Reduction In Depressive Symptoms Research Articles

Testing the Effectiveness of a Mobile Smartphone App Designed to Improve the Mental Health of Junior Physicians: Protocol for a Randomized Controlled Trial

Background Shift (Black Dog Institute) is the first mobile health smartphone app created to support the mental health of junior physicians. Junior physicians experience demanding work conditions, leading to high levels of psychological distress and burnout. However, they are often concerned about the potential career impacts of seeking mental health support. The confidentiality and ease of access of digital interventions may be particularly suited to address these concerns. The Shift app provides therapeutic and psychoeducational content and strategies contextualized for the specific needs of physicians in training. App content includes information on mental health, help seeking, mindfulness, and common workplace-related concerns of junior physicians. Objective This study aims to test, at scale, the effectiveness of Shift among junior physicians working in Australia using a randomized controlled trial design. The primary aim is to examine whether junior physicians using Shift experience a reduction in depressive symptoms compared with a waitlist control group. The secondary aim is to examine whether the app intervention group experiences improvements in anxiety, work and social functioning, help seeking, quality of life, and burnout compared with the control group. Methods A total of 778 junior physicians were recruited over the internet through government and nongovernment medical organizations across Australia, as well as through paid social media advertisements. They were randomly allocated to one of 2 groups: (1) the intervention group, who were asked to use the Shift app for a period of 30 days, or (2) the waitlist control group, who were placed on a waitlist and were asked to use the app after 3 months. Participants completed psychometric measures for self-assessing mental health and wellbeing outcomes, with assessments occurring at baseline, 1 month after completing the baseline period, and 3 months after completing the baseline period. Participants in the waitlist control group were asked to complete an additional web-based questionnaire 1 month after receiving access to the app or 4 months after completing the baseline survey. Participants took part in the study on the internet; the study was completely automated. Results The study was funded from November 2022 to December 2024 by the New South Wales Ministry of Health. Data collection for the study occurred between January and August 2024, with 780 participants enrolling in the study during this time. Data analysis is underway; the effectiveness of the intervention will be estimated on an intention-to-treat basis using a mixed-model, repeated measures analysis. Results are expected to be submitted for publication in 2025. Conclusions To the best of our knowledge, this is the first randomized controlled trial to examine the effectiveness of a mobile health smartphone app specifically designed to support the mental health of junior physicians. Trial Registration Australia and New Zealand Clinical Trials Registry ACTRN12623000664640; https://tinyurl.com/7xt24dhk International Registered Report Identifier (IRRID) DERR1-10.2196/58288

The efficacy of mobile applications for reducing depression in adolescents and young adults: A meta-analysis of randomized control trials.

Mobile applications for mental health have the potential to aid people with mental health disorders, especially depression, by providing them with tools and coping mechanisms. Adolescents and young adults, being at risk of depressive symptoms and leading mobile users, are among the main targets of using mobile applications to alleviate symptoms. This study aimed to evaluate the impact of mobile application-based psychological interventions in reducing depression symptoms in adolescents and young adults compared to those not exposed to the intervention. We conducted a meta-analysis focusing on mobile applications for reducing depressive symptoms. We searched two databases: MEDLINE and EMBASE and included randomized controlled trials conducted in English among participants aged 18-35 years old who were assessed for depressive symptoms using a validated screening measure and used mobile applications-based psychological interventions. Two of six independent reviewers conducted study selection, data extraction, and bias assessment. A pooled mean standardized difference (Cohen's d) and 95% CI were calculated using random-effects meta-analysis. Risk of bias was assessed using I2 statistics and forest plot. Egger's test was used for assessing publication bias. After screening 740 references, we identified 12 trials with 1869 participants, with a mean age of participants ranging from 14.70 to 25.1 years. The interventions ranged from cognitive behavioral therapy (CBT)-based mobile apps to interactive story-telling apps and apps delivering a mix of CBT, interpersonal psychotherapy for adolescents, and dialectical behavior therapy elements. Control groups included information-only, waitlist, no intervention, and treatment as usual. Seven studies used Patient Health Questionnaire-9 (PHQ-9) to assess the severity of depressive symptoms, while the other five used different scales. There was no evidence of publication bias (p = 0.325). The mobile applications reduced depression score by 0.08 units of standardized difference more than the control, with a 95% CI of -0.19 to 0.03 (p = 0.294, I2 = 15.4%) using standardized mean difference (SMD) as the effect estimate. In a sensitivity analysis including only studies that used PHQ-9, we found a similar trend, SMD -0.72 (95%CI -1.48 to 0.03). However, both findings were not significant. Current evidence is insufficient to support mobile applications to relieve depression symptoms in adolescents and young adults. Further trials with larger sample size are needed to confirm our findings of a positive trend. With emerging technologies and the high exposure of apps in this population, mobile applications for depression hold promise for the future of treatment and awareness of mental health disorders in this population.

