Disorders - depressive disorders
Tol, W. A., Komproe, I. H., Jordans, M. J. D., Vallipuram, A., Sivayokan, S., MacY, R. D., De ong, J. T.,
We aimed to examine outcomes, moderators and mediators of a preventive school-based mental health
intervention implemented by paraprofessionals in a war-affected setting in northern Sri Lanka. A cluster randomized trial was employed. Subsequent to
screening 1,370 children in randomly selected schools, 399 children were assigned to an intervention (n=199) or waitlist control condition (n=200).
The intervention consisted of 15 manualized sessions over 5 weeks of cognitive behavioral techniques and creative expressive elements. Assessments
took place before, 1 week after, and 3 months after the intervention. Primary outcomes included post-traumatic stress disorder (PTSD), depressive,
and anxiety symptoms. No main effects on primary outcomes were identified. A main effect in favor of intervention for conduct problems was observed.
This effect was stronger for younger children. Furthermore, we found intervention benefits for specific subgroups. Stronger effects were found for
boys with regard to PTSD and anxiety symptoms, and for younger children on pro-social behavior. Moreover, we found stronger intervention effects on
PTSD, anxiety, and function impairment for children experiencing lower levels of current war-related stressors. Girls in the intervention condition
showed smaller reductions on PTSD symptoms than waitlisted girls. We conclude that preventive school-based psychosocial interventions in volatile
areas characterized by ongoing war-related stressors may effectively improve indicators of psychological wellbeing and posttraumatic stress-related
symptoms in some children. However, they may undermine natural recovery for others. Further research is necessary to examine how gender, age and
current war-related experiences contribute to differential intervention effects.
World
Psychiatry, 11(2) : 114-122
- Year: 2012
- Problem: Post Traumatic Stress Disorder, Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Other Psychological Interventions, Creative expression: music, dance, drama, art
Weisz, J. R., Chorpita, B. F., Palinkas, L.
A., Schoenwald, S. K., Miranda, J., Bearman, S. K., Daleiden, E. L., Ugueto, A. M., Ho, A., Martin, J., Gray, J., Alleyne, A., Langer, D. A., Southam-Gerow, M. A., Gibbons,
R. D., Glisson, C., Green, E. P., Hoagwood, K. E., Kelleher,
K., Landsverk, J., Mayberg, S.
Context: Decades of randomized controlled trials have produced separate evidence-based treatments for
depression, anxiety, and conduct problems in youth, but these treatments are not often used in clinical practice, and they produce mixed results in
trials with the comorbid, complex youths seen in practice. An integrative, modular redesign may help. Objective: Standard/separate and
modular/integrated arrangements of evidence-based treatments for depression, anxiety, and conduct problems in youth were compared with usual care
treatment, with the modular design permitting a multidisorder focus and a flexible application of treatment procedures. Design: Randomized
effectiveness trial. Setting: Ten outpatient clinical service organizations in Massachusetts and Hawaii. Participants: A total of 84 community
clinicians were randomly assigned to 1 of 3 conditions for the treatment of 174 clinically referred youths who were 7 to 13 years of age (70% of
these youths were boys, and 45% were white). The study was conducted during the period from January 12, 2005 to May 8, 2009. Interventions: Standard
manual treatment (59 youths [34% of the sample]; cognitive behavioral therapy for depression, cognitive behavioral therapy for anxiety, and
behavioral parent training for conduct problems), modular treatment (62 youths [36%]; integrating the procedures of the 3 separate treatments), and
usual care (53 youths [30%]). Main Outcome Measures: Outcomes were assessed using weekly youth and parent assessments. These assessments relied on a
standardized Brief Problem Checklist and a patient generated Top Problems Assessment (ie, the severity ratings on the problems that the youths and
parents had identified as most important). We also conducted a standardized diagnostic assessment before and after treatment. Results: Mixed effects
regression analyses showed that modular treatment produced significantly steeper trajectories of improvement than usual care and standard treatment
on multiple Brief Problem Checklist and Top Problems Assessment measures. Youths receiving modular treatment also had significantly fewer diagnoses
than youths receiving usual care after treatment. In contrast, outcomes of standard manual treatment did not differ significantly from outcomes of
usual care. Conclusions: The modular approach outperformed usual care and standard evidence-based treatments on multiple clinical outcome measures.
