Reduction In Depressive Symptoms Research Articles

Reducing Barriers to Evidence-Based Services: A High School-University Partnership to Adapt the Unified Protocol for Urban, Underserved Youth with Elevated Internalizing Symptoms

ABSTRACT Background Rates of depression and anxiety in adolescents are rising and access to effective treatment remains limited. Public schools are instrumental in reducing barriers to treatment. Objective The present study describes a community-engaged approach to the adaptation and open trial of The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A; Ehrenreich-May et al. 2018) delivered as a group-based intervention in a Chicago Public High School among predominantly low-income Black and Latine adolescents experiencing elevated depression symptoms (i.e. “Healthy Minds, Happy Lives program;” HMHL). Methods This study utilized qualitative and quantitative analyses to evaluate: (1) the systematic adaptation process that aimed to balance fidelity (to the original UP-A intervention) and flexibility (e.g. the school-based group delivery, and community partner input), (2) the initial feasibility and acceptability of the HMHL intervention by analyzing salient themes from focus groups, and (3) pre- to post-intervention changes in symptoms, in order to inform intervention refinement and methodological considerations for a pilot clinical trial. Our adaptation process utilized the Framework for Reporting Adaptations and Modifications to Evidence-based Interventions and relied on the engagement of key school-staff partners (N = 8) and student-trial participants with elevated depression symptoms (N = 16). Focus group content was coded and thematically analyzed. Outcome trends were evaluated using reliable change indices. Results Preliminary feasibility was promising, with participants attending an average of 7 out of 8 hMHL sessions and retention was excellent with 100% of participants completing the program. Additionally, most trial participants demonstrated a clinically meaningful reduction in depression symptoms and increased emotional state awareness following the intervention. Conclusions HMHL may be a feasible and acceptable intervention for increasing access to care for youth who may otherwise not have access to evidence-based services. Recommendations are provided for enhancing both the content and delivery of the intervention.

Magnetic Seizure Therapy in Refractory Psychiatric Disorders: A Systematic Review and Meta-Analysis: La thérapie par convulsions magnétiques pour la prise en charge des troubles psychiatriques réfractaires : revue systématique et méta-analyse.

To qualitatively and quantitatively synthesize the literature on the efficacy and safety of magnetic seizure therapy (MST) in psychiatric disorders. A literature search was conducted of the OVID Medline, OVID EMBASE, PsychINFO, CINAHL, Web of Science and Cochrane databases from inception to 14 January 2024, using subject headings and key words for "magnetic seizure therapy." Randomized controlled trials (RCTs), post-hoc analyses of RCTs, open-label trials, or case series investigating MST in adults with a verified psychiatric diagnosis and reporting on two possible primary outcomes (1) psychiatric symptom reduction (as measured by validated rating scale) or (2) neurocognitive outcomes (as measured by standardized testing), were included. Abstracts, individual case reports, reviews and editorials were excluded. Extracted data included: (1) basic study details; (2) study design; (3) sample size; (4) baseline demographics; (5) outcome data (including secondary outcomes of suicidal ideation and adverse events); and (6) stimulation parameters. Cochrane's risk of bias tool was applied. A quantitative analysis was conducted for the depression studies, using Hedge's g effect sizes. A total of 24 studies (n = 377) were eligible for inclusion. Seventeen studies in depression (including three RCTs), four studies in schizophrenia (including one RCT), one study in bipolar disorder, one study in obsessive-compulsive disorder and one study in borderline personality disorder were summarized. We found no significant difference in depressive symptom reduction between MST and electroconvulsive therapy (ECT) in randomized, controlled trials (g = 0.207 towards ECT, 95% confidence interval (CI) -0.132 to 0.545, P = 0.232). We found a significant reduction in depressive symptoms overall with MST in the pooled RCT and open-label analysis (g = 1.749, CI 1.219 to 2.279, P < 0.005). It is suggested that MST has modest cognitive side effects. Large-scale RCTs are necessary to confirm early signals of MST as an effective intervention in psychiatric disorders with a cognitive profile that is potentially more favourable than ECT.

