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JAMA Network Open Nov 2023Mobile mental health applications (apps) for moderate to severe depression are proliferating, likely owing to their capacity to overcome the limitations of conventional... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Mobile mental health applications (apps) for moderate to severe depression are proliferating, likely owing to their capacity to overcome the limitations of conventional psychotherapy, but research on the potential moderators of treatment efficacy is lacking.
OBJECTIVE
To examine the treatment efficacy associated with mobile app interventions for moderate to severe depression and identify the potential moderators associated with better treatment outcomes.
DATA SOURCES
PubMed, Embase, and PsycINFO were searched from their inception to January 22, 2023.
STUDY SELECTION
Only randomized clinical trials evaluating mobile app treatments in adults with moderate to severe depression that published their results in English were included in the analysis.
DATA EXTRACTION AND SYNTHESIS
Three independent researchers extracted and assessed relevant studies, their risk of bias, the characteristics of the population and study design, and the components of the intervention program following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines. A fixed-effects model was used for data analysis, and exploratory post hoc meta-regression and subgroup analyses were also conducted. Data were analyzed from February 16 to March 25, 2023.
MAIN OUTCOMES AND MEASURES
The main outcome was changes in depression symptom severity from before to after treatment, measured by standardized depression assessment instruments. Secondary outcomes included study-, intervention-, and patient-level factors associated with app efficacy.
RESULTS
Of 2128 studies identified, 13 studies evaluating 16 intervention apps with 1470 participants with moderate to severe depression were included in the analysis. The overall pooled effect size of mobile app interventions vs both active and inactive control groups was 0.50 (95% CI, 0.40 to 0.61). Interventions with in-app notifications were associated with significantly lower treatment outcomes (standardized mean difference [SMD], 0.45; 95% CI, 0.29-0.60) than interventions without (SMD, 0.71; 95% CI, 0.54-0.87; P = .02). In addition, app interventions delivered for less than 8 weeks were associated with a significantly greater effect size (SMD, 0.77; 95% CI, 0.59-0.96) than interventions delivered for 8 weeks or longer (SMD, 0.43; 95% CI, 0.30-0.57; P = .004).
CONCLUSIONS AND RELEVANCE
In this systematic review and meta-analysis, the feasibility and efficacy of mobile app interventions were supported in treating moderate and severe depression, and practical implications were also provided for developing effective app-based interventions in clinical practice.
Topics: Adult; Humans; Depression; Depressive Disorder, Major; Mobile Applications; Behavior Therapy; Control Groups
PubMed: 37983028
DOI: 10.1001/jamanetworkopen.2023.44120 -
Journal of Medical Internet Research Nov 2023The COVID-19 pandemic necessitated rapid changes to health care delivery, including a shift from in-person to digitally delivered psychotherapy. While these changes... (Review)
Review
BACKGROUND
The COVID-19 pandemic necessitated rapid changes to health care delivery, including a shift from in-person to digitally delivered psychotherapy. While these changes helped ensure timely psychotherapy provision, many concerns exist, including clinical, cultural, practical, privacy, and security issues.
OBJECTIVE
This scoping review systematically mapped existing peer-reviewed research on synchronous, therapist-delivered web-based psychotherapy for individuals with a diagnosed mental illness. Data were analyzed through the lens of the Alberta Quality Matrix for Health (AQMH) to assess to what degree this literature addresses key indicators of health care quality. This analysis aided in the identification and organization of knowledge gaps with regard to web-based psychotherapies, highlighting potential disparities between previously prioritized dimensions of care and those requiring further attention.
METHODS
This review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We included peer-reviewed primary research studies in the English language investigating synchronous, therapist-delivered remote psychotherapy delivered to adults (aged 18 years and older) with a Diagnostic and Statistical Manual of Mental Disorders or International Statistical Classification of Diseases diagnosed mental illness. All other citations were excluded. Relevant studies were identified through MEDLINE, APA PsycINFO, Embase (OVID), Web of Science: Core Collection (Clarivate), Cochrane Library (Wiley), and Scopus (Elsevier) databases. Databases were searched on March 18, 2021. For every publication that was taken into consideration, the data were charted independently by 2 reviewers, and in the event of a discrepancy, the principal investigator validated the choice of either extractor. Results were thematically described according to the 6 AQMH dimensions: acceptability, accessibility, appropriateness, effectiveness, efficiency, and safety.
