Reduction In Depressive Symptoms Research Articles

Resistance training and combined resistance and aerobic training as a treatment of depression and anxiety symptoms in young people: A systematic review and meta-analysis.

To determine the treatment effect of resistance training in reducing symptoms of anxiety and depression in young people. We searched MEDLINE, PsychINFO, and PubMed for articles published in English from January 1980 to September 2023 for randomized controlled trials (RCT) that included at least 4 weeks of resistance training, with participants aged 26 years or younger with clinically elevated anxiety and depression symptoms. A random-effects meta-analysis was used to calculate a pooled effect size of resistance training pre-and post-intervention compared to control groups. The quality of evidence was assessed using the Cochrane risk-of-bias 2 (RoB 2) and Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria. Ten RCTs involving 376 participants (209 females and 127 males) across educational, clinical, and community based setting were eligible for inclusion in the analysis. Resistance training was associated with a significant reduction in depressive (Hedge's g = -1.06, 95% CI -1.61 to -0.51, p < .001) and anxiety (Hedge's g = -1.02, 95% CI -1.50 to -0.54, p < .001) symptoms. Substantial heterogeneity was observed in the analysis of depression symptoms (I2 = 79%) and anxiety symptoms (I2 = 66%). Six trials had a low risk of bias, four trials showed some concerns. The GRADE analysis demonstrated a high level of certainty for depressive symptoms and a moderate level for anxiety symptoms. Resistance training is an effective intervention in reducing depression and anxiety symptoms in young people, delivered across a range of settings. Future trials exploring the effect resistance training interventions with long-term follow up are warranted to understand the outcomes.

Discovering the Potential Value of Coenzyme Q10 as an Adjuvant Treatment in Patients With Depression.

Depressive disorder or mental cold is the most common mental disorder, and depression exists all over the world and in all countries and cultures. The results of several studies have shown that using compounds with antioxidant properties has been fruitful in patients with depression. Coenzyme Q10 (CoQ10) is a fat-soluble antioxidant and exerts its antioxidant effect by directly neutralizing free radicals or reducing tocopherol and preventing the inhibition of mitochondrial activity because of oxidative stress. This study aimed to investigate the effects of oral CoQ10 in patients with depression as an adjunctive treatment. Sixty-nine patients with moderate and severe depression were randomly divided into 2 CoQ10 groups (36) and placebo (33). The first group of patients received CoQ10 supplements at a dose of 200 mg daily for 8 weeks along with standard interventions and treatments for depression, and the second group received standard treatments for depression along with a placebo. The change in the score of Montgomery-Åsberg Depression Rating Scale depression scale was evaluated 4 and 8 weeks after the intervention. Also, at baseline and 8 weeks later at the end of the study, serum levels of total antioxidant capacity, total thiol groups, nitric oxide, malondialdehyde, and interleukin 6 were assessed. The changes in the depression score at the end of the study showed that, in the group receiving the CoQ10 supplement after 8 weeks, there was a reduction in depression symptoms, which was statistically significant compared with before the start of the study Meanwhile, no significant changes were observed in the patients of the placebo group in terms of symptom reduction. Compared with baseline and the placebo condition, serum levels of nitric oxide and total thiol groups significantly decreased and increased, respectively. Also, no statistically significant changes were observed for interleukin 6, malondialdehyde, and total antioxidant capacity. A dose of 200 mg of CoQ10 supplement daily for 8 weeks can reduce depression and fatigue, as well as improve the quality of life of patients with depression. In addition, CoQ10 can significantly improve inflammation and oxidative stress status in patients with depression.

Mobile apps to reduce depressive symptoms and alcohol use in youth: A systematic review and meta-analysis: A systematic review.

Among youth, symptoms of depression, anxiety, and alcohol use are associated with considerable illness and disability. Youth face many personal and health system barriers in accessing mental health care. Mobile applications (apps) offer youth potentially accessible, scalable, and anonymous therapy and other support. Recent systematic reviews on apps to reduce mental health symptoms among youth have reported uncertain effectiveness, but analyses based on the type of app-delivered therapy are limited. We conducted this systematic review with youth co-researchers to ensure that this review addressed the questions that were most important to them. The objective of this review is to synthesize the best available evidence on the effectiveness of mobile apps for the reduction of depressive symptoms (depression, generalized anxiety, psychological distress) and alcohol use among youth. We conducted electronic searches of the following bibliographic databases for studies published between January 1, 2008, and July 1, 2022: MEDLINE (via Ovid), Embase (via Ovid), PsycINFO (via Ovid), CINAHL (via EBSCOHost), and CENTRAL (via the Cochrane Library). The search used a combination of indexed terms, free text words, and MeSH headings. We manually screened the references of relevant systematic reviews and included randomized controlled trials (RCTs)for additional eligible studies, and contacted authors for full reports of identified trial registries or protocols. We included RCTsconducted among youth aged 15-24 years from any setting. We did not exclude populations on the basis of gender, socioeconomic status, geographic location or other personal characteristics. We included studies which assessed the effectiveness of app-delivered mental health support or therapy interventions that targeted the management of depressive disorders and/or alcohol use disorders. We excluded apps that targeted general wellness, apps which focused on prevention of psychological disorders and apps that targeted bipolar disorder, psychosis, post-traumatic stress disorder,attention-deficit hyperactivity disorder,substance use disorders (aside from alcohol), and sleep disorders. Eligible comparisons included usual care, no intervention, wait-list control, alternative or controlled mobile applications. We included studies which reported outcomes on depressive symptoms, anxiety symptoms, alcohol use and psychological distress over any follow-up period. We standardized the PICO definitions (population, intervention, comparison, and outcome) of each included study and grouped studies by the type of therapy or support offered by the app. Whenever app design and clinical homogeneity allowed, we meta-analyzed outcomes using a random-effects model. Outcome data measured using categorical scales were synthesized using odds ratios. Outcome data measured using continuous scales were synthesized as the standardized mean difference. We assessed the methodological quality of each included study using the Cochrane Risk of Bias 2.0 tool and we assessed certainty of the evidence using the GRADE approach. From 5280 unique citations, we included 36 RCTs published in 37 reports and conducted in 15 different countries (7984 participants). Among the 36 included trials, we assessed two with an overall low risk of bias, 8 trials with some concern regarding risk of bias, and 26 trials with a high risk of bias. Interventions varied in the type of therapy or supports offered. The most common intervention designs employed mindfulness training, cognitive behavioral therapy (CBT), or a combination of the two (mindfulness + CBT). However, other interventions also included self-monitoring, medication reminders, cognitive bias modification or positive stimulation, dialectical behavioral therapy, gamified health promotion, or social skill building. Mindfulness apps led to short term improvements in depressive symptoms when compared to a withheld control (SMD = -0.36; 95%CI [-0.63, -0.10]; p = 0.007, n = 3 RCTs, GRADE: very low certainty) and when compared to an active control (SMD = -0.27; 95%CI [-0.53, -0.01]; p = 0.04, n = 2 RCTs, GRADE: very low). Apps delivering this type of support also significantly improved symptoms of anxiety when compared to a withheld control (SMD = -0.35; 95% CI [-0.60, -0.09]; p = 0.008, n = 3 RCTs, GRADE: very low) but not when compared to an active control (SMD = -0.24; 95% CI [-0.50, 0.02]; p = 0.07, n = 2 RCTs, GRADE: very low). Mindfulness apps showed improvements in psychological stress that approached statistical significance among participants receiving the mindfulness mobile apps compared to those in the withheld control (SMD = -0.27; 95% CI [-0.56, 0.03]; p = .07, n = 4 RCTs, GRADE: very low). CBT apps also led to short-term improvements in depressive symptoms when compared to a withheld control (SMD = -0.40; 95%CI [-0.80, 0.01]; p = 0.05, n = 2 RCTs, GRADE: very low) and when compared to an active control (SMD = -0.59; 95%CI [-0.98, -0.19]; p = 0.003, n = 2 RCTs, GRADE: very low). CBT-based apps also improved symptoms of anxiety compared to a withheld control (SMD = -0.51; 95%CI [-0.94, -0.09]; p = 0.02, n = 3 RCTs, GRADE: very low) but not when compared to an active control (SMD = -0.26; 95% CI [-1.11, 0.59]; p = 0.55, n = 3 RCTs, GRADE: very low). Apps which combined mindfulness and CBT did not significantly improve symptoms of depression (SMD = -0.20; 95%CI [-0.42, 0.02]; p = 0.07, n = 2 RCTs, GRADE: very low) or anxiety (SMD = -0.21; 95% CI [-0.49, 0.07]; p = 0.14, n = 2 RCTs, GRADE: very low). However, these apps did improve psychological distress (SMD = -0.43; 95% CI [-0.74, -0.12]; p = 0.006, n = 2 RCTs, GRADE: very low). The results of trials on apps to reduce alcohol use were inconsistent. We did not identify any harms associated with the use of apps to manage mental health concerns. All effectiveness results had a very low certainty of evidence rating using the GRADE approach, meaning that apps which deliver therapy or other mental health support may reduce symptoms of depression, anxiety and psychological distress but the evidence is very uncertain. We reviewed evidence from 36 trials conducted among youth. According to our meta-analyses, the evidence is very uncertain about the effect of apps on depression, anxiety, psychological distress, and alcohol use. Very few effects were interpreted to be of clinical importance. Most of the RCTs were small studies focusing on efficacy for youth at risk for depressive symptoms. Larger trials are needed to evaluate effectiveness and allow for further analysis of subgroup differences. Longer trials are also needed to better estimate the clinical importance of these apps over the long term.

Behavioral activation for depression in groups embedded in psychosomatic rehabilitation inpatient treatment: a quasi-randomized controlled study

BackgroundBehavioral activation (BA) and cognitive-behavioral therapy (CBT) have shown to be efficacious treatment methods for depression. Previous studies focused mostly on the outpatient treatment either in group or individual setting. The present study aimed at comparing the efficacy of group treatment BA vs. CBT, when embedded in inpatient psychosomatic rehabilitation treatment.Methods375 inpatients were randomly assigned to either BA (N = 174) or CBT (N = 201). We used established scales for depression such as the Beck Depression Inventory II (BDI-II, self-rating), the Quick Inventory of Depressive Symptomatology (QIDS; expert rating) and the Behavioral Activation for Depression Scale (BADS) to assess changes over the course of the treatment and at follow-up (4 to 6 months). In addition, we measured disability-related functioning with the Mini-ICF-APP, a rating scale built in reference to the International Classification of Functioning, Disability and Health (ICF). Multilevel models with repeated measures were conducted to examine the differences between groups in relation to change over time with patients’ random effects.ResultsBoth group formats showed substantial reduction in depressive symptoms at the end of treatment (d= 0.83 BA vs. d= 1.08 CBT; BDI-II) and at follow-up after 4 to 6 months (d = 0.97 BA vs. d = 1.33 CBT, BDI-II; and d = 1.17 BA vs. d = 1.09 CBT, QIDS). There were no significant differences between treatment approaches. At least 50% symptom reduction was achieved by 53.7% and 54.2% in BA vs. CBT respectively. Reported activation levels increased from pre- to posttreatment (d = 0.76 BA vs. d = 0.70CBT), while showing loss of increment between the end of the treatment until follow up in both formats (d = 0.28 BA vs. d = 0.29 CBT).DiscussionBoth modalities led to significant improvement of symptomatology and functioning at the end of the treatment and at follow-up, thus for the first time demonstrating the practicability of BA in rehabilitation clinics. Considering its lower requirements regarding cognitive abilities and its easier implementation, BA proved to be a good alternative to other psychotherapeutic treatments.

Longitudinal Associations Between Physical Activity and Depressive Symptoms in Chinese Children: Evidence from the Tongji Mental Health Cohort Study.

We aimed to examine the associations between depressive symptoms and physical activity parameters (e.g., intensity, frequency, and duration) among Chinese school-aged children. Participants in this study were extracted from the Tongji Mental Health Cohort Study. The baseline survey was conducted in June 2020 involving 2588 school-aged children from two primary schools in Hubei Province, China. A total of 2435 children were followed up successfully in December 2020. The Children's Depression Inventory Short Form (CDI-S) was applied to evaluate depressive symptoms among school-aged children. The Physical Activity Rating Scale-3 (PARS-3) was adopted to estimate children's physical activity parameters including the intensity, frequency, and duration. Generalized estimation equation models were used to explore the longitudinal associations between physical activity and depressive symptoms among school-aged children. Engaging in moderate levels of physical activity (OR, 0.800; 95%CI, 0.692-0.924) or high levels of physical activity (OR, 0.808; 95%CI, 0.689-0.947) in the baseline survey was associated with a reduced risk of developing depressive symptoms in the follow-up survey compared with children engaging in low levels of physical activity. Stratified analyses revealed that the associations between physical activity and depressive symptoms exhibited a significant correlation among boys and children in the older age group (11-12years). Our findings showed that engaging in physical activity more than once a week, with each session lasting 20min or longer, was related to significant reductions in depressive symptoms by 43.8% and 22.3%, respectively. Self-reported physical activity is positively associated with improved mental health among Chinese school-aged children, especially when considering parameters such as frequency and duration. The association between vigorous-intensity physical activity and depressive symptoms in children should be cautiously interpreted. Future research should continue to explore the effects of vigorous-intensity physical activity on depressive symptoms in children.

Comparing changes in eating disorder psychopathology and comorbid symptoms over treatment in anorexia nervosa and atypical anorexia nervosa in a partial hospitalization program.

The objective of this study is to compare treatment trajectories in anorexia nervosa (AN) and atypical AN. Adolescents and adults with AN (n = 319) or atypical AN (n = 67) in a partial hospitalization program (PHP) completed diagnostic interviews and self-report questionnaires measuring eating disorder (ED), depression, and anxiety symptoms throughout treatment. Premorbid weight loss did not differ between diagnoses. Individuals with atypical AN had more comorbid diagnoses, but groups did not differ on specific diagnoses. ED psychopathology and comorbid symptoms of depression/anxiety did not differ at admission between groups nor did rate of change in ED psychopathology and comorbid symptoms of depression/anxiety from admission to 1-month. From admission to discharge, individuals with atypical AN had a faster reduction in ED psychopathology and comorbid symptoms of depression and anxiety (ps < 0.05; rs = 0.01-0.32); however, there were no group differences in ED psychopathology or depression symptoms at discharge (ps>.50; ds = .01-.30). Individuals with atypical AN had lower anxiety at discharge compared to individuals with AN (p = 0.05; d = .4). Length of stay did not differ between groups (p = 0.11; d = .21). Groups had similar ED treatment trajectories, suggesting more similarities than differences. PHP may also be effective for AAN. This study supports previous research that individuals with AN and atypical AN have more similarities than differences. Results from this study indicate that individuals with AN and atypical AN have similar treatment outcomes for both ED psychopathology and depressive symptoms; however, individuals with atypical AN have lower anxiety symptoms at discharge compared to individuals with AN. AN and atypical AN also have more symptom similarity at admission and throughout treatment, which challenges their current designation as distinct disorders.

A Service‐Led Pragmatic Evaluation of Family Foundations Targeting the Reduction of Perinatal Parent Mental Health Difficulties and Family Conflict in Australia

ABSTRACTA service‐led evaluation of home‐based Family Foundations (FF), a perinatal intervention targeting interparental conflict and mental health difficulties, was conducted in Melbourne, Australia. The aims were to assess (a) pre–post intervention changes, (b) parent satisfaction and (c) intervention fidelity. Participants included 288 families who completed self‐report surveys, and FF clinicians who completed fidelity checklists. Approximately 78% of families who commenced FF completed all 10 sessions. High parent satisfaction and intervention fidelity were reported. For Parent 1s (primarily mothers), there were reductions in symptoms of depression, anxiety and stress, interparental conflict and parenting hostility and increases in co‐parenting support, parenting warmth and parenting self‐efficacy—all associated with small effect sizes. For Parent 2s (primarily fathers), there were reductions in interparental conflict and parenting hostility and an increase in parenting self‐efficacy—also associated with small effect sizes. These findings provide a platform for comprehensive and robust long‐term evaluations of home‐based FF in the future.

Subcutaneous ketamine reduces suicide risk and improves functioning in depression: A proof-of-concept study

This investigation explores the efficacy of subcutaneous ketamine for mitigating depressive symptoms and suicidal ideation, addressing a crucial need for rapid-onset treatments in severe depression cases. It introduces an innovative approach to administering an NMDA receptor antagonist, significantly advancing psychopharmacological methods for treating suicidal behaviors as distinct entities, even within depressive episodes. The study's objective is to assess the impact of subcutaneous ketamine on diminishing suicidal thoughts and mood symptoms during depressive episodes through a naturalistic, prospective observational design. Conducted at Hospital de Clínicas de Porto Alegre, Brazil, between 2021 and 2023, the study involved 26 patients undergoing a current depressive episode. Of these, 23 completed the acute phase of treatment, and 18 were followed up for 6 months. The treatment regimen commenced with a ketamine dose of 0.5 mg/kg, which was adjusted according to individual responses under psychiatric supervision. The findings revealed substantial decreases in Columbia Suicide Severity Rating Scale scores following multiple ketamine sessions, with most patients achieving remission after approximately eight sessions. A notable reduction in depressive symptoms was also observed. A clear dose-response relationship was established, indicating that higher doses of ketamine were associated with more significant improvements in depressive symptoms, suicidal ideation, and overall functionality. Follow-up assessments suggested that these improvements were sustained over time. The subcutaneous administration of ketamine was generally well-tolerated, with minor and short-lived side effects. The study posits that subcutaneous ketamine may present a promising solution for treating severe depression accompanied by suicidal tendencies, particularly considering its positive influence on patient functionality and well-being. This method could offer a cost-effective and accessible treatment alternative, especially relevant in settings with limited resources. Given its potential in reducing long-term disability and economic viability, the study advocates for its broader application and further validation through larger, controlled trials.Trial Registration: ClinicalTrials.gov NCT05249309.

Client predictors of dropouts and outcomes in psychotherapy for generalized anxiety disorder: an exploratory study

ABSTRACT This study is a secondary analysis exploring client predictors of dropouts and outcomes in the treatment of generalized anxiety disorder (GAD). Data was taken from a feasibility randomized control trial (RCT) exploring the relative efficacy of emotion-focused therapy (EFT) compared with cognitive-behavioral therapy (CBT). Relationships between client characteristics and dropouts were explored using logistic regression analysis. Relationships between client characteristics and psychotherapy outcomes were explored using hierarchical linear regression analyses. For the full dataset (n = 58), a comorbid personality disorder predicted a higher number of dropouts. Eleven participants dropped out of therapy. Having a disability predicted less improvement in symptoms of depression and general distress. Being male-identified predicted a greater reduction in symptoms of anxiety and general distress, and comorbid agoraphobia predicted a greater reduction in symptoms of depression for the CBT condition (n = 21 completers). For the EFT condition (n = 26 completers), being older predicted greater improvements in symptoms of anxiety and comorbid panic disorder predicted a lower reduction in symptoms of depression. Caution should be taken in interpreting these findings given the small number of participants. However, they provide useful insights for the generation of hypotheses in relation to predictors of dropouts and outcomes for future studies.

Exploring the Relationship of Leisure Travel with Loneliness, Depression, and Cognitive Function in Older Adults.

Loneliness, depression, and cognitive decline are pressing concerns among older adults. This study examines the association between leisure travel participation and these health outcomes in older adults, aiming to provide further evidence of the benefits of leisure travel. Using nationally representative historical data from the 2006 household survey of the Health and Retirement Study, this study conducted a series of regression analyses to investigate the relationship between traveling and the three health outcomes, adjusting for age, sex, race, marital status, education, total wealth, annual income, and difficulty with daily activities. The results reveal that travel patterns in terms of distance are significantly associated with loneliness, depression, and cognitive function. Long-distance travel is positively related to higher cognitive function and a reduction in depressive symptoms, along with lower levels of loneliness, reinforcing the notion that leisure travel can potentially act as a catalyst for improved cognitive and mental health by offering opportunities for enhancing social connections and forming new relationships. The findings on the relationships between participation in leisure travel and mental and cognitive health contribute to the body of evidence supporting the therapeutic value of leisure travel in promoting healthy aging and enhancing the overall well-being in older adults.

Adherence to the Mediterranean Diet in Saudi Arabia and Its Association with Socioeconomic Status and Depression.

Background and Objectives: Several RCTs have reported significant reductions in depression symptoms with the Mediterranean diet (MedDiet), but observational studies have reported inconsistent findings. Moreover, studies have rarely investigated the mediating role of socioeconomic status (SES), including objective material status, in adherence to the MedDiet and its impact on depressive symptoms in the same population. Therefore, this cross-sectional study investigated the relationship between adherence to the MedDiet, socioeconomic factors, and depression severity. Materials and Methods: A cross-sectional online survey was conducted between June and December 2022 across Saudia Arabia. The snowball sampling technique was used to recruit participants aged ≥18 years. Mediterranean diet adherence screener (MEDAS) and Patient Health Questionnaire-9 (PHQ-9) were used to assess adherence to the MedDiet and depression severity. An SES index, validated in the Saudi Arabian context, was used to assess SES. The data were analyzed using the Chi-square and Pearson's correlation tests. Results: Only 21% of our study population (n = 467) was MedDiet adherent. Adherence was significantly associated with education (p = 0.014) but not employment status among traditional SES indicators. Similarly, only television ownership (p = 0.009) was associated with MedDiet adherence among the 20 objective material possessions investigated. Nonetheless, the MedDiet-adherent group had a significantly lower PHQ-9 score than the non-adherent group (6.16 ± 0.68 vs. 8.35 ± 0.31, p = 0.002). A moderate but significantly negative correlation between MEDAS and PHQ-9 scores (r = -0.16, p = 0.001) was noted. Conclusions: MedDiet adherence was associated with lower depression severity scores. In addition to education and television ownership, adherence was not associated with any objective indicators of SES.

Comparison of changes in stress coping strategies between cognitive behavioral therapy and pharmacotherapy.

Coping refers to conscious responses to negative circumstances, with the intention of ameliorating these situations. Few studies have compared the differences between psychotherapy and medication treatment for coping strategies for depression. In this study, we investigated the differences in coping strategies between cognitive behavioral therapy (CBT) combined with medication (CBT group) and medication alone (pharmacotherapy group) among outpatients with depression. A prospective observational study was conducted among 50 patients with major depression (24 and 26 in the CBT and pharmacotherapy groups, respectively). Stress coping strategies (Coping Inventory for Stressful Situations [CISS]) and depression severity (Beck Depression Inventory-Second Edition [BDI-II]) were assessed at baseline and 16 weeks later. Changes in the CISS and BDI-II scores in both groups were tested using repeated analysis of variance. Inverse probability weighting with propensity score analysis was applied to address potential selection bias. At 16 weeks, the CBT group exhibited increased CISS task-oriented coping, distraction, and social diversion scores, which differed from those of the pharmacotherapy group. The CBT group exhibited a significantly greater reduction in depressive symptoms than the pharmacotherapy group. This study was not a randomized controlled trial and thus may have selection bias. Gaining adaptive coping skills, including task-oriented coping, distraction, and social diversion skills, by combining CBT with medication may lead to greater improvement in depression symptoms. These findings suggest that clinicians should evaluate coping strategies and facilitate the acquisition of adaptive coping strategies in patients with depression to reduce their symptoms.

Is behavioural activation an effective treatment for depression in children and adolescents? An updated systematic review and meta-analysis.

