Disorders - depressive disorders
Macdonald, G., Higgins, J. P., Ramchandani, P., Valentine, J. C., Bronger, L. P., Klein, P., O'Daniel, R., Pickering, M., Rademaker, B., Richardson,
G., Taylor, M.
Despite
differences in how it is defined, there is a general consensus amongst clinicians and researchers that the sexual abuse of children and adolescents
('child sexual abuse') is a substantial social problem worldwide. The effects of sexual abuse manifest in a wide range of symptoms, including fear,
anxiety, post-traumatic stress disorder and various externalising and internalising behaviour problems, such as inappropriate sexual behaviours.
Child sexual abuse is associated with increased risk of psychological problems in adulthood. Cognitive-behavioural approaches are used to help
children and their non-offending or 'safe' parent to manage the sequelae of childhood sexual abuse. This review updates the first Cochrane review
of cognitive-behavioural approaches interventions for children who have been sexually abused, which was first published in 2006. To assess the
efficacy of cognitive-behavioural approaches (CBT) in addressing the immediate and longer-term sequelae of sexual abuse on children and young people
up to 18 years of age. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2011 Issue 4); MEDLINE (1950 to November Week 3
2011); EMBASE (1980 to Week 47 2011); CINAHL (1937 to 2 December 2011); PsycINFO (1887 to November Week 5 2011); LILACS (1982 to 2 December 2011) and
OpenGrey, previously OpenSIGLE (1980 to 2 December 2011). For this update we also searched ClinicalTrials.gov and the International Clinical Trials
Registry Platform (ICTRP). We included randomised or quasi-randomised controlled trials of CBT used with children and adolescents up to age 18 years
who had experienced being sexually abused, compared with treatment as usual, with or without placebo control. At least two review authors
independently assessed the eligibility of titles and abstracts identified in the search. Two review authors independently extracted data from
included studies and entered these into Review Manager 5 software. We synthesised and presented data in both written and graphical form (forest
plots). We included 10 trials, involving 847 participants. All studies examined CBT programmes provided to children or children and a non-offending
parent. Control groups included wait list controls (n = 1) or treatment as usual (n = 9). Treatment as usual was, for the most part, supportive,
unstructured psychotherapy. Generally the reporting of studies was poor. Only four studies were judged 'low risk of bias' with regards to sequence
generation and only one study was judged 'low risk of bias' in relation to allocation concealment. All studies were judged 'high risk of bias' in
relation to the blinding of outcome assessors or personnel; most studies did not report on these, or other issues of bias. Most studies reported
results for study completers rather than for those recruited.Depression, post-traumatic stress disorder (PTSD), anxiety and child behaviour problems
were the primary outcomes. Data suggest that CBT may have a positive impact on the sequelae of child sexual abuse, but most results were not
statistically significant. Strongest evidence for positive effects of CBT appears to be in reducing PTSD and anxiety symptoms, but even in these
areas effects tend to be 'moderate' at best. Meta-analysis of data from five studies suggested an average decrease of 1.9 points on the Child
Depression Inventory immediately after intervention (95% confidence interval (CI) decrease of 4.0 to increase of 0.4; I(2) = 53%; P value for
heterogeneity = 0.08), representing a small to moderate effect size. Data from six studies yielded an average decrease of 0.44 standard deviations on
a variety of child post-traumatic stress disorder scales (95% CI 0.16 to 0.73; I(2) = 46%; P value for heterogeneity = 0.10). Combined data from five
studies yielded an average decrease of 0.23 standard deviations on various child anxiety scales (95% CI 0.3 to 0.4; I(2) = 0%; P value for
heterogeneity = 0.84). No study reported adverse effects. The conclusions of this updated review remain the same as those when it was first
published. The eview confirms the potential of CBT to address the adverse consequences of child sexual abuse, but highlights the limitations of the
evidence base and the need for more carefully conducted and better reported trials.
Cochrane Database of Systematic
Reviews, 5 : CD001930
- Year: 2012
- Problem: Anxiety Disorders (any), Post Traumatic Stress Disorder, Depressive Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
McLaughlin, K. A., Zeanah, C. H., Fox, N. A., Nelson, C. A.
