data, and acceptability was assessed using thematic analysis and the Theoretical Framework of Acceptability to analyse exit interviews with participants and counsellors at follow-up. ResultsA total of 157 older adults were screened, and thirty-two participants were enroled, with eight allocated to one counsellor per site. The enrolment rate of those clinically eligible at screening was 52%, with the majority unable to attend due to living too far away from the clinic. The retention rate was high at 97% (N=31). Qualitative feedback indicated the programme was acceptable because it helped older adults ‘open up’ and did not interfere with everyday life. ConclusionsZiba Ufa was feasible and acceptable in Tanzania when delivered in routine clinical settings, with travel reimbursed.

The Effect of Digital Problem Solving Therapy on Quality of Life in Pregnant Women Who Are Victims of Domestic Violence

Aim: This study aims to determine the effect of digital problem-solving therapy (DPST) on the quality of life (QOL) of pregnant women who are victims of domestic violence. Methods: The research was conducted using a quasi-experimental design with two groups: an intervention group receiving digital problem-solving therapy and a control group receiving standard care. The study took place over three months at the National Commission on Violence Against Women service centers and referral hospitals in Bekasi City, West Java. The intervention involved four sessions per month focusing on psychological well-being and QOL. A total of 100 pregnant women participated, meeting the criteria of being over three months pregnant, having experienced domestic violence, owning a smartphone, and living with their husbands. Results: The results showed a statistically significant increase in QOL scores within the intervention group after the therapy, with a t-score of 13.76 and a p-value of 0.001. Additionally, the intervention group exhibited a larger improvement in QOL at post-test compared to the control group (ß = 8.20, p < 0.001). Conclusion: Digital problem-solving therapy significantly improves the quality of life of pregnant women experiencing domestic violence. Future studies should explore the effectiveness of this intervention among more diverse research groups, focusing on participants with varied mental health and psychological characteristics.

Efficacy of problem-solving therapy in treating late-life depression with potential cognitive impairment: a systematic review and meta-analysis.

Late-life depression (LLD) is a global public health issue, often accompanied by cognitive impairments that can exacerbate the severity of depression and impair social functioning. Despite being a well-established treatment for LLD, the suitability of problem-solving therapy (PST) for individuals with LLD and varying degrees of cognitive impairments warrants further investigation. This paper presents the protocol for a systematic review and meta-analysis of randomised controlled trials (RCTs) aimed at evaluating the effectiveness and acceptability of PST for this specific demographic. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we will conduct a systematic review to synthesise existing research on PST for individuals in this demographic. We will comprehensively search multiple databases and sources, including PubMed, EMBASE, the Cochrane Database and APA PsycNET from inception to October 2023, without language, publication year or type restrictions. Relevant studies will be manually screened from the references. Only RCTs involving PST for LLD will be included. The primary efficacy outcome will be the standardised mean difference in total scores on continuous depression severity scales across different comparison arms. Data extraction will be conducted independently by two reviewers (CH and J-JW), and methodological rigour will be assessed using the Cochrane Risk of Bias assessment tool. Subgroup and sensitivity analyses will be performed to investigate the impact of concomitant cognitive impairments and to evaluate the robustness of the findings. The meta-analysis project is expected to be ethically unproblematic and does not require approval from a research ethics committee. The results of this study will be shared through articles in scholarly peer-reviewed journals and presentations in various formats, both print and digital. CRD42023473782.

Smartphone-based distress screening, information provision, and psychotherapy for reducing psychological distress among AYA cancer survivors: protocol for a fully decentralized multicenter randomized controlled clinical trial.

Fear of cancer recurrence (FCR) is a common and distressing condition among adolescents and young adults (AYAs). This study aims to investigate the efficacy of digital interventions, including distress screening-based information provision and smartphone problem-solving therapy, on common psychological distress, especially FCR, in AYA patients with cancer. Participants will be 224 AYA outpatients with cancer aged 15-39years who will be randomly assigned to either an 8-week smartphone-based intervention or a waitlist control group. This intervention includes smartphone-based distress screening, information provision, and psychotherapy (problem-solving therapy). The primary endpoint will be the Fear of Cancer Recurrence Inventory-Short Form score at week 8. This study will be conducted as a fully decentralized, randomized, and multicenter trial. The study protocol was approved by the Institutional Review Board of Nagoya City University on 19 April 2024 (ID: 46-23-0005). Trial registration: UMIN-CTR: UMIN000054583.