Buprenorphine for the Treatment of Military-related PTSD With Treatment-resistant Depression and Unexpected Benefit for Chronic Pain: Case Report.

The prevalence of treatment-resistant depression within global and military populations highlights the need for novel treatment approaches beyond monoamine neurotransmitter modulators. Buprenorphine (BUP), a semi-synthetic partial opioid agonist, is approved for the treatment of opioid use disorder and has shown promise in treating both depression and chronic pain. This case report discusses the use of transdermal BUP in treating a 36 year-old man with treatment-resistant depression with prominent anhedonia, military-related posttraumatic stress disorder, and chronic pain because of barosinusitis. Significant reductions in anxious and depressive symptoms, including in anhedonia, were observed with lasting effects. An unexpected finding was the discontinuation of prescribed hydromorphone for pain, suggesting the potential unique benefit of BUP in treating chronic pain and treatment resistant depression comorbidities. These findings implicate the diverse beneficial potential of BUP in psychiatric treatments for military populations.

A - 24 Treatment Response to Internet-Delivered Cognitive Behavioral Therapy for Depression in Multiple Sclerosis

Abstract Objective A recent randomized-controlled (phase III) clinical trial examined the efficacy of an internet-delivered cognitive behavioral therapy (iCBT) intervention designed to treat depressive symptoms in persons with multiple sclerosis (PwMS). Significant mean reductions in depressive symptoms were found in the stand-alone iCBT and guided-iCBT conditions compared to the control group. The purpose of the current study was to identify the proportion of PwMS who responded to iCBT (stand-alone and guided) for depression compared to a waitlist control group. Method 224 PwMS completed the Beck Depression Inventory-II (BDI-II) to measure depression severity at baseline and post-intervention. Reliable change index (RCI) scores for depressive symptoms were calculated for each participant. Clinical significance was determined using the 95th percentile cutoff (RCI = ± 1.96). Results Combining the stand-alone and guided-iCBT (n = 147) groups, 89 PwMS (61%) demonstrated a reliable decrease in BDI-II scores, whereas 58 PwMS (39%) did not show a reliable decrease. For waitlist controls (n = 77), 19 PwMS (25%) showed a reliable decrease in BDI-II scores, χ2(2, N = 224) = 33.82, p < 0.001, φ = 0.39. Conclusions We found that the iCBT treatment was highly effective, with 61% of PwMS showing a reliable decline in depressive symptoms compared with only 25% of waitlist controls. Still, generally consistent with previous research, almost 40% of PwMS did not respond to iCBT for depression. Future work will investigate baseline cognitive, psychosocial, and disease-related predictors of response to iCBT to better understand treatment outcomes and possible targets to optimize interventions for depression in MS.

An online compassion-focused intervention for middle school students: the Inspiring Comfort program

ABSTRACT Interventions that build compassion for others may help increase social connectivity, combat loneliness, and promote positive adjustment in youth. However, limited research has examined the effects of this type of intervention on youth well-being. The goal of this small open pilot study was to examine the feasibility, acceptability, and outcomes of Inspiring Comfort, a 12-session group program in which youth learn and practice compassion, empathy, and helping others in distress. The program was implemented virtually during the COVID-19 pandemic with a sample of 10 students (ages 11 to 14) attending a non-profit special education school. Following the program, reductions in child-reported loneliness, depressive symptoms, and social anxiety were observed, along with increases in compassion for others and self-compassion. Students reported high satisfaction with the program, though challenges with the virtual format were noted. Findings suggest that a compassion-focused intervention may hold promise for addressing loneliness and internalising symptoms in youth, though randomised controlled trials with larger samples are needed.

A cross-sectional study of the association between physical activity and depressive symptoms among adolescents in southwest China stratified by parental absence: the mediating role of insomnia and the moderating role of resilience

ObjectivesThis study explored the mechanisms by which physical activity was associated with depressive symptoms in multi-ethnic (Han, Yi and Tibetan) adolescents in southwest China. The mediating role of insomnia in...

Comparing Email Versus Text Messaging as Delivery Platforms for Supporting Patients With Major Depressive Disorder: Noninferiority Randomized Controlled Trial.

The prevalence of major depressive disorder (MDD) poses significant global health challenges, with available treatments often insufficient in achieving remission for many patients. Digital health technologies, such as SMS text messaging-based cognitive behavioral therapy, offer accessible alternatives but may not reach all individuals. Email communication presents a secure avenue for health communication, yet its effectiveness compared to SMS text messaging in providing mental health support for patients with MDD remains uncertain. This study aims to compare the efficacy of email versus SMS text messaging as delivery platforms for supporting patients with MDD, addressing a critical gap in understanding optimal digital interventions for mental health care. A randomized noninferiority pilot trial was conducted, comparing outcomes for patients receiving 6-week daily supportive messages via email with those receiving messages via SMS text message. This duration corresponds to a minimum of 180 days of message delivery. The supportive messages maintained consistent length and structure across both delivery methods. Participants (N=66) were recruited from the Access 24/7 clinic in Edmonton, Alberta, among those who were diagnosed with MDD. The outcomes were measured at baseline and 6 months after enrollment using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the World Health Organization Well-Being Index (WHO-5). Most of the participants were females (n=43, 65%), aged between 26 and 40 years (n=34, 55%), had high school education (n=35, 58%), employed (n=33, 50%), and single (n=24, 36%). Again, most participants had had no history of any major physical illness (n=56, 85%) and (n=61, 92%) responded "No" to having a history of admission for treatment of mood disorders. There was no statistically significant difference in the mean changes in PHQ-9, GAD-7, and WHO-5 scores between the email and SMS text messaging groups (mean difference, 95% CI: -1.90, 95% CI -6.53 to 2.74; 5.78, 95% CI -1.94 to 13.50; and 11.85, 95% CI -3.81 to 27.51), respectively. Both supportive modalities showed potential in reducing depressive symptoms and improving quality of life. The study's findings suggest that both email and SMS text messaging interventions have equivalent effectiveness in reducing depression symptoms among individuals with MDD. As digital technology continues to evolve, harnessing the power of multiple digital platforms for mental health interventions can significantly contribute to bridging the existing treatment gaps and improving the overall well-being of individuals with depressive conditions. Further research is needed with a larger sample size to confirm and expand upon these findings. ClinicalTrials.gov NCT04638231; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552095/.

Strain-specific effects of probiotics on depression and anxiety: a meta-analysis

IntroductionDepression and anxiety are pervasive mental health disorders with substantial global burdens. Probiotics, live microorganisms known for their health benefits, have emerged as a potential therapeutic intervention for these conditions. This systematic review and meta-analysis aim to evaluate the strain-specific effects of probiotics on relieving depressive and anxiety symptoms while elucidating underlying mechanisms.MethodsEMBASE, Cochrane CENTRAL and PubMed/Medline were systematically queried to identify studies released until May 15, 2024. Randomized Controlled Trials (RCTs) that employed standardized assessment tools for depression and anxiety namely Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HAMD), Depression Anxiety Stress Scales (DASS), or Montgomery-Asberg Depression Rating Scale (MADRS) were included.Results12 RCTs involving 707 participants were included. Seven RCTs utilizing the BDI questionnaire demonstrated a significant decrease in depressive symptoms favoring probiotics containing strains such as Lactobacillus acidophilus, Lactobacillus paracasei, Lactobacillus casei, Lactobacillus plantarum, Lactobacillus salivarius, Bifidobacterium bifidum, Bifidobacterium lactis, Bifidobacterium breve, and Bifidobacterium longum (MD: -2.69, CI95%: -4.22/-1.16, p value: 0.00). Conversely, RCTs using HAMD showed a non-significant reduction in depressive symptoms (MD: -1.40, CI95%: -3.29/0.48, p value: 0.14). RCTs employing DASS and MADRS scales also showed no significant differences.ConclusionThis meta-analysis offers valuable insights into the strain-specific effects of probiotics containing Lactobacillus and Bifidobacterium species on depressive and anxiety symptoms. While our findings suggest a significant reduction in depressive symptoms based on the BDI scale favoring probiotics, the lack of significant effects observed on the HAMD, DASS, and MADRS scales underscores the complexity inherent in these conditions. It is imperative to acknowledge the mixed results across different measurement scales, indicating the need for cautious interpretation. Therefore, we advocate for a nuanced understanding of probiotics’ impacts on various dimensions of mood, emphasizing the necessity for further research.

The long-term effect of surf therapy on posttraumatic stress, depression, and anxiety symptomology among current and former australian defence force members - A nonrandomised controlled longitudinal study in a community setting

BackgroundSurf therapy programs have demonstrated engagement among military samples, showing promising concurrent short-term reductions in symptoms of posttraumatic stress disorder, major depressive disorder, and generalised anxiety disorder; however, the long-term retained benefits of such programs have not been studied beyond three months. MethodsThis nonrandomised controlled longitudinal study recruited current and former Australian Defence Force personnel (N = 116) to examine the effect of a ten-session surf therapy program (n = 88) compared to a control group (no intervention; n = 28). Validated self-assessment measures of post-traumatic stress, depression and anxiety symptoms were recorded at pre and post intervention, and at one month, four months, and seven months follow up. ResultsLinear mixed model results reveal statistically significant post-program reductions in symptoms of posttraumatic stress (PCL-M; ß = −11.92, 95% CI [-17.44, −6.36]), depression (MDI; ß = −7.87, 95% CI [-12.35, −3.38]) and anxiety (GAD-7; ß = −4.02, 95% CI [-6.42, −1.57]), which were retained at 7-months follow-up. Clinically significant changes were also observed on all three outcomes. No changes were observed in the control group. Additional statistically significant beneficial effects for each model outcome were recorded for leisure surfing following the program. Most surf therapy participants continued surfing post program, indicating effective lifestyle change. ConclusionsThis is the largest quantitative surf therapy study among adults to date, and the first to follow up seven months post program. It confirms previous surf therapy findings of high engagement and transdiagnostic effects, and provides new clinically relevant knowledge by demonstrating retained beneficial effects regardless of continued surfing post program.

Psychiatric Safety of Semaglutide for Weight Management in People Without Known Major Psychopathology

Obesity is associated with numerous psychosocial complications, making psychiatric safety a consideration for treating people with obesity. Few studies have investigated the psychiatric safety of newly available antiobesity medications. To evaluate the psychiatric safety of subcutaneous semaglutide, 2.4 mg, once weekly in people without known major psychopathology. This post hoc analysis of pooled data from the randomized, double-blind, placebo-controlled, multicenter phase 3a STEP 1, 2, and 3 trials (68 weeks; 2018-2020) and phase 3b STEP 5 trial (104 weeks; 2018-2021) included adults with overweight or obesity; STEP 2 participants also had type 2 diabetes. Trial designs have been published previously. Semaglutide, 2.4 mg, vs placebo. Depressive symptoms and suicidal ideation/behavior were assessed using the Patient Health Questionnaire (PHQ-9) and Columbia-Suicide Severity Rating Scale, respectively. Psychiatric and nervous system disorder adverse events were investigated. This analysis included 3377 participants in the STEP 1, 2, and 3 trials (2360 women [69.6%]; mean [SD] age, 49 [13] years) and 304 participants in STEP 5 (236 women [77.6%]; mean [SD] age, 47 [11] years). In the STEP 1, 2, and 3 trials, mean (SD) baseline PHQ-9 scores for the semaglutide, 2.4 mg, and placebo groups were 2.0 (2.3) and 1.8 (2.3), respectively, indicating no/minimal symptoms of depression. PHQ-9 scores at week 68 were 2.0 (2.9) and 2.4 (3.3), respectively; the estimated treatment difference (95% CI) between groups was -0.56 (-0.81 to -0.32) (P < .001). Participants treated with semaglutide vs placebo were less likely to shift (from baseline to week 68) to a more severe category of PHQ-9 depression (odds ratio, 0.63; 95% CI, 0.50-0.79; P < .001). Based on the Columbia-Suicide Severity Rating Scale, 1% or fewer of participants reported suicidal ideation/behavior during treatment, with no differences between semaglutide, 2.4 mg, and placebo. Psychiatric disorder adverse events were generally balanced between groups. Similar results were observed in STEP 5. The results of this post hoc analysis suggest that treatment with semaglutide, 2.4 mg, did not increase the risk of developing symptoms of depression or suicidal ideation/behavior vs placebo and was associated with a small but statistically significant reduction in depressive symptoms (not considered clinically meaningful). People with obesity should be monitored for mental health concerns so they can receive appropriate support and care. ClinicalTrials.gov Identifiers: STEP 1 (NCT03548935), 2 (NCT03552757), 3 (NCT03611582), and 5 (NCT03693430).

Childhood maltreatment as predictor and moderator for treatment outcome in patients with major depressive disorders treated with metacognitive therapy or behavioral activation

BackgroundChildhood maltreatment (CM) is a risk factor for developing and maintaining depression. It is unclear whether CM influences the effect of treatments for depression. This study examined CM's predictor and moderator effect in Behavioral Activation (BA) and Metacognitive Therapy (MCT). MethodCM was analyzed in a trial comparing a six months treatment program of either BA or MCT for 122 outpatients with major depressive disorder (MDD). Depression was assessed by the Hamilton Rating Scale for Depression (HRSD-24). CM was assessed using the Childhood Trauma Questionnaire (CTQ). ResultsLinear mixed models showed no predictor or moderator effects for the CTQ total score (all p > .58) but revealed a moderator effect for ‘sexual abuse’ on the reduction of depressive symptoms (β = 10.98, SE = 4.48, p = .015) indicating that patients with experiences of childhood sexual abuse benefited more from BA. There also was a predictor effect for ‘physical neglect’ (β = −3.35, SE = 1.70, p = .049): patients without the experience of physical neglect benefited more from treatment regardless of condition. Exploratory analyses indicated no predictor or moderator effects for the onset or persistence of depression, comorbid anxiety disorders or Cluster-C PDs (all p > .28). LimitationsLimitations include small sample sizes for some of the subsamples. ConclusionChildhood sexual abuse seems to moderate treatment effectiveness in a sample of severely affected outpatients with MDD treated with MCT or BA. If confirmed in further trials, a history of sexual abuse might guide the choice between MCT and BA. Trial registrationGerman Clinical Trials Register DRKS-ID: DRKS00011536 (retrospectively registered on February 13, 2017, without changes to the study protocol).

Effectiveness of Trauma-Focused Art Therapy (TFAT) for Psychological Trauma: A Mixed Method Single Case Study

Art therapy (AT) shows promise in treating clients with posttraumatic stress disorder (PTSD), especially those who don't respond well to traditional treatments (more than 30%). This case study aimed to explore the effects of Trauma-Focused Art Therapy (TFAT) on PTSD symptoms and establish its viability as a non-verbal therapy for trauma-related issues.A 10-week intervention and a 3-week follow-up phase were explored using a mixed method single case experimental design (SCED) aimed at integrated results. Bringing the two types of data together adds value and enables to understand the findings better. Quantitative data was collected with weekly questionnaires focused on severity of depression, resilience, self-esteem, mental health and self-expression and emotion regulation in art therapy. The PTSD Checklist for DSM-5 (PCL-5) was completed in week 1 and 10. Qualitative data was collected through interviews, the patient dossier, and artwork.The combined findings indicate a decrease in PTSD symptoms, reduced depression symptoms, enhanced emotional articulation, increased mental resilience, self-esteem, and positive mental health. The qualitative data support these results, and also add improved emotional connection, increased emotional acknowledgment, and enhanced self-compassion.Based on the combined results of this mixed method design we understand that the TFAT protocol led to a clinically significant reduction in PTSD symptoms and improved mental health, demonstrating effectiveness of AT for trauma in this case. This is the first study that tested the TFAT protocol in posttraumatic distress.

Efficacy and safety of esketamine versus propofol in electroconvulsive therapy for treatment-resistant depression: A randomized, double-blind, controlled, non-inferiority trial

BackgroundElectroconvulsive therapy (ECT) is a commonly used alternative for treatment-resistant depression (TRD). Although esketamine has a rapid pharmacological antidepressant action, it has not been studied as an ECT anesthetic. The objective of this study was to compare the efficacy and safety of esketamine with propofol when both are used as ECT anesthetic agents. MethodsForty patients with TRD were assigned to one of two arms in a double-blind, randomized controlled trial: esketamine or propofol anesthesia for a series of eight ECT sessions. Using a non-inferiority design, the primary outcome was the reduction in HAMD-17 depressive symptoms. The other outcomes were: rates of response and remission, anxiety, suicidal ideation, cognitive function, and adverse events. These were compared in an intention-to-treat analysis. ResultsEsketamine-ECT was non-inferior to propofol-ECT for reducing TRD symptoms after 8 sessions (adjusted Δ = 2.0, 95 % CI: −1.2–5.1). Compared to propofol-ECT, esketamine-ECT also had higher depression response (80 % vs. 70 %; p = .06) and remission (65 % vs. 55 %; p = .11) rates but non-inferiority was not established. In four components of cognitive function (speed of processing, working memory, visual learning, and verbal learning) esketamine-ECT was non-inferior to propofol-ECT. The results for anxiety, suicidal ideation, and adverse events (all p's > .05) were inconclusive. ConclusionEsketamine was non-inferior to propofol when both are used as anesthetics for TRD patients undergoing ECT. Replication studies with larger samples are needed to examine the inconclusive results. Registration numberChiCTR2000033715.

Coping behaviors to reduce anxiety and depressive symptoms: A prospective repeated assessment study

IntroductionHealth institutions provide general recommendations to cope with global crises such as pandemics or geopolitical tensions. However, these recommendations are mainly based on cross-sectional evidence. The preregistered Repeated Assessment of Behaviors and Symptoms in the Population (RABSYPO) study sought to establish prospective longitudinal evidence from a cohort with a demographic distribution similar to that of the Spanish population to provide evidence for developing solid universal recommendations to reduce anxiety and depressive symptoms during times of uncertainty. Material and methodsWe first recruited via social networks a pool of Spanish individuals willing to participate and then randomly selected some within each stratum of age×gender×region×urbanicity to conduct a one-year-long bi-weekly online follow-up about the frequency of ten simple potential coping behaviors as well as anxiety (GAD-7) and depressive symptoms (PHQ-9). Mixed-effects autoregressive moving average models were used to analyze the relationship between past behaviors’ frequency and subsequent symptom changes across the twenty-seven time points. ResultsAmong the 1049 who started the follow-up, 942 completed it and were included in the analyses. Avoiding excessive exposure to distressing news and maintaining a healthy/balanced diet, followed by spending time outdoors and physical exercise, were the coping behaviors most strongly associated with short and long-term reductions of anxiety and depressive symptoms. Engaging in relaxing activities and drinking water to hydrate were only associated with short-term symptom reductions. Socializing was associated with symptom reductions in the long term. ConclusionsThis study provides compelling prospective evidence that adopting a set of simple coping behaviors is associated with small but significant reductions in anxiety and depressive symptoms during times of uncertainty. It also includes a layman's summary of this evidence to help develop general recommendations that serve as universal tools for enhancing mental health and well-being.

One-year Follow-up of a Primary Care-Based 12-week Exercise Intervention for Adults with Anxiety Disorders

Background and AimsWhile there is increasing evidence for the short-term effectiveness of exercise interventions for adults with anxiety disorders, follow-up studies are rare. The aim of this study was to examine whether the significant reductions in anxiety and depression symptoms observed in connection with our primary care-based 12-week exercise RCT were maintained at subsequent follow-up after nine-months. A further aim was to investigate the hypothesis whether exercise interacted with antidepressant medication. Methods113 out of 153 who completed the 12-week intervention completed the follow-up assessments. Symptoms were self-assessed with the Beck Anxiety Index (BAI) and the Montgomery Åsberg Depression Rating Scale (MADRS-S) at baseline, intervention completion (the 12-weeks follow-up) and 9 months post-intervention (the 1-year follow up). ResultsThe reduced symptoms of anxiety and depression effects seen after 12 weeks in the intervention groups were maintained at the 1-year follow-up. Similar reductions were seen in the control group. However, among antidepressant users, the odds ratios for the intervention group to reach improvement in anxiety were four-fold, and in depression, eleven-fold compared to controls at the 1-year follow-up. ConclusionThe results strengthen the view that physical exercise is an effective treatment for anxiety especially in among those with antidepressant treatment.

Relations between changes in safety behavior, paranoid ideations, cognitive biases, and clinical characteristics of patients with a psychotic disorder over time

BackgroundSafety behaviors, both positive (maladaptive coping behavior) and negative (avoidance behavior), are used by people with paranoid delusions to avoid perceived threats. Safety behaviors contribute to the persistence of paranoid delusions by preventing disconfirmation of threat beliefs and may influence other psychiatric symptoms. This study investigated how changes in safety behaviors are related to changes in paranoid ideation, social anxiety, depression, cognitive biases and self-esteem over time. MethodsThis study included 116 patients diagnosed with a psychotic disorder (DSM-IV) and at least moderate levels of paranoid ideations (GTPS >40).The data were collected as part of a multi-center randomized controlled trial where patients were randomized to VR-CBT (n = 58) or treatment as usual (TAU; n = 58). Assessments were completed at baseline (T0), after three months (T3) and after six months (T6). For all variables, change scores between T0 and T3 and T3 and T6 were calculated and Pearson correlations between change scores were computed. ResultsA decrease in total safety behavior was related to diminished paranoid ideation, social anxiety, and depression. No significant temporal associations were found between changes in safety behavior and changes in cognitive biases and self-esteem. Similar but less robust results were found for respectively negative safety behavior and positive safety behavior. ConclusionDropping safety behavior can be specifically targeted in behavioral interventions. Whereas there appears to be a relation with reduction in anxiety, paranoia, and depressive symptoms, changes in safety behavior do not seem to align with changes in cognitive thinking processes.

Psychometric characteristics of the Hospital Anxiety and Depression Scale in stroke survivors of working age before and after inpatient rehabilitation.

The aim was to examine the psychometric properties of the Hospital Anxiety and Depression Scale (HADS) in cohorts of working age stroke survivors, before and after inpatient rehabilitation. Stroke patients aged 18-66 years registered in the national quality register WebRehab Sweden were included in the study at hospital admission (n = 256), discharge (n = 223), and 1-year follow-up (n = 313). Classical and modern (Rasch) methods were used for psychometric evaluation. The two-factor HADS model measuring anxiety and depression showed better fit than a single factor measuring emotional distress. The instrument's psychometric stability before and after rehabilitation was satisfactory. The anxiety scale showed good psychometric properties, except for item 7, which is not anxiety-specific. Some concerns were observed for the depression items showing weaker discriminant validity, and item 8 performing poorly as a measure of depression. Cronbach's alpha and McDonald's omega coefficients showed satisfactory internal consistency reliability, whereas Rasch person reliability coefficients indicated weaker reliability, especially for the depression scale. Effect size of change between hospital admission and discharge showed a reduction in anxiety and depression symptoms. HADS showed a stable two-factor structure over the rehabilitation period. Patients' perception of items was not affected by the recovery, allowing relevant comparison of HADS scores between different phases of the rehabilitation process. Measures of responsiveness suggest that HADS is sensitive to capturing improvements in emotional distress following rehabilitation interventions. Overall, despite minor psychometric weaknesses, HADS is a suitable instrument for assessing anxiety and depresssion symptoms in stroke patients aged 18-66 years.