The modular approach may be a promising way to build on the strengths of evidence-based treatments, improving their utility and effectiveness with
referred youths in clinical practice settings. Trial Registration: clinicaltrials.gov Identifier: NCT01178554. (copyright)2012 American Medical
Association. All rights reserved.
Archives of General
Psychiatry, 69(3) : 274-282
- Year: 2012
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other service delivery and improvement
interventions
Williford, A., Boulton, A., Noland, B., Little, T. D., Karna, A., Salmivalli, C.
The present study investigated the effects of the KiVa antibullying
program on students' anxiety, depression, and perception of peers in Grades 4-6. Furthermore, it was investigated whether reductions in peer-
reported victimization predicted changes in these outcome variables. The study participants included 7,741 students from 78 schools who were randomly
assigned to either intervention or control condition, and the program effects were tested with structural equation modeling. A cross-lagged panel
model suggested that the KiVa program is effective for reducing students' internalizing problems and improving their peer-group perceptions.
Finally, changes in anxiety, depression, and positive peer perceptions were found to be predicted by reductions in victimization. Implications of the
findings and future directions for research are discussed.
Journal of Abnormal Child Psychology, 40(2) : 289-
300
- Year: 2012
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
VanDerZanden, R., Kramer, J., Gerrits, R., Cuijpers, P.
Depression is a serious mental health problem, whose first onset is usually in adolescence. Online treatment may offer
a solution for the current undertreatment of depression in youth. For adults with depressive symptoms, the effectiveness of Internet-based cognitive
behavioral therapy has been demonstrated. This study is one of the first randomized controlled trials to investigate the effectiveness online
depression treatment for young people with depressive complaints and the first to focus on an online group course. To evaluate and discuss the
effectiveness of a guided Web-based group course called Grip op Je Dip (Master Your Mood [MYM]), designed for young people aged 16 to 25 years with
depressive symptoms, in comparison with a wait-listed control group. We randomly assigned 244 young people with depressive symptoms to the online MYM
course or to a waiting-list control condition. The primary outcome measure was treatment outcome after 3 months on the Center for Epidemiologic
Studies Depression Scale. Secondary outcomes were anxiety (measured by the Hospital Anxiety and Depression Scale) and mastery (Mastery Scale). We
studied the maintenance of effects in the MYM group 6 months after baseline. Missing data were imputed. The MYM group (n = 121) showed significantly
greater improvement in depressive symptoms at 3 months than the control group (n = 123) (t(187 )= 6.62, P < .001), with a large between-group effect
size of d = 0.94 (95% confidence interval [CI] 0.64-1.23). The MYM group also showed greater improvement in anxiety (t(187 )= 3.80, P < .001, d =
0.49, 95% CI 0.24-0.75) and mastery (t(187 )= 3.36, P = .001, d = 0.44, 95% CI 0.19-0.70). At 12 weeks, 56% (68/121) of the participants in the MYM
group and 20% (24/123) in the control group showed reliable and clinically significant change. This between-group difference was significant ((chi)
(2) (1 )= 35.0, P < .001) and yielded a number needed to treat of 2.7. Improvements in the MYM group were maintained at 6 months. A limitation is the
infeasibility of comparing the 6-month outcomes of the MYM and control groups, as the controls had access to MYM after 3 months. The online group
course MYM was effective in reducing depressive symptoms and anxiety and in increasing mastery in young people. These effects persisted in the MYM
group at 6 months.