Nursing Interventions Targeting Fatigue in Inflammatory Bowel Disease: A Systematic Review

A prevalent symptom among Inflammatory Bowel Disease (IBD) patients is fatigue, characterized by a persistent sense of energy depletion that affects all aspects of daily life. This review aims to evaluate nursing interventions reported in the literature to alleviate fatigue in IBD patients. A comprehensive search was conducted across four electronic databases—PubMed, CINAHL, Cochrane, and Scopus—and four scientific journals: “Gastroenterology”, “Inflammatory Bowel Disease”, “Journal of Crohn’s and Colitis”, and “United European Gastroenterology Journal”. Inclusion criteria were clinical trials involving adult IBD patients in remission or mild disease activity. Out of 234 studies, 2 were selected for review. These studies assess the effectiveness of Solution-Focused Therapy (SFT) that emphasizes solving problems and developing strategies for improvement, and Problem-Solving Therapy (PST) that focuses on identifying problems and coping strategies. SFT showed a positive impact on fatigue with a significant improvement in the Checklist Individual Strength after three months: 45.5% in the control group, 85.7% in the SFT group, and 60% in the PST group, but its impact declined over time. Additionally, SFT demonstrated potential for reducing healthcare costs compared to standard of care and PST. Further research is needed to provide nurses interventions for managing fatigue in IBD patients. The review protocol has been registered at OSF.io.

User Engagement in an Online Digital Health Intervention to Promote Problem Solving

Abstract Digital health interventions (DHIs) can facilitate positive health outcomes. User engagement (UE) plays an important role in DHI efficacy. Yet, DHIs vary in functionality, design and intended outcomes, underscoring the importance of incremental, user-centred design to understand engagement in specific settings. This study explores the relationship between user engagement and DHI implementation in three design iterations, or rounds, of a unique, multi-week asynchronous intervention that leverages online discussion and problem-solving therapy (PST). The intervention seeks to engage older adults to improve problem solving skills relating to the intervention focus, health aging (two rounds) and Lewy Body Dementias (LBD) caregiving (one round). The PST component drew upon personas, a common user-centered design method, in a novel way. Exit interviews were conducted at the end of each round to understand participants' experiences. Using thematic analysis, we identified factors that contributed to social engagement (‘engaging with others’) and learning engagement (‘engaging with content’) with the DHI. The findings demonstrate how iterative changes in the design and delivery of a DHI can contribute to user engagement, increasing the likelihood of knowledge acquisition and developing problem-solving skills as part of health self-management.

Implementation Determinants of Problem-Solving Therapy Delivered by Near-Peer Lay Counselors for Youth Living with HIV in Botswana: Lay Counsellor Perspectives

AbstractAn evidence-based psychological intervention, known as Friendship Bench, for depression and anxiety was adapted among adolescents living with HIV (ALHIV) in Gaborone, Botswana, and renamed Safe Haven. The purpose of this study was to qualitatively describe the barriers and facilitators that influence the implementation of Safe Haven from the perspective of peer counselors delivering the intervention in Gaborone, Botswana. We conducted a secondary analysis using qualitative data from a pilot study to evaluate Safe Haven. Eight peer counselors participated in semi-structured interviews to describe their experiences with implementing Safe Haven during the pilot. We analyzed the interview data thematically using the Consolidated Framework for Implementation Research to guide theme development. We identified six barriers and two facilitators of Safe Haven implementation. The barriers were 1) client reticence and confidentiality concerns, 2) parent disapproval, 3) client accessibility, 4) counselor psychological wellbeing, 5) scheduling conflicts 6) limited financial resources for counselors. The facilitators were 1) peer delivery of counseling was deemed more acceptable among adolescents than counseling delivered by older adults, and 2) the counselors placed high value on the intervention. We found that parental disapproval and shared trauma among counselors and clients are key barriers that may negatively impact implementation outcomes such as sustainability and penetration. To improve accessibility of the intervention, peer counselors recommended implementation in school settings and to educate parents on mental health. Overall, the barriers and facilitators identified in our study can guide larger scale implementation of Safe Haven among ALHIV in resource-poor settings.

Effectiveness of Problem-Solving Therapy in Improving Patient Mental Health, Function, Quality of Life, and Mortality Post-Stroke: A Systematic Review.

