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Chris Roberts - One of the best experts on this subject based on the ideXlab platform.
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cognitive behavioural therapy and short term psychoanalytic psychotherapy versus brief Psychosocial Intervention in adolescents with unipolar major depression impact a multicentre pragmatic observer blind randomised controlled trial
Health Technology Assessment, 2017Co-Authors: Ian M Goodyer, Shirley Reynolds, Barbara Barrett, Sarah Byford, Bernadka Dubicka, Jonathan Hill, Fiona Holland, Raphael Kelvin, Nick Midgley, Chris RobertsAbstract:BACKGROUND: Although there are effective psychological treatments for unipolar major depression in adolescents, whether or not one or more of the available therapies maintain reduced depressive symptoms 1 year after the end of treatment is not known. This is a non-trivial issue because maintaining lowered depressive symptoms below a clinical threshold level reduces the risk for diagnostic relapse into the adult years. OBJECTIVE: To determine whether or not either of two specialist psychological treatments, cognitive–behavioural therapy (CBT) or short-term psychoanalytic psychotherapy (STPP), is more effective than a reference brief Psychosocial Intervention (BPI) in maintaining reduction of depression symptoms in the year after treatment. DESIGN: Observer-blind, parallel-group, pragmatic superiority randomised controlled trial. SETTING: A total of 15 outpatient NHS clinics in the UK from East Anglia, north-west England and North London. PARTICIPANTS: Adolescents aged 11–17 years with Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition major depression including those with suicidality, depressive psychosis and conduct disorder. Patients were randomised using stochastic minimisation controlling for age, sex and self-reported depression sum score; 470 patients were randomised and 465 were included in the analyses. InterventionS: In total, 154 adolescents received CBT, 156 received STPP and 155 received BPI. The trial lasted 86 weeks and study treatments were delivered in the first 36 weeks, with 52 weeks of follow-up. MAIN OUTCOME MEASURES: Mean sum score on self-reported depressive symptoms (primary outcome) at final study assessment (nominally 86 weeks, at least 52 weeks after end of treatment). Secondary measures were change in mean sum scores on self-reported anxiety symptoms and researcher-rated Health of the Nation scales for children and adolescents measuring Psychosocial function. Following baseline assessment, there were a further five planned follow-up reassessments at nominal time points of 6, 12, 52 and 86 weeks post randomisation. RESULTS: There were non-inferiority effects of CBT compared with STPP [treatment effect by final follow-up = –0.578, 95% confidence interval (CI) –2.948 to 4.104; p = 0.748]. There were no superiority effects for the two specialist treatments (CBT + STPP) compared with BPI (treatment effect by final follow-up = –1.898, 95% CI –4.922 to 1.126; p = 0.219). At final assessment there was no significant difference in the mean depressive symptom score between treatment groups. There was an average 49–52% reduction in depression symptoms by the end of the study. There were no differences in total costs or quality-of-life scores between treatment groups and prescribing a selective serotonin reuptake inhibitor (SSRI) during treatment or follow-up did not differ between the therapy arms and, therefore, did not mediate the outcome. CONCLUSIONS: The three psychological treatments differed markedly in theoretical and clinical approach and are associated with a similar degree of clinical improvement, cost-effectiveness and subsequent maintenance of lowered depressive symptoms. Both STPP and BPI offer an additional patient treatment choice, alongside CBT, for depressed adolescents attending specialist Child and Adolescent Mental Health Services. Further research should focus on psychological mechanisms that are associated with treatment response, the maintenance of positive effects, determinants of non-response and whether or not brief psychotherapies are of use in primary care and community settings. LIMITATIONS: Neither reason for SSRI prescribing or monitoring of medication compliance was controlled for over the course of the study, and the economic results were limited by missing data. TRIAL REGISTRATION: Current Controlled Trials ISRCTN83033550.