Journal of
Medical Internet Research, 14(3) : e86
- Year: 2012
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Technology, interventions delivered using technology (e.g. online, SMS)
Vazquez, F. L., Torres, A., Blanco, V., Diaz, O., Otero, P., Hermida, E.
Although cognitive-behavioural programmes for preventing
depression have produced promising findings, their administration requires extensive training. Relaxation techniques are more straightforward
psychological strategies, but they have not been investigated in the prevention of depression. This trial aimed to compare the results of relaxation
training (RT) with that of a cognitive-behavioural programme (CBT) for prevention of depression in university students with elevated depressive
symptoms. The 133 participants (mean age 23.3 years, 82% women) were randomly assigned to CBT or RT. Both programmes were administered to groups of 5
or 6 participants in eight weekly 90-min sessions. Participants were evaluated by independent raters before, immediately after, and 3 and 6 months
after taking part in the programmes. By itself, intervention type had no significant effect on either depression or anxiety scores. The scores were
lower at the follow-up time points with respect to pre-intervention scores. Effect size was greatest between pre- and immediately post-intervention
scores for CBT, d = 1.32, 95% CI [1.00, 1.64], and between pre- and 6-month post-intervention scores for RT, d = 0.75, 95% CI [0.47, 1.03]. Anxiety
symptoms were significantly improved by both interventions at 3-month follow-up, and by CBT at 6-month follow-up also. In the medium term (3-6
months), relaxation training produced similar reductions in depressive and anxiety symptoms as a more complex cognitive-behavioural programme.
(copyright) 2012 Elsevier Ltd.
Journal of Psychiatric Research, 46(11) : 1456-
1463
- Year: 2012
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Relaxation
Salloum, A., Overstreet, S.
This study evaluated the differential
effects of the Grief and Trauma Intervention (GTI) with coping skills and trauma narrative processing (CN) and coping skills only (C). Seventy
African American children (6-12 years old) were randomly assigned to GTI-CN or GTI-C. Both treatments consisted of a manualized 11-session
intervention and a parent meeting. Measures of trauma exposure, posttraumatic stress symptoms, depression, traumatic grief, global distress, social
support, and parent reported behavioral problems were administered at pre, post, 3 and 12 months post intervention. In general, children in both
treatment groups demonstrated significant improvements in distress related symptoms and social support, which, with the exception of externalizing
symptoms for GTI-C, were maintained up to 12 months post intervention. Results suggest that building coping skills without the structured trauma
narrative may be a viable intervention to achieve symptom relief in children experiencing trauma-related distress. However, it may be that highly
distressed children experience more symptom relief with coping skills plus narrative processing than with coping skills alone. More research on the
differential effects of coping skills and trauma narration on child distress and adaptive functioning outcomes is needed. (copyright) 2012 Elsevier
Ltd.
Behaviour
Research & Therapy, 50(3) : 169-179
- Year: 2012
- Problem: Post Traumatic Stress Disorder, Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Skills training, Other Psychological Interventions
Zhang, W., Guo, T., Zhang, H., Ma, W.
Purpose: To assess the efficacy of electro-acupuncture on
quality of life improvement of undergraduates in depressive states. Methods: Fifty undergraduates in depressive states (CES-D score (greater-than or
equal to)16, HAMD score(greater-than or equal to)7, <17) were assigned to 4 groups based on intervention preference in a pragmatic trial. Electro-
acupuncture, cognitive behavior therapy (CBT), and a combined intervention of electro-acupuncture and CBT were implemented as interventions. A
rejected intervention group in which no intervention was practiced was considered as a control condition. The electro-acupuncture implemented
traditional Chinese medicine (TCM)-style acupuncture. The CBT is practiced as 8 sessions of group counseling (1 time/week). Each 8-week course of
electroacupuncture consisted of 16 sessions (2 times/week) in the clinic of Beijing University of Traditional Chinese Medicine. The combined
intervention consisted of 16 sessions of electro-acupuncture (2 times/ week) and 8 sessions of CBT (1 time/week) in an 8-week course. WHOQOL-BREF was
evaluated at baseline and 8 weeks after interventions. Results: Two subjects terminated interventions before the completion of the 8-week
intervention. Intention to treat and per protocol analyses were applied but there were no differences shown. After 8 weeks, the rejected intervention
group and CBT group showed no significant difference (p>0.05), and although the score of electro-acupuncture intervention and combined intervention
participants in overall QOL were significantly improved (p<0.05), no evidence of a differential improvement of electro-acupuncture intervention over
combined intervention was found (p>0.05). Conclusion: Electro-acupuncture showed a beneficial advantage in overall QOL improvement of undergraduates
in depression states.