Problem-solving therapy (PST) is a potential psychological intervention aimed at preventing and treating psychological issues in stroke patients, although its efficacy is not clearly established. This systematic review assessed the effectiveness of PST in improving mental health, functioning, quality of life, and mortality in this population. Six databases were searched for literature indexed through March 2024, including the Cochrane Library, PubMed, Scopus, CINAHL, NeuroBITE, and OTseeker. This review (CRD42023483757) followed the PRISMA guidelines and the Cochrane Library Handbook, utilizing the RoB 2 tool and GRADE system to assess the quality of the evidence. It included eight randomized controlled trials (RCTs) involving 1249 patients with stroke. Among them, five RCTs showed that PST might improve depression. Additionally, individual RCTs demonstrated the efficacy of PST in addressing patient anxiety, apathy, and coping. With respect to mental health, PST might affect patient quality of life and mortality. However, the results of four RCTs demonstrated no effect of PST on patient functioning. The quality of evidence for the outcomes ranged from very low to high. PST may improve mental health, quality of life, and mortality in patients with stroke.

Improving mental health in chronic care in general practice: study protocol for a cluster-randomised controlled trial of the Healthy Mind intervention

BackgroundMental health issues are common among patients with chronic physical conditions, affecting approximately one in five patients. Poor mental health is associated with worse disease outcomes and increased mortality. Problem-solving therapy (PST) may be a suitable treatment for targeting poor mental health in these patients. This study protocol describes a randomised controlled trial of the Healthy Mind intervention, a general practice-based intervention offering PST to patients with type 2 diabetes and/or ischaemic heart disease and poor mental well-being.MethodsA stepped-wedge cluster-randomised controlled trial with 1-year follow-up will be conducted in Danish general practice. At the annual chronic care consultation, patients with type 2 diabetes and/or chronic ischaemic heart disease will be screened for poor mental well-being. Patients in the control group will be offered usual care while patients in the intervention group will be offered treatment with PST provided by general practitioners (GPs) or general practice staff, such as nurses, who will undergo a 2-day PST course before transitioning from the control to the intervention group. The primary outcome is change in depressive symptoms after 6 and 12 months. Secondary outcomes include change in mental well-being, anxiety, and diabetes distress (patients with type 2 diabetes) after 6 and 12 months as well as change in total cholesterol levels, low-density lipoprotein (LDL) levels, and blood glucose levels (patients with diabetes) after 12 months. Process outcomes include measures of implementation and mechanisms of impact. We aim to include a total of 188 patients, corresponding to approximately 14 average-sized general practices.DiscussionThe Healthy Mind trial investigates the impact of PST treatment for patients with chronic disease and poor mental well-being in general practice. This will be the first randomised controlled trial determining the effect of PST treatment for patients with chronic diseases in general practice. The results of this study will provide relevant insights to aid GPs, and general practice staff manage patients with poor mental well-being.Trial registrationClinicalTrials.gov NCT05611112. Registered on October 28, 2022.

Comparative Effectiveness of Clinician- Versus Peer-Supported Problem-Solving Therapy for Rural Older Adults With Depression.

Self-guided and peer-supported treatments for depression among rural older adults may address some common barriers to treatment. This pilot study compared the effect on depression of peer-supported, self-guided problem-solving therapy (SG-PST) with case management problem-solving therapy (CM-PST) among older adults in rural California. Older adults with depression (N=105) received an introductory PST session with a clinician, followed by 11 sessions of CM-PST with a clinician (N=85) or SG-PST with a peer counselor (N=20). Both interventions resulted in clinically significant improvement in depression by week 12. Depression scores in the CM-PST group dropped by 4.1 points more than in the SG-PST group between baseline and week 12 (95% CI=0.99-7.22, p<0.001, Hedges's g=1.08). The results suggest that peer-supported SG-PST is a viable, acceptable option for rural older adults with depression as a second-line treatment if access to clinicians is limited.

Abstract 2230: Connecting Black men to point of prostate cancer diagnosis (PPCD) support using precision intervention based on Virtual Reality Assistant (ViRA)