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cognitive behavioural therapy and short term psychoanalytical psychotherapy versus a brief Psychosocial Intervention in adolescents with unipolar major depressive disorder impact a multicentre pragmatic observer blind randomised controlled superiorit
The Lancet Psychiatry, 2017Co-Authors: Ian M Goodyer, Shirley Reynolds, Barbara Barrett, Sarah Byford, Bernadka Dubicka, Jonathan Hill, Fiona Holland, Raphael Kelvin, Nick Midgley, Chris RobertsAbstract:Summary Background Psychological treatments for adolescents with unipolar major depressive disorder are associated with diagnostic remission within 28 weeks in 65–70% of patients. We aimed to assess the medium-term effects and costs of psychological therapies on maintenance of reduced depression symptoms 12 months after treatment. Methods We did this multicentre, pragmatic, observer-blind, randomised controlled superiority trial (IMPACT) at 15 National Health Service child and adolescent mental health service (CAMHS) clinics in three regions in England. Adolescent patients (aged 11–17 years) with a diagnosis of DSM IV major depressive disorder were randomly assigned (1:1:1), via a web-based randomisation service, to receive cognitive behavioural therapy (CBT) or short-term psychoanalytical therapy versus a reference brief psychological Intervention. Randomisation was stochastically minimised by age, sex, self-reported depression sum score, and region. Patients and clinicians were aware of group allocation, but allocation was concealed from outcome assessors. Patients were followed up and reassessed at weeks 6, 12, 36, 52, and 86 post-randomisation. The primary outcome was self-reported depression symptoms at weeks 36, 52, and 86, as measured with the self-reported Mood and Feelings Questionnaire (MFQ). Because our aim was to compare the two psychological therapies with the brief Psychosocial Intervention, we first established whether CBT was inferior to short-term psychoanalytical psychotherapy for the same outcome. Primary analysis was by intention to treat. This trial is registered with Current Controlled Trials, number ISRCTN83033550. Findings Between June 29, 2010, and Jan 17, 2013, we randomly assigned 470 patients to receive the brief Psychosocial Intervention (n=158), CBT (n=155), or short-term psychoanalytical therapy (n=157); 465 patients comprised the intention-to-treat population. 392 (84%) patients had available data for primary analysis by the end of follow-up. Treatment fidelity and differentiation were established between the three Interventions. The median number of treatment sessions differed significantly between patients in the brief Psychosocial Intervention group (n=6 [IQR 4–11]), CBT group (n=9 [5–14]), and short-term psychoanalytical therapy group (n=11 [5–23]; p Interpretation We found no evidence for the superiority of CBT or short-term psychoanalytical therapy compared with a brief Psychosocial Intervention in maintenance of reduced depression symptoms 12 months after treatment. Short-term psychoanalytical therapy was as effective as CBT and, together with brief Psychosocial Intervention, offers additional patient choice for psychological therapy, alongside CBT, for adolescents with moderate to severe depression who are attending routine specialist CAMHS clinics. Funding National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme, and the Department of Health.
Ian M Goodyer - One of the best experts on this subject based on the ideXlab platform.
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changes in general and specific psychopathology factors over a Psychosocial Intervention
Journal of the American Academy of Child and Adolescent Psychiatry, 2019Co-Authors: Matthew P Constantinou, Ian M Goodyer, Ivan Eisler, Stephen Butler, Abdullah Kraam, Stephen Scott, Stephen Pilling, Elizabeth Simes, Rachel EllisonAbstract:Objective Recent research suggests that comorbidity in child and adolescent psychiatric symptoms can be summarized by a single latent dimension known as the p factor and more specific factors summarizing clusters of symptoms. This study investigated within- and between-person changes in general and specific psychopathology factors over a Psychosocial Intervention. Method A secondary analysis was conducted of the Systemic Therapy for At-Risk Teens study, a pragmatic randomized controlled trial that compared the effects of multisystemic therapy with those of management as usual for decreasing antisocial behavior in 684 adolescents (82% boys; 11–18 years old at baseline) over an 18-month period. The general p factor and specific antisocial, attention, anxiety, and mood factors were estimated from a symptom-level analysis of a set of narrowband symptom scales measured repeatedly during the study. General and specific psychopathology factors were assessed for reliability, validity, and within- and between-person change using a parallel process multilevel growth model. Results A revised bi-factor model that included a general p factor and specific anxiety, mood, antisocial, and attention factors with cross-loadings fit the data best. Although the factor structure was multidimensional, the p factor accounted for most of the variance in total scores. The p factor, anxiety, and antisocial factors predicted within-person variation in external outcomes. Furthermore, the p factor and antisocial factors showed within-person declines, whereas anxiety showed within-person increases, over time. Despite individual variation in baseline factor scores, adolescents showed similar rates of change. Conclusion The bi-factor model is useful for teasing apart general and specific therapeutic changes that are conflated in standard analyses of symptom scores. Clinical trial registration information START (Systemic Therapy for At Risk Teens): A National Randomised Controlled Trial to Evaluate Multisystemic Therapy in the UK Context; http://www.isrctn.com ; ISRCTN77132214.
