Psychosocial Interventions Research Articles

Supporting cognitive catch-up: The effects of cluster-randomized psychosocial stimulation interventions on preterm low birthweight children in rural China.

Improved survival of preterm low birthweight (LBW) infants due to advances in neonatal care has brought issues such as postnatal development trajectories to the foreground. This study pools evidence from three cluster-randomized experiments evaluating community-based psychosocial stimulation programs conducted from 2014 to 2017 that included 3571 rural Chinese children aged 6-24 months (51.1% male, 96.2% Han Chinese). The risk of severe cognitive delay was found to be 26.5 percentage points higher for preterm LBW children than for their peers at age 2.5, with a prevalence rate of 48.3%. Results show that psychosocial stimulation interventions can improve child cognitive development at scale, with beneficial impacts on child cognition disproportionately larger for preterm LBW children, helping them to catch up developmentally.

Associations between different forms of intimate partner violence and posttraumatic stress among women who use drugs and alcohol in Kyrgyzstan.

Survivors of intimate partner violence (IPV) have an increased risk of experiencing posttraumatic stress, and the subsequently associated symptoms can vary by form of IPV exposure (i.e., physical, sexual, or psychological IPV). Related research among socially marginalized populations, however, is limited, including among women who use and misuse substances. Drawing on baseline data from a pilot study conducted among 213 women in Kyrgyzstan who reported using drugs or engaging in hazardous alcohol use, we examined the associations between different forms of IPV and severe posttraumatic stress symptoms (PTSS). The vast majority of participants reported lifetime (93.9%, n = 200) and past 3-month (65.3%, n = 139) IPV, and two thirds of participants (65.3%, n = 139) reported experiencing PTSS in the prior month. Multivariable logistic regression analyses indicated statistically significant associations between only some forms of IPV and PTSS, including physical IPV, adjusted odds ratio (aOR) = 3.24, 95% confidence interval (CI) [1.15, 9.14], and injurious IPV, aOR = 2.71, 95% CI [1.10, 6.65]. Additionally, experiencing any form of IPV was associated with 4.95 higher odds of reporting PTSS, 95% CI [1.16, 21.15]; no other results were significant. These results not only underscore the need for future research on the mechanisms that might explain the unique associations between different forms of IPV and posttraumatic stress, but also highlight an urgent need for trauma-informed mental health and psychosocial support interventions for women who use drugs and alcohol.

Acceptability of a Randomized Trial of Anti-depressant Medication or Interpersonal Therapy for Treatment of Perinatal Depression in Women with HIV

Postpartum depression (PPD) affects nearly 20% of postpartum women in Sub-Saharan Africa (SSA), where HIV prevalence is high. Depression is associated with worse HIV outcomes in non-pregnant adults and mental health disorders may worsen HIV outcomes for postpartum women and their infants. PPD is effectively treated with psychosocial or pharmacologic interventions; however, few studies have evaluated the acceptability of treatment modalities in SSA. We analyzed interviews with 23 postpartum women with HIV to assess the acceptability of two depression treatments provided in the context of a randomized trial. Most participants expressed acceptability of treatment randomization and study visit procedures. Participants shared perceptions of high treatment efficacy of their assigned intervention. They reported ongoing HIV and mental health stigma in their communities and emphasized the importance of social support from clinic staff. Our findings suggest a full-scale trial of PPD treatment will be acceptable among women with HIV in Zambia.

One year follow-up of participants in a randomised controlled trial of a CBT-based group therapy programme for adolescents diagnosed with ADHD

Background Adolescents with ADHD often struggle on many areas of their lives and have a high risk of adverse outcomes and negative life trajectories. Multimodal treatment including psychosocial interventions is recommended but evidence regarding effect of such interventions is still limited. Materials and methods This study was a follow-up study of adolescents participating in a randomised controlled trial (RCT) of a group intervention based on cognitive behavioural therapy (CBT). Participants were adolescents diagnosed with ADHD and still impaired by their symptoms after standard treatment including psychoeducation and medication. All participants were interviewed by telephone one year after inclusion, and outcome measures included both quantitative and qualitative measures. Results There were 100 adolescents included in the study. We found no significant differences between treatment and control group on measures of ADHD-symptoms, self-efficacy, overall problems, global psychosocial functioning, or symptom severity at one-year follow-up. Still, participants in the intervention group reported on positive gains and that they learned a lot about ADHD and themselves. Conclusions The intervention delivered in this trial failed to show a treatment effect on symptom level when added to standard care. Participants did however report on positive gains and felt they learned a lot. More research is needed to explore how the programme and delivery of treatment might be improved, and which patients might benefit the most from this type of interventions.