Abstract Background: The point of prostate cancer (CaP) diagnosis (PPCD) instantly leads to a life changing experience for Black men, with diverse emotional reactions that includes fear, denial, overwhelmingness, cancer fatalism etc. Black men diagnosed with CaP expressed several needs at the PPCD, including time to reflect on the diagnosis, being comfortable, emotional support, psycho-oncology support and social determinants of health (SDOH) navigation. Given that Black men are diverse in terms of their needs at the PPCD, precision intervention is needed to support them. Aim: The aim was to develop, implement, and establish the acceptance and usability of a Virtual Reality Assistant (ViRA) that will provide precision intervention tailored to the needs of Black men at the PPCD. This study is one of the five iCCaRE for Black Men projects focused on survivorship care. Methodology: The development of the ViRA was guided by CaP survivors through qualitative study. Reflective, analytic, and interpretive memos were used to generate action plans for the development of the ViRA. Based on a comprehensive PPCD ViRA intervention guide created by the team, the ViRA prototype was developed with mobile immersive technologies that integrated SDOH navigation, standard CaP psycho-oncology support and emotional support. The goal was to have the intervention personalized to everyone based on participant-provided information. Alpha testing of the ViRA is ongoing and will be completed on November 20, 2023. Participants are three prostate cancer survivors and three clinicians. The assessments will confirm the accuracy of the ViRA predictions and the functionality of the ViRA. Results: We developed the ViRA SDOH screening and navigation tool to identify participants’ needs and appropriately connect them with relevant support services and resources in their communities. The emotional support intervention was based on four CaP survivors as virtual reality avatars, providing empathetic rapport through self-disclosure and sharing of survivorship stories in different settings (home, clinic, barbershop etc). The psycho-oncology support intervention was developed with the guidance of a psycho-oncologist, with her avatar providing psychoeducation about the PPCD experience, reify and concretize the PPCD experience, and foster hope using the basic tenets of Problem-Solving Therapy. The results of the alpha testing and the modified ViRA will be presented during the conference. Conclusion: Meeting the needs of Black men at the PPCD requires a personalized and decentralized approach, which would allow Black men to access support anywhere. The presentation will unveil the iCCaRE ViRA, a smart and connected personalized AR-enabled intervention that will deliver SDOH navigation, CaP psycho-oncology support and emotional support tailored to the needs of Black men. Citation Format: Folakemi T. Odedina, Che Ngufor, Arnold Merriweather, Deidre Pereira, Roxana Dronca, Ernest Kaninjing, Kimlin Ashing, Solomon Rotimi, Vinessa Gordon, iCCaRE for Black Men Consortium. Connecting Black men to point of prostate cancer diagnosis (PPCD) support using precision intervention based on Virtual Reality Assistant (ViRA) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2230.

Rural Friendship Bench: A qualitative study in Zaka district, Zimbabwe

BackgroundWe piloted the Friendship Bench—an evidence-based, urban-area task sharing intervention for common mental disorders—in rural Zimbabwe. The intervention combines problem solving therapy with income generating activities. This study sought to understand the intervention's implementation in terms of acceptability, feasibility, and sustainability as well as local attitudes towards mental wellbeing in rural Zimbabwe. MethodsUsing four separate semi-structured interview guides, we conducted in-depth interviews (N = 32) with patients (n = 9), village health workers (n = 12), nurses (n = 6), and community leaders (n = 5). We analyzed our data using thematic analysis with a diverse coding team using an integrative deductive-inductive approach. ResultsFive themes emerged: 1) explanatory models for mental illness, 2) clinical workflow and emphasis on documentation, 3) positive feedback about the Friendship Bench, 4) accessibility, and 5) feasibility. ConclusionIn its current format, our intervention was acceptable but neither feasible nor sustainable. Sociocultural context is critical in the development of rural task sharing interventions for mental health. We thus recommend a robust pilot and adaptation phase when scaling task sharing interventions in rural sub-Saharan Africa to elevate community voices, leverage existing social structures, and embed interventions as deeply into communities as possible.

Psychotherapies at a Glance: Consensus Guideline-Recommended Psychotherapies for Adults With Psychiatric Disorders.

Clinical decision making by psychiatrists and informed consent by patients require knowledge of evidence-based psychotherapies (EBPs) and their indications. However, many mental health professionals are not versed in the empirical literature on EBPs or the consensus guideline recommendations derived from this literature. The authors compared rigorous national consensus guidelines for EBP treatment of DSM-defined adult psychiatric disorders-derived from well-conducted randomized controlled trials and meta-analyses and from expert opinions from the United States, United Kingdom, and Canada-to create the Psychotherapies-at-a-Glance tool. Recommended EBPs are cognitive-behavioral therapy, family therapy, contingency management, dialectical behavior therapy, eye movement desensitization reprocessing, interpersonal psychotherapy, mentalization-based treatment, motivational interviewing, peer support, problem-solving therapy, psychoeducation, short-term psychodynamic psychotherapy, and 12-step facilitation. The Psychotherapies-at-a-Glance tool summarizes the indications, rationales, and therapeutic tasks that characterize these differing psychotherapies and psychosocial treatments. The tool is intended for use in clinical teaching, treatment planning, and patient communications.