BMC Complementary & Alternative
Medicine, 12 :
- Year: 2012
- Problem: Depressive Disorders
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Acupuncture, acupressure
Smith, A. P., Woods, M.
Recent research has indicated that chewing gum can relieve perceptions of stress in an occupational sample (Smith, 2009). In
the present study, 72 students completed 2. weeks of either chewing gum or refraining from chewing gum. They completed scales measuring perceived
stress, anxiety, depression, and single item measures of work levels and tiredness. These were completed both pre- and post-treatment. Perceived
stress decreased as a function of the amount of gum chewed. The chewing gum condition was also associated with a decrease in not getting enough
academic work done. There were no significant effects of chewing gum on mental health outcomes. These results confirm some of findings from previous
studies of chewing gum and stress in other samples. (copyright) 2012 Elsevier Ltd.
Appetite, 58(3) : 1037-
1040
- Year: 2012
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Other complementary & alternative
interventions
Shamseddeen, W., Clarke,
G., Wagner, K. D., Ryan, N. D., Birmaher, B., Emslie, G., Asarnow, J. R., Porta, G., Mayes, T., Keller, M. B., Brent, D. A.
Objective: There is little work on
the effect of school on response to treatment of depression, with available research suggesting that children and adolescents with school
difficulties are less likely to respond to fluoxetine compared with those with no school difficulties. Method: Depressed adolescents in the Treatment
of Resistant Depression in Adolescents study, who had not responded to a previous adequate selective serotonin reuptake inhibitor (SSRI) trial, were
randomly assigned to one of the following: another SSRI, venlafaxine, another SSRI + cognitive behavior therapy (CBT), or venlafaxine + CBT.
Participants were classified into four groups depending on whether their enrollment in the study and end of treatment was during school or summer
vacation. Results: Controlling for baseline differences, adolescents ending their 12-week treatment during summer vacation had odds 1.7 times (95%
confidence interval = 1.02-2.8, p = .04) greater to have an adequate response as those ending their treatment while being in school. In addition,
adequate depression response was associated with fewer school problems at week 12 (scores <5 versus scores <5: odds ratio = 3.3, 95% confidence
interval = 1.9-5.8, p < .001). There was a significant interaction between school difficulties and timing of treatment, with the lowest rates of
response being among adolescents having school difficulties and ending their treatment during the active school year. Conclusion: School problems are
relevant to treatment response in depressed adolescents and should be incorporated into the treatment plan. These findings also suggest that the time
of the year might need to be taken into consideration for analysis of clinical trials in school-aged youth. Clinical trial registration
information--Treatment of SSRI-Resistant Depression in Adolescents (TORDIA); http://www.clinicaltrials.gov; NCT00018902. (copyright) 2011 American
Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent Psychiatry, 50(11) : 1140-
1148
- Year: 2011
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Treatment resistant/treatment refractory
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors
(SNRIs), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Silverstein, M., Feinberg, E., Cabral, H., Sauder, S., Egbert, L., Schainker, E., Kamholz, K., Hegel, M., Beardslee, W
We sought to assess the feasibility and document key study
processes of a problem-solving intervention to prevent depression among low-income mothers of preterm infants. A randomized controlled pilot trial
(n(element of)=(element of)50) of problem-solving education (PSE) was conducted. We assessed intervention provider training and fidelity; recruitment
and retention of subjects; intervention acceptability; and investigators' ability to conduct monthly outcome assessments, from which we could obtain
empirical estimates of depression symptoms, stress, and functioning over 6 months. Four of four bachelor-level providers were able to deliver PSE
appropriately with standardized subjects within 4 weeks of training. Of 12 randomly audited PSE sessions with actual subjects, all met treatment
fidelity criteria. Nineteen of 25 PSE subjects (76%) received full four-session courses; no subjects reported negative experiences with PSE. Eighty-
eight percent of scheduled follow-up assessments were completed. Forty-four percent of control group mothers experienced an episode of moderately
severe depression symptoms over the follow-up period, compared to 24% of PSE mothers. Control mothers experienced an average 1.19 symptomatic
episodes over the 6 months of follow-up, compared to 0.52 among PSE mothers. PSE appears feasible and may be a promising strategy to prevent
depression among mothers of preterm infants. (copyright) 2011 Springer-Verlag.
