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What is the Sustainability of a Biobehavioural Intervention Implemented by Therapists & Sustainment in Community Settings?

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Research Paper Title

Sustainability of a biobehavioral intervention implemented by therapists and sustainment in community settings.

Background

The ultimate aim of dissemination and implementation of empirically supported treatments (ESTs) in behavioural medicine is:

  • Sustainability of the therapist/provider’s EST usage; and
  • Sustainment of EST delivery in the setting.

Thus far, sustainability has been understudied, and the therapist and setting variables that may be influential are unclear.

The purpose of the study was to test the therapists’ sustainability of a cancer-specific EST using a prospective longitudinal design and examine its predictors.

Methods

Oncology mental health therapists (N = 134) from diverse settings (N = 110) completed training in the biobehavioural intervention (BBI) and were provided with 6 months of support for implementation, with no support thereafter. BBI usage (percent of patients treated) was reported at 2, 4, 6, and 12 months.

Using a generalised estimating equation with a logistic link function, 12-month sustainability (a non-significant change in usage from 6 to 12 months) was studied along with therapist, supervisor, and setting variables as predictors.

Results

BBI usage increased through 6 months and, importantly, usage was sustained from 6 (68.4% [95% CI = 62.2%-73.9%]) to 12 months (70.9% [95% CI = 63.6%-77.3%]), with sustainment in 66 settings (60.0%).

Predictors of implementation-to-sustainability usage were therapists’ early intentions to use the BBI (p < .001) and from the setting, supervisors’ positive attitudes toward ESTs (p = .016).

Conclusions

Adding to the DI literature, a health psychology intervention was disseminated, implemented, and found sustainable across diverse therapists and settings.

Therapists and setting predictors of usage, if modified, might facilitate future sustainability/sustainment of ESTs.

Reference

Ryba, M.M., Lo, S.B. & Andersen, B.L. (2019) Sustainability of a biobehavioral intervention implemented by therapists and sustainment in community settings. Translational Behavioral Medicine. pii: ibz175. doi: 10.1093/tbm/ibz175. [Epub ahead of print].

Timely Referrals from Primary Care to Specialty Mental Health, and Back

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Research Paper Title

Provider perspectives on a clinical demonstration project to transition patients with stable mental health conditions to primary care.

Background

Research to improve access to mental healthcare often focuses on increasing timely referrals from primary care (PC) to specialty mental health (SMH).

However, timely and appropriate transitions back to PC are indispensable for increasing access to SMH for new patients.

Methods

The researchers developed and implemented a formalised process to identify patients eligible for transition from SMH to PC.

The FLOW intervention was piloted at a Veterans Health Administration community-based outpatient clinic. Qualitatively examine provider perspectives regarding patient transitions at initiation and termination of the FLOW project.

Sixteen mental health providers and three PC staff completed qualitative interviews about the benefits and drawbacks of FLOW at initiation. Ten mental health providers and one PC staff completed interviews at 12-month follow-up. Primary benefits anticipated at initiation were that FLOW would increase access to SMH, provide acknowledgement of veterans’ recovery, and differentiate between higher and lower intensity mental health services.

Results

SMH providers reported additional perceived benefits at 12-month follow-up, including:

  • Decreased stress over their caseloads; and
  • Increased ability to deliver efficient, effective treatment.

Anticipated drawbacks at initiation were that veterans would get inconsistent care, PC could not offer the same level of care as SMH, and veterans might view transition as a rejection by their SMH provider.

Perceived drawbacks were similar at 12-month follow-up, but there was less frequent endorsement.

Conclusions

Findings highlight need for sustained and frequent provider education regarding:

  1. The appropriate characteristics of individuals eligible for transition; and
  2. Established procedures to ensure care coordination during and after transition.

Reference

Fletcher, T.L., Johnson, A.L., Kim, B., Yusuf, Z., Benzer, J. & Smith, T. (2019) Provider perspectives on a clinical demonstration project to transition patients with stable mental health conditions to primary care. Translational Behavioral Medicine. pii: ibz172. doi: 10.1093/tbm/ibz172. [Epub ahead of print].

What are the Factors Associated with Anxiety Disorders among Patients with Substance Use Disorders

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Research Paper Title

Factors associated with anxiety disorders among patients with substance use disorders in Lebanon: Results of a cross-sectional study.

Background

Estimate the rate of anxiety disorders (AD) and associated factors among patients with substance use disorder (SUD) in Lebanon.

Methods

A cross-sectional study, conducted between April and September 2017, enrolled 57 inpatients with SUD.

Results

The rate of AD in patients with SUD was 61.4%. The university level of education compared to the primary level of education (ORa = 0.221) was significantly associated with lower anxiety among patients with SUD. Being sexually abused and having a family history of depression tended to significance.

Conclusions

AD is widespread in Lebanon and high rates of anxiety in patients with SUD were found, warranting the implementation of strategic interventions and establishing national policies and legislation for mental health services to provide optimal care.