Behavioural Activation (BA)-a brief therapy based on the scheduling of enjoyable, purposeful and rewarding activities-is an effective and cost-effective treatment for depression in adults that shows promise for children and adolescents. We provide an update on a previous systematic review of evidence on BA-delivered in-person, telephone, or online-for depression and comorbid anxiety in children and adolescents.We conducted systematic literature searches in 6 databases up to February 2024. We included all study designs evaluating BA with participants up to 18years old with diagnosable depression, as established by a validated screening tool or diagnostic manual. We used the Moncrieff Scale and the Cochrane Risk of Bias tool to assess study quality. We summarised the findings of all study types with a narrative synthesis and of randomised controlled trials (RCTs) with a meta-analysis.Overall, 24 studies (6 RCTs, 18 pre-post evaluations, n = 2,758) met our inclusion criteria. A meta-analysis of 4 RCTs (n = 156) showed that BA has a small effect of 0.24 (Hedge's adjusted g) in reducing depression symptoms compared to a waiting-list control, usual care and other therapies. Online and telephone-facilitated BA was shown to be feasible in 3 studies and effective in 1. Outcomes on comorbid anxiety were mixed. No economic evaluations met our inclusion criteria.BA shows sufficient promise as an intervention for reducing depression symptoms in children and adolescents to justify the need for further RCTs, providing that five conditions are met: studies are powered to detect a minimal clinically important difference; BA materials are fit-for-purpose to produce clinically meaningful change; follow-ups are longer than 6months; primary outcomes are child-reported; and intervention costs, resource use and adverse events are reported.

Outcomes of transdiagnostic internet-delivered cognitive behavioural therapy tailored to public safety personnel: A longitudinal observational study

First responders and other public safety personnel (PSP) experience high rates of mental health problems and face barriers to accessing mental healthcare. Internet-delivered cognitive behavioural therapy (ICBT) is an effective and accessible treatment for various mental health concerns. Canadian PSP report favorable attitudes toward ICBT, and preliminary outcomes demonstrate that they benefit from it. Expanding on this research, the current study consisted of a longitudinal observational study of 560 Canadian PSP who participated in ICBT. It was designed to assess the longer term effectiveness of ICBT and moderators of outcomes by gender, linguistic and occupational group, and years of occupational experience. We evaluated symptom change at 8, 26, and 52 weeks post-enrollment, and results among PSP who had elevated clinical scores, showed large reductions (Hedges’ g) in symptoms of depression (g = 1.3), anxiety (g =1.48), posttraumatic stress (g =1.24), panic (g =1.19), and anger (g =1.07) and moderate reductions in symptoms of social anxiety (g =.48–.56). Moderator analyses revealed modest differences in pre-treatment symptoms among certain groups but no group differences in symptom change over time. Clients showed good completion of treatment materials and reported high treatment satisfaction. The results suggest further study of ICBT tailored to PSP is warranted, including evaluating ICBT tailored for PSP in other countries.

A Randomized Evaluation of MoodFX, a Patient-Centred e-Health Tool to Support Outcome Measurement for Depression: Une évaluation randomisée de MoodFX, un outil de santé en ligne centré sur le patient pour soutenir la mesure du résultat dans la dépression.

e-Health tools using validated questionnaires to assess outcomes may facilitate measurement-based care for psychiatric disorders. MoodFX was created as a free online symptom tracker to support patients for outcome measurement in their depression treatment. We conducted a pilot randomized evaluation to examine its usability, and clinical utility. Patients presenting with a major depressive episode (within a major depressive or bipolar disorder) were randomly assigned to receive either MoodFX or a health information website as the intervention and control condition, respectively, with follow-up assessment surveys conducted online at baseline, 8 weeks and 6 months. The primary usability outcomes included the percentage of patients with self-reported use of MoodFX 3 or more times during follow up (indicating minimally adequate usage) and usability measures based on the System Usability Scale (SUS). Secondary clinical outcomes included the Quick Inventory of Depressive Symptomatology, Self-Rated (QIDS-SR) and Patient Health Questionnaire (PHQ-9). Forty-nine participants were randomized (24 to MoodFX and 25 to the control condition). Of the 23 participants randomized to MoodFX who completed the user survey, 18 (78%) used MoodFX 3 or more times over the 6 months of the study. The mean SUS score of 72.7 (65th-69th percentile) represents good usability. Compared to the control group, the MoodFX group had significantly better improvement on QIDS-SR and PHQ-9 scores, with large effect sizes and higher response rates at 6 months. There were no differences between conditions on other secondary outcomes such as functioning and quality of life. MoodFX demonstrated good usability and was associated with reduction in depressive symptoms. This pilot study supports the use of digital tools in depression treatment.

Effect of Depression Interventions in Patients Undergoing Total Joint Arthroplasty Without a Formal Diagnosis of Depression: A Systematic Review

Purpose: Depression is a notable contributor to suboptimal outcomes after total joint arthroplasty (TJA). We conducted a systematic review of comparative studies to review the available evidence of interventions that affected depression scores and/or outcomes for patients undergoing TJA. Methods: EMBASE, Ovid MEDLINE, PubMed, and Scopus were reviewed systematically from inception until November 15, 2022. Studies that were relevant for this review included comparative studies between patients who received an intervention within 3 months before or after their primary total hip or knee arthroplasty procedure. The interventions included a wide range of modalities, which were grouped into psychotherapy, enhanced perioperative support, and pharmacotherapy. Other interventions included physiotherapy techniques with a psychological focus, art/music-based therapy, occupational therapy support, and educational interventions. Meta-analysis was conducted for psychotherapy and enhanced support. Results: The final systematic review consisted of 28 relevant studies, most of which were randomized controlled trials. A total of 3,702 patients, with a mean age of 66 years, were considered, of whom 59% were female. Most of the studies reported a notable reduction in depressive symptoms and/or scores based on the interventions being analyzed. At 3 months postoperatively, psychotherapy and enhanced support both resulted in markedly better depression and function scores compared with control subjects, with psychotherapy additionally improving pain scores. Conclusions: Overall, a wide range of interventions aimed at psychological optimization of patients undergoing TJA can improve depressive symptoms, pain, and function, even in the absence of a formal diagnosis of depression. Specifically, cognitive-based psychotherapy and enhanced perioperative support had the best evidence. Routine pharmacotherapy plays a limited role, if any, in the care of TJA. Additional efforts to develop pragmatic, evidence-based, and reproducible interventions are warranted to continue to optimize outcomes in TJA patients.

Quality of Life and Depression Symptoms After Therapy De-Escalation in HPV+ Oropharyngeal Squamous Cell Carcinoma

Despite interest in therapy de-escalation for survivors of human papillomavirus-mediated oropharyngeal squamous cell carcinoma (HPV-positive OPSCC), the association of de-escalated therapy with patient-reported quality of life (QoL) outcomes and burden of depressive symptoms remains unclear. To identify associations between clinicopathologic and therapeutic variables with patient-reported QoL outcomes and depression symptom burden in patients with HPV-positive OPSCC, who were enrolled in a therapy de-escalation trial. In this nonrandomized controlled, open-label, curative-intent therapy de-escalation clinical trial in adults with stage I, II, and III HPV-positive OPSCC, patients were recruited from a high-volume head and neck oncology practice. The main outcomes of this study included quantitative, patient-reported QoL and depression symptoms per well-validated inventories. Patient-reported QoL was based on Functional Assessment of Cancer Therapy-Head & Neck (FACT-HN) scores (range, 0-148; lower score indicates inferior QoL). Patient-reported depression-related symptom burden was based on Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) scores (range, 0-27; a higher score indicates a higher burden of depression symptoms). Baseline clinicopathologic and treatment variables were paired with FACT-HN and QIDS-SR scores at baseline, 3, 6, 12, 24, and 36 months. Linear mixed-effect models with a random intercept were used for each participant and fixed effects for other measures. Regression coefficients are reported with 95% CIs. A total of 95 patients were followed up for a median (IQR) of 2.2 (1.6-3.2) years. Of these, 93 patients (98%) were male with a mean (SD) age of 60.5 (8.2) years. Overall, 54 participants (57%) had a history of current or former smoking, 47 (50%) underwent curative-intent surgery (with or without adjuvant therapy), and 48 (50%) underwent primary radiotherapy (with or without chemotherapy). The median (IQR) radiotherapy dose was 60 (60-70) Gy. Five deaths and 2 recurrence events were observed (mean [SD] recurrence interval, 1.4 [1.5] years). A higher radiotherapy dose was the only modifiable factor associated with inferior patient-reported QoL (lower FACT-HN) (coefficient, -0.66 [95% CI, -1.09 to -0.23]) and greater burden of depression-related symptoms (higher QIDS-SR) (coefficient, 0.11 [95% CI, 0.04-0.19]). With the 70-Gy dose as reference, improvements in FACT-HN and QIDS-SR scores were identified when patients received 51 to 60 Gy (coefficient, 12.75 [95% CI, 4.58-20.92] and -2.17 [-3.49 to -0.85], respectively) and 50 Gy or lower (coefficient, 15.03 [4.36-25.69] and -2.80 [-4.55 to -1.04]). In this nonrandomized controlled, open-label, curative-intent therapy de-escalation trial, a higher radiotherapy dose was associated with inferior patient-reported QoL and a greater burden of depression-related symptoms. This suggests opportunities for improved QoL outcomes and reduced depression symptom burden with a reduction in radiotherapy dose. ClinicalTrials.gov Identifier: NCT04638465.

Emotion Regulation as a Mechanism of Mindfulness in Individual Cognitive-Behavioral Therapy for Depression and Anxiety Disorders

Background. The global prevalence of depression and anxiety disorders underscores the need for a more profound comprehension of effective treatments. Mindfulness has shown promise in enhancing treatment outcomes and preventing relapse in these conditions, but the underlying mechanisms remain poorly understood. Methods. This study examined the role of emotion regulation as a mediator in the relationship between changes in mindfulness and the reduction of depression and anxiety symptoms during individual cognitive-behavioral therapy (CBT). We tracked longitudinal changes in mindfulness, emotion regulation, depression, and anxiety at baseline (pre), early treatment (session 5), midtreatment (session 15), and posttreatment (session 25) in 162 patients with depression and anxiety disorders. Further, we examined whether the effects of mindfulness on emotion regulation could be enhanced by introducing a brief mindfulness intervention at the beginning of each CBT session, as compared to progressive muscle relaxation and individual psychotherapy without any standardized session-introducing interventions. Results. Multilevel structural equation modeling indicated that decreases in rumination and increases in reappraisal and acceptance mediated the relationship between mindfulness and reductions in depressive symptoms. In contrast, reductions in avoidance explained the association between mindfulness and changes in anxiety symptoms. These links remained unchanged when adding a mindfulness intervention into individual CBT. Conclusion. Results support emotion regulatory properties of mindfulness and highlight distinct pathways of symptom reduction in depression and anxiety. These findings have important implications for understanding the mechanisms of mindfulness and tailoring treatment to individual patient needs. This trial is registered with NTC02270073.

275 Cultural Adaptation and Implementation of Cognitive Behavior Therapy in a Rural Mental Health Clinic of Puerto Rico

OBJECTIVES/GOALS: Culturally Centered Cognitive-Behavioral Therapy (CCCBT) is a therapeutic approach that acknowledges the effect of cultural values, beliefs, and norms on mental health. Study aims to develop a CCCBT for rural community by enhancing engagement, relevance, and outcomes through culturally tailored interventions, and evaluate its implementation. METHODS/STUDY POPULATION: Diverse mixed methods study with participants ages 18-65 from Partial Hospitalization Program in rural community located in Puerto Rico Mountain region. CCCBT intervention will have a span of 9 consecutive bi-weekly sessions. The study consists of 2 phases: 1. Evaluate intervention acceptability through focus groups (n=12) with repeated measures to learn about enhancing mental health outcomes, 2. Measure intervention effectiveness in reducing mild-moderate depression and anxiety symptoms using validated questionnaires (PHQ-9 and GAD-7) with a 100 participants from same region. Descriptive analysis for sociodemographic characteristics will be used to provide overview of participants characteristics. Qualitative analysis of focus groups will be obtained through feedback and content analysis. RESULTS/ANTICIPATED RESULTS: We anticipate high intervention acceptability through positive participant feedback and cultural relevance feedback from focal groups. We expect to find significant reduction in symptoms of depression and anxiety post-intervention, demonstrating the efficacy of CCCBT in Puerto Rican rural communities. These results will support the feasibility of implementing this approach, addressing mental health disparities, and enhancing treatment engagement and outcomes in underserved populations. The study will inform future research to refine and expand this intervention in rural communities of Hispanics and/or other rural underserved populations in the US. DISCUSSION/SIGNIFICANCE: This study’s success will advance culturally tailored mental health care in underserved rural Puerto Rican communities, reducing disparities and enhancing treatment relevance and engagement, with potential implications for improving mental health outcomes in similar populations in the US and worldwide.

All in the Family: Does Grandparenting Impact Chinese Grandparents’ Depressive Symptoms?

Grandparenting is becoming increasingly prevalent worldwide, especially in Chinese society. However, the impact of grandparenting on older adults’ health remains unclear. This study examined whether and how grandparenting is associated with depressive symptoms in Chinese older adults and the role of intergenerational support (i.e., financial, emotional, and instrumental support) in this relationship. Using data from the China Longitudinal Aging Social Survey (CLASS) 2018 wave, the researchers employed multivariate linear regression models to investigate variations in depressive symptoms and their associations with grandparenting; the role of intergenerational support was also explored. The results indicated that older adults who engage in grandparenting, particularly in non-intensive care, experience a reduction in depressive symptoms, even after accounting for sociodemographic and health-related factors. Overall, intergenerational support plays a mediating role in the relationship between grandparenting and associated mental health outcomes. Bidirectional emotional and financial support and receiving instrumental support were associated with lower depressive symptoms among Chinese grandparents. In general, the findings of this study suggest that grandparenting, along with intergenerational support, provides certain protective health benefits for Chinese grandparents. With rapid changes in Chinese society, further prospective longitudinal studies are needed to examine family contexts in the relationship between grandchild caregiving and associated health outcomes.