Children reared in institutions experience elevated rates
of psychiatric disorders. Inability to form a secure attachment relationship to a primary caregiver is posited to be a central mechanism in this
association. We determined whether the ameliorative effect of a foster care (FC) intervention on internalizing disorders in previously
institutionalized children was explained by the development of secure attachment among children placed in FC. Second we evaluated the role of lack of
attachment in an institutionalized sample on the etiology of internalizing disorders within the context of a randomized trial. A sample of 136
children (aged 6-30 months) residing in institutions was recruited in Bucharest, Romania. Children were randomized to FC (n = 68) or to care as usual
(CAU; n = 68). Foster parents were recruited, trained, and overseen by the investigative team. Attachment security at 42 months was assessed using
the Strange Situation Procedure, and internalizing disorders at 54 months were assessed using the Preschool Age Psychiatric Assessment. Girls in FC
had fewer internalizing disorders than girls in CAU (OR = 0.17, p = .006). The intervention had no effect on internalizing disorders in boys (OR =
0.47, p = .150). At 42 months, girls in FC were more likely to have secure attachment than girls in CAU (OR = 12.5, p < .001), but no difference was
observed in boys (OR = 2.0, p = .205). Greater attachment security predicted lower rates of internalizing disorders in both sexes. Development of
attachment security fully mediated intervention effects on internalizing disorders in girls. Placement into FC facilitated the development of secure
attachment and prevented the onset of internalizing disorders in institutionalized girls. The differential effects of FC on attachment security in
boys and girls explained gender differences in the intervention effects on psychopathology. Findings provide evidence for the critical role of
disrupted attachment in the etiology of internalizing disorders in children exposed to institutionalization. (copyright) 2011 The Authors. Journal of
Child Psychology and Psychiatry (copyright) 2011 Association for Child and Adolescent Mental Health.
Journal of Child Psychology & Psychiatry & Allied Disciplines, 53(1) : 46-
55
- Year: 2012
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Kidger, J., Araya, R., Donovan, J., Gunnell, D.
BACKGROUND AND
OBJECTIVES: The evidence base for the importance of the school environment for adolescent emotional health has never been systematically reviewed. We
aimed to synthesize the evidence for the effect on adolescent emotional health of (1) interventions targeting the school environment and (2) the
school environment in cohort studies. METHODS: Searches of Medline, Embase, PsychINFO, CINAHL, ERIC, the Social Citation Index, and the gray
literature were conducted. Criteria for inclusion were (1) cohort or controlled trial designs, (2) participants aged 11 to 18 years, (3) emotional
health outcomes, and (4) school environment exposure or intervention. Relevant studies were retrieved and data extracted by 2 independent reviewers.
RESULTS: Nine papers reporting 5 controlled trials were reviewed, along with 30 cohort papers reporting 23 studies. Two nonrandomized trials found
some evidence that a supportive school environment improved student emotional health, but 3 randomized controlled trials did not. Six (20%) cohort
papers examined school-level factors but found no effect. There was some evidence that individual perceptions of school connectedness and teacher
support predict future emotional health. Multilevel studies showed school effects were smaller than individual-level effects. Methodological
shortcomings were common. CONCLUSIONS: There is limited evidence that the school environment has a major influence on adolescent mental health,
although student perceptions of teacher support and school connectedness are associated with better emotional health. More studies measuring
schoollevel factors are needed. Randomized controlled trials evaluating 1 or 2 environmental components may have more success in establishing
effective and feasible interventions compared with complex whole-school programs. Copyright (copyright) 2012 by the American Academy of
Pediatrics.
Pediatrics, 129(5) : 925-949
- Year: 2012
- Problem: Anxiety Disorders (any), Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Kutcher, S., Wei, Y.
PURPOSE OF REVIEW: Addressing youth mental health in secondary schools
has received greater attention globally in the past decade. It is essential that educators, mental health experts, researchers, and other related
service providers understand the most current research findings to inform policy making, and identify priority areas for the development of future
interventions and research strategies. This review describes literature during the past year on school-based mental health programs addressing mental
health promotion, prevention, early identification and intervention/treatment. RECENT FINDINGS: In contrast to the abundance of school-based mental
health programs, the evidence of program effectiveness, safety and cost-effectiveness in this area is somewhat insufficient, mostly due to the lack
of rigorous research designs, the heterogeneity of school environments, and the complexities of interventions that require multisector collaboration.
SUMMARY: Although the opportunity in school mental health is substantial, much yet needs to be done to develop and evaluate interventions that can be
proven to be effective, safe and cost-effective. Mental health literacy may be an appropriate start that will help to set the foundation for mental
health promotion, prevention and intervention. (copyright) 2012 Wolters Kluwer Health | Lippincott Williams &Wilkins.