Using personal network analysis to understand the interaction between programmes’ facilitators and teachers in psychoeducational interventions

In this study we use personal network analysis to examine the social relationships taking place throughout programme implementation. Previous literature on psychosocial intervention has used network analysis techniques to examine: (a) the interaction between participants, (b) the facilitators' link to the intervention target group, (c) the transfer of knowledge between experts and facilitators, and (d) the interaction of facilitators with each other. However, there has been little research on how facilitators connect with other figures in their organisational context, impacting both intervention fidelity and the fit of the programme to the local context. In this study we combine the analysis of personal networks with qualitative interviews with 102 teachers in 72 schools in Barranquilla (Colombia), with whom we describe the implementation of the psychoeducational programmes Pisotón and Metodologías Flexibles. The results show that programme implementation networks not only rely on facilitators but also on the contribution of the schools’ director of studies, the coupling with the regular classroom teachers, and occasional collaborations from the rest of the school staff. After conducting a cluster analysis, we detected the existence of two types of personal networks, some based on the functioning of highly cohesive teams and others with a greater level of centralisation around the head of studies. Implementation networks not only enable the implementation of programme activities, but also the integration of the programme into educational organisations. In the discussion we reflect on how the analysis of facilitators' personal networks can be used to improve the process of programme implementation.

Health-related quality of life and fear of progression in individuals with Li-Fraumeni syndrome.

Li-Fraumeni syndrome (LFS) is a rare autosomal dominant cancer predisposition syndrome associated with a highly elevated lifetime cancer risk. This and the recommended intense surveillance program represent a large psychological burden on families. In order to develop targeted psychosocial interventions, we conducted a needs assessment. Adults (≥18 years) with LFS were included via regular hospital visits and online support groups and newsletters. Individuals filled out a questionnaire addressing among others: fear of progression (FoP-questionnaire, short-form), health-related quality of life (HRQoL, Short-Form Health Survey-12), distress (National Comprehensive Cancer Network distress thermometer), perceived cancer risk, and aspects of surveillance adherence. Collecting data over a 14-month period (March 2020 - June 2021), 70 adults were recruited (female = 58, 82.9%; mean age = 41.53 years). With mean mental component scores (MCS) of 42.28 (SD = 10.79), and physical component scores (PCS) of 48.83 (SD = 10.46), HRQoL was low in 34.8% (physical) and 59.4% (mental) of individuals when applying a mean cut-off of 45.4 (PCS) and 47.5 (MCS) to indicate poor HRQoL. High levels of FoP and distress were present in 68.6% and 69.1% of the participants, respectively. Performing a multiple linear regression on MCS and PCS, no sociodemographic variable was shown to be significant. FoP (β = -0.33, p < 0.05) and distress (β = -0.34, p < 0.05) were significantly associated with MCS. Individuals in our sample were burdened more than expected, with the majority reporting low levels of (mental) HRQoL, high distress, and FoP. Psychosocial support is necessary to help individuals with LFS (survivors as well as "previvors") increase their HRQoL, as it is crucial to survival.

Eliciting perspectives on remote healthcare delivery from service users with psychosis in the community: a cross-sectional survey study.