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cognitive behavioural therapy and short term psychoanalytic psychotherapy versus brief Psychosocial Intervention in adolescents with unipolar major depression impact a multicentre pragmatic observer blind randomised controlled trial
Health Technology Assessment, 2017Co-Authors: Ian M Goodyer, Shirley Reynolds, Barbara Barrett, Sarah Byford, Bernadka Dubicka, Jonathan Hill, Fiona Holland, Raphael Kelvin, Nick Midgley, Chris RobertsAbstract:BACKGROUND: Although there are effective psychological treatments for unipolar major depression in adolescents, whether or not one or more of the available therapies maintain reduced depressive symptoms 1 year after the end of treatment is not known. This is a non-trivial issue because maintaining lowered depressive symptoms below a clinical threshold level reduces the risk for diagnostic relapse into the adult years. OBJECTIVE: To determine whether or not either of two specialist psychological treatments, cognitive–behavioural therapy (CBT) or short-term psychoanalytic psychotherapy (STPP), is more effective than a reference brief Psychosocial Intervention (BPI) in maintaining reduction of depression symptoms in the year after treatment. DESIGN: Observer-blind, parallel-group, pragmatic superiority randomised controlled trial. SETTING: A total of 15 outpatient NHS clinics in the UK from East Anglia, north-west England and North London. PARTICIPANTS: Adolescents aged 11–17 years with Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition major depression including those with suicidality, depressive psychosis and conduct disorder. Patients were randomised using stochastic minimisation controlling for age, sex and self-reported depression sum score; 470 patients were randomised and 465 were included in the analyses. InterventionS: In total, 154 adolescents received CBT, 156 received STPP and 155 received BPI. The trial lasted 86 weeks and study treatments were delivered in the first 36 weeks, with 52 weeks of follow-up. MAIN OUTCOME MEASURES: Mean sum score on self-reported depressive symptoms (primary outcome) at final study assessment (nominally 86 weeks, at least 52 weeks after end of treatment). Secondary measures were change in mean sum scores on self-reported anxiety symptoms and researcher-rated Health of the Nation scales for children and adolescents measuring Psychosocial function. Following baseline assessment, there were a further five planned follow-up reassessments at nominal time points of 6, 12, 52 and 86 weeks post randomisation. RESULTS: There were non-inferiority effects of CBT compared with STPP [treatment effect by final follow-up = –0.578, 95% confidence interval (CI) –2.948 to 4.104; p = 0.748]. There were no superiority effects for the two specialist treatments (CBT + STPP) compared with BPI (treatment effect by final follow-up = –1.898, 95% CI –4.922 to 1.126; p = 0.219). At final assessment there was no significant difference in the mean depressive symptom score between treatment groups. There was an average 49–52% reduction in depression symptoms by the end of the study. There were no differences in total costs or quality-of-life scores between treatment groups and prescribing a selective serotonin reuptake inhibitor (SSRI) during treatment or follow-up did not differ between the therapy arms and, therefore, did not mediate the outcome. CONCLUSIONS: The three psychological treatments differed markedly in theoretical and clinical approach and are associated with a similar degree of clinical improvement, cost-effectiveness and subsequent maintenance of lowered depressive symptoms. Both STPP and BPI offer an additional patient treatment choice, alongside CBT, for depressed adolescents attending specialist Child and Adolescent Mental Health Services. Further research should focus on psychological mechanisms that are associated with treatment response, the maintenance of positive effects, determinants of non-response and whether or not brief psychotherapies are of use in primary care and community settings. LIMITATIONS: Neither reason for SSRI prescribing or monitoring of medication compliance was controlled for over the course of the study, and the economic results were limited by missing data. TRIAL REGISTRATION: Current Controlled Trials ISRCTN83033550.