Current Opinion in Psychiatry, 25(4) : 311-
316
- Year: 2012
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Other service delivery and improvement
interventions
Merry, S. N., Stasiak, K., Shepherd, M., Frampton,
C., Fleming, T., Lucassen, M. F.
To
evaluate whether a new computerised cognitive behavioural therapy intervention (SPARX, Smart, Positive, Active, Realistic, X-factor thoughts) could
reduce depressive symptoms in help seeking adolescents as much or more than treatment as usual. Multicentre randomised controlled non-inferiority
trial. 24 primary healthcare sites in New Zealand (youth clinics, general practices, and school based counselling services). 187 adolescents aged 12
-19, seeking help for depressive symptoms, with no major risk of self harm and deemed in need of treatment by their primary healthcare clinicians: 94
were allocated to SPARX and 93 to treatment as usual. Computerised cognitive behavioural therapy (SPARX) comprising seven modules delivered over a
period of between four and seven weeks, versus treatment as usual comprising primarily face to face counselling delivered by trained counsellors and
clinical psychologists. The primary outcome was the change in score on the children's depression rating scale-revised. Secondary outcomes included
response and remission on the children's depression rating scale-revised, change scores on the Reynolds adolescent depression scale-second edition,
the mood and feelings questionnaire, the Kazdin hopelessness scale for children, the Spence children's anxiety scale, the paediatric quality of life
enjoyment and satisfaction questionnaire, and overall satisfaction with treatment ratings. 94 participants were allocated to SPARX (mean age 15.6
years, 62.8% female) and 93 to treatment as usual (mean age 15.6 years, 68.8% female). 170 adolescents (91%, SPARX n = 85, treatment as usual n = 85)
were assessed after intervention and 168 (90%, SPARX n = 83, treatment as usual n = 85) were assessed at the three month follow-up point. Per
protocol analyses (n = 143) showed that SPARX was not inferior to treatment as usual. Post-intervention, there was a mean reduction of 10.32 in SPARX
and 7.59 in treatment as usual in raw scores on the children's depression rating scale-revised (between group difference 2.73, 95% confidence
interval -0.31 to 5.77; P=0.079). Remission rates were significantly higher in the SPARX arm (n = 31, 43.7%) than in the treatment as usual arm (n =
19, 26.4%) (difference 17.3%, 95% confidence interval 1.6% to 31.8%; P = 0.030) and response rates did not differ significantly between the SPARX arm
(66.2%, n = 47) and treatment as usual arm (58.3%, n = 42) (difference 7.9%, -7.9% to 24%; P = 0.332). All secondary measures supported non-
inferiority. Intention to treat analyses confirmed these findings. Improvements were maintained at follow-up. The frequency of adverse events
classified as \"possibly\" or \"probably\" related to the intervention did not differ between groups (SPARX n = 11; treatment as usual n = 11). SPARX
is a potential alternative to usual care for adolescents presenting with depressive symptoms in primary care settings and could be used to address
some of the unmet demand for treatment. Australian New Zealand Clinical Trials ACTRN12609000249257.
British Journal of
Psychiatry, 344 : e2598
- 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), Self-help, Technology, interventions delivered using technology (e.g. online, SMS)
Moritz, S., Toews,
J., Rickhi, B., Paccagnan, P., Malhotra, S., Hart, C., Maser, R., Cohen, J.
Purpose: 1) To
pilot the LEAP Project (http://www.leapproject.com), an online spirituality based depression intervention for young people aged 13-24. 2) To estimate
the impact of the intervention on depression severity. Methods: This pilot study used a parallel-group randomized controlled assessor-blinded trial
design. A total of 46 individuals aged 13-24 with clinically diagnosed unipolar major depression of mild to moderate severity are being recruited in
Calgary, Canada and randomized to two study arms: 1. Immediate Intervention Group (eight week online intervention) and 2. Waitlist Control Group (no
intervention for 8 weeks followed by the online intervention). Participants were assessed at baseline, 8, 16 and 24 weeks. The main outcome measure
(depression severity) was based on the Children Depression Rating Scale (CDRS for participants aged 13 to 18) and the Hamilton Depression Rating
Scale (HAM-D for participants aged 19-24). Results: Preliminary analysis of 30 participants (20 participants aged 13-18, 10 participants aged 19-24)
indicates notable changes in depression severity at 8 weeks in the Immediate Intervention Group compared to the Waitlist Control Group. For those
aged 13-18 in the Immediate Intervention Group the CDRS score change at 8 weeks was -13.8 compared to -1.8 in the Waitlist Control Groups (p=0.044).