The transition towards remote healthcare has been rapidly accelerated in recent years due to a number of factors, including the COVID-19 pandemic, however, few studies have explored service users' views of remote mental healthcare, particularly in community mental health settings. As part of a larger study concerned with the development of a remotely delivered psychosocial intervention, a survey was conducted with service users with psychosis (N = 200) from six NHS trusts across England to gain cross-sectional data about service users' opinions and attitudes towards remote interventions and explore how digital access varies across different demographic groups and geographical localities. The majority of service users had access to technological devices and a quiet space to receive care. Age was a key factor in motivation to engage with remote care as older participants had less access to technological devices and the internet, and reported less confidence to learn how to use new technologies compared to younger participants. Differences in access and attitudes towards remote care were found across the different geographical localities. Over half of the participants (53.1%) preferred a hybrid model (i.e., mixture of face-to-face and remotely delivered treatment), with only 4.5% preferring remote treatment exclusively. Factors that both encourage and deter service users from engaging with remote care were identified. The findings of this study provide important information about the environmental and clinical barriers that prevent, or limit, the uptake of remotely delivered care for people with psychotic disorders. Although service users often have the ability and capacity to receive remote care, providers need to be cognisant of factors which may exacerbate digital exclusion and negatively impact the therapeutic alliance.

Mediating role of parental depression, parental bonding, and child self-esteem between family income and child depression: a longitudinal study

ABSTRACT The underlying mechanisms between family income and mental health of children merit further investigation. Based on the family stress model and the psychological factors model, we proposed that familial factors (parental depression and parenting) and the individual factor (child self-esteem) would mediate the relationship between family income and child depression concurrently. Data were obtained from a nationally representative longitudinal survey (i.e., the China Family Panel Studies), involving 1,283 families (2,732 parents and 1,384 children). The age of the children ranged from 4 to 15 years (M age = 8.04, SD = 1.87) at baseline. Path analysis showed that the effect of family income (in 2010, T1) on child depression (in 2014, T3) was mediated by parental depression (in 2012, T2), parental bonding (in 2012 or 2014, T2 or T3), and child self-esteem (in 2012 or 2014, T2 or T3), in a parallel rather than sequential manner. The findings indicate that health policies and psychosocial interventions that simultaneously improve parental depression, parenting techniques, and child self-esteem would be an effective approach to alleviate the impact of family income on child depression.

Advancing Methodological Rigor for Psychosocial Aspects of Neuropalliative Care Interventions.

Background: Neurological disorders (NDs) have unique biopsychosocial-spiritual features that impact patients and their families. As a result, the subspeciality of neuropalliative care (NPC) emerged within the past decade and has grown exponentially in research and practice. Given the cognitive, emotional, and behavioral changes associated with NDs, psychosocial components (eg, coping skills) of NPC interventions are essential for improving the quality of life for patients and families. However, psychosocial components of NPC interventions warrant more rigorous testing to improve their evidence base and their likelihood of implementation and dissemination. Aim: In this commentary, we provide methodological recommendations with the goal of improving scientific knowledge and rigor for psychosocial components of multicomponent NPC interventions in clinical trials. Results: We emphasize the need for transparent reporting of psychosocial intervention components; using established models of intervention development to guide the development and testing of multicomponent NPC interventions; identifying mechanisms of action for psychosocial outcomes; and choosing psychometrically sound measures for mechanisms and outcomes. Conclusions: Given the importance of psychosocial care to the holistic NPC model, rigorous testing of psychosocial components of NPC interventions is a high priority for clinical investigators to advance the evidence base and practice of NPC.

Psychosocial and digital intervention for patients with schizophrenia

Background: Schizophrenia is a severe mental disorder that significantly impairs the daily functioning of patients that causes substantial societal and economic burden. While drug therapy is crucial for schizophrenia treatment, relying solely on antipsychotic drugs does not yield the most favorable therapeutic outcomes.Current Concepts: Integrating psychosocial interventions could result in maximized therapeutic effects for individuals living with schizophrenia. Evidence-based psychosocial interventions for schizophrenia management include cognitive behavioral therapy, family involvement, psychoeducation, supported employment programs, lifestyle adjustments for physical health, and coordinated and comprehensive early intervention services. Incorporating peer support, allowing both service users and care providers to share knowledge and their illnessrelated personal experiences, facilitates mutual assistance along the path to recovery. Moreover, growing interest follows in using digital interventions, such as wearable technology and smartphone applications, as effective therapeutic tools for illness management.Discussion and Conclusion: The above-mentioned psychosocial interventions empower individuals with schizophrenia, helping them improve their functioning, enhance their life quality, and adapt more effectively to society. Combining early medication with comprehensive psychosocial interventions, including digital technology, is crucial for the best outcomes. This approach should begin as soon as schizophrenia is diagnosed, aiming to promote recovery and overall well-being in affected individuals.