Psilocybin Therapy for Clinicians With Symptoms of Depression From Frontline Care During the COVID-19 Pandemic

The psychological morbidity experienced by physicians, advanced practice practitioners (APPs), and nurses from working during the COVID-19 pandemic includes burnout, depression, and posttraumatic stress disorder (PTSD). To investigate whether psilocybin therapy could improve symptoms of depression, burnout, and PTSD in US clinicians who developed these symptoms from frontline clinical work during the pandemic. This double-blind randomized clinical trial enrolled participants from February to December 2022. Participants included physicians, APPs, and nurses who provided frontline care for more than 1 month during the pandemic and had no prepandemic mental health diagnoses but had moderate or severe symptoms of depression at enrollment. Participants were randomly assigned to either the psilocybin or niacin arm. Data analysis was conducted between December 2023 and May 2024 and was based on the intention-to-treat principle. One intervention episode consisted of 2 preparation visits, 1 medication session, and 3 integration visits. At the medication session, participants received psilocybin, 25 mg, or niacin, 100 mg, orally. The primary outcome was a change from baseline (preparation 1 session) to day 28 (after medication administration) in symptoms of depression as measured by the clinician-administered Montgomery-Asberg Depression Rating Scale (MADRS) used by blinded raters. The secondary outcomes were a change in symptoms of burnout (measured with the Stanford Professional Fulfillment Index [SPFI]) and symptoms of PTSD (measured with the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [PCL-5]). A total of 30 clinicians (15 females [50%]; mean [range] age, 38 [29-60] years) participated, of whom 15 were randomly assigned to receive psilocybin and 15 to receive niacin. The mean change in symptoms of depression (MADRS scores) from preparation 1 session to day 28 was -21.33 (7.84) in the psilocybin arm compared with -9.33 (7.32) in the niacin arm, with a mean difference between arms of -12.00 (95% CI, -17.67 to -6.33; P < .001), a decrease in MADRS scores indicating improvement. The mean change in SPFI scores from preparation 1 session to day 28 showed a numerically larger improvement in symptoms of burnout in the psilocybin compared with the niacin arm (-6.40 [5.00] vs -2.33 [5.97]; P = .05) but was not statistically significant. Since the SPFI score change did not reach statistical significance, the PCL-5 score change was evaluated descriptively. The mean change in PCL-5 scores showed a numerically larger decrease in symptoms of PTSD from preparation 1 session to day 28 in the psilocybin vs the niacin arm (-16.67 [15.04] vs -6.73 [10.69]), but this difference was not statistically tested. This randomized clinical trial found that psilocybin therapy resulted in a significant, sustained reduction in symptoms of depression experienced by clinicians after frontline work during the COVID-19 pandemic. The findings establish psilocybin therapy as a new paradigm of treatment for this postpandemic condition. ClinicalTrials.gov Identifier: NCT05163496.

Effects of Ketamine vs. Midazolam in Adolescent Treatment Resistant Depression

Background: Adolescent treatment resistant depression (TRD) is increasing in recent years. While ketamine showed rapid antidepressant effects in adult TRD studies, research on its effectiveness in adolescents is limited. Methods: This study examines the effects of intravenous ketamine vs. midazolam on depressive and anxiety symptomatology assessed by the Montgomery–Åsberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HAM-A), and Children’s Depression Inventory (CDI) at two time points—2 h after initial infusion (T0+2h) and 24 h after the end of the treatment (Te+24h) in a sample of 55 adolescent TRD females (27 receiving ketamine, 28 midazolam). Results: At T0+2h, within-group comparisons revealed a significant reduction in MADRS and HAM-A scores compared to baseline in the ketamine and midazolam groups. At Te+24h, both groups demonstrated similar significant reductions in MADRS, HAM-A, and CDI scores compared to baseline. The MADRS assessment in the ketamine group showed 33% and 59% responders, and in the midazolam group, 14% and 46% responders at T0+2h and Te+24h, respectively. HAM-A evaluation in the ketamine group revealed 33% and 56% responders, and in the midazolam group, 11% and 39% responders at T0+2h and at Te+24h, respectively. CDI rating discovered 11% and 44% responders in the ketamine group and 4% and 21% responders in the midazolam group at T0+2h and Te+24h, respectively. Moreover, inner tension significantly decreased in ketamine compared to the midazolam group at Te+24h. Conclusions: Ketamine showed a reduction in depressive and anxiety symptoms during a short-term period with particular efficacy in alleviating inner tension over midazolam, suggesting its potential advantages in specific symptom relief in rarely studied adolescent TRD.