Follow-up scores for this group at 16 and 24 weeks show a further reduction in depression severity compared to the baseline score (CDRS score change
at 16 weeks: -21.6 and at 24 weeks: -23.3). For those aged 19-24 in the Immediate Intervention Group the HAM-D score change at 8 weeks was -8.8
compared to -3.6 in the Waitlist Control Groups (p=0.037); 16 and 24 week follow-up scores suggest that the post intervention score was maintained.
Conclusion: Preliminary results suggest that the LEAP Project can reduce depression severity long term. Data collection is continuing and final
results will be available for presentation in May 2012.
BMC Complementary & Alternative Medicine, 12 :
- Year: 2012
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Mirzamani, S. M., Azvar, F., Dolatshahi, B., Asgari, A.
The purpose of
this study was to investigate the efficacy of life skills training to reduce depressive symptoms in a student population in the city of piranshahr.
For this reason, the investigator randomly selected 64 high school students. Participants were selected based on multistage randomized sampling,
which their depression scores on children depression scale was ranged 96 to 140 these participants were randomly distributed between two groups A)
experimental group and B) control group.12 session of group life skills training were conducted for the experimental group, and no intervention for
the control group. Both groups complete children depression scale pre and post intervention. UNISEF educational life skills package was conducted.
Results of analyze of covariance showed that life skills training is effective in reducing depressive symptoms and significantly reduce social
problems.
Bipolar Disorders, 14 : 105
- Year: 2012
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Skills training
O'Dougherty, M., Hearst, M.
O., Syed, M., Kurzer, M. S., Schmitz, K. H.
Objective: Examine interactive
effects of life events, perceived stress and depressive symptoms during a randomized controlled aerobics intervention among women (aged 18-30) in the
urban U.S. Midwest, 2006-2009. Method: Participants [n = 372 at baseline and n = 303 at follow-up] completed perceived stress, depressive symptoms
and life events scales at baseline and 5-6 month follow-up. Life events were correlated with perceived stress and depressive symptoms scales using
Pearson correlation. Multivariate linear regression tested the relationship between the 20 most common life events with perceived stress and
depressive symptoms. Regression models explored relationships between life events, perceived stress and depressive symptoms and the intervention
effect. Results: Higher levels of perceived stress and depressive symptoms correlated with more life events. At baseline, for every additional life
event, depressive symptoms were higher; follow-up showed marginal significance with depressive symptoms, but a strong positive association with
perceived stress. In the stratified model, for every life event at follow up, the perceived stress scale increased by 0.68 in the exercise group, but
not in the controls. For every life event at follow-up, depressive symptoms were higher in controls, but not in the exercise group. Conclusion:
Perceived stress and depressive symptoms co-occurred with life events at baseline and follow-up for participants. At follow up, perceived stress
increased significantly among exercisers; depressive symptoms were significantly higher among controls. Findings suggest that new participation in
structured physical activity entails a change in daily life that may buffer against depressive symptoms in relation to life events but not perceived
stress. (copyright) 2012 Elsevier Ltd. All rights reserved.
Mental Health & Physical Activity, 5(2) : 148-
154
- Year: 2012
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Physical activity, exercise
Nobel, Rachel, Manassis, Katharina, Wilansky-Traynor,
Pamela
Research has demonstrated an association between perfectionism and depressive and anxious symptoms
in children. We examined whether a school-based program targeting anxious and depressive symptoms would reduce perfectionism, and whether
perfectionism would interfere with intervention outcomes. The participants were 78 school-age children identified as at-risk for anxiety and/or
depression. At-risk children took part in a randomized controlled trial of a school-based intervention program. Levels of perfectionism, depression,
and anxiety were assessed at pre-treatment (Time 1) and again at post-treatment (Time 2) after participating in either a cognitive behavioral group
or a structured activity group. Participation in either group was associated with significant reductions in overall levels of self-oriented
perfectionism, anxious symptoms, and depressive symptoms. Supplementary analyses indicated that pre-treatment self-oriented perfectionism influenced
post-treatment depression scores, suggesting that perfectionism interferes with treatment outcome. Perfectionism in children appeared amenable to
group-based intervention, and identifying perfectionism may be important for treating children with depressive symptoms. (PsycINFO Database Record