Management of cardiovascular disease in patients with schizophrenia

Background: Individuals with schizophrenia experience premature mortality by approximately 15 to 20 years compared to the general population. The most common cause of death in schizophrenia is cardiovascular disorder, yet cardiovascular disease-related conditions are often neglected in the treatment of schizophrenia.Current Concepts: The overall incidence rate of cardiovascular disorders in patients with schizophrenia is about 10%. Diverse risk factors likely contribute to the association, with increased risk of metabolic syndrome, unhealthy lifestyle behaviors like smoking and a sedentary lifestyle, and an unhealthy diet playing a prominent role. While the effects of certain psychotropic medications, particularly atypical antipsychotics, may contribute to the presence of metabolic syndrome, their ability to reduce the psychiatric symptom burden reduces mortality. Shared pathophysiological mechanisms, including genetic, psychological, and inflammatory factors, have also been suggested. In particular, increased inflammation directly associated with disease-related brain activity may further impact the cardiovascular risk.Discussion and Conclusion: Regular monitoring of metabolic syndrome, with psychoeducation for patients and their caregivers, is crucial to promote optimal cardiovascular health. Implementation of active psychosocial interventions targeted at behavior change is necessary. In addition, education to reduce stigma among medical professionals is warranted to improve communication between patients and medical professionals.

Impact of Cognitive and Behavioural Psychosocial Interventions on the Effective Management of Hypertension

Hypertension or elevated blood pressure is a chronic non-communicable disease, in which the force of the circulating blood through the major blood vessels and arteries of the body, is consistently high leading to severe health complications. Given the high rates of unawareness of the condition and low rates of detection, diagnosis and treatment of high BP, which has been termed as the “silent killer”, patients tend to be non-adherent to their treatment regimen which lowers their blood pressure control, quality of life and prognosis. A community-based cluster randomized controlled trial, that utilized a 4x3 factorial between-subjects experimental design, was adopted to determine the simultaneous and comparative impact, of three cognitive and behavioural psychosocial interventions on the systolic and diastolic BP control, hypertension knowledge, therapeutic adherence, health beliefs and self-efficacy among hypertensive patients, across the three time points of the study. A sample of 224 hypertensive participants were randomly selected from the four villages of Railapur, Athvelly, Nuthankal, and Rawalkol and were randomly assigned to the Doctor, Video, Community Health Worker and Control conditions respectively. The results showed that the hypertensive patients in the three psychosocial intervention groups showed significantly higher therapeutic adherence, blood-pressure control, hypertension-related knowledge, hypertension-related health beliefs and self-efficacy as compared to the control group after the administration of the interventions. By means of pathway modelling using multiple linear regression analyses, the three psychosocial interventions were found to be direct, significant, and positive predictors of the therapeutic adherence among hypertensive patients, which in turn was the largest, significant and negative contributor to the systolic and diastolic BP reading among them.

A Qualitative Exploration of Postoperative Bariatric Patients' Psychosocial Support for Long-Term Weight Loss and Psychological Wellbeing.

There is a paucity of research exploring postoperative psychosocial interventions for bariatric surgery patients exceeding 2 years, and therefore, an interdisciplinary postoperative approach is warranted. This qualitative study explored the psychosocial support that bariatric surgery patients feel they need to sustain long-term weight loss and their psychological wellbeing. Fifteen postoperative patients participated in recorded semi-structured online interviews that were transcribed verbatim and analysed using a reflexive thematic analysis approach. Three themes and six subthemes emerged. Theme 1, Journey to surgery, has two subthemes: Deep roots and Breaking point. Theme 2, The precipice of change, has two sub-themes: Continuity of care and Can't cut the problem out. Theme 3, Bridging the Gap, has two subthemes: Doing it together and Taking back the reigns. The inconsistencies participants experienced in their pre- and postoperative care led to dissonance, and they felt unprepared for the demands of life postoperatively. Bariatric surgery is a catalyst for physical change, but surgery alone is insufficient to ensure sustained change. Surgical and psychosocial interventions are interdependent rather than mutually exclusive. Patients favour an integrative, personalised, stepped-care approach pre- and postoperatively, with active participation fostering autonomy and access to ongoing support extending into the long-term.