REABILITAÇÃO E AUTOCONFIANÇA: O PAPEL DA FISIOTERAPIA NA VIDA DE AMPUTADOS DE MEMBROS INFERIORES

Physiotherapy plays a fundamental role in the rehabilitation and adaptation process of amputees. By providing physical, emotional and educational support to amputees, multidisciplinary work enables patients to recover by promoting lost functionality until they adapt to the physical and emotional transformations and are able to live fully and actively again. In addition, the physiotherapeutic approach is multifaceted and involves several techniques, including gait training, strengthening exercises, manual therapy and psychological support. These interventions are essential to help patients overcome the challenges related to the use of the prosthesis and the recovery of functionality. Thus, the main objective of this study is to analyze the importance of physiotherapy in the rehabilitation of patients using lower limb prostheses, highlighting the gains in mobility, adaptation to the prosthetic device and quality of life, emphasizing as a focus of the problem what are the impacts of physiotherapy on the rehabilitation of lower limb amputees in terms of mobility, adaptation to the prosthesis and quality of life? This study is characterized as a mixed approach (quantitative and qualitative) field research, carried out in a rehabilitation center specialized in lower limb prostheses in Brazil. This mixed approach allowed a more comprehensive analysis, combining numerical data with subjective perceptions of the participants. Thus, continuous and personalized physiotherapy monitoring based on measurements and field research reiterated the beneficial benefits of adaptation to the prosthesis in the lower limbs when considering the fit, comfort and functionality, and when taking into account the gait training and the established strengthening exercises. Transtibial and femoral amputation has represented not only a surgical intervention, but also a long readaptation treatment, that is, a milestone in the lives of affected individuals, which brings significant challenges. Rehabilitation begins in the preoperative period, progresses to the prosthesis fitting, and continues beyond these events, being crucial for the functional/emotional recovery of patients. Understanding the various stages of treatment and having a comprehensive rehabilitation plan are essential factors for promoting a new quality of life, which is possible for amputees, as demonstrated in the evaluations completed by patients portrayed in the various graphs representing responses to the questionnaires applied. The aim is therefore to carry out continuous and personalized physiotherapy monitoring to promote significant improvements in mobility, self-confidence and quality of life of amputee patients who use lower limb prostheses; and through treatment, a key factor for successful adaptation to the prosthesis, to facilitate the return to daily activities and promote greater functional independence. The research should also demonstrate improvements in the emotional well-being of patients, with a reduction in symptoms of depression and anxiety when considering the necessary psychological monitoring.

Role of Inflammation and Cytokine Dysregulation in Depression in Patients with Inflammatory Skin Conditions.

The growing field of psychodermatology examines the interplay between dermatological and psychiatric comorbidities. While current literature recognizes that cutaneous and psychiatric conditions often coexist within patients, the relationship between dysregulated inflammation and depression in patients with inflammatory skin conditions has not been thoroughly explored. This review seeks to describe the connection between cutaneous disease and depression via shared inflammatory cytokine pathways. A review of current literature was conducted, and studies addressing the co-occurrence of depression and inflammatory skin diseases were included. This review focuses on depression in patients with psoriasis, atopic dermatitis, and hidradenitis suppurativa. Studies that focused on the prevalence of depression in these populations, shared inflammatory pathways, and co-management of cutaneous and psychiatric disorders were chosen. The literature revealed a high prevalence of depression in individuals with inflammatory skin conditions compared with those without cutaneous disease. Recent studies described how proinflammatory cytokines in inflammatory skin diseases can elicit inflammation in the brain, leading to depressive symptoms. Certain subsets of cytokines that mediate inflammatory pathways were associated with both cutaneous inflammation and depression, highlighting shared pathology. Antiinflammatory medications targeting shared cytokines found reductions in both cutaneous and depressive symptoms. Practitioners have emphasized interdisciplinary approaches to treating both conditions, including psychotherapy and pharmacological methods. There is a clear association between inflammatory cutaneous diseases and depression. Co-management of these conditions, including interdisciplinary methods, is essential for patients' well-being. Future research addressing similar links between other cutaneous and psychiatric conditions could yield new treatment opportunities as well.

Psychedelic Research for Alcohol Use Disorder with Comorbid Major Depressive Disorder: An Unmet Need.