RESULTS
From 13,209 publications, 48 articles were included, largely from North American studies. Most studies measured treatment effectiveness (n=48, 100%) and acceptability (n=29, 60%) health quality dimensions. Over 80% (40/48) of studies investigated either a cognitive or exposure intervention for either posttraumatic stress disorder or a mood or anxiety disorder, generally indicating comparable results to in-person therapy. Safety (n=5, 10%) was measured in fewer studies, while treatment accessibility, appropriateness, and efficiency were not explicitly measured in any study, although these dimensions were mentioned as a future direction, hypothesis, or potential outcome.
CONCLUSIONS
In relation to web-based therapist-delivered psychotherapies for those with a diagnosed mental illness, important aspects of health care quality (accessibility, appropriateness, efficiency, and safety) have received little scientific examination, underscoring a need to address these gaps. There are also significant issues related to the generalizability of this literature, including the underrepresentation of many geographic regions, cultures, populations, clinical contexts, and psychotherapy modalities. Qualitative research in underrepresented populations and settings may uncover important patient and contextual factors important for the future implementation of quality web-based psychotherapy.
Topics: Adult; Humans; Pandemics; Psychotherapy; Anxiety Disorders; Stress Disorders, Post-Traumatic; Internet
PubMed: 37921863
DOI: 10.2196/40710 -
PloS One 2023Breast cancer is known as one of the most common diseases among women, the psychological consequences of which are common in women and affect various aspects of their... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Breast cancer is known as one of the most common diseases among women, the psychological consequences of which are common in women and affect various aspects of their lives, so this study aims to investigate the prevalence of depression among women with breast cancer globally.
METHOD
The present meta-analysis was performed by searching for keywords related to breast cancer and depression in 4 main databases: PubMed, Embase, Web of Sciences and Scopus in the period of January 2000 to November 2021 and the results of the study using R and CMA software were analyzed.
RESULTS
A total of 71 studies were selected in English and the results of the analysis showed that the prevalence of depression in women with breast cancer is 30.2%, with Pakistan having the highest (83%) prevalence of depression and Taiwan having the lowest (8.3%). And in the WHO regions, EMRO region had the highest (49.7%) rate and SEARO region had the lowest (23%) prevalence of depression. Also, with increasing age, the prevalence of depression among women with breast cancer increases.
CONCLUSION
Community and family support for women with breast cancer, holding psychology and psychotherapy courses, lifestyle modifications and training in this area can be effective in preventing the reduction of the prevalence of depression, and given the pivotal role of women in family affairs, this This can be in line with the work of health system policymakers.
Topics: Humans; Female; Breast Neoplasms; Depression; Prevalence; Family Support; Psychotherapy
PubMed: 37494393
DOI: 10.1371/journal.pone.0287372 -
The Cochrane Database of Systematic... Oct 2023Despite improvements in medical care, the quality of life of adults and adolescents with congenital heart disease remains strongly affected by their condition, often... (Review)
Review
BACKGROUND
Despite improvements in medical care, the quality of life of adults and adolescents with congenital heart disease remains strongly affected by their condition, often leading to depression. Psychotherapy, cognitive behavioural therapy, and other talking therapies may be effective in treating depression in both adults and young adults with congenital heart disease. The aim of this review was to assess the effects of treatments, such as psychotherapy, cognitive behavioural therapies, and talking therapies for treating depression in this population.
OBJECTIVES
To evaluate the effects (both harms and benefits) of psychological interventions for reducing symptoms of depression in adolescents (aged 10 to 17 years) and adults with congenital heart disease. Psychological interventions include cognitive behavioural therapy, psychotherapy, or 'talking/counselling' therapy for depression.
SEARCH METHODS
We updated searches from the 2013 Cochrane Review by searching CENTRAL, four other databases, and Conference Proceedings Citation Index to 7 March 2023, and two clinical trial registers to February 2021. We applied no language restrictions.
SELECTION CRITERIA
Randomised controlled trials (RCTs) comparing psychological interventions to no intervention in the congenital heart disease population, aged 10 years and older, with depression.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened titles and abstracts, and independently assessed full-text reports for inclusion. Further information was sought from the authors if needed. Data were extracted in duplicate. We used standard Cochrane methods. Our primary outcome was a change in depression. Our secondary outcomes were: acceptability of treatment, quality of life, hospital re-admission, non-fatal cardiovascular events, cardiovascular behavioural risk factor, health economics, cardiovascular mortality, all-cause mortality. We used GRADE to assess the certainty of evidence for our primary outcome only.
MAIN RESULTS
We identified three new RCTs (480 participants). Participants were adults with congenital heart disease. Included studies varied in intervention length (90 minutes to 3 months) and follow-up (3 to 12 months), with depression assessed post-intervention and at follow-up. Risk of bias assessment identified an overall low risk of bias for the main outcome of depression. Psychological interventions (talking/counselling therapy) may reduce depression more than usual care at both three-month (mean difference (MD) -1.07, 95% confidence interval (CI) -1.84 to -0.30; P = 0.006; I = 0%; 2 RCTs, 156 participants; low-certainty evidence), and 12-month follow-up (MD -1.02, 95% CI -1.92 to -0.13; P = 0.02; I = 0%; 2 RCTs, 287 participants; low-certainty evidence). There was insufficient evidence to draw conclusions about the impact of psychological interventions on quality of life. None of the included studies reported on our other outcomes of interest. Due to the low number of studies included, we did not undertake any subgroup analyses. One study awaits classification.
AUTHORS' CONCLUSIONS
Psychological interventions may reduce depression in adults with congenital heart disease compared to usual care. However, the certainty of the evidence is low. Further research is needed to establish the role of psychological interventions in this population, defining the optimal duration, method of administration, and number of sessions required to obtain the greatest benefit.
Topics: Young Adult; Adolescent; Humans; Depression; Psychosocial Intervention; Psychotherapy; Cognitive Behavioral Therapy; Heart Defects, Congenital; Quality of Life
PubMed: 37787122
DOI: 10.1002/14651858.CD004372.pub3 -
Molecular Psychiatry Oct 2023This pre-registered (CRD42022322038) systematic review and meta-analysis investigated clinical and cognitive outcomes of external trigeminal nerve stimulation (eTNS) in... (Meta-Analysis)
Meta-Analysis Review
This pre-registered (CRD42022322038) systematic review and meta-analysis investigated clinical and cognitive outcomes of external trigeminal nerve stimulation (eTNS) in neurological and psychiatric disorders. PubMed, OVID, Web of Science, Chinese National Knowledge Infrastructure, Wanfang, and VIP database for Chinese technical periodicals were searched (until 16/03/2022) to identify trials investigating cognitive and clinical outcomes of eTNS in neurological or psychiatric disorders. The Cochrane Risk of Bias 2.0 tool assessed randomized controlled trials (RCTs), while the Risk of Bias of Non-Randomized Studies (ROBINS-I) assessed single-arm trials. Fifty-five peer-reviewed articles based on 48 (27 RCTs; 21 single-arm) trials were included, of which 12 trials were meta-analyzed (N participants = 1048; of which ~3% ADHD, ~3% Epilepsy, ~94% Migraine; age range: 10-49 years). The meta-analyses showed that migraine pain intensity (K trials = 4, N = 485; SMD = 1.03, 95% CI[0.84-1.23]) and quality of life (K = 2, N = 304; SMD = 1.88, 95% CI[1.22-2.53]) significantly improved with eTNS combined with anti-migraine medication. Dimensional measures of depression improved with eTNS across 3 different disorders (K = 3, N = 111; SMD = 0.45, 95% CI[0.01-0.88]). eTNS was well-tolerated, with a good adverse event profile across disorders. eTNS is potentially clinically relevant in other disorders, but well-blinded, adequately powered RCTs must replicate findings and support optimal dosage guidance.
Topics: Humans; Child; Adolescent; Young Adult; Adult; Middle Aged; Mental Disorders; Cognitive Behavioral Therapy; Trigeminal Nerve; Migraine Disorders; Cognition
PubMed: 37674019
DOI: 10.1038/s41380-023-02227-4 -
JAMA Network Open Dec 2023Although there is substantial evidence to suggest the health benefits of acceptance and commitment therapy (ACT) among informal caregivers of people with chronic health... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Although there is substantial evidence to suggest the health benefits of acceptance and commitment therapy (ACT) among informal caregivers of people with chronic health conditions, the great variation in intervention designs among published studies limits its application.
OBJECTIVES
To identify intervention characteristics of ACT that are associated with improved psychological health and to assess the acceptability of ACT among informal caregivers.
DATA SOURCES
Seven English- and 3 Chinese-language databases without limits on publication dates, the reference lists of previous reviews, and gray literature were searched up to February 2023.
STUDY SELECTION
Randomized clinical trials comparing the effect of ACT vs control groups on improving psychological health among informal caregivers.
DATA EXTRACTION AND SYNTHESIS
Two reviewers independently screened searched records and extracted data from eligible studies. Random-effects meta-analysis and mixed-effects metaregression were performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed.
MAIN OUTCOMES AND MEASURES
Psychological health outcomes (eg, depressive symptoms) measured by valid measurements and the acceptability of ACT based on identified parameters.
RESULTS
A total of 29 studies with 2010 participants, published between 2015 and 2023, were identified. ACT showed moderate to large effect sizes for improving psychological health at postintervention assessments (Hedges g range, -0.55 [95% CI, -0.98 to -0.12] to -1.14 [95% CI, -1.83 to -0.45]) and at 1-to-3-month and 4-to-6-month follow-ups (Hedges g range, -0.47 [95% CI, -0.69 to -0.25] to -1.29 [95% CI, -2.33 to -0.24]). Multivariable metaregression analysis regarding intervention characteristics found that ACT delivered in a mixed individual- and group-based format, face-to-face, or through more intervention sessions was associated with greater improvements for experiential avoidance (face-to-face: β = -1.170 [95% CI, -2.020 to -0.319]; number of sessions: β = -0.242 [95% CI, -0.353 to -0.130]), depressive symptoms (mixed delivery format: β = -2.583 [95% CI, -4.845 to -0.321]; face-to-face: β = -1.555 [95% CI, -3.002 to -0.108]), or anxiety symptoms (face-to-face: β = -1.241 [95% CI, -2.337 to -0.146]). In general, ACT had low attrition rates (11%), and participants' adherence (51%-80%) and satisfactory ratings (72%-95%) lend support to its acceptability.
CONCLUSIONS AND RELEVANCE
This systematic review and meta-analysis found that ACT was consistently associated with improvements in psychological health, supporting its application to improve informal care for chronic disease management. This review provides specific details on the design parameters of ACT for achieving greater efficacy.
Topics: Humans; Acceptance and Commitment Therapy; Caregivers; Chronic Disease; Anxiety; Mental Health
PubMed: 38051530
DOI: 10.1001/jamanetworkopen.2023.46216 -
Journal of Affective Disorders Jul 2023To evaluate the effectiveness of VR therapy (VRT) for symptoms related to social anxiety disorder (SAD), namely fear and avoidance of social interactions and performance... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the effectiveness of VR therapy (VRT) for symptoms related to social anxiety disorder (SAD), namely fear and avoidance of social interactions and performance situations (FASIP), fear of negative evaluation (FNE), anxiety and depression, a systematic review and meta-analysis were performed.
METHODS
Medline, PubMed, Science Direct, Web of Science, CINAHL, PsychINFO and Scopus were searched to include randomised controlled trials of VRT for SAD that met the criteria. A total of 15 RCTs with 720 participants published between 1998 and 2022 were included. Hedge's g with a 95 % confidence interval (CI) was adopted to compute the effect sizes.
RESULTS
Results showed no difference between the effect of VRT and cognitive behavioural therapy (CBT) on FASIP, FNE, anxiety and depression and a large effect size for VRT versus the waitlist control group on FASIP (g = -1.170, 95 % CI: -2.056-0.283; p < 0.010). The moderator analysis demonstrated that VRT was superior to the controlled group in addressing FASIP, FNE and anxiety when the sample size was smaller than 50 and the number of sessions was five or fewer.
LIMITATIONS
Differences in hardware, software and intervention duration for VRT across studies.
CONCLUSION
This study confirmed the feasibility of VRT in alleviating the FASIP in patients with SAD, with the waitlist control group as a comparison. However, the effectiveness of VRT was not significant in FASIP, FNE, anxiety and depression compared to CBT. Additional social interaction scenarios should be developed in VRT, standardised hardware should be used and the proper length of exposure time to VR should be determined to enhance the efficacy of VRT.
Topics: Humans; Phobia, Social; Virtual Reality Exposure Therapy; Anxiety Disorders; Anxiety; Cognitive Behavioral Therapy; Randomized Controlled Trials as Topic
PubMed: 37084968
DOI: 10.1016/j.jad.2023.04.043 -
Psicothema Nov 2023In recent years, eye movement desensitization and reprocessing (EMDR) has spread, in both the number of publications and professionals who use this technique in the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
In recent years, eye movement desensitization and reprocessing (EMDR) has spread, in both the number of publications and professionals who use this technique in the clinical setting. The objective of this meta-analysis was to verify the efficacy of EMDR in treatment of post-traumatic stress disorder.
METHOD
Based on the inclusion/exclusion criteria, 18 articles were selected ( n = 1213 subjects), published between 1991-2022.
RESULTS
The effect sizes found in the meta-analysis were small in the reduction of symptoms associated with PTSD, anxiety and depression, both in post-treatment and in maintenance. The analysis of the moderating variables revealed that both intervention time, the number and duration of the sessions, the experience of the therapist, and the type of therapist in charge of the intervention play an important role in the size of the final effect. No statistically significant data were found in the meta-regression analysis.
CONCLUSIONS
Although the study had restrictive criteria for study selection, there is a certain risk of bias in the selected articles, which lack sufficient methodological quality to be extrapolated to the clinical field.
Topics: Humans; Stress Disorders, Post-Traumatic; Eye Movement Desensitization Reprocessing; Randomized Controlled Trials as Topic; Anxiety; Anxiety Disorders; Treatment Outcome
PubMed: 37882423
DOI: 10.7334/psicothema2022.309 -
PloS One 2023This paper aimed to evaluate the use of nonpharmacological interventions for the management of autism spectrum disorder (ASD). The effects of acupuncture and behavioural... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIMS
This paper aimed to evaluate the use of nonpharmacological interventions for the management of autism spectrum disorder (ASD). The effects of acupuncture and behavioural therapy, two nonpharmalogical interventions, on social function in ASD patients are still controversial. This meta-analysis investigated the impact of these two treatments and compared their effects.
METHODS
Seven electronic databases were systematically searched to identify randomized controlled trials (RCTs) on the use of acupuncture or behavioural therapy for ASD. A meta-analysis was carried out using Review Manager 5.4 software. Continuous data are reported as mean differences (MDs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs). An assessment of methodological quality using the Cochrane risk-of-bias (ROB) tool for trials was carried out. The Grading of Recommendation Assessment, Development, and Evaluation (GRADE) was applied to evaluate the quality (certainty) of evidence for results regarding social function indicators.
RESULTS
Thirty RCTs on acupuncture and 36 on behavioural therapy were included. Compared with the control condition, body acupuncture (SMD: 0.76, 95% CI: [0.52, 1.01]; low certainty), modern acupuncture technology (SMD: 0.84, 95% CI: [0.32, 1.35]; low certainty), cognitive behavioural therapy (SMD: 0.42, 95% CI: [0.26, 0.58]; high certainty), the Denver model (SMD: 0.61, 95% CI: [0.23, 0.99]; moderate certainty) and social skills training (SMD: 0.56, 95% CI: [0.41, 0.71]; moderate certainty) improved social functioning.
CONCLUSION
Behavioural therapies (such as CBT, the Denver model, social skills training), improved the social functioning of patients with ASD in the short and long term, as supported by high- and moderate-quality evidence. Acupuncture (including scalp acupuncture, body acupuncture and use of modern acupuncture technology) also improved social functioning, as supported by low- and very low-quality evidence. More high-quality evidence is needed to confirm the effect of acupoint catgut embedding and Early Intensive Behavioural Intervention (EIBI).
Topics: Humans; Adult; Child; Acupuncture Therapy; Behavior Therapy; Cognitive Behavioral Therapy; Acupuncture Points; Autism Spectrum Disorder
PubMed: 37725597
DOI: 10.1371/journal.pone.0291720 -
Journal of Affective Disorders Aug 2023Grief in young people is common and associated with symptoms of anxiety and depression, yet grief interventions for this age group are under-researched. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Grief in young people is common and associated with symptoms of anxiety and depression, yet grief interventions for this age group are under-researched.
METHOD
We conducted a systematic review and meta-analysis to examine the efficacy of grief interventions in young people. The process was co-designed with young people and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PsycINFO, Medline, and Web of Science databases were searched in July 2021 (updated December 2022).
RESULTS
We extracted results from 28 studies of grief interventions with young people (14-24 years) that measured anxiety and/or depression (N = 2803 participants, 60 % girls/women). Cognitive behavior therapy (CBT) for grief demonstrated a large effect for anxiety and medium effect for depression. A meta-regression indicated that CBT for grief that included a higher degree of CBT strategies, was not trauma focused, had >10 sessions, offered on an individual basis, and did not involve parents, was associated with larger effect sizes for anxiety. Supportive therapy had a moderate effect for anxiety and a small-moderate effect for depression. Writing interventions were not effective for anxiety or depression.
LIMITATIONS
Studies are limited in number and there were few randomized controlled studies.
CONCLUSIONS
Findings indicate that CBT for grief is an effective intervention for reducing symptoms of anxiety and depression in young people experiencing grief. CBT for grief should be offered as the first line treatment for grieving young people experiencing anxiety and depression.
PROTOCOL REGISTRATION
PROSPERO (registration number CRD42021264856).
Topics: Female; Humans; Adolescent; Male; Depression; Anxiety; Anxiety Disorders; Cognitive Behavioral Therapy
PubMed: 37196936
DOI: 10.1016/j.jad.2023.05.032