Individual psychological characteristics and features of coping with the disease in patients with the first psychotic episode and post-psychotic depression as targets for psychosocial interventions

Purpose of the study: to determine the individual psychological characteristics and features of coping with the disease in patients with the first psychotic episode and post-psychotic depression in order to identify targets for subsequent psychosocial interventions. We examined 1112 patients who underwent the first psychotic episode, of which, after the introduction of inclusion/exclusion criteria, two groups were formed in the final design: 243 patients with postpsychotic depression and 119 patients without depression in partial remission. Clinical and psychopathological method with objectification by PANSS, CDSS scales, clinical and psychological method with diagnostics of coping, psychological defense mechanisms, perfectionism and self-stigmatization by standardized questionnaires were used, regression analysis was carried out using the method of multiple linear regression with stepwise inclusion. From the numerical characteristics of the samples, the arithmetic mean was determined with the calculation of the standard error of the mean, standard deviation. Statistically significant results were accepted at the p&lt;0.05 significance level.Conclusions: the study found a significant effect on the clinical manifestations of postpsychotic depression in patients who underwent PES of schizophrenia, all studied individual psychological characteristics with the highest coping activity, which indicates the undoubted involvement of reactive mechanisms in the development of this type of pathology. This confirms the importance in the treatment of the studied cohort of patients, not only of differentiated psychopharmacotherapy, but also of active psychotherapeutic support with the study of selected “targets” of coping, individual psychological characteristics.

Randomized controlled trial of individualized arousal-biofeedback for children and adolescents with disruptive behavior disorders (DBD).

Disruptive behavior disorders [including conduct disorder (CD) and oppositional defiant disorder (ODD)] are common childhood and adolescent psychiatric conditions often linked to altered arousal. The recommended first-line treatment is multi-modal therapy and includes psychosocial and behavioral interventions. Their modest effect sizes along with clinically and biologically heterogeneous phenotypes emphasize the need for innovative personalized treatment targeting impaired functions such as arousal dysregulation. A total of 37 children aged 8-14years diagnosed with ODD/CD were randomized to 20 sessions of individualized arousal biofeedback using skin conductance levels (SCL-BF) or active treatment as usual (TAU) including psychoeducation and cognitive-behavioral elements. The primary outcome was the change in parents´ ratings of aggressive behavior measured by the Modified Overt Aggression Scale. Secondary outcome measures were subscales from the Child Behavior Checklist, the Inventory of Callous-Unemotional traits, and the Reactive-Proactive Aggression Questionnaire. The SCL-BF treatment was neither superior nor inferior to the active TAU. Both groups showed reduced aggression after treatment with small effects for the primary outcome and large effects for some secondary outcomes. Importantly, successful learning of SCL self-regulation was related to reduced aggression at post-assessment. Individualized SCL-BF was not inferior to active TAU for any treatment outcome with improvements in aggression. Further, participants were on average able to self-regulate their SCL, and those who best learned self-regulation showed the highest clinical improvement, pointing to specificity of SCL-BF regulation for improving aggression. Further studies with larger samples and improved methods, for example by developing BF for mobile use in ecologically more valid settings are warranted.

Interventions to address parenting stress among caregivers of children with chronic diseases: An umbrella review.