Archives of Women's Mental Health, 14(4) : 317-
324
- Year: 2011
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Siemer, C. P., Fogel, J., VanVoorhees, B. W.
The authors conducted a
review of the literature with regard to child and adolescent mental health intervention, from which they identified 20 unique publications and 12
separate interventions. These interventions encompassed depression, anxiety, substance abuse, eating disorders, and mental health promotion. Studies
were heterogeneous, with a wide range of study designs and comparison groups creating some challenges in interpretation. However, modest evidence was
found that Internet interventions showed benefits compared with controls and preintervention symptom levels. Interventions had been developed for a
range of settings, but tended to recruit middle-class participants of European ethnicity. Internet interventions showed a range of approaches toward
engaging children and incorporating parents and peers into the learning process. (copyright) 2011 Elsevier Inc.
Child & Adolescent
Psychiatric Clinics of North America, 20(1) : 135-153
- Year: 2011
- Problem: Anxiety Disorders (any), Depressive Disorders, Eating Disorders
(any)
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Technology, interventions delivered using technology (e.g. online, SMS)
Rutherford, Bret R., Sneed, Joel R., Tandler, Jane M., Rindskopf,
David, Peterson, Bradley S., Roose, Steven P.
Objective: Method: Results: Conclusions: This study investigated how study type, mean
patient age, and amount of contact with research staff affected response rates to medication and placebo in acute antidepressant trials for pediatric
depression.Data were extracted from nine open, four active comparator, and 18 placebo-controlled studies of antidepressants for children and
adolescents with depressive disorders. A multilevel meta-analysis examined how study characteristics affected response rates to antidepressants and
placebo.The primary finding was a main effect of study type across patient age and contact amount, such that the odds of medication response were
greater in open versus placebo-controlled studies (odds ratio 1.87, 95% confidence interval 1.17-2.99, p = .012) and comparator studies (odds ratio
2.01, 95% confidence interval 1.16-3.48, p = .015) but were not significantly different between comparator and placebo-controlled studies. No
significant main effects of patient age or amount of contact with research staff were found for analyses of response rates to medication and placebo.
Response to placebo in placebo-controlled trials did significantly increase with the amount of therapeutic contact in older patients (age by contact;
odds ratio 1.08, 95% confidence interval 1.01-1.15, p = .038).Although patient expectancy strongly influences response rates to medication and
placebo in depressed adults, it appears to be less important in the treatment of children and adolescents with depression. Attempts to limit placebo
response and improve the efficiency of antidepressant trials for pediatric depression should focus on other causes of placebo response apart from
expectancy.\rCopyright © 2011 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.
Journal of
the American Academy of Child & Adolescent Psychiatry, 50(8) : 782-795
- Year: 2011
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Antidepressants
(any)