Reference

Haddad, C., Darwich, M.J., Obeid, S., Sacre, H., Zakhour, M., Kazour, F., Nabout, R., Hallit, S. & Tahan, F.E. (2019) Factors associated with anxiety disorders among patients with substance use disorders in Lebanon: Results of a cross-sectional study. Perspectives in Psychiatric Care. doi: 10.1111/ppc.12462. [Epub ahead of print].

Would a Clinical Staging Tool be useful in Clinical Practice to Predict Disease Course in Anxiety Disorders?

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Research Paper Title

A clinical staging approach to improving diagnostics in anxiety disorders: Is it the way to go?

Background

Clinical staging is a paradigm in which stages of disease progression are identified; these, in turn, have prognostic value.

A staging model that enables the prediction of long-term course in anxiety disorders is currently unavailable but much needed as course trajectories are highly heterogenic.

This study therefore tailored a heuristic staging model to anxiety disorders and assessed its validity.

Methods

A clinical staging model was tailored to anxiety disorders, distinguishing nine stages of disease progression varying from subclinical stages (0, 1A, 1B) to clinical stages (2A-4B).

At-risk subjects and subjects with anxiety disorders (n = 2352) from the longitudinal Netherlands Study of Depression and Anxiety were assigned to these nine stages.

The model’s validity was assessed by comparing baseline (construct validity) and 2-year, 4-year and 6-year follow-up (predictive validity) differences in anxiety severity measures across stages.

Differences in depression severity and disability were assessed as secondary outcome measures.

Results

Results showed that the anxiety disorder staging model has construct and predictive validity.

At baseline, differences in anxiety severity, social avoidance behaviours, agoraphobic avoidance behaviours, worrying, depressive symptoms and levels of disability existed across all stages (all p-values < 0.001).

Over time, these differences between stages remained present until the 6-year follow-up.

Differences across stages followed a linear trend in all analyses: higher stages were characterised by the worst outcomes.

Regarding the stages, subjects with psychiatric comorbidity (stages 2B, 3B, 4B) showed a deteriorated course compared with those without comorbidity (stages 2A, 3A, 4A).

Conclusions

A clinical staging tool would be useful in clinical practice to predict disease course in anxiety disorders.

Reference

Bokma, W.A., Batelaan, N.M., Hoogendoorn, A.W., Penninx, B.W. & van Balkom, A.J. (2019) A clinical staging approach to improving diagnostics in anxiety disorders: Is it the way to go? The Australian & New Zealand Journal of Psychiatry. doi: 10.1177/0004867419887804. [Epub ahead of print].

Can Emotional Responses to Stressors in Everyday Life Predict Long-Term Trajectories of Depressive Symptoms?

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Research Paper Title

Emotional Responses to Stressors in Everyday Life Predict Long-Term Trajectories of Depressive Symptoms.

Background

Individuals’ emotional responses to stressors in everyday life are associated with long-term physical and mental health. Among many possible risk factors, the stressor-related emotional responses may play an important role in future development of depressive symptoms.

The current study examined how individuals’ positive and negative emotional responses to everyday stressors predicted their subsequent changes in depressive symptoms over 18 months.

Methods

Using an ecological momentary assessment approach, participants (n = 176) reported stressor exposure, positive affect (PA), and negative affect (NA) five times a day for 1 week (n = 5,483 observations) and provided longitudinal reports of depressive symptoms over the subsequent 18 months.

A multivariate multilevel latent growth curve model was used to directly link the fluctuations in emotions in response to momentary stressors in everyday life with the long-term trajectory of depressive symptoms.

Results

Adults who demonstrated a greater difference in stressor-related PA (i.e., relatively lower PA on stressor vs. nonstressor moments) reported larger increases in depressive symptoms over 18 months.

Those with greater NA responses to everyday stressors (i.e., relatively higher NA on stressor vs. nonstressor moments), however, did not exhibit differential long-term changes in depressive symptoms.

Conclusions

Adults showed a pattern consistent with both PA and NA responses to stressors in everyday life, but only the stressor-related changes in PA (but not in NA) predicted the growth of depressive symptoms over time.

These findings highlight the important-but often overlooked-role of positive emotional responses to everyday stressors in long-term mental health.

Reference

Zhaoyang, R., Scott, S.B., Smyth, J.M., Kang, J.E. & Sliwinski, M.J. (2019) Emotional Responses to Stressors in Everyday Life Predict Long-Term Trajectories of Depressive Symptoms. Annals of Behavioral Medicine. pii: kaz057. doi: 10.1093/abm/kaz057. [Epub ahead of print].

Primary Care Physicians & the Mental Health Gap Action Programme (mhGAP)

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Research Paper Title

Building capacity in mental health care in low- and middle-income countries by training primary care physicians using the mhGAP: a randomized controlled trial.

Background

To address the rise in mental health conditions in Tunisia, a training based on the Mental Health Gap Action Programme (mhGAP) Intervention Guide (IG) was offered to primary care physicians (PCPs) working in the Greater Tunis area.

Non-specialists (such as PCPs)’ training is an internationally supported way to target untreated mental health symptoms.

Methods

The researchers aimed to evaluate the programme’s impact on PCPs’ mental health knowledge, attitudes, self-efficacy and self-reported practice, immediately following and 18 months after training.

They conducted an exploratory trial with a combination of designs: a pretest-posttest control group design and a one-group pretest-posttest design were used to assess the training’s short-term impact; and a repeated measures design was used to assess the training’s long-term impact.

The former relied on a delayed-intervention strategy: participants assigned to the control group (Group 2) received the training after the intervention group (Group 1).

The intervention consisted of a weekly mhGAP-based training session (totalling 6 weeks), comprising lectures, discussions, role plays and a support session offered by trainers.

Data were collected at baseline, following Group 1’s training, following Group 2’s training and 18 months after training. Descriptive, bivariate and ANOVA analyses were conducted.

Overall, 112 PCPs were randomised to either Group 1 (n = 52) or Group 2 (n = 60).

Results

The training had a statistically significant short-term impact on mental health knowledge, attitudes and self-efficacy scores but not on self-reported practice.

When comparing pre-training results and results 18 months after training, these changes were maintained.

PCPs reported a decrease in referral rates to specialised services 18 months after training in comparison to pre-training.

Conclusions

The mhGAP-based training might be useful to increase mental health knowledge and self-efficacy, and decrease reported referral rates and negative mental health attitudes among PCPs in Tunisia and other low- and middle-income countries.

Future studies should examine relationships among these outcome variables.

Reference

Spagnolo, J., Champagne, F., Leduc, N., Rivard, M., Melki, W., Piat, M., Laporta, M., Guesmi, I., Bram, N. & Charfi, F. (2019) Building capacity in mental health care in low- and middle-income countries by training primary care physicians using the mhGAP: a randomized controlled trial. Health Policy and Planning. pii: czz138. doi: 10.1093/heapol/czz138. [Epub ahead of print].

Mental Health Conditions: Medication & Standing Trial

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In this article (below), Laura Spinney weaves through the ethical grey area of forcing people with mental health conditions to take medication so they can stand trial.

It is an interesting that attempts to look at both sides of the argument.

Read the article:

Trial by Medication (Spinney, 2019)Download

Reference

Spinney, L. (2019) Comment: Trial by Medication. New Scientist. 28 September 2019, pp.24.

Use Your Smartphone to Spot Schizophrenia, Soon

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Speaking into your smartphone for two minutes could reveal whether you have a mental health condition!

That is according to the developers of an app that analyses facial expressions and speech to diagnose schizophrenia.

The company behind the app, AICure, hopes it could be used to better support and monitor people with schizophrenia, and eventually those who have other mental health conditions.

The current version was developed to measure symptoms of schizophrenia like low mood and difficulty thinking, which are normally harder to measure than symptoms like hallucinations and delusions.

To do this, the app tracks facial movements, as well as the content, tone and pitch of a person’s speech. Some people with schizophrenia move more slowly, and show less emotion on their faces. The app can then send a score to the person’s doctor, rating these symptoms.

However, it is not designed to spot other symptoms associated with the condition, such as hallucinations.

AICure tested the app with 21 people who have schizophrenia and nine people who do not. The participants made weekly recordings over 12 weeks. Each person was also evaluated by a clinician at Mount Sinai Hospital in New York at the start and end of the study.

The results of this small trial suggest that the app’s ratings “are highly correlated” with those of a clinician, states AICure. However, AICure does not yet have enough data to prove its app works, because the sample size is very small. The results can be viewed more as a proof of concept than as a diagnostic tool, which is a little way off.

Reference

Hamzelou, J. (2019) Smartphone App Could Spot Signs of Schizophrenia. New Scientist. 28 September 2019, pp.7.

Happiness: Linking Temperament, Perspective, & Misfortune

Published on by Andrew Marshall1 Comment

I really like this reply by a reader to an article (in the New Scientist) about happiness (2019, p.26):

“Apparently, the search for happiness is now a well-funded industry.

Surely this calls into question whether spending so much time, money and, quite possibly, anxiety in its pursuit is counter-productive.

Instead, wouldn’t it be better to question what exactly happiness is?

To me, it is experienced in response to a joyous event or achievement.

It is fleeting, before a return to the baseline.

Maintain this state for too long and it will lose its magic.

More superlative events will be needed to maintain this level of happiness, inflating everyday irritations to trauma.

Surely the answer lies in contentment?

A neutral level of default temperament offers a greater ability to enjoy genuine happiness at all levels, to keep minor annoyances in perspective and to promote greater strength in dealing with misfortune.”

Reference

Groves, R. (2019) Money Can’t Buy You Happiness or Contentment. New Scientist. 21 September 2019, pp.26.