Caregivers of children with chronic diseases suffer from great parenting pressure, which directly affects the treatment and rehabilitation of children, reduces the quality of life of caregivers and damages family functioning. Existing reviews have not systematically summarized and evaluated interventions for parenting stress in caregivers of children with chronic diseases. Embase, PubMed, Web of Science, OVID, CNKI, CBM, Wan Fang and Cochrane Library were searched for eligible reviews in November 2021 and October 2022. Two reviewers independently screened titles and abstracts, reviewed full texts of articles for eligibility, and appraised the quality of reviews using JBI. The quality of the evidence was assessed using GRADE. Findings are reported in accordance with PRISMA checklist. Narrative summaries grouped findings by intervention types. Out of 2632 records, we included 21 systematic reviews for a synthesis. Interventions for parenting stress in children with chronic diseases were divided into seven categories. Cognitive behavioural interventions, psychosocial interventions, child behavioural and/or developmental parent interventions and synthesized interventions have shown high-level evidence in reducing parenting stress for caregivers of children with chronic diseases. Furthermore, outcome measures and intervention protocols were highly heterogeneous across interventions. This umbrella review suggest that reducing the parenting stress of caregivers of children with chronic diseases can directly target caregivers' parenting stress through cognitive behavioural interventions/psychosocial interventions and/or provide guidance to parents on the behavioural and developmental problems of children with chronic diseases. A more standardized approach to outcome measures is essential to assess efficacy and compare interventions across studies. The findings provide information and evidence for reducing parenting stress among caregivers of children with chronic diseases to guide the development of comprehensive intervention strategies. Patient or public contribution does not apply to this study.

The Role of First-Line Managers in a Pandemic in Reducing the Spread of Infections and Promoting the Health and Well-Being of Rohingya Refugees

ABSTRACT Humanitarian organizations in Bangladesh introduced emergency services to protect Rohingya refugees from COVID-19. This article aims to explore the roles front-line leaders from those organizations played in reducing the spread of the infection and protecting the refugees. By using in-depth interviews with 42 first-line managers (FLMs), it explores the innovative actions and strategies adopted by these managers to implement COVID-19-related programs and services. Initiatives such as training and engaging Rohingya volunteers and developing services promptly in order to raise awareness and manage testing, treatment, and psychosocial interventions contributed significantly to pandemic management in Rohingya refugee camps.

The impact of a virtual mind-body program on symptoms of depression and anxiety among international English-speaking adults with neurofibromatosis.

The neurofibromatoses (NFs) are a set of incurable genetic disorders that predispose individuals to nervous system tumors. Although many patients experience anxiety and depression, there is little research on psychosocial interventions in this population. The present study examined the effects of a mind-body intervention on depression and anxiety in adults with NF. This is a secondary analysis of the Relaxation Response Resiliency Program for NF (3RP-NF), an 8-week virtual group intervention that teaches mind-body skills (e.g., relaxation, mindfulness) to improve quality of life. Participants were randomized to 3RP-NF or the Health Enhancement Program for NF (HEP-NF) consisting of health informational sessions and discussion. We evaluated depression (PHQ-9) and anxiety (GAD-7) at posttreatment, 6 months, and 12 months. Both groups improved in depression and anxiety between baseline and posttest, 6 months, and 12 months. The 3RP-NF group showed greater improvements in depression scores from baseline to 6 months compared with HEP-NF and with lower rates of clinically significant depressive symptoms. There were no between-group differences for anxiety. Both interventions reduced distress and anxiety symptoms for individuals with NF. The 3RP-NF group may be better at sustaining these improvements. Given the rare nature of NF, group connection may facilitate reduced distress.

Valuable interaction with cognitive remediation and optimal antipsychotics for recovery in schizophrenia (VICTORY-S): study protocol for an interventional, open-label, randomized comparison of combined treatment with cognitive remediation and lurasidone or paliperidone.