Developing consensus-based clinical competencies to guide stroke clinicians in the implementation of psychological care in aphasia rehabilitation.

Background People with aphasia experience depression and anxiety associated with negative outcomes across a range of time post-stroke. Stroke clinicians are well-positioned to facilitate low-intensity psychotherapeutic interventions after aphasia (e.g. mood screening, behavioural activation, problem-solving therapy, relaxation therapy); however, they self-report a lack of knowledge, skills and confidence to do so. The Theoretical Domains Framework (TDF) provides a lens through which to view and target clinician behaviours and training needs in this area of practice. The aim of this study was to develop and gain consensus on items for a rating scale of clinical competencies in facilitating individual-based, low-intensity psychotherapeutic interventions for people with aphasia. Methods An e-Delphi methodology using focus groups and survey rounds was used to gain consensus on clinical competencies considered important. Results Eight stroke clinicians (speech pathologists and psychologists), two people with aphasia and three family members participated in one of four focus groups. Four themes were derived from the data: (1) Communication support, (2) Assessment and therapy structure, (3) Interpersonal skills, and (4) Needs of the significant other (family or friend). Themes informed an initial list of 23 self-rated and observer-rated competency items. Following two rounds of e-Delphi surveys, 11 stroke clinicians (six speech pathologists and five psychologists) reached consensus (80-100%) for 19 competencies. Conclusions The Psychological Care in Aphasia Rehabilitation Competency scale offers a preliminary list of items to guide and train clinicians to implement low-intensity psychotherapeutic interventions for people with aphasia.

Effectiveness and cost-effectiveness of a transdiagnostic intervention for alcohol misuse and psychological distress in humanitarian settings: study protocol for a randomised controlled trial in Uganda

BackgroundThe war in South Sudan has displaced more than four million people, with Uganda hosting the largest number of South Sudanese refugees. Research in Uganda has shown elevated levels of alcohol misuse and psychological distress among these refugees. The World Health Organization (WHO) has developed a trans-diagnostic scalable psychological intervention called Problem Management Plus (PM +) to reduce psychological distress among populations exposed to adversities. Our study aims to evaluate the effectiveness and cost-effectiveness of the CHANGE intervention, which builds on PM + , to also address alcohol misuse through problem-solving therapy and selected behavioural strategies for dealing with alcohol use disorders. We hypothesise that the CHANGE intervention together with enhanced usual care (EUC) will be superior to EUC alone in increasing the percentage of days abstinent.MethodsA parallel-arm individually randomised controlled trial will be conducted in the Rhino Camp and Imvepi settlements in Uganda. Five hundred adult male South Sudanese refugees with (i) elevated levels of alcohol use (between 8 and 20 on the Alcohol Use Disorder Identification Test [AUDIT]); and (ii) psychological distress (> 16 on the Kessler Psychological Distress Scale) will be randomly assigned 1:1 to EUC or CHANGE and EUC. CHANGE will be delivered by lay healthcare providers over 6 weeks. Outcomes will be assessed at 3 and 12 months post-randomisation. The primary outcome is the percentage of days abstinent, measured by the timeline follow-back measure at 3 months. Secondary outcomes include percentage of days abstinent at 12 months and alcohol misuse (measured by the AUDIT), psychological distress (i.e. depression, anxiety, posttraumatic stress disorder), functional disability, perpetration of intimate partner violence, and health economic indicators at 3 and 12 months. A mixed-methods process evaluation will investigate competency, dose, fidelity, feasibility, and acceptability. Primary analyses will be intention-to-treat.DiscussionCHANGE aims to address alcohol misuse and psychological distress with male refugees in a humanitarian setting. If it is proven to be effective, it can help fill an important under-researched gap in humanitarian service delivery.Trial registrationISRCTN ISRCTN10360385. Registered on 30 January 2023.