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cognitive behavioural therapy and short term psychoanalytical psychotherapy versus a brief Psychosocial Intervention in adolescents with unipolar major depressive disorder impact a multicentre pragmatic observer blind randomised controlled superiorit
The Lancet Psychiatry, 2017Co-Authors: Ian M Goodyer, Shirley Reynolds, Barbara Barrett, Sarah Byford, Bernadka Dubicka, Jonathan Hill, Fiona Holland, Raphael Kelvin, Nick Midgley, Chris RobertsAbstract:Summary Background Psychological treatments for adolescents with unipolar major depressive disorder are associated with diagnostic remission within 28 weeks in 65–70% of patients. We aimed to assess the medium-term effects and costs of psychological therapies on maintenance of reduced depression symptoms 12 months after treatment. Methods We did this multicentre, pragmatic, observer-blind, randomised controlled superiority trial (IMPACT) at 15 National Health Service child and adolescent mental health service (CAMHS) clinics in three regions in England. Adolescent patients (aged 11–17 years) with a diagnosis of DSM IV major depressive disorder were randomly assigned (1:1:1), via a web-based randomisation service, to receive cognitive behavioural therapy (CBT) or short-term psychoanalytical therapy versus a reference brief psychological Intervention. Randomisation was stochastically minimised by age, sex, self-reported depression sum score, and region. Patients and clinicians were aware of group allocation, but allocation was concealed from outcome assessors. Patients were followed up and reassessed at weeks 6, 12, 36, 52, and 86 post-randomisation. The primary outcome was self-reported depression symptoms at weeks 36, 52, and 86, as measured with the self-reported Mood and Feelings Questionnaire (MFQ). Because our aim was to compare the two psychological therapies with the brief Psychosocial Intervention, we first established whether CBT was inferior to short-term psychoanalytical psychotherapy for the same outcome. Primary analysis was by intention to treat. This trial is registered with Current Controlled Trials, number ISRCTN83033550. Findings Between June 29, 2010, and Jan 17, 2013, we randomly assigned 470 patients to receive the brief Psychosocial Intervention (n=158), CBT (n=155), or short-term psychoanalytical therapy (n=157); 465 patients comprised the intention-to-treat population. 392 (84%) patients had available data for primary analysis by the end of follow-up. Treatment fidelity and differentiation were established between the three Interventions. The median number of treatment sessions differed significantly between patients in the brief Psychosocial Intervention group (n=6 [IQR 4–11]), CBT group (n=9 [5–14]), and short-term psychoanalytical therapy group (n=11 [5–23]; p Interpretation We found no evidence for the superiority of CBT or short-term psychoanalytical therapy compared with a brief Psychosocial Intervention in maintenance of reduced depression symptoms 12 months after treatment. Short-term psychoanalytical therapy was as effective as CBT and, together with brief Psychosocial Intervention, offers additional patient choice for psychological therapy, alongside CBT, for adolescents with moderate to severe depression who are attending routine specialist CAMHS clinics. Funding National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme, and the Department of Health.
Jennifer Dalotto - One of the best experts on this subject based on the ideXlab platform.
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multimodal Psychosocial Intervention for caregivers of patients undergoing hematopoietic stem cell transplantation hct a randomized clinical trial
Biology of Blood and Marrow Transplantation, 2020Co-Authors: Areej Eljawahri, Jamie M. Jacobs, Ashley M Nelson, Lara Traeger, Joseph A Greer, Showly Nicholson, Lauren Waldman, Alyssa L Fenech, Annemarie Jagielo, Jennifer DalottoAbstract:Background Caregivers (i.e., family and friends) of patients undergoing HCT experience immense caregiving burden during HCT. Multimodal Interventions to address the needs of caregivers prior to, during, and after HCT are lacking. Methods We conducted a randomized trial of a multimodal Psychosocial Intervention (BMT-CARE) for caregivers of patients undergoing autologous and allogeneic HCT at Massachusetts General Hospital. Caregivers were randomly assigned to BMT-CARE or usual care. BMT-CARE was tailored to the HCT trajectory and integrated treatment-related education and self-care with cognitive-behavioral skills and caregiving-specific strategies to promote coping. Caregivers assigned to BMT-CARE met with a trained Interventionist in-person, via telephone or videoconferencing for six sessions starting prior to HCT and up to day+60 post-HCT. We assessed Caregiver quality of life (QOL; CareGiver-Oncology-Questionnaire), caregiving burden (Caregiver Reaction Assessment), psychological distress (Hospital Anxiety and Depression Scale), self-efficacy (Cancer Self-Efficacy Scale-Transplant), and coping (Measures of Current Status) at baseline and 60 days post-HCT. We assessed the preliminary efficacy of BMT-CARE for improving caregiver-reported outcomes at 60 days post-HCT using analysis of covariance adjusting for baseline criterion values. We conducted causal mediation analyses to examine whether changes in self-efficacy or coping mediated the effect of the Intervention on caregiver QOL and psychological distress at 60 days post-HCT. Results We enrolled 72.5% (100/138) of eligible caregivers. Caregivers randomized to BMT-CARE reported improved QOL (adjusted means: 81.22 [95%CI 77.69, 84.74] vs. 70.96 [95%CI 67.56, 74.36], P Conclusions A brief multimodal Psychosocial Intervention tailored for caregivers of HCT recipients has promising efficacy for improving QOL, mood, coping, and self-efficacy while reducing caregiving burden during the acute HCT period. Improvements in coping skills and self-efficacy partially account for the effect of BMT-CARE on caregiver QOL and psychological distress.
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multimodal Psychosocial Intervention for family caregivers of patients undergoing hematopoietic stem cell transplantation a randomized clinical trial
Cancer, 2020Co-Authors: Areej Eljawahri, Jamie M. Jacobs, Ashley M Nelson, Lara Traeger, Joseph A Greer, Showly Nicholson, Lauren Waldman, Alyssa L Fenech, Annemarie Jagielo, Jennifer DalottoAbstract:BACKGROUND: Caregivers of patients undergoing hematopoietic stem cell transplantation (HCT) experience an immense caregiving burden before, during, and after HCT. METHODS: We conducted an unblinded, randomized trial of a Psychosocial Intervention (BMT-CARE) for caregivers of patients undergoing autologous and allogeneic HCT at Massachusetts General Hospital. Caregivers were randomly assigned to BMT-CARE or usual care. BMT-CARE was tailored to the HCT trajectory and integrated treatment-related education and self-care with cognitive-behavioral skills to promote coping. Caregivers assigned to BMT-CARE met with a trained Interventionist (a psychologist or a social worker) in person, via telephone, or via videoconferencing for 6 sessions starting before HCT and continuing up to day +60 after HCT. The primary endpoint was feasibility, which was defined as at least 60% of eligible caregivers enrolling and completing 50% or more of the Intervention sessions. We assesed caregiver quality of life (QOL; Caregiver Oncology Quality of Life Questionnaire), caregiving burden (Caregiver Reaction Assessment), psychological distress (Hospital Anxiety and Depression Scale), self-efficacy (Cancer Self-Efficacy Scale-Transplant), and coping (Measures of Current Status) at baseline and 30 and 60 days after HCT. We used mixed linear effect models to assess the effect of BMT-CARE on outcomes longitudinally. RESULTS: We enrolled 72.5% of eligible caregivers (100 of 138), and 80% attended 50% or more of the Intervention sessions. Caregivers randomized to BMT-CARE reported improved QOL (B = 6.11; 95% CI, 3.50-8.71; P < .001), reduced caregiving burden (B = -6.02; 95% CI, -8.49 to -3.55; P < .001), lower anxiety (B = -2.18; 95% CI, -3.07 to -1.28; P < .001) and depression symptoms (B = -1.23; 95% CI, -1.92 to -0.54; P < .001), and improved self-efficacy (B = 7.22; 95% CI, 2.40-12.03; P = .003) and coping skills (B = 4.83; 95% CI, 3.04-6.94; P < .001) in comparison with the usual-care group. CONCLUSIONS: A brief multimodal Psychosocial Intervention tailored for caregivers of HCT recipients is feasible and may improve QOL, mood, coping, and self-efficacy while reducing the caregiving burden during the acute HCT period.
Jamie M. Jacobs - One of the best experts on this subject based on the ideXlab platform.
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multimodal Psychosocial Intervention for caregivers of patients undergoing hematopoietic stem cell transplantation hct a randomized clinical trial
Biology of Blood and Marrow Transplantation, 2020Co-Authors: Areej Eljawahri, Jamie M. Jacobs, Ashley M Nelson, Lara Traeger, Joseph A Greer, Showly Nicholson, Lauren Waldman, Alyssa L Fenech, Annemarie Jagielo, Jennifer DalottoAbstract:Background Caregivers (i.e., family and friends) of patients undergoing HCT experience immense caregiving burden during HCT. Multimodal Interventions to address the needs of caregivers prior to, during, and after HCT are lacking. Methods We conducted a randomized trial of a multimodal Psychosocial Intervention (BMT-CARE) for caregivers of patients undergoing autologous and allogeneic HCT at Massachusetts General Hospital. Caregivers were randomly assigned to BMT-CARE or usual care. BMT-CARE was tailored to the HCT trajectory and integrated treatment-related education and self-care with cognitive-behavioral skills and caregiving-specific strategies to promote coping. Caregivers assigned to BMT-CARE met with a trained Interventionist in-person, via telephone or videoconferencing for six sessions starting prior to HCT and up to day+60 post-HCT. We assessed Caregiver quality of life (QOL; CareGiver-Oncology-Questionnaire), caregiving burden (Caregiver Reaction Assessment), psychological distress (Hospital Anxiety and Depression Scale), self-efficacy (Cancer Self-Efficacy Scale-Transplant), and coping (Measures of Current Status) at baseline and 60 days post-HCT. We assessed the preliminary efficacy of BMT-CARE for improving caregiver-reported outcomes at 60 days post-HCT using analysis of covariance adjusting for baseline criterion values. We conducted causal mediation analyses to examine whether changes in self-efficacy or coping mediated the effect of the Intervention on caregiver QOL and psychological distress at 60 days post-HCT. Results We enrolled 72.5% (100/138) of eligible caregivers. Caregivers randomized to BMT-CARE reported improved QOL (adjusted means: 81.22 [95%CI 77.69, 84.74] vs. 70.96 [95%CI 67.56, 74.36], P Conclusions A brief multimodal Psychosocial Intervention tailored for caregivers of HCT recipients has promising efficacy for improving QOL, mood, coping, and self-efficacy while reducing caregiving burden during the acute HCT period. Improvements in coping skills and self-efficacy partially account for the effect of BMT-CARE on caregiver QOL and psychological distress.
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multimodal Psychosocial Intervention for family caregivers of patients undergoing hematopoietic stem cell transplantation a randomized clinical trial
Cancer, 2020Co-Authors: Areej Eljawahri, Jamie M. Jacobs, Ashley M Nelson, Lara Traeger, Joseph A Greer, Showly Nicholson, Lauren Waldman, Alyssa L Fenech, Annemarie Jagielo, Jennifer DalottoAbstract:BACKGROUND: Caregivers of patients undergoing hematopoietic stem cell transplantation (HCT) experience an immense caregiving burden before, during, and after HCT. METHODS: We conducted an unblinded, randomized trial of a Psychosocial Intervention (BMT-CARE) for caregivers of patients undergoing autologous and allogeneic HCT at Massachusetts General Hospital. Caregivers were randomly assigned to BMT-CARE or usual care. BMT-CARE was tailored to the HCT trajectory and integrated treatment-related education and self-care with cognitive-behavioral skills to promote coping. Caregivers assigned to BMT-CARE met with a trained Interventionist (a psychologist or a social worker) in person, via telephone, or via videoconferencing for 6 sessions starting before HCT and continuing up to day +60 after HCT. The primary endpoint was feasibility, which was defined as at least 60% of eligible caregivers enrolling and completing 50% or more of the Intervention sessions. We assesed caregiver quality of life (QOL; Caregiver Oncology Quality of Life Questionnaire), caregiving burden (Caregiver Reaction Assessment), psychological distress (Hospital Anxiety and Depression Scale), self-efficacy (Cancer Self-Efficacy Scale-Transplant), and coping (Measures of Current Status) at baseline and 30 and 60 days after HCT. We used mixed linear effect models to assess the effect of BMT-CARE on outcomes longitudinally. RESULTS: We enrolled 72.5% of eligible caregivers (100 of 138), and 80% attended 50% or more of the Intervention sessions. Caregivers randomized to BMT-CARE reported improved QOL (B = 6.11; 95% CI, 3.50-8.71; P < .001), reduced caregiving burden (B = -6.02; 95% CI, -8.49 to -3.55; P < .001), lower anxiety (B = -2.18; 95% CI, -3.07 to -1.28; P < .001) and depression symptoms (B = -1.23; 95% CI, -1.92 to -0.54; P < .001), and improved self-efficacy (B = 7.22; 95% CI, 2.40-12.03; P = .003) and coping skills (B = 4.83; 95% CI, 3.04-6.94; P < .001) in comparison with the usual-care group. CONCLUSIONS: A brief multimodal Psychosocial Intervention tailored for caregivers of HCT recipients is feasible and may improve QOL, mood, coping, and self-efficacy while reducing the caregiving burden during the acute HCT period.
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How changes in physical activity relate to fatigue interference, mood, and quality of life during treatment for non-metastatic breast cancer
General Hospital Psychiatry, 2017Co-Authors: Hannah M. Fisher, S C Lechner, Jamie M. Jacobs, Chloe J. Taub, John E. Lewis, Bonnie B. Blomberg, Charles S. Carver, Michael H. AntoniAbstract:Objective: Physical activity (PA) following surgery for breast cancer may improve depressive symptoms and quality of life (QoL) via reduction in fatigue-related daily interference (FRDI). Less is known about how change in PA may relate to these Psychosocial factors throughout the course of treatment. In a secondary analysis of a previous Psychosocial Intervention trial, we examined relationships between change in PA, depressive symptoms, and functional QoL, as mediated by change in FRDI, and whether naturally occurring change in PA provided benefit independent of the Intervention. Method: Women (N = 240) with non-metastatic stage 0-III breast cancer were randomized to cognitive-behavioral stress management (CBSM) or a control 2-10. weeks post-surgery. PA, FRDI, clinician-rated depressive symptoms, self-reported depressed mood, and functional QoL were assessed at baseline and three months post-Intervention. Results: Increased PA was associated with reductions in clinician-rated depressive symptoms, depressed mood, and improved QoL, mediated by a reduction in FRDI. This was above and beyond the effect of CBSM. Conclusions: Increased PA may mitigate FRDI and improve depressive symptoms and functional QoL for women undergoing breast cancer treatment, beyond effects of a Psychosocial Intervention. Benefits of an integrated PA and Psychosocial approach should be investigated further.
Jonathan Hill - One of the best experts on this subject based on the ideXlab platform.
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cognitive behavioural therapy and short term psychoanalytic psychotherapy versus brief Psychosocial Intervention in adolescents with unipolar major depression impact a multicentre pragmatic observer blind randomised controlled trial
Health Technology Assessment, 2017Co-Authors: Ian M Goodyer, Shirley Reynolds, Barbara Barrett, Sarah Byford, Bernadka Dubicka, Jonathan Hill, Fiona Holland, Raphael Kelvin, Nick Midgley, Chris RobertsAbstract:BACKGROUND: Although there are effective psychological treatments for unipolar major depression in adolescents, whether or not one or more of the available therapies maintain reduced depressive symptoms 1 year after the end of treatment is not known. This is a non-trivial issue because maintaining lowered depressive symptoms below a clinical threshold level reduces the risk for diagnostic relapse into the adult years. OBJECTIVE: To determine whether or not either of two specialist psychological treatments, cognitive–behavioural therapy (CBT) or short-term psychoanalytic psychotherapy (STPP), is more effective than a reference brief Psychosocial Intervention (BPI) in maintaining reduction of depression symptoms in the year after treatment. DESIGN: Observer-blind, parallel-group, pragmatic superiority randomised controlled trial. SETTING: A total of 15 outpatient NHS clinics in the UK from East Anglia, north-west England and North London. PARTICIPANTS: Adolescents aged 11–17 years with Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition major depression including those with suicidality, depressive psychosis and conduct disorder. Patients were randomised using stochastic minimisation controlling for age, sex and self-reported depression sum score; 470 patients were randomised and 465 were included in the analyses. InterventionS: In total, 154 adolescents received CBT, 156 received STPP and 155 received BPI. The trial lasted 86 weeks and study treatments were delivered in the first 36 weeks, with 52 weeks of follow-up. MAIN OUTCOME MEASURES: Mean sum score on self-reported depressive symptoms (primary outcome) at final study assessment (nominally 86 weeks, at least 52 weeks after end of treatment). Secondary measures were change in mean sum scores on self-reported anxiety symptoms and researcher-rated Health of the Nation scales for children and adolescents measuring Psychosocial function. Following baseline assessment, there were a further five planned follow-up reassessments at nominal time points of 6, 12, 52 and 86 weeks post randomisation. RESULTS: There were non-inferiority effects of CBT compared with STPP [treatment effect by final follow-up = –0.578, 95% confidence interval (CI) –2.948 to 4.104; p = 0.748]. There were no superiority effects for the two specialist treatments (CBT + STPP) compared with BPI (treatment effect by final follow-up = –1.898, 95% CI –4.922 to 1.126; p = 0.219). At final assessment there was no significant difference in the mean depressive symptom score between treatment groups. There was an average 49–52% reduction in depression symptoms by the end of the study. There were no differences in total costs or quality-of-life scores between treatment groups and prescribing a selective serotonin reuptake inhibitor (SSRI) during treatment or follow-up did not differ between the therapy arms and, therefore, did not mediate the outcome. CONCLUSIONS: The three psychological treatments differed markedly in theoretical and clinical approach and are associated with a similar degree of clinical improvement, cost-effectiveness and subsequent maintenance of lowered depressive symptoms. Both STPP and BPI offer an additional patient treatment choice, alongside CBT, for depressed adolescents attending specialist Child and Adolescent Mental Health Services. Further research should focus on psychological mechanisms that are associated with treatment response, the maintenance of positive effects, determinants of non-response and whether or not brief psychotherapies are of use in primary care and community settings. LIMITATIONS: Neither reason for SSRI prescribing or monitoring of medication compliance was controlled for over the course of the study, and the economic results were limited by missing data. TRIAL REGISTRATION: Current Controlled Trials ISRCTN83033550.
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cognitive behavioural therapy and short term psychoanalytical psychotherapy versus a brief Psychosocial Intervention in adolescents with unipolar major depressive disorder impact a multicentre pragmatic observer blind randomised controlled superiorit
The Lancet Psychiatry, 2017Co-Authors: Ian M Goodyer, Shirley Reynolds, Barbara Barrett, Sarah Byford, Bernadka Dubicka, Jonathan Hill, Fiona Holland, Raphael Kelvin, Nick Midgley, Chris RobertsAbstract:Summary Background Psychological treatments for adolescents with unipolar major depressive disorder are associated with diagnostic remission within 28 weeks in 65–70% of patients. We aimed to assess the medium-term effects and costs of psychological therapies on maintenance of reduced depression symptoms 12 months after treatment. Methods We did this multicentre, pragmatic, observer-blind, randomised controlled superiority trial (IMPACT) at 15 National Health Service child and adolescent mental health service (CAMHS) clinics in three regions in England. Adolescent patients (aged 11–17 years) with a diagnosis of DSM IV major depressive disorder were randomly assigned (1:1:1), via a web-based randomisation service, to receive cognitive behavioural therapy (CBT) or short-term psychoanalytical therapy versus a reference brief psychological Intervention. Randomisation was stochastically minimised by age, sex, self-reported depression sum score, and region. Patients and clinicians were aware of group allocation, but allocation was concealed from outcome assessors. Patients were followed up and reassessed at weeks 6, 12, 36, 52, and 86 post-randomisation. The primary outcome was self-reported depression symptoms at weeks 36, 52, and 86, as measured with the self-reported Mood and Feelings Questionnaire (MFQ). Because our aim was to compare the two psychological therapies with the brief Psychosocial Intervention, we first established whether CBT was inferior to short-term psychoanalytical psychotherapy for the same outcome. Primary analysis was by intention to treat. This trial is registered with Current Controlled Trials, number ISRCTN83033550. Findings Between June 29, 2010, and Jan 17, 2013, we randomly assigned 470 patients to receive the brief Psychosocial Intervention (n=158), CBT (n=155), or short-term psychoanalytical therapy (n=157); 465 patients comprised the intention-to-treat population. 392 (84%) patients had available data for primary analysis by the end of follow-up. Treatment fidelity and differentiation were established between the three Interventions. The median number of treatment sessions differed significantly between patients in the brief Psychosocial Intervention group (n=6 [IQR 4–11]), CBT group (n=9 [5–14]), and short-term psychoanalytical therapy group (n=11 [5–23]; p Interpretation We found no evidence for the superiority of CBT or short-term psychoanalytical therapy compared with a brief Psychosocial Intervention in maintenance of reduced depression symptoms 12 months after treatment. Short-term psychoanalytical therapy was as effective as CBT and, together with brief Psychosocial Intervention, offers additional patient choice for psychological therapy, alongside CBT, for adolescents with moderate to severe depression who are attending routine specialist CAMHS clinics. Funding National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme, and the Department of Health.