(c) 2012 APA, all rights reserved) (journal abstract)
Journal of Rational-Emotive & Cognitive Behavior Therapy, 30(2) : 77-
90
- Year: 2012
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Plazier, Mark, Joos, Kathleen, Vanneste, Sven, Ost,
Jan, DeRidder, Dirk
Transcranial direct current stimulation (tDCS) is the application of a weak electrical direct
current (1.5 mA), which has the ability to modulate spontaneous firing rates of the cortical neurons by depolarizing or hyperpolarizing the neural
resting membrane potential. tDCS in patients with depressive disorders has been proven to be an interesting therapeutic method potentially
influencing pathologic mood states. Except one study, no alterations in mood could be confirmed applying tDCS in healthy participants. In this study,
bifrontal or bioccipital stimulation was applied in 17 healthy subjects during 20 minutes with 1.5 mA in a placebo-controlled manner. Bifrontal
stimulation consisted of both anodal and cathodal placement on right and left dorsolateral prefrontal cortex (DLPFC) in two separate sessions. Using
a set of self-reported moodscales (SUDS, POMS-32, PANAS, BISBAS) no significant mood changes could be observed, neither with bifrontal nor
bioccipital tDCS. As already demonstrated by previous studies, we confirmed the minimal side effects and the safety of this neuromodulation
technique. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Brain Stimulation, 5(4) : 454-461
- Year: 2012
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Biological Interventions
(any), Transcranial magnetic stimulation
(TMS), Other biological interventions
Penton-Voak, I. S., Bate, H., Lewis, G., Munafo, M. R.
We investigated the effects of emotion
perception training on depressive symptoms and mood in young adults reporting high levels of depressive symptoms (trial registration:
ISRCTN02532638). Participants were randomised to an intervention procedure designed to increase the perception of happiness over sadness in ambiguous
facial expressions or a control procedure, and completed self-report measures of depressive symptoms and mood. Those in the intervention condition
had lower depressive symptoms and negative mood at 2-week follow-up, but there was no statistical evidence for a difference. There was some evidence
for increased positive mood. Modification of emotional perception may lead to an increase in positive affect.
British
Journal of Psychiatry, 201(1) : 71-72
- Year: 2012
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Osypuk, T. L., Tchetgen-Tchetgen, E. J., Acevedo-Garcia, D., Earls, F. J., Lincoln,
A., Schmidt, N. M., Glymour, M. M.
Context: Extensive observational evidence indicates that youth in high-poverty neighborhoods exhibit poor mental health, although not all
children may be affected similarly. Objective: To use experimental evidence to assess whether gender and family health problems modify the mental
health effects of moving from high- to lowpoverty neighborhoods. Design: Randomized controlled trial. Setting: Volunteer low-income families in
public housing in 5 US cities between 1994-1997. Participants: We analyze 4- to 7-year outcomes in youth aged 12 to 19 years (n=2829, 89% effective
response rate) in the Moving to Opportunity Study. Intervention: Families were randomized to remain in public housing (control group) or to receive
government-funded rental subsidies to move into private apartments (experimental group). Intention-to-treat analyses included intervention
interactions by gender and health vulnerability (defined as prerandomization health/developmental limitations or disabilities in family members).
Main Outcome Measures: Past-year psychological distress (Kessler 6 scale [K6]) and the Behavioral Problems Index (BPI). Supplemental analyses used
past-year major depressive disorder (MDD). Results: Male gender (P=.02) and family health vulnerability (P=.002) significantly adversely modified the
intervention effect on K6 scores; male gender (P=.01), but not health vulnerability (P=.17), significantly adversely modified the intervention effect
on the BPI. Girls without baseline health vulnerabilities were the only subgroup to benefit on any outcome (K6: (beta)=-0.21; 95% CI, -0.34 to -0.07;
P=.003; MDD: odds ratio=0.42; 95% CI, 0.20 to 0.85; P=.02). For boys with health vulnerabilities, intervention was associated with worse K6
((beta)=0.26; 95% CI, 0.09 to 0.44; P=.003) and BPI ((beta)=0.24; 95% CI, 0.09 to 0.40; P=.002) values. Neither girls with health vulnerability nor
boys without health vulnerability experienced intervention benefits. Adherence-adjusted instrumental variable analysis found intervention effects
twice as large. Patterns were similar for MDD, but estimates were imprecise owing to low prevalence. Conclusions: Although some girls benefited, boys
and adolescents from families with baseline health problems did not experience mental health benefits from housing mobility policies and may need
additional program supports. (copyright)2012 American Medical Association. All rights reserved.
Archives of General Psychiatry, 69(12) : 1284-1294
- Year: 2012
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions