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Scientific Reports Sep 2020We examined if manualized cognitive behavioral therapy (CBT) was more effective than Treatment As Usual (TAU) for clinically depressed adolescents within routine care.... (Randomized Controlled Trial)
Randomized Controlled Trial
We examined if manualized cognitive behavioral therapy (CBT) was more effective than Treatment As Usual (TAU) for clinically depressed adolescents within routine care. This multisite Randomized controlled trail included 88 clinically depressed adolescents (aged 12-21 years) randomly assigned to CBT or TAU. Multiple assessments (pre-, post treatment and six-month follow-up) were done using semi-structured interviews, questionnaires and ratings and multiple informants. The primary outcome was depressive or dysthymic disorder based on the KSADS. Completers, CBT (n = 19) and TAU (n = 26), showed a significant reduction of affective diagnoses at post treatment (76% versus 76%) and after six months (90% versus 79%). Intention-to-treat analyses on depressive symptoms showed that 41.6% within CBT and 31.8% within the TAU condition was below clinical cut-off at post treatment and after six-months, respectively 61.4% and 47.7%. No significant differences in self-reported depressive symptoms between CBT and TAU were found. No prediction or moderation effects were found for age, gender, child/parent educational level, suicidal criteria, comorbidity, and severity of depression. We conclude that CBT did not outperform TAU in clinical practice in the Netherlands. Both treatments were found to be suitable to treat clinically referred depressed adolescents. CBT needs further improvement to decrease symptom levels below the clinical cut-off at post treatment.
Topics: Adolescent; Adult; Child; Cognitive Behavioral Therapy; Humans; Netherlands; Surveys and Questionnaires; Treatment Outcome; Young Adult
PubMed: 32908173
DOI: 10.1038/s41598-020-71160-1 -
Journal of Medical Internet Research Jul 2020An increasing number of studies suggest that web-based interventions for patients with depression can reduce their symptoms and are expected to fill currently existing... (Randomized Controlled Trial)
Randomized Controlled Trial
Efficacy of a Guided Web-Based Self-Management Intervention for Depression or Dysthymia: Randomized Controlled Trial With a 12-Month Follow-Up Using an Active Control Condition.
BACKGROUND
An increasing number of studies suggest that web-based interventions for patients with depression can reduce their symptoms and are expected to fill currently existing treatment gaps. However, evidence for their efficacy has mainly been derived from comparisons with wait-list or treatment as usual controls. In particular, designs using wait-list controls are unlikely to induce hope and may even have nocebo effects, making it difficult to draw conclusions about the intervention's efficacy. Studies using active controls are rare and have not yielded conclusive results.
OBJECTIVE
The main objective of this study is to assess the acute and long-term antidepressant efficacy of a 6-week, guided, web-based self-management intervention building on the principles of cognitive behavioral therapy (iFightDepression tool) for patients with depression compared with web-based progressive muscle relaxation as an active control condition.
METHODS
A total of 348 patients with mild-to-moderate depressive symptoms or dysthymia (according to the Mini International Neuropsychiatric Interview) were recruited online and randomly assigned to 1 of the 2 intervention arms. Acute antidepressant effects after 6 weeks and long-term effects at 3-, 6-, and 12-month follow-up were studied using the Inventory of Depressive Symptomatology-self-rating as a primary outcome parameter and change in quality of life (Short Form 12) and user satisfaction (client satisfaction questionnaire) as secondary outcome parameters. Treatment effects were assessed using mixed model analyses.
RESULTS
Over the entire observation period, a greater reduction in symptoms of depression (P=.01) and a greater improvement of life quality (P<.001) was found in the intervention group compared with the active control group. Separate tests for each time point revealed significant effects on depressive symptoms at the 3-month follow-up (d=0.281; 95% CI 0.069 to 0.493), but not after 6 weeks (main outcome:d=0.192; 95% CI -0.020 to 0.404) and 6 and 12 months. The intervention was significantly superior to the control condition with respect to user satisfaction (25.31 vs 21.97; t=5.804; P<.01).
CONCLUSIONS
The fact that antidepressant effects have been found for a guided self-management tool in comparison with an active control strengthens the evidence base for the efficacy of web-based interventions. The antidepressant effect became most prominent at the 3-month follow-up. After 6 weeks of intervention, significant positive effects were observed on life quality but not on depressive symptoms. Although the effect size of such web-based interventions on symptoms of depression might be smaller than that suggested by earlier studies using wait-list control conditions, they can be a cost-effective addition to antidepressants and face-to-face psychotherapy.
TRIAL REGISTRATION
International Clinical Trials Registry Platform ICTRP080-15-09032015; https://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00009323.
Topics: Adult; Depression; Dysthymic Disorder; Female; Follow-Up Studies; Humans; Internet-Based Intervention; Male; Psychotherapy; Quality of Life; Self-Management; Time Factors
PubMed: 32673233
DOI: 10.2196/15361 -
Psychiatry Research Sep 2020This study tested the hypothesis that chronic depression (CD) is more similar to depression with multiple prior episodes (ME) than to depression with few prior episodes... (Comparative Study)
Comparative Study
This study tested the hypothesis that chronic depression (CD) is more similar to depression with multiple prior episodes (ME) than to depression with few prior episodes (FE). Data from participants (n = 1013) with mild to moderate depressive symptoms (Patient Health Questionnaire [PHQ-9] score 5 - 14) who took part in a randomized control trial of an internet intervention for depression (EVIDENT trial) were re-analyzed. The MINI-interview was conducted to diagnose CD (n = 376). If CD was not diagnosed, the self-reported number of depressive episodes was used to categorize participants as having episodic depression with up to five (FE, n = 422) or more than five (ME, n = 215) prior episodes. Over a three-year period, participants were assessed repeatedly regarding the course of depression (PHQ-9, QIDS), quality of life (SF-12) and therapeutic progress (FEP-2). At baseline, most scores were different between CD and FE but comparable between CD and ME. Time to remission did not differ between CD and ME but was longer in CD compared to FE. Results suggest that ME closely resembles CD and that CD differs from FE.
Topics: Adult; Chronic Disease; Depression; Depressive Disorder, Major; Female; Humans; Male; Middle Aged; Patient Health Questionnaire; Quality of Life; Randomized Controlled Trials as Topic; Self Report; Time Factors
PubMed: 32599445
DOI: 10.1016/j.psychres.2020.113235 -
Behaviour Research and Therapy Aug 2020Studies suggest that depression severity and duration interact to predict outcomes in depression treatment. To our knowledge, no study has explored this question in a... (Randomized Controlled Trial)
Randomized Controlled Trial
Studies suggest that depression severity and duration interact to predict outcomes in depression treatment. To our knowledge, no study has explored this question in a sample with a placebo control, two therapies, and their combination nor with adolescents. We used data from the Treatment of Adolescent Depression Study (N = 439), in which adolescent were randomized to placebo (PBO), cognitive-behavioral therapy (CBT), antidepressants medications (MEDs), or their combination (COMB). We explore the interaction between depression severity, chronicity, and treatments (vs. placebo) in predicting outcomes. There was interaction between severity and chronicity when comparing COMB and CBT with PBO, but not MEDs. In non-chronic depression, the effects of CBT were inversely related to severity to the point that CBT appeared iatrogenic with more severe depression. In chronic depression, the effects of CBT did not vary by severity, but the relative effects of COMB grew, being smallest in milder, more dysthymic-like depression, and largest in chronic-severe depression. These findings support calls to classify depression by severity and chronicity as well efforts to risk stratify patients to different intensity of care according to these variables.
Topics: Adolescent; Antidepressive Agents; Chronic Disease; Cognitive Behavioral Therapy; Depressive Disorder; Female; Humans; Male; Prognosis; Severity of Illness Index; Time Factors; Treatment Outcome
PubMed: 32413595
DOI: 10.1016/j.brat.2020.103637 -
Journal of Child Psychology and... Mar 2021Severe irritability has become an important topic in child and adolescent mental health. Based on the available evidence and on public health considerations, WHO...
BACKGROUND
Severe irritability has become an important topic in child and adolescent mental health. Based on the available evidence and on public health considerations, WHO classified chronic irritability within oppositional defiant disorder (ODD) in ICD-11, a solution markedly different from DSM-5's (i.e. the new childhood mood diagnosis, disruptive mood dysregulation disorder [DMDD]) and from ICD-10's (i.e. ODD as one of several conduct disorders without attention to irritability). In this study, we tested the accuracy with which a global, multilingual, multidisciplinary sample of clinicians were able to use the ICD-11 classification of chronic irritability and oppositionality as compared to the ICD-10 and DSM-5 approaches.
METHODS
Clinicians (N = 196) from 48 countries participated in an Internet-based field study in English, Spanish, or Japanese and were randomized to review and use one of the three diagnostic systems. Through experimental manipulation of validated clinical vignettes, we evaluated how well clinicians in each condition could identify chronic irritability versus nonirritable oppositionality, episodic bipolar disorder, dysthymic depression, and normative irritability.
RESULTS
Compared to ICD-10 and DSM-5, ICD-11 led to more accurate identification of severe irritability and better differentiation from boundary presentations. Participants using DSM-5 largely failed to apply the DMDD diagnosis when it was appropriate, and they more often applied psychopathological diagnoses to developmentally normative irritability.
CONCLUSIONS
The formulation of irritability and oppositionality put forth in ICD-11 shows evidence of clinical utility, supporting accurate diagnosis. Global mental health clinicians can readily identify ODD both with and without chronic irritability.
Topics: Adolescent; Attention Deficit and Disruptive Behavior Disorders; Child; Diagnostic and Statistical Manual of Mental Disorders; Humans; International Classification of Diseases; Irritable Mood; Mood Disorders
PubMed: 32396664
DOI: 10.1111/jcpp.13244 -
Behaviour Research and Therapy Aug 2020This study examined the feasibility, acceptability, and preliminary efficacy of a decision rule driven treatment for youth with comorbid conduct problems and depression.... (Randomized Controlled Trial)
Randomized Controlled Trial
This study examined the feasibility, acceptability, and preliminary efficacy of a decision rule driven treatment for youth with comorbid conduct problems and depression. A randomized, controlled, repeated measures design was used to compare two treatment approaches: Decision-Rule Based Treatment (DR) and Sequential Treatment (SEQ). Participants included 30 children (ages 8-14; 66% female; 80% Caucasian) who met criteria for a depressive disorder (major depressive disorder and/or dysthymia) and a conduct problem disorder (oppositional defiant disorder and/or conduct disorder). Assessments were conducted at baseline, post-treatment, and six-month follow-up. Treatment adherence, attendance, and session evaluations ratings indicate that the treatments were feasible to implement and acceptable to parents and youth in both conditions. Both treatments showed similar remission of internalizing and externalizing diagnoses. Participants in DR showed significantly greater improvements at six-month follow-up in child-reported depressive symptom severity compared to SEQ. Both DR and SEQ conditions showed significantly lower behavior problems at end of treatment and six-month follow-up. DR showed significant reductions in emotion dysregulation at 6-month follow-up, while SEQ did not. Findings suggest that a decision rule based intervention holds promise as a feasible and acceptable treatment with high rates of remittance.
Topics: Adolescent; Attention Deficit and Disruptive Behavior Disorders; Child; Cognitive Behavioral Therapy; Comorbidity; Conduct Disorder; Decision Support Systems, Clinical; Depressive Disorder; Depressive Disorder, Major; Dysthymic Disorder; Emotional Regulation; Feasibility Studies; Female; Humans; Male; Parents; Patient Acceptance of Health Care; Pilot Projects; Treatment Outcome
PubMed: 32353635
DOI: 10.1016/j.brat.2020.103625 -
The Journal of Clinical Psychiatry Apr 2020It remains unclear whether specific clinical factors contribute to heterogeneity in the timing of the onset of nonfatal suicidal behavior. This knowledge could have...
BACKGROUND
It remains unclear whether specific clinical factors contribute to heterogeneity in the timing of the onset of nonfatal suicidal behavior. This knowledge could have important implications for suicide prevention.
METHODS
Using a nationally representative US adult sample, the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (2004-2005; n = 34,629), we compared the characteristics of 4 different suicide attempter groups: those who first attempted (1) before 18 years, (2) from 18 to 34 years, (3) from 35 to 49 years, and (4) at 50 years or older. Specifically, DSM-IV psychiatric disorders that occurred before the first suicide attempt, childhood maltreatment experiences, parental history of psychiatric disorders, and sociodemographic characteristics were examined.
RESULTS
Most first nonfatal suicide attempts (85.3%) occurred before age 35 years. Compared with suicide attempts occurring from 18 to 34 years, suicide attempts occurring before 18 years were more strongly associated with childhood maltreatment and less strongly linked to lifetime prior psychiatric disorders, whereas first suicide attempts occurring at 35 years and older were more strongly associated with a prior lifetime history of substance use disorders, including alcohol use disorder and nicotine dependence, and mood disorders, including mania/hypomania and dysthymic disorder between 35 and 49 years and major depressive episode at 50 years and older (all P < .05).
CONCLUSIONS
These results suggest age differences in risk factors for first nonfatal suicide attempt. Improving early detection and treatment of psychiatric disorders and preventing childhood maltreatment may have broad benefits to reduce the burden of suicidal behavior at all ages.
Topics: Adolescent; Adult; Adult Survivors of Child Abuse; Age Factors; Aged; Child of Impaired Parents; Educational Status; Humans; Male; Mental Disorders; Middle Aged; Racial Groups; Risk Factors; Sex Factors; Suicide, Attempted; United States; Young Adult
PubMed: 32271505
DOI: 10.4088/JCP.19m13017 -
Clinical Epidemiology 2020Psychiatric disorders such as attention-deficit/hyperactivity disorder may negatively impact drug compliance and the prognosis of enuresis. However, existing studies...
BACKGROUND
Psychiatric disorders such as attention-deficit/hyperactivity disorder may negatively impact drug compliance and the prognosis of enuresis. However, existing studies regarding associations between lifetime psychiatric disorders and childhood enuresis are primarily from Western countries, and studies from Taiwan are lacking.
METHODS
We conducted a population-based retrospective cohort analysis using the Taiwan Longitudinal Health Insurance Database 2010. A total of 1,146 children with enuresis (ICD-9-CM code: 307.6) and 4,584 randomly selected sex- and age-matched controls were identified between January 1, 1997 and December 31, 2011. Logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the development of psychiatric disorders in the children with enuresis.
RESULTS
Enuresis was more common in the younger children, and the rate was significantly higher in boys (58.7%) than in girls (41.3%). A total of 171 patients (14.9%) in the enuresis group had at least one psychiatric diagnosis vs 259 (5.7%) in the control group (p<0.001). Multivariate analysis showed that the presence of enuresis increased the odds of developing major depressive/dysthymic disorder (OR=2.841, 95% CI: 1.619, 4.987), attention-deficit/hyperactivity disorder (OR=3.156, 95% CI: 2.446, 4.073), autism spectrum disorder (OR=2.468, 95% CI: 1.264, 4.822), anxiety disorders (OR=3.113, 95% CI: 2.063, 4.699), intelligence disability (OR=3.989, 95% CI: 2.476, 6.426), disruptive behavior disorders (OR=3.749, 95% CI: 1.756, 8.004), and tic disorder (OR=2.660, 95% CI: 1.642, 4.308).
CONCLUSION
Children with enuresis are likely to have psychiatric disorders, and physicians should consider this during their evaluation.
PubMed: 32110107
DOI: 10.2147/CLEP.S230537 -
Social Psychiatry and Psychiatric... Oct 2020Putative causal relations among depressive symptoms in forms of network structures have been of recent interest, with prior studies suggesting that high connectivity of...
PURPOSE
Putative causal relations among depressive symptoms in forms of network structures have been of recent interest, with prior studies suggesting that high connectivity of the symptom network may drive the disease process. We examined in detail the network structure of depressive symptoms among participants with and without depressive disorders (DD; consisting of major depressive disorder (MDD) and dysthymia) at two time points.
METHODS
Participants were from the nationally representative Health 2000 and Health 2011 surveys. In 2000 and 2011, there were 5998 healthy participants (DD-) and 595 participants with DD diagnosis (DD+). Depressive symptoms were measured using the 13-item version of the Beck Depression Inventory (BDI). Fused Graphical Lasso was used to estimate network structures, and mixed graphical models were used to assess network connectivity and symptom centrality. Network community structure was examined using the walktrap-algorithm and minimum spanning trees (MST). Symptom centrality was evaluated with expected influence and participation coefficients.
RESULTS
Overall connectivity did not differ between networks from participants with and without DD, but more simple community structure was observed among those with DD compared to those without DD. Exploratory analyses revealed small differences between the samples in the order of one centrality estimate participation coefficient.
CONCLUSIONS
Community structure, but not overall connectivity of the symptom network, may be different for people with DD compared to people without DD. This difference may be of importance when estimating the overall connectivity differences between groups with and without mental disorders.
Topics: Depression; Depressive Disorder, Major; Dysthymic Disorder; Health Surveys; Humans; Psychiatric Status Rating Scales
PubMed: 32047972
DOI: 10.1007/s00127-020-01843-7 -
The Primary Care Companion For CNS... Jan 2020
Topics: Adult; Antidepressive Agents; Bupropion; Dysthymic Disorder; Ejaculation; Humans; Male
PubMed: 31917530
DOI: 10.4088/PCC.19l02453