Disorders - depressive disorders
Yamamoto, A., Tsujimoto, E., Taketani, R., Tsujii, N., Shirakawa, O., Ono, H.
Background: Subthreshold depression and poor stress coping strategies are major
public health problems among undergraduates. Interpersonal counseling (IPC) is a brief structured psychological intervention originally designed for
use in primary care to treat depressive patients whose symptoms arose from current life stress. Objectives: This study examined the efficacy of IPC
in treating subthreshold depression and coping strategies among undergraduates in school counseling. Materials and Methods: We carried out an
exploratory randomized controlled trial comparing the efficacy of IPC with counseling as usual (CAU). Participants were 31 undergraduates exhibiting
depression without a psychiatric diagnosis. Results: The Zung Self-Rating Depression Scale total score decreased significantly in the IPC group (n =
15; Z = -2.675, p = .007), but not in the CAU group (n = 16). The task-oriented coping score of the Coping Inventory for Stressful Situations showed
a tendency towards a greater increase in the IPC group than in the CAU group (t = 1.919, df = 29, p = .065). Conclusions: The IPC might be more
useful for student counseling because it can teach realistic coping methods and reduce depressive symptoms in a short period. Further studies using
more participants are required. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Depression Research and
Treatment, 2018(ArtID 4201897) :
- Year: 2018
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Interpersonal therapy (IPT), Supportive
therapy
Gladstone, T., Terrizzi, D., Stinson, A., Nidetz, J., Canel, J., Ching, E., Berry, A., Cantorna, J., Fogel, J., Eder, M., Bolotin, M., Thomann, L. O., Griffith, K., Ip, P., Aaby, D. A., Brown, C. H., Beardslee, W., Bell, C., Crawford, T. J., Fitzgibbon, M., Schiffer, L., Liu, N., Marko-Holguin, M., Van-Voorhees, B.
W.
Importance: Although 13-20% of American adolescents
experience a depressive episode annually, no scalable primary care model for adolescent depression prevention is currently available. Objective(s):
To study whether CATCH-IT (Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training) reduces the hazard for
depression in at-risk adolescents identified in primary care, as compared to a general health education attention control (HE). Design(s): The
Promoting AdolescenT Health (PATH) study compares CATCH-IT and HE in a phase 3 single-blind multicenter randomized attention control trial.
Participants were enrolled from 2012 to 2016 and assessed at 2, 6, 12, 18, and 24 months post-randomization. Setting(s): Primary care. Participant
(s): Eligible adolescents were 13-18 years with subsyndromal depression and/or history of depression and no current depression diagnosis or
treatment. Of 2,250 adolescents screened for eligibility, 446 participants completed the baseline interview and 369 were randomized into CATCH-IT
(n=193) and HE (n=176). Intervention(s): CATCH-IT is a 20-module (15 adolescent modules, 5 parent modules) online psychoeducation course that
includes a parent program, supported by three motivational interviews. Main Outcomes and Measures: Time-to-event for depressive episode; depressive
symptoms at 6 months. Result(s): Mean age was 15.4 years, and 68% were female; 28% had both a past episode and subsyndromal depression; 12% had a
past episode only, 59% had subsyndromal depression only, and 1% had borderline subsyndromal depression. The outcome of time-to-event favored CATCH-IT
but was not significant with intention-to-treat analyses (N=369; unadjusted HR=0.59; 95% CI 0.27, 1.29; p=0.18; adjusted HR=0.53; 95% CI 0.23, 1.23,
p=0.14). Adolescents with higher baseline CES-D10 scores showed a significantly stronger effect of CATCH-IT on time-to-event relative to those with
lower baseline scores (p=0.04). For example, for a CES-D10 score of 15 (significant sub-syndromal depression), HR=0.20 (95% CI 0.05, 0.77), compared
to CES-D10 of 5 (no sub-syndromal depression), HR=1.44 (95% CI, 0.41, 5.03). In both CATCH-IT and HE groups, depression symptoms declined and
functional scores increased. Conclusions and Relevance: CATCH-IT may be better than HE for preventing depressive episodes for at-risk adolescents
with sub-syndromal depression. CATCH-IT may be a scalable approach to prevent depressive episodes in adolescents in primary care.
JAMA network open, 1(7) :
- Year: 2018
- 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), Interpersonal therapy (IPT), Motivational interviewing, includes Motivational Enhancing Therapy, Psychoeducation, Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Harrer, M., Adam, S. H., Fleischmann, R. J., Baumeister, H., Auerbach, R., Bruffaerts, R., Cuijpers, P., Kessler, R.
