Disorders - Depressive Disorders
Ahlen, J., Lenhard, F., Ghaderi, A.
The present study concerns a 3-year follow-up of a universal prevention trial targeting anxiety and depressive symptoms in school children. In addition to evaluating the long-term effect of the prevention program, we also examined attrition and its effect on the outcome. High rates of attrition have commonly been observed in studies in the field. However, the role of attrition is not sufficiently understood regarding internal and external validity biases. The current study comprised 695 children (aged 8-11 at baseline) from 17 schools in Sweden. Schools were cluster-randomized to either the intervention or control condition. Children completed measures of anxiety and depressive symptoms and parents completed measures of their child's anxiety and general mental health. We found no evidence of long-term effects of the prevention program, except for a small effect regarding parent reports of child anxiety. However, that effect was not found to be of clinical significance. Regarding attrition, children with missing data at the 3-year follow-up displayed higher levels of psychiatric symptoms at baseline and increasing symptoms across time. Furthermore, children in the control condition with missing follow-up data were found to be significantly deteriorated across time compared to the corresponding children in the intervention condition regarding depressive symptoms and total difficulties. In other words, attrition served as a moderator of the effect, which suggests that the overall result was biased toward a null-result. Our study highlights that large and nonrandom attrition severely limits the validity of the results. Further, given the common problem of retaining participants in long-term evaluations of school-based prevention trials, previous studies may suffer from the same limitations as the current study. Copyright © 2018
Behavior Therapy., 50(1) : 200-213
- Year: 2019
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Berk, M., Mohammadreza, M., Dean, O. M., Cotton, S. M., Chanen, A. M., Dodd, S., Ratheesh, A., Amminger, G. P., Phelan, M., Williams, A., Mackinnon, A., Giorlando, F., Baird, S., Rice, S., O'Shea, M., Schafer, M. R., Mullen, E., Hetrick, S., Kerr, M., Harrigan, S. M., Quinn, A. L., McGorry, P. D., Davey, C. G.
Background & aims: Inflammation is an important part of the neurobiology of major depressive disorder. This implies that novel anti-inflammatory therapies for the treatment of depression may have potential, such as statins like rosuvastatin, and aspirin, which both have anti-inflammatory properties. The trial aimed to determine whether adjunctive anti-inflammatory therapy with aspirin or rosuvastatin compared to placebo reduced the symptoms of MDD. Method(s): YoDA-A was a 12-week triple-blind, randomised placebo controlled trial. Participants between 15-25, who had moderate-to-severe MDD (n = 129) received either aspirin (n = 40), rosuvastatin (n = 48) or placebo (n = 42) in addition to treatment as usual. They were seen at baseline and at weeks 4, 8, 12, and 26. Change in the Montgomery-Asberg Depression Rating Scale (MADRS) from baseline to week 12 was the primary outcome. Result(s): On the a-priori primary endpoint, MADRS scores at week 12, differences between aspirin and placebo was not statistically significant but the difference between rosuvastatin and placebo narrowly missed significance at trend level. Secondary analyses on the MADRS between rosuvastatin and aspirin were in favour of rosuvastatin. Both aspirin and placebo were superior to placebo on the Suicidal Ideation Questionnaire (SIQ), while aspirin was superior to placebo on the Quality of Life Enjoyment and Satisfaction Questionnaire (QLESQ), statins were superior to placebo on the Alcohol Use Disorders Identification Test (AUDIT) and statins were superior to aspirin on both the Clinical Global Impression (CGI) severity scale and the Negative Problem Orientation Questionnaire scale (NPOQ). Conclusion(s): This study provides partial but not definitive support for the efficacy of rosuvastatin but not aspirin in youth depression and indirectly for the role of inflammation in MDD.
Bipolar Disorders, 21 (Supplement 1) : 14
- Year: 2019
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions, Complementary & Alternative Interventions (CAM)
, Other complementary & alternative interventions
Sun, M., Rith-Najarian, L. R., Williamson, T. J., Chorpita, B. F.
Our aim was to investigate whether four treatment features (i.e., the inclusion of parental involvement, goal-setting strategies, maintenance/relapse prevention sessions, the addition of booster sessions) were associated with posttreatment and follow-up effect size of youth cognitive behavioral therapies (yCBTs) for anxiety, depression, posttraumatic stress disorder, and obsessive-compulsive disorder in age groups spanning young children to adolescents. We conducted a random-effects meta-analysis of 106 yCBTs tested in 76 randomized clinical trials from the PracticeWise Database to examine average effects of yCBTs posttreatment and at a later follow-up assessment. We coded the use of parental involvement, goal setting, booster sessions, and maintenance/relapse prevention in each yCBT and conducted random-effects meta-regression analyses to investigate whether these treatment features were associated with yCBT effects at posttreatment as well as at follow-up. Overall, yCBTs produced large pre- to posttreatment effects (d = 1.05), 95% confidence interval [0.94, 1.15], and larger pre- to follow-up effects (d = 1.29), 95% confidence interval [1.18, 1.40]. Metaregression results indicated that parental involvement was significantly associated with larger pre- to posttreatment effect sizes as well as pre- to follow-up effect sizes. Booster sessions, goal setting, and maintenance/relapse prevention were not significantly related to effect sizes at posttreatment or follow-up. Parental involvement may be helpful for maximizing long-term effectiveness of yCBT. Future studies should investigate for whom and under what conditions inclusion of yCBT treatment features is related to the durability of treatment gains.
Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 48(Supplement1) : S269-S283
- Year: 2019
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
, Relapse prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other service delivery and improvement interventions
Topooco, N., Andersson, G.
Aims: Depression is a major cause of disability-adjusted life years among adolescents globally. In addition to the limited treatment resources, adolescents are underrepresented in standard care settings for reasons of stigma and limited mental health literacy. We describe the development and evaluation of an internet-delivered cognitive behavioral therapy intervention, designed to reduce structural and individual barriers to treatment. Method(s): The intervention comprised of 8 web-based modules and 8 individual therapist chat-sessions. It included enrollment at the national level by means of self-referral without the need for parental consent. This was evaluated in two RCT's, each involving 70 adolescents 15-19 years of age suffering from depressive symptoms including, but not restricted to, MDD. Participants were randomized to treatment or to attention control (1:1 ratio). Study inclusion: BDI-II score <=14. Primary Outcome: self-reported depression level at post-treatment. Follow-up: 6/12 months. Result(s): Significant effects of treatment vs control were observed, corresponding to a moderate between-group effect size in RCT1 (n = 70, d = 0.71, 95%, CI: 22-1.19, P < 0.05), and a large effect size in RCT2 (n = 70, d = 0.86, 95%, CI: 37-1.35, P < 0.001), with maintenance of gains at follow-up. The effect on depression symptoms was repeated in clinician-reported outcomes (P < 0.05). Participants reported high treatment acceptability. Conclusion(s): The results demonstrate that clinically meaningful treatment effects and target audience acceptability can be achieved with internet-delivered CBT for the treatment of adolescent depression. Lessons learned and implications for future research will be discussed in the context of the growing interest in how to utilize technology-assisted treatment models to manage mood disorders in youth.
Bipolar Disorders, 21 (Supplement 1) : 54
- Year: 2019
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Technology, interventions delivered using technology (e.g. online, SMS)
Warren, M.B., Cowen, P.J., Harmer, C.J.
Background: The neurocognitive model of antidepressant treatment in depression states that antidepressants work by producing relatively immediate positive shifts in emotional processing, which translate into clinical improvement with time. St John's Wort has shown antidepressant potential in randomised controlled trials; however, its pharmacological actions are broad and it is unknown whether treatment also produces changes in emotional processing. Aims: We investigated whether short-term treatment with St John's wort has similar effects on emotional processing to those reported with other antidepressants such as selective serotonergic reuptake inhibitors. Methods: Forty-eight healthy participants were given St John's wort or placebo treatment for seven days. On day 7 they completed a battery of tasks to measure emotional processing and other elements of cognition. Results: St John's wort treatment produced similar changes to other antidepressants, for example reducing recognition of disgusted faces and attention to fearful faces, while increasing memory for positive words. We failed to find evidence for an effect of St John's wort on other aspects of cognition including working memory. Conclusions: These findings lend support to the theory that the production of early positive biases in emotional processing may be a common feature of all clinically effective antidepressants with diverse pharmacological mechanisms. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Journal of Psychopharmacology, 33(2) : 194-201
- Year: 2019
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Homeopathic, plant-based medicines
Crane, M. F., Boga, D., Karin, E., Gucciardi, D. F., Sinclair, L.
Objective: This group-randomized control trial examined the efficacy of guided coping and emotion regulatory self-reflection as a means to strengthen resilience by testing the effects of the training on anxiety and depression symptoms and perceived stressor frequency after an intensive stressor period. Method(s): The sample was 226 officer cadets training at the Royal Military College, Australia. Cadets were randomized by platoon to the self-reflection (n = 130) or coping skills training (n = 96). Surveys occurred at 3 time points: Baseline, immediately following the final reflective session (4-weeks postbaseline), and longer-term follow-up (3-months postinitial follow-up). Result(s): There were no significant baseline differences in demographic or outcome variables between the intervention groups. On average, cadets commenced the resilience training with mild depression and anxiety symptoms. Analyses were conducted at the individual-level after exploring group-level effects. No between-groups differences were observed at initial follow-up. At longer-term follow-up, improvements in mental health outcomes were observed for the self-reflection group, compared with the coping skills group, on depression (Cohen's d = 0.55; 95% CI [0.24, 0.86]), anxiety symptoms (Cohen's d = 0.69; 95% CI [0.37, 1.00]), and perceived stressor frequency (Cohen's d = 0.46; 95% CI [0.15, 0.77]). Longitudinal models demonstrated a time by condition interaction for depression and anxiety, but there was only an effect of condition for perceived stressor frequency. Mediation analyses supported an indirect effect of the intervention on both anxiety and depression via perceived stressor frequency. Conclusion(s): Findings provide initial support for the use of guided self-reflection as an alternative to coping skills approaches to resilience training. Copyright © 2019 American Psychological Association.
Journal of Consulting and Clinical Psychology, 87(2) : 125-140
- Year: 2019
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Skills training, Other Psychological Interventions
Wolpert, M., Dalzell, K., Ullman, R., Garland, L., Cortina, M., Hayes, D., Patalay, P., Law, D.
This Review reports on a scoping review followed by a systematic review to consider interventions designed to address or manage depression or anxiety in children and young people up to the age of 25 years without the need to involve mental health professionals. The scoping review identified 132 approaches, 103 of which referred to children or young people (younger than 25 years). These approaches included social interaction, engagement with nature, relaxation, distraction, sensory stimulation, physical activity, altering perceptions, engaging in hobbies, self-expression, and exploration. A systematic review of effectiveness studies from the literature identified in the scoping review found only 38 studies on seven types of intervention that met the inclusion criteria. 16 studies were based on cognitive or behavioural principles (15 on digital interventions and one on bibliotherapy), ten focused on physical exercise, five on light therapy, three on dietary supplements, two on massage therapy, one on online peer support, and one on contact with a dog. Most studies focused on adolescents or young adults. Evidence suggested that light therapy could be effective for season depression and that digital interventions based on attention bias modification are ineffective for anxiety. Mixed evidence was available on the effectiveness of computerised cognitive behavioural therapy for depression and anxiety, and of physical exercise for depression. All other studies had insufficient certainty to obtain even tentative conclusions about effectiveness. These results highlight the disparity between the extensive range of approaches identified in the scoping review and the restricted number and focus found in the systematic review of effectiveness of these approaches. We call for an expanded research agenda that brings evaluation rigour to a wide range of self or community approaches. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
The Lancet Psychiatry, 6(1) : 46-60
- Year: 2019
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Service Delivery & Improvement, Psychological Interventions (any)
, Other complementary & alternative interventions
, Technology, interventions delivered using technology (e.g. online, SMS), Other service delivery and improvement interventions
Boylan, K., MacQueen, G., Kirkpatrick, R., Lee, J., Santaguida, P. L.
To update a comparative effectiveness review (1980-2011) of treatments for adolescents whose depressive episode or disorder (MDE/MDD) did not respond to one or more trials of SSRI antidepressants. MEDLINE, Cochrane Central, PsychINFO, Cochrane Database of Systematic Reviews, EMBASE, CINAHL, and AMED were searched in addition to the grey literature. We spanned May 2011 to September 1, 2017 and included only articles in English. 11 new studies were reviewed based on the criteria of having tested a comparative treatment in adolescents with MDD or MDE who were confirmed to have failed one or more SSRI trials. Data were extracted using standardized forms and a reference guide in DistillerSR; a second reviewer verified the accuracy of the data fields and discrepancies were resolved by consensus. One trial (N = 29) found a small benefit of escalating doses of fluoxetine and the treatment of adolescent depression study (TORDIA, N = 334) found significant benefits of combined SSRI or venlafaxine treatment with CBT for most outcomes. No new studies were identified since the previous review (2012). One trial is currently registered that will be a cross over trial of rTMS; other registered trials are open label. Multiple secondary data analyses of TORDIA have identified important predictors of treatment response and relapse. No new comparative studies were identified since the original review. Trials are desperately needed to identify new treatments for youth with SSRI resistant MDD. These youth should not be deemed as treatment resistant until completing one or two failed trials of SSRI combined with evidence-based psychotherapy. Copyright © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
European Child and Adolescent Psychiatry., :
- Year: 2019
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Treatment resistant/treatment refractory
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors (SNRIs), Antidepressants (any)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Brown, J. S., Blackshaw, E., Stahl, D., Fennelly, L., McKeague, L., Sclare, I., Michelson, Daniel
Introduction: Schools may provide a convenient intervention setting for young people with mental health problems generally, as well as for those who are unwilling or unable to access traditional clinic-based mental health services. However, few studies focus on older adolescents, or those from ethnic minority groups. This study aims to assess the feasibility of a brief school-based psychological intervention for self-referred adolescents aged 16-19 years. Methods: A two-arm cluster randomised controlled trial was conducted in 10 inner-city schools with block randomisation of schools. The intervention comprised a one-day CBT Stress management programme with telephone follow-up (DISCOVER) delivered by 3 psychology (2 clinical and 1 assistant) staff. The control was a waitlist condition. Primary outcomes were depression (Mood and Feelings Questionnaire; MFQ) and anxiety (Revised Child Anxiety and Depression Scale; RCADS-anxiety subscale). Data were analysed descriptively and quantitatively to assess feasibility. Results: 155 students were enrolled and 142 (91.6%) followed up after 3 months. Participants were predominantly female (81%) and the mean age was 17.3 years, with equal numbers enrolled from Year 12 and Year 13. Over half (55%) of students were from ethnic minority groups. Intraclass correlations were low. Variance estimates were calculated to estimate the sample size for a full RCT. Preliminary outcomes were encouraging, with reductions in depression (d = 0.27 CI-0.49 to -0.04, p = 0.021) and anxiety (d = 0.25, CI-0.46 to -0.04, p = 0.018) at follow-up. Conclusions: Results support the feasibility of a school-based, self-referral intervention with older adolescents in a definitive future full-scale trial (Trial no. ISRCTN88636606). (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Journal of Adolescence, 71 : 150-161
- Year: 2019
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other Psychological Interventions
Rodriguez-Ayllon, M., Cadenas-Sanchez, C., Estevez-Lopez, F., Munoz, N. E., Mora-Gonzalez, J., Migueles, J. H., Molina-Garcia, P., Henriksson, H., Mena-Molina, A., Martinez-Vizcaino, V., Catena, A., Lof, M., Erickson, K. I., Lubans, D. R., Ortega, F. B., Esteban-Cornejo, I.
BACKGROUND: Evidence suggests that participation in physical activity may support young people's current and future mental health. Although previous reviews have examined the relationship between physical activity and a range of mental health outcomes in children and adolescents, due to the large increase in published studies there is a need for an update and quantitative synthesis of effects. OBJECTIVE(S): The objectives of this study were to determine the effect of physical activity interventions on mental health outcomes by conducting a systematic review and meta-analysis, and to systematically synthesize the observational evidence (both longitudinal and cross-sectional studies) regarding the associations between physical activity and sedentary behavior and mental health in preschoolers (2-5 years of age), children (6-11 years of age) and adolescents (12-18 years of age). METHOD(S): A systematic search of the PubMed and Web of Science electronic databases was performed from January 2013 to April 2018, by two independent researchers. Meta-analyses were performed to examine the effect of physical activity on mental health outcomes in randomized controlled trials (RCTs) and non-RCTs (i.e. quasi-experimental studies). A narrative synthesis of observational studies was conducted. Studies were included if they included physical activity or sedentary behavior data and at least one psychological ill-being (i.e. depression, anxiety, stress or negative affect) or psychological well-being (i.e. self-esteem, self-concept, self-efficacy, self-image, positive affect, optimism, happiness and satisfaction with life) outcome in preschoolers, children or adolescents. RESULT(S): A total of 114 original articles met all the eligibility criteria and were included in the review (4 RCTs, 14 non-RCTs, 28 prospective longitudinal studies and 68 cross-sectional studies). Of the 18 intervention studies, 12 (3 RCTs and 9 non-RCTs) were included in the meta-analysis. There was a small but significant overall effect of physical activity on mental health in children and adolescents aged 6-18 years (effect size 0.173, 95% confidence interval 0.106-0.239, p<0.001, percentage of total variability attributed to between-study heterogeneity [I2]=11.3%). When the analyses were performed separately for children and adolescents, the results were significant for adolescents but not for children. Longitudinal and cross-sectional studies demonstrated significant associations between physical activity and lower levels of psychological ill-being (i.e. depression, stress, negative affect, and total psychological distress) and greater psychological well-being (i.e. self-image, satisfaction with life and happiness, and psychological well-being). Furthermore, significant associations were found between greater amounts of sedentary behavior and both increased psychological ill-being (i.e. depression) and lower psychological well-being (i.e. satisfaction with life and happiness) in children and adolescents. Evidence on preschoolers was nearly non-existent. CONCLUSION(S): Findings from the meta-analysis suggest that physical activity interventions can improve adolescents' mental health, but additional studies are needed to confirm the effects of physical activity on children's mental health. Findings from observational studies suggest that promoting physical activity and decreasing sedentary behavior might protect mental health in children and adolescents. PROSPERO Registration Number: CRD42017060373.
Sports medicine, :
- Year: 2019
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Physical activity, exercise
Berg, M., Rozental, A., Johansson, S., Liljethorn, L., Radvogin, E., Topooco, N., Andersson, G.
Background and objectives: Clients' knowledge about their condition and treatment is considered crucial for general health improvement, and knowledge acquisition is an essential part in internet-based cognitive behavioural therapy (ICBT). Yet, little is known about the role of knowledge and how it influences treatment outcome. This study aimed to examine if explicit knowledge increased following ICBT for adolescent depression, if knowledge gain would be associated with symptom reduction, and if pre-existing knowledge predicted changes in depressive symptoms. Method(s): Seventy-one adolescents were randomised to a therapist-supported ICBT or a attention control condition. A measure of depression (BDI-II) and a knowledge test dealing with depression, comorbid anxiety, and its CBT-treatment were administered before and after treatment. Result(s): Significant improvements in knowledge were observed following ICBT compared to the attention control (between-group Cohen's d = 1.25, 95% CI [0.67-1.79]). On average, participants in the treatment group answered 1.4 more questions correctly at post treatment compared to the control group. No relation between change in knowledge and change in depressive symptoms could be observed. Knowledge scores at baseline were high for both groups, with participants answering approximately 75% of the questions correct. A higher level of initial knowledge level predicted poorer treatment response (Parson's r = -0.38, p =.048). Conclusion(s): The findings indicate that knowledge about basic concepts and principles about depression, anxiety, and CBT increases following ICBT. This increase in knowledge was not related to change in depressive symptoms, indicating that knowledge is a different construct. The results also suggest that clients who are more knowledgeable prior to treatment might benefit less from ICBT. In sum, the results highlight the need to further examine the role of knowledge in ICBT. Copyright © 2018 The Authors
Internet Interventions, 15 : 10-17
- Year: 2019
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Supportive therapy, Technology, interventions delivered using technology (e.g. online, SMS)
Facer-Childs, E. R., Middleton, B., Skene, D. J., Bagshaw, A. P.
Background: There is conflict between living according to our endogenous biological rhythms and our external environment, with disruptions resulting in negative consequences to health and performance. This is often documented in shift work and jet lag, but 'societal norms' (eg, typical working hours) can create profound issues for 'night owls', people whose internal biological timing predisposes them to follow an unusually late sleep-wake cycle. Night owls have also been associated with health issues, mood disturbances, poorer performance and increased mortality rates. Method(s): This study used a randomized control trial design aimed to shift the late timing of night owls to an earlier time (phase advance), using non-pharmacological, practical interventions in a real-world setting. These interventions targeted light exposure (through earlier wake up/sleep times), fixed meals times, caffeine intake and exercise. Result(s): Overall, participants demonstrated a significant advance of ~2 h in sleep/wake timings as measured by actigraphy and circadian phase markers (dim light melatonin onset and peak time of the cortisol awakening response), whilst having no adverse effect on sleep duration. Notably, the phase advance was accompanied by significant improvements to self-reported depression and stress, as well as improved cognitive (reaction time) and physical (grip strength) performance measures during the typical 'suboptimal' morning hours. Conclusion(s): Our findings propose a novel strategy for shifting clock timing towards a pattern that is more aligned to societal demands that could significantly improve elements of performance, mental health and sleep timing in the real world. Copyright © 2019 Elsevier B.V.
Sleep Medicine., :
- Year: 2019
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Other complementary & alternative interventions