Cognitive impairment, a core feature of schizophrenia, is associated with poor outcomes. Pharmacotherapy and psychosocial treatment, when used alone, have inadequate effect sizes for cognitive impairment, leading to recent interest in combination interventions. A previous study examined the additive effect of cognitive remediation on lurasidone in patients with schizophrenia, which was negative. Although improvement in cognitive function was suggested for lurasidone, it was inconclusive because there was no antipsychotic control in the study. To clarify whether lurasidone has a meaningful impact on cognitive function in combination with cognitive remediation, we use paliperidone as a control antipsychotic in this study. We hypothesize that combination with lurasidone will improve cognitive and social function to a greater extent than paliperidone. The valuable interaction with cognitive remediation and optimal antipsychotics for recovery in schizophrenia study is a multicenter, interventional, open-label, rater-blind, randomized comparison study, comparing the effect of lurasidone plus cognitive remediation with that of paliperidone plus cognitive remediation in patients with schizophrenia. The Neuropsychological Educational Approach to Remediation (NEAR) is used for cognitive remediation. Eligible patients will be randomized 1:1 to receive lurasidone or paliperidone combined with NEAR (6 weeks antipsychotic alone followed by 24 weeks combination antipsychotic plus NEAR). The primary endpoint is the change from baseline in the tablet-based Brief Assessment of Cognition in Schizophrenia composite T-score at the end of the NEAR combination treatment period. Secondary endpoints will include change from baseline in social function, schizophrenia symptoms, and quality of life at the end of the NEAR combination treatment period. Furthermore, change from baseline to the end of the pharmacotherapy period and change from the end of the pharmacotherapy period to the end of the NEAR combination treatment period will be assessed for all endpoints. Safety will also be evaluated. Achievement of adequate cognitive function is central to supporting social function, which is a key treatment goal for patients with schizophrenia. We think this study will fill in the gaps of the previous study and provide useful information regarding treatment decisions for patients with schizophrenia. Japan Registry of Clinical Trials ID, jRCTs031200338.

Digital Health Psychosocial Intervention in Adult Patients With Cancer and Their Families: Systematic Review and Meta-Analysis.

Patients with cancer and their families often experience significant distress and deterioration in their quality of life. Psychosocial interventions were used to address patients' and families' psychosocial needs. Digital technology is increasingly being used to deliver psychosocial interventions to patients with cancer and their families. A systematic review and meta-analysis were conducted to review the characteristics and effectiveness of digital health interventions on psychosocial outcomes in adult patients with cancer and their family members. Databases (PubMed, Cochrane Library, Web of Science, Embase, CINAHL, PsycINFO, ProQuest Dissertations and Theses Global, and ClinicalTrials.gov) were searched for randomized controlled trials (RCTs) or quasi-experimental studies that tested the effects of a digital intervention on psychosocial outcomes. The Joanna Briggs Institute's critical appraisal checklists for RCTs and quasi-experimental studies were used to assess quality. Standardized mean differences (ie, Hedges g) were calculated to compare intervention effectiveness. Subgroup analysis was planned to examine the effect of delivery mode, duration of the intervention, type of control, and dosage on outcomes using a random-effects modeling approach. A total of 65 studies involving 10,361 patients (mean 159, SD 166; range 9-803 patients per study) and 1045 caregivers or partners (mean 16, SD 54; range 9-244 caregivers or partners per study) were included in the systematic review. Of these, 32 studies were included in a meta-analysis of the effects of digital health interventions on quality of life, anxiety, depression, distress, and self-efficacy. Overall, the RCT studies' general quality was mixed (applicable scores: mean 0.61, SD 0.12; range 0.38-0.91). Quasi-experimental studies were generally of moderate to high quality (applicable scores: mean 0.75, SD 0.08; range 0.63-0.89). Psychoeducation and cognitive-behavioral strategies were commonly used. More than half (n=38, 59%) did not identify a conceptual or theoretical framework. Most interventions were delivered through the internet (n=40, 62%). The median number of intervention sessions was 6 (range 1-56). The frequency of the intervention was highly variable, with self-paced (n=26, 40%) being the most common. The median duration was 8 weeks. The meta-analysis results showed that digital psychosocial interventions were effective in improving patients' quality of life with a small effect size (Hedges g=0.05, 95% CI -0.01 to 0.10; I2=42.7%; P=.01). The interventions effectively reduced anxiety and depression symptoms in patients, as shown by moderate effect sizes on Hospital Anxiety and Depression Scale total scores (Hedges g=-0.72, 95% CI -1.89 to 0.46; I2=97.6%; P<.001). This study demonstrated the effectiveness of digital health interventions on quality of life, anxiety, and depression in patients. Future research with a clear description of the methodology to enhance the ability to perform meta-analysis is needed. Moreover, this study provides preliminary evidence to support the integration of existing digital health psychosocial interventions in clinical practice. PROSPERO CRD42020189698; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=189698.