C., Berking, M., Lehr, D., Ebert, D. D.
BACKGROUND: Mental health problems are highly prevalent among college students. Most students
with poor mental health, however, do not receive professional help. Internet-based self-help formats may increase the utilization of treatment.
OBJECTIVE(S): The aim of this randomized controlled trial was to evaluate the efficacy of an internet-based, app-supported stress management
intervention for college students. METHOD(S): College students (n=150) with elevated levels of stress (Perceived Stress Scale 4-item version, PSS-4
>=8) were randomly assigned to either an internet- and mobile-based stress intervention group with feedback on demand or a waitlist control group.
Self-report data were assessed at baseline, posttreatment (7 weeks), and 3-month follow-up. The primary outcome was perceived stress posttreatment
(PSS-4). Secondary outcomes included mental health outcomes, modifiable risk and protective factors, and college-related outcomes. Subgroup analyses
were conducted in students with clinically relevant symptoms of depression (Center for Epidemiological Studies' Depression Scale >17). RESULT(S): A
total of 106 participants (76.8%) indicated that they were first-time help-seekers, and 77.3% (intervention group: 58/75; waitlist control group:
58/75) showed clinically relevant depressive symptoms at baseline. Findings indicated significant effects of the intervention compared with the
waitlist control group for stress (d=0.69; 95% CI 0.36-1.02), anxiety (d=0.76; 95% CI 0.43-1.09), depression (d=0.63; 95% CI 0.30-0.96), college-
related productivity (d=0.33; 95% CI 0.01-0.65), academic work impairment (d=0.34; 95% CI 0.01-0.66), and other outcomes after 7 weeks
(posttreatment). Response rates for stress symptoms were significantly higher for the intervention group (69%, 52/75) compared with the waitlist
control group (35%, 26/75, P<.001; number needed to treat=2.89, 95% CI 2.01-5.08) at posttest (7 weeks). Effects were sustained at 3-month follow-up,
and similar findings emerged in students with symptoms of depression. CONCLUSION(S): Internet- and mobile-based interventions could be an effective
and cost-effective approach to reduce consequences of college-related stress and might potentially attract students with clinically relevant
depression who would not otherwise seek help. TRIAL REGISTRATION: German Clinical Trial Register DRKS00010212;
http://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00010212 (Archived by WebCite at http://www.webcitation.org/6w55Ewhjd).
Copyright ©Mathias Harrer, Sophia Helen Adam, Rebecca Jessica Fleischmann, Harald Baumeister, Randy Auerbach, Ronny Bruffaerts, Pim Cuijpers, Ronald
C Kessler, Matthias Berking, Dirk Lehr, David Daniel Ebert. Originally published in the Journal of Medical Internet Research (http://www.jmir.org),
23.04.2018.
Journal of Medical Internet
Research, 20(4) : e136
- Year: 2018
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Problem solving therapy (PST), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Choukri, M. A., Conner, T. S., Haszard, J. J., Harper, M. J., Houghton, L. A.
Epidemiological evidence has linked low
vitamin D status to a range of mood disorders. However, studies examining whether vitamin D supplementation can improve mood-related outcomes in
healthy populations are limited. We investigated whether vitamin D supplementation over winter is beneficial for improving mood-related outcomes in
healthy women. A total of 152 healthy women (18-40 years) in Dunedin, New Zealand were randomly assigned to receive 50 000 IU (1.25 mg) of oral
vitamin D3 or placebo once per month for 6 months. They completed the Center for Epidemiologic Studies Depression Scale, the anxiety
subscale of the Hospital Anxiety and Depression Scale and the Flourishing Scale every month. Additionally, they reported their positive and negative
mood each day for three consecutive days every 2 months. Participants provided a blood sample at the beginning and at the end of the study for 25-
hydroxyvitamin D3 analysis. ANCOVA was used to compare the outcome measures between the groups, controlling for baseline. We found no
evidence of lower depression (P = 0.339), lower anxiety (P = 0.862), higher flourishing (P = 0.453), higher positive moods (P = 0.518) or lower
negative moods (P = 0.538) in the treatment group compared with the control group at follow-up. Mood outcomes over the study period were similar for
the two groups. We found no evidence of any beneficial effect of monthly vitamin D3 supplementation on mood-related outcomes in healthy
premenopausal women over the winter period, so recommendations for supplementations are not warranted in this population for mood-related outcomes.
Copyright © The Author(s) 2018.
Journal of Nutritional
Science., :
- Year: 2018
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Vitamins and supplements
Tesler, R., Plaut, P., Endvelt, R.