In this narrative review, we discuss evidence for psilocybin- and LSD-assisted treatment of alcohol use disorder (AUD) and major depressive disorder (MDD). We describe limitations of psychedelic research and posit methodological considerations when designing a trial in patients with both disorders. In AUD, a growing evidence base for psilocybin treatment shows a promising beneficial and sustained effect on measures of drinking frequency. In MDD, a recent meta-analysis has demonstrated that psilocybin therapy provides a large and consistent reduction in depressive symptoms compared to no treatment. Co-occurrence of MDD and AUD is quite prevalent, and this comorbidity exacerbates symptomatology of the two individual disorders and complicates their treatment. Theoretically, patients presenting with both AUD and MDD would benefit from an integrated therapy that could treat MDD and AUD simultaneously. We believe that more research into the efficacy of psilocybin in patients with both AUD and MDD is warranted and justified.

THE CONNECTION OF SPIRITUALITY AND MENTAL DISEASES

Understanding how spirituality affects mental health can provide important insights into treatment and support methods for people with mental illness. In modern society, spirituality is increasingly recognized as an important aspect of human life. It signifies the deep values and life views that people want to live by. A higher level of spirituality aids personal growth and development, including an individual's mental health and emotional well-being. Providing spiritual health care is considered important for the prevention of depressive symptoms and includes activities such as listening to patients, offering peace, respect, comfort and hope. A holistic approach to treating patients is increasingly being recognized and applied throughout the world. A holistic approach to health recognizes the interconnectivity of the psychological, social, biological and spiritual aspects of a person, which is reflected in the application of various methods including medication, education, communication, self-help and alternative therapies. History shows that scientific research has long confirmed the connection between spirituality and improved health. Spirituality seems increasingly important in the context of increased life stress, and recent research suggests that spiritual practices can contribute to the reduction of depressive symptoms. Spiritual beliefs and practices can also provide comfort to people who are fearful or anxious, increasing their sense of control, security and confidence. The effects of spirituality on mental health are individual and depend on personal beliefs, life experiences and the context in which it is practiced. An individualized approach in the assessment and integration of spiritual and religious aspects in the treatment of mental disorders is key. This paper explores the connection between spirituality and mental illness, with the aim of illuminating how spirituality can be both a source of support and challenge for people struggling with mental disorders. Keywords: spirituality, mental diseases, mental health

Does enhanced meaning after meaning-centered group psychotherapy mediate a reduction in depressive symptoms in cancer survivors? A mediation analysis in the context of a randomized controlled trial.

After meaning-centered group psychotherapy for cancer survivors (MCGP-CS), depressive symptoms tend to decrease. An enhanced sense of meaning may play a mediating role in this decrease. The aim of this study was to assess whether personal meaning mediates the relationship between MCGP-CS and depressive symptoms. Cancer survivors (n = 114) were randomly allocated to MCGP-CS or care as usual (CAU). The assessments were scheduled at baseline, postintervention, and at 3- and 6-month follow-up. Mediation models were estimated based on structural equation modeling. We computed the indirect effect of MCGP-CS on depressive symptoms at the 3-month follow-up through personal meaning, and other meaning-related mediators, measured postintervention. A small but significant indirect effect of MCGP-CS on depressive symptoms at the 3-month follow-up was found through personal meaning postintervention (b = - 0.29, 95% bootstrap CI (- 0.63, - 0.03)). There were no significant indirect effects through the other meaning-related factors. This study tentatively supports the MCGP-CS working model in that an enhanced sense of meaning as a result of MCGP-CS mediates a reduction in depressive symptoms. Personal meaning mediated a small effect of MCGP-CS on depressive symptoms. The longitudinal mediating effect of personal meaning occurred within a time period of 3months after MCGP-CS. MCGP-CS is a psychological intervention that supports cancer survivors in regaining or enhancing a sense of meaning in their lives. This enhanced sense of meaning is a protective factor against depressive symptoms. The RCT was registered in the Netherlands Trial Register (number NTR3571/NL3421) on August 10, 2012.

Urban and Rural Differences in the Efficacy of a Mobile Health Depression Treatment for Young Adults

Depression among young adults represents a growing health problem in the U.S., but access to effective treatment remains a challenge. Mobile health (mHealth) approaches promise to deliver accessible and effective depression treatment; however, questions remain regarding how mHealth depression treatment efficacy may vary geographically based on urban and rural environmental contexts. The present study addresses this knowledge gap by leveraging data from a randomized clinical trial of an mHealth depression treatment called Cognitive Behavioral Therapy-text (CBT-txt) as applied to a sample of 103 U.S. young adults (ages 18–25). Prior research has demonstrated the efficacy of CBT-txt to reduce depressive symptoms. In the present study, we conduct an exploratory, post hoc analysis employing moderated growth curve modeling to investigate whether observed treatment efficacy differed between study participants residing in rural versus urban areas. The findings indicate that CBT-txt treatment effects in terms of reducing depression symptoms were significantly stronger for young adults residing in rural, as compared to urban, regions (β = 13.759, 95% CI = 0.796, 26.723, p &lt; 0.038). We speculate that this is because of the lack of mental healthcare resources in rural, as compared to urban areas, as well as the greater level of environmental stressors, such as artificial light and noise, found in cities, which may mitigate treatment effects.

Feasibility and Acceptability of Internet-Based Emotion-Focused Cognitive Behavioral Therapy in Women with Suspected Fetal Anomalies: A Quasi-Experimental Study

Background: There is a notable lack of empirical validation regarding the use of internet-based emotion-focused cognitive behavioral therapy (IECBT) for counseling pregnant women. Objectives: This study examines the feasibility, acceptability, and effectiveness of IECBT in counseling women with suspected fetal anomalies. Methods: In a quasi-experimental study, 130 pregnant women diagnosed with anxiety disorders were randomly assigned to either IECBT with spousal participation (65 participants) or IECBT alone (65 participants). All participants completed three pregnancy-specific stress questionnaires—the NuPDQ, Spielberger State Anxiety Inventory, and Edinburgh Depression Scale—both before and immediately after the intervention. Results: Within-group analyses indicated that both counseling methods, with and without spousal involvement, led to significant reductions in pregnancy-specific stress, depression, and anxiety symptoms by the end of the intervention (P &lt; 0.001). Between-group comparisons revealed that IECBT with spousal participation significantly reduced pregnancy-specific stress (effect size = 0.055, P = 0.007) and depressive symptoms (effect size = 0.480, P &lt; 0.001) compared to IECBT without spousal involvement. However, neither intervention produced a significant reduction in anxiety symptoms (effect size = 0.001, P = 0.787). Conclusions: Both IECBT approaches (with and without spousal participation) are feasible, reliable, and effective methods for alleviating depression and stress symptoms in pregnant women with suspected fetal anomalies.

Implementation trial I: Clinical outcomes and acceptability of an internet-delivered intervention for anxiety and depression delivered as part of routine care for university students in New Zealand

BackgroundPsychological distress is highly prevalent among university students and can contribute to poor academic performance and drop-out. Help-seeking has increased in recent years, contributing to growing interest in employing internet-delivered psychological treatments to support the mental health of university students. However, few large-scale “real-world” effectiveness trials have been conducted in routine care settings for this population. AimThe aim of the current study was to examine the acceptability and effectiveness of a brief, five-week internet-delivered cognitive behavioural therapy (iCBT) intervention for anxiety and depression when delivered as part of routine care by a university counselling service in New Zealand. DesignA large, prospective, single-group Phase IV clinical trial. MethodStudents (N = 1044) engaging with the university counselling service between 2018 and 2023 were provided the option to receive the intervention based on their needs and preferences. Students completed standardised measures of depression and anxiety severity at pre-treatment, each week of the intervention, and post-treatment. A subsample (n = 405) also completed these at 3-month follow-up. ResultsOver a 5-year period, 839 students participated in the intervention. Significant reductions in symptoms of depression (% reduction = 35%, Hedges' g = 0.56) and anxiety (% reduction = 36%, Hedges' g = 0.73) were observed, alongside high levels of satisfaction (> 60%). Symptom deterioration was observed in <10% of students. ConclusionThe current results provide further support for the provision of internet-delivered psychological interventions as routine care to university students with symptoms of anxiety and depression.

Implementation trial II: Clinical outcomes and acceptability of an internet-delivered intervention for anxiety and depression delivered as part of routine care for university students in Australia