Cardiovascular diseases and community mental health

&lt;p class="Default"&gt;Cardiovascular diseases (CVDs) are cited as the deadliest of illnesses. Their incidence and prevalence around the world are steadily rising. CVDs are the cause of approximately one-third of all deaths in the world. It has been stated in empirical studies over the years that poor socioeconomic status, the lack of social support, stress at work and in the family, depression, and psychosocial risk factors such as anxiety and feelings of hostility aggravate the risk of developing coronary heart disease and also worsen the clinical course and prognosis. Additionally, psychobiological, and behavioral mechanisms have been identified in this context. Psychosocial risk factors should be identified in clinical practice and medical results shared with individuals with CVDs, who should also be screened for anxiety, stress, and stress management, as well as for symptoms of depression. Individuals at risk or who are diagnosed as displaying symptoms of anxiety and depression should be referred to psychiatric professionals to ensure that they receive assistance. Cardiac rehabilitation may involve psychosocial interventions that include cognitive behavioral therapy, problem-solving therapy, and stress management programs, applied on their own or together with other interventions. The aim of this review article is to examine CVDs and community mental health, determine which applications may be adopted as standard practice in this context, and raise awareness about this topic among the public and especially among health professionals. &lt;/p&gt;

Factors affecting the fear of recurrence in Breast cancer patients

The fear of cancer recurrence is defined as a mental state of anxiety or concern that cancer may return or spread. It is assumed to be the commonest unpleasant psychological disorder among cancer survivors. Breast cancer is assumed to be one of the commonest cancers in women. Also, the treatment modalities for breast cancer are strongly developed and there is an increase in the cure rate in recent years. However, surviving cancer patients are still feared of recurrence of the neoplasm. The fear of cancer recurrence affected negatively the patients' health and lowered their quality of life. Therefore, we sought to establish effective preventive strategies to improve the psychological health of patients. We searched the literature and reviewed the most recent available data from 2017 to 2023 to clarify the different factors affecting the fear of cancer recurrence in breast cancer patients.We identified different factors that increase the fear of cancer recurrence in breast cancer patients including; anxiety, chemotherapy, avoidance, intrusive thoughts, distress and exhaustion. Also, we identified other factors that decrease the fear of cancer recurrence in breast cancer patients including; younger age patients, having a good quality of time, good social support and good self-efficacy. Regarding preventive measures; our meta-analysis showed that breast cancer patients who underwent Mindfulness-Based Stress Reduction had significant improvements on the Center for Epidemiological Studies-Depression scale (P&lt;0.0001), State-Trait Anxiety Inventory scale (P=0.0002) and perceived stress scale (P=0.0004). Also, we noticed that breast cancer patients who underwent blended cognitive behavior therapy or Smartphone problem-solving therapy had lower fear of cancer recurrence than those who received usual care. Finally, we advocate more research articles applying different modalities to overcome FCR in patients with breast cancer. Also, we recommend the use of different psychological treatments for patients with breast cancer to decrease their fear of cancer recurrence and improve their health.

Effect of a brief psychological intervention for common mental disorders on HIV viral suppression: A non-randomised controlled study of the Friendship Bench in Zimbabwe.

For people living with co-morbid HIV and common mental disorders (CMD), it is not known whether a brief psychological intervention for CMD can improve HIV viral suppression. We conducted a prospective cohort study in eight primary care clinics in Harare, Zimbabwe, enrolling adults with co-morbid HIV and CMD. Six clinics provided the Friendship Bench (FB), a brief psychological intervention for CMD based on problem-solving therapy, delivered by lay counsellors. Two clinics provided enhanced usual care (EUC). The primary outcome was viral non-suppression after six months (viral load ≥400 copies/mL). Data were analysed using a difference-in-difference approach with linear regression of cluster-level proportions, adjusted for baseline viral non-suppression (aDiD). The secondary outcome was presence of CMD measured by the Shona Symptom Questionnaire. In FB clinics, 407/500 (81.4%) participants had viral load results at baseline and endline: 58 (14.3%) had viral non-suppression at baseline and 41 (10.1%) at endline. In EUC clinics, 172/200 (86.0%) had viral load results at baseline and endline: 22 (12.8%) were non-suppressed at baseline and 26 (15.1%) at endline (aDiD = -7.3%; 95%CI 14.7% to -0.01%; p = 0.05). Of the 499 participants virally suppressed at baseline, the FB group had lower prevalence of non-suppression at endline compared to the EUC group (2.9% vs 9.3%; p = 0.002). There was no evidence of a difference in endline viral non-suppression by group among the 80 participants with non-suppression at baseline (53.5% vs 54.6%; p = 0.93). The FB group was less likely to screen positive for CMD at endline than the EUC group (aDiD = -21.6%; 95%CI -36.5% to -6.7%; p = 0.008). People living with co-morbid HIV and CMD may benefit from receiving a low-cost mental health intervention to enhance viral suppression, especially if they are already virally suppressed. Research is needed to understand if additional adherence counselling could further improve viral suppression.