Background: At-risk
adolescents have been defined as youth who are or might be in physical, mental, or emotional danger. An Urban Forest Health Intervention Program
(UFHIP) was formed at a center for at-risk adolescents in Israel, in order to promote physical activity and reduce risky behavior. Objective(s): To
evaluate the intervention's effect on physical activity, smoking, alcohol consumption, psychosomatic symptoms, and life satisfaction. Method(s):
From 2015 to 2016, at-risk youth were nonrandomly selected to participate in the UFHIP. Questionnaires were administered to both intervention and
control groups before and after the intervention. Univariate and multivariable analyses evaluated the intervention's effect. Result(s): The study
participants (n = 53) showed 0.81 more sessions per week of 60 min of physical activity than did the control group (n = 23; p = 0.003). Among the
intervention group, smoking frequency reduced from a mean of 2.60 (SD = 1.30) to 1.72 (SD = 1.08), whereas that in the control group increased from
3.17 (1.03) to 3.39 (1.03). In both groups, there was a reduction in alcohol consumption, with a greater change among intervention participants: -
1.08 (SD = 1.30), compared with -0.09 (SD = 1.79) in the control group. Conclusion(s): Findings indicate that the environmental intervention was
efficacious in increasing physical activity and reducing risky behaviors among youth. The effectiveness of this intervention among larger samples is
warranted in future prospective studies. Copyright © 2018 by the authors. Licensee MDPI, Basel, Switzerland.
International Journal of Environmental
Research and Public Health, 15 (10) (no pagination)(2134) :
- Year: 2018
- Problem: Anxiety Disorders (any), Depressive Disorders, Alcohol
Use
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Other Psychological Interventions, Dietary advice, dietary change, Physical activity, exercise
Bang, K. S., Kim, S., Song, M. K., Kang, K. I., Jeong, Y.
As problems relating
to children's health increase, forest therapy has been proposed as an alternative. This study examined the effects of a combined health promotion
program, using urban forests and nursing student mentors, on the perceived and psychosocial health of upper-grade elementary students. The quasi-
experimental study ran from June to August 2017, with 52 upper-grade elementary students from five community after-school centers. With a purposive
sampling, they were assigned to either an experimental group (n = 24), who received a 10-session health promotion program, or to a control group (n =
28). Seven undergraduate nursing students participated as mentors. Running over 10 weeks, each weekly session consisted of 30 min of health education
and 60 min of urban forest activities. Data were analyzed by independent t-test, Mann-Whitney U-test, paired t-test, or Wilcoxon signed rank test.
General characteristics and outcome variables of both groups were homogeneous. The experimental group showed significant improvement in self-esteem
(p = 0.030) and a significant decrease in depressive symptoms (p = 0.020) after the intervention, compared to the control group. These results
suggest that forest healing programs may contribute to the spread of health promotion programs that make use of nature. Copyright © 2018 by the
authors. Licensee MDPI, Basel, Switzerland.
International Journal of Environmental Research and Public Health, 15 (9) (no
pagination)(1977) :
- Year: 2018
- Problem: Depressive Disorders
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Psychoeducation, Other Psychological Interventions, Physical activity, exercise, Other complementary & alternative
interventions
Takagaki, K., Jinnin, R., Mori, A., Nishiyama, Y., Yamamura, T., Yokoyama, S., Shiota, S., Okamoto, Y., Miyake, Y., Ogata, A., Kunisato, Y., Shimoda, H., Kawakami, N., Furukawa, T. A., Yamawaki, S.
Background: No significant effect of psychological treatment has been reported from meta-
analysis of subthreshold depression patients and control subjects at 1-year follow-up. However, behavioral activation is a simpler and more cost-
effective treatment than cognitive behavioral therapy. The primary purpose of this study was to assess by comparison to an assessment-only control
group whether the effects of behavioral activation program for depressive symptoms can persist up to 1-year follow-up without the use of
antidepressants or other psychotherapy. Patients and Methods: Late adolescent students were the population targeted in this study. Participants were
allocated randomly to an intervention group (n=62) or a control group (n=56). Treatment consisted of five-weekly 60-minute sessions. Participants
underwent a structured interview and completed self-report scales at 1 year post-assessment. Result(s): Late adolescent students receiving treatment
had significantly lower mean Beck Depression Inventory, second edition scores at 1-year follow-up than control group students. The effect size
(Hedges' g) for between-group differences at 1-year follow-up was-0.41. Conclusion(s): Our behavioral activation program is simple and short.
Nevertheless, the results obtained at 1-year follow-up of the control group and late adolescent students receiving treatment indicated a significant
difference in their Beck Depression Inventory, second edition scores. Our 5-week behavioral activation program based on behavioral characteristics
for subthreshold depression might be promising for subthreshold depression. The sample examined for this study imposed some study limitations.
Copyright © 2018 Takagaki et al.
Neuropsychiatric Disease and
Treatment, 14 : 2633-2641
- Year: 2018
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Ranney, M. L., Pittman, S. K., Dunsiger,
S., Guthrie, K. M., Spirito, A., Boyer, E. W., Cunningham, R. M.
This study's purpose was to evaluate feasibility and acceptability, obtain preliminary efficacy data, and evaluate predictors of
improvement with iDOVE, a technology-augmented violence and depression prevention intervention for high-risk adolescents seen in the emergency
department (ED). We conducted a pilot randomized controlled trial (RCT) with 116 English-speaking adolescents (ages 13-17 years), presenting to the
ED for any reason, who reported past-year physical peer violence and current depressive symptoms. The cognitive-behavioral therapy- and motivational
interviewing-based intervention consisted of a brief in-ED intervention session and 8 weeks of automated text-message daily mood queries and tailored
responses. The control was a brief in-ED presentation and twice-weekly text messages on healthy behaviors. Follow-up was conducted at 8 and 16 weeks.
Descriptive statistics, bivariate comparisons, mixed-effects longitudinal regression models, and latent class models (LCMs) were calculated. iDOVE
had high acceptability and feasibility, with 86% of eligible youth consenting (n = 116), 95% completing 8-week follow-up, and 91% completing 16-week
follow-up. High quantitative and qualitative satisfaction were reported by intervention and control participants. Comparing intervention to control,
improved depressive symptoms (p = .07) and physical peer violence (p = .01) were observed among the more symptomatic youth in the intervention group
(but no difference in symptoms between full intervention and control groups). LCMs showed that intervention responsiveness correlated with lower mood
(measured through daily text messages) at Day 7 of the intervention. This RCT of a technology-augmented intervention shows high feasibility and
acceptability and a promising signal of reduced violence among the highest-risk participants. (PsycINFO Database Record (c) 2018 APA, all rights
reserved).
Psychological Services, 15(4) : 419-
428
- Year: 2018
- 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), Motivational interviewing, includes Motivational Enhancing Therapy, Psychoeducation, Technology, interventions delivered using technology (e.g. online, SMS)
Hall, B. J., Xiong, P., Guo, X., Sou, E. K. L., Chou, U. I., Shen, Z.
Mental disorders and
sleep dysfunction are common among Chinese university students. This study aimed to evaluate a low cost scalable mindfulness intervention program to
improve psychological health and sleep quality among Chinese university students. A randomized controlled trial with 101 university students (mean
age 22.30 +/- 2.63, 69.31% female) was conducted. Participants were randomized into 4 groups: Group 1: control group (n = 25), Group 2: mindfulness
only group (n = 27), Group 3: mindfulness + plain-text reminder group (n = 24), and Group 4: mindfulness + enhanced text reminder with animal meme
group (n = 25).The mindfulness intervention consisted of two in-person guided sessions along with weekly self-guided practice for 7 weeks. The
Depression, Anxiety and Stress Scale (DASS-21) and The Pittsburgh Sleep Quality Index (PSQI) were used to measure depression, anxiety, stress, and
sleep dysfunction. After the intervention at week 4, compared to controls, completers in group 2, 3 and 4 (n = 42) showed significantly reduced
depression (Cohen's d = 0.83), anxiety (Cohen's d = 0.84), and stress (Cohen's d = 0.75), and improved subjective sleep quality (Cohen's d =
2.00), sleep latency (Cohen's d = 0.55), and habitual sleep efficiency (Cohen's d = 0.86). The effect was maintained at week 7. Low-intensity
mindfulness interventions might be a useful intervention program in university settings. (PsycINFO Database Record (c) 2019 APA, all rights
reserved)
Psychiatry Research, 270 : 394-
403
- Year: 2018
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Mindfulness based
therapy, Technology, interventions delivered using technology (e.g. online, SMS)
Dopp, R.
Objectives: Adolescents with depression deserve treatment that is targeted to
remission of depressive symptoms. Even with the combination of psychotherapy and medication, nearly two-thirds of patients may still be depressed
after 12 weeks. Exercise has been shown to be an effective treatment for adults with MDD. We will examine the efficacy of exercise for treating
depression in adolescents, explore comparison conditions, examine the mechanisms by which exercise might exert its antidepressant effects, and
discuss strategies to translate research to clinic-based models. Method(s): Adolescents (N = 18) with clinically significant depressive symptoms
[Children's Depression Rating Scale-Revised (CDRS-R) >40] and low levels of physical activity were randomly assigned to a 12-week exercise
intervention (EXI; n = 9) or a treatment-as-usual (TAU; n = 9) condition. Participants in both conditions were allowed to continue their previous
treatment. The EXI consisted of once-weekly individual exercise sessions monitored by study staff, and participants were expected to independently
exercise twice each week. Those in the EXI condition completed weekly surveys regarding mood, activity levels, and psychosocial functioning. The TAU
condition also included weekly meetings with study staff for completion of the same surveys. Result(s): For participants in the EXI condition, mean
CDRS-R score was 55.0 (SD = 7.5) at baseline and 35.1 (SD = 13.0) postintervention. For participants in the TAU condition, mean CDRS-R score was 50.4
(SD = 7.7) at baseline and 47.6 (SD = 13.6) after 12 weeks. Reductions in CDRS-R scores were significantly greater for participants in the EXI
condition compared with those in the TAU condition [t(16) = -2.42, p < 0.03]. Conclusion(s): In this randomized controlled trial, adolescents with
depression who exercised regularly showed significantly greater decreases in depressive symptoms compared with those who were in the TAU condition.
The reductions in depression for those in the EXI condition were similar to those observed in a pilot, feasibility study in which adolescents
demonstrated a 22.5-point reduction on the CDRS-R after 12 weeks of exercise. Exercise should be a focus of treatment for adolescents with depressive
disorders. ADOL, DDD, EBP Copyright © 2018
Journal of the American Academy of Child and Adolescent Psychiatry, 57 (10
Supplement) : S48
- Year: 2018
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Physical activity, exercise
Duque, A., Vazquez, C.
OBJECTIVE: This study examines whether a 4-day dot-probe attentional training to orient attention toward positive
words could lead participants with dysphoria to change selective attention to emotional faces. It was also explored whether this positive attentional
bias training could lead to a decrease in depressive symptoms. METHOD(S): Participants were randomly assigned to Positive Training Group (PTG) and No
Training Group (NTG). PTG was composed of 16 subjects, whereas NTG was composed of 15 subjects. All participants were women with a mean age of 22.87
(SD = 3.21). RESULT(S): Results showed that dysphoric participants in the PTG did not show changes in attentional patterns to emotional faces.
Furthermore, depressive symptoms did not significantly change after the 4-session training. CONCLUSION(S): These results suggest that cognitive
training procedures based on dot-probe paradigms are probably not adequate to modify attentional patterns in individuals with depressive symptoms.
The theoretical and practical implications are discussed. Copyright © 2018 Wiley Periodicals, Inc.
Journal of Clinical Psychology, 74(12) : 2145-
2160
- Year: 2018
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Attention/cognitive bias
modification
Cheung, A.H., Zuckerbrot,
R.A., Jensen, P.S., Laraque, D,, Stein, R.E.
Objectives:
To update clinical practice guidelines to assist primary care (PC) in the screening and assessment of depression. In this second part of the updated
guidelines, we address treatment and ongoing management of adolescent depression in the PC setting. Methods: By using a combination of evidence- and
consensus-based methodologies, the guidelines were updated in 2 phases as informed by (1) current scientific evidence (published and unpublished) and
(2) revision and iteration among the steering committee, including youth and families with lived experience. Results: These updated guidelines are
targeted for youth aged 10 to 21 years and offer recommendations for the management of adolescent depression in PC, including (1) active monitoring
of mildly depressed youth, (2) treatment with evidence-based medication and psychotherapeutic approaches in cases of moderate and/or severe
depression, (3) close monitoring of side effects, (4) consultation and comanagement of care with mental health specialists, (5) ongoing tracking of
outcomes, and (6) specific steps to be taken in instances of partial or no improvement after an initial treatment has begun. The strength of each
recommendation and the grade of its evidence base are summarized. Conclusions: The Guidelines for Adolescent Depression in Primary Care cannot
replace clinical judgment, and they should not be the sole source of guidance for adolescent depression management. Nonetheless, the guidelines may
assist PC clinicians in the management of depressed adolescents in an era of great clinical need and a shortage of mental health specialists.
Additional research concerning the management of depressed youth in PC is needed, including the usability, feasibility, and sustainability of
guidelines, and determination of the extent to which the guidelines actually improve outcomes of depressed youth. (PsycINFO Database Record (c) 2018
APA, all rights reserved)
Pediatrics, 141(3) : 1-
16
- Year: 2018
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)