Addressing depression and comorbid health conditions through solution-focused brief therapy in an integrated care setting: a randomized clinical trial

BackgroundCo-occurring physical and mental health conditions are common, but effective and sustainable interventions are needed for primary care settings.PurposeOur paper analyzes the effectiveness of a Solution-Focused Brief Therapy (SFBT) intervention for treating depression and co-occurring health conditions in primary care. We hypothesized that individuals receiving the SFBT intervention would have statistically significant reductions in depressive and anxiety symptoms, systolic blood pressure (SBP), hemoglobin A1C (HbA1c), and body mass index (BMI) when compared to those in the control group. Additionally, we hypothesized that the SFBT group would have increased well-being scores compared to the control group.MethodsA randomized clinical trial was conducted at a rural federally qualified health center. Eligible participants scored ≥ 10 on the Patient Health Questionnaire (PHQ-9) and met criteria for co-occurring health conditions (hypertension, obesity, diabetes) evidenced by chart review. SFBT participants (n = 40) received three SFBT interventions over three weeks in addition to treatment as usual (TAU). The control group (n = 40) received TAU over three weeks. Measures included depression (PHQ-9) and anxiety (GAD-7), well-being (Human Flourishing Index), and SFBT scores, along with physical health outcomes (blood pressure, body mass index, and hemoglobin A1c).ResultsOf 80 consented participants, 69 completed all measures and were included in the final analysis. 80% identified as female and the mean age was 38.1 years (SD = 14.5). Most participants were white (72%) followed by Hispanic (15%) and Black (13%). When compared to TAU, SFBT intervention participants had significantly greater reductions in depression (baseline: M = 18.17, SD = 3.97, outcome: M = 9.71, SD = 3.71) and anxiety (baseline: M = 14.69, SD = 4.9, outcome: M = 8.43, SD = 3.79). SFBT intervention participants also had significantly increased well-being scores (baseline: M = 58.37, SD = 16.36, outcome: M = 73.43, SD = 14.70) when compared to TAU. Changes in BMI and blood pressure were not statistically significant.ConclusionThe SFBT intervention demonstrated efficacy in reducing depressive and anxiety symptoms and increasing well-being but did not affect cardio-metabolic parameters over a short period of intervention.Trial RegistrationThe study was pre-registered at ClinicalTrials.gov Identifier: NCT05838222 on 4/20/2023. *M = Mean, SD = Standard deviation.

Relationships of Multidimensional Factors to Diabetes Complications: A Cross-Sectional, Correlational Study.

Diabetes complications are prevalent in people with diabetes, causing considerable individual suffering and increased health costs. However, the relationships of multidimensional, modifiable, and nonmodifiable factors to diabetes complications and the role of diabetes distress have been rarely examined. The aims of this study were to examine the associations of age, sex, knowledge, self-efficacy, self-compassion, resilience, self-esteem, depressive symptoms, diabetes distress, social support, and body mass index with diabetes complications and to investigate the mediating role of diabetes distress. In this cross-sectional, correlational study, data on all study variables were collected from 148 people with diabetes through REDCap in 2023. Multiple regression analysis and the PROCESS macro for SPSS were used to address the aims. Older age and higher levels of diabetes distress were associated with more diabetes complications. Depressive symptoms were associated with diabetes distress; and diabetes distress, but not depressive symptoms, was associated with diabetes complications, controlling for all other variables. Depressive symptoms and diabetes distress were directly or indirectly associated with diabetes complications, and diabetes distress was a mediator in the relationship between depressive symptoms and diabetes complications. Health care providers can target reduction of depressive symptoms and diabetes distress to reduce diabetes complications.

Outcomes of a Self-Management Program for People with Non-Communicable Diseases in the Context of COVID-19.

To evaluate the effectiveness of the online version of the Chronic Disease Self-Management Program (CDSMP) on physical activity and depressive symptoms in individuals with non-communicable diseases (NCDs) in Mexico and Peru during the COVID-19 pandemic. Quasi-experimental study with a non-probability sample of 114 people with NCDs, recruited by invitation in Mexico and by convenience in Peru. The participants were assigned to intervention (n = 85) and control (n = 29) groups. The Personal Health Questionnaire (PHQ-8) and the Physical Activity Scale were used to assess the outcomes. Measurements were taken before and after the intervention. The CDSMP comprises six sessions that take place once per week and last 2.5 h each. The intervention group showed a significant reduction in depressive symptoms and an increase in physical activity (PA) at the end of the program. In contrast, the control group showed no significant improvement in depression and presented a significant decrease in PA.