BackgroundUniversity students report high levels of psychological distress, which is a contributor to poorer academic, social and health outcomes. There is increasing interest in the use of internet-delivered psychological treatments in student counselling services as a strategy improving access to psychological care at scale. However, to date, few large-scale prospective effectiveness trials of internet-delivered psychological treatment have been conducted in “real world” settings with university student populations. AimTo investigate the effectiveness and acceptability of a brief transdiagnostic internet-delivered cognitive behavioural therapy (iCBT) intervention for anxiety and depression when delivered as part of routine care by the counselling service of an Australian university. DesignA large, prospective, single-group Phase IV clinical trial. MethodStudents engaging with the university counselling service between 2018 and 2023 (N = 845; 8.5% of those presenting to the service) were given the option to receive the intervention based on their clinical needs and preferences. Students completed standardised measures of depression and anxiety severity at pre-treatment, each week of the intervention, and post-treatment. A subsample (n = 426) also completed the measures at 3-month follow-up. ResultsOver a 5-year period, 700 students participated in the intervention and 489 provided data at post-treatment. Significant reductions in depression symptoms (% reduction = 27%, Hedges' g = 0.35) and anxiety (% reduction = 37%, Hedges' g = 0.61) were observed, alongside high levels of satisfaction (>70%) and adherence (68%). Over 50% of students had clinically significant improvements in symptom severity, and symptom deterioration was observed in <15% of students. ConclusionThe results of the current trial provide support for the effectiveness and acceptability of internet-delivered psychological interventions provided as part of routine care to university students with symptoms of anxiety and depression.

Parenting with nutrition education and unconditional cash reduce maternal depressive symptoms and improve quality of life: findings from a cluster randomised controlled trial in urban Bangladesh

ABSTRACT Background Maternal post-natal depression is a global public health problem. Parenting interventions targeting children’s development may also bring benefits to mothers, but few parenting interventions have been studied thoroughly. Objectives The study aimed to measure the effect of a parenting intervention using culturally appropriate and locally made toys, along with nutrition education and unconditional cash, on maternal depressive symptoms (MDS) and quality of life (QoL). Methods The study was a cluster randomised controlled trial with two arms: i) intervention: parenting with nutrition education and unconditional cash and ii) comparison: unconditional cash in an urban setting in Bangladesh. Twenty clusters were randomised to either the intervention or control group. Community Health Workers (CHWs) delivered parenting and nutrition education sessions fortnightly in households for one year. The participants were mother-child (6–16 months) dyads. The MDS and QoL were measured using the Self-Reporting Questionnaire-20 and a brief version of the QoL questionnaire. Linear regression analysis was used to assess the treatment effects. Results After one year of intervention, 547 mothers (93%) completed the study. The mothers in the intervention group had lower MDS [Regression coefficient (β)=-1.53, Confidence interval (95% CI)=-2.28, −0.80] and higher QoL scores in physical health [β = 4.21 (95% CI = 1.71, 6.73)], psychological health [β = 3.14 (95% CI = 1.10, 5.19)], social relationships [β = 3.21 (95% CI = 0.76, 5.66)] and environment [β = 3.40 (95% CI = 1.37, 5.44)] compared with the comparison group. Conclusion Parenting interventions including nutrition education and unconditional cash, aimed at improving children’s development, resulted in a reduction in maternal depressive symptoms and improvement in quality of life.

Sex differences in response to intranasal oxytocin as an adjunctive therapy for patients with severe mental illness

Studies investigating the potential benefits of intranasal oxytocin (INOT) as an add-on treatment for patients with severe mental illness (SMI) have yielded inconsistent results, potentially due to sex differences in response to INOT. This study explored the differential effects of INOT among male and female patients with SMI. A secondary analysis was conducted on a previously studied group of patients who participated in a double-blind, placebo-controlled trial evaluating the impact of INOT as an add-on treatment for patients with SMI. Patients treated in inpatient settings (N = 87) received twice-daily INOT (32IU) or placebo (PLC) for a period of four weeks. Sex moderated the effect of OT/PLC on the Hamilton Rating Scale for Depression (HRDS) (p < 0.001). A significant effect for sex was found in the Hopkins Symptom Checklist–short form (HSCL-11) (p = 0.04) and HRDS (p < 0.001), with females showing greater reductions in anxiety and depression symptoms and severity. This effect was not found for males. We conclude that the addition of INOT to the treatment of patients with SMI in an inpatient setting was beneficial for female patients, particularly reducing depressive symptoms, but not for male patients. Future studies should aim to identify patients who are more likely to benefit from INOT administration.

Evaluating attachment-based family therapy in residential treatment in the United States: does adolescents’ increased attachment security to caregivers lead to decreases in depressive symptoms?

BackgroundThe inclusion of family therapy in residential treatment centers (RTCs) has increased over time. However, there is little data on whether empirically-supported family therapies (ESFTs) are being adopted and if they contribute to treatment effectiveness. This study aimed to test whether Attachment-Based Family Therapy (ABFT), an ESFT integrated into a large residential psychiatric system, would improve perceived attachment insecurity (anxiety and avoidance) and contribute to decreases in depression for adolescents.MethodABFT was integrated into the clinical program of a large, residential psychiatric system. All family therapists were trained to a level of certification. Improvement was measured by changes in adolescent’s perceived attachment to caregivers and reduction in depressive symptoms. The sample included 4786 patients. Attachment insecurity and depressive symptoms were measured at intake, week 3, and week 5. A random-intercept, cross-lagged panel model was used to examine the relationships between attachment and depression over time.ResultsThe results generally supported hypotheses. Attachment insecurity and depressive symptoms improved over the five weeks of treatment. Improvements in attachment avoidance preceded improvements in depressive symptoms within subjects, over time. Simultaneously, improvements in depressive symptoms preceded those in both dimensions of attachment. Thus, improvement in perceived attachment was associated with a reduction in depressive symptoms.ConclusionRTCs that can generate improvements in attachment insecurity and depressive symptoms, via ABFT or other ESFTs, might improve treatment outcomes, and ideally, adolescents’ successful transition back home to families. More research is needed to disentangle the contribution of ABFT and other treatment elements in a multimodal, residential treatment program. The study supports the call for increased incorporation of families into the RTC treatment process.

Abstract 4137441: Online Cognitive Behavioral Therapy Targeting Psychological Distress Following Open Heart Surgery: An Uncontrolled Pilot Study

Background: Cardiac surgery is a significant procedure that reduces mortality and alleviates symptom burden in individuals with cardiovascular diseases. However, many patients develop depression and cardiac-related anxiety postoperatively, which negatively affects long-term prognosis and rehabilitation. There is a clinical need to develop scalable psychological treatments to mitigate these negative health effects. Objective: To investigate the feasibility and potential efficacy of a brief internet-delivered cognitive behavioral therapy (internet-CBT) intervention to reduce psychological distress in patients following cardiac surgery. Methods: The pilot study included 32 cardiac surgery patients (i.e., CABG, heart valve repair/replacement, aortic repair, or combined CABG and valve repair/replacement) with endorsed postoperative psychological distress and/or interference with daily life who underwent surgery from eight weeks to nine months prior to enrollment. Exclusion criteria included prior cardiac surgery with a ventricular assist device or heart transplant and severe medical or psychiatric illness. The internet-CBT targeted cardiac anxiety and depressive inactivity, lasted for five weeks, and was guided by clinical psychologists via text-based interactive online treatment modules. It included interoceptive exposure, in-vivo exposure, and behavioral activation. Self-assessments were completed at pre-treatment, post-treatment, and at 6-month follow-up. Results: Preliminary analyses post-treatment showed substantial pre-post improvements across multiple domains. Notable findings included significant reductions in depressive symptoms (Cohen’s d = 0.70; p = 0.04), cardiac anxiety (Cohen’s d = 1.53; p &lt; 0.001), and perceived severity of post-operative symptoms (Cohen’s d = 1.06; p = 0.006). Participants demonstrated high adherence to the treatment, with the large majority of participants completing all five treatment modules (83.3%). Satisfaction with the treatment was also high (25.5 points out of 32), as measured by the Client Satisfaction Questionnaire, and no adverse events were reported. Conclusion: This novel internet-CBT intervention post-cardiac surgery appears to be feasible, acceptable, and clinically promising in reducing postoperative psychological distress. It could be used as a viable adjunct treatment to enhance recovery post-cardiac surgery. These preliminary findings warrant further testing in a randomized controlled trial.

Evaluation of the Pregnancy to Parenthood program: A dyadic intervention for mothers with perinatal mental disorders and their infants.

Dyadic interventions targeting maternal mental health and the mother-infant relationship in the perinatal period are critical due to the potential consequences of perinatal mental illness and relational disturbance for the mother, the infant, and their family. This paper describes the Pregnancy to Parenthood (P2P) model of care, a dyadic mother-infant community-based program designed to support vulnerable families in Western Australia in the context of an identified need to build workforce capacity. A pragmatic service evaluation study was conducted by analyzing routine clinical data collected from 105 dyads who completed pre- and post-intervention measures, including the Edinburgh Postnatal Depression Scale (EPDS), Perinatal Anxiety Screening Scale (PASS), and the Mother Object Relations Scale-Short Form (MORS-SF). Reliable change index and cut-off analyses indicated a clinically reliable pre-post reduction in perinatal depressive and anxiety symptoms for 71% and 68% of the sample, respectively. Significant pre-post improvements with medium effect sizes (r=-.46, r=-.32) were found for caregiving representations on the MORS-SF, suggesting representations became more balanced. These results provide provisional evidence that the P2P model of care may be effective in improving maternal mental health and caregiving representations. Further research is required to evaluate the efficacy of P2P in relation to enhancing family well-being, and to inform policy and mental health service development.

Behavioral activation program for reducing depressive symptoms among the bereaved of cancer patients: A feasibility and preliminary effectiveness study in Japan.

This study aimed to examine the feasibility and preliminary effectiveness of a behavioral activation (BA) program for the bereaved of cancer patients toward reducing depressive symptoms. The BA program for the bereaved was a partially modified version for cancer patients. This program encompassed a preinterview and seven 50-minute sessions every 1-2 weeks, using worksheets, with homework assignments each day. To examine feasibility, the completion rates of intervention and 3 months of follow-up were examined. To examine the preliminary effectiveness, psychological symptoms were assessed with the Patient Health Questionnaire (PHQ-9; primary outcome) and Beck Depression Inventory-II (BDI-II) for depression and the Generalized Anxiety Disorder-7 (GAD-7) for anxiety. These were evaluated 3 times: before, immediately after, and 3-month post-intervention. Non-parametric tests were used for comparison of scores at 3 time points and calculation of effect size. Of the 42 bereaved who were contacted, 21 were eligible and 20 were participated, while 19 and 18 were in the completed intervention and completed 3-month post-intervention categories (intervention completion rate was 95% and follow-up completion rate was 90%). PHQ-9, BDI-II, and GAD-7 showed significant reductions immediately and 3 months after the intervention compared to pre-intervention, and the effect sizes were all large after 3 months, although they were less than immediately after (PHQ-9: 0.89, 0.71; BDI-II: 0.88, 0.67; GAD-7: 0.57, 0.53). This study indicated that the BA program for the bereaved of cancer patients was feasible and effective vis-à-vis reducing depressive symptoms.

Facilitating Thought Progression to Reduce Depressive Symptoms: Randomized Controlled Trial.

The constant rise in the prevalence of major depressive disorder calls for new, effective, and accessible interventions that can rapidly and effectively reach a wide range of audiences. Recent developments in the digital health domain suggest that dedicated online platforms may potentially address this gap. Focusing on targeting ruminative thought, a major symptomatic hallmark of depression, in this study we hypothesized that delivering a digital health-based intervention designed to systematically facilitate thought progression would substantially alleviate depression. The study aims to investigate the efficacy of a novel digital intervention on the reduction of depressive symptoms. This intervention was designed as an easy-to-use gamified app specifically aimed to facilitate thought progression through intense practicing of associative, semantically broad, fast, and creative thought patterns. A randomized clinical trial was conducted, comparing changes in depression symptoms between participants who used the app in the intervention group (n=74) and waitlist control group (n=27) over the course of 8 weeks. All participants filled out a battery of clinical questionnaires to assess the severity of depression at baseline and 4 and 8 weeks after starting the study. These primarily included the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Patient Health Questionnaire-9 as well as the Positive Affect Negative Affect Scale-Negative Affect Score, Ruminative Response Scale, and Symptoms of Depression Questionnaire. Additional questionnaires were implemented to assess anxiety, positive affect, anhedonia, and quality of life. The results indicate that across multiple clinical measurements, participants in the intervention group who played the gamified app showed greater and faster improvement in depressive symptoms compared with their waitlist control counterparts. The difference between the groups in MADRS improvement was -7.01 points (95% CI -10.72 to -3.29; P<.001; Cohen d=0.67). Furthermore, the difference in improvement between groups persisted up to 4 weeks posttrial (MADRS differences at week 12: F49,2=6.62; P=.003; ηp2=0.21). At the end of the trial, participants who played the app showed high interest in continuing using the app. The results demonstrate that a gamified app designed to facilitate thought progression is associated with improvement in depressive symptoms. Given its innovative and accessibility features, this gamified method aiming to facilitate thought progression may successfully complement traditional treatments for depression in the future, providing a safe and impactful way to enhance the lives of individuals experiencing depression and anxiety. ClinicalTrials.gov NCT05685758; https://clinicaltrials.gov/